Important oral care needs of older French people: A cross-sectional study.

BACKGROUND: Older persons comprise a growing proportion of the European population and may have a distinct epidemiological oral profile requiring specific preventive and curative care poorly documented. The objectives of this study were to assess the oral health status of people ≥90 years of age in France, to compare their perceived and observed oral care needs and to investigate the oral problems associated with a low oral health-related quality-of-life (OHRQoL). METHODS: An oral cross-sectional study was performed during the 25th follow-up of a cohort of older persons being followed up prospectively for screening of dementia over a 15-year period in Gironde and Dordogne, France. Clinical oral indices were determined by oral examinations conducted at the participants' place of living. Cohen's Kappa coefficient was used to assess the agreement between perceived and observed oral care needs. Oral problems associated with a low OHRQoL, measured with the Geriatric Oral Health Assessment Index (GOHAI<50) were investigated with logistic regression. Odds ratios (OR) were estimated with their 95% confidence intervals (CI). RESULTS: Data from 90 persons were analysed (76% female; median age=93 years; 20% living in an institution). Plaque and calculus were present in 93% and 58% respectively, of the 74 dentate participants. The mean number of decayed, missing, and filled teeth was 26.5 (±5.3); 66% of the participants had at least one untreated decayed tooth. Among the 85 participants with tooth loss not replaced by a fixed denture, two thirds had a removable dental prosthesis; 84% of these prostheses were considered to be maladapted. Among the 39 participants who felt unable to consult a dentist (43%), lack of transportation was the most frequently cited reason. Although 88% of the participants needed oral care, only 26% perceived that they had such a need (Kappa=0.06). Oral problems associated with a GOHAI<50 were the absence of posterior occluding teeth (OR=7.15; 95%CI=1.53-33.35; P=0.012), feeling of dry mouth (OR=11.94; 95%CI=3.21-44.39; P=0.0002) and oral pain (OR=9.06; 95%CI=1.91-69.00; P=0.033). CONCLUSIONS: Persons ≥90 years of age have considerable preventive and curative dental care needs that impact their quality-of-life but they are rarely aware and lack transportation. NCT04065828.

Outcome of CO2 laser vaporization for oral potentially malignant disorders treatment.

BACKGROUND: Oral cancer is a public health issue worldwide. Oral potentially malignant disorders (OMPDs) are lesions of the oral mucosa that are predisposed to malignant transformation. The mainstay of OMPDs treatment around the world is now the carbon dioxide (CO2) laser but the reported recurrence and malignant transformation rates vary widely in the literature. We aimed to estimate the recurrence and the malignant transformation rates of OPMDs treated with CO2 laser at the University Hospital of Bordeaux, in France, from 2010 to 2014, and to identify associated factors with recurrence or malignant transformation. MATERIAL AND METHODS: We conducted a retrospective study in patients with a minimum follow-up of 12 months. Collected variables included characteristics of the patients (gender, age, alcohol and tobacco consumption, previous diagnosis of graft-versus-host disease, previous treatments for OPMD or for upper aerodigestive tract cancers and human immunodeficiency virus infection), characteristics of the lesions (form, colour, size, location, degree of dysplasia), laser treatment outcome (complications, recurrence, malignant transformation). RESULTS: Twenty-five patients were included. Mean follow-up was 28.9 months. Recurrence was observed in 11 patients (44%). Annual recurrence rate was 18.3% and annual malignant transformation rate was 1.7%. Hyperplasia without dysplasia was the only factor found to be statistically associated with recurrence. CONCLUSIONS: Our results suggest that OMPDs treated by CO2 laser vaporization have high recurrence rates, particularly those presenting hyperplasia. A standardized definition of recurrence would be necessary for inter-study comparisons. Long-term follow-up is recommended in order to detect and treat squamous cell carcinoma in its early stages.

Pain-relieving effects of clonazepam and amitriptyline in burning mouth syndrome: a retrospective study.

This retrospective study aimed to evaluate the efficacy of clonazepam and amitriptyline in the treatment of burning mouth syndrome (BMS). A single-centre retrospective cohort study was performed among patients diagnosed with BMS. Either clonazepam or amitriptyline was administered. Patients were asked to evaluate their pain using a 10-point verbal numerical scale (VNS) at baseline, and at 6 weeks and 3 months of treatment. Mean pain-relief values were assessed according to the treatment received using the Kruskal-Wallis test. Thirty-nine patients (85% female) were included. The mean age was 65±10.5years. The mean VNS score at baseline was 7.1±2.0 in patients treated with clonazepam and 7.5±1.1 in those treated with amitriptyline. The mean VNS scores in the clonazepam and amitriptyline groups were 4.9±2.4 and 6.1±2.6, respectively, after 6 weeks of treatment (P=0.498) and 4.4±2.0 and 4.1±2.7, respectively, after 3 months (P=0.509). There was no difference between the two treatments in terms of pain reduction. Clonazepam as well as amitriptyline may be an effective treatment for BMS.

The global burden of oral diseases in pediatric HIV-infected populations: a workshop report.

OBJECTIVES: To achieve a comprehensive understanding about the global burden of oral diseases in HIV-infected children and to identify research needs. MATERIALS AND METHODS: A literature search was conducted in PubMed (2009-2014) to address five questions: (i) prevalence of oral diseases in HIV-infected compared with uninfected children, (ii) impact of oral diseases on quality of life, (iii) effect of antiretroviral exposure in utero on craniofacial and dental development, (iv) important co-infections and antiretroviral complications, and (v) value of atraumatic restorative treatment. RESULTS: Studies showed a high prevalence of dental caries in HIV-infected children but the relationship between HIV infection and dental caries remains unclear. Also quality of life needs further investigation supported by better study designs and improvement of the instruments used. Up-to-date evidence suggested long-term harms associated with in utero antiretroviral exposure were minor but would require long-term follow-up through National Registries. The reviews also revealed the wide spectrum of metabolic disease due to antiretroviral therapy and co-infections such as tuberculosis. Finally, atraumatic restorative technique appears to be a simple and safe technique to treat dental caries but outcomes need further evaluation. CONCLUSIONS: The impact of antiretroviral therapy in HIV-infected children has raised novel challenging questions in the field of oral health warranting future research.

Oral health condition of French elderly and risk of dementia: a longitudinal cohort study.

OBJECTIVES: Oral condition could be associated with cognitive impairment, but this is not yet well documented. We therefore hypothesized that people with poor oral condition would be more at risk to develop dementia. The objective of this study thus was to describe the oral condition of French community-dwelling elderly persons and to assess its relationship with the occurrence of dementia. METHODS: Oral examination was conducted on a sample of individuals aged 66-80 years followed-up prospectively for screening of dementia over 15 years in Gironde, France. Univariate and multivariate analyses of the risk of dementia were performed using a Cox proportional hazard model with delayed entry. RESULTS: Data from 405 individuals were analyzed; 45.4% men; median age at baseline: 70 years [interquartile range (IQR): 68-75]. The median number of decayed, missing, and filled teeth was 18 (IQR: 13-24) and was higher in women (median: 20 versus 17, P = 0.004) and in persons with lower school level (median: 21 versus 17, P = 0.003). Among 348 persons with sextant eligible for periodontal assessment, 2/3 required periodontal care: 5.2% had bleeding observed, 44.8% calculus, 17.8% 4-5 mm pockets, and 2.9%≥ 6 mm pockets. The incidence of dementia during a median follow-up of 10 years (IQR: 6.5-13.7) was 19 per 1000 person-years. The adjusted hazard ratio for a number of missing teeth ≥ 11 (median) on the risk of dementia was 1.13 (95% confidence interval, CI = [0.60-2.12]) in people with higher education (n = 312) and 0.30 (CI = 0.11-0.79) in persons with lower school level (n = 93) (P for modification effect = 0.0002). CONCLUSIONS: Having eleven or more missing teeth seemed to be associated with a lower risk of dementia in people with lower education possibly owing to the suppression of source of chronic inflammation.

Population pharmacokinetics of tenofovir in HIV-1-infected pregnant women and their neonates (ANRS 12109).

Thirty-eight human immunodeficiency virus-1 (HIV-1)-infected pregnant women were administered tenofovir disoproxil fumarate (TDF; 300 mg)-emtricitabine (FTC; 200 mg) tablets: two at labor initiation and one daily for 7 days postpartum. Maternal, umbilical, and neonatal plasma tenofovir concentrations were measured by high-performance liquid chromatography and analyzed using a population approach. Data were described using a two-compartment model for the mother, an effect compartment linked to maternal circulation for cord, and a neonatal compartment disconnected after delivery. Absorption was greater for women delivering by caesarian section than for those delivering vaginally. The maternal 600 mg TDF administration before delivery produces the same concentrations as 300 mg administration in other adults. If the time elapsed between maternal administration and delivery is >or=12 h, two tablets of TDF-FTC should be readministered. Tenofovir showed good placental transfer (60%). Administering 13 mg/kg of TDF as soon as possible after birth should produce neonatal concentrations comparable with those observed in adults.