Testing the ability for autonomous oral hygiene in hospitalized geriatric patients-clinical validation study.

OBJECTIVES: This study aimed to evaluate if the Timed Test for Money Counting (TTMC) complemented with testing the range of shoulder motion by griping the backside of the neck (NG) predicts the ability of geriatric inpatients to perform effective plaque reduction by autonomously conducted oral hygiene. MATERIAL AND METHODS: This clinical validation study involved 74 hospitalized geriatric inpatients, 48 (64.9%) females, aged between 66 and 98 years (mean age 84.1 years). Oral health status was examined. Dental plaque was assessed with the Turesky modified Quigley-Hein Index (TI) on teeth and the Denture Hygiene Index (DHI) on removable dentures. The performance and duration of TTMC and NG were recorded. After autonomous tooth brushing and denture cleaning by the patient, dental plaque was scored again with the TI and DHI. Geriatric assessment data were collected from medical records. RESULTS: Forty-nine (66.2%) geriatric inpatients completed the TTMC&NG successfully. Passing the TTMC&NG was significantly associated with better plaque removal on teeth and dentures by autonomously conducted oral hygiene. The sensitivity of the TTMC&NG for above average plaque reduction was 86.4% on teeth and 77.8% on dentures. The test revealed a negative predictive value of 75.0% to detect below average plaque reduction on teeth and 72.7% on dentures. CONCLUSIONS: The TTMC&NG served as a suitable predictor for the ability of geriatric inpatients to perform autonomously effective tooth brushing and denture cleaning. CLINICAL RELEVANCE: This simple and short test might help the medical staff to identify geriatric inpatients unable to perform effective oral hygiene by themselves.

[Oral Health in Children and Adolescents with Mental Disability and Psycho-Emotional Disorders from Lower Saxony and Thuringia]. / Mundgesundheit von Kindern und Jugendlichen mit geistiger Behinderung und psychoemotionalen Störungen aus Niedersachsen und Thüringen.

AIM: This study aimed to compare the oral health status of 6-16 year old pupils with mental disability (MD) and psycho-emotional disorders (PED) from Lower Saxony (LS) and Thuringia (TH). METHODS: Oral examination was provided for 571 pupils with MD from TH, 118 students with MD and 80 students with PED from LS. Caries experience, odontogenic infections, fissure sealants and periodontal health were recorded. Data were statistically analysed by linear and binary logistic regression after adjusting for age. RESULTS: Students with PED revealed highest caries prevalence and experience in both dentitions with highest prevalence of odontogenic infections in the primary dentition. In 6-11 year old pupils with MD, there were only minor differences in odontogenic infections between TH and LS. Pupils with PED aged 6-11 years had a more that two-fold higher risk to develop dental caries and odontogenic infections than peers with MD. Care index was higher in pupils with PED compared to those with MD in both dentitions. Pupils with MD from TH were less affected with dental caries and received better care than those from LS. Compared to peers without mental disabilities or disorders, pupils with MD or PED were more affected with dental caries in both dentitions. They revealed a lower care index and less fissure sealants. CONCLUSION: Pupils with MD or PED reveal unsatisfactory oral health status constituting a group with particular high caries risk, while those with PED are most affected by caries and odontogenic infections. The care index is insufficient especially in pupils with MD compared to those with PED or peers without disabilities and indicates disparity in oral health for this vulnerable group.

Dental Caries and Developmental Defects of Enamel in the Primary Dentition of Preterm Infants: Case-Control Observational Study.

AIM: Assessment of dental health in the primary dentition of preterm infants (PTI) including investigation of mother- and infant-related risk factors in a case-control study design. MATERIAL AND METHODS: One hundred twenty-eight infants aged 3-4 years were included. Sixty-four PTI (27 males) were randomly selected from the preterm registry of the Jena University Hospital. As a control group served 64 full-term infants (FTI) recruited from the Department of Paediatric Dentistry, matched for age and sex. Dental examinations were provided by one dentist under standard clinical conditions. Caries was scored using the International Caries Detection and Assessment System (ICDAS II) and the DMFT, gingival health using the Periodontal Screening Index, and developmental defects of enamel using the DDE index. Mother- and infant-related factors were collected via a questionnaire and from medical records. RESULTS: The caries prevalence was 50.0% (ICDAS II >0) in PTI and 12.5% (ICDAS II >0) in FTI. The caries experience was higher in PTI (DMFT 1.0 ± 3.1) than in FTI (DMFT 0.3 ± 1.0). PTI had a higher risk of caries (OR 7.0), initial lesions (OR 6.2), DDE (OR 7.5), and gingivitis (OR 6.5) than FTI. The highest risk occurred in PTI with an extremely low birth weight (<1,000 g). A higher risk of DDE was present when mothers suffered from illness during pregnancy (OR 3.9). A higher risk of caries was revealed in infants with respiratory syndrome (OR 6.2) or when their mothers had a lower socioeconomic status (OR 6.3). CONCLUSIONS: PTI had less healthy teeth than FTI and are at a higher risk for DDE, caries, and gingivitis. The poorer dental health in PTI is associated with a low birth weight, a low socioeconomic status, and mothers' illness during pregnancy.

Nutritional status, dental caries and tooth eruption in children: a longitudinal study in Cambodia, Indonesia and Lao PDR.

BACKGROUND: Untreated dental caries is reported to affect children's nutritional status and growth, yet evidence on this relationship is conflicting. The aim of this study was to assess the association between dental caries in both the primary and permanent dentition and nutritional status (including underweight, normal weight, overweight and stunting) in children from Cambodia, Indonesia and Lao PDR over a period of 2 years. A second objective was to assess whether nutritional status affects the eruption of permanent teeth. METHODS: Data were used from the Fit for School - Health Outcome Study: a cohort study with a follow-up period of 2 years, consisting of children from 82 elementary schools in Cambodia, Indonesia and Lao PDR. From each school, a random sample of six to seven-year-old children was selected. Dental caries and odontogenic infections were assessed using the World Health Organization (WHO) criteria and the pufa-index. Weight and height measurements were converted to BMI-for-age and height-for-age z-scores and categorized into weight status and stunting following WHO standardised procedures. Cross-sectional and longitudinal associations were analysed using the Kruskal Wallis test, Mann Whitney U-test and multivariate logistic and linear regression. RESULTS: Data of 1499 children (mean age at baseline = 6.7 years) were analyzed. Levels of dental caries and odontogenic infections in the primary dentition were significantly highest in underweight children, as well as in stunted children, and lowest in overweight children. Dental caries in six to seven-year old children was also significantly associated with increased odds of being underweight and stunted 2 years later. These associations were not consistently found for dental caries and odontogenic infections in the permanent dentition. Underweight and stunting was significantly associated with a lower number of erupted permanent teeth in children at the age of six to seven-years-old and 2 years later. CONCLUSIONS: Underweight and stunted growth are associated with untreated dental caries and a delayed eruption of permanent teeth in children from Cambodia, Indonesia and Lao PDR. Findings suggest that oral health may play an important role in children's growth and general development. TRIAL REGISTRATION: The study was restrospectively registered with the German Clinical Trials Register, University of Freiburg (trial registration number: DRKS00004485 ; date of registration: 26th of February, 2013).

'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR.

BACKGROUND: The Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR. METHODS: The study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression. RESULTS: A total of 1847 children (mean age = 6.7 years, range 6.0-8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination - 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools. CONCLUSIONS: The study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children. The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).

Fluoride/vitamin D tablet supplementation in infants-effects on dental health after 10 years.

OBJECTIVE: We examined whether fluoride/vitamin D supplementation in the first year of life is associated with caries or molar incisor hypomineralization (MIH) at 10 years of age. METHODS: The study population consisted of 406 children for whom information on fluoride/vitamin D supplementation during the first year of life was available. Dental examination at the age of 10 included caries and MIH registration. The results of logistic regression models were adjusted for gender, age, BMI, parental education, and equivalent income. RESULTS: Children receiving supplementation during the entire first year of life had a significantly lower probability of having caries-related restorations in primary teeth in comparison to those who received supplementation for less than 6 months (fluoride supplementation: odds ratio (OR) for d3-4mfs 2.47 (1.32-4.63), for fs 2.70 (1.43-5.10); vitamin D supplementation: OR for d3-4mfs 2.08 (1.00-4.32), fs 2.50 (1.19-5.25)). The majority of logistic regression analyses indicated no association between supplementation and MIH. CONCLUSIONS: It was found a consistent significant caries-preventive effect in the primary dentition of children who received fluoride (256/372)/vitamin D supplementation (274/376) in all 12 months over the first year of life; no effects were observed for permanent dentition. The high parental interest in supplementation is linked to an imbalance of the study groups. Furthermore, tooth brushing frequency, use of fluoride toothpastes and/or other oral hygiene products were not recorded during the observation period which may also confound the results. CLINICAL RELEVANCE: Fluoride/vitamin D supplementation can be used in children for preventing caries in the primary dentition.

Preventive and invasive treatment in special needs patients: a German retrospective study.

OBJECTIVES: Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. MATERIAL AND METHODS: Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. RESULTS: A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d3/4mft/0.9 D3/4MFT) than in ODC (2.5 d3/4mft /0.9 D3/4MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). CONCLUSION: Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. CLINICAL SIGNIFICANCE: This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN).

OBJECTIVES: This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany. METHODS: From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models. RESULTS: Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities. CONCLUSION: This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities. CLINICAL RELEVANCE: Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

Caries Prevalence and Risk Assessment in Thuringian Infants, Germany.

PURPOSE: To determine the caries prevalence and experience in Thuringian infants and to assess their caries risk. MATERIAL AND METHODS: The subjects were participants in a regional preventive programme, a birth cohort study with the aim of preventing caries. In the first year of life, children were invited to a dental examination at the Jena University Hospital. Dental caries was scored using WHO diagnostic criteria at the d1-level without radiography. Children were categorised as being of low, moderate or high risk for caries according to the caries-risk assessment tool of the American Academy of Pediatric Dentistry (AAPD). RESULTS: 512 children (mean age 6.7 ± 2.2 months) were examined. 58.2% (n = 298) of all children had teeth (2.21 ± 2.76). Caries prevalence of cavitated carious lesions was 1.7%, and prevalence of non-cavitated carious lesions was 7.7% in children who had teeth. Caries experience was 0.3 ± 1.0 d1-4mfs/0.2 ± 1.5 d3-4mfs (range of 0 to 16). Children with caries were on average 10.8 ± 3.2 months old, while children without caries were 6.6 ± 2.1 months. One hundred sixty-nine children (33.1%) were categorised at high risk for caries, and 98 already had teeth. CONCLUSION: Although caries prevalence and experience was relatively low in infants, one third of all children were categorised as being at high caries risk. Early dental visits are necessary to detect the first signs of caries, to assess the caries risk and to establish a dental home with a risk-related recall system. The caries-risk assessment tool (CAT) of the AAPD can assist the clinician in the decision-making process.

Evaluation of an interdisciplinary preventive programme for early childhood caries: findings of a regional German birth cohort study.

OBJECTIVES: The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary preventive programme (PP) for early childhood caries in 3-year-old children in Germany. MATERIAL AND METHODS: From July 2009 to October 2010, all parents of newborns (n = 1162) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to a dental examination in Jena University Hospital. Participating children were included in a risk-related recall system with continuous oral care over 3 years. Caries-risk assessment tool of the AAPD was used for risk categorizing. High-risk children received fluoride varnish biannual. In 2013, the total birth cohort (participants and non-participants) was invited to evaluate the PP. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Data were analysed statistically (multivariate logistic regression). RESULTS: Seven hundred fifty-five children (mean age 3.26 ± 0.51 years) were examined. Children in the PP (n = 377) showed significantly lower caries prevalence and experience than non-participants (15.6 vs. 37.8 %, 0.9 ± 3.3 d1-4mfs vs. 2.6 ± 5.2 d1-4mfs). Lack of vitamin D supplements (OR = 1.9, CI 0.99-3.51), familial caries experience (OR = 2.2, CI 1.27-3.73) and visible plaque on teeth (OR = 6.5, CI 4.41-9.43) were significant risk factors for caries development, whereas regular dental care (OR = 0.5, CI 0.38-0.79) had a protective effect. CONCLUSIONS: The PP was an effective interdisciplinary approach for preventing early childhood caries in small children. CLINICAL RELEVANCE: Early dental visits with caries-risk-related preventive dental care are necessary to prevent early childhood caries (ECC). TRIAL REGISTRATION: German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Midwives' oral health recommendations for pregnant women, infants and young children: results of a nationwide survey in Germany.

BACKGROUND: Studies suggest that poor oral health during pregnancy can lead to perinatal complications, such as low birth weight and preterm delivery as well as poor oral health in children. Aim of this study was to assess the German midwives knowledge about oral health and preventive recommendations for pregnant women, infants and young children. METHODS: The nationwide online-survey was conducted with use of a self-developed, pretested and validated standardized questionnaire. The German association of midwives (Deutscher Hebammenverband e.V.) informed their members about the survey through email, newsletter, website and association journal (Hebammenforum) (n = 7.500). Data were analyzed using descriptive statistics. RESULTS: Response rate was 12.6 % (mean age 42.9 ± 9.3 years). The majority of midwives advised pregnant women about periodontal diseases (78.6 %). Of the midwives, 8.4 % mentioned the possible associations between periodontal diseases and perinatal complications. In general, half of the midwives (53.5 %) recommended a dental visit during pregnancy. A total of 65.5 % of midwives advised parents about early childhood caries. The majority of midwives recommended that oral hygiene starts with eruption of the first tooth (60.4 %) and the first dental visit of the child should be at age 2 or 3 years (51.6 %). Midwives recommendations regarding the implementation of oral hygiene and the referral to a dentist during pregnancy and childhood were highly variable. CONCLUSIONS: To increase oral awareness and to improve the oral health knowledge among midwives and all other health-care professionals, uniform guidelines should be developed in Germany. TRIAL REGISTRATION: German Clinical Trial Register DRKS00008021.

Occlusal characteristics in 3-year-old children--results of a birth cohort study.

BACKGROUND: Aim of this prospective study was to determine prevalence of malocclusion and associated risk factors in 3-year-old Thuringian children. METHODS: Subjects (n = 377) were participants in a regional oral health programme, a birth cohort study with the aim to prevent caries (German Clinical Trials Register DRKS00003438). Children received continuous dental care since birth. Occlusal characteristics (overjet, overbite, anterior open bite, canine relationship and posterior crossbite) were measured at the age of 3 years by one calibrated clinician using a vernier caliper (accuracy 0.1 mm; Münchner Modell 042-751-00, Germany). A regular parent survey was conducted to assess risk factors for development of malocclusion. RESULTS: Three hundred seventy seven children (mean age 3.31 ± 0.70 years; 52.5% male) were examined. Children had a mean overjet of 2.4 ± 0.8 mm and the mean overbite was 0.8 ± 1.2 mm; 58.8 % of the children had a normal overjet ≤ 3 mm and 88.8% a normal overbite with < [Formula: see text] overlap. Prevalence of malocclusion was 45.2% (10.9% anterior open bite, 41.2% increased overjet ≥ 3 mm, 40.8% Class II/III canine relationship, 3.4% posterior crossbite). All children who sucked the thumb had a malocclusion. Children who used a pacifier had greater odds of having a malocclusion at age of 3 years than children without pacifier use (OR = 3.36; 95% CI: 1.87-6.05). Malocclusion and dental trauma were associated, but not statistically significant (OR = 1.83; 95% CI: 0.99-3.34; p = 0.062). Malocclusion was not associated with gender, migration background, low socioeconomic status, preterm birth, special health care needs, breathing or dietary patterns (p > 0.05). CONCLUSIONS: Non-nutritive sucking habits were important risk factors for development of a malocclusion in the primary dentition.

Clinical consequences of untreated dental caries in German 5- and 8-year-olds.

BACKGROUND: About half of all carious lesions in primary teeth of German 6- to 7-year-old children remain untreated, but no data regarding the clinical consequences of untreated dental caries are available. Therefore, this cross-sectional observational study aimed to assess the prevalence and experience of caries and odontogenic infections in the primary dentition of 5- and 8-year-old German children. METHODS: Dental examinations were performed in 5-year-old pre-school children (n = 496) and in 8-year-old primary school children (n = 608) living in the Westphalian Ennepe-Ruhr district. Schools and preschools were selected by sociodemographic criteria including size, area, ownership, socio-economic status. Caries was recorded according to WHO criteria (1997). The Lorenz curves were used to display the polarisation of dental caries. Caries pattern in 5-year-olds was categorized by Wyne's (1997) definition of early childhood caries (ECC). Odontogenic infections as clinical consequence of untreated dental caries were assessed by the pufa index. The 'untreated caries-pufa ratio' was calculated, and the Spearman's rank correlation coefficient (ρ) was used for evaluating the correlation between dmft and pufa scores. Categorical data were compared between groups using the chi-square test and continuous data were analysed by t-test. RESULTS: Caries prevalence and experience in the primary dentition was 26.2 %/0.9 ± 2.0 dmft in 5-year-olds and 48.8 %/2.1 ± 2.8 dmft in 8-year-olds. ECC type I (22 %) was the prevalent caries pattern in 5-year-olds. About 30 % of the tooth decay was treated (5y: 29.7 %/8y: 39.3 %). The Lorenz curves showed a strong caries polarisation on 20 % of the children. Pufa prevalence and experience was 4.4 %/0.1 ± 0.5 pufa in 5-year-olds and 16.6 %/0.3 ± 0.9 pufa in 8-year-olds. In 5-year-olds 14.2 % and in 8-year-olds 34.2 % of the d-component had progressed mainly to the pulp. A significant correlation between dmft and pufa scores exists in both age groups (5y: ρ = 0.399; 8y: ρ = 0.499). First deciduous molars were most frequently affected by odontogenic infections, presenting virtually all pufa scores (>95 %). CONCLUSIONS: Prevalence and experience of odontogenic infections and the untreated caries-pufa ratio were increasing from the younger to the elder children. Dmft and pufa scores in primary teeth predict a higher caries risk in permanent teeth. The pufa index highlights relevant information for decision makers to develop effective oral health care programs for children at high risk for caries.

Genome-wide association study (GWAS) for molar-incisor hypomineralization (MIH).

OBJECTIVES: This genome-wide association study (GWAS) investigated the relationship between molar-incisor hypomineralization (MIH) and possible genetic loci. Clinical and genetic data from the 10-year follow-up of 668 children from the Munich GINI-plus and LISA-plus birth cohort studies were analyzed. MATERIAL AND METHODS: The dental examinations included the diagnosis of MIH according to the criteria of the European Academy of Paediatric Dentistry (EAPD). Children with MIH were categorized as those with a minimum of one hypomineralized first permanent molar. A GWAS was implemented following a quality-control step and an additive genetic effect was assumed. RESULTS: A total of 2,013,491 single-nucleotide polymorphisms (SNPs) were available for analysis. Rs13058467, which is located near the SCUBE1 gene on chromosome 22 (p < 3.72E-7), was identified as a possible locus linked to MIH when using a threshold of p value <1E-6. CONCLUSIONS: After considering the limitations of the present study (e.g., limited sample size and lack of an independent replication sample), it can be concluded that (1) replication analyses in an independent cohort study are strongly recommended and (2) large-scale and well-powered studies are needed to investigate a possible genetic link to MIH.

Pediatricians' oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany.

BACKGROUND: German societies of pediatricians and dentists disagree about oral health-related preventive recommendations (use of fluoride supplements, fluoride-containing toothpaste) for children aged 0-3 years. After failure to reach a consensus, there is no study that has evaluated the guidelines that pediatricians use in daily practice. METHODS: A standardized questionnaire was sent to all 167 practicing pediatricians in the state of Thuringia, Germany, to assess the current oral health-related preventive recommendations. Data were analyzed using descriptive statistics. RESULTS: The response rate was 52.0%. More than 9.0% of the pediatricians advise parents with regard to diet, use of baby bottles, oral hygiene and dental visits. The majority of pediatricians recommend to start tooth-brushing after the 1st birthday and recommend the use of toothpaste and a 1st dental visit after the 2nd birthday (78.0%). Additionally, 23.3% (n = 20) of pediatricians prescribe solely vitamin D, and 20.9% (n = 18) prescribe vitamin D combined with fluoride. Fluoride supplements are given as required by 37.2% (n = 32) of pediatricians, primarily between the 1st and 6th birthdays. The guidelines of the Pediatric Society were used by 1.2% of the pediatricians, the guidelines of the dentists were used by 5.8%, and a mix of both was used by 93.0%. The simultaneous use of fluoride supplements and fluoride toothpaste in the first three years was recommended by 45.9% of the pediatricians. CONCLUSIONS: Pediatricians' oral health recommendations are based on a mix of the guidelines from the German societies of pediatricians and dentists and led to no use or possible overdose of fluoride. Against the background of early childhood caries and dental fluorosis, there is a need for uniform guidelines.

Association of dental caries and weight status in 6- to 7-year-old Filipino children.

OBJECTIVES: The aims of the study were (1) to assess in 6- to 7-year-old Filipino children caries prevalence and experience and the weight status and (2) to investigate the association between dental caries and weight status. MATERIALS AND METHODS: Dental and anthropometric examinations were conducted on 1,962 6- to 7-year-old children during the National Oral Health Survey in 2005-2006. Dental caries assessments were carried out using World Health Organisation (WHO) criteria (1997). Weight status was assessed with body mass index according to WHO growth reference. A multivariable logistic regression model was applied to investigate the effect of dental caries and sociodemographic variables on the children's weight status. RESULTS: Caries prevalence was 96.8 % in primary and 39.7 % in permanent teeth, and caries experience was 8.4 dmft and 0.6 DMFT. Of the children, 17.8 % were underweight, 73.0 % had normalweight, 6.0 % were overweight and 3.2 % were obese. Girls had a lower risk of being underweight than boys odds ratios (OR) 0.70, confidence interval (CI) 0.55-0.88. Children living in rural areas and with no television at home were more likely to be underweight (OR 1.36, CI 1.07-1.72; OR 1.37, CI 1.07-1.76, respectively). Fewer primary and permanent teeth were risk factors for being underweight (OR 0.93, CI 0.92-0.95; OR 0.90, CI 0.89-0.94, respectively). CONCLUSIONS: Underweight was associated stronger with demographic and socioeconomic conditions than with dental variables. However, underweight and dental caries are public health issues of high priority affecting children at an important phase of their development. CLINICAL RELEVANCE: Definite conclusions upon an association between dental caries and weight status in high caries risk schoolchildren cannot be drawn.

Is there a relationship between hyperactivity/inattention symptoms and poor oral health? Results from the GINIplus and LISAplus study.

OBJECTIVES: A few clinical observations reported that children with attention deficit hyperactivity disorder (ADHD) have poor oral health compared to children without ADHD. However, evidence is not conclusive. We assess the association between hyperactivity/inattention and oral health in a population-based study. MATERIAL AND METHODS: As part of the ongoing birth cohort studies German Infant Nutritional Intervention-plus (GINIplus) and Influences of lifestyle-related factors on the immune system and the development of allergies in childhood-plus (LISAplus), 1,126 children at age 10 years (±10.2) from Munich (Germany) were included in the present analysis. During the dental examination, oral hygiene, non-cavitated and cavitated caries lesions, dental trauma, and enamel hypomineralization (EH) in the permanent dentition (MIH/1) were recorded. Children with a Molar-Incisor-Hypomineralization were subcategorized into those with EH on at least one first permanent molar (MIH/1A), and on at least one first permanent molar and permanent incisor (MIH/1B). Data on children's hyperactivity/inattention symptoms were collected by parent-reported Strength and Difficulties Questionnaire. Logistic regressions and zero-inflated Poisson regression models were applied adjusted for gender, parental education, parental income, and methylphenidate or atomoxetine medication. RESULTS: Logistic regressions showed that non-cavitated caries lesions were positively related with the presence of hyperactivity/inattention (ORadj = 1.51,CI95% = 1.08-2.11). When adjusted for parental background, an association showed between hyperactivity/inattention symptoms and MIH/1A but did not reach statistical significance (ORadj = 1.59,CI95% = 1.00-2.53). CONCLUSIONS: Children with borderline and abnormal values of hyperactivity/inattention symptoms showed more non-cavitated caries lesions. Severe levels of hyperactivity/inattention may contribute to a higher risk for MIH/1A in school age. CLINICAL RELEVANCE: Adequate dental preventive care for children with hyperactivity/inattention, especially from a low social background, is of importance for optimal caries prevention.

Is there a positive relationship between molar incisor hypomineralisations and the presence of dental caries?

OBJECTIVE: This epidemiological study aimed to compare the caries experience in 10-year-olds with and without molar incisor hypomineralisation (MIH). METHODS: About 693 children from an ongoing birth cohort study (GINIplus10) were examined for caries lesions to determine the DMF index. Furthermore, enamel hypomineralisation (EH) was scored on all permanent teeth/surfaces, according to the criteria of the European Academy of Paediatric Dentistry. Children with EH were categorised into those with a minimum of one EH in the permanent dentition (MIH/1), with EH on at least one-first permanent molar (MIH/1A), on at least one-first permanent molar and permanent incisor (MIH/1B), and on other permanent teeth (MIH/1C). RESULTS: The mean caries experience was 0.4 (SD 0.9) DMFT. Existence of MIH/1, MIH/1A, MIH/1B, and MIH/1C was determined in 36.5%, 14.7%, 9.4%, and 21.8% of all children. The corresponding DMFT values were the following: no MIH: 0.3 (SD 0.8); MIH/1: 0.5 (SD 0.9); MIH/1A: 0.5 (SD 0.9); MIH/1B: 0.4 (SD 0.9); and MIH/1C: 0.4 (SD 0.9) DMFT. No significant differences were found between all groups. CONCLUSIONS: There was no relationship between the presence of EH/MIH and caries in 10-year-olds. A ratio of one EH-associated defect to two caries lesions indicates that both conditions are prevalent and influence the oral health status of 10-year-old children from Munich, Germany.

Preschool children's taste acceptance of highly concentrated fluoride compounds: effects on nonverbal behavior.

OBJECTIVE: The aim of this video-based study was to examine the taste acceptance of children between the ages of 2 and 5 years regarding highly concentrated fluoride preparations in kindergarten-based preventive programs. STUDY DESIGN: The fluoride preparation Duraphat was applied to 16 children, Elmex fluid to 15 children, and Fluoridin N5 to 14 children. The procedure was conducted according to a standardized protocol and videotaped Three raters evaluated the children's nonverbal behavior as a measure of taste acceptance on the Frankl Behavior Rating Scale. The interrater reliability (intraclass correlation coefficient; ICC) was .86. In an interview, children indicated the taste of the fluoride preparations on a three-point "smiley" rating scale. The interviewer used a hand puppet during the survey to establish confidence between the children and examiners. RESULTS: Children's nonverbal behavior was significantly more positive after Fluoridin N5 and Duraphat were applied compared to the application of Elmex fluid. The same trend was found during the smiley assessment. The response of children who displayed cooperative positive behavior before the application of fluoride preparations was significantly more positive than those who displayed uncooperative negative behavior. CONCLUSION: To achieve a high acceptance of the application of fluoride preparations among preschool children, flavorful preparations should be used.

Effectiveness of a new fluoride varnish for caries prevention in pre-school children.

OBJECTIVE: To investigate the effectiveness of a new fluoride varnish (Clinpro White Varnish, 3MEspe, Seefeld, Germany) with regard to the caries incidence within a 2-year period STUDY DESIGN: A non-randomized sample of 400 children from the Kyffhäuser district (Thuringia, Germany) was divided into a fluoride group (FG, biannual application of fluoride varnish) and control group (CG, no intervention). (Non-)cavitated caries lesions were recorded using World Health Organization (WHO) and Universal Visual Scoring System (UniViSS) criteria. Parents were given questionnaires to gather information about their socio-economic status (SES). Non-parametric methods and binomial logistic regression were used for data analysis. RESULTS: There was a significant increase in caries incidence in both groups. The number of non-cavitated carious lesions was significantly lower in the FG (mean 2.2; sd 2.3) compared with the CG (mean 2.9; sd 1.9). Initial statistical analysis revealed that fluoride varnish might prevent non-cavitated carious lesions. When including SES as a confounder into regression model, potential preventive effect was lost. CONCLUSIONS: This study underlines the importance of the multi-factorial etiology of caries and illustrates that the effectiveness of biannual fluoride varnish application was evident in non-cavitated carious lesions only.