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.

[Independent dental patient consultation service--experiences of the information center for the Rhine-Neckar district]. / Unabhängige zahnärztliche Patientenberatung - Erfahrungen aus der Beratungsstelle für den Rhein-Neckar-Kreis.

Patients should be the focus of health care - or so resounds the frequently heard cry of politicians, consumer protection groups and patient representatives. It cannot be denied that the increased co-determination of the insured and of patients in the health service is a sign of the times. Demanding ever increasing health insurance premiums and exacting higher additional contributions from patients on the one hand without increasing their say and their rights on the other hand meets with little sympathy. Spouting like a mantra about "personal responsibility", the "voice of the patient" or the "sovereignty of the consumer" in talk-shows or studio debates is not sufficient. Words must be followed up by actions in order to give patients the necessary skills to enable them to make autonomous decisions. One step in this direction is the model of an independent dental consumer and patient advisory service in the Rhine-Neckar district health authority presented here and sponsored by the central associations of the health insurance companies in the scope of the funding provided under section sign 65 b SGB V [Social Security Code]. Since 2001 over 4000 people seeking advice have received information about dental treatment, planned therapies or legal issues. More than half of those seeking advice are between 40 and 70 years old and the number of women outweighs the number of men. The majority of patients want an independent second opinion, demonstrating the limits of call centres or Internet advice services. The anonymity of the consultation is an important factor for those seeking advice. The successful integration of the advisory service is evident, not only from the high number of consultations, but also from the fact that the majority of those seeking advice have been referred to the service by their respective health insurance company. For various reasons it can be assumed that there will be an increasing demand for qualified dental advice. It is therefore incumbent on health policy to create a regulatory framework and to ensure the funding on a broader base. Wherever possible the public health service can take control, ensuring the independence of the advisory service and guaranteeing that group interests remain outside.

Caries prevalence and treatment needs of 7- to 10-year-old schoolchildren in southwestern Germany.

The caries status of 1784 children aged 7 to 10 years was examined in a cross-sectional, epidemiological study in the Rhine-Neckar-District. Results showed that 30.5% of the children had caries-free primary and 65.2% had caries-free permanent teeth. The d(m)ft index was 2.68, and the D(M)FT averaged 0.76. As in previous studies, a high risk caries group was found, with 10% of all children showing more than 50% of all carious and filled teeth in the permanent dentition. Overall, 45.6% of the children's primary teeth and 16.3% of their permanent teeth needed treatment. As indicated by higher dt:ft (DT:FT) ratios in younger age groups, dentists preferred treating older children. Apart from a higher caries prevalence in primary teeth in males, no significant sex differences were found. Children of rural origin had a higher caries experience. The results confirm previous data showing considerable improvements with a declining caries experience in the young population. But the caries status of German pre-teenage children is still moderately high according to WHO criteria. For further improvements, considerable efforts have to be made with special emphasis on prevention in high risk caries groups.

[Incidence of caries and degree of dental hygiene in nursery school children of the City of Heidelberg and the Rhine-Neckar district]. / Kariesbefall und Sanierungsgrad bei Kindergartenkindern der Stadt Heidelberg und des Rhein-Neckar-Kreises.

A study conducted by the Heidelberg Public Health authorities shows that mass examinations by dental surgeons in kindergartens enhance the degree of "cleanup" achieved in "first teeth" sets. The continual contact between Public Health authorities and the kindergartens also results in motivating the educationists to promote increased inclusion of the subject "Teeth and Health of the Human Denture" in the kindergarten itineraries. Special prophylaxis programmes will have to be worked out in future for a small group of children in whom dental caries is particularly active, since such children are not covered by group prophylactic measures.

[Dental care of youth in schools of the Rhine-Neckar district and the city of Heidelberg]. / Untersuchung zur Jugendzahnpflege in den Schulen des Rhein-Neckar-Kreises und der Stadt Heidelberg.

Experience at the Heidelberg Health Authority has shown that youth dental care without the intervention of a dental officer does not possess the necessary efficiency. The percentage of pupils not in the permanent care of a dental practitioner is increasing yearly. Hence, early preventive care is hampered. During the course of follow-up investigations by a professional dentist motivation is possible which cannot be achieved by collective motivation within the school class. In order to cope with "problem children", who generally belong to the lower social groups, it is desirable to place these under the supervision of dentists of the regional authorities. Thus this social class will also receive the necessary dental care and education.