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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.
The Institute of German Dentists [Institut der Deutschen Zahnärzte (IDZ)] conducted four national cross-sectional surveys of oral health in the German resident population [German Oral Health Studies, "Deutsche Mundgesundheitsstudien", (DMS)]: in 1989 (DMS I, only West Germany), 1992 (DMS II, only East Germany), 1997 (DMS III), and 2005 (DMS IV). In this study, the first two surveys (1989/92) were merged to achieve comparability with the last two studies. The Studies of Health in Pomerania (SHIP) are two independent regional cross-sectional population-based studies conducted during 1997-2001 (SHIP-0) and 2008-2012 (SHIP-Trend) in northeast Germany. In this thesis, we addressed three main questions: First, we aimed to explore the relative contributions of clinical oral health variables assessing caries, periodontal status, and prosthetic status to self-perceived oral health by means of an age-specific approach in DMS IV. Second, we aimed to assess the changes of dental health in West and East Germany between 1989 and 2005 in DMS I-IV. Third, we aimed to evaluate the changes of periodontal status and number of teeth within the last decade based on data from the DMS and the SHIP studies. To explore the associations of self-perceived oral health with clinical oral health variables, we developed separate multinomial logistic regression models for adults and seniors in DMS IV by using stepwise methods. To assess the changes of dental health in West and East Germany between 1989 and 2005, we applied regression models and assessed associations between region, survey year, their interactions and variables assessing dental disease status (number of missing, filled, decayed and sound teeth, the DMFT-index and the probability of having ≤20 teeth), adjusting for potential risk factors for caries. To assess changes of periodontal status in Germany, prevalences, percentages and numbers of teeth affected were defined. In summary, the number of unreplaced teeth showed the strongest association with self-perceived oral health in adults and was the second variable to enter the model for seniors during the stepwise selection process. Between 1997 and 2005, the number of missing teeth considerably decreased in DMS but East Germans had consistently more missing teeth than West Germans in each survey year. Further, during the last decade, the periodontal status significantly improved in SHIP and in West German adults, which might translate into a even higher tooth retention in the future.