Interview: “Information will not speak to your heart, only motivation will”
Polish dentist Dr Teresa Fehrenbach has worked in her field since 1980 and speaks with passion about the importance of good oral hygiene. She maintains a private practice in Germany and has been involved in a programme on individually trained oral prophylaxis for nearly 12 years. During the FDI Annual World Dental Congress in Poznań, Dental Tribune Online spoke with Fehrenbach about her work, prophylaxis in dentistry, and her ideas on promoting its importance.
Dental Tribune Online: Dr Fehrenbach, could you please tell our readers more about your background and work.
Dr Teresa Fehrenbach: I graduated from Wroclaw Medical University in Poland quite some time ago and gained practical experience during many years of working in a private dental practice in Germany. I focus on and have advanced the field of dental prevention in Poland. Over time, I have sought to promote knowledge of new trends in dental prophylaxis in Polish kindergartens, schools and universities and in my own practice, of course. I travel frequently to Poland to hold training and workshops on proper brushing techniques, prevention of oral disease and innovative oral health care products.
I focus on individual and group prophylaxis in Poland and teach prevention of oral disease to small and larger groups. My team and I teach prophylaxis at kindergartens, schools and universities. I have received wonderful feedback from my patients. I am very interested in my patients’ and audience’s well-being, and I am convinced that gaining their interest and compliance requires a powerful message. I am a bit forthright in this regard, but have been well received so far. [smiles]
You have strongly promoted individually trained oral prophylaxis (iTOP) among dental professionals and held many lectures on prophylaxis in Poland for nearly 12 years. What has your experience been?
We have been very successful in Poland and have already completed several iTOP courses in the country. This approach is something new and different. No other company has yet so strongly supported the idea that we, as dentists, should learn about oral prophylaxis and dental hygiene in a condensed way by attending courses over one or two full days. Brushing one’s teeth correctly was not taught during my dental education at university. Once one has completed the iTOP course, one knows how to brush one’s teeth properly with the right products. For me, the most important tool is the interdental brush, followed by the toothbrush.
You said that you also work with people outside of dentistry and have even tried to convince local politicians to do more for oral prophylaxis.
Yes, we have hosted great workshops with hundreds of participants who applied the techniques right away, but we have also held meetings that have left me a little baffled. For example, we organised oral prophylaxis training in kindergartens and schools in a small town near Warsaw last summer. The local mayor was invited to our course. He told me that he had 1 hour to learn more about oral prophylaxis, so I told him what I knew and why prevention was so important in kindergartens. After the hour was up, he said that they would first need to determine whether there was actually a need for prevention among kindergarten children. I was disappointed that I was not able to reach him and demonstrate the importance of my topic.
After the meeting, I thought about a research report that I had read. This study examined the prevalence of caries among 12-year-old Europeans with permanent dentition. In Germany, about 0.7 teeth exhibited dental caries. In Poland, however, around 3.2 teeth of every 12-year-old child were affected. This includes teeth that had to be removed owing to caries or signs of carious lesions. A combination of sugar consumption and insufficient daily cleaning are the usual causes, especially in Poland. The Polish consume more sugar than Germans, for example, do. In light of the oral situation of 12-year-old children, what would you expect the dental status of an adult or senior person in Poland to be? It is evident that dental hygienists are in great need in Poland, but dentists do not want to employ them.
What is the status of oral health care in Poland?
In my opinion, this topic is not given adequate attention, despite a sufficient number of providers. Poland offers both public and private dental care. Similar to the National Health System in the UK, all public services need to be approved by the Narodowy Fundusz Zdrowia, the Polish national health fund. Since the early nineties, we have seen dramatic improvements in dental equipment and instruments in our clinics. Furthermore, comparing dental education in Poland and Germany shows that Polish students obtain more clinical experience. Poland has one of the densest networks of private dental practices in the European Union. However, about 50 per cent of dentists work without any assistants. How can they learn more about prevention if they can only focus on restoration? There are about 20 dental associations in Poland, three of which are concerned with implantology, but none that focus on oral prophylaxis.
For 12 years, I have been visiting practices in Poland. At the beginning of my prophylaxis courses, I had 200 or 300 dentists attending, in order to obtain continuing education credits. I have seen a drop in interest and the situation has changed: dentists need to understand that learning more about and investing in prophylaxis will earn them more money without encroaching on their time. For example, if one employs a dental hygienist, one receives up to €200 for a 1-hour dental hygiene appointment. The financial benefits are evident.
How could we promote prevention in dentistry?
It is not easy, as prevention needs to be combined with motivation of and communication with patients. The best prevention has to be taught individually in the practice. Many consider this an expensive endeavour. The dentist can talk for hours about using a good toothbrush, following a diet low in sugar and visiting the dentist twice a year, but this information will not speak to your heart, only motivation will. This is exactly the challenge that we have in preventative dentistry, especially in paediatric dentistry. Prevention is my passion and I am sure it could become the passion of many of my colleagues as well. The earlier one teaches prevention, the more successful one will be. It may be more difficult to change the hand movements of a 40-year-old, but a child 7 years of age or older will be easier to convince. If one teaches kindergarten children the right technique, these children will then teach their parents how to do it.
In Germany, there is a song for kindergarten children that helps them brush their teeth. It has a nice rhythm and involves the whole family. [Starts singing: “Mama brushes, papa brushes, too.”] I have translated it into Polish and used it for my courses as well. Much to my surprise, it has worked. Twice a year, we teach children how to brush properly and sing together. We sit down with them, we talk about sugar, fruits and daily cleaning. I tell them that, when they have finished playing, they need to wash their hands; and when they have finished eating, they need to brush their teeth. I love my work and continue to do so every day.
Thank you very much for the interview.