What are the advantages and disadvantages of professional teeth-cleaning?
Many dentists offer professional teeth-cleaning for the prevention of tooth decay and gum disease. It can also be done after treatment for periodontitis in order to prevent the inflammation from returning. But there is currently no evidence that professional teeth-cleaning achieves these goals any better than the standard dental check-ups and treatments do.
The aim of cleaning your teeth thoroughly is to remove the sticky bacterial film known as plaque from all of your tooth surfaces. The bacteria and their waste products can attack the teeth and gums, causing tooth decay or a gum inflammation (gingivitis). If left untreated, gingivitis can develop into periodontitis over time. In periodontitis, the inflammation has spread to the soft tissues and bone that support the teeth (the periodontium).
You can sometimes feel plaque when you run your tongue over your teeth: The surface of the teeth might feel “furry” or rough. You can remove plaque yourself by regularly and thoroughly brushing your teeth and cleaning the gaps between your teeth. If plaque isn’t removed properly, it can turn into a hard substance known as tartar (calculus). Tartar can only be removed by a dental professional, for instance during a check-up appointment. This is also known as “scaling.” In Germany, the costs of removing tartar are covered by statutory health insurers once a year in general, and twice a year in people who are in need of nursing care or have a disability.
In addition to removing tartar as part of the standard check-ups, dentists offer professional teeth-cleaning in their practice. There are two possible aims of this procedure:
- In people who have a healthy mouth, the aim is to help prevent tooth decay and gum disease.
- In people who have periodontitis, the aim is to increase the chances of successful treatment and prevent the inflammation from returning after treatment.
Professional teeth-cleaning involves “scaling and polishing” your teeth: The dentist removes plaque and tartar, as well as stains from coffee, black tea or smoking. But no good-quality studies have proven that professional teeth-cleaning has any advantages. It isn’t generally covered by statutory health insurers in Germany, so you normally have to pay for it yourself.
Does it make sense to have professional teeth-cleaning for preventive purposes?
In Germany, statutory health insurers cover the costs of having tartar removed. Children and teenagers below the age of 18 – and people who are in need of nursing care or have a disability – can also have free patient education to learn how to clean their teeth and gums properly.
It’s currently not possible to say whether professional teeth-cleaning prevents tooth decay, gingivitis and periodontitis more effectively than the standard scaling (tartar removal) does. There are no suitable studies in this area.
What role does professional teeth-cleaning play in periodontitis?
Tartar removal and good oral hygiene are very important in the treatment of periodontitis. Before the actual treatment is started, dentists often recommend combining professional teeth-cleaning and patient education to ensure good oral hygiene and reduce very severe inflammations somewhat. After the treatment, this combination is recommended in order to prevent the inflammation from coming back.
But there’s no suitable research on the potential advantages of professional teeth-cleaning in the treatment of periodontitis. So it’s not possible to say whether the combination of professional teeth-cleaning and patient education before or after periodontitis treatment can prevent the progression of the disease any better than the standard tartar removal can.
Does professional teeth-cleaning have other advantages?
Some people think that professional teeth-cleaning will give them brighter teeth and keep the necks of their teeth (the part closest to the gums) cleaner. But if you carry on drinking coffee or black tea, or if you continue smoking, your teeth might be stained again within a few weeks.
It's sometimes claimed that professional teeth-cleaning fights bad breath too. Only a few studies have looked into this, though, and they are of poor quality. So their results aren’t reliable enough to prove that professional teeth-cleaning can prevent bad breath.
Could professional teeth-cleaning have disadvantages too?
There’s no research on potential long-term side effects of professional teeth-cleaning. So it’s not clear whether, for instance, it makes the teeth more sensitive over time, or damages the gums or the surfaces of the teeth.
Like the removal of tartar, professional teeth-cleaning can be unpleasant – especially if the necks of the teeth are exposed. If the gums are already irritated or inflamed, they are likely to bleed during the procedure. Because of this, it’s important to let the dentist know beforehand whether you are taking blood-thinning medication such as acetylsalicylic acid (the drug in medicines like Aspirin).
What does professional teeth-cleaning involve?
Professional teeth-cleaning can include several steps: cleaning, polishing and a fluoride treatment. The dentist or dental hygienist might also offer to show you how to clean your teeth properly yourself.
The first step is scaling, where plaque and tartar are removed – also from hard-to-reach areas between the teeth and at the edges of the gums. This is done using things like ultrasound devices and hand-held instruments (called scalers or curettes). The gaps between the teeth are cleaned using dental floss, special dental sandpaper or small brushes. Some dental practices also use a jet of water and powder to clean the teeth and remove stains too.
After the teeth have been cleaned, they are polished. This is done using a special paste on the rotating head of a hand-held instrument. The head is made out of rubber or a small brush. The polishing smooths the surface of the teeth, making it harder for bacteria to stick to them.
At the end, the teeth are usually covered in a fluoride gel or varnish to protect and strengthen the enamel.
Professional teeth-cleaning can take about 45 to 60 minutes. It is carried out by a dentist or a specially trained dental professional (dental hygienist). Dental hygienists are allowed to remove visible and easy-to-reach tooth deposits. If someone has particularly sensitive teeth, they can be given a numbing injection before having their teeth cleaned professionally.
How much does professional teeth-cleaning cost?
This procedure isn’t generally covered by statutory health insurers in Germany. It usually costs between about 80 and 120 euros.
A number of statutory health insurers cover a part of the costs, though, and some even cover all of the costs. Most additional dental insurances (Zahnzusatzversicherungen) that supplement statutory health insurances cover some or all of the costs, too.
Bundeszahnärztekammer (BZÄK), Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK). Patienteninformation: Professionelle Zahnreinigung (PZR). February 2013.
Gemeinsamer Bundesausschuss (G-BA). Richtlinie des Gemeinsamen Bundesausschusses für eine ausreichende, zweckmäßige und wirtschaftliche vertragszahnärztliche Versorgung (Behandlungsrichtlinie). March 1, 2006.
Gemeinsamer Bundesausschuss (G-BA). Richtlinie des Gemeinsamen Bundesausschusses über die Früherkennungsuntersuchungen auf Zahn-, Mund- und Kieferkrankheiten (zahnärztliche Früherkennung gemäß § 26 Absatz 1 Satz 5 und Absatz 2 Satz 5 SGB V) (FU-RL). January 17, 2019.
Gemeinsamer Bundesausschuss (G-BA). Richtlinie des Gemeinsamen Bundesausschusses über Maßnahmen zur Verhütung von Zahnerkrankungen bei Pflegebedürftigen und Menschen mit Behinderungen (Richtlinie nach § 22a SGB V). July 1, 2018.
Gemeinsamer Bundesausschuss (G-BA). Richtlinien des Bundesausschusses der Zahnärzte und Krankenkassen über Maßnahmen zur Verhütung von Zahnerkrankungen (Individualprophylaxe). June 4, 2003.
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Assessment of the systematic treatment of parodontopathies; Commission N15-01. March 5, 2018. (IQWiG reports; Volume 602).
Kassenzahnärztliche Bundesvereinigung (KZBV). Mundgeruch.
Kassenzahnärztliche Bundesvereinigung (KZBV). Professionelle Zahnreinigung.
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