Prof. Stanisław Suliborski Ph. D. MD.

Founder of Dentistry Center Aesthetic and Implantology "Panaceum" in ŁódĽ

www.suliborski.pl   
www.panaceum.dentonet.pl
Stomatologia polska - dzisiaj i jutro
What is the current state of Polish dentistry?
Generally I evaluate it very positively. We are regarded in Europe as a well-trained group of professionals, who may take work in Europe and in Poland offer treatment to patients from the most highly developed countries. We are appreciated by the British, the Scandinavians, the Germans, the Italians and others such as the Americans and Australians.
Professor, do you rate all dentists in Poland so highly?
In every professional group and also among doctors there are the leaders, those propelling progress, a well-trained group representing a high level of professionalism and also doctors, who by various criteria often unconnected with professional ambition and intellectual potential do not develop their abilities. I think that the proportions are changing beneficially.
How is it that there is no such development distance in relation to the countries of Western Europe?
There are many causes for the rapid development of dentistry in Poland. One of them is privatisation - removal from dependence in practising the profession on state organisational structures. Many dental doctors develop their abilities independent from the limits of the standards of the Polish National Health Fund. They invest in their abilities, in equipment, materials and rely upon the free market, and there it is competence, quality of services and customer service that count. Also patients are becoming increasingly aware of the new possibilities of modern dentistry and so the patient has ever greater expectations of his dentist. That is why it is that an ever more numerous group of dentists provide services at a high international level in Poland. Polish dentists extend their knowledge and abilities in many training sessions, symposia and dental conferences in Poland and abroad. Also the technical support, that is provided by Polish prosthetic laboratories with regard to equipment and ability are equal to the best.
After 1990 Polish dentistry gained access to the knowledge, materials, apparatus, instruments and techniques of modern world dentistry. From then on we have noted a rapid rise in the level of dental services provided in Poland.
All areas of dentistry such as periodontology, orthodontics, endodontics and particularly reproductive dentistry together with implantology are developing very intensively. It became possible to reproduce alveolar bone tissue (e.g. under implants), correct mouth cavity soft tissue (in order to improve health and appearance), rebuilt damaged tooth crowns with minimally invasive methods and obtain very good aesthetic effects - obtain excellent colour and shape imitating nature. In association with the development of endodontics concerned with dental pulp ailments including channel treatment, the treatment of teeth, which earlier would have been removed, became possible. The introduction of microscopic procedures enabled conducting procedures with a much increased diagnostic and treatment effectiveness. Due to implantology it is now possible to perform permanent fillings meaning such, that may not be removed from the mouth of someone without natural teeth. We note enormous progress in diagnostic methods using computer tomography enabling the use of three-dimensional programmes fully simulating projected surgical and implant procedures and even the prosthetics. And one could talk and talk about the interesting aspects and possibilities in various branches of dentistry today.
From that it appears that all is rosy and that there is nothing left to do?
One never arrives at the situation where there is nothing left to do. Dentistry is developing very rapidly, new treatment possibilities are constantly appearing and therefore everyone even the best must continuously enhance their knowledge and abilities. I think that there will be more and more dental surgeries and dentists, who will be able to satisfy evermore demanding clients.
What aspects in the sector seem to be the most important?
There are several. I think that the most important in Polish dentistry is the raising of the level of mouth cavity hygiene and the propagation of wide knowledge on the causes of mouth cavity ailments. From there one should begin because it is on these factors that the health not only of the mouth cavity depends. Knowing the causes of ailments, it is easier to prevent them. We fasten seatbelts in cars because today we know the effects in the event of an accident if we do not fasten them and remember how many years information was issued about the effectiveness of seat belts. Today it is obvious; now nobody talks about it or writes about it, it has become part of everyday life.
And do we know enough about the effects of neglect of hygiene and prophylactics?
I think that we must contend in Poland with a lack of sufficient oral hygiene in our community. In this area in relation to the developed countries of Western Europe we are behind. Deficiencies in the systematic teaching of oral hygiene in pre-schools and schools and continuously little intensity in teaching oral hygiene in dental surgeries differentiates us from the leading countries of Europe. Lack of sufficient knowledge of the consequences of hygienic neglect among adult patients causes this problem to continually grow and carry on to the next generation and here there is a great deal to be done. For several years I have thought about opening mouth cavity hygiene schools for patients and people interested in this problem. It is not sufficient to know that one must brush one's teeth but one must know how to do it and if what one does is effective and the proper method. The issues associated with oral hygiene for children are entirely different to those of adults with prosthetic treatments or people with paradontic ailments, bite defects, manually incapacitated persons etc., lack of appropriate hygiene causes a rapid and continuous process of ailments in the mouth cavity affecting soft tissue and hard teeth, frequently preventing the conducting of appropriate dental treatment and having a generally negative effect on the general health of the person. It is this that we must counter.
Professor what are highest standards of oral hygiene?
For instance in Western Europe. It seems to us that there it is better but also there are differences. We should take examples from the best. Scandinavia and also Switzerland, Germany and the Czech Republic have regulated systems. Teaching in schools and in pre-schools instils the appropriate habits and abilities, which in adult life are a support in individual care. Dental surgeries are also orientated toward services in the area of professional hygiene procedures and regular check-up visits to maintain the appropriate mouth hygiene. Regular checkups are connected with limitations of the "guarantee" of replacement services. In dental surgeries much time is dedicated to prophylactics, hygiene, early diagnosis of mouth cavity ailments, and especially tooth decay. Hygiene and prophylactics in dental surgeries is undertaken by very well qualified dental hygienists not only conducting professional procedures but also individual instruction, teaching and checking the effectiveness of procedures. The role of the dentist is only to check. The patient is informed of the date of the visit and the performance of possible professional procedures entailed. More and more dental surgeries in Poland are trying to introduce such a system.
And the second aspect of development?
In these days of enormous possibilities in replacement treatment there is a necessity to introduce principles applied to treatment methods enabling the limitation or elimination of non-reversible interference with healthy tooth structures. I defined it several years ago as the "Mini - Max" principle, that is the minimum intervention and the maximum therapeutic effects. Traditional methods of rebuilding damaged or lost teeth require great loss of healthy tooth tissue. The application from example of a prosthetic crown involves the non-reversible loss of tooth tissue amounting to 72%. Such methods and techniques which enable the reproduction of lost or diseased parts of teeth while simultaneously leaving undisturbed the healthy parts should be applied wider and wider. However it requires great professional ability, very precise work, appropriate materials and technical support. It also requires a change in professional consciousness and a departure from the schemes learned and applied every day. It is always necessary to look at the process of treatment and the application of methods in the perspective of the life of the patient and to ask the question what is the effect that interference will cause in 5-10- 20 or 30 years? Conducting such solutions concerns issues connected with changes in the philosophy of dental treatment, constant professional training and achieving progress in the introduction of new techniques into one's own dental practice.
Are you thinking of veneers, inlays and onlays applied instead of prosthetic crowns?
Yes among others, but this is only part of a broader issue. The introduction of reproduction methods based on adhesion techniques ensuring permanent attachment of composite or porcelain with the tooth without the necessity filing it and executing mechanical retentions. This is great progress in respect for oral health. Additionally we obtain excellent aesthetic effects. And the development of implantology, which limits the application of traditional bridges requiring filing of teeth, application of mobile prosthetics such examples may be multiplied.
Will this direction be developed in dental practices?
I hope so and not only in dental practices but also in pre-diploma teaching. Today we should be introducing a change in treatment philosophy into the teaching programme and modern techniques and reproduction methods, in order to limit the application in the future of aggressive therapeutic methods.
Is there still a third aspect?
Aspect of dental development? Of course - anaesthetics - the development of the area of dentistry known as cosmetic dentistry. This is the driving force of dentistry in the developed countries. Cosmetic dentistry is coming into Polish dentistry more and more. We wish like the citizens of neighbouring countries to be younger, wealthier, more beautiful and healthier. Ever more patients are interested in beautiful teeth. Ever more people of various ages wish to devote time and money so that their smile would be perfect and that their face would inspire trust and be positively perceived. There are many methods, which may be used in equally with regard to the Mini- Max principles, which I mentioned earlier. Aesthetic dentistry is not always associated with improvement of oral health. At times it is a purely cosmetic procedure e.g. tooth whitening. Brighter teeth after whitening are not healthier. Neither are they sick, but without a doubt they improve people's self image and how they feel. Cosmetic dentistry is a compelling line of activity for dentists. It combines achievements in practically every branch of dentistry. Maybe that is why it is so difficult and at the same time so exceptionally responsible because treatment affecting theappearance of the face is an interference with the face of a person. Such interference may give the desired effects, and it may be the cause of much disappointment.
We have not spoken about money. Will financial aspects be a restraint in the development of dentistry in Poland?
You have touched upon a very sensitive subject. Obviously dentistry costs money and it is not cheap. It is a restraint in the application of the best dentistry. In the countries of Western Europe to say nothing of the United States dentistry is very expensive. In Poland it is relatively significantly cheaper, but still very expensive to Polish citizens. This results from many causes. The costs of new technology e.g. CAD/ CAM based on refined scanners, lathes, computer programs enabling the patient to obtain, after a dozen or so minutes in the dental surgery, very exact porcelain inlays, which are then cemented into the mouth. It saves the time dedicated to several visits. The introduction of such technology is accompanied by the expenditure of several hundred thousand Polish złoty to cover the cost of apparatus and its use. This is to say nothing of the education necessary to introduce such technology. We are unable to rely upon the National Health Fund. We are only able to rely on our own resources. Therefore speaking of dental development in Poland, I spoke in the first point of hygiene and prophylactics. Remember prevention is significantly cheaper than cure. Let us take care of what nature has given us and give it particular attention.

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