Epidemiological trends, predictive factors, and projection of tooth loss in Germany 1997-2030: part I. missing teeth in adults and seniors.

OBJECTIVE: This is the first part of a report on tooth loss in Germany 1997-2030. Here, we describe trends in the prevalence of tooth loss in adults and seniors 1997-2014, assess predictive factors for tooth loss and projected it into 2030. MATERIAL AND METHODS: Data of the cross-sectional, multi-center, nationally representative German Oral Health Studies of 1997, 2005, and 2014 were used. Age, sex, educational level, smoking status, and the cohort were used for ordinary least square regression to assess the association of predictors with tooth loss (missing teeth, MT). The yielded regression coefficients were used to predict tooth loss in 2030. RESULTS: Compared with 1997, the mean MT in adults (35-44 years old) in 2030 was predicted to decrease by two-thirds to 1.3. The prevalence of tooth loss (MT > 0) will decrease by 72% from 1997 to 2030. In 2030, half of the population of adults will not exhibit any tooth loss. Compared with 1997, the mean MT among seniors (65-74 years old) will decline to 5.6 teeth (i. e. two-thirds reduction) until 2030. Prevalence of tooth loss will be halved by 2030, and approximately one-third of this age group will not exhibit any tooth loss. CONCLUSIONS: Based on the model used, the trend of a robust decline in tooth loss will become more dynamic by the year 2030. As a result, every second adult will have experienced no tooth loss at all in 2030, and seniors will possess more teeth than they have previously lost. CLINICAL RELEVANCE: This study presents the trends of tooth loss in Germany for a period of three decades. It provides clinically relevant data for health care planning by 2030.

Combined-modality 125J-seed-brachytherapy, external beam radiation and androgen deprivation therapy of unfavorable-risk prostate cancer: report of outcomes and side-effects.

PURPOSE: To analyze outcomes and complication rates in an unselected cohort of men with unfavorable (NCCN intermediate and high-risk) PCa receiving combined-modality radiation treatment (CRT). METHODS: Patients received androgen deprivation therapy for 1 year and combined-modality radiation treatment (CRT) consisting of external-beam radiotherapy (EBRT, 59.4 Gy, 33 fractions) and 125J seed-brachytherapy (S-BT, 100 Gy). Subgroups, including WHO group 3-5, and initial PSA (iPSA) < 20 and > 20 ng/ml were identified. Biochemical recurrence-free (BRFS), metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) were calculated at 5 and 10 years using the Kaplan-Meier method. Subgroups were compared using log-rank test and Cox proportional hazards regression. Urogenital and gastrointestinal side-effects were reported according to the CTCAE classification. RESULTS: After a median of 6.9 years (range 2-13) calculated 5- and 10-year rates for the whole cohort of 425 men were 92.8% and 82.5% for BRFS, 95.1%, and 88.8% for MFS, 98.2%, and 95.1 for CSS, and 95.4%, and 80.1% for OS, respectively. Univariate (UVA) and multivariate analysis (MV) identified a group with unfavorable outcome with iPSA > 20 ng/ml, comprising 24% of all patients, in which 55% of recurrences, 54% of metastases and 71% of cancer-specific deaths occurred. Side-effects were limited, with < 5% of patients complaining of genitourinary and 0.5% of gastrointestinal AEs after 5 years. CONCLUSION: CRT is an excellent treatment option for men with unfavorable PCa. In a subgroup of patients with iPSA > 20 ng/ml further, possibly systemic, treatment options should be identified.

Development of undergraduate gerodontology courses in Austria, Germany and Switzerland 2004-2014.

PURPOSE/OBJECTIVES: In view of the demographic shift, undergraduate dental students should be prepared for growing numbers of older people and their specific needs. The study examines changes in undergraduate dental teaching in Austria, Germany and Switzerland between 2004 and 2014. METHODS: Questionnaires were mailed in 2004, 2009 and 2014 to all deans and all department heads of Austrian (n = 4), German (n = 30) and Swiss (n = 4) dental schools. RESULTS: Response rates were 51% for deans and 47% for heads of department. Gerodontology was taught in 5 German universities, all 3 Swiss and 1 Austrian dental school. Aspects of gerodontology were included in traditional core subjects; however, in a large number of German (88%) and Austrian (50%) universities, dedicated lecture series and seminars are lacking. Changes over time indicate firmly established teaching in Switzerland, minor fluctuations in Austria and reduced dedicated teaching activities in Germany. CONCLUSIONS: Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the challenges of tomorrow.

[Special care dentistry for dependent elderly and people with disabilities]. / Zahnmedizinische Betreuung von Pflegebedürftigen und Menschen mit Behinderungen.

In 2009, 7.1 million people (8% of the population) were officially recognized as having severe disabilities in the Federal Republic of Germany. At the same time, about 2.34 million Germans were in need of special care with some overlap between these groups. Although structured preventive programs in Germany helped to improve oral health generally (DMS IV 2006), care recipients and people with disabilities did not benefit to the same extent from this development. They often show a higher risk of caries and periodontal diseases due to both a lack of compliance and insufficient personal plaque control. It is desirable that care recipients and persons with disabilities attain the same level of oral health as persons without impairments. All care givers ought to be aware of the dental problems of these groups and should be sufficiently trained to deal with them. Dental care should compensate any deficits to ultimately attain the same standard of oral health. To achieve these goals, ease of access to dental care as well as dental services appropriate to the impairments have to be established.

[Do long-term care residents benefit from the dental bonus system?]. / Hilft das zahnmedizinische Bonussystem den stationär Pflegebedürftigen?

Oral health of long-term care (LTC) residents is often poor. From 30 random German LTC facilities, 242 random residents (Berlin n=75, Northrhine-Westfalia (NRW) n=94, Saxony n=73) (median age: 82 years, female: 78.5%) were interviewed as to their use of dental services, possession of a bonus booklet (BB), and completeness of records. Only 18.6% possessed a BB. Significant regional differences were observed (Berlin=5.3%, NRW=18.1%, Saxony=32.9%) (χ(2) test p<0.01). The number of teeth was higher (Mann-Whitney test p=0.01) and the time since last dental visit shorter (p<0.01) for all residents with a BB. Only 18.6% of people possessing a BB declared not having had a dental appointment within the previous 12 months (LTC residents without BB 51.3%). As a means towards improved quality management in nursing, better oral infection control of residents and increased oral health and general quality of life, the introduction of a regular annual preventive dental screening program including the use of a dental bonus system are suggested.

Oral health-related quality of life of elderly Germans--comparison of GOHAI and OHIP-14.

OBJECTIVE: To obtain information about the subjective oral health status of non-clinical elderly populations of urban regions of Germany, one in the East and one in the West, by using OHIP-14 and, for first time, the GOHAI, and, furthermore, to compare the results obtained by use of both instruments. BASIC RESEARCH DESIGN: Cross-sectional. CLINICAL SETTING: Randomly chosen, non-clinical elderly population in urban regions of Germany. PARTICIPANTS: 197 participants (51% male) born in the years 1930-1932. MAIN OUTCOME MEASURES: GOHAI, OHIP-14. RESULTS: Median GOHAI score was 54; median OHIP-14 score was 2. Scores indicative of severely impaired oral health were rare. The effect of living in eastern or western Germany was of minor significance. Although the internal consistency of both measures was comparable and the same positive association with psychological wellbeing, absence of dry mouth, burning mouth, and removable dentures (p < 0.05) was observed, differences occurred. In simultaneous analysis of all items, factor analysis revealed only partial overlap of the items in extracted factors. Furthermore, the extreme score indicating no impairment was five times more frequent for OHIP-14. Of those who scored zero in OHIP-14, only 20% had the GOHAI equivalent score of 60, and for some GOHAI items the answer category for highest impairment was obtained. CONCLUSIONS: GOHAI scores for this randomly chosen non-clinical group enable comparison with scores for Germany measured in the future. The differences between GOHAI and OHIP-14 make it necessary to select the most appropriate instrument for a planned purpose and study population.

Self-rating of satisfaction with dental appearance in an elderly German population.

OBJECTIVE: To assess data on satisfaction with dental appearance in old age. DESIGN: Cross-sectional study of an elderly non-patient group born from 1930 to 1932. SETTING: Two urban regions of Germany. PARTICIPANTS: 225 subjects (73-75 years, 49.3% male). METHODS: A questionnaire was completed. Descriptive analysis and bivariate analysis of gender differences, and a regression model for multivariate analysis were performed. MAIN OUTCOMES: Satisfaction with overall dental appearance, tooth/denture colour, shape, and position, and importance of dental appearance to overall appearance. RESULTS: Importance of dental appearance to overall appearance was rated high (7.5 +/- 2.0, where 10 denotes most important), as was overall satisfaction with dental appearance (7.2 +/- 1.8, where 10 denotes best possible). Up to 12% were not at all satisfied with tooth/denture colour, shape, or position, however. Women were more critical when judging overall satisfaction with dental appearance (p = 0.02). A significant positive association was obtained between overall dental appearance and position of teeth (p < 0.001). CONCLUSIONS: Satisfaction with dental appearance was high, as was the importance of dental appearance to elderly patients. Both aesthetic and functional aspects should therefore receive special attention in dental treatment. In this context the position of teeth should be regarded as of special importance.

[Gerodontology--a challenge also for public health services]. / Gerostomatologie--eine Herausforderung auch für den Offentlichen Gesundheitsdienst.

The dental services of the public health service (OGD) should not confine themselves to dental screening in kindergartens and schools but also turn their attention to the advancement of oral health in the special risk groups of the senior citizens. Although government resources are limited, new capacities could be gained by restructuring. Is it really prudent, in a lifetime perspective, for the OGD to solely focus on the oral health of youths while oral neglect in long-term care carries on unabated? A stronger support by the OGD of gerodontology should be instituted on its boards, publicised in health reports, and implemented in supervisory bodies for quality management of the long-term care facilities. An endorsement of the structures of long-term care insurance and training facilities would be desirable. The OGD could assist the fitter seniors through specific education to participate in dental prevention programmes and motivate physicians to inspect the oral cavity. Furthermore, recommendations regarding the structuring of geriatric dental care by the OGD would be helpful. The OGD is a vital partner to gerodontology. Therefore, further projects should be conducted in cooperation with dental organisations.

[Oral health, dental state and nutrition in older adults]. / Mundgesundheit, Zahnstatus und Ernährung im Alter.

The loss of natural teeth impairs essentially the chewing function and can only partly be restored by the insertion of dental prostheses. Equally, xerostomia and dysphagia may aggravate the nutritional intake in older adults. Often denture wearers do subjectively not notice the adjustment of their food choice and the employment of special preparation techniques. Finally the dental state influences the nutritional intake. A reduced number of teeth correlates with the intake of less calories, proteins, fat, non-starch polysaccharides and vitamins. Often missing calories are compensated by an increased consumption of sugar and fat. Especially edentulous persons with a low level of education choose a diet which is rich in fat and sugar. Further the daily intake of fruit and vegetables diminishes along with fewer occlusal contacts in posterior teeth. The restoration of the chewing function by dental intervention does not lead to an improvement of the nutritional intake by itself and should therefore always be complemented by nutritional advice.

Geriatric oral health issues in Germany.

A review of the oral health issues for the elderly in Germany is presented. The percentage of aged and very old people in the total population of Germany is increasing rapidly, as is the percentage of the dentate population due to the high standard of dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for all who care for the elderly, to adjust to caring for the dentate patient and to begin to work together and communicate about the patient's needs. Physicians in particular need to be given training in the detection of caries, periodontal diseases and denture problems. They should feel comfortable working with the dentist and dental team as partners in rehabilitation treatment. The dental treatment needs of the German population aged 70 years and older are not yet adequately met although the social insurance of the elderly includes dental treatment. Provision of oral health care for the dependent elderly, especially those who are homebound or in nursing homes, is not effectively organised and has to be completely reconsidered. The social health insurance and the social long-term care insurance must adjust their insurance coverage to the dental needs of the frail elderly. The development and further improvement of age-adjusted dental care is of crucial importance with respect to future demographic changes.

The uptake of dental services by elderly Germans.

OBJECTIVE: The aim of the study was to assess the uptake of dental services by the old and very old population within the scope of the Berlin Aging Study (Berliner Altersstudie BASE). DESIGN: A multi-disciplinary structured interview was performed on 928 subjects, aged from 70 to 103 years of whom 516 persons volunteered to take part in a 14-session intensive protocol. Six representative study groups were matched for age and gender. Subjects were asked to recall the timing of their most recent dental visit. Data were validated by sending for dental records and compared with all study participants from the multi-disciplinary intake assessment. Data were related to age group, dental state, dementia and education. RESULTS: Reported last contact with dental services ranged from 2 weeks to 52 years (median 18 months) with a higher time lapse in the study groups aged 85 and older. Dentate subjects had seen their dentist more recently than edentate subjects. Higher education correlated with an increased dental utilisation. Subjective memory on the time lapse since the last dental appointment coincided in 13% of the subjects with available dental records (n=84), was misjudged between one and six months in 55%, and by more than six months in the remainder. Moderately or severely demented subjects who remembered their last dental appointment (n=48 of 70) showed no consistently different utilisation to healthy or mildly demented study participants. CONCLUSION: Edentate old and very old subjects show the least frequent utilisation of dental services. Data on motivation and barriers to care are needed to develop strategies to improve the use of dental services and thus promote oral health in late life.

[Fundamentals of dentistry for geriatric rehabilitation--an introduction to geriatric dentistry]. / Zahnmedizinische Grundlagen zur geriatrischen Rehabilitation--eine Einführung in die Alternszahnmedizin.

The percentage of aged and very old people in the total population is increasing rapidly in industrialized countries. This is an important change which, in particular, affects the areas of dentistry and oral medicine. The problems that this older population group face need to be given more attention and need to be brought more into the forefront of dental and oral medicine. The percentage of the dentate population has increased in Germany, due to the high standard of the dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for those who care for the elderly to adjust to caring for the dentate patient, as opposed to edentulous patient. It is important for all professions involved in the treatment and care of geriatric patients to have an awareness of the basic fundamentals of geriatric dentistry within general rehabilitation. Doctors in particular need to be given training in the detection of caries, peridontal diseases, and denture problems. They should feel confident working with the dentist and his team as partners in the rehabilitation treatment. It is especially important that geriatric hospitals have experience in dentistry and oral hygiene, so that damage to life-long well cared for teeth can be prevented, and so that poor oral hygiene during a hospital stay does not result in dental problems. Dentists and their teams will have to adjust to the treatment of aged and multimorbidic patients. More discussion is also necessary between dentists involved in all areas of geriatric medicine, geriatric dentistry, and geriatric dental public health.

Amalgam fillings and cognitive abilities in a representative sample of the elderly population.

OBJECTIVES: The ongoing controversial discussion about a possible negative effect of amalgam fillings on the cognitive abilities and the pathogenesis dementia was the objective of the present study. SAMPLE: A total of 300 patients aged from 70 to 103 years were selected from the multidisciplinary 'Berlin Aging Study' (BASE). The sample was heterogeneous concerning lifestyle, education and social prestige. According to their dental state subjects were allocated into three groups: edentate > or = 20 years (I) and residual teeth without (II) or with (III) amalgam restorations. All groups were matched for age and gender. DESIGN: Dental examinations and various psychiatric as well as psychological assessments were carried out by professionals within the protocol of the BASE. Tests were chosen to reveal the presence and degree of dementia and assess cognitive abilities such as 'perceptual speed', 'reasoning', 'memory', 'fluency' and 'knowledge'. RESULTS: The present findings negate a correlation between the dental state and the pathogenesis of dementia and the physiological age-related decline in cognitive abilities. Thus the presence of amalgam fillings did neither correlate to a demented mental condition nor an impaired cognitive performance.

[Dental care in homes for the elderly and aged. Organization and opinion of home management]. / Zahnmedizinische Betreuung in Seniorenheimen. Organisation und Beurteilung durch die Heimleitungen.

Managements of homes for the elderly and aged have been interviewed on the size and general organisation of their institutions, the amount of new admissions, and type and frequency of dental care for their residents. The home management was also asked to evaluate the dental care. Many managements show no understanding for problems in this respect. Regular dental control and assistance with oral hygiene, as well as regular training of the staff, are often thought to be unnecessary. This estimation of the actual state of dental care in such institutions indicates that information and motivation of management and nursing staff is the first step to improve the dental care of the home-residents.