Caries prevalence in 6- to 10-year-old German schoolchildren with and without disability.

BACKGROUND: Both nationally and internationally, there is a lack of data on the caries experience of schoolchildren with disability, especially for children aged 6 to 10 years. AIM: To compare the caries experience of 6- to 10-year-old schoolchildren with disability attending special needs schools (SpS) with children without disability attending primary schools (PS) in two study periods five years apart. MATERIALS AND METHODS: The caries prevalence and severity in schoolchildren aged 6 to 10 years attending PS or SpS was determined according to WHO standards for the school years 2010/2011 and 2015/2016, and the results were compared. RESULTS: Data for 6805 schoolchildren were available. In both examination periods the caries prevalence in the deciduous teeth of 6- to 10-year-old children attending SpS was significantly higher than in children attending PS. The mean dmft values for children attending SpS were also significantly higher (2.11 in both years) than for those attending PS (1.48 and 1.77, respectively). CONCLUSIONS: The dental health of schoolchildren with disability was worse than that of schoolchildren without disability. To improve this situation, caries prevention efforts in day care centers and schools should be intensified for children with disability.

Comparison of micro-CT imaging and histology for approximal caries detection.

Histological sectioning is a generally accepted in vitro validation method for caries detection techniques. However, it requires cumbersome sample preparation and induces irreversible sample destruction. Micro-Computer Tomography (micro-CT) allows non-destructive imaging of tooth structure. The aim of this study was to compare the performance of histological sectioning and micro-CT imaging in detecting approximal carious lesions. Unlike previous studies, evaluation is objectified by comparing visual appearance of exactly corresponding anatomical regions. Sixty extracted human teeth were scanned with a desktop micro CT system. Axial histological slices were prepared and photographed. Sample preparation, combined with dedicated image processing, ensured selection of identical anatomical regions on radiographic and histological images. Evaluation of the presence and extent of carious lesions was performed by four dentists using custom-designed software. Each section was scored independently (histo or micro CT). Scores of approximal surfaces were retained for further analysis. Spearman's correlation coefficients (0.738 to 0.829, p < 0.0001) showed a good agreement between signs of carious lesions in the identical region obtained with both methods. Bland-Altman plots showed that 90.76% of the data points were within the limits of agreement. Micro-CT imaging was shown to provide an interesting alternative to histological sectioning as detection method for carious lesions.

Severity of MIH findings at tooth surface level among German school children.

AIM: This study was to investigate the distribution and clinical characteristics of teeth diagnosed with MIH at surface and defect type level in a cohort of German children. METHODS: The study cohort included 242 children diagnosed with MIH which had been recorded during the compulsory dental school examinations of 20 German primary schools. The subjects had been enrolled by cluster sampling. All children attended the second to fourth grade (age 7-10 years, mean 8.1 ± 0.8). The children were examined by five calibrated examiners (kappa = 0.9) after tooth brushing. The recording comprised teeth, surfaces, type and severity of MIH defects and was conducted using a portable light, mirrors and cotton rolls. MIH was registered according to the EAPD criteria. Defects <1 mm were not recorded. Statistical analysis included descriptive statistics and Spearman's correlation. RESULTS: Most affected teeth were first permanent molars (71.4 %) followed by the maxillary central incisors (15.6 %). The most common defects were demarcated opacities (82.2 %), while the remaining 17.8 % of the affected teeth exhibited severe enamel defects. The most frequently affected surface in molars was the occlusal surface (72.4 %); in incisors, it was the buccal surface (73.5 %). There were no atypical restorations in the affected incisors. Different types of MIH defects at various surfaces of the same tooth were common. The number of affected tooth surfaces was positively correlated with the severity of MIH at child (p < 0.001). CONCLUSIONS: The study demonstrates severe enamel defects involving in almost one-fifth of all MIH teeth. The knowledge of the intra-oral distribution and severity of MIH findings at the enamel surface level is important for assessing the treatment needs.

Factors contributing to severe early childhood caries in south-west Germany.

OBJECTIVES: The purpose of this study is to investigate the contribution of selected variables to the occurrence of severe early childhood caries (S-ECC) in 3- to 5-year-old kindergarten children. METHODS: A cross-sectional study was conducted in 2010 in 30 randomly selected kindergartens in the German Rhein-Neckar district. After informed consent, parents were asked to complete a questionnaire. The oral examinations took place in the selected kindergartens and the WHO methods as well as the criteria proposed by the American Academy of Pediatric Dentistry were followed. Logistic regression was applied to explore the main factors contributing to S-ECC in a multivariate model. RESULTS: In all, 1,007 children aged 3 to 5 years with an average age of 4.1 (SD = 0.8) years were examined. Five variables were associated significantly with the occurrence of S-ECC: breastfeeding for more than 12 months (OR = 3.27), use of the nursing bottle in bed (OR = 3.08), start of tooth brushing after the first anniversary (OR = 2.42), regular visits at the dentists (OR = 0.14) and mother with immigration background (OR = 4.05). Prevalence rate of S-ECC was 9.5 %. The mean d(3+4)mft values were 5.69 (S-ECC group) and 0.23 (non-S-ECC group). CONCLUSION: These results show that occurrence of S-ECC is a complex interaction between socioeconomic, psychological and behavioural factors of parents. New and specific ways to provide preventive dental care for toddlers and infants of caries risk groups have to be developed. CLINICAL RELEVANCE: Parents of newborn children have to receive information about timely start of tooth brushing and adequate use of nursing bottles.

Caries prevalence in 12-year-old children from Germany: results of the 2009 national survey.

OBJECTIVE: In 2009, complementary epidemiological studies were conducted in 16 German states. DESIGN: A 2009 cross-sectional oral health survey of children aged 12 years with 5% samples selected using a two-stage random sampling procedure. SUBJECTS: A random selection of 30,943 12-year-olds were examined in schools. METHOD: DMFT and fissure sealants were recorded following WHO criteria. Caries was diagnosed at the caries into dentine threshold (D3) using the visual method without radiography or fibre-optic transillumination. Statistical evaluation was performed using the software SPSS (v12.0). RESULTS: The proportion of children across Germany with caries experience was 31%. The mean DMFT score was 0.72 and the average Significant Caries Index (SiC) was 2.29. The results showed a wide variation among the different federal states, with mean regional DMFT values ranging from 0.56 to 1.06. Compared to the results obtained in 2004, caries prevalence and caries experience decreased distinctly in this age group. The mean DMFT score for 12-year-olds dropped from 2.44 to 0.72 between 1994 and 2009. The mean DMFT scores were 72.7% lower at the end of the observation period than a few years after the introduction of extensive caries prevention measures in Germany. The mean number of fissure sealed teeth ranged between 2.24 and 3.04. CONCLUSION: The decrease in caries prevalence observed between 1994 and 2004 continued between 2004 and 2009, although once again inequalities in oral health between federal states were observed.

Caries experience and treatment need in adults with intellectual disabilities in two German regions.

OBJECTIVE: The aim of the study was to determine the caries experience, caries prevalence, dental treatment need and care index of adults with intellectual disabilities living in the German federal states of Baden-Württemberg and Sachsen which differ distinctly with respect to the socio-economic conditions. RESEARCH DESIGN: In 2007, legal custodians of all persons working in special day-care institutions (n=2037) were asked to give consent for dental examinations of their custodees. Some 21.9% consented. Thus, 428 persons received a dental examination in the day-care institutions. RESULTS: The mean age of the participants was 35.5 years (range 18-64). Caries prevalence was 93.7% (95% CI 91.3-95.9) in Baden-Württemberg and 97.6% (95% CI 96.2-99.0) in Sachsen. All caries-free persons (n=19) were younger than 35 years. The mean DMFT of the whole sample was 12.3 (95% CI 11.6-12.9). Although DMFT values were the same in both German regions, persons from Baden-Württemberg had more missing teeth than those from Sachsen but untreated carious defects were more common in Sachsen. CONCLUSIONS: Dental care for those with intellectual disabilities could be better harmonised within Germany. Furthermore, specific dental care and dental treatment strategies could be introduced in Germany in order to reduce caries prevalence and number of extracted teeth in persons with intellectual disabilities.

Caries prevalence in 12-year-old Cypriot children.

OBJECTIVE: To determine caries prevalence and caries experience in 12-year-old children living in the Republic of Cyprus and to evaluate whether different variables were associated with caries experience. METHODS: According to the WHO recommendation, schools were randomly selected by taking into account the distribution between rural and urban regions, so that 10% of Cypriot children attending the sixth grade could be examined. In the school year 2003/2004 the children were examined in schools by one person with the aid of artificial light but without taking radiographs or fibre-optic transillumination. DMFT, presence of fissure sealants and black stain were recorded. RESULTS: In total 951 children were examined. Caries prevalence was 32.6% (95% CI 29.62-35.6). The mean DMFT was 0.65 (sd 1.17) and the SiC was 1.95. Fissure sealants were found in 14.3% of the children. No association between frequency of tooth brushing, presence of fissure sealants or presence of black stain and caries experience was observed. Children living in rural areas had significantly higher mean DMFT values than children living in urban areas. CONCLUSION: A further caries decline may be attained by promoting a more extensive use of preventive measures like application of fluoride varnish or fissure sealants.

A survey on education in cariology for undergraduate dental students in Europe.

The aim of the survey was to collect relevant information about education in cariology for dental undergraduate students in Europe. The ORCA/ADEE cariology curriculum group prepared a questionnaire that was mailed in 2009 to 179 European dental schools. One hundred and twenty-three dental schools (72%) from 32 countries completed and returned the questionnaires. In most of these schools, education in cariology is delivered by at least two different units. The units mainly involved are Paediatric Dentistry, Conservative Dentistry, Restorative Dentistry or Operative Dentistry. Theoretical education in cariology is delivered by practically all responding dental schools, and in 96% of these schools, it starts within the first 3 years. Pre-clinical exercises are offered by 98% of the schools starting mainly in the third or fourth year. In 97% of the schools, clinical exercises are carried out, and this occurs mainly in the fourth and fifth year. In nearly all dental schools (88%), education in cariology comprises not only caries but also dental erosion and non-erosive wear. The vast majority of the responding dental schools (89%) supported the idea of developing a European Core Curriculum in Cariology.

European Core Curriculum in Cariology for undergraduate dental students.

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North/South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-Making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.

Decision-making and preventive non-surgical therapy in the context of a European Core Curriculum in Cariology.

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and non-surgical treatment. In particular, it will provide some background information on this part of the European core curriculum. The dentist, on graduation, must be competent at applying the principles of prevention of dental hard tissue disease processes (primary prevention) and progression when it has manifested itself (secondary prevention). The competences should apply in differing ways to patients of all ages. Goals of prevention should be clearly defined in order for outcomes to be evaluated, and a dentist should be competent at determining these outcomes. Although this concept is recognised by many academics and experts, clinical teaching, practice and health insurance coverage frequently emphasise surgical treatment. There are many reasons and obstacles that might account for this, and this paper suggests some reasons why this might be and makes suggestions for how these can be addressed in the future. One factor that is essential in the provision of a preventive, non-surgical approach is that of communication with the patient. However, this unfortunately takes less space in the dental curricula compared with technical skills aimed at restorative procedures; this weighting needs to be more equally balanced.

European core curriculum in cariology for undergraduate dental students.

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North-South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.

[Oral health in adult athletes with intellectual disabilities in Germany]. / Mundgesundheit erwachsener Athleten mit geistiger Behinderung.

In 2008 the summer games of Special Olympics Germany took place in Karlsruhe, Germany. The athletes were offered on site the opportunity to have a voluntary and free dental examination. The examinations were performed by dental clinicians in rooms which were equipped with dental chairs. Data were collected following the criteria of WHO. 420 adult athletes took part in the dental examination. Their age ranged between 18 and 70 years and their mean age was 30.8 years. Nearly two thirds of the participants were males. The caries prevalence of the athletes was 90.8% (95% confidence interval 86.9-92.8%). The mean DMFT value was 9.4. Athletes who were living with their families had a significantly lower mean DMFT value than those living in an institution. In 22.1% of the examined athletes at least one fissure sealed tooth was observed. 58.8% presented with gingivitis and 21% had received prosthodontic care. 95% of the athletes brushed their teeth alone. Only 28% used an electric toothbrush. Less than 7% used regularly a gel with high fluoride concentration. This study shows that persons with intellectual disability still have a poorer oral health than the general population. In order to improve dental health and quality of life in persons with intellectual disability, efficient preventive programmes should be developed and applied in cooperation with parents, relatives and caregivers.

Association between caries experience and body mass index in 12-year-old French children.

The prevalence of overweight and obesity reached 19.7% in 12-year-old French children in the year 2005. Recently, nationwide programs have been broadly implemented in France to reduce the overconsumption of sugars, salt and fat. The aims of this study were to assess the distribution of body mass index (BMI) and D(3+4)MFT index in a sample of 12-year-old French children, and to compare several regression models in order to analyze the association between these two indices. A cross-sectional study was conducted in Montpellier, France, and the height, weight, D(3+4)MFT, sugar and soft drink consumption were recorded in a randomly selected sample of 835 schoolchildren. In order to analyze the association between BMI and DMFT, four models of regression were tested: logistic, Poisson, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB). The mean BMI was 18.9 for the whole sample and the corresponding DMFT value was 1.47. The caries prevalence was 51.7%. The best fitted models for testing the association between BMI and DMFT were ZIP and ZINB models. They showed a significant association between DMFT and sugar consumption, but not with BMI. As a result of the best fitted models (ZIP and ZINB), where BMI was not statistically associated with DMFT, we conclude, within the limits of a cross-sectional survey, that there is no association between these two variables.

Approximal caries diagnosis after data import from different digital radiography systems: interobserver agreement and comparison to histological hard-tissue sections.

AIMS: To evaluate the agreement of approximal caries diagnosis obtained with different types of digital radiography systems after image import into a reference system. METHODS: Digital radiographs were taken from 30 extracted human premolars with 60 diagnostic surfaces using a reference and two test systems from which images were imported as TIFF files. Four observers evaluated the radiographs using the reference software. Teeth were sectioned for histology. Agreement between histology and each technique was calculated using receiver operating characteristic (ROC) statistics. RESULTS: The areas under the ROC curves were not significantly different between reference and test systems. CONCLUSIONS: Importing files from different programs did not affect diagnostic accuracy.