Search

The oral care of a child with autism spectrum disorders (ASD) is a challenge, not only for dentists, but also for parents. The objective of this study was to evaluate the difficulties encountered by parents in maintaining oral hygiene in autistic children and the solutions they found to facilitate this daily act. A questionnaire with closed and open questions about characteristics of the child and oral health at home, conducted via Google Form, was sent to French families through 301 associations of parents with autistic children. For the quantitative analysis, logistic regression was used. The open answers were analysed by theme. This study included 756 offspring aged 14.4 (± 8.1) years. Girls were 1.7 (95% CI: 1.1–2.8) times more likely to have toothbrushing difficulty than boys. Nonverbal patients (OR:3.2; 95% CI: 2.2–4.9), autistic patients (OR:2.8; 95% CI: 1.4–5.2), patients using pictograms (OR:1.6; 95% CI: 1.1–2.4), and younger children (OR:0.9; 95% CI: 0.9–0.9) were significantly more likely to encounter difficulties in tolerating toothbrushing. The qualitative analysis showed that parents used three main ways to facilitate toothbrushing: planning, modelling and making it enjoyable. Seventy-nine percent of parents did not feel sufficiently informed about the different oral hygiene prevention tools and techniques for their ASD children and would like to be educated in the daily management of oral hygiene. The role of parents remains essential and professionals should work in collaboration with them.

Objective The study aimed to describe and to analyze the first morbidity and mortality review (MMRs) set up within a Dental University Hospital using detailed case reports to highlight the benefits of MMRs for patients, practitioners, teachers and to implement appropriate protocols to prevent recurrence. Materials and Methods The MMRs were performed within the dentistry departments of the hospital over the 1-year study period. Each case was reviewed according to a protocol based on a tool defined by the Clinical Risk Unit and the Association of Litigation and Risk Management (ALARM). Results Four cases were selected based on an oral report by a doctor from the dental service, a downstream service, or by the attending physician. The first case report related to a patient who suffered a breathing shock. The second concerned a tooth inhalation by a young disabled boy. The third was a therapeutic failure instigated by a student during a tooth preparation, and the fourth case involved an unexpected face-to-face meeting between a prisoner accompanied by police guards and an ancient victim at the dental hospital. Discussion Clinical incidents were investigated with the ALARM protocol. This process is also less focused on the individual who makes the error and more on contributing systemic factors. The systematic analysis of cases associated with bibliographic reviews improves learning and performance outcomes. Clear answers were given in response to the problems raised during these MMRs. Conclusion In dental hospitals, the culture of MMRs needs to be integrated into resident training like in medical hospitals.

BACKGROUND: The etiology of dental fear (DF) is multifactorial and involves other contributing factors than dental traumatic experiences. AIM: To study, among adolescents, associations between DF and exposure to child physical abuse (CPA), intimate partner violence (IPV), and bullying. MATERIALS AND METHODS: We extracted data from a population-based survey of 4977 adolescents who were 15-17 years old in 2017. The questionnaire queried socioeconomic background factors, DF, self-perceived oral health, general health, and exposure to child abuse. To estimate associations between DF and exposure to child abuse, we used multivariate logistic regression analysis. RESULTS: Overall, 8.2% reported DF, girls (10.5%) reported DF significantly more often than boys (5%), and adolescents not identifying themselves as girl or boy reported the highest prevalence of DF (25.5%; p

Objectives The location of the mandibular foramen is essential for the quality of the inferior alveolar nerve block anaesthesia and has often been studied with contradictory results over the years. The aim of this study was to locate the mandibular foramen, according to the dental age of the subject, through 3D analysis. Methods Three-dimensional images were reconstructed from mandibular computed tomography of 260 children, adolescents and adults. The occlusal plane was determined as the average plane passing through the buccal cusps of mandibular molars, premolars, and canines, and through the incisor edge. The mandibular foramen was located three dimensionally in relation to the anterior edge of the ramus (or coronoid notch), the sagittal plane and the occlusal plane. Results All along mandibular growth, the three distances defining the relative position of the mandibular foramen showed negligible changes. The mandibular foramen is located from − 0.4 to 2.9 mm above the occlusal plane. The distance between the mandibular foramen and the leading edge of the mandibular ramus ranged from 17 to 19.5 mm. The angle between the ramus and the sagittal plane ranged from 3° to 5.4°. Conclusion In our sample, and using the occlusal plane and the anterior edge of the ramus as anatomical references, the location of the mandibular foramen was considered to be similar in all patients regardless of age.

Endometriosis is a frequent and chronic inflammatory disease with impacts on reproduction, health and quality of life. This disorder is highly estrogen-dependent and the purpose of hormonal treatments is to decrease the endogenous ovarian production of estrogens. High estrogen production is a consistently observed endocrine feature of endometriosis. mRNA and protein levels of estrogen receptors (ER) are different between a normal healthy endometrium and ectopic/eutopic endometrial lesions: endometriotic stromal cells express extraordinarily higher ERβ and significantly lower ERα levels compared with endometrial stromal cells. Aberrant epigenetic regulation such as DNA methylation in endometriotic cells is associated with the pathogenesis and development of endometriosis. Although there is a large body of data regarding ERs in endometriosis, our understanding of the roles of ERα and ERβ in the pathogenesis of endometriosis remains incomplete. The goal of this review is to provide an overview of the links between endometriosis, ERs and the recent advances of treatment strategies based on ERs modulation. We will also attempt to summarize the current understanding of the molecular and cellular mechanisms of action of ERs and how this could pave the way to new therapeutic strategies.

Estetrol (E4) is a natural estrogen synthesized exclusively during pregnancy by the human fetal liver, and the physiological role of this hormone is unknown. Interestingly, E4 was recently evaluated in preclinical and phase II-III clinical studies in combination with a progestin, with the advantage to not increase the circulating level of coagulation factors, at variance to oral estradiol or ethinylestradiol. Here, we evaluated the effect of E4 on hemostasis and thrombosis in mouse. Following chronic E4 treatment, mice exhibited a prolonged tail-bleeding time and were protected from arterial and also venous thrombosis in vivo. In addition, E4 treatment decreased ex vivo thrombus growth on collagen under arterial flow conditions. We recently showed that E4 activates uterine epithelial proliferation through nuclear estrogen receptor (ER) α. To analyze the impact of nuclear ERα actions on hemostasis and thrombosis, we generated hematopoietic chimera with bone marrow cells deficient for nuclear ERα. E4-induced protection against thromboembolism was significantly reduced in the absence of hematopoietic nuclear ERα activation, while the increased tail-bleeding time was not impacted by this deletion. In addition to its "liver friendly" profile described in women, our data shows that E4 has anti-thrombotic properties in various mouse models. Altogether, the natural fetal estrogen E4 could represent an attractive alternative to classic estrogens in oral contraception and treatment of menopause.

Previous studies indicated distinct differences in biting and chewing behaviors between children and adults. However, these studies used different methodologies and failed to study age-related changes in the fine motor control of biting from childhood to adulthood. Therefore, this study aimed to investigate age-related changes in oral fine motor control in healthy children in comparison to adults. Sixty-five healthy children (3–17 years) were equally divided into five age-groups based on their dental eruption stages. Each participant was asked to hold half a peanut rested on a force transducer between two opposing anterior teeth for 3–4 s before splitting it. The force applied on the transducer was continuously monitored and recorded during food holding and splitting. The data obtained from the children subgroups were compared to an adult group (18–35 years). Results showed that the force regulation during food manipulation was higher and more variable in children with primary to early-permanent dentition stages compared to adults. Additionally, children with primary and early-mixed dentition showed longer food splitting duration than adults and exhibited a predominantly step-wise ramp-increase of force. The results of the present study showed age-related changes in fine motor control of food biting maneuvers. The results of the study also suggested that younger children with primary dentition show signs of immature oral fine motor control. However, with an increase in age and the accompanying structural changes, the oral fine motor control eventually transits to a more matured “adult-like” biting maneuvers.

Women now live more than a third of their lives after the onset of menopause. The decline in endogenous estrogen production during this period is accompanied by functional disorders that affect quality of life. These symptoms may be relieved by menopausal hormone therapy (MHT) initially based on the administration of equine conjugated estrogens (mainly in the United States, oral route) or the natural estrogen, 17β-estradiol (in Europe, transdermal route). Estrogen receptor α (ERα), but not ERβ, mediates most of the physiological effects of estrogens. ERα belongs to the superfamily of nuclear receptors and regulates the transcription of genes via its activation functions AF1 and AF2. In addition to these classical genomic actions, estrogens can activate a subpopulation of ERα present at the cell membrane and thereby induce rapid signals. In this review, we will summarize the evolution of MHTs in last decades, as well as treatments that use various selective estrogen receptor modulators (SERMs). Next, we will describe recent advances in the understanding of the mechanisms of estrogen action, in particular the respective roles of nuclear and membrane ERα as well as the potential implications for future therapies.

International audience; Tooth inhalation remains a rare incident but it may occur during dental care, especially in children. We report here the case of a four-year-old boy with Down syndrome who came to the hospital after a dental trauma. During the extraction procedure, he aspired his maxillary incisor without presenting any signs of respiratory distress and was discharged by the surgical team, who thought that he had swallowed the tooth. Three weeks later, he was admitted to the emergency service because of a pulmonary infection. Two endoscopy interventions under general anesthesia were necessary to recover the foreign body inside the left lung. Because of the multiple symptoms associated with the trisomy 21 syndrome (general hypotonia, impaired immunity, etc.), practitioners should be very mindful of aspiration risks and complications during dental care. The systematic prescription of lung radiography would prevent the onset of pulmonary infections and enable an earlier intervention.

Objectives: A better understanding of the microstructure and mechanical properties of enamel and dentine may enable practitioners to apply the current adhesive dentistry protocols to clinical cases involving dentine disorders (dentinogenesis imperfecta or dentine dysplasia). Data/sources: Publications (up to June 2020) investigating the microstructure of dentine disorders were browsed in a systematic search using the PubMed/Medline, Embase and Cochrane Library electronic databases. Two authors independently selected the studies, extracted the data in accordance with the PRISMA statement, and assessed the risk of bias with the Critical Appraisal Checklist. A Mann-Whitney U test was computed to compare tissues damage related to the two dentine disorders of interest. Study selection: From an initial total of 642 studies, only 37 (n = 164 teeth) were included in the present analysis, among which 18 investigating enamel (n = 70 teeth), 15 the dentine-enamel junction (n = 62 teeth), and 35 dentine (n = 156 teeth). Dentine is damaged in cases of dentinogenesis imperfecta and osteogenesis imperfecta (p = 2.55E-21 and p = 3.99E-21, respectively). These studies highlight a reduction in mineral density, hardness, modulus of elasticity and abnormal microstructure in dentine disorders. The majority of studies report an altered dentine-enamel junction in dentinogenesis imperfecta and in osteogenesis imperfecta (p = 6.26E-09 and p = 0.001, respectively). Interestingly, enamel is also affected in cases of dentinogenesis imperfecta (p = 0.0013), unlike to osteogenesis imperfecta (p = 0.056). Conclusions: Taking into account all these observations, only a few clinical principles may be favoured in the case of adhesive cementation: (i) to preserve the residual enamel to enhance bonding, (ii) to sandblast the tooth surfaces to increase roughness, (iii) to choose a universal adhesive and reinforce enamel and dentine by means of infiltrant resins. As these recommendations are mostly based on in vitro studies, future in vivo studies should be conducted to confirm these hypotheses. Keywords: Bonding; Defect; Dentine; Dentine-enamel junction; Dentinogenesis imperfect; Dysplasia; Restorative.

Necrotizing ulcerative gingivitis, sometimes observed in young children, may lead to necrotizing stomatitis and noma. Therefore, its interception is a necessity and a challenge for the paediatric practitioners. First, this article aims to propose a systematic review of recent literature on the use of local antiseptic and antibiotic prescription in this particular periodontal condition. Then, a protocol is proposed to have a simple, costless and reproducible treatment on children.

Les femmes vivent désormais plus d’un tiers de leur vie après la survenue de la ménopause. Le déclin de la production d’œstrogènes endogènes au cours de cette période s’accompagne fréquemment de troubles fonctionnels qui affectent la qualité de vie. Ces symptômes peuvent être soulagés par un traitement hormonal (THM) initialement fondé sur l’administration d’œstrogènes conjugués équins (principalement aux États-Unis, par voie orale) ou d’un œstrogène naturel, le 17β-estradiol (en Europe, notamment par voie transdermique). Le récepteur des œstrogènes α (REα) relaye la majorité des effets physiologiques des œstrogènes. REα appartient à la superfamille des récepteurs nucléaires. Il régule la transcription de gènesviases fonctions activatrices (AF1 et AF2). Outre ces actions génomiques classiques, les œstrogènes peuvent aussi activer une sous-population de récepteurs REα présents à la membrane des cellules et ainsi induire des signaux rapides. Dans cette revue, nous résumerons l’évolution des THM depuis les débuts de la substitution hormonale jusqu’aux nouvelles molécules émergentes fondées sur une modulation sélective du REα. Nous décrirons également les progrès récents sur la compréhension des mécanismes d’action des œstrogènes, en détaillant les rôles respectifs des REα nucléaire et membranaire et les développements thérapeutiques possibles qui pourraient en découler.

Women now spend more than one-third of their lives in the postmenopausal years, and the decline of endogenous estrogen production during menopause is accompanied by a series of functional disorders that affect the quality of life. These symptoms could be alleviated or even totally suppressed by menopausal hormone therapy (MHT), initially based on natural estrogens extracted from the urine of pregnant mares (mainly in the USA, using the oral route) and later from the synthesis of the natural estrogen, 17β-estradiol (mainly in Europe, in particular using the transdermal route). Estrogen receptor (ER) α is the main receptor mediating the physiological effects of estrogens. ERα belongs to the nuclear receptor superfamily and activates gene transcription in a time and tissue-specific manner through two distinct activation functions (AF), AF1 and AF2. In addition to these classical genomic actions, ERα also mediates membrane initiated signaling enabling rapid actions of estrogen, potentially along or in interaction with other receptors. Here, we provide a brief historical overview of MHT, and we then highlight recent advances in the characterization of new treatments based on the association of estrogens with selective estrogen receptor modulators (SERMs) or on the modulation of nuclear or membrane ERα.

After a dental trauma, difficulties of communication and the consequences of the complex clinical situation often make regular chairside oral care long and complicated for special needs patients. The aim of this case report is to show how CAD/CAM technology may help in the prosthetic treatment of a clinical situation by keeping the number and duration of clinical sessions to a minimum while enabling a good aesthetic and functional result to be achieved in the long term.

International audience; A promising alternative to conventional hormone therapy for postmenopausal symptoms is treatment combining Bazedoxifene (BZA), a third-generation selective estrogen receptor modulator (SERM), and conjugated equine estrogen (CE). This combination is also known as a tissue-selective estrogen complex (TSEC). Understanding the tissue-specific actions of SERMs and the TSEC remains a major challenge to try to predict their clinical effects. The aim of this study was to compare acute versus chronic treatment with BZA, CE or CE + BZA in two major targets of estrogens, the uterus and the liver. In these two tissues, acute treatment with CE, but not with BZA, induced similar gene expression change than the most important endogenous estrogen, 17-β estradiol (E2). Acute induction of gene expression by E2 or by CE was antagonized by the addition of BZA. Concomitantly, BZA alone or in combination with E2 or CE induced a partial degradation of ERα protein after acute exposure. In uterus, chronic treatment of BZA alone had no impact on tissue weight gain or on epithelial cell proliferation, and also antagonized CE-effect in uterus, thereby mimicking the acute effect. By contrast, in the liver, chronic BZA and CE + BZA elicited agonistic transcriptional effects similar to those of CE alone. In addition, at variance to BZA acute effect, no change in ERα protein abundance was observed after chronic treatment in this tissue. These experimental in vivo data highlight a new aspect of the time-dependent tissue-specific action of BZA or TSEC, i.e. they can act acutely as antagonists but become agonists after chronic treatment. This shift was observed in liver tissue, but not in proliferative sex target such as the uterus.

Acute leukaemia is the most common type of childhood cancer, the acute lymphoblastic type accounting for the majority of cases. Children affected by leukaemia receive various forms of treatments including chemotherapeutic agents and stem cell transplants. Leukaemia and its treatment can directly or indirectly affect oral health and further dental treatments. The oral complications include mucositis, opportunistic infections, gingival inflammation and bleeding, xerostomia and carious lesions. An additional consideration in children is the impact of the treatments on the developing dentition and on orofacial growth. The aim of this review is to describe the oral complications in children with acute lymphoblastic leukaemia and the methods of prevention and management before, during and after the cancer treatment.

Objectives: The aim of this prospective study was to measure nasal and oral airflow during speech, before and after obturation. Patients and Methods: Included were children aged 3-18 years with nonsyndromic clefts and palatal fistulae. The corpus used was: syllable /pi/; a sentence containing stop consonants and a nasal phoneme; and the description of a picture of a scene. Analysis criteria were: percentage of nasality; value of average flow for the explosion; perceived nasality and intelligibility; and tolerance of the proposed device. Results: Only 5 children were included due to the observation of an increase in the percentage of nasality after obturation. The value of average flow for the explosion increased in all patients. A decrease in perceived nasality was noted in all but 1 patient. An improvement in intelligibility was observed in 3 out of the 5 children. The tolerance of the device was good. Conclusion: While the small number of patients studied does not permit firm conclusions concerning the efficiency of the obturation, the method described, as well as the introduction of ‘speed of explosion' of stop consonants, offer new perspectives to prospectively study obturator effects on speech.

Objective: The aim of this study was to evaluate the attitude of parents towards the oral health of their children before oral rehabilitation under general anesthesia (GA).Study design: Children receiving dental treatment under GA between November 2013 and July 2014 in the Pediatric Dentistry Department (University Hospital Center, Toulouse, France) were enrolled in an oral health preventive program. An anonymous questionnaire was self-administered by the parents during the pre-operative session. Results: The sample comprised 67 children with a mean age of 4.8 years. 48 % of the parents had difficulties in maintaining the oral hygiene of their child. Two thirds of them reported a lack of cooperation. An adult cleaned the child's teeth in 43% of the cases. 14% of the study population brushed their teeth twice a day or more. In addition, half of the parents reported that they modified food consumption or teeth cleaning habits of their children since the initial consultation. Conclusions: This study suggests a low compliance of parents and children with the recommendations on oral hygiene and food consumption given at the initial visit and demonstrates the feasibility of a preventive program in this population.

Arsenic oxide compounds were traditionally used as devitalizing agents. Due to its toxicity, leakage of such compounds into the periodontium can cause gingival and osteo-necrosis. Their use is forbidden in Europe and the USA for decades, however, some dentists seem to still use it. We report the case of a 14-year-old girl referred to the paediatric dentistry department of Toulouse University hospital, France, presenting a bone necrosis following the use of an arsenic trioxide product to accelerate pulp necrosis. The treatment included surgical removal of necrosis bone sequestrum, complete pulpectomy and an intermediate restoration of the tooth 27. After 1 week, the clinical conditions greatly improved. A restoration using a ceramic crown was performed after 2 months, and complete healing was observed after 1 year follow-up. Although arsenic trioxide is neither appropriate nor permitted for use in modern dentistry, especially in paediatric dentistry, some rare cases of arsenic-induced osteo-necrosis can still be encountered. A clearer message must be given to all dental practitioners against the use of arsenic trioxide in modern endodontic treatment.

Morphological study of fiber post/bonding system/root dentin interface by evaluation of two bonding systems.The aim of the study was to analyze the interfaces, and thus the seal, between root dentin and bonded fiber-reinforced posts. The interfaces were obtained by applying two enamel-dentin adhesive systems, a one-bottle system used after application of phosphoric acid and a self-etch system, both used with an adhesive cement. The interface was evaluated by SEM observation of the continuity of the hybrid layer and the morphology of the resin tags, in terms of length, density and presence of side branches, at the interface between the fiber-reinforced post, the bonding system and the root dentin.Twenty-six anterior single-rooted teeth extracted for periodontal reasons were treated endodontically and then randomly separated into two groups of 13 teeth each: group 1: Excite DSC (Ivoclar Vivadent, Liechtenstein); group 2: AdheSE DC (Ivoclar Vivadent, Schaan, Liechtenstein). After preparation of the root canal and application of the adhesive, each specimen received a Postec translucent FRC post (Ivoclar Vivadent, Schaan, Liechtenstein) that was cemented in with Variolink II dual-curing luting composite (Ivoclar Vivadent, Schaan, Liechtenstein). The specimens were then prepared for SEM observation of the continuity of the hybrid layer and scoring of the morphology of the resin tags in each third of the root (at 1, 4.5 and 8mm from the coronal surface).There was no significant difference (at p0.05) between the two groups in terms of continuity of the hybrid layer or morphology of the resin tags. The hybrid layer was present, unbroken and uniform in both the group where adhesive was used with a phosphoric acid total etch and the self-etch system group. Whatever the bonding system, the resin tags had side branches, and greater length and density in the cervical third than in the middle or apical thirds. Bubbles were found in the cement layer in most of the specimens.The one-bottle and self-etch bonding systems gave similar results in terms of interface morphology when a translucent fiber-reinforced post was cemented into the endodontically prepared roots.

International audience; Les divisions labio-alvéolaires et vélo-palatines constituent des dysmorphoses congénitales dont la prise en charge s'étend communément de la naissance à la fin de l'adolescence. Des patients adultes sont également concernés par une prise en charge prothétique, notamment en cas d'échecs ou d'insuffisances chirurgicales. Chez le nourrisson, différents dispositifs sont décrits : plaques palatines fixes ou amovibles, actives ou passives ; chez l'adulte, en cas de fentes vélaires séquellaires, peuvent être réalisés des obturateurs vélaires solidaires d'une plaque palatine en résine ou d'un châssis métallique de prothèse partielle amovible. Les auteurs se proposent, après la présentation de classifications récentes incluant une démarche thérapeutique, de revenir sur les principaux dispositifs orthopédiques et prothétiques du nourrisson à l'adulte, tous porteurs de fentes labio-alvéolaires et/ou vélo-palatines congénitales.