Pain during primary molar local anaesthesia with SleeperOne5 computerized device versus conventional syringe: A randomized, split-mouth, crossover, controlled trial.

BACKGROUND: Because of controversial results from clinical studies comparing different dental local anesthesia methods in children, the primary objective of this randomized, split-mouth, crossover, controlled trial was to compare pain intensity during local anaesthesia (LA) performed with a computer-controlled LA delivery system (C-CLADS) versus a conventional syringe (CONV). Secondary objectives included comparisons during dental treatment. METHODS: Participants (4-8 years) with tooth pair requiring similar treatment were recruited from five French hospitals. The right primary molar, which was treated at the first visit, was randomly allocated to one of the anaesthesia groups (either intraosseous with C-CLADS or infiltration with CONV), whereas the contralateral molar (treated at the second visit) was assigned to the other group. Pain intensity and behaviour outcomes, assessed with the Faces Pain and Venham revised scales, respectively, were compared between groups using Proc mixed. Stratified analyses were performed on dentition and location. RESULTS: Among 107 participants, the analysis revealed reduced pain perception during LA in the C-CLADS group compared with the CONV group (-0.72, 95% CI: -1.43, -0.006), but not during dental treatment. Stratified analyses showed that this effect was observed only in primary dentition (p = .006) and mandibular molars (p = .005). Behavioural issues were fewer in the C-CLADS group than in the CONV group (p = .05) only during injection. CONCLUSION: C-CLADS emerged as the preferable system in primary dentition.

[Knowledge, attitudes and practices in oral health of breastfeeding women]. / Connaissances, attitudes et pratiques en santé orale des femmes allaitantes.

The benefits of breastfeeding on the health of infants and mothers are no longer in doubt. On the other hand, the advantages in terms of maxillofacial development and the risks of prolonged breastfeeding on oral health are much less discussed. An exploratory qualitative study, carried out within the pediatric dentistry functional unit of the dental care service of the Lille University Hospital Center in 2022, aimed to analyze the knowledge, attitudes and practices in oral health of breastfeeding women. This article will discuss the gaps in prevention as well as the obstacles and levers to improving care.

Development of impression trays for treating infants with trisomy 21 before their deciduous teeth erupt.

The treatment of infants with trisomy 21 (TS21) with a myostimulation plate can improve their development and quality of life. The manufacture of these plates requires an accurate cast of the maxilla, and their efficacy relies on their stability and retention. As such, the quality of the impression is a determining factor. The lack of commercially available stock trays for infants with TS21 creates difficulties, including inadequate impression quality and the risk of inhaling impression material. The present technique simplifies impression making for infants with TS21 from 3 months of age to when their maxillary deciduous teeth erupt by using computer-aided design and computer-aided manufacturing (CAD-CAM) impression trays. Sixty-five stored gypsum maxillary casts from infants with TS21 that had been used to manufacture myostimulation plates were analyzed to select four differently sized representative casts for designing the impression trays. A CAD software program was used to digitally shape four sizes of the impression tray from the selected gypsum casts. Practitioners interested in this approach can download and export the standard tessellation language (STL) files using a quick response (QR) code. The impression trays should be manufactured with the stereolithography additive technique using biocompatible resin. This technique allows practitioners to make accurate maxilla impressions for infants with TS21 by manufacturing their own impression trays using the free-access STL files rather than the cumbersome conventional method.

[Therapeutic education and oral health, an opportunity for the child]. / Éducation thérapeutique et santé orale, une opportunité pour l'enfant.

Early childhood caries is an infectious disease of bacterial origin. It is mainly associated with social inequalities in oral health and affects children from the least privileged backgrounds. Because of its recurrent nature, it is the most common chronic disease in preschool children. Since it shares common risk factors with a number of other chronic conditions (diabetes, obesity), promoting global oral health is essential to achieving a favorable general health status.

Obstacles to comprehensive dental care in patients with sustained limitations of their decision-making abilities: findings from a Delphi study.

The objective of this study was to explore the therapeutic limitations experienced by a panel of special-care dentists in France when treating patients with sustained limitations of their decision-making abilities. We used a Delphi technique conducted in three rounds from 01 June 2014 to 30 September 2015. A first questionnaire comprising open-ended questions was addressed to 72 panellists. A content analysis of the returned questionnaires served to draft a second questionnaire comprising closed-ended questions; this was sent to the 28 panellists who responded in the first round. A third questionnaire was sent to the 20 panellists who responded in the second round to give them an opportunity to reconsider their response in the context of the second-round response group. Sixteen panellists answered the last round. A large majority agreed on the importance of providing comprehensive care, but they encountered obstacles at two time points: (i) when proposing the care; and (ii) when setting it up. The panel put forward recommendations in two main areas: (i) the training of those involved in oral health decisions; and (ii) dental care management and organization of the care system. The study provided a foundation for building future orientations in health care for patients with limited decision-making abilities.

[A therapeutic education tool in paediatric dentistry]. / Un outil d'éducation thérapeutique en odontologie pédiatrique.

Therapeutic education for children is developing in the treatment of dental caries. The Elmy pathway, a pedagogical game aiming to improve children's oral health skills, has been designed. The qualitative assessment of this tool seems to confirm its benefit for use in therapeutic education sessions.

Social vulnerability in paediatric dentistry: an overview of ethical considerations of therapeutic patient education.

Dental caries is a multifactorial condition that remains a major public health issue in high income countries. The prevalence of dental caries in children has markedly declined in most countries over the past 30 years. However, the disease continues to affect a vulnerable population defined as a high-risk group. As many public health policies are inefficient in dealing with this underprivileged group, it is necessary to find other strategies to decrease the incidence and the burden of dental caries. Defining dental caries as a chronic disease enables us to develop the concept of 'therapeutic patient education.' It is meant to train patients to self-manage or adapt treatment to their particular chronic disease and to cope with new processes and skills. The purpose of this paper is to propose a new approach to dental caries, in particular to early childhood caries. That should decrease the gravity and prevalence of the disease in this specific population. As a result, this new approach could increase the quality of life of many children both in terms of function and aesthetics.

The inception of a hospital-based dental emergency department in a precarious region decreases the incidence of severe cellulitis of odontogenic origin.

INTRODUCTION: Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay. MATERIAL & METHODS: In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected. RESULTS: The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001]. CONCLUSION: The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures.

[Amelogenesis imperfecta and anterior open bite: how to optimize patient management? A review of the literature]. / Amélogenèse imparfaite héréditaire et béance antérieure : comment optimiser la prise en charge ? Une revue de la littérature.

INTRODUCTION: Amelogenesis imperfecta is a genetic disease, characterized by a structural defect of the enamel and has variable clinical expressions. It can be isolated or associated as part of a syndrome. Three clinical forms exist: hypoplastic, hypomature and hypomineralized. DISCUSSION: Enamel fragility involves dentin exposure and dental hypersensitivity as frequent consequences. Some severe forms are mainly associated with an anterior open bite. The care of these patients constitutes a real challenge for the dentist. Materials et Methods: A literature review was carried out using the PubMed, Web of Science and Scopus interfaces over the past ten years in order to highlight the different treatment options available. CONCLUSION: From conservative to surgical treatment, it is necessary to develop a collaboration between the orthodontist and the pediatric dentist in order to offer multidisciplinary care adapted to the patient's needs.

Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France.

Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.

Laser preconditioning on cranial bone site: analysis of morphological vascular parameters.

BACKGROUND AND OBJECTIVES: Bone vascularization is a key factor in the bone healing process following X-ray irradiation. Preserving the vascular network from X-ray-induced injury is a relevant approach in the promotion of bone healing. Previously, we developed a protocol of laser preconditioning (810 nm diode laser, 36 J/cm²) prior to X-ray radiation (18.75 Gy) which protects the bone vascular network from deleterious effects of X-ray radiation. The aim of this present work is to characterize the effects of laser preconditioning on the bone through a morphological analysis of vascular parameters. MATERIALS AND METHODS: Digital images of the vascular plexus were taken through an optical bone chamber which was implanted onto the calvaria of rabbits. Bespoke software was used for the quantification of the vessels (classified in four groups according to their diameter), vessel length, and number of nodes at weeks 0, 4, and 8. Twenty rabbits were divided into four groups: control group #1 (n = 5); laser group #2 (n = 5). X-ray radiation group #3 (n = 5), laser preconditioning 24 hours prior to X-ray radiation group #4 (n = 5). RESULTS: The bone vascular network was stable for groups #1 and #2. Statistical analysis showed a significant reduction of each observed vascular parameter for groups #3 and #4. In the laser preconditioned group #4 the loss was less marked than in the X-ray group #3, especially for large vessels (diameter >50 µm). DISCUSSION AND CONCLUSION: We provide in vivo microcirculatory evidence to support the concept of laser preconditioning of bone. A computer-based semi-automatic system is described to quantify superficial bone vascular network parameters that had been treated by laser preconditioning prior to X-ray radiation. Laser preconditioning significantly attenuates the deletion of the superficial bone vascular network irradiated by X-ray, especially concerning large diameter vessels.

A preliminary investigation into the effects of X-ray radiation on superficial cranial vascularization.

Radiation therapy (RT) is an established treatment modality for malignant neoplasms. RT induces tissue damage that may lead to osteoradionecrosis in more severe cases. Suitable animal models to study RT-induced changes in membranous craniofacial bone are currently not available. The aim of this study was therefore to quantify RT-induced changes in cranial microcirculation using a newly developed calvaria chamber model and to relate these changes to RT-induced histological damage. New Zealand white rabbits received a total radiation dose of 18.75 Gy through the calvaria chamber, and the number of vessels, the vessel length density (VLD), and angiogenic sprouting were quantified on a weekly basis during a 12-week period. At the end of 12 weeks, the RT-treated (n = 5) or control (n = 5) calvarias were biopsied for histopathological analysis. RT resulted in a steep reduction in the number of vessels and the VLD during the first 3 weeks, particularly in larger-diameter vessels, followed by a flat stabilization/remodeling phase in the subsequent 9 weeks that never restored to baseline values. Histomorphometric analysis revealed a high degree of osteocytic depletion, prominent hypocellularity in the lacunae and intraosseous vasculature, enlarged and nonconcentric Haversian systems, and a severely disorganized bone matrix in the RT-treated calvarias. Despite the prevalence of some angiogenic potential, the RT-induced effects in the early phase persisted in the intermediate to late phase, which may have contributed to the poor recovery of the RT-treated bone.

Masticatory behavior for different solid foods in preschool children according to their oral state.

Gradual introduction of solid foods in early childhood takes part in the maturation of mastication. The impact of any oral state alteration on food oral processing development is poorly documented for this age group. This study investigated the masticatory behavior in 3 to 6 year-old children with or without early childhood caries (ECC) for three solid foods of different textures. Twenty-one children with healthy oral state and 23 children with severe ECC were observed during complete mastication of calibrated samples of raw carrot, cheese and breakfast cereals. Food refusals and kinematic parameters (Ti: chewing time, Nc: number of cycles and Fq: chewing frequency) were used to assess children masticatory behavior. Oral Health-related Quality of Life and orofacial dysfunctions were evaluated using, respectively the early childhood oral health impact scale (ECOHIS) and the Nordic orofacial dysfunction test screening (NOT-S). Children suffering from ECC exhibited significantly higher ECOHIS and NOT-S scores, in particular for the mastication domain. Accordingly, lower chewing frequencies values were recorded in children with ECC (i.e., carrot Fq: 1.21 ± 0.20 vs 1.35 ± 0.22, p ≤ 0.01), as well as more frequent refusals for carrots. Kinematic parameters were shown to be repeatable in all children for successive samples of the same food, and tended to vary depending on the proposed food. Some masticatory behavior regulation according to food properties could already be present in preschool children. Children with ECC developed alternative behavioral strategies to overcome feeding difficulties. Further studies should investigate food bolus properties according to oral health, as well as nutritional issues. PRACTICAL APPLICATIONS: During childhood, the way solid foods are processed in the oral cavity to be safely swallowed and then digested in available nutrients, is poorly documented. In this study, preschool children have been shown to repeatedly adapt their masticatory behavior to a given food. The collection of various food boli as recorded at the moment of swallowing could then be considered in further food bolus properties research investigations. Moreover, this study suggested that children with altered dentition modified their masticatory kinematic parameters and developed alternative strategies, including food or texture selection, to overcome their feeding difficulties. The development of a mastication evaluation protocol could help medical professionals to detect children masticatory deficiencies and then propose diet adaptations. Considering the importance of food diversity in mastication development and maturation, food industries may consider to develop a range of texture adapted foods for young children, especially designed to gradually rehabilitate the masticatory function.

Emergence of permanent teeth: secular trends and variance in a modern sample.

The purpose of this study was to update the most commonly used tables of dental eruption (emergence), which are more than 50 years old and do not distinguish between ethnic and socio-economic groups. Clinical emergence data was collected for a modern sample of 574 French children and adolescents, aged 5.5 years to 15 years (294 girls and 280 boys). With respect to the present sample, the commonly used eruption tables of Hurme were accurate for most aspects of mandibular emergence, but were seriously flawed for the maxillary arch. Emergence of all permanent maxillary teeth varied by at least 3 months from Hurme's means; lateral incisors, canines, and second molars erupted earlier, but both premolars emerged later. Compared to similar French data collected in 1958, there appears to be a secular trend for later eruption of the maxillary premolars and earlier emergence of permanent second molars. These changes may reflect an evolutionary reduction in the size of the maxilla, a progressive decrease in genetic control of permanent canines, as well as first and second premolars, and/or progress in dental preventive measures to conserve primary molars. From a clinical perspective, appropriate dental emergence data are essential for effectively intercepting developmental malocclusions in children and adolescents.

Impact of early childhood caries and its treatment under general anesthesia on orofacial function and quality of life: A prospective comparative study

BACKGROUND: Early Childhood Caries (ECC) has become a major public health concern worldwide, mostly affecting children from disadvantaged families in increasingly severe forms. This condition has been frequently reported to alter children's nutrition, growth and general development. It negatively impacts their quality of life, through painful episodes and severe eating difficulties. While this period is crucial for oral praxes development, the impact of dental state on oro-facial functions is poorly documented. This study evaluated the impact of ECC and its treatment under general anesthesia on oro-facial functions and quality of life in pre-school children. MATERIAL AND METHODS: The dysfunction and quality of life scores from 25 children with ECC were evaluated before treatment (T0), one month (T1) and three months after treatment (T2), using the Nordic Orofacial TestScreening (NOT-S) and the Early Childhood Oral Health Impact Scale (ECOHIS), respectively, in comparison with 16 caries-free children. The number and extent of inter-arch dental contacts were also observed. RESULTS: The pre-operative higher NOT-S score observed in children with ECC decreased to reach the control level at T2. The mastication item was the most affected in the ECC group throughout the study. Their mean ECOHIS score also significantly decreased post-operatively and differences remaining between both groups were no longer clinically relevant. In addition, in children with ECC, values of functional inter-arch surfaces tended to increase over the follow-up period. CONCLUSIONS: Oro-facial functions and quality of life, altered by ECC, could be restored through a conservative treatment approach. Relations between dental state, orofacial functions and particularly chewing, and nutrition should be investigated further

Laser preconditioning of calvarial bone prior to an X-ray radiation injury: a preliminary in vivo study of the vascular response.

BACKGROUND AND OBJECTIVES: Thermal preconditioning prior to injury induces a cytoprotective effect on soft tissues and promotes their recovery. Lasers are an adequate tool to generate controlled and reproducible heat. X-ray irradiation induces a chronic antiangiogenic effect on bone, affecting its healing and remodeling processes. The aim of this study was to investigate the effect of laser preconditioning on the re-vascularization of X-ray irradiated bone. MATERIALS AND METHODS: A bone chamber was implanted onto the calvaria of rabbits to study the vascularization process. Digital pictures were taken of the vascular plexus at the target bone site using a modified digital camera. Vascular density (VD) was determined using image processing. It was defined as the ratio of blood vessel pixels to the total number of pixels to the region of interest. Laser preconditioning was performed with a diode laser (810 nm, 2 W, 3 seconds, 48 J/cm(2), 4 mm). A 12-week follow-up study was performed on 20 rabbits divided into four groups: #1: control group (n = 5); #2: laser irradiation alone (n = 5). #3: X-ray radiation (18.75 Gy) alone (n = 5), #4: laser preconditioning 24 hours prior to X-ray radiation (n = 5). RESULTS: VD remained stable during the 12-week follow up for group #1. No significant difference was observed between laser irradiation group (#2) and control group (#1) (P>0.5). The angiolytic action of X-ray radiation was confirmed in groups #3 and #4, which were statistically different from group #1 (P<0.001). However, the decrease of the vascularization was limited in group #4 highlighting a different evolution between group #3 and #4 (P<0.05). These results were confirmed by histological analysis. DISCUSSION AND CONCLUSION: The bone chamber is an effective reproducible method for the longitudinal analysis of the dynamics of vascularization. Our findings have shown that laser preconditioning is capable of preserving vascularization in an X-ray irradiated bone site, thus suggesting a novel approach for promoting the healing of bone tissue in which the vascular supply has been damaged.

Effect of a laser irradiation on the vascularisation of safety and X-ray radiated bone.

Thermal preconditioning induces a cytoprotective effect and promotes tissue recovering. Laser is an appropriated method to generate a controlled and reproducible heating. Bone healing, a crucial challenge in medicine, is affected by X-ray radiation which induces a chronic antiangiogenic effect. So, this study aims to investigate the role of laser preconditioning on the vascularisation of bone after X-ray radiation. An optical bone chamber allowed the study of the vascularization process. The vascular density (VD) was determined using image processing. A longitudinal study was performed on 20 rabbits divided in four groups: #1: control group (n=5); #2: laser irradiation alone (diode laser 810nm, fluence= 48J/cm2) (n=5). #3: X-ray radiation (18.75Gy) alone (n=5), #4: laser preconditioning 24 hours before a X-ray radiation (n=5). VD remained stable during 12-week follow up for groups #1 and #2. X-ray radiation lead to an important decrease of the superficial bone vascularization in group #3. The decrease of the vascularization was limited in group #4 highlighting a different evolution between group #3 and #4. Those results were confirmed by histological analysis. Our preliminary findings show that laser preconditioning preserves vascularization in X-ray radiated bone site, outlining a novel approach for the bone healing in which the vascular supply has been injured.