Professional tooth cleaning

from Wikipedia, the free encyclopedia
Tartar removal using ultrasound as part of a PZR
Scaling as part of a PZR
Cleaning the interdental spaces with an interdental brush
Polishing the teeth as part of a PZR
Fluoridation of teeth
Professional teeth cleaning for dolphins

The Professional tooth cleaning (PZR) or Professional Medical tooth cleaning (PMZR) is a main component of the dental prophylaxis , mostly of the individual prophylaxis . It is understood as a comprehensive mechanical cleaning of the teeth, which eliminates the deficits in daily oral hygiene.

indication

After one to two days, a layer of plaque or biofilm forms on the teeth of every mouth . This biofilm consists of billions of bacteria that develop a lively metabolism. Isolated carbohydrates are used and acids and cell toxins are excreted. These aggressive substances cause tooth damage ( dental caries ) and inflammation of the gums ( gingivitis ) up to and including bone loss ( periodontitis ). Even with thorough dental care, many patients fail to reach all the gaps and niches in the oral cavity and thereby remove these bacteria.

Regular thorough cleaning of the dentition is essential, especially in older patients, because the gums recede. This increases the surface of the teeth exposed to plaque and bacteria. Furthermore, the dexterity decreases with age , which reduces the quality of the daily cleaning technique . In addition, the metabolism changes unfavorably in old age, for example due to chronic diseases or medication , which increases the susceptibility to tooth decay and periodontitis.

Pre- and aftercare

The dental scientific societies recommend prevention through regular professional tooth cleaning. It should be done every six to twelve months. The frequency of preventive care is determined by numerous factors. Studies show that place of residence and lifestyle have a decisive influence on dental health. Therefore, a rigid 12-month cycle is not necessary for all patients. In the case of caries-active teeth or previous periodontal damage, a PZR should be performed every three to six months.

As maintenance therapy after periodontal treatment ( supportive periodontal therapy ) , regular PZR is indicated in order to preserve the treatment result. In these high-risk patients, the frequency of PZR may be increased depending on the periodontal condition.

effectiveness

In several more than 30 years of classic studies, Per Axelsson from Sweden , among others , demonstrated in the 1980s that regular systematic teeth cleaning can greatly reduce the risk of periodontitis and tooth decay and thus the likelihood of illness. Axelsson and numerous other studies confirm the long-term success of systematic caries and periodontal prophylaxis. In individual statements from health insurance companies, the scientific quality of studies examining the effectiveness of PZR was not classified as particularly high in the past. Another study states that a PZR without simultaneous oral hygiene instruction from the dentist or the prophylactic assistant cannot have any effect. A side effect is that the teeth become lighter, because even the smallest point-like discoloration on teeth makes the dentition appear darker.

execution

The PZR is carried out by the dentist or by trained specialists, such as dental prophylaxis assistants (ZMP), dental specialist assistants (ZMF) or dental hygienists (DH). As a rule, the PZR includes the complete removal of hidden, soft and mineralized plaque above ( tartar ) and below ( concrement ) the gums. The named assistant professions are only allowed to remove these deposits if they are clinically visible and accessible. Otherwise they are reserved for the dentist.

The cleaning is done with hand instruments ( scaler ), sandpaper strips, brushes, dental floss and ultrasonic devices . Any remaining discoloration and deposits on tooth surfaces (also on dentures and tooth crowns ) can then be removed using powder blasting devices. Similar to sandblasting , a heated mixture of air, water and a special cleaning salt blows the coverings out of every space and every furrow ( fissure ). The teeth are then polished with a rotating rubber cup or a rotating small brush using increasingly finer abrasive prophylactic pastes in order to smooth the tooth surfaces and make it more difficult to re- attach plaque . Finally, to protect the enamel, all tooth surfaces are treated with a special fluoride varnish . In rare cases, with particularly sensitive teeth, professional teeth cleaning can be carried out under local anesthesia .

In children and adolescents undergoing orthodontic treatment, the arches and all additional parts are removed for a PZR and reinserted after the treatment is complete.

costs

The costs for a PZR amount to around 35 to 150 euros, depending on the number of teeth, effort and design. With the entry into force of the amendment to the fee schedule for dentists (GOZ) on January 1, 2012, according to fee item 1040, with average expenditure (2.3 times the factor), 3.62 euros per tooth will be charged.

While some private health insurers usually cover these costs, other private insurers refuse reimbursement on the grounds that the PZR is a prophylactic measure. This is excluded from reimbursement. According to the opinion of the dental associations, the rejection of reimbursement as a prophylactic measure or as a non-medically necessary service is not legally compliant. People with statutory health insurance must initially bear the costs of a PZR themselves. The National Association of Statutory Health Insurance Dentists has been conducting annual surveys among statutory health insurers since 2016 as to whether and to what extent they subsidize professional tooth cleaning, but only around 30% of health insurers respond to the survey. Some additional dental insurances for those with statutory health insurance cover the costs partially or completely, depending on the tariff. According to Stiftung Warentest, more than two thirds of the health insurance companies offer grants for professional teeth cleaning once or twice a year as an extra service. They are between 10 euros and 300 euros per year.

criticism

The IGeL monitor of the MDS (Medical Service of the Central Association of Health Insurance Funds) rates the PZR as “unclear”, as the scientists did not find any reliable study in their systematic literature research that would prove a benefit. Damage is not to be expected. 47 of 49 statutory health insurance companies that took part in a survey by the National Association of Statutory Health Insurance Dentists (KZBV) nevertheless make voluntary contributions to the PZR. Only two health insurance companies stated that they did not make any contributions to the PZR. It is not known to what extent the health insurance companies that did not take part in the survey make subsidies for the PZR. The AOK states on its website: “Regular professional tooth cleaning (PZR) can stop or slow down gum disease in periodontal disease. In addition, discolorations on the teeth that arise, for example, from tea, coffee or smoking, can be removed. The PZR supports dental care, but does not replace it. ” The Bundesinnungskrankenkasse Gesundheit warns on their side that complications can arise in immunocompromised people due to the exposure of further bacteria.

According to a meta study by the Cochrane Collaboration , professional tooth cleaning (in adults without severe periodontitis) has little or no effect on gingivitis, the probing depth (as a parameter for the health of the gums) and the dental health-related quality of life (in each case with a high quality of the evidence). Little or no effects were also found with regard to plaque, although the evidence is of low quality. Further information is expected from the large-volume INTERVAL study, the results of which should be available at the end of 2019 [out of date] .

Situation in other countries

United States

In the United States established dentists are always working with a salaried dental hygienists ( dental hygienist ) together. Instead of going to the dentist for six-monthly check-ups, Americans go to their teeth cleaning twice a year. In the course of this, the dental hygienist will also conduct a thorough examination, so that if problems such as tooth decay or gingivitis are easy to diagnose, they are usually the first to detect them and notify the dentist. In most practices, the examination and teeth cleaning is usually followed by an examination by the dentist.

The costs, which are around US $ 100 per treatment in the USA, are mostly covered by dental insurance companies; however, many Americans have no dental insurance coverage whatsoever.

The profession of dental hygienist in the USA is mostly practiced part-time and almost exclusively by women. The professional requirement is at least two years of specialist study at the college; Occasionally, four- and six-year courses are also offered. The largest professional association of American dental hygienists, the American Dental Hygienists' Association , has more than 150,000 members. In 2006, 167,000 dental hygienists were employed nationwide , most of them in the practices of private dentists.

See also

Portal: Dentistry  - Overview of Wikipedia content on dentistry

literature

Web links

Individual evidence

  1. ↑ B. Curtis, RW. Evans, A. Sbaraini, E. Schwarz: Geographic location and indirect costs as a barrier to dental treatment: a patient perspective . In: Australian Dental Journal . Vol. 52, No. 4 , 2007, p. 271-275 , doi : 10.1111 / j.1834-7819.2007.tb00501.x , PMID 18265681 .
  2. ↑ P. Axelsson, J. Lindhe: Effect of controlled oral hygiene procedures on caries and periodontal disease in adults . In: Journal of Clinical Periodontology . tape 5 , 1978, p. 133-151 .
  3. ↑ P. Axelsson, B. Nyström, J. Lindhe: The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. In: Journal of clinical periodontology. Vol. 31, number 9, September 2004, ISSN  0303-6979 , pp. 749-757. doi: 10.1111 / j.1600-051X.2004.00563.x . PMID 15312097 .
  4. ↑ Bastendorf, Laurisch: Long-term successes of systematic caries prophylaxis. DZZ 09/2009, pp. 548-557
  5. ^ Hellwig in Federal Health Gazette 2011, Vol. 54, pp. 1015-1021
  6. ↑ CM Bollen, BN Vandekerckhove, W. Papaioannou, J. Van Eldere, M. Quirynen: Full- versus partial-mouth disinfection in the treatment of periodontal infections. A pilot study: long-term microbiological observations. In: Journal of clinical periodontology. Vol. 23, number 10, October 1996, pp. 960-970, ISSN  0303-6979 . PMID 8915027 .
  7. ↑ M. Quirynen, H. Zhao, C. Soers, C. Dekeyser, M. Pauwels, W. Coucke, D. v. Steenberghe: The impact of periodontal therapy and the adjunctive effect of antiseptics on breath odor-related outcome variables: a double-blind randomized study. In: Journal of Periodontology . Vol. 76, number 5, May 2005, pp. 705-712, ISSN  0022-3492 . doi: 10.1902 / jop.2005.76.5.705 . PMID 15898930 .
  8. ↑ WB Kaldahl, KL Kalkwarf, KD Patil, MP Molvar, JK Dyer: Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. In: Journal of periodontology. Vol. 67, Number 2, February 1996, pp. 93-102, ISSN  0022-3492 . doi: 10.1902 / jop.1996.67.2.93 . PMID 8667142 .
  9. ↑ Dagmar Lühmann / Pantelis Petrakakis: Professional tooth cleaning. In: tk-online.de. March 10, 2014, accessed on August 9, 2014 (website of Techniker Krankenkasse).
  10. ↑ Richard Niederman: Little value in providing professional mechanical plaque removal without oral hygiene instruction. In: nature.com. 2006, accessed on August 8, 2014 (article from Evidence-Based Dentistry (2006) 7, 69–70. Doi: 10.1038 / sj.ebd.6400426 printed / published online in nature).
  11. ^ The reimbursement of the professional tooth cleaning Dental Chamber North Rhine.
  12. ↑ Subsidy for professional teeth cleaning , National Association of Statutory Health Insurance Dentists. Retrieved April 13, 2017.
  13. ↑ [KZBV_PZR-grant_Krankenkassen_2017-04-13.pdf grant health insurance], National Association of Statutory Health Insurance Dentists, as of April 13, 2017. Accessed on April 13, 2017.
  14. ↑ Reimbursement of PZR additional dental insurance on www.versicherung-online.net .
  15. ↑ Tooth cleaning: Which fund pays how much. In: Stiftung Warentest. December 17, 2013, accessed on August 9, 2014 (report on an investigation in Finanztest 01/2014).
  16. ↑ Effectively prevent periodontitis with the TruDent. (No longer available online.) Archived from the original on August 12, 2014 ; Retrieved August 9, 2014 . 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. @1@ 2Template: Webachiv / IABot / www.tk.de
  17. ↑ Professional teeth cleaning at BKK BMW. Retrieved August 9, 2014 .
  18. ↑ Subsidy for professional teeth cleaning ( Memento of the original from August 10, 2014 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. AOK Plus @1@ 2Template: Webachiv / IABot / www.aokplus-online.de
  19. ↑ Evaluation of professional teeth cleaning. In: IGeL-Monitor. Retrieved October 11, 2018 .
  20. ↑ Subsidy for professional teeth cleaning. National Association of Statutory Health Insurance Dentists, accessed on November 2, 2018 .
  21. ↑ Professional teeth cleaning. AOK Baden-Württemberg, accessed on February 9, 2019 .
  22. ↑ Professional teeth cleaning - great teeth with the BIG | BIG direct healthy. Retrieved July 25, 2019 .
  23. ↑ Lamont T, Worthington HV, Clarkson JE, Beirne PV: Routine scale and polish for periodontal health in adults . In: Cochrane Database of Systematic Reviews . No. 12 , 2018, doi : 10.1002 / 14651858.CD004625.pub5 (English, Art. No .: CD004625).
  24. ↑ Beatriz Goulao: Scale and polish? Shining a light on routine dental care. In: evidentlycochrane.net. January 25, 2019, accessed February 9, 2019 .
  25. ↑ American Dental Hygienists' Association website .