Poliklinik für Kieferorthopädie, Präventive Zahnmedizin und Kinderzahnheilkunde
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This paper reviews the first part of the outcomes of the ORCA Saturday Afternoon Symposium 2014 dealing with ‘caries epidemiology and community dentistry: chances for future improvements in caries risk groups'. After the caries decline in many countries, there are remaining pockets of higher caries levels, mostly in the primary dentition and/or linked to a low socio-economic status (SES). The review into the evidence of caries-preventive measures clearly points to the use of fluorides, especially toothbrushing with fluoridated toothpaste and collective measures such as water fluoridation. In contrast to several unsuccessful high-risk approaches, community and public health programmes seem to be able to ensure a population-wide access and compliance in risk groups. Their simple and evidence-based measures mostly combine regular plaque removal and fluoride applications via toothbrushing, at least for children and adolescents. For the future, the common risk factor approach which addresses associations between oral health, social deprivation, diet, hygiene, smoking, alcohol use and stress should lead to combined efforts with other community health and education specialists. Further engagement with public policy, community leaders and administration is needed in order to strengthen healthy choices and behaviour, e.g. in ‘healthy' schools and kindergartens. It seems advisable that these population programmes also aim at improving upstream factors.
Background: Referral to specialized pediatric treatment seems to rise in Germany, especially for children under 5 years of age and mostly due to behaviour management problems, rampant caries and the need for comprehensive dental treatments. There are indications that more dental treatments under general anesthesia were needed in last decade, but there are very few studies on this topic in Germany. Aim: The objectives of this research were to investigate the characteristics and dental features of referred children to Greifswald university dental clinic in 2008 and 2011 as well as to assess dental treatment and characteristics of the children who underwent general anesthesia in 2011 at Greifswald University Clinic in comparison with three specialized pediatric private practices in Germany. Materials and methods: This retrospective analytical comparative study examined the records of all children younger than 18 years of age, whose were referred to the university dental clinic in Greifswald between 2008 and 2011. In addition, all cases that underwent general anesthesia at the university dental clinic and three other private practices in 2011 were analyzed anonymously. All data including age, gender, dental status and caries levels (dmft/DMFT), as well as diagnosis, referral/GA reasons and the dental treatments were collected and then analyzed using the Statistical Package for the Social Sciences program (SPSS, Ver. 16 for Windows). Descriptive analysis was performed, along with univariate analysis of variance (ANOVA) and Chi square tests. Differences between groups were tested through Mann-Whitney U test and Student’s t-test as appropriate. Results: The final study sample for children and adolescents referred to the university consisted of 389 under 18 years old (205 males and 184 females) with a mean age of 8.75 years in 2008 and 7.38 years in 2011. In addition, 297 children (160 males and 137 females) with a mean age of 4.77 years had been treated under general anesthesia in the three specialized private practices (n= 219, age: 4.81±2.06 years) and in the university (n=78, age: 4.65±2.59 years). More patients of age group 1 (5 yrs or younger), as well as, patients residing within a distance of 31-40 km away from the clinic were referred in 2011 (47.2% and 35.9% resp.) in comparison with 2008 (37.1% and 22.7% resp.) Panoramic and intraoral dental x-rays (46.7%, 11.8% resp.) have been widely carried out in 2011 compared to 2008 (29.9%, 6.5% resp. P = 0.002). Statistical analyses have shown that, younger children with higher values of dental caries indices (dmft, DMFT) were referred in 2011 (5.4 and 2.15 resp.) than in 2008 (5.16 and 1.57 resp.) with increasing demand for comprehensive dental treatment under GA. Whereas, more patients were diagnosed to have rampant caries (42.1%) in 2011 followed by orthodontic/oral surgery problems (16.9%) in comparison with 2008 (29.3%, 10.1% resp. P < 0.001). Non-invasive treatment was much more delivered (63%) in first dental visit for referred patients in 2011 followed by dental consultation (23.6%) compared to 2008 (53.6% and 21.3% resp.). While, on the other hand, considerably more fillings were supplied in 2008 (11.5%) compared to 2011 (2.6%). Further dental treatment pattern revealed more treatment under GA (27%) and a slightly more extractions (16.1%) were done in 2011 compared to 2008 (20.9%, 15.5% resp.). On the contrary, less fillings and preventive procedures were performed in 2011 (26.3% and 4.4% resp.) in comparison with 2008. Sixty-one percent of children were referred back to their family dentists in 2011 which was more than it in 2008. Indeed, about a half of children aged 5 years or younger preferred to stay at the University Clinics in 2011, while, the vast majority of children older than 12 years continued their dental care outside the University Clinics. About eighty percent and seventy percent of children underwent GA at both the university clinics and private practices respectively were under five years old. In total 7.1% mental disabilities and 2.4% preterm birth were detected in children treated under GA, as well as, dental caries were mostly diagnosed (37%) among them followed by irreversible pulpitis (21.5%) and Early Childhood Caries (ECC) (18.5%), where only 4.38% of all examined children had no carious lesions. More panoramic radiographs (41%) and less dental films (26.9%) were conducted at the university clinics as in the private practices (15.1% and 52.1% respectively) with a significant reduction in using x-rays at the university (69.2%) compared to private practices (94.1%). Dental extractions were often performed at university clinic (40.2%, 3.14±2.4) followed by fillings (33.9%, 2.65±2.7), while, more restorations and less extractions were supplied at private practices (47.8%, 5.47±3.1 and 16.3%, 1.86±2 resp.). Both of long (106-120 Min) and short (0-15 Min) treatment’s durations were needed in the university clinics to carried out the adequate dental therapy under GA, while, most of the GAs at private practices have lasted between 45 and 90 minutes. Conclusion: There is a growing definite need for specialized pediatric dentistry in Germany, especially for children under 5 years of age being referred with rampant caries and behaviour management problems to specialized pediatric dentistry. This results in a high number of extensive treatment performed under GA. In contrast to other countries, this seems to be a singular event for most children in Germany indicating a solid treatment under GA and possibly also improvements in the caries activity of the affected children afterwards. The range of dental treatment and its outcome at Greifswald University and in the examined three specialized private practices is very similar reflecting in both the profile of the children a valid indication for GA and the subsequent treatment up to date approaches in pediatric dentistry. Thus, the very professional treatment and effective secondary preventive strategies achieve better oral health and reestablished quality of life for these children, but a primary preventive approach would be preferable decreasing the number of children in need of dental treatment under general anaesthesia.
Background: Despite of the remarkable caries reduction in permanent dentition, caries levels of primary teeth has stagnated in Germany. Early Childhood Caries (ECC) or also known as baby bottle tooth decay is the most vulnerable form of caries in young children, but minimal data and information from different German states are available to determine the appropriate preventive programs. Aim: The purpose of the current study is to find the prevalence of ECC among young children in the state of Mecklenburg-Vorpommern (North-East Germany) and to optimize an intervention on ECC prevention in a community setting. In addition to education, fluoride varnish is evaluated on young children with active ECC. Design: In this cross-sectional study, a total of 4283 children living in the state of Mecklenburg-Vorpommern were examined. Four age groups - with an accuracy of one day - were formed as follows: less than one year (n=8), one year (n=293), two years (n=1618) and three years (n=1888). The examination was carried out by community dental service’s examiners whom are calibrated to ECC diagnostic criteria of Robke and Buitkamp (2002), and dmf-t values for caries diagnosis. These data are compared by those of children (n=5355) of same age group for the year 2011-2012. In addition, a structured questionnaire on the starting preventive programme on ECC was filled out by the community dentists and for the city of Greifswald, fluoride varnish (Duraphat®, 5% NaF = 2.26%F, Colgate-Palmolive, Germany) was applied for 32 children previously diagnosed with active ECC (ECC1: n=15, ECC2: n=17). Lesions are identified as active or non active according to texture and luminosity, and oral hygiene index (OHI-S) is measured and re-evaluated at three months follow up. Results: The percentage of children under three years old in 2012-2013 with ECC was comparatively low (4%) which possibly reflects the very young age of the children and a restriction for ECC on the upper incisors. The overall caries prevalence in Mecklenburg-Vorpommern varied from 9% to 15%. Most cavitated lesions are untreated. These results are comparable with the results from other German counties. The interventions of the ECC programme vary considerably among the different counties. There was no significant difference in the oral hygiene index (OHI-S) prior and post fluoride varnish application (p-value = 0.25). The use of fluoride varnish resulted in an 81%, statistically significant decrease of active ECC lesions in Greifswald (p < 0.001). Conclusion: The prevalence of caries among young children was considerable in Mecklenburg-Vorpommern. A preventive intervention in nurseries and fluoride varnish applications for active ECC lesions seems to be a feasible approach in controlling caries in early childhood. However, further quality management and standardization of the program should be reinforced.
Less invasive caries management techniques for treating cavitated carious primary teeth, which involve the concept of caries control by managing the activity of the biofilm, are becoming common. This study aimed to compare the clinical efficacy (minor/major failures) and survival rates (successful cases without any failures) of 3 carious lesion treatment approaches, the Hall Technique (HT), non-restorative caries treatment (NRCT), and conventional restorations (CR), for the management of occlusoproximal caries lesions (ICDAS 3-5) in primary molars. Results at 2.5 years are presented. A total of 169 children (3- to 8-year-olds) were enrolled in this secondary care-based, 3-arm parallel-group, randomised controlled trial. Participants were allocated to: HT (n = 52; sealing caries with stainless-steel crowns without caries removal), NRCT (n = 52; opening up the cavity and applying fluoride varnish), CR (n = 65; control arm, complete caries removal and compomer restoration). Statistical analyses were: non-parametric Kruskal-Wallis analysis of variance, Mann-Whitney U test and Kaplan-Meier survival analyses. One hundred and forty-two participants (84%; HT = 40/52; NRCT = 44/52; CR = 58/65) had follow-up data of 1-33 months (mean = 26). Overall, 25 (HT = 2, NRCT = 9, CR = 14) of 142 participants (17.6%) presented with at least 1 minor failure (reversible pulpitis, caries progression, or secondary caries; p = 0.013, CI = 0.012-0.018; Mann-Whitney U test). Ten (HT = 1, NRCT = 4, CR = 5) of 142 participants (7.04%) experienced at least 1 major failure (irreversible pulpitis, abscess, unrestorable tooth; p = 0.043, CI = 0.034-0.045). Independent comparisons between 2 samples found that NRCT-CR had no statistically significant difference in failures (p > 0.05), but for CR-HT (p = 0.037, CI = 0.030-0.040) and for NRCT-HT (p = 0.011, CI = 0.010-0.016; Kruskal-Wallis test) significant differences were observed. Cumulative survival rates were HT = 92.5%, NRCT = 70.5%, and CR = 67.2% (p = 0.012). NRCT and CR outcomes were comparable. HT performed better than NRCT and CR for all outcomes. This study was funded by the Paediatric Dentistry Department, Greifswald University, Germany (Trial registration No. NCT01797458).
Background: Early childhood caries remains an unsolved problem in children under three worldwide. Midwives are important health care persons around birth and can shape behavior. They possibly can play a positive role in preventing early childhood caries in young children. Objective: to assess how involved midwives are in early childhood caries prevention, what preventive measures they recommend and what knowledge they have about early childhood caries, as well as to study the potential differences between the various federal states or due to their work experience. Materials and Methods: An online survey targeted midwives in Germany regarding their knowledge about early childhood caries as well as the preventive measures they recommended. Participants were members of the German Association of Midwives (DHV). The survey invitation was published with the monthly newsletter and in the association journal of the DHV. Data was collected anonymously. Results: 191 midwives nationwide responded to the questionnaire. Most midwives were aware about ECC prevalence, consequences, causes and the teeth mainly affected. Midwives gave excellent recommendations regarding diet, oral hygiene and avoiding prolonged bottle feeding. However, only 40.8% of midwives recommended the first dental visit with the eruption of the first tooth. 71.7% recommended a fluoride tooth paste with the eruption of the first tooth. The rest advised a later use or non-fluoridated toothpaste. Regional differences were minimal. Conclusion: Midwives have good oral health knowledge, but there is some variability in recommendations on the first dental visit and the use of fluoride toothpaste which reflects an inconsistency of professional recommendations delivered by different health care institutions in Germany.
Cerebral palsy (CP) remains one of the most common debilitating diseases in the world.
Factors such as neuromuscular incoordination, use of soft diet and delayed oral
clearance of food make maintenance of optimum oral hygiene a challenging task in
these children. The compromised oral hygiene in turn make these children highly
vulnerable to dental disease. Maintaining optimal oral/dental health in CP children is of
utmost importance as these children usually suffer from several associated general
health problems in addition to their primary condition. Poor dental health further
compromises their general health. Nevertheless, CP children often suffer from dental
diseases including dental caries more than healthy children. This underscores the need
for improvement in oral health of the CP children. The CP children are dependent on
those around them for their oral hygiene maintenance and dietary intake. CP children
spend most of their time with health care workers in special centers for them or with
their parents/care takers at home. Therefore, the attitude of special health care workers
and parents towards their dental health is of prime importance. The purpose of this
project included to determine the attitude of special health care workers towards their
dental health and oral health comprehension by parents of CP children. In addition, a
study on caries experience of CP children and associated risk factors was also completed.
The final objective was to identify various potential areas of improvement with ultimate
goal of improving dental health of the CP children.
The study involving special health care workers in a Disabled Children’s Center revealed
that oral health knowledge and practices among the workers could generally be labeled
as satisfactory, however some weak areas (such as trend towards symptom-oriented
utilization of oral health care and lack of knowledge about fluoridated water) were
identified. There is a need to enhance the workers’ knowledge in these areas.
The study involving parents of the CP children showed mixed results. Some areas of
strong oral health comprehension (such as importance of good dental health, harmful
effects of sweetened foods), others satisfactory (such as need for routine dental visits,
use of fluoride) and some weak areas (use of flavored fizzy drinks, bottled/canned juices
and sweetened/flavored milks, seeking early treatment) were identified among parents
of CP children. The results strongly indicated a need for enhanced efforts towards
improvement of oral health comprehension in the parents of the CP children.
The study about caries experience and risk factors in CP children has provided useful
information in an area where literature has been scarce. Almost all the studied children
had clinical dental caries, and most of the caries were untreated. Very few children in
the present study had optimal oral hygiene. This study confirmed the strong correlation
between high dental caries experience and poor oral hygiene. Routine dental check-up
visits and topical fluoride application clearly resulted in lower caries experience. Bottled
juices and crispy potato chips were the two predictors for high caries experience.
As stated before, the goal of the project was to identify various potential areas of
improvement in oral health attitude of special health care workers, oral health
comprehension of the parents of CP children and risk factors for dental caries in CP
children. It is contemplated that by addressing the identified weak areas, an
improvement in dental health and care of the CP children is expected. It is also expected
that the collected information will help in improvement of clinical preventive as well as
restorative services for the CP children. CP children and their parents lead a challenging
life. This project was an effort to assist these children and their parents/care takers with
ultimate goal of improving their oral health and in turn their overall quality of life.
Abstract
Background: Behavior management techniques (BMT) are essential in order to
achieve a successful dental treatment with a minimum amount of stress in paediatric
dentistry, but parents are not equally accepting different advanced BMT.
Purpose: To investigate the differences in parental acceptance of advanced
behavior management techniques between University of Greifswald/Germany and
Jordan University/Jordan.
Methods: Parents of the children treated in the pedodontic departments at the
University of Greifswald/Germany and Jordan University/Jordan rated their
acceptance level of four advanced behavior management techniques (passive
restraint, active restraint, nitrous oxide sedation and general anesthesia) for normal
treatment, and for urgent treatment using a five points Likert scale. 200 parents (100
in each university) completed the questionnaire forms for analysis.
Results: Nitrous oxide sedation was rated the most accepted technique in
Greifswald and Jordan (mean 3.78±1.34; 3.22±1.50, respectively). The least
acceptable technique in Greifswald was passive restraint (2.05±1.18) and in Jordan
general anesthesia (2.11±1.30). The parents in Greifswald are significantly more
accepting nitrous oxide sedation than parents in Jordan (p=0.010), while parents in
Jordan are significantly more willing to accept passive restraint (p=0.001). The
acceptance of all advanced behavior management techniques increased significantly
in both groups when the treatment is urgent (p≤0.05),
Conclusions: Parental culture and the urgency of the treatment affect the
acceptance to different behavior management techniques. Moreover, the parental
attitude to the pharmacological technique has changed, as nitrous oxide sedation
generally appears to be the most preferred advanced technique in both groups.
A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough “round table” discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.
A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough “round table” discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.