[ZApprO versus ZÄPrO: results of a first comparative study]. / ZApprO versus ZÄPrO: Ergebnisse einer ersten Vergleichsstudie.

BACKGROUND: More than 60 years after the enactment of the first Licensing Regulations for Dentists (ZÄPrO), a new Licensing Regulations for Dentists, the ZApprO, was implemented in 2020. The aims of this study were to evaluate and compare the "Course in Technical Propaedeutics" (TPK) with the course "Dental Propaedeutics with a Focus on Dental Technology" (ZPDT), which are based on different legal foundations. METHODS: The following parameters were compared after completion of the courses: (1) theoretical and practical knowledge, (2) regular department-internal learner evaluation, and (3) special evaluation of learning conditions by the learners and (4) by the instructors. The theoretical and practical exams and the questionnaires were analyzed in terms of their test-statistical characteristics (difficulty, discrimination index, internal consistency). Group comparisons between TPK and ZPDT were conducted using t­tests for independent groups. RESULTS: Significant differences were only detected in the students' evaluation of their learning conditions, with theoretical and practical knowledge transfer being rated lower in the TPK than in the ZPDT. DISCUSSION: The comparable results of the knowledge assessments and the regular learner evaluation, triangulated with the comprehensive learner and instructor evaluation, allowed a broad assessment of both courses. The significant differences identified provide opportunities for optimization of the newly implemented ZPDT course.

Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars.

BACKGROUND: The importance of Silver diamine fluoride (SDF) as a minimally invasive and nonaerosolizing management during COVID-19 pandemic has highly increased. SDF is a caries-arresting agent that causes staining of tooth structure. Managing this discoloration will increase its acceptance in treating primary teeth. The main aim of this study was to quantify the color change associated with the application of SDF on extracted carious primary molars, the potential masking of this color change by potassium iodide (KI), composite (CMP) and glass ionomer cement (GI) and the effect of aging on this color masking effect. METHODS: An in-vitro study in which 52 carious primary molars were collected, prepared, and distributed randomly into four groups equally as follows: Group A: SDF 38%; Group B: SDF 38% + KI; Group C: SDF 38% + CMP; Group D: SDF 38% + GI. Color changes were recorded for each sample at baseline, and after application of the tested materials. Moreover, all samples had undergone Suntest aging followed by a third color reading. CIELAB values L*, a*, b*, ΔL, Δa, and Δb were measured, ΔE was calculated, and data were analyzed using multivariate analysis of variance (MANOVA) and post-Hoc Scheffé test (p < 0.05). RESULTS: MANOVA revealed the significant influence of the factor 'material'. SDF caused an obvious color change compared to the color of carious dentin. Regarding ΔL, the color change of groups C and D was not significant directly after application of the tested materials. After aging, it was significant among all groups, including groups C and D. In Δa there was a difference between SDF and groups B and C after application of the tested materials, and aging produced the same results. The color shifts of Δb of all tested groups varied significantly from one another. After aging, there was no difference between group D and either group A or B. CONCLUSIONS: Treatment with SDF caused obvious discoloration of carious dentin. Directly after SDF application, all tested materials could effectively mask the color change associated with the application of SDF. CMP was the only material whose color masking effect was not completely reversed by aging.

Prevalence of Molar-Incisor-Hypomineralisation among school children in four German cities.

BACKGROUND: A wide range for the prevalence of Molar-Incisor-Hypomineralisation (MIH) has been found in regional studies. AIM: The aim of this study was to determine the prevalence of MIH in Germany and to compare the findings with other studies. DESIGN: In the compulsory dental school examination, the first permanent molars, permanent incisors, and second primary molars were examined according to EAPD criteria in 2395 children (8.1 ± 0.8 years) in four regions in Germany for the presence of MIH. Examinations were performed by five calibrated examiners (κ = 0.9) on clean teeth after toothbrushing. RESULTS: The prevalence of MIH at the four regions differed considerably (4.3-14.6%) with a mean prevalence of 10.1%. The DMFT/dmft was generally low, but children with MIH exhibited statistically significant higher caries values. A total of 12.0% of the children with MIH also had at least one affected primary molar, which resulted in a statistically significant correlation between primary and permanent teeth. Most of the affected teeth had demarcated opacities, but more than half of the affected children showed at least one tooth with severe MIH. CONCLUSIONS: Molar-Incisor-Hypomineralisation is a prevalent finding in German school children. The prevalence varies highly in different regions, and the high rate of severe forms has clinically relevant implications.

Blackbox error management: how do practices deal with critical incidents in everyday practice? A qualitative interview study.

BACKGROUND: Error management plays a key role in patient safety. It is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analyzing them. Almost nothing is known about the incidents physicians in outpatient care consider to be critical and how they deal with them. We carried out an interview study to explore outpatient physicians' views on error management, discover what they regard as critical incidents, and find out how error management is put into practice in ambulatory care. METHODS: We conducted 72 semi-structured interviews with physicians from ambulatory practices. We asked participants what they considered to be a critical incident, how they reacted following an incident, how they discussed incidents with their coworkers, and whether they used critical incident reporting systems. The interviews were transcribed verbatim and analyzed using qualitative content analysis. RESULTS: Interviewed physicians defined the term "critical incident" differently. Most participants reported that they recorded information on incidents and discussed them in their teams. Several physicians reported taking a 'pay better attention next time-approach' to the analysis of incidents. Systematic error management involving incident documentation, analysis, preventive measure development, and follow-up, was the exception. CONCLUSIONS: To promote error management, medical training should include teaching on the topic, so that medical professionals can learn about critical incidents and how to deal with them in an open and structured manner. This would help establish the culture of safety that has long been called for internationally.

Clinical significance of sleep bruxism on several occlusal and functional parameters.

The aim of this study was to evaluate the association between various functional and occlusal parameters and sleep bruxism. Thirty-nine (39) sleep bruxism patients and 30 controls participated in this investigation. The assessment of sleep bruxism was performed using the Bruxcore Bruxism-Monitoring Device (BBMD) combined with a new computer-based analyzing method. Sixteen functional and/or occlusal parameters were recorded. With a mean slide of 0.95 mm in the sleep bruxism group and a mean slide of 0.42 mm in the control group (Mann Whitney U test; p<0.003), results solely demonstrated a significant group difference regarding the length of a slide from centric occlusion to maximum intercuspation. The results suggest that the slightly pronounced slide could be of clinical importance in the development of increased wear facets in patients with current sleep bruxism activity. Following further evaluation including polysomnographic recordings, the BBMD combined with this new analyzing technique seems to be a clinically feasible instrument that allows the practitioner to quantify abrasion over a short period.

Pain perception and functional/occlusal parameters in sleep bruxism subjects following a therapeutic intervention.

BACKGROUND: This study was conducted to assess the individual pain perception in sleep bruxism (SB) subjects. Moreover, the effects of a cognitive behavioural therapy (CBT) compared to an occlusal appliance (OA) on pain perception and a possible continuative impact on several functional parameters were investigated. METHODS: A total of 57 SB subjects participated in this investigation. The diagnosis of SB was based on the clinical criteria of the American Academy of Sleep Medicine (AASM). Twenty-eight SB subjects were randomly allocated to the CBT group and 29 to the OA group. The therapeutic intervention took place over a period of 12 weeks, whereby both groups were examined at baseline, immediately after termination of the intervention, and at a 6-month follow-up for pain perception and functional parameters. At each of the three measurement periods, participants completed the pain perception scale and ten functional/occlusal parameters were recorded. RESULTS: Of the 12 parameters recorded, statistically significant main effects were found for the affective pain perception (p < 0.05) and for the three functional variables. Interestingly, the values obtained for the affective pain perception were considerably below that of a reference group. Apart from the determined statistically significant results, the values recorded for all functional/occlusal variables as well as those obtained for the sensory pain perception were clearly located within normative ranges. CONCLUSIONS: Within the limitations of this study, it might be concluded that the significantly reduced affective pain perception in SB subjects is the expression of an adaptation mechanism.

A new analyzing method for quantification of abrasion on the Bruxcore device for sleep bruxism diagnosis.

AIMS: To evaluate a newly developed semi-automatic computer-based method to analyze the objectivity of the Bruxcore Bruxism-Monitoring Device (BBMD) by assessing the interrater reliability. The capability of the BBMD to differentiate between sleep bruxers (SB) and healthy controls was also verified by estimating the sensitivity, specificity, and predictive values. METHODS: Forty-eight SB and 21 controls took part in this investigation. After a detailed clinical dental examination, each participant received a BBMD to be worn for 5 consecutive nights. The BBMDs were then scanned and rated by 2 independent examiners using the new method, which counted the abraded area in pixels. Interrater reliability was assessed by intraclass correlation coefficient (ICC) analyses. RESULTS: The analyses showed a very high interrater reliability of ICC = 0.99, and comparison of the mean pixel scores revealed values that were approximately 8 times higher for the SB than for the controls. With a selected pixel score cutoff point of 2900, a sensitivity of 79.2% and a specificity of 95.2% were found. The clinical diagnosis was correctly predicted in 97.4% of the SB and 66.7% of the controls. CONCLUSION: The results support the assumption that the newly developed analyzing method for the assessment of the BBMD is a clinically suitable, objective, and applicable method that seems to be able to differentiate between SB and a healthy control sample. These data, however, need to be confirmed in further investigations using polysomnographic recordings.

Effects of sleep bruxism on functional and occlusal parameters: a prospective controlled investigation.

This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigation was to analyze the relationship between sleep bruxism and several functional and occlusal parameters. The null hypothesis of this study was that there would be no differences among sleep bruxism subjects and non-sleep bruxism controls regarding several functional and occlusal parameters. Fifty-eight sleep bruxism subjects and 31 controls participated in this study. The diagnosis sleep bruxism was based on clinical criteria of the American Academy of Sleep Medicine. Sixteen functional and occlusal parameters were recorded clinically or from dental study casts. Similar to the recently published retrospective pilot study, with a mean slide of 0.77 mm (s.d., 0.69 mm) in the sleep bruxism group and a mean slide of 0.4 mm (s.d., 0.57 mm) in the control group, the evaluation of the mean comparison between the two groups demonstrated a larger slide from centric occlusion to maximum intercuspation in sleep bruxism subjects (Mann-Whitney U-test; P=0.008). However, following Bonferroni adjustment, none of the 16 occlusal and functional variables differed significantly between the sleep bruxism subjects and the non-sleep bruxism controls. The present study shows that the occlusal and functional parameters evaluated do not differ between sleep bruxism subjects and non-sleep bruxism subjects. However, as the literature reveals a possible association between bruxism and certain subgroups of temporomandibular disorders, it appears advisable to incorporate the individual adaptive capacity of the stomatognathic system into future investigations.

Correlation between stress, stress-coping and current sleep bruxism.

BACKGROUND: Stress is discussed as a potential factor in the development of sleep bruxism (SB). The aim of this study was to investigate whether specific stress-factors correlate with SB-activity. METHODS: Sixty-nine subjects, of which 48 were SB-patients, completed three German questionnaires assessing different stress-parameters and stress-coping-strategies: Short questionnaire for recognition of stress-factors (Kurzer Fragebogen zur Erfassung von Belastungen, KFB), Questionnaire for recuperation and strain (Erholungs-Belastungs-Fragebogen, EBF-24 A/3) and the stress-coping questionnaire (Stressverarbeitungsfragebogen-78, SVF-78). The diagnosis of SB was based on the clinical criteria of the American Academy of Sleep Medicine (AASM). The degree of SB-activity was measured by the Bruxcore-Bruxism-Monitoring-Device (BBMD, Bruxcore, Boston, USA), worn for five consecutive nights and analyzed using a computer-based method. Non-parametric Spearman correlation coefficients, rho, were calculated between the psychometric data and the amount of SB-activity measured by a pixel score of the BBMD. RESULTS: Significant correlations were found for 'daily problems' (r = 0.461, p < 0.01), 'trouble at work' (r = 0.293), 'fatigue' (r = 0.288), 'physical problems' (r = 0.288) and the coping-strategy 'escape' (r = 0.295) (all p < 0.05). CONCLUSIONS: Within the limitations of this study it could be shown that subjects with high SB-activity tend to feel more stressed at work and in their daily life, which in turn might influence their physical state. These subjects also seem to deal with stress in a negative way. However, due to the rather low to almost moderate correlation coefficients and the descriptive character of the study, further investigations are necessary to examine a possible causal relationship.

In vivo evaluation of noncarious cervical lesions in sleep bruxism subjects.

STATEMENT OF PROBLEM: Occlusal load has frequently been suggested to be involved in the development of a noncarious cervical lesion (NCL). However, there is a lack of clinical studies evaluating NCLs and occlusal parameters in sleep bruxism (SB) subjects. PURPOSE: The purpose of this clinical study was to assess the frequency of NCLs and determine potential occlusal differences between SB subjects and healthy control subjects. MATERIAL AND METHODS: A total of 91 volunteers, 58 women and 33 men, with a mean (SD) age of 28.37 (4.89) years (range of 20 to 39 years), participated in this investigation. The clinical assessment of SB was based on the criteria of the American Academy of Sleep Medicine. The participants were divided into 2 groups; 58 subjects were assigned to the SB group and 33 subjects to the control group, following a thorough dental examination that was performed by a single trained dentist. Additionally, the following parameters were recorded: mean number of teeth present, existence/absence of NCLs, frequency of NCLs relating to the type of tooth, type of occlusal guidance scheme, existence of a slide from centric occlusion (CO) to maximum intercuspation (MI), length of the slide, and report of tooth hypersensitivity. Group differences were statistically analyzed using chi-square tests for the qualitative variables and Mann-Whitney U tests for the quantitative variables (alpha=.05). RESULTS: NCLs were significantly more prevalent in SB subjects (39.7%) than in the control subjects (12.1%) (P=.006). In SB subjects, the first premolars were the teeth most affected, and in control subjects, the first molars were most affected. Tooth hypersensitivity was reported in 62.1% of the SB subjects and in 36.4% of the control subjects (P=.018). The evaluation of occlusal guidance schemes revealed no significant difference between the groups. In SB subjects (70.7%), a slide from CO to MI was significantly more prevalent than in control subjects (42.4%) (P=.008). Moreover, SB subjects demonstrated a significantly longer mean (SD) slide of 0.77 (0.69) mm compared to that of control subjects of 0.4 (0.57) mm (P=.008). CONCLUSIONS: Within the limitations of this study, SB subjects demonstrated significantly more NCLs than the control group; whereas, the type of occlusal guidance scheme seems to be of minor importance in the development of NCLs.

Effects of an occlusal splint compared with cognitive-behavioral treatment on sleep bruxism activity.

The impact of an occlusal splint (OS) compared with cognitive-behavioral treatment (CBT) on the management of sleep bruxism (SB) has been poorly investigated. The aim of this study was to evaluate the efficacy of an OS with CBT in SB patients. Following a randomized assignment, the OS group consisted of 29, and the CBT group of 28, SB patients. The CBT comprised problem-solving, progressive muscle relaxation, nocturnal biofeedback, and training of recreation and enjoyment. The treatment took place over a period of 12 wk, and the OS group received an OS over the same time period. Both groups were examined pretreatment, post-treatment, and at 6 months of follow-up for SB activity, self-assessment of SB activity and associated symptoms, psychological impairment, and individual stress-coping strategies. The analyses demonstrated a significant reduction in SB activity, self-assessment of SB activity, and psychological impairment, as well as an increase of positive stress-coping strategies in both groups. However, the effects were small and no group-specific differences were seen in any dependent variable. This is an initial attempt to compare CBT and OS in SB patients, and the data collected substantiate the need for further controlled evaluations, using a three-group randomized design with repeated measures to verify treatment effects.

Maladaptive coping strategies in patients with bruxism compared to non-bruxing controls.

BACKGROUND: Sleep bruxism is the non-functional grinding or clenching of teeth during sleep. It may lead to tooth damage and myofascial pain. Although stress is discussed as a main causal agent, there is a lack of studies concerning coping strategies in patients with sleep bruxism. PURPOSE: The aim of the present study was to investigate whether bruxers, compared to non-bruxing individuals, apply maladaptive coping strategies. METHOD: Seventy-five sleep bruxers and 38 non-bruxers were selected by dental examination and tested by a German coping questionnaire (SVF78). RESULTS: A significant difference in positive coping strategies was observed between the two groups. Bruxers reported less positive coping strategies, mainly less "reaction control" and "positive self-instructions." In general, males reported less negative coping strategies. CONCLUSION: The reported effects demonstrate a deficit of functional coping strategies in bruxers, whereas strategies that enhance stress do not seem to be associated with sleep bruxism. Findings do not admit the conclusion that there is a causal association of maladaptive coping and bruxism. However, they support the approach of a multidisciplinary therapy involving psychological treatment.