Andreas Gerhard Schulte

Protective effect of amifostine on dental health after radiotherapy of the head and neck

PURPOSE The cytoprotective agent amifostine has been shown to reduce the radiation-induced acute and chronic xerostomia in head and neck cancer patients. The purpose of this study was to evaluate whether or not amifostine also reduces the incidence of dental caries associated with the radiation-induced xerostomia. METHODS AND MATERIALS The dental status before and 1 year after radiotherapy was retrospectively compared in 35 unselected patients treated as part of the prospective randomized and multicenter open-label Phase III study (WR-38) at the University Hospitals of Heidelberg, Freiburg, and Erlangen. The WR-38 study compared radiotherapy in head and neck cancer with and without concomitant administration of amifostine. RESULTS Patient and treatment characteristics (particularly the radiation dose and percentage of parotids included in the treatment volume) were equally distributed between the patients who received (n = 17) or did not receive (n = 18) amifostine. Fifteen patients of the amifostine group showed no deterioration of the dental status 1 year after radiotherapy as compared to 7 patients who did not receive the cytoprotector (p = 0. 015, two-tailed Fisher exact test). CONCLUSION Our data suggest a protective effect of amifostine on the dental health after radiotherapy of the head and neck. The dental status should be used as a primary endpoint in future studies on amifostine.

Association between Caries Experience and Body Mass Index in 12-Year-Old French Children

The prevalence of overweight and obesity reached 19.7% in 12-year-old French children in the year 2005. Recently, nationwide programs have been broadly implemented in France to reduce the overconsumption of sugars, salt and fat. The aims of this study were to assess the distribution of body mass index (BMI) and D3+4MFT index in a sample of 12-year-old French children, and to compare several regression models in order to analyze the association between these two indices. A cross-sectional study was conducted in Montpellier, France, and the height, weight, D3+4MFT, sugar and soft drink consumption were recorded in a randomly selected sample of 835 schoolchildren. In order to analyze the association between BMI and DMFT, four models of regression were tested: logistic, Poisson, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB). The mean BMI was 18.9 for the whole sample and the corresponding DMFT value was 1.47. The caries prevalence was 51.7%. The best fitted models for testing the association between BMI and DMFT were ZIP and ZINB models. They showed a significant association between DMFT and sugar consumption, but not with BMI. As a result of the best fitted models (ZIP and ZINB), where BMI was not statistically associated with DMFT, we conclude, within the limits of a cross-sectional survey, that there is no association between these two variables.

Longevity of cast gold inlays and partial crowns--a retrospective study at a dental school clinic.

Abstract From 1963 to 1993, 890 patients were treated with 3518 cast gold restorations by students and postgraduate dentists. The longevity of these restorations was studied retrospectively using the patient files. Longevity was calculated using the method described by Kaplan and Meier. After the observation period, 111 (3.2%) of the examined restorations were not in place anymore. The most frequent reasons for failure were caries (33.7%), lack of retention (32.7%), endodontic treatment (29.6%), insufficient marginal adaptation (3.1%) and extraction (1%). The cumulative survival rate and a 95% interval of confidence was calculated for all restorations and for each of the locations and surfaces included in the trial. The 10-year survival rate for occlusal inlays was, 76.1% (12.1) for MO inlays 88.3% (4.2), for DO inlays 83.4% (4.6), for MOD inlays 87.5% (2.4), for partial crowns 86.1% (3.3) and 85.7% (1.7) for all restorations. Based on the statistical method used, the cast gold restorations demonstrated satisfactory longevity results.

Prevalence of Molar–Incisor–Hypomineralisation among school children in four German cities

BACKGROUND A wide range for the prevalence of Molar-Incisor-Hypomineralisation (MIH) has been found in regional studies. AIM The aim of this study was to determine the prevalence of MIH in Germany and to compare the findings with other studies. DESIGN In the compulsory dental school examination, the first permanent molars, permanent incisors, and second primary molars were examined according to EAPD criteria in 2395 children (8.1 ± 0.8 years) in four regions in Germany for the presence of MIH. Examinations were performed by five calibrated examiners (κ = 0.9) on clean teeth after toothbrushing. RESULTS The prevalence of MIH at the four regions differed considerably (4.3-14.6%) with a mean prevalence of 10.1%. The DMFT/dmft was generally low, but children with MIH exhibited statistically significant higher caries values. A total of 12.0% of the children with MIH also had at least one affected primary molar, which resulted in a statistically significant correlation between primary and permanent teeth. Most of the affected teeth had demarcated opacities, but more than half of the affected children showed at least one tooth with severe MIH. CONCLUSIONS Molar-Incisor-Hypomineralisation is a prevalent finding in German school children. The prevalence varies highly in different regions, and the high rate of severe forms has clinically relevant implications.

Posteruptive Changes of Electrical Resistance Values in Fissure Enamel of Premolars

In studies about 15–25% of the caries–free teeth proved to have as low electrical resistance values as carious teeth, due probably to incomplete enamel maturation. It was the aim of the present prospective clinical study to investigate, if an increase in electrical resistance values could be observed after the eruption of premolars. The electrical resistance measurements were performed in children who were patients of the Dental School of the University of Marburg, Germany. The first measurement was made when a premolar was erupting or when it had erupted within 12 months before. The electrical resistance measurements were repeated every 3–6 months until the 24th posteruptive month. The measuring device consisted of an AC ohmmeter modified by Gente indicating the real component of the impedance and employing a frequency of 500 Hz and an amplitude of about 1 μA. For erupting teeth a mean resistance value of 17±15 kohm was computed when the contact fluid had been NaCl (A). The corresponding values were 72±51 kohm when distilled water (B) had been applied and 392±374 kohm when the initially saliva–coated teeth had briefly been dried (C). The mean resistance values of the premolars increased continuously from the eruption up to the 15th posteruptive month. This observation was independent of the three modes of measuring that had been used. It is concluded that enamel maturation leads to an increase in electrical resistance. To improve accuracy of caries diagnosis with electrical resistance measurements, the posteruptive age of teeth should be taken into account. In addition, electrical resistance measurements offer the opportunity to observe enamel maturation in vivo noninvasively.

A survey on education in cariology for undergraduate dental students in Europe

The aim of the survey was to collect relevant information about education in cariology for dental undergraduate students in Europe. The ORCA/ADEE cariology curriculum group prepared a questionnaire that was mailed in 2009 to 179 European dental schools. One hundred and twenty-three dental schools (72%) from 32 countries completed and returned the questionnaires. In most of these schools, education in cariology is delivered by at least two different units. The units mainly involved are Paediatric Dentistry, Conservative Dentistry, Restorative Dentistry or Operative Dentistry. Theoretical education in cariology is delivered by practically all responding dental schools, and in 96% of these schools, it starts within the first 3 years. Pre-clinical exercises are offered by 98% of the schools starting mainly in the third or fourth year. In 97% of the schools, clinical exercises are carried out, and this occurs mainly in the fourth and fifth year. In nearly all dental schools (88%), education in cariology comprises not only caries but also dental erosion and non-erosive wear. The vast majority of the responding dental schools (89%) supported the idea of developing a European Core Curriculum in Cariology.

Association of caries experience in 12-year-old children in Heidelberg, Germany, and Montpellier, France, with different caries preventive measures.

UNLABELLED In Germany and France, different approaches to oral health promotion have been chosen. OBJECTIVES It was the aim of the present study to assess whether different preventive measures were positively or negatively associated with caries experience in 12-year-old children in Heidelberg, Germany, and in Montpellier, France. METHODS In the school year 1998/99, 12-year-old children were examined in Heidelberg (n=864) and in Montpellier (n =828). D3+4MFT, D3+4MFS (D3+4=dentinal caries), prevalence of fissure sealants and use of fluorides were recorded. RESULTS The mean D3+4MFT scores of the pupils in Heidelberg and Montpellier were 1.56 and 1.42, the proportion of caries-free children being 43.5% and 46.9%, respectively. In 63.2% of the children in Heidelberg and in 6.8% of the children in Montpellier, at least one fissure sealed tooth was found. Fluoridated salt was used by 38.8% of families of the 12-year-olds from Heidelberg and the corresponding value was 73.3% in Montpellier. Topical fluorides were applied by 39.9% of the children in Heidelberg, but only by 5.4% of pupils in Montpellier. Multiple regression analysis revealed that, in Heidelberg, fissure sealants and the combination of topical fluorides and fluoridated salt were negatively associated with the D3+4MFT values, while in Montpellier the frequency of dental visits was positively associated with the D3+4MFT scores. CONCLUSION A further decrease in the caries experience of 12-year-old children may well be obtainable by enlarging the share of marketed fluoridated salt in Heidelberg, by increasing the application of fissure sealants in Montpellier, and by extending the use of topical fluorides in both cities.

European core curriculum in cariology for undergraduate dental students

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North-South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.

Caries prevalence in 11- to 14-year old migrant children in Germany

SummaryObjectives:To assess whether immigration stage is associated with higher prevalence of dental caries among schoolchildren in Heidelberg, Germany.Methods:A cross-sectional dental examination on 570 schoolchildren, aged 11 to 14 years, in schools with high proportions of immigrant pupils (49.5%) was performed. Carious, missing and filled permanent teeth were recorded for each child, so that mean DMFT values could be calculated. The pupils were classified into three groups: M0 (children and their parents were born in Germany), M1 (children who were born in Germany but whose parents were born outside of Germany), and M2 (children and their parents were born outside of Germany).Results:The mean DMFT values in M1 and M2 were close, and both were significantly higher than the corresponding values in M0. The proportions of caries-free children in M0, M1 and M2 were 63.7%, 40.3% and 42.3%, respectively.Conclusion:In Germany, migrant children have a poorer dental health status than native children coming from the same low socio-economic classes. Risk-oriented public health policies with appropriate prevention programs must be developed for these children.

Relationship between caries prevalence and fissure sealants among 12-year-old German children at three educational strata

SummaryObjectives:To investigate the relationship between caries prevalence and fissure sealants among 12-year-old German children at three educational levels. Methods:In 1998 a cross-sectional investigation which comprised 60 % of the 12-year-old children was performed in Heidelberg, Germany. The children attended three types of schools: Gymnasium, Hauptschule, and Realschule. The children received a dental examination. Teeth with caries experience were recorded according to WHO criteria, and teeth with a fissure sealant were also noted. Results:The mean number of fissure sealed teeth per child was 2.49 (Gymnasium), 2.31 (Realschule) and 1.17 (Hauptschule). In children who attended a Gymnasium the mean DMFT scores were the lowest (0.87 in children with fissure sealant and 1.31 in children without fissure sealant). The corresponding values for children who attended a Realschule were distinctly higher. The highest mean DMFT scores (2.14 and 3.48, resp.) were observed in children who attended a Hauptschule. The proportion of caries-free children was higher in all three types of school when fissure sealants were present. Conclusions:In spite of a high prevalence of fissure sealants there is an unequal caries experience among 12-year-old children from different educational strata. To improve this situation, persons important to promotion of dental health should do all their part to ensure that fissure sealants are applied to permanent teeth as early as possible, especially when children have caries experience in their primary dentition.