Rainer A. Jordan

Changes in prevalence of periodontitis in two German population‐based studies

AIM We aimed to assess changes of periodontal status in Germany. MATERIALS & METHODS The Studies of Health in Pomerania (SHIP) are two cross-sectional population-based studies conducted during 1997-2001 (SHIP-0, 20-81 years, n = 3736) and 2008-2012 (SHIP-Trend, 20-84 years, n = 3622) in northeast Germany. The German Oral Health Studies (DMS, 35-44 and 65-74 years) are national cross-sectional population-based surveys conducted in 1997 (DMS III, n = 1454) and 2005 (DMS IV, n = 1668), whose results were separately reported for West and East Germany. Prevalences, percentages and numbers of teeth affected were defined. RESULTS In SHIP, prevalence of attachment loss (AL) ≥ 3 mm decreased from 89.7% (95% confidence interval (CI): 88.6-90.8) to 85.1% (95%CI: 83.9-86.3) (p < 0.05) and the mean extent reduced from 62.8% (95%CI: 61.7-63.8) to 55.9% (95%CI: 54.9-56.9) (p < 0.05). Probing depth (PD) ≥ 4 mm and the respective extent remained unchanged. In West Germany, AL ≥ 3 mm decreased for 35-44-year-olds and increased for 65-74-year-olds (p < 0.05). In SHIP and DMS, the number of teeth in dentates increased significantly in all age groups. CONCLUSIONS Prevalences and extents of AL improved almost in all age categories in SHIP and West German adults, whereas PDs remained unchanged. Nonetheless, the improvement of periodontal conditions implies an increase of treatment needs regarding moderately diseased teeth because of simultaneous increases of the number of present teeth.

Cleaning Efficacy and Soft Tissue Trauma After Use of Manual Toothbrushes With Different Bristle Stiffness

BACKGROUND The purpose of this study is to evaluate the efficacy of manual toothbrushes of the same type with different bristle stiffness concerning plaque removal, gingivitis development, and soft tissue trauma. METHODS In a randomized controlled trial, three groups with 40 subjects each used manual toothbrushes with either hard-, medium-, or soft-bristle stiffness. The at-home brushing time was set for 2 minutes, twice a day. Four and 8 weeks after the baseline examination, clinical parameters for plaque removal, gingivitis, and soft tissue damage were recorded again. Recruitment and examinations of the subjects were performed at the Department of Operative and Preventive Dentistry and Endodontics, Heinrich Heine University. A total of 120 volunteers (age range: 18 to 62 years) were recruited and stratified according to sex and age. Primary outcome measures were differences in the Quigley and Hein index (QHI) and papillary bleeding index (PBI) compared to baseline; secondary outcome measures were differences in the modified approximal plaque index (MAPI) and Danser gingival abrasion index. RESULTS The QHI and MAPI showed lower index scores in subjects who used hard-bristled toothbrushes after 8 weeks (P <0.05 and P <0.001, respectively). In contrast, subjects who used toothbrushes with hard bristles demonstrated more gingival lesions (P <0.01) and higher PBI scores after 4 and 8 weeks (P <0.001) compared to subjects who used soft- or medium-bristled toothbrushes. CONCLUSION Manual toothbrushes with hard bristles may better remove plaque, but may also cause more soft tissue trauma compared to brushes with softer bristles.

Fluoride bioavailability in saliva and plaque

BackgroundDifferent fluoride formulations may have different effects on caries prevention. It was the aim of this clinical study to assess the fluoride content, provided by NaF compared to amine fluoride, in saliva and plaque.MethodsEight trained volunteers brushed their teeth in the morning for 3 minutes with either NaF or amine fluoride, and saliva and 3-day-plaque-regrowth was collected at 5 time intervals during 6 hours after tooth brushing. The amount of collected saliva and plaque was measured, and the fluoride content was analysed using a fluoride sensitive electrode. All subjects repeated all study cycles 5 times, and 3 cycles per subject underwent statistical analysis using the Wilcoxon-Mann-Whitney test.ResultsImmediately after brushing the fluoride concentration in saliva increased rapidly and dropped to the baseline level after 360 minutes. No difference was found between NaF and amine fluoride. All plaque fluoride levels were elevated after 30 minutes until 120 minutes after tooth brushing, and decreasing after 360 minutes to baseline. According to the highly individual profile of fluoride in saliva and plaque, both levels of bioavailability correlated for the first 30 minutes, and the fluoride content of saliva and plaque was back to baseline after 6 hours.ConclusionsFluoride levels in saliva and plaque are interindividually highly variable. However, no significant difference in bioavailability between NaF and amine fluoride, in saliva, or in plaque was found.

The Fifth German Oral Health Study (Fünfte Deutsche Mundgesundheitsstudie, DMS V) – rationale, design, and methods

BackgroundOral diseases rank among the most prevalent non-communicable diseases in modern societies. In Germany, oral epidemiological data show that both dental caries and periodontal diseases are highly prevalent, though significant improvements in oral health has been taking in the population within the last decades, particularly in children. It is, therefore, the aim of the Fifth German Oral Health Study (DMS V) to actualize the data on current oral health status and to gather information on oral health behavior and risk factors. In addition to current oral health monitoring, the study will also permit conclusions about trends in the development of oral health in Germany between 1989 and 2014.Methods/DesignDMS V is a cross-sectional, multi-center, nationwide representative, socio-epidemiological study to investigate the oral health status und behavior of the German resident population in four age cohorts. Study participants are children (12-year-olds), adults (35- to 44-year-olds), young olds (65- to 74-year-olds), and old olds (75- to 100-year-olds) who are drawn from local residents’ registration offices. Social-science investigation parameters concern subjective perceptions and attitudes regarding oral health and nutrition, sense of coherence, and socio-demographic data. Clinical oral parameters are tooth loss, caries and periodontitis, prosthodontic status, further developmental and acquired dental hard tissue and mucosal lesions. To ensure reproducibility, the dental investigators are trained and calibrated by experts and multiple reliability checks are performed throughout the field phase. Statistical analyses are calculated according to a detailed statistical analysis plan.DiscussionThe DMS studies first performed in 1989, 1992 and repeated in 1997 and 2005 are the only cross-sectional oral health studies conducted in Germany on a population-based national representative level. Updated prevalence and trend analyses of key oral diseases are, therefore, of major epidemiological and health services research interest.Trial registrationGerman Health Services Research Data Bank VfD_DMSV_13_002152

Estimating future dental services' demand and supply: a model for Northern Germany.

OBJECTIVES To plan dental services, a spatial estimation of future demands and supply is required. We aimed at estimating demand and supply in 2030 in Northern Germany based on the expected local socio-demography and oral-health-related morbidity, and the predicted number of dentists and their working time. METHODS All analyses were performed on zip-code level. Register data were used to determine the number of retiring dentists and to construct regression models for estimating the number of dentists moving into each zip-code area until 2030. Demand was modelled using projected demography and morbidities. Demand-supply ratios were evaluated and spatial analyses applied. Sensitivity analyses were employed to assess robustness of our findings. RESULTS Compared with 2011, the population decreased (-7% to -11%) and aged (from mean 46 to 51 years) until 2030. Oral-health-related morbidity changed, leading to more periodontal and fewer prosthetic treatments needs, with the overall demand decreasing in all scenarios (-25% to -33%). In contrast, the overall number of dentists did only limitedly change, resulting in moderate decrease in the supplied service quantities (max. -22%). Thus, the demand-supply ratio increased in all but the worst case scenario, but was unequally distributed between spatial units, with several areas being over- and some being under- or none-serviced in 2030. CONCLUSIONS Within the limitations of the underlying data and the required assumptions, this study expects an increasingly polarized ratio of dental services demand and supply in Northern Germany. Our estimation allows to assess the impact of different influence factors on demand or supply and to specifically identify potential challenges for workforce planning and regulation in different spatial units.

Performance of Atraumatic Restorative Treatment (ART) depending on operator-experience

OBJECTIVES Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. METHODS One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. RESULTS There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P < 0.05). No significant differences were found between the two groups of auxiliaries (trainees versus experienced COHWs, P > 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). CONCLUSIONS For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

Pilot pathfinder survey of oral hygiene and periodontal conditions in the rural population of The Gambia (West Africa)

OBJECTIVE To document oral hygiene and periodontal conditions in the rural population of The Gambia. BASIC RESEARCH DESIGN Cross-sectional study according to the recommendations of the WHO for oral health surveys. CLINICAL SETTING Examination by two calibrated investigators in the health centres of rural communities after a public radio call. Patients were randomly allocated to the investigators. PARTICIPANTS   162 patients (20-54 years old; 52.5% female, 47.5% male). INTERVENTIONS Patients were interviewed for personal information and examined in a full-mouth recording. MAIN OUTCOME MEASURES Oral Hygiene Index (OHI), Gingival Index (GI), Community Periodontal Index (CPI), and the Gingivitis-Periodontitis-Missing/Teeth Index (GPM/T). Statistical analysis was performed using the Wilcoxon-rank-sum test and Kruskal-Wallis test with statistical significance at P < 0.05. RESULTS OHI increased by age from 6.9 to 9.2 (P < 0.05) and showed in tendency higher levels in men (P = 0.07), while the GI remained stable at 1.2. Community Periodontal Index codes increased by age (P < 0.05) and showed a fourfold higher prevalence for severe periodontitis in males (P < 0.05). Likewise, an age-related increase in GPM/T was evident (20.5 versus 25.4), significantly in the number of moderate periodontitis and missing teeth (P < 0.05). In GPM/T, males again demonstrated significantly more teeth affected by periodontitis than women. No statistical associations were found between ethnic groups or for different oral hygiene methods concerning CPI or GPM/T. CONCLUSIONS Prevalence of predominantly mild to moderate periodontal disease indicates treatment needs that should be considered when developing a national oral health care plan in The Gambia (West Africa).

Class III Atraumatic Restorative Treatment (ART) in adults living in West Africa – outcomes after 48 months

OBJECTIVES This observational study assessed the effectiveness of class III restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth over a 48-month period. METHODS Dental auxiliaries placed a total of 117 class III ART restorations in 2004, using a cosmetically improved glass-ionomer (Ionofil® Plus; VOCO, Cuxhafen, Germany), in 67 patients with a mean age of 27.3 years in the rural Jahali Health Center, The Gambia. Independent examiners evaluated the restorations after 24 and 48 months using the clinical ART evaluation criteria. RESULTS Seventy-six of the restorations could be observed over 48 months in 51 patients. After 48 months, 53 of 76 restorations were classified as clinically acceptable (without or with minor intervention (repair) needed), and 23 restorations were classified as insufficient. There was no statistical difference in a clustered performance rating between restorations placed in central and lateral incisors (P=1.0). CONCLUSIONS The adoption of the ART approach to class III caries cavities made restorative dental care in anterior teeth available in a West African region. The long-term performance was comparable to other studies. Longitudinal clinical studies with greater populations are required to substantiate these results.

Clinical effectiveness of basic root canal treatment after 24 months: a randomized controlled trial.

INTRODUCTION The purpose of this study was to investigate the effectiveness of basic root canal treatment (BRT) with tactile working length determination in terms of radiographic and clinical outcome parameters compared with endodontic treatment with standard radiographic working length control. METHODS This was a clinical, multicenter, controlled, open-label trial to evaluate BRT effectiveness after 24 months. The primary end point was the apical extension score of the radiographic quality parameter of root canal fillings. The secondary radiographic end point was the periapical index, and the secondary clinical end point was tooth tender to percussion. The safety end point was tooth loss as a consequence of endodontic failure. Statistical analyses of binary and categoric data were calculated using cross tables and the chi-square test. RESULTS BRT with tactile working length determination compared with standard radiographic working length control did not significantly differ in terms of radiographic and clinical outcomes after 24 months. The apical extension of the root canal fillings and the periapical anatomic structures showed no significant differences according to radiographic analyses (P = .5). Corresponding results were found in clinical aspects of tooth tender to percussion (P = .6) and tooth loss (P = .7). CONCLUSIONS Tactile working length determination in BRT resulted in comparable treatment outcomes compared with standard endodontic treatment with radiographic working length control and turned out to be an accurate method in BRT.

More teeth in more elderly: Periodontal treatment needs in Germany 1997-2030

Abstract Objective With more teeth retained for longer in an ageing population, population‐wide periodontal treatment needs may increase. We assessed and projected periodontal treatment needs from 1997 to 2030 in Germany. Methods Partial‐mouth probing‐pocket depths (PPDs) from repeated waves (1997, 2005, 2014) of the nationally representative German Oral Health Studies were transformed into full‐mouth PPDs via decision‐tree‐based ensemble‐modelling. In line with German healthcare‐regulations, teeth with PPD ≥ 4 mm were regarded as needing periodontal treatment. Weighted means were interpolated cross‐sectionally by fitting spline‐curves and then regressed longitudinally 1997–2030. Results In 1997, younger adults (35–44 years old) had a mean of 7.4 teeth needing treatment (overall 93.8 million teeth); this decreased to 4.8 teeth (47.3 million teeth) in 2014. For 2030, we project 3.2 teeth (33.7 million teeth). In seniors, an increase was recorded (1997: 4.5 teeth, 33.5 million teeth; 2014: 7.5 teeth, 63.4 million teeth); this is expected to continue until 2030 (to 12.2 teeth, 140.8 million teeth). The cumulative number of teeth needing treatment increased from 2000 (355 million) to 2015 (365 million), and will increase further to 2030 (464 million). Conclusions Population‐wide periodontal treatment needs may increase until 2030, mainly in the elderly. Concepts for addressing, these growing needs are required.