Influence of malocclusion on OHRQoL in adolescents in initial orthodontic treatment phase.

OBJECTIVES: Besides correcting malocclusions, another main objective of orthodontic treatment is to improve patients' oral health-related quality of life (OHRQoL). This study aimed to assess changes in OHRQoL of children within the first six months of orthodontic therapy with fixed orthodontic appliances. METHODS: 85 patients aged 11 to 14 years requiring fixed orthodontic appliance therapy were included. The children completed the German version of the Child Perceptions Questionnaire (CPQ-G-11-14) before (T0), 1 month (T1) and 6 months (T2) after the start of orthodontic treatment. The type of malocclusion was categorized according to the Index of Orthodontic Treatment Need (IOTN). RESULTS: The initial type of malocclusion affected the children's OHRQoL, whereas gender and age did not. The IOTN dental health component (DHC) had a significant impact on the CPQ score (median CPQ of 15.00 for the group DHC 4 vs. 22.50 for DHC 5, p = 0.032). The onset of orthodontic treatment initially affected the CPQ domains "Oral symptoms" and "Functional limitations, with a change versus baseline of 2.00 (p = 0.001), but improved again after 6 months. Regression analysis demonstrated that children with an IOTN DHC 5 malocclusion experienced a greater impact on their ORHQoL, as indicated by a CPQ score 7.35 points higher than that of children with an IOTN DHC 4 malocclusion (p = 0.015). CONCLUSIONS: At the beginning of orthodontic treatment, the OHRQoL slightly worsens, probably due to the discomfort and appearance of the appliances. However, 6 months after the start of orthodontic treatment, OHRQoL improved again in patients with severe malocclusion (IOTN 4 and 5), and approached baseline values. CLINICAL RELEVANCE: The results help the clinician to better understand specific aspects of oral health that may be affected by different malocclusions, thereby improving the child's satisfaction and overall quality of life.

OHIP-5 FOR SCHOOL-AGED CHILDREN.

BACKGROUND: Different dental patient-reported outcome measures (dPROMs) exist for children and adults, leading to an incompatibility in outcome assessment in these 2 age groups. However, the dental patient-reported outcomes (dPROs) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the same in the 2 groups, providing an opportunity for compatible dPRO assessment if dPROMs were identical. Therefore, we adapted the 5-item Oral Health Impact Profile (OHIP-5), a recommended dPROM for adults, to school-aged children to allow a standardized dPRO assessment in individuals aged 7 years and above. AIM: It was the aim of this study to develop a 5-item OHIP for school-aged children (OHIP-5School) and to investigate the instrument's score reliability and validity. METHODS: German-speaking children (N = 95, mean age: 8.6 years +/- 1.3 years, 55% girls) from the Department of Pediatric Dentistry at the Medical University of Vienna, Austria and a private dental practice in Bergisch Gladbach, Germany participated. The original OHIP-5 was modified and adapted for school going children aged 7-13 years and this modified version was termed OHIP-5School. It's score reliability was studied by determining scores' internal consistency and temporal stability by calculating Cronbach's alpha and intraclass correlation coefficients, respectively. Construct validity was assessed comparing OHIP-5School scores with OHIP-5 as well as Child Perceptions Questionnaire (CPQ-G8-10) scores. RESULTS: Score reliability for the OHIP-5School was "good" (Cronbach's alpha: 0.81) or "excellent" (Intraclass correlation coefficient: 0.92). High correlations between OHIP-5School, OHIP-5, and CPQ-G8-10 scores were observed and hypotheses about a pattern of these correlations were confirmed, providing evidence for score validity. CONCLUSION: The OHIP-5School and the original OHIP-5 are short and psychometrically sound instruments to measure the oral health related quality of life in school-aged children, providing an opportunity for a standardized oral health impact assessment with the same metric in school-aged children, adolescents, and adults.

LESSONS LEARNED FROM the FIRST STEPS of IMPLEMENTING VALUE-BASED ORAL HEALTH CARE: A CASE STUDY FROM the MEDICAL UNIVERSITY of VIENNA.

BACKGROUND: Value-based oral healthcare (VBOHC) has two fundamental components, the assessment of patients' dental outcomes and the measurement of the costs to achieve those outcomes. The aim of this article is to describe challenges and opportunities of implementing dental patient-reported outcomes (dPROs) in clinical care at the University Clinic of Dentistry, Medical University of Vienna, in Austria, to determine lessons learned and describe next steps forward to VBOHC implementation. METHODS: A case study determining lessons learned based on an implementation process to incorporate a dental patient-reported outcome measure (dPROM) in routine clinical care was conducted. The German version of the five items Oral Health Impact Profile (OHIP-5), a dPROM was selected and integrated into the general anamnesis including dental and medical history for patients aged ≥16 years. The anamnesis is paper based and is to be completed by each new patient during the registration process. Thereafter, it is uploaded to the patients' dental record via scan by the main central admission. However, it is then the treating dentist's task to transfer the data into the digital system. Data accuracy between digital and paper forms was investigated, and lessons learned regarding the first steps of implementing VBOHC were summarized based on the implementation process findings. RESULTS: To date, 8,147 patients were approached to fill in OHIP-5. However, only 266 patients´ OHIP- 5 files were transferred into the digital system by the dentist. To explore the accuracy between the manual transfer of data from paper forms to digital format, the data of 89 randomly selected patients was compared. Of this sample, 74 (83.1%) patient's data sets were found to be identical. Lessons learned included the importance of institutional dedication, stakeholders' engagement, dPROMs integration in follow up visits, the significance of digital solutions, and the continuous monitoring and evaluation. CONCLUSION: Integrating dPROMs in clinical settings is achievable and is the first important step to move forward with VBOHC implementation.

Prevalence and patterns of traumatic dental injuries in primary teeth: a 3-year retrospective overview study in Vienna.

OBJECTIVES: The aim of this study was to retrospectively identify the prevalence, patterns, and accident types of traumatic dental injuries (TDIs) in children with primary teeth in Vienna, Austria. MATERIAL AND METHODS: The investigation was conducted as a retrospective overview study including all children with TDIs in primary teeth at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records including age, gender, location of trauma, type of trauma, cause of TDI, and location of traumatic incident were obtained. Furthermore, the time of presentation and the time span between TDI and initial treatment were evaluated. RESULTS: The sample comprised TDIs in 243 patients with 403 primary teeth. In a ratio of 1:1.45, boys were significantly more involved than girls. Upper central and lateral incisors were most frequently affected (n = 371, 92.1%). Dislocations were the most common type of injury (n = 298, 74%) with subluxations being the most prevalent form (n = 85, 28.5%). In 23% (n = 92), fractures were observed. The majority of traumatic incidents occurred at home (88.5%). CONCLUSION: The injury characteristics are comparable to what has previously been reported in other studies in pediatric populations. CLINICAL RELEVANCE: TDIs are a prevalent event in children worldwide and incisors are the most affected teeth in the primary dentition. Thus, dental practitioners should be able to handle these injuries.

Hypersensitivity relief of MIH-affected molars using two sealing techniques: a 12-week follow-up.

OBJECTIVES: The aim of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 12 weeks after sealing using two different materials (composite and glass ionomer). Furthermore, the retention rates of both materials were analyzed. METHODS: Thirty-nine children with two MIH-affected molars showing hypersensitivity and non-occlusal breakdowns were included. Hypersensitivity was assessed with an evaporative (air) stimulus. Both teeth were sealed by two calibrated operators using a split-mouth design with either Clinpro Sealant in combination with Scotchbond Universal (C) or Ketac Universal (K), respectively. Clinical pain assessments (Schiff Score Air Sensitivity Scale [SCASS], Visual Analog Scale [VAS]) were made at baseline ("pre"), immediately after treatment ("post"), and after 1, 4, 8, and 12 weeks. Paired t tests were calculated in each group between baseline and all other time points. RESULTS: Thirty-eight children with 76 molars completed all stages of the study. Regardless of the material used, the application of the sealant decreased hypersensitivity significantly immediately as well as throughout the 12-week recalls (all p values < 0.001). We found no statistically significant difference among both materials chosen in any of the time points evaluated. Furthermore, retention of both materials was comparable in both groups. CONCLUSIONS: Both sealant materials were able to reduce hypersensitivity successfully immediately and throughout the 12-week follow-up. Furthermore, their performance was similar in terms of retention. CLINICAL RELEVANCE: Hypersensitivity can be a major complaint in patients with MIH. This is the first study evaluating hypersensitivity relief of MIH-affected molars using two sealing techniques.

Impact of molar incisor hypomineralization on oral health-related quality of life in 8-10-year-old children.

OBJECTIVES: The aim of this study was to compare oral health-related quality of life (OHRQoL) in children with and without molar incisor hypomineralization (MIH) and to assess the impact of severity of MIH on OHRQoL in children between 8-10 years using the German version of the Child Perceptions Questionnaire (CPQ-G8-10). MATERIALS AND METHODS: Children aged 8-10 years were recruited at a pediatric dental clinic in Hannover, Germany. Half of them were affected by MIH. Participants were evaluated for presence and severity of MIH (MIH-TNI), plaque and dental caries status. Children were asked to answer the CPQ-G8-10. Statistical analysis was performed using GraphPad Prism-software version 8. RESULTS: One hundred eighty-eight children (mean age 8.80 [± 0.84]; 43.10% female) were included in the study with 94 children having MIH. CPQ-G8-10 mean scores in MIH-affected children were significantly higher than in children showing no MIH (13.87 [± 8.91] vs. 4.20 [± 3.74]; p < 0.0001) showing that MIH has negative impact OHRQoL. Similar trends were seen in all four subdomains. Regarding severity, CPQ-G8-10 mean scores increased from mild to severe forms of MIH. CONCLUSION: Children affected by MIH show an impaired OHRQoL compared to children without MIH; with increasing severity, OHRQoL gets more impaired. Clinical relevance To understand the patient's perception and the individual oral health needs will help to prioritize MIH and recognize its impact.

Artificial intelligence system for training diagnosis and differentiation with molar incisor hypomineralization (MIH) and similar pathologies.

OBJECTIVES: Molar incisor hypomineralization (MIH) is a difficult-to-diagnose developmental disorder of the teeth, mainly in children and adolescents. Due to the young age of the patients, problems typically occur with the diagnosis of MIH. The aim of the present technical note was to investigate whether a successful application of a neural network for diagnosis of MIH and other different pathologies in dentistry is still feasible. MATERIALS AND METHODS: For this study, clinical pictures of four different pathologies were collected (n = 462). These pictures were categorized in caries (n = 118), MIH (n = 115), amelogenesis imperfecta (n = 112) and dental fluorosis (n = 117). The pictures were anonymized and a specialized dentist taking into account all clinical data did the diagnosis. Then, well-investigated picture classifier neural networks were selected. All of these were convolutional neural networks (ResNet34, ResNet50, AlexNet, VGG16 and DenseNet121). The neural networks were pre-trained and transfer learning was performed on the given datasets. RESULTS: For the vgg16 network, the precision is the lowest with 83.98% as for the dense121 it shows the highest values with 92.86%. Comparing the different pathologies between the investigated neural networks, there is no trend detectable. CONCLUSION: In the long term, an implementation of artificial intelligence for the detection of specific dental pathologies is conceivable and sensible. CLINICAL RELEVANCE: Finally, this application can be integrated in the area of training and teaching in order to teach dental students as well as general practitioners for MIH and similar dental pathologies.

PATIENT-REPORTED OUTCOME MEASURES FOR PEDIATRIC DENTAL PATIENTS: A METHODOLOGICAL REVIEW AND MAPPING EXERCISE.

OBJECTIVES: The most important dental patient-reported outcome (dPRO) is oral health-related quality of life (OHRQoL) which was commonly based on the following four dimensions: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. However, until now, analyses linking dPROSs to the four dimensions have only been done in adults. We therefore examined if the existing dental patient-reported outcome measures (dPROMS) for pediatric patients could also be mapped to these four domains. METHODS: We performed a literature search to identify generic dPROMs administered in children and adolescents. Two researchers independently assessed titles, abstracts and full texts and extracted pediatric dPROMs and items. dPROM items were then mapped to the four OHRQoL dimensions. RESULTS: We identified 701 articles. After abstract screening, 118 articles were reviewed in full text. Fifteen articles met the inclusion criteria. Twelve instruments were identified, including 6 modified versions of the questionnaires. All questionnaires and their included items could be mapped to the four dimensions. In some cases, items were linked to two dimensions. CONCLUSIONS: The four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for existing dPROMs in pediatric dental patients. These dimensions should therefore be considered when measuring OHRQoL in children and adolescents in future studies.

Pediatric patients' reasons for visiting dentists in all WHO regions.

BACKGROUND: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. METHODS: Dentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients' oral health problems and prevention needs were computed. FINDINGS: Data from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories. CONCLUSIONS: The study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Influence of caries and molar incisor hypomineralization on oral health-related quality of life in children.

OBJECTIVES: This study was aimed to compare the impact of caries and molar incisor hypomineralization (MIH) on oral health-related quality of life (OHRQoL) in children. MATERIAL AND METHODS: A total of 528 German children aged 7 to 10 years were recruited, half affected by caries and the other half affected by MIH. Both groups were matched according to age, sex, and social status and divided into 3 categories according to severity. The German version of the Child Perceptions Questionnaire for 8- to 10 years old (CPQ-G8-10) was used to analyze the impact on OHRQoL by applying ANOVA models. RESULTS: Patients with MIH showed a mean CPQ score of 10.7 (± 9.3). This was significantly higher compared to the caries group with 8.1 (± 9.8). The score increased linearly from the low severity category to the high severity category in both groups (caries, 4.1 to 13.8; MIH, 5.2 to 17.7, respectively). CONCLUSION: With increasing severity, both clinical conditions showed a greater negative impact on OHRQoL. MIH was associated with more impairments. CLINICAL RELEVANCE: Currently, the focus in pediatric dentistry is placed on the prevention and treatment of caries. Both diseases may have a negative influence on OHRQoL. Since children perceive the impairments by MIH as worse and the prevalence is equal to that of caries, which focus might be shifted in the future.

Effect of method of administration on the oral health-related quality of life assessment using the Early Childhood Oral Health Impact Scale (ECOHIS-G).

OBJECTIVES: The influence of the administration method used to collect oral health-related quality of life (OHRQoL) in children remains largely unknown. The aim of this study was to determine whether the OHRQoL information obtained using the Early Childhood Oral Health Impact Scale (ECOHIS) differed with different methods of data collection (face-to-face interview, telephone, or self-administered questionnaire). MATERIALS AND METHODS: The OHRQoL of 38 preschool children, aged 1 to 5 years, was measured using the German version of the ECOHIS. The instrument was administered to the caregivers of these children using three different methods, with an interval of 1 week between each administration. Test-retest reliability for the repeated ECOHIS-G assessments across the three methods of administration, agreement, and convergent validity was determined. RESULTS: Kappa coefficients for agreement between two different methods of administration, respectively, ranged from moderate to substantial (0.47 to 0.65). Test-retest reliability was moderate (ICC 0.65-0.79). CONCLUSION: In conclusion, the three methods of administration (face-to-face interview, telephone interview, or self-administered questionnaire) of the ECOHIS-G were comparable in 1- to 5-year-old preschool children. CLINICAL RELEVANCE: All three methods of administration can be used to obtain valid and reliable OHRQoL information in German speaking countries.

Changes in oral health-related quality of life after treatment of hypersensitive molar incisor hypomineralization-affected molars with a sealing.

OBJECTIVES: The aim of this study was to investigate the changes in oral health-related quality of life (OHRQoL) before and after treatment of hypersensitive molars affected by molar incisor hypomineralization (MIH) with a sealing. METHODS: Thirty-eight children with two MIH-affected molars showing hypersensitivity and non-occlusal breakdowns were included. Hypersensitivity was assessed with an evaporative (air) stimulus. Two affected teeth were sealed by two calibrated operators using a split-mouth design: Clinpro Sealant in combination with Scotchbond Universal, and Ketac Universal (3M), respectively. OHRQoL was measured using the German version of the CPQ8-10 (CPQ-G8-10) at baseline, and after 1, 4, 8, and 12 weeks, respectively. RESULTS: The CPQ total score decreased significantly from a mean of 14.7 (±5.9) to 6.4 (±4.7) (p < 0.001) 1 week after treatment revealing improved OHRQoL. After 12 weeks, OHRQoL improved again proven by a decreased mean score of 2.7 (±3.2). CONCLUSIONS: Sealing of hypersensitive MIH-affected molars revealed a significant improvement of OHRQoL immediately and throughout the 12-week follow-up. CLINICAL RELEVANCE: Hypersensitivity can be a major complaint in patients with MIH. This is the first study evaluating the effect of sealing on OHRQoL in affected patients.

Changes in oral health-related quality of life among Austrian preschool children following dental treatment under general anaesthesia.

OBJECTIVES: To analyse possible changes in oral health-related quality of life (OHRQoL) before and after dental treatment under dental general anaesthesia (DGA) among Austrian preschool children. METHODS: A consecutive sample of 89 parents of children aged 2 to 5 years, suffering from early childhood caries (ECC) and scheduled for DGA, were recruited from two locations in Austria (Vienna and Salzburg). Parents self-completed the German version of the ECOHIS before (baseline) and 4 weeks (T4) after their child's dental treatment. The ECOHIS consists of 13 questions and is divided into two main parts, namely, the child impact section (9 items) and the family impact section (4 items). RESULTS: A total of 80 children (89%) completed a sufficient number ECOHIS questions at baseline and the follow-up assessment after 4 weeks. "Pain in the teeth, mouth, and jaws" and "difficulty eating some foods" from the child section and parents' ratings of "feeling upset" and "guilty" were the most frequently reported impacts at baseline. The ECOHIS total score decreased significantly from a mean of 14.60 to 9.89 (p < 0.001) after DGA treatment, revealing a large effect size for the child (0.8) section, family (0.6) section, and the total score (0.8). Parents rated their child's overall and oral health significantly higher after the DGA treatment (p < 0.001). CONCLUSIONS: Significant improvements in oral health-related quality of life were observed 4 weeks after DGA in children suffering from ECC. CLINICAL RELEVANCE: ECC has an impact on OHRQoL. Rehabilitation under general anaesthesia makes a sustainable improvement.

The German version of Child Perceptions Questionnaire for children aged 8 to 10 years (CPQ-G8-10): translation, reliability, and validity.

OBJECTIVES: The aims of this study were to develop a German version of the Child Perceptions Questionnaire for children aged 8 to 10 years (CPQ-G8-10), a measure of oral health-related quality of life, and to assess the instrument's reliability and validity. METHODS: The original English version of the CPQ8-10 questionnaire was translated into German (CPQ-G8-10) by a forward-backward translation method. A total of 409 8- to 10-year-old children who were recruited at the Department of Paediatric Dentistry in Vienna, Austria, participated in this study. The children self-completed the CPQ-G8-10 and were clinically examined for the presence of dental caries and plaque accumulation. Reliability of CPQ-G8-10 was investigated in a subsample of 58 children after 3 weeks. RESULTS: Questionnaire summary score test-retest reliability was 0.85 (intraclass correlation coefficient, 95% confidence interval (CI) ranging from 0.75 to 0.91) and internal consistency was 0.88 (Cronbach's alpha, lower limit of the 95% CI: 0.87). Validity of the CPQ-G8-10 questionnaire was supported by correlation coefficients with global ratings of oral health of - 0.40 (95% CI - 0.49 to - 0.31) and overall well-being of - 0.26 (95% CI - 0.33 to - 0.13) which met the expectations. Mean CPQ-G8-10 scores were statistically significantly higher in children with caries (dmft+DMFT > 0) compared with caries-free children (p = 0.02). CONCLUSIONS: The German version of the CPQ8-10 was found to be reliable and valid in children aged 8 to 10 years. CLINICAL RELEVANCE: These findings enable assessments of oral health-related quality of life in German speaking 8- to 10-year-old children.

Four-dimensional oral health-related quality of life impact in children: A systematic review.

Oral health-related quality of life (OHRQoL) is an important dental patient-reported outcome which is commonly based on 4 dimensions, namely Oral Function, Orofacial Pain, Orofacial Appearance and Psychosocial Impact. The Oral Health Impact Profile (OHIP) is the most used OHRQoL instrument designed for adults; nevertheless, it is used off-label for children as well. Our aim was to describe the OHRQoL impact on children measured by OHIP and map the information to the 4-dimensions framework of OHRQoL. A systematic literature review following the PRISMA statement was conducted to include studies assessing OHRQoL of children ≤ 18 years using OHIP. The OHIP seven-domain information was converted to the OHRQoL 4-dimension scores accompanied by their means and 95% confidence interval. Risk of bias was assessed using a six-item modified version of quality assessment tool for prevalence studies. We identified 647 articles, after abstracts screening, 111 articles were reviewed in full text. Twelve articles were included, and their information was mapped to the 4-dimensional OHRQoL. Most included studies had low risk of bias. OHRQoL highest impact was observed for Oral Function, Orofacial Pain, and Orofacial Appearance for children with: Decayed-Missing-Filled-Surface (DMFS) of ≥10, anterior tooth extraction without replacement and untreated fractured anterior teeth, respectively. Across all oral health conditions, Psychosocial Impact was less affected than the other three dimensions. OHIP has been applied to a considerable number of children and adolescents within the literature. One instrument and a standardised set of 4-OHRQoL dimensions across the entire lifespan seem to be a promising measurement approach in dental and oral medicine.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

Knowledge, attitudes, and beliefs regarding molar incisor hypomineralization (MIH) amongst German dental students.

BACKGROUND: Knowledge of molar incisor hypomineralization (MIH) has relevance for paediatric dentists. AIM: To assess final-year German dental students' knowledge, attitudes, and beliefs regarding MIH. MATERIALS AND METHODS: A previously validated questionnaire was posted to the 31 German dental schools. Demographic covariates as well as knowledge regarding diagnosis and prevalence, and attitudes and beliefs around aetiology and management were collected. RESULTS: Twenty-two (71%) dental schools responded and a total of 877 students participated. Most (97%) were familiar with MIH and 88% were aware of the diagnostic criteria for MIH; however, only 42% knew how to implement them. One-third were able to identify MIH and 16% reported diagnostic confidence when doing so; 90% assumed the MIH prevalence to be <10%. Two-thirds of the respondents implicated genetic components as the main aetiological factor of MIH. Resin composite (60%) and preformed metal crowns (46%) were the dental materials most often suggested for restorative management. Almost all (98%) respondents were interested in receiving more clinical training. CONCLUSION: German students were familiar with MIH; however, they reported low levels of knowledge and confidence regarding its prevalence and diagnosis. Standardized nationwide, up-to-date curricula should be implemented to educate future dentists in Germany.

Regional and gender differences in population-based oral health insurance data.

OBJECTIVE: Early dental monitoring contributes substantially to good oral health in children. However, little is known on whether children from different geographical regions and gender are equally reached with current preventive and curative oral health strategies. The aim of our study therefore was to explore regional and gender differences in a population-based oral health dataset of Austrian children up to the age of 14. MATERIALS AND METHODS: We extracted the first electronically available health insurance data of children aged up to 14 years on dental services within a 4-year observation period in Austria and performed a separate analysis in up to 6-year-old children. In addition, we used a smaller randomly selected sample dataset of 3000 children as the large numbers would result in significant, but very small effects. RESULTS: In a total of 130,895 children, of whom 77,173 children (59%) were up to the age of six, we detected an east-west gradient: The eastern regions of Austria showed an older age at first contact and a higher number of dental services. A child aged up to 6 years who needed more than four dental services had a likelihood of 40% to be from Vienna, Austria's capital city located in the east. The smaller random sample did not show significant gender differences. CONCLUSIONS: Even in regions with a high density of dentists, such as Vienna, we obviously did not reach young children in the same extent as in other regions. CLINICAL RELEVANCE: Stratified interventions could be developed to overcome regional inequalities.

Associated factors to caries experience of children undergoing general anaesthesia and treatment needs characteristics over a 10 year period.

BACKGROUND: Aim of this study was to describe the characteristics of 1- to 6-year-old children who underwent general anesthesia (GA) in a German specialized pediatric dental institution between 2002 and 2011, and to evaluate the risk factors (age, migration background, nutritional status) for caries experience (dmf-s) in these children. METHODS: A cross-sectional study with retrospective data collection was designed. Children who underwent comprehensive dental treatment under GA were enrolled in the study. The data were collected from patient records and included personal background: age, sex, dmf-s, nutritional status, reasons for GA and treatments provided. Mann-Whitney-U test, Chi-square tests, and linear regression modelling were applied for statistical analyses. RESULTS: 652 children (median age: 3 years [IQR: 2-4], 41.6% female) were treated under GA between 2002 and 2011. Of these, 30.8% had migration background, 17.3% were underweight and 14.8% overweight. The median dmf-s was 28 (IQR: 19-43.5). Univariate, only age and migration showed a significant association with dmf-s (p < 0.01) up to the age of 5 years. In the linear regression analysis, this association of dmf-s with age (OR: 4.04/CI: 2.81-5.27; p < 0.01) and migration (OR: 4.26/CI: 0.89-7.62; p = 0.013) was confirmed. At the patient level, tooth extraction was the most chosen option in both time periods, however, more restorative approaches were taken between 2007 and 2011 including pulp therapy and the use of strip and stainless steel crowns compared to 2002-2006. CONCLUSIONS: Children aged 1-6 years treated under GA showed a high caries experience (dmf-s), whereby age as well as migration, but not BMI, were relevant risk factors. Although tooth extraction is the first choice in most cases in the first time period, more conservative procedures were performed in the second half of the follow-up period.

Multidisciplinary patient care in X-linked hypophosphatemic rickets: one challenge, many perspectives.

X­linked hypophosphatemic rickets (XLH, OMIM #307800) is a rare genetic metabolic disorder caused by dysregulation of fibroblast-like growth factor 23 (FGF23) leading to profound reduction in renal phosphate reabsorption. Impaired growth, severe rickets and complex skeletal deformities are direct consequences of hypophosphatemia representing major symptoms of XLH during childhood. In adults, secondary complications including early development of osteoarthritis substantially impair quality of life and cause significant clinical burden. With the global approval of the monoclonal FGF23 antibody burosumab, a targeted treatment with promising results in phase III studies is available for children with XLH. Nevertheless, complete phenotypic rescue is rarely achieved and remaining multisystemic symptoms demand multidisciplinary specialist care. Coordination of patient management within the major medical disciplines is a mainstay to optimize treatment and reduce disease burden. This review aims to depict different perspectives in XLH patient care in the setting of a multidisciplinary centre of expertise for rare bone diseases.