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Objectives: Oral health plays a central role in overall well-being, including in the elderly. The demographic transition and its effects are resulting in a higher proportion of older people, both with and without care requirements. This paper provides an overview of the dental situation of the elderly from the 6th German Oral Health Study (DMS • 6).

Method and materials: DMS • 6 is a population-representative oral epidemiologic study that surveys oral health in Germany. Data from 797 younger seniors aged 65 to 74 were collected by calibrated examiners. The methodology remains largely consistent with that of the previous studies.

Results: Among the younger seniors (65- to 74-year-olds), edentulism has more than halved to 5.0% compared to the Fifth German Oral Health Study (DMS V) (12.4% in 2014). The mean number of missing teeth (8.6) decreased further, compared to DMS IV (14.1) and DMS V (11.1). At 18.8 teeth, the FST Index (number of filled or sound teeth) has shown improvement compared to the previous studies (DMS IV, 13.6; DMS V, 16.4). The root caries (59.1%) increased compared to DMS IV (28.0%). Caries experience (decayed, missing, filled teeth [DMFT]: 17.6), in contrast, hardly changed from DMS V (17.7). Half of 65- to 74-year-olds were diagnosed with moderate periodontitis (49.4%) and almost a third (30.4%) with severe periodontitis. In younger seniors with care requirements, therapeutic capability was greatly reduced for almost half (47.4%) and oral hygiene ability for one fifth (18.5%).

Conclusion: The prevalence of tooth loss and edentulism among younger seniors in Germany continues to decline. Due to further morbidity compression, the challenges of dental treatment lie in the continuous treatment of younger seniors to prepare them for older stages of life.

Objectives: Past German Oral Health Studies (DMS) have revealed that toothbrushing patterns - a behavioral index comprising toothbrushing frequency, duration and timing - have steadily improved over the previous decades. What has not yet been investigated, however, are toothbrushing skills, ie, the ability to achieve oral cleanliness by removing all plaque deposits.

Method and materials: All participants of the DMS • 6 from the age groups of 12-year-olds, 35- to 44-year-olds, and 65- to 74-year-olds were asked to brush their teeth to the best of their ability. To do so, they used their own devices or those provided. The plaque that remained after brushing was recorded using the modified Marginal Plaque Index (mMPI), expressing the percentage of segments remaining at the gingival margin that were colonized by plaque. Relationships to questionnaire data regarding demographics (age, gender, education status), toothbrushing behavior (frequency, utilization of an electric toothbrush), and selected dental treatments (professional tooth cleaning, lifetime periodontal treatment) were assessed.

Results: Even following the best possible brushing, roughly half of the segments (44% to 52%) across all age groups showed persisting plaque deposits. Survey data revealed the most pronounced group differences regarding education, whereby even in the group of younger seniors with a high education status, 37% of the areas showed persisting plaque after cleaning.

Conclusion: The data demonstrate that there are population-wide deficits in the ability to achieve oral cleanliness. Future prevention efforts should also focus on improving the population's toothbrushing skills.

Objectives: Epidemiologic studies have indicated a correlation between dental and cardiovascular diseases, which remains insufficiently explored. Therefore, this study aimed to compare the prevalence of common dental diseases in younger seniors (65- to 74-year-olds) with and without cardiovascular diseases.

Method and materials: Participants with available self-reported data on cardiovascular diseases were selected from the cohort of the population-representative 6th German Oral Health Study (DMS • 6), in which caries, periodontitis, and tooth loss were recorded in a standardized manner. The prevalence of oral diseases was compared between participants with and without cardiovascular diseases.

Results: Compared with participants without cardiovascular diseases, those with cardiovascular diseases had an average of 2.1 fewer teeth, were more frequently edentulous, and were more likely to have advanced periodontal disease (stage IV). In contrast, participants without cardiovascular disease had more fillings (mean + 1.7 teeth) than those with cardiovascular disease.

Conclusion: The main cause of increased tooth loss - caries or periodontal disease - could not be clarified from the available data. In this study, the prevalence of tooth loss with oral-function limitation was higher in younger seniors with cardiovascular disease.

Objectives: In addition to caries, other dental hard tissue diseases, such as erosive wear, are gaining importance in prevention and treatment. The survey aimed to collect current data on the prevalence of erosions in younger adults and to compare these with the previous state of knowledge.

Method and materials: As part of the representative 6th German Oral Health Study (DMS • 6), all teeth were assessed according to the basic erosive wear examination (BEWE). The maximum value of the findings per sextant was included in the evaluation.

Results: The prevalence of erosions was found to be 43.2%. At 49.1%, men had significantly more erosions than women (37.8%). Younger adults with a high education status were affected by erosions more frequently than persons with a medium or low education status (49.2%, 37.9%, and 45.1%, respectively).

Conclusion: The prevalence of erosions remains practically unchanged from the Fifth German Oral Health Study (DMS V) of 2014. However, the proportion of people at increased risk has risen sharply. The continued high prevalence of erosions combined with the increased proportion of people with a medium or high risk classification indicates that the prevention and treatment of erosive wear is a clinically relevant issue.

Objectives: The German Oral Health Studies (DMS) are nationally representative surveys on oral health in Germany, conducted approximately every 8 years since 1989. The current sixth edition of the study (DMS • 6) was planned and executed in accordance with international standards. A field institute selected from across Europe was responsible for data collection.

Method and materials: For six age groups, data collection for the DMS • 6 took place across Germany from October 2022 to September 2023. Data for a seventh age group had already been collected earlier, in the spring of 2021. In addition to conducting a cross-sectional study with new participants, for the first time, a longitudinal component was included by reengaging study participants from the previous study, the Fifth German Oral Health Study (DMS V). Participation was organized via postal invitations, followed by reminder letters or personal visits if there was no response. Data collection in the field was conducted at temporarily established study centers.

Data collection: The primary aim of the DMS • 6 was to assess the current oral health status, oral health behavior, and the dental care status in Germany. For this purpose, both new study participants and participants from the preceding DMS V study underwent clinical examinations and social science surveys. The clinical examinations followed a standardized protocol outlined in a manual. The social science survey was conducted in two parts: a paper and pencil interview (PAPI) completed at home and a computer-assisted personal interview (CAPI) administered immediately before the clinical examination in the study center. A non-response survey showed no systematic differences between study participants and non-participants, indicating an unbiased data basis. Quality assurance: The DMS • 6 included a comprehensive examination program supported by a multi-stage quality assurance system. This system involved pre-testing of the social science research instruments, conducting a pilot study to simulate the main study, multiple training sessions, and the calibration and certification of the dental study personnel both before and during fieldwork. This ensured a high level of data validity.

Objectives: One goal of the 6th German Oral Health Study (DMS • 6) was to survey the caries experience and care for caries in a representative cross-sectional study across Germany.

Method and materials: Using almost the same methodology as the previous studies DMS III (1997) to V (2014), data were collected on caries experience (including dmft/DMFT, root caries) in the three standard World Health Organization age groups (12-year-olds, 35- to 44-year-olds, and 65- to 74-year-olds) as well as among 8- and 9-year-olds.

Results: The caries experience expressed as dmft/DMFT in 8- and 9-year-olds was 1.4 teeth, 59.9% were caries-free; the DMFT among 12-year-olds was 0.5 teeth, with 77.6% caries-free. There was a significant decrease in caries-related restorations among 35- to 44-year-olds, with DMFT being 8.3 teeth. The group of 65- to 74-year-olds had a DMFT of 17.6 teeth, which was mainly due to higher tooth retention; 5.0% were edentulous. The prevalence of root caries was 13.8% among 35- to 44-year-olds and 59.1% among 65- to 74-year-olds.

Conclusions: The various oral health measures taken over recent decades seem to continue to have a positive impact in terms of reduced caries experience. Nevertheless, it appears that the maximum has been reached among 12-year-olds; however, within this group there continues to be a strong polarization of dental caries in adolescents from families with a low education status and a comparatively high treatment need for the primary teeth. The social gradient in tooth decay and tooth loss extends over the entire life span. The DMS • 6 study, being representative of the oral epidemiology of the population, shows the sustainability of successful prevention measures for caries in all age groups and education groups in Germany. At the same time, social inequalities persist. From a socio-medical perspective, it would make sense to align future prevention strategies specifically to the lifeworld of groups and communities that have not yet been reached.

Objectives: Dietary habits have significant implications for oral health, with the consumption of sugar-rich foods being strongly associated with caries. However, additional factors must be considered to fully establish their harmful effects. These relationships are examined in three age groups of the 6th German Oral Health Study (DMS • 6).

Method and materials: Dietary habits were assessed using the short form of the Marburg Sugar Index (MSI-S), which comprises six questions regarding food consumption frequencies in various contexts. Responses provide insight into the degree of cariogenic eating behavior. In addition to demographic factors (gender, education status, migration history), clinical variables such as caries experience (decayed, missing, filled teeth [DMFT] index), plaque accumulation (modified Marginal Plaque Index [mMPI]), and the number of remaining teeth were included.

Results: No direct relationship between the extent of cariogenic dietary habits (MSI-S total score) and clinical variables was observed in any of the examined age groups (n = 870 younger adolescents [12-year-olds], n = 853 younger adults [35- to 44-year-olds], and n = 730 younger seniors [65- to 74-year-olds]). Gender and education status also showed no significant differences. However, 12-year-olds with a migration history exhibited higher MSI-S scores compared to those without. Analyzing extreme groups (the top and bottom 10% of MSI-S scores), systematic differences in caries experience were observed among 12-year-olds and younger seniors, and in plaque levels among younger seniors. Younger adults showed no significant differences in clinical variables, even within extreme groups.

Conclusion: The MSI-S scores demonstrated that particularly cariogenic dietary habits, as opposed to more favorable ones (extreme groups), are associated with increased caries experience. This was especially evident among 12-year-olds but also observed in younger seniors. The lack of differences among adults as well as the absence of significant associations between dietary habits and clinical variables in the overall groups suggest that the impact of cariogenic diets on oral health is moderated by additional variables, such as oral hygiene practices and dental service utilization. Migration history was identified as a relevant factor among 12-year-olds. The detrimental effects of cariogenic dietary habits on oral health are most evident when analyzed in the context of additional influencing factors and stratified by target groups. Promoting oral health awareness regarding nutrition is particularly important for adolescents and seniors.

Objectives: As part of the 6th German Oral Health Study (DMS • 6), the migration history of the study participants was determined at the population level for the first time.

Method and materials: The evaluation and presentation of migration-related indicators, oral health behavior, and oral diseases were carried out separately for 12-year-olds, 35- to 44-year-olds, and 65- to 74-year-olds.

Results: When considering the prevalence of disease and care, differences were found between people with and without migration history in all three age groups. The first group had higher prevalences of oral diseases as well as a more complaint-oriented utilization of dental services.

Conclusion: The data on the prevalence of oral diseases, oral health behavior, and dental service utilization provide evidence that people with migration history do not seem to benefit in the same way from group and individual prophylaxis services as people without migration history.

Objectives: With the First German Oral Health Study (DMS I) in 1989, the Institut der Deutschen Zahnärzte (IDZ) laid the foundation for a population-representative socioepidemiologic monitoring of oral health and care status in Germany. The objective of the sixth wave of the survey was to update the status of oral health.

Research questions: The primary questions address cross-sectional data: 1. What are the current prevalence rates of oral diseases? 2. What associations exist between oral health and other participant characteristics? The third question is based on the comparison of cross-sectional data with previous German oral health studies (trend): 3. How has the oral health and care status in Germany developed from 1989 to 2023? The last two questions require longitudinal data: 4. How do oral diseases change over the course of a lifetime? 5. What individual characteristics influence the progression of (new) oral diseases?

Study design: The DMS • 6 is a combined cross-sectional and cohort study and therefore classified as an observational study.

Study participants: The age groups for the cross-sectional study were selected following the World Health Organization (WHO) recommendations for oral epidemiologic studies. These include 12-year-olds as representatives for younger adolescents, 35- to 44-year-olds for younger adults, and 65- to 74-year-olds for younger seniors. An additional age group of 8- and 9-year-olds (younger children) was included to obtain information on oral health during the mixed dentition phase. In total, 3,377 study participants were included in the analyses for the cross-sectional questions (prevalences). Participant characteristics provide insights into their sociodemographic and behavioral parameters.

Objectives: The 6th German Oral Health Study (DMS • 6) is a combined cross-sectional and cohort study with the main objective of reporting oral diseases in Germany. Based on cross-sectional data, current prevalence estimates and trend analyses on the development of oral health and care status in Germany were conducted using representative data. Associations between oral health and further participant characteristics were examined. The aim of this article is to provide details on data handling and statistical analysis of the cross-sectional data. Sample weighting: Weighting factors were used as part of the statistical analysis to correct for deviations between the analysis set and the population structure in Germany. The objective was to make nationwide representative statements for the age groups examined in the cross-sectional component of the DMS • 6. Different types of weights were calculated: design, non-response, and calibration weights. Processing of quantitative variables: The indices and transformed variables required for data analysis were defined based on variables collected in clinical examinations and social science interviews. Dental characteristics were aggregated at the participant level.

Statistical methods: For epidemiologic description, prevalence rates and means with associated 95% confidence intervals were calculated. Regression models were adjusted to estimate the strength of associations between participant characteristics of interest and oral health-related outcomes. To describe trends in the temporal development of oral health and dental care status in Germany, epidemiologic descriptions from DMS • 6 and previous studies were compared.