Don ’t Test All Commercials on Your Teeth | Bulgaria On Air Magazine | 2015

Dr. Petar Duchev, founder of DENTAL CLINIC PETAR DUCHEV, to Bulgaria On Air

Dr. Duchev, you often speak of “digital smile design”. What does it mean?

– Lately our profession has become very digitized. Our work is now absolutely unthinkable without high-quality photography: profile and full face, tooth details. This is the only way in which our dental technician, who is in Italy, can see the patient.
X-ray examinations, too, are almost completely digitized. Negative plates are an anachronism, they provide only few details for examination.
In contrast, the programmes we use enable us to overlay photographs and scanned images and thus to produce a preliminary image of future dental restorations. We can then send this file to the laboratory and get the ready crown.
Dental imprints are no longer necessary. The process is very quick and about to become very accurate. This will minimize the time a patient has to spend in the dental chair.

What else has changed in your profession in the last twenty years – from the time you were only patients?

– Two things have changed fundamentally, after which the profession will never be the same again. The first is the advent of implants in dental treatment, which have become extremely reliable.
The second thing is less obvious to bystanders– the so-called adhesive technology. This is the adhesive cementation of etchable ceramic restorations which chemically bond with the tooth. To the extent as to make them indiscernible even under a microscope.
This was a huge step forward because it greatly reduced the need for tooth filing and nerve removal. Filing causes irreversible damage to a tooth. True, it had some advantages, but they could not outweigh the disadvantages.

What’s next? Recently there has been a lot of talk about growing new teeth from stem cells, for example. Should we expect something like this in the near future?

– No. I doubt that this will happen, at least not in the foreseeable future. Not a single protocol for clinical pplication has as yet been developed. Currently there are only in vitro tests, in laboratory conditions. Clinical trials have not even started, and once they do, it will take at least some twenty years before the technology is possibly translated into practice.

Then how do you imagine your job in another ten years’ time?

– I expect 3D-printing to find widespread application. Dentistry will be increasingly digitized and I also expect it to be divided. Many dental technicians will actually stop working manually and will manage the processes on the computer instead. Only the best dental technicians will continue to work manually – an exclusive service for a limited number of private customers who can afford it. Machinemade crowns will be widely used. That’s not bad because it will be quicker and better than the current average level. But the difference between mass and exclusive service will become even greater.

It will perhaps come as a surprise to most people that teeth are worn down by all sorts of factors, including too frequent brushing… What should we actually do to best preserve our teeth?

– Let me put it this way: we should refrain from testing all commercials on our teeth. And stay away from any aggressive agents.
Our best advice is to consult your dentist about the products you intend to use. Nowadays the dental hygiene products sold in pharmacies are so many that even I am hard put to know what is what.
We, in particular, advise our patients to use a softer toothbrush and less aggressive toothpaste. This is compensated by longer brushing and correct movements.
True, with electric toothbrushes it is indeed much easier and smarter. But, first, they do not clean as well, and, secondly, where they clean they also abrade the teeth.
Electric toothbrushes were created 25 years ago for people with manual or mental problems, whose fine motor skills were impaired. Later the big companies caught on and made them fashionable. But not every product that is aggressively marketed is necessarily designed with our health in mind. Especially in our field. A company invests millions in the development of a new product. And even if it sees in the end that the product is not all that good, under pressure from the investors, it will nevertheless market and strongly advertise it.

I presume that this also applies to many whitening products?

– Absolutely. Until recently we had an inviolable principle in our clinic: no live teeth whitening. This is a purely cosmetic procedure. But we realised that if we refuse our patients, they simply go and have it done somewhere else, so we decided nevertheless to also offer whitening if the patient so insists. But we offer it in the possibly least damaging way. We do not do “in-office” whitening – i.e. you sit down and in 20 minutes you’re ready. That’s too aggressive. We offer controlled whitening over a period of 12 days with bleaching trays that are worn at night and an agent that is the least damaging.

There was this partly funny, partly scary statistics from the 1960s, according to which only one third of the Bulgarians used toothpaste. What are things like today, has dental awareness improved?

– When we discuss the subject with my colleagues, they say that my view is not realistic because of our highly select patients. But I still maintain that patients in big cities now have fewer caries. This is particularly true of the young generation. But another problem has appeared – the excessive abrasion of teeth. Simply because our teeth are not adapted to the food and beverages we are consuming more and more – I am talking about fizzy drinks, constantly drinking from a straw before the computer… At least, that’s how I see things.
By the way, some people think that if they go to an expensive dentist, they no longer have to take any care. That’s not true. No matter what kind of dentist you go to, the main care is your own.

A major problem in general in the medical sector is the shortage of staff and the fact that many trained people go abroad, attracted by better conditions. You were second best in the course you took at gIDE – the Global Institute for Dental Education. I assume that you would easily make a successful career abroad. Why did you choose Bulgaria?

– Because this is where you have a chance to develop. In the West the profession is overregulated and rigorously regimented. There is dentistry that is financed by health insurance or social security, and a much smaller private dentistry segment, that is very exclusive. It is very difficult for an outsider to get into it, and it would take years.
In Bulgaria, in contrast, the profession is less regulated and there is an absolutely democratic private practice. In fact, this is one of the most flawless businesses in Bulgaria: a patient comes in, he likes it – he pays, he doesn’t like it – he leaves. The Health Insurance Fund is virtually uninvolved, because the amounts it covers are negligible. Whereas if I go to France, I have to stick by the rules established by the French Dental Association 30 years ago. I cannot follow the latest trends.

What are the chances of Bulgaria becoming a centre of medical and dental tourism? Lately increasingly more foreigners choose to seek treatment in Bulgaria, and I expect in your clinic as well?

– No, not in our clinic. I have my own opinion on the subject. To me, dental tourism in the way it happens now had better not happen at all. It’s like with the seaside resorts – a phase of rapid development, followed by a phase of collapse.
Dental tourism in Bulgaria will make sense when foreigners start coming not only because of the low price and promised quick treatment, but also because of the high quality of the service. But we still have a long way to go before we can offer such high quality as a whole. Right now, dental tourism is largely based on the same principle as Sunny Beach resort with its cheap alcohol.
I get several offers a week for work with dental tourists, which I refuse. First, our prices are almost the same as the average in Western Europe. And, second, we are not willing to rush our work.

After a quarter century health reform in Bulgaria hardly anyone is happy with what has happened. Many say that the reform was made by bureaucrats, without a clue about genuine healthcare.

– My own view is that the State mismanages its property and should privatize the hospitals, setting clear rules for their operation. And, of course, end the monopoly of the Health Insurance Fund. Only private interest is a good administrator.
Incidentally, dentistry in Bulgaria, no matter what we say about it, is developing in the right direction and has fewer problems, namely because an end was put to state-run dentistry in 2000.
Of course, this cannot happen in the same way in cardiology, for example. But it is an undeniable fact that there is no worse owner than the State. I recently had to go to hospital and I don’t think the situation could get much worse.

How do you deal with the shortage of staff?

– In different ways. For one thing, absolutely all dentists who come to us are not allowed to work with patients on their own during the first six months. During that time we teach them basic things they did not learn at university.
Four times a year they have to undergo training courses outside the clinic. Some are optional, others are compulsory. I think that it is easier for our younger colleagues, because they receive guidance. It was not like that for myself and my wife. We groped in the dark for a long time. For me personally, the gIDE programme at the University of California (UCLA) was of enormous importance. It helped me to put things straight in my mind and to judge what is valuable and what not.

In conclusion, a word of advice from you to people who want to enter the profession?

– The problem in Bulgaria right now is that there is no good quality product on the market. There is a huge demand in the field of quality dentistry. True, 99% of my colleagues say that people cannot afford such a product, but that’s not true. It simply isn’t offered enough.
Hence, right now Bulgaria is a very good place to practise dentistry. I would therefore advise them to seek a solution and education abroad, and then to return and work here.

The first visit – before the first tooth

A child ’s first visit to the dentist should take place already during the first year of its life, Dr. svetelina Ducheva says. “This may come as a shock to some parents, but it’s good to take your child to a specialist even before it has grown its first teeth. This is when we talk to the parent, explain when to brush the teeth, what products to use – because the market is really oversaturated.
Brushing must start with the appearance of the first milk teeth – at first with special baby silicon finger brushes and later, when the child is able to sit up, with toothbrush and toothpaste. Some parents think that since milk teeth will be replaced anyhow, they don’t need as much care. Exactly the opposite is true – baby teeth have roots, and root canals, and can also develop caries.”

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