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Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN)

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This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany.


From 1283 students with SHCN aged 6–16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models.


Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6–11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12–16-year-olds 59.6 %/2.4 DMFT; 6–11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12–16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6–11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities.


This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities.

Clinical relevance

Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

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We acknowledge the support of the headmaster and teachers of all schools during the clinical examination of the children.

Authors’ contributions

IMS and RHW conceptualized and reviewed the paper for content, including the final version of the manuscript. RHW developed the study design. KL, SI and IG organized and conducted the clinical examinations in the different regions. MD collected the data, performed the statistical analysis, conducted the literature research and authored the major portion of the manuscript. IMS and TL contributed towards statistical analysis and data handling. IMS contributed to the writing of the manuscript. All authors have read and approved the manuscript.

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Correspondence to Marco Dziwak.

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The authors declare that they have no conflict of interest.


The work was not supported by any funding.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The Ethics Committee of Jena University Hospital approved the present study (processing number 2930-09/10).

Informed consent

Written informed consent was obtained from all students with SHCN and/or their parents included in the study.

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Dziwak, M., Heinrich-Weltzien, R., Limberger, K. et al. Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN). Clin Oral Invest 21, 1997–2006 (2017).

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