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Previous studies demonstrated an association between severe chronic periodontitis (CP) and metabolic syndrome (MetS). However, these studies mostly used the outdated National Cholesterol Education Program‐Adult Treatment Panel (NCEP‐ATP) III case definition of MetS. Additionally, CP was rarely diagnosed based on a full‐mouth examination. Thus, the aim of the current study was to re‐evaluate the potential association between CP and MetS in the Hamburg City Health Study (HCHS), a large population‐based survey of middle‐aged and elderly men and women in Germany, in view of more current definitions of MetS and CP. A cross‐sectional study was performed with baseline‐data from participants of the HCHS. Periodontitis severity grades were determined in a random sample of 6,209 participants of which 5,456 had sufficient data to call absence or presence of MetS. Variables defining MetS according to the currently valid harmonized definition were determined and a full‐mouth examination was performed, including determination of the clinical attachment loss, bleeding on probing, and dental plaque index. CP was classified in three grades of severity (none/mild, moderate, and severe). The Kruskal‒Wallis test or the Chi‐squared test were used for descriptive statistics and multivariate logistic regression models with and without adjustments for potential confounders (age, sex, smoking, high‐sensitivity C‐reactive protein [hsCRP], energy intake, and physical activity) were used to test for associations. The prevalence of MetS (39.0%) increased according to the severity grades of periodontitis (none/mild: 33.6%; moderate: 38.7%, and severe: 46.8%). Multivariate logistic regression analyses demonstrated that severe but not moderate CP was associated with MetS after adjusting for age and sex (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.03 to 1.48; P= 0.02). However, the association was attenuated after additional adjustment for smoking (OR, 1.19; 95% CI, 0.99 to 1.43; P= 0.058) and hsCRP, energy intake, and physical activity (OR, 1.11; 95% CI, 0.91 to 1.36; P= 0.294). The use of the more current definitions for MetS and CP confirmed previous observations of an age‐ and sex‐adjusted association between severe CP and MetS. Smoking, high‐energy intake, and low physical activity were identified as important lifestyle‐related confounders. Abdominal obesity, as indicated by elevated waist circumference, was determined as the most important component of MetS in relationship to CP.

Background: Oral health care of older adults is of rising importance due to ongoing demographic changes. There is a lack of studies examining the determinants of dental treatment avoidance in this age group. Therefore, the objective of this study was to identify those determinants. Methods: Cross-sectional data were drawn from the second wave (year 2002) of the German Ageing Survey which is a population-based sample of community-dwelling individuals ≥ 40 years in Germany (n= 3398). Dental treatment avoidance was quantified using the question “Did you need dental treatments in the past twelve months, but did not go to the dentist?” [no; yes, once; yes, several times]. Socioeconomic and health-related determinants were adjusted for in the analysis. Multiple logistic regressions were performed. Results: In terms of need, 6.7% of individuals avoided dental treatment in the preceding twelve months. Multiple logistic regressions revealed that dental treatment avoidance was associated with younger age (total sample [OR 0.978; 95% CI 0.958–0.998] and men [OR 0.970; 95% CI 0.942–0.999]), unemployment (total sample [OR 1.544; 95% CI 1.035–2.302] and men [OR 2.004; 95% CI 1.085–3.702]), lower social strata (women [OR 0.814; 95% CI 0.678–0.977]), increased depressive symptoms (men [OR 1.031; 95% CI 1.001–1.062]), and increased physical illnesses (total sample [OR 1.091; 95% CI 1.006–1.183] and men [OR 1.165; 95% CI 1.048–1.295]). The outcome measure was not associated with income poverty, marital status and physical functioning. Conclusions: The present study highlights the association between dental treatment avoidance and different socioeconomic and health-related factors. These results suggest that it is necessary to promote the importance of dental visits.

Background: There is a lack of studies investigating the impact of postponed dental visits due to financial constraints on quality of life. Aims: The aim of this study was to identify whether these factors are associated longitudinally. Methods: Data were derived from waves 5 and 6 of the “Survey of Health Ageing and Retirement in Europe” (SHARE). The analysis focused on Germany (n= 7506). The widely used CASP-12 was used to quantify the quality of life. Postponed dental visits for financial reasons in the preceding 12 months (no, yes) were used as the main explanatory variable. Socioeconomic and health-related covariates were included in regression analysis. Results: Gender stratified regression analysis showed that quality of life decreased with the presence of postponed dental visits due to financial reasons in men. Furthermore, quality of life decreased with the worsening of self-rated health in both men and women. The outcome measure was not associated with age, marital status, income, and chronic diseases in both sexes. Discussion: Study findings suggest that postponing dental visits due to financial constraints contributes to a decreased quality of life among older men. Conclusion: Efforts to avoid these circumstances might help to maintain the quality of life in older men.

The aim of the current study is to investigate the association between periodontitis (exposure variable) and depression severity (outcome variable) in an older German population. We evaluated data from 6,209 participants (median age 62 years) of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov(NCT03934957). Depression severity were assessed with the 9-item Patient Health Questionnaire (PHQ-9). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Multiple linear regression models were adjusted for age, sex, diabetes, education, smoking, and antidepressant medication. Linear regression analyses revealed a significant association between log-transformed depression severity and periodontitis when including the interaction term for periodontitis * age, even after adjusting for age, sex, diabetes, education, smoking and antidepressant medication. We identified a significant association between severe periodontitis and elevated depression severity, which interacts with age. Additionally, we performed a linear regression model for biomarker analyses, which revealed significant associations between depression severity and severe periodontitis with log-transformed inflammatory biomarkers interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP). In order to identify new therapeutic strategies for patients with depression and periodontal disease, future prospective studies are needed to assess the physiological and psychosocial mechanisms behind this relationship and the causal directionality.

Aim: Aim of this study was to investigate the association between periodontitis and arterial hypertension, both of which show correlations with classical cardiovascular risk factors and inflammatory activity. Materials and methods: A cross-sectional analysis of data from a large population-based health survey (the Hamburg City Health Study, HCHS) including 5934 participants with complete periodontal examination and blood pressure data, of whom 5735 had medical records regarding anti-hypertensive medication, was performed. Probing depths, gingival recessions, bleeding on probing (BOP), dental plaque, and decayed-missing-filled teeth (DMFT) indices were recorded as measures of oral health. Clinical attachment loss (CAL) per tooth was calculated and periodontitis was staged into three groups (no/mild, moderate, severe). Arterial hypertension was diagnosed based on the participants’ medication history and systolic and diastolic blood pressure values. Logistic regression models were constructed accounting for a set of potential confounders (age, sex, smoking, body mass index (BMI), diabetes, educational level, alcohol intake) and high sensitivity-C-reactive protein (hsCRP). Results: The odds of arterial hypertension increased significantly along with periodontitis severity (OR for severe periodontitis: 2.19; 95% CI 1.85–2.59; p< 0.001; OR for moderate periodontitis: 1.65; 95% CI 1.45–1.87; p< 0.001). Participants with moderate or severe periodontitis also had significantly higher age- and sex-adjusted odds of arterial hypertension, which was slightly weakened when additionally adjusted for BMI, diabetes, smoking, educational level, and alcohol intake (OR for severe PD: 1.28, 95% CI 1.04–1.59, p= 0.02; OR for moderate PD: 1.30, 95% CI 1.11–1.52, p= 0.001). The fraction of participants with undertreated hypertension (untreated and poorly controlled hypertension) was considerably larger in participants with severe periodontitis than in those with no/mild periodontitis (50.1% vs. 37.4% for no/mild periodontitis). Conclusions: The study shows an association between periodontitis and arterial hypertension that is independent of age, sex, diabetes, BMI, smoking, educational level, and alcohol intake. In addition, undertreatment of hypertension was more common in people with severe periodontitis compared with periodontally more healthy people.

The aim of this study was to evaluate the use of blending learning that added online tools to traditional learning methods in a preclinical course in prosthetic dentistry at one dental school in Germany. The e‐learning modules were comprised of three main components: fundamental principles, additional information, and learning objective tests. Video recordings of practical demonstrations were prepared and cut into sequences meant to achieve single learning goals. The films were accompanied by background information and, after digital processing, were made available online. Additionally, learning objective tests and learning contents were integrated. Evaluations of 71 of 89 students (response rate: 80%) in the course with the integrated e‐learning content were available for the study. Compared with evaluation results of the previous years, a substantial and statistically significant increase in satisfaction with learning content (from 30% and 34% to 86%, p<0.001) and learning effect (from 65% and 63% to 83%, p<0.05) was observed. Satisfaction ratings stayed on a high level in three subsequent courses with the modules. Qualitative evaluation revealed mostly positive responses, with not a single negative comment regarding the blended learning concept. The results showed that the e‐learning tool was appreciated by the students and suggest that learning objective tests can be successfully implemented in blended learning.

The effects of chronic pressure on the mandible during skin expansion procedures have been investigated. In 19 Gottingen miniature pigs with an average age of 3 months, tissue expanders were placed s.c. in close proximity to the growing ascending ramus of the mandible on the surface of the masseter muscle. After complete filling of the expanders (100 cc) after 6 weeks, a significant transverse discrepancy could be observed compared with the contralateral side. Additionally, severe medial dislocation of the molars were noticed. Ten weeks after the removal of the implant, the occlusal disturbance still existed, deviation of the transverse mandibular diameter still reached up to -13.6+/-2.1%. Because only four animals were measured based on a CT investigation, further statistical analysis was not possible. Histological examination showed osteoclastic activity of the expander with consequent bone resorption and remodelling. Strict indications should be agreed for tissue expansion in the vicinity of growing bone, as, for example, when tissue expansion is applied in children.

100 Eiern der Rasse „Weiße Blumberger“ wurden 0,2 ml einer 0,05%igen Endoxan-Lösung in das Eiweiß injiziert.Die nach dem 11. Bruttage noch lebenden 15 Embryonen wurden auf Mißbildungen, besonders des Schnabels, untersucht.Es wurden Schnabelverkürzungen verschiedenen Grades gefunden. Davon war der Unterschnabel stärker betroffen als der Oberschnabel, der eine ±starke ventrade Krümmung bis zum „Papageienschnabel“ zeigte.Die Krümmung des Oberschnabels äußerte sich im knöchernen Skelet nur in einer Lageveränderung des Prämaxillare, während das Knorpelskelet nicht beeinflußt war.Das Knorpelskelet des verkürzten Unterschnabels zeigte am Ceratobranchiale und der Cartilago Meckelii verschieden starke Verbiegungen.Dentale und Spleniale zeigten engere Beziehungen zum Verlauf der Cartilago Meckelii als Supraangulare und Angulare, vermutlich auf Grund ihrer ontogenetisch späteren Anlage.An Hand der Befunde und der Literatur wird angenommen, daß Endoxan stärker auf die Haut und ihre Abkömmlinge als auf die übrigen Gewebe hemmend wirkt.

1.100 Eiern der Rasse „Weiße Blumberger“ wurden 0,2 ml einer 0,05%igen Endoxan-Lösung in das Eiweiß injiziert.2.Die nach dem 11. Bruttage noch lebenden 15 Embryonen wurden auf Mißbildungen, besonders des Schnabels, untersucht.3.Es wurden Schnabelverkürzungen verschiedenen Grades gefunden. Davon war der Unterschnabel stärker betroffen als der Oberschnabel, der eine ±starke ventrade Krümmung bis zum „Papageienschnabel“ zeigte.4.Die Krümmung des Oberschnabels äußerte sich im knöchernen Skelet nur in einer Lageveränderung des Prämaxillare, während das Knorpelskelet nicht beeinflußt war.5.Das Knorpelskelet des verkürzten Unterschnabels zeigte am Ceratobranchiale und der Cartilago Meckelii verschieden starke Verbiegungen.6.Dentale und Spleniale zeigten engere Beziehungen zum Verlauf der Cartilago Meckelii als Supraangulare und Angulare, vermutlich auf Grund ihrer ontogenetisch späteren Anlage.7.An Hand der Befunde und der Literatur wird angenommen, daß Endoxan stärker auf die Haut und ihre Abkömmlinge als auf die übrigen Gewebe hemmend wirkt.