Background. The treatment of patients born with cleft lip and palate has been gradually modified over the years as the surgical procedures have developed and improved. Multidisciplinary team care has evolved and provided improved care with enhanced results. Clefts in the alveolus can be reconstructed by alveolar bone grafting or by periosteoplasty. The main goal is to repair and close the alveolar cleft and create a continuous alveolar processes so that the teeth can erupt. Aims. This thesis has several aims: to investigate the impact of dental status and initial cleft width on the outcome of Secondary alveolar bone grafting (SABG) in patients born with unilateral cleft lip and palate (UCLP) at the 10-year follow-up (Studies I and II); to compare the outcomes of primary periosteoplasty (PPP) with those of SABG in patients born with unilateral cleft lip and alveolus (CLA) (Study III); to evaluate clinical and radiographic conditions and identify factors important for the final treatment outcomes after SABG ( Study IV); to evaluate two radiographic methods, i.e. occlusal radiographs and cone beam tomography (CBCT)) for assessing alveolar bone height ( study IV). Results. In UCLP patients, SABG achieved excellent results in terms of bone height; tended to reduce with time, correlated with dental status and dental restoration factors. Occlusal radiographs correspond well with the CBCT, for evaluating alveolar bone height in cleft area. The width of the initial cleft does not seem to affect the success of SABG. Finally, patients with CLA treated with PPP at the time of lip repair have inferior bone formation outcomes in the cleft area compared with patients treated with SABG at the time of mixed dentition. Conclusion.  Poor dental status and malpositioning negatively affect the long-term survival of bone in the alveolar cleft. The initial cleft width affects certain dental status factors. In adults with UCLP, the alveolar bone height in the cleft was correlated to the presence of gingival inflammation and restorations at 20 years follow-up. Specially designed maintenance therapy is beneficial, after complex dental restorations in the cleft area. SABG is preferred to PPP for the reconstruction of alveolar clefts.

O número de idosos vem crescendo em todo o mundo devido a um aumento na expectativa de vida e diminuição da taxa de natalidade. Concomitantemente, os avanços da ciência e da tecnologia na área da saúde poderiam contribuir para a manutenção de dentes por períodos mais prolongados, gerando um crescente número de idosos com dentes na boca. O objetivo dessa pesquisa foi conhecer a condição dentária e restauradora de pacientes idosos de um centro público que oferece tratamento dentário em São Paulo, Brasil. Materiais e métodos: Foram avaliados pacientes (60 anos ou mais) que compareceram ao serviço de triagem do CRI-Norte. Todos os pacientes foram entrevistados inicialmente (dados pessoais, história odontológica, hábitos de higiene). Pacientes dentados foram submetidos a um exame clínico: dentes perdidos, condição dos dentes e restaurações presentes. Para comparação foram utilizados os testes ANOVA e Qui-quadrado (p<0.05). Resultados: Foram avaliados 177 pacientes desdentados (54%) e 148 dentados, sendo 66% do sexo feminino e 34% masculino. 49,8% possuíam entre 60-69 anos e 63% nasceram na Região Sudeste. 73% dos pacientes não se consultavam com um dentista durante a infância, nem possuíam o hábito de realizar consultas periódicas durante a vida adulta (72%). Pacientes dentados (20%) frequentaram o consultório odontológico mais regularmente que os desdentados (8%). 80% dos pacientes dentados relataram escovar os dentes de 1 a 2 vezes por dia e 64% não fazem uso do fio dental. 32% dos pacientes apresentavam entre 5 e 19 dentes e apenas 6,5% apresentavam mais de 20 dentes na boca. Dentre os pacientes desdentados, 70% eram mulheres e 30% eram homens. O CPOD encontrado foi de 26, com predominância do componente perdido (média=21). Dentes inferiores anteriores são os mais retidos pela população idosa (41%). 14,6% dos dentes avaliados apresentaram lesão cariosa (63% lesões coronárias e 37% radiculares). A face coronária mais atingida por cárie foi a mesial (27%). 33% dos dentes presentes apresentaram restaurações sendo 60% satisfatórias e 40% insatisfatórias. 41% das restaurações de amálgama apresentaram-se satisfatórias com diferença estatística comparada a resina composta (13%). Em relação às faces coronárias restauradas, a oclusal foi a que mais apresentou essa condição (31%). Os pré molares foram os dentes com mais restaurações radiculares (48%). 40% dos pacientes apresentaram lesão cervical não cariosa (54% das lesões ocorreram em dentes anteriores), Pré molares (38%) e incisivos (34%) são os dentes mais atingidos por esse tipo de perda de estrutura. Em relação ao desgaste incisal/oclusal, 73% dos pacientes apresentaram essa condição (98% das lesões ocorreram em dentes anteriores). Conclusão: Conclui-se que no serviço público o número de pacientes idosos totalmente desdentados é relevante. Uma pequena parcela dos pacientes apresenta mais que 20 dentes, sendo que muitas restaurações não apresentam-se satisfatórias. O amálgama é a restauração que mais se manteve satisfatoriamente. Uma maior atenção deve ser dada aos tratamentos realizados e à conservação deles na população idosa. / The number of elderly people is increasing all over the world due to increased life expectancy and decreasing birth rate. Simultaneously, the progress of science and technology in health could contribute to the maintenance of teeth in the mouth for longer periods, generating an increasing number of older patients with teeth in the mouth.Objective: Identify the restorative and dental status of elderly patients at a public service in Sao Paulo-Brazil. Methods: Patients (60 years or older) who attended the dental service of CRI-Norte, in São Paulo, Brazil were evaluated. They were submitted to an initial interview which consisted in: personal data, dental history and hygienic habits. Dentate patients were submitted to a clinical examination to evaluate the status of the remaining teeth and conditions of restorations. ANOVA and Chi-square tests (p <0.05) were used for comparison. Results: 177 edentulous and 148 dentate patients were evaluated (66% female and 34% male). 49.8% were 60-69 years old and 65% were born in Southeastern Brazil. 73% had not been to a dental office during childhood and 72% had not regularly been to the dentist\'s in adult life. 20% of dentate and 8% of edentulous attended a dental office regularly. 80% of dentate brushed their teeth 1-2x per day and 64% did not use dental floss. 32% of patients had 5-19 teeth and 6.5% had over 20 teeth. 41% were anterior mandibular teeth. The number of decayed, missing and filled teeth was 26, with prevalence of missing component (mean =21); 14,6% had caries (37% radicular). 33% of the teeth presented restorations (40% unsatisfactory). 41% of amalgam restorations were satisfactory with statistical difference from composite resin (13%). Pre molars were the most radicular restored teeth (48%) with statistical difference between other teeth. 40% of patients presented non-carious lesions; 73% presented incisal/occlusal wear (98% anterior teeth). Conclusion: The number of edentulous patients is relevant. Few patients have more than 20 teeth, and many restorations are not satisfactory. Amalgam is the material that presented the best survive hability. Greater attention should be given to the performed dental treatments and their conservation in the elderly population, increasing their quality of oral health.

O número de idosos vem crescendo em todo o mundo devido a um aumento na expectativa de vida e diminuição da taxa de natalidade. Concomitantemente, os avanços da ciência e da tecnologia na área da saúde poderiam contribuir para a manutenção de dentes por períodos mais prolongados, gerando um crescente número de idosos com dentes na boca. O objetivo dessa pesquisa foi conhecer a condição dentária e restauradora de pacientes idosos de um centro público que oferece tratamento dentário em São Paulo, Brasil. Materiais e métodos: Foram avaliados pacientes (60 anos ou mais) que compareceram ao serviço de triagem do CRI-Norte. Todos os pacientes foram entrevistados inicialmente (dados pessoais, história odontológica, hábitos de higiene). Pacientes dentados foram submetidos a um exame clínico: dentes perdidos, condição dos dentes e restaurações presentes. Para comparação foram utilizados os testes ANOVA e Qui-quadrado (p<0.05). Resultados: Foram avaliados 177 pacientes desdentados (54%) e 148 dentados, sendo 66% do sexo feminino e 34% masculino. 49,8% possuíam entre 60-69 anos e 63% nasceram na Região Sudeste. 73% dos pacientes não se consultavam com um dentista durante a infância, nem possuíam o hábito de realizar consultas periódicas durante a vida adulta (72%). Pacientes dentados (20%) frequentaram o consultório odontológico mais regularmente que os desdentados (8%). 80% dos pacientes dentados relataram escovar os dentes de 1 a 2 vezes por dia e 64% não fazem uso do fio dental. 32% dos pacientes apresentavam entre 5 e 19 dentes e apenas 6,5% apresentavam mais de 20 dentes na boca. Dentre os pacientes desdentados, 70% eram mulheres e 30% eram homens. O CPOD encontrado foi de 26, com predominância do componente perdido (média=21). Dentes inferiores anteriores são os mais retidos pela população idosa (41%). 14,6% dos dentes avaliados apresentaram lesão cariosa (63% lesões coronárias e 37% radiculares). A face coronária mais atingida por cárie foi a mesial (27%). 33% dos dentes presentes apresentaram restaurações sendo 60% satisfatórias e 40% insatisfatórias. 41% das restaurações de amálgama apresentaram-se satisfatórias com diferença estatística comparada a resina composta (13%). Em relação às faces coronárias restauradas, a oclusal foi a que mais apresentou essa condição (31%). Os pré molares foram os dentes com mais restaurações radiculares (48%). 40% dos pacientes apresentaram lesão cervical não cariosa (54% das lesões ocorreram em dentes anteriores), Pré molares (38%) e incisivos (34%) são os dentes mais atingidos por esse tipo de perda de estrutura. Em relação ao desgaste incisal/oclusal, 73% dos pacientes apresentaram essa condição (98% das lesões ocorreram em dentes anteriores). Conclusão: Conclui-se que no serviço público o número de pacientes idosos totalmente desdentados é relevante. Uma pequena parcela dos pacientes apresenta mais que 20 dentes, sendo que muitas restaurações não apresentam-se satisfatórias. O amálgama é a restauração que mais se manteve satisfatoriamente. Uma maior atenção deve ser dada aos tratamentos realizados e à conservação deles na população idosa. / The number of elderly people is increasing all over the world due to increased life expectancy and decreasing birth rate. Simultaneously, the progress of science and technology in health could contribute to the maintenance of teeth in the mouth for longer periods, generating an increasing number of older patients with teeth in the mouth.Objective: Identify the restorative and dental status of elderly patients at a public service in Sao Paulo-Brazil. Methods: Patients (60 years or older) who attended the dental service of CRI-Norte, in São Paulo, Brazil were evaluated. They were submitted to an initial interview which consisted in: personal data, dental history and hygienic habits. Dentate patients were submitted to a clinical examination to evaluate the status of the remaining teeth and conditions of restorations. ANOVA and Chi-square tests (p <0.05) were used for comparison. Results: 177 edentulous and 148 dentate patients were evaluated (66% female and 34% male). 49.8% were 60-69 years old and 65% were born in Southeastern Brazil. 73% had not been to a dental office during childhood and 72% had not regularly been to the dentist\'s in adult life. 20% of dentate and 8% of edentulous attended a dental office regularly. 80% of dentate brushed their teeth 1-2x per day and 64% did not use dental floss. 32% of patients had 5-19 teeth and 6.5% had over 20 teeth. 41% were anterior mandibular teeth. The number of decayed, missing and filled teeth was 26, with prevalence of missing component (mean =21); 14,6% had caries (37% radicular). 33% of the teeth presented restorations (40% unsatisfactory). 41% of amalgam restorations were satisfactory with statistical difference from composite resin (13%). Pre molars were the most radicular restored teeth (48%) with statistical difference between other teeth. 40% of patients presented non-carious lesions; 73% presented incisal/occlusal wear (98% anterior teeth). Conclusion: The number of edentulous patients is relevant. Few patients have more than 20 teeth, and many restorations are not satisfactory. Amalgam is the material that presented the best survive hability. Greater attention should be given to the performed dental treatments and their conservation in the elderly population, increasing their quality of oral health.

In der vorliegenden Arbeit erfolgte ein Vergleich zweier Patientengruppen (einer aus Albanien und einer aus Deutschland kommend) im Hinblick auf ihre Zahnbehandlungsangst und weiterer psychischer Parameter. In einer Vielzahl von Studien wurden bereits Patienten in einer Zahnarztpraxis oder Uniklinik zu ihrem psychischen Befinden, während einer Zahnbehandlung befragt. Eine Studie im zahnärztlichen Setting eines „Industriestaats“ setzt allerdings voraus, dass das Angstniveau dieser Personen es zulässt, sich einer Zahnbehandlung zu unterziehen. Um eine für die Forschung interessante Gruppe, d.h. potenzielle Behandlungsvermeider miteinzubeziehen, wurden in dieser Dissertation, neben Zahnarztpatienten aus Deutschland, Patientengruppen eines „Dritten Lands“, wie Albanien befragt. Insgesamt haben 263 Patienten an der Studie teilgenommen, davon 133 in einer Zahnarzt-praxis in Plauen/Deutschland und 130 in dem zahnmedizinischen Universitätsklinikum in Tirana/Albanien. Alle Befragten erhielten die gleichen Fragebögen zur Beurteilung ihrer psychischen Situation, die anschließend ausgewertet wurden. Danach konnte die Zahnbehandlungsangst mit der Dental Anxiety Scale (DAS) gemessen werden sowie mit zwei Items der Amsterdam Properative Anxiety Scale (APAIS), zur Behandlung der Angst. Die beiden Instrumente korrelierten signifikant stark miteinander (Spearman: r = 0,50, p = 0,000). Bei den Patienten der Zahnarztpraxis in Deutschland wurde außerdem der Zahnstatus mittels DMF-T/S Werten ermittelt. Das Durchschnittsalter aller Teilnehmer betrug 37,94 (SD 14,66) Jahre. Auffällig war, dass sowohl in der Zahnarztpraxis (67,7 %) als auch im Universitätsklinikum (52,3 %) mehr weibliche Personen an der Studie teilnahmen. Besonders in der Zahnarztpraxis im Vergleich zum Uniklinikum, war der Frauenanteil bei den Teilnehmern signifikant höher. Hinsichtlich des Bildungsniveaus beider Patientengruppen, befand sich dieses über dem deutschen Durchschnitt (Statistisches Bundesamt). Dabei konnte festgestellt werden, dass der gegenwärtige subjektive Gesundheitszustand von albanischen Patienten signifikant schlechter eingeschätzt wird als der von deutschen Patienten. Bei den Zahnarztpatienten in Albanien stand ein signifikant schlechterer Gesundheitszustand in Beziehung zu höherem Alter und niedrigerem Bildungsniveau. Die Probanden der deutschen Zahnarztpraxen wiesen zudem anhand des GSI (BSI-18) eine signifikant höhere allgemeine psychische Belastung auf. Die durchschnittlichen Werte waren demnach in den Subskalen Ängstlichkeit, Depressivität und Somatisierung signifikant höher. Der durchschnittliche Wert der DAS lag bei 13,58 (SD 2,94) bzw. bei 12,62 (SD 2,44) bei den deutschen bzw. den albanischen Patienten. Die Durchschnittswerte der APAIS (Angst vor der Behandlung) befanden sich bei 6,38 (SD 2,15) in der Zahnarztpraxis in Deutschland und bei 6,03 (SD 1,64) in der Praxis in Albanien. Die Patientengruppen unterschieden sich somit nicht nur im Allgemeinen (BSI-18), sondern auch im Speziellen auf das die Zahnbehandlung bezogene Angstniveau (DAS, APAIS) signifikant voneinander. Die durchschnittlichen Werte für die mundgesundheitsbezogene Lebensqualität (OHIP) der beiden Patientengruppen unterschieden sich jedoch nicht signifikant voneinander. Die deutschen Patienten wiesen allerdings in allen Subskalen signifikant schlechtere Werte im Vergleich zu denen der albanischen Patienten auf. Dennoch gaben die deutschen Zahnarztpatienten an allgemein zufriedener mit ihrem Leben (L-1) zu sein. Ihre Angst gegenüber der Zahnmedizin (DFS) schätzten wiederum die deutschen Patienten signifikant schlechter ein. Der OSLO-3 Gesamtwert betrug in der albanischen Population im Durchschnitt 7,95 (SD 1,15) und bei deutschen Patienten im Durchschnitt 7,77 (SD 1,46). Hierbei ließen sich keine signifikanten alters-, geschlechts- und bildungsspezifischen Unterschiede zwischen den beiden Studienteilnehmern wahrnehmen. Dennoch ließ sich konstatieren, dass albanische, weibliche und jüngere Patienten sowie solche mit Abitur die höchsten Werte zu verzeichnen haben. Ihren Optimismus-Pessimismus-Status schätzten die deutschen Patienten im Durchschnitt mit einem Wert von 11,13 (SD 1,95) ein und die albanischen Patienten mit einem Wert von 11,75 (1,97). Die Skala zur Messung von Optimismus-Pessimismus ergab demnach, dass ältere Patienten mit einem niedrigeren Bildungsniveau pessimistischer eingestellt sind als Jüngere, wobei festgestellt werden konnte, dass dieser Wert bei albanischen Patienten signifikant hoch gewesen ist. Es ließen sich auch signifikante Werte bei albanischen Männern feststellen im Vergleich zu albanischen Frauen und deutschen Teilnehmen, womit sich geschlechtsspezifische Unterschiede wahrnehmen ließen. Im Hinblick auf das zahnmedizinische Vorsorgeverhalten erzielten die albanischen Patienten einen signifikant schlechteren Vorsorgeindex (p = 0.010). Zahnarztpatienten in Albanien ließen sich demnach seltener Zahnstein entfernen und eine professionelle Zahnreinigung durchführen. Trotz einem erhöhten DAS-Angstniveau gaben deutsche Patienten an häufiger zum Zahnarzt zu gehen als albanische Patienten mit niedrigerer Angstausprägung. Die Korrelation des DAS-Angstniveaus und der Zahngesundheit ergab einen signifikanten Zusammenhang zwischen dem Angstniveau der Patienten und dem Gesamtwert des DMF-T (Spearman: r = 0,19, p = 0,031) sowie DMF-S (r = 0,18, p = 0,034). Der durchschnittliche DMF-T Index betrug 13,54 (SD 7,64) und der durchschnittliche DMF-S Index 44,17 (SD 31,92). Dies ergab höhere signifikante Unterschiede in den DMF-T/S-Werten der Altersgruppen (p = 0,000). Patienten mit höherem Bildungsniveau hatten demnach weniger fehlende Zähne/Zahnflächen vorzuweisen. Hierbei waren gab auch Geschlechtsunterschiede feststellbar, wonach der DMF-T-Wert war bei Frauen in der Zahnarztpraxis in Deutschland signifikant höher (p = 0,033) war. Personen mit einem geringeren DAS-Angstniveau (APAIS) und mit Zahnbehandlungsangst (DFS) hatten mehr sanierungsbedürftige und fehlende Zähne/Zahnflächen. Ein besserer selbsteingeschätzter Gesundheitszustand stand in signifikantem Zusammenhang mit einem besseren Zahnstatus. Die Einschränkung der mundgesundheitsbezogenen Lebensqualität (OHIP), die allgemeine psychische Belastung, die allgemeine Sozial Support Skala (OSSS) und der Optimismus-Pessimismus-Status (SOP2) korrelierten stark mit der Anzahl der fehlenden Zähne bzw. Zahnflächen. Auffallend ist, dass bei Patienten mit höherer allgemeiner psychischer Belastung, meist auch die Zahnflächen oder Zähne beeinträchtigt sind. Die These, dass Personen, die außerhalb der „Industriestaaten“ befragt werden, ein höheres Angstniveau und weitere psychische Belastungen aufweisen, da sie den Zahnarztbesuch unter Umständen meiden, konnte in vorliegender Studie nicht bestätigt werden. Dennoch sollten albanische Zahnärzte für das Thema „Zahnbehandlungsangst“ sensibilisiert werden, um Patienten mit erhöhtem Angstniveau entsprechend zu begegnen.:1 Einleitung 1.1 Allgemeine Definition und Ausführung zum Thema Angst 1.1.1 Angststörungen und phobische Störungen 1.1.2 Phobien 1.2 Zahnbehandlungsangst und Angststörungen 1.2.1 Beschreibung der Störung 1.2.2 Zahnbehandlungsangst und andere psychische Störungen 1.2.3. Zahnbehandlungsangst, Mundgesundheit und somatische Störungen 1.3 Prävalenz 1.4 Epidemiologie 1.5 Ätiologie 1.6 Diagnostik von Behandlungsangst und Phobie 1.7 Differenzialdiagnose 1.8 Andere phobischen Störungen 1.8.1 Posttraumatische Belastungsstörung (PTB) 1.9 Komorbiditäten 1.10 Vorbeugung und Therapie 1.11 Vergleich im zahnmedizinischen Versorgungssystem zwischen Albanien und Deutschland. 2 Fragestellungen 3 Material und Methoden 3.1 Studiendesign 3.2 Instrumente 3.2.1 Übersicht über die verwendeten Instrumente / Konstrukte 3.2.2 Beschreibung der Instrumente 3.3 Statistische Auswertung 3.4 Durchführung 4 Ergebnisse 4.1 Beschreibung des Patientenkollektivs 4.1.1 Soziodemografie 4.2 Patientenkollektiv: psychisches Befinden - Ein Vergleich zwischen Deutschland und Albanien. 4.2.1 Einflussfaktoren der Gesamtgruppe 4.2.2 Vergleich zwischen beiden Populationsgruppen 4.3 Vorsorgeverhalten und Stellung der Mundgesundheit 4.3.1 Mundgesundheitsbezogenes Befinden (OHIP) 4.4 Auswertung der Ergebnisse in der Zahnarztgruppe in Deutschland 4.4.1 Mundgesundheit der Zahnarztgruppe 4.4.2 Zahnstatus im Zusammenhang mit anderen verwendeten Instrumenten 4.4.3 Zahnbehandlungsangst und Zahnstatus 5 Diskussion 5.1 Patientenkollektiv 5.1.1 Soziodemographie der Gesamtgruppe 5.1.2 Psychisches Befinden der Gesamtgruppe 5.1.3 Vorsorgeverhalten und Stellung der Mundgesundheit in der Gesamtgruppe 5.2 Vergleich der beiden Patientenpopulationen 5.2.1 Soziodemographie – Vergleich der beiden Patientengruppen 5.2.2 Psychisches Befinden – Vergleich der beiden Patientengruppen 5.2.3 Albaner zwischen psychischen Erkrankungen und Vorurteilen 5.2.4 Vorsorgeverhalten und Stellung der Mundgesundheit – Vergleich der beiden Patientengruppen 5.3 Diskussion der Ergebnisse im Zusammenhang mit Zahnstatus 5.3.1 Mundgesundheit der Zahnarztgruppe in Deutschland 5.3.2 Vorsorgeverhalten, Stellung der Mundgesundheit und Zahnstatus 5.3.3 Zahnbehandlungsangst und Zahnstatus 5.3.4 Zahnstatus und andere verwendete Instrumente 5.4 Kritische Betrachtung 5.5 Ausblick 123 5.5.1 Implikationen für die Forschung 5.5.2 Implikationen für die Praxis 6 Zusammenfassung Summary Literaturverzeichnis Tabellenverzeichnis Abbildungsverzeichnis Abkürzungen Anhang Danksagung Erklärungen / In the present study, two groups of patients were compared with regard to their dental treatment anxiety and other psychological parameters. In a large number of studies, patients in dental practices/universities have already been questioned about their psychological state in the situation of dental treatment. However, a study in the dental setting of an 'industrialized country' presupposes that the anxiety level of these individuals allows them to undergo dental treatment. In order to include a group of potential treatment avoiders that is interesting for research, this dissertation surveyed and evaluated not only dental patients from Germany but also patient groups from a 'third country' such as Albania. A total of 263 patients participated in the study, 133 of them in a dental practice in Plauen/Germany and 130 in the dental university hospital in Tirana/Albania. All respondents received the same questionnaires to assess their psychological situation. Dental anxiety was measured with the Dental Anxiety Scale (DAS) and with two items of the Amsterdam Properative Anxiety Scale (APAIS) to treat anxiety. The two instruments correlated significantly strongly with each other (Spearman: r = 0.50, p = 0.000). Dental status was also assessed in the patients of the dental practice in Germany using DMF-T/S values. The mean age of all participants was 37.94 (SD 14.66) years. It was noticeable that more females participated in the study in both the dental practice (67.7 %) and the university hospital (52.3 %). Compared to the university hospital, the proportion of females was significantly higher among participants in the dental practice. In both patient groups, the level of education was above the German average (German Federal Statistical Office). It was found that the current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients. Among the dental patients in Albania, a significantly worse state of health was related to higher age and lower level of education. The subjects in the German dental practices also showed significantly higher general psychological distress based on the GSI (BSI-18). Mean scores were significantly higher in the anxiety, depression, and somatization subscales. The mean score of the DAS was 13.58 (SD 2.94) and 12.62 (SD 2.44) in the German and Albanian patients, respectively. The mean scores of APAIS (fear of treatment) were 6.38 (SD 2.15) in the dental practice in Germany and 6.03 (SD 1.64) in the practice in Albania. Thus, the patient groups differed not only in general (BSI-18), but also specifically on the dental treatment-related anxiety level (DAS, APAIS) differed significantly from each other. However, the mean oral health-related quality of life (OHIP) scores of the two patient groups did not differ significantly from each other. However, the German patients had significantly worse scores in all subscales compared with the Albanian patients. Nevertheless, the German dental patients were generally more satisfied with their lives (L-1). Fear of dentistry (DFS) was again rated significantly worse by the German patients. The OSLO-3 total score averaged 7.95 (SD 1.15) in the Albanian population and 7.77 (SD 1.46) in German patients. Here, no significant age-, gender-, and education-specific differences could be perceived between the two study participants. Accordingly, Albanian, female, and younger patients and those with high school diplomas had the highest scores. The German patients assessed their optimism-pessimism status with an average value of 11.13 (SD 1.95) and the Albanian patients with a value of 11.75 (1.97). Accordingly, the optimism-pessimism scale showed that older patients with a lower educational level were more pessimistic than younger ones, and it was found that this value was significantly high in Albanian patients. Significant values were also found in Albanian men compared to Albanian women and German participants, thus allowing gender-specific differences to be perceived. With regard to preventive dental care behavior, Albanian patients scored significantly lower on the preventive care index (p = 0.010). Dental patients in Albania were thus less likely to have tartar removed and professional dental cleaning performed. Despite an elevated DAS anxiety level, German patients reported going to the dentist more frequently than Albanian patients with lower levels of anxiety. Correlation of DAS anxiety level and dental health revealed a significant relationship between patients' anxiety level and total DMF-T score (Spearman: r = 0.19, p = 0.031) as well as DMF-S (r = 0.18, p = 0.034). The mean DMF-T index was 13.54 (SD 7.64), and the mean DMF-S index was 44.17 (SD 31.92). There were larger significant differences in DMF T/S values between age groups (p = 0.000). Patients with higher levels of education had fewer missing teeth/tooth surfaces. There were also gender differences, with DMF-T scores significantly higher in female participants in a dental cabinet in Germany (p = 0.033). Individuals with lower DAS anxiety levels, APAIS, and dental treatment anxiety (DFS) had more teeth/dental surfaces in need of rehabilitation and missing teeth/dental surfaces. Better self-rated health was significantly associated with better dental status. Oral health-related quality of life (OHIP) limitation, general psychological distress, general social support scale (OSSS), and optimism-pessimism status (SOP2) were strongly correlated with the number of missing teeth/dental surfaces, suggesting that in patients with higher general psychological distress, the number of dental surfaces was also related. The hypothesis that individuals interviewed outside the 'developed' countries have higher levels of anxiety and further psychological distress because they may avoid visiting the dentist could not be confirmed in the present study. Nevertheless, Albanian dentists should be sensitized to the topic of 'dental anxiety' in order to deal appropriately with patients with increased anxiety levels.:1 Einleitung 1.1 Allgemeine Definition und Ausführung zum Thema Angst 1.1.1 Angststörungen und phobische Störungen 1.1.2 Phobien 1.2 Zahnbehandlungsangst und Angststörungen 1.2.1 Beschreibung der Störung 1.2.2 Zahnbehandlungsangst und andere psychische Störungen 1.2.3. Zahnbehandlungsangst, Mundgesundheit und somatische Störungen 1.3 Prävalenz 1.4 Epidemiologie 1.5 Ätiologie 1.6 Diagnostik von Behandlungsangst und Phobie 1.7 Differenzialdiagnose 1.8 Andere phobischen Störungen 1.8.1 Posttraumatische Belastungsstörung (PTB) 1.9 Komorbiditäten 1.10 Vorbeugung und Therapie 1.11 Vergleich im zahnmedizinischen Versorgungssystem zwischen Albanien und Deutschland. 2 Fragestellungen 3 Material und Methoden 3.1 Studiendesign 3.2 Instrumente 3.2.1 Übersicht über die verwendeten Instrumente / Konstrukte 3.2.2 Beschreibung der Instrumente 3.3 Statistische Auswertung 3.4 Durchführung 4 Ergebnisse 4.1 Beschreibung des Patientenkollektivs 4.1.1 Soziodemografie 4.2 Patientenkollektiv: psychisches Befinden - Ein Vergleich zwischen Deutschland und Albanien. 4.2.1 Einflussfaktoren der Gesamtgruppe 4.2.2 Vergleich zwischen beiden Populationsgruppen 4.3 Vorsorgeverhalten und Stellung der Mundgesundheit 4.3.1 Mundgesundheitsbezogenes Befinden (OHIP) 4.4 Auswertung der Ergebnisse in der Zahnarztgruppe in Deutschland 4.4.1 Mundgesundheit der Zahnarztgruppe 4.4.2 Zahnstatus im Zusammenhang mit anderen verwendeten Instrumenten 4.4.3 Zahnbehandlungsangst und Zahnstatus 5 Diskussion 5.1 Patientenkollektiv 5.1.1 Soziodemographie der Gesamtgruppe 5.1.2 Psychisches Befinden der Gesamtgruppe 5.1.3 Vorsorgeverhalten und Stellung der Mundgesundheit in der Gesamtgruppe 5.2 Vergleich der beiden Patientenpopulationen 5.2.1 Soziodemographie – Vergleich der beiden Patientengruppen 5.2.2 Psychisches Befinden – Vergleich der beiden Patientengruppen 5.2.3 Albaner zwischen psychischen Erkrankungen und Vorurteilen 5.2.4 Vorsorgeverhalten und Stellung der Mundgesundheit – Vergleich der beiden Patientengruppen 5.3 Diskussion der Ergebnisse im Zusammenhang mit Zahnstatus 5.3.1 Mundgesundheit der Zahnarztgruppe in Deutschland 5.3.2 Vorsorgeverhalten, Stellung der Mundgesundheit und Zahnstatus 5.3.3 Zahnbehandlungsangst und Zahnstatus 5.3.4 Zahnstatus und andere verwendete Instrumente 5.4 Kritische Betrachtung 5.5 Ausblick 123 5.5.1 Implikationen für die Forschung 5.5.2 Implikationen für die Praxis 6 Zusammenfassung Summary Literaturverzeichnis Tabellenverzeichnis Abbildungsverzeichnis Abkürzungen Anhang Danksagung Erklärungen