Heute haben wir einen sehr guten Gastbeitrag von Prashant Singh, meinem geschätzten indischen Kollegen, der in unserer Praxis erste Eindrücke und Erfahrungen sammelt. Seine Sicht auf unsere Zahnmedizin und die Bedürfnisse unserer Patienten ist so scharfsinnig wie bereichernd:
Occlusion, it’s a symptom, not a disease.
Mr Müller starts his day to the sound of his alarm and a cup of instant coffee. Gets ready for office, gets in his €15 000 car on the way to his € 50 000/ year Job and drives along a € 100 000/ km stretch of perfectly smooth road. On the way to office he thinks of his files at work, his family, the coming weekend plans and then notices a bit of headache on one side. In a perfectly organised traffic he waits at the next red light, and then looks at his teeth in the mirror and then carries on with his day. In the middle of the day after 5 hours in front of his computer, he once again notices that same pain for a few moments. Decides to take an aspirin and move on. Somewhere before the day gets over, he remembers his € 7 000 premium on medical insurance, picks up the phone, hits a few numbers and in a matter of seconds has an appointment with his Physician.
Next morning, the physician does an examination. Orders a few tests to rule out the usual causes, all paid for by the insurance, concludes for weekly follow ups, prescribes some pain killer and moves on. 6 months later, Mr Müller is still not satisfied; he does not enjoy the sense of taking a pain killer every now and then. The pain now triggers sometimes in his teeth. But it’s too small a concern considering the rest of the work that he must take care of. He decides to mention it next time he goes for his scheduled 6 monthly Prophylaxis to his dentist.
At the Dentists office a mouse click and the patient records show him to be with an excellent oral hygiene. A few fillings, perfectly maintained teeth and oral hygiene. To a dentist in the the developing world, it would appear to be a case of wait and watch. But for a dentist in the 21st Century West, it’s the 10th time since morning he has heard the same story.
The signs are all too clear. Without a seconds hesitation he orders a Panoramic X-ray, which shows signs of premature contacts near the posterior teeth. A careful evaluation under magnification inside the mouth shows small wear facets on an otherwise healthy tooth and finally a palpation of the Masticatory muscles shows changes in muscular tension on one side.
The diagnosis- CMD
The treatment plan- A night guard, occlusal correction, weekly follow ups and physiotherapy.
But in all these 100’s of cases like that of Mr. Müller, the teeth tell a straightforward story; Question- Are you under stress at this moment?
Answer in 70% of cases- Yes
Welcome to the world of 21st Century Western diseases.
What Mr Müller and many like him experience is one of the many symptoms of everyday stress. In the east, the first thing associated with increased Stress is Hypertension. Such findings are not new or unusual but what makes this highly unusual, is the magnitude of prevalence of this symptom in clinical practice. When almost 30% of patients are coming because of oral manifestations of Stress daily, then a broader outlook to such problems is necessary. Intervention by a night guard or Physiotherapy is only the symptomatic treatment of a bigger disease. Common sense entails the diagnosis to be “Stress” and Treatment to be “Lifestyle changes”.