Autistic patients: a retrospective study on their dental needs and the behavioural approach.

INTRODUCTION: Autism spectrum disorder (ASD) is a lifelong heterogeneous psychiatric disorder that represents a challenge for dentists. The aim of this retrospective study was to analyse ASD patients' dental needs and to investigate key factors influencing the behavioural management. MATERIALS AND METHODS: One hundred eighteen ASD subjects (levels 2 and 3 of the DSM-5), adults and children, treated at university dental hospital, were included. For each of them, an index card was created to record general and medical information, dental care progress and treatment management. Data were analysed to characterize this specific population in terms of dental needs, technical approach and follow-up. The relationships between care approach and age (ANOVA test), care approach and concomitant pathologies as well as care approach and required treatment (chi-square test) were evaluated. RESULTS: Almost all patients required oral care. No treatment could be provided under conscious conditions. Oral premedication and/or nitrous oxide/oxygen inhalation was significantly more efficient in children and allowed conservative procedures. In adults, general anaesthesia was significantly more employed. Few patients were followed up over a long period. CONCLUSIONS: The variety of autism spectrum disorders complicates the statement of guidelines for dental care. The development of the collaboration between psychiatrics and dentists emerges as a key factor to improve the quality and the success of oral outpatient treatment. CLINICAL RELEVANCE: Oral premedication and/or nitrous oxide/oxygen inhalation at high dose represented a good way to carry out conservative dental cares, with a significant efficiency in children. Nevertheless, in a considerable number of ASD patients, especially in adults, general anaesthesia could not be avoided.

[Dental care for disabled people]. / Soins bucco-dentaires pour les patients handicapés.

CONTEXT: Patients with disabilities represent a population with special needs whose dental care management constitutes a public health problem. This article describes dental care of disabled people in a hospital dental care unit to highlight the difficulties encountered and propose ways to improve this care. METHODS: A retrospective descriptive study was carried out on patients followed between 2010 and 2016 as part of the partnership between the Albert Chenevier Hospital odontology department and the RHAPSOD'IF network. The data collected by means of ?follow-up sheets? described the procedures performed and any medication used. These anonymised records were analysed by Excel software. RESULTS: Dental care sessions for the 434 disabled persons consisted of visits (42 to 57%), restorations and scalings each represented 1/6 of all procedures performed (14 to 19% and 14 to 18%), and surgery and radiography each represented 1/8 of procedures (4 to 12% and 6 to 11%). There were almost no dental prostheses (0 to 1%). Most dental care sessions were performed without premedication (61 to 76%). CONCLUSION: This type of dental care requires training of families and caregivers, a good interpersonal approach and time to build a relationship of trust. Participation in a network is important to help, support, and advise the practitioner and to provide financial support.

[Oral hygiene prevention actions at Albert Chenevier hospital: Open day for schools]. / Actions de prévention bucco-dentaire à l’hôpital Albert Chenevier : journée « portes ouvertes ¼ pour les écoles.

BACKGROUND: Since 1994, the dental department of Albert Chenevier hospital in Créteil organizes an "open day" for schoolchildren in Creteil. This action is organized in collaboration with the Creteil Social Action Community Centre (CCAS) health prevention service and is part of a prevention programme designed to reduce caries prevalence in children aged 6 to 7 years. This programme helps especially children from disadvantaged groups or with disabilities. We want to report results for the last three years. METHODS: Allezard and Beauvin schools and La Nichée and Leloup special schools attended this open day, consisted of two parts. The first part concerned prevention, designed to teach children to brush their teeth. The second part consisted of screening of tooth decay. CCAS provided disposable toothbrushes, toothpaste and examination instruments. The Albert Chenevier hospital dental department provided hospital personnel, appropriate hygiene materials and premises. RESULTS: About 50% of children of all ages and from all schools presented tooth decay. The use of dental care decreased between 2011 and 2013 for Allezard and Beauvin schools. It was 100% in 2011 and 2012 for special schools and virtually zero for the Beauvin special school for disabled children. Dental care decreased from year to year for these special classes and for special schools. About 20% of children at the Allezard school had good oral hygiene. CONCLUSION: The effect of health education activities can be improved by involving the child's family. Oral hygiene must be based on a collective approach in which everyone has a role to play: children, parents, educators, teachers, principals and nursing staff should be involved to ensure continuing improvement of oral hygiene and to try to promote access to care. This preventive action therefore remains necessary and the information must be repeated.

Regional odontodysplasia: expression of matrix metalloproteinases and their natural inhibitors.

Regional odontodysplasia is a localized disorder of tissues of dental origin that results in a ghost-like appearance of the affected teeth. We present a case with a study of gingival tissue around the follicle. The results show evidence of the role of the matrix metalloproteinases and their natural inhibitors by resident cells in this pathosis. An imbalance in the amounts of matrix metalloproteinases and their natural inhibitors is associated with the pathologic breakdown of the collagen.