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

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

[Oral health goals for Germany 2030: reduction of caries and periodontitis and improvement of prevention]. / Mundgesundheitsziele für Deutschland 2030: Karies und Parodontitis weiter reduzieren sowie Prävention verbessern.

In 1996, the German Dental Association (BZÄK) defined oral health goals for the dental profession in Germany for the first time. The third revision of the goals for the year 2030 is now based on new oral epidemiological studies. The formerly tooth-oriented focus of the objectives has been expanded to include both disease-related as well as oral health-promoting and preventive objective areas in the sense of an integrative perspective of primary, secondary and tertiary prevention. This paper presents a sample of the updated oral health goals specifically related to the reduction of caries in children and periodontal disease in adults, but also to the improvement of oral health behaviour of the population and the implementation of group prophylactic measures. The current situation is assessed and recommendations for action are made.By 2030, the primary dentition of 3­year-olds should be at least 90% caries-free. A dmft-value (caries index of the primary dentition) of maximum 0.4 is being targeted. The permanent teeth of 12-year-olds should also be at least 90% caries-free, and the DMFT (caries index of the permanent teeth) should be kept at 0.5. Severe periodontal diseases are to be reduced to 10% in 35-44-year-olds and to 20% in 65-74-year-olds; the 2020 goals in this regard are thus adressed once again. The oral health behaviour of the population should be further improved and group prophylactic measures strengthened.The basis for achieving the 2030 oral health goals is the commitment of the relevant actors in the health system and health policy as well as an appropriate use of resources.

Professional identity, career choices, and working conditions of future and young dentists in Germany - study design and methods of a nationwide comprehensive survey.

BACKGROUND: Little is known regarding young and future dentists' career choices, professional identity, and working conditions in Germany. While the dental healthcare environment and demands in treatment are changing, it remains unclear what job perceptions young dentists have developed at the beginning of their work life and if and how these perceptions change during the subsequent years. The aim of this study was to survey future and young dentists regarding their professional identity, planned career paths, and working conditions and strains to understand career decisions and choices and enable policy makers to include future dentists' views and expectations in their decisions. METHODS/DESIGN: This study is a longitudinal nationwide survey over a time span of 4 years of dental students and young dentists in Germany and is comprised of three waves. The first wave focuses on dental students in their final year before the state examination and is composed of a qualitative pre-study in the form of focus groups and a quantitative main survey in the form of a questionnaire. The end points were established to analyse (1) the professional identity of the young future dentists; (2) their career paths, preparation for a career, and basic career conditions; and (3) perceived conditions and strains. The aim of the overall survey was to depict the development of these three aspects during the first years of work life. All of the questions were evaluated with a descriptive univariate analysis. The analysed subgroups were grouped according to gender, target working condition (employed/self-employed), and primary socialisation (parents dentists/parents not dentists). DISCUSSION: To our knowledge, this is the only study which focuses on career choices, professional identity, and working conditions of future and young dentists in Germany. The longitudinal observation provides information that is essential for professional and purposive dental health care planning, and to meet the oral health demands and needs of the German population appropriately over the long term. TRIAL REGISTRATION: German Health Services Research Data Bank VfD_Y-Dent_14_003759 .

Early Childhood Caries and Caries Experience in Permanent Dentition: A 15-year Cohort Study.

In Germany, caries of young people has been declining since the late 1980s, while the prevalence of early childhood caries has remained steady. Data from a number of regional studies suggest a current prevalence between 10% and 15%. However, there is a dearth of longitudinal observational study data on the risk of caries in the permanent teeth of persons who as children had to undergo comprehensive treatment for caries under intubation general anesthesia. The aim of this study was to compare caries experience in the permanent teeth of patients who had to undergo surgical treatment under general anesthesia as a result of non-compliance with caries treatment in early childhood with the experience of patients who did not develop caries at a young age. Analysis of the data revealed that severe caries experience during early childhood resulted in a more severe caries experience during adulthood (difference: 14.8 DMFS; p = 0.001). This increase in caries experience applied to both untreated and treated carious surfaces, and was also apparent in relation to tooth extractions. When compared with persons whose first teeth had been caries-free, patients with severe childhood caries experience tended to show poorer dental hygiene in relation to smooth (p < 0.06) and interproximal (p < 0.04) surfaces. Patients who had been non-compliant as young children were not found to suffer from dental anxiety as young adults. Patients in the treatment and control groups differed with regard to dental health. Aside from being statistically relevant, these differences also have implications for clinical dental practice.

[Health insurance dentists' subjective perceptions of quality when implementing quality management in practice - results from a nationwide survey]. / Subjektives Qualitätsverständnis von Vertragszahnärzten im Umgang mit Qualitätsmanagement - Ergebnisse eines bundesweiten Surveys.

BACKGROUND: Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems. METHODS: As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis. RESULTS: When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality. CONCLUSIONS: The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM.