RESUMO
WNT10A gene encodes a canonical wingless pathway signaling molecule involved in cell fate specification as well as morphogenetic patterning of the developing ectoderm, nervous system, skeleton, and tooth. In patients, WNT10A mutations are responsible for ectodermal-derived pathologies including isolated hypo-oligodontia, tricho-odonto-onycho-dermal dysplasia and Schöpf-Schulz-Passarge syndrome (SSPS). Here we describe the dental, ectodermal, and extra-ectodermal phenotypic features of a cohort of 41 patients from 32 unrelated families. Correlations with WNT10A molecular status (heterozygous carrier, compound heterozygous, homozygous) and patient's phenotypes were performed. Mild to severe oligodontia was observed in all patients bearing biallelic WNT10A mutations. However, patients with compound heterozygous mutations presented no significant difference in phenotypes compared with homozygous individuals. Anomalies in tooth morphology were frequently observed with heterozygous patients displaying hypodontia. No signs of SSPS, especially eyelids cysts, were detected in our cohort. Interestingly, extra-ectodermal signs consisted of skeletal, neurological and vascular anomalies, the latter suggesting a wider phenotypic spectrum associated with WNT10A mutations. Indeed, the Wnt pathway plays a crucial role in skeletal development, lipid metabolism, and neurogenesis, potentially explaining patient's clinical manifestations.
Assuntos
Estudos de Associação Genética , Mutação/genética , Dente/patologia , Proteínas Wnt/genética , Adolescente , Adulto , Criança , Estudos de Coortes , Tomografia Computadorizada de Feixe Cônico , Ectoderma/patologia , Heterozigoto , Homozigoto , Humanos , Mandíbula/patologia , Pessoa de Meia-Idade , Fenótipo , Dente/diagnóstico por imagem , Adulto JovemRESUMO
PURPOSE: It is traditionally considered that breaking bad news to patients does not represent a cause for concern for dental professionals. However, there are situations where they will be confronted with this task, as in the case of rare dental diseases. Little information is available regarding the feelings of healthcare professionals on this subject. There are no qualitative studies that explore how a diagnosis of oligodontia is announced to patients by dentists and orthodontists. The aim of our study is to explore the difficulties and ethical issues experienced by dental health professionals when they have to announce a diagnosis of oligodontia to a patient and their family. METHODS: This study relied on a qualitative research method using focus groups of dentists and orthodontists and a thematic analysis procedure. RESULTS: The difficulties experienced could be summarised within five topics: organisational difficulties, difficulties with the management of dental treatment and with the administrative management associated with this anomaly, difficulties with the content of the announcement, and relational difficulties. These could be grouped in two categories: practical difficulties and ethical difficulties. CONCLUSION: This survey allowed us to understand the difficulties encountered by dentists and orthodontists when announcing oligodontia. The participants felt uncomfortable with this task and were under stress. They reported difficulties in delivering the medical information and in adapting to the message. It is essential that dental professionals develop skills in medical communication.
Assuntos
Relações Dentista-Paciente , Odontólogos , Grupos Focais , Pesquisa Qualitativa , Humanos , França , Odontólogos/ética , Odontólogos/psicologia , Feminino , Relações Dentista-Paciente/ética , Ética Odontológica , Masculino , Ortodontistas/ética , Revelação da Verdade/ética , Anodontia , Atitude do Pessoal de Saúde , AdultoRESUMO
BACKGROUND: This study aims to evaluate whether an e-learning curriculum was sufficient to impart the necessary knowledge to dentists to allow them to implement an oral health promotion intervention in an institution for persons with disability. MATERIALS AND METHODS: Participants were asked to complete a 10-module online training course and to implement a standardised intervention in an institution. The outcome measures were as follows: online tracking of progress; multiple choice questionnaires completed at the end of most modules; self-efficacy questionnaire completed before and after online training; completion of training and calibration in the use of a standardised risk assessment form; initiation and full completion of an oral health promotion intervention in an institution; satisfaction of participants with the online training experience; and evaluation of the impact of the intervention by the institution staff. RESULTS: The study sample included 26 dentists. The 10 modules were passed by 24 dentists, and the mean value of the highest overall score recorded in the multiple questionnaires was 88.4% (± 4.0). Twenty participants completed the self-efficacy questionnaire before and after training; the mean values of scores after training were statistically different and higher than those at baseline. Questionnaire regarding satisfaction with the online training experience was completed by 22 participants; all of them stated that they were satisfied with the online training experience. CONCLUSIONS: The results indicate that the online training course helped participants to increase self-efficacy and to provide interventions in institutions. This study could have implications for both undergraduate and postgraduate dental education in France.
Assuntos
Currículo , Pessoas com Deficiência/educação , Educação em Odontologia/métodos , Educação a Distância/métodos , Promoção da Saúde/métodos , Saúde Bucal/educação , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Medição de Risco/métodos , Autoeficácia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Postural control is classically described as being based on the visual, vestibular, and proprioceptive musculo-articular sensory systems. The influence of mandibular proprioception on postural stabilization remains controversial. Most previous studies analyzed how postural stability is influenced by partial changes in mandibular proprioception (dental occlusion and jaw position). RESEARCH QUESTION: In the present experiment, we asked whether drastic mandibular changes, resulting from orthognathic surgery (including dental, joint and muscular efferents), modify postural control. METHODS: The analyzes were performed in 22 patients tested before, and 2.5 months, after orthognathic surgery for treatment of dysmorphic jaws. Experiments were performed under 4 experimental conditions: 2 visual conditions: Eyes Open (EO) and Eyes Closed (EC), and 2 occlusal conditions: Occlusion (OC: mandible positioned by the contact of the teeth), and Rest Position (RP: mandible positioned by the muscles without tooth contact). The analyses focused on head orientation in the frontal plane and on postural stabilization in a static task, consisting of standing upright. RESULTS: The results show that, 2.5 months after orthognathic surgery, head orientation in the frontal plane was improved, since patient's external intercanthal lines became closer to the true horizontal line when they were tested EC and in OC condition. Postural responses, based on the wavelet transformation data, highlight an improvement in maintaining an upright stance for all the tested sensory conditions. However, such improvement was greater in the EC and RP conditions. SIGNIFICANCE: These results show, for the first time, that after drastic mandibular changes, the weight of proprioceptive cues linked to the mandibular system may be so enhanced that it may constitute a new reference frame to orient the head in space, in darkness, and improve static postural stabilization, even in the presence of visual cues.
Assuntos
Mandíbula/fisiopatologia , Procedimentos Cirúrgicos Ortognáticos/métodos , Equilíbrio Postural/fisiologia , Postura/fisiologia , Propriocepção/fisiologia , Adulto , Sinais (Psicologia) , Feminino , Humanos , Anormalidades Maxilomandibulares/complicações , Anormalidades Maxilomandibulares/cirurgia , Masculino , Mandíbula/cirurgia , Orientação Espacial/fisiologiaRESUMO
Bruxism is defined as repetitive activity of the masticatory muscles, characterized by clenching the teeth or teeth grinding and/or by tapping and swaying. This study investigated sleep bruxism. The etiology is multifactorial: mainly central (neuropathic disorder, anxiety) but also genetic and local (posture, mouth breathing). The diagnosis is based primarily on the anamnesis and examination of dental wear and progression over time (photos and dental castings). A diagnostic guide is proposed in this article. Frequently found in children, bruxism is not always considered pathological. The severity criteria relate intensity (number of dental attrition facets) as well as the context found in children: anxiety, ventilation disorders, and fragile dental structures. Management is multidisciplinary and depends on the etiologic diagnosis.
Assuntos
Bruxismo do Sono/etiologia , Bruxismo do Sono/terapia , Adenoidectomia , Criança , Terapia Cognitivo-Comportamental , Árvores de Decisões , Prótese Dentária , Restauração Dentária Temporária , Revestimento de Dentadura , Prótese Parcial Removível , Humanos , Técnica de Expansão Palatina , Educação de Pacientes como Assunto , Fatores de Risco , Bruxismo do Sono/diagnóstico , Tonsilectomia , Abrasão Dentária/etiologia , Abrasão Dentária/terapiaRESUMO
The purpose of this study was to compare the intraosseous biocompatibility of Dyract, a new hydrophilic glass-ionomer cement, to that of Super EBA. Twenty-four New Zealand rabbits were anesthetized, one leg was shaved, the femur exposed, and two holes were drilled through the cortical plate. The materials were loaded into silicone carriers and inserted into the femur. Half of the rabbits were killed 4 weeks after implantation and the other half at 12 weeks and the femurs were prepared using standard histological procedures. The tissue reactions were graded from none to severe. At 4 weeks both materials showed slight to moderate reactions, characterized by the presence of fibrous tissue interposition and inflammatory cells. At 12 weeks, bone healing had occurred, despite the persistence of some fibrous tissue interposition, and the reactions were classified as slight. At both observation periods, statistical analysis failed to show any difference between the two materials indicating that Dyract and Super EBA had similar intraosseous biocompatibility.
Assuntos
Materiais Biocompatíveis/toxicidade , Compômeros , Adesivos Dentinários/toxicidade , Metacrilatos/toxicidade , Materiais Restauradores do Canal Radicular/toxicidade , Silicatos/toxicidade , Animais , Osso e Ossos/efeitos dos fármacos , Fêmur , Implantes Experimentais , Coelhos , Estatísticas não ParamétricasRESUMO
OBJECTIVES: Most of the devices used to evaluate the cytotoxicity of resin-based composites in vitro use a dentin barrier test. However, it is difficult to obtain the number of freshly extracted teeth, all on the same day, that is necessary for powerful statistical analysis. Tooth cryopreservation provides a way to build up a supply of teeth. This in vitro study compared cryopreserved teeth and freshly extracted teeth in an evaluation of the cytotoxicity of resin-based composites. In addition, this study also evaluated the effects of pulsatile pressure and the importance of dentin permeability on the cytotoxic response to bonding resins. METHODS: Forty freshly extracted and forty cryopreserved third molars were used. A standardized Class I cavity was prepared within the dentin. The hydraulic conductance of each tooth was recorded. The cavities were filled either with Scotchbond Multi-Purpose Plus and Z 100 (3M Dental Products) or with Optibond and Herculite (Kerr). A plexiglas device was designed to permit 24 h long contact between culture medium and the roof of the pulp chamber while a pulsatile pulpal pressure was simulated. The viability of L 929 cells cultured with a control medium and evaluated by an MTT assay was compared to that of L 929 cells cultured with medium which remained for 24 h in contact with the pulp chamber of restored teeth. A three-way ANOVA was used to compare the cytotoxicity among the different groups. A simple least-squares linear regression was used to seek a relationship between the hydraulic conductance of dentin and the cytotoxicity of composite restorative materials. RESULTS: No significant differences in cytotoxicity were found between the freshly extracted teeth and the cryopreserved teeth (p = 0.53). The cytotoxicity of the resin adhesives was statistically higher when a pulsatile pulpal pressure was simulated (p = 0.04). A significant relationship was found between the hydraulic conductance of dentin and the cytotoxicity of resin-based composites (p = 0.02). SIGNIFICANCE: Cryopreserved teeth can be used for in vitro evaluation of the cytotoxicity of resin adhesives. Pulsatile pulpal pressure simulations increased the in vitro cytotoxicity of the tested materials.
Assuntos
Criopreservação , Polpa Dentária/efeitos dos fármacos , Permeabilidade da Dentina , Adesivos Dentinários/toxicidade , Cimentos de Resina/toxicidade , Adulto , Análise de Variância , Animais , Bis-Fenol A-Glicidil Metacrilato/toxicidade , Pressão Sanguínea , Resinas Compostas/toxicidade , Polpa Dentária/irrigação sanguínea , Polpa Dentária/fisiologia , Dentina/fisiologia , Relação Dose-Resposta a Droga , Fibroblastos/efeitos dos fármacos , Humanos , Pressão Hidrostática , Células L/efeitos dos fármacos , Análise dos Mínimos Quadrados , Metacrilatos/toxicidade , Camundongos , Fluxo Pulsátil , Fatores de TempoRESUMO
Did the first hominids have a short developmental period similar to that of the great apes or a longer period closer to that of modern humans? Evidence from studies on dental and facial growth favors the first point of view. Additional evidence presented in this report is provided by a morphogenetic analysis of the lower limb. Some morphological modifications undergone by the human femur during infantile and adolescent growth are shown to be excellent markers of different developmental stages. The angular remodelling of the femoral diaphysis, which results in femoral bicondylar angle, is a marker of infancy, while the reshaping of the distal femoral epiphysis is a marker of adolescence. This reshaping of the bony epiphysis consists of the strong projection of the external lip of the femoral trochlea, the increase of the radius of curvature of the external condyle, and the anteroposterior lengthening of the whole epiphysis. The growth spurt in linear dimensions of the femur, characteristic of human adolescence, is shown to be associated with qualitative changes of the distal femoral epiphysis engendered by the late closure of the distal epiphysis. The femur of the first hominids (Australopithecus afarensis) shows only features of infantile growth, whereas characters of both precocious and later growth are typical of later hominids (Homo). The absence of the derived epiphyseal features in Australopithecus would be linked to their early epiphyseal closure and short adolescent growth period; their presence in Homo would have been promoted by their delayed epiphyseal closure and prolonged adolescent growth period. The transition from Australopithecus to Homo appears to have involved a heterochronic process of time hypermorphosis (Gould, [1977], Ontogeny and Phylogeny [Cambridge: Harvard University Press]) in which the size of the femur increases, the epiphysis is modified, and the period of peripubertal growth is prolonged. The shape of the distal epiphyses of KNM-WT 15000, an immature Homo erectus (Brown et al. [1985] Nature 316:788-792), lies clearly within the range of modern human adolescents. In contradiction to Smith's ([1993] in A. Walker and R. Leakey [eds.]: The Nariokotome Homo erectus Skeleton [Cambridge: Harvard University Press], pp. 195-220) hypothetical reconstruction of life span of Homo erectus, we infer that a growth spurt had begun with Homo erectus but was probably less pronounced and of shorter duration than in modern humans. Our findings on the femur are consistent with studies of the growth on the hominid pelvis (Berge [1996] in LF Marcus, M Corti, A Loy, G Naylor, and DE Slice [eds.]: Advances in Morphometrics [Chicago: Plenum Publishing Corp.], pp. 441-448). It is suggested that the lengthening of the adolescent growth period, from Australopithecus to Homo, would have been also associated with the shape changes of the pelvis and with the lengthening of the lower limbs.