Individual prophylaxis
The individual prophylaxis is the umbrella term for by the dentist yielded prophylactic measures in the individual patients. A distinction must be made between individual prophylaxis for children and adolescents on the one hand and adults on the other.
Medical check-up
During a dental check-up, the teeth and the oral cavity are examined in detail to determine any tooth, mouth and jaw diseases. For the content of the preventive medical check-up see
Individual prophylaxis in children and adolescents
Individual prophylaxis for children and adolescents is particularly encouraged by the legislature and has been anchored as a health insurance benefit in Section 22 of the Social Code Book V.
“(1) Insured persons who have reached the age of six but not yet eighteen can have a dental examination once every six months to prevent dental diseases.
(2) The examinations should focus on the findings of the gums, the explanation of the causes of disease and their avoidance, the creation of diagnostic comparisons on oral hygiene, the condition of the gums and susceptibility to caries diseases, on the motivation and instruction in oral care as well as on measures extend to harden the enamel of the teeth.
(3) Insured persons who have reached the age of six but not yet eighteen are entitled to fissure sealing of the molars . "
The Federal Joint Committee (G-BA) issued guidelines on January 1, 2004 through authorization in Section 92 of Book V of the Social Code .
Statutory health insurance benefits
In order to carry out individual prophylaxis services for children and adolescents, several fee items were included in the uniform assessment standard for dental services (BEMA), which is the basis for billing the dentist with the statutory health insurance funds . The individual prophylaxis services are abbreviated with the letters IP . Billing is done by the Association of Statutory Health Insurance Dentists .
frequency
Two-thirds of children between the ages of two and six do not go to a dentist. According to an evaluation by BARMER GEK, around 30 percent of adults did not visit a dentist in 2014.
Children and young people
FU - Dental screening examination
The dental screening of a child from the 30th to the 72nd month of life can be billed a maximum of three times according to the BEMA fee number FU.
The first screening examination has to be done in the 3rd year of life. If the 1st FU takes place later, the child is only entitled to two FUs. Exceptions can be:
- delayed tooth eruption
- Long-term illness of the child that did not allow a visit to the dentist
The minimum interval between two screening examinations is 12 months.
For small children up to the age of 33 months with statutory health insurance, three additional early diagnosis examinations are planned from July 1, 2019. The Federal Joint Committee (G-BA) decided on January 17, 2018. They include, among other things, a detailed examination of the child, advice to parents and instructions for daily brushing of toddlers' teeth. In addition, toddlers up to 33 months of age have an additional right to enamel hardening with fluoride varnish twice every six months in the dental practice.
IP 1 oral hygiene status
The oral hygiene status according to IP 1 can be billed once every six months and only with individual instruction. There is no need to provide evidence of this in the bonus booklet for 6-11 year old patients . For 12–17 year-old patients, the date of the IP1 (even if no plaque retention points are found) must be entered in the bonus booklet once every six months.
The assessment of the oral hygiene status includes the assessment of oral hygiene and the condition of the gingiva using a suitable index (e.g. approximal plaque index, Quigley-Hein index, papillary hemorrhage index; the index once selected must be retained), the determination and assessment of plaque retention points and possibly staining of the teeth. The creation of bitewing X-rays for caries diagnosis may also be indicated.
IP 2 oral health education in children and adolescents
This fee number contains information for the insured person and, if applicable, his / her legal guardian about the causes of the illness and how to avoid it, motivate and remotivate it. It can be billed once per calendar half-year and must be given as an individual instruction.
Oral health education includes the following services:
- Education about the causes of tooth decay and gingivitis and how to avoid them;
- if necessary, nutritional advice and oral hygiene advice, also taking into account the measured values of the selected oral hygiene indices;
- Recommendations for the use of suitable fluoridating agents for hardening enamel (fluoridated table salt, fluoridated toothpaste, fluoridated jellies and the like); if necessary dispensing / prescription of fluoride tablets;
- practical exercise of oral hygiene techniques, also for cleaning the interdental spaces.
The dentist should determine the content and scope of the necessary prophylactic measures according to the individual circumstances of the individual case. Within a period of three years, all service components must be performed at least once. In cases of satisfactory oral hygiene after repeated prophylactic measures, IP 2 may be omitted.
IP 4 Local fluoridation of the teeth
This fee figure is calculable for the local fluoridation for the hardening of tooth enamel with varnish or gel, including the removal of soft plaque and the drying of the teeth. Fluoridation requires thorough cleaning and drying of the tooth. The removal of hard plaque ( tartar removal ) is billed according to BEMA No. 107.
A benefit according to IP 4 can also be billed for children before the age of 6 if the 6-year molar breakthrough prematurely . As a rule, it can be billed once per calendar half year. For insured persons with a high risk of tooth decay , from the age of 6 up to the age of 18, the number IP 4 can also be billed twice per calendar half year.
IP 5 sealing of permanent molars
The sealing of caries-free fissures and pits of the permanent molars (teeth 6 and 7) with hardening plastics is billed per tooth. This includes the thorough removal of the soft plaque and the drying of the teeth to be sealed. The removal of hard plaque is billed according to BEMA No. 107. A service according to No. IP 5 can also be billed if the 6-year molar breakthrough in children before the age of 6. It is not indicated if the fissure is already infected with caries. The tooth must be sealed before fluoridation.
BEMA no. 107 Removing hard plaque
The removal of hard plaque is charged per session, but can only be charged once a year. Tartar removal that has become necessary more often must be billed according to the private fee schedule for dentists.
Early detection examination in young children
Individual statutory health insurances have concluded contracts with state KZVen for early diagnosis examinations for small children, who can use two additional early diagnosis examinations free of charge between the sixth and thirtieth month of life, during which, among other things, the risk of caries is assessed. The National Association of Statutory Health Insurance Dentists (KZBV) has developed a concept for dental prevention in small children against early childhood caries (ECC), which provides for this service to be included in the service catalog (BEMA) of the statutory health insurance companies.
Adults
BEMA no. 107 Removing hard plaque
The removal of hard plaque is charged per session, but can only be charged once a year.
Further individual prophylactic services
This includes the collection of the periodontal screening index (PSI code), a gum pocket depth measurement, to which health insurance patients are entitled every two years. Billing is based on BEMA number. 04.
Further individual prophylactic services can be used privately according to the schedule of fees for dentists.
Private dentistry
The private fee schedule for dentists (GOZ) provides six fee items for individual prophylaxis. In the general provisions it says: “Prophylactic services according to Section B are only billable with individual instruction ( individual prophylaxis ); they are not billable for group instruction ( group prophylaxis ). “The services are limited in terms of quantity. It says, the service according to number 1000 is billable once within a year, the service according to number 1010 three times within a year. Additional services can be provided as so-called demand services in accordance with § 1 Paragraph 2 GOZ, i.e. H. at the express request of the patient. Demand benefits are often subject to a benefit exclusion in private health insurance contracts , so that the patient cannot expect any reimbursement for them.
GOZ 1000 Creation of an oral hygiene status
Creation of an oral hygiene status and detailed instruction on the prevention of caries and periodontal diseases, duration at least 25 minutes.
GOZ 1010 control
Control of the exercise success including further instruction, duration at least 15 minutes.
GOZ 1020 Local fluoridation
Local fluoridation to improve the hard tooth structure, to prevent and treat caries, with varnish or gel, per session. The services include the collection of oral hygiene indices, staining of teeth, practical instruction with individual exercises and motivating the patient. The service according to number 1020 is billable a maximum of four times within a year.
GOZ 1030 Local application of drugs
Local application of medication to prevent caries or initial caries treatment with an individually manufactured splint as a medication carrier, per jaw. The manufacture of an individual splint as a medicament carrier (e.g. deep-drawn splint) is separately billable. The fee covers the cost of the drug used. The use of a ready-made spoon as a medicament carrier does not fulfill the content of the service according to number 1030. If an individually manufactured splint is used as a medicament carrier for fluoridating agents, the more than four-time calculation of the service according to number 1030 within one year must be justified in the invoice.
GOZ 1040 Professional teeth cleaning
The service of professional tooth cleaning includes the removal of supragingival / gingival plaque on tooth and root surfaces including cleaning of the interdental spaces, removal of the biofilm , surface polishing and suitable fluoridation measures, per tooth or implant or pontic .
GOZ 2000 sealing
Sealing of caries-free tooth fissures with hardening plastics, also smooth surface sealing, per tooth
GOZ 4050, GOZ 4055 Removal of hard and soft plaque
GOZ 4050 Removal of hard and soft plaque , if necessary including polishing on a single-rooted tooth or implant, also pontic
GOZ 4055 Removal of hard and soft plaque, if necessary including polishing on a multi-rooted tooth
The services according to numbers 4050 and 4055 are for the same tooth within 30 Days only billable once.
GOZ 4060 check after removal of hard and soft plaque
Check after removal of hard and soft plaque or professional tooth cleaning according to GOZ number 1040 with post-cleaning including polishing, per tooth or implant, including bridge pontic
The service under number 4060 is not billable in addition to the services under numbers 1040, 4050 and 4055.
See also
Individual evidence
- ↑ Joint Federal Committee, Guidelines on Measures to Prevent Dental Diseases (Individual Prophylaxis) (PDF; 45 kB)
- ↑ Assessment standard for dental services (BEMA) ( Memento of the original from September 10, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 322 kB)
- ↑ Afraid of the dentist? Germans do not care enough about dental care ( memento of the original from September 19, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Press release Barmer GEK, September 16, 2016. Accessed September 19, 2016.
- ↑ Three additional early detection examinations and enamel hardening measures for the smallest of the little ones , National Association of Statutory Health Insurance Dentists, January 17, 2019, accessed on January 21, 2018.
- ↑ Prophylaxis for small children is moving more and more into the focus of the dentistry Kassenzahnärztliche Vereinigung Bayerns , kzvb-Transparent
- ↑ Avoid early childhood caries. A concept for dental prevention in young children , KZBV
- ↑ Schedule of Fees for Dentists , Federal Dental Association . Retrieved April 7, 2017.
