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The FDI World Dental Federation suggests that "dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life." This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.

The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.

The Script Concordance Test (SCT) is an educational tool that aims to assess the ability to interpret medical information under conditions of uncertainty. It is widely used and validated in health education, but almost unknown in dentistry. Based on authentic clinical problem-solving situations, it allows to assess clinical reasoning that experienced health workers develop over the years. A specific scoring system, dedicated to SCT, considers the variability of responses of practitioners in the same clinical situations. Finally, the scores generated by SCT reflect the respondents' ability to interpret clinical data compared to experienced clinicians. This article aims to familiarise the dental educators' community with SCT construction, optimisation and its possible applications.

This paper reports on the recent activity of the pan‐European consensus of the ADEE Special Interest Group for Pre‐Clinical Operative Skills. Following the previous recommendations from the group, and in order to support teachers and to harmonise the delivery of skills training across Europe, a more formal curriculum relating to pre‐clinical operative skills needs to be created.\ud \ud This paper reports European consensus surrounding the categorisation (level of importance, and difficulty) of basic operative dental clinical skills within the undergraduate curriculum, and provides recommendations relating to session structure and timing of curricular elements for basic operative dental clinical skills teaching

Introduction\ud \ud The Erasmus+O-Health-EDU project aims to gain a comprehensive view of oral health professional (OHP) education in Europe, through the development of web-based surveys and online toolkits. A glossary to facilitate a common language through which academic teams could cooperate and communicate more accurately was identified as a key need within the project. The aim of ARTICULATE was thus to create a shared language, with a European focus, for terms and concepts used in the field of OHP education.\ud \ud \ud \ud Methods\ud \ud The methodology was developed from those published for construction of other glossaries with a circular and iterative process: the creation of content and definitions by a group of experts in OHP education, the testing of “fitness for purpose” of the content, and stakeholder consultation. All creation steps were followed by refinements based on testing results and stakeholder comments. The final glossary was then launched as an online resource including a built-in mechanism for user feedback.\ud \ud \ud \ud Results\ud \ud The scope and structure of the glossary were mapped out at a workshop with 12 dental education experts from 7 European countries. A total of 328 terms were identified, of which 171 were finally included in ARTICULATE. After piloting with a close group of other colleagues, the glossary was opened for external input. Thirty European Deans or Heads of Education assessed the definition of each term as “clear” or “not clear.” A total of 86 definitions were described as “clear” by all individuals. Terms deemed unclear by at least one individual were revisited and changes made to 37 of the definitions. In conjunction with the launch of the glossary, a range of stakeholder organisations were informed and asked to participate in an open global consultation by providing feedback online. Since its launch in June 2021, the ARTICULATE website (https://o-health-edu.org/articulate) has had an average of 500 visits/month. To promote community ownership, forms embedded on the ARTICULATE webpage allow users to give feedback and suggest new terms. A standing taskforce will meet regularly to consider amendments and make changes to ensure that the glossary remains a relevant and up-to-date resource over time.\ud \ud \ud \ud Conclusion\ud \ud ARTICULATE is a unique, evolving, online glossary of terms relating to OHP education, created as a resource for all interested OHP educators. The glossary is a key output of the O-Health-Edu project, which relies on a comprehensive vision of OHP education to address the future oral health needs of the European population.

Introduction Dental undergraduates will access the Internet searching for learning materials to complement their training; however, open access content is not generally recommended by dental schools. This study aimed to evaluate how dental students are using online video content. Materials and Methods Students from eight Universities (Athens, Birmingham, Brescia, Cardiff, Melbourne, Paris, Sao Paulo and Valdivia) representing three continents were invited to complete a survey on their access and learning from online videos. Results International students behave similarly when studying dental content online. Of 515 respondents, 94.6% use the Internet as a learning tool. It was observed that videos are not frequently recommended during didactic lectures (9.6%). But many students (79.9%) will use YouTube for their learning which includes clinical procedures. Students will check online content before performing procedures for the first time (74.8%), to understand what was explained in class (65.9%) or read in books (59.5%), to relearn clinical techniques (64.7%) and to visualise rare procedures (49.8%). More than half of the students do not fully trust the accuracy or the reliability of online content. This does not prevent students from watching and sharing dental videos with classmates (64.4%). The content watched is not shared with teachers (23.3%) even when it contradicts what was learnt in the school (38.2%). Conclusion This study concludes that students regularly integrate open access digital resources into learning portfolios but are hesitant to inform their teachers about their viewing habits. Students wish to receive critical skills on how to evaluate the material they encounter outside their traditional learning space.

This consensus paper reports on the process of developing a renewed vision for Oral Health Professional (OHP) education across Europe, and forms part of a larger EU‐funded collaborative Erasmus+ project, “O‐Health‐Edu.” The vision aligns with the World Health Organisation milestones (2016) and resolutions (2021), and EU4Health programme (2020) objectives ‐ and projects 20 years into the future, to 2040. This longitudinal vision takes a multi‐stakeholder perspective to deliver OHP education that acts in the best interests of both students and patients, and sits within the context of a wider strategy for general health. Included, it is an infographic to help communicate the vision to various stakeholders of OHP education.

The recent advances in the field of cell-based therapeutics open promising perspectives for oral tissue regeneration. The development of large animal models, which overcome the limits of the rodent models and allow to emulate clinical situations, is crucial for the validation of regenerative strategies to move toward clinical application. Currently, porcine, canine, and ovine models are mainly developed for oral regeneration and their specific characteristics have an impact on the outcomes of the studies. Thus, this systematic review investigates the application of porcine, canine, and ovine models in present cell-based oral regeneration, according to the species characteristics and the targeted tissue to regenerate. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2015 to March 2020 was conducted. Relevant articles about cell-based oral tissues engineering in porcine, canine, and ovine models were evaluated. Among the evaluated articles, 58 relevant studies about cell-based oral regeneration in porcine, canine, and ovine models matched the eligibility criteria and were selected for full analysis. Porcine models, the most similar species with humans, were mostly used for bone and periodontium regeneration; tooth regeneration was reported only in pig, except for one study in dog. Canine models were the most transversal models, successfully involved for all oral tissue regeneration and notably in implantology. However, differences with humans and ethical concerns affect the use of these models. Ovine models, alternative to porcine and canine ones, were mainly used for bone and, scarcely, periodontium regeneration. The anatomy and physiology of these animals restrain their involvement. If consistency was found in defect specificities and cell trends among different species animal models of bone, dentin-pulp complex, or tooth regeneration, variability appeared in periodontium. Regeneration assessment methods were more elaborate in porcines and canines than in ovines. Risk of bias was low for selection, attrition and reporting, but unclear for performance and detection. Overall, if none of the large animal models can be considered an ideal one, they are of deemed importance for oral cell-based tissue engineering and researchers should consider their relevance to establish favorable conditions for a given preclinical cell-based therapeutics. Impact statement This systematic review investigates porcine, canine, and ovine models for current oral cell-based regeneration procedures, and researchers could refer to it for the choice of the most pertinent preclinical model for a given cell-based therapeutics. ispartof: TISSUE ENGINEERING PART B-REVIEWS vol:28 issue:3 pages:489-505 ispartof: location:United States status: published

International audience; BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are amongst the most anxiety-provoking competency assessment methods. An online serious game (OSCEGame) was developed and implemented within the OSCE curriculum. This study aimed to evaluate the usefulness of this serious game on preparedness and reducing OSCE-related stress.METHODS: A serious game was designed to help dental students train for OSCEs. Two game courses (4 stations each) were designed according to year of undergraduate training (4(th) and 5(th) year), based on 6 pre-existing multi-competency OSCE stations. The OSCEGame was available online on a learning platform 4 to 6 weeks before the summative OSCEs. Game use was evaluated by analysing connection data. Preparedness, stress and time management skills were assessed using a questionnaire following the summative OCSEs. The results of 4(th)-year students (OSCE naive population) were compared to those of 5(th)-year students to assess usefulness and benefits of such preparation method.RESULTS: In total, 97% and 60% of the students in 4(th) year and 5(th) year, respectively, used the game. The game was seen as an essential preparation tool to reduce anxiety (for 60% of all students) and increase time management skills (65% of all students). However, significant differences were observed between 4(th-) and 5(th)-year students (anxiety reduction: 65% vs. 22%, p < 0.001; time management skills: 59% vs. 41%, p < 0.05) suggesting that it is most useful for OSCE naive students.CONCLUSION: This serious game is a useful time efficient online tool, for OSCE preparation, especially in OSCE naive students.

The prevalence and burden of untreated oral diseases throughout the life course remains high worldwide, and inequalities in oral health and dental care are increasing. This is a major public health issue that is not being enough addressed by the health care systems. To better manage populations' oral health, oral health professionals must be trained to adapt to population needs and societal and technological changes. Furthermore, dental institutions must fulfill their social responsibility by prioritizing educational and research activities that promote advancing individual and community health. In Europe, great variability exists between dental programs within the same country or between countries. This variability is an issue as European graduates can practice around the European Union through mutual recognition of their qualifications. This might lead to inequities in the availability, accessibility, acceptability and quality of health services. The convergence of competencies and quality standards at the international level must thus be better clearly identified, defined and improved. The purpose of the O-Health-Edu, EU funded project, “Advancing Oral Health: A vision for Dental Education” is thus to assess the current situation concerning the oral health professionals' education (OHP) and to identify educational priorities so that future graduating OHPs have competencies aligned with emerging population needs. The project is supported within the KA203 - “Cooperation for Innovation and the Exchange of Good Practices - Strategic Partnerships for higher education” Erasmus program. It began in October 2019 for three years, with eight European university partners and the ADEE (Association for Dental Education in Europe). The firsts steps consist of a scoping review to identify the available information followed by a questionnaire survey to gather more comprehensive data so that to build an opened data source, and a glossary of dental education terms. Key messages Few Information about the current situation of dental education in Europe. Graduates must be equipped with adequate competencies to face populations needs.

Introduction\ud \ud The variability in oral health professional education is likely to impact on the management of oral health needs across Europe. This scoping review forms the initial part of a larger EU‐funded collaborative Erasmus+ project, ‘O‐Health‐Edu’. The aim of this scoping review is to investigate how oral health professional education in Europe is reported.\ud \ud \ud Methods\ud \ud The PRISMA and Arksey & O’Malley methodological frameworks for scoping reviews were used to guide reviewers in answering the research question “How is oral health professional education reported in Europe?”. The search strategy encompassed published literature searches, internet searches and further searching of relevant documents from educational organisations, regulators and professional bodies. Once the search strategy was developed it was sent to key stakeholders for consultation. Sources were reviewed by two authors (JD, JF), and included in the review if they reported on oral health professional education in Europe.\ud \ud \ud Results\ud \ud A total of 508 sources were retrieved from all of the searches. 405 sources were excluded as they did not report on the topic of interest, leaving 103 sources that reported on oral health professional education in Europe. Handsearching the references of published sources lead to a further 41 sources being screened, of which 15 were included. In total, 33 duplications were removed and the final number of included sources was 85. The average year of publication for the included sources was 2007, with sources most commonly published in journals dedicated to dental education. Surveys represented the most common form of reporting. From the data obtained, four broad themes of reporting were evident: Dental education at a Programme Level, Dental education at a Discipline Level, Other Oral Health Professional Education, and, Postgraduate Education and Continuous Professional Development.\ud \ud \ud Conclusion\ud \ud The reporting of dental and oral health professional education in Europe is limited. Whilst there are many useful documents that provide guidelines on dental education, there is limited knowledge on how education is implemented and delivered. There is a greater need for comprehensive educationally driven programme level data on oral health professional education across Europe.

Introduction\ud \ud Since 1981, the qualifications for various healthcare professionals across the European Union have enjoyed mutual recognition in accordance with the EU Directive 81/1057/EEC. Whilst the directive includes dental practitioners, it is recognised that significant variation exists in curriculum structure, content and scope of practice across institutions. This article aimed to explore pan-European practice in relation to curriculum content, teaching and learning strategies and assessment of pre-clinical dental skills.\ud \ud Method\ud \ud A request to complete an online questionnaire, in English, was sent electronically to skills leads at all Association of Dental Education in Europe member schools. The questionnaire collected information in relation to institution and country, regulatory requirements to demonstrate safety, details of specific pre-clinical skills courses, learning materials and teaching staff.\ud \ud Results\ud \ud Forty-eight institutions, from 25 European countries responded. Seven countries (n=7, 28%) reported no requirement to demonstrate student operative safety prior to patient treatment. Several core and operative clinical skills are common to the majority of institutions. The most commonly taught core skills related directly to the clinical environment such as cross-infection control and hand washing. The least common were skills that indirectly related to patient care, such as communication skills and working as a team.\ud \ud Conclusion\ud \ud There are clear differences within European pre-clinical dental education, and greater efforts are needed to demonstrate that all European students are fit to practice before they start treating patients. Learning outcomes, teaching activities and assessment activities of pre-clinical skills should be shared collaboratively to further standardise curricula.

The craniofacial area is prone to trauma or pathologies often resulting in large bone damages. One potential treatment option is the grafting of a tissue-engineered construct seeded with adult mesenchymal stem cells (MSCs). The dental pulp appears as a relevant source of MSCs, as dental pulp stem cells display strong osteogenic properties and are efficient at bone formation and repair. Fibroblast growth factor-2 (FGF-2) and/or hypoxia primings were shown to boost the angiogenesis potential of dental pulp stem cells from human exfoliated deciduous teeth (SHED). Based on these findings, we hypothesized here that these primings would also improve bone formation in the context of craniofacial bone repair. We found that both hypoxic and FGF-2 primings enhanced SHED proliferation and osteogenic differentiation into plastically compressed collagen hydrogels, with a much stronger effect observed with the FGF-2 priming. After implantation in immunodeficient mice, the tissue-engineered constructs seeded with FGF-2 primed SHED mediated faster intramembranous bone formation into critical size calvarial defects than the other groups (no priming and hypoxia priming). The results of this study highlight the interest of FGF-2 priming in tissue engineering for craniofacial bone repair. Stem Cells Translational Medicine 2019;8:844–857

Objective: To investigate risk factors specific to posterior crossbite and anterior open bite at the age of 3 years.Materials and Methods: The study included 422 children of the French EDEN mother-child cohort. The main outcomes were the presence of posterior crossbite and anterior open bite assessed by dentists at 3 years. Social characteristics (collected during pregnancy), neonatal characteristics (collected at birth), duration of breast-feeding (collected prospectively), sucking habits at 3 years, and open lips (as a proxy for mouth breathing) were studied and two logistic regressions conducted.Results: Preterm birth appears to be a risk factor specific for posterior crossbite (OR: 3.13; 95% CI: 1.13–8.68), whereas small for gestational age seems to be associated with a lower risk of posterior crossbite (OR: 0.32; 95% CI: 0.12–0.87). Ongoing pacifier or thumb sucking at 3 years is a risk factor for both posterior crossbite and anterior open bite.Conclusions: Children born preterm seem to be more at risk for posterior crossbite than those born at term. Different mechanisms may be involved in posterior crossbite and anterior open bite.

Resume Il est aujourd’hui prouve que les traitements orthodontiques augmentent le risque d’apparition de lesions carieuses, constituant un prejudice pour les patients et compromettant fortement la reussite de ces traitements. Ce risque est inherent a la fois a l’appareillage qui provoque une augmentation des sites de retention de plaque, mais aussi a une modification de la flore bacterienne et a l’âge des patients. Une evaluation precise du risque carieux doit donc etre realisee avant toute mise en place d’appareillage et reevaluee periodiquement au cours du traitement. Doivent s’adjoindre des mesures preventives qui commencent par l’education et la motivation des patients a la maitrise d’une bonne hygiene buccodentaire. La prevention passe egalement par une utilisation adequate des differents vecteurs de distribution du fluor topique, notamment l’application de vernis a haute teneur en fluor. Des mesures prophylactiques complementaires, comme l’utilisation de vernis a la chlorhexidine et le scellement des sillons sont egalement recommandees. Enfin, l’orthodontiste peut limiter au maximum les facteurs de retention de plaque dentaire comme le sont les bagues ou les maillons elastomeriques. L’objectif de cet article est de proposer une demarche diagnostique specifique et de presenter les mesures de prevention scientifiquement validees, a mettre en œuvre parallelement a la therapeutique orthodontique.

Tissue engineering strategies based on implanting cellularized biomaterials are promising therapeutic approaches for the reconstruction of large tissue defects. A major hurdle for the reliable establishment of such therapeutic approaches is the lack of rapid blood perfusion of the tissue construct to provide oxygen and nutrients. Numerous sources of mesenchymal stem cells (MSCs) displaying angiogenic potential have been characterized in the past years, including the adult dental pulp. Establishment of efficient strategies for improving angiogenesis in tissue constructs is nevertheless still an important challenge. Hypoxia was proposed as a priming treatment owing to its capacity to enhance the angiogenic potential of stem cells through vascular endothelial growth factor (VEGF) release. The present study aimed to characterize additional key factors regulating the angiogenic capacity of such MSCs, namely, dental pulp stem cells derived from deciduous teeth (SHED). We identified fibroblast growth factor-2 (FGF-2) as a potent inducer of the release of VEGF and hepatocyte growth factor (HGF) by SHED. We found that FGF-2 limited hypoxia-induced downregulation of HGF release. Using three-dimensional culture models of angiogenesis, we demonstrated that VEGF and HGF were both responsible for the high angiogenic potential of SHED through direct targeting of endothelial cells. In addition, FGF-2 treatment increased the fraction of Stro-1+/CD146+ progenitor cells. We then applied in vitro FGF-2 priming to SHED before encapsulation in hydrogels and in vivo subcutaneous implantation. Our results showed that FGF-2 priming is more efficient than hypoxia at increasing SHED-induced vascularization compared with nonprimed controls. Altogether, these data demonstrate that FGF-2 priming enhances the angiogenic potential of SHED through the secretion of both HGF and VEGF., info:eu-repo/semantics/published

Mutations in PHEX (phosphate-regulating gene with homologies to endopeptidases on the X-chromosome) cause X-linked familial hypophosphatemic rickets (XLH), a disorder having severe bone and tooth dentin mineralization defects. The absence of functional PHEX leads to abnormal accumulation of ASARM (acidic serine- and aspartate-rich motif) peptide − a substrate for PHEX and a strong inhibitor of mineralization − derived from MEPE (matrix extracellular phosphoglycoprotein) and other matrix proteins. MEPE-derived ASARM peptide accumulates in tooth dentin of XLH patients where it may impair dentinogenesis. Here, we investigated the effects of ASARM peptides in vitro and in vivo on odontoblast differentiation and matrix mineralization. Dental pulp stem cells from human exfoliated deciduous teeth (SHEDs) were seeded into a 3D collagen scaffold, and induced towards odontogenic differentiation. Cultures were treated with synthetic ASARM peptides (phosphorylated and nonphosphorylated) derived from the human MEPE sequence. Phosphorylated ASARM peptide inhibited SHED differentiation in vitro, with no mineralized nodule formation, decreased odontoblast marker expression, and upregulated MEPE expression. Phosphorylated ASARM peptide implanted in a rat molar pulp injury model impaired reparative dentin formation and mineralization, with increased MEPE immunohistochemical staining. In conclusion, using complementary models to study tooth dentin defects observed in XLH, we demonstrate that the MEPE-derived ASARM peptide inhibits both odontogenic differentiation and matrix mineralization, while increasing MEPE expression. These results contribute to a partial mechanistic explanation of XLH pathogenesis: direct inhibition of mineralization by ASARM peptide leads to the mineralization defects in XLH teeth. This process appears to be positively reinforced by the increased MEPE expression induced by ASARM. The MEPE-ASARM system can therefore be considered as a potential therapeutic target.

It is now established that orthodontic treatment increases the risk of carious lesions, with consequent harm to the patient and a high risk of compromising treatment outcome. This risk is related to the appliances, which increase the number of sites where plaque can accumulate as well as to changes in the bacterial flora and the age of the patient. A thorough evaluation of the risk of caries is therefore needed before any appliance is put in place and further evaluations should then be performed regularly throughout the course of treatment. In addition, preventive measures should be taken, involving first and foremost educating and motivating patients regarding the need for good oral hygiene. Prevention also implies adequate usage of the various sources of local fluoride administration, notably the application of fluoride-rich varnish. Other prophylactic measures such as using chlorhexidine varnish and sealing dental grooves are also recommended. Finally, the orthodontist can reduce to a minimum the use of items likely to retain dental plaque such as bands and elastomeric ties. The aim of this article is to suggest a specific diagnostic approach and to present the scientifically validated prevention measures, which need to be applied throughout orthodontic treatment.

In the face of our planet’s environmental degradation, eco-responsibility is one of the most important concepts. This term involves all the actions designed to reduce our environmental impact. As actors of society, dentists have a part to play and must adopt an eco-responsible attitude. This work presents an assessment of environmental impact of dental practices and proposes concrete solutions to reduce it. One of the major challenges of this decade is to have an environment-friendly practice, applicable to all practitioners and which obviously respects regulations to maintain the quality of care.; Face à la détérioration de notre planète, une des notions les plus importantes est l’écoresponsabilité. Ce terme représente l’ensemble des actions qui vise à diminuer notre impact sur l’environnement. Les chirurgiens-dentistes ont un rôle à jouer, comme acteurs de la société et se doivent d’adopter une attitude écoresponsable. Ce travail présente une évaluation de l’impact sur l’environnement des cabinets dentaires et propose des solutions concrètes pour le réduire. Avoir une pratique soucieuse de l’environnement, applicable pour tous les praticiens et, qui respecte bien évidemment les règlementations pour maintenir la qualité des soins, est un des enjeux majeurs de cette décennie.

La fusion de deux UFR d’Odontologie est une première en France. Celle-ci va avoir un impact pour les étudiants car cela va changer les méthodes d’apprentissage théorique et clinique mais cela va aussi impacter les enseignants, lesquels vont devoir trouver un point d’entente afin de proposer aux étudiants la meilleure formation possible. L’objectif de ce travail est de recueillir les avis des étudiants des UFR concernées par la fusion, leurs attentes, ainsi que leurs craintes vis-à-vis de celle-ci, au travers d’un sondage anonyme. Nous avons donc envoyé un sondage en ligne aux 431 étudiants qui sont concernés par cette fusion (1er cycle). Nous avons obtenu 75,9 % de réponses au questionnaire. Les réponses sont majoritairement similaires pour les deux UFR. Il en ressort principalement un manque d’information des étudiants, ainsi qu’une crainte des changements à venir, notamment pour les étudiants provenant de Garancière au niveau des lieux d’enseignement et de clinique. Les modalités de cette fusion inter UFR n’étant pas encore tout à fait définies, tout est encore possible, et c’est donc un défi pour les enseignants et l’administration de faire en sorte que celle-ci se déroule dans les meilleures conditions pour les étudiants.

En Suède, la politique de santé repose sur un système de promotion de la santé bucco-dentaire pour l’ensemble de la population, et ce, dès le plus jeune âge. Les enfants atteints de handicaps étant plus vulnérables face aux pathologies buccodentaires, des stratégies de prévention spécifiques sont à développer. En quoi le système de santé scandinave, axé sur la prévention, prend-il en compte la prise en charge spécifique des enfants en situation de handicap ? Comment les hygiénistes s’intègrent-ils dans cette organisation ? Pour cela, nous reviendrons sur la base du système de santé en Suède : ses principes, son organisation et la valorisation de l’odontologie pédiatrique. Puis, nous nous attarderons sur le métier d’hygiéniste, son historique et son contexte actuel, afin de le replacer dans l’équipe de soins et de définir son rôle dans la prise en charge des populations. Ensuite, nous nous centrerons sur la stratégie de la prise en charge des enfants en situation de handicap, en rappelant dans un premier temps les objectifs thérapeutiques de cette prise en charge puis de son organisation concrète sur le territoire. Enfin, nous tenterons d’analyser ces stratégies de prise en charge nordiques.

The decision to use general anaesthesia relies mostly on the sensitivity or the experience of the practitioner. This work aims to provide an indicator score to assist the practitioner in his decision process. The score is based on objective criteria, such as age, number of sextants to treat, child's behaviour and medical background. In order to assess the reliability of this indicator score, all records of patients treated under general anaesthesia between 2015 and 2016 have been analysed and retrospectively tested. Among 101 cases, nearly 90% of patients obtained a score superior or equal to the threshold which requests general anaesthesia. Patients under the threshold were mainly treated for oral surgery. The provided general anaesthesia indicator score turns out to be a decision-making tool which assists the practitioner to select the best medical care, more specifically for polycarious children or children with special needs. This tool seems less relevant when facing one-time surgery for children in good health. This work also pointed out that, with the incorporation of a time factor and a software, the indication score enables to dynamically manage the waiting list for general anaesthesia; Le choix de l’indication de l’anesthésie générale est aujourd’hui trop souvent lié à la sensibilité et à l’expérience des praticiens. Le but de ce travail est de proposer un score d’indication de l’anesthésie générale à l’aide de critères objectifs, comme l’âge, le nombre de sextants à traiter, le comportement de l’enfant et les antécédents médico-chirurgicaux. Afin d’évaluer sa validité, l’ensemble des dossiers des patients opérés sous anesthésie générale à Louis Mourier (AP-HP) entre 2015 et 2016 ont été analysés et le score appliqué rétrospectivement. Parmi les 101 dossiers analysés, près de 90% des patients présentent un score supérieur ou égal au seuil d’indication de l’anesthésie générale. Ceux pour lesquels le score est inférieur relèvent d’une indication de chirurgie orale. Le score d’indication d’anesthésie générale proposé apparaît comme un outil d’aide pour une prise en charge optimale, notamment pour les très jeunes enfants et les enfants à besoins spécifiques. En y ajoutant un facteur temps, ce score permet, à l’aide d’un modèle informatisé, une gestion active des listes d’attente.