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.

Dental characteristics and according treatments of children under GA in Germany.

PURPOSE: Due to rising numbers of dental referral to general anesthesia, more specialized dental treatments under GA were needed in the last decades in Germany. However, there are few studies about it. Therefore, the present study aimed to assess dental treatment and characteristics of the children underwent GA at Greifswald University Clinic in comparison with specialized pediatric private practices in Germany. MATERIALS AND METHODS: This analytical comparative research reviewed the records of all children younger than 18 years old, whose underwent GA at the university dental clinic and three private practices in 2011. All cases were analyzed anonymously, including age, gender, caries levels, diagnostics and dental treatments. RESULTS: About 54% and 50%, respectively, of children who underwent GA at both the university clinic and private practices were under 5 years old. Dental caries were mostly diagnosed among referred children (47.4% and 33.8% at university and private practices, resp.) followed by irreversible pulpitis (19.2% and 22.4%, resp.) and ECC (14.1% and 20.1%, resp.). Dental extractions were often performed at university clinic (40.2%) followed by fillings (33.9%), while more restorations and less extractions were supplied at private practices (47.8% and 16.3%, resp.). CONCLUSIONS: Dental caries and its complications like pulpal problems were the most important reason for children who underwent GA combined with young age (< 5 years). Therefore, a primary preventive approach would be preferable to decrease the number of children in need of comprehensive dental treatment under GA.

Surgical repair of esophageal perforation in cirrhotic patients with varices.

A 51-year-old woman, a known alcohol abuser, had sclerotherapy for esophageal varices from portal hypertension. A perforation of the distal esophagus, diagnosed several days later, could not be closed primarily at thoracotomy due to extensive bleeding. The method of "exclusion and diversion in continuity" was modified by ligation of the esophagogastric junction with absorbable suture over a tube stent. The perforation healed and patency of the esophageal lumen was demonstrated 2 weeks later. This alternative life-saving procedure may be useful in chronic esophageal perforation, especially in cirrhotic or otherwise debilitated patients.