Συνέντευξη : Τζούλη Κούτσουρη – Οδοντιάτρος PhD
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Συναντήσαμε την Κα. Κούτσουρη Τζούλη (PhD) και της ζητήσαμε να μας βοηθήσει να αναλύσουμε με λεπτομέρεια και δίνοντας πρακτικές οδηγίες τα ιδιαίτερα θέματα που καλείται να αντιμετωπίσει ένας αθλητής αναφορικά με τη στοματική του υγεία.
Athens Journal.gr – Οι αθλητές και ιδιαίτερα εμείς οι αθλητές αντοχής (τρίαθλο, αθλητές μαραθωνίου, ποδηλάτες) κάνουμε πολύωρες προπονήσεις που αυτές απαιτούν την κατανάλωση απλών σακχάρων είτε με τη μορφή gel ή με αθλητικών ποτών. Τι μπορούν να προκαλέσουν τα σάκχαρα στο στόμα μας και ποια οδοντιατρική φροντίδα οφείλουμε να ακολουθήσουμε για να προστατεύσουμε την υγιεινή των δοντιών μας;
Τζούλη Κούτσουρη : Οι αθλητές αντοχής καταβάλουν μεγάλη προσπάθεια για να παράγουν έργο σε πολύωρες καθημερινές προπονήσεις καθώς και κατά την διάρκεια του αγώνα. Για να καλύψουν τις ανάγκες τους σε άμεσα παρεχόμενη ενέργεια καταναλώνουν ποσότητες σακχάρων είτε λαμβάνοντας τζελάκια είτε ενεργειακά ποτά. Σε μία έρευνα φάνηκε πως το 85% των αθλητών πίνουν συχνά αθλητικά ποτά, 59% τρώνε ενεργειακές μπάρες και 70% χρησιμοποιούν ενεργειακά gels κατά την διάρκεια της προπόνησης και του αγώνα.
Έχουν αυτά επιπτώσεις στην στοματική τους υγεία; Και βέβαια έχουν.
Έρευνα που έγινε από Πανεπιστήμιο του Λονδίνου εξέτασε 352 άντρες και γυναίκες αθλητές από 11 σπορ. Τα αποτελέσματα της μελέτης έδειξαν πως οι elite αθλητές είχαν φτωχή στοματική υγιεινή παρόλη την προσπάθεια που κατέβαλαν για σωστή περιποίηση των δοντιών τους. Για παράδειγμα το 94% των αθλητών βούρτσιζαν τα δόντια τους 2 φορές την ημέρα σε σχέση με το 75% του γενικού πληθυσμού. Επίσης το 44% των αθλητών έκαναν οδοντικό νήμα καθημερινά σε σχέση με το 21% του πληθυσμού.
Γιατί λοιπόν οι αθλητές παρόλο που βουρτσίζουν τα δόντια τους 2 φορές την ημέρα, δεν καπνίζουν και ακολουθούν μία υγιεινή δίαιτα και ένα υγιεινό τρόπο ζωής εν γένει έχουν φτωχή στοματική υγεία (49% των αθλητών σε άλλη έρευνα είχε ενεργές τερηδόνες και το 32% ανέφερε πως η στοματική τους υγεία είχε αρνητική επίπτωση στις επιδόσεις τους).
Ένας από τους λόγους μπορεί να είναι η συχνή κατανάλωση σακχάρων είτε με την μορφή gel είτε ως αθλητικά ποτά. Αυτά που συμβαίνουν στο στόμα με την συχνή λήψη σακχάρων συνοψίζονται στα παρακάτω:
- Η ζάχαρη που προσλαμβάνεται από το στόμα επικάθεται στα δόντια και μεταβολίζεται από τα βακτήρια που υπάρχουν επάνω σε αυτά. Αποτέλεσμα του μεταβολισμού των σακχάρων στην οδοντική πλάκα είναι η πτώση του pH . Τα δόντια λοιπόν κολυμπούν σε ένα όξινο περιβάλλον και αυτό βοηθά στο να χάνουν γρήγορα μεταλλικά ιόντα από την δομή τους και να διαβρώνονται ή να δημιουργούνται τερηδόνες.
- Η μορφή που προσλαμβάνεται αυτή η ζάχαρη έχει επίσης σημασία. Όταν αυτή η πρόσληψη γίνεται με οτιδήποτε κολλάει πάνω στα δόντια αφενός μεν το σάλιο δεν μπορεί εύκολα να το απομακρύνει και αφετέρου γίνεται πιο επιβλαβές.
- Τα τζελ και τα ενεργειακά ποτά είναι όξινα. Για παράδειγμα τα αναψυκτικά έχουν pH μεταξύ 2,5-3,6, οι χυμοί φρούτων 3,4-3,6, τα τζελάκια περιέχουν κιτρικό οξύ ή μηλικό οξύ και pH 3,5-4,2. Από την άλλη η αδαμαντίνη (το σμάλτο των δοντιών) διαλύεται σε pH χαμηλότερο από 5,5. Αν λοιπόν τα παραπάνω λαμβάνονται με μεγάλη συχνότητα και σε μεγάλη ποσότητα μπορούν να προκαλέσουν βλάβες στα δόντια
Επίσης ο μεγάλος όγκος προπόνησης και η ένταση κατά την διάρκεια της δημιουργούν αφυδάτωση στους αθλητές η οποία με την σειρά της επηρεάζει την ποσότητα του σάλιου που κυκλοφορεί στο στόμα μας. Το σάλιο είναι βασικό στοιχείο για την προστασία των δοντιών μας γιατί
- διατηρεί το pH πάνω από 5,5
- προμηθεύει στα δόντια μας μεταλλικά στοιχεία όπως το ασβέστιο και ο φώσφορος που τα χρειάζονται για να επαναδομούνται. Όταν λοιπόν τα σάλιο ελαττώνεται τότε και ο ρυθμός της καταστροφής των δοντιών αυξάνεται.
Η συχνή λήψη σακχάρων μπορεί να δημιουργήσει
Τερηδόνες –τα δόντια χαλάνε, μαλακώνουν και δημιουργούνται κοιλότητες που πρέπει να σφραγιστούν ώστε να αποκατασταθεί η ακεραιότητα του δοντιού
Διαβρώσεις –τα δόντια διαβρώνονται, μικραίνουν σε όγκο, γίνονται πιο επίπεδα στις κορυφές τους και πιο λεπτά.
Με ποιους τρόπους μπορούμε να αντιμετωπίσουμε το πρόβλημα;΄
Σε παιδιά ή κατά την διάρκεια χαμηλής έντασης προπονήσεων
- Προτείνουμε νερό για ενυδάτωση και
- Αν χρειάζονται υδατάνθρακες μπανάνες
Για ψηλή ένταση ή για πολύωρες προπονήσεις
- Αν πρέπει να πιείτε αθλητικό ποτό να είναι χωρίς ανθρακικό
- Να γίνεται προσπάθεια ώστε να μένετε ενυδατωμένοι
- Αν μασάτε τσίχλα να είναι χωρίς ζάχαρη
- Να αποφεύγετε να κρατάμε για πολύ ώρα στο στόμα σας το τζελ ή το ποτό
- Αν μποροείτε να πίνετεμε καλαμάκι το αθλητικό ποτό είναι προτιμότερο γιατί ελαττώνεται η επαφή με τα δόντια
- Όταν ετοιμάζετε τα ποτά από σκόνη να τα φτιάχνετε στην προτεινόμενη αναλογία και όχι πιο συμπυκνωμένα
- Να χρησιμοποιείτε για την παρασκευή του ποτού κρύο νερό γιατί έχει φανεί πως μειώνει την διάβρωση
- Όταν παίρνετε τζελ να πίνετε νερό μετά και όχι αθλητικό ποτό
Μετα την προπόνηση αγώνα
- Να μην βουρτσίζετε τα δόντια αμέσως αλλά τουλάχιστον μία ώρα μετά την κατανάλωση τζελ ή ποτών.
- Να φροντίζετε την στοματική υγιεινή
- Να λαμβάνετε τροφές που δίνουν ασβέστιο όπως γάλα, γιαούρτι και τυρί που βοηθούν στην αναδόμηση των δοντιών.
- Να επισκέπτεστε τον οδοντίατρο κάθε εξάμηνο έτσι ώστε να γίνεται έλεγχος, φθορίωση, καθαρισμός και εντόπιση βλαβών όταν αυτές βρίσκονται σε πρώιμο στάδιο.
Athens Journal.gr : Μετά από πολύωρη προπόνηση στην θάλασσα χάνεται η αίσθηση της γεύσης. Πρέπει να κάνουμε κάποιες πλύσεις και με τι όταν βγαίνουμε από μεσαίας ή μεγάλης διάρκειας προπόνηση ή αγώνα στην θάλασσα;
Τζούλη Κούτσουρη : Η κολύμβηση στην ανοικτή θάλασσα είναι αρκετά διαφορετική από την κολύμβηση σε μία πισίνα. Ένα από τα προβλήματα που δημιουργούνται στους κολυμβητές μεγάλων αποστάσεων (marathon swimmers)είναι το salt mouth.
Καθώς οι αθλητές κολυμπάνε και εισπνέουν από το στόμα, θαλασσινό νερό εισέρχεται σε αυτό. Το αλάτι που περιέχεται στο θαλασσινό νερό αρχίζει να αθροίζεται πάνω στην γλώσσα, στον στοματικό βλεννογόνο ακόμη και στον λαιμό του αθλητή. Οι γευστικές κάλυκες που είναι υπεύθυνες για την αίσθηση της γεύσης βρίσκονται κατά κύριο λόγο στην γλώσσα και σε μικρότερους αριθμούς στον στοματικό βλεννογόνο. Η άθροιση αυτή του αλατιού δημιουργεί αρχικά μία προσωρινή απώλεια της γεύσης. Εάν η προπόνηση η ο αγώνας είναι μεγάλης διάρκειας –δηλαδή ξεπερνά τις 5 ώρες- τότε εκτός από την απώλεια της γεύσης δημιουργούνται και άλλα προβλήματα όπως η αίσθηση ότι η γλώσσα έχει παχύνει, πόνος στην μάσηση και στην κατάποση σαν αποτέλεσμα της φλεγμονής του λαιμού. Όλα αυτά τα συμπτώματα περιγράφουν μία κατάσταση που χαρακτηρίζεται ως salt mouth και είναι ένα αρκετά κοινό πρόβλημα στους κολυμβητές μεγάλων αποστάσεων.
Προφανώς η ένταση και η διάρκεια των συμπτωμάτων εξαρτώνται από τον χρόνο κολύμβησης, από την ποσότητα του θαλασσινού νερού που έχει καταποθεί, από την αλατότητα της θάλασσας καθώς και από την θερμοκρασία της.
Δική μου υπόθεση είναι πως η αφυδάτωση κατά την διάρκεια της άσκησης ελαττώνει τον σίαλο που κυκλοφορεί στο στόμα και αυτό έχει την δική του επίδραση στην αίσθηση της γεύσης, αφού και οι ξηροστομικοί ασθενείς έχουν απώλεια της γεύσης.
Ποιος τρόπους αντιμετώπισης έχει ο αθλητής για την αντιμετώπιση αυτού του φαινομένου?
- Οι πλύσεις με κάποιο στοματικό διάλυμα πριν η και κατά την διάρκεια της προπόνησης έχει φανεί πως βοηθά. Το στοματικό διάλυμα καλό θα είναι να είναι αραιωμένο με νερό (προτεινόμενες αραιώσεις 25, 33 ή 50%) έτσι ώστε να μην δημιουργεί κάψιμο. Η συχνότητα της λήψης του στοματικού διαλύματος μπορεί να είναι κάθε 90 λεπτά. Καλό θα είναι να επιλέγεται κάποιο ήπιο στοματικό διάλυμα χωρίς μεγάλη ποσότητα αλκοόλ (alcohol free στοματικά διαλύματα υπάρχουν στην Colgate, την Crest καθώς και κάποιο Listerine)
- Να γίνεται προσπάθεια ώστε να μην μένει το στόμα πολύ ανοικτό.
Athens Journal.gr : Κάθε πότε πρέπει να επισκεπτόμαστε τον οδοντίατρο μας προληπτικά και τι παρεμβάσεις πρέπει να κάνουμε
Τζούλη Κούτσουρη : Νομίζω πως ο οδοντίατρος είναι κάποιος που πρέπει να επισκεπτόμαστε κάθε 6 μήνες προκειμένου να διασφαλίσουμε πως θα έχουμε καλή στοματική υγεία.
Οι αθλητές καταναλώνουν σάκχαρα ώστε να έχουν ενέργεια και αυτό τους καθιστά μία κατηγορία πιο ευάλωτη στην δημιουργία προβλημάτων στα δόντια τους. Ο οδοντίατρος μπορεί να βοηθήσει μέσω:
- Καθαρισμού των δοντιών από την πέτρα και την πλάκα βοηθώντας στα ούλα να είναι υγιή
- Στην έγκαιρη εντόπιση μικρών τερηδόνων που μπορεί να σφραγίσει έτσι ώστε να μην εξελιχθούν σε μεγαλύτερο πρόβλημα
- Στην εφαρμογή φθορίου έτσι ώστε να δυναμώσουν τα δόντια. Μπορεί το φθόριο να εφαρμοστεί είτε με την μορφή τζελ είτε με την μορφή βερνικιού που μένει πιο πολύ πάνω στα δόντια. Το φθόριο μπορεί να δυναμώσει τα δόντια και να αντιμετωπίσει τυχόν ευαισθησία στο κρύο ή στο ζεστό που μπορεί να ακολουθεί την διάβρωση των δοντιών.
- Στην επικάλυψη κάποιων αρχόμενων η πιο προχωρημένων διαβρώσεων με σύνθετες ρητίνες πράγμα που δημιουργεί μία περαιτέρω προστασία στην διάβρωση του δοντιού.
- Στο να δώσει πιο συγκεκριμένες οδηγίες σε ότι αφορά στην σωστή χρήση της οδοντόβουρτσας, των μεσοδοντιών και των στοματικών διαλυμάτων έτσι ώστε να φτιάξουμε σωστά ένα εξατομικευμένο πρόγραμμα στοματικής υγιεινής.
Τζούλη Κούτσουρη : Διαβάσαμε πρόσφατα στο internet για συνάνθρωπο μας (Δημοσιογράφο Αναστάσιο Δαφνή 30 ετών) που πέθανε οπού τα προβλήματα υγείας ξεκίνησαν από ένα πρόβλημα στο δόντι. Είναι υπερβολικό αυτό η πραγματικά μία φλεγμονή ή μόλυνση στο στόμα μπορεί σε κάποιες περιπτώσεις να οδηγήσει σε πολύ σημαντικά προβλήματα υγείας;΄
Athens Journal.gr : Το γεγονός πως έγινε πρώτη είδηση ο θάνατος ενός συνανθρώπου μας μετά από πρόβλημα που ξεκίνησε από δόντι δείχνει ότι δεν είναι συχνό να χάσει κάποιος τη ζωή του από αυτό.
Αυτό που είναι περισσότερο συχνό είναι να ταλαιπωρηθούμε αρκετά με πόνο και γενικότερη κακουχία από φλεγμονές που έχουν ξεκινήσει από δόντια και πιο ειδικά από αποστήματα της τραχηλοπροσωπικής χώρας. Το απόστημα ξεκινά με την συλλογή πύου το οποίο έχει την τάση να διαχέεται στους παρακείμενους ιστούς μέσω της οδού με την μικρότερη αντίσταση. Τα αποστήματα μπορεί να επεκταθούν
- Στο οστό προκαλώντας οστεομυελίτιδα
- Στο ιγμόρειο και από εκεί και στους άλλους παραρρίνιους κόλπους αν είναι στην άνω γνάθο
- Στους μυς όπου γίνεται δύσκολη η διάνοιξη του στόματος
- Στο έδαφος του στόματος, τον τράχηλο και το ανώτερο αναπνευστικό σύστημα (λουδοβίκειος κυνάγχη) που είναι μία πολύ απειλητική κατάσταση για την ζωή του ασθενή
- Στο κατώτερο αναπνευστικό σύστημα
Άρα φροντίζουμε την στοματική μας υγεία κάνοντας έλεγχο στον οδοντίατρο κάθε 6 μήνες. Καλό είναι ύστερα από οδηγία του οδοντιάτρου να προβαίνουμε και σε ακτινογραφικό έλεγχο όπου μπορεί να ανιχνευθούν προβλήματα και να αντιμετωπιστούν πριν να δημιουργηθούν φλεγμονές.
ΑΝ όμως εμφανίσουμε κάποιο πόνο ή πρήξιμο χρειάζεται άμεση επικοινωνία με οδοντίατρο. Μπορεί να χρειαστεί η χορήγηση κάποιας αντιβίωσης, η διάνοιξη του υπεύθυνου δοντιού.
Σε πιο προχωρημένες καταστάσεις μπορεί να πρέπει να δοθεί εισαγωγή σε νοσοκομείο, ενδοφλέβια αντιβίωση, υποστηρικτική θεραπεία, λήψη κορτικοστεροειδών καθώς και σε εξωστοματική σχάση τους αποστήματος με την βοήθεια αγωγών παροχέτευσης.
ΒΙΟΓΡΑΦΙΚΟ
Η Τζούλη Κούτσουρη γεννήθηκε στην Αθήνα.
Αποφοίτησε από την Οδοντιατρικής Σχολή του Πανεπιστημίου Αθηνών το 1995.
Στην συνέχεια απέκτησε PhD και Diploma in Biomedical Methods από την Οδοντιατρική Σχολή του Cardiff στην Μ. Βρετανία.
Υπήρξε Επιστημονικός Συνεργάτης της Οδοντιατρικής Σχολής ΕΚΠΑ στο Γνωστικό Αντικείμενο της Οδοντικής Χειρουργικής από το 1996-1997 και 2001-2004.
Από το 2000 εργάζεται στο ιδιωτικό της Οδοντιατρείο, ασκώντας γενική οδοντιατρική με έμφαση στην Αισθητική Οδοντιατρική.
Έχει παρουσιάσει ομιλίες σε ελληνικά και διεθνή συνέδρια. Έχει δημοσιεύσει ερευνητικές μελέτες αλλά και κλινικές εργασίες σε ελληνικά και ξένα επιστημονικά περιοδικά. Επίσης έχει συμμετάσχει στην συγγραφή οδοντιατρικών συγγραμμάτων.
Επιμορφώνεται συνεχώς στα επιμέρους αντικείμενα της Οδοντιατρικής, έτσι ώστε να ενημερώνεται για τις καινούργιες εξελίξεις.
Το ιατρείο μου είναι στην Κηφισιά στην Λεωφόρο Κηφισίας 319 Α. Εκεί εγώ και άλλοι συνάδελφοι διαφόρων ειδικοτήτων της οδοντιατρικής παρέχουμε υπηρεσίες γενικής οδοντιατρικής, ορθοδοντικής, περιοδοντολογίας, τοποθέτησης εμφυτευμάτων και προσθετικής.
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