Christian H. Splieth

New regression equations for predicting the size of unerupted canines and premolars in a contemporary population.

The determination of a tooth-size to arch-length discrepancy in the mixed dentition requires an accurate prediction of the mesiodistal widths of the unerupted permanent teeth. This is an essential factor in treatment planning. The aim of this study was to validate Tanaka and Johnstons analysis on 600 Syrian patients aged 14-22 years. Tanaka and Johnstons tables, equations, and approximations were modified in order to improve the accuracy of the prediction. The correlation coefficients found between the size of the permanent mandibular central incisors and maxillary first molars (31, 41, 16, and 26) and the maxillary and mandibular canines and premolars were high (r = .72 and .74, respectively). New, more accurate prediction tables applicable at earlier ages, and new regression equations were constructed. In addition, new easier approximations were developed to allow the prediction of the size of the unerupted maxillary canines and premolars by adding 6 mm to the half-widths of teeth 31, 41, 16, and 26. The analogous prediction of the size of the unerupted mandibular canines and premolars was obtained by adding 5.5 mm to the half-widths of same teeth, 31, 41, 16, and 26.

Health-related behaviour, knowledge, attitudes, communication and social status in school children in Eastern Germany

Enhancing health literacy is a keystone in health promotion. Yet, most studies on health literacy are limited to functional literacy levels. Furthermore, little evidence is available from children. Based on Nutbeams outcome model for health promotion, this study aims (i) to elaborate a set of short scales to measure important health literacy domains in children and (ii) to analyse their associations among each other, with health behaviour as an intermediate health outcome, subjective health, social status and gender. The sample comprised 852 school children in fifth grade, aged 9-13 years, in Western Pomerania, Germany. Items were taken from the childs questionnaire to form short scales for health-related knowledge, attitudes, communication and behaviour. The internal consistencies of the communication and attitude scales were 0.73 and 0.57, respectively. Unidimensional scalability of the knowledge and behaviour scales was supported by item response models. Associations between health scales were modest. In regression analyses, social status and gender predicted only health knowledge and communication but not health behaviours, attitudes and self-efficacy. Health knowledge was not associated with any other scale. Our results suggest that targeting one specific component of health literacy in children is likely to exert only small effects on health status and health behaviour.

Modelling lifelong costs of caries with and without fluoride use

Cost-benefit or cost-cost analyses are becoming increasingly important in dentistry. Therefore, the aim of the present study was to evaluate the economic consequences of caries prevention with fluorides. German epidemiological data were used in a system dynamics model to assess the lifelong costs of caries in a population. Without fluoride prevention, lifelong treatment for caries resulted in mean costs of 6,976 euro and a present value of 932 euro per person (5% discounting). In different scenarios of constant, increasing, or decreasing caries-controlling effects, and of limited (age 6-18 yr) or lifelong application, the combination of fluoride salt, fluoride toothpaste, and fluoride gel were most cost-effective. They reduced the costs for caries treatment and prophylaxis to 482, euro or to a present value of 148 euro (5% discounting), when applied from age 6-18 yr, and to 211-213 euro for lifelong use (present value, 5% discounting). In conclusion, a lifelong model of costs of caries demonstrates that the use of fluorides in caries prevention is highly cost-effective.

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.

Standardizing Interarch Tooth-Size Harmony in a Syrian Population

The Bolton analysis is considered to be a good indicator for evaluating the degree of intermaxillary tooth-size harmony, but the possibility of ethnic variation of these values should be examined. Thus, the aim of this study was to calculate both the anterior and overall ratios of mandibular and maxillary tooth sizes for a Syrian sample of harmonious permanent dentitions and to compare these ratios with the data from the Bolton and the Michigan studies. In plaster models of 55 Syrian patients (11-22 years) with neutral occlusion (Angle Class I), harmonious overjet and overbite, no reduction of mesiodistal tooth width or missing teeth, the mesiodistal widths of each tooth from the incisors to the first permanent molars were measured in both arches. In the statistical data analysis, the anterior and overall ratios were calculated according to Bolton. The results for the anterior ratio (78.99 +/- 2.18) and the overall ratio (92.26 +/- 2.06) showed no statistically significant differences by sex (P > .48). These values and the degree of variation were similar to the original data by Bolton. Both studies differed considerably from the values of the anterior ratio found in the Michigan University study, which also shows a higher degree of variability. Nevertheless, the overall ratios of all three studies were very similar. Therefore, the interarch tooth-size analysis and values for a harmonious dentition developed by Bolton can also be transferred to an Arabian or at least a Syrian population.

Clinical applicability of resin infiltration for proximal caries.

OBJECTIVE Resin infiltration is a new microinvasive treatment to arrest the progress of proximal initial caries lesions. This study evaluated the clinical applicability of proximal caries infiltration. METHOD AND MATERIALS In the study population of 50 children, adolescents, and young adults (mean age, 17.3 ± 6.4 years), 10 dentists at the University of Greifswald, Greifswald, Germany, applied the infiltration material Icon on noncavitated proximal lesions in permanent and primary teeth as described by the manufacturer. The applicability was evaluated using two questionnaires filled out by clinicians and patients assessing the comfort, complexity, time, and difficulties of the application in comparison to a filling. RESULTS The results showed good patient satisfaction with the procedure. The mean time for infiltration (24.3 ± 7.4 minutes), which included rubber dam application (7.7 ± 4 minutes) and the effort were perceived to be comparable to or even easier than a composite filling by clinicians. In three patients (6%), it was not possible to gain sufficient proximal space for the application of an infiltration. The location of the infiltrated tooth, separation problems, and the routine of clinicians with the infiltration technique had an effect on the duration of the infiltration. A clear learning curve with a reduction of treatment time for subsequent treatments was observed (P < .001). CONCLUSION Resin infiltration of initial noncavitated proximal lesion showed good clinical applicability for clinicians and very high acceptance by patients.

Activities of lysozyme and salivary peroxidase in unstimulated whole saliva in relation to plaque and gingivitis scores in healthy young males.

Abstract The purpose of the present investigation was to study the suitability of the salivary activity of lysozyme and salivary peroxidase for monitoring the inflammatory state of the gingiva. Salivary peroxidase and lysozyme activities in resting whole saliva were measured in a group of 140 male subjects (aged 18–30 years). A full mouth, clinical assessment of the plaque index (PI) and the sulcus bleeding index (SBI) was made and gingival crevicular fluid (GCF) flow was measured at teeth 16, 12, 24, 36, 32 and 44 with the Periotron 6000. There were no significant differences in the mean values of lysozyme and salivary peroxidase activities between groups with different PI, SBI and GCF flow values. Statistically significant correlations were found among the clinical parameters, with SBI and PI showing the strongest relation (r=0.47). The correlation between GCF flow and PI was higher (r=0.43) than the correlation between GCF flow and SBI (r=0.20). However, there were no statistically significant correlations between the activities of salivary peroxide and lysozyme and the clinical measures of gingival health.

Inequalities in dental caries experience among 6-year-old German children after the caries decline.

Abstract Objective. As in many other countries, caries decline in Germany has left pockets of persisting caries prevalence. This study aims to assess the benefit of a 10-year community-based prophylaxis program, focused on regular toothbrushing with fluoridated toothpastes or gels and involving institutions noted as having the highest caries levels. Materials and methods. The caries data (d3mft/D3MFT) was extracted from the results of the compulsory school entry examinations in Greifswald/Germany (2003/2004–2012/2013) involving ∼ 280 6–7-year-olds each year. Data from schools that include children with the highest caries levels and coming from low-SES families were analyzed independently and used for comparisons. Additionally, caries trends from Greifswald were compared to data from representative national surveys (2004–2009). Results. Data from 2871 children were available for analysis. The baseline d3mft value (2003/2004) was 3.2 ± 3.8; the d3-component corresponded to 70% of the index. The latest caries data (2012/2013) showed a strong reduction (43.8%) in caries prevalence (d3mft = 1.8 ± 2.5). Similarly, the SiC-Index declined significantly from 2003/2004 (7.9 ± 2.3) to 2012/2013 (4.8 ± 2.3; p < 0.001). Nevertheless, in all analyzed years the d3mft values and the SiC-Index were significantly higher in the institutions that included children coming from lower-SES families (p < 0.05). The amount of caries reduction between 2004 and 2009 corresponded to 38% in Greifswald as compared to 13% in Germany. Conclusions. This strategy involving a combination of regular toothbrushing and fluoride application has achieved an overall substantial caries reduction, thereby indicating that caries-control strategies for heterogeneous risk groups can be highly successful as setting approach. However, activities targeting high risk groups still need to be strengthened.

Alternative Caries Management Options for Primary Molars: 2.5-Year Outcomes of a Randomised Clinical Trial

Less invasive caries management techniques for treating cavitated carious primary teeth, which involve the concept of caries control by managing the activity of the biofilm, are becoming common. This study aimed to compare the clinical efficacy (minor/major failures) and survival rates (successful cases without any failures) of 3 carious lesion treatment approaches, the Hall Technique (HT), non-restorative caries treatment (NRCT), and conventional restorations (CR), for the management of occlusoproximal caries lesions (ICDAS 3-5) in primary molars. Results at 2.5 years are presented. A total of 169 children (3- to 8-year-olds) were enrolled in this secondary care-based, 3-arm parallel-group, randomised controlled trial. Participants were allocated to: HT (n = 52; sealing caries with stainless-steel crowns without caries removal), NRCT (n = 52; opening up the cavity and applying fluoride varnish), CR (n = 65; control arm, complete caries removal and compomer restoration). Statistical analyses were: non-parametric Kruskal-Wallis analysis of variance, Mann-Whitney U test and Kaplan-Meier survival analyses. One hundred and forty-two participants (84%; HT = 40/52; NRCT = 44/52; CR = 58/65) had follow-up data of 1-33 months (mean = 26). Overall, 25 (HT = 2, NRCT = 9, CR = 14) of 142 participants (17.6%) presented with at least 1 minor failure (reversible pulpitis, caries progression, or secondary caries; p = 0.013, CI = 0.012-0.018; Mann-Whitney U test). Ten (HT = 1, NRCT = 4, CR = 5) of 142 participants (7.04%) experienced at least 1 major failure (irreversible pulpitis, abscess, unrestorable tooth; p = 0.043, CI = 0.034-0.045). Independent comparisons between 2 samples found that NRCT-CR had no statistically significant difference in failures (p > 0.05), but for CR-HT (p = 0.037, CI = 0.030-0.040) and for NRCT-HT (p = 0.011, CI = 0.010-0.016; Kruskal-Wallis test) significant differences were observed. Cumulative survival rates were HT = 92.5%, NRCT = 70.5%, and CR = 67.2% (p = 0.012). NRCT and CR outcomes were comparable. HT performed better than NRCT and CR for all outcomes. This study was funded by the Paediatric Dentistry Department, Greifswald University, Germany (Trial registration No. NCT01797458).

Overweight and dental caries: the association among German children

OBJECTIVES The aim of this study was to determine the relationship between iso-body mass index (iso-BMI) and both dental caries status and caries increment among German school children. METHODS Six hundred and ninety-four students (age range 9-12 years, mean 10.34 ± 0.56, 48% females) were recruited from the fifth grade of 18 primary schools. Weight, height, and oral health data number of decayed, missing and filled teeth (DMFT) as well as parent/legal guardian questionnaire (measuring SES) were collected during school dental examination at baseline and after one and a half-year follow-up. The body mass index (BMI) was calculated using the international classification system for childhood overweight and obesity (iso-BMI). Statistical analyses were performed using Poisson regression models. RESULTS Iso-BMI was significantly associated with dental caries prevalence and severity in the permanent dentition (P = 0.039). Low-normal weight children had a lower mean DMFT (0.56) than did overweight/obese children (0.70). In addition, a border-line significant association was found between overweight/obese children and caries increment (P = 0.055). CONCLUSION Although iso-BMI was associated with dental caries prevalence and severity, the association between caries increment and iso-BMI did not reach a statistical significance. Overweight/obese children however acquired more additional carious lesions during the follow-up period than children with low-normal weight.