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Although halitosis is a widespread condition, it is still seen as too personal or embarrassing to talk about. The cause of real halitosis can be intraoral or extraoral. In order to determine the level of knowledge of health care providers in Switzerland, a survey was conducted over a period of three years in which 150 family physicians, 150 ear, nose and throat specialists, 154 dentists and 151 dental hygienists were personally interviewed. The survey shows that only 46.7% of the dentists and only 47.0% of the dental hygienists are consulted by patients for their halitosis, whereas 58.0% of the family physicians and 50.7% of the ENT specialists reported treating 1-10 patients for halitosis per year, while 46.7% of the ENT doctors even reported treating 11-100 patients for halitosis per year. 81.5% of all interviewed doctors and dental hygienists were of the opinion that halitosis mainly originates intraorally. 76.0% of the dentists and 72.8% of the dental hygienists as well as 33.3% of the family physicians recommend periodontitis therapy as halitosis treatment. This proves that a large percentage of medical professionals thinks that marginal periodontitis is the most common cause of halitosis. This study also shows that patients seek first consultations with dentists and dental hygienists less often than with family physicians and ENT specialists, despite the fact that the cause of halitosis is primarily intraoral.

Bad breath is a widespread condition that has been increasingly discussed among professionals and in the mass media in the last few years. In nine of ten cases, halitosis originates intraorally; hence it has become an important topic of study in the education and training of dentists and dental hygienists. However, the de facto knowledge of professionals has never been examined until today. 750 dentists and dental hygienists from Switzerland, Germany, and France were personally interviewed. Their knowledge of halitosis was assessed using a specifically designed questionnaire. In general, considerable differences were ascertained between the German-speaking countries and France, dentists and dental hygienists, and women and men. 27.5% of the French participants believed that the underlying cause of halitosis has a non-oral nature, whereas only 8% of the Swiss and German participants believed so (p ⟨ 0.001). In contrast to dental hygienists, dentists more often considered gastrointestinal factors as a cause of halitosis (p ⟨ 0.001). Dental hygienists from Switzerland and Germany more frequently reported the use of tongue scrapers as a therapeutic method (97% and 97.3%) than did dentists of the same countries (87.3% and 89.3%). Among the French participants, only 52% mentioned the use of tongue scrapers to treat halitosis. 2.7% of French dental professionals had participated in a continuing education course about halitosis, which is much lower than the rate of attendance in Switzerland and Germany (46%). Additionally, interdisciplinary discrepancies were observed, as 65.3% of the dental hygienists frequented advanced training courses, which was twice as much as dentists. Therefore, there are clear differences between dentists in France and their colleagues from the German-speaking countries, but also between dental hygienists and dentists. Dental hygienists from Switzerland and Germany appear to be far ahead in terms of halitosis knowledge.

Two manual toothbrushes were tested in a questionnaire study by 171 dental hygienists in a crossover design: a new toothbrush with conical filaments (meridol toothbrush, GABA International AG) and a reference toothbrush with end-rounded filaments (ADA toothbrush, American Dental Association). Each trial subject tested the two manual toothbrushes in two consecutive periods. Not only was the immediate impression of interest but also the impression after a period of three weeks. Therefore, four questionnaires in total had to be answered. All but a few questions (e.g. "the most often used toothbrush up to date" in the first questionnaire) were identical in the four questionnaires. After a single use the overall impression of the meridol toothbrush was good and very good for 95.1% of the trial subjects (ADA: 26.4%). The feeling along the gingival margin was very positively judged after a single brushing by the meridol user: 92.7% (ADA: 35.3%). The cleaning performance of the meridol toothbrush was found to be good and very good by 85.5% of the meridol beginner group, whereas only 60.2% of the ADA beginner group judged the ADA toothbrush as good or very good. The most remarkable fact is that nearly 90% of these professional trial subjects have decided to continue to use the meridol toothbrush and more than 90% would recommend it to their patients.

The treatment of root surfaces in periodontal lesions with mechanical instruments is becoming more and more popular as an alternative to the conventional treatment with curets. In this in-vitro study a phantom head with a simulated periodontitis was used. The aim of this investigation was to determine the percentage of the subgingival non-treated root surfaces after treatment with different instruments and by different persons. Newly developed mechanical file instruments (Rootshape) were tested. Hand curets served as control group. The treatment of the teeth was carried out by three groups, each including 4 people. Group one were dental hygienists (DH), group two dentists with (Spez) and group three dentist without (Zaz) experience in the therapy of periodontal diseases. They were asked to perform a scaling and root planing on six teeth (16, 21, 24, 36, 41, 44) both with curets and Rootshape files. The size of the non-treated areas was subsequently determined planimetrically and expressed as percentage of the entire subgingival root surface. Independent of the group the percentage after file treatment was significantly lower (mean 9.85 +/- 7.78%) than that after curet-treatment (mean 14.74 +/- 10.20%). Significant differences were found when the three groups were compared after treatment either with files or curets (DH 9.61 +/- 8.02%, Spez 12.11 +/- 8.01%, Zaz 15.18 +/- 11.01%; p0.001). Zaz working with files achieved as good results as DH or Spez with curets (por = 0.05). The results indicate that the files represent an alternative to hand instruments concerning the accessibility of root surfaces.

A prophylactically oriented concept of periodontal treatment is inconceivable without purpose-trained personnel. This fact led to the new profession of dental hygienist, being introduced into many countries more than 15 years ago. In Germany, attempts were made to close the gap with the profession of dental assistant (ZMF). This model has, however, proved a failure because--besides the advanced training curriculum not being sufficiently specialized--the demand for dental assistants is far greater than the supply. Many dentists, therefore, employ assistants with relevant training in the form of updating courses. Apart from the fact that this frequently results in legal misgivings, it also fails to meet the demand. For this reason, it is absolutely essential that personnel structures be adapted nationwide to a prophylactically oriented concept of periodontal treatment. Account is being taken of experience already gained abroad, as well as current opportunities for training and advanced training in Germany, including the legal principles valid in this country.

The significant role oral prophylactic measures play in the prevention of caries and periodontal disease and the importance of continuing systematic treatment for patients suffering from periodontitis have been scientifically documented in clinical studies. Practical application of this knowledge on a day-to-day basis in dental offices has thus far been hampered by the shortage of appropriately trained personnel. In September 1989, the Zahnärztekammer Berlin founded the "Intensive Studies Seminar for Dental Prophylaxis". In a one-year, vocational course of study, participants acquire the knowledge and practical skills necessary to establish and maintain a system of prophylactic treatment capable of being integrated into the dental practice. The purpose of the following article is to give information concerning the concept behind the program, as well as to introduce the course of study and its various aspects. The experiences gained in the program's first year were positive, and graduates of the course are in demand. It is therefore to be hoped that the concept underlying this seminar will take hold.

The comprehensive range of functions in a dental practice with special emphasis on periodontal cure requires cooperation amongst highly qualified personnel. The dental hygienist has a special standing and is responsible for as well as in charge of important treatment stages, as much as the dentist himself. The treatment stages are of greater relevance to long-lasting therapeutic achievements.

Dental hygienists in most European countries and in America are highly qualified assistants to the dentist's daily professional life. Especially for long lasting achievements in periodontal therapy and maintenance, the hygienist's help is absolutely essential. All attempts to introduce a similar vocational reputation, as well as an adequate career training course throughout the Federal Republic have failed so far.

The experience gained by the training of dental assistants using individual education programs shows that there is a need for similar training and education of dental hygienists. The presently existing education programs in this field are not related specifically to training of periodontal procedures and prophylaxis and are insufficient for the treatment of patients with periodontal diseases. This was also the conclusion of a committee for dental auxiliary personnel that was recently initiated by the German Society of Periodontology.

Periodontics overlaps regularly with the other dental disciplines and plays an important part in comprehensive dentistry. During the last decades a world-wide outgrowing research activity in basic science as well as in clinical research has contributed to a better understanding of the complexity of periodontal problems. The situation of periodontology in Germany must be improved. In order to obtain a better education in dental schools and consequently an optimal treatment of the patients, it is necessary to give to periodontology the same level of education as to other specialties in dentistry. Prophylaxis-oriented dentistry can only be established with the help of dental hygienists.

The dental care of the population may be considerably inproved by the further development of non-academic careers in stomatology. Past experience has shown that, in the majority of cases, the dental care of the children is jeopardized if the ratio of dentists to population is low, and the need for care is great. Therefore, the employment of specialized nurses with appropriate duties is of particular importance in paedodontics. The possibilities and variants are discussed in the light of international trends.

On the basis of findings in 1200 individuals aged between 7 to 16 years, the authors indicate priorities of dental care in the different age-groups. Apart from other criteria, the readiness for treatment and the disciplined behaviour of the children and adolescents during treatment may be used for assessing the dentist's achievements.

On the basis of studies on the work efficiency of stomatological auxiliaries, the author suggests a standard educational program for stomatological nurses in the U.S.S.R.

Caries and the inflammation of the marginal periodontium are initiated by different pathomechanisms of microbial factors of the dental plaque. Etiologically, both pathologic changes are therefore associated with the dental plaque. Progression is modifiable by both local and general factors. Consequently, prevention of these major stomatological diseases is based upon a common concept and divides naturally into primary, secondary, and tertiary measures.

It was thought for many years that successful motivation in oral health should be based on the knowledge of epidemiology of caries and periodontal diseases and the methods of prevention. One should learn from mistakes: 95 per cent of the Swiss population "suffers" from caries and periodontal disease but apparently this had little impact on prevention. Simple, world-wide accepted methods of prevention are not used by the majority although they provide a pronounced reduction of caries and gingivitis. The number of Swiss communities which offer adequate preventive programs to schoolchildren ranges between 5 to 10 per cent. Although the budgets of school dental services could be lowered by 75%. Reasons for such failures may be inadequate information of dentists, authorities and the population. Not enough information is spread regarding sugarless sweets, or prevention by fluoride. Unsuccessful motivation probably also lies in the inadequate assignment of the roles ofthe patient, his dentist and the social security. So far only the dentist has formulated oral health duties to the patient, e.g. a better oral hygiene, a reasonable healthy nutrition. In the future the patient should have the right to ask the dentist some questions. Is his dentition at the end of a treatment, healthy and ready to render hygienic efforts effective? Patient, doctor and insurances should know that disease still exists if gingival papillae bleed upon using a toothpick. Absence or presence of gingival bleeding are the criteria for health or disease. A check list of the state of oral health and a signed questionnaire concerning the patient's knowledge of oral health are used to improve motivation of both patient and dentist.

On the basis of a literature study, the author outlines the international development of the career of dental hygienist and deals with her possible uses. Then follows a description of the development and of the actual tasks in the GDR, starting from the objectives of the socialist health service.