[Exogenous tooth discoloration in children: black stains]. / Les colorations dentaires noires exogènes chez l'enfant : Black-stains.

Black-stains are a coloring frequently met in pediatric dentistry. They can be medically diagnosed as 1-mm borders or unfinished lines formed by a dark exogenous substance which follows the gingival festoon of bet coronary (in cervical third of the crown) temporary teeth and permanent, or they can appear in like points or dark spots. They are caused by bacteria anaerobic chromogenous. The dominant responsible species are actinomyces. Blacks-stains are ferrous depots, formed following a chemical interaction on the surface of the tooth between sulphide of hydrogen (under the effect of the anaerobic bacteria which are producing hydrogen) and the iron contained in the saliva (by a healthy diet) or that released by red blood corpuscles (in case of bloody gums). Black-stains are a shape of characteristic dental plaque by its flora with trend to calcify. It contains an insoluble iron salt with a content raised in calcium and in inorganic phosphor. The coloring Black-stain is a mild pathology and has no incidence on the vitality of the tooth. Certainly these spots are unsightly. The dental surgeon in current practice can deprive them. The pediatrician plays a leading role in the diagnosis and advice to parents and patients affected by these stains.

[The functional mandibular prognathism]. / Le proglissement mandibulaire.

The functional mandibular prognathism belong to the class III malocclusion according to the terminology of Angle. Its origins are multiple, from the abnormality of eruption of deciduous or definitive incisors to lingual dysfunction (low position of the tongue). In spite of its weak prevalence, it must be prematurely detected and treated (mixed or temporary teeth) to prevent a functional anomaly to become a skeletal anomaly. It is important at this stage to proceed to the unique gesture which allows making the differential diagnosis: it is the De Névrezé procedure; it allows obtaining a more retrusive position of the mandible to minimize the dental relations. In case of true mandibular prognathism, the maneuver does not succeed; there is no modification of the dental reports. An interceptive therapeutic phase allows finding quickly a previous correct guide and to rehabilitate the growth of jaws.

[Diagnosis and treatment of cross-bite in children]. / Les anomalies maxillomandibulaires du sens transversal chez l'enfant.

Transverse maxillomandibular discrepancies are a major component of several malocclusions. They must be prematurely detected and treated. The causes are parafunctional, dysfunctional or kinetic. The different clinical forms encountered are alveolar (endoalveolia) or skeletal (endognathia), which may be associated with a kinetic anomaly. Orthopedic and orthodontic forces are used routinely to correct a maxillary transverse deficiency in a young patient to achieve harmonious growth.

[Digital volume tomography using the NewTom system: advantages of this new technique in children]. / La tomographie volumétrique numérisée par le système NewTom: intérêt de ce nouvel examen d'imagerie médicale chez l'enfant.

In some cases, after preliminary clinical examination, medical imaging can provide indispensable complementary information for the care of young patients. Volume imaging using two- and three-dimensional reconstructions provides the most complete information possible. Problems involving the superposition of anatomical structures, which can occur with conventional X-rays, are a thing of the past, and this technique represents the future in this field. In high-density tissue such as bone or teeth, tomodensitometry is the preferred examination as it can give a three-dimensional approach to the study. However, because of the high radiation dose required, scanner is still a second intention examination. Development of digital volume tomography using NewTom system, designed for maxillofacial exploration, produces the same type of image for a very much reduced X-ray dose, and at low cost. Although the use of this new examining technique is developing rapidly in Europe and throughout the world since its recent introduction, France is lagging behind as to date there are only seven machines in the entire country. The main uses in children, illustrated by original clinical cases, relate to preoperative surgery planning, post-trauma diagnostic workups, orthodontic checkups, postoperative follow-up and TMJ examinations. The purpose of this article is to inform dental surgeons, paediatricians and doctors about this new medical imaging examination, which will most definitely have a place in the battery of diagnostic tools available to us. After weighing the advantages/risks involved, it should be possible to reduce the number of tomodensitometry exams in favour of this new examination technique in children according to the clinical examination data and diagnostic information required.

[The polyols in pediatric dentistry: advantages of xylitol]. / Les polyols en odontologie pédiatrique : intérêt du xylitol.

Sugars ingested outside of meals play an important role in the etiology of caries. In this respect, sugar substitutes present a very interesting alternative. In addition to the recommendations and usual care to their patients, dental surgeons also have to inform them on a dietetic level. Chewing sugar-free chewing gum after any light meal when it is not followed by a brushing presents a real interest. The authors describe the different polyols and their respective uses. Polyols are widely found in foodstuffs (sweets, chewing-gum, biscuits, cooked meals for diabetic), pharmaceutical products (syrups, pastilles to be sucked, various medicines), non-pharmaceutical chemists (toothpastes, mouth-washes...). By the light of the most recent published works, the particular properties of xylitol are described. Polyols are more particularly indicated for sugar-eater or sick children (syrups), and for those carrying a hight risk of developing caries (progressive polycaries, hyposialie...). Therefore polyols are not only a means of stabilizing some pathologies (diabetes, obesity) but also a weapon in the prevention of dental caries.

[Contribution of day care general anaesthesia for dental care in children and handicapped patients]. / Apport de l'anesthésie générale ambulatoire pour les soins buccodentaires des enfants et des patients handicapés.

Dental surgeons, pediatrists and doctors daily note the precocity and the importance of caries in children. This evolution makes essential the general anaesthesia in paediatric dentistry among the therapeutic arsenal of pedodontists. Fortunately, with the greatest knowledge of the child physiology, the better control of the anaesthetic operative protocols, general anaesthesia is very efficient. Furthermore, the development of the day care treatment now allows the access of these treatments to an increasingly large public. For pedodontists and anaesthetist, generals anaesthesia is essentially indicated for children with many decays, presenting behaviour disorders, a physical or cerebral handicap, a turmoil engraves general state. This operating mode aims to restore: This particular aspect of the dental practice remains still too little developed and cannot answer the demands. The necessity made it a rule to set up a theoretical and practical training. This specialized dentistry waits for recognition on behalf of supervisory organisms and a similar message spread by all nursing persons.

[Care of handicapped children under general anesthesia in relation to different clinical parameters. Preliminary notes]. / Prise en charge des enfants handicapés sous anesthésie générale. Lien avec différents paramètres cliniques. Notes préliminaires.

Losses of teeth are significant and frequent among handicapped patients. For this study a sample of 58 children handicapped out of the 412 children dealt with for preserving dental care under general anaesthesia, was analyzed. If at equal age these children present a CAD on permanent teeth more significant, their undertake, the procedure of general anaesthesia and the preserving treatments under general anaesthesia do not present more difficulties than the child is handicapped or not. The factor determining in the effectiveness and the speed of the exempted acts seems to be the training of the dental care team.

[Care of handicapped children under general anaesthesia. Relationships with various clinical parameters. Preliminary notes]. / Undertake handicapped children under general anaesthesia. Link with various clinical parameters. Preliminary notes.

Losses of teeth are significant and frequent among handicapped patients. For this study a sample of 58 children handicapped out of the 412 children dealt with for preserving dental care under general anaesthesia, was analyzed. If at equal age these children present a CAD on permanent teeth more significant, their undertake, the procedure of general anaesthesia and the preserving treatments under general anaesthesia do not present more difficulties than the child is handicapped or not. The factor determining in the effectiveness and the speed of the exempted acts seems to be the training of the dental care team.

Update on digital image management and PACS.

Information technology is becoming a vital component of all health care enterprises, from managed care services to large hospital networks, that provides the basis of electronic patient records and hospital-wide information. The rationale behind such systems is deceptively simple: physicians want to sit down at a single workstation and call up all information, both clinical data and medical images, concerning a given patient. Picture archiving and communication systems (PACS) are responsible for solving the problem of acquiring, transmitting, and displaying radiologic images. The major benefit of PACS resides in its ability to communicate images and reports to referring physicians in a timely and reliable fashion. With the changes in economics and the shift toward managed and capitated care, the teleradiology component of PACS is rapidly gaining momentum. In allowing remote coverage of multiple sites by the same radiologists and remote consultations and expert opinion, teleradiology is in many instances the only option to maintain economically viable radiologic settings. The technical evolution toward more integrated systems and the shift toward Web-based technology is rapidly merging the two concepts of PACS and teleradiology in global image management and communication systems.

A hospital-wide distributed PACS based on intranet.

A hospital-wide Picture Archiving and Communication System (PACS) is currently under development at the University Hospital of Geneva. After a first implementation including two oneterabyte optical libraries, the system is expanded to integrate all the imaging modalities of the hospital. The new storage requirement is 10 terabytes to cover three year archive. A large distributed image archive has been designed including new archive servers for long-term storage and display servers for medium-term storage. The acquisition, archive and distribution cycles are performed using separated networks combining Fast Ethernet and Ethernet. Image files are distributed to the wide-hospital using a prefetching strategy or an Intranet server, RADIOLAB. The first mode takes advantage of the fully integrated hospital information system DIOGENE 2 to allow the automatic retrieval of studies in advance. The second mode provides a convivial study selection from any conventional WWW (World Wide Web) browser. Image files are then transmitted to the user's display station using HTTP (HyperText Transfer Protocol) and handled by OSIRIS software, which acts as a helper or viewer. Such a system is expected to meet the time requirement, which is less than three seconds per image.