Andreas Gerhard Schulte

Objectives: Only a little is known about the tooth brushing behaviors and oral health care of people with early childhood autism (P-EA). To remedy this, a survey was carried out with P-EA of all ages. Materials and methods: In summer 2021, an online survey questionnaire with 124 questions, addressed only at caregivers of P-EA, was sent to all members of the Bundesverband Autismus Deutschland e.V. Our present study evaluated the 20 survey questions related to dental self-care. Results: In total, 130 questionnaires were evaluated. The mean age of the P-EA was 22.7 years (min: 3y; max: 60y; SD ± 14.1y). Only 17.7% (n =23) of the P-EA were female, while 82.3%(n =107) were male. Overall, 54.6% (n = 71) of P-EA are always actively assisted in tooth brushing. Although 57.7% (n = 75) of P-EA brushed teeth twice daily, 39.2% brushed for one to two minutes (n = 51). P-EA younger than 18 years old selected toothpaste primarily for taste reasons (32.7%;n = 18). Only 9.3% (n = 7) of adult P-EA selected toothpaste because of the fluoride content. Manual toothbrushes were preferred by 40.8% (n = 53) of the P-EA, and electric toothbrushes by 34.6% (n = 45). Almost three quarters (71.5%;n = 93) did not use additional dental care implements. The same number (75.4%;n = 98) of P-EA had not practiced supervised brushing in a dental office. Conclusions/Clinical relevance: Active support in dental self-care is crucial for a majority of the P-EA in Germany, regardless of their age. Professional support needs to be fundamentally improved. Clinical concepts for practical instruction in dental hygiene should be developed for P-EA.

Background: The current literature lacks scientific research on child and adolescent psychiatrists’ (CAPPS) perspectives on dental and oral health. This study aims to investigate the opinions and approaches of child and adolescent psychiatrists and their patients regarding oral and dental health. Methods: A questionnaire-based cross-sectional study was conducted among members of the Professional Association for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany. Results: Out of the association members, 10.9% (n = 109) participated, with 5.2% (n = 52; 38f/14m) completing the questionnaire. Dental and oral health topics were discussed with one-fifth of the patients (19.2%), while 11.5% reported that they were “never” a part of their therapy. Patient-related concerns about dental and oral health were primarily brought into the context of child and adolescent psychiatric work. Dental treatment anxieties were prominent. Only 3.8% of the participants regularly assigned diagnoses related to dental status. The CAPPS employ a bio-psycho-social model for the genesis of oral health-related conditions in Children and Adolescents with Special Needs. Conclusions: CAPPS have a foundation in relationship-based work for assessing oral and dental healthcare and providing recommendations for further dental care. Regional networking and science must be further developed.

Zusammenfassung: Ziel der Studie In Deutschland leben etwa 350.000 Menschen mit Störungen der geistigen bzw. intellektuellen Entwicklung. Sie sind bei Kommunikation mit den Leistungserbringenden des Gesundheitswesens auf Unterstützung angewiesen. Ein unzureichender Informationstransfer kann dabei folgenschwer sein. Diese Studie untersucht Erfahrungen, Barrieren und Lösungsansätze in der Kommunikation bei der Versorgung von Menschen mit intellektueller Entwicklungsstörung. Die Potentiale des Einsatzes digitaler Anwendungen zum Informationstransfer sollen eine besondere Betrachtung finden. Methodik Es wurden 13 leitfadengestützte Expert*innen-Interviews mit Betreuenden und medizinisch Versorgenden von Menschen mit intellektueller Entwicklungsstörung geführt. Es wurde eine inhaltlich strukturierende Inhaltsanalyse mit deduktiv-induktiver Kategorienbildung nach Meuser und Nagel durchgeführt. Ergebnisse Die Versorgung von Menschen mit intellektueller Entwicklungsstörung ist geprägt von Zeitmangel und Unsicherheit im Umgang, wenn Erfahrungen im Umgang fehlen. Der Informationstransfer ist geprägt von einer Informationsflut von sehr individuellen Informationen, die mündlich oder schriftlich durch Betreuende weitergegeben werden, sowie von einer passiven Rolle der Patient*innen häufig ohne gezielte Einbindung in die Kommunikation. Hinsichtlich der Potentiale zur Einbindung digitaler Anwendungen zum Informationstransfer zeigt sich eine Kontroverse zwischen Chance und Risiko. Schlussfolgerung Fortbildung im Umgang mit Menschen mit intellektueller Entwicklungsstörungen sowie ausreichende Zeitkontingente sind zentrale Faktoren für erfolgreiche Schnittstellenkommunikation. Externe Arbeiten zeigen, dass Informationstransfer durch digitale Anwendungen unterstützt werden kann, wenn handhabbare und implementierbare technische Ausstattung bereitsteht. Digitale Anwendungen bieten dabei neue Möglichkeiten, mit Menschen mit intellektueller Entwicklungsstörung zu kommunizieren, wie durch die Nutzung von Formaten mit leichter oder bildlicher Sprache. Hierzu bedarf es jedoch anknüpfenden Forschung, welche sich mit der digitalen Kontroverse in dieser Arbeit auseinandersetzt.

Background: Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic. Methods: An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017). Results: The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2–3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste. Conclusions: Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Background: The treatment of children and adolescents with disabilities (CA-Dis) and psycho-emotional disorders (CA-Psy) places special demands on dentists. Aim: To explore German dentists’ (with key expertise in paediatric dentistry) perception of their competence and comfort levels in dealing with these patients, and implications for access to care. Methods: Online questionnaire surveying demographic information and self-assessment of training, knowledge, and comfort in dealing with CA-Dis and CA-Psy among 1725 members of the German Society of Paediatric Dentistry (DGKiZ). Results: Ninety-two participants (11 male, 81 female) completed the questionnaire: 17.4% (n = 16) treated CA-Dis once or more a day; CA-Psy were rarely treated on a daily basis (7.6%; n = 7). In regard to CA-Dis, 62% (n = 57) rated their level of expertise as “good” or “very good”; for CA-Psy this was 40.2% (n = 37). Overall, 76.1% (n = 70), respectively, 88.0% (n = 81) of the respondents felt they had been inadequately prepared to treat CA-Dis or CA-Psy. Although the physical burden of treating CA-Psy was rated as “not at all stressful” or only “slightly stressful” by 45.7% of the participants, 31.5% rated the psychological distress as “very stressful” or “extremely stressful”. The better their self-assessed expertise in treating CA-Dis was, the lower their own psychological distress was rated (r = −0.34). Training on this topic seems to have an impact on the perceived burden of treating such patients. Conclusions: A core curriculum in special care dentistry needs to be embedded in the German dental curriculum. The results permit the development of health programs for workplace health management in dentistry.

Studies on children’s nutritional behaviour (CNB) rarely compare children’s answers regarding the frequency of their sugar intake with the respective statements of their parents. Therefore, data from a prevention study were used to analyse this aspect, as well as a potential correlation between Marburg Sugar Index (MSI) values and caries experience of children. The present study based its questionnaire data on CNB and caries data. Pairs of questionnaires filled in separately by children and parents of the participating families were dichotomised by either having completed the diet section entirely (Group A) or in part (Group B). The MSI scores were calculated separately for children and parents. The statistical confidence level was set at α = 0.05 (two-sided). Furthermore, the Pearson correlation coefficient was calculated and tested for “r = 0”. Additionally, a test for equality of the correlations was applied. The number of available questionnaire pairs was 429 in Group A and 400 in Group B. In both groups, significant correlations between children’s and parents’ MSI scores (A: r = 0.301, p < 0.001; B: r = 0.226, p < 0.001) were found. Using Spearman’s Rho, a significant correlation between MSI scores and children’s caries experiences was observed in Group A. MSI scores based on dietary questionnaires can be used to obtain consistent information on children’s CNB provided by the children themselves or their parents. This is true even when the MSI score has to be calculated on the basis of incomplete questionnaires. Questionnaire-based CNB information can improve the effectiveness of individual or group preventive measures supplemented by individually adapted nutritional counselling.

Cerebral palsy is a common cause of chronic motor neuron impairment. A constant prevalence of 2 to 3/1000 births in industrialized countries has been described.This case report describes the treatment of a 9 year old boy presenting this form of motor neuron impairment and class II malocclusion with an overjet of 14 mm, hyperdivergent growth pattern and various habits.Orthodontic treatment consisted mainly of a two‐phase treatment. The first phase was treated with removable appliances and followed by a phase with fixed appliances.Treatment duration with removable appliances was 4 years and 5 months and for the fixed appliance phase, 1 year and 7 months.A class I occlusion could be achieved in this case by removable and fixed orthodontic appliances combined with adjunctive treatment for the hypotonic orofacial musculature.

Background: In Germany, there is limited evidence on the oral health of adults with intellectual disabilities (AwID). Methods: In 2017/18, dental examinations of AwID and a questionnaire survey of their legal guardians were carried out. The mean D3MFT values were calculated to describe the caries experience. The prevalence of AwID with at least one fissure sealant (FS) was determined and associations between caries experience and various sociodemographic factors (e.g., age, gender, living arrangements) were investigated. Results: The data of 132 AwID (mean age 35.2 years; range 18–69 years) could be included. For all AwIDs the mean D3MFT value was 9.5 (95% CI 8.1–11.0). The mean D3MFT value for the 35–44-year-olds was 10.9 (95% CI 8.4–13.4). All caries-free persons (n = 14) were younger than 45 years. Furthermore, the mean D3MFT value for AwID living with their parents was lower at a statistically significant level than that of AwID in independent living arrangements. Moreover, younger AwIDs (18–34-year-olds) with at least one FS had a statistically significantly lower mean D3MFT value compared to those without any FS (D3MFT: 3.0 vs. 6.7). Conclusions: The dental health of AwID has improved in Germany in recent years, but, on average, AwIDs still have more missing teeth than their peers in the general population. Oral epidemiological studies on AwID should include information on their living arrangements to assess potential associations between sociodemographic factors and oral health.

Zusammenfassung: Zur Frage der Mundgesundheit bei Menschen mit Behinderung in Deutschland wurde die letzte Übersichtsarbeit im Jahr 2012 veröffentlicht. Dafür konnten lediglich 3 Feldstudien zur Kariesprävalenz bei Kindern, Jugendlichen oder Erwachsenen mit Behinderung identifiziert werden, die zwischen den Jahren 2000 und 2012 publiziert worden waren. Das Ziel der vorliegenden Übersichtsarbeit ist es, einen Überblick zum aktuellen Stand der Daten zur Mundgesundheit bei Menschen mit Behinderung in Deutschland zu geben und auf die Konsequenzen aufmerksam zu machen, die sich daraus ergeben. Es wurden sämtliche Publikationen und Abstracts eingeschlossen, die zwischen dem 01.01.2000 und dem 31.01.2021 publiziert bzw. zur Publikation angenommen worden waren.In Deutschland wurden im eingeschlossenen Zeitraum 6 regionale Studien und 1 überregionale Studie bei Kindern und Jugendlichen mit Behinderung sowie 3 regionale Studien und 1 überregionale Studie bei Erwachsenen mit Behinderung in 4 Bundesländern durchgeführt. Darin wurde die Karieserfahrung mithilfe des dmft- bzw. DMFT-Index bestimmt. Es zeigte sich, dass Kinder mit Behinderung im Grundschulalter im Mittel eine deutlich höhere Karieserfahrung hatten als Kinder ohne Behinderung. Im Jugendalter trifft dies nur für Personen mit geistiger Behinderung zu. Bei Erwachsenen mit geistiger Behinderung wirkte sich die höhere Karieserfahrung so aus, dass insgesamt mehr Zähne extrahiert wurden als in der Allgemeinbevölkerung.Daraus wird die Schlussfolgerung gezogen, dass die zahnärztliche und präventive Betreuung von Personen mit Behinderung weiter intensiviert werden muss. Dies kann u. a. durch die Berücksichtigung der zahnmedizinischen Versorgung von Menschen mit Behinderung in der Approbationsordnung Zahnmedizin und in den Curricula für das Fach Zahnmedizin an den einzelnen Universitätsstandorten erreicht werden.

Background: Patients with autism spectrum disorder (ASD) or other mental or physical limitations experience an imbalance in the frequency of dental treatment as compared with the general patient population, in part, due to inadequate pre-graduate training of future dentists. Case presentation: This case report describes a successful anterior tooth restoration, in awake state, in a 15-year-old boy with early childhood autism. The procedure was carried out independently by students of dentistry within the scope of their integrated clinical training semesters. Desensitization sessions were used as a preparatory measure and elements of behavioral facilitation (tell-show-feel-feel-do) were applied during the treatment. Conclusions: To avoid discrimination of this group of patients in the provision and quality of dental care, a structured approach to the transfer of theoretical and practical knowledge in the field of special care dentistry is indispensable. To this end, treatment strategies for special care patients should be taught to pre-graduate dental students as a fundamental part of their university curriculum.