Performance of restorations in primary molars over a seven-year period.

OBJECTIVE: The aim of this study was to evaluate the use and reintervention rate of fillings compared to preformed metal crowns in the everyday clinical practice of German dentists. METHODS: In this retrospective, longitudinal analysis, fee codes from the Kassenzahnärztliche Vereinigung Westfalen-Lippe for restorations placed in primary molars between 2012 and 2015 in children until 7 years of age followed for a 7-year period (latest until December 2022) were filtered and analyzed with the Fine and Gray competing risk regression and Cox proportional hazards regression to calculate the risk of reintervention divided into the main outcomes "Successful", "Minor Failure/Repair" and "Major Failure/Endodontic Treatment/Extraction". 367,139 primary molars (one-surface fillings: n = 117,721; two-surface fillings n = 198,815; three-surface fillings n = 36,695; more than three-surface fillings n = 8,267 and preformed metal crowns n = 5,641 were included in this study. RESULTS: Teeth treated with preformed crowns needed significantly less re-interventions. Subdistribution hazard ratio for minor events was 0.117 (95 %-CI: 0.097 to 0.141) and hazard ratio of major events (HR=0.786; 95 %-CI: 0.695 to 0.890) when compared to one-surface fillings in multivariable adjusted analysis. Within 7-year follow-up preformed crowns required less repairs (80.6 % success rate, minor failure 4.4 %, major failure 16.3 %) than the teeth treated with composite fillings (46.2 %-52.6 % success rate, minor failure 27.0 %-39.5 %, major failure 15.5 %-28.4 %, p < 0.001). CONCLUSION: Within the German healthcare system fillings are the first choice for treating primary molars despite considerably higher reintervention rates. This encourages a discussion on the indication of fillings and the more durable preformed metal crowns to reduce unnecessary reintervention in young children. CLINICAL SIGNIFICANCE: This study gives an unprecedented insight into the German healthcare system regarding the reintervention rates of the most relevant treatment techniques for caries in primary molars.

Management of pre-eruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up.

BACKGROUND: Pre-eruptive intra-coronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentinal junction of unerupted teeth, particularly in lower molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. CASE SERIES: This case series reports on four patients with progressive pre-eruptive intra-coronal radiolucency. In case 1 and 2, lesions were incidentally discovered in an OPG during orthodontic planning (lower permanent 2nd molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly in case 3, the PEIR was not visible in earlier x-rays though the crown of the tooth was already mineralized (lower permanent 2nd molar). For case 4, the tooth presented with symptoms of reversible pulpitis (lower permanent 1st molar). All lesions were treated with indirect pulp capping using biocompatible material. The patients were followed-up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (case 2), 1.4 years (case 1), 1.5 years (case 4), and 8 years (case 3). CONCLUSION: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.

Influence of School Type and Class Level on Mean Caries Experience in 12-Year-Olds in Serial Cross-Sectional National Oral Health Survey in Germany-Proposal to Adjust for Selection Bias.

The objective of this study is to analyse the effects of attended school type and class level on the reported caries experience (DMFT) obtained in the serial cross-sectional National Oral Health Study in Children in Germany (NOHSC) for the WHO reference group of 12-year-olds. METHODS: Caries data from the 2016 NOHSC were adjusted for each federal state on the basis of two additional large-scale datasets for school type and class level. RESULTS: Twelve-year-olds in all grades in Saxony-Anhalt (n = 96,842) exhibited significantly higher DMFT values than 12-year-olds in 6th grade (n = 76,456; +0.10 DMFT; ~14.2%, p < 0.001). Adjustments for school type had effects on DMFT on the level of federal states but almost balanced out on the national level (-0.01 DMFT; ~2%). Due to putatively similar structures of the federal states, the national mean DMFT for 12-year-olds in the latest NOHSC (2016; n = 55,002) was adjusted from 0.44 to 0.50 DMFT, correcting for selection bias. CONCLUSION: Selection bias in this NOHSC leads to an underestimation of caries levels by about 15%. Due to very low caries experience in children in Germany, these precise adjustments (+0.06 DMFT) have only a minor effect on interpretations of the national epidemiologic situation. Consequently, other national caries studies worldwide using the robust marker of DMFT should also adjust for systematic selection bias related to socio-economic background rather than increasing efforts in examination strategy.

Tooth Brushing Learning Methods: Differential or Conventional? A Randomized Controlled Clinical Trial.

INTRODUCTION: Proper tooth brushing is a complicated process for children. Therefore, the aim of this study was to investigate the effect of differential learning to improve tooth brushing in children. METHODS: In this prospective, controlled, single-blinded, randomized clinical trial, 58 children between 3 to 8 years of age (mean: 5.7±1.5 years; 29 female) were randomly assigned to test or control group through the child's self-drawing of an unlabeled envelope from a box. All children received oral hygiene instructions and information in these sealed envelopes and were asked to follow the corresponding instructions at home for 28 days. Children in the test group received instructions with exercises using the differential learning method, whereas the children in the control group received the usual tooth brushing instructions. RESULTS: At baseline and planned follow-ups after 4 and 12 weeks, plaque and gingival indices (QHI, PBI) were recorded in both groups by 2 calibrated and blinded investigators. At baseline, there were no significant differences between the test and control groups regarding plaque and gingival indices (QHI: 4.1±0.5 vs. 4.1±0.4; p=0.7; PBI: 0.6±0.3 vs. 0.6±0.3; p=0.7). At the 1st and 2nd follow-up, both groups showed improved oral health indices, but there was an overall better improvement in the test group. While the difference in gingival indices was statistically significant in the 1st recall (PBI/test: 0.1±0.2 vs. control: 0.3±0.2; p<0.001), the difference in plaque indices was not (QHI/test: 2.1±0.9; control: 2.6±0.9; p=0.07). At the 2nd recall (mean week=19.5 weeks), the test group showed statistically significant and clinically relevant better oral health indices than the control group (2nd recall, QHI/test: 2.1±0.9 vs. control: 3.2±1; p<0.001; PBI/test: 0.1±0.2 vs. control: 0.5±0.2; p<0.001). CONCLUSION: In conclusion, differential learning leads to oral hygiene improvement in children with high caries risk and initially poor oral hygiene, which was superior to the conventional learning method through repetition in the medium term.

Success rates and failures of fixed and removable space maintainers after the premature loss of primary molars.

OBJECTIVE: The evidence base for the use of space maintainers is relatively sparce despite being used for decades after the premature loss of primary molars. This study aims to increase the dental evidence base via investigating retrospectively the success rates of prefabricated fixed and removable space maintainers inserted from 2019 to 2021 and followed up until February 2023 at a specialized university clinic and to identify reasons for any reported minor and major failure. The authors hypothesized that there is no significant difference in failure rates between fixed and removable space maintainers inserted after the premature loss of a single primary molar per quadrant. METHOD AND MATERIALS: Patients' digital records were searched yielding 645 space maintainers. After the application of inclusion criteria, 157 (67%) fixed prefabricated space maintainers in 112 children and 77 (33%) removable space maintainers in 61 children were analyzed for an average of 18.4 ± 9.5 months. RESULTS: Kaplan-Meier survival analysis with Mantel-Cox statistics showed an overall cumulative survival time of 31.6 months (SE = 1.15, 95% CI = 29.4 to 33.9). Major failure occurred significantly more in removable maintainers (n = 40/67, 59.7%), mostly due to loss of the appliance, compared to fixed space maintainers (n = 27/67, 40.3%; P < .001). The present study indicates that space maintainers were mainly placed in young children with high caries experience, where treatment was mostly possible using advanced behavior management. CONCLUSIONS: Fixed space maintainers had a significantly lower failure rate than their removable counterpart. However, both require continual repairs, preservation, or even replacement till the eruption of the permanent tooth.

Introducing an Innovative Approach for Managing Proximal Non-Cavitated Carious Lesions in Juvenile Permanent Dentition: Combining Orthodontic Separators and Silver Fluoride Application.

BACKGROUND AND OBJECTIVES: The aim was to introduce an innovative, easy and cheap clinical approach for the control of multiple proximal non-cavitated lesions via the application of 38% silver fluoride after placement of orthodontic separators in the permanent dentition in high-caries-risk children. MATERIALS AND METHODS: The case series describes the management of initial proximal carious lesions using silver fluoride (SF) products in the permanent dentition of two adolescent patients with prior proximal caries progression. Both presented with multiple asymptomatic carious lesions that were identified through the use of bitewing radiographs and classified according to the ADA proximal caries classification system. Using orthodontic separators prior to the planned application of SF, most of the surfaces could then be quickly directly examined to check for surface integrity. Follow-up examinations were conducted clinically and radiographically for at least one year to monitor lesion progression. RESULTS: None of the 25 enamel lesions (E1/E2) exhibited signs of progression after single SF application, while 2 out of 11 dentine lesions (D1) showed progression and required restorative intervention. The progressed lesions potentially had non-cleansable micro-cavitations that were either clinically undetected or not fully reached with the micro-brush in SF application. Thus, this should have been repeated or combined with SF application via soaked superfloss to potentially achieve better results. CONCLUSIONS: Single application of 38% silver fluoride directly onto active enamel lesions in juvenile permanent teeth with the prior use of orthodontic separators combined with a caries-risk-specific prevention program appears to be highly effective and should be considered as a viable minimally invasive option for patients and clinicians due to its cost-effectiveness and time efficiency.

Influence of treatment setting on success of pulpectomy in primary molars: a retrospective analysis up to 4 years.

OBJECTIVES: The objective of this study was to analyze the success of primary molar pulpectomy with a minimum of 1 year and up to 4 years follow-up with focus on the treatment setting (general anesthesia, sedation, local anesthesia alone). METHOD AND MATERIALS: Data were retrieved from 92 patients' records between 2012 and 2020. The pulpectomy treatment using calcium-hydroxide/iodoform paste was performed under general anesthesia (n = 45), nitrous oxide sedation (n = 21), or local anesthesia alone (n = 39). Bivariate and multivariate analyses were performed. RESULTS: The overall success of pulpectomy was 59.5% 4 years post-treatment. The 4-years clinical success rate was clinically relevantly higher under general anesthesia (78.6% vs 57.1% under nitrous oxide sedation, 43.8% with local anesthesia only) and in the mandibular arch (70.8% vs 38.5% in the maxillary arch). This could be related to the strict case selection under sedation and especially general anesthesia. Despite statistically significant differences in the bivariate analysis for most outcomes and follow-up periods, this was not the case in multivariate regression. CONCLUSION: Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia.

Effect of Prevalence and Severity of Molar-Incisor Hypomineralization on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis.

Objectives: The aim of this systematic review and meta-analysis is to assess the association between the MIH presence as well as the severity and OHRQoL in children. Material and methods: Relevant studies were identified in PubMed, Embase, Cochrane and Google Scholar. Studies involving MIH and OHRQoL in children were included. A methodological quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) and its adapted version for cross-sectional studies. Random effects models were used to estimate summary effect measures for the association between MIH presence (presence vs. absence) as well as severity (moderate/severe MIH vs. no MIH) and OHRQoL using generic inverse variance meta-analyses. Tests for heterogeneity, publication bias and sensitivity of results were also performed. Results: Out of 1696 identified publications 11 studies reporting on 5,017 children were included in the meta-analysis assessing the impact of MIH presence. There was no statistically significant association between the presence of MIH and lower OHRQoL in affected children (OR = 1.72, 95% CI = 0.99-2.98). Concerning MIH severity and its impact on OHRQoL, a sum of 6 studies were included in the meta-analysis involving a total of 2,595 children. There was a significant association between moderate/severe MIH and lower OHRQoL in affected children (OR = 3.43, 95% CI = 1.69-6.98). Conclusion: Moderate/Severe MIH has a significant and clinically relevant negative impact on OHRQoL, and it should therefore be addressed adequately. Future research should also consider the impact of a uniform MIH diagnosis and precise severity criteria.

Potential for nitrous oxide sedation in pedodontics practice to reduce the need for dental general anesthesia.

OBJECTIVE: To investigate the possible reduction in the need for dental general anesthesia through nitrous oxide sedation in combination with behavior management techniques among patients younger than 12 years of age referred to a specialized pedodontics practice due to high dental treatment need and poor cooperation with dental treatments. METHOD AND MATERIALS: Retrospective analysis of the digital medical records of all children treated under nitrous oxide sedation in a specialized pedodontics clinic between 2012 and 2017 was performed. The reduction of the need for dental general anesthesia was measured depending on the success rate of nitrous oxide sedation at the patient level with relation to multiple related factors such as age, reason for referral, and treatment need. RESULTS: Nitrous oxide was used in 406 dental treatment sessions on 228 pre-cooperative and/or anxious patients aged 3 to 12 years (mean 6.4 ± 1.7; 43.4% female); 91.9% of the nitrous oxide sedation sessions were successful in achieving the intended dental treatment. Complete oral rehabilitation was possible for 84.0% of the patients using nitrous oxide sedation without the need for dental general anesthesia. Regarding age, dental general anesthesia reduction among preschool children was lower than school children (77.8% and 87.9%, respectively). CONCLUSION: A high proportion of anxious or semi-cooperative children with high dental treatment need can be treated without the use of dental general anesthesia when a comprehensive concept of caries management is combined with the use of nitrous oxide sedation and behavior management techniques. Nitrous oxide sedation should therefore be considered as an option for dental treatment of semi-cooperative children with high dental treatment need before planning dental general anesthesia.

Teaching Cariology in Asia and Arabia.

The European Organisation for Caries Research education platform 2020 had the aim to assess the undergraduate curriculum in cariology in Asian and Arabian countries in order to support structured teaching of cariology in these countries with about almost half of the global population. Representatives of 4 Asian and 4 Arabian countries completed a comprehensive questionnaire on structure of dental education in their country in general and the extent, the content, the responsibilities, structure and standardization regarding cariology in particular. In spite of a wide range from very few universities (Lebanon 3) to larger numbers of dental schools (India 313, China 121, Russia 52) there were similar statements on the list of content for cariology teaching. Often the catalogue was close to the Undergraduate Core Curriculum in Cariology (UCCC) covering most of the 5 domains from basic science to dental public health, but a national curriculum for cariology or dentistry was mostly missing. With various departments being involved, a need of coordination is obvious. Most representatives thought it possible and feasible to teach a standardized curriculum in cariology on the basis of the UCCC. In conclusion, many Arabian and Asian countries have implemented modern, evidence-based curricula in their universities, but an obligatory national curriculum in cariology would be advisable to standardize the quality in teaching.

Multicenter RCT on intensive caries prevention for children undergoing dental general anaesthesia: Intensive caries prevention for children undergoing dental general anesthesia.

OBJECTIVES: Early childhood caries is a persistent problem often leading to dental treatment under general anesthesia (GA). Thus, this study investigated the effect of two additional individual caries prevention appointments before and after GA. MATERIALS AND METHODS: In this multi-center, 2-arm randomized, controlled clinical trial, 408 children (age 2-5 years, mean 4.2 ± 1.04) intended for GA were recruited and randomly assigned to the intervention and control groups with or without two additional intensive oral hygiene appointments before and after the GA. At baseline and at 6-/12-months follow-ups, approximal plaque index (API), gingival sulcus bleeding index (SBI), caries experience (dmft/s) and initial caries were recorded. RESULTS: Participants in test group and control group (ITT; n = 161 vs. n = 147) as well as drop-outs in test and control groups (n = 40 vs. n = 58) showed no statistical significant difference in baseline characteristics. Test and control groups showed equivalent baseline oral health parameters (API: 78 and 77%, SBI: 22.6 and 23.5%, dmft: 8.5 and 8.2, respectively), which continuously improved during the study. The test group exhibited statistically significant greater improvement (API: 42%, SBI: 7%) than the control (API: 54%, OR: 0.48; P = 0.003; SBI: 12%, OR=0.44; P = 0.005). Due to the robust rehabilitation with predominantly stainless steel crowns and extractions, caries incidence was minimal and, therefore, without statistical significance (mean increase dt, test: 0.5, control: 0.6; P = 0.68), which was also true for new initial carious lesions (mean increase test: 0.8 vs. CONTROL: 0.9; P = 0.55). CONCLUSIONS: Additional preventive sessions for children undergoing treatment under GA improved their oral hygiene parameters signifiqantly. CLINICAL SIGNIFICANCE: Intensive caries prevention appointments for children receiving dental treatment under GA improved their oral hygiene and might reduce their caries risk.

How did the COVID-19 pandemic lockdown affect dental emergency care in children? Retrospective study in a specialized pedodontic center.

OBJECTIVES: COVID-19 led to the adoption of containment measures including the temporary closure of dental clinics. However, dental emergencies have not ceased during this pandemic. Thus, the aim of this study was to analyze patient profiles and the offered management options to pediatric patients presenting with dental emergencies during a COVID-19 lockdown. METHOD AND MATERIALS: Retrospective analysis was performed of patient records of children seeking emergency dental treatment during a 7-week lockdown period in 2020 in a university pedodontic clinic in Germany, and compared to a similar cohort from 2019. Data on patient, tooth, and session level were collected. RESULTS: The 2020 cohort consisted of 83 patients, and the 2019 cohort included 46 patients, showing a 45% greater need for emergency treatment in 2020. The most common chief complaint was plaque-induced gingivitis/oral mucosal conditions in 2020 (26.4%), and irreversible pulpitis in 2019 (25.5%). Dental caries (without spontaneous pain) was the second most common chief complaint in both cohorts (20.7% and 23.4%, respectively). Most interventions in 2020 were minimally invasive treatments (eg, Hall Technique, silver diammine fluoride; 20.3%), which were in 2019 not considered at all; followed by pharmacologic treatment (16.9%), which was in 2019 also highly used (35.9%). CONCLUSION: The COVID-19 pandemic led to an increase in emergency pediatric dental visits and shifted treatment options towards less invasive procedures.

[Oral health trends in children : Results from the epidemiological surveys accompanying group prophylaxis in Germany]. / Mundgesundheitstrends im Kindesalter : Ergebnisse aus den epidemiologischen Begleituntersuchungen zur Gruppenprophylaxe in Deutschland.

To describe the current epidemiological trends in the dental caries experiences of children in Germany, oral health data was primarily presented on the basis of the Epidemiological Studies Accompanying Group Prophylaxis (DAJ study) for the 2015/16 schoolyear. Caries data of 301,684 children from three different age groups were available. The trends in caries development were based on previous national and regional studies conducted in Germany.Caries in the primary dentition occur very early (approx. 10-17% of 3­year-olds) and are still widespread among 6­ to 7­year-olds (approx. 40-60%). The proportion of unrestored decayed primary teeth is very high (3-year-olds: 73.9%; 6 to 7­year-olds: 42.5%). There has also been no significant improvement among 6­ to 7­year-olds in the last 10 years. The values for the 3­year-olds that were nationally examined for the first time in the DAJ study are in the range of previous regional studies from recent decades. Caries prevalence among the 6­ to 7­year-olds shows a regional convergence. Among the 12-year-olds, mean caries experience in the permanent dentition has fallen by about 80% in the last 20 years. Regarding oral health in this age group, Germany ranks highest among countries worldwide.There is still a substantial need for oral health improvement in the primary dentition of children in Germany. Recently implemented preventive measures already focus on tackling this problem. Further improvements in caries prevention similar to those in the permanent dentition are feasible and expected.

Pain perception during injection of local anesthesia in pedodontics.

OBJECTIVE: Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the study was to evaluate the difference in the assessment of procedural pain by the child, parent, dental practitioner, and independent observers during injection of local anesthesia for dental treatment in pediatric dentistry. METHOD AND MATERIALS: In total, 27 male and 22 female children (5 to 17 years of age, mean ± SD 9.8 ± 4.0 years) received local anesthesia (LA) via infiltration or mandibular alveolar blocks according to a standard protocol. After the dental treatment, the children assessed the pain levels for the procedures on a visual analog scale (VAS), while their parents and the dental practitioner used a numeric rating scale (0 to 10). Independent observers also assessed pain via video tape for an evaluation after blinding. The heart rate was monitored continuously during the procedure. The Bland-Altman method was used to quantify the comparison between pain ratings. RESULTS: The assessed level of pain by dental practitioner, parent, and child during injection of LA differed clearly (child: 3.94 ± 2.71; parent: 3.31 ± 2.60; dental practitioner: 3.02 ± 1.98; video observer 1: 1.76 ± 2.56; video observer 2: 1.89 ± 2.55). In 42.9% of cases the dental practitioner's rating and the self--reported pain by the child during injection of LA differed by ≥ 2 on the numeric rating scale, which is clinically a highly different and relevant assessment. CONCLUSION: As pain perception in children during the injection of local anesthetic and its assessment varies considerably depending on the assessing person and the treated child, dental practitioners and researchers should be cautious in interpreting the patient's pain perception.

One year clinical success of pulpectomy in primary molars with iodoform-calcium hydroxide paste.

OBJECTIVES: In order to retain primary molars, eg with irreversible pulpitis or pulp necrosis, pulpectomy can be an alternative to extraction. However, reports on the success of pulpectomies in primary teeth vary widely in the literature. Thus, the objective of this study was not only to analyze the success rate of primary tooth pulpectomy 12 months posttreatment in the setting of a specialized clinic, but also to identify and analyze various factors that modify the outcome. METHOD AND MATERIALS: Between 2012 and 2018, a total of 76 dental records of the Department of Preventive and Pediatric Dentistry at the University of Greifswald fulfilled the inclusion criteria, resulting in a 1-year analysis of 62 primary molars with an idoform-calcium hydroxide paste as root canal filling material almost exclusively covered by a stainless steel crown as restoration. RESULTS: The pulpectomy treatment was successful after 1 year in 93.5%, with a significantly higher survival for mandibular primary molars (100.0% vs 83.3%; chi-square test P = .01). Apart from the very few cases in the mixed dentition, no other factors related to the patient (sex, caries level, general health conditions, distance to clinic), tooth (first or second primary molar, pulpal and periapical condition before treatment), or treatment (indication, academic qualification of the operator, number of visits) proved to be of significance for the treatment outcome due to the overall high success rate. CONCLUSION: Pulpectomies for pulpally involved or even necrotic primary molars followed by stainless steel crowns as restoration should be considered as a treatment option, especially in the mandible. (Quintessence Int 2021;52:528-537; doi: 10.3290/j.qi.b1244443).

How to Intervene in the Caries Process: Early Childhood Caries - A Systematic Review.

For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child's cooperation, or a general anaesthesia setting.

40-Year Longitudinal Caries Development in German Adolescents in the Light of New Caries Measures.

This study assessed the 40-year longitudinal caries development in German adolescents in the light of the sixth National Oral Health Survey in Children (NOHSC, 2016) employing initial DMFT (IDMFT), Significant Caries Index (SiC) and Specific Affected Caries Index (SaC). On the basis of the current NOHSC (randomized cluster selection using school list or regional community school surveys, 55,956 12-year-old sixth-graders examined by 482 calibrated community/study dentists) DMFT, SiC, a novel IDMFT including initial lesions (IT) and the recently introduced SaC were calculated and also recalculated for national and international surveys from the last 4 decades. In 2016, 78.8% of children were caries-free (DMFT = 0), 65.5% including IT lesions. The mean DMFT was 0.44 (single components: DT = 0.14, MT = 0.02, FT = 0.29, IT = 0.52) showing a clear association with the school type as marker for the socio-economic status. The mean number of affected teeth in children with DMFT >0 was 2.07 (SaC) in comparison to almost 9 teeth in the 1970s. The current care index on the tooth level was 66.3%, leaving only 7.7% of children with restorative treatment needs. Longitudinally, a continuous caries decline of more than 80%, including the risk groups (SiC/SaC), to an internationally extremely low level was observed. In conclusion, the National Oral Health Surveys reveal a continuous caries decline to a very low caries level in 12-year-old 6th-graders in Germany even if IT lesions are included (IDMFT). In spite of proportional reductions in the risk groups (SiC/SaC), the polarized caries distribution according to socio-economic parameters reveals the need for targeted preventive programmes.

Caries Trends in the Primary Dentition of 6- to 7-Year-old Schoolchildren in Germany from 1994 to 2016: Results from the German National Oral Health Surveys in Children.

Long-term nationally representative caries data in the primary dentition are rare, but nonetheless central to assess needs in caries prevention and treatment. This study evaluated the prevalence and trends of caries levels in the primary dentition of 6- to 7-year-olds in Germany as a whole and its federal states individually. In 2016, employing a randomized cluster selection, 6- to 7-year-old first graders were included in the National German Oral Health Survey performed regularly since 1994/95. Children were examined by 482 calibrated dentists in all 17 German regions using the WHO criteria for the decayed, missing, and filled teeth (dmft) including the assessment of initial carious lesions (it). In total, 151,555 6- to 7-year-olds were examined. Caries prevalence in the primary dentition dropped from 65% in 1994 to 44% in 2016, while the mean caries experience dropped from 2.89 to 1.73 dmft (dt = 0.74, mt = 0.19, ft = 0.80). When initial lesions were included, the mean caries experience increased to idmft = 2.12 (it = 0.38). In 2016, 49.7% of the examined 6- to 7-year-olds were caries-free including initial lesions. The Care Index at the tooth level was 57.5%, and the Significant Caries Index was 4.84 dmft. Depending on the German region, the mean dmft varied considerably, ranging from 1.37 to 2.31. In conclusion, despite the overall caries decline in 6- to 7-year-olds in Germany, only minor caries reductions were observed over the last decade, with a still existing high proportion of untreated dental decay. This calls for more effective preventive and restorative efforts with focus on the primary dentition in Germany.