Dentistry or dentistry (often equated with stomatology ), also known as dentistry, oral and maxillofacial medicine , is a medical specialty that includes the prevention, detection and treatment of diseases in the tooth , mouth and jaw area.
The specialty overlaps with oral and maxillofacial surgery and ear, nose and throat medicine , but also with other areas, as pathological changes in the oral cavity can affect the rest of the body. Conversely, many diseases (e.g. blood disorders , cancer , infections ) show symptoms , often as initial symptoms in the oral cavity. The forensic dentistry is used to identify corpses based on dentition.
The dentist acquires his license to practice the right to practice dentistry. He can work as a contract dentist , private dentist or as an employed dentist in a clinic or a dental practice. In contrast to the doctor, the dentist is not authorized to practice all of medicine, but is limited to his specialty .
Completed studies in human and dental medicine are required to acquire the specialist title of specialist in oral and maxillofacial surgery in Germany . The five-year specialist training can already be started while studying dentistry. With at least four years of further training , the field titles of specialist dentist for orthodontics , specialist dentist for oral surgery or dentist for public health can be acquired - as well as the specialist dentist for periodontology in the Westphalia-Lippe chamber area .
As early as 3000 BC Teeth were treated in the area of the Indus culture . The first verifiable dental interventions include primarily the therapy of toothache, but also the closing of gaps in the front teeth. In the sixteenth century BC , the Ebers papyrus from Egypt gave instructions on dental treatment, among other things. It was not just since the Middle Ages that people had the idea that a worm that eats its way through the tooth caused dental disease. Agonizing toothache is cured to 1829 with the cautery for cauterization of caries and the nerves . Most patients lost consciousness during this treatment . Arsenic paste was used to kill the exposed pulp (in layman's terms: nerve ) . This way the patient could be relieved of the pain . Also, ether , chloroform and nitrous oxide were known. Cocaine later supplemented the means for treating pain . In 1905 the later Hoechst AG brought the Novocain developed by Alfred Einhorn onto the market, which for a long time had a dominant position in local anesthesia (dentistry) .
The patron saint of dentists is St. Apollonia .
For centuries , frayed wooden sticks , sprinkled with alkaline ash , ginger , Bengal pepper or soaked in alum, were used to clean teeth. The first toothbrushes probably date from the early 16th century, often in the form of bony rods with stiff pig bristles attached to the front end. In the Middle Ages and the following centuries, teeth were not pulled by academically trained doctors , but by craftsmen, mostly bathers or, especially since the 14th century, "tooth breakers" or "tooth tears" who appeared as traveling healers. Specialists practiced their profession with the help of various instruments , but there were also barkers and charlatans whose main interest lay in making money and whose reputation was doubtful. Before the possibility of anesthesia (anesthesia) was the patient available or local anesthesia of his teeth was possible, the practitioner had to work very quickly.
Initially, the anamnesis takes place , the collection of the medical history in the form of a personal conversation between dentist and patient. General diseases can affect dental health and pose specific treatment risks. A nutritional questionnaire can also be completed to determine the individual risk of tooth decay .
This is followed by the intra- and extra- oral findings, the determination of the actual condition of the teeth, the periodontium ( gums ), the remaining oral mucosa , the masticatory muscles and the temporomandibular joints. In individual cases, the saliva flow rate is determined , which is recorded in documentation, the tooth status.
The recording of the condition of the teeth is referred to as tooth status . Missing teeth, replaced teeth, tooth decay, fillings, dentures including inlays , onlays , implants , gum diseases as well as misalignments of the teeth and other diseases in the tooth, mouth and jaw area are recorded in writing. In addition, photo documentation can be carried out using intra- and extraoral recordings. Diagnostics include checking the sensitivity of the teeth, if necessary x-rays using individual images , x-ray status , panoramic x-rays or digital volume tomography (DVT). Additional special diagnostic measures include the survey of the periodontal status and functional diagnostics . The latter enables the diagnosis of TMJ disorders and occlusion disorders (disorders of the clenching).
Dental prophylaxis deals with preventive measures that are intended to prevent the development or worsening of diseases of the teeth and the teeth supporting structure. In addition to general recommendations for caries prophylaxis, the dentist or a specialist who has been specially trained in prophylaxis or dental hygiene will provide guidance on the correct tooth brushing technique and carry out professional tooth cleaning . Generally good oral hygiene reduces the risk of tooth decay and the risk of secondary diseases of the teeth and the periodontium . Visits to the dentist at regular intervals are useful in order to be able to recognize and treat existing caries at an early stage and thus to minimize the consequential damage.
Conservative dentistry deals with tooth preservation and can be subdivided into:
Cariology and filling therapy
Cariology is the study of the causes, development and consequences of tooth decay . All factors that trigger demineralization processes are taken into account, for example the influence of food on the demineralization of teeth. When treating caries with a filling therapy , it is usually important to remove the tooth structure infected and destroyed by caries bacteria and to reconstruct the tooth with a filling material.
Periodontology is the study of the supporting structures of the teeth, the periodontium, its diseases and their treatment.
Dental surgery (oral surgery) includes surgical interventions: e.g. B. surgical tooth removal , periodontal surgery, surgical endodontics ( root tip resection ), implantology, the treatment of jaw fractures, tumors and cysts.
The dentist carries out minor interventions of this type under local anesthesia (local anesthesia). If he is not sufficiently experienced in surgery, he will refer major interventions to an oral surgeon or a specialist in oral and maxillofacial surgery .
Tooth loss can result from tooth decay, periodontitis or injuries . Replacing the missing teeth with bridges , full or partial dentures is the treatment area of prosthetics . The genetic failure of teeth ( hypodontia ) can make dentures necessary.
Orthodontics deals with the prevention, detection and treatment of misalignments of the jaws and teeth (tooth or jaw regulation) - popularly with braces.
Forensic dentistry is used to identify corpses individually by comparing their dentition ( teeth / jaw ) ante and post mortem (before and after death). It is used for victims of natural disasters, fire , aircraft , ship , train and traffic disasters as well as crimes . In addition, she deals with the allocation of bite marks, age diagnostics, with victims of abuse and in the broadest sense with treatment errors .
Ethnic dentistry deals with the teeth and oral health of indigenous cultures . Research into the various procedures for changing teeth and lips is also a relatively new field.
Disciplines related to dentistry
The trauma is the study of the injuries and wounds and their treatment. This includes the care of affected teeth, the jaw and the surrounding tissue.
Mouth, jaw, and facial surgery
Oral and maxillofacial surgery (maxillofacial surgery, also cranio-maxillo-facial surgery) is a medical specialty that includes diagnostics, therapy, prevention, functional (chewing, swallowing, speaking) and aesthetic rehabilitation for diseases, injuries, Including broken bones, malformations and changes in shape of the teeth, oral cavity, jaw and face.
It includes general dental surgery , the treatment of tumor diseases , diseases of the jaw and facial nerves and malformations . It includes diagnosis and therapy of inflammatory diseases , functional disorders and pain syndromes in the jaw and face area and dental implantology . Plastic-aesthetic operations, for example to restore after accidents or tumor operations, as well as purely cosmetic operations belong to this specialty.
The psychosomatic describes the relationship between the psyche and physical diseases in humans. In the dental field, for example, mental tension can be expressed in the form of nocturnal teeth grinding ( bruxism ). This can affect the functionality of the chewing apparatus, especially the teeth and the temporomandibular joint. Pain can also be felt more intensely in stressful psychological situations.
Dental treatment phobia is the phobia before dental treatment that has developed a small number of the population (called anxiety patients). Anyone who suffers from this phobia has such severe anxiety states in or in front of the triggering situation that these can manifest themselves in sweats, tremors, concentration disorders, loss of appetite and / or sleep disorders.
The most common causes of this particular phobia are traumatic experiences during treatment and (rarely) stories about such experiences. The consequences include pronounced avoidance behavior on the part of patients, which can go so far that they avoid the dreaded situation for decades and do not visit a dental practice. The condition of the teeth suffers from this, often also that of the gums, that of the rest of the oral mucosa and the tooth supporting structure. In addition to their phobia, many sufferers develop pronounced feelings of shame and suffer from it in everyday life due to an enormous impairment of their quality of life. The approaches to the therapy of the phobia and thus of the teeth are diverse. They range from behavior therapy to drug sedation, or a combination of both, to treatment under anesthesia. Contact persons are dentists, psychologists or psychiatrists.
Dental treatment costs
In a large-scale study from 2015, an international research project led by Heidelberg evaluated the global treatment costs and productivity losses as a result of dental diseases. According to this, dental diseases cost 442 billion US dollars annually (as of 2010).
In 2003 the statutory health insurance funds spent almost 11.8 billion euros on dental treatment and dentures.
The fees for dental treatments for statutory health insurance patients are determined in accordance with the assessment standard for dental services (BEMA), which defines the fee ratio between the individual services. The billing of additional services is set out in the fee schedule for dentists (GOZ) or in the fee schedule for doctors (GOÄ). In the fee schedule, the individual services are rated with points. Multiplying the points by a point value results in the respective fee.
As far as dental services by at legally insured dentists as benefits in kind are provided, the health insurance companies pay as medical treatment " in accordance with the general agreements to the respective dentists 'associations with the effect a compensation package for the entire contract dental care of members residing in the district of the dentists' association including family members who are also insured . ”(Section 85 (1) SGB V in conjunction with Section 72 (1) sentence 2 SGB V).
This total remuneration was divided between 2004 and 2011 in accordance with the fee distribution agreements (HVV), which had to be concluded by mutual agreement with the health insurance companies , among the dentists participating in statutory dental care (Section 85 (1) SGB V).
Since 2012, the fee distribution standard (HVM) has been set within the framework of the statutory autonomy of the statutory health insurance associations by their representative assemblies - in consultation with the health insurance companies. If there is a threat of exceeding the total remuneration limit, the fee distribution standard applies, which is designed differently depending on the KZV area. It forces either a fee reduction for the individual services (which may lead to reimbursement) or a decrease in the amount of services provided by the dentists.
In principle, the patient is the fee debtor. Invoices are only sent directly to those payers with whom the Swiss Dental Association has concluded contracts: B. statutory accident insurers UVG, IV, military insurance or the health insurers KVG. If social circumstances justify it, an application can be made to government or private organizations to cover part of the costs.
In Austria the right of free choice of doctor and dentist applies. If you have health insurance and are treated by a doctor with a health insurance contract, certain contractual services are free. There are exceptions if you are insured with a health fund that requires a deductible. For some services that go beyond the catalog of health insurance benefits, the health insurance company can grant a subsidy.
- History of the Dentist Profession
- Information and communication technologies in dentistry - Dental Informatics
- International Dental Show
- Legal aspects in the doctor-patient relationship see medical education , medical treatment , informed consent , Compliance (medicine) , personal injury and medical malpractice
- German Society for Dentistry, Oral and Maxillofacial Medicine
- Academy Practice and Science
- The World Oral Health Report 2003 . WHO , Geneva 2003
- Ernst Lautenbach (Hrsg.): Dictionary of dentistry. Tooth, mouth, jaw, face. Hanau 1992.
- Walter Hoffmann-Axthelm : Lexicon of dentistry . Quintessenz Verlag, Berlin 1974; 3rd edition ibid 1983 (and other editions, ISBN 3-87652-609-4 ).
- Gerhard Baader , Walter Hoffmann-Axthelm : The development of dental, oral and maxillofacial medicine in the European Middle Ages. In: Medical History Journal. Volume 6, 1971, pp. 113-159.
- Model professional regulations of the German Dental Association (PDF)
- Sample advanced training regulations - Orthodontics and Oral Surgery - of the German Dental Association (the advanced training regulations of the respective State Dental Association are binding) (PDF)
- Sample advanced training regulations - dentist for public health - of the Federal Dental Association (the advanced training regulations of the respective State Dental Association are binding) (PDF)
- KM Lehmann, E. Hellwig, H.-J. Wenz: Dental propaedeutics . Ed .: Deutscher Zahnärzte Verlag. 12th edition. Introduction to Dentistry. Cologne 2011, ISBN 978-3-7691-3569-5 , pp. 386 .
- regulations ( Memento of March 27, 2014 in the Internet Archive )
- regulations of the Westphalia-Lippe Dental Association .
- RJ Forshaw: The practice of dentistry in ancient Egypt. In: British Dental Journal 206, 481-486 (2009). Macmillan Publishers Limited, part of Springer Nature., May 9, 2009, accessed June 16, 2017 .
- Werner E. Gerabek : Dentistry. In: Werner E. Gerabek, Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 1518-1523; here: p. 1518.
- Liselotte Buchheim: The oldest toothworm text - in Babylonian cuneiform , Zahnärztliche Mitteilungen 54 (1964), pp. 1014-1018.
- cf. Heinz Nord: About local anesthesia, especially the local anesthetic Anaesthi-norm, Marburg, Med.Diss., 1937.
- See Klaus Rötzscher: Forensic Dentistry. Books on Demand, Norderstedt u. a. 2005, ISBN 3-8334-0372-1 .
- Cf. for example Gernot Huppmann: On the beginnings of dental psychology: work by Erich Stern (1898–1959), Wilhelm Balters (1893–1973) and Erich Heinrich (1895–1982). In: H.-G. Sergl, G. Huppmann, G. Kreyer (Hrsgg.): Yearbook of psychology and psychosomatics in dentistry. Volume 6, 1998, pp. 213-224.
- S. Listl, J. Galloway, PA Mossey, W. Marcenes: Global Economic Impact of Dental Diseases. In: Journal of Dental Research . 94, 2015, p. 1355, doi: 10.1177 / 0022034515602879 .
- Tooth and oral diseases, Chapter 1.2.7 [Health in Germany, 2006] ( Memento from September 28, 2015 in the web archive archive.today ), Federal Health Reporting. Retrieved September 28, 2015.
- Information for patients, Swiss Dental Association SSO
- Quality and price consumer