Tartar
As tartar fixed deposits is referred to on the tooth can be removed by rinsing or by brushing, which can not. Tartar is created by the storage of inorganic substances (especially calcium and phosphate compounds) from the saliva in the plaque (soft plaque). A particularly large amount of tartar develops in the area of the ducts of the salivary glands .
composition
Tartar consists of apatite (Ca 5 [F (PO 4 ) 3 ]), hydroxyapatite (Ca 5 [OH (PO 4 ) 3 ]), brushite (Ca [PO 3 (OH)] · 2 H 2 O), whitlockite ( Ca 9 (Mg Fe II ) [PO 3 (OH) | (PO 4 ) 6 ]), proteins and carbohydrates .
Emergence
The inorganic substances in saliva have a physiological function. They allow the tooth enamel to regenerate to a limited extent, for example if the tooth has been etched by eating acidic foods such as citrus fruits. The etched tooth enamel is remineralized by the minerals in the saliva. But the minerals also penetrate the dental plaque. Dental plaque, on the other hand, only occurs in places that have not been adequately cleaned. Within a few days the plaque is mineralized and hardened to such an extent that it can no longer be removed by the usual daily tooth cleaning. Tartar is therefore a mineralized plaque. Tartar itself does not lead to periodontal disease ; The living plaque bacteria adhering to the rough surface are responsible for this. Where there is no plaque, there can be no tartar.
The submandibular gland (mandibular salivary gland ) and the sublingual gland ( sublingual gland) open out via the sublingual gland in the floor of the mouth next to the frenulum on the inside of the mandibular incisors. The duct parotid duct of the parotid gland (parotid gland) opens at the cheek on the outside of the maxillary molars .
Salivary glands:
1 parotid
gland 2 submandibular gland
3 sublingual gland
Caruncula sublingualis, opening of the mandibular salivary gland and the sublingual salivary gland
Gingival sulcus. A = tooth crown, B = tooth root, E = gingiva
The formation of tartar at these predilection sites is due to the high concentration of inorganic components in saliva in the ducts. The rough surface of the tartar forms a retention surface for further plaque, which is subsequently also mineralized. Tartar is created in layers. Tartar can develop on all teeth over a long period of time.
Concrements
Tartar, which rests subgingivally (below the gum line ) on the surface of the root, has a dark brown-gray color. Such deposits are called calculus . The mineral components of the concretions do not arise from the minerals of the saliva, but from components of the blood serum and other components of the sulcus fluid (liquid in the gingival pocket).
Phases of tartar formation
There are four phases in tartar formation:
- Formation of an enamel cuticle
- Initial microbial colonization by spherical bacteria
- Fusion of the bacterial colonies by spherical and rod-shaped bacteria
- Dental plaque mineralization
Tartar removal
Tartar can be removed mechanically with hand instruments ( scalers , curettes ) or mechanically e.g. B. removed with ultrasound equipment . Ultrasound devices remove the tartar using a metal tip that vibrates at high frequencies and is guided over the surface of the tooth with minimal pressure. The vibration of the metal tip generates heat that is dissipated with water. The removal of tartar is followed by polishing the teeth with fine rotating brushes and polishing paste in order to smooth any remaining rough tooth surface with tartar residues, as these, as crystallization points, favor renewed tartar formation.
Scaler - a hand instrument for removing tartar
Ultrasonic instrument for removing tartar (center)
Metal tip of the ultrasonic device (opening for the water outlet)
Advanced tartar on a human's lower front teeth
Delegability
The removal of tartar is considered a service that can be delegated to appropriately qualified staff in accordance with Section 1, Paragraphs 5 and 6 of the Dentistry Act (ZHG). These include the health professions such as dental prophylaxis assistant (ZMP), dental assistant (ZMF) or the dental hygienist (DH).
Side effects of removal
Endocarditis prophylaxis
In high-risk patients suffering from inflammation of the endocardium (inner lining of the heart), endocarditis prophylaxis and the like is recommended . a. Necessary for dental interventions to avoid bacteremia (bacteria floating in the blood), which is unavoidable when removing tartar. Endocarditis prophylaxis takes place by taking antibiotics before the actual treatment.
Ultrasonic
Since, on the one hand, the vibration is transmitted to the tooth and irritates it (or its nerves) and, on the other hand, the gums can be mechanically irritated, the removal of tartar using ultrasound is perceived by more sensitive patients as uncomfortable to painful. Some patients are bothered by the accompanying noises that reach down into the audible range.
Tooth loosening
Some patients notice a loosening of their teeth after a tartar removal, especially the lower front teeth, and attribute this to the tartar removal. The loosening of the teeth, however, was caused by the periodontitis indirectly caused by the tartar, which the patient has not noticed until now, as the teeth were held together by the tartar. With the tartar removal, the "blocking" of the teeth was broken. If the periodontitis is not very advanced, the teeth will strengthen again after a relatively short time. Otherwise, further measures, such as periodontal treatment or splinting of the teeth, are necessary.
Temperature sensitivity
Tartar has an insulating function on the teeth. They become more sensitive in order to be able to perceive cold and warm stimuli, for example, through the tartar. After a tartar removal, the teeth are initially oversensitive, as the teeth first have to get used to a condition without the "insulating layer" of the tartar.
Historical meaning
As part of a study, it was possible to isolate and decipher large amounts of genetic material from medieval tartar of a thousand-year-old skeleton . It is tartar from a man who lived in the Dalheim monastery (Lichtenau) in the Middle Ages . Substantial parts of the genome of a periodontal bacterium could be reconstructed, whereby genetic material of food components was found for the first time, including 40 opportunistic pathogens and antibiotic resistance genes. The genome reconstruction of the periodontal pathogen Tannerella forsythia was successful . In addition, 239 bacterial and 43 human proteins were discovered. The discovery paves the way to a better understanding of tooth and gum disease and shows how the human oral flora and common diseases have developed and adapted in human evolution .
Reimbursement by health insurance companies
Germany
Since 2004, the statutory health insurances have reimbursed the cost of tartar removal (according to the assessment standard of dental services : Zst, fee number 107; 16 points; corresponds to around € 14.20 - as of 2013), only once per calendar year. Some health insurances make a voluntary grant for professional teeth cleaning . Private health insurances reimburse the removal of tartar as often as necessary according to the fee schedule for dentists (GOZ), fee number 4050 or 4055.
Austria
In Austria, the removal of tartar is covered by health insurance companies.
Switzerland
In Switzerland, dental treatments are usually fully paid for by the patient himself.
Tartar in dogs
Tartar is particularly common in dogs on the necks of the canines, fangs, and molars of the upper jaw. It can accumulate both on the enamel and under the gums in the gum pockets. Tartar is gray-greenish to brownish in color and has a firm texture. If a dog has tartar, this is also noticeable by a foul smell from the oral cavity. New plaque accumulates on the rough surface of the tartar in a short time, which can lead to gingivitis due to the bacteria and germs it contains. Inflammation and bleeding of the gums as well as a dog's reluctance to eat are further indications of tartar.
When cleaning the teeth, a toothbrush with soft to medium-hard nylon bristles should be used, the size of which fits the individual tooth region of the animal. A toothpaste suitable for animals is applied to this brush and pressed as deep as possible into the bristles with the finger so that the animal does not lick the toothpaste off before cleaning. Toothpastes for humans are not suitable for cleaning animals' teeth because they contain fluoride and foam-forming substances. The animal could swallow them while cleaning their teeth and have stomach problems. In dogs, teeth should be cleaned once a day. In order to be able to do this, the dog has to be introduced gradually to the procedure over several weeks with a lot of patience so that it can run stress-free. Daily teeth cleaning can also be carried out with a quietly running electric toothbrush as soon as the dog has got used to the vibration.
With a professional dental cleaning by the veterinarian, the dog is given a light anesthetic . The vet can remove the tartar either with hand instruments ( scaler ) or with an ultrasound device.
Web links
Individual evidence
- ↑ Philip Marsh, Michael V. Martin: Orale Mikrobiologie . Thieme, Stuttgart 2003, ISBN 3-13-129731-X , p. 86.
- ↑ a b c d Klaus-Dieter Hellwege. The practice of dental prophylaxis: a guide to individual prophylaxis, group prophylaxis and initial periodontal therapy . Georg Thieme Verlag; 2003. ISBN 978-3-13-127186-0 , p. 34.
- ↑ G. Klinger: Sulcus fluid flow rate in relation to hormonal influence. In: Stomatology of the GDR. Volume 32, Number 1, January 1982, pp. 53-55, ISSN 0302-4725 . PMID 7043801
- ↑ Endocarditis prophylaxis: only for high-risk patients .
- ^ Rainer Buchmann. Patient-friendly periodontics . Georg Thieme Verlag; November 24, 2010. ISBN 978-3-13-162431-4 . P. 14.
- ↑ Ch. Warinner, J. Matias Rodrigues a. a .: Pathogens and host immunity in the ancient human oral cavity. In: Nature Genetics. 2014, S., doi : 10.1038 / ng . 2906 .
- ↑ Fee schedule for contract dentists. Status: January 1, 2015, item no. 20 and line 10 of the Erl.
- ^ Markus Eickhoff. Dentistry, oral and maxillofacial medicine for small animals and pets . Georg Thieme Verlag; 2005. ISBN 978-3-8304-1038-6 . P. 108.
