National oral health survey on refugees in Germany 2016/2017: caries and subsequent complications.

OBJECTIVES: To assess oral health, caries prevalence, and subsequent complications among recently arrived refugees in Germany and to compare these findings with the German resident population. METHODS: This multicenter cross-sectional study recruited 544 refugees aged 3-75+ years; they were examined at ten registration institutions in four federal states in Germany by two calibrated dentists. The refugees were screened for caries (dmft/DMFT) and its complications (pufa/PUFA); this data was compared to the resident population via the representative national oral health surveys). RESULTS: The deciduous dentition of the 3-year-old refugees had a mean dmft value of 2.62 ± 3.6 compared with 0.48 dmft in the German resident population, and caries increased to 5.22 ± 3.4 for 6-7-year-olds (Germany: 1.73 dmft). Few refugee children had naturally healthy teeth (7% in 6-7-year-olds, Germany: 56%). In the permanent dentition, the gap in caries prevalence between refugees and the German population decreased with age (35-44-year-olds: 10.55 ± 7.1 DMFT; Germany: 11.2), but refugees exhibited more caries defects (35-44-year-olds DT = 3.13 ± 3.0; Germany: 0.5). German residents had more restorations (35-44-year-olds FT = 4.21 ± 4.6). Regarding complications, the 6-7-year-olds exhibited the highest pufa index (0.86 ± 1.4) which decreased in adolescence (13-17-year-olds, 0.18 ± 0.6) and increased in adults (45-64-year-olds, 0.45 ± 0.8). CONCLUSION: The refugees had high caries experience, often untreated caries teeth and more complications compared with the German resident population, especially in children. Closing this gap by extending preventive systems to the refugees would decrease future treatment needs. CLINICAL RELEVANCE: European countries should be prepared for the higher dental treatment needs in recent refugees, especially in children.

How to intervene in the caries process: proximal caries in adolescents and adults-a systematic review and meta-analysis.

OBJECTIVES: For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". MATERIAL AND METHODS: Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded. RESULTS: Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam. CONCLUSIONS: Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity. CLINICAL RELEVANCE: Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.

Treatment of Carious Lesions Using Self-Assembling Peptides.

Modern approaches in caries treatment involve lesion management without tissue removal. Regenerative medicine focuses on replacing damaged tissues with biologically similar tissues. This article discusses the scientific evidence and clinical results for self-assembling peptides in modern caries management. The biomimetic remineralization promoted by self-assembling peptide P11-4 has been proven in vitro as an effective therapy for initial caries. P11-4 was rationally designed to promote formation of hydroxyapatite on its surface. The formulation was optimized to ensure the ability of monomeric P11-4 to penetrate past the subsurface lesions and assembly into a biomatrix within. Furthermore, P11-4 has shown that it assembles into fibers within carious lesions, and promotes the remineralization thereof. In a recent clinical study, the safety and efficacy of P11-4 in treatment of initial caries were evaluated. The additional effect of the application of P11-4 (Curodont Repair) was compared to the application of fluoride varnish (Duraphat) alone in active occlusal initial caries lesions on erupting permanent molars. In the 3- and 6-month recalls, the test group showed, both in the laser fluorescence readings and in the clinical assessment of the caries stage and activity, significantly superior lesion regression compared to the control group. No adverse events, medical complications, or allergic reactions related to the treatments were reported. Clinical applicability of treatment was regarded as satisfactory. Patients were happy to receive noninvasive caries treatments. In conclusion, biomimetic mineralization facilitated by P11-4 in combination with fluoride may present a simple, safe, and effective noninvasive treatment for early carious lesions.

The impact of bias of underlying literature in guidelines on its recommendations: assessment of the German fluoride guideline.

PURPOSE: The significance of the underlying literature in clinical guidelines can be weakened by the risk of bias, which could negatively affect the recommendations. Especially in controversial matters, such as fluoride use for caries prevention in children, biased results may be not reliable and lead to incorrect conclusions. This study was performed to detect bias in underlying literature of the German guideline for caries prevention using fluoride in children, where no consensus was reached between paediatricians and paediatric dentists. METHODS: Three tools used for risk of bias assessments of different study designs were RoB 2 for RCTs, ROBINS-I for non-randomized studies, and ROBIS for systematic reviews. For each study cited in the guideline two independent risk of bias assessments were performed. Disagreements were resolved by consensus. RESULTS: Out of 58 papers, 48.3% (n = 28) showed high risk of bias, with the majority in sections regarding fluoride tablets, fluoridated toothpaste, and paediatricians' recommendations. 9 out of 20 recommendations and statements were based on studies with high risk of bias, all of which were in these three controversial sections. 13 out of 29 RCTs showed high risk of bias (44.8%), as all 13 non-randomized trials did, while only 2 of 16 (12.5%) systematic reviews had high risk of bias. CONCLUSION: Considering risk of bias of cited studies in clinical guidelines may result in substantial changes in its recommendations and aid in reaching consensus. Efforts should be made to assess risk of bias of underlying literature in future clinical guidelines.

Impact of operators' experience and patients' age on the success of nitrous oxide sedation for dental treatment in children.

AIM: To evaluate the success rates and potential influencing factors of nitrous oxide sedation for dental treatment in a specialised paediatric dental service. MATERIALS: Medical records of all children treated under nitrous oxide sedation in a specialised pedodontics clinic between 2012 and 2017 were analysed retrospectively for parameters such as age of the patient, experience and change of operating dentists, treatment procedure and success or failure regarding the sedation and treatment. CONCLUSION: Given the high overall success rate of over 90%, nitrous oxide sedation can be a highly effective treatment option for performing dental treatment in pre-cooperative and/or anxious children and adolescents. With age of the children and experience of the dentist, success rates increased.

Parental acceptance of advanced behaviour management techniques in paediatric dentistry in families with different cultural background.

PURPOSE: To investigate the differences of parental acceptance of advanced behaviour management techniques (BMT) in different cultural backgrounds (Germany vs. Jordan). METHODS: A convenience sample of 100 parents each of paediatric patients at the University of Greifswald/Germany and Jordan University/Jordan completed a questionnaire to rate their acceptance of four advanced BMT (passive restraint, active restraint, nitrous oxide sedation, and general anaesthesia) using a five-point Likert scale. RESULTS: In both groups, nitrous oxide sedation was the most accepted advanced BMT (mean 3.78 ± 1.34/3.22 ± 1.50, respectively). The least acceptable technique in Germany was passive restraint (2.05 ± 1.18) and in Jordan general anaesthesia (2.11 ± 1.30). The parents in Germany are significantly more accepting of nitrous oxide sedation than are parents in Jordan (p = 0.010), while parents in Jordan are more willing to accept passive restraint (p = 0.001). The acceptance of all advanced BMT increased significantly in both groups when the treatment was urgent. CONCLUSIONS: Parental cultural background and the urgency of the treatment affect the acceptance of different BMT. Moreover, the parental attitude to the pharmacological technique has changed, as nitrous oxide sedation generally appears to be the most preferred advanced technique in both groups.

Ten-year trends in DMF-S and DMF-T in a northeast German adult population.

OBJECTIVE: The aim of this study was to assess 10-year trends in coronal caries in adults aged 20-83 years using data from the two-representative population-based Studies of Health in Pomerania (SHIP-0/SHIP-Trend-0). METHODS: Repeated cross-sectional data from 4,286 SHIP-0 and 3,913 SHIP-Trend-0 participants were analysed. Carious, filled and missing teeth/surfaces were recorded in a half-mouth design and the DMF-T/S scores and sound surfaces/teeth were calculated according to WHO criteria. Trends in DMF-T/S scores and its single components were presented stratified by age group and sex. RESULTS: A statistically significant decline in coronal caries experience (DMF-T and DMF-S) in adults aged 20 to 83 years as well as for D-T/S components was observed. The proportion of edentulous participants was almost halved from 8.7% (SHIP-0) to 5.1% (SHIP-Trend-0), while the number of M-T declined from 4.4 to 3.5 revealing an overall clear shift to a higher retention rate of teeth. In younger adults (25-34 years) 3.8 more sound teeth (17.2 sound surfaces) were found in average in the mouth and in elderly (65-74 years) a clear shift from extracted to filled teeth was observed (M-T reduced by 5.4, while F-T increased by 4). Regarding sex differences, females had consistently on average higher MF-T/S values, but lower D-T/S values than males. CONCLUSION: A clinically relevant drop in the severity of coronal caries experience in all adult age groups in Northeast Germany shows that not only reductions in caries experience in adolescence translated into adulthood but also later improvements led to long-term oral health.

Parental acceptance of advanced behaviour management techniques in normal treatment and in emergency situations used in paediatric dentistry.

BACKGROUND: Behaviour management techniques (BMT) in children are essential to achieve a successful dental treatment, but parents are not equally accepting BMT. AIM: To investigate the parental acceptance of advanced behaviour management techniques used in paediatric dentistry in normal and in emergency situations in Germany. METHODS: Parents bringing their children for dental care answered a questionnaire on the acceptance of four advanced BMT: passive restraint, active restraint, nitrous oxide sedation and general analgesia. The study was conducted in five university dental clinics in Germany. Parents rated overall acceptance of each technique using a five points Likert scale. RESULTS: 136 parents answered the questionnaire. The acceptance of all advanced BMT was significantly higher when the treatment was urgent (p < 0.001, paired sample t test). Nitrous oxide sedation was rated as the most acceptable technique in normal treatment (52.6%) and in emergency situation (68.2%), while passive restraint was the least acceptable technique in both normal (19.9%) and emergency situation (37.8%). CONCLUSIONS: Parents in Germany are more willing to accept advanced BMT in emergency situations, with nitrous oxide being generally the most preferred technique.