Child abuse and neglect: A comparative study between dental and medical students' competencies in Germany.

INTRODUCTION: Despite children's right to a non-violent upbringing, they become daily victims of violence. Physical violence concerns mostly the head-especially the orofacial area. Therefore, dentists and paediatricians should be able to suspect possible abuse and to initiate child protection. This study aimed to record and compare the training situation and competencies of dental and medical students at Jena University Hospital regarding child abuse and neglect (CAN). MATERIALS AND METHODS: Using a three-part questionnaire about CAN, 123 medical and 77 dental students were surveyed anonymously after completing all courses on the topic. The question sets included as follows: (1) educational experiences, training content and satisfaction; (2) current knowledge regarding diagnostic, management and legal concerns; (3) self-evaluation, needs of further education and wishes. Reliability of the questionnaire was tested with kappa-statistics and assessed as good. RESULTS: Dental and medical students' overall satisfaction with CAN-related training is low. Although medical students had more knowledge on CAN, all participants showed large deficits. Better diagnostic than management skills were reported in both groups. Only 1.3% dental and 16.3% medical students felt adequately prepared to deal with CAN. 7% of all study participants stated that they can report CAN without any help. 87.0% of medical and 79.2% of dental students expressed a desire for further education. To improve their knowledge, both courses prefer seminars, followed by expert talks, lectures and simulation-based training (SkillsLab). CONCLUSION: Dental and medical students are inadequately prepared to suspect possible abuse and to deal with possible signs of CAN. Mandatory interdisciplinary courses and lectures addressing CAN are recommendable for both medical and dental curricula.

Radiation Exposure and Frequency of Dental, Bitewing and Occlusal Radiographs in Children and Adolescents.

Dental radiographs are valuable diagnostic aids for oral healthcare, but exposure to ionizing radiation carries health risks, especially in children due to their high radio-sensitivity. Valid reference values for intraoral radiographs in children and adolescents are still missing. This study aimed to investigate the radiation dose values and underlying justifications of dental, bitewing and occlusal X-rays in children and adolescents. Data from routinely executed intraoral radiographs between 2002 and 2020 with conventional and digital tube-heads were extracted from the Radiology Information System. The effective exposure was calculated from technical parameters and statistical tests performed. A total number of 4455 intraoral (3128 dental, 903 bitewing and 424 occlusal) radiographs were investigated. For dental and bitewing radiographs, the dose area product (DAP) was 2.57 cGy × cm2 and the effective dose (ED) 0.77 µSv. For occlusal radiographs, the DAP was 7.43 cGy × cm2 and the ED 2.22 µSv. Overall, 70.2% of all intraoral radiographs were dental, 20.3% bitewing and 9.5% occlusal radiographs. The most frequent indication for intraoral radiographs was trauma (28.7%), followed by caries (22.7%) and apical diagnostics (22.7%). Moreover, 59.7% of all intraoral radiographs were taken in boys, especially for trauma (66.5%) and endodontics (67.2%) (p ≤ 0.00). Girls were significantly more frequently X-rayed for caries diagnostics than boys (28.1% vs. 19.1%, p ≤ 0.00). The average ED of 0.77 µSv for intraoral dental and bitewing radiographs in this study was within the range of other reported values. The technical parameters of the X-ray devices were found at the lowest recommended levels to best limit the radiation exposure and to assure acceptable diagnostic efficacy. Intraoral radiographs were performed predominantly for trauma, caries and apical diagnostics-reflecting general recommendations for the use of X-rays in children. For improved quality assurance and radiation protection, further studies are necessary to determine the meaningful dose reference level (DRL) for children.

Effectiveness of Individual Oral Health Care Training in Hospitalized Inpatients in Geriatric Wards.

OBJECTIVE: To investigate the effectiveness of individual oral health care training (IndOHCT) on dental plaque removal and denture cleaning in hospitalized geriatric inpatients. BACKGROUND: The literature reveals neglect of hygiene and oral care in people aged over 65 years, especially in persons in need of care. Hospitalized geriatric inpatients have poorer dental health than those non-hospitalized. Furthermore, the existing literature reporting on oral healthcare training interventions for hospitalized geriatric inpatients is scarce. MATERIALS AND METHODS: This pre-post-controlled intervention study dichotomized 90 hospitalized geriatric inpatients into an intervention group (IG) and a control group (CG). Inpatients in the IG received IndOHCT. Oral hygiene was assessed using the Turesky modified Quigley-Hein index (TmQHI) and the denture hygiene index (DHI), at baseline (T0), at a second examination (T1a), and after supervised autonomous tooth brushing and denture cleaning (T1b). The influence of the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Barthel Index (BI) scores on oral hygiene was examined. RESULTS: There was no significant plaque reduction on teeth or dentures between T0 and T1a in either group. Between T1a and T1b, plaque reduction on the teeth was more effective in the IG than in the CG (p < 0.001). Inpatients with 1-9 remaining teeth removed significantly more dental plaque than inpatients with 10 or more remaining teeth. Inpatients with lower MMSE scores (p = 0.021) and higher age (p = 0.044) reached higher plaque reduction on dentures. CONCLUSIONS: IndOHCT improved oral and denture hygiene in geriatric inpatients by enabling them to clean their teeth and dentures more effectively.

Frequency of Dental X-ray Diagnostics in Children and Adolescents: What Is the Radiation Exposure?

Children are exposed to ionizing radiation through radiographs during their development for various reasons. At present, there are no officially valid reference values for dental X-rays in children and adolescents for dental X-ray diagnostics. This study retrospectively examined 9680 extraoral dental radiographs in pediatric patients between 2002 and 2020. The aim was to analyze the radiation doses in pediatric patients, which indications were used, and whether there were specific age and gender differences. The evaluation showed that radiation doses were considered low, with dose area products of 2.2 cGy × cm2 for a lateral cephalogram, 14 cGy × cm2 for an orthopantomogram (OPG), and 45 cGy × cm2 for cone beam computer tomography (CBCT). This corresponds to an effective dose of 1.5 µSv for a lateral cephalogram, 7 µSv for an OPG, and 33.8 µSv for CBCT. Of the 9680 images, 78% were orthopantomograms, and only 0.4% were CBCT images. OPG has become more important over the years, as reflected in the indication. Approximately one-third of all extraoral exposures are orthodontic indications. Overall, the indications were similar for both genders. According to the dental indications, boys were X-rayed slightly more frequently than girls (54.5-45.5%). A future publication of dose guide values and corresponding guidelines is of high priority.

Oral health and oral health-related quality of life in patients with chronic peripheral facial nerve palsy with synkineses-A case-control-study.

Facial nerve palsy (FP) is the most common cranial nerve lesion, leading to partial or complete immobility of the affected half of face. If food residues on tooth surfaces cannot be removed by natural self-cleaning mechanisms that this is likely to lead to an increase dental plaque formation and the risk of dental, periodontal and general diseases. It was the aim of this study to assess oral health, oral hygiene with the influence of handedness and oral health related quality of life in patients with chronic peripheral FP. This study included 86 people. Patients with FP (n = 43) in an FP-group (FPG) were matched with 43 participants without ever diagnosed FP in a control group (CG). Oral health and oral hygiene were assessed in a clinical examination performed in hospital. Decayed-missing-filled-teeth-index, periodontal-screening-index, approximal plaque index and sulcus bleeding index were used to evaluate dental caries and periodontal health status. Oral health-related quality of life data (OHQoL) was collected with the Oral health impact profile (Germany-14) by interview. Oral health parameters in the FPG were significantly worse than in the CG. The median revealed 14.3% more proximal plaque (p = 0.014), 20.8% more sulcus bleeding (p = 0.002) and more than twice as much caries (p = 0.024). The paretic side compared to the non-paretic side of patients was significantly more affected by inflammatory periodontal diseases (p = 0.032) and had a higher prevalence of caries (p = 0.163). Right-handed patients with right-sided FP performed worse than right-handed patients with left-sided FP (p = 0.004). Patients with FP described a greater limitation of OHQoL than patients without this disease (p < 0.001). In conclusion, facial nerve palsy affects oral health, oral hygiene and OHQoL of patients while handedness influences oral hygiene and oral health.

Testing the ability for autonomous oral hygiene in hospitalized geriatric patients-clinical validation study.

OBJECTIVES: This study aimed to evaluate if the Timed Test for Money Counting (TTMC) complemented with testing the range of shoulder motion by griping the backside of the neck (NG) predicts the ability of geriatric inpatients to perform effective plaque reduction by autonomously conducted oral hygiene. MATERIAL AND METHODS: This clinical validation study involved 74 hospitalized geriatric inpatients, 48 (64.9%) females, aged between 66 and 98 years (mean age 84.1 years). Oral health status was examined. Dental plaque was assessed with the Turesky modified Quigley-Hein Index (TI) on teeth and the Denture Hygiene Index (DHI) on removable dentures. The performance and duration of TTMC and NG were recorded. After autonomous tooth brushing and denture cleaning by the patient, dental plaque was scored again with the TI and DHI. Geriatric assessment data were collected from medical records. RESULTS: Forty-nine (66.2%) geriatric inpatients completed the TTMC&NG successfully. Passing the TTMC&NG was significantly associated with better plaque removal on teeth and dentures by autonomously conducted oral hygiene. The sensitivity of the TTMC&NG for above average plaque reduction was 86.4% on teeth and 77.8% on dentures. The test revealed a negative predictive value of 75.0% to detect below average plaque reduction on teeth and 72.7% on dentures. CONCLUSIONS: The TTMC&NG served as a suitable predictor for the ability of geriatric inpatients to perform autonomously effective tooth brushing and denture cleaning. CLINICAL RELEVANCE: This simple and short test might help the medical staff to identify geriatric inpatients unable to perform effective oral hygiene by themselves.

[Oral Health in Children and Adolescents with Mental Disability and Psycho-Emotional Disorders from Lower Saxony and Thuringia]. / Mundgesundheit von Kindern und Jugendlichen mit geistiger Behinderung und psychoemotionalen Störungen aus Niedersachsen und Thüringen.

AIM: This study aimed to compare the oral health status of 6-16 year old pupils with mental disability (MD) and psycho-emotional disorders (PED) from Lower Saxony (LS) and Thuringia (TH). METHODS: Oral examination was provided for 571 pupils with MD from TH, 118 students with MD and 80 students with PED from LS. Caries experience, odontogenic infections, fissure sealants and periodontal health were recorded. Data were statistically analysed by linear and binary logistic regression after adjusting for age. RESULTS: Students with PED revealed highest caries prevalence and experience in both dentitions with highest prevalence of odontogenic infections in the primary dentition. In 6-11 year old pupils with MD, there were only minor differences in odontogenic infections between TH and LS. Pupils with PED aged 6-11 years had a more that two-fold higher risk to develop dental caries and odontogenic infections than peers with MD. Care index was higher in pupils with PED compared to those with MD in both dentitions. Pupils with MD from TH were less affected with dental caries and received better care than those from LS. Compared to peers without mental disabilities or disorders, pupils with MD or PED were more affected with dental caries in both dentitions. They revealed a lower care index and less fissure sealants. CONCLUSION: Pupils with MD or PED reveal unsatisfactory oral health status constituting a group with particular high caries risk, while those with PED are most affected by caries and odontogenic infections. The care index is insufficient especially in pupils with MD compared to those with PED or peers without disabilities and indicates disparity in oral health for this vulnerable group.

Dental Caries and Developmental Defects of Enamel in the Primary Dentition of Preterm Infants: Case-Control Observational Study.

AIM: Assessment of dental health in the primary dentition of preterm infants (PTI) including investigation of mother- and infant-related risk factors in a case-control study design. MATERIAL AND METHODS: One hundred twenty-eight infants aged 3-4 years were included. Sixty-four PTI (27 males) were randomly selected from the preterm registry of the Jena University Hospital. As a control group served 64 full-term infants (FTI) recruited from the Department of Paediatric Dentistry, matched for age and sex. Dental examinations were provided by one dentist under standard clinical conditions. Caries was scored using the International Caries Detection and Assessment System (ICDAS II) and the DMFT, gingival health using the Periodontal Screening Index, and developmental defects of enamel using the DDE index. Mother- and infant-related factors were collected via a questionnaire and from medical records. RESULTS: The caries prevalence was 50.0% (ICDAS II >0) in PTI and 12.5% (ICDAS II >0) in FTI. The caries experience was higher in PTI (DMFT 1.0 ± 3.1) than in FTI (DMFT 0.3 ± 1.0). PTI had a higher risk of caries (OR 7.0), initial lesions (OR 6.2), DDE (OR 7.5), and gingivitis (OR 6.5) than FTI. The highest risk occurred in PTI with an extremely low birth weight (<1,000 g). A higher risk of DDE was present when mothers suffered from illness during pregnancy (OR 3.9). A higher risk of caries was revealed in infants with respiratory syndrome (OR 6.2) or when their mothers had a lower socioeconomic status (OR 6.3). CONCLUSIONS: PTI had less healthy teeth than FTI and are at a higher risk for DDE, caries, and gingivitis. The poorer dental health in PTI is associated with a low birth weight, a low socioeconomic status, and mothers' illness during pregnancy.