Investigation of Dental and Oral Health in Children and Adolescents with Special Support Needs from a Child and Adolescent Psychiatric Perspective.

BACKGROUND: The current literature lacks scientific research on child and adolescent psychiatrists' (CAPPS) perspectives on dental and oral health. This study aims to investigate the opinions and approaches of child and adolescent psychiatrists and their patients regarding oral and dental health. METHODS: A questionnaire-based cross-sectional study was conducted among members of the Professional Association for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany. RESULTS: Out of the association members, 10.9% (n = 109) participated, with 5.2% (n = 52; 38f/14m) completing the questionnaire. Dental and oral health topics were discussed with one-fifth of the patients (19.2%), while 11.5% reported that they were "never" a part of their therapy. Patient-related concerns about dental and oral health were primarily brought into the context of child and adolescent psychiatric work. Dental treatment anxieties were prominent. Only 3.8% of the participants regularly assigned diagnoses related to dental status. The CAPPS employ a bio-psycho-social model for the genesis of oral health-related conditions in Children and Adolescents with Special Needs. CONCLUSIONS: CAPPS have a foundation in relationship-based work for assessing oral and dental healthcare and providing recommendations for further dental care. Regional networking and science must be further developed.

[Interface Communication and Information Transfer in Medical Care for People with Intellectual Disabilities: Qualitative Expert Interviews]. / Schnittstellenkommunikation und Informationstransfer in der medizinischen Versorgung von Menschen mit intellektueller Entwicklungsstörung: Qualitative Expert*innen-Interviews.

BACKGROUND: The aim of this study was to investigate the experiences, barriers, and solutions in communication during the provision of care for people with intellectual developmental disabilities in Germany. As there are approximately 350,000 people living with intellectual or developmental disabilities in Germany, who rely on assistance when communicating with healthcare providers, this study was conducted to examine the communication challenges and potential solutions in this population. The analysis especially focused on the potentials of digital applications facilitating information transfer. METHODS: Thirteen expert interviews were conducted using a structured interview guide with caregivers and medical providers to people with intellectual developmental disabilities. The interviews were analyzed using an inductive and deductive content analysis approach, according to Meuser and Nagel. RESULTS: The results revealed that the provision of care for people with intellectual developmental disabilities was characterized by time constraints and uncertainty when caregivers lack experience in caring for this population. Additionally, information transfer increased in complexity due to an overload of individual information provided by caregivers verbally or paper-based as well due to the passive role of patients who were usually not actively involved in the communication process. With regard to the potential for integrating digital applications for information transfer, a controversy between opportunity and risk emerged. CONCLUSION: The findings demonstrate that there is a need to implement training programs for professionals to enable them to offer improved health care for people with intellectual developmental disabilities. It is essential that caregivers are given sufficient time to communicate with patients, and that digital applications are utilized to support information transfer. Moreover, other research shows that digital applications offer new possibilities to communicate with people with intellectual developmental disabilities, such as the use of simplified or pictorial language. By addressing these communication challenges, healthcare professionals may be able to provide more effective and efficient care to this population. However, this requires further research, which addresses the controversial results regarding digital applications outlined in this paper.

Orofacial findings and orthodontic treatment conditions in patients with down syndrome - a retrospective investigation.

INTRODUCTION: The most common chromosomal anomaly is Down syndrome/Trisomy 21, which can be associated with varying degrees of intellectual disability and physical malformation. Specific orofacial characteristics regarding orthodontic treatment options and features are described on the basis of a patient collective from the Witten/Herdecke University, Germany. METHODS: Data of 20 patients (14 boys and 6 girls, mean age: 11.69 ± 3.94 years) who underwent orthodontic treatment between July 2011 and May 2022 were analyzed. Baseline skeletal and dental conditions were assessed, as well as the presence of hypodontia, displacements, and treatment-related root resorptions. The treatment need was evaluated based on the main findings according to the German KIG classification. In addition, treatment success was determined in relation to patient compliance. RESULTS: The patient group was characterized predominantly by a class III relationship (ΔANB: -2.07 ± 3.90°; ΔWITS: -3.91 ± 4.33 mm) and a brachyfacial cranial configuration (ΔML-NL: -4.38 ± 7.05°, ΔArGoMe: - 8.45 ± 10.06°). The transversal discrepancy of the dental arch width from maxilla to mandible was -0.91 ± 3.44 mm anteriorly and -4.4 ± 4.12 mm posteriorly. Considering the orthodontic indication groups, the most frequent initial finding and treatment indication represented hypodontia (85%), followed by frontal (75%) and unilateral lateral (35%) crossbite. In 55% of the cases, the teeth had a regular shape, but in 35% a generalized and in 15% an isolated hypoplasia. Only 25% of the patients could be treated with a fixed multiband appliance due to sufficient cooperation. In each of these patients, varying degrees of root resorptions were detected during treatment, and 45% of all treatments had to be terminated prematurely due to a lack of cooperation by patients or parents. CONCLUSION: The extent of dental and skeletal malformations and the high rate of findings requiring treatment in patients with Down syndrome represent a significant indication for orthodontic therapy, which can be well illustrated by the KIG classification. However, this is in contrast to the eventually increased risk of root resorption, with significantly reduced patient cooperation. A compromised treatment outcome and process must be expected. Consequently, the orthodontic treatment must be simple and realistic to achieve fast and therapeutically satisfactory treatment result.

[Diagnostic Prevalence of Dental Findings in Children, Adolescents and Young Adults with Mental Disorders Compared to Healthy People - an Analysis and Estimation Based on Claims Data from 2019]. / Zahnmedizinische Diagnoseprävalenzen bei Kindern, Jugendlichen und jungen Erwachsenen mit psychischen Störungen im Vergleich zu Gesunden-Analyse und Abschätzung kassenärztlicher Abrechnungsdaten (2019).

AIM: To analyse oral health-related diagnostic prevalences in children, adolescents (KiJu), young adults with mental/behavioural disorders (PEVS) and those of the general population in Germany based on claims data. METHOD: Anonymously provided ZI (Zentralinstitut)-data sets of GKV-insured persons (0-44 years) were i. e. stratified according to gender, age groups, ICD-K00-K14 diagnosis. RESULT: No reliable oral or dental health-related information was generated from the requested data set. Regardless of the F diagnosis, according to the data set, 1.8% of all 11,854,384 KiJu-GKV-insured persons and 0.2% of 18-44-year-olds (23,348,399 GKV-insured persons) had a diagnosis related to the dental hard tissue (ICD-10 K02/K03.2). Based on available literature on the prevalence of caries in KiJu with PEVS, a mean unweighted prevalence of 51% can be assumed. According to the available literature on the prevalence of caries in KiJu with PEVS a mean unweighted prevalence of 51% can be calculated. Following this and the diagnosis prevalence of PEVS in 0- to 17-year-olds from 2017, an estimated 957.952 children with PEVS should also have a caries. CONCLUSION: The nationwide data on the prevalence of oral health-related diagnoses made by physicians in the general population and in people of the same age with PEVS are very low. Apparently, dental diagnoses are only given very rarely by general practitioners and paediatricians, among others. The existing literature as well as the clinical experience of the authors indicate that this claim data is not suitable to realistically represent the dental and oral health of the examined group of people. Thus, for networking, the improvement of health care research and the care, e. g. of subgroups of the society, is an interprofessional dental/medical, data protection-compliant central database to be driven forward.

A five-year cohort study on German dental students: Self-assessment in regard to previous experience and attitude toward patients with different types of disability.

AIMS: In Germany, a curriculum in special care dentistry (SCD) is not mandatory. As a result, very little is known about dental students' attitudes toward interacting with people with disability (PwD). The study´s aim was to assess this among dental students at Witten/Herdecke University (UW/H). MATERIAL AND METHODS: In the academic years 2016-2017 to 2020-2021, dental students in the 7th semester (UW/H) were asked to complete a self-assessment questionnaire. Prior to its start, the study had obtained a positive vote from the ethics committee of the UW/H (#174/2016). RESULTS: Out of 199 students 166 persons on average 24.5 years old completed the questionnaire. Nearly all participants had already had previous experience with PwD in various domains of life prior to dental school (89.2%). Three-quarters indicated not having reservations about interacting with PwD. The proportion of persons without previous experience in interacting with a PwD was almost twice as high in the group with reservation (16.2%) as it was in the group without reservation (8.7%). Almost all surveyed students (92.8%) affirmed that they would like to learn more on the topic of "Professional Interaction with PwD." CONCLUSION: Most of the respondents did not have reservations about interacting with PwD. Almost all the participants indicated a high level of interest in topics related to SCD. Also, the authors like to encourage the curriculum committees of dental schools at other universities to integrate courses on SCD, based on the iADH recommendations, into their dental curricula.

Oral Health Care of People with Down Syndrome in Germany.

BACKGROUND: Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic. METHODS: An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017). RESULTS: The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2-3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste. CONCLUSIONS: Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Is examining children and adolescents with autism spectrum disorders a challenge?-Measurement of Stress Appraisal (SAM) in German dentists with key expertise in paediatric dentistry.

OBJECTIVES: This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. METHODS: An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. RESULTS: Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. CONCLUSIONS: Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.

Self-Assessment of Knowledge on the Treatment of Children and Adolescents with Special Care Needs: Results of a Survey amongst German Dentists with Key Expertise in Paediatric Dentistry.

BACKGROUND: The treatment of children and adolescents with disabilities (CA-Dis) and psycho-emotional disorders (CA-Psy) places special demands on dentists. AIM: To explore German dentists' (with key expertise in paediatric dentistry) perception of their competence and comfort levels in dealing with these patients, and implications for access to care. METHODS: Online questionnaire surveying demographic information and self-assessment of training, knowledge, and comfort in dealing with CA-Dis and CA-Psy among 1725 members of the German Society of Paediatric Dentistry (DGKiZ). RESULTS: Ninety-two participants (11 male, 81 female) completed the questionnaire: 17.4% (n = 16) treated CA-Dis once or more a day; CA-Psy were rarely treated on a daily basis (7.6%; n = 7). In regard to CA-Dis, 62% (n = 57) rated their level of expertise as "good" or "very good"; for CA-Psy this was 40.2% (n = 37). Overall, 76.1% (n = 70), respectively, 88.0% (n = 81) of the respondents felt they had been inadequately prepared to treat CA-Dis or CA-Psy. Although the physical burden of treating CA-Psy was rated as "not at all stressful" or only "slightly stressful" by 45.7% of the participants, 31.5% rated the psychological distress as "very stressful" or "extremely stressful". The better their self-assessed expertise in treating CA-Dis was, the lower their own psychological distress was rated (r = -0.34). Training on this topic seems to have an impact on the perceived burden of treating such patients. CONCLUSIONS: A core curriculum in special care dentistry needs to be embedded in the German dental curriculum. The results permit the development of health programs for workplace health management in dentistry.

Children's and Parents' Marburg Sugar Index (MSI) Values: Are They Comparable?

Studies on children's nutritional behaviour (CNB) rarely compare children's answers regarding the frequency of their sugar intake with the respective statements of their parents. Therefore, data from a prevention study were used to analyse this aspect, as well as a potential correlation between Marburg Sugar Index (MSI) values and caries experience of children. The present study based its questionnaire data on CNB and caries data. Pairs of questionnaires filled in separately by children and parents of the participating families were dichotomised by either having completed the diet section entirely (Group A) or in part (Group B). The MSI scores were calculated separately for children and parents. The statistical confidence level was set at α = 0.05 (two-sided). Furthermore, the Pearson correlation coefficient was calculated and tested for "r = 0". Additionally, a test for equality of the correlations was applied. The number of available questionnaire pairs was 429 in Group A and 400 in Group B. In both groups, significant correlations between children's and parents' MSI scores (A: r = 0.301, p < 0.001; B: r = 0.226, p < 0.001) were found. Using Spearman's Rho, a significant correlation between MSI scores and children's caries experiences was observed in Group A. MSI scores based on dietary questionnaires can be used to obtain consistent information on children's CNB provided by the children themselves or their parents. This is true even when the MSI score has to be calculated on the basis of incomplete questionnaires. Questionnaire-based CNB information can improve the effectiveness of individual or group preventive measures supplemented by individually adapted nutritional counselling.

Orthodontic treatment of an adolescent with cerebral palsy - A case report.

Cerebral palsy is a common cause of chronic motor neuron impairment. A constant prevalence of 2 to 3/1000 births in industrialized countries has been described. This case report describes the treatment of a 9 year old boy presenting this form of motor neuron impairment and class II malocclusion with an overjet of 14 mm, hyperdivergent growth pattern and various habits. Orthodontic treatment consisted mainly of a two-phase treatment. The first phase was treated with removable appliances and followed by a phase with fixed appliances. Treatment duration with removable appliances was 4 years and 5 months and for the fixed appliance phase, 1 year and 7 months. A class I occlusion could be achieved in this case by removable and fixed orthodontic appliances combined with adjunctive treatment for the hypotonic orofacial musculature.

[Dental Health of Children and Adolescents in the Rhine-Erft District attending Secondary General and Special Needs Schools: A 5-year comparison]. / Zahngesundheit von Kindern und Jugendlichen des Rhein-Erft-Kreises mit Haupt- bzw. Förderschulbedarf im 5-Jahresvergleich.

BACKGROUND: Nationally there is a lack of data on the prevalence and experience of caries among 10- to 14-year-old schoolchildren with increased caries risk, and in the second period of mixed dentition/early period of permanent dentition. AIM: To compare caries prevalence and experience and prevalence of fissure sealant (FV) among schoolchildren with disability attending special needs schools (FS) with children with lower level of educational attainment attending secondary general schools (HS). METHODS: Dental health of schoolchildren aged 10 to 14 years attending FS or HS was determined according to WHO standards in two study periods (UP1=school year 2010/2011; UP2=school year 2015/2016). Data were anonymized and analyzed with MS Excel 2019 and IBM SPSS Version 26. The study was approved by the ethics committee of the University of Witten/Herdecke (#119/2016). RESULTS: Data on 2539 schoolchildren were available for analysis. Prevalence of caries in schoolchildren attending HS (UP1=36.5%; UP2=32.7%) and FS (UP1=31.4%; UP2=33.3%) was very similar as also the corresponding mean DMFT values. There was a significant difference in caries prevalence between the 2 groups in UP1 and a significant decrease between UP1 and UP2 among schoolchildren attending HS. With respect to FV, 50.7% (UP1) and 50.9% (UP2) of schoolchildren attending HS and 36.3% (UP1) and 52.1% (UP2) of schoolchildren attending FS had at least one FV. Furthermore, caries experience and caries prevalence of schoolchildren with at least one FV of both school types was significantly lower compared to schoolchildren without FV. Mean DMFT values for schoolchildren attending HS were 0.53 (UP1, FV>0), 1.16 (UP1, FV=0), and 0.49 (UP2, FV>0), 0.99 (UP2, FV=0) with p<0.001 in each case. Mean DMFT values for schoolchildren attending FS were 0.56 (UP1, FV>0), 0.9 (UP1, FV=0) (p=0.01), and 0.51 (UP2, FV>0), 1.02 (UP2, FV=0) (p=0.003). CONCLUSIONS: Dental health of schoolchildren attending HS and FS in the REK is significantly poorer compared to the general population. This suggests that both these groups belong to population-subgroups with an increased risk of developing caries. In order to improve this situation, caries prevention measures should be implemented beyond primary school age in children attending these 2 types of school.

[Outreach Dental Care for Children and Adolescents with Special Needs - An Evaluation of KZBV Data]. / Aufsuchende zahnärztliche Versorgung von Kindern und Jugendlichen mit Pflegegrad oder Eingliederungshilfe ­ eine Auswertung von Abrechnungsdaten der KZBV.

BACKGROUND: There are only limited data on the extent to which children and adolescents with the need of integrative assistance (KiJu-PflEh) are considered for outreach dental care service. Aim The aim of this study was to evaluate accounting data from the Kassenzahnärztliche Bundesvereinigung (KZBV) on the use of dental care by KiJU-PflEh. Material and Methods Based on six specific BEMA items (accounting year 2019), the KZBV performed a filtering of GKV-insured persons (0-17 years). The generated data sets of the study group (KiJu-PflEh) and the control group (all KiJu) were made the UW/H available in anonymized form for further analyses. RESULTS: The study group comprised 1602 KiJu-PflEh (mean age: 11.6 years). The gender ratio from ♂ to ♀ was 2:1. 56.0% of the KiJu-PflEh underwent diagnostic dental examination. The use of individual prophylactic (IP) measures was as follows: oral hygiene status assessment - IP1 (47.5%), oral health promotion - IP2 (46.1%), fluoridation of the teeth - IP4 (63.1%), fissure sealing per tooth - IP5 (30.1%). Compared to KiJu, statistically significantly fewer IP-measures were taken and carried out in the study group KiJu-PflEh. (KiJu: 85.7%; KiJu-PflEh: 46.7%). CONCLUSION: For the first time, it was shown that KiJu-PflEh is inadequately cared for and provided with dental care in comparison to peers in the general population. Increased dental care is urgently recommended as the KiJu-PflEh group has a high risk of caries. Medical information is also necessary to implement targeted prevention measures for all KiJu-PflEh. For this purpose, the introduction of a central database, which enables dental and general medical networking, should be driven forward. Furthermore, there is a need for more research to obtain primary data on the epidemiology of caries in KiJu-PflEh to verify the findings of the present pilot study.

Spanish Curriculum in Cariology for undergraduate dental students: Proceedings and consensus.

INTRODUCTION: Cariology is today a broad-based discipline and in the Spanish university teaching field, all this knowledge is not unified in a curriculum. Therefore, the aim was to develop a consensus text based on the European Core Curriculum, updated, and adapted to the characteristics of the Spanish university environment. MATERIALS AND METHODS: A Spanish Cariology Curriculum Group (SCCG) was set up with members of the Spanish Society of Epidemiology and Oral Public Health (SESPO), Spanish Society of Conservative and Aesthetic Dentistry (SEOC) and Spanish Society of Paediatric Dentistry (SEOP) and university experts to adapt the European Core Curriculum in Cariology for undergraduate dental students (ECCC) for Spain. The work was carried out online during 2018 and 2019, and also face-to-face meetings took place to obtain a draft curriculum open for discussion that was presented to all the Spanish universities. The final modifications to the document were specified in a Consensus Conference of Spanish universities offering a Degree in Dentistry that took place in Madrid on 19 November 2019. RESULTS: Thirty-eight university experts, under SCCG supervision, participated in the elaboration of the new framework document. A total of 16 universities, from 23 invited, reached a consensus as to the contents of the Spanish Curriculum in Cariology for undergraduate dental students. This new Curriculum emphasises learning outcomes, uses a consensus-based terminology pertaining to caries and other hard-tissue conditions, and introduces a new domain of competence in Domain III of ECCC. CONCLUSION: This new Cariology Curriculum is the result of a very broad-based consensus of university experts in Spain and lays the foundation for the implementation of an integrated teaching of Cariology in Spain in adherence to Alliance for a Caries Free Future (ACFF) objectives.

Caries Experience of Adults with Intellectual Disability in the Western Part of Germany.

BACKGROUND: In Germany, there is limited evidence on the oral health of adults with intellectual disabilities (AwID). METHODS: In 2017/18, dental examinations of AwID and a questionnaire survey of their legal guardians were carried out. The mean D3MFT values were calculated to describe the caries experience. The prevalence of AwID with at least one fissure sealant (FS) was determined and associations between caries experience and various sociodemographic factors (e.g., age, gender, living arrangements) were investigated. RESULTS: The data of 132 AwID (mean age 35.2 years; range 18-69 years) could be included. For all AwIDs the mean D3MFT value was 9.5 (95% CI 8.1-11.0). The mean D3MFT value for the 35-44-year-olds was 10.9 (95% CI 8.4-13.4). All caries-free persons (n = 14) were younger than 45 years. Furthermore, the mean D3MFT value for AwID living with their parents was lower at a statistically significant level than that of AwID in independent living arrangements. Moreover, younger AwIDs (18-34-year-olds) with at least one FS had a statistically significantly lower mean D3MFT value compared to those without any FS (D3MFT: 3.0 vs. 6.7). CONCLUSIONS: The dental health of AwID has improved in Germany in recent years, but, on average, AwIDs still have more missing teeth than their peers in the general population. Oral epidemiological studies on AwID should include information on their living arrangements to assess potential associations between sociodemographic factors and oral health.

[Oral health in persons with disability in Germany-an overview of the literature]. / Mundgesundheit bei Menschen mit Behinderung in Deutschland ­ eine Literaturübersicht.

The last systematic review regarding oral health of persons with disability in Germany was published in 2012. For that review, only three field studies on caries prevalence of children, adolescents, or adults with disability published between 2000 and 2012 were identified. The aim of the present overview is to present the results of new studies and the evolving consequences. In this regard, all studies and abstracts that had been published or accepted for publication between 1 January 2000 and 31 January 2021 were included.In this time interval, six regional studies and one supra-regional study were conducted in Germany in children and adolescents with disability. In addition, three regional studies and one supra-regional study were conducted in adults with disability. The studies had taken place in four of the 16 German federal states. Caries experience of the study participants was determined with the aid of a specific index. On average, children with disability and aged between 6 and 10 years had a higher caries experience than children without disability. In adolescents this difference is only true for those with intellectual disability. In adults with intellectual disability the higher caries experience yielded in a higher mean number of missing teeth compared to the general population.In conclusion, preventive and dental care for persons with disability still has to be intensified. This goal may be achieved by adding dental care for persons with disability to the national dental curriculum and by integrating this discipline in the education of dental students in all universities where dentistry is taught.

Restoration of an Upper Anterior Tooth in an Adolescent with Autism Spectrum Disorder-A Student Case Report.

BACKGROUND: Patients with autism spectrum disorder (ASD) or other mental or physical limitations experience an imbalance in the frequency of dental treatment as compared with the general patient population, in part, due to inadequate pre-graduate training of future dentists. CASE PRESENTATION: This case report describes a successful anterior tooth restoration, in awake state, in a 15-year-old boy with early childhood autism. The procedure was carried out independently by students of dentistry within the scope of their integrated clinical training semesters. Desensitization sessions were used as a preparatory measure and elements of behavioral facilitation (tell-show-feel-feel-do) were applied during the treatment. CONCLUSIONS: To avoid discrimination of this group of patients in the provision and quality of dental care, a structured approach to the transfer of theoretical and practical knowledge in the field of special care dentistry is indispensable. To this end, treatment strategies for special care patients should be taught to pre-graduate dental students as a fundamental part of their university curriculum.

Implant-supported prosthetic rehabilitation of a senescent patient with Down syndrome.

OBJECTIVE: Some patients with Down syndrome experience premature edentulism, which can lead to severe alveolar atrophy. This may cause retention problems with purely mucosa-supported dentures and ill-fitting total dentures. The intellectual disability associated with Down syndrome, with an (implied) inadequate ability for compliance, may pose a further challenge to dental treatment. The aim of this case report was to demonstrate that a combined implant-prosthetic denture with bar constructions can, nevertheless, be implemented in elderly Down syndrome patients with limited cooperation ability. METHOD AND MATERIALS: This report is the first to describe the procedure for an implant-supported total prosthetic restoration with bar joint in a 52-year-old edentulous patient with Down syndrome and limited ability to cooperate. Previous dental solutions had severely curtailed the patient's quality of life. By combining various forms of treatment, including behavior management, the course of therapy could be adapted to the patient's cooperation capability. RESULTS: The implant-supported total prosthetic restoration with bar joint was well accepted by the patient. Moreover, the patient's relatives reported that his life quality had improved distinctly (eg, considerable weight-gain, more positive mood). No impairments of the prostheses were observed during the 24-month follow-up period, and both implants remained clinically inconspicuous. CONCLUSION: The lack, or inadequacy, of dental prostheses can impair the life quality of individuals in need of such restorations. Implant-supported dentures in combination with a bar construction improve the retention of prostheses in atrophied jaws. This form of restoration is also proving to be a successful therapy option for elderly persons with Down syndrome.

Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR.

A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough "round table" discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.

The Joint ORCA-EADPH Symposium on Sugar: The Oral Health Perspective - A Commentary.

Caries is the most prevalent chronic condition worldwide and the association between high-level intake of sugars and dental decay is strong and well established. Interestingly, to combat caries, dental practitioners and public health dentists in many countries have focused mainly on the application of different kinds of fluorides and fissure sealants but not on the reduction of sugar intake. Furthermore, for many years, sugars have not been the focus of dental research activities presented at the annual conferences of the European Organisation for Caries Research (ORCA) and the European Association of Dental Public Health (EADPH). In 2015, following the publication of the new WHO guidelines on the intake of sugars, the boards of ORCA and EADPH agreed to organize a common symposium entitled "Joint ORCA-ADPH Symposium on Sugar: The Oral Health Perspective". This symposium was organized by a scientific committee and took place on July 6, 2016, in association with the 63rd ORCA Congress in Athens, Greece. It included 9 lectures highlighting different aspects of sugar consumption, contribution of sugar to dental caries, measuring sugar consumption, and fighting against sugar on a patient and public health basis. The purpose of this commentary is to give background information about the rationale of the above-mentioned symposium.

European Organization for Caries Research Workshop: Methodology for Determination of Potentially Available Fluoride in Toothpastes.

Toothpastes are the most universally accepted form of fluoride delivery for caries prevention. To provide anti-caries benefits, they must be able to release fluoride during the time of tooth brushing or post brushing into the oral cavity. However, there is no standard accepted procedure to measure how much fluoride in a toothpaste may be (bio) available for release. The European Organization for Caries Research proposed and supported a workshop with experts in fluoride analysis in toothpastes and representatives from industry. The objective of the workshop was to discuss issues surrounding fluoride analysis in toothpaste and reach consensus on terminology and best practices, wherever the available evidence allowed it. Participants received a background paper and heard presentations followed by structured discussion to define the problem. The group also reviewed evidence on the validity, reliability and feasibility of each technique (namely chromatography and fluoride electroanalysis) and discussed their strengths and limitations. Participants were able to reach a consensus on terminology and were also able to identify and summarize the advantages and disadvantages of each technique. However, they agreed that most currently available methods were developed for regulatory agencies several decades ago, utilizing the best available data from clinical trials then, but require to be updated. They also agreed that although significant advances to our understanding of the mechanism of action of fluoride in toothpaste have been achieved over the past 4 decades, this clearly is an extraordinarily complex subject and more work remains to be done.