Professional Dental Cleaning in Practice and Clinic

The professional teeth cleaning (PZR) is an integral part of dental practice, and a large number of patients, both in the practice and in the clinic, schedule one or two visits for it firmly in their annual calendar. However, it seems to make no difference what is actually done during the PZR. It is important to clearly distinguish it from periodontal treatments and their aftercare. What are the differences between a PZR and supportive periodontal therapy (UPT)? The authors attempt to clarify this question in the following article.

What is a PZR? What does the dentist understand, and what does the patient understand by it? Is PZR the same as PZR, and how has it become synonymous with “Tempo^®” (a term for any kind of tissue)? Professional teeth cleaning includes the removal of biofilm from supragingival tooth and root surfaces, surface polishing, and fluoridation measures. It can be performed by the dentist or trained personnel. The term professional is aptly chosen, as it can be assumed that the cleaning of the teeth is carried out by professionals. However, it is not precisely described which hand, ultrasonic/sound instruments, polishing cups, or powder-water jet devices are best suited for the PZR.

The PZR can also be understood as wellness for the teeth. The deposits are removed, and this brightens the teeth. The fluoridation measures help make them more resistant to caries. By completely removing the biofilm, gingivitis is reduced after just a few days.

The PZR is often rightly understood as a preventive measure, but it can also be used as a pre-treatment for periodontal treatments. In this context, it serves not only wellness but also the elimination of existing superficial gum inflammation. Thus, the PZR can also be seen as a medically sensible and necessary component of dental treatment spectra.

PZR, PA Pre-Treatment and UPT/PA Recall

The PZR is a purely supragingival cleaning and has nothing in common with a PA therapy/UPT, which aims to remove subgingival deposits and attachments as well. If this difference is understood by the practice staff, it should be explained well and thoroughly to the patient. The authors of this article have experienced that there are often misunderstandings on the part of patients as well as in professional discussions among colleagues. In everyday life, the patient almost exclusively speaks of "PZR," and in the practice, the term is the universal word for both the classic PZR and the PA recall. This ultimately leads to a dilution of the term and often to confusion or even dissatisfaction. It is important to clearly differentiate between PZR, UPT, and PA treatment, as PA treatments and their follow-up are often more expensive. Moreover, these treatments are primarily medically initiated therapies, which are often not as pleasant for the patient compared to the PZR.

Due to an inaccurate delineation of the therapeutic methods, many colleagues feel attacked when it is said that the professional tooth cleaning (PZR) is not effective within the framework of periodontal therapy and its follow-up care. A better differentiation would help both patients and practices. The practice staff should pay close attention to whether a patient has an appointment for PZR or is presenting for periodontal therapy or its follow-up program. Likewise, the practitioner should clearly differentiate between PZR and UPT/periodontal treatments with the patient to ensure that the same topic is being discussed. The greatest effort lies in adequate and detailed information about the therapy necessary for each patient. Once this has been done, the foundation for future treatments is established, and misunderstandings do not arise.

Materials

The materials used for a professional tooth cleaning (PZR) vary greatly and depend heavily on the preferences of the respective practitioner. The most commonly used tools are ultrasonic and sonic instruments as well as various hand instruments to safely remove hard and soft deposits. There is no difference in effectiveness. Ultrasonic/sonic instruments or hand instruments (Fig. 1 and 2) can both be used gently and effectively. For polishing, there is a wide variety of pastes and brush heads, as well as different powders depending on the type of deposits present.

The selection of materials is very similar in practice and clinic. There are practices that only use powder-water jet devices (Fig. 3) during periodontal therapy to achieve a better differentiation between periodontal treatments and professional tooth cleaning (PZR). However, this is not a worse therapy. There are different types of powders: for the removal of supragingival deposits and for subgingival use. On one hand, there are sodium bicarbonate-based powders, which are abrasive and suitable for removing discolorations. On the other hand, powders such as glycine (amino acid) or erythritol (sugar substitute) are available, which serve to smooth the subgingival root surfaces. These are often used as a supplement in periodontal treatments and UPT.

Benefits for the patient

The teeth are cleaned very thoroughly during the professional dental cleaning appointments. By removing deposits, they are slightly brightened, and the patient feels good (Fig. 4 and 5). If he has any complaints, he can explain them during the longer sessions without time pressure. Often, a simultaneous check by the dentist is possible. Furthermore, the patient shows the practice that he attends regularly and takes his dental care seriously. Initial lesions can be observed for a longer time due to better compliance. Through regular appointments, the patient's dental health is brought to their awareness, and the risk of unexpected toothaches is kept as low as possible.

Advantages for the practice and the practitioner

Patients who regularly come for professional tooth cleaning have high compliance and place great value on their oral health. An initial caries does not need to be treated immediately but can be observed for a longer period. Patient retention and the trust from the patient help to get to know the patient better and to find the right therapy more quickly in case of tooth loss. Also, regarding the success rates of implants, problems in patients who regularly visit the practice are lower. Furthermore, the integration into an adequate aftercare program after periodontal treatment is essential. The regular repetition of supportive periodontal therapy (SPT) is a crucial pillar for stabilizing the success of periodontal therapy.

Are there differences between practice and clinic?

Basically, there are differences just like between two different practices or clinics. Regarding the PZR, one can assume minor differences. The distinction from periodontal therapy is easier for the patient to understand in the clinic, as there is usually a separate department for each treatment. This spatial separation is not the case in most practices.

If only the PZR is considered, the biggest difference lies in the use of powder-water jet devices, the powder used, and whether cleaning is done more with hand instruments or ultrasonic or sonic-powered instruments are used. This has no impact on the quality of the PZR and is dependent on the specific preferences of the practitioners as well as the patients. It is important to distinguish between the PZR and the UPT. As already mentioned, this is somewhat easier to manage in clinics due to the different departments than in private practice. In addition to the different approaches, particularly trained personnel is also required. This is often more difficult to implement for smaller practices than for large clinics. However, since the PZR, like any other therapy in dentistry, is performed by human hands, the question is less “Practice or clinic?” and more “Who is the practitioner?”.

The article was published in the Prophylaxis Journal.