Protecting teeth from caries (tooth decay) and periodontitis (inflammation of the periodontium) well into old age is a feasible goal if prophylactic (preventive) measures such as consistent home dental care and regular professional dental cleaning (PZR) at the dentist go hand in hand. Home oral hygiene makes areas such as the interdental spaces (spaces between teeth) and the retromolar spaces (behind the last molars) much more difficult to cover than the chewing, outer and inner surfaces of the teeth. However, if plaque (microbial plaque) accumulates over a period of several days, gingivitis (inflammation of the gums) is the result, which in turn can turn into periodontitis if it continues chronically for a longer period of time. In addition, cariogenic bacteria in plaque jeopardize dental health by causing caries. While gingivitis can be reversed by improved and ambitious brushing techniques, this is of no further help once plaque has hardened into tartar (above the gum line) or even calculus (tartar below the gum line) due to mineral deposits. Solid color deposits, which are formed when drinking coffee, tea, nicotine or the like, are also difficult to remove with home oral hygiene techniques. This is where professional tooth cleaning (PZR) comes in, which is usually performed in the dental practice by trained specialists (dental prophylaxis assistant, dental assistant, dental hygienist). The combination of good dental hygiene and PZR can effectively prevent caries (tooth decay, bacterial destruction of the hard tooth substances), gingivitis (inflammation of the gums) and periodontitis (inflammation of the tooth bed) for life. Professional dental cleaning (PZR) includes:
- The removal of soft and hard plaque on the enamel and possibly exposed tooth roots supragingival or gingival (above or in the area of the gum line).
- Cleaning the interdental spaces (interdental spaces).
- Removing the biofilm (the plaque, microbial plaque).
- The surface polishing of the teeth
- Appropriate local (local) fluoridation measures to protect against caries.
- Oral hygiene training/exercises and/or use of oral hygiene aids.
Indications (areas of application)
PZR is used for:
- To remove supragingival calculus (above the gingival margin) and calculus in the clinically accessible subgingival area (in the upper area of the gingival pocket).
- For the therapy of bacterial gingivitis.
- For the removal of deposited tooth discoloration
- For halitosis (bad breath)
- As part of an initial periodontal treatment (before more extensive measures to treat a periodontal inflammation).
- For maintenance therapy after treatment of periodontitis (periodontitis).
- In the context of a recall (a pre- or post-treatment).
The intervals of a recall (the follow-up appointments) are to be determined individually for each patient and are usually three to six months. In particular, if supportive periodontal therapy for long-term maintenance (UPT) after a successful periodontal therapy (treatment of periodontal inflammation, eg. surgically or with the Vector method), close-meshed recalls will be indicated to prevent the reattachment of subgingival calculus (calculus below the gingival margin in the gingival pockets) from the outset and to promote a shift in the bacterial composition in the biofilm toward apathogenic germs (without disease value).
Contraindications
Bleeding may occur during PZR, especially in the presence of gingivitis or periodontitis. Since the integrity of the gingival tissue is violated in this case, bacteremia (washing of germs into the bloodstream) is the consequence. This results in the following contraindications:
- Necrotizing and ulcerative gingivitis (NUG) and periodontitis (NUP): in this case, soft plaque is initially only dabbed extremely carefully with pellets soaked in chlorhexidine or hydrogen peroxide. The PZR takes place only after the acute symptoms have subsided.
- Blood clotting disorders or drug-induced bleeding tendency below a quick value (=Thromboplastinzeit = TPZ; blood clotting parameter) of 30 to 35%.In consultation with the attending physician, the value can be adjusted accordingly in advance, if necessary.
Relative contraindications
- Cardiac risk history (of the heart): here, in certain cases, antibiosis must be given for endocarditis prophylaxis (prevention of bacterial endocarditis).
- Weakened immune defenses: here, too, treatment may be possible under shielding by an antibiotic.
- Pacemakers of older design: here should be avoided during PZR due to possible interference effects on the use of magnetostrictive ultrasound devices (magnetostriction: deformation of magnetic substances) such as the Cavitron.
- Adolescent teeth with not yet completed enamel maturation: after tooth eruption, the enamel still needs a long period of time (about three years), depending on the oral environment, to reach its final hardness v. a. by storage of fluoride, phosphate and calcium ions from the saliva. In this phase, ultrasound, powder jet and polishing pastes can cause damage to the tooth structure.
- White Spots (less mineralized enamel at the onset of caries): again, the enamel does not have the necessary hardness to withstand the cleaning measures.
Before the procedure
- Intraoral inspection (observation of the oral cavity): before the procedure, if necessary, an oral hygiene status is established, which reproducibly documents the state of inflammation of the gingiva (the gums) and the plaque infestation of the teeth on the basis of so-called indices (= collection of bleeding and plaque index).
- By demonstrating bacterial plaque by means of colored plaque revelators (substances that color the plaque and thus make it more visible), the patient can be motivated in advance and specifically made aware of hygiene deficits.
- Takes place to protect against infection a disinfectant mouthwash (eg 30 seconds with 0.2% chlorhexidine) to reduce the bacterial count in the droplet spray that occurs during ultrasonic cleaning.
- If necessary, the dentist will recontour and polish excess filling margins and other plaque retention sites (sites where the microbial plaque can adhere particularly well due to morphology) in advance.
The procedures
- First, the teeth are freed from tartar with the help of ultrasonic oscillations (e.g. Vector Scaler) and /or classic hand scalers.
- Alternatively, there is the possibility of tartar removal with powder jet devices (e.g. Air-Flow system or ProphyFlex), which, however, are used particularly effectively for the removal of stubborn dark stains caused by food and stimulants such as coffee, tea, red wine or nicotine. The biofilm (plaque, microbial coatings) is also removed in this operation at the latest.
- (Supra)gingival plaque removal (below the gum): this is done, if necessary, by mechanical methods and with hand instruments.
- Polishing of tooth surfaces: Subsequently, the surface polishing of all tooth surfaces including the interdental spaces (interdental spaces) with nylon brushes and / or rubber particles, which are loaded with polishing pastes in descending abrasiveness (roughness).
- Finally, the teeth are treated with fluoride in the form of rinses, varnishes, gels or fluids for caries prophylaxis (prevention of tooth decay).
- Oral hygiene instruction: oral hygiene training/exercises and/or use of oral hygiene aids.
- Recall appointments: depending on the individual risk classification.
Possible complications
- Removal of firmly adherent calculus or calculus debris in hard-to-see areas such as root entrances can be problematic.
- In the event of incorrect use of cleaning instruments and materials such as coarse-grained polishing pastes or powder jet, the removal of tooth structure, especially if it is pre-damaged (initial caries, white spots) or not yet mature, cannot be ruled out.
- Metal surfaces (e.g. cast crowns and inlays) can lose their high gloss due to coarse-grained polishing pastes or powder jet.
- Ceramic veneers can be damaged by ultrasonic use.
- Composite fillings can be ablated by coarse-grained pastes or powder jet.
