Christian Hirsch

The LIFE child study: a life course approach to disease and health

BackgroundProfound knowledge about child growth, development, health, and disease in contemporary children and adolescents is still rare. Epidemiological studies together with new powerful research technologies present exciting opportunities to the elucidation of risk factor-outcome associations with potentially major consequences for prevention, diagnosis and treatment.AimTo conduct a unique prospective longitudinal cohort study in order to assess how environmental, metabolic and genetic factors affect growth, development and health from fetal life to adulthood.MethodsThe ‘Leipzig Research Centre for Civilization Diseases (LIFE) Child Study’ focuses on two main research objectives: (1) monitoring of normal growth, development and health; (2) non-communicable diseases such as childhood obesity and its co-morbidities, atopy and mental health problems. Detailed assessments will be conducted alongside long-term storage of biological samples in 2,000 pregnant women and more than 10,000 children and their families.ResultsClose coordination and engagement of a multidisciplinary team in the LIFE Child study successfully established procedures and systems for balancing many competing study and ethical needs. Full participant recruitment and complete data collection started in July 2011. Early data indicate a high acceptance rate of the study program, successful recruitment strategies and the establishment of a representative cohort for the population of Leipzig. A series of subprojects are ongoing, and analyses and publications are on their way.DiscussionThis paper addresses key elements in the design and implementation of the new prospective longitudinal cohort study LIFE Child. Given the recognized need for long-term data on adverse effects on health and protective factors, our study data collection should provide magnificent opportunities to examine complex interactions that govern the emergence of non-communicable diseases.

Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.

The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.

Temporomandibular disorders in German and Chinese adolescents.

Objective:The etiology of temporomandibular disorders (TMD) remains unclear. The aim of this study was, by comparing the prevalence of TMD between adolescents of different ethnic origin, to examine whether certain genetic factors may play a role in causing TMD.Subjects and Methods:We assessed the prevalence of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in 1,058 subjects (561 German, 497 Chinese) aged 13 to 18 years from two general population samples.Results:In total, the prevalence of RDC/TMD diagnoses was 13.9% (N = 147). The difference between German (13.0%, N = 73) and Chinese adolescents (14.9%, N = 74) was not statistically significant. After controlling for the effects of age, gender and orthodontic treatment using multivariable logistic regression analyses, the prevalence of RDC/TMD group II diagnoses (disc displacement) was lower in China than Germany (odds ratio [OR] = 0.5, 95% confidence interval [CI]: 0.3–0.8), whereas the prevalence of RDC/TMD pain diagnoses (group I, III) was higher in China (OR = 3.3, 95%-CI: 1.7–6.5).Conclusions:Our study reveals obvious differences in the prevalence of TMD between adolescents of different ethnic origins (Asians and Europeans). These differences cannot be attributed to cultural differences alone, which implies the involvement of genetic factors in the etiology of TMD.ZusammenfassungZiel:Die Ätiopathogenese kraniomandibulärer Dysfunktionen (CMD) ist trotz intensiver Forschung im Detail noch immer weitgehend unklar. Das Ziel der vorliegenden Studie war, mit einem Vergleich der CMD-Prävalenz bei Jugendlichen verschiedener ethnischer Gruppen zu eruieren, ob genetische Faktoren als Ursache für CMD mit in Betracht gezogen werden müssen.Probanden und Methodik:Für den interkulturellen Vergleich der CMD-Prävalenz wurden zufällig ausgewählte Probanden zweier repräsentativer Stichproben in Deutschland (N = 561) und China (N = 497) im Alter von 13 bis 18 Jahren auf das Vorkommen von CMD nach den „Research Diagnostic Criteria for Temporomandibular Disorders“ (RDC/TMD) untersucht.Ergebnisse:Von den insgesamt 1058 Probanden wiesen 13,9% (N = 147) eine CMD-Diagnose auf. Dabei war der Unterschied in der CMD-Prävalenz (alle Diagnosegruppen zusammen) zwischen Deutschland (13,0%, N = 73) und China (14,9%, N = 74) statistisch nicht signifikant. Bei der Analyse in den diagnostischen Subgruppen mittels multivariabler logistischer Regression unter Kontrolle der Effekte von Alter, Geschlecht und kieferorthopädischer Behandlung zeigte sich, dass bei Jugendlichen in China im Vergleich zu Deutschland signifikant weniger Diskusverlagerungen im Kiefergelenk (Odds Ratio [OR] = 0,5; 95%-Konfidenzintervall [KI]: 0,3–0,8), jedoch mehr CMD-Schmerzdiagnosen (OR = 3,3; 95%-KI: 1,7–6,5) zu finden waren.Schlussfolgerungen:Die Studie weist eindeutig Unterschiede in der CMD-Prävalenz bei Jugendlichen verschiedener ethnischer Gruppen (hier Asiaten und Europäer) auf. Da diese nicht allein durch kulturell bedingte Unterschiede erklärt werden können, muss zumindest von einer Beteiligung genetischer Faktoren an der CMD-Ätiopathogenese ausgegangen werden.

What is known about the influence of dentine hypersensitivity on oral health-related quality of life?

ObjectivesOral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient’s perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient’s quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS.Material and methodsA PubMed literature research was conducted using the terms (“dentin sensitivity” [MeSH Terms] OR (“dentin” [All Fields] AND “sensitivity” [All Fields]) OR “dentin sensitivity” [All Fields]) AND ((“oral health” [MeSH Terms] OR (“oral” [All Fields] AND “health” [All Fields]) OR “oral health” [All Fields]) AND related [All Fields] AND (“quality of life” [MeSH Terms] OR (“quality” [All Fields] AND “life” [All Fields]) OR “quality of life” [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review.ResultsThe combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS.ConclusionsPatients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research.Clinical relevanceOral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients’ OHRQoL.

Live Helicobacter pylori in the root canal of endodontic-infected deciduous teeth

BackgroundMany polymerase chain reaction (PCR)-based studies have shown that Helicobacter pylori DNA is prevalent in the oral cavity, but reports on the isolation of live bacteria are extremely rare. Thus, it is still unclear whether H. pylori can indeed survive in the oral environment.MethodsHere we used electron microscopy, selective growth techniques, urease assays, 16S rRNA PCR, and western blotting to investigate the possible presence of live H. pylori in 10 root canal and corresponding plaque samples of endodontic-infected deciduous teeth in three children.ResultsAlthough H. pylori DNA was verifiable by PCR in several plaque and root canal samples, bacterial colonies could only be grown from two root canals, but not from plaque. These colonies were unequivocally identified as H. pylori by microscopic, genetic, and biochemical approaches.ConclusionsOur findings show that root canals of endodontic-infected teeth may be a reservoir for live H. pylori that could serve as a potential source for transmission.

The LIFE Child study: a population-based perinatal and pediatric cohort in Germany

The LIFE Child study is a large population-based longitudinal childhood cohort study conducted in the city of Leipzig, Germany. As a part of LIFE, a research project conducted at the Leipzig Research Center for Civilization Diseases, it aims to monitor healthy child development from birth to adulthood and to understand the development of lifestyle diseases such as obesity. The study consists of three interrelated cohorts; the birth cohort, the health cohort, and the obesity cohort. Depending on age and cohort, the comprehensive study program comprises different medical, psychological, and sociodemographic assessments as well as the collection of biological samples. Optimal data acquisition, process management, and data analysis are guaranteed by a professional team of physicians, certified study assistants, quality managers, scientists and statisticians. Due to the high popularity of the study, more than 3000 children have already participated until the end of 2015, and two-thirds of them participate continuously. The large quantity of acquired data allows LIFE Child to gain profound knowledge on the development of children growing up in the twenty-first century. This article reports the number of available and analyzable data and demonstrates the high relevance and potential of the study.

No Increased Risk of Temporomandibular Disorders and Bruxism in Children and Adolescents during Orthodontic Therapy

Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. The issue is highly relevant to public health due to the frequency of these functional disorders in the general population and the sheer number of orthodontic treatments. The aim of this cross-sectional study was to investigate the risk of TMD or bruxism in children and adolescents during orthodontic therapy. The study included 1,011 children and adolescents between the ages of 10 and 18 selected at random from the general public who had been examined for signs of TMD using the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Parafunctional activities (bruxism) were surveyed and documented in reference to wear effects on the front teeth using the method developed by Egermark-Eriksson. In addition, probands were asked about their current orthodontic treatments. Nearly 30% (N = 296) of the probands stated that they were undergoing orthodontic therapy. Roughly 1/10 proband presented with a clinical TMD according to the Helkimo index (9.6%; N = 97) or a TMD diagnosis according to the RDC/TMD (10.2%; N = 102). After controlling for the effects of age, gender and school-type using a multinomial logistical regression analysis there was no increased risk of anamnestic or clinical TMD symptoms or diagnoses during orthodontic treatment (odds ratios between 0.63 and 1.18; all p-values > 0.05). At the same time, both wear facets on the front teeth (tooth-related mean value with vs. without appliance: 0.12 vs. 0.16; t test: p = 0.038) and self-reported bruxing be havior (OR = 0.57; p = 0.018) were significantly reduced by orthodontic treatment. Our study revealed no increased risk of TMD in children and adolescents during orthodontic therapy, which seems to reduce parafunctional activities and thus the likelihood of noncarious dental damage. Die Frage, ob die kieferorthopädische Therapie einen Risikofaktor für kraniomandibuläre Dysfunktionen (CMD) oder Parafunktionen wie Bruxismus darstellt, wird schon seit langem diskutiert. Die Fragestellung besitzt wegen der Häufigkeit dieser Funktionsstörungen in der Bevölkerung sowie der Vielzahl an kieferorthopädischen Behandlungen eine hohe Public-Health-Relevanz. Ziel der Querschnittsstudie war, das Risiko für CMD bzw. Bruxismus bei Kindern und Jugendlichen während der kieferorthopädischen Therapie zu untersuchen. Es wurden 1011 zufällig ausgewählte Kinder und Jugendliche im Alter von 10 bis 18 Jahren aus der Allgemeinbevölkerung auf das Vorkommen von CMD nach dem Helkimo-Index sowie den Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) untersucht. Parafunktionelle Aktivitäten (Bruxismus) wurden erfragt bzw. anhand von Schliff-Facetten an den Frontzähnen nach der Methode von Egermark-Eriksson erfasst. Zusätzlich wurden die Probanden nach gegenwärtigen kieferorthopädischen Behandlungen befragt. Knapp 30% (N = 296) der Probanden gaben an, sich derzeit in kieferorthopädischer Therapie zu befinden. Etwa jeder zehnte Proband wies eine klinische CMD nach dem Helkimo-Index (9,6%; N = 97) bzw. eine CMD-Diagnose nach den RDC/TMD auf (10,2%; N = 102). Nach Kontrolle der Effekte von Alter, Geschlecht und Schulform mittels multinomialer logistischer Regressionsanalyse ergab sich weder für anamnestische noch klinische CMD-Symptome bzw. -Diagnosen ein erhöhtes Risiko während der kieferorthopädischen Behandlung (Odds-Ratios zwischen 0,63 und 1,18; alle p-Werte > 0,05). Gleichzeitig waren sowohl Schliff-Facetten an den Frontzähnen (zahnbezogener Mittelwert mit vs. ohne Apparatur: 0,12 vs. 0,16; t-Test: p = 0,038) als auch subjektiv angegebene Bruxismusaktivitäten (OR = 0,57; p = 0,018) durch die kieferorthopädische Behandlung signifikant verringert. Die Studie ergab kein erhöhtes Risiko für CMD bei Kindern und Jugendlichen während der kieferorthopädischen Therapie. Gleichzeitig reduziert diese offenbar parafunktionelle Aktivitäten und damit die Gefahr von nichtkariösen Zahnschäden.Background and Objective:Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. The issue is highly relevant to public health due to the frequency of these functional disorders in the general population and the sheer number of orthodontic treatments. The aim of this cross-sectional study was to investigate the risk of TMD or bruxism in children and adolescents during orthodontic therapy.Probands and Methods:The study included 1,011 children and adolescents between the ages of 10 and 18 selected at random from the general public who had been examined for signs of TMD using the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Parafunctional activities (bruxism) were surveyed and documented in reference to wear effects on the front teeth using the method developed by Egermark-Eriksson. In addition, probands were asked about their current orthodontic treatments.Results:Nearly 30% (N = 296) of the probands stated that they were undergoing orthodontic therapy. Roughly 1/10 proband presented with a clinical TMD according to the Helkimo index (9.6%; N = 97) or a TMD diagnosis according to the RDC/TMD (10.2%; N = 102). After controlling for the effects of age, gender and school-type using a multinomial logistical regression analysis there was no increased risk of anamnestic or clinical TMD symptoms or diagnoses during orthodontic treatment (odds ratios between 0.63 and 1.18; all p-values > 0.05). At the same time, both wear facets on the front teeth (tooth-related mean value with vs. without appliance: 0.12 vs. 0.16; t test: p = 0.038) and self-reported bruxing be havior (OR = 0.57; p = 0.018) were significantly reduced by orthodontic treatment.Conclusion:Our study revealed no increased risk of TMD in children and adolescents during orthodontic therapy, which seems to reduce parafunctional activities and thus the likelihood of noncarious dental damage.ZusammenfassungHintergrund und Ziel:Die Frage, ob die kieferorthopädische Therapie einen Risikofaktor für kraniomandibuläre Dysfunktionen (CMD) oder Parafunktionen wie Bruxismus darstellt, wird schon seit langem diskutiert. Die Fragestellung besitzt wegen der Häufigkeit dieser Funktionsstörungen in der Bevölkerung sowie der Vielzahl an kieferorthopädischen Behandlungen eine hohe Public-Health-Relevanz. Ziel der Querschnittsstudie war, das Risiko für CMD bzw. Bruxismus bei Kindern und Jugendlichen während der kieferorthopädischen Therapie zu untersuchen.Probanden und Methodik:Es wurden 1011 zufällig ausgewählte Kinder und Jugendliche im Alter von 10 bis 18 Jahren aus der Allgemeinbevölkerung auf das Vorkommen von CMD nach dem Helkimo-Index sowie den Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) untersucht. Parafunktionelle Aktivitäten (Bruxismus) wurden erfragt bzw. anhand von Schliff-Facetten an den Frontzähnen nach der Methode von Egermark-Eriksson erfasst. Zusätzlich wurden die Probanden nach gegenwärtigen kieferorthopädischen Behandlungen befragt.Ergebnisse:Knapp 30% (N = 296) der Probanden gaben an, sich derzeit in kieferorthopädischer Therapie zu befinden. Etwa jeder zehnte Proband wies eine klinische CMD nach dem Helkimo-Index (9,6%; N = 97) bzw. eine CMD-Diagnose nach den RDC/TMD auf (10,2%; N = 102). Nach Kontrolle der Effekte von Alter, Geschlecht und Schulform mittels multinomialer logistischer Regressionsanalyse ergab sich weder für anamnestische noch klinische CMD-Symptome bzw. -Diagnosen ein erhöhtes Risiko während der kieferorthopädischen Behandlung (Odds-Ratios zwischen 0,63 und 1,18; alle p-Werte > 0,05). Gleichzeitig waren sowohl Schliff-Facetten an den Frontzähnen (zahnbezogener Mittelwert mit vs. ohne Apparatur: 0,12 vs. 0,16; t-Test: p = 0,038) als auch subjektiv angegebene Bruxismusaktivitäten (OR = 0,57; p = 0,018) durch die kieferorthopädische Behandlung signifikant verringert.Schlussfolgerung:Die Studie ergab kein erhöhtes Risiko für CMD bei Kindern und Jugendlichen während der kieferorthopädischen Therapie. Gleichzeitig reduziert diese offenbar parafunktionelle Aktivitäten und damit die Gefahr von nichtkariösen Zahnschäden.

Frequency of orthodontic treatment in German children and adolescents: influence of age, gender, and socio-economic status

Orthodontic treatment is a common dental procedure in developed countries. However, the frequency and factors associated with treatment demand are different between countries. The aim of this study was to examine the frequency of orthodontic treatment in German children and adolescents and to analyse the influence of age, gender, and socio-economic status (SES; education and region) on the frequency of treatment. Subjects in a random population sample of 1538 German children and adolescents, aged 11-14 years, were interviewed at home in the autumn of 2008 regarding current orthodontic treatment and associated factors. Approximately one-third (33.5 per cent) of the subjects interviewed were undergoing orthodontic treatment at that time. In a multivariable logistic regression model, the likelihood of receiving orthodontic treatment was higher for girls [odds ratio (OR) = 1.32, 95 per cent confidence interval (CI): 1.06-1.65], for high school pupils (OR = 1.19, 95 per cent CI: 1.06-1.34), and for children and adolescents living in the western part of Germany (OR = 1.45, 95 per cent CI: 1.00-2.08) and increased with age (OR = 1.13 per year, 95 per cent CI: 1.02-1.25). Subjects undergoing orthodontic treatment more often received prophylactic measures (OR = 2.06, 95 per cent CI: 1.63-2.59) compared with those not currently receiving orthodontic treatment. The frequency of orthodontic treatment in Germany largely depends on gender and SES.

[An abbreviated version of RDC/TMD].

BACKGROUND The aim of this study was to develop a short diagnostic test for pain-related craniomandibular disorders (CMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). MATERIAL AND METHOD Participants included 1,177 CMD patients and 896 general population subjects who were examined according to the RDC/TMD. This new diagnostic short test consisted of a combination of the least amount of RDC/TMD items that distinguished between patients and subjects with a sensitivity of > or =70% and a specificity of > or =90%. The diagnostic test items were selected from all available RDC/TMD items using best subset logistic regression. RESULTS The question about the presence of facial pain achieved a sensitivity of 96% and a specificity of 95%. The lower limits of the confidence interval for test accuracy measures exceeded the postulated thresholds specified for test development. Assuming a CMD pain prevalence of 10% in the general population this short test resulted in a positive predictive value of 80% and a negative predictive value of >99%. CONCLUSION A single question about facial pain is a strong predictor for a pain-related CMD disorder and could provide an effective CMD short test.

Dental caries in the primary dentition of german children with cleft lip, alveolus, and palate.

Objective The purpose of this cross-sectional study was to assess the prevalence of dental caries in children with cleft lip, alveolus, and/or cleft palate living in central Germany between 1996 and 2010. Participants A total of 295 children 1 to 6 years of age from three birth cohorts (BC) with clefts from central Germany were included in the study. They were compared with 548 1- to 6-year-old cleft-free children from the same region. Setting Children with clefts underwent a dental examination in an outpatient dental clinic at the University of Leipzig. The first BC was examined between 1996 and 1998, the second between 2002 and 2004, and the third between 2008 and 2010. Controls were examined at day-care centers in Leipzig during the same periods. Main Outcome Measure The standard dental caries index for the primary dentition (dmf/t3-4) was used for clinical assessment. Results Over the entire study period, the mean prevalence of dental caries in deciduous teeth was significantly higher (1.32 dmf/t3-4) in children with clefts compared with cleft-free children. However, a decline in caries (approximately 1 dmf/t3-4) and an increase in the proportion of children with healthy primary dentition were observed in both groups. These results represent a caries decline of 61% in children with clefts. Conclusions Caries rates for children 1 to 6 years of age with clefts from central Germany showed a considerable decline over the last years. The caries rates for clefts patients in the third BC (2008 to 2010) was similar to that of cleft-free children in the first BC (1996 to 1998).