A proposal for an oral health educational programme for the first 1000 days of life: from pregnancy to childhood.

AIM: The aim of this paper is to highlight the need to consider oral health during the first 1000 days of a child's life with a view to developing appropriate educational programmes. CONTEXT: The first 1000 days of life represent a window of opportunity for prevention in children. This concept is built on a consideration of the overall health of mother and child, taking into account social inequalities in health. It is now established that the oral health of the mother determines the oral health of her child. Furthermore, parents' knowledge and behaviour have a direct influence on their child's health. CONCLUSION: The majority of the population does not have the necessary skills to adopt behaviours that promote oral health. The need for oral health education begins in the first 1000 days of life. Following the model of family health education, these programmes would involve providing pregnant women and, therefore, families with the skills they need to manage their own oral health and that of their future child as early as possible.

[Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]. / Inégalités sociales de santé orale et caries précoces de l'enfant : comment prévenir efficacement ? Une revue de portée des prédicteurs de la maladie.

BACKGROUND: Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies. METHODS: This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries. RESULTS: The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters. CONCLUSION: Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.

[Lack of medical or dental care: Impact on health expenditures for people with chronic disease]. / L'effet du non-recours aux soins médicaux et dentaires sur les dépenses de santé des personnes ayant une maladie chronique.

BACKGROUND: People with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease. METHODS: We conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010-2013). RESULTS: People who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease. CONCLUSION: The lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.

[Children's consultations for dental emergency. Retrospective study in Île-de-France]. / Consultations pour urgence bucco-dentaire chez les enfants : étude rétrospective en Île-de-France.

BACKGROUND: In France, the children oral health status has improved but the use of care remains insufficient. The complexity of the acts, the access to care difficulties and the programs of prevention and care for children lack of knowledge contribute to late care and often, in emergency. This study aims to describe the young patients' characteristics consulting in dental emergency and analyse the modalities of recourse. METHODS: A retrospective study was conducted on medical records. An extraction of data was carried out concerning all children under the age of 16, admitted to the Dental Emergency Functional Unit of the Pitié-Salpêtrière Hospital Group in 2015. Several variables of interest were analysed: socio-demographic characteristics, the time of the visit and the diagnostic category (tooth pathologies, facial trauma, infections, periodontal diseases and other emergencies). Descriptive and bivariate analyses were conducted. RESULTS: On the 62,500 dental emergency consultations in 2015, 5359 were for patients under 16 years of age (8%). Data were available for 5044 children. Among these, children aged 6 to 11 accounted most of consultations (43.9%). There were more boys (57.2%). The most frequent emergency diagnoses were related to a tooth pathology (42.9%) and traumatic event (38.4%). Consultations were more held on the evening schedule on weekdays and the day on weekends. Patients aged 0 to 5 years consulted more at night (P<10-3) and were, proportionally, the most affected by traumatic events (39.2%). Children aged 6 to 11 and 12 to 16 years consulted more often during the day (P<10-3), for emergencies related to a carious event (43.9% and 43.6%). Patients residing in Seine-Saint-Denis accounted for 22.6% of total visits and those living in Paris accounted for 20.8%. CONCLUSION: A large proportion of children presenting for dental emergencies, have most of the time, only the need for usual care. An offer of dental care, adapted to the territory needs, is necessary for the children dental health management. Preventive measures from an early age and early recourse would be favourable.

Factors associated with oral health-related quality of life in patients with diabetes.

BACKGROUND: Oral pathologies are prevalent in diabetes, and they may affect the quality of life and patient's perception of their oral health. The aim of this study was to investigate the factors associated with oral health-related quality of life of patients with diabetes. METHODS: A cross sectional study was conducted involving 316 patients visiting a hospital diabetic unit. Sociodemographic, oral and medical care data were recorded, and a General Oral Health Assessment Index (GOHAI) questionnaire was completed. A multivariable analysis was performed. RESULTS: Of the 316 study participants, 61.7% had type 2 diabetes (T2DM) and 20.5% had poorly controlled diabetes. Forty-five percent had at least one oral complication, 55% had visited a dentist within the past year and 67% reported having poor oral health and 281 answered the GOHAI questionnaire. A low GOHAI score (≤50) was obtained for 24.6% of the patients and was associated with T2DM, poorer oral health, dry mouth sensation and use of a removable prosthesis. CONCLUSIONS: Oral health status was poorer and had a negative effect on the quality of life among patients with T2DM, possibly contributing to poorly balanced nutrition.

[Dental health and dental care according diabetic status; results from 2008 ESPS study]. / État de santé et suivi bucco-dentaire selon le statut diabétique : exploitation de l'enquête ESPS 2008.

BACKGROUND: Poorly controlled diabetes leads to serious complications including periodontal disease, oral disease leading to tooth loss. Diabetics benefit from care facilitated follow-up. Social inequalities are observed in oral health and diabetes. The objective of this study was to estimate the effect of the social factors on oral health and use of dental care for people with diabetes from the Health and Social Protection Survey 2008 (ESPS) and to compare it with that observed among non-diabetic people. METHODS: The ESPS is a representative survey of the French population. In 2008, data were derived from a self-administered health questionnaire given to all household members aged 16 or older. The scope of this study was restricted to persons aged 35 and over (12.082) having filled out their health survey (8961). Diabetes was defined from self-reports of disease or use of anti-diabetic medication. Oral health was estimated from perceived oral health and the number of missing teeth not replaced. Use of dental care was measured by self-report of a visit within the last two years. Socio-demographic and social coverage indicators were collected. RESULTS: The participation rate was 74.1% and prevalence of diabetes was 7.2% (648). People with diabetes had a poorer dental status (42.7% vs 26.5% - OR=1.22, 95% CI [1.01-1.47]), related to social characteristics. The effect of level of precariousness on dental health was equivalent in diabetic and non-diabetic populations. The use of dental care (73.4% of participants) was associated with social factors. Diabetics were less likely to consult dentists than non-diabetics (61.5% vs 74.4%), but this difference was not statistically significant (OR=0.86, 95%CI [0.72-1.04]). The effect of the level of precariousness on use of dental care was the same in both populations. CONCLUSION: This study raises the question of the impact of recommendations on monitoring dental health among diabetics especially for vulnerable populations despite better management and coverage.

[Dental status, access to care and precariousness]. / Etat dentaire, recours aux soins et précarité.

BACKGROUND: The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions. METHODS: A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health. RESULTS: Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner. CONCLUSION: This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

Evaluation of a dental care program for school beginners in a Paris suburb.

OBJECTIVES: Dental care for children is available in France, but the method of administration is cumbersome: care is generally provided by private dentists, and parents can claim reimbursement of at least 70% of the costs afterwards. In the Département of Val d'Oise (north of Paris and including some densely populated suburbs), a scheme is in place to provide 100% reimbursement. To encourage participation, schoolchildren are screened by dentists who advise if treatment is needed. The objective of this study was to ascertain the effectiveness of screening as a stimulus for seeking dental care. METHODS: In two towns, 6-7-year-old schoolchildren were cluster-sampled to give 507 participants. At screening, about half of the participants were found to be in need of operative treatment. Questionnaires about demographic and other background factors were sent home. From those needing treatment, 186 (77%) sets of questionnaires were returned. These persons were the analytical basis of the study. Six months after screening, the 186 participants were examined to estimate whether they had sought and received treatment as advised. RESULTS: The majority of the participants came from low socioeconomic and deprived backgrounds. Most of the parents were born in countries outside Europe. Only about one-quarter of the children advised to seek treatment had actually done so after 6 months. Slightly under half of those who were treated had claimed the reimbursable amount after the treatment. Of the 186 participants needing treatment, 24% had more than 4 dt + DT but 70% of these had not received any care. CONCLUSION: These findings suggest that even when costs are totally reimbursed, most children in need of care do not receive it; the greater the need of care, the lower the likelihood of getting it. The deprived people and immigrants frequently inhabiting the Parisian suburbs seem to experience cultural, financial, linguistic, and administrative barriers to care, which impede uptake and which must be changed if these children are to enjoy improved dental health.