Fig. 4: Severe form of early childhood caries (ECC) with numerous deeply destroyed teeth, which occurs not only at the maxillary front teeth, but also at the milk molars. In some cases, abscesses can already be found on teeth 65 and 51. Depending on the cooperation of the child, the condition of the teeth can indicate a dental treatment under anaesthesia.
According to current studies (e.g. German Oral Health Study, DAJ Study, Study of Health in Pomerania) on caries prevalence and experience, the decline in caries in permanent dentition in children, but also in adults has been enormous in recent decades in Germany. These improvements in oral health show that caries prevention in permanent dentition is a success story for children, adolescents and adults. But what about the milk teeth?
The current study commissioned by the DAJ (Deutsche Arbeitsgemeinschaft für Jugendzahnpflege – German Working Group for Youth Dental Care), which focuses on milk teeth, provides information on this subject.
Caries epidemiology – Results of the latest DAJ study
Since 1994, the caries prevalence and caries experience (dmft/DMFT)* of children in Germany in the various federal states have been recorded at regular intervals in the epidemiological accompanying investigations for group prophylaxis (DAJ study). For the study period 2015/16 the 6- to 7-year-olds in the 1st class were examined nationwide. In addition, for the first time in more than half of the federal states the 3-year-olds could be registered in day care centres. In the 2015/16 school year, an extraordinarily large number of children were examined nationwide for this study.
DAJ-Study 2016: examined children per age group
6 to 7-year-olds, 1st grade
Table 1: Number of age groups relevant for the milk dentition in the epidemiological accompanying investigations for group prophylaxis (DAJ study) throughout Germany: 3-year-olds and 6- to 7-year-olds
* The mean dmft value indicates the average number of decayed, missing and filled teeth per child in an examined group. For the milk teeth the spelling “dmft” is used, for the permanent dentition “DMFT”. With the help of this index the caries experience is indicated. The mean dmft or DMFT thus indicates the degree of dental health of a group.
Fig. 1: Prevalence of caries in the milk teeth (dmft > 0) and a high severity of milk teeth caries (dmft ≥ 4) in 3-year-olds
3-year-olds in day-care centres
The 3-year-olds in day care centers had a mean caries experience of 0.5 dmft, with 86 percent of the children at defect level being caries-free (dmft = 0). The average caries experience of children with caries experience (children with dmft > 0) was already 3.6 dmft. In addition, about three quarters of the decayed milk teeth in the 3-year-olds were open decayed defects, i.e. cavities that had not been repaired (Team DAJ 2017).
average caries experience in Germany
average caries experience depending on federal state
Percentage of children with caries experience at defect level (dmft>0)
Percentage of children with high caries experience at defect level (dmft≥4)
Percentage of untreated decayed milk tooth defects
average caries experience of children with caries experience (children with dmft>0)
Table 2: Main results of the epidemiological studies accompanying group prophylaxis 2016 in 3-year-olds in day-care centres (data source: Team DAJ 2017)
Fig. 2: Milk teeth caries in 6- to 7-year-olds of the 1st class in Germany
6- to 7-year-olds in 1st grade
The 6- to 7-year-olds in the first class had an average caries experience of 1.7 dmft, with about 56 percent of the children at defect level being caries-free (dmft = 0) (Fig. 2). However, the mean caries experience of the third of the children with the highest caries experience (SiCdmft) was even 4.8 dmft. In addition, about 43 percent of the decayed milk teeth in 6- to 7-year-olds were not repaired (Team DAJ 2017).
average caries experience in Germany
Value range of average caries experience at federal state level
Children with caries experience in the milk teeth at defect level (dmft>0)
Proportion of decayed deciduous milk teeth defects not repaired
SiCdmft (average caries experience of one third of children with highest caries experience)
Table 3: Main results of the epidemiological studies accompanying group prophylaxis 2016 in 6- to 7-year-olds in 1st classes (data source: Team DAJ 2017)
Fig. 3: Early childhood caries (ECC) on the anterior maxillary teeth
What do these values mean?
In the milk teeth, caries values have been stagnating at too high a level in recent years. Even 3-year-olds currently have an average of half a carious tooth, which means a high average dmft for these small children. Clinically, this usually occurs as early childhood caries (ECC) and initially affects the anterior maxillary teeth (Fig. 3).
If there is insufficient oral hygiene and further high-frequency sugar intake, for example via a teat bottle, this can progress to severe forms of ECC (Fig. 4), which can often only be treated under anaesthesia. The caries values of 6- to 7-year-olds are also higher in an international comparison than in Denmark, England or France, for example. In addition, the degree of decontamination is unsatisfactorily low with only about half of the affected milk teeth and often affects the proximal surfaces of the milk molars, which are more difficult to treat (Fig. 5).
Fig. 4: Severe form of early childhood caries (ECC) with numerous deeply destroyed teeth, which occurs not only at the maxillary front teeth, but also at the milk molars. In some cases, abscesses can already be found on teeth 65 and 51. Depending on the cooperation of the child, the condition of the teeth can indicate a dental treatment under anaesthesia.
There is a need for improvement
With a prevalence of deciduous tooth decay in about every seventh 3-year-old and about every second first grader with a very low degree of clean-up at the same time, there is currently a clear need for improvement in Germany in the prevention and treatment of decay in the milk teeth.
Fig. 5: Numerous, clinically clearly visible, non-repaired proximal carious lesions of the milk molars in a 6-year-old child are currently not uncommon in Germany.
DAJ study
The report “Epidemiological Accompanying Investigations for Group Prophylaxis 2016” was prepared on behalf of the DAJ (Bonn) and was presented by the DAJ team in Greifswald (ZA Roger Basner, OÄ Dr. Ruth M. Santamaría, Dr. Julian Schmoeckel, Dr. Elisabeth Schüler and Prof. Dr. Dr. Dr. G. H. H.). Dr. Christian H. Splieth), in cooperation with Bettina Berg, DAJ Bonn, and PD Dr. Siegfried Gabler, GESIS – Leibniz Institute for Social Sciences (Mannheim), and the 17 State Working Groups for Youth Dental Care. For the first time, the DAJ team of the University of Greifswald took over the scientific management of the epidemiological accompanying studies on group prophylaxis for 2015/2016 on behalf of the DAJ.
