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10 Danksagung AusderUniversitätsklinikfürZahn-,Mund-undKieferheilkunde derAlbert-Ludwigs-UniversitätFreiburgimBreisgau AbteilungPoliklinikfürZahnerhaltungskundeundParodontologie (ÄrztlicherDirektor:Prof.Dr.E.Hellwig) FührtdieVerwendungeinesInterdentalstimulators zusätzlichzuZahnbürste,ZahnpastaundZahnseide zueinerVerringerungvorhandenerPlaque? −SystematischeLiteraturübersichtundkontrollierteklinischeStudie − INAUGURAL-DISSERTATION zur ErlangungdesZahnmedizinischenDoktorgrades derMedizinischenFakultät derAlbert-Ludwigs-Universität FreiburgimBreisgau vorgelegt2004 vonImkeNinaSybilleBecker geboreninBühl/Baden Dekan: Prof.Dr.J.Zentner 1. Gutachter: Prof.Dr.G.Krekeler 2. Gutachter: Prof.Dr.Dr.J.Düker JahrderPromotion:2004 I Inhaltsverzeichnis 1 Einleitung .............................................................................................................. 1 2 Literaturübersicht................................................................................................ 3 2.1 Einführung.............................................................................................................. 3 2.2 Plaque..................................................................................................................... 4 2.2.1 EpidemiologiedesPlaquebefalls ........................................................................... 4 2.2.2 ÄtiologiederdentalenPlaque ................................................................................ 5 2.3 Gingivopathien ....................................................................................................... 8 2.3.1 EpidemiologievonGingivopathien ....................................................................... 9 2.3.2 ÄtiologievonGingivopathien................................................................................ 9 2.4 Parodontopathien.................................................................................................. 11 2.4.1 EpidemiologievonParodontopathien .................................................................. 11 2.4.2 ÄtiologievonParodontopathien........................................................................... 11 2.5 Karies ................................................................................................................... 14 2.5.1 EpidemiologiederKaries..................................................................................... 14 2.5.2 ÄtiologiederKaries ............................................................................................. 16 2.6 Plaqueentfernung.................................................................................................. 18 2.6.1 MechanischePlaquekontrolle .............................................................................. 18 2.6.1.1 QualitätundQuantitätdermechanischenPlaquekontrolle.................................. 19 2.6.1.2 MechanischePlaquekontrolledurchprofessionelleZahnreinigung .................... 21 2.6.1.3 MechanischePlaquekontrollemittelsHandzahnbürsten...................................... 22 2.6.1.3.1 GeschichtlicheszuHandzahnbürsten................................................................... 23 2.6.1.3.2 BorstenartenderZahnbürsten .............................................................................. 24 2.6.1.3.3 AustauschvonZahnbürsten ................................................................................. 24 2.6.1.3.4 Zahnbürstendesign ............................................................................................... 25 2.6.1.3.5 Borstenhärte ......................................................................................................... 27 2.6.1.3.6 Borstenenden........................................................................................................ 27 2.6.1.4 MechanischePlaquekontrollemittelselektrischenZahnbürsten ......................... 28 2.6.1.4.1 DauerdesPutzvorganges ..................................................................................... 31 2.6.1.4.2 Anpresskraft ......................................................................................................... 32 2.6.2 Zahnpasta ............................................................................................................. 33 2.6.2.1 DefinitionvonZahnpasta ..................................................................................... 33 2.6.2.2 BestandteilevonZahnpasten................................................................................ 33 2.6.2.3 WirksamkeitvonZahnpasten............................................................................... 34 II 2.6.3 ChemischePlaquekontrolle.................................................................................. 38 2.6.3.1 Chlorhexidindigluconat(CHX)............................................................................ 38 2.6.3.2 Fluoride ................................................................................................................ 41 2.6.3.3 Triclosan-Kopolymer ........................................................................................... 42 2.7 Interdentalhygiene................................................................................................ 43 2.7.1 NotwendigkeitderInterdentalhygiene ................................................................. 43 2.7.2 HäufigkeitderInterdentalhygiene........................................................................ 44 2.7.3 Interdentalhygienehilfsmittel ............................................................................... 45 2.7.3.1 Zahnseide ............................................................................................................. 45 2.7.3.1.1 GeschichtlicheszurZahnseide ............................................................................. 45 2.7.3.1.2 ReinigungswirkungderZahnseide....................................................................... 46 2.7.3.2 Interdentalbürsten................................................................................................. 48 2.7.3.3 Mundduschen ....................................................................................................... 51 2.7.3.4 Interdentalstimulatoren(Gummistimulatoren)..................................................... 51 2.7.4 VergleichverschiedenerHilfsmittelzurInterdentalraumhygiene ....................... 51 2.8 EinflussderMotivationaufdieMundhygiene..................................................... 55 2.9 Zahnfleischmassage ............................................................................................. 56 2.9.1 ZahnfleischmassagemitdemFinger.................................................................... 57 2.9.2 ZahnfleischmassagemitderHandzahnbürste ...................................................... 59 2.9.3 ZahnfleischmassagemitelektrischenZahnbürsten.............................................. 60 2.9.4 ZahnfleischmassagemitGummikelchen ............................................................. 61 2.9.5 ZahnfleischmassagemitGummifingerlingen ...................................................... 61 2.9.6 ZahnfleischmassagemitspeziellenInstrumenten:„Wigel“,„Masso-Dent“, „WigglyPick“ ...................................................................................................... 63 2.9.7 ZahnfleischmassagemitSchienen ....................................................................... 64 2.9.8 DiskussionenrundumdieZahnfleischmassage................................................... 65 2.9.9 Schlussfolgerung .................................................................................................. 69 3 SystematischeÜbersicht .................................................................................... 70 3.1 Methodik .............................................................................................................. 70 3.2 ErgebnissederRecherche .................................................................................... 72 3.2.1 DefinitionenundBeschreibungenvonInterdentalstimulatoren........................... 76 3.2.1.1 HandsucheinzahnmedizinischenLexika ............................................................ 76 3.2.1.2 HandsucheinLehrbüchernderParodontologieundProphylaxe......................... 76 3.2.2 DerInterdentalstimulatoralsHilfsmittelfürdieZahnzwischenraumreinigung .. 78 III 3.2.2.1 HandsucheinzahnmedizinischenLexika ............................................................ 78 3.2.2.2 HandsucheinLehrbüchernderParodontologieundProphylaxe......................... 79 3.2.2.3 HandsucheindenZahnärztlichenMitteilungen................................................... 84 3.2.2.4 HandsucheinderSchweizerischenMonatsschriftfürZahnheilkunde ................ 85 3.2.3 DerInterdentalstimulatoralsHilfsmittelzurZahnfleischmassage, GingivakeratinisierungundPapillenmodellation................................................. 86 3.2.3.1 HandsucheinzahnmedizinischenLexika ............................................................ 86 3.2.3.2 HandsucheinLehrbüchernderParodontologieundProphylaxe......................... 86 3.2.3.3 HandsucheindenZahnärztlichenMitteilungen................................................... 94 3.2.4 ArtikelüberklinischeStudien.............................................................................. 94 4 KlinischeStudie................................................................................................ 110 4.1 ProbandenundMethode....................................................................................
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