Oral emergencies at Strasbourg teaching hospitals during the COVID-19 lockdown: Patient care circuits, typologies, and profiles / Urgences bucco-dentaires aux hôpitaux universitaires de Strasbourg et confinement lié au COVID-19 : parcours, typologie et profils

Purpose of research: We aimed to describe the type of emergencies as well as the population treated for oral emergencies at the Pôle de Médecine et Chirurgie Bucco-Dentaires (Dental Medicine and Surgery Center) of Strasbourg during the COVID-19 lockdown period from March 17 to May 9, 2020.Information on patient care circuits as well as the demographic and clinical data concerning all those who accessed the Center during the study period were collected by questionnaire and from medical files. Pain was rated on a numerical scale from 0 to 10. Diagnoses and treatments provided were divided into clinically relevant classes. During the forty-two days of activity, 2,470 patients were seen and 94.2 percent of them were treated. A constant increase in activity, almost doubling between the beginning and the end of the period, was observed. Pain with an intensity greater than or equal to 5 on the scale was reported by 77.9 percent of patients; pain greater than or equal to 7 by 52.5 percent of patients. Coordination between the various general practice and hospital organizations is necessary to deal with oral emergencies, considering the high number of patients concerned and the associated pain level. This coordination was particularly effective during the COVID-19 lockdown, which led to a massive and constantly increasing recourse to emergency dental care. We were able to describe and detail the consultations for oral emergencies and confirm that the intense associated pain did not allow treatment to be postponed.

But de l'étude: Décrire le type d'urgences ainsi que la population prise en charge pour des urgences bucco-dentaires au Pôle de Médecine et Chirurgie Bucco-Dentaires de Strasbourg au cours de la période de confinement liée au COVID-19 du 17 mars 2020 au 9 mai 2020.Le parcours des patients et les données démographiques et cliniques de l'ensemble des patients s'étant présentés pendant la période étudiée ont été collectées par questionnaire et dans les dossiers médicaux. La douleur a été évaluée sur une échelle numérique. Les diagnostics et les prises en charge ont été divisés en classes cliniquement pertinentes. Pendant les 42 jours d'activité, 2 470 patients se sont présentés et 94.2 % d'entre eux ont été pris en charge. On observe une augmentation constante avec un quasi doublement de l'activité entre le début et la fin de la période. Une douleur d'intensité supérieure ou égale à 5 a été rapportée par 77.9 % des patients ; une douleur supérieure ou égale à 7 par 52.5 % des patients. La coordination entre les différents acteurs de ville et hospitalier est une nécessité pour prendre en charge les urgences bucco-dentaires au vu du nombre de patients concernés et des douleurs associées. Cette coordination a été particulièrement efficace pendant la période de confinement qui a entrainé un recours massif aux soins d'urgence, recours ayant augmenté constamment. Les consultations pour urgences bucco-dentaires ont été détaillées et nous avons confirmé que les intenses douleurs associées ne permettent pas de reporter leur prise en charge.

Accuracy of Age Estimation Using Three Dental Age Estimation Methods in a Young, Large, and Multiethnic Patient Sample.

European countries have become host countries for migrants and unaccompanied minors. However, many migrants arrive without identity documents. Many methods exist to estimate age; among them, several methods using dental age have been proposed. Our objective was to evaluate the accuracy of biological age determination in a multiethnic sample using dental age estimated using three methods: Nolla, Demirjian, and the London Atlas. Orthopantomograms collected for 324 patients of various ethnicities aged from 4 to 20 years old were included. Then, for each orthopantomogram, a blind trained examiner used the three methods of age estimation. For each method, the estimated mean age was greater than the real mean age (p < 0.0001). The accuracy after 18 years old with a 1-year margin was under 50%. Demirjian's method gave a less accurate estimated age than Nolla's method (p < 0.0001) or the London Atlas (p < 0.001). The most accurate methods were those of Nolla and the London Atlas, with average absolute deviations of 1.3 and 1.2 years, respectively. Demirjian's method was much less accurate, with a deviation of around 2 years. The evaluated methods are unable to provide reliable information to determine if an individual is a minor.

The "new normal" of hygiene measures at the end of the COVID-19 epidemic: a survey among French dentists.

OBJECTIVES: The COVID-19 epidemic upset the standards in terms of hygiene and protection in the dental office, bringing additional precautions for dentists. The objective of our study was to draw the "new normal" of hygiene measures at the end of the COVID-19 epidemic. MATERIALS AND METHODS: A self-administered questionnaire about transitional recommendations for oral care in the context of the COVID-19 epidemic was published online in private groups dedicated to French dentists. RESULTS: The 246 respondents understood the reasons behind those recommendations, since 10 out of 11 measures reached a mean score greater than 2.5 on a 0 (not at all) to 4 (absolutely) scale when it came to determining whether the measure made the practitioner feel safe and ensured patient safety. Besides, more of the respondents intended to maintain the measures than they were to apply them before the epidemic. CONCLUSIONS: The COVID-19 epidemic reshaped the relationship to hygiene and protection measures in the context of dental practices. The "new normal" of hygiene measures at the end of the COVID-19 epidemic will probably involve more protective measures than before. CLINICAL RELEVANCE: These results constitute interesting avenues for public health deliberation, which would make it possible to best adapt future health recommendations in order to define the "new normal" of hygiene measures in dental practices at the end of the COVID-19 epidemic. Therefore, it could have an impact on all practitioners in their clinical activities.

Back pain prevention program: An evaluation after a 10-year implementation amongst dental students.

BACKGROUND: Many studies show a higher prevalence of back pain for dentists and dental students than in the general population. This leads to a need to integrate an effective back pain prevention program (BPPP) into the student's curriculum. We have implemented such a program for 10 years, and the objective was to evaluate its effectiveness. MATERIAL AND METHODS: Data from 102 dentists and students who benefited from the BPPP were collected. Back pain prevalence and its intensity (0-10 scale) regarding neck, upper back and lower back location were studied, as well as sex, age, implementation or not of elements of the BPPP into daily practice, and if so at what moment of the professional life. For identical items, answers were compared with those from a national survey conducted amongst French students and practitioners in 2018. RESULTS: Amongst the BPPP beneficiaries, 60% were suffering from chronic back pain versus 77% in the previous national survey (p < .001). Mean pain intensity was lower in each location for the BPPP beneficiaries on the 0-10 scale: neck 1.91 vs. 2.40 (p = .05); upper back 1.94 vs. 2.72 (p < .001); lower back 2.26 vs. 2.67 (p = .15). Respondents who implemented elements of the BPPP from the start of their clinical practice showed a prevalence of chronic back pain of 48.4%, against 77% for respondents who did so only from the first year or after (p < .05). CONCLUSION: Our BPPP seems to show a positive preventive effect on dentists and students after a 10-year implementation. It is a solid basis that can however be further improved.

Orofacial problems in scuba diving: prevalence and prevention-a large-scale survey among civilian divers in France.

Self-contained underwater breathing apparatus (SCUBA) diving is becoming widely democratized among hobbyist practitioners. It can cause orofacial problems, mostly linked to pressure changes. The aim of this study was to assess the prevalence of these problems and to analyze civilian divers' behavior about their dental prevention in France, via a cross-sectional study. Data from 1015 French civilian divers were collected via a nationwide online questionnaire in which participants indicated information concerning orofacial experienced problems during their diving activity, and their medical preventive habits. As results, oral manifestations were experienced by 25.2% of the divers, including barodontalgia (10.8%), mouth syndrome (13.4%), gum pain (2.8%) and dental fractures caused by barotrauma (3.7%) or shocks (1.9%). Mouth syndrome was more frequent among women (18.6%) and divers aged between 18 and 34 years (18.9%). The prevalence of dental fractures increased significantly with age. High diving level was associated with more frequent barodontalgia (17.5%), gum pain (7%) and barotrauma (7.6%). Among respondents, 43.5% completed a dental examination before a diving season and showed fewer oral problems during their scuba diving practice than those who did not. In conclusion, oral problems in scuba diving represent frequent events that can compromise the safety of divers. Despite awareness rising, there is a lack of recourse to the dentist. This leads to incomplete information, especially concerning the preventive means available to divers.

Comparative effectiveness of nonsurgical interventions in the treatment of patients with knee osteoarthritis: A PRISMA-compliant systematic review and network meta-analysis.

BACKGROUND: To find out, based on the available recent randomized controlled trials (RCTs), if the nonsurgical interventions commonly used for knee osteoarthritis patients are valid and quantify their efficiency. METHODS: The database of MEDLINE and EMBASE were searched for RCTs evaluating nonsurgical treatment strategies on patients with mild to moderate knee osteoarthritis. A Bayesian random-effects network meta-analysis was performed. The primary outcome was the mean change from baseline in the Western Ontario and McMaster university (WOMAC) total score at 12 months. Raw mean differences with 95% credibility intervals were calculated. Treatments were ranked by probabilities of each treatment to be the best. RESULTS: Thirteen trials assessed 7 strategies with WOMAC at 12 months: injection of platelet rich plasma (PRP), corticosteroids, mesenchymal stem cells (MSCs), hyaluronic acid, ozone, administration of nonsteroidal anti-inflammatory drugs with or without the association of physiotherapy. For treatment-specific effect size, a greater association with WOMAC decrease was found significantly for MSCs (mean difference, -28.0 [95% CrI, -32.9 to -22.4]) and PRP (mean difference, -19.9 [95% CrI, -24.1 to -15.8]). Rank probabilities among the treatments indicated that MSCs had a much higher probability (P = .91) of being the best treatment compared with other treatments, while PRP ranked as the second-best treatment (P = .89). CONCLUSION: In this systematic review and network meta-analysis, the outcomes of treatments using MSCs and PRP for the management of knee osteoarthritis were associated with long-term improvements in pain and function. More high quality RCTs would be needed to confirm the efficiency of MSCs and PRP for the treatment of patients with knee osteoarthritis.

Mechanistic Illustration: How Newly-Formed Blood Vessels Stopped by the Mineral Blocks of Bone Substitutes Can Be Avoided by Using Innovative Combined Therapeutics.

One major limitation for the vascularization of bone substitutes used for filling is the presence of mineral blocks. The newly-formed blood vessels are stopped or have to circumvent the mineral blocks, resulting in inefficient delivery of oxygen and nutrients to the implant. This leads to necrosis within the implant and to poor engraftment of the bone substitute. The aim of the present study is to provide a bone substitute currently used in the clinic with suitably guided vascularization properties. This therapeutic hybrid bone filling, containing a mineral and a polymeric component, is fortified with pro-angiogenic smart nano-therapeutics that allow the release of angiogenic molecules. Our data showed that the improved vasculature within the implant promoted new bone formation and that the newly-formed bone swapped the mineral blocks of the bone substitutes much more efficiently than in non-functionalized bone substitutes. Therefore, we demonstrated that our therapeutic bone substitute is an advanced therapeutical medicinal product, with great potential to recuperate and guide vascularization that is stopped by mineral blocks, and can improve the regeneration of critical-sized bone defects. We have also elucidated the mechanism to understand how the newly-formed vessels can no longer encounter mineral blocks and pursue their course of vasculature, giving our advanced therapeutical bone filling great potential to be used in many applications, by combining filling and nano-regenerative medicine that currently fall short because of problems related to the lack of oxygen and nutrients.

Changes in tooth brushing frequency and its associated factors from 2006 to 2014 among French adolescents: Results from three repeated cross sectional HBSC studies.

OBJECTIVES: This study aimed to evaluate in the changes in the percentage of adolescents who brush their teeth twice a day and the association with socio-economic status and health behaviors between 2006, 2010 and 2014 among adolescents from the French cross-sectional studies of the Health Behavior in School-aged Children (HBSC) survey. METHODS: Our sample included 18727 adolescents aged 11, 13 or 15 years old (y/o). The relationship between toothbrushing frequency (TBF) and eating habits, health and socio-economic status markers, family status, school perception, substance use, sedentary lifestyle and physical activity, together with their evolution over the 3 studies, were investigated using multivariate logistic regression. RESULTS: The proportion of adolescents brushing twice a day increased from 68.8% in 2006 to 70.8% in 2010 and 78.8% in 2014 (p<0.0001). Notable associated factors (p<0.0001) were: being a girl (adjusted Odds Ratio = 1.5) and, even more, an older girl (aOR 1.5 for 15 y/o vs 11 y/o girls), having breakfast (aOR 1.4) and eating fruits daily (aOR 1.6), excellent perceived health (aOR 1.2), obesity or overweight (aOR 0.6), being bullied at school (aOR 0.8), and perceived family wealth (aOR 1.4 for High vs Low). No impact from any associated factor changed over the 3 studies. CONCLUSIONS: Among French adolescents, TBF improved from 2006 to 2014. TBF was significantly associated with other health behaviors. These associations stayed similar in 2006, 2010 and 2010. This increase in TBF may be linked with global prevention programs developed during this time period. These programs should be maintained and associated with more specific ones targeting and adapted to disadvantaged populations, in order to reduce inequalities in oral hygiene and oral health.

Mobile Dental Delivery System: An Effective Protocol for Hygiene and Disinfection.

Mobile dental delivery systems (MDDSs) are receiving growing interest for reaching isolated patients, as well as in dental care for fragile and hospitalized patients, with the advantage of being able to be used from room to room or during general anesthesia (GA) in an operating room. Therefore, ensuring the care safety is crucial. The aim of this study was to elaborate and assess an MDDS maintenance protocol, containing the management of dental unit waterlines and adapted to specific conditions such as dental care under GA. A step-by-step protocol was established and implemented for an MDDS used during dental care under GA in children. Samples of the output water were collected at J0, J+1, 3, 6, 12, and 24 months, and cultured to observe the microbiological quality of the water. All the results (heterotrophic plate count at 22 °C, at 37 °C, and specific pathogenic germs sought) showed an absence of contamination. The protocol presented was effective over time and allowed ensuring the safety of care to be ensured when using MDDS, even during dental procedures under GA. As a result, it could be implemented by any dental care delivery structure wanting to reinforce the safety of its practice.

Back pain prevalence, intensity and associated factors in French dentists: a national study among 1004 professionals.

OBJECTIVES: Back pains are the most frequent musculoskeletal disorders among dentists, exposed to many work-related risk factors. We aimed to assess the prevalence and intensity of back pains as well as the impact of some work behaviors among a large sample of dentists. MATERIALS AND METHODS: Data from 1004 French dentists were collected via an Internet questionnaire. Neck, upper back and lower back pains prevalence, intensity (0-10 scale) and consequences on work were studied, as well as sex, age, years of practice, working position, type of seat, stretching on work days. RESULTS: Dentists were 77.9% to report chronic back pains, with intensity from 3.9 to 4.3 according to location. Women reported more frequent and intense pains than men in neck and upper back (OR 1.5). Age and years of practice were associated with more intense pains (OR up to 3.9), dentists alternating standing and sitting positions reported more frequent and more intense pains in upper and lower back (OR up to 1.5) than those with a fixed position, be it sitting or standing. CONCLUSIONS: Prevalence and intensity of back pain are important among dentists and increase greatly over working life. Preventive methods such as ergonomics exist and awareness should be raised among dentists and dental student. These slides can be retrieved under Electronic Supplementary Material.

Polymer-Based Instructive Scaffolds for Endodontic Regeneration.

The challenge of endodontic regeneration is modulated by clinical conditions which determine five kinds of tissue requirements: pulp connective-tissue formation, dentin formation, revascularization, reinnervation and radicular edification. Polymer scaffolds constitute keystone of the different endodontic regenerative strategies. Indeed, scaffolds are crucial for carrying active molecules and competent cells which optimize the regeneration. Hydrogels are very beneficial for controlling viscosity and porosity of endodontic scaffolds. The nanofibrous and microporous scaffolds mimicking extracellular matrix are also of great interest for promoting dentin-pulp formation. Two main types of polymer scaffolds are highlighted: collagen and fibrin. Collagen scaffolds which are similar to native pulp tissue, are adequate for pulp connective tissue formation. Functionnalization by active biomolecules as BMP, SDF-1, G-CSF enhances their properties. Fibrin or PRF scaffolds present the advantage of promoting stem cell differentiation and concomitant revascularisation. The choice of the type of polymers (polypeptide, PCL, chitosan) can depend on its ability to deliver the active biomolecule or to build as suitable hydrogel as possible. Since 2010s, proposals to associate different types of polymers in a same scaffold have emerged for adding advantages or for offsetting a disadvantage of a polymer. Further works would study the synergetic effects of different innovative polymers composition.

The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial.

OBJECTIVES: To assess the effect of periodontal treatment on clinical and biochemical parameters of rheumatoid arthritis (RA) and quality of life (QoL) in patients with moderately active RA who were diagnosed with periodontitis. METHODS: In this open-label randomised controlled trial, RA subjects (n = 22) were allocated to "immediate" or "delayed" periodontal treatment (full-mouth non-surgical scaling and root planing, systemic antibiotics, and oral hygiene instructions). The main outcome was the 3-month change on the Disease Activity Score 28 based on the Erythrocyte Sedimentation Rate (DAS28-ESR). The Health Assessment Questionnaire and the General Oral Health Assessment Index were used to assess general and oral health QoL, respectively. RESULTS: Periodontal health significantly improved after periodontal treatment (P = 0.03). Periodontal treatment appeared to be safe but led to no significant effects on the DAS28-ESR (adjusted mean difference with 95% confidence interval (aMD) of -0.03 [-0.98; 0.92]). There was no evidence of improvement in the general QoL after periodontal treatment and no significant effect was found for the oral health QoL, despite a positive trend in the "psychological impacts" domain (aMD of 0.13 [-0.07; 0.33], P = 0.20). CONCLUSIONS: Although no clinical effect of periodontal treatment on RA was identified, this trial provides important data to support periodontal care in RA patients. Periodontal treatment is safe and reduces oral inflammation with a possible effect on oral health QoL. Since both periodontitis and RA are complex and multifactorial chronic diseases, it is likely that patient-centred approaches involving both oral health professionals and rheumatologists will contribute to optimal patient care. ISRCTN79186420.

Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management.

Bone replacement might have been practiced for centuries with various materials of natural origin, but had rarely met success until the late 19th century. Nowadays, many different bone substitutes can be used. They can be either derived from biological products such as demineralized bone matrix, platelet-rich plasma, hydroxyapatite, adjunction of growth factors (like bone morphogenetic protein) or synthetic such as calcium sulfate, tri-calcium phosphate ceramics, bioactive glasses, or polymer-based substitutes. All these substitutes are not suitable for every clinical use, and they have to be chosen selectively depending on their purpose. Thus, this review aims to highlight the principal characteristics of the most commonly used bone substitutes and to give some directions concerning their clinical use, as spine fusion, open-wedge tibial osteotomy, long bone fracture, oral and maxillofacial surgery, or periodontal treatments. However, the main limitations to bone substitutes use remain the management of large defects and the lack of vascularization in their central part, which is likely to appear following their utilization. In the field of bone tissue engineering, developing porous synthetic substitutes able to support a faster and a wider vascularization within their structure seems to be a promising way of research.

Socioeconomic and behavioral determinants of tooth brushing frequency: results from the representative French 2010 HBSC cross-sectional study.

OBJECTIVES: To describe tooth brushing frequency and its association with a wide range of socioeconomic and behavioral characteristics, using a nationally representative sample of school-aged children in France. METHODS: Our sample included 11,337 students aged from 10 to 16 years, who answered the HBSC questionnaire. Some variables were grouped into composite variables, thus generating scores for: eating habits, health and body, relationships with parents, socioeconomic status (SES) of family, and school life. Multivariate logistic regression analyses were used to study the relationship between these variables and tooth brushing frequency. RESULTS: Girls were more likely to brush twice a day than boys [adjusted Odds Ratio: aOR 2.47, 95 percent confidence interval CI95% (1.97; 3.11), aOR 1.89, CI95% (1.56; 2.29), aOR 1.45, CI95% (1.25; 1.68) for low, mid, and high school life score, respectively]. Students were more likely to brush twice a day when they had high (versus low) scores for healthy eating habits [aOR = 1.60; 95 percent CI: (1.40; 1.83)], well-being concerning health and body [aOR = 1.61; 95 percent CI: (1.40; 1.86)] and SES [aOR = 1.25; 95 percent CI: (1.09; 1.43)]. CONCLUSIONS: We believe that preventive health campaigns should target school and family environments more specifically to reach the most disadvantaged sections of the population and include promotion of whole health. The messages should be designed to efficiently reach adolescents, e.g., by appealing to their maturity, self-esteem, and emotional factors. Through the incorporation of qualitative research elements, identifying the reasons for not brushing twice a day would also help to develop new prevention programs.