Dental News - Interview: “I truly believe in the effect of preventative measures”

Monique Mehler, Dental Tribune International

Fri. 7. September 2018

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Despite being one of the most easily preventable diseases, dental caries still poses a major health concern across all age groups around the world. Very young children especially are affected for many reasons, which are the focus of investigation by clinicians such as Prof. Ece Eden. In 1988, Eden graduated from Ege University in Izmir in Turkey, where she has been practising dentistry and conducting research to this day. At the Department of Pedodontics, Eden lectures and supervises dental and medical students, in addition to directing numerous scientific projects and speaking at international congresses. To learn more about her motivation, Dental Tribune Online spoke to her about her work in the field of paediatric dentistry and the lectures she has given in Buenos Aires.

Prof. Eden, at the World Dental Congress this week, you gave three lectures. Two of them focused on controlling and preventing dental caries. Why did you pick this topic as your main issue of discussion?
Dental caries is the most highly prevalent disease of all ages, with symptoms of the process causing carious lesions. Dentists all around the world are mostly dealing with consequences of dental caries rather than treating the disease itself and are educated more on restorative work as the most important part of oral rehabilitation. However, as dentists, we need to understand the aetiology of the disease of dental caries and we need to use this knowledge to provide necessary care for our patients for better oral health.

On the other side, today, we are well aware that oral health is one of the major determinants of well-being and overall health. Although the current scientific evidence has shown the importance of oral health, we are still dealing with caries as the most prominent oral disease today. Thus, we, as today’s generation of dentists, should educate our patients and especially seek to gain patient compliance for success in our daily routine. This way, our aim to provide health with functioning and good-looking dentition for a lifetime can be achieved. With all of this in mind, I spoke about how we can manage this challenging caries prevention task in young children in my first lecture and in different situations in my second presentation.

Focusing on your first lecture, “Early childhood caries: Problems of the very young and role of the family”. What are the main risk factors for early childhood caries?
The condition we call early childhood caries (ECC) today was formerly known as nursing bottle caries or nursing caries, ascribing it to inappropriate feeding practices. However, multiple aetiological factors are involved in this early-stage disease. In addition to dietary factors, lack of oral hygiene, lack of fluoride exposure, and enamel defects are some of the major factors. The oral health of a caregiver with a high cariogenic bacterial load causes an early transmission of cariogenic bacteria, which is important in its aetiology.

Immigrants and children from socially disadvantaged and low socio-economic backgrounds, who tend to have inappropriate feeding practices, have a higher risk of developing ECC and its severe form. It is very clear that there are many different determinants and factors of the elevated risk status of our children. We need to outline all these factors in order to develop either individual or public prevention programmes to address the global caries problem.

For many years now, you have been working in and conducting research on paediatric dentistry. Have you observed any growing trends? For example, does caries affect more newborns these days than, say, ten years ago?
Unfortunately, as an active clinician working in the university’s paediatric dentistry clinic in the third-biggest city of a developing country for more than 20 years, I have to admit that there is still high caries prevalence among children. Socio-economic pressures have forced more mothers to work, changing the family structure and causing grandparents or nannies to take over the responsibility of caring for children at home. These generations consumed more sugar-added cariogenic food without any improvements in oral hygiene practices. Neither grandparents nor mothers are adequately aware of the importance of oral hygiene practices right after the eruption of the first tooth.

All these have contributed to the high prevalence of the disease in children. The difference I have observed today is that I have younger patients with severe ECC being treated then I had ten years ago. In recent years, more children with the severe form have been brought to clinics at younger ages soon after the start of the disease for proper care. This early encounter with the dentist at the onset of the disease is beneficial for preserving more healthy tooth tissue and the possibility of controlling the disease, but treatment is difficult and costly as well as it is late. This was the primary reason we conducted the study on pregnant women that I spoke about in my lecture. I believe our study, which began monitoring at pregnancy with three-year follow-up, is a good example that demonstrates the role of the family and the importance of education as effective primary prevention.

Do you think there is more that can be done by the government, such as a sugar tax or health labels on sugary drinks, to guide caregivers and therefore prevent caries? Or do you think that the main responsibility to educate themselves and their kids on the causes of caries lies with parents?
I think all parties should work hand in hand to prevent and control ECC. The outcome of the disease causes losses for the community, besides affecting the quality of life of the affected children and their families. The situation is capable of generating social and behavioural disorders, and low self-esteem, and has a financial impact. Targeted strategies should include various stakeholder groups, such as dental practitioners and policymakers. A common risk factor approach for non-communicable diseases to link caries prevention with hygiene and control of obesity and diabetes is a good opportunity to seize. Educating expectant mothers, parents, educators and healthcare professionals will help to prevent the disease. Society-based precautions should include health labelling on potentially cariogenic drinks and food. Governments may control hazardous products by taxation and can establish prevention programmes, starting with social awareness and education.

What was the take-home message for your audience?
Risk of carious lesion development should be carefully monitored by the dentist and the balance between demineralisation and remineralisation should be controlled. Educating mothers, who play a very important role in providing oral hygiene and proper diet for children, is mandatory. Dentists should be educated on strategies to modify behaviour in mothers so that they take action regarding their children’s oral health, and dentists need to help them to overcome the burden of ECC in the community. Although there are many barriers in relation to the community and culture that end up with dental caries, educating mothers is effective in reducing ECC, but we need to transform the whole community and integrate oral health into general health for greater success.

Is there anything else you would like to add?
I truly believe in the effect of preventative measures, and with the evidence on caries prevention and basic understanding of the cariogenic process, dentists all around the world should practise caries management according to the needs of their patients. Moreover, as dental professionals, we should raise a unified voice globally to promote awareness particularly of the early prevention of caries and thus oral health.

Participants from all over the world flock to the 106th FDI World Dental Congress. (Photograph: Monique Mehler, Dental Tribune International)

This year's event venue, La Rural, is located in the heart of Buenos Aires. (Photograph: Monique Mehler, Dental Tribune International)

The World Dental Daily congress newspapers can be collected from the registration area and the Dental Tribune Intentional booth #1D07. (Photograph: Monique Mehler, Dental Tribune International)

(Photograph: Monique Mehler, Dental Tribune International)

CURAPROX booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Straumann booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

TePe booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

More information about FDI related matters can be obtained from the FDI Pavillion which is located in the Scientific Sessions Hall. (Photograph: Monique Mehler, Dental Tribune International)

FDI President Dr. Kathryn Kell welcomed all World Dental Congress attendees at the Opening Ceremony on Wednesday night. (Photograph: Monique Mehler, Dental Tribune International)

Women Dentists Worldwide Forum attendees got together for a group photo with FDI President Dr. Kathryn Kell. (Photograph: Monique Mehler, Dental Tribune International)

At the Dental Tribune International booth #1D07, WDC attendees can learn about our publications, DDS.WORLD and PracticeDent. (Photograph: Monique Mehler, Dental Tribune International)

Rositsa Svetoslavova, Buldent Marketing Manager, is on-site at WDC 2018 to present the PracticeDent platform and all its features. (Photograph: Monique Mehler, Dental Tribune International)

Nobel Biocare booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

LM Dental booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Planmeca booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Live demonstration of the Planmeca Emerald intraoral scanner the the Planmeca booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Ivoclar Vivadent booth at FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Endo workshop at the Dentsply Sirona booth at the FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Live demonstration at the Zumax booth at the FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Colgate booth at the FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

GC America booth at the FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

Live demonstration at the Fotona booth at the FDI World Dental Congress (Photograph: Monique Mehler, Dental Tribune International)

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