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.

T1 Mapping for Microstructural Assessment of the Cervical Spinal Cord in the Evaluation of Patients with Degenerative Cervical Myelopathy.

BACKGROUND AND PURPOSE: Although current radiologic evaluation of degenerative cervical myelopathy by conventional MR imaging accurately demonstrates spondylosis or degenerative disc disease causing spinal cord dysfunction, conventional MR imaging still fails to provide satisfactory anatomic and clinical correlations. In this context, we assessed the potential value of quantitative cervical spinal cord T1 mapping regarding the evaluation of patients with degenerative cervical myelopathy. MATERIALS AND METHODS: Twenty patients diagnosed with mild and moderate-to-severe degenerative cervical myelopathy and 10 healthy subjects were enrolled in a multiparametric MR imaging protocol. Cervical spinal cord T1 mapping was performed with the MP2RAGE sequence procedure. Retrieved data were processed and analyzed regarding the global spinal cord and white and anterior gray matter on the basis of the clinical severity and the spinal canal stenosis grading. RESULTS: Noncompressed levels in healthy controls demonstrated significantly lower T1 values than noncompressed, mild, moderate, and severe stenotic levels in patients. Concerning the entire spinal cord T1 mapping, patients with moderate-to-severe degenerative cervical myelopathy had higher T1 values compared with healthy controls. Regarding the specific levels, patients with moderate-to-severe degenerative cervical myelopathy demonstrated a T1 value increase at C1, C7, and the level of maximal compression compared with healthy controls. Patients with mild degenerative cervical myelopathy had lower T1 values than those with moderate-to-severe degenerative cervical myelopathy at the level of maximal compression. Analyses of white and anterior gray matter confirmed similar results. Strong negative correlations between individual modified Japanese Orthopaedic Association scores and T1 values were also observed. CONCLUSIONS: In this preliminary study, 3D-MP2RAGE T1 mapping demonstrated increased T1 values in the pathology tissue samples, with diffuse medullary alterations in all patients with degenerative cervical myelopathy, especially relevant at C1 (nonstenotic level) and at the maximal compression level. Encouraging correlations observed with the modified Japanese Orthopaedic Association score make this novel approach a potential quantitative biomarker related to clinical severity in degenerative cervical myelopathy. Nevertheless, patients with mild degenerative cervical myelopathy demonstrated nonsignificant results compared with healthy controls and should now be studied in multicenter studies with larger patient populations.

[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.

Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups.

Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).

Fluoride Use in Health Care Settings: Association with Children's Caries Risk.

Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).

Examining caries aetiology in adolescence with structural equation modelling.

OBJECTIVES: This analysis examines the aetiology of caries development in adolescents using structural equation modelling to identify behavioural mediators of the relationship between socioeconomic status (SES) and caries incidence, and to investigate the role of sex on caries-preventive behaviour and caries. METHODS: This analysis was based on data from the Iowa Fluoride Study, a longitudinal study of a birth cohort. We hypothesized that socioeconomic status earlier in life has a direct effect on caries development and an indirect effect from improved behavioural variables-dental visit attendance, toothbrushing frequency and percentage of beverage intake consisting of sugar-sweetened beverages-and that sex also plays a role in behavioural variables, as well as caries. A structural equation model was developed based on these hypotheses, and direct and indirect standardized path coefficients were calculated, as well as their standard errors. RESULTS: Based on our proposed model, SES at birth significantly influences SES during adolescence, but not adolescent behaviours. The effect of SES during adolescence on caries in the permanent dentition is mediated by adolescent behaviours. Female participants have worse caries than male participants, despite lower self-reported percentages of sugar-sweetened beverage intake and more frequent brushing and dental attendance. CONCLUSIONS: This analysis models the relationships among known causal factors for caries and suggests that the role of SES in caries may not be as important as previously thought and different behaviours that affect oral health between males and females as well as differences in caries between the sexes could begin during adolescence. These findings could help improve caries prevention programmes for adolescents.

Frequency of daily tooth brushing: predictors of change in 9- to 11-year old US children.

OBJECTIVE: To investigate whether an increase in daily tooth brushing frequency in children was predicted by either a) having a strong intention to brush twice a day or b) their parents receiving information about their new caries experience. BASIC RESEARCH DESIGN: Secondary data analyses were conducted on two waves of data from the Aban Aya Youth Project and the Iowa Fluoride Study. PARTICIPANTS: The Aban Aya study included 576 10- and 11-year olds from Chicago, Illinois. The Iowa Fluoride Study included a convenience sample of 709 babies born in Iowa. The present study includes those children at age 9. MAIN OUTCOME MEASURES: In both studies, reported daily tooth brushing frequency was assessed twice six months apart. RESULTS: In the Aban Aya data, compared with children with a weak intention at wave 1 to brush twice a day, children with a strong intention to brush twice a day were more likely to increase their brushing frequency by wave 2, OR 7.0, 95%CI 1.5,32.9. In the Iowa Fluoride Study, compared with children who did not have new caries at wave 1, children who had new caries experience were less likely to increase their brushing frequency by wave 2, OR 0.4, 95%CI 0.2,0.9. CONCLUSIONS: Strengthening intention to brush twice a day might increase children's brushing frequency. However, simply providing parents with information about new caries probably will not. Future studies should assess tooth brushing frequency, habit strength, intention, and situational cues at closely-spaced waves.

[Arthroscopic assessment of articular fractures of distal radius osteosyntheses by percutaneous pins]. / Bilan arthroscopique des fractures articulaires du radius distal ostéosynthésées par des techniques d'embrochage percutanée.

OBJECTIVES: We studied the radiological results of percutaneous pinning in articular fractures of the distal radius. We did not, thereby, have a method of direct ligamentous and articular assessment. We realized an anatomical arthroscopic assessment at six weeks of osteosynthesis of wrists. The purpose was to study the correlation between the presence of anatomical lesions and the functional result. METHODS: Thirty-five patients presenting an articular fracture with posterior displacement were included; 30 women and five men. The mean age was 62 years. All the patients were right -handed and this was the fractured side in 18 patients. The patients had clinical and radiological follow-up at three, six, 12 weeks and one year. Surgical techniques were Py or Kapandji pinning. An arthroscopy of the wrist was carried out at six weeks from the fixation at pin removal. An assessment of ligamentous lesions and quality of articular reduction was performed. RESULTS: Twenty-eight per cent of the patients had ligamentous lesions. Nine patients presented an interfragmentary distance greater than 1mm. Two patients had an articular step as high as 2mm. CONCLUSIONS: Clinical examination did not show any correlation between the anatomical imperfections noted at the time of arthroscopy and the function of the wrist at one year postoperative, regardless of the technique used.