Poliklinik für Kieferorthopädie, Präventive Zahnmedizin und Kinderzahnheilkunde
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1. The study confirms an association between transverse arch dimensions and severity of ankyloglossia, which reflects relationship between molar difference and free tongue. 2. Molar difference in group A (complete and severe ankyloglossia cases) has high negative values (average -4.38) which was much smaller than the data from the literature concerning many different types of occlusion. 99 3. The exact relation between transverse arch dimension and severity of ankyloglossia needs further research.
Therapeutic Sealing of Proximal Tooth Surfaces: Two-Year Clinical and Radiographic Evaluation
(2009)
The diagnosis, prevention and treatment of proximal carious lesions comprise a constant problem in clinical dentistry. The purpose of this investigation was to test the safety and clinical effect of a new treatment for proximal caries. In 50 patients with two proximal initial lesions (D1-3 without cavitation, bitewing X-ray), orthodontic rubber rings were applied to gain access to the interproximal space. One of the lesions was sealed with a thin polyurethane-dimethacrylate foil using a bonding agent (Heliobond®, Vivadent, Schaan/Liechtenstein); the other lesion received oral home-care with dental floss and fluoridated toothpaste and was left as control. In clinical follow-ups after 6 and 12 months and X-ray evaluation after two years, clinical retention of proximal tape and the underlying sealant, marginal adaptation, discoloration, tooth vitality, proximal plaque and gingivitis were checked. In addition, caries was assessed clinically and radiographically. The sealants showed good retention, marginal adaptation and colour. After two years, vitality of all teeth was still positive and no relevant differences in plaque accumulation or gingival status were found between sealed and control teeth. Two sealed surface had to be filled due to caries progression (D3 with cavitation). 9 sealed lesions showed caries regression. In contrast, only 4 control lesions regressed and also two showed progression. The loss of tape had no significant influence on the lesion progression indicating the effect of the underlying bond. All other sealants and control lesions were stable indicating an arrest of the lesion. In conclusion, sealing initial proximal lesions showed no clinical problems and mostly arrest of initial carious lesions on bitewing X-rays.
The aim of this study was to invistigate the effect of the oral health component of a general health promoting program implemented in primary schools of Greifswald city and east Pomerania region. Methods: This program was part of an innovative multidisciplinary general health promoting program, a longitudinal collaborative project based on health competence concept. Seven hundred and forty students with an age range 9-12 years (mean 10.34, SD±0.56, 48% females) were recruited from the fifth grade students of different 18 primary schools. The schools were randomly allocated into two groups. Oral health education was provided to the teachers in the intervention schools and then they conveyed it to their students, while no additional measures were conducted in the control schools. School dental examinations as well as questionnaires for the students and their parents were conducted at baseline and after one and half year of the program. Results: A significant correlation between caries increment and intervention/control group was reported, with a 35% higher risk in the control group. High socio-economic status has a significant highly protective effect in the intervention program with a reduction in incidence risk ratio of 94% (p < 0.001). In the low socio-economic status no preventive effect could found. The association between overweight/obese students and caries increment was border line significance (IRR 1.37, p = 0.055). The intervention program left a protective effective on the students who reported; lower tooth-brushing frequency, do not take care of their teeth, and do not consider sound and healthy teeth. Conclusion: The implemented program was effective in improving dental health, especially among students with high socio-economic status, but failed to achieve an effect in the low socio-economic group. The program was successful in maintaining a good dental health status among students who lack for the essential oral health competence items at the beginning. Social inequalities are an important issue which was partly tackled with a competence-based health promoting program, therefore, additional 76 compulsory preventive measures, such as daily or weekly tooth-brushing at school, should be seriously considered as behavior-centered approach.
Eight hundred and fifty two students with an age range 9-13 years (mean 10.34, SD±0.56, 48% females) were recruited from the fifth grade students of different 19 primary schools in Greifswald and East Pomerania. In conjunction with the compulsory dental community examination, additional data were collected with two questionnaires for the children and their parents. Newly generated items were taken from the children’s questionnaire to form short scales for oral health-related knowledge, behaviour, attitudes. Parents’ questionnaire contains questions on socio-economic status (SES) and child’s health. The response rate was 93.2%; 78.8% for children; parents, respectively. Results: The distribution of DMFT values was highly polarized with most of the children (71%) exhibiting no carious defects, fillings or missing teeth in the permanent dentition with a mean of 0.6 ±1.2. There was a significant correlation between DMFT and social class levels (rs=-0.19, p=0.001) with mean DMFT values of 0.9 ± 1.3, 0.6 ±1.1 and 0.4 ± 0.9 for the low, medium and higher social strata, respectively. There was a clear correlation between the dental attitude and dental behaviour (rs=0.32, p=0.003). However, correlations between knowledge vs. attitude and knowledge vs. behaviour were loose. A statistically significant correlation between DMFT and dental behaviour was found (rs=-0.15, p=0.003). It should be noted that children with higher self-esteem were found to have significantly higher dental awareness scores (rs=0.19, p=0.001). General health was a significant predictor for caries incidence (rs=0.08, p=0.01). The frequency of drinking lemonade or ice tea and eating salty snacks (chips, nuts) showed clear correlations with the DMFT (rs=0.17 and 0.13, p<0.01). Prolonged daily TV watching was associated directly with DMFT values (rs=0.13, p=0.001). A significant correlation was found between caries and smoking, even after adjusting for age (rs=0.1, p=0.002). Smoking children had a significantly higher DMFT rate than children who were not smokers with a mean DMFT of 0.9 ±1.5 vs 0.6 ±1.2 (p=0.004). Interestingly, each of prolonged TV watching, more lemonade drinking and smoking were correlated directly with the low socioeconomic status (Spearman correlation coefficient of 0.13, 0.2 and 0.17, respectively, p<0.05). Regarding malocclusion, 64% the subjects had at least one type of anomaly. Crowding and maxillary overjet represented the major proportion 28% and 23%, respectively. Males exhibited significantly higher increased overbite scores than females p=0.04. Whereas the prevalence of crowding was more common in females than males (p=0.05). Amazingly, more malocclusion was registered in children with caries-free primary teeth when compared to children with carious primary teeth (p=0.05). No significant differences in the mean of dmft or DMFT value were found between normal and non normal occlusion (p>0.05). Undergoing to orthodontic treatment was associated with significantly higher dental awareness scores (p=0.003). No correlation between socio-economic status and malocclusion was registered. Conclusion: This thesis confirms the decline and polarisation of dental caries. Dental behaviour was mostly independent of dental knowledge, but depended on dental attitude. Higher scores in dental behaviour resulted in lower DMFT scores; possibly, oral health promotion should strengthen attitude and actual behaviour instead of knowledge. Higher scores in self-esteem and general health connected with lower caries incidence and higher score in dental awareness. Social inequalities was strongly linked with health inequalities with more prevalence of caries, smoking, prolonged TV watching, wrong diet habits and less sealants application among children of low SES. Hence, oral health-related interventions in children sample should be directed at the social structures with more incorporating of oral health promotion programs into other general health promotion programs. This thesis suggests that; the establishment of healthy behaviours such as a regular teeth brushing at school could be one of the most successful ways to involve all children especially children of low SES in dental care. Malocclusion traits were very common in this sample. This underlines the need for more orthodontic preventive programs among children, in order to reducing the risk factors of malocclusion. The association between prevalence of malocclusion and socio economic status could not be established. No generalised conclusion could be drawn about the relationship between caries and malocclusion.
The aim of this study was to analyse the predictive power of several clinical baseline parameters and the de-/remineralisation properties of in vivo etched sites measured with quantitative light-induced fluorescence (QLF) for subsequent 2-year caries increment. At baseline, in 44 children (8.23 ± 1.5 years) two areas (diameter 2 mm) of the buccal surface of a primary posterior tooth were etched with 36% phosphoric acid gel for 1 and 4 min, respectively. The etched sites were analysed immediately after etching (ΔQ1) and 24 h (ΔQ2) later by QLF. Additionally, caries status (deft/DMFT and initial caries), approximal plaque, bleeding on probing, and the patient’s current use of fluorides were recorded. In the 2-year follow-up, 29 children were re-assessed. After clinical examination, the caries increment was calculated (ΔDMFT) and correlated with the baseline clinical variables and the QLF readings. Results showed a significant positive correlation between ΔQ<sub>1 min</sub> and the ΔDMFT (r = 0.44, p = 0.02). The ΔDMFT was significantly correlated with the baseline deft (r = 0.56, p = 0.002), cavitated active caries lesions (r = 0.52, p = 0.003), and filled teeth (r = 0.53, p = 0.003). In a regression analysis the use of fluoridated salt (SC = –0.10) and fluoride gel (SC = –0.14) were negatively associated with ΔDMFT. In conclusion, these findings suggest that the demineralisation properties of the etched sites and the outcome of the 24-hour measurements with QLF are significantly associated with caries increment. Previous caries experience strongly correlated with caries increment in this group of children.
Despite a plethora of therapeutic approaches, the injection of local anaesthetics itself remains one of the most painful and dreadful procedures among children. Stimulation of acupoint LI4 is associated with analgesic effects in dentistry. Goal of the study To investigate whether stimulation of LI4, added to standard therapy (ST), reduces pain and distress during injection of local anaesthetic (LA) in comparison with ST alone. Materials and Methods Children, scheduled for dental treatment in local anaesthesia on 2 separate days were enrolled in this trial, approved by local ethics commission. On one day each child received bilateral acupuncture of LI4 point, using indwelling fixed “New Pyonex” needles (0.2 x 1.5 mm; Seirin, Japan). The parents of the children were asked to stimulate the needles by massage. Standardized injection of LA was performed 5 min following acupuncture. The needles were withdrawn at the end of dental treatment. On the other day of treatment children received LA injection without acupuncture. The order of treatment days (acupuncture first or vice versa) was randomised. Primary endpoint was the pain intensity during LA injection reported by children on Visual Rating Scale from 0=no pain to 10=maximal pain imaginable (VRS-11). Secondary endpoints were parent- and dentist-assessed pain intensity (measured on Numeric Rating Scale 1-10), patients’ heart rate before and during dental treatment and satisfaction with received therapy (measured on Numerical Rating Scale 1-5.) Side effects of LI4 stimulation were also recorded. Results and Discussion The data of 49 children (22 females; age 10 ± 4 yrs; mean ± SD), who completed both visits, were analysed. Children reported less pain with than without acupuncture: 2.2 ± 2.5 vs. 3.9 ± 2.7; mean ± SD, p<0.001. Heart rate decreased after LI4 stimulation compared to ST alone throughout the dental treatment (p<0.05). LI4 stimulation was safe and raised better satisfaction with the treatment among children and parents, than ST alone (p<0.05). Other secondary endpoints were comparable between both sessions. Conclusion Stimulation of acupuncture point LI4 reduces pain and autonomous stress during injection of local anaesthetics in paediatric dentistry.
Until now proximal caries is still a significant problem in the clinical dentistry in spite of the caries decline recently. As resin infiltration offers a new micro-invasive treatment to arrest the progression of proximal initial carious lesions, this study aimed to evaluate its clinical applicability, safety and effect. In the study population of 50 children, adolescents and young adults (mean age 17.9 years ± 6.8), ten dentists at University of Greifswald applied the infiltration material ICON® (DMG, Germany) on non-cavitated proximal lesions in permanent and primary teeth as described in the manual instructions from the producer. The results showed good patient satisfaction with the procedure. The time for the infiltration (24.3 min ± 7.4), which included rubber dam application (7.7 min ± 4), and the effort were perceived as comparable to a composite filling by the dentist or as even easier. In three patients (6%), it was not possible to gain sufficient proximal space for the application of an infiltration. The location of the infiltrated tooth, separation problems as well as the routine of the dentists with the infiltration technique had an effect on the duration of the infiltration. A clear learning curve with a reduction of treatment time for subsequent treatments was observed (P < 0.001). Within the follow-up interval of 12 months, vitality of all infiltrated teeth was still positive and no relevant differences in plaque accumulation or gingival status were recorded. In addition, the infiltrated surfaces showed smooth margins and considerable decrease in the discoloration. In the radiographic evaluation after one year, only two lesions (4.7%) have progressed. Thus, caries infiltration is an applicable method for the treatment of initial non-cavitated proximal lesions without prior temporary tooth separation. Even without special training it can be applied easily by dentist and they experience a clear learning curve within the first 5-10 applications. In addition, the infiltration technique shows a high acceptance by the patients. Furthermore, caries infiltration lead to very good results regarding safety and preventing the lesion progression of non-cavitated proximal caries lesions located in the enamel or in the outer third of dentin.
Due to the wide range of reported prevalence of Molar-Incisor-Hypomineralisation (MIH) found in regional studies, the aim of this study was to determine the prevalence of MIH in school children at different areas in Germany and to compare the findings to other studies. In the compulsory dental school examination, the first permanent molars, permanent incisors and second primary molars were examined for the presence of MIH according to EAPD criteria (Lygidakis et al., 2010; Weerheijm et al., 2003) in 2395 children attending 2nd to 4th grade (mean age 8.1 ±0.8 years, range 7- 10 years) in four regions in Germany. Examinations were performed by five calibrated examiners (Kappa> 0.9) on clean teeth after brushing. The MIH prevalence at the four regions differed considerably (Düsseldorf 14.6 %, Hamburg 14.0 %, Heidelberg 6.0 %, Greifswald 4.3%) with a mean prevalence of 10.1 % (10.7 % boys, 9.5 % girls, χ2-test: p= 0.57). The caries prevalence was low in general, but children with MIH exhibited statistically significantly higher caries experience in the primary and permanent dentition (MIH group: dmft 2.0 ±2.5; DMFT 0.2 ±0.6; other children: dmft 1.5 ±2.2; DMFT 0.1 ±0.5; t-test: p= 0.001 and p< 0.001, respectively). The mean number of permanent teeth affected by MIH was 2.8 (±1.7). 12.0 % of the children with MIH also had at least one affected primary molar which resulted in a statistically significant correlation for MIH in primary and permanent teeth (p< 0.01, Spearmans correlation). Most of the affected teeth had demarcated opacities (81.2 %), but more than half of the affected children showed at least one tooth with a severe form of MIH characterized by breakdown of the tooth, atypical restorations or pain during brushing or eating. In conclusion, MIH is a clinically and epidemiologically relevant problem in German school children. The prevalence which is highly varying in different regions requires more research on the aetiology of MIH. The high rate of severe forms is of clinical concern. The findings of the present study stress the need for educating present and future dentists and pediatric specialists in MIH, as well as for developing public health policies for the prevention and adequate treatment of MIH.
Prediction of high caries increment in adults – a 5-year longitudinal study from North-East Germany
(2013)
The aim of this study is to develop an easily applicable prediction model for high coronal caries increment in adults (20-79 years) from a representative sample (N=2,565) to identify a high risk-group for specific caries prevention. The data from SHIP-0 (1997-2001) and the 5-year follow-up SHIP-1 (2002-2006) is used for analyses. The oral health examination was conducted according to WHO criteria [1997]. The drop-out analysis reveals that drop-outs are significantly older, have a lower school education, are more frequently current smokers, but have a better self-perception of their teeth. The majority of the study-population (76%) has caries incidence in this 5-year period. Caries increment shows a polarized distribution, as the high caries increment group (≥9 surfaces in half-mouth, 11.4% of the sample) comprise 40% of the total increment. The variables male gender, age ≥40 years, lower school education or lower income, current smoking, pain-associated dental visit, baseline caries experience and a non-satisfying self-perception of teeth show a statistically significant influence on high caries increment. The prediction model allows a fair to good prediction on an epidemiological level for men (AUC=0.75). The factors smoking, school education and pain-associated visit only have a significant impact on the prediction of high caries increment in men. Due to very high caries prevalence and increment a population-based prevention in adults should be optimized first, before risk-group specific preventive programmes might be implemented.
We presented the prevalence of MIH in Dubai/UAE for the first time, which represents a developed Middle Eastern city and compared it to results obtained from Greifswald/Germany, which represents a developed European city. The results have shown that the prevalence of MIH in Dubai/UAE is higher than Greifswald/Germany. However, in comparison to the literature, the prevalence of MIH in Dubai is lower than other Middle Eastern cities. Furthermore, we have shown that there is a higher caries level associated with MIH in Dubai. This is also true in Greifswald, Germany and other international studies. In addition, we have reported the prevalence of caries and fluorosis in Dubai and compared them to Greifswald and the previous studies in Dubai. Nevertheless, caries values presented in this study and previous studies indicate that strong attention is required from health authority to this topic. This research provides a strong and comparable source of information on the prevalence of MIH in Dubai for other studies, since it followed strictly all methodological and clinical standards suggested for the assessment and diagnosis of MIH, which are the EAPD criteria. The findings presented in this study require particular attention from the local health authorities and general practitioners for such developmental defect to facilitate early and adequate diagnosis and treatment. This could be achieved by implementing continuing education courses on MIH detection, diagnosis, and treatment for general practitioners. Furthermore, this study has the potential to trigger new studies that would help in understanding the MIH etiology.