Ecotoxicological evaluation of surface waters in Northern Namibia.

The increasing pressure on freshwater systems due to intensive anthropogenic use is a big challenge in central-northern Namibia and its catchment areas, the Kunene and the Kavango Rivers, and the Cuvelai-Etosha Basin, that provide water for more than 1 million people. So far, there is no comprehensive knowledge about the ecological status and only few knowledge about the water quality. Therefore, it is crucial to learn about the state of the ecosystem and the ecological effects of pollutants to ensure the safe use of these resources. The surface waters of the three systems were sampled, and three bioassays were applied on three trophic levels: algae, daphnia, and zebrafish embryos. Additionally, in vitro assays were performed to analyze mutagenicity (Ames fluctuation), dioxin-like potential (micro-EROD), and estrogenicity (YES) by mechanism-specific effects. The results show that acute toxicity to fish embryos and daphnia has mainly been detected at all sites in the three catchment areas. The systems differ significantly from each other, with the sites in the Iishana system showing the highest acute toxicity. At the cellular level, only weak effects were identified, although these were stronger in the Iishana system than in the two perennial systems. Algae growth was not inhibited, and no cytotoxic effects could be detected in any of the samples. Mutagenic effects and an estrogenic potential were detected at three sites in the Iishana system. These findings are critical in water resource management as the effects can adversely impact the health of aquatic ecosystems and the organisms within them.

Caries prevalence in 6- to 10-year-old German schoolchildren with and without disability.

BACKGROUND: Both nationally and internationally, there is a lack of data on the caries experience of schoolchildren with disability, especially for children aged 6 to 10 years. AIM: To compare the caries experience of 6- to 10-year-old schoolchildren with disability attending special needs schools (SpS) with children without disability attending primary schools (PS) in two study periods five years apart. MATERIALS AND METHODS: The caries prevalence and severity in schoolchildren aged 6 to 10 years attending PS or SpS was determined according to WHO standards for the school years 2010/2011 and 2015/2016, and the results were compared. RESULTS: Data for 6805 schoolchildren were available. In both examination periods the caries prevalence in the deciduous teeth of 6- to 10-year-old children attending SpS was significantly higher than in children attending PS. The mean dmft values for children attending SpS were also significantly higher (2.11 in both years) than for those attending PS (1.48 and 1.77, respectively). CONCLUSIONS: The dental health of schoolchildren with disability was worse than that of schoolchildren without disability. To improve this situation, caries prevention efforts in day care centers and schools should be intensified for children with disability.

Parallel substrate supply and pH stabilization for optimal screening of E. coli with the membrane-based fed-batch shake flask.

BACKGROUND: Screening in the fed-batch operation mode is essential for biological cultivations facing challenges as oxygen limitation, osmotic inhibition, catabolite repression, substrate inhibition or overflow metabolism. As a screening tool on shake flask level, the membrane-based fed-batch shake flask was developed. While a controlled supply of a substrate was realized with the in-built membrane tip, the possibilities for replenishing nutrients and stabilizing pH values was not yet exploited. High buffer concentrations were initially used, shifting the medium osmolality out of the biological optimum. As the growth rate is predefined by the glucose release kinetics from the reservoir, the resulting medium acidification can be compensated with a controlled continuous supply of an alkaline compound. The focus of this research is to establish a simultaneous multi-component release of glucose and an alkaline compound from the reservoir to enable cultivations within the optimal physiological range of Escherichia coli. RESULTS: In combination with the Respiratory Activity MOnitoring System, the membrane-based fed-batch shake flask enabled the detection of an ammonium limitation. The multi-component release of ammonium carbonate along with glucose from the reservoir resulted not only in the replenishment of the nitrogen source but also in the stabilization of the pH value in the culture medium. A biomass concentration up to 25 g/L was achieved, which is one of the highest values obtained so far to the best of the author's knowledge with the utilization of a shake flask and a defined synthetic medium. Going a step further, the pH stabilization allowed the decrease of the required buffer amount to one-fourth establishing an optimal osmolality range for cultivation. As optimal physiological conditions were implemented with the multi-component release fed-batch cultivation, the supply of 0.2 g glucose in a 10 mL initial culture medium volume with 50 mM MOPS buffer resulted in a twofold higher biomass concentration than in a comparable batch cultivation. CONCLUSIONS: The newly introduced multi-component release with the membrane-based fed-batch shake flask serves a threefold purpose of replenishing depleted substrates in the culture medium, stabilizing the pH throughout the entire cultivation time and minimizing the necessary amount of buffer to maintain an optimal osmolality range. In comparison to a batch cultivation, these settings enable to achieve higher biomass and product concentrations.

Characterizing Adversity of Lysosomal Accumulation in Nonclinical Toxicity Studies: Results from the 5th ESTP International Expert Workshop.

Lysosomes have a central role in cellular catabolism, trafficking, and processing of foreign particles. Accumulation of endogenous and exogenous materials in lysosomes represents a common finding in nonclinical toxicity studies. Histologically, these accumulations often lack distinctive features indicative of lysosomal or cellular dysfunction, making it difficult to consistently interpret and assign adverse dose levels. To help address this issue, the European Society of Toxicologic Pathology organized a workshop where representative types of lysosomal accumulation induced by pharmaceuticals and environmental chemicals were presented and discussed. The expert working group agreed that the diversity of lysosomal accumulations requires a case-by-case weight-of-evidence approach and outlined several factors to consider in the adversity assessment, including location and type of cell affected, lysosomal contents, severity of the accumulation, and related pathological effects as evidence of cellular or organ dysfunction. Lysosomal accumulations associated with cytotoxicity, inflammation, or fibrosis were generally considered to be adverse, while those found in isolation (without morphologic or functional consequences) were not. Workshop examples highlighted the importance of thoroughly characterizing the biological context of lysosomal effects, including mechanistic data and functional in vitro readouts if available. The information provided here should facilitate greater consistency and transparency in the interpretation of lysosomal effects.

Psychosocial impact, perceived stress and learning effect in undergraduate dental students during transition from pre-clinical to clinical education.

INTRODUCTION: This study aimed to develop a suitable instrument for a comprehensive quantitative and qualitative assessment of perceived psychosocial impact, levels of stress and learning effect in undergraduate dental students during the transition from pre-clinical to clinical education. These findings might improve curricular structures and didactic organisation during this period. MATERIALS AND METHODS: At the beginning of their first clinical year, undergraduate dental students were asked to complete an anonymous forty-item questionnaire. Two hundred and seventy-six undergraduate dental students were willing to participate and completed the questionnaire and participated during the years 2011-2016. RESULTS: The response rate was between 45% and 96%. Correlational analysis (Spearman-Rho) in the field of psychosocial impact showed the dental teacher to be the most important multiplier of students' feelings. If the students feel that their teacher acts cooperatively, positive items increase and negative items decrease significantly (P < .0001). Also, students who report high levels of stress are affected significantly in their psychosocial interaction (P < .0001). Wilcoxon test yielded highest levels of stress in endodontology during the first weeks (P < .0001). During the same period, the greatest learning increment was seen for diagnostics and caries excavation. CONCLUSION: In conclusion, teaching of undergraduate dental students during the transition period from pre-clinical to clinical education can be positively influenced by a supportive learning environment and by specific chronological modifications in the curriculum. Students should start their clinical training with diagnostics, preventive dentistry and initial periodontal treatment. Due to high levels of perceived stress, endodontology should be introduced later in the clinical curriculum.

hYKL-40 cancer biomarker electroanalysis in serum samples and model cell lysates: capacitive immunosensing compared with enzyme label immunosorbent assays (ELISA).

Human chitinase 3-like protein 1 (CHI3L1 or hYKL-40), a potential molecular marker for several cancers, was measured in clinical human serum samples and model cell lysates by indirect and competitive enzyme-linked immunosorbent assay (ELISA) and by capacitive immunosensing, so as to evaluate a recently introduced electrochemical method for routine use in cancer-monitoring studies. The clinical samples tested included serum from four healthy individuals, five breast cancer and four glioblastoma patients; cultures of the human monocytic cell line THP-1, known to secrete hYKL-40, and of the human embryonic kidney 293t cell line, which does not express hYKL-40, provided cell lysates and cell culture media for positive and negative bio- and electrochemical control trials. A good agreement was observed between the results of the three tested methods during hYKL-40 quantifications in human serum and cell lysates. Measurements of 'spiked' samples from healthy volunteers, cancer patients and hYKL-40-free 293t cell lysates revealed that capacitive immunosensing and the two types of ELISA all recovered the analyte with an efficiency close to 100%. On this basis, capacitive hYKL-40 immunosensor screening is a promising stand-alone or complementary analytical tool for the analysis of hYKL-40 in serum, and would be useful for the validation of standard ELISA data and also, because of the significantly lower hYKL-40 detection limit of the electroanalytical procedure, would permit assay of the marker and cancer observation at earlier stages than is currently possible using ELISA.

[Attitude towards organ and tissue donation in Europe : Prerequisite for osteochondral allograft treatment]. / Bereitschaft zur Organ- und Gewebespende in Europa : Voraussetzung für die Behandlung mit osteochrondralen Allografts.

BACKGROUND: The biggest obstacle to overcome for routine treatment of various pathologies with fresh osteochondral allograft is the availability of tissue for transplantation. Large fresh osteochondral allografts are usually harvested from organ donors, but in contrast to organs, tissues can be procured after cardiac arrest. OBJECTIVE: Medical staff as well the general public are much less aware of the possibilities and requirements of tissue donation compared to organ donation. This review aims to highlight the current situation of organ and tissue donation in Europe and to raise this much needed awareness. MATERIAL AND METHODS: For this research, PubMed database was scanned using the terms "tissue/organ donation", "bone donation/transplantation", "cartilage transplantation/allografts" and "osteochrondral allografts". RESULTS: Relatives of potential donors are often not approached because physicians and nurses do not feel sufficiently prepared for this task and, thus, are reluctant to address this topic. Different options could alleviate the pressure medical staff is feeling. Furthermore, there are different factors influencing consent that can be addressed to increase donation rates. CONCLUSION: Currently, a lot of potential concerning musculoskeletal tissue grafts remains unused. Most importantly, families should be encouraged to speak about their potenzial will to donate and educational programs should be established to increase trust in organ and tissue donation and the allocation system and to increase knowledge about the importance of transplantation medicine. But joined efforts of different parts of the medical systems and different organizations involved in tissue transplantation should improve the situation for patients waiting for much needed transplants.

Variation in methods used to determine national mean DMFT scores for 12-year-old children in European countries.

AIM: The aim of this study was to investigate the methods used to identify national mean DMFT scores for 12-year-old children in all the Member States of the European Union and European Economic Area, and in 11 other European countries. METHODS: The most recent national mean DMFT scores were accessed from the World Health Organisation Oral Health CAPP and the Council of European Chief Dental Officers databanks. A literature search was then performed to access the reports of the studies that had produced these DMFT scores, cited on these databanks. The reports were then analysed to determine: the year in which the survey/study that produced the score took place, the year the results were published, the geographical area (national, regional or local) covered, the number of children examined, how many examiners took part, how they were trained and calibrated, and the criteria used for the detection of caries. RESULTS: Data and information from 43 European countries were accessed. The years when the studies were performed ranged from 1990 to 2014. There were doubts over the representativeness of some samples. A wide range of different methods were used. Examiner training and calibration were very variable both in terms of duration and reported inter and intra-examiner consistency. There were important variations in the criteria employed for the detection of caries. CONCLUSIONS: These findings support the view that most of current national caries data for DMFT levels in 12-year-old children are not comparable across Europe.

Managing Carious Lesions: Consensus Recommendations on Terminology.

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided.Dental cariesis the name of the disease, and thecarious lesionis the consequence and manifestation of the disease-the signs or symptoms of the disease. The termdental caries managementshould be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereascarious lesion managementcontrols the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions' clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1)selective removal of carious tissue-includingselective removal to soft dentineandselective removal to firm dentine; 2)stepwise removal-including stage 1,selective removal to soft dentine, and stage 2,selective removal to firm dentine6 to 12 mo later; and 3)nonselective removal to hard dentine-formerly known ascomplete caries removal(technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community.

Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal.

The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according toselective removal to firm dentine.In deep cavitated lesions in primary or permanent teeth,selective removal to soft dentineshould be performed, although in permanent teeth,stepwise removalis an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term.

[Requirements for drug approval and additional benefits assessment: Regulatory aspects and experiences]. / Anforderungen an Zulassung und Zusatznutzenbewertung von Arzneimitteln : Regulatorische Aspekte und Erfahrungen.

The early assessment of benefits of newly approved drugs with novel active substances or new applications, which came into force on 1 January 2011 still represents a challenge to all parties involved. This article highlights the definitions, regulatory requirements and interaction between drug marketing approval and early assessment of benefits in Germany. The constellation of an extensively harmonized European and even international drug authorization process with a predominantly national regulation of drug reimbursement situation inevitably causes friction, which could be markedly reduced through early joint advisory discussions during the planning phase for pivotal clinical trials. During the year 2015 the Federal Institute for Drugs and Medical Devices (BfArM) carried out 300 scientific advice procedures of which 34 were concerned with applications in the field of indications for the central nervous system (CNS). In comparison 98 advisory meetings were held by the Federal Joint Committee (G-BA) of which the BfArM provided advice in 12 instances and in 2 cases on CNS indications. Study design, endpoints and appropriate comparative therapies are the key issues in exchanges and discussions between the BfArM, the G­BA and applicants. Under these aspects the BfArM and G­BA promote an early and consistent involvement in early advice procedures regarding the prerequisites for drug approval and assessment of additional benefits.

Factors contributing to severe early childhood caries in south-west Germany.

OBJECTIVES: The purpose of this study is to investigate the contribution of selected variables to the occurrence of severe early childhood caries (S-ECC) in 3- to 5-year-old kindergarten children. METHODS: A cross-sectional study was conducted in 2010 in 30 randomly selected kindergartens in the German Rhein-Neckar district. After informed consent, parents were asked to complete a questionnaire. The oral examinations took place in the selected kindergartens and the WHO methods as well as the criteria proposed by the American Academy of Pediatric Dentistry were followed. Logistic regression was applied to explore the main factors contributing to S-ECC in a multivariate model. RESULTS: In all, 1,007 children aged 3 to 5 years with an average age of 4.1 (SD = 0.8) years were examined. Five variables were associated significantly with the occurrence of S-ECC: breastfeeding for more than 12 months (OR = 3.27), use of the nursing bottle in bed (OR = 3.08), start of tooth brushing after the first anniversary (OR = 2.42), regular visits at the dentists (OR = 0.14) and mother with immigration background (OR = 4.05). Prevalence rate of S-ECC was 9.5 %. The mean d(3+4)mft values were 5.69 (S-ECC group) and 0.23 (non-S-ECC group). CONCLUSION: These results show that occurrence of S-ECC is a complex interaction between socioeconomic, psychological and behavioural factors of parents. New and specific ways to provide preventive dental care for toddlers and infants of caries risk groups have to be developed. CLINICAL RELEVANCE: Parents of newborn children have to receive information about timely start of tooth brushing and adequate use of nursing bottles.

Effects of echinocandin preparations on adult rat ventricular cardiomyocytes. Preliminary results of an in vitro study.

BACKGROUND: Candida infections represent a relevant risk for patients in intensive care units resulting in increased mortality. Echinocandins have become the agents of choice for early and specific antifungal treatment in critically ill patients. Due to cardiac effects following echinocandin administration seen in intensive care unit (ICU) patients the in vitro effects of echinocandins and fluconazole on isolated cardiomyocytes of the rat were examined. AIM: The study was designed to investigate a possible impact of echinocandins and fluconazole in clinically relevant concentrations on the in vitro contractile responsiveness and shape of isolated rat cardiomyocytes. MATERIAL AND METHODS: Ventricular cardiomyocytes were isolated from Lewis rats. Cardiomyocytes were cultured in the presence of all licensed echinocandin preparations and fluconazole at concentrations of 0 (control), 0.1, 1, 3.3, 10, 33 and 100 µg/ml for 90 min. Cells were stimulated by biphasic electrical stimuli and contractile responsiveness was measured as shortening amplitude. Additionally, the ratio of rod-shaped to round cells was determined. RESULTS: Anidulafungin concentrations of 3.3 and 10 µg/ml caused a significant increase in contractile responsiveness, caspofungin showed a significant decrease at 10 µg/ml and micafungin concentrations of 3.3-33 µg/ml led to a significant increase in cell shortening. Measurement was not possible at 33 µg/ml for anidulafungin and caspofungin and at 100 µg/ml for all echinocandins due to a majority of round-shaped, non-contracting cardiomyocytes. Fluconazole showed no significant effect on cell shortening at all concentrations tested. For the three echinocandins the ratio of round-shaped, non-contracting versus rod-shaped normal contracting cardiomyocytes increased in a dose-dependent manner. CONCLUSIONS: Echinocandins impact the in vitro contractility of isolated cardiomyocytes of rats. This observation could be of great interest in the context of antifungal treatment.

Caries experience and treatment need in adults with intellectual disabilities in two German regions.

OBJECTIVE: The aim of the study was to determine the caries experience, caries prevalence, dental treatment need and care index of adults with intellectual disabilities living in the German federal states of Baden-Württemberg and Sachsen which differ distinctly with respect to the socio-economic conditions. RESEARCH DESIGN: In 2007, legal custodians of all persons working in special day-care institutions (n=2037) were asked to give consent for dental examinations of their custodees. Some 21.9% consented. Thus, 428 persons received a dental examination in the day-care institutions. RESULTS: The mean age of the participants was 35.5 years (range 18-64). Caries prevalence was 93.7% (95% CI 91.3-95.9) in Baden-Württemberg and 97.6% (95% CI 96.2-99.0) in Sachsen. All caries-free persons (n=19) were younger than 35 years. The mean DMFT of the whole sample was 12.3 (95% CI 11.6-12.9). Although DMFT values were the same in both German regions, persons from Baden-Württemberg had more missing teeth than those from Sachsen but untreated carious defects were more common in Sachsen. CONCLUSIONS: Dental care for those with intellectual disabilities could be better harmonised within Germany. Furthermore, specific dental care and dental treatment strategies could be introduced in Germany in order to reduce caries prevalence and number of extracted teeth in persons with intellectual disabilities.

Caries prevalence in 12-year-old children from Germany: results of the 2009 national survey.

OBJECTIVE: In 2009, complementary epidemiological studies were conducted in 16 German states. DESIGN: A 2009 cross-sectional oral health survey of children aged 12 years with 5% samples selected using a two-stage random sampling procedure. SUBJECTS: A random selection of 30,943 12-year-olds were examined in schools. METHOD: DMFT and fissure sealants were recorded following WHO criteria. Caries was diagnosed at the caries into dentine threshold (D3) using the visual method without radiography or fibre-optic transillumination. Statistical evaluation was performed using the software SPSS (v12.0). RESULTS: The proportion of children across Germany with caries experience was 31%. The mean DMFT score was 0.72 and the average Significant Caries Index (SiC) was 2.29. The results showed a wide variation among the different federal states, with mean regional DMFT values ranging from 0.56 to 1.06. Compared to the results obtained in 2004, caries prevalence and caries experience decreased distinctly in this age group. The mean DMFT score for 12-year-olds dropped from 2.44 to 0.72 between 1994 and 2009. The mean DMFT scores were 72.7% lower at the end of the observation period than a few years after the introduction of extensive caries prevention measures in Germany. The mean number of fissure sealed teeth ranged between 2.24 and 3.04. CONCLUSION: The decrease in caries prevalence observed between 1994 and 2004 continued between 2004 and 2009, although once again inequalities in oral health between federal states were observed.

Liver hypertrophy: a review of adaptive (adverse and non-adverse) changes--conclusions from the 3rd International ESTP Expert Workshop.

Preclinical toxicity studies have demonstrated that exposure of laboratory animals to liver enzyme inducers during preclinical safety assessment results in a signature of toxicological changes characterized by an increase in liver weight, hepatocellular hypertrophy, cell proliferation, and, frequently in long-term (life-time) studies, hepatocarcinogenesis. Recent advances over the last decade have revealed that for many xenobiotics, these changes may be induced through a common mechanism of action involving activation of the nuclear hormone receptors CAR, PXR, or PPARα. The generation of genetically engineered mice that express altered versions of these nuclear hormone receptors, together with other avenues of investigation, have now demonstrated that sensitivity to many of these effects is rodent-specific. These data are consistent with the available epidemiological and empirical human evidence and lend support to the scientific opinion that these changes have little relevance to man. The ESTP therefore convened an international panel of experts to debate the evidence in order to more clearly define for toxicologic pathologists what is considered adverse in the context of hepatocellular hypertrophy. The results of this workshop concluded that hepatomegaly as a consequence of hepatocellular hypertrophy without histologic or clinical pathology alterations indicative of liver toxicity was considered an adaptive and a non-adverse reaction. This conclusion should normally be reached by an integrative weight of evidence approach.

Caries prevalence in 12-year-old Cypriot children.

OBJECTIVE: To determine caries prevalence and caries experience in 12-year-old children living in the Republic of Cyprus and to evaluate whether different variables were associated with caries experience. METHODS: According to the WHO recommendation, schools were randomly selected by taking into account the distribution between rural and urban regions, so that 10% of Cypriot children attending the sixth grade could be examined. In the school year 2003/2004 the children were examined in schools by one person with the aid of artificial light but without taking radiographs or fibre-optic transillumination. DMFT, presence of fissure sealants and black stain were recorded. RESULTS: In total 951 children were examined. Caries prevalence was 32.6% (95% CI 29.62-35.6). The mean DMFT was 0.65 (sd 1.17) and the SiC was 1.95. Fissure sealants were found in 14.3% of the children. No association between frequency of tooth brushing, presence of fissure sealants or presence of black stain and caries experience was observed. Children living in rural areas had significantly higher mean DMFT values than children living in urban areas. CONCLUSION: A further caries decline may be attained by promoting a more extensive use of preventive measures like application of fluoride varnish or fissure sealants.

European core curriculum in cariology for undergraduate dental students.

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North-South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.

[Oral health in adult athletes with intellectual disabilities in Germany]. / Mundgesundheit erwachsener Athleten mit geistiger Behinderung.

In 2008 the summer games of Special Olympics Germany took place in Karlsruhe, Germany. The athletes were offered on site the opportunity to have a voluntary and free dental examination. The examinations were performed by dental clinicians in rooms which were equipped with dental chairs. Data were collected following the criteria of WHO. 420 adult athletes took part in the dental examination. Their age ranged between 18 and 70 years and their mean age was 30.8 years. Nearly two thirds of the participants were males. The caries prevalence of the athletes was 90.8% (95% confidence interval 86.9-92.8%). The mean DMFT value was 9.4. Athletes who were living with their families had a significantly lower mean DMFT value than those living in an institution. In 22.1% of the examined athletes at least one fissure sealed tooth was observed. 58.8% presented with gingivitis and 21% had received prosthodontic care. 95% of the athletes brushed their teeth alone. Only 28% used an electric toothbrush. Less than 7% used regularly a gel with high fluoride concentration. This study shows that persons with intellectual disability still have a poorer oral health than the general population. In order to improve dental health and quality of life in persons with intellectual disability, efficient preventive programmes should be developed and applied in cooperation with parents, relatives and caregivers.

Decision-making and preventive non-surgical therapy in the context of a European Core Curriculum in Cariology.

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and non-surgical treatment. In particular, it will provide some background information on this part of the European core curriculum. The dentist, on graduation, must be competent at applying the principles of prevention of dental hard tissue disease processes (primary prevention) and progression when it has manifested itself (secondary prevention). The competences should apply in differing ways to patients of all ages. Goals of prevention should be clearly defined in order for outcomes to be evaluated, and a dentist should be competent at determining these outcomes. Although this concept is recognised by many academics and experts, clinical teaching, practice and health insurance coverage frequently emphasise surgical treatment. There are many reasons and obstacles that might account for this, and this paper suggests some reasons why this might be and makes suggestions for how these can be addressed in the future. One factor that is essential in the provision of a preventive, non-surgical approach is that of communication with the patient. However, this unfortunately takes less space in the dental curricula compared with technical skills aimed at restorative procedures; this weighting needs to be more equally balanced.