Dental treatment of children with special healthcare needs: A retrospective study of 10 years of treatment.

BACKGROUND/AIM: Children with special healthcare needs (CSHCN) often face oral health challenges. This retrospective cross-sectional study at a university hospital aimed to determine CSHCN's medical spectrum, dental treatment needs, and mode of treatment: general anesthesia (GA) or outpatient dental care (ODC). DESIGN: Data from the Department of Conservative Dentistry, Heidelberg University Hospital, 2012-2022, were reviewed, considering age, gender, International Classification of Diseases-10 diagnoses, caries experience (dmft/DMFT), restorative parameters, and treatment under GA/ODC. For patients under GA, their American Society of Anesthesiologists (ASA) classification was considered. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U-test and logistic regression were utilized. RESULTS: Of 669 patients, congenital and chromosomal malformations (34.7%), diseases of the nervous system (19.1%), and mental and behavioral disorders (16.0%) were mainly diagnosed. Dentin caries prevalence was high at 79.1%, with treatments performed mainly under GA (51.4%). The odds of receiving treatment under GA decreased with patient age and increased with higher dmft/DMFT scores. Most under GA were classified as ASA 3 (51.7%), indicating high anesthesia risks. CONCLUSION: Children with special healthcare needs often have diseases that can lead to higher challenges related to cooperation. The high prevalence of dentin caries underscores the substantial need for dental treatments, which were consequently often performed under GA, despite the associated risks. These findings stress the need for trained dental professionals.

75 Years Ago: Discovery of Resin Adhesion to Acid-etched Enamel - A Comparison of the 1949 and 1955 Methods.

PURPOSE: This paper describes previously unknown details about the discovery of resin adhesion to acid-etched human enamel. MATERIALS AND METHODS: A literature review was performed through manual assessments. Primary sources revealing the discovery of resin curing on etched enamel were analyzed considering the research objectives and methodological procedure during that era, including the type of teeth used, preparatory measures, acid-etching process, type of resin and its application, and follow-up observations. Additionally, the political and economic contexts were examined. RESULTS: In 1949, acid etching was found to promote adhesion with acrylic resin, a finding described again in 1955. The 1949 studies utilized nitric acid for enamel etching and the acrylate resin Paladon from the Kulzer company (Germany). Conversely, the 1955 investigations employed phosphoric acid and an unnamed acrylate, likely a self-curing resin supported by Kulzer in the late 1930s. Disparities in the 1949 and 1955 findings can be ascribed to varying objectives and test conditions amidst a turbulent political backdrop, significantly impacting the Kulzer company. CONCLUSION: The discovery of resin adhesion to acid-etched enamel, approaching its 75th anniversary in 2024, is a landmark in 20th-century adhesive dentistry. Paladon represents a pioneering compound, exemplifying the influence of political, ideological, and economic factors on scientific advancements during that period.

Oral health-related quality of life and survival analysis after preventive and restorative treatment of molar-incisor hypomineralisation.

The aim of this study was to assess the impact of molar-incisor hypomineralisation (MIH) on oral health-related quality of life (OHRQoL) in children and adolescents, including information on restorative care, tooth sensitivity, as well as sociodemographic factors. Thirty-five patients aged between 7 and 17 years underwent a comprehensive oral examination. Severity of MIH was graded using the MIH Treatment Need Index (MIH-TNI), OHRQoL using the Child Oral Health Impact Profile (COHIP-19). Clinical quality of restorations was assessed according to modified FDI-criteria, tooth sensitivity using the Schiff Cold Air Sensitivity Scale (SCASS). The mean age was 11.3 ± 3.0 years, 34% were female. On average, 6.9 ± 2.8 teeth were affected, 62,9% had hypersensitive teeth (SCASS ≥ 1). Eighty-nine percent of patients had received restorative care, with a mean of 3.3 ± 2.1 teeth restored, most often with composite, followed by fissure sealing. Nine percent of restorations failed by the FDI-criteria. Mean estimated survival times for success were 4.9 years (95% CI 3.5; 6.2) and 5.6 years (95% CI 5.0; 6.3) for fissure sealants and composite restorations, respectively. The mean COHIP-19 score was 64.3 ± 8.2 (max. possible score = 76). A higher severity of MIH-TNI correlated significantly with impaired OHRQoL (rs = - 0.38, p = 0.013). However, this was not mirrored in multiple regression analysis. Despite the high rate of restorative treatment with an acceptable failure rate, OHRQoL is reduced in children with MIH. Many teeth affected by MIH remain sensitive. Further studies are needed to assess the benefits of different restorative options.

Outcome after Partial Pulpotomy: Long-term Results of the Prospective Clinical MMP-9 Study.

PURPOSE: While the objective of partial pulpotomy is to preserve the vitality and function of the pulp tissue, the preopera-tive pulp status is the main prognostic factor for its success. To date, however, there is little data on long-term success rates. Therefore, the aim of this prospective pilot study was to assess the long-term outcome of partial pulpotomy in per-manent teeth after carious pulp exposure without signs or symptoms of irreversible pulpitis, verified clinically, radio-graphically, and via MMP-9 levels. MATERIALS AND METHODS: Patients in whom permanent teeth with extremely deep carious lesions were diagnosed as com-pletely asymptomatic (n = 8) or with signs of reversible pulpitis (n = 10) underwent non-selective caries removal followed by a blood test to assess the level of MMP-9. The teeth were thereafter partially pulpotomised, MTA-capped, and immedi-ately restored with composite resin. Follow-up examinations were performed by endodontically experienced examiners focusing on clinical and radiographic assessment. RESULTS: One patient could not be contacted and was lost to follow-up. Overall, the follow-up period ranged from 2-8 years (mean = 4.4 years). The majority of teeth remained functional and without pathology; one tooth was classified as having failed because of a vertical root fracture. There was no statistically significant difference in the groups' success rate (p = 0.3). The estimated overall survival rate was 94.1% (95% CI: 0.84-1.00) after 4 years according to the Kaplan-Meier method. CONCLUSION: Pulp vitality in permanent teeth can be preserved with high success rates by means of partial pulpotomy after carious pulp exposure in asymptomatic teeth or in teeth with reversible pulpitis.

Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake-A Retrospective Cohort Study.

In the present study, the impacts on success rates between three different antibiotic regimes in patients receiving preventive tooth extraction during/after antiresorptive treatment were compared. For the retrospective analysis, we enrolled patients who had undergone tooth extraction from 2009 to 2019 according to the specified preventive conditions under antiresorptive therapy. Three antibiotic regimens were distinguished: (Group 1) intravenous for 7 days, (Group 2) oral for 14 days, and (Group 3) oral for 7 days of application. The primary endpoint was the occurrence of medication-related osteonecrosis of the jaw at 12 weeks after surgery. A total of 760 patients and 1143 extraction regions were evaluated (Group 1 n = 719; Group 2 n = 126; Group 3 n = 298). The primary endpoint showed no significant difference in the development of medication-related osteonecrosis of the jaw between the groups studied (Group 1 n = 50/669 (7%); Group 2 n = 9/117 (7%); Group 3 n = 17/281 (6%); p = 0.746). Overall, the success rate was 93% after intervention when preventive measures were followed. With the same success rate, a reduced, oral administration of antibiotics seems to be sufficient regarding the possible spectrum of side effects, the development of resistance and the health economic point of view.

New Options for Subgingival Oral Hygiene with a Flattened Interdental Brush Design - In Vitro Examination and Case Report.

PURPOSE: The subgingival area is only reached to a limited extent during home oral hygiene with the aids available to date. The question was investigated whether a newly developed, flattened cross-sectional design of interdental brushes (IDBs) can extend their subgingival reach. MATERIALS AND METHODS: In part I, the passage-hole diameters (PHD) of IDBs of different sizes and side-bristle lengths, with circular and flattened cross-sections, were compared according to the ISO standard 16409/2016. In part II, handling of flattened IDBs was described based on a case report of a patient with generalised stage 4, grade C periodontitis with locally persistent pockets. RESULTS: Depending on the brush's size, flattening of IDBs reduced the PHD by 1-18 intervals. IDBs with longer side bristles could thus be inserted into interdental spaces with equal force. This may increase the potential range of IDBs in the vertical dimension. Regular instruction and check-ups are necessary to enable correct handling, as the flattened brushes can only be used in two positions. The observations documented in the case report (duration: 1.5 years) showed that flattened IDBs were associated with reduced signs of inflammation (reduction of pocket depths from 6 to 3 mm, absence of bleeding on probing). CONCLUSION: IDBs with a flattened cross-sectional design have not been previously described in the literature. It was shown that flattening of IDBs leads to a size-dependent decrease in PHD. Based on a case report, it was hypothesised that the design change of the IDBs could be clinically relevant in the case of persistent deep pockets in narrow interdental spaces. However, this can only be verified or falsified by clinical studies.

Clinical evaluation of bulk-fill and universal nanocomposites in class II cavities: Five-year results of a randomized clinical split-mouth trial.

AIM: Evaluating the clinical survival and quality parameters of class-II restorations using 3M™ FiltekTM Bulk Fill Posterior Restorative compared to 3M™ FiltekTM Supreme XTE Universal Restorative over a period of five years. MATERIALS AND METHODS: A longitudinal, randomized, prospective split-mouth study with 60 patients (29 female, 31 male; mean age 44 y; range 20-77 y) and a total of 120 load-bearing class II restorations (TEST: n=60 Filtek Bulk Fill Posterior Restorative; CONTROL: n=60 Filtek Supreme XTE Universal Restorative) was conducted. Clinical evaluation was performed by blinded evaluators according to FDI criteria. Kaplan-Meier method was used for survival analysis and an intergroup comparison (Mann-Whitney-U-Test) was carried out. A basic significance level of 0.05 was corrected by the Bonferroni method to account for multiple testing (significance after correction: p<0.00067). RESULTS: The mean overall survival of restorations was 92% after 56.98±1.51 months in the TEST group (95 CI= 54.02;59.94) and 92% after 57.25±1.46 months (95 CI= 54.39; 60.12) in the CONTROL group (log-rank p=0.995). In total, four failures occurred in both TEST and CONTROL group during the observation period (mean annual failure rate: 1.6%). The most common reasons for failure were chipping-fractures, debonding, cracked-tooth-syndrome and recurrent decay. With regard to the FDI criteria, no significant differences between TEST and CONTROL material occurred for any of the evaluated variables. In the TEST group two restorations had to be repaired and two had to be replaced, in the CONTROL group four restorations had to be replaced. CONCLUSION: Both materials showed acceptable clinical performance and survival during the 5-year observation period. CLINICAL SIGNIFICANCE: The use of a nanofilled bulk-fill composite proved to be an aesthetically, functionally and biologically satisfactory alternative in posterior dentition.

Retrospective Clinical Evaluation of Subgingival Composite Resin Restorations with Deep-Margin Elevation.

PURPOSE: To evaluate the long-term clinical quality of subgingivally placed composite resin restorations and the inflammatory status of surrounding supracrestal gingival and periodontal tissues. MATERIALS AND METHODS: Patients with at least one subgingival restoration with deep-margin elevation placed between 2010 and 2020 at Heidelberg University Hospital and Tübingen University Hospital were identified. A sound tooth was used as control. Intraoral examination including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival bleeding index (GBI), and plaque control record (PCR) was conducted. The clinical quality of the restorations was evaluated using the modified FDI criteria. For comparison between control and test teeth, a logistic mixed-effects model was used for GBI, PCR, and BOP, while a linear mixed-effects model was used for CAL. Multivariable linear and logistic regressions were used to examine the influence of smoking, age of restoration, number of decayed, missing and filled teeth, use of interdental brushes, and CAL. RESULTS: Sixty-three patients were included in the study. The mean age of the restorations was 2.70 ± 1.90 years. There were no significant differences between test and control teeth with respect to inflammatory parameters BOP, GBI, and PCR. CAL was significantly higher in test teeth than in controls (p = 0.027). The regression models revealed that CAL has a significant influence on GBI (p = 0.008) and BOP (p < 0.001). A significantly increased GBI occurred especially on test teeth in patients who did not use interdental brushes daily (p = 0.010). The clinical quality of restorations was rated excellent or good in 70%, an no restoration was rated unacceptable. CONCLUSION: No increased inflammation was observed on sites with subgingivally placed composite restorations over an observation period of approximately 3 years. Regular interdental brush use was associated with less gingival inflammation.

MTA Matrix Technique: Restoration of Teeth with Deep Subgingival Defects Extending Down to the Osseous Crest.

PURPOSE: To present a new restorative technique for the restoration of teeth with deep subgingival hard tissue defects extending down to the osseous crest without additional surgical or orthodontic interventions by combining mineral trioxide aggregate (MTA) and composite material. MATERIALS AND METHODS: The MTA matrix technique starts by deeply inserting a metal matrix as far down to the bone level as possible. The matrix should then be fixated with a matrix holder in its end position. If the matrix band does not seal tightly in the deepest area of the cavity, small portions of MTA are carefully applied to the lower end of the inner side of the matrix band. The MTA acts as a barrier for fluid control. Additional haemostasis is not necessary. Subsequently, the tooth is restored with an etch-and-rinse adhesive and composite resin. The clinical effects were observed in a case series of three patients over a period of 3 to 4.5 years. RESULTS: Excellent outcomes were observed clinically and radiologically. Teeth restored with the MTA matrix technique showed no failures due to the materials used or due to secondary caries or periodontal inflammation after an observation period of 3 to 4.5 years. Probing depths ranged from 2 to 4 mm without bleeding on probing, including the subgingivally restored areas. CONCLUSION: Although only a few casuistic observations are available to date, by using the MTA matrix technique, successful restoration of teeth with subgingival defects down to the alveolar bone crest seems possible without the need of additional surgical or orthodontic measures. Further clinical studies are necessary to confirm the feasibility of this technique.

A randomized clinical split-mouth trial of a bulk-fill and a nanohybrid composite restorative in class II cavities: Three-year results.

OBJECTIVES: The aim of this randomized controlled clinical trial was to evaluate the clinical survival and quality parameters of class-II restorations using a bulk-fill composite resin compared to a conventional nanohybrid composite resin in a split-mouth design. METHODS: One hundred and twenty direct restorations were placed in stress bearing class II cavities (n = 60 test group: Filtek™ Bulk Fill Posterior and n = 60 control group: Filtek™ Supreme XTE) in adult permanent teeth. Survival and clinical quality were evaluated at baseline and after 3 years using modified World Dental Federation (FDI) criteria. Participants and clinical evaluators were blinded relating to the group assignment of the restorations. RESULTS: Seventeen restorations (14.2%) were lost to follow-up, leading to 51 restorations available for survival analysis in the test group and 52 restorations in the control group. Seven restorations showed unfavorable events and were classified as failure. Four bulk-fill restorations failed due to tooth infracture (n = 1), chipping fractures (n = 2) and recurrent decay (n = 1), whereas three conventional nanohybrid composite restorations failed due to adhesive failure (n = 1), tooth infracture (n = 1) and chipping as well as recurrent decay (n = 1). The mean annual failure rate was 2.4% and 1.8%, respectively. The difference between test and control group was not significant (p = 0.7). Data on the detailed assessment of FDI criteria were available for n = 48 and n = 49 restorations, respectively. No significant differences between the two groups could be found regarding the assessment of esthetic, functional and biological properties. SIGNIFICANCE: Both materials showed similar clinical performance and survival. The use of bulk-fill composite proved to be an esthetically, functionally and biologically satisfactory alternative in the posterior dentition during the 3-year follow-up.

Maintaining oral health for a hundred years and more? - An analysis of microbial and salivary factors in a cohort of centenarians.

Aim: To investigate associations between oral health-related conditions and the oral microbiome in a representative study sample of centenarians. Materials and methods: Clinical and microbial parameters from 54 centenarians were assessed in the Heidelberg Dental Centenarian Study. Plaque and salivary samples were collected, and the microbiota was characterized by 16S rRNA gene sequencing. Results: Diversity and structure of the oral microbiome were mainly influenced by the presence of natural teeth and the number of decayed, missing, and filled teeth (0.028 ≤ p ≤ 0.001 in plaque and salivary samples). Centenarians with less caries experience possessed a more diverse oral microbiome. Moreover, the number of dental visits also showed a significant influence on the microbial composition. Most centenarians presented with hyposalivation (mean stimulated flow rate = 0.84 ± 0.55 ml/min), a low buffering capacity, and an acidic pH. The latter was between 5.0 and 5.8 in 46.3% of cases, and we observed that an increased salivary pH correlated with higher alpha-diversity in both salivary and plaque samples. Conclusion: The microbiome diversity correlated significantly with successful oral aging. In addition, regular dental visits were a beneficial factor. However, diversity can be negatively influenced by hyposalivation, associated with pH changes due to aging effects.

Neuralgia-inducing cavitational osteonecrosis - A systematic review.

OBJECTIVE: To assess the aetiologic factors, proposed diagnostic means and treatment strategies for neuralgia-inducing cavitational osteonecrosis. METHODS: A search of the literature published up to June 2020 was conducted using Medline, the Cochrane Library, PsycINFO, CINAHL and Web of Science. The scientific quality of the evidence was rated according to NIH Quality Assessment Tools. RESULTS: 4,051 articles were found, 59 were reviewed in full text, and 29 studies were included. With the exception of hereditary coagulopathies, which were identified as potential risk factors in five studies, suggestions concerning the aetiology varied widely. No gold standard diagnostic mean could be identified. Treatment was most often performed by surgical curettage of the affected bone. Surgical treatment outcomes were equally varied: significant facial pain remission was reported in 66%-100% for periods varying between 2 months to 18 years, whereas no or little relief and recurrences were reported in up to ⅓ of cases. All studies were observational in their design. All investigations were rated as poor quality because of high risk of bias and non-transparent reporting. CONCLUSIONS: Evidence concerning the aetiology, diagnosis and treatment of NICO is poor. Prospective diagnostic and therapeutic studies are needed before the usefulness of invasive therapeutic procedures can be evaluated.

Association of Dental and Prosthetic Status with Oral Health-Related Quality of Life in Centenarians.

To date, there is little evidence on centenarians' dental and prosthetic status or their oral-health-related quality of life (OHRQoL). Therefore, the aim of this study was to assess possible associations between sociodemographic and oral health factors, including prosthetic needs in this special age group and their potential influence on OHRQoL. Persons born before 1920 were recruited from population registries in south-western Germany. Fifty-five centenarians participated and underwent a comprehensive oral examination. Cognitive capacity was evaluated using the short Mini-Mental State Examination (S-MMSE, max. 21 points). At an S-MMSE > 10, an analysis of OHRQoL by means of the Geriatric Oral Health Assessment Index (max. ADD-GOHAI score 60 points) was performed (n = 43). Bivariate statistics and a linear regression model were used after variable selection to analyze data. Centenarians presented with a mean (SD) of 22 (7.2) missing teeth. Complete (65.5%) or partial dentures (21.8%) in at least one jaw were most common. One-third of the dentures needed repair/replacement; 16% of the centenarians presented with denture sores. In 60% of cases, OHRQoL was rated unsatisfactory (ADD-GOHAI < 57). Trouble biting or chewing resulted in the lowest levels of OHRQoL. Fewer remaining teeth, reduced functional capacity and removable prostheses correlated with an impaired OHRQoL (rs = -0.36, p = 0.01; rs = -0.34, p = 0.01; rs = -0.29, p = 0.03, respectively). After variable selection, the final linear regression model included only the number of missing teeth, the associated ADD-GOHAI score decreasing by 0.3 points per missing tooth. In conclusion, tooth loss and removable prostheses in need of repair or replacement are highly prevalent in centenarians. These factors seem to modulate OHRQoL negatively, assumedly due to impaired chewing function. Larger confirmatory studies are needed to validate these first results.

The Origins of Acrylates and Adhesive Technologies in Dentistry.

PURPOSE: To examine the origins of acrylates and adhesive dentistry up to 1955. MATERIALS AND METHODS: A search of MEDLINE database and a manual literature search were conducted to find relevant articles. RESULTS: Acrylic acid was discovered in 1843, methacrylic acid in 1865. In 1880, light polymerization of acrylate compounds using glass prisms was introduced. In 1928, polymethyl methacrylate (PMMA) was industrially produced from methyl methacrylate (MMA). In 1930, PMMA moldings that could be adapted under heat and pressure were introduced into dentistry. The process was improved in 1936 by mixing pulverized PMMA and liquid MMA. In 1940, the intraoral polymerization of dental resins using UV light or catalysts was discovered. In the same year, the combined procedure (dual-curing) and addition of inorganic fillers to improve the material properties (precursors of composites) were proposed. Effects on the oxygen inhibition layer and intraoral bonding between several resin portions were also described. In 1942, direct restorations with self-curing resins (combined with a precursory version of cavity sealing) were described. These new resins were marketed in the late 1940s. Intraoral repair of restorations and cementation of crowns and bridges with resins were also described in 1942. In 1949, a glycerophosphoric acid-based sealer was marketed. In the same year, it was discovered that etching of the enamel (with nitric acid) caused an adhesion to thin layers of acrylic-based materials. In 1955, phosphoric acid etching of enamel was shown to improve adhesion. CONCLUSION: In the first half of the 20th century, important but little or unknown discoveries took place. These discoveries can improve our understanding of how adhesive dentistry evolved.

Replacing single missing teeth in the posterior region using direct composite restorations: Survival and clinical quality.

OBJECTIVES: The aim of this pilot study was to test the survival and clinical quality of frugal methods to replace single missing teeth in the posterior region with direct composite restorations of different categories. METHODS: We performed a detailed intraoral examination and assessed the clinical quality of the restorations according to modified FDI-criteria. Irreparable loss of a restoration was recorded as "failure" (F). Damaged restorations that could be repaired were defined as "survival with repair" (SR). Restorations without any unfavorable events were classified as "success" (S). RESULTS: The mean follow-up time of the restorations was 5.07 years (minimum = 1; maximum = 21.5), with 15.1% having a follow-up time of more than 10 years. Three unfavorable events were documented. Two restorations (3.8%) were classified as F, one restoration (1.9%) as SR, and the remaining 50 restorations (94.3%) as S. The estimated overall and functional survival rate at 5 years using the Kaplan-Meier method was 96.2% (confidence interval [CI]:85.5% to 99%) and 98% (CI:86.9% to 99.7%), respectively. Ninety-four percent of the restorations were evaluated as good or excellent clinical quality. Most restorations showed no periodontal complications, however, restorations in the mandible showed significantly more plaque accumulation (p=0.002). CONCLUSIONS: These conservative frugal methods to replace single missing teeth in the posterior region showed promising clinical survival data and quality parameters. CLINICAL SIGNIFICANCE: Direct composite restorations of different categories can be considered as additional treatment option for gap closure in specific clinical situations.

Influence of COVID-19 Restrictions on Patients' Self-reported Oral Health Care Needs.

PURPOSE: To assess how current COVID-19 restrictions regarding elective dental procedures influence patients' self-reported oral health care needs at a University Hospital in Germany. MATERIALS AND METHODS: Patients with COVID-19 induced cancellation of elective treatment appointments previously scheduled for the period March 16th to April 30th 2020 were contacted by telephone and questioned about the occurrence of oral health problems, pain, self-reported treatment needs, and the use of emergency dental services. Data were analysed retrospectively. RESULTS: Information on 370 patients aged between 1 and 91 years was included. 16.2% (n = 60) of patients reported having experienced an oral health problem for which they requested timely dental treatment. Within this group, the most frequent complaints were pain or tooth hypersensitivity (42.4%, n = 26), insufficient restorations (28.8%, n = 17) and gingival or periodontal problems (23.7%, n = 14). Associations between the type of treatment pending and the report of an oral health problem were considerable for patients awaiting treatment under full anesthesia, surgical procedures and endodontic treatment (p = 0.001; 0.003 and 0.048, respectively). Problems were reported most frequently in these treatment groups, ranging from 27.7% to 100%, compared to 12.6% among patients scheduled for routine check-ups. Overall, 8.6% (n = 32) were experiencing pain, of whom 5 patients experienced constant pain. However, only 1.9% (n = 7) of patients made use of emergency dental services. CONCLUSIONS: The results suggest that while the postponement of routine check-ups is justifiable during emergency situations, the long-term cancellation of surgical and endodontic therapies must be viewed critically.

Mechanical plaque control of the interdental space with the "Heidelberg set".

At present, the most important criterion for the size selection of interdental brushes is the PHD-value (passage hole diameter) according to the ISO standard for interdental brushes ISO 16409:2016. The PHD size range of commercially available products currently lies between 0.6 and 5.2 mm. With the exceptions of special situations, a range between 0.7 and 2.9 mm is sufficient for clinical routine. As most products have longer filaments nowadays, one brush can often be applied for two PHD intervals. Consequently, adequate patient counseling and the individual selection of the appropriate interdental brushes can generally be achieved with an assortment of 12 systematically arranged interdental brush sizes. An application example is the "Heidelberg set" described herein. It is crucial that the correct choice of size is based upon continuously rising PHD-values, and not upon parameters such as stem size, outer diameter of filaments, or similar, as these do not allow for a reliable conclusion regarding the interdental passage. The usage of ISO sizes is also not recommendable due to their insufficient size differentiation. (Quintessence Int 2021;52: 176-186; doi: 10.3290/j.qi.b872241; Revised from an article originally published (in German) in Parodontologie 2020;31(1)37-49)

Accuracy of a 7-Item Patient-Reported Stand-Alone Tool for Periodontitis Screening.

Periodontitis is interrelated with various other chronic diseases. Recent evidence suggests that treatment of periodontitis improves glycemic control in diabetes patients and reduces the costs of diabetes treatment. So far, however, screening for periodontitis in non-dental settings has been complicated by a lack of easily applicable and reliable screening tools which can be applied by non-dental professionals. The purpose of this study was to assess the diagnostic accuracy of a short seven-item tool developed by the German Society for Periodontology (DG PARO) to screen for periodontitis by means of patient-reported information. A total of 88 adult patients filled in the patient-reported Periodontitis Risk Score (pPRS; range: 0 points = lowest periodontitis risk; 20 points = very high periodontitis risk) questionnaire before dental check-up at Heidelberg University Hospital. Subsequent clinical assessments according to Periodontal Screening and Recording (PSR®) were compared with pPRS scores. The diagnostic accuracy of pPRS at different cutoff values was assessed according to sensitivity, specificity, positive, and negative predictive values, as well as Receiver-Operator-Characteristic curves, Area Under the Curve (AUC), and logistic regression analysis. According to combined specificity and sensitivity (AUC = 0.86; 95%-CI: 0.76-0.95), the diagnostic accuracy of the pPRS for detecting periodontal inflammation (PSR® ≥ 3) was highest for a pPRS cutoff distinguishing between pPRS scores < 7 vs. ≥ 7. Patients with pPRS scores ≥ 7 had a 36.09 (95%-CI: 9.82-132.61) times higher chance of having a PSR® ≥ 3 than patients with scores < 7. In conclusion, the pPRS may be considered an appropriately accurate stand-alone tool for the screening for periodontitis.

Oral Health Status, Oral Health Behaviours and Oral Health Care Utilisation Among Migrants Residing in Europe: A Systematic Review.

As the reported data on oral health status among the migrants in Europe is fragmented, we systematically reviewed the published literature on the oral health status, behaviours and care utilisation among migrants residing in Europe. For this, we retrieved publications from PubMed and EMBASE, supplemented by manual citation screening and grey literature search on Google scholars. Two independent reviewers screened the studies, extracted data and critically appraised the publications. A total of 69 studies included showed higher dental caries among migrant children. But some studies on adolescents and adults reported similar or even better oral health among migrants compared to the host population, while other reported the opposite. Poor oral health behaviours were generally reported among the migrants and they frequently made use of emergency service utilisation compared to the host population. We shed light on the gaps in dental literature and make some recommendations for the future.