Wolfgang Micheelis

Dimensions of Oral-health-related Quality of Life

Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16–79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIP-G. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general.

Prevalence of periodontal disease and treatment demands based on a German dental survey (DMS IV)

AIM We assessed the prevalence and extent of periodontitis in Germany. Furthermore, region- and gender-specific differences in periodontal disease prevalence were evaluated. MATERIAL AND METHODS The fourth German Dental Health Survey is a national cross-sectional survey conducted in 2005. Nine hundred and twenty-five adults (35-44 years) and 1040 seniors (65-74 years) were examined. The survey comprised social- and health-related interviews and dental examinations. Probing depth (PD) and clinical attachment loss (CAL) were assessed at three sites at 12 index teeth. RESULTS Prevalence of CAL> or =3 mm was found in 95.0% in adults and 99.2% in seniors with 68.7% and 91.4% of teeth being affected, respectively. PD> or =4 mm was prevalent in 76.9% and 87.7% in both age groups, respectively. According to the CDC definition considering mesiobuccal and distolingual sites, prevalence of periodontitis was 70.9% and 87.4% in both age cohorts, with one-fourth and one-half presenting severe forms, respectively. Periodontal prevalence was significantly higher in male subjects and East German subjects. CONCLUSIONS Periodontitis was highly prevalent in German adults. To reduce periodontal burden, treatment of periodontal diseases and continuous maintenance should become an integral part in dental practice. Furthermore, health recommendations should be implemented at the community, professional, and individual level.

Social gradients and cumulative effects of income and education on dental health in the Fourth German Oral Health Study

OBJECTIVE To consider differential effects of income and education on oral health for each indicator separately and in combination. Finally the combined effects of the lowest income level and the lowest level of education were examined. METHODS Data were drawn from the Fourth German Oral Health Study. They were collected using proportional random sampling in order to obtain information also for less densely populated regions. The subjects included in the study were between 35 and 44 years of age (n = 925). It included a clinical dental examination and a sociological survey. Social differentiation was depicted by education and income (divided into categories), oral health was measured using the DMFT-index. RESULTS Social gradients emerged for both indicators of social differentiation. The effects derived from single analyses were somewhat higher than those obtained by simultaneous estimations. The odds ratio of the lowest as compared with the highest income category was OR = 3.74 and OR = 2.34 in the analysis with both indicators. For education the respective effects were OR = 3.75 and OR = 2.95. The cumulative effect of the lowest income and the lowest educational level combined was OR = 6.06. CONCLUSION Education and income are shaping social inequalities in oral health independently from each other, and they are only moderately correlated. They refer to different dimensions of disadvantage thus making preventive measures more complicated.

More to learn about: periodontitis‐related knowledge and its relationship with periodontal health behaviour

AIM To assess periodontitis-related knowledge and its relation to oral health behaviour on a community level and to identify target groups and major topics for health education interventions. MATERIAL AND METHODS By means of a multistratified, stochastic telephone survey, 1001 interviews with Germans older than 14 years were carried out. Participants answered questions on the definition, aetiology, and risk factors of periodontal disease and on the risks associated with and measures to prevent them. They also reported on their current oral health behaviour. RESULTS Severe knowledge deficits were found with respect to all topics. No consistent relationships with age or education were found, although less educated and very young and old people tended to show the greatest deficits. Knowledge of preventive measures was most strongly related to current oral health behaviour. CONCLUSIONS Health education on periodontal diseases must be improved on a community level, although schoolchildren, older citizens and the less educated are the groups most in need. Interventions should focus on preventive measures.

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.

Changes in problem-based and routine-based healthcare attendance: a comparison of three national dental health surveys

BACKGROUND Healthcare utilization either may be guided by a preventive orientation leading to regular visits to the doctor, or it may be triggered by impaired health. Using data from three German national surveys, we wanted to examine whether the effects of income on the utilization of dental health services increased over time owing to the considerable decrease in insurance coverage over the years and the increase in higher out-of-pocket costs from patients. METHODS Data from three national dental health surveys (1989, 1997 and 2005) were used. The data of all respondents aged between 35 and 44 years were available, and the number of caries-free and unrestored healthy teeth was used as outcome. RESULTS Over the years, the proportion of routine attenders increased considerably, and the dental health measure used indicates the improvement. The least educated respondents and those with the lowest income profited less than other groups. In spite of higher copayments, the effects of income on the utilization of dental care did not increase over time. Regarding the results of education, a significant effect was only found in the study from 2005. No clear differences between routine- and problem-oriented attenders emerged with respect to the dental health measure chosen. CONCLUSIONS Material conditions and education had effects on utilization behaviour. Contrary to expectation, increasing copayments did not yield higher effects of income on healthcare utilization.

Prediction of periodontal disease: modelling and validation in different general German populations

AIM To develop models for periodontitis using self-reported questions and to validate them externally. METHODS The Study of Health in Pomerania (SHIP-0) was used for model development. Periodontitis was defined according to the definitions of the Center for Disease Control and Prevention-American Academy of Periodontology, the 5th European Workshop in Periodontology, and Dietrich et al. (≥2 teeth with inter-proximal clinical attachment loss of ≥4 mm and 6 mm as moderate and severe periodontitis) respectively. These models were validated in SHIP-Trend and the Fourth German Oral Health Study (DMS IV). RESULTS Final models included age, gender, education, smoking, bleeding on brushing and self-reported presence of mobile teeth. Concordance-statistics (C-statistics) of the final models from SHIP-0 were 0.84, 0.82 and 0.85 for the three definitions respectively. Validation in SHIP-Trend revealed C-statistics of 0.82, 0.81 and 0.82 respectively. As bleeding on brushing and presence of mobile teeth were unavailable in DMS IV, reduced models were developed. C-statistics of reduced models were 0.82, 0.81 and 0.83 respectively. Validation in DMS IV revealed C-statistics of 0.72, 0.78 and 0.72 for the three definitions respectively. All p values of the goodness-of-fit tests were >0.05. CONCLUSIONS The models yielded a moderate usefulness for prediction of periodontitis.

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

Trends in dental health of 35- to 44-year-olds in West and East Germany after reunification.

OBJECTIVES The German reunification (1990) resulted in huge social upheavals in East Germany involving changes in health-care systems. We aimed to assess the changes of dental health between 1989 and 2005, hypothesizing that dental health converged in West and East Germany. METHODS We evaluated data from 855 East and 1,456 West Germans aged 35-44 years from the cross-sectional German Oral Health Studies (Deutsche Mundgesundheitsstudien) conducted in 1989/92, 1997, and 2005. Regression models were applied to assess associations between region, survey year, their interactions and variables assessing dental disease status [number of decayed (DT), missing (MT), and filled teeth (FT), the DMFT-index, the probability of having ≤ 20 teeth and the number of sound teeth (ST)], adjusting for potential risk factors for caries. RESULTS After a slight increase of MT between 1989/92 and 1997 (West: 3.6 to 3.6; East: 4.5 to 4.9), numbers of MT considerably decreased between 1997 and 2005 (West: 3.6 to 2.2; East: 4.9 to 3.1). East Germans had consistently more MT. Numbers of FT, DT, ST, and the DMFT-index equalized at the latest in 2005. The East German DMFT-index increased between 1989/92 and 1997 and slightly decreased between 1997 and 2005, whereas the West German DMFT-index steadily decreased between 1989/92 and 2005. CONCLUSIONS Dental health converged in West and East Germany, but the higher number of MT in 2005 indicates that East Germany was not able to catch up completely with West Germany.

Change in FS‐T index in adults in the German national oral health surveys between 1989 and 2005

OBJECTIVES To assess changes in the number of functioning teeth (filled and sound teeth, FS-T index) from 1989/1992 to 2005 in West and East Germany and to evaluate survey- and region-specific associations between sociodemographic and behavioral risk factors and the FS-T index. METHODS Within the German Oral Health Studies, random samples from 35-44-year-olds were drawn in 1989, 1992, 1997 and 2005. The FS-T index and a questionnaire with socioeconomic and behavioral items were assessed. Negative binomial regression models were evaluated, including all sociodemographic and behavioral factors simultaneously as independent variables. RESULTS For West Germany, median FS-T index increased by 3 teeth between 1989 and 2005 (Ptrend < 0.001). In East Germans, FS-T index was similar in 1992 and 1997 (median, 24), but increased by one tooth until 2005 (Ptrend < 0.001). For West and East Germany, middle and high school education were significantly associated with higher FS-T indices in all surveys, although effects were most pronounced in 2005. Being married, reporting regular dental visits and good oral hygiene were significantly related to a higher number of functioning teeth in at least one survey year. CONCLUSIONS Dental health assessed as the number of functioning teeth improved between 1989/92 and 2005 in both German parts and across all educational levels. However, considering the educational level, dental health was less equally distributed in 2005 compared with previous surveys.