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Introduction : Les lignes esthétiques sont des paramètres céphalométriques de référence proposées dans les années 60 et connues de tous les orthodontistes. Les plus utilisées sont celles de Ricketts, Steiner et Burstone. Elles formalisent de façon simple l’évaluation du profil labial cutané dans le sens sagittal et déterminent le diagnostic de prochélie, normochélie ou rétrochélie. Cependant, nous pouvons nous interroger sur la pertinence de ces références. L’objectif de cette étude observationnelle transversale est d’évaluer leur légitimité afin de guider le plan de traitement orthodontique et l’indication de repositionnement dentaire selon l’âge du patient. Matériel et méthode : L’échantillon est composé de 96 patients sans limite d’âge dont les téléradiographies sont sélectionnées par stratification aléatoire. Les trois critères de jugement principaux sont les lignes E de Ricketts, S de Steiner et B de Burstone. Les mesures sont effectuées par un seul opérateur via le logiciel IMAGEJ. Résultat : D’après l’analyse de Spearman, plus le sujet est âgé, plus la rétrochélie augmente. Ceci avec une forte fiabilité pour les critères de Ricketts (rho>0,6) et Steiner (rho>0,6). De plus, l’âge pivot à 25 ans est vérifié par le test de Wilcoxon-Mann-Whitney (p < 0,05). Conclusion : L’utilisation des lignes esthétiques E, S et B comme argument d’un repositionnement dentaire chez l’adolescent et l’adulte jeune est injustifiée, de par l’absence de prise en compte du recul labial physiologique avec l’âge.

Introduction In the last decades, health professions have progressively moved towards person-centredness. Dentistry, however, lags behind the other health professions and remains deeply anchored in a biomedical vision.Aims Our objective was thus to better understand how dentists perceived person-centred care (PCC) and identify the challenges they may face in implementing it.Methods We conducted qualitative descriptive research in the province of Quebec, Canada; it was based on in-depth interviews with 11 general dental practitioners working in private clinics.Results Thematic analyses reveal that dentists had little interest in understanding the life and stories of their patients. Furthermore, their openness to share decision-making was limited to procedures that they considered of relatively low value and less for procedures they considered of higher value, such as indirect restorations.Discussion We argue that dentists' reluctance to understanding and shared decision-making is rooted in the old-established identity of dentistry as an art. Dentists indeed considered the dental craft as sacred - an art form with unbreakable axioms that defined quality of care.Conclusion It is time for the dental profession to reflect on its ideological foundations and reconsider its identity. This reflection is crucial to respond to the needs of a changing society that is losing its confidence in the profession.

Background: The cone-beam computed tomography (CBCT) technology has continuously evolved since its appearance in oral medicine in the early 2000s. Objective: To present recent advances in CBCT in oral medicine: i) selection of recent and consensual evidence-based sources, ii) structured summary of the information based on an iterative framework and iii) compliance with ethical, public health and patient-centered concerns. Main Findings: We will focus on technological advances, such as sensors and reconstruction algorithms used to improve the constant quality of the image and dosimetry. CBCT examination is now performed in almost all disciplines of oral medicine: currently, the main clinical disciplines that use CBCT acquisitions are endodontics and oral surgery, with clearly defined indications. Periodontology and ear, nose and throat medicine are more recent fields of application. For a given application and indication, the smallest possible field of view must be used. One of the major challenges in contemporary healthcare is ensuring that technological developments do not take precedence over admitted standards of care. The entire volume should be reviewed in full, with a systematic approach. All findings are noted in the patient’s record and explained to the patient, including incidental findings. This presupposes the person reviewing the images is sufficiently trained to interpret such images, inform the patient and organize the clinical pathway, with referrals to other medical or oral medicine specialties as needed. Conclusion: A close collaboration between dentists, medical physicists, radiologists, radiographers and engineers is critical for all aspects of CBCT technology.

Background To reduce the risk of infection after orthopedic surgery, patients are asked to undergo preoperative assessments in various medical domains. However, to our knowledge, there has been no systematic review to evaluate the performance of a preoperative dental assessment before orthopedic surgery. We focus on two questions as follows: (1) is there a link between the presence of preoperative dental assessment and orthopedic infections?; (2) is the probability of an orthopedic infection increased in the presence of dental risk factors and comorbidities? Patients and methods Databases including PubMed, the Cochrane Library databases and Google Scholar were searched for English-language articles until November 2018. The inclusion criteria were descriptions of infections of joint prostheses and dental infections, and potential dental origins of pathogenic infections. Studies dealing with oral assessments performed before orthopedic surgery were included. Results Based on eligibility criteria, 12 case series, 4 case-control studies and 12 cohort studies were included. In case-controls, prosthesis infection was presumably associated with a dental abscess in 6/224 of cases (2.9%). In cohort studies, exposure was defined as “any dental assessment or dental treatment performed before surgery”. Even if only 4 cohort studies provide this information exposure, it would seem that the presence of an infectious complication is less frequent if the preoperative examination has been performed. Dental treatment given before surgery was mainly for scaling–polishing in 78/205 (38%), extraction in 49/205 of cases (24%) and restorative work in 37/205 (18%). Discussion The literature review was made complex by the substantial heterogeneity among included studies. Although there is no formal evidence for or against preoperative dental assessment, it is advisable to perform this with the aim of maintaining favorable oral hygiene and thus reduce the risk factors. Level of evidence Level III, systematic review.

Background: Tobacco and alcohol are the main risk factors for oral squamous cell carcinoma, the low survival rate of which is a public health problem. European-wide health policies (prevention campaign, tobacco packaging) have been put in place to inform the population of the risks associated with their consumption. Due to the increase in smoking among women and changes in sexual practices, the incidence of this disease is still too high. The identification of data from internet research on the population could make it possible to measure the impact and better orient these preventive measures.The objective was to analyse the data on interest shown in oral cancers from several online databases, and to cross-reference them with the data on the introduction of European public health programs.Methods: A search of data from Google ©, Wikipedia © and Twitter © users in 28 European countries relating to oral cancer between 2004 and 2019 was carried out. Bibliometric analysis of press and scientific articles over the same period was also analysed. The association between these data and the introduction of public health programs in Europe has been studied.Results: Changes in tobacco packaging correlated with a significant increase in internet research on oral cancer in 7 countries. Unlike national policies and campaigns, the European awareness program Make Sense has had no influence on internet research. There was an asymmetric correlation in internet searches between publications on oral cancer from scientific articles or "traditional" media (weak association) and those from internet media such as Twitter © or Wikipedia © (strong association).Conclusion: Our work highlights 7 areas of work around which oral cancer awareness in Europe could be refocused.

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AIMS We aimed to explore the scientific literature on accessible dental clinics for wheelchair users. More specifically, we sought out literature addressing how the human environment and physical space shape the dental services of accessible dental clinics. METHODS We conducted a scoping review (May 2019) in Embase, PubMed, Web of Science, and the Avery index of architectural Periodicals (3994 articles). We followed Arksey and O'Malley's recommended procedures; after screening, we retained 17 articles. We performed a critical appraisal, followed by thematic content analyses of extracted data. RESULTS The articles originated mainly from the United States and United Kingdom. Only three reported original research. We illustrated the results within a three-step dental care pathway cycle. In each step, the interaction between accessibility of the physical and human environments (ie, the layout/design of the clinic and the attitudes and skills of the dental professional, respectively) contributed to the overall accessibility. We also found that empirical evidence on clinics' accessibility was lacking: many articles resorted to broad "one size fits all" recommendations and fragmented information on accessibility. Finally, the voice of wheelchair users was missing. CONCLUSION There are knowledge gaps in terms of dental clinics' accessibility. We thus invite researchers to conduct original studies with dental professionals, wheelchair users, and their caregivers.

BACKGROUND Delivering dental care to patients in their home or residential institutions is known as "portable dentistry". The demand for portable dental services is on the rise, but dentists remain reluctant to adopt portable practices. OBJECTIVES To explore the literature on portable dental services and understand (a) the process of planning and delivering portable dental services and (b) the benefits and challenges of portable dentistry for service providers and patients. METHODS A systematic scoping search was conducted. We retrieved 3994 documents, 28 of which were included in the final synthesis. Three authors read the papers and conducted thematic content analyses independently. RESULTS We present a synthesis of the literature and proposed a model of portable dentistry containing three levels with the patient is at the centre surrounded by concentric rings representing the dentist (dental team) and society. At each of these levels, our model is further subdivided into three components: 1) organisation of the service; 2) arrival and set-up of the service; and 3) delivery of the service. In addition, each level includes 1) human factors, which are related either to the dental professional or the patient; 2) non-human factors, which refer to either the equipment or the physical environment; and 3) financial factors, which are related to cost and remuneration. CONCLUSIONS We propose a model for portable dentistry that dentists and dental educators interested in this practice should find useful.

Objectives The aims of the Oral Status And Rheumatoid Arthritis (OSARA) cross-sectional study were to study the oral health-related quality of life and to assess the associated factors in a population of outpatients with rheumatoid arthritis in France. Methods The data were collected by five trained and standardised dentists who asked each subject the questions of a socio-demographic, behavioural and medical questionnaire, which was completed with the medical records, and performed the dental examination. Each subject filled out two self-assessment questionnaires: the Health Assessment Questionnaire and the General Oral Health Assessment Index. Results Seventy-three subjects were included. The mean age of the participants was 60.2 ± 11.9 years and 75.3% were women. For 58.3% of the subjects, their self-perceived oral health-related quality of life was described as poor. The logistic regression analysis found that a small number of teeth and marked difficulties in dressing and grooming were associated with bad oral health-related quality of life [ORa = 10.5 (1.96–56.19) and ORa = 4.3 (1.15–15.77), respectively]. Conclusions More care should be given to the prevention of dental diseases in order to improve the oral health-related quality of life of patients with rheumatoid arthritis and their self-esteem, which will already be heavily affected.

BACKGROUND Background: Tobacco and alcohol are the main risk factors for oral cancers, whose low survival rate is a public health problem. Health policies on a European scale (prevention campaign, modification of tobacco packaging) have therefore been launched to prevent and dissuade the population from the consequences of their consumption. Due to the increase in smoking among women and changes in sexual practices, the incidence of this disease is still too high. The evaluation of the research data of the population on the internet could make it possible to measure the impact and better guide these preventive measures. OBJECTIVE Objective: The objective of our study was to analyse the data on interest shown in oral cancers from several online databases, and to cross check that with the data on the introduction of public healthcare programmes in the EU. METHODS Methods: Search data collected from Google©, Wikipedia© and Twitter© users relating to oral cancers in the 28 countries of the EU between January 1st, 2004 and September 30th, 2018. Data on articles published in the press and the bibliometric analysis of scientific articles during the same period was analysed. The link between these results and the introduction of public health programmes in the EU over the same period was studied. RESULTS Results: Shock images and health warnings on cigarette packets have led to a significant increase in interest shown in oral cancers on the internet in 7 countries. The European Make Sense Campaign did not have any influence on internet searches, in contrast to campaigns on a national level. There was an asymmetry in the interest shown in oral cancers on the internet between those seeking to raise awareness (press, scientific community) and the general population (Wikipedia©, Twitter©) which was more likely to follow the news than look for precise medical information. CONCLUSIONS Conclusion: Our work highlights 7 areas of work around which oral cancer awareness in Europe should be refocused. INTERNATIONAL REGISTERED REPORT RR2-17243

There is a dearth of tools designed to inform people about what to expect from person-centred dental encounters and to guide them during the care process. This is why we propose the Montreal-Toulouse Wheel of patients' expectations for dental visits, which describes what people could expect during person-centred clinical encounters. The Wheel comprises four core expectations: 1) be understood; 2) be respected; 3) have power; and 4) be given enough time. It also includes three expectations that are more specific to the process of care: 5) be informed and understand; 6) share decisions with the dentist and even co-construct the treatment plan; and 7) be comfortable during clinical procedures and the whole care process. We also propose a Q-List to help patients reflect on their relationship with dental professionals and engage them in person-centred dental care. This Q-List describes the seven expectations of the Wheel and provides open-ended questions that we invite patients to reflect upon. We also hope that dental professionals and educators will find the Wheel and the Q-List useful to develop person-centredness and promote inclusive and equitable dentistry.

Objectives For more than twenty years, dental practice-based research networks (D-PBRN) have helped to structure clinical research in private practice. They bring together practitioners working in several structures and may include a greater number of subjects. The aims of this study were thus to systematically explore the scientific production from dental private practices in general and to map and describe the D-PBRN activity worldwide. Data sources Two research procedures were carried out in parallel. The first was conducted as a scoping review to examine peer-reviewed literature indexed in the PubMed database and the second was performed on the World Wide Web to identify the main characteristics of the networks (location, scientific production…). Study selection 368 publications were identified among which 202 were published by PBRN members and the others by private practitioners not affiliated to any network. 210 (57 % of the included articles) were produced in the USA. A higher number of diverse centers are involved in each study when it is conducted by a PBRN (59.06 ± 66.59 vs. 13.51 ± 31.58 for networks and independent teams, respectively; p Conclusions Although dental practice-based research has grown over the years, the number of D-PBRN worldwide remains low. Even if it requires some investment to produce research in dental offices, this type of networks helps to fill the gap between private practice and research and to improve knowledge on oral health. Relevance The mapping of all the dental PBRN together with the research topics studied throughout the world make the relevance of this article. The ways to improve practice-based research in dentistry are also discussed in the paper.

The biomedical model has been severely criticised in the last decades and its dominance challenged. This is why the concept of person-centred dentistry has penetrated the professional discourse and become a growing concern for our profession. Furthermore, dentists have been urged to take patients' environment more into account and to tackle the social determinants of their health, illness and access to care. Unfortunately, dentists still poorly comprehend person-centredness and social dentistry, and face difficulties to implement biopsychosocial approaches. To respond to these issues, we propose the Montreal-Toulouse Biopsychosocial Model for dentistry, which encompasses patient-centredness and social dentistry. Our model presents three types of tasks (understanding, decision-making and intervening) that dentists should take in each of three overlapping levels (individual, community and society). We also propose a 'Q-List', an original tool designed to help dental professionals adopting this model and reflecting upon their actions. This Q-List includes key questions to elicit dentists' reflexiveness and to support their biopsychosocial practice of dentistry. We invite dental professionals to adopt biopsychosocial approaches and use the Montreal-Toulouse Model as a guide. We also encourage them to use our Q-List and adapt it to their context of practice.

Resume Objectifs Evaluer l’effet du traitement parodontal sur les parametres cliniques et biochimiques de la polyarthrite rhumatoide (PR) et la qualite de vie chez des patients atteints d’une PR moderement active et d’une parodontite. Methodes Dans cet essai ouvert, randomise et controle, des sujets atteints de PR (n = 22) ont ete affectes a un traitement parodontal « immediat » ou « differe » (detartrage et debridement radiculaire non chirurgical complet, antibiotherapie par voie systemique et instructions d’hygiene orale). Le critere de jugement principal a ete le changement du DAS28 (avec vitesse de sedimentation) a 3 mois. La qualite de vie generale et la qualite de vie relative a la sante bucco-dentaire ont ete evaluees. Resultats La sante parodontale s’est considerablement amelioree apres le traitement parodontal (surface enflammee de la gencive, p = 0,03). Le traitement parodontal n’a entraine ni evenement indesirable ni amelioration de DAS28 (difference moyenne ajustee avec un intervalle de confiance a 95 % de −0,03[−0,98 ; 0,92]). Aucune amelioration de la qualite de vie generale n’a ete constatee apres le traitement parodontal ni aucun effet significatif sur la qualite de vie bucco-dentaire, malgre une tendance positive dans le domaine « impacts psychologiques » (0,13[− 0,07 ; 0,33], p = 0,20). Conclusions Bien qu’aucun effet du traitement parodontal sur les parametres de la PR n’ait ete identifie, cet essai fournit des donnees importantes pour recommander les soins parodontaux chez les patients atteints de PR. Le traitement parodontal est sur et reduit l’inflammation orale avec un effet possible sur la qualite de vie bucco-dentaire. Comme la parodontite et la PR sont des maladies chroniques complexes et multifactorielles, il est probable que les approches centrees sur le patient impliquant a la fois les professionnels de la sante bucco-dentaire et les rhumatologues contribueront a optimiser les soins aux patients.

Additional file 1.

BackgroundAs far as we know, little data, whether obtained from self-administered questionnaires or upon dental clinical examination, has been published on the prevalence of sensitive teeth (ST) in the French adult population. The objectives of the present work were to estimate ST prevalence and characteristics in the general population of France and to explore the associated factors.MethodA multicentre cross-sectional study was conducted between November 2011 and March 2013 in six French cities. Adult passers-by in public places were invited to answer an electronic questionnaire on a tablet computer. Only people who declared having at least one natural tooth were included in the study. A logistic regression model was used for the multivariate analysis.ResultsThe prevalence of ST during the previous 12 months reported by the sample of 2413 participants was 42.2% [95% CI: 40.2–44.1%]. The final logistic regression model showed significant statistical associations between ST and female gender, use of tobacco, consumption of soft drinks, limited access to oral care and poor oral hygiene habits (p ConclusionsThis study provides prevalence data on ST in a general population in France, which seems to remain high despite the existence of many therapies. It should alert professionals to a clinical manifestation that is becoming increasingly prevalent and that they will have to take into consideration to help reduce the discomfort arising from it.

Resume L’enseignement de la sante publique regroupe diverses disciplines en lien intelligent, tournees vers une approche populationnelle et une conscientisation de la « vie non technique » d’un cabinet dentaire et de la pratique de la chirurgie dentaire en general. Aussi, la prevention, l’economie de la sante, l’epidemiologie, l’ethique, l’odontologie legale, l’ergonomie ou encore l’hygiene et l’asepsie sont enseignees. Discipline jeune, dont la sous-section universitaire est nee en 1986, l’enseignement de la sante publique apparait primordial aux futurs chirurgiens-dentistes pour comprendre les mutations de la profession, s’en emparer et s’y adapter. De plus en plus, un besoin en specialistes de Sante Publique Orale et Odontologie Sociale se fait entendre pour preserver la sante orale de la population dans un cadre professionnel juste et structure. Ce sont tous les enjeux de la creation d’un DES (diplome d’etudes specialisees) pour preciser les missions de specialistes en sante publique orale et odontologie sociale, qui seront de structurer des observatoires de la sante orale, d’amener une expertise methodologique dans la recherche, de gerer le traitement et l’analyse de donnees fiables, de developper des strategies sanitaires territoriales, de consolider l’enseignement de la sante publique et de la sensibilisation au questionnement ethique, et de promouvoir la medecine dentaire sociale. Ce faisant, cette specialite fait entrer la discipline dans son âge adulte.

The aim of this national survey was to record the use of nitrous oxide and the perceptions of French dental practitioners to this form of sedation. The use of nitrous oxide sedation (NOS) has been authorised in private dental practice in France since December 2009 but, to date, no study implementing both quantitative and qualitative methods has explored such use. The data were collected using a Google Forms questionnaire. A mixed methodology was used for data analysis: a quantitative approach to explore the use of conscious sedation and a qualitative thematic approach (using Nvivo software) to determine the practitioner’s perception of it. Responses were collected from 225 practitioners (19% of the target population of 1185). Most of the responders were trained in NOS use in private dental clinics. Seventy-three percent of those who trained privately actually used NOS, compared to 53% of those trained at university (p-value = 0.0052). Above all, NOS was used for children requiring restorative dentistry. The average price of the sedation was 50 Euros and it lasted, on average, for 37 min. The qualitative and thematic analysis revealed the financial and technical difficulties of implementing NOS in private practice. However, it also showed the benefits and pleasure associated with NOS use. This statistical survey of French dental practitioners offers an insight of the current state of the use of conscious sedation with nitrous oxide in private general dental practice in France. It also includes the first report of dental practitioners’ perceptions of NOS use and may lead to a better understanding of the reasons why sedation is sometimes not used in private practice.

Contexte : L’evaluation clinique des etudiants en chirurgie-dentaire est traditionnellement basee sur des criteres quantitatifs, correspondant a un nombre minimum d’actes specifiques a realiser. Ce type de methode est remis en question, en raison de l’environnement comptable qu’il induit aupres des etudiants, et de la deshumanisation de la relation de soins qui s’ensuit. But : Ce travail a pour objectif d’evaluer l’impact de la mise en place d’une evaluation alternative, de type « patient-traite », pour laquelle l’objet de l’evaluation est le patient et non plus seulement l’acte technique. Methodes : Il s’agit d’une etude unicentrique de type qualitatif, conduite a partir d’entretiens semi-diriges aupres d’etudiants en derniere annee d’etude de chirurgie dentaire, a la faculte de Toulouse durant l’annee 2015–2016. Les donnees sont recueillies jusqu’a saturation des themes et analysees selon la methode de l’analyse thematique. Resultats : Cette etude montre que l’evaluation quantitative est globalement acceptee par les etudiants et repond a certaines attentes sur le nombre d’actes realises. Elle confirme egalement les effets indesirables d’une evaluation clinique quantitative, comme les abandons de patients ou les modifications de plan de traitement. L’evaluation par patient-traite est percue comme plus humaine, moins stressante et plus efficace. Conclusion : Des methodes d’evaluation clinique nouvelles, mettant au centre du dispositif les etudiants et les patients, doivent etre developpees pour favoriser l’emergence de competences en phase avec les evolutions societales.

Objectives In-vitro experiments on ormocers (ORganically MOdified CERamics) have provided controversial results. Consequently, the objectives of this meta-analysis were to (1) compare clinical performances of first generation ormocers versus conventional composite restorations, (2) explore the influence of various clinical factors and the impact of the quality of studies on published results. Methods The following databases were explored until 2017/01/08: Ovid MEDLINE In-Process, Pubmed, CENTRAL, HTA, DARE, LILACS and Google Scholar. Studies of more than two years with quantitative comparisons between ormocers and control groups were selected. Outcome was the failure of a restoration (need to repair, remove or replace). Multivariate random-effects Poisson’s regression was used to obtain a summary estimate. Results 75% of the 8 included trials concerned Class I/II restorations. Although non-significant, the global failures were higher for ormocers (0.22 [−0.16; 0.61]). For Class I/II restorations, a significantly higher sensitivity was observed for ormocer-based materials compared to other composites (0.75 [0.01; 1.50]). An increase of the number of restorations per patient was associated with higher marginal adaptation failures for ormocers in Class I/II obturations (0.59 [0.11; 1.08]). Significance This study did not identify clear advantages of using the first generation of ormocer-based fillings rather than conventional composites. Given the recent development of new, dimethacrylate-diluent-free ormocer matrices, potentially more stable and resistant, new randomized clinical trials should be developed comparing this new family of pure ormocers with current composites.

BACKGROUND Tobacco and alcohol are the main risk factors for oral cancers, whose low survival rate is a public health problem. Health policies on a European scale (prevention campaign, modification of tobacco packaging) have therefore been launched to prevent and dissuade the population from the consequences of their consumption. Due to the increase in smoking among women and changes in sexual practices, the incidence of this disease is still too high. The evaluation of the research data of the population on the internet could make it possible to measure the impact and better guide these preventive measures. OBJECTIVE The objective of our study was to analyse the data on interest shown in oral cancers from several online databases, and to cross check that with the data on the introduction of public healthcare programmes in the EU. METHODS Search data collected from Google©, Wikipedia© and Twitter© users relating to oral cancers in the 28 countries of the EU between January 1st, 2004 and September 30th, 2018. Data on articles published in the press and the bibliometric analysis of scientific articles during the same period was analysed. The link between these results and the introduction of public health programmes in the EU over the same period was studied. RESULTS Shock images and health warnings on cigarette packets have led to a significant increase in interest shown in oral cancers on the internet in 7 countries. The European Make Sense Campaign did not have any influence on internet searches, in contrast to campaigns on a national level. There was an asymmetry in the interest shown in oral cancers on the internet between those seeking to raise awareness (press, scientific community) and the general population (Wikipedia©, Twitter©) which was more likely to follow the news than look for precise medical information. CONCLUSIONS Our work highlights 7 areas of work around which oral cancer awareness in Europe should be refocused.

Resume Contexte Afin de reduire le risque d’infection apres une chirurgie orthopedique, les patients doivent effectuer differents bilans medicaux preoperatoires. Cependant, a notre connaissance, il n’existe aucune revue systematique de la litterature pour evaluer l’efficacite du bilan buccodentaire avant une chirurgie orthopedique. Nos problematiques sont les suivantes : (1) y a-t-il un lien entre la presence d’un bilan dentaire preoperatoire et les infections orthopediques ; (2) la presence de facteurs de risques et comorbidites augmente-elle la probabilite de survenue d’une infection orthopedique ? Materiels et methodes Les recherches ont ete effectuees sur les bases de donnees de PubMed, Cochrane Library databases et Google Scholar sur des articles en anglais jusqu’en novembre 2018. Les criteres d’inclusion sont la description d’une infection orthopedique et d’une infection dentaire, ainsi qu’une potentielle origine dentaire des agents infectieux. Les etudes traitant d’une evaluation dentaire effectuee avant la chirurgie sont inclues. Resultats Basees sur nos criteres d’eligibilites, 12 series de cas, 4 etudes cas temoins et 12 etudes de cohortes ont ete inclues. Pour les cas temoins, les infections de protheses articulaires sont supposees associees a des abces dentaires dans 6/224 cas (2,9 %). Dans les etudes de cohortes, l’exposition est definie comme « tout bilan ou traitement dentaire effectue avant la chirurgie ». Meme si seulement 4 etudes de cohortes fournissent cette information, il semble que la presence d’une complication infectieuse soit moins frequente si l’examen dentaire preoperatoire est effectue. Les traitements dentaires realises avant la chirurgie sont principalement des detartrages – surfacages pour 78/205 cas (38 %), des avulsions pour 49/205 cas (24 %) et des soins conservateurs pour 37/205 cas (18 %). Discussion L’heterogeneite des etudes inclues dans cette revue de la litterature ne permet pas de conclure sur la necessite de ce bilan. Bien qu’il n’y ait aucune preuve scientifique pour ou contre le bilan dentaire preoperatoire avant chirurgie orthopedique, il est conseille d’effectuer ce bilan afin de maintenir une hygiene dentaire favorable et reduire les facteurs de risque. Niveau de preuve III, revue systematique.

Knowledge Transfer Statement: We are calling researchers, educators, and dental professionals to be at the forefront of actions addressing social determinants of health. We indeed argue that 1) it is the dentists’ and other oral health care professionals’ role to tackle social determinants of health and 2) as researchers and educators, we need to help clinicians in this endeavor and lead the development of a “social dentistry” movement.

This is the open peer reviewers comments and recommendations regarding the submitted GigaScience article and/or dataset.

Methods for analysing dental caries and associated risk indicators have evolved considerably in recent decades. The use of zero-inflated or hurdle models is increasing so as to take account of the decayed, missing, and filled teeth (DMFT) distribution, which is positively skewed and has a high proportion of zero scores. However, there is a need to develop new statistical models that involve pragmatic biological considerations on dental caries in epidemiological surveys. In this paper, we show that the zero-inflated and the hurdle models can both be expressed as a compound sum. Using the same compound sum, we then present the generalized negative binomial (GNB) distribution for dental caries count data, and provide a numerical application using the data of the EPIPAP study. The GNB model generates the best score functions while handling the lifetime dental caries disease process better. In conclusion, the GNB model suits the nature of some count data, in particular when structural zeros are unlikely to occur and when several latent spells can lead to new countable events. For these reasons, the use of the GNB distribution appears to be relevant for the modelling of dental caries count data.

Person-centered or patient-centered care (PCC) focuses on the individual’s needs and concerns. Although PCC is widely acknowledged as a core value of modern medicine, there has been a lack of research on how dental curricula could engage future dentists in PCC approaches. The aim of this study was to assess the impact of a PCC course on empathy in dental students. A controlled study was conducted with fourth-year dental students in four dental faculties in France in 2014–15. The test group (n=63) received 20 hours of PCC training including arts-based approaches, narrative dentistry activities, and workshops on communication based on the Calgary-Cambridge guide. There was no change in the curriculum of the control group (n=217). Pretest and posttest measures with the Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) were compared for the two groups. The comparisons showed no significant differences on the TEQ or JSPE (p=0.25 and p=0.08, respectively). However, there was a higher proportion of students with more than an eight-point decrease in TEQ values in the control group (p=0.02). The stabilization of empathic ability in the test group may have counteracted the tendency for natural erosion of empathy among students during their clinical activities. These results suggest that PCC training constitutes a promising approach to developing dental students’ empathic ability, but there is a need to assess the effects of such training over longer periods.

We aim to provide an innovative, comprehensive way of mapping the profusion of stem cell-based clinical trials registered at ClinicalTrials.gov to explore the diversity of the fields of application and the temporal complexity of the domain. We used a chord diagram and phylogenetic-like tree visualizations to assist in data mining and knowledge discovery. The search strategy used the following terms: “stromal OR stem OR mesenchymal OR progenitor.” The Medical Subject Headings (MeSH) thesaurus was used to more finely classify diseases treated by stem cells, from large fields of application to specific diseases. Of the 5,788 trials screened, 939 were included, 51.1% of which were related to mesenchymal stem cells (MSCs). No real specificity emerged as to the therapeutic uses of the different types of stem cells. More than half the MSC studies concerned allogeneic MSCs and received more support from industry than autologous MSC studies (p < .001). Over time, the uses of cultured cells have increased greatly, particularly since 2009. Cells derived from adipose tissue are also increasingly used in trials compared with bone marrow cells. The use of adipose-derived stromal cells was predominantly autologous (p < .001), restricted to European countries (p < .01), and supported by industry (p = .02) compared with other MSCs. Details about MeSH keywords are available at http://multireview.perso.sfr.fr/. In conclusion, mapping may reveal a lack of global strategy despite the regulations and the related costs associated with good manufacturing practices. A systematic approach to preclinical data, intended to objectively and robustly reveal the most appropriate fields with the most efficient cells, is needed. Repeated exchanges between the bench and the bedside are necessary. Significance Except for a few trials concerning specific tissue stem cells used in their corresponding tissues, this global analysis revealed no real specificity of stem cell uses (including mesenchymal stromal cells). This raised the question of the physiopathological rationale for these uses and the lack of a global strategy despite the regulations and the related costs associated with good manufacturing practices. This original method, leading to the development of new concepts from already available data, would help policymakers to optimize resources and investments in terms of public health priorities. Such an approach should draw parallels between in vitro, in vivo, and human data. Exchanges in both directions between preclinical and clinical research could optimize the parameters of clinical trials step by step.

Resume Les questions relatives a la religiosite et a la spiritualite dans le champ de l’odontologie commencent a etre pleinement considerees. Cet article propose de dresser un panorama de l’etat des connaissances sur les liens entre odontologie et spiritualite/religiosite. Une premiere partie porte sur le patient, avec une description des effets potentiels de la spiritualite/religiosite sur la sante bucco-dentaire : rites et preceptes impactant directement la sante bucco-dentaire, evocation des « dentisteries alternatives » et role du tissu social religieux dans l’acces aux soins bucco-dentaires. Une deuxieme partie traite du chirurgien-dentiste, avec une discussion sur les possibles effets de la religiosite/spiritualite sur sa qualite de vie, et l’existence de reseaux dentaires religieux a visee professionnelle. Enfin, une troisieme partie, axee sur la relation de soins, presente le concept de « competence religieuse » permettant au chirurgien-dentiste d’adapter sa pratique en fonction de la religion de ses patients : adaptation des prescriptions et materiaux, adaptation de l’agenda therapeutique, adaptation de l’attitude. Finalement, une rencontre reussie entre laicite et respect des religions consiste a pratiquer une approche centree sur la personne, en structurant la relation de soin autour de la confiance, le respect, le dialogue et surtout la volonte mutuelle d’aboutir.

Introduction Dental education emphasises the acquisition of technical skills. Recent advances in 3D printing technologies have enabled the emergence of new educational tools usable in hands-on work sessions. The possibility to print 3D models from CT scans of patients is now available to dental practitioners. The aim of this study was to develop and evaluate a 3D printed model for paediatric dentistry training and compare it to the reference model used in our faculty. Materials and method 3D models were obtained by modifying and printing the CT scan of a young patient using the Voco® Solflex 350 3D® printer and Voco® V-print resin. Thirty-four students were asked to perform a pulpotomy and preparation for a stainless steel paediatric crown on tooth 85 on both the 3D printed model and the industrial model (Frasaco®), and then to answer a questionnaire. The data were analysed using R software. Result Both models obtained high scores. The learning potential and its applicability to clinical practice showed no statistically significant difference. Although the colour and the simulation of the proximal area disturbed the students (P = 0.009), the 3D models were seen as a good idea (P = 0.012). When it came to model design, the students appreciated the simulation of caries on 3D models (P = 0.0001) and considered the use 3D of models as a more realistic experience (P = 0.017). Discussion Although this study has some limitations (number of participants, choice of the models to be compared), it constitutes the first attempt to compare students' perception of 3D and series models. It shows that 3D technology makes it possible to obtain models of similar quality while offering a more realistic experience. Conclusion There are still many ways in which these models could be improved. For example, modifying the quality of resins could improve the milling sensation, and the design could be improved to achieve better contact points. Nevertheless, these 3D models offer the possibility to give the patient a more central place in the education of future practitioners.

AIM: To assess whether periodontal treatment can lead to clinical, glycaemic control and quality of life improvements in metabolically unbalanced diabetic patients (type 1 or type 2) diagnosed with periodontitis. METHODS: In this open-labelled randomized controlled trial, diabetic subjects (n = 91) were given "immediate" or "delayed" periodontal treatment (full-mouth non-surgical scaling and root planing, systemic antibiotics, and oral health instructions). The main outcome was the effect on glycated haemoglobin (HbA1C ) and fructosamine levels. The General Oral Health Assessment Index and the SF-36 index were used to assess quality of life (QoL). RESULTS: Periodontal health significantly improved after periodontal treatment (p < 0.001). Periodontal treatment seemed to be safe but had no significant effects on glycaemic control based on HbA1C (adjusted mean difference with a 95% confidence interval (aMD) of 0.04 [-0.16;0.24]) and fructosamine levels (aMD 5.0 [-10.2;20.2]). There was no obvious evidence of improvement in general QoL after periodontal treatment. However, there was significant improvement in oral health-related QoL (aMD 7.0 [2.4;11.6], p = 0.003). CONCLUSION: Although periodontal treatment showed no clinical effect on glycaemic control in this trial, important data were provided to support periodontal care among diabetic patients. Periodontal treatment is safe and improves oral health-related QoL in patients living with diabetes. ISRCTN15334496.

If dental professionals want to improve the oral health of their patients, they need to address what makes them sick: the social determinants of health. In this article, we propose a model of 'social dentistry' that shows how dentists could tackle these fundamental causes of oral disease. Socially engaged dentists conduct actions at three levels. At the individual level, they provide patient-centred care and, when necessary, liaise with local resources to better address what makes their patients sick. At the community level, they adapt their practice to the needs of the most vulnerable groups and advocate for healthier local policies. At the societal level, they are engaged in upstream actions addressing the social determinants of health.

There has been a relatively slow incorporation of person-centered care into dental care. Despite the efforts to sustain this approach in dental health care delivery, the perspectives of patients have yet to be considered, especially those using free dental clinics. Our objectives were: (1) to describe the perspectives of adults unable to access private dental clinics when using free dental clinics, (2) to document their suggestions for improvements to dental care. This qualitative descriptive study included 13 adults using a free dental clinic. To select participants, we adopted a maximum variation sampling strategy regarding age, sex, marital status, education level and employment status. We used in-depth, semi-structured interviews to collect data and thematic content analysis to analyze the verbatim transcripts. Participants were generally satisfied with the dental care they received in private and free dental clinics. However, they did not appreciate the long wait times at free clinics, and were bothered by the cost at private clinics. They emphasized a desire for quality time with the dentist allowing for more informed and shared decisions about their care, regardless of the clinic they visited. Participants want to feel cared for through a trustworthy relationship with the clinician, and suggested incorporating a walk-in concept into free clinics to address access to care. Adults using free dental clinics have various experiences with private and public dentistry, but they all need clinicians who adopt a comprehensive approach when providing information. This could improve patients’ experiences through a more person-centered approach to dental care.

Most healthcare professions have shifted the way they teach clinical approaches from a biomedical to a person-centred perspective. Yet, dentistry remains strongly anchored in a biomedical world. The objective of this project was to understand the barriers practicing dentists face to provide what we consider person-centred care. We conducted a qualitative descriptive study that comprised semi-structured interviews with dentists in private practice in the Greater Montreal area. After the analysis, we identified six barriers: • Fear of interpersonal conflict: participants thought that engaging in genuine conversations with patients would lead to situations of disagreement and even conflicts. • Fear of litigation: dentists considered that the legal and licensing infrastructure would judge the treatment they provide through a strict biomedical framework. • Fear of loss of money: participants thought that providing person-centred care was more time consuming and thus financially penalizing. • Pleasure to excel technically: some dentists did not consider offering interventions that provided less procedural pleasure than technical ones. • Narrow interpretation of health: participants considered the biomedical dimension as the only important dimension. • Lack of information: participants knew nothing or very little about person or patient-centred care. They seemed willing to integrate it into their practice had they had known more about it. These findings should help academic institutions to design their programs on person-centred care and respond to the fears expressed by professionals. Also, legal infrastructures must recognize the paradigm shift from the biomedical to the person-centred.

Objective Elite athletes are prone to develop oral diseases, which could increase the risk for injuries. The aim of this study was to evaluate the oral health and the composition of oral microbiota of elite rugby players compared to the general population. Methods We set up a case-control study by screening 24 professional rugby players (PRG) and 22 control patients (CG) for dental and gingival examinations and performed a taxonomic analysis and a predicted functional analysis of oral microbiota. Results The Decay, Missing and Filled (DMF) teeth index (5.54 ± 6.18 versus 2.14 ± 3.01; p = 0.01) and the frequency of gingivitis (58,33% versus 13.63%) were significantly increased in PRG compared to CG. PRG were characterized by a dysbiotic oral microbiota (Shannon Index: 3.32 ± 0.62 in PRG versus 3.79 ± 0.68 in CG; p = 0.03) with an increase of Streptococcus (58.43 ± 16.84 versus 42.60 ± 17.45; p = 0.005), the main genus implicated in caries. Predicted metagenomics of oral microbiota in rugby players was suggestive of a cariogenic metagenome favourable to the development of caries. Conclusions Our study shows that the oral health of PRG was poorer than the general population. PRG are characterized by a dysbiotic oral microbiota with an increase of the relative abundance of Streptococcus genus, positively correlated to the weight and negatively correlated to the diversity of oral microbiota. Clinical significance Dental screening should be included in the medical follow-up of professional rugby players as a part of their health management. New strategies such as using probiotics like Lactobacillus could help to control the dysbiosis of oral microbiota.