Associations of early childhood medication exposure and molar incisor hypomineralization (MIH): A routine data analysis.

OBJECTIVES: Molar incisor hypomineralization (MIH) has become a major oral health problem of widely unknown origin. Besides genetic predisposition, exposure to certain drugs in early childhood are suspected to be associated with MIH. Aim of this routine data analysis was to examine associations of MIH and exposure to medication as well as perinatal factors. METHODS: Individuals with MIH were identified in claims data using a validated predefined specific treatment pattern. The database was a comprehensive routine data set of a major national health insurance company (BARMER, Germany). Based on this treatment pattern a MIH group and an unaffected control group were formed for analysis. Various medical data including medical diagnoses and prescriptions were available. Associations were examined comparing results for a set of variables in both groups. Differences between the groups were tested for significance using T-tests (P<0.01). RESULTS: Between 2010 to 2019, a total of 298,502 children between 6 and 9 years of age were included in this analysis. 22,947 were assigned to the MIH group. For individuals in this group, significantly larger prescription quantities in the main ATC (Anatomical, Therapeutic, Chemical) groups J (antiinfectives for systemic use), R (respiratory system) and S (sensory organs) were found in the first 4 years of life compared to MIH unaffected individuals. With antibiotics, there were both significantly larger prescription quantities and significantly higher numbers of respective prescriptions in the first 4 years of life. The differences amounted up to about 10.62% in frequently used antibiotics to be found in ATC J01D (other beta-lactam antibacterials) for the number of prescriptions in the 4th year of life. No association was found for premature birth, mode of delivery or the use of antipyretic or anti-inflammatory medication. CONCLUSIONS: While perinatal factors do not seem to be associated with MIH development, early life exposure to antibiotics might play a role. CLINICAL SIGNIFICANCE STATEMENT: Although causal relations can still not be proven, a responsible use of the unquestionably beneficial antibiotics is encouraged from a clinical point of view.

Tooth loss in periodontally treated patients: A registry- and observation-based analysis.

AIM: According to retrospective clinical studies, periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking. MATERIALS AND METHODS: We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER-MV; sub-sample of the Federal State of Mecklenburg-Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP-TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss (YTL) estimates and incidence rates were evaluated. RESULTS: For moderately to severely affected groups, YTL and incidence rates were higher in BARMER-MV patients (0.35 and 0.18, respectively) than in untreated SHIP-TREND controls (0.19 and 0.08, respectively). In line, treated SHIP-TREND participants exhibited higher YTL rates than untreated SHIP-TREND controls (0.26 vs. 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding the beneficial effects of periodontal treatment conducted either in the university (GANI_MED data) or in the general practice. CONCLUSION: Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short- to mid-term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, the future will show whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long-term tooth retainment.

Performance of fixed dental prostheses up to 6 years-A massive data analysis.

STATEMENT OF PROBLEM: Metal and metal-ceramic fixed dental prostheses (FDPs) have been clinically determined to provide long-term durable restorations. However, data on their performance under practice conditions are sparse. PURPOSE: The purpose of this clinical study was to evaluate the longevity of FDPs under practice conditions by analyzing a large insurance claims database. MATERIAL AND METHODS: Data were extracted from the data warehouse of a major German national health insurance company (BARMER). The analysis focused on the FDP types with the lowest deductibles in the insurance system. All metal-based FDPs replacing up to 3 adjacent teeth were included. Ceramic veneering was optional and only approved on the labial surfaces of maxillary teeth mesial to the first molar and mandibular teeth mesial to the second premolar. Fee codes allowed clinical courses to be traced on a day count basis. Three groups with FDPs replacing 1 tooth, 2 teeth, and 3 teeth were formed. Kaplan-Meier survival analyses were conducted for the target events removal or extraction, indicating FDP failure and extraction of an abutment tooth. RESULTS: The sample comprised 124 660 FDPs that replaced 1 tooth (76.5%), 2 teeth (19.8%), or 3 teeth (3.7%). The cumulative survival rates for removal or extraction at 6 years differed significantly, with 83.0% for 1-pontic FDPs, 78.1% for 2-pontic FDPs, and 74.0% for 3-pontic FDPs. Thus, approximately 1 of 6 one-pontic FDPs, 1 of 5 two-pontic FDPs, and 1 of 4 three-pontic FDPs failed. The cumulative survival rates for extraction of an abutment tooth at 6 years showed no significant difference, with 96.0% for 1-pontic FDPs, 95.6% for 2-pontic FDPs, and 95.1% for 3-pontic FDPs. CONCLUSIONS: The survival rates of FDPs according to insurance data were lower than those reported by clinical studies, indicating a gap between efficacy and effectiveness.

Routine Data Analyses for Estimating the Caries Treatment Experience of Children.

Oral health surveys are considered the gold standard for assessing the caries experience of children. Analyses of routine data offer additional opportunities not yet fully explored. This study aimed at estimating the caries treatment experience by mining an insurance claims database. Comprehensive claims data sets were extracted from the data warehouse of a major health insurance company (BARMER, Germany). A surrogate variable for caries experience was formed that reflected the proportion of children without any former potentially caries-related treatment (filling, root canal treatment, and extraction) at ages from 1 to 14 years. The statistical calculations were based on Kaplan-Meier survival analyses. The evaluation for the permanent dentition comprised N = 593,330 children at 6 years and N = 114,568 at 12 years. At 12 years of age, 66.8% had not yet experienced potentially caries-related treatments. This value hints at a significantly higher caries experience at 12 years compared to available epidemiological data. For the deciduous dentition, the respective rates were 74.0% at 6 years and 45.8% at 10 years. Although various sources of bias have to be taken into account, the potential of routine data mining is evident. The approach is supplemental to oral health surveys. It can be useful in coming closer to reality when estimating the caries experience of children. From our results, we conclude that the oral health of up to 14-year-olds in Germany remains in urgent need of improvement.

Massive data analyses show negative impact of type 1 and 2 diabetes on the outcome of periodontal treatment.

OBJECTIVES: The aim was to evaluate the impact of diabetes on the outcome of periodontal treatment based on massive data analyses. MATERIALS AND METHODS: Data originated from the database of a major German National Health Insurance. Patients who underwent periodontal treatment were allocated to four groups according to their medical condition: type 1 diabetes (D1), type 2 diabetes with the intake of oral anti-diabetics (D2M), type 2 diabetes without the intake of oral anti-diabetics (D2), and a control group without diabetes (ND). Four-year Kaplan-Meier survival analyses on the patient level and multivariate regression analyses were conducted for tooth extraction. RESULTS: Of 415,718 patients, 4139 matched the criteria for D1, 22,430 for D2M, and 23,576 for D2. At 4 years, the cumulative survival rate (no extraction) was 51.7% in the D1 group, 54.0% in the D2M group, and 57.7% in the D2 group. The ND control group had a significantly higher survival rate of 65.9% (P < 0.0001). In the multivariate analyses, both diabetes types were significantly associated with further tooth loss after periodontal treatment. CONCLUSIONS: The diagnosis of diabetes type 1 or 2 seems to be associated with a higher risk of tooth loss after periodontal treatment. CLINICAL RELEVANCE: The long-term prognosis of teeth in diabetes patients should be judged carefully.

Six-year survival of single crowns - A massive data analysis.

OBJECTIVES: Numerous clinical trials have proven the long-term stability of metal and metal-ceramic crowns. However, data on their performance under practice conditions are rare. PURPOSE: To evaluate the longevity of crowns by means of massive data analyses. METHODS: The data were extracted from the data warehouse of a major German national health insurance company (BARMER, Berlin, Germany). The analysis focused on crown types with the lowest deductibles. Metal crowns and metal-ceramic crowns with ceramic veneering on the vestibular aspects of teeth 15-25 and 34-44 placed from 2012 to 2017 were included. The placement of the crowns, crown removals and tooth extractions were identified using the corresponding fee codes. Kaplan-Meier survival analyses were conducted for the outcomes "crown removal or extraction" and for "extraction". RESULTS: The cumulative six-year survival rates were 88.0 % for the outcome "crown removal or extraction" and 92.5 % for the outcome "extraction" (N = 192,868). The survival functions had slightly steepening but close to linear courses. CONCLUSIONS: The outcome of the treatment with metal and metal-ceramic crowns was moderately inferior in comparison to clinical trials. However, treatment with metal and metal-crowns is judged to be a reliable and safe option under practice conditions. CLINICAL SIGNIFICANCE STATEMENT: Clinicians must inform patients about potential treatment outcomes. Therefore, additional knowledge about single crown outcomes under general practice settings based on large database analyses is important.

Tooth loss after periodontal treatment-Mining an insurance database.

OBJECTIVES: The aim of this study was to evaluate tooth loss after periodontal treatment. METHODS: The data was collected from the digital database of a major German national health insurance company. Periodontal treatment was the intervention in the treatment group. Kaplan-Meier survival analyses on the patient level with the primary outcome extraction were carried out over four years. A control group without treatment was matched and analysed. Differences were tested with the Log-Rank-test. Extraction incidences were calculated over a matched observation period six years before and four years after treatment for both treatment and control group. RESULTS: A total of 415,718 periodontal treatments could be traced. Focussing on the outcome "extraction", the cumulative four-year survival rate was 63.8% after periodontal treatment. The matched control group without periodontal treatment showed a survival rate of 72.5%. These differences were significant (p < 0.0001). The extraction incidence over time was higher in a four-year period after periodontal treatment compared to a six-year period before periodontal treatment. CONCLUSIONS: The outcome of periodontal treatment was acceptable. In about two thirds of the patients, extractions could be completely avoided within a four year period after treatment. CLINICAL SIGNIFICANCE STATEMENT: This study within the German national health insurance system shows that extractions were not observed after periodontal treatment in the majority of cases. Although periodontitis is a chronic disease, patients suffering from periodontitis have a considerable chance to prevent further tooth loss.

Four-year outcomes of restored posterior tooth surfaces-a massive data analysis.

OBJECTIVES: There is only sparse knowledge concerning the outcomes of treatments with posterior permanent restorations in general practice settings. This study aimed at evaluating outcomes based on a large dataset by using a novel approach on a tooth surface basis. MATERIALS AND METHODS: The study based on routine data from a major German national health insurance company. Respective treatment fee codes allowed for tracking the clinical courses on a tooth surface level. The study intervention was defined as the placement of a restoration on an interproximal or occlusal posterior tooth surface regardless of its actual extension and material on which no information was available. All surfaces restored between January 1st, 2010 and December 31st, 2013 were included. Kaplan-Meier survival analyses were conducted to estimate four-year survival. The primary outcome was a restorative re-intervention on the same tooth surface. Separate analyses were performed for the secondary outcomes "crowning" and "extraction". RESULTS: Over ten million interproximal surfaces and eight million occlusal surfaces in nine million posterior teeth had been restored. At 4 years, the cumulative survival rates concerning the primary outcome "re-intervention" for mesial surfaces (81.4%; CI 81.3-81.5%) and distal surfaces (81.2%; CI 81.1-81.2%) differed significantly from those for occlusal surfaces (77.0%; CI 76.9-77.0%). Restored surfaces in premolars showed significantly higher survival rates compared to molars. Four-year survival rates for the secondary outcome "crowning" were 91.9% (CI 91.8-91.9%) for mesial surfaces, 92.1% (CI 92.1-92.2%) for distal surfaces and 93.3% (CI 93.2-93.3%) for occlusal surfaces. The respective rates for the secondary outcome "extraction" were 94.5% (CI 94.5-94.5%) for mesial surfaces, 94.8% (CI 94.7-94.8%) for distal surfaces and 95.4% (CI 95.4-95.5%) for occlusal surfaces. CONCLUSIONS: Re-interventions after restorative treatment play a significant role in general practice settings. Surface-related survival rates of restorations reveal a need for improvement. CLINICAL RELEVANCE: This study allows the estimation of the probability of re-interventions after restoring posterior tooth surfaces. It is based on several million cases from general practises under the terms and conditions of a national health insurance system.

Re-interventions after restoring teeth-Mining an insurance database.

OBJECTIVES: The aim of this study was to examine re-interventions after restorative treatment. METHODS: The data was collected from the digital database of a major German national health insurance company. Only permanent teeth were observed. Placing a permanent restoration other than a crown regardless of involved surfaces and material was the study intervention. The data did not allow for a differentiation between fillings and inlays that were estimated only a very small portion of the restorations. Success was defined as not undergoing any restorative re-intervention with fillings or inlays on the same tooth (primary outcome) and assessed with Kaplan-Meier survival analyses over four years. An additional analysis was conducted rating "crowning" and "extraction" of respective teeth as target events. Differences were tested with the Log-Rank-test. A multivariate Cox regression analyses was carried out. RESULTS: A total of 17,024,344 restorations placed in 4,825,408 anterior teeth and 9,973,177 posterior teeth could be traced. Focussing on the primary outcome re-intervention, the cumulative four-year success rate was 69.9% for one surface restorations, 74.8% for two surface restorations, 66.6% for three surface restorations and 61.0% for four surface and more extended restorations. These differences were significant (p<0.0001). Focussing on all three target events re-intervention, crowning and extraction, the cumulative four-year success rate was 66.1% for one surface restorations, 67.5% for two surface restorations, 63.0% for three surface restorations and 55.8% for four surface and more extended restorations. The number of restoration surfaces as well as the tooth position remained significant in the multivariate Cox regression. CONCLUSIONS: The sustainability of restorative dental treatment under the terms and conditions of the German national health insurance system shows room for improvement. From a public health perspective, special focus should be laid on primary and secondary prevention to minimize the restorative treatment need. CLINICAL SIGNIFICANCE STATEMENT: This study shows that re-interventions are observed regularly after restorative treatment. Therefore, preventive and restorative strategies should be revisited and optimised.

Attentional capture and inhibition of saccades after irrelevant and relevant cues.

Attentional capture is usually stronger for task-relevant than irrelevant stimuli, whereas irrelevant stimuli can trigger equal or even stronger amounts of inhibition than relevant stimuli. Capture and inhibition, however, are typically assessed in separate trials, leaving it open whether or not inhibition of irrelevant stimuli is a consequence of preceding attentional capture by the same stimuli or whether inhibition is the only response to these stimuli. Here, we tested the relationship between capture and inhibition in a setup allowing for estimates of the capture and inhibition based on the very same trials. We recorded saccadic inhibition after relevant and irrelevant stimuli. At the same time, we recorded the N2pc, an event-related potential, reflecting initial capture of attention. We found attentional capture not only for, relevant but importantly also for irrelevant stimuli, although the N2pc was stronger for relevant than irrelevant stimuli. In addition, inhibition of saccades was the same for relevant and irrelevant stimuli. We conclude with a discussion of the mechanisms that are responsible for these effects.

Effects of relevant and irrelevant color singletons on inhibition of return and attentional capture.

We tested whether color singletons lead to saccadic and manual inhibition of return (IOR; i.e., slower responses at cued locations) and whether IOR depended on the relevance of the color singletons. The target display was preceded by a nonpredictive cue display. In three experiments, half of the cues were response-relevant, because participants had to perform a discrimination task at the cued location. With the exception of Experiment 2, none of the cue colors matched the target color. We observed saccadic IOR after color singletons, which was greater for slow than for fast responses. Furthermore, when the relevant cue color matched the target color, we observed attentional capture (i.e., faster responses at cued locations) with rapid responses, but IOR with slower responses, which provides evidence for attentional deallocation. When the cue display was completely response-irrelevant in two additional experiments, we did not find evidence for IOR. Instead, we found attentional capture when the cue color matched the target color. Also, attentional capture was greater for rapid responses and with short cue-target intervals. Thus, IOR emerges when cues are relevant and do not match the target color, whereas attentional capture emerges with relevant and irrelevant cues that match the target color.

Spatial mislocalization as a consequence of sequential coding of stimuli.

In three experiments, we tested whether sequentially coding two visual stimuli can create a spatial misperception of a visual moving stimulus. In Experiment 1, we showed that a spatial misperception, the flash-lag effect, is accompanied by a similar temporal misperception of first perceiving the flash and only then a change of the moving stimulus, when in fact the two events were exactly simultaneous. In Experiment 2, we demonstrated that when the spatial misperception of a flash-lag effect is absent, the temporal misperception is also absent. In Experiment 3, we extended these findings and showed that if the stimulus conditions require coding first a flash and subsequently a nearby moving stimulus, a spatial flash-lag effect is found, with the position of the moving stimulus being misperceived as shifted in the direction of its motion, whereas this spatial misperception is reversed so that the moving stimulus is misperceived as shifted in a direction opposite to its motion when the conditions require coding first the moving stimulus and then the flash. Together, the results demonstrate that sequential coding of two stimuli can lead to a spatial misperception whose direction can be predicted from the order of coding the moving object versus the flash. We propose an attentional sequential-coding explanation for the flash-lag effect and discuss its explanatory power with respect to related illusions (e.g., the Fröhlich effect) and other explanations.