Search

Objectives The aims of this study were to determine the frequency of oral health-related quality of life (OHRQoL) impairment in a national representative sample of 8 to 9 year olds in Germany and to evaluate the impact of orthodontic treatment need. Methods Data were collected in the Sixth German Oral Health Study (Sechste Deutsche Mundgesundheitsstudie, DMS 6) and subjects were sampled using a multistage sampling technique. OHRQoL was measured with a modified version of the 5‑item Oral Health Impact Profile (OHIP-5) which was administered in a computer-assisted personal interview. Children were also examined for malocclusion and orthodontic treatment need. Results In all, 1892 children aged 8–9 years were invited to take part. Finally, data of 705 children (48.6% female) could be included in the analysis. The OHIP‑5 mean was 1.3 (±2.0). There was no relevant influence from age and gender on the OHIP‑5 summary scores (r p = 0.020). Nevertheless, the level appears to be low. Conclusions Malocclusions with orthodontic treatment need have an influence on OHRQoL.

ZusammenfassungBei der Molaren-Inzisiven-Hypomineralisation (MIH) handelt es sich um einen qualitativen Defekt des Schmelzes, der klassischerweise an einem bis zu vier bleibenden ersten Molaren mit oder ohne Beteiligung der Inzisiven auftritt. Charakteristisch für das Krankheitsbild sind Opazitäten, ggf. fortschreitende posteruptive Schmelzeinbrüche und das Auftreten von Hypersensibilitäten. Insbesondere überempfindliche MIH-Zähne können für den Behandler eine Herausforderung sein. Das Therapiespektrum reicht hier von dem regelmäßigen Gebrauch von Pasten bis zur Versiegelung der Zähne.

ZusammenfassungDie Molaren-Inzisiven-Hypomineralisation (MIH) beschreibt einen qualitativen Defekt des Schmelzes an einem bis zu vier bleibenden ersten Molaren mit oder ohne Beteiligung der permanenten Inzisiven. Charakteristisch sind Opazitäten, ggf. fortschreitende posteruptive Schmelzeinbrüche und das Auftreten von Hypersensibilitäten. Mit den Kriterien der European Academy of Paediatric Dentistry (EAPD) ist es sehr gut möglich, eine MIH in der Praxis sicher zu diagnostizieren. Differentialdiagnostisch müssen genetische Strukturanomalien des Schmelzes, postnatale Entwicklungsstörungen oder exogen bedingte Dysplasien ausgeschlossen werden. Das Würzburger Konzept bietet eine Möglichkeit, MIH-betroffene Zähne in Schweregrade einzuteilen und eine darauf abgestimmte Therapie zu finden.

ObjectivesThe aim of this study was to compare oral health–related quality of life (OHRQoL) in children with and without molar incisor hypomineralization (MIH) and to assess the impact of severity of MIH on OHRQoL in children between 8–10 years using the German version of the Child Perceptions Questionnaire (CPQ-G8-10).Materials and methodsChildren aged 8–10 years were recruited at a pediatric dental clinic in Hannover, Germany. Half of them were affected by MIH. Participants were evaluated for presence and severity of MIH (MIH-TNI), plaque and dental caries status. Children were asked to answer the CPQ-G8-10. Statistical analysis was performed using GraphPad Prism-software version 8.ResultsOne hundred eighty-eight children (mean age 8.80 [± 0.84]; 43.10% female) were included in the study with 94 children having MIH. CPQ-G8-10 mean scores in MIH-affected children were significantly higher than in children showing no MIH (13.87 [± 8.91] vs. 4.20 [± 3.74];p ConclusionChildren affected by MIH show an impaired OHRQoL compared to children without MIH; with increasing severity, OHRQoL gets more impaired.Clinical relevanceTo understand the patient’s perception and the individual oral health needs will help to prioritize MIH and recognize its impact.

Objectives This study was aimed to compare the impact of caries and molar incisor hypomineralization (MIH) on oral health-related quality of life (OHRQoL) in children. Material and methods A total of 528 German children aged 7 to 10 years were recruited, half affected by caries and the other half affected by MIH. Both groups were matched according to age, sex, and social status and divided into 3 categories according to severity. The German version of the Child Perceptions Questionnaire for 8- to 10 years old (CPQ-G8-10) was used to analyze the impact on OHRQoL by applying ANOVA models. Results Patients with MIH showed a mean CPQ score of 10.7 (± 9.3). This was significantly higher compared to the caries group with 8.1 (± 9.8). The score increased linearly from the low severity category to the high severity category in both groups (caries, 4.1 to 13.8; MIH, 5.2 to 17.7, respectively). Conclusion With increasing severity, both clinical conditions showed a greater negative impact on OHRQoL. MIH was associated with more impairments. Clinical relevance Currently, the focus in pediatric dentistry is placed on the prevention and treatment of caries. Both diseases may have a negative influence on OHRQoL. Since children perceive the impairments by MIH as worse and the prevalence is equal to that of caries, which focus might be shifted in the future.

Sarra Boukhobza,1 Valentin Ritschl,2 Tanja Stamm,2 Katrin Bekes1 1Department of Pediatric Dentistry, University Clinic of Dentistry, Medical University Vienna, Vienna, Austria; 2Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University Vienna, Vienna, AustriaCorrespondence: Katrin BekesDepartment of Pediatric Dentistry, University Clinic of Dentistry, Medical University Vienna, Sensengasse 2a, Vienna, 1090, AustriaTel +43-1-400702801Fax +43-1-400702809Email katrin.bekes@meduniwien.ac.atIntroduction: Universities with dental schools are faced with complex problems during the COVID-19 pandemic. Dentistry students are at a higher risk of contracting infections, specifically COVID-19, due to direct contact with patients. The aim of this study was to assess the knowledge, perception and attitude regarding COVID-19 among dentistry students in Austria.Methods: During the first lockdown in Austria, an online survey was distributed among 165 dentistry students in their clinical term at the Medical University of Vienna. The survey contained elaborative questions on the general knowledge and attitude towards COVID-19. A special focus of the questionnaire was set on the modification of the student’s curriculum regarding infection control.Results: In total, 77 (47%) students replied; 68 questionnaires were included in the analysis. Dentistry students were found to have good general knowledge of COVID-19 during the early phase of the pandemic. Most students (89.6%) got their information regarding the COVID-19 infection from official sources; however, 58% would like to attend further lectures on COVID-19 to expand their knowledge.Discussion: The current study finds good general knowledge on COVID-19 among dental students, but some gaps regarding hygienic protocols and infection control. Students’ preferences regarding modification in the curriculum suggest practical courses and lectures as a way to close COVID-19 related knowledge gaps.Keywords: COVID-19, pandemic, infection, dentistry students, infection control

ObjectivesThe aim of this study was to investigate the changes in oral health-related quality of life (OHRQoL) before and after treatment of hypersensitive molars affected by molar incisor hypomineralization (MIH) with a sealing.MethodsThirty-eight children with two MIH-affected molars showing hypersensitivity and non-occlusal breakdowns were included. Hypersensitivity was assessed with an evaporative (air) stimulus. Two affected teeth were sealed by two calibrated operators using a split-mouth design: Clinpro Sealant in combination with Scotchbond Universal, and Ketac Universal (3M), respectively. OHRQoL was measured using the German version of the CPQ8–10 (CPQ-G8–10) at baseline, and after 1, 4, 8, and 12 weeks, respectively.ResultsThe CPQ total score decreased significantly from a mean of 14.7 (±5.9) to 6.4 (±4.7) (p< 0.001) 1 week after treatment revealing improved OHRQoL. After 12 weeks, OHRQoL improved again proven by a decreased mean score of 2.7 (±3.2).ConclusionsSealing of hypersensitive MIH-affected molars revealed a significant improvement of OHRQoL immediately and throughout the 12-week follow-up.Clinical relevanceHypersensitivity can be a major complaint in patients with MIH. This is the first study evaluating the effect of sealing on OHRQoL in affected patients.

Background: In Austria, almost every second child has caries. The consequences of untreated carious lesions are infections, pain, and limitations in everyday life. The aim of this study was to evaluate the influence of silver diamine fluoride (SDF) treatment on the oral health-related quality of life (OHRQoL) of uncooperative children aged 0–5 years using the German version of the Early Childhood Oral Health Impact Scale (ECOHIS-G). Methods: This prospective study was conducted at the Department of Paediatric Dentistry at the Medical University of Vienna. Preschool children with behavioral problems and carious lesions that required SDF application were included. The ECOHIS-G questionnaire was given to the caregiver before (T0) and three months (T1) after treatment. Using descriptive analysis and the Wilcoxon Signed-Rank test, changes in the ECOHIS scores were evaluated and tested for significance. Results: A total of 30 children aged 0–5 years were enrolled and received SDF treatment. At baseline, the total ECOHIS score was 21.4 (±8.5). Three months after therapy, a significant improvement was achieved (16.3 [±5.6], p < 0.05). Significantly better scores were observed in six subdomains, especially in “child function” (3.9 [±2.0]) and “child symptoms” (2.0 [±1.3]) (p < 0.05). Conclusions: Treatment of carious lesions with SDF in the primary dentition resulted in an improvement in the OHRqoL of children with behavioral problems.

Objectives To analyse possible changes in oral health-related quality of life (OHRQoL) before and after dental treatment under dental general anaesthesia (DGA) among Austrian preschool children. Methods A consecutive sample of 89 parents of children aged 2 to 5 years, suffering from early childhood caries (ECC) and scheduled for DGA, were recruited from two locations in Austria (Vienna and Salzburg). Parents self-completed the German version of the ECOHIS before (baseline) and 4 weeks (T4) after their child’s dental treatment. The ECOHIS consists of 13 questions and is divided into two main parts, namely, the child impact section (9 items) and the family impact section (4 items). Results A total of 80 children (89%) completed a sufficient number ECOHIS questions at baseline and the follow-up assessment after 4 weeks. “Pain in the teeth, mouth, and jaws” and “difficulty eating some foods” from the child section and parents’ ratings of “feeling upset” and “guilty” were the most frequently reported impacts at baseline. The ECOHIS total score decreased significantly from a mean of 14.60 to 9.89 (p < 0.001) after DGA treatment, revealing a large effect size for the child (0.8) section, family (0.6) section, and the total score (0.8). Parents rated their child’s overall and oral health significantly higher after the DGA treatment (p < 0.001). Conclusions Significant improvements in oral health-related quality of life were observed 4 weeks after DGA in children suffering from ECC. Clinical relevance ECC has an impact on OHRQoL. Rehabilitation under general anaesthesia makes a sustainable improvement.

Background: Treatment of oral diseases can have a long-lasting impact on a child’s life well beyond its childhood years. The purpose of this study was to compare the impact of treatment on the oral-health-related quality of life (OHRQoL) of children with severe caries and severe molar incisor hypomineralization (MIH). Methods: A total of 210 children (mean age 9 years; 49% female) with severe caries (inner third of dentin) and severe MIH (post-eruptive breakdown, crown destruction) were included in the study. Both groups were matched according to age, gender, and social status. The German version of the Child Perception Questionnaire for 8–10-year-olds (CPQ-G8–10) was used before and after treatment to analyze the impact on OHRQoL. Results: Patients with severe MIH showed a significantly higher total CPQ score (17.8 (±10.6)) before treatment compared to the caries group (13.8 (±14.3)). The mean CPQ score in all subdomains decreased significantly after therapy in the MIH group. Children with severe carious lesions had similar results except in the domain “functional limitations”, as treatment led to only minor changes (2.9 (±3.6) to 2.2 (±2.6)). Conclusions: Despite a narrower treatment spectrum, patients with severe MIH experienced a greater overall improvement in OHRQoL compared to the caries group.

Since untreated dental caries remain a worldwide burden, this umbrella review aimed to assess the quality of evidence on the clinical effectiveness of different restorative materials for the treatment of carious primary teeth. A literature search in electronic bibliographic databases was performed to find systematic reviews with at least two-arm comparisons between restorative materials and a follow-up period ≥12 months. Reviews retrieved were screened; those eligible were selected, and the degree of overlap was calculated using the ‘corrected covered area’ (CCA). Data were extracted and the risk of bias was assessed using the ROBIS tool. Fourteen systematic reviews with a moderate overlap (6% CCA) were included. All materials studied performed similarly and were equally efficient for the restoration of carious primary teeth. Amalgam and resin composite had the lowest mean failure rate at 24 months while high-viscosity and metal-reinforced glass ionomer cements had the highest. At 36 months, high-viscosity glass ionomer cements showed the highest failure rate with compomer showing the lowest. Most reviews had an unclear risk of bias. Within the limitations of the review, all materials have acceptable mean failure rates and could be recommended for the restoration of carious primary teeth.

Objectives The 14-item Oral Health Impact Profile (OHIP-14) is the most frequently used instrument to measure oral health-related quality-of-life (OHRQoL) in adults. Despite its popularity, its psychometric properties have been predominantly investigated based on the classical test theory while the fundamental principles of measurement have not been fully assessed. Therefore, our aim was to investigate to what extent the OHIP-14 meets the fundamental requirments of measurements. Methods We used the Rasch model to explore person-item-targeting, unidimensionality, local independence of items, invariance (differential-item-functioning, DIF), and the order of thresholds between response-options in the German version OHIP-14. We used data from osteoarthritis patients because hand disabilities and joint pain might influence oral hygiene. Furthermore, osteoarthritis in the temporomandibular-joint directly affects oral functioning. Results Five-hundred sixteen patients were included (mean age 66.5 years [±10.2; ranging from 34 to 89]; 71.3% [368] females). The OHIP-14 median total score was 0 (interquartile-range from 0 to 4), indicating a right-skewed distribution because many patients reported good OHRQoL. The instrument was found unidimensional. However, there was strong evidence of local dependency, disordered thresholds between response-options, and age-related DIF for item 5. A revised scoring scheme with three instead of five answer-options in all items and eliminating two items resolving local dependency, the newly adapted OHIP-12, showed better reliability and item-fit to the Rasch model than the original OHIP-14. Conclusions This study assesses, for the first time, the OHIP-14 in terms of fundamental principles of measurement and proposes an item-reduced OHIP-12 as a psychometrically more accurate version of the instrument. Clinical significance The Rasch model is essential to ensure instruments' precision and clinical meaningfulness when measuring OHRQoL in clinical practice and research. The OHIP-12, derived from the OHIP-14 by deleting two items due to local dependency, with a revised scoring scheme for all items distinguishing three answer-options instead of five, represents a psychometrically improved version of the instrument.

The pandemic caused by the COVID-19 virus has led to enormous challenges in pediatric dental care. In contrast to adults, many children are without any symptoms of disease if infected with COVID-19 and are not vaccinated. The aim of this study was to conduct an inquiry into the perspective of pediatric dentists in Germany towards the impact of COVID-19 on daily patient care during the lockdowns caused by the pandemic. All members of the Germany Society of Pediatric Dentistry were invited to participate in an online survey. The questionnaire focused on five topics: safety measures, well-being/knowledge, patient care, prospects, and demographic data. A total of 549 pediatric dentists participated (58.11% females, 8.2% males, 0.18% inter/diverse, and 33.51% no answer). In total, 75.2% of the dental clinics were open during the first lockdown (LD1) and 78.1% during the second lockdown (LD2). In LD1, only 22.2% were operating at full capacity, while 40.1% were open with restrictions, and 11.8% only offered emergency treatment. In LD2, 71.2% of practices were operating again and resumed offering all treatment methods. A significant decrease in pediatric patients was reported due to the fact of COVID-19. Furthermore, measures, such as oral hygiene and recall appointments, were reduced. Measures that were performed after the lockdown were mainly aerosol-generating procedures and extractions as well as general anesthesia or sedation. The increased willingness to treat in the second lockdown has shown that pediatric dentists have adapted to the pandemic conditions, which seems to be of great importance, especially in view of the problem of unvaccinated children.

Molar incisor hypomineralization (MIH) is a difficult-to-diagnose developmental disorder of the teeth, mainly in children and adolescents. Due to the young age of the patients, problems typically occur with the diagnosis of MIH. The aim of the present technical note was to investigate whether a successful application of a neural network for diagnosis of MIH and other different pathologies in dentistry is still feasible.For this study, clinical pictures of four different pathologies were collected (n = 462). These pictures were categorized in caries (n = 118), MIH (n = 115), amelogenesis imperfecta (n = 112) and dental fluorosis (n = 117). The pictures were anonymized and a specialized dentist taking into account all clinical data did the diagnosis. Then, well-investigated picture classifier neural networks were selected. All of these were convolutional neural networks (ResNet34, ResNet50, AlexNet, VGG16 and DenseNet121). The neural networks were pre-trained and transfer learning was performed on the given datasets.For the vgg16 network, the precision is the lowest with 83.98% as for the dense121 it shows the highest values with 92.86%. Comparing the different pathologies between the investigated neural networks, there is no trend detectable.In the long term, an implementation of artificial intelligence for the detection of specific dental pathologies is conceivable and sensible.Finally, this application can be integrated in the area of training and teaching in order to teach dental students as well as general practitioners for MIH and similar dental pathologies.

Katrin Bekes,1 Kaya Melichar,1 Tanja Stamm,2 Karim Elhennawy3 1Department of Paediatric Dentistry, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria; 2Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Section for Outcomes Research, Vienna, Austria; 3Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité – Universitätsmedizin Berlin, Berlin, GermanyCorrespondence: Katrin BekesDepartment of Pediatric Dentistry, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, 1090, AustriaTel +43-1-400702801Fax +43-1-400702809Email katrin.bekes@meduniwien.ac.atPurpose: Molar incisor hypomineralization (MIH) is a frequently encountered dental condition worldwide. The aim of this study was to evaluate the knowledge of Austrian dental students about MIH.Methods: A validated paper-based survey was distributed among 100 final year dental students at the Medical University of Vienna to assess their knowledge, perception and believes regarding MIH. One hundred dental students at the University Dental Clinic of Vienna were included in the study. At the time of the survey, they were in their 11th or 12th semester (final year). Information about the knowledge on diagnosis and prevalence, and attitudes and beliefs around etiology and management was collected.Results: All students replied, 94 questionnaires could be included in the analysis (50% female). 98% of the students were familiar with MIH and 86% were aware with the clinical features of MIH. Only 13% reported clinical ability to identify MIH. Regarding the etiology of MIH, most of the students (69%) named “genetic factors” as the most frequent etiological factor.Conclusion: Dental students showed great interest in the topic of MIH, as the majority of all respondents were in favor of deepening their knowledge regarding this topic. The students should be offered opportunities to do this both during and after their studies.Keywords: molar incisor hypomineralization, MIH, students, knowledge, beliefs, attitudes

The aim of this study was to retrospectively analyze the prevalence and patterns of traumatic dental injuries (TDIs) in permanent teeth at the University Dental Clinic of Vienna and examine influential variables. The study included all patients with dental trauma in permanent teeth who presented at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records, including age, gender, location of trauma, type of trauma, cause of TDI, and location of the traumatic incident, were obtained. Clinical oral and radiographic examinations were conducted in accordance with the current guidelines of the German Society of Dental, Oral, and Craniomandibular Sciences (DGZMK). The sample comprised 1132 permanent teeth of 578 patients with TDIs. The most frequently injured teeth were upper central incisors (n = 719, 63.5%), followed by upper lateral incisors (n = 231, 20.4%). Fractures were the most frequent injury type (53%, n = 596). TDIs mostly occur due to falling accidents. The majority of traumatic incidents occurred at home (79.4%, n = 459). The injury characteristics are comparable to the results of other international studies. Due to the high prevalence of TDIs in dental medicine, dental practitioners should be equipped to effectively manage their immediate care and treat potential long-term complications.

Molar incisor hypomineralization (MIH) describes the clinical picture of more or less strongly hypomineralized first permanent molars with or without the involvement of permanent anterior teeth. In the meantime, however, MIH-typical substance defects were found on every possible tooth. Affected teeth can be hypersensitive. This hypersensitivity can only be treated when complete pain control is ensured. With the awareness of possible causes of hypersensitivity and the help of a correct behavior management and anesthesia technique as well as sometimes with the help of sufficient premedication and compassion for our patients, it should be possible to treat most of these hypersensitive teeth affected by MIH. With the therapy-appropriate formulations of the adequate anodyne, it is also possible to control the symptoms of chronically inflammatory MIH molars (pain protocol; pain algorithms). Sedation with nitrous oxide/oxygen allows a more intensive use of behavior management techniques. As a last treatment option, the patient could be brought to rehabilitation under general anesthesia.

The aims of this study were to develop a German version of the Early Childhood Oral Health Impact Scale (ECOHIS), a measure of oral health-related quality of life in pre-school-age children, and to assess the instrument’s reliability and validity. The original English version of the ECOHIS questionnaire was translated into German (ECOHIS-G) by a forward-backward translation method. A total of 336 children aged 0 to 5 years and their caregivers who were recruited at the Department of Paediatric Dentistry in Vienna, Austria, participated in this study. The caregivers completed the ECOHIS-G and their children were clinically examined for the presence of dental caries and plaque accumulation. Reliability of ECOHIS was investigated in a subsample of 59 subjects after 3 weeks. Questionnaire summary score test-retest reliability was 0.81 (intraclass correlation coefficient, 95% confidence interval (CI) ranging from 0.68 to 0.89) and internal consistency was 0.83 (Cronbach’s alpha, lower limit of the 95% CI 0.80). Validity of the ECOHIS-G questionnaire was supported by correlation coefficients with global ratings of oral health of − 0.42 (95% CI − 0.45 to − 0.35) and overall well-being of − 0.29 (95% CI − 0.34 to − 0.22) which met the expectations. Mean ECOHIS-G scores were statistically significantly higher in children with caries compared with caries-free children. The German version of the ECHOHIS was found to be reliable and valid in children aged 0 to 5 years. These findings enable assessments of oral health-related quality of life in German-speaking pre-school children.

Background: Molar–incisor hypomineralization (MIH) has a strong negative effect on oral-health-related quality of life (OHRQoL). Malformed teeth can be hypersensitive, and the discoloration might affect children’s appearances, reducing their well-being. The purpose of the study was to investigate how hypomineralized incisors and molars differ in children’s perceived OHRQoL. Materials and Methods: 252 children aged 7–10 years old were included and subdivided into three equal groups (n = 84). Group A included children with asymptomatic molars and affected incisors. Group B included children presenting only affected molars. Group C was the control group, with children showing no MIH. All participants were asked to complete the German version of the Child Perceptions Questionnaire (CPQ-G8-10) to measure OHRQoL. Results: Participants in the posterior group showed a median total CPQ of 13.4 (±1.7), which was significantly higher than scores in the anterior and control group, which showed a median total CPQ of 8.4 (±1.4) and 4.2 (±0.7), respectively. Children in the posterior group suffered more from oral symptoms and functional limitations, whereas the anterior group dealt more with social and emotional well-being problems. Conclusions: The position of the MIH-affected teeth causes different influences on perceived OHRQoL.

Objectives The aim of this study was to retrospectively identify the prevalence, patterns, and accident types of traumatic dental injuries (TDIs) in children with primary teeth in Vienna, Austria. Material and methods The investigation was conducted as a retrospective overview study including all children with TDIs in primary teeth at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records including age, gender, location of trauma, type of trauma, cause of TDI, and location of traumatic incident were obtained. Furthermore, the time of presentation and the time span between TDI and initial treatment were evaluated. Results The sample comprised TDIs in 243 patients with 403 primary teeth. In a ratio of 1:1.45, boys were significantly more involved than girls. Upper central and lateral incisors were most frequently affected (n = 371, 92.1%). Dislocations were the most common type of injury (n = 298, 74%) with subluxations being the most prevalent form (n = 85, 28.5%). In 23% (n = 92), fractures were observed. The majority of traumatic incidents occurred at home (88.5%). Conclusion The injury characteristics are comparable to what has previously been reported in other studies in pediatric populations. Clinical relevance TDIs are a prevalent event in children worldwide and incisors are the most affected teeth in the primary dentition. Thus, dental practitioners should be able to handle these injuries.

BackgroundOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.MethodsDentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed.FindingsData from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories.ConclusionsThe study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

ObjectivesThe aim of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 12 weeks after sealing using two different materials (composite and glass ionomer). Furthermore, the retention rates of both materials were analyzed.MethodsThirty-nine children with two MIH-affected molars showing hypersensitivity and non-occlusal breakdowns were included. Hypersensitivity was assessed with an evaporative (air) stimulus. Both teeth were sealed by two calibrated operators using a split-mouth design with either Clinpro Sealant in combination with Scotchbond Universal (C) or Ketac Universal (K), respectively. Clinical pain assessments (Schiff Score Air Sensitivity Scale [SCASS], Visual Analog Scale [VAS]) were made at baseline (“pre”), immediately after treatment (“post”), and after 1, 4, 8, and 12 weeks. Pairedttests were calculated in each group between baseline and all other time points.ResultsThirty-eight children with 76 molars completed all stages of the study. Regardless of the material used, the application of the sealant decreased hypersensitivity significantly immediately as well as throughout the 12-week recalls (allpvalues < 0.001). We found no statistically significant difference among both materials chosen in any of the time points evaluated. Furthermore, retention of both materials was comparable in both groups.ConclusionsBoth sealant materials were able to reduce hypersensitivity successfully immediately and throughout the 12-week follow-up. Furthermore, their performance was similar in terms of retention.Clinical relevanceHypersensitivity can be a major complaint in patients with MIH. This is the first study evaluating hypersensitivity relief of MIH-affected molars using two sealing techniques.

To compare the frequency of patients' oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions.An anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients' oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients' problems and prevention needs were calculated together with the significance of Slovenian and international dentists' differences based on dental fields and WHO regions.Dentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (0.1).According to the dentists' responses, the frequency of patients' oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.V raziskavi smo želeli primerjati pogostost ustno-obraznih težav in potreb po preventivnem zdravju zobozdravstvenih pacientov med slovenskimi in mednarodnimi zobozdravniki s pomočjo spletne ankete, ki bi potrdila veljavnost štirih dimenzij oralnega zdravja v šestih kliničnih zobozdravstvenih specialnostih iz vseh svetovnih regij, kot jih določa Svetovna zdravstvena organizacija.V programski opremi Qualtrics smo v angleškem jeziku izdelali anonimno spletno anketo z namenom kategorizirati ustno-obrazne težave in preventivne ukrepe zobozdravstvenih pacientov v štiri dimenzije oralnega zdravja (funkcionalna, bolečinska, estetska in psihosocialna) na osnovi šestih stomatoloških specialnosti. Naključno vzorčenje smo uporabili za slovenske zobozdravnike, medtem ko smo za zobozdravnike iz 31 držav uporabili priložnostno vzorčenje. Za preverjanje pacientovih ustno-obraznih težav ter njihove potrebe po zdravljenju na osnovi zobozdravnikove ocene smo uporabili razmerja v odstotkih. Velikost učinka smo računali za preverjanje razlik med slovenskimi in tujimi zobozdravniki iz vseh regij po razdelitvi Svetovne zdravstvene organizacije in na osnovi šestih zobozdravstvenih specialnosti.Tisoč petsto osemdeset zobozdravnikov iz 32 držav je izpolnilo spletno anketo. Od tega je bilo 223 slovenskih (68 % žensk) s povprečno starostjo (SD) 41 (10,6) let in 1.358 tujih zobozdravnikov (51 % žensk) s povprečno starostjo (SD) 38 (10,4) let. Slovenski (37 %) in tuji (45 %) zobozdravniki so izbrali ustnoobrazno bolečino kot najpogostejšo težavo in preventivni ukrep pri zobozdravstvenih pacientih v vseh šestih zobozdravstvenih specialnostih. Po Cohenu so bile razlike med slovenskimi in pacienti iz drugih držav z ustnoobraznimi težavami in pri preventivnih ukrepih zelo majhne (0,1).Ustno-obrazne težave zobozdravstvenih pacientov in njihove potrebe po zdravljenju znotraj vseh šestih zobozdravstvenih specialnosti so v Sloveniji in drugih 31 državah, regionalno in globalno, primerljive. Vse štiri dimenzije podpirajo zobozdravnikov celostni pogled na oralno zdravje in preventivne ukrepe zobozdravstvenih pacientov po svetu in zobozdravstvenih specialnostih.

Dental patient-reported outcomes (dPROs) describe the impact of oral diseases and interventions on dental patients.1 Scores of dPRO measures (dPROMs) quantify this impact in numbers. They are necessary for evidence-based dentistry,2,3 doctor-patient communication,4 and value-based oral health care.5 Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact - the dimensions of oral health-related quality of life (OHRQoL) 6-8 - capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future.9 Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information using the four OHRQoL dimensions across oral diseases and settings. ADULTS: In a systematic review MOM identified four-dimensional impact information for 189 patient populations, i.e., distinct and clinically relevant groups of dental patients,10 contained in 170 publications. On average, 1.6 dental patient samples were available per population. The quality of this information was assessed and found to be predominantly good. No association between quality of information and magnitude of the patient's OHRQoL impact and no publication bias were detected. A typical functional, painful, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units.11-14 CHILDREN: In a systematic review MOM identified four-dimensional impact information for 22 populations, i.e., distinct and clinically relevant groups of individuals,15 contained in 12 publications. On average, 1.2 samples were available per population. The quality of this information was assessed and found to be predominantly good. Publication bias was not assessed. A typical functional, painful, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 units.15.

Objectives The influence of the administration method used to collect oral health–related quality of life (OHRQoL) in children remains largely unknown. The aim of this study was to determine whether the OHRQoL information obtained using the Early Childhood Oral Health Impact Scale (ECOHIS) differed with different methods of data collection (face-to-face interview, telephone, or self-administered questionnaire). Materials and methods The OHRQoL of 38 preschool children, aged 1 to 5 years, was measured using the German version of the ECOHIS. The instrument was administered to the caregivers of these children using three different methods, with an interval of 1 week between each administration. Test-retest reliability for the repeated ECOHIS-G assessments across the three methods of administration, agreement, and convergent validity was determined. Results Kappa coefficients for agreement between two different methods of administration, respectively, ranged from moderate to substantial (0.47 to 0.65). Test-retest reliability was moderate (ICC 0.65–0.79). Conclusion In conclusion, the three methods of administration (face-to-face interview, telephone interview, or self-administered questionnaire) of the ECOHIS-G were comparable in 1- to 5-year-old preschool children. Clinical relevance All three methods of administration can be used to obtain valid and reliable OHRQoL information in German speaking countries.

Objective The dimensions of oral health–related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions. Methods Dentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated. Results For every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering. Conclusion Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.

Objective\ud To be fit-for-purpose, oral health-related quality of life instruments must possess a range of psychometric properties which had not been fully examined in the 16-item Short Form Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14 ISF-16). We used advanced statistical approaches to determine the CPQ’s measurement accuracy, precision, invariance and dimensionality and analyzed whether age range could be extended from 8 to 15 years.\ud \ud Methods\ud Fit to the Rasch model was examined in 6648 8-to-15-year-olds from Australia, New Zealand, Brunei, Cambodia, Hong Kong, Malaysia, Thailand, Germany, United Kingdom, Brazil and Mexico.\ud \ud Results\ud In all but two items, the initial five answer options were reduced to three or four, to increase precision of the children’s selection. Items 10 (Shy/embarrassed) and 11 (Concerned what others think) showed an ‘extra’ dependency between item scores beyond the relationship related to the underlying latent construct represented by the instrument, and so were deleted. Without these two items, the CPQ was unidimensional. The three oral symptoms items (4 Food stuck in teeth, 3 Bad breath and 1 Pain) were required for a sufficient person-item coverage. In three out of 14 items (21 %), Europe and South America showed regional differences in the patterns of how the answer options were selected. No differential item functioning was detected for age.\ud \ud Conclusion\ud Except for a few modifications, the present analysis supports the combination of items, the cross-cultural validity of the CPQ with 14 items and the extension of the age range from 8 to 15 years.\ud \ud Clinical significance\ud The valid, reliable, shortened and age-extended version of the CPQ resulting from this study should be used in routine care and clinical research. Less items and a wider age range increase its usability. Symptoms items are needed to precisely differentiate between children with higher and lower quality of life.

In order to not only understand the pathogenesis of MIH but also derive appropriate treatment strategies, knowledge of the structural, mechanical, and chemical properties and changes of MIH-affected enamel compared to normal enamel is required. The present chapter summarizes the findings of studies on changes in MIH versus sound enamel. A number of studies reported on structural, mechanical, and chemical properties of MIH-affected enamel; however, the results of these studies are not always consistent because of the wide range of different analytical methods used. Future studies should hence aim for the use of standardized methods, if possible in combination with each other, and linking the histological, mechanical, and chemical properties with clinical parameters (severity, symptoms). Common structural findings pertain to (1) an increased protein content and enamel porosity, (2) decreased mineral density, and (3) inferior mechanical properties of the affected enamel. While it is not fully clear how these findings can be linked into clinical practice, future strategic avenues may involve an extension of the cavity preparation into seemingly healthy enamel to allow bonding to truly unaffected enamel, the use of flexure-resistant materials to overcome the mechanical limitations of the underlying MIH-affected enamel, and the use of modified conditioning techniques, tailored for MIH-affected enamel to optimize the prognosis of restorations in MIH teeth.

Molars affected by molar incisor hypomineralization can represent a spectrum of severity and extension of the defect. The aim of this chapter is to review available indirect restorative treatment modalities for severe cases of MIH with cavitated structural defects. The choice of material is governed by a number of factors including severity of the condition, patient’s dental age, cooperation of the child, and child/parent’s social background and expectation.

Molar incisor hypomineralization (MIH) is defined as hypomineralization of systemic origin of one to four permanent first molars frequently associated with affected incisors. The aim of this chapter is to describe currently available diagnostic criteria, discuss differential diagnoses and present classifications and treatment options.

BACKGROUND: Knowledge of molar incisor hypomineralization (MIH) has relevance for paediatric dentists.AIM: To assess final-year German dental students' knowledge, attitudes, and beliefs regarding MIH.MATERIALS AND METHODS: A previously validated questionnaire was posted to the 31 German dental schools. Demographic covariates as well as knowledge regarding diagnosis and prevalence, and attitudes and beliefs around aetiology and management were collected.RESULTS: Twenty-two (71%) dental schools responded and a total of 877 students participated. Most (97%) were familiar with MIH and 88% were aware of the diagnostic criteria for MIH; however, only 42% knew how to implement them. One-third were able to identify MIH and 16% reported diagnostic confidence when doing so; 90% assumed the MIH prevalence to be CONCLUSION: German students were familiar with MIH; however, they reported low levels of knowledge and confidence regarding its prevalence and diagnosis. Standardized nationwide, up-to-date curricula should be implemented to educate future dentists in Germany.

Objectives The most important dental patient-reported outcome (dPRO) is oral health-related quality of life (OHRQoL) which was commonly based on the following four dimensions: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. However, until now, analyses linking dPROSs to the four dimensions have only been done in adults. We therefore examined if the existing dental patient-reported outcome measures (dPROMS) for pediatric patients could also be mapped to these four domains. Methods We performed a literature search to identify generic dPROMs administered in children and adolescents. Two researchers independently assessed titles, abstracts and full texts and extracted pediatric dPROMs and items. dPROM items were then mapped to the four OHRQoL dimensions. Results We identified 701 articles. After abstract screening, 118 articles were reviewed in full text. Fifteen articles met the inclusion criteria. Twelve instruments were identified, including six modified versions of the questionnaires. All questionnaires and their included items could be mapped to the four dimensions. In some cases, items were linked to two dimensions. Conclusions The four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for existing dPROMs in pediatric dental patients. These dimensions should therefore be considered when measuring OHRQoL in children and adolescents in future studies.