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To compare oral health-related quality of life (OHRQoL) in children and adolescents with and without migration background, and to assess whether potential differences in OHRQoL can be sufficiently explained by oral health characteristics. A consecutive sample of 112 children and adolescents was recruited in a German university-based orthodontic clinic, and a convenience sample of 313 children and adolescents of German public schools was enrolled in the study (total N = 425, age range 7–17 years). However, 29 participants were excluded due to insufficient information regarding migration background. Accordingly, the non-migrant group consisted of 262 participants (61.6%). For children with migration background, two groups were classified: (i) one parent born in a foreign country (N = 41, 9.6%, single-sided migration background), and (ii) both parents and/or child born in a foreign country ( N= 93, 21.9%, double-sided migration background). OHRQoL was assessed using the German 19-item version of the Child Oral Health Impact Profile (COHIP-G19). Additionally, physical oral health of 269 children with classified migration background was determined in a dental examination. Overall, OHRQoL was significantly lower in the group with double-sided migration background indicated by lower COHIP-G19 summary scores (mean: 58.6 points) than in the group with single-sided migration background (mean: 63.3 points) or the non-migrant group (mean: 63.2 points). Likewise, the summary scores of the subscale “oral health well-being” and the subscale “social/emotional, school, and self-image” were also lower in the double-sided migrant group than in the other two groups. Linear regression analysis showed an association between double-sided migration background and impaired OHRQoL, even after statistically controlling for demographic, socioeconomic, and oral health characteristics. Children and adolescents with double-sided migration background have poorer OHRQoL than comparably aged migrants with single-sided migration background or non-migrations. Between-group differences in OHRQoL could not be sufficiently explained by effects of socioeconomic status or physical oral health characteristics. Thus, other methodological, cultural, or immigration-related factors might also play an important role for the observed effects.

Oral health-related quality of life (OHRQoL) in children and adolescents can be assessed with two different approaches: children can directly report their own perceptions or parents can serve as proxies and rate their child’s OHRQoL from their perspectives. It was the aim to investigate whether parents can accurately rate their children’s OHRQoL and to compare agreement between OHRQoL domains and between age groups. In this cross-sectional study, a sample of 140 children aged 7–17 years was consecutively recruited at a university-based orthodontic clinic and a public school. OHRQoL was assessed with the 19-item Child Oral Health Impact Profile (COHIP) with one version for the child and one for the parent. Correlation between child and parent ratings and diagnostic accuracy of the parental rating to assess children’s OHRQoL was calculated, and findings were compared between 7–11- and 12–17-year-old children. COHIP summary score differed only slightly between parents (mean 60.7 ± 9.8 points) and children (mean 61.9 ± 8.9 points). Correlation of summary scores was r = 0.38, corresponding to a moderate agreement. Median of item prevalence of all 19 items was 29.5 % for children and 41.7 % for parents. Median of positive predictive values was 50.9 % and median of negative predictive values 76.7 %, with no substantial differences in age groups. Parents’ perception of their children’s OHRQoL is not accurate enough to detect oral health problems in an individual child aged between 7 and 17 years, and therefore, proxy OHRQoL assessment for individuals in this age group cannot be recommended.

Parafunctional habits such as clenching or grinding (bruxism) during daytime and at night are considered to have a great impact on the etiopathogenesis of temporomandibular disorders (TMD). However, the size of the effect and how daytime activities interact with nocturnal activities is not yet clear. The aim of this study was to assess the association of TMD pain with both awake and sleep bruxism in adults. In this case–control study, data of a consecutive sample of 733 TMD patients (cases; mean age ± SD: 41.4 ± 16.3 years; 82 % women) with at least one pain-related TMD diagnosis according to the German version of the Research Diagnostic Criteria for TMD (RDC/TMD) and of a community-based probability sample of 890 subjects (controls; mean age ± SD: 40.4 ± 11.8 years; 57 % female) without TMD were evaluated. Clenching or grinding while awake and/or asleep was assessed with self-reports. Association of TMD pain with awake and sleep bruxism was analyzed using multiple logistic regression analyses and controlled for potential confounders. Odds ratios (OR) with corresponding 95 % confidence intervals (CI) were calculated. While 11.2 % of the controls reported clenching or grinding while awake, this proportion was significantly higher in TMD patients (33.9 %; p

This study seeks to develop and validate the 19-item German version of the Child Oral Health Impact Profile (COHIP-G19), an instrument to assess the oral health-related quality of life (OHRQoL) in children and adolescents. The 19 items of the original English-language COHIP were translated into German using an established forward–backward approach. For the assessment of the psychometric properties of the COHIP-G19, children and adolescents aged 7–17 years came from two samples: 112 patients were consecutively recruited at a university-based orthodontic clinic and 313 came from a convenience sample of students in public schools. Internal consistency of the COHIP-G19 was satisfactory in both populations (Cronbach’s alpha, 0.78/0.80; average inter-item correlation, 0.16/0.17). The COHIP-G19 summary scores were correlated in the expected direction with a global oral health rating (r = 0.46/0.40) and two measures for perceived general health (EQ-5D-Y: r = 0.26/0.29; KIDSCREEN-27: r = 0.40/0.33). While COHIP-G19 summary scores did not significantly differ with respect to the presence of caries or gingivitis (p > 0.05), malocclusion and insufficient oral hygiene behavior were related to more impaired OHRQoL, represented in significantly lower COHIP-G19 summary scores in students in public schools (p

Introduction The aim was to evaluate the proliferation of pulp cells 1, 3, and 7 days after direct pulp capping with ProRoot MTA (MTA) and to compare the results with calcium hydroxide (Ca(OH) 2 ). Methods An occlusal cavity was prepared in 36 molar teeth of 18 Wistar rats. Then MTA or Ca(OH) 2 was placed on the exposed pulp. All cavities were restored with composite. After 1, 3, and 7 days the animals were killed. One hour before scarification 5-bromo-2'-deoxyuridine (BrdU) was injected into the intraperitoneal cavity for immunohistologic analysis. BrdU was incorporated into the cell nucleus during the S phase of the cell cycle. Proliferating cells were tagged and counted by using alkaline phosphatase and anti–alkaline phosphatase antibody staining. Three animals (6 molar teeth) served as controls and were not further treated. The number of the tagged cells was statistically analyzed by comparing the results of the 3 groups. A Bonferroni correction was performed, because the data of the Ca(OH) 2 – group was used 3 times for pairwise comparison. Results The marked cells were identified as fibroblasts, endothelial cells (after 1, 3, and 7 days), and Hohl cells (after 7 days). The MTA group showed a similar amount of Hohl cells when compared with the Ca(OH) 2 group ( P > .05). One day and 7 days after capping, no significant differences were observed between the 2 tested groups and the controls ( P > .05). After 3 days, significantly more cells were stained in the MTA and Ca(OH) 2 groups than in the control group ( P Conclusions Immunohistologic analysis demonstrated that MTA showed similar results when compared with Ca(OH) 2 within the first week after direct pulp capping.

The aim was to evaluate the proliferation of pulp cells 1, 3 and 7 days after direct pulp capping with the dentine adhesive Gluma Comfort Bond (GCB) and to compare it with calcium hydroxide (Ca(OH)(2)). An occlusal cavity was prepared in 72 molar teeth of 36 Wistar rats. Then GCB or Ca(OH)(2) was placed on the exposed pulp. All cavities were restored with composite. After 1, 3 and 7 days, the animals were sacrificed. One hour prior sacrification, 5-bromo-2'-desoxyuridine (BrdU) was injected into the intraperitoneal cavity for immunohistological analysis of 18 animals. BrdU was incorporated into the DNA to tag proliferating cells using an antibody staining. Three animals served as controls and were not further treated. The number of the tagged cells was statistically analysed by comparing the results of the three groups. In 18 rats, routine histological analysis was performed in order to evaluate the pulp tissue for bacterial infection, inflammatory cells and necrosis. The marked cells were identified as fibroblasts, endothelial cells (after 1, 3 and 7 days) and Höhl cells (after 7 days). One day after capping, significantly more cells were stained in the GCB than in the Ca(OH)(2) group (p 0.05). After 3 days, significantly more cells were stained in the GCB than in the Ca(OH)(2) and the control group (p 0.016). Direct contact of GCB with pulp tissue leads to an increased formation of granulation tissue (fibroblasts, endothelial cells) because of an inflammatory reaction. This may be explained by missing antibacterial effect and foreign body reactions. Also, GCB may have a negative effect on Höhl cells.

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. The interventions’ intensity and psychosocial burden of the cleft may have a lasting impact on the child. The aim of this study was to assess the psychosocial functioning of 4 to 7-year-old children with non-syndromic CLP. Health-Related Quality of Life (HRQoL) was assessed using the revised German KINDL HRQoL questionnaire, a five-point, 24-Likert-item questionnaire covering six domains (physical well-being, emotional well-being, self-esteem, family life, friends and school). The total score is the sum of all item scores. In addition, a chronic generic module consisting of six items, and a specific parent module consisting of 22 items have been added to the core KINDL questionnaire. Higher scores indicate better HRQoL. All the parents of 4 to 7-year-old children with non-syndromic CLP treated at the interdisciplinary CLP center at Cologne University Hospital were invited to participate in the study. A total of 74 families were contacted, 61 of whom agreed to study participation (82% response). The 61 children (32 boys and 29 girls) had a mean age of 5.39 years. The mean values for the total scale were slightly lower for children with CLP, but when compared, CLP and non-CLP children revealed no statistically significant difference in HRQoL levels. This study demonstrated that 4 to 7-year-old children with CLP do not appear to experience major psychosocial problems when compared with their non-CLP peers.

Germany has a three-tiered system of education at secondary school level, divided into the school types ‘Hauptschule’, Realschule’ and ‘Gymnasium’. All students receive, when aged 6–12 years, a uniform annual dental examination and oral health education programme. Objectives: The aim of this cross-sectional study was to report on the dental caries levels of school-age children stratified into these three different school types at secondary school level to enable oral healthcare personnel to administer a focused, school-based dental screening and education programme according to patients’ needs rather than a uniform dental examination. Methods: A representative, random sample of 12-year-old school children in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Results: A total of 322 12-year-old children participated. The mean DMFT was 0.69. An examination of the distribution of the DMFT score revealed that its distribution is positively skewed. For this reason, this study provides summary analyses based on medians and a non-parametric rank sum test. The non-parametric Kruskal-Wallis H-test showed a highly significant difference between median scores across the different school types (P-value = 0.004). The significance was a result of the ‘Gymnasium’ distribution of DMFT scores which differed markedly from the other two school types. Conclusions: The finding of the present study suggests that it may be useful to stratify the school dental screening and education programme according to school type and to prioritize children who attend ‘Realschule’ and ‘Hauptschule’. This shift should systematically target children with the greatest need for dental care.

To evaluate the influence of coronal restorations on the fracture resistance of endodontically treated teeth, 676 root canal-filled and restored posterior teeth were evaluated after a mean period of 9.7 (± 2.8; minimum: 5) years. A total of 86.2% of the endodontically treated and restored teeth survived the mean observation period of 9.7 years without fracture. The overall survival period was 13.6 (± 0.2) years. All teeth with gold partial crowns survived without fractures (n = 24). Teeth with crowns and adhesively sealed access cavities showed a mean survival period of 15.3 (± 0.4) years, with crown and bridge restorations 14.0 (± 0.3), with individual metal posts 13.9 (± 0.2), with composite fillings 13.4 (± 0.5), with prefabricated metal posts 12.7 (± 0.6), with amalgam fillings 11.8 (± 0.6) and with glass ionomer cements (GIC) 6.6 (± 0.5) years. Teeth with one or two surfaces restored by amalgam, composite or GIC showed a significantly lower fracture rate than teeth with three and more restored surfaces (P0.05). The mean fracture rate of teeth restored with GIC was significantly higher when compared with all other groups (P0.001). In general, endodontically treated teeth restored with prosthetic restorations demonstrated a significantly lower mean fracture rate than teeth restored with fillings. Cavities with up to three surfaces may well be successfully restored adhesively with composite filling material.

Dental caries among preschool children remains a significant dental public health problem. In Ireland, there are no national data available regarding dental caries levels in preschool children. Furthermore, the number of young children with disabilities and their dental caries levels remains unknown. The aim of the present study was to measure the dental caries levels in a sample of preschool children with disabilities.A team of trained and calibrated dentists examined a sample of all 0- to 6-year old preschool children with disabilities in two health service administrative areas under standardized conditions. Dental caries was recorded using WHO criteria.Of a total of 422 participants, 337 datasets were included in the study. Of these 337 examined children, approximately 75.1% had a cognitive disability and 12.9% had a noncognitive disability. In 12% of the children, a diagnosis had not yet been established. Dental caries at dentin level was detected from the age of 4 years. The overall mean decayed/missing/ filled teeth (dmft) was 0.49 (SD, 1.39). The analysis of mean dmft levels in children with positive (dmft0) scores revealed a mean dmft of 1.14.The evidence from this study demonstrated that dental caries levels in preschool children with disabilities in Ireland are low when compared with the general population. Furthermore, children aged 3 years or younger exhibited no dental caries at dentin level and therefore were not affected by early childhood caries. An adjustment of current oral health prevention practice may lead to a further reduction in dental caries levels in this section of the child population.

To investigate reactions of pulp tissue when in contact with the dentin adhesives Resulcin AquaPrime + MonoBond (RAPMB, Merz Dental), Scotchbond 1 (SB1, 3M ESPE), and Gluma Comfort Bond (GCB, Heraeus Kulzer) in comparison with calcium hydroxide after 1 to 70 days.An occlusal cavity was prepared in 152 molars of 76 Wistar rats. The pulps were exposed and dentin adhesives placed on the pulp tissue of 10 molars for each dentin adhesive group and time period. Eight molars per time period served as controls and were capped with calcium hydroxide. All cavities were restored with composite resin. The animals were sacrificed 1, 3, 7, and 70 days after pulp capping. Pulp tissue was histologically evaluated for the following criteria: bacterial infection, inflammatory cells, necrosis, and reparative dentin. The data were statistically evaluated using the Kruskal-Wallis test (P.05).Overall, significantly more bacterial infections were detected 1, 3, 7, and 70 days after pulp capping with dentin adhesive (P.05). In all dentin adhesive groups, 1 day after direct pulp capping, significantly more inflammatory cells were found, whereas after 7 days, this was only the case for the SB1 group (P.05). After 70 days, capping with calcium hydroxide resulted in significantly less necrosis than with RAPMB and SB1 (P.05). Regarding necrosis, SB1 showed the worst results: Pulp necrosis occurred significantly more often than with calcium hydroxide and GCB (P.05). After the application of calcium hydroxide, significantly more reparative dentin formation occurred (P.05).Direct pulp capping with calcium hydroxide seems to produce remarkably better results than with dentin adhesive.

Several studies reported superior healing results for ProRoot mineral trioxide aggregate (MTA; Dentsply Tulsa) cement in direct pulp capping when compared to calcium hydroxide. However, this could not be confirmed by other authors. The aim of this study was to compare the reaction of MTA-treated rat pulp tissue to calcium hydroxide [Ca(OH)2]-treated rat pulp tissue in direct pulp capping after 1 to 70 days.Seventy-two caries- free, maxillary right and left first molars of 36 Wistar rats were prepared with an occlusal cavity. The pulp chambers were then perforated with a sharp probe. For each of four time periods, MTA was placed on the exposed pulp of 10 molars according to the manufacturer's instructions, and Ca(OH)2 was placed on 8 molars. All cavities were then filled with dentin adhesive and flowable composite. The animals were sacrificed 1, 3, 7, and 70 days after pulp capping. The pulps were histologically analyzed (light and transmission electron microscopic) for bacterial infection, inflammatory cells, necrosis, and reparative dentin and classified according to occurrence in scores from 1 to 4. To ensure that the coronal restorations did not leak, occlusal cavities were prepared in four maxillary molars of one rat. The coronal cavity was then sealed with resin. After 70 days, the rat was sacrificed, and the molars were immersed in new fuchsin. Data were statistically evaluated with the Kruskal-Wallis test (P.05).The MTA group showed statistically significantly lower signs of necrosis 1 and 3 days after pulp capping when compared with the Ca(OH)2 group (P.05). No other statistically significant differences were found (P.05). After 70 days, all pulps displayed healthy tissue. In the leakage test no specimens revealed any dye penetration.MTA showed equally good results as Ca(OH)2 and can berecommended clinically for direct pulp capping.

SUMMARY Background: It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay. Aims: The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach. Design: A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child’s parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification. Results: A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value=0.015) which was due to lower dental caries levels in children with non-deprived social background. Conclusions: In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.

Objectives: To compare dental caries levels of schoolchildren stratified in different social classes whose domestic water supply had been fluoridated since birth (Dublin) with those living in an area where fluoridated salt was available (Freiburg). Methods: A representative, random sample of twelve-year-old children was examined and dental caries was recorded using World Health Organization criteria. Results: A total of 699 twelve-year-old children were examined, 377 were children in Dublin and 322 in Freiburg. In Dublin the mean decayed, missing, and filled permanent teeth (DMFT) was 0.80 and in Freiburg it was 0.69. An examination of the distribution of the DMFT score revealed that its distribution is highly positively skewed. For this reason this study provides summary analyses based on medians and inter-quartile range and nonparametric rank sum tests. In both cities caries levels of children in social class 1 (highest) were considerably lower when compared with the other social classes regardless of the fluoride intervention model used. The caries levels showed a reduced disparity between children in social class 2 (medium) and 3 (lowest) in Dublin compared with those in social class 2 and 3 in Freiburg. Conclusions: The evidence from this study confirmed that water fluoridation has reduced the gap in dental caries experience between medium and lower social classes in Dublin compared with the greater difference in caries experience between the equivalent social classes in Freiburg. The results from this study established the important role of salt fluoridation where water fluoridation is not feasible.