[Preserving the oral health of patients on antiresorptive drugs]. / Préserver la santé orale des patients sous antirésorbeurs osseux.

PRESERVING THE ORAL HEALTH OF PATIENTS ON ANTIRESORPTIVE DRUGS. For many years, antiresorptive medication have proven their effectiveness in reducing the risk of pathological fractures in osteoporotic or tumoral bone. However, bisphosphonates and denosumab may, in rare cases, induce osteonecrosis of the jaw, especially when prescribed for malignant disease (bone metastases or multiple myeloma). The presence of oral infections and the performance of invasive procedures, particularly dental avulsions, increase the risk of this complication. The management of osteonecrosis of the jaw is complex, and the prescribing physician and the dental surgeon must implement preventive measures. There are numerous recommendations published by national and international scientific societies that guide practitioners in the oral management of these patients. An oral check-up and oral cavity restoration are strongly recommended before treatment, as well as the implementation of rigorous oral hygiene and regular visits to the dental surgeon. During and after treatment with antiresorptive medication, oral care protocols are used to reduce the risk of osteonecrosis of the jaws and, when it occurs, to manage it.

PRÉSERVER LA SANTÉ ORALE DES PATIENTS SOUS ANTIRÉSORBEURS OSSEUX. Depuis de nombreuses années, les antirésorbeurs osseux ont prouvé leur efficacité dans la diminution du risque de fracture pathologique sur os ostéoporotique ou tumoral. Parmi eux, les bisphosphonates et le dénosumab sont cependant susceptibles d'induire, dans de rares cas, une ostéonécrose des maxillaires, notamment lorsqu'ils sont prescrits pour une pathologie maligne (métastases osseuses ou myélome multiple). La présence de foyers infectieux bucco- dentaires et la réalisation de gestes invasifs, notamment des avulsions dentaires, augmentent le risque de cette complication. La prise en charge de l'ostéonécrose des maxillaires étant complexe, le médecin prescripteur et le chirurgien-dentiste doivent mettre en place des mesures préventives. Il existe de nombreuses recommandations éditées par des sociétés scientifiques nationales et internationales qui guident les praticiens dans la prise en charge bucco- dentaire de ces patients. Un bilan bucco-dentaire et une remise en état de la cavité buccale sont fortement recommandés avant la mise en place du traitement, ainsi que l'instauration d'une hygiène orale rigoureuse et de consultations régulières chez le chirurgien-dentiste. Pendant et après le traitement par antirésorbeurs osseux, des protocoles de soins bucco-dentaires permettent de diminuer le risque d'ostéonécrose des maxillaires et, lorsqu'elle survient, de la prendre en charge.

Oral health status and care of institutionalized elderly individuals in Lebanon.

BACKGROUND: Oral health of the elderly is a major public health challenge. Data on oral health and dental care of the institutionalized elderly is lacking in Lebanon. AIMS: (1) Assess the oral health of Lebanese people aged 65 years and over living in residential facilities; and (2) identify factors associated with poor oral status. MATERIALS AND METHODS: A.sample of 526 nursing home residents aged 65 years and older was randomly selected from 46 residential facilities. Information collected were sociodemographic characteristics, degree of autonomy regarding toilet use and nutrition, presence of chronic diseases and medications, dry mouth sensation, dental brushing, access to oral health and reasons of dental visits. A structured oral examination was conducted to gather data on DMFT index, oral hygiene indices modified gingival index, and the unmet need for prosthesis. Statistical methods included bivariate and multivariate analyses. RESULTS: 55.9% of the participants were edentates, 41.4% used partial and/or complete dentures, and the minority used dentures with good hygiene. 15% of the dentate sample reported regular tooth brushing, 7% reported to have visited the dental office in the past 12 months, and 57% presented an unmet need for prosthesis. Oral health status was significantly related to age, smoking, daily tooth brushing, and autonomy (P < 0.05). Subjects with chronic diseases and consuming medications were more likely to have xerostomia. CONCLUSION: Oral health status is poor in the elderly institutionalized Lebanese population, which should promote a multidisciplinary team sharing responsibility for daily oral hygiene and access to dental treatment.

Prevalence of Oral Mucosal Lesions Among the Institutionalized Elderly Population in Lebanon.

This study aimed to determine the prevalence of oral mucosal lesions and risk factors among the institutionalized elderly Lebanese population. A representative sample of 526 individuals (49% males and 61% females) aged 65 years and above was examined. A questionnaire and clinical examination were administered. Bivariate and multivariate regressions were carried out. The frequency of oral mucosal lesions was 22.8% and it was associated to the use, integrity (p < .002), and hygiene level (p < .047) of removable mandibular and maxillary prosthesis. Multiple regression analysis also predicted the relationship between the mandibular prosthesis hygiene level and the occurrence of mucosal lesions. The factors controlling the occurrence of oral mucosal lesion were mainly related to the level of oral care given to the individuals. Therefore, a proper oral health care system should be implemented in the Lebanese residential homes to ensure the well-being of the residing population.

Could Ethical Tensions in Oral Healthcare Management Revealed by Adults with Intellectual Disabilities and Caregivers Explain Unmet Oral Health Needs? Participatory Research with Focus Groups.

BACKGROUND: Cognitively impaired patients often present poor oral health status that may be explained by ethical tensions in oral healthcare management. This participatory study explored such tensions among adults with intellectual disabilities and with caregivers. The second objective was to specify, with caregivers, the points that should be developed in a future study among dentists. MATERIALS AND METHODS: Three focus groups involving adults with intellectual disabilities, family caregivers and professional caregivers were organized in France in 2013. RESULTS: The thematic content analysis identified discrepancies between experiences and expectations, which were particularly marked for the dentist's competence and attitudes, the dentist's role in decisions, the dental care management and the French socio-political context. CONCLUSIONS: These discrepancies could partly explain multiple attempts to find the 'right' dentist or the fact that care was abandoned, and could at least contribute to oral health needs being unmet.

Inhibition of the differentiation of monocyte-derived dendritic cells by human gingival fibroblasts.

We investigated whether gingival fibroblasts (GFs) can modulate the differentiation and/or maturation of monocyte-derived dendritic cells (DCs) and analyzed soluble factors that may be involved in this immune modulation. Experiments were performed using human monocytes in co-culture with human GFs in Transwell® chambers or using monocyte cultures treated with conditioned media (CM) from GFs of four donors. The four CM and supernatants from cell culture were assayed by ELISA for cytokines involved in the differentiation of dendritic cells, such as IL-6, VEGF, TGFß1, IL-13 and IL-10. The maturation of monocyte-derived DCs induced by LPS in presence of CM was also studied. Cell surface phenotype markers were analyzed by flow cytometry. In co-cultures, GFs inhibited the differentiation of monocyte-derived DCs and the strength of this blockade correlated with the GF/monocyte ratio. Conditioned media from GFs showed similar effects, suggesting the involvement of soluble factors produced by GFs. This inhibition was associated with a lower stimulatory activity in MLR of DCs generated with GFs or its CM. Neutralizing antibodies against IL-6 and VEGF significantly (P<0.05) inhibited the inhibitory effect of CM on the differentiation of monocytes-derived DCs and in a dose dependent manner. Our data suggest that IL-6 is the main factor responsible for the inhibition of DCs differentiation mediated by GFs but that VEGF is also involved and constitutes an additional mechanism.

[Dental care for dependent elderly people]. / Soins dentaires aux personnes âgées dépendantes.

In 1995, the faculty of dental surgery of Paris-Descartes University set up a scheme whereby students at the end of their basic training offer their assistance and skills to institutions caring for dependent elderly people. This article presents a 2011 assessment of the difficulties encountered by the students and nurses' awareness of the importance of integrating oral hygiene into patients' overall care.

Tissular senescence and modifications of oral ecosystem in the elderly: risk factors for mucosal pathologies.

The aim of this present review is to describe the pathogenesis and mechanisms behind mucosal pathologies in the elderly including a description of the risk factors for these pathologies. The oral cavity - and particularly oral mucosae - is exposed to many stresses as well as physical, chemical, thermic and pathogenic agents. In the elderly, mucosae are less resistant to the insults, and this increases the occurrence of diseases. Several factors contribute to the prevalence of mucosal pathologies with aging. There are two categories: intrinsic factors linked to the senescence of the tissues and functions, and extrinsic factors related to the older people general health status. The intrinsic factors are: 1) mucosal senescence which induces fragility 2) immunosenescence which causes a decrease in the host response against micro-organisms and an increase in the autoimmune diseases and 3) senescence of salivary glands and reduction of the saliva protective function. Furthermore, there are extrinsic factors which contribute to change the oral ecosystem during aging, such as polypathologies and polymedications, malnutrition, degradation of oral hygiene, pathogen proliferation (mainly bacteria and Candida species) and old or ill-fitted removable dentures. In the elderly several diseases occur on the oral mucosae: inflammation, bacterial infections or candidiasis, ulcerations, autoimmune dermatosis, tumoral processes. This review describes some common oral mucosal pathologies in the older people, which illustrate the impact of different risk factors described in the first part.

[Improving the physician-dental surgeon relationship to improve patient care]. / La relation médecin/chirurgien-dentiste doit être améliorée pour une meilleure prise en charge des patients Enquête au sein d'un réseau de santé.

AIMS: This study had two aims: to assess the nature of the relationship between general practitioners (GPs) and dental surgeons in relation to patient care and to evaluate qualitatively their interest in the changes that health networks and shared patient medical files could bring. METHODS: Questionnaires were completed by 12 GPs belonging to ASDES, a private practitioner-hospital health network that seeks to promote a partnership between physicians and dental surgeons, and by 13 private dental surgeons in the network catchment area. RESULTS: The GPs and dentists had quite different perceptions of their relationship. Most dentists rated their relationship with GPs as "good" to "excellent" and did not wish to modify it, while GPs rated their relationship with dentists as nonexistent and expressed a desire to change the situation. Some GPs and some dentists supported data exchange by sharing personal medical files through the network. CONCLUSION: Many obstacles hinder communication between GPs and dentists. There is insufficient coordination between professionals. Health professionals must be made aware of how changes in the health care system (health networks, personal medical files, etc) can help to provide patients with optimal care. Technical innovations in medicine will not be beneficial to patients unless medical education and training begins to include interdisciplinary and holistic approaches to health care and preventive care.

Do Langerhans cells behave similarly in elderly and younger patients with chronic periodontitis?

OBJECTIVE: The purpose of this study was to compare the number, the distribution and the expression of markers of maturation of Langerhans cells (LC) in elderly and younger patients with chronic periodontitis in order to evidence the effect of aging on LC in inflammatory gingival tissue. METHODS: Gingival tissue specimens presenting chronic periodontitis from 8 elderly patients aged >75 (group E) and from 8 younger patients aged 50-60 (considered as controls, group C) were used for immunohistochemistry with monoclonal antibodies against CD45RB (leucocytes), CD1a (LC), markers of LC maturation (DC-LAMP, CD83) and number of immunolabelled cell subsets was evaluated using image analysis. RESULTS: The difference in the number of CD45RB+ leucocytes in the upper connective tissue between groups was not significant. In group E, the number of CD1a+ LC was significantly decreased (P<0.002) in the epithelium and significantly increased (P<0.0004) in the upper connective tissue. Furthermore, in group E, intraepithelial CD1a+ LC are more often observed in the upper epithelium and their dendritic processes were shorter and less numerous. Concerning the expression of markers of maturation, the numbers of intraepithelial DC-LAMP+ cells and CD83+ cells were significantly increased (P<0.0007 and P<0.02, respectively) in group E. CONCLUSION: During chronic periodontitis in elderly patients, the decrease in the number of intraepithelial LC and the alteration of dendritic processes could be balanced by a cellular distribution often observed in the upper epithelium associated with changes in cell maturation in response to bacterial elements.