Detection and localization of caries and hypomineralization on dental photographs with a vision transformer model.

Caries and molar-incisor hypomineralization (MIH) are among the most prevalent diseases worldwide and need to be reliably diagnosed. The use of dental photographs and artificial intelligence (AI) methods may potentially contribute to realizing accurate and automated diagnostic visual examinations in the future. Therefore, the present study aimed to develop an AI-based algorithm that can detect, classify and localize caries and MIH. This study included an image set of 18,179 anonymous photographs. Pixelwise image labeling was achieved by trained and calibrated annotators using the Computer Vision Annotation Tool (CVAT). All annotations were made according to standard methods and were independently checked by an experienced dentist. The entire image set was divided into training (N = 16,679), validation (N = 500) and test sets (N = 1000). The AI-based algorithm was trained and finetuned over 250 epochs by using image augmentation and adapting a vision transformer network (SegFormer-B5). Statistics included the determination of the intersection over union (IoU), average precision (AP) and accuracy (ACC). The overall diagnostic performance in terms of IoU, AP and ACC were 0.959, 0.977 and 0.978 for the finetuned model, respectively. The corresponding data for the most relevant caries classes of non-cavitations (0.630, 0.813 and 0.990) and dentin cavities (0.692, 0.830, and 0.997) were found to be high. MIH-related demarcated opacity (0.672, 0.827, and 0.993) and atypical restoration (0.829, 0.902, and 0.999) showed similar results. Here, we report that the model achieves excellent precision for pixelwise detection and localization of caries and MIH. Nevertheless, the model needs to be further improved and externally validated.

Effect of Individualized Oral Health Care Training Provided to 6-16-Year-Old Psychiatric In-Patients-Randomized Controlled Study.

BACKGROUND: To assess the effect of individualized oral health care training (IndOHCT) administered to 6-16-year-old psychiatric in-patients on dental plaque removal. METHODS: 74 in-patients with mental health disorders (49 males) aged 6-16 years with a mean age of 10.4 ± 2.3 years, were randomly divided into two equal groups. At the start of hospitalization, one calibrated dentist assessed the oral health status in the hospital setting. In-patients of the intervention group (IG) received IndOHCT, while those of the control group (CG) got an information flyer. Dental plaque was assessed by the Turesky modified Quigley-Hein-Index (TI) at the start (t0) and at the end of hospitalization before (t1a) and after (t1b) autonomous tooth brushing. RESULTS: During hospitalisation, the TI was reduced in both groups (t0→t1a: IG = -0.1; CG = -0.2, p = 0.71). However, in-patients receiving IndOHCT achieved significantly higher plaque reduction rates than the controls when plaque values before and after autonomous tooth brushing were compared (t1a→t1b: IG = -1.0; CG = -0.8; p = 0.02). The effect size (ES) demonstrates the efficacy of IndOHCT (ES = 0.53), especially in children with mixed dentition (ES = 0.89). CONCLUSIONS: IndOHCT enabled hospitalized children and adolescents with mental health disorders to achieve a better plaque reduction by tooth brushing but failed to improve self-controlled routine oral hygiene.

Testing the ability for autonomous oral hygiene in hospitalized geriatric patients-clinical validation study.

OBJECTIVES: This study aimed to evaluate if the Timed Test for Money Counting (TTMC) complemented with testing the range of shoulder motion by griping the backside of the neck (NG) predicts the ability of geriatric inpatients to perform effective plaque reduction by autonomously conducted oral hygiene. MATERIAL AND METHODS: This clinical validation study involved 74 hospitalized geriatric inpatients, 48 (64.9%) females, aged between 66 and 98 years (mean age 84.1 years). Oral health status was examined. Dental plaque was assessed with the Turesky modified Quigley-Hein Index (TI) on teeth and the Denture Hygiene Index (DHI) on removable dentures. The performance and duration of TTMC and NG were recorded. After autonomous tooth brushing and denture cleaning by the patient, dental plaque was scored again with the TI and DHI. Geriatric assessment data were collected from medical records. RESULTS: Forty-nine (66.2%) geriatric inpatients completed the TTMC&NG successfully. Passing the TTMC&NG was significantly associated with better plaque removal on teeth and dentures by autonomously conducted oral hygiene. The sensitivity of the TTMC&NG for above average plaque reduction was 86.4% on teeth and 77.8% on dentures. The test revealed a negative predictive value of 75.0% to detect below average plaque reduction on teeth and 72.7% on dentures. CONCLUSIONS: The TTMC&NG served as a suitable predictor for the ability of geriatric inpatients to perform autonomously effective tooth brushing and denture cleaning. CLINICAL RELEVANCE: This simple and short test might help the medical staff to identify geriatric inpatients unable to perform effective oral hygiene by themselves.

Meta-analysis of the longevity of commonly used pit and fissure sealant materials.

OBJECTIVE: This systematic literature review and meta-analysis compared the clinical retention of primed or adhesively bonded sealants to that of conventional sealant materials. METHODS: A search of the MEDLINE, EMBASE and CENTRAL databases identified 3707 abstracts published prior to 12/31/2017, of which 335 clinical publications were analysed in detail. A total of 67 studies included information about sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis using a random effects model was conducted to calculate the pooled estimate of the retention rates for the five groups of sealants. Subgroup moderator analysis was performed to compare the pooled retention rate estimate (RRE) of primed sealants against those of the other groups. RESULTS: Primed sealants had a 2-year pooled RRE of 43.2% (95% CI: 30.5-55.8), which was significantly inferior to those of auto-polymerizing (80.8%, 95% CI: 72.2-89) and light-polymerizing sealants (68.4%, 95% CI: 60.2-76.7). Fluoride-releasing and light-polymerizing sealants had the highest 3-year pooled RREs (86.4%, 95% CI: 73.4-99.3 and 83.1%, 95% CI: 75.6-90.7, respectively). SIGNIFICANE: The results of this meta-analysis suggest that primed sealants cannot be fully recommended for clinical practice due to their moderate survival rates. Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

[Oral Health in Children and Adolescents with Mental Disability and Psycho-Emotional Disorders from Lower Saxony and Thuringia]. / Mundgesundheit von Kindern und Jugendlichen mit geistiger Behinderung und psychoemotionalen Störungen aus Niedersachsen und Thüringen.

AIM: This study aimed to compare the oral health status of 6-16 year old pupils with mental disability (MD) and psycho-emotional disorders (PED) from Lower Saxony (LS) and Thuringia (TH). METHODS: Oral examination was provided for 571 pupils with MD from TH, 118 students with MD and 80 students with PED from LS. Caries experience, odontogenic infections, fissure sealants and periodontal health were recorded. Data were statistically analysed by linear and binary logistic regression after adjusting for age. RESULTS: Students with PED revealed highest caries prevalence and experience in both dentitions with highest prevalence of odontogenic infections in the primary dentition. In 6-11 year old pupils with MD, there were only minor differences in odontogenic infections between TH and LS. Pupils with PED aged 6-11 years had a more that two-fold higher risk to develop dental caries and odontogenic infections than peers with MD. Care index was higher in pupils with PED compared to those with MD in both dentitions. Pupils with MD from TH were less affected with dental caries and received better care than those from LS. Compared to peers without mental disabilities or disorders, pupils with MD or PED were more affected with dental caries in both dentitions. They revealed a lower care index and less fissure sealants. CONCLUSION: Pupils with MD or PED reveal unsatisfactory oral health status constituting a group with particular high caries risk, while those with PED are most affected by caries and odontogenic infections. The care index is insufficient especially in pupils with MD compared to those with PED or peers without disabilities and indicates disparity in oral health for this vulnerable group.

Nutritional status, dental caries and tooth eruption in children: a longitudinal study in Cambodia, Indonesia and Lao PDR.

BACKGROUND: Untreated dental caries is reported to affect children's nutritional status and growth, yet evidence on this relationship is conflicting. The aim of this study was to assess the association between dental caries in both the primary and permanent dentition and nutritional status (including underweight, normal weight, overweight and stunting) in children from Cambodia, Indonesia and Lao PDR over a period of 2 years. A second objective was to assess whether nutritional status affects the eruption of permanent teeth. METHODS: Data were used from the Fit for School - Health Outcome Study: a cohort study with a follow-up period of 2 years, consisting of children from 82 elementary schools in Cambodia, Indonesia and Lao PDR. From each school, a random sample of six to seven-year-old children was selected. Dental caries and odontogenic infections were assessed using the World Health Organization (WHO) criteria and the pufa-index. Weight and height measurements were converted to BMI-for-age and height-for-age z-scores and categorized into weight status and stunting following WHO standardised procedures. Cross-sectional and longitudinal associations were analysed using the Kruskal Wallis test, Mann Whitney U-test and multivariate logistic and linear regression. RESULTS: Data of 1499 children (mean age at baseline = 6.7 years) were analyzed. Levels of dental caries and odontogenic infections in the primary dentition were significantly highest in underweight children, as well as in stunted children, and lowest in overweight children. Dental caries in six to seven-year old children was also significantly associated with increased odds of being underweight and stunted 2 years later. These associations were not consistently found for dental caries and odontogenic infections in the permanent dentition. Underweight and stunting was significantly associated with a lower number of erupted permanent teeth in children at the age of six to seven-years-old and 2 years later. CONCLUSIONS: Underweight and stunted growth are associated with untreated dental caries and a delayed eruption of permanent teeth in children from Cambodia, Indonesia and Lao PDR. Findings suggest that oral health may play an important role in children's growth and general development. TRIAL REGISTRATION: The study was restrospectively registered with the German Clinical Trials Register, University of Freiburg (trial registration number: DRKS00004485 ; date of registration: 26th of February, 2013).

Dental Caries and Developmental Defects of Enamel in the Primary Dentition of Preterm Infants: Case-Control Observational Study.

AIM: Assessment of dental health in the primary dentition of preterm infants (PTI) including investigation of mother- and infant-related risk factors in a case-control study design. MATERIAL AND METHODS: One hundred twenty-eight infants aged 3-4 years were included. Sixty-four PTI (27 males) were randomly selected from the preterm registry of the Jena University Hospital. As a control group served 64 full-term infants (FTI) recruited from the Department of Paediatric Dentistry, matched for age and sex. Dental examinations were provided by one dentist under standard clinical conditions. Caries was scored using the International Caries Detection and Assessment System (ICDAS II) and the DMFT, gingival health using the Periodontal Screening Index, and developmental defects of enamel using the DDE index. Mother- and infant-related factors were collected via a questionnaire and from medical records. RESULTS: The caries prevalence was 50.0% (ICDAS II >0) in PTI and 12.5% (ICDAS II >0) in FTI. The caries experience was higher in PTI (DMFT 1.0 ± 3.1) than in FTI (DMFT 0.3 ± 1.0). PTI had a higher risk of caries (OR 7.0), initial lesions (OR 6.2), DDE (OR 7.5), and gingivitis (OR 6.5) than FTI. The highest risk occurred in PTI with an extremely low birth weight (<1,000 g). A higher risk of DDE was present when mothers suffered from illness during pregnancy (OR 3.9). A higher risk of caries was revealed in infants with respiratory syndrome (OR 6.2) or when their mothers had a lower socioeconomic status (OR 6.3). CONCLUSIONS: PTI had less healthy teeth than FTI and are at a higher risk for DDE, caries, and gingivitis. The poorer dental health in PTI is associated with a low birth weight, a low socioeconomic status, and mothers' illness during pregnancy.

Risk factors for dental problems: Recommendations for oral health in infancy.

Primary care providers, gynaecologists and paediatricians have to be aware of the importance of oral health in infancy and possible consequences for child's development, growth, health and quality of life. Oral diseases, particularly dental caries, developmental defects of the dental tissues and periodontal or orthodontic issues have a complex and interrelated aetiology with common, primarily behavioral based risk factors. A sugar-rich diet is the key risk factor with detrimental consequences for general and oral health, particularly in combination with an insufficient oral hygiene. Therefore, daily tooth brushing with fluoride toothpaste and reducing of sugar intake are the key pillars to prevent oral diseases, including a positive effect on numerous chronic diseases. Future preventive approaches should focus on pregnant women and mothers of infants with a common vision of health and a shared responsibility for children's oral health care to promote healthy lifestyles and self-care practices in families.

Caries Prevalence and Risk Assessment in Thuringian Infants, Germany.

PURPOSE: To determine the caries prevalence and experience in Thuringian infants and to assess their caries risk. MATERIAL AND METHODS: The subjects were participants in a regional preventive programme, a birth cohort study with the aim of preventing caries. In the first year of life, children were invited to a dental examination at the Jena University Hospital. Dental caries was scored using WHO diagnostic criteria at the d1-level without radiography. Children were categorised as being of low, moderate or high risk for caries according to the caries-risk assessment tool of the American Academy of Pediatric Dentistry (AAPD). RESULTS: 512 children (mean age 6.7 ± 2.2 months) were examined. 58.2% (n = 298) of all children had teeth (2.21 ± 2.76). Caries prevalence of cavitated carious lesions was 1.7%, and prevalence of non-cavitated carious lesions was 7.7% in children who had teeth. Caries experience was 0.3 ± 1.0 d1-4mfs/0.2 ± 1.5 d3-4mfs (range of 0 to 16). Children with caries were on average 10.8 ± 3.2 months old, while children without caries were 6.6 ± 2.1 months. One hundred sixty-nine children (33.1%) were categorised at high risk for caries, and 98 already had teeth. CONCLUSION: Although caries prevalence and experience was relatively low in infants, one third of all children were categorised as being at high caries risk. Early dental visits are necessary to detect the first signs of caries, to assess the caries risk and to establish a dental home with a risk-related recall system. The caries-risk assessment tool (CAT) of the AAPD can assist the clinician in the decision-making process.

'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR.

BACKGROUND: The Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR. METHODS: The study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression. RESULTS: A total of 1847 children (mean age = 6.7 years, range 6.0-8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination - 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools. CONCLUSIONS: The study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children. The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).

Preventive and invasive treatment in special needs patients: a German retrospective study.

OBJECTIVES: Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. MATERIAL AND METHODS: Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. RESULTS: A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d3/4mft/0.9 D3/4MFT) than in ODC (2.5 d3/4mft /0.9 D3/4MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). CONCLUSION: Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. CLINICAL SIGNIFICANCE: This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN).

OBJECTIVES: This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany. METHODS: From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models. RESULTS: Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities. CONCLUSION: This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities. CLINICAL RELEVANCE: Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

Fluoride/vitamin D tablet supplementation in infants-effects on dental health after 10 years.

OBJECTIVE: We examined whether fluoride/vitamin D supplementation in the first year of life is associated with caries or molar incisor hypomineralization (MIH) at 10 years of age. METHODS: The study population consisted of 406 children for whom information on fluoride/vitamin D supplementation during the first year of life was available. Dental examination at the age of 10 included caries and MIH registration. The results of logistic regression models were adjusted for gender, age, BMI, parental education, and equivalent income. RESULTS: Children receiving supplementation during the entire first year of life had a significantly lower probability of having caries-related restorations in primary teeth in comparison to those who received supplementation for less than 6 months (fluoride supplementation: odds ratio (OR) for d3-4mfs 2.47 (1.32-4.63), for fs 2.70 (1.43-5.10); vitamin D supplementation: OR for d3-4mfs 2.08 (1.00-4.32), fs 2.50 (1.19-5.25)). The majority of logistic regression analyses indicated no association between supplementation and MIH. CONCLUSIONS: It was found a consistent significant caries-preventive effect in the primary dentition of children who received fluoride (256/372)/vitamin D supplementation (274/376) in all 12 months over the first year of life; no effects were observed for permanent dentition. The high parental interest in supplementation is linked to an imbalance of the study groups. Furthermore, tooth brushing frequency, use of fluoride toothpastes and/or other oral hygiene products were not recorded during the observation period which may also confound the results. CLINICAL RELEVANCE: Fluoride/vitamin D supplementation can be used in children for preventing caries in the primary dentition.

Identification of the first multi-exonic WDR72 deletion in isolated amelogenesis imperfecta, and generation of a WDR72-specific copy number screening tool.

Amelogenesis imperfecta (AI) is a clinically and genetically heterogeneous disorder of tooth development which is due to aberrant deposition or composition of enamel. Both syndromic and isolated forms exist; they may be inherited in an X-linked, autosomal recessive, or autosomal dominant manner. WDR72 is one of ten currently known genes for recessive isolated AI; nine WDR72 mutations affecting single nucleotides have been described to date. Based on whole exome sequencing in a large consanguineous AI pedigree, we obtained evidence for presence of a multi-exonic WDR72 deletion. A home-made multiplex ligation-dependent probe amplification assay was used to confirm the aberration, to narrow its extent, and to identify heterozygous carriers. Our study extends the mutational spectrum for WDR72 to include large deletions, and supports a relevance of the previously proposed loss-of-function mechanism. It also introduces an easy-to-use and highly sensitive tool for detecting WDR72 copy number alterations.

Midwives' oral health recommendations for pregnant women, infants and young children: results of a nationwide survey in Germany.

BACKGROUND: Studies suggest that poor oral health during pregnancy can lead to perinatal complications, such as low birth weight and preterm delivery as well as poor oral health in children. Aim of this study was to assess the German midwives knowledge about oral health and preventive recommendations for pregnant women, infants and young children. METHODS: The nationwide online-survey was conducted with use of a self-developed, pretested and validated standardized questionnaire. The German association of midwives (Deutscher Hebammenverband e.V.) informed their members about the survey through email, newsletter, website and association journal (Hebammenforum) (n = 7.500). Data were analyzed using descriptive statistics. RESULTS: Response rate was 12.6 % (mean age 42.9 ± 9.3 years). The majority of midwives advised pregnant women about periodontal diseases (78.6 %). Of the midwives, 8.4 % mentioned the possible associations between periodontal diseases and perinatal complications. In general, half of the midwives (53.5 %) recommended a dental visit during pregnancy. A total of 65.5 % of midwives advised parents about early childhood caries. The majority of midwives recommended that oral hygiene starts with eruption of the first tooth (60.4 %) and the first dental visit of the child should be at age 2 or 3 years (51.6 %). Midwives recommendations regarding the implementation of oral hygiene and the referral to a dentist during pregnancy and childhood were highly variable. CONCLUSIONS: To increase oral awareness and to improve the oral health knowledge among midwives and all other health-care professionals, uniform guidelines should be developed in Germany. TRIAL REGISTRATION: German Clinical Trial Register DRKS00008021.

Longitudinal study of caries progression in 2- and 3-year-old German children.

OBJECTIVE: This 2-year longitudinal study in 2- and 3-year-old kindergarten children investigated lesion progression on different surfaces of primary teeth. METHODS: The study was conducted between September 2008 and September 2010 on a sample of 400 children from the Kyffhäuser district (Thuringia, Germany). A calibrated investigator recorded (non)cavitated caries lesions according to World Health Organization (WHO), International Caries Detection and Assessment System (ICDAS) and Universal Visual Scoring System (UniViSS) criteria. Nonparametric methods and linear regression using a mixed-effects model with an unbalanced design were used for data analysis. RESULTS: There was a significant increase in the prevalence of noncavitated caries lesions during the 2-year period, with the highest chance for change on all surfaces compared to cavitated lesions. First visible sign lesions on occlusal surfaces had the highest chance for change (estimate 0.38), whereas established lesions revealed the highest chance for change on proximal (estimate 1.05) and smooth surfaces (estimate 0.62). Proximal lesions exhibited the greatest chance for change irrespective of severity level. CONCLUSION: Our study demonstrated that each type of carious lesion had different changing rates. Greater lesion severity correlated with greater chances to change and receive treatment. This information is crucial for dental practitioners in decision-making processes.

Evaluation of an interdisciplinary preventive programme for early childhood caries: findings of a regional German birth cohort study.

OBJECTIVES: The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary preventive programme (PP) for early childhood caries in 3-year-old children in Germany. MATERIAL AND METHODS: From July 2009 to October 2010, all parents of newborns (n = 1162) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to a dental examination in Jena University Hospital. Participating children were included in a risk-related recall system with continuous oral care over 3 years. Caries-risk assessment tool of the AAPD was used for risk categorizing. High-risk children received fluoride varnish biannual. In 2013, the total birth cohort (participants and non-participants) was invited to evaluate the PP. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Data were analysed statistically (multivariate logistic regression). RESULTS: Seven hundred fifty-five children (mean age 3.26 ± 0.51 years) were examined. Children in the PP (n = 377) showed significantly lower caries prevalence and experience than non-participants (15.6 vs. 37.8 %, 0.9 ± 3.3 d1-4mfs vs. 2.6 ± 5.2 d1-4mfs). Lack of vitamin D supplements (OR = 1.9, CI 0.99-3.51), familial caries experience (OR = 2.2, CI 1.27-3.73) and visible plaque on teeth (OR = 6.5, CI 4.41-9.43) were significant risk factors for caries development, whereas regular dental care (OR = 0.5, CI 0.38-0.79) had a protective effect. CONCLUSIONS: The PP was an effective interdisciplinary approach for preventing early childhood caries in small children. CLINICAL RELEVANCE: Early dental visits with caries-risk-related preventive dental care are necessary to prevent early childhood caries (ECC). TRIAL REGISTRATION: German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Clinical consequences of untreated dental caries in German 5- and 8-year-olds.

BACKGROUND: About half of all carious lesions in primary teeth of German 6- to 7-year-old children remain untreated, but no data regarding the clinical consequences of untreated dental caries are available. Therefore, this cross-sectional observational study aimed to assess the prevalence and experience of caries and odontogenic infections in the primary dentition of 5- and 8-year-old German children. METHODS: Dental examinations were performed in 5-year-old pre-school children (n = 496) and in 8-year-old primary school children (n = 608) living in the Westphalian Ennepe-Ruhr district. Schools and preschools were selected by sociodemographic criteria including size, area, ownership, socio-economic status. Caries was recorded according to WHO criteria (1997). The Lorenz curves were used to display the polarisation of dental caries. Caries pattern in 5-year-olds was categorized by Wyne's (1997) definition of early childhood caries (ECC). Odontogenic infections as clinical consequence of untreated dental caries were assessed by the pufa index. The 'untreated caries-pufa ratio' was calculated, and the Spearman's rank correlation coefficient (ρ) was used for evaluating the correlation between dmft and pufa scores. Categorical data were compared between groups using the chi-square test and continuous data were analysed by t-test. RESULTS: Caries prevalence and experience in the primary dentition was 26.2 %/0.9 ± 2.0 dmft in 5-year-olds and 48.8 %/2.1 ± 2.8 dmft in 8-year-olds. ECC type I (22 %) was the prevalent caries pattern in 5-year-olds. About 30 % of the tooth decay was treated (5y: 29.7 %/8y: 39.3 %). The Lorenz curves showed a strong caries polarisation on 20 % of the children. Pufa prevalence and experience was 4.4 %/0.1 ± 0.5 pufa in 5-year-olds and 16.6 %/0.3 ± 0.9 pufa in 8-year-olds. In 5-year-olds 14.2 % and in 8-year-olds 34.2 % of the d-component had progressed mainly to the pulp. A significant correlation between dmft and pufa scores exists in both age groups (5y: ρ = 0.399; 8y: ρ = 0.499). First deciduous molars were most frequently affected by odontogenic infections, presenting virtually all pufa scores (>95 %). CONCLUSIONS: Prevalence and experience of odontogenic infections and the untreated caries-pufa ratio were increasing from the younger to the elder children. Dmft and pufa scores in primary teeth predict a higher caries risk in permanent teeth. The pufa index highlights relevant information for decision makers to develop effective oral health care programs for children at high risk for caries.

Occlusal characteristics in 3-year-old children--results of a birth cohort study.

BACKGROUND: Aim of this prospective study was to determine prevalence of malocclusion and associated risk factors in 3-year-old Thuringian children. METHODS: Subjects (n = 377) were participants in a regional oral health programme, a birth cohort study with the aim to prevent caries (German Clinical Trials Register DRKS00003438). Children received continuous dental care since birth. Occlusal characteristics (overjet, overbite, anterior open bite, canine relationship and posterior crossbite) were measured at the age of 3 years by one calibrated clinician using a vernier caliper (accuracy 0.1 mm; Münchner Modell 042-751-00, Germany). A regular parent survey was conducted to assess risk factors for development of malocclusion. RESULTS: Three hundred seventy seven children (mean age 3.31 ± 0.70 years; 52.5% male) were examined. Children had a mean overjet of 2.4 ± 0.8 mm and the mean overbite was 0.8 ± 1.2 mm; 58.8 % of the children had a normal overjet ≤ 3 mm and 88.8% a normal overbite with < [Formula: see text] overlap. Prevalence of malocclusion was 45.2% (10.9% anterior open bite, 41.2% increased overjet ≥ 3 mm, 40.8% Class II/III canine relationship, 3.4% posterior crossbite). All children who sucked the thumb had a malocclusion. Children who used a pacifier had greater odds of having a malocclusion at age of 3 years than children without pacifier use (OR = 3.36; 95% CI: 1.87-6.05). Malocclusion and dental trauma were associated, but not statistically significant (OR = 1.83; 95% CI: 0.99-3.34; p = 0.062). Malocclusion was not associated with gender, migration background, low socioeconomic status, preterm birth, special health care needs, breathing or dietary patterns (p > 0.05). CONCLUSIONS: Non-nutritive sucking habits were important risk factors for development of a malocclusion in the primary dentition.

A silent public health crisis: untreated caries and dental infections among 6- and 12-year-old children in the Philippine National Oral Health Survey 2006.

The oral health status of 6- and 12-year-old Filipino children was assessed in a representative national sample of 2030 6-year-old and 2022 12-year-old children, using WHO Basic Methods for Oral Health Surveys (4th edition, 1997) and the PUFA (pulpal involvement [P/p], ulceration caused by dislocated tooth fragments [U/u], fistula [F/f], and abscess [A/a]) index. A subsample of 242 12-year-old children was included to assess backward comparability between the 1998 Oral Health Survey that used WHO Basic Methods (3rd edition, 1987). The results showed that 97% of 6-year-old children had caries (mean dmft 8.4), 85% showed dental infection (mean pufa 3.4), 20% reported pain when examined. In all, 82% of 12-year-old children had caries (mean DMFT 2.9), 56% prevalence of pulp involvement (mean PUFA 1.0), and 16% reported pain when examined. Differences in methodology between the 1998 and the 2006 surveys are likely to have had an effect on the observed reduction in DMFT, indicating that the real caries prevalence had not changed much and remains very high.