The oral health component of «100% santé¼ reform: initial descriptive elements / Le volet bucco-dentaire de la réforme 100 % santé : premiers éléments descriptifs

The "100% Santé" (100% Health) reform constitutes a major change to oral health pricing and insurance practices in France. The objective of this study was to observe the evolution of dental care consumption, and in particular prosthetic care, over a period including the years before and after the reform. This exploratory study, based on descriptive data, provides the first elements of analysis useful for evaluating the oral health component of the "100% Santé" reform. The study is based on the health care consumption data of 3,466,764 state health insurance beneficiaries aged three to twenty-five years in Occitania, covering the period from January 1, 2016, to December 31, 2020. The descriptive analysis of this data revealed that prosthodontic care is the only area to show an increase in the average amount of care consumed between 2019 and 2020: a relative increase of +4 percent among 3­25-year-olds and +6.7 percent among 21­25-year-olds. Moreover, among 21­25-year-olds, we observe a drop in the share of prostheses in the care consumed in 2019, and then a recovery approaching 0.3 percent of the initial share in 2020. Although it is not possible to conclude that there is an impact, these results show a positive trend whereby the reform's objective of increasing prosthodontic care consumption seems to have been achieved. This study highlights the importance of assessing the long-term impact of the COVID-19 crisis and the "100% Santé" reform on dental care consumption.

La réforme 100 % Santé est un choc important dans les pratiques tarifaires et assurantielles en santé orale en France. L'objectif de l'étude est d'observer l'évolution de la consommation de soins dentaires et notamment prothétiques sur une période regroupant des années ante- et post-réforme. Cette étude exploratoire, soutenue par des travaux de recherche descriptifs, fournit les premiers éléments d'analyse utiles pour évaluer la réforme 100 % santé sur le volet bucco-dentaire. Il s'agit d'une étude exploratoire reposant sur les données de consommation de soins de 3 466 764 bénéficiaires de 3-25 ans de l'Assurance maladie en Occitanie, sur la période allant du 1er janvier 2016 au 31 décembre 2020. L'analyse descriptive de ces données a permis de mettre en évidence que les soins prothétiques sont les seuls soins consommés dont la moyenne augmente entre 2019 et 2020 : hausse relative de +4 % chez les 3-25 ans et +6,7 % chez les 21-25 ans. De plus, chez les 21-25 ans, on observe un recul de la part des prothèses dans les soins consommés en 2019, puis un regain se rapprochant de 0,3 % de la part initiale en 2020. Malgré l'impossibilité de conclure à un réel effet, ces résultats montrent une tendance positive selon laquelle l'objectif d'augmentation de la consommation des soins prothétiques de la réforme semble se réaliser. Cette étude souligne l'importance d'évaluer les répercussions à long terme de la crise Covid et de la réforme 100 % Santé sur les consommations de soins dentaires.

Teledentistry, new oral care tool for prisoners.

Purpose In France, all incarcerated prisoners are required to undergo a dental examination (Ministère de la santé et de la protection sociale, 2004 and Ministère de la justice, 2004). However, only one in two prisoners benefits from this oral health check-up. Oral teleconsultation could improve the quality of oral care in prisons. The paper aims to discuss these issues. Design/methodology/approach The focus of this study was therefore to apply oral teleconsultation as an experiment. Using an oral teleconsultation system, a dentist and a nurse were separately asked to give patients a score, according to how urgently their dental issue needed to be treated. This score will henceforth be referred to as the "dental emergency scores given". Findings The separate dental emergency scores given by the dentist and the nurse were compared and the results demonstrate the following: - 36.7 per cent (11) of the two scores were equal - 53.3 per cent (16) of the two scores differed by 1 point - 10 per cent (3) of the two scores differed by 2 points. The average score of the nurse was 2.23 and that of the dentist was 2.13. The small disparity should not obscure the fact that 63 per cent of the diagnoses turned out to be incorrect. Practical implications Dental care could easily be improved with oral teleconsultation as a care plan could be developed for each patient. Social implications The condition of one's dental health is, of course, very important for general health, but it also affects social aspects. Good oral hygiene and health are very important when looking for a job after having been released from prison. Originality/value This is the first study on oral teleconsultation in prisons. Dental care is rarely studied on prisoners. Telemedicine in dentistry is just beginning all over the world. This study is the first step of an extensive project in the University Hospital of Montpellier and the Villeneuve-les-Maguelone prison.

Development of a new quantitative gas permeability method for dental implant-abutment connection tightness assessment.

BACKGROUND: Most dental implant systems are presently made of two pieces: the implant itself and the abutment. The connection tightness between those two pieces is a key point to prevent bacterial proliferation, tissue inflammation and bone loss. The leak has been previously estimated by microbial, color tracer and endotoxin percolation. METHODS: A new nitrogen flow technique was developed for implant-abutment connection leakage measurement, adapted from a recent, sensitive, reproducible and quantitative method used to assess endodontic sealing. RESULTS: The results show very significant differences between various sealing and screwing conditions. The remaining flow was lower after key screwing compared to hand screwing (p = 0.03) and remained different from the negative test (p = 0.0004). The method reproducibility was very good, with a coefficient of variation of 1.29%. CONCLUSIONS: Therefore, the presented new gas flow method appears to be a simple and robust method to compare different implant systems. It allows successive measures without disconnecting the abutment from the implant and should in particular be used to assess the behavior of the connection before and after mechanical stress.

Oral hygiene and the need for treatment of the dependent institutionalised elderly.

OBJECTIVE: To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. BACKGROUND: For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. MATERIALS AND METHODS: From 2003 to 2004, a cross-sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. RESULTS: The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. CONCLUSION: The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.