Upper aerodigestive tract cancer and oral health status before radiotherapy: A cross-sectional study of 154 patients.

OBJECTIVES: We aimed to determine primarily the oral health status of patients with upper aerodigestive tract cancer before radiotherapy, and secondarily the prevalence of risk factors for poor oral status. METHODS: A cross-sectional study was conducted in Marseille University hospital. Assessment criteria were the Decay, Missing and Filled (DMF) Index and periodontal status. RESULTS: One hundred and fifty-four patients, mean age 60.9years, were included. The most common sites of primary tumors were the larynx (28.6%) and oral cavity (26.6%). Current or past smokers accounted for 80.5% of patients and 67% were alcohol abusers. Most patients (83.8%) did not have xerostomia. They ate three meals a day (61%), with sugar consumption in 40%. The median number of daily tooth brushings was 2, with a manual toothbrush (81.2%). Few patients used dental floss or interproximal brushes. Individual DMF index was 17.6 (D=2.3, M=9.3, F=6.0) and was higher in patients with xerostomia and alcohol abusers (P=0.01). Osseous level was 62.3% and 57.8% of patients had osseous infections, which were more common with poor hygiene (P=0.04). Most patients (85.7%) had periodontal disease, but incidence did not significantly differ according to risk factors. DISCUSSION: The DMF index was higher in presence of periodontal disease and osseous infections. Alcohol and xerostomia were associated with a high individual DMF index and osseous infections were more frequent in patients with poor hygiene. Patients with upper aerodigestive tract cancer are at high risk of osteoradionecrosis if they do not receive dental treatment before radiotherapy.

[Correlation between the position of the 1st molars and the 3-dimensional trajectory of anterior guidance]. / Etude de la corrélation entre la mise en place des premières molaires et les trajectoires tridimensionnelles du guide antérieur.

This study tries to demonstrate that there is a correlation between the anterior trajectories of the mandible, in the anterior-posterior and lateral directions, and the occlusal morphology of the first permanent molars. The clinical consequences are interesting for prosthetic treatments, in the rehabilitation of anterior and canine guidance, and for orthodontic treatments.

Characteristics and prediction of the alveolar bone loss: essay of modeling.

The alveolar bone loss is a phenomenon which intervenes throughout the life and which can be aggravated by the action of individual and behavioural factors. From this observation we shall try to characterize it and to propose formulas of prediction of the alveolar bone loss according to the age of the patient. We shall expose an analysis of factors bound to the alveolar bone loss and propose a modeling of the alveolar bone loss according to the age in an essentially predictive purpose. The methodology is based on the medical exploitation of CT-dentascanners and medical questionnaire as well as administrative questionnaire used in odontology. Measures of the distance ECJ and the summit of crest are made on the radiology and the individual factors and behavioural factors are scored. The descriptive analysis of the data allowed us to characterize the phenomenon of alveolar bone loss in a therapeutic purpose. The statistical treatment of these data will establish various models according to gender. The described method is simple and its applications seem numerous in the several domains: prevention, improvement of prosthetic and periodontal therapeutics.

Characteristics of tracheostomy phonation valves.

Phonation valves are commonly used devices that allow the restoration of speech in tracheostomised patients. However, their use should not compromise the physiological benefit of tracheostomy. Six commercialised phonation valves were studied in a dynamic set-up simulating a respiratory frequency of 20 breaths.min(-1), a tidal volume of 0.5 L and a peak flow rate of 0.5 L.s(-1). Resistance and additional work of breathing (WOB) were calculated. In 10 tracheostomised patients, evaluations using no phonation valve (baseline), and the most and one of the least resistive valves were carried out. Respiratory patterns and gas exchanges were recorded. Inspiratory difficulty was evaluated using the modified Borg scale. Valves displayed a wide array of resistance ranging 1.3-5.9 cmH2O.L(-1).s(-1). Additional WOB varied with a ratio of 4.4 between the best and the worst valve. While the different clinical conditions did not modify respiratory patterns and gas exchanges, a significant effect on the Borg scale rating was observed using ANOVA and post hoc analysis of baseline versus worst valve and one of the best valves versus worst valve. In conclusion, the variety of aerodynamic characteristics of phonation valves should be considered when choosing the device, according to the underlying condition of the patients benefiting from their use.