Childhood obstructive sleep apnea syndrome: an interdisciplinary approach: a prospective epidemiological study of 4,318 five-and-a-half-year-old children.

UNLABELLED: Population-representative data on sleep disorders in children is scarce. BACKGROUND AND OBJECTIVE: The aim of this epidemiological study was to determine the prevalence of various sleep-related breathing disorders (SRBD) and any correlations with occlusion and jaw abnormalities in preschool children. MATERIALS AND METHODS: The study material consisted of 4,318 children (5.5 years old) whose parents completed the Pediatric Sleep Questionnaire (PSQ); 60 out of 140 children (6.3 ± 0.78 years old) with a positive questionnaire score (> 0.33) were examined by an orthodontist and ENT specialist. From this cohort, 15 children who presented a dental occlusion and jaw abnormality but no indication for surgical reduction of adenotonsillar tissue underwent polysomnography in a sleep laboratory. RESULTS: According to the PSQ, 3.3% of the 5.5-year-olds showed evidence of a SRBD. Boys were affected significantly more frequently. Lack of concentration, hyperactivity, morning fatigue, mouth breathing, loud snoring, and breathing interruptions were indicators of SRBD. The SRBD children more frequently presented with jaw abnormalities such as mandibular retrognathia, lateral cross-bite, and increased overjet. The SRBD cohort showed a higher rate of orofacial dysfunctions. Adenotonsillar hyperplasia still played a significant role in the development of SRBD. CONCLUSION: In contrast to previous reports in the literature, the frequency of SRBD in our group of 5- to 6-year-olds was lower (3%). Boys with adenotonsillar hyperplasia and/or mandibular retrognathia, lateral cross bite, and an enlarged overjet require special attention.

Failure of tooth eruption in two patients with cerebral palsy and bruxism-a 10-year follow-up: a case report.

The aim of this paper was to analyze delayed tooth eruption in two children with cerebral palsy who had severe bruxism and to determine whether treatment could influence tooth eruption and alignment. Extraction of primary teeth was carried out and orthodontic treatment was considered due to severe tooth wear of primary teeth, lack of space, and development of a class III malocclusion. Analysis was based on clinical examination, photographs, radiographs, and dental casts. In both patients, early mixed dentition was delayed for more than 5 years. Calcification and root development of posterior permanent teeth corresponded with the chronological age. Root resorption of the severely abraded primary teeth and eruption of their successors were delayed or failed. Eruption of permanent teeth occurred slowly after primary teeth were extracted. Orthodontic treatment succeeded in one patient, achieving a normal overjet in combination with a successful orofacial therapy. The disturbed exfoliation of abraded primary teeth and failure of tooth eruption of the posterior teeth could be linked to the systemic pathology and to bruxism. At age 20, eruption of the canines and premolars remained questionable.

Examiner differences in the assessment of different malocclusions.

BACKGROUND: In the current discussion about ensuring treatment quality and reducing costs in the health sector, indication systems with which to determine the need for a treatment and the success of therapy are increasingly being used in orthodontics. These indication systems require the objective evaluation of malocclusions. Our objective was to determine the examiner reliability in the assessment of various malocclusions. MATERIALS AND METHODS: In 180 adults (64 male, 116 female, aged 20-49) from the population-based Study of Health in Pomerania (SHIP), malocclusions were recorded clinically and on models by calibrated examiners. An experienced orthodontist conducted the clinical examination. Another orthodontically-experienced examiner analyzed the models. To compare the model examiners, two examiners with varying degrees of orthodontic experience evaluated 60 of the 180 models as well (29 male, 31 female). One of the model examiners repeated the assessment of 60 models at a later time (intra-individual comparison). RESULTS AND CONCLUSIONS: Reliability amongst the examiners depended on which malocclusions were judged: crowding and contact point displacement showed little agreement, while cross bite, edge-to-edge bite, deep bite and enlarged overjet revealed greater agreement. Comparison between the clinical examination and model analysis (kappa median 0.57) revealed the greatest differences between the examiners. Comparison of the three model examiners also showed differences. The contrast to the orthodontically least experienced examiner was greater (kappa median 0.61 and 0.62) than the divergence between the two orthodontically more experienced examiners (kappa median 0.70). The intra-individual examiner comparison revealed the smallest differences (kappa median 0.82).

Presurgical nasoalveolar molding in patients with unilateral clefts of lip, alveolus and palate. Case study and review of the literature.

INTRODUCTION: The case of a newborn female patient with unilateral cleft lip, alveolus and palate is presented with a markedly sunken nasal wing at the cleft side. This finding may lead to a very unsatisfactory aesthetic result after primary cheiloplasty and nasoplasty. PATIENT AND METHOD: Five months prior to surgery, the patient was treated with a palatal plate and additionally with a nasoalveolar conformer for 4 months thereof. The device consisted of an acrylic pelotte (attached to the maxillary plate with a wire) which lifted the nasal dome and was activated regularly. Under this presurgical treatment, the cleft edges moved closer to each other by 1.8 mm at the alveolar ridge and by 4.5 mm in the palatal area. The nasal wing was lifted by 5 mm. This was enabling elevation of the nasal wing during primary surgery in the case described. Questions are raised as to the remaining effects on nasal symmetry until completion of growth and, on the other hand, as to the chances to reduce postsurgical alar relapse by continued nasal molding beyond primary surgery. CONCLUSION: Presurgical nasal molding seems to improve aesthetics of the nose in patients with unilateral clefts of lip, alveolus and palate and distinctly flattend nasal wings.

Comparison of craniofacial morphology in patients with unilateral cleft lip, alveolus and palate with and without secondary osteoplasty.

PROBLEM: What kind of skeletal differences do exist between juvenile patients with unilateral cleft lip, alveolus and palate treated with or without secondary osteoplasty, and between cleft patients and non-cleft patients? PATIENTS AND METHODS: Thirty-nine patients with unilateral cleft lip, alveolus and palate at a mean age of 15.8 years who were surgically treated with (n = 18) and without (n 21) secondary osteoplasty were compared with a control group of non-cleft patients (mean age 15.1 years). The patients were analyzed using lateral cephalograms. Cephalometric analysis included common sagittal and vertical variables as well as measurements of anterior tooth position and soft-tissue profile. RESULTS: Analysis of lateral cephalograms revealed no significant differences between the two groups of cleft patients. The differences in comparison with the control group mainly revealed maxillary retroposition, a vertically open configuration, a steep position of the upper and lower anterior teeth and a decreased Holdaway-angle (flat midface). CONCLUSION: Secondary osteoplasty exhibited no significant influence on craniofacial growth in children with unilateral cleft lip and palate. Both groups of cleft patients are not markedly different regarding sagittal and vertical skeletal configurations.

The influence of craniofacial growth in a case of transverse facial cleft.

This report presents the case of a female patient bearing a right-side transverse facial cleft. She has received interdisciplinary treatment since birth. At regular intervals, dental casts were made, and profile and full-face photographs, lateral and postero-anterior cephalograms were taken during the course of orthodontic treatment and maxillofacial surgery. We evaluated her diagnostic records with the intent of documenting the effects of growth and therapy on the skeletal structures of the facial cranium and on occlusion, and to show the influence on facial esthetics. Her facial morphology and occlusion were manifest at birth and in the primary dentition. The maxilla and mandible deviated from the midsagittal plane toward the cleft side, with the mandible considerably more affected, revealing a markedly posterior position. The lateral skeletal deviation of both jaws increased slightly during growth, yet the midline deviation of the dental arches and malocclusion clearly worsened. The increasing deviation was not obvious in full-face photographs. Especially in the primary and mixed dentition, the mandible shifted to the anterior, which was visible in both the lateral cephalograms and profile photographs. On the whole, however, no noteworthy alteration in the character of the craniofacial morphology occurred by the time growth was complete, despite functional jaw-orthopedic and maxillofacial surgical treatment consisting of two distraction osteogenesis procedures.

Influence of examiner differences on KIG-classification when assessing malocclusions.

OBJECTIVE: Indication systems such as the German KIG system (Kieferorthopädische Indikationsgruppen = Orthodontic Indication Groups) presuppose the objective assessment of underlying malocclusions. In this survey, we aimed to investigate the degree of agreement among the findings of several examiners in the assessment of different malocclusions and their classification according to the KIG system. SUBJECTS AND METHODS: Calibrated examiners assessed in the clinical evaluation and on plaster models orthodontic malocclusions in 180 adults (aged 20-49, 64 male, 116 female) from the population-based Study of Health in Pomerania (SHIP). Clinical examination was carried out by an experienced orthodontist, and the plaster models were also analysed by an examiner experienced in orthodontics. To compare inter- and intra-individual model examiners, we had two examiners with differing orthodontic experience carry out additional analyses of 60 of the 180 models (29 male, 31 female). RESULTS: The examiner differences yielded various KIG classifications and hence different assessments (i. e., whether KIG case-costs should be borne by health insurance). The comparison "clinical examination versus model analysis" revealed differences regarding 16.7% of the study participants in the assessment of whether the expense would be borne by the statutory health insurance fund. At 5.0-8.3%, the number of participants whose assessments had differed was much smaller in the inter-individual comparison of model-examiners and was smallest (at 3.3-6.7%) when comparison was made between intra-individual assessments (by a sole examiner). With regard to overall malocclusion assessment, the greatest examiner differences were again revealed when comparing the clinical examination with the model analysis (median kappa 0.57). The model-examiner comparison revealed larger differences among examiners with less orthodontic experience (median kappa 0.61 and 0.62) than the comparison between examiners with orthodontic experience (median kappa 0.70). CONCLUSIONS: There can occasionally be considerable examiner differences in the classification of participants according to orthodontic indication groups and hence varying assessments of whether such persons are KIG cases or not. Various means of data collection (clinical evaluation-plaster models) in the assessment of malocclusions by multiple examiners and by those with little orthodontic experience may negatively influence agreement among examiners.

The influence of dynamic occlusal interferences on probing depth and attachment level: results of the Study of Health in Pomerania (SHIP).

BACKGROUND: The purpose of this study was to investigate potential associations between dynamic occlusal interferences and signs of periodontal disease in posterior teeth based on dental and medical measurements obtained from a population-based sample in the cross-sectional epidemiological study entitled, "Study of Health in Pomerania" (SHIP). METHODS: Medical history and dental and sociodemographic parameters of 2,980 representatively selected dentate subjects, 20 to 79 years of age, were collected. The analysis was performed on posterior teeth only using a mixed linear model that considers the clustered structure of the data. The model also was adjusted with respect to known risk factors for periodontal disease. RESULTS: The presence of non-working side contacts only was significantly related to probing depth (P<0.0001) and attachment loss (P=0.001). The presence of non-working side contacts and working side contacts on the same tooth was significantly related to increased probing depth (P=0.004) but not attachment level. The effect magnitude was a mean increase of 0.13 mm for probing depth and 0.14 mm in attachment loss. Known risk factors for periodontal disease that also showed significant associations with probing depth and attachment loss included male gender, age, smoking, education, and plaque score. Other factors significantly related to probing depth and/or attachment loss were tilted teeth, restored occlusal surfaces versus sound surfaces, elongated teeth, and tooth type (molar versus premolar). CONCLUSION: The effect of non-working contacts on periodontal disease status was discernible, but weak in terms of magnitude and specificity.

Association of malocclusion and functional occlusion with subjective symptoms of TMD in adults: results of the Study of Health in Pomerania (SHIP).

An analysis of exclusively representative population-based studies on adults has shown that only few and inconsistent associations could be detected between malocclusions and clinical signs of temporomandibular disorders (TMD)--and none for functional occlusion factors (occlusal interferences, non-working side contacts, etc). The aim of this study was to analyze associations between morphologic occlusion as well as factors of functional occlusion and subjectively perceived symptoms of TMD--again on the basis of the population-based Study of Health in Pomerania (SHIP), providing a sample of 4310 subjects (out of 7008 subjects yielding a response rate of 68.8%) aged 20 to 81 years, and other international representative studies from the systematic review. Besides occlusal factors also parafunctions and socioeconomic status (SES) were taken into account (including age and sex). Multiple logistic regression analysis was used--adjusted for SES. In this study, none of the occlusal factors were significantly associated with the indication of more frequent subjective TMD symptoms. However, the parafunction "frequent clenching" was connected with subjective TMD symptoms (odds ratio = 3.4). Compared with other population-based studies few and (across studies) inconsistent associations between malocclusions and subjective TMD symptoms could be ascertained. No significant associations of factors of functional occlusion with TMD symptoms were identifiable.

Risk factors for headache, including TMD signs and symptoms, and their impact on quality of life. Results of the Study of Health in Pomerania (SHIP).

OBJECTIVE: The aim of this investigation was to evaluate the role of various signs and symptoms of temporomandibular disorders (TMD), among other potential risk factors, in developing frequent headache in a population-based sample of the cross-sectional epidemiologic Study of Health in Pomerania (SHIP). The impact of headache and of myogenous and arthrogenous signs of TMD on the quality of life of this sample was evaluated. METHOD AND MATERIALS: Medical history and dental and sociodemographic parameters of 4,255 subjects were checked for correlations with frequent headache using a multivariate logistic regression model. The quality of life of the headache sufferers was evaluated with a questionnaire on mental and physical health. RESULTS: Of the sample, 9% reported suffering from frequent headache. Significant values for the odds ratios for the whole sample were found for pain on palpation of the masticatory muscles; the anamnestic question on masticatory muscle pain; ear noises; lateral palpation pain of the temporomandibular joints (TMJ); several sleep disorders; psychosomatic complaints; and risk for women. Palpation pain of the muscles showed a dose/response effect. Subjects with a higher education level had a significantly reduced risk for developing frequent headache. Anamnestic questions for pain in the TMJ area, TMJ clicking, smoking, alcohol abuse, contraceptives, income, and chronic diseases did not correlate significantly with frequent headache. Subjects who reported frequent headache exhibited a significant reduction of physical and mental health scores. Pain upon muscle palpation showed significantly reduced scores on both scales for both genders. CONCLUSION: Within the limitations of this study, in addition to sensitive TMJs, mainly palpation-sensitive masticatory muscles showed a significant relation to the occurrence of frequent headache. Because of the number of tested covariates originally included in the model, this relation seems essential.

Do bivariate and multivariate cephalometric analyses lead to different results concerning the skeletal cause of postnormal occlusion?

In most cephalometric studies on the craniofacial pattern of untreated Class-ll-malocclusion subjects mean values were bivariately compared with the mean values of subjects with normal occlusion or Class I malocclusion, or with standard values. A multivariate approach, which does not merely compare two variables at a time but which analyses several skeletal variables at once, is lacking. The objective of the present study was in a first step to bivariately compare the sagittal and vertical skeletal pattern of Norwegian untreated postnormal occlusion patients with Class I children and in a second step to compare the results of the bivariate analysis with the results of a multivariate analysis on the same subjects. Previous studies showed in the majority of cases a retropositioned mandible rotated to the posterior with an indefinite positioned maxilla. A bivariate comparison of 138 Norwegian subjects with Class II/1 malocclusion and 80 children with Class I occlusion from the same region (mean age of both 9 years) confirmed the posterior position of the mandibles. However, a multivariate analysis (harmony-box-concept) of the same subjects yielded a different result. Simultaneously taking the sagittal and vertical position of both jaws and the cranial base flexure angle (NSBA) into consideration, the comparison of the two groups demonstrated a forward positioned maxilla as the skeletal cause of the Class II/1 malocclusion. The mandibles were on average normal positioned instead of retropositioned relative to other skeletal structures of the viscerocranium. Apparently standard bivariate tests and multivariate analysis methods may lead to different results which also have to be considered by the functionally treating orthodontist.

Association of malocclusion and functional occlusion with signs of temporomandibular disorders in adults: results of the population-based study of health in Pomerania.

The objective of this study was to determine whether associations exist between occlusal factors and signs of temporomandibular disorders (TMD) in adults using the population-based Study of Health in Pomerania (SHIP), Germany. A representative sample of 4310 men and women aged 20 to 81 years (response 68.8%) was investigated for TMD signs, malocclusions, functional occlusion factors, and sociodemographic parameters. Multiple logistic regression analysis, adjusted for sex, age, and socioeconomic status, was used. The results were compared with other population-based studies identified by a systematic review. Few malocclusions and no factors of functional occlusion except socioeconomic parameters were associated with TMD signs, and these associations were mostly weak. Only bilateral open bite up to three mm appeared to be clinically relevant and was associated with TMD signs (odds ratio [OR] = 4.0). This malocclusion, however, was of rare occurrence, with a prevalence of 0.3% (n = 9), and this finding was not confirmed by other representative studies. Occlusal factors examined in this study explained only a small part of the differences between normal subjects and those with TMD signs. This and other population-based studies indicate that malocclusions and factors of functional occlusion surveyed should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of temporomandibular dysfunction. Single occlusal factors that showed significant effects throughout several studies could not be detected. In view of the large number of occlusal variables already investigated, other variables including nonocclusal ones probably also play a role and should be looked at more intensely.

[Dental occlusion and subjective temporomandibular joint symptoms in men and women. Results of the Study of Health in Pomerania (SHIP)]. / Okklusion und subjektive Kiefergelenksymptome bei Männern und Frauen. Ergebnisse der Study of Health in Pomerania (SHIP).

Aim of the study was to determine whether associations exist in men as well as in women between occlusal factors like malocclusions or factors of functional occlusion and subjective temporomandibular joint (TMJ) symptoms, based on the population-based Study of Health in Pomerania (SHIP-0). A representative sample of 4310 men and women (response rate 68.8%) aged 20 to 81 years was examined for subjective temporomandibular joint symptoms, malocclusions (incl. normal occlusion), factors of functional occlusion and for sociodemographic parameters. Men and women were analyzed separately with multiple logistic regression analyses, adjusted for age. The results were compared to other population-based studies from an own systematic review on this subject. In men and women, none of the 48 occlusal factors under survey (malocclusions or functional occlusion) was significantly more frequently associated with the dependent variable "subjective temporomandibular joint symptoms". In contrast, the parafunction "frequent clenching" was associated more frequently and clinically relevant with TMJ symptoms in both sexes (for men, odds ratio = 4.2, prevalence 4.9%; for women OR = 2.9, prevalence 5.6%). Malocclusions and functional occlusion factors only explained a smaller part of the differences between the male and female population with and without subjective TMJ symptoms. Compared to other population-based studies only few and inconsistent associations between occlusal factors and subjective temporomandibular symptoms were ascertainable in both sexes.

Periodontal disease, but not edentulism, is independently associated with increased plasma fibrinogen levels. Results from a population-based study.

The systemic response to periodontal disease was analyzed in the cross-sectional Study of Health in Pomerania (SHIP). The completed data of 2,738 subjects aged 20 to 59 years were used for logistic regression analysis with an increased plasma fibrinogen level (> or =3.25 g/L according to Clauss) as the dependent variable. Participants were divided into four groups according to the number of periodontal pockets > or =4 mm (0, 1-7, 8-14, > or =15 pocketing). An additional group comprised the 52 edentulous subjects. The adjusted odds ratio (OR) of > or =15 periodontal pockets for increased plasma fibrinogen levels was 1.88 (95% CI: 1.25-2.83). Edentulism per se was not associated with increased plasma fibrinogen levels but was contained in a two-way interaction with the number of cigarettes/day in current smokers (p = 0.031). For edentulous nonsmokers the adjusted OR was 1.10 (95% CI: 0.51-2.39). Furthermore, body mass index, the interaction between gender and body mass index, serum LDL cholesterol, medication, the interaction between LDL cholesterol and medication, aspirin, smoking, school education, chronic bronchitis, and the interaction between alcohol consumption and chronic gastritis were associated with plasma fibrinogen levels. Our results show that periodontal disease but not edentulism per se is associated with an increased plasma fibrinogen level.

Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP).

PURPOSE: Using a population-based sample of the cross-sectional epidemiologic "Study of Health in Pomerania" (SHIP), this study evaluated whether certain occlusal and sociodemographic factors besides age and gender are risk factors for high dental wear. MATERIALS AND METHODS: Medical history and dental and sociodemographic parameters of 2,529 dentate subjects selected representatively and according to age distribution were checked for correlations with the occurrence of high occlusal wear symptoms using a multivariate logistic regression model. Occlusal wear was recorded using the attrition index by Ekfeldt et al and was age adjusted by determining high occlusal wear for every 10-year age group as index values > or = 90th percentile. RESULTS: The following independent variables were found to be correlated with high occlusal wear: male gender, odds ratio 2.2; frequent bruxism, odds ratio 2.5; loss of molar occlusal contact (Eichner classification), odds ratio from 1.5 to 3.1; edge-to-edge relation of incisors, odds ratio 1.7; unilateral buccolingual cusp-to-cusp relation, odds ratio 1.8; and unemployment, odds ratio 1.6. In contrast, anterior cross-bite, unilateral posterior cross-bite, and anterior crowding were protective for high occlusal wear levels, as shown by significantly reduced odds ratios. Gender-separated analysis showed that self-reported bruxism was a risk factor only for men. CONCLUSION: In addition to some occlusal factors, the main factors associated with occlusal wear were bruxism and gender.

Malocclusions and clinical signs or subjective symptoms of temporomandibular disorders (TMD) in adults. Results of the population-based Study of Health in Pomerania (SHIP).

AIM AND METHOD: The objective was to determine with reference to a representative sample of 4310 men and women aged 20 to 81 (response rate 68.8%) drawn from the population-based Study of Health in Pomerania (SHIP-0) whether associations exist between malocclusions and temporomandibular dysfunctions in adults. Besides clinically investigated signs, subjectively perceived symptoms of temporomandibular disorders (TMD) were studied in each individual together with malocclusions (plus normal occlusion), functional occlusion factors, and sociodemographic parameters. A multivariate logistic regression analysis was used, adjusted for age and discriminated for gender. The results were compared with those of other population-based studies identified by a systematic review undertaken by the present authors. RESULTS: Some malocclusions were associated with signs or symptoms of TMD but tended to occur only rarely: unilateral open bite, negative overjet, and unilateral scissors-bite in men, and edge-to-edge bite in women. However, malocclusions (and functional occlusion factors) accounted for only a small part of the differences between the control population and the study population with signs or symptoms of TMD. In terms of the multifactorial problem of temporomandibular disorders they should be seen as cofactors. The results, together with those of other population-based studies, revealed no specific, i.e. recurring malocclusions (or other occlusal factors) presenting as risk markers.

Association of malocclusion and functional occlusion with temporomandibular disorders (TMD) in adults: a systematic review of population-based studies.

The aim of this systematic review of population-based studies was to establish whether or not associations exist between different types of malocclusions, as well as factors of functional occlusion (eg, occlusal interferences, nonworking-side occlusal contacts) and temporomandibular disorders (TMD) in adults 20 years or older. Defined criteria were employed in the search of MEDLINE and EMBASE databases, as well as in a manual search. Finally, using inclusion criteria (eg, random sampling from residents' registration office files or census lists, adequate response rates), out of 22 preselected studies, four relevant population-based studies on this subject were found. Eighteen studies were excluded because of insufficient description of material and methods (eg, lack or unclear description of sample method, randomization, age distribution), mixed under- and over-20-year-old study population, or different outcome of interest (eg, tooth loss, dentures). The methodologic quality of the selected studies was established with a quality assessment list. The average total methodologic score achieved was 43 out of a possible 100 points. Few associations were reported between malocclusion and parameters of functional occlusion and clinical as well as subjective TMD, and these associations were not uniform. No particular morphologic or functional occlusal factor became apparent. Additionally, the occlusal factors found were partly protective for TMD, ie, subjects with these occlusal parameters showed fewer signs and symptoms of TMD (angle Class II malocclusion, deep bite, anterior crossbite). A positive relationship was only described in two cases-between the number of rotated lateral teeth and subjective symptoms of dysfunction, and between excessive abrasions and clinical dysfunction. In neither case, however, was the strength of the correlation given. In summary, few associations were established between malocclusion or functional occlusion and signs and symptoms of TMD. In view of the small number of randomized studies and their methodologic quality, these results should be verified through further valid representative studies.

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania.

OBJECTIVE: The aim of this study was to describe the oral health status of older adults living in northeastern Germany. MATERIALS AND METHODS: Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross-sectional, population-based study. Data on 1446 subjects aged 60-79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss. RESULTS: The prevalence of edentulousness varied from 16% in the 60-65-year-old group to 30% in the 75-79-year-old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60-65 years) to one in the oldest (75-79 years). Among subjects aged 60-69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70-79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70-79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60-69 years: 85% vs. 71% in 70-79-year-old men; women aged 60-69 years: 71% vs. 62% in 70-79-year-olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern. CONCLUSIONS: It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.

Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based Study of Health in Pomerania.

OBJECTIVE: Based on a randomized, population study (Study of Health in Pomerania [SHIP]), the objective of the present study was to determine incidence of signs and symptoms of temporomandibular disorders (TMD) in adults 20 years or older and to compare the data with TMD prevalence of other exclusively random sample studies that fulfilled criteria similar to those of this study (age > or = 20 years, age range > or = 40 years, sample size > or = 500 subjects, equal gender distribution). METHOD AND MATERIALS: Men and women (n = 7,008) 20 to 79 years of age from mid- and small-sized towns in a rural region in northeast Germany were randomly sampled from resident registry office files. The response rate was 68.8%. Adults between the ages of 20 and 81 years (n = 4,289) were clinically and anamnestically examined. RESULTS: Half of the subjects (49.9%) had one or more clinical signs of TMD, but only 2.7% were subjectively aware of temporomandibular joint (TMJ) pain symptoms. Women showed higher frequency for all signs and symptoms of TMD than men. However, these differences were not significant for all signs and symptoms in all age groups. The influence of age on TMD signs and symptoms was less pronounced. The prevalence for the following variables found in the present study compared to those of other comparable, random sample studies was: clinical examination; (TMJ) tenderness to palpation (5% versus 2% to 6%); masticatory muscle tenderness (15% versus 19% to 21%); joint sounds (25% versus 15% to 25%); limited maximum mouth opening < 40 mm (9% versus 5% to 8%); pain upon movement of the mandible (1% versus 1% to 3%); irregular jaw movements (deviation, deflection) (28% versus 28%); interview: subjective joint sounds (9% versus 11% to 13%); and subjective TMJ pain (3% versus 4% to 7%). CONCLUSION: The TMD incidence in the current study agreed quite well with the other studies based on random samples with similar subjects and design. The large range of prevalence for signs and symptoms of TMD documented in reviews and meta-analyses could therefore not be confirmed.

Complete cleft lip and palate without bone grafting and its effect on craniofacial morphology in three planes.

The aim of the study was to analyze the morphology of the viscerocranium in patients with unilatertal or bilateral cleft lip and palate (CLP) who had undergone no surgical intervention of the alveolous meaning that no bone grafting was conducted. In this cross-sectional study 47 patients with complete unilateral (UCLP) or bilateral clefts (BCLP) were examined, and compared to a group of 42 patients without facial clefts. Each group was subdivided into two age groups (ca. 8 and ca. 15 years) approximately before and after the pubertal growth maximum. All patients with CLP received a complete palate closure by means of velopharyngoplasty at age of three, without any alveolar ridge osteoplasty. The craniofacial morphology of all patients was analysed in three planes (sagittal, coronal, horizontal) with help of model analysis and cephalometric analysis. The craniofacial morphology of all groups of CLP patients differed from that of the control groups. On average, more markedly impaired growth was observed in the older age group. Moderate retrognathic maxilla and slight mandible, a coronal skeletal excess, and a remarkable retrusion of the upper and lower anterior teeth were characteristic. Horizontal restriction of width could only be identified in the region of maxillary canines. CLP patients who had no bone grafting showed that the craniofacial developmental impairment was reasonably slight compared to patients without CLP, although it became more pronounced in the older age groups.