Caries Epidemiology and Community Dentistry: Chances for Future Improvements in Caries Risk Groups. Outcomes of the ORCA Saturday Afternoon Symposium, Greifswald, 2014. Part 1

This paper reviews the first part of the outcomes of the ORCA Saturday Afternoon Symposium 2014 dealing with ‘caries epidemiology and community dentistry: chances for future improvements in caries risk groups'. After the caries decline in many countries, there are remaining pockets of higher caries levels, mostly in the primary dentition and/or linked to a low socio-economic status (SES). The review into the evidence of caries-preventive measures clearly points to the use of fluorides, especially toothbrushing with fluoridated toothpaste and collective measures such as water fluoridation. In contrast to several unsuccessful high-risk approaches, community and public health programmes seem to be able to ensure a population-wide access and compliance in risk groups. Their simple and evidence-based measures mostly combine regular plaque removal and fluoride applications via toothbrushing, at least for children and adolescents. For the future, the common risk factor approach which addresses associations between oral health, social deprivation, diet, hygiene, smoking, alcohol use and stress should lead to combined efforts with other community health and education specialists. Further engagement with public policy, community leaders and administration is needed in order to strengthen healthy choices and behaviour, e.g. in ‘healthy' schools and kindergartens. It seems advisable that these population programmes also aim at improving upstream factors

Internet y el español / José Antonio Millán. Madrid: Fundación Retevisión, 2001

Sección: ReseñasEl pasado 4 de julio se presentó en el Circulo de Bellas Artes de Madrid el libro de José Antonio Millán Internet y el español. La presentación corrió a cargo de Juan Luis Cebrián, reciente académico de la lengua y buen conocedor de los medios de comunicación. A continuación tomó la palabra el autor. José Antonio es lingüista, ha sido editor tradicional y ahora es editor digital. Ha dirigido el equipo que creó el primer diccionario electrónico del español CD ROM del diccionario de la Real Academia de la Lengua y el proyecto del Centro Virtual Cervantes.N

Introducing a Specific Term to Present Caries Experience in Populations with Low Caries Prevalence: Specific Affected Caries Index (SaC)

Up to now, indices like the mean dmft/DMFT and the SiC (Significant Caries Index) have been used to depict caries experience in populations with high prevalence. With the caries decline, particularly for populations with low caries levels, these indices reach their statistical limits. This paper aims to introduce a specific term, the Specific affected Caries Index (SaC) for the risk groups in populations with low caries prevalence and to illustrate its use based on the consecutive German National Oral Health Survey (GNOHS) in children. In groups with a caries prevalence less than one-third of the population, many caries-free children (DMFT = 0) are included in the SiC (risk group), which calls for a new way of illustration. Mean caries experience (DMFT), caries prevalence, the SiC and SaC were portrayed for 12-year-olds in the GNOHS from 1994/95 to 2016. The SaC describes the mean caries experience (DMFT) in the group presenting caries experience (DMFT > 0). In 12-year-old 6th graders in Germany, the mean caries experience decreased from 2.4 (1994/95) to 0.4 DMFT (2016), with a recent prevalence of 21.2% (DMFT > 0, 2016). In 2016, the mean number of affected teeth in children with DMFT > 0 (SaC) was 2.1, while the SiC including 12% DMFT-free children in the risk group was 1.3. The SiC fails to reflect the caries severity in children in a population with low caries prevalence. Therefore, the newly introduced term Specific affected Caries Index (SaC) may be used to describe accurately caries experience in caries risk children in populations presenting low caries prevalence

Alternative caries management options for primary molars:2.5-yr 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)

Cost-effectiveness of managing cavitated primary molar caries lesions:A randomized trial in Germany

The Hall Technique (HT), Non-Restorative Cavity Control (NRCC) and conventional carious tissue removal and restoration (CR) are strategies for managing cavitated caries lesions in primary molars. A randomized controlled three-arm parallel group trial in a university clinic in Germany was used to measure the cost-effectiveness of these strategies. 142 children (HT: 40; NRCC: 44; CR: 58) were followed over a mean 2.5 years. A German healthcare perspective was chosen. The primary outcome was estimated molar survival; secondary outcomes were not needing extraction, not having pain or needing endodontic treatment/extraction, or not needing any re-intervention at all. Initial, maintenance and endodontic/restorative/extraction re-treatment costs were derived from fee items of the statutory insurance. Cumulative cost-effectiveness and cost-effectiveness acceptability were estimated from bootstrapped samples. HT molars survived longer (estimated mean; 95% CI: 29.7; 26.6–30.5 months) than NRCC (25.3; 21.2–28.7 months) and CR molars (24.1; 22.0–26.2 months). HT was also less costly (66; 62–71 Euro) than NRCC (296; 274–318 Euro) and CR (83; 73–92 Euro). HT was more cost-effective than NRCC and CR in >96% of samples, and had acceptable cost-effectiveness regardless of a payer’s willingness-to-pay. This superior cost-effectiveness was confirmed for secondary health outcomes. Cost-advantages were even more pronounced when costs were calculated per year of tooth retention (mean annual costs were HT: 29, NRCC: 154, CR: 61 Euro). HT was more cost-effective than CR or NRCC for managing cavitated caries lesions in primary molars, yielding better dental health outcomes at lower costs. If choosing between these three strategies for managing cavitated caries lesions in primary molars, dentists should prefer HT over NRCC or CR. This would also save costs for the healthcare payer

Učinak prevalencije i težine molarno-incizalne hipomineralizacije na kvalitetu života povezanu s oralnim zdravljem: sistematizirani pregled i metaanaliza

Objectives: The aim of this systematic review and meta-analysis is to assess the association between the MIH presence as well as the severity and OHRQoL in children. Material and methods: Relevant studies were identified in PubMed, Embase, Cochrane and Google Scholar. Studies involving MIH and OHRQoL in children were included. A methodological quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) and its adapted version for cross-sectional studies. Random effects models were used to estimate summary effect measures for the association between MIH presence (presence vs. absence) as well as severity (moderate/severe MIH vs. no MIH) and OHRQoL using generic inverse variance meta-analyses. Tests for heterogeneity, publication bias and sensitivity of results were also performed. Results: Out of 1696 identified publications 11 studies reporting on 5,017 children were included in the meta-analysis assessing the impact of MIH presence. There was no statistically significant association between the presence of MIH and lower OHRQoL in affected children (OR = 1.72, 95% CI = 0.99–2.98). Concerning MIH severity and its impact on OHRQoL, a sum of 6 studies were included in the meta-analysis involving a total of 2,595 children. There was a significant association between moderate/severe MIH and lower OHRQoL in affected children (OR = 3.43, 95% CI = 1.69–6.98). Conclusion: Moderate/Severe MIH has a significant and clinically relevant negative impact on OHRQoL, and it should therefore be addressed adequately. Future research should also consider the impact of a uniform MIH diagnosis and precise severity criteria.Svrha istraživanja: Cilj ovog sistematiziranog pregleda i metaanalize bio je procijeniti povezanost između MIH-a i OHRQoL-a u djece. Materijali i metode: Pronađena su relevantna istraživanja u bazama PubMed, Embase, Cochrane i Google Scholar. Uključena su istraživanja koja su obrađivala MIH i OHRQoL u djece. Metodološka procjena kvalitete tih istraživanja obavljena je s pomoću ljestvice Newcastle-Ottawa (NOS) i njezine prilagođene verzije za presječne studije. Za procjenu sažetih mjera učinka za povezanost između prisutnosti MIH-a (prisutnost prema odsutnosti) upotrijebljeni su modeli slučajnih učinaka, a za težinu (umjereni/teški MIH prema odsutnosti MIH-a) i OHRQoL upotrijebljena je generička metaanaliza inverzne varijance. Obavljeni su i testovi heterogenosti, pristranosti objave i osjetljivosti rezultata. Rezultati: Od 1696 identificiranih časopisa, u metaanalizu procjene utjecaja prisutnosti MIH-a uključeno je 11 istraživanja koja su izvještavala o 5017 djece. Nije bilo statistički značajne povezanosti između prisutnosti MIH-a i nižega OHRQoL-a u pogođene djece (OR = 1,72, 95 % IP = 0,99–2,98). Kad je riječ o težini MIH-a i njegova utjecaja na OHRQoL, zbroj od 6 istraživanja uključen je u metaanalizu koja obuhvaća ukupno 2595 djece. Postojala je značajna povezanost između umjerenoga/teškoga MIH-a i nižega OHRQoL-a u pogođene djece (OR = 3,43, 95 % IP = 1,69 – 6,98)

Hypnosis and Sedation for Anxious Children Undergoing Dental Treatment: A Retrospective Practice-Based Longitudinal Study.

To assess whether the treatment of children with oral midazolam and pediatric hypnosis techniques can improve the compliance in consecutive sessions, a retrospective longitudinal practice-based observational study was designed and carried out. A total of 311 children between 3 and 12 years of age were treated under hypnosis and sedation with midazolam (0.40 mg/kg body weight). Treatments were performed in one to a maximum of three sessions. A total of 183 children received one, 103 received two and 25 children received three treatment sessions. The behavior of the children during the sessions was examined by means of the Venham score. The self-evaluation of the children was based on the Wong-Baker Scale. Child behavior using midazolam and hypnosis techniques showed little difference and good compliance between the sessions. Venham scores did not increase significantly regarding total treatment from the first (0.99 ± 1.41) to the second (1.17 ± 1.39) and to the third session (1.27 ± 1.20) (p > 0.05). However, considering the highest Venham scores that occurred in each case, the behavior of the children worsened significantly (p < 0.01) during the three treatment sessions, from 1.37 ± 1.31 (first) to 1.87 ± 1.74 (second) to 2.32 ± 1.33 (third). In 6.11% of the children, treatment was discontinued in the first session (n = 19), 0.96% in the second (n = 3) and 0% in the third. Treatment with low-dose midazolam, combined with hypnosis techniques, showed to be an effective option for dental treatment in children. Within the limitations of the current study, and with consideration of highest possible compliance, no more than two treatment sessions for pediatric dental treatment should be performed

Implementation and evaluation of the population-based programme "health literacy in school-aged children" (GeKoKidS)

Aim: Health literacy (HL) is a key outcome of health education. Low HL is associated with a higher risk of health-related impairments and high health-related costs. This article therefore describes the contents and evaluation of the school-based programme “Health literacy in school-aged children” (GeKoKidS) and its acceptance by teachers. A second focus of the study is the description of methods to increase the response of schools, students and parents as a crucial condition for the validity and generalizability of results from epidemiologic prevention studies. Subjects and methods: The evaluation of the prevention program GeKoKidS included 5th grade students aged 9–13 years in schools in the region of Greifswald and East Pomerania [longitudinal randomised control group pre-post design (RCT)]. Data collections took place within the extended school dentist examination visits at the beginning of the 2007/2008 school year and at the beginning of the second half term of the 2008/2009 school year. This included medical examinations and self-completion questionnaires of students, parents and teachers. The study was authorised by the data protection commissioner of Mecklenburg-West Pomerania, the Ministry of Education, Science and Culture of Mecklenburg-West Pomerania and the Ethics Commitee of the Ernst Moritz Arndt University Greifswald. Based on the authorisation of the data protection concept and concerns about selective response, parents were not granted a consent but rather a right to refuse participation. Results: In Greifswald/East Pomerania, 19 of 22 schools with 5th year classes participated in GeKoKidS (response rate: 86.3%). Out of 914 eligible students in the participating schools, 882 children (96.4%) took part in the school dentist examinations. A total of 863 children (94.4%) participated in the extended school dentist examination; 852 children (93.2%) took part in the student survey. In the parental survey 721 parents participated (response rate: 78.8%). A high level of acceptance referring to teacher training and the appropriateness of the GeKoKidS programme was achieved. Conclusion: As shown by the low rate of refusal, the programme and the evaluation study were well accepted. Possible reasons for these results could be the chosen procedure of establishing contact with schools before sending the questionnaires and the parent’s right to refuse their child's participation instead of giving an active confirmation. Because of this high response rate, the database enables comprehensive conclusions to be reached on the health-related state of students in Greifswald/East Pomerania

How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement

Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual

How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement

Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, longterm stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual