We examine photon propagation, black hole shadows, and weak lensing in Reissner–Nordström Anti de Sitter (RN–AdS) spacetimes with Kiselev quintessence immersed in dispersive plasma. Using the effective optical metric and a finite distance bending prescription suited to non asymptotically flat geometries, we retain full nonlinear dependence on charge, cosmological curvature, quintessence, and plasma. For a homogeneous plasma and for a singular isothermal sphere profile, exact turning point conditions yield photon spheres, shadow observables, and an illustrative consistency comparison with very long baseline interferometric deviation windows for M87* and Sgr A*. The thin lens mapping provides a plasma renormalized Einstein angle and a reference description of magnification trends in the weak lensing regime. Over the explored parameter ranges, stronger dispersion and more negative cosmological curvature enhance bending and magnification, while the finite distance shadow size increases with plasma loading for the considered profiles. Electric charge reduces bending and magnification and tends to lower the shadow deviation, whereas larger quintessence normalization amplifies near field signatures. These trends help break degeneracies between refraction and geometry and offer a practical baseline for multi frequency tests of near horizon physics.
Oral health is a key determinant of overall wellbeing and general health, particularly in seniors who are often affected by multimorbidity and polypharmacy and may also require nursing care. The German Oral Health Studies (DMS) are population-representative epidemiologic surveys that assess oral health in Germany. This study aimed to clarify the prevalence, incidence, and progression of oral diseases in seniors using longitudinal data from the DMS • 6 cohort. The longitudinal analyses were based on data from 373 individuals who had previously participated in DMS V in 2014 as 65- to 74-year-olds (baseline) and were reexamined in 2023 as 73- to 82-year-olds (follow-up). Data on social demographics, disability, need for care, morbidity, oral functional capacity, and oral diseases were collected through social science interviews and clinical examinations. The mean age of the participants at baseline and follow-up was 69.4 ± 2.9 years and 78.3 ± 3.0 years, respectively. From baseline to follow-up, the mean number of missing teeth (excluding third molars) and incidence of edentulism increased. Furthermore, the number of replaced and unreplaced missing teeth both increased, and the mean number of missing teeth replaced with removable dentures increased. The caries incidence increased slightly, and periodontal health deteriorated. The number of teeth with probing depth (PD) ≥ 4 mm increased, whereas that of teeth with PD ≥ 6 mm remained unchanged. The proportion of participants requiring nursing care increased, and control-oriented dental service utilization decreased. Seniors lost approximately two teeth during the 9-year observation period. However, many teeth were retained at an advanced age. The challenges faced by people in higher ages are not limited to dental therapy but are complemented by lifelong dental care. Implementing preventive dental requirements during disease-related transition processes in senior women and men is challenging for the dental profession, as good oral health despite frailty and care needs must in part also be organized and ensured outside the dental practice. (Quintessence Int 2026;57(Suppl):S66-S75; doi: 10.3290/j.qi.b6955454).
Exposure to acidic and mechanical forces results in the continuous loss of dental hard tissue over the course of life, commonly referred to as tooth wear. However, longitudinal data on tooth wear are limited. Particularly, data on acid-induced wear, such as dental erosion, are scarce. This study assessed the incidence and progression of dental erosion over 9 years in adolescents and adults using data from the 6th German Oral Health Study (DMS • 6). The sample included 371 adolescents and 341 adults from the DMS • 6 cohort who were first examined in 2014 (baseline) and reexamined in 2023 (follow-up). Dental erosion was assessed using the basic erosive wear examination (BEWE). Prevalence estimates, distributions of the maximum scores, and risk-level classifications were determined at baseline and follow-up. Additionally, the incidence rates of clinically manifest erosive defects and disease progression rates were calculated, and the mean changes in the BEWE score sums and changes in the restoration patterns were analyzed. During the observation period, the prevalence of erosive tooth wear increased by approximately 2.6 percentage points to 18.8% among adolescents and by 10.8 percentage points to 53.6% among adults. The incidence rates of clinically manifest erosive defects among adolescents and adults were 1.2 and 5.4 per 100 person-years, respectively. Furthermore, the maximum BEWE score in the two groups progressed in 1.2 and 4.0 cases per 100 person-years, respectively. Pronounced tissue loss affecting ≥ 50% of the tooth surface was observed exclusively in a small proportion of adults (2%). Participants with erosive lesions at baseline received almost twice as many restorations during follow-up as those without erosion. In posterior sextants with remitted clinically manifest defects, nearly three times as many newly restored teeth, particularly those with extensive five-surface restorations, were observed compared to those in sextants without changes in the erosion status. Compared with other countries, the incidence of erosions among German adolescents was relatively low. However, comparability is limited because the incidence estimates in this study refer exclusively to clinically manifest erosive defects and do not include the initial loss of surface structures. The larger number of newly placed extensive restorations among affected individuals suggests that restorative treatment is attributable to erosion rather than to caries. However, the contribution of mechanical wear was not evaluated in this study. Although the incidence of dental erosion is low in adolescents, it is substantially higher in adults; nonetheless, few individuals exhibit severe clinical manifestations. The findings suggest that the prevalence of tooth wear in middle-aged adults may increase modestly in the future with potential implications for dental care needs. (Quintessence Int 2026;57(Suppl):S90-S97; doi: 10.3290/j.qi.b6955490).
Molar incisor hypomineralization (MIH) is a developmental defect of the dental hard tissues characterized by insufficient enamel mineralization. However, the natural course of this developmental enamel defect is unknown. This study aimed to assess changes in MIH severity over a 9-year period. This longitudinal study included individuals who had participated in the Fifth German Oral Health Study (DMS V) in 2014 as 12-year-olds (baseline) and were reexamined in 2023 as 20-year-olds (follow-up). A total of 158 teeth from 366 adolescents with MIH defects at baseline were included, and MIH severity at baseline and follow-up was assessed according to the criteria of the European Academy of Pediatric Dentistry (EAPD). In 11.6% of the analyzed teeth, the MIH worsened during the follow-up period (cumulative progression), corresponding to a progression rate of 1.4 progressive events per 100 tooth-years. Detailed transition analysis showed that 88.1% of the teeth with demarcated opacities at baseline remained unchanged after 9 years. In 7.4% of the cases, an atypical restoration was observed in teeth that had previously presented with only discoloration. In addition, 60% of the enamel breakdown lesions observed at baseline were restored at follow-up. Mild MIH may remain stable over several years. However, the risk of requiring restorative treatment is high in teeth with posteruptive enamel breakdown. (Quintessence Int 2026;57(Suppl):S82-S88; doi: 10.3290/j.qi.b6955485).
Since 1989, the German Oral Health Studies (DMS) have collected nationally representative socio-epidemiologic data on oral health in Germany. For the first time, the 6th study in this series (DMS • 6) was designed as a combined cross-sectional and cohort study. The DMS • 6 cohort comprised participants from the preceding study (DMS V) who were reexamined after approximately 9 years. The primary aims of this longitudinal component of DMS • 6 were to analyze incident diseases and individual disease trajectories across the observation period and to identify antecedent risk factors. All DMS V participants from the target population served as the sampling base for the follow-up examination in the DMS • 6 cohort (baseline; n = 3,476). After excluding individuals who declined consent to participate or were lost to follow-up or quality-neutral and systematic attrition, the final sample for the DMS • 6 cohort comprised 1,089 participants, with a retention rate of 31.3%. These participants were reassessed approximately 9 years after the baseline examination and were categorized into three age groups: adolescents (12-year-olds at baseline; 20-year-olds at follow-up), adults (35- to 44-year-olds at baseline; 43- to 52-year-olds at follow-up), and seniors (65- to 74-year-olds at baseline; 73- to 82-year-olds at follow-up). Baseline data were collected from October 2013 to June 2014. The mean interval between baseline and follow-up was 9.1 (± 0.3) years. Fieldwork and data collection for the follow-up were conducted from October 2022 to September 2023. In both study waves, data on oral health, oral-health behaviors, and sociopsychological characteristics were obtained through clinical examinations and social-science surveys conducted at temporarily established study centers. Data processing and statistical analyses: Longitudinal statistical analyses comprised an epidemiologic description of changes in disease patterns over time based on a dataset weighted using calibrated attrition weights. The prevalence, distribution, and means of the relevant characteristics at baseline and follow-up were compared. Subsequently, the incidence (new onset) and progression (worsening) of each condition of interest were estimated. Cumulative incidence/progression and incidence/progression rates were reported. To quantify the magnitude of change, the mean difference between baseline and follow-up measurements and the annual rate of change were calculated. In addition, longitudinal association analyses were performed to evaluate the influence of participant characteristics on the changes in oral diseases. (Quintessence Int 2026;57 (Suppl):S4-S13; doi: 10.3290/j.qi.b6955464).
This study compared the oral health status of the German population with that of the populations of European Union (EU) and selected Organisation for Economic Co-operation and Development (OECD) countries. Data from the 6th German Oral Health Study (DMS • 6) were compared with those obtained from the Oral Health Country/Area Profile Project (CAPP) database at Malmö University and from a systematic literature search of the PubMed and Google Scholar databases. Priority was given to nationally representative studies. Regarding dental caries in 12-year-olds, 35- to 44-year-olds, and 65- to 74-year-olds, Germany ranked 2nd of 39, 5th of 21, and 10th of 20 countries, respectively. The proportion of periodontally healthy individuals in Germany was comparatively low. However, Germany showed the lowest prevalence of erosive tooth wear among individuals aged 35 to 44 years. Furthermore, the prevalence of molar incisor hypomineralization (MIH) in Germany was 15.3%, which was consistent with the average international prevalence. Among participants aged 12 years, a significant inverse correlation was observed between gross domestic product (GDP) per capita at purchasing power parity and caries experience. Overall, Germany showed a favorable caries profile compared to EU and OECD countries, but lost the leading position achieved in childhood and adolescence with increasing age. This finding suggests that the preventive gains made in early life were not sustained into adulthood owing to the absence of continuous measures. The relatively high prevalence of root caries in Germany is attributed to an intrinsically higher disease risk and greater tooth retention in adults and seniors. In contrast, the periodontal situation was less favorable, although methodologic differences between studies and the high rate of tooth retention must be considered in this context. Similarly, Germany's leading position regarding erosive tooth wear should be interpreted cautiously because of limited data. MIH prevalence was consistent with the international average, and clarification of its etiology is warranted for targeted prevention. The association between GDP per capita and caries underscores the influence of socioeconomic factors and the importance of long-term population-level preventive strategies. (Quintessence Int 2026;57(Suppl): S142-S151; doi: 10.3290/j.qi.b6955513).
To assess the impact of periodontitis and associated factors on self-perception of oral health among Brazilian male crack cocaine users in withdrawal treatment. A cross-sectional study was conducted with 242 adult male crack cocaine users in rehabilitation programs in two municipalities in Paraná, Brazil. Periodontal status, oral health behavior, addiction history, socioeconomic, and sociodemographic data were analyzed. Self-perceived oral health-related quality of life (OHRQoL) was assessed by the short form of the Oral Health Impact Profile (OHIP-14), cross-culturally adapted and validated for the Brazilian population. Descriptive statistical analysis and univariate and multiple Poisson regression were performed. The periodontal parameters were observed: probing depth ≥ 4 mm in 20.2% of crack cocaine addicts, clinical attachment level ≥ 4 mm in 23.6%, bleeding on probing in 90.9%, gingival bleeding in 96.3%, plaque and calculus in equal frequencies of 97.1%. Periodontitis was diagnosed in 63% of the sample and the mean OHIP-14 score was 24. All individuals with periodontitis presented impact on OHRQoL. Periodontal inflamed surface area (PISA) was significantly correlated with OHRQoL (r = 0.18; P = .007). In the multiple regression model, the prevalence of a negative impact on perception of oral health was statistically different among individuals with metallic taste in the mouth (prevalence ratio = 1.11; 95% CI = 1.03-1.20) and tooth mobility (prevalence ratio = 1.09; 95% CI = 1.00-1.18). Periodontitis may be associated with OHRQoL and high scores of OHIP-14 in crack cocaine users in withdrawal treatment, regardless of socioeconomic, demographic, behavioral, and other oral conditions. (Quintessence Int 2026;57:460-469; doi: 10.3290/j.qi.b6982838).
To report the prevalence of peri-implant disease and factors associated with peri-implant tissue inflammation in a German population-based cohort comprising younger adults (35- to 44-year-olds) and younger seniors (65- to 74-year-olds) among participants in the 6th German Oral Health Study (DMS • 6). Data were available for 925 and 788 younger adults and younger seniors, of whom 63 (n = 108 implants) and 163 (n = 477 implants) had at least one dental implant. Probing depth (PD) and bleeding on probing (BOP) were recorded at six sites per implant. For each implant, peri-implant health was defined as a maximum of one site with BOP. Peri-implant mucositis was defined as at least two sites with BOP with a maximum of one site with BOP having PD > 6 mm. Peri-implantitis was defined as at least two sites with BOP and PD > 6 mm. Among the entire population, 2.1% (95% confidence interval [CI], 1.3-3.5%) of younger adults and 7.0% (95% CI, 5.2-9.4%) of younger seniors were diagnosed with peri-implant disease. Among the study participants with dental implants, healthy peri-implant tissue was observed in 68.3% (95% CI, 56.1-78.7%) of younger adults and 68.1% (95% CI, 60.7-74.9%) of younger seniors. Peri-implant mucositis and peri-implantitis were diagnosed in 30.2% (95% CI, 19.9-42.2%) and 1.6% (95% CI, 0.2-7.2%) and 30.7% (95% CI, 24.0-38.0%) and 1.2% (95% CI, 0.3-3.9%) of younger adults and younger seniors, respectively. At the implant level, the corresponding values were 25.9% (95% CI, 18.4-34.7%) and 0.9% (95% CI, 0.1-4.2%) and 20.5% (95% CI, 17.1-24.3%) and 0.4% (95% CI, 0.1-1.3%), respectively. Stage III/IV periodontitis was significantly associated with an increased risk of peri-implant disease (odds ratio, 2.52; P = .006). Peri-implant mucositis was frequently observed in participants with implants, whereas clinically defined (probing based) peri-implantitis was rare in both age groups. Severe periodontitis (stage III/IV) was associated with higher odds of developing peri-implant disease. (Quintessence Int 2026;57(Suppl):S46-S54; doi: 10.3290/j.qi.b6955520).
Various pathologic conditions can cause oral mucosal changes. However, data regarding the prevalence and sociodemographic distribution of oral mucosal changes are insufficient. The 6th German Oral Health Study (DMS • 6) not only provides cross-sectional analyses of oral mucosal changes but also longitudinal analyses after a 9-year follow-up. For cross-sectional analysis, data from 797 younger seniors (65- to 74-year-olds) from the DMS • 6 cross-sectional component were employed. Longitudinal analysis was performed on data from the DMS • 6 senior cohort including 373 participants from 2014 (baseline) who were reexamined in 2023 (follow-up). The most frequent oral mucosal changes were documented based on the DMS V protocol. Each lesion was photographed and verified by two independent experts, and no other diagnostic tests were performed. Among younger seniors, the overall prevalence of oral mucosal changes was 13.3%. Furthermore, the prevalence of leukoplakia was 4.3%. These rates are consistent with those previously reported. Regarding gender distribution, men were affected more frequently than women. Longitudinal analysis revealed that the majority (68%) of oral mucosal changes detected at baseline were not detected at follow-up. However, three participants showed persistent prosthesis-related changes. Approximately 10% of those who were healthy at baseline presented one or more incident oral mucosal changes over the observation period. In detail, 2.8% developed new serious lesions (carcinomas and leukoplakias). The progression of oral lichen planus and smoker's keratosis could not be determined because individuals with these findings in previous studies were no longer part of the longitudinal sample. Documentation of malignant lesions plays an important role in research and for those affected. However, non-malignant lesions, such as leukoplakia, oral lichen planus, and smoker's keratosis should also be documented in epidemiologic studies, particularly their risk of degeneration and correlation with tobacco consumption. (Quintessence Int 2026;57(Suppl):S76-S81; doi: 10.3290/j.qi.b6955533).
This study aimed to investigate the cross-sectional associations between type 2 diabetes (T2D) and periodontitis, dental caries, and tooth loss, according to the glycemic control status, time from T2D diagnosis, and microvascular complications (MVCs) among participants in the 6th German Oral Health Study (DMS • 6). Cross-sectional data was pooled from participants from the DMS • 6 cross-sectional and cohort components who completed questionnaires regarding their oral and general health behaviors. Information on self-assessed oral health was obtained from interviews. T2D was defined as self-reported diagnosis by a physician. Participants were categorized according to their last self-reported glycosylated hemoglobin (HbA1c) level, time from T2D diagnosis, and presence of MVCs. Probing depth (PD), clinical attachment level (CAL), and presence of coronal and root caries were assessed for all teeth except the third molars, and the number of missing teeth was recorded. T2D was diagnosed in 9.0% of individuals. Severe periodontitis was diagnosed in 16.0% and 5.6% of individuals with and without T2D, respectively. Participants with T2D were more frequently edentulous, had more missing teeth, had higher prevalence of coronal and root caries, and exhibited poorer oral hygiene and dental-care practices. Fully adjusted models revealed that the mean PD and mean CAL were both higher in individuals with T2D than in those without. Compared with participants without T2D, those with T2D were 1.89 times more likely to have worse periodontal status. Among individuals with T2D, HbA1c levels > 7% showed stronger associations with periodontal variables than HbA1c ≤ 7%. Moreover, individuals with poorly controlled T2D had a higher prevalence of root caries than those without T2D. No significant associations were observed between decayed, missing, or filled teeth, percentage of decayed and filled teeth, or self-assessed oral health. Importantly, effect sizes for all outcomes did not differ significantly according to the time from T2D diagnosis. Poorly controlled T2D significantly affects periodontal health. Therefore, future studies should focus on intensified screening for undiagnosed diabetes by the dental workforce and closer communication between various specialists. (Quintessence Int 2026;57(Suppl):S106-S116; doi: 10.3290/j.qi.b6955523).
Although health care services should be accessible, their use should not impose expenditures that put individuals and families at financial risk. This study aimed to identify the prevalence and determinants of catastrophic dental expenditure (CDE) among 12-year-olds, 35- to 44-year-olds, and 65- to 74-year-olds living in Germany. Using dental expenditure data from the 6th German Oral Health Study (DMS • 6) and annual household cost-of-living information from the German Federal Statistical Office, the extent and determinants of CDE, defined as out-of-pocket spending on dental or orthodontic treatments > 40% of an individual's equivalent capacity to pay over a 1-year period, were examined. Descriptive analyses for sociodemographic variables were performed, and regression analysis was used to clarify the associations of age, gender, type of insurance, geographic region, socioeconomic status (SES), and comorbidities with CDE. The prevalence of CDE among 12-year-olds, 35-to 44-year-olds, and 65- to 74-year-olds in Germany was 0.4% (95% confidence interval [CI], 0.1-1.8%), 0.7% (95% CI, 0.2-1.9%), and 0.4% (95% CI, 0.2-1.2%), respectively. Among the independent variables, only SES and age were significantly associated with CDE (P .05). The risk of CDE was higher in the low-SES group than in the middle- and high-SES groups and higher in older individuals. Among all age groups, prevalence of CDE was the highest in the 35-to-44-year-olds. Careful consideration of these findings is warranted to better understand the underlying mechanisms and derive potential policy recommendations. (Quintessence Int 2026;57(Suppl):S134-S141; doi: 10.3290/j.qi.b6955492).
The aim of this overview is threefold: evaluate whether the evidence available up to 2019 supported the American Academy of Orofacial Pain's (AAOP) critical position on the use of low-level laser therapy (LLLT) for the management of temporomandibular pain; identify and evaluate new evidence published since 2019; and provide updated clinical recommendations. A comprehensive PubMed search was conducted (last updated February 2026). Systematic reviews (SRs) and randomized controlled trial (RCT) articles were identified using respective filters. Relevant citations were extracted into a spreadsheet and analyzed. Thirty SRs associated with 156 distinct publications on LLLT, and 11 RCT articles representing data from 10 studies were included. While studies before 2020 were methodologically weak, more recent evidence demonstrates greater methodologic rigor and more consistent positive outcomes. Available SRs reported significant short-term pain reduction and improved maximum jaw opening, preferably with wavelengths between 810 and 1,100 nm, and therapy durations exceeding 4 weeks. Combination therapies (LLLT with splints or physiotherapy) showed enhanced outcomes. However, heterogeneity in study design and laser parameters persists, which limits generalizability. The extant literature published since 2019 suggests that LLLT is more effective at managing temporomandibular pain than the 2023 AAOP guidelines indicate. This observation is particularly salient in cases of TMJ arthralgia and other intra-articular pathologies. LLLT appears to be a safe, noninvasive, and effective adjunctive therapy within multimodal management. Future studies should standardize therapy-related parameters to strengthen clinical recommendations. (Quintessence Int 2026;57:350-357; doi: 10.3290/j.qi.b6961747).
Dental anxiety (DA) is the fifth most common type of anxiety and leads to avoidance strategies that impact oral health and health-related quality of life. This study aimed at examining the prevalence of epidemiologically significant dental diseases, including dental caries, periodontitis, and tooth loss, according to DA severity. Younger adults (35- to 44-year-olds) and younger seniors (65- to 74-year-olds) with available data on self-reported DA using the modified DA scale (MDAS) were selected from the cohort of the population-representative 6th German Oral Health Study (DMS • 6). The prevalence of oral diseases was compared among participant groups with different levels of DA (no/mild, moderate, and severe/phobia). Among younger adults and younger seniors, 26.4% and 22.8% reported DA, respectively. In these age groups, 9.5% and 7.6% reported severe DA or phobia, respectively, and the prevalence was higher among women in both age groups. Although the overall decayed, missing, filled teeth scores did not differ significantly according to DA levels, the number of untreated caries lesions and missing teeth increased with increasing anxiety levels. In younger seniors, the number of restored teeth and filled and sound teeth index decreased with increasing DA severity. Similarly, periodontal treatment needs and prevalence of advanced periodontitis (stage III and IV) increased with higher DA levels. Moreover, the number of missing and non-replaced missing teeth increased significantly with DA, whereas edentulism was not significantly different between the DA groups. The prevalence of dental caries, periodontitis, and missing teeth increases with even moderate DA and is worse in patients with severe DA/phobia. (Quintessence Int 2026;57(Suppl):S118-S125; doi: 10.3290/j.qi.b6955509).
The objective was to better understand why toothbrushing often fails to achieve the desired state of plaque-free dentition, by systematically analyzing toothbrushing behavior in four age groups (12-year-olds, 20-year-olds, 35- to 44-year-olds, 65- to 74-year-olds). Analyzable video recordings of toothbrushing, as well as plaque scores assessed immediately after brushing, were available from 1,941 participants of the 6th German Oral Health Study (DMS • 6). All videos were analyzed in terms of tooth contact time (TCT), use of interdental cleaning aids, and type of toothbrush (electric/manual). A more detailed analysis of oral hygiene behavior was conducted in two extreme groups comprising the 10% of adults who showed the lowest (n = 35) vs the highest (n = 33) plaque sores after manual brushing. Only younger seniors (65- to 74-year-olds) showed a mean TCT below 2 minutes. Interdental cleaning was practiced by 25% of the participants, while 44% used electric toothbrushes. The extreme-group comparison revealed significant differences across all observed behavioral aspects, except for correct dental floss use, which no participant was able to master. The use of interdental cleaning aids was associated with a more elaborate toothbrushing behavior. These findings highlight the critical role of toothbrushing behavior in achieving oral cleanliness. The extent of plaque removal is associated with various aspects of toothbrushing behavior. (Quintessence Int 2026;57(Suppl):S98-S104; doi: 10.3290/j.qi.b6955521).
Longitudinal evidence on individual-level changes in caries experience across the life course in Germany is lacking. Therefore, one objective of the 6th German Oral Health Study (DMS • 6) was to reexamine participants of the Fifth German Oral Health Study (DMS V) after 9 years, to assess changes in the caries burden during the life course. The caries experience, including decayed, missing, filled teeth (DMFT), and root caries, was assessed at baseline (2014) and follow-up (2023) in three age groups of the DMS • 6 cohort. The sample comprised 371 adolescents (20-year-olds at follow-up), 342 adults (43- to 52-year-olds at follow-up), and 350 seniors (73- to 82-year-olds at follow-up). Mean changes in caries experience and participant-level caries incidence and progression were calculated. Mean DMFT increased from 0.4 to 1.8 in adolescents, from 10.7 to 11.8 in adults, and from 16.1 to 18.5 in seniors. Furthermore, the proportion of caries-free adolescents reduced from 81.7% to 47.7%. The cumulative caries incidence in adolescents who were caries-free at baseline was 43.2%. Cumulative caries progression (at least one additional DMF tooth) was observed in 54.1%, 58.4%, and 77.0% of adolescents, adults, and seniors, respectively. Regarding the tooth surface level, 98.3%, 91.1%, and 77.5% of tooth surfaces remained sound throughout the observation period in adolescents, adults, and seniors, respectively. The prevalence of root caries markedly increased from 11.1% to 30.7% in adults and from 32.9% to 61.1% in seniors. This 9-year longitudinal study demonstrated caries increments during the life course in all three age groups. Adolescents predominantly presented with newly filled teeth, adults showed increased numbers of filled and missing teeth, and seniors primarily presented with a larger number of extracted teeth. Individuals with early caries experience exhibited greater increments. The pronounced increase in root caries among adults and seniors highlights the need to intensify targeted root-surface-focused prevention alongside ongoing primary prevention for high-risk groups. (Quintessence Int 2026;57(Suppl):S14-S22; doi: 10.3290/j.qi.b6955475).
This longitudinal study used data from the 6th German Oral Health Study (DMS • 6) to determine the incidence of tooth loss and prosthetic treatment over a 9-year period in participants from the DMS • 6 cohort who were examined in 2014 (baseline) and reexamined in 2023 (follow-up). The sample comprised 342 adults (43- to 52-year-olds at follow-up) and 373 seniors (73- to 82-year-olds at follow-up) who met the inclusion criteria for the DMS • 6 analysis set and for whom complete information on prosthetic treatments was available were included. The prevalence, extent, and incidence of tooth loss and prosthetic treatment were compared between baseline and follow-up. Over the 9-year observation period, the cumulative incidence of tooth loss among seniors was twice that among adults. The level of education influenced tooth loss: seniors with > 10 years of schooling remained unchanged, whereas those with ≤ 10 years exhibited an increase. The cumulative incidence of edentulism was 3.2% among seniors, and no adult was edentulous at any timepoint. Among adults, the prevalence of full dentition decreased from 44.0% at baseline to 37.6% at follow-up. The proportion of fixed-denture treatments increased by 11.1 percentage points in adults and decreased by 2.8 percentage points in seniors. However, the prevalence of implants increased in both cohorts. The incidence rates (per 100 person-years) of tooth loss indicate an accelerated loss rate in seniors (seniors: 10.0 vs adults: 4.1). The incidence of new implants was similar among adults and seniors (incidence rates: 1.1 and 1.4 per 100 person-years, respectively). The cumulative incidence of edentulism among seniors was low, and the increase in the frequency of implant treatment appeared to effectively compensate for tooth loss, with comparable rates in both age cohorts. School education had a pronounced impact on oral health and the need for prosthetic treatment. (Quintessence Int 2026;57(Suppl):S56-S65; doi: 10.3290/j.qi.b6955470).
Understanding population-level dental service needs is essential for planning and optimizing dental care. Building on a previously validated model, this study aimed to quantify current dental service needs in the statutory health insurance system in Germany using updated epidemiologic data from the German Oral Health Study (DMS). Secondary analyses of data from DMS III, IV, V, and DMS • 6 were performed. The analyses focused on operative, prosthetic, and periodontal services and their subcomponents stratified according to age groups: younger adults (35- to 44-year-olds) and younger seniors (65- to 74-year-olds). Service needs were derived from morbidity indicators such as decayed, filled, and missing teeth; root caries and root fillings; and periodontally compromised teeth. These indicators were linked to population data and adjusted for utilization patterns and statutory health insurance coverage, resulting in expected number of service units and workload hours. Between DMS III and DMS • 6, the total annual dental service needs remained stable (approximately 44 million service units) but shifted markedly between age groups. In younger adults, the number of service units declined by 40%, as did the expected clinical workload needed to fulfill the service requirements. In contrast, in younger seniors, the number of dental service units needed doubled (from 12.3 to 24.8 million), and the expected workload in hours increased significantly. Reductions in restorative and prosthetic services were observed in younger adults, whereas younger seniors showed an increase in the use of fixed dental prostheses and periodontal services. The root-caries-related treatment time increased substantially. The need for full dental prostheses declined sharply. DMS • 6 confirms the redistribution of dental service needs in Germany from adults to older dentate populations. This shift has implications for service delivery, workforce training, and financing. (Quintessence Int 2026;57(Suppl):S126-S132; doi: 10.3290/j.qi.b6955517).
Epidemiologic evidence on oral health in Germany was updated in 2025 by the 6th German Oral Health Study (DMS • 6). However, epidemiologic data describing changes and progression of dental restorations over time under real-world conditions are lacking at the population level. This analysis of DMS • 6 data therefore aimed to assess the clinical development of caries-related dental restorations and the materials used, and to quantify their rates of change, including the development of secondary caries, after a 9-year follow-up. First, a cross-sectional analysis of caries-related dental restorations was conducted. A total of 958 younger adolescents (12-year-olds), 927 younger adults (35- to 44-year-olds), and 797 younger seniors (65- to 74-year-olds) underwent standardized clinical examinations. Restorations were classified as direct and indirect restorations, and by restorative material (tooth-colored, casting alloy, and cement). Secondary (dentin) caries at the restoration margins were also assessed. Second, 371 individuals from the adolescent cohort (12-year olds at baseline; 20-year-olds at follow-up), 342 individuals from the adult cohort (35- to 44-year-olds at baseline; 43- to 52-year-olds at follow-up), and 350 individuals from the senior cohort (65- to 74-year-olds at baseline; 73- to 82-year-olds at follow-up) were reexamined after 9.1 (± 0.3) years for longitudinal analyses (incidence and progression). Younger adolescents predominantly presented with tooth-colored restorations, whereas amalgam fillings and indirect restorations were virtually absent. In adulthood, the prevalence of amalgam restorations increased continuously with age, reaching a maximum of 42% in seniors. The prevalence of indirect restorations also increased with age. The proportion of secondary caries increased to 10.5% in senior age. During the 9-year observation period, the prevalence of dental restorations among adolescents increased from 13.2% to 47.7%. The progression rates of dental restorations (per 100 person-years) were 16.4 and 15.8 in adults and seniors, respectively. The prevalence of dental restorations increased markedly across the life course, with indirect restorations being more frequent in older age groups. The development of secondary caries also appears to be age-dependent. Under real-world conditions, tooth-colored restorations did not exhibit a higher risk of secondary caries than amalgam restorations. (Quintessence Int 2026;57(Suppl): S24-S33; doi: 10.3290/j.qi.b6955480).
The aim of this article is to review the general adverse events from the administration of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and emphasize the oral and maxillofacial sequelae. A search of the literature was performed on the general and oral and maxillofacial adverse events of GLP-1 RAs from the electronic databases of PubMed and Google Scholar from January 2021 through May 2026, along with articles cited within these culled references. Sought publications included review articles, controlled clinical investigations, case series, and case reports. The online Food and Drug Administration Adverse Event Reporting System was also examined for GLP-1-related adverse events. The most common adverse events attributed to GLP-1 RAs were gastrointestinal symptoms, predominately nausea, emesis, and diarrhea. Relevant articles also identified a multitude of adverse events that occurred within the oral and maxillofacial region, related to gastroesophageal reflux disease (GERD), nasopharyngitis, taste disturbances, xerostomia, and promotion of a gaunt-like facial expression. Adverse events, secondary to intake of GLP-1 RAs, may overlap with various disorders and promote challenges to establish etiology. Thus, clinicians should consider GLP-1 RAs in the differential diagnosis of various pathoses affecting oral and maxillofacial structures. Timely recognition of GERD and other oral and maxillofacial adverse events potentially implicated with intake of these agents may improve patient outcomes.
To examine mortality trends and disparities in cancers of the lip, oral cavity, and pharynx (LOCP) among adults in the United States. We analyzed underlying cause-of-death data (ICD-10 C00-C14) for LOCP cancers among adults aged ≥25 years from 1999 to 2023 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. Age-adjusted mortality rates (AAMR) were standardized to the 2000 U.S. standard population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC), and Autoregressive Integrated Moving Average models projected mortality through 2046. From 1999 to 2023, 225,876 deaths were recorded. Overall AAMR declined until 2009 (APC: -1.28)* and then increased through 2023 (APC: 0.72)*. Males accounted for 69.6% of deaths, and adults aged 75-84 years showed the fastest recent increase (APC: 3.83)*. By 2023, Non-Hispanic (NH) White individuals had a higher AAMR than NH Black individuals (4.64 vs 3.51 per 100,000). Mortality increased in nonmetropolitan areas (AAPC: 0.53)* and the Midwest (AAPC: 0.56)*. State-level AAMR was highest in West Virginia and lowest in Utah. Projections suggest this burden will persist through 2046. Mortality from LOCP cancers has shifted toward NH White individuals, older adults, nonmetropolitan populations, and the Midwest. These findings support targeted prevention, early detection, and referral strategies for high-burden groups.