Epidemiological trends, predictive factors, and projection of tooth loss in Germany 1997-2030: part I. missing teeth in adults and seniors.

OBJECTIVE: This is the first part of a report on tooth loss in Germany 1997-2030. Here, we describe trends in the prevalence of tooth loss in adults and seniors 1997-2014, assess predictive factors for tooth loss and projected it into 2030. MATERIAL AND METHODS: Data of the cross-sectional, multi-center, nationally representative German Oral Health Studies of 1997, 2005, and 2014 were used. Age, sex, educational level, smoking status, and the cohort were used for ordinary least square regression to assess the association of predictors with tooth loss (missing teeth, MT). The yielded regression coefficients were used to predict tooth loss in 2030. RESULTS: Compared with 1997, the mean MT in adults (35-44 years old) in 2030 was predicted to decrease by two-thirds to 1.3. The prevalence of tooth loss (MT > 0) will decrease by 72% from 1997 to 2030. In 2030, half of the population of adults will not exhibit any tooth loss. Compared with 1997, the mean MT among seniors (65-74 years old) will decline to 5.6 teeth (i. e. two-thirds reduction) until 2030. Prevalence of tooth loss will be halved by 2030, and approximately one-third of this age group will not exhibit any tooth loss. CONCLUSIONS: Based on the model used, the trend of a robust decline in tooth loss will become more dynamic by the year 2030. As a result, every second adult will have experienced no tooth loss at all in 2030, and seniors will possess more teeth than they have previously lost. CLINICAL RELEVANCE: This study presents the trends of tooth loss in Germany for a period of three decades. It provides clinically relevant data for health care planning by 2030.

[Satisfaction with dental care from the patient's perspective - the dental-ZAP-V1]. / Zufriedenheit mit der zahnärztlichen Versorgung aus Perspektive der Patienten - Der Zahn-ZAP-V1.

BACKGROUND: Patient satisfaction is a central topic in quality management in outpatient dental care. The ZAP questionnaire was validated to explore patient satisfaction in general and specialist outpatient settings. This study aims at assessing the psychometric properties of the ZAP in dental care. METHODS: A minimally modified version of the ZAP consisting of 4 domains (office organisation, cooperation, interaction, information) was administered in personal interviews to a population-based sample. Descriptive, exploratory and confirmatory psychometric analyses were conducted with random subsets of the study sample. RESULTS: The study population comprised 1 773 subjects with at least one dental visit during their lifetime (mean age=50 years, female=51.6%). The exploratory factor analysis identified 3 subscales (office organisation, interaction, information). Based on these results, items of the subscale "cooperation" were excluded from further analyses. The remaining items had a medium difficulty of 0.75, all item-total-correlations were above 0.4. Missing values ranged between 2.3% and 28.7%. Cronbach's alpha ranged between 0.79 and 0.95. After introduction of 3 residual correlations, the confirmatory factor analyses reached a good model fit (TLI: 0.97; CFI: 0.97, RMSEA: 0.06). Partial standardised factor loadings ranged between 0.77 and 0.87. The 3 latent factors were highly correlated. There was a positive correlation between the 3 subscales and global patient satisfaction with the dentist. CONCLUSION: The psychometric assessment can be used in the 3 modified subscales (office organisation, interaction, and information) to assess patient satisfaction with dental care. To assess dentist's competence in relation to dental anxiety and pain as well as shared decision making new scales specific to dental care should be explored.

[Oral health in Germany: an oral epidemiological outline]. / Zur Mundgesundheit in Deutschland : Ein oralepidemiologischer Umriss.

The article describes the current situation with regard to oral health in Germany on the basis of selected surveys. The analysis is confined to the two main oral diseases, i.e., dental caries and periodontitis. At the same, data on the rates of restorative procedures are presented and trends in the development of prevalences are addressed. Whereas in Germany caries (crown caries) is clearly declining as a burden of disease, the situation with respect to the prevalence of periodontitis is unclear; however, the undertreatment of people having periodontitis in Germany must be assumed. Tooth loss among the adult population in Germany has decreased considerably.

Impact of Powered Toothbrush Use and Interdental Cleaning on Oral Health.

The long-term effectiveness of powered toothbrushes (PTBs) and interdental cleaning aids (IDAs) on a population level is unproven. We evaluated to what extent changes in PTB and IDA use may explain changes in periodontitis, caries, and tooth loss over the course of 17 y using data for adults (35 to 44 y) and seniors (65 to 74 y) from 3 independent cross-sectional surveys of the German Oral Health Studies (DMS). Oaxaca decomposition analyses assessed to what extent changes in mean probing depth (PD), number of caries-free surfaces, and number of teeth between 1) DMS III and DMS V and 2) DMS IV and DMS V could be explained by changes in PTB and IDA use. Between DMS III and V, PTB (adults: 33.5%; seniors: 28.5%) and IDA use (adults: 32.5%; seniors: 41.4%) increased along with an increase in mean PD, number of caries-free surfaces, and number of teeth. Among adults, IDA use contributed toward increased number of teeth between DMS III and V as well as DMS IV and V. In general, the estimates for adults were of lower magnitude. Among seniors between DMS III and V, PTB and IDA use explained a significant amount of explained change in the number of caries-free surfaces (1.72 and 5.80 out of 8.44, respectively) and the number of teeth (0.49 and 1.25 out of 2.19, respectively). Between DMS IV and V, PTB and IDA use contributed most of the explained change in caries-free surfaces (0.85 and 1.61 out of 2.72, respectively) and the number of teeth (0.25 and 0.46 out of 0.94, respectively) among seniors. In contrast to reported results from short-term clinical studies, in the long run, both PTB and IDA use contributed to increased number of caries-free healthy surfaces and teeth in both adults and seniors.

Oral health in German children, adolescents, adults and senior citizens in 2005.

OBJECTIVE: The aim of this field study (the "Fourth German Oral Health Study") was to obtain representative data on caries (DMFT index), periodontitis (CPI) and prosthetic status in the German population and to evaluate changes in the oral health of the German people as compared with the findings of the Third German Oral Health Study conducted eight years previously. BASIC RESEARCH DESIGN: The study took the form of a population-representative cross-sectional survey with random samples, and was complemented by a questionnaire to reveal sociological as well as behavioural data. PARTICIPANTS: The age cohorts in the present study were 12-year-olds (children), 15-year-olds (adolescents), 35- to 44-year-olds (adults) and 65- to 74-year-olds (senior citizens). RESULTS: All age groups showed considerable improvements in oral health with respect to caries. Of the children, 70.1% were free of dentine caries and the mean DMFT value was 0.7. In adults and senior citizens both the DMFT value and the number of missing teeth and edentulousness declined. With regard to periodontal conditions, increasing prevalence of moderate and severe findings was recorded in adults and senior citizens, owing probably to the larger number of natural teeth remaining in the oral cavity. CONCLUSION: The study documents a distinct improvement in oral health in the German population. Interrelated with the higher numbers of remaining natural teeth a higher prevalence of moderate and severe periodontal conditions in German adults and senior citizens was observed.

Depression as a risk factor for denture dissatisfaction.

Depression is associated with impaired health outcomes. This study investigated whether there is a significant association between depression and dissatisfaction with dentures in older adults. In a population-based study (1180 adults aged 65-74 yrs), depression was measured by an abbreviated Geriatric Depression Scale. Denture dissatisfaction was assessed with a five-point Likert-type question ("very dissatisfied" to "very satisfied"). The depression-denture dissatisfaction association was analyzed with simple (dissatisfied vs. not dissatisfied outcome) and ordinal logistic regression (based on outcome's full range). For each unit increase on the 15-point depression scale, the probability of denture dissatisfaction increased by 24% [95% confidence interval, 15-34%, P < 0.001 (simple logistic regression)] and the probability for higher levels on the five-point dissatisfaction scale increased by 16% [95% CI, 11-22%, P < 0.001 (ordinal logistic regression)], adjusted for potential confounding variables. The likely causal association in older adults has major implications for the evaluation of treatment effects and the demand for prosthodontic therapy.

Dimensions of oral-health-related quality of life.

Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16-79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIP-G. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general.

Oral health of representative samples of Germans examined in 1989 and 1992.

This paper presents selected results of two recent representative cross sectional studies of oral health in the German population, conducted by the IDZ (Institute of German Dentists) for the old Federal States (the former Federal Republic of Germany) in 1989 (n= 1741) and the new Federal States (the former German Democratic Republic) in 1992 (n=1519). Each epidemiological study reported both clinical and sociological data. The following average DMFT values were determined: for the children aged 8/9 yr: 1.4; for the adolescents aged 13/14 yr: 4.9; for the adults aged 35-44 yr: 16.1; and for the adults aged 45-54 yr: 17.9. These are the overall averages for "Germany West" and "Germany East" combined. The overall results for periodontal health in adults were as follows: CPITN 0: 4.9%; CPITN 1:11.2%; CPITN 2: 24.6%; CPITN 3: 42.7%; and CPITN 4:16.6% for the adults aged 35-44 yr and CPITN 0: 2.4%; CPITN 1: 8.1%; CPITN 2: 20.4%; CPITN 3: 46.8%; and CPITN 4: 22.3% for the adults aged 45-54 yr. The following average tooth loss figures were calculated for Germany as a whole: age group 35-44 yr: 3.9 missing teeth; age group 45-54 yr: 7.7 missing teeth. In addition, all the morbidity data determined have been analysed for statistical significance in the comparison between "West" and "East" Germany. The prevalences presented are also differentiated according to the socioeconomic status (SES) of the subjects, with the lower social strata as a whole showing higher morbidity prevalences. Comparisons show that caries has declined significantly among children and adolescents in Germany in the last 10-15 yr. Finally, the authors recommend the inclusion of qualitative research techniques when studying the differential causation of the inverse correlation between oral morbidity and social status.

[Introduction to the problem of compliance]. / Einführung in die Compliance-Problematik.

The following article attempts to elucidate the basic knowledge and essential statement of the problem of compliance research--based on an exemplary literature review. Characteristics of the scope of dental care are introduced into the discussion. The following is being pointed out: 1. Non-Compliance constitutes one of the major practical problems in medicine; 2. Compliance resp. Non-Compliance can only be understood appropriately from the wider structure of the doctor-patient-relationship; 3. Non-Compliance often occurs even in the case of serious diseases; and 4. Several concrete measures can be formulated which comprise an improvement of Compliance.