Dr.  Luís Bacalhau

Médico Dentista

Dentistry and oral health

More than just white teeth and beautiful smiles

HPA Magazine 6

Dental Medicine has been one of the fastest growing clinical specialties in the past few years in the HPA Group. Oral health education and screening are still neglected, despite their importance in the general context of health and wellbeing, throughout our life cycles. The old Portuguese proverb that says, “Only someone with a toothache goes to the dentist”, is still a common practice for the majority of the population, furthering the prevalence and recurrence of oral diseases, which are considered to be a silent epidemic in this country.
We spoke to Dr. Luis Bacalhau, Director of Dental Medicine of the HPA Group, who is “determined” to contradict this “inevitability”.

Without giving away any secrets, share with us the principles, from the clinical point of view, of this development of dentistry that we have seen at the HPA Health Group?
The growth of dentistry in the group has led us to create a multidisciplinary team that allows us to treat all of the pathologies of the oral cavity.
The elements that make up the clinical body present a wide diversity in areas such as oral surgery, implantology, orthodontia and periodontology, just to mention a few examples. The fact that the service is integrated in a hospital group brings with it added advantages that are not available in a “normal” dental clinic. We have the possibility to treat the patients with conscious sedation, heavy sedation or general anesthesia.
We offer medical support for highly diverse care in medical specialties that are of major importance for the success of the treatment, such as maxillofacial surgery, otolaryngology or pediatrics. At the technical level, the installations were purpose-built in order to include the most advanced technology possible, including digital radiology, low radiation 3D tomography, a piezoelectric surgery unit, and even digitized medical records, permanently available in all of the units of the group.

Nowadays it is well known that oral health care should begin during gestation, when the baby is still being formed. However, we see that the majority of people only go to the dentist “when a tooth hurts”. How do you explain this behavior?
Contrary to what happens in other European countries, in Portugal the mouth and teeth have always been considered something secondary, something that is not part of our physical or emotional health. The proof of this is the fact that the national health service, which was established more than 30 years ago, still does not offer oral health care to the population. National statistics tell us that the greater part of the population suffers from dental health problems and that only a minority make regular visits to the dentist.
Nevertheless, we recognize that there has been a positive evolution in the consciousness of the people towards this problem in recent years.
The solution is in educating young people, whether in school or at home, as well as simplifying access to oral health care.

Are there age groups that should have a more regular or stricter care, or is this behaviour common for all age groups?
Prevention dentistry is of the utmost importance. While we are more aware of cavities or crooked teeth in children, in adults gum disease or missing teeth are more frequent. This shows that throughout life there are many oral health problems that can be avoided if detected in time. Treatment is also easier, and even more economical, with early diagnosis. Children make up the most vulnerable group, so they deserve special attention. It is recommended that they have their first consultation at the age of 3, although oral health care should be practiced from birth.
How often we need to see the dentist should be determined by the state of oral/general health and a correct assessment of the risk factors.

Several areas of dentistry have seen a surprising evolution, whether for easy access to techniques or for functional and aesthetic results. Would you like to highlight a few?
The evolution of techniques and materials used in dentistry has meant that we are more and more conservative and less invasive in the treatments. Increasingly, we try to preserve the existing teeth by using adhesive techniques, with materials that mimic the natural and aesthetic structure of the tooth. When it is not physically possible to save a tooth and we have to remove it, opting for dental implants is a simple solution, with a success rate of over 90%. 
One area that has evolved quite a bit in recent years, along with biomaterials, is the technology associated with CAD-CAM (computer-aided design and computer-aided manufacturing) systems. We can now plan a treatment virtually before the procedure itself. With the help of photographs, videos, 3D radio-
logy, specialised software and the latest laboratory equipment, we can recreate the ideal smile or even reposition the jaws in digital models. This allows us to preview the final result, with the greatest security and without deviation of the results, but above all, to meet the patient’s expectations.