Child oral health: A plea for interdisciplinarity / La santé orale de l'enfant : un plaidoyer pour l'interdisciplinarité

A child's oral health has major implications both for their general health and for their quality of life. Even before birth, the mother's oral health can affect the development of the baby and pregnancy outcomes. From the very first months of life, feeding habits together with non-nutritive sucking ones, early transmission of pathogenic bacteria, and oral hygiene practices prefigure the child's future health. The aim of this article is to provide a comprehensive overview of our current knowledge regarding the main oral health issues affecting children, namely dental caries, erosive tooth wear, developmental defects of enamel, maxillofacial growth anomalies, and traumatic dental injuries. Additionally, it aims to examine the oral health prevention and promotion programs that have been implemented in France over several decades. These prevention and promotion initiatives are not only part of a national program but are also being organized at a territorial level, although, unfortunately, they often remain limited to regional, departmental, or municipal scopes. It is essential for all those involved with children, whether they are health care professionals or not, to collaborate effectively to enhance both oral health and overall well-being. This requires fostering an interdisciplinary approach that involves various contributors working together in a complementary way.

La santé orale de l'enfant est d'un enjeu majeur, tant pour sa santé en général que pour sa qualité de vie. Avant même sa naissance, la santé orale de la mère impacte le développement du bébé et l'issue de la grossesse. Dès les tout premiers mois de vie, le mode d'alimentation, les habitudes de succion non nutritives, la transmission précoce de bactéries pathogènes et les pratiques d'hygiène orale préfigurent la future santé de l'enfant. L'objectif de cet article est de faire une synthèse des connaissances sur les principales affections bucco-dentaires chez l'enfant que sont la maladie carieuse, l'usure érosive, les défauts de minéralisation, les anomalies de croissance maxillo-faciale et les traumatismes dentaires et de s'interroger sur les programmes de prévention et de promotion de la santé en santé orale en France depuis plusieurs décennies. Des initiatives de prévention et de promotion de la santé orale s'organisent (en complément du programme national), dans une déclinaison territoriale, encore trop souvent seulement régionale, départementale ou municipale. Ainsi, ce sont tous les acteurs autour de l'enfant, professionnels de la santé ou non, qui doivent s'engager, ensemble, pour améliorer sa santé orale et sa santé en général et c'est tout une culture interdisciplinaire qui doit se développer autour d'une pluralité d'acteurs qui pourraient agir et collaborer, en toute complémentarité.

Is There an Association between Viral Infections and Risk for Pediatric Obstructive Sleep Apnea? A Systematic Review.

(1) Background: Obstructive sleep apnea (OSA) affects approximately 1% to 5% of children. To date, the main pathophysiological factor is adenotonsillar tissue hypertrophy. As many respiratory viruses can persist in secondary lymphoepithelial organs after upper airway infection, the objective of this systematic review was to investigate the link between history of viral infections and the risk of pediatric OSA. (2) Methods: Corresponding references were searched electronically (PubMed [MEDLINE], Cochrane Library and Scopus) until 21 November 2022. Prospective or retrospective cohorts, evaluating the children suffering from OSA with history of viral infections and comparing them with children with no history of viral infections written in English, were included. Four independent reviewers selected studies, extracted data, and evaluated the risk of bias using ROBINS-I. (3) Results: Of 1027 potentially eligible articles, four studies (one retrospective, two prospective cohorts and one case-control) were included. (4) Conclusions: Exposure to lower airway infections may precede the diagnosis of pediatric OSA suggesting that respiratory viruses may play a mechanical role in the development of pediatric OSA. Further research is required to improve our understanding of the role of viral infections. Registration: PROSPERO CRD awaiting.

Malocclusions and oral dysfunctions: A comprehensive epidemiological study on 359 schoolchildren in France.

OBJECTIVES: The purpose was to conduct a comprehensive study of malocclusions and oral dysfunctions on 11-year-old children and to study the risk factors associated with malocclusions. MATERIAL AND METHODS: A cross-sectional descriptive epidemiological survey was conducted among 359 children in France. A clinical examination was conducted, and orthodontic and oral functional data were collected. In addition, the need for orthodontic treatment was evaluated using the criteria defined by of the French National Authority for Health (HAS). Finally, a univariate and multivariate analysis was performed to assess the risks associated with malocclusions. RESULTS: Most children (88%) exhibited a malocclusion, regardless of gender (p = .912). The examination of oral functions identified a large number of swallowing (87%) and respiration (42.7%) disorders. The presence of malocclusion was statistically linked to the low position of the tongue at rest (p < .001), abnormal swallowing (p = .03), and improper mouth breathing (p = .001). After a multivariate analysis, the type of respiration (odds ratio [OR] = 3.2 [1.4-7.3]) and the position of tongue at rest (OR = 3.43 [1.7-7.1]) were the two most prominent factors in the prediction of emerging malocclusion. CONCLUSION: This epidemiological survey reveals a high prevalence of dental malocclusions and functional disorders. Oral respiration and the low position of the tongue at rest are the most important factors in the prediction of a malocclusion.

Biofilm and Orthodontic Materials: literature reviews and Scanning Electron Microscopy (SEM) images gallery / Relations entre biofilm et matériels orthodontiques : revues de la littérature et galerie d'images en microscopie électronique à balayage (MEB)

Introduction: Plaque control remains a concern in oral health but also in orthodontics. Objective: The aim of this paper was to investigate the dental plaque adhesion to different orthodontic appliances. Materials and Methods: Four literature reviews were initiated to clarify the accumulation of dental plaque to different orthodontic appliances, namely the type of brackets (conventional versus self-ligating, metal versus clear), the type of ligatures (metal versus elastomeric) in addition to the type of archwires. Moreover, a gallery of Scanning Electron Microscopy (SEM) images was made on different orthodontic appliances before and/or after time in the oral cavity. Results: Considering the strong methodological heterogeneity of the included studies, there is no consensus on which type of bracket should be preferred for the prevention of plaque retention. Metal ligatures would be less prone to plaque accumulation compared to elastomeric ligatures, which are themselves color-dependent. The type of archwire was not investigated in this topic. SEM images highlighted the presence of anfractuosities on the surface of new orthodontic archwires as well as the presence of biofilm at different degrees of maturation on the appliances after time in the oral cavity. Conclusion: Although it is not possible to establish a consensus on which orthodontic appliances should be preferred to decrease plaque retention, different stages of biofilm evolution are observable on their surface and therefore potentially associated with a proportional virulence.

Introduction: Le contrôle de la plaque dentaire reste une préoccupation en santé bucco-dentaire mais aussi en orthodontie. Objectif: Le but de cet article était d'investiguer l'adhésion de la plaque dentaire sur différents dispositifs orthodontiques. Matériels et méthodes: Quatre revues de la littérature ont été réalisées afin d'étudier l'adhésion de la plaque dentaire sur différents dispositifs orthodontiques, à savoir le type d'attaches (conventionnelles versus autoligaturantes ; métalliques versus céramiques), le type de ligatures (métalliques versus élastomériques) et, enfin, le type d'arcs. Une galerie d'images obtenues par microscopie électronique à balayage (MEB) a également été réalisée sur différents dispositifs orthodontiques avant et/ou après vie en bouche. Résultats: Tenant compte de la forte hétérogénéité méthodologique des études incluses, privilégier un type d'attaches dans la prévention de la rétention de la plaque dentaire ne fait pas l'objet d'un consensus. Les ligatures métalliques seraient moins sujettes à l'accumulation de la plaque dentaire par rapport aux ligatures élastomériques, elle-même dépendantes de leur couleur. Le type d'arcs n'a pas fait l'objet d'investigations sur cette thématique. Les images MEB mettaient en lumière la présence d'anfractuosités à la surface des arcs orthodontiques neufs, ainsi que la présence d'un biofilm à différents degrés de maturation sur les dispositifs après vie en bouche. Conclusion: Bien qu'il ne soit pas possible d'établir un consensus sur les dispositifs orthodontiques à privilégier pour diminuer la rétention de la plaque dentaire, différents stades d'évolution du biofilm sont observables à leur surface et donc potentiellement associés à une virulence proportionnelle.

Cleaning and Disinfection Protocols for Clear Orthodontic Aligners: A Systematic Review.

(1) Background: Clear orthodontic aligners support the development of oral biofilms, which could lead to interferences with the oral microbiota already existing and the deterioration of oral health, with the development of dental caries, periodontal disease and even systemic infections. Therefore, preventive oral health care requires a cleaning and disinfection procedure for aligners. (2) Methods: A systematic review of the literature was conducted across four databases following the PRISMA guidelines up to May 2021, combining an electronic and a manual search. Prospective studies, including randomized controlled trials (RCTs), crossover studies (COSs) and controlled clinical trials (CCTs), published in the English language without time restrictions, evaluating the efficacy of cleaning and disinfection protocols for clear orthodontic aligners by comparing them with a placebo or a negative control, were included. The article selection, data extraction and risk of bias assessment were performed by two independent blinded review authors. In case of disagreement, a third author was solicited throughout the selection process. (3) Results: Among the 221 articles screened in the search process, 4 studies were included in the review, all designed as crossover studies (single arm without randomization with the same sequence of different cleaning and disinfection protocols for each participant). Different cleaning and disinfection methods were studied such as mechanical methods (brushing with toothpaste or vibration), chemical methods/pharmaceutical products (chlorhexidine antibacterial substance, anionic or cationic detergents or effervescent tablets) or combinations of both. (4) Conclusion: Although the determination of the most remarkable method of cleaning and disinfection was impossible because no direct comparison was conducted between all these methods, a multi-step protocol, including the combination of a mechanical and a chemical method, seems to be the most effective approach. Further research is needed to define the most preventive oral health care protocol. Registration: PROSPERO CRD 42021278498.

Management of temporomandibular disorders with transcutaneous electrical nerve stimulation: A systematic review.

Objective: The objectives of this systematic review were to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) for the management of temporomandibular disorders (TMD) and to determine the indications and most appropriate application modalities.Methods: Papers published in the Medline database, EMBASE, and the Cochrane Library before November 2018 were included.Results: Fourteen articles were retained, corresponding to a total of 532 patients, among which, 285 had a TMD. Immediately after a TENS session, significant relief of pain (19.2% to 77%), significant functional improvement (mouth opening amplitude increased by between 8.7% and 19.46%), and reduced electromyographic activity of the anterior temporalis and masseter muscles were observed. However, studies comparing TENS to other physical medicine modalities (ultrasound and laser) reported equivalent results.Conclusion: Further randomized comparative clinical trials will be necessary to optimize the use of TENS (program, duration of sessions, duration of treatment) for different types of TMD.

The dental "box of horrors" clinical practice game: A pilot project.

BACKGROUND: The dental department of the University Hospital of Nice has set the "box of horrors," an innovative concept inspired by the "room of horrors," created in 2006 in Canada, and utilized since 2011 in France. PURPOSE: The aim was to assess the impact and perceived value of this clinical practice game utilized by fourth-year dental students. METHODS: This pilot study following a cross-sectional pre- and posttest research design was used to assess students' change in performance. The experimental group was divided into 12 students teams (n = 50). A questionnaire was completed before they entered the box; they had then to find out 10 errors hidden in the box in a set time. A debriefing was held immediately after. The control group answered the same questions but did not follow the course inside the box. The percentages of correct answers were compared between the two groups with a Mann-Whitney test, and the scores per student were analyzed with a mixed effects ordinal multiple logistic regression. Finally, a satisfaction questionnaire was proposed. RESULTS: After the course, the students from the experimental group performed 94% correct answers, while those from the control group showed 78% (significant difference). The outcome of the mixed effect multiple regression showed a significant group effect (p = 0.0001) and gender effect (p = 0.001). CONCLUSION: Clinical games, although complex to implement, are interesting and rewarding tools. The adaptation of the tool to the dental sector appeared to be feasible.

What Are the Cleaning and Disinfection Methods for Acrylic Orthodontic Removable Appliance? A Systematic Review.

(1) Background: The use of removable orthodontic appliances, which is common in early ages, requires careful hygiene, as several different microorganisms are found on their surface during the orthodontic treatment. (2) Methods: Comprehensive electronic searches were conducted up to May 2021. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs), prospective or retrospective, evaluating the efficacy of cleaning and disinfection methods for acrylic removable orthodontic appliances, redacted in the English language, were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment. (3) Results: A total of 2491 records were screened and eight studies (six RCTs and two CCTs) fulfilled the inclusion criteria. Among the overall cleaning and disinfection methods described in the included studies, four categories could be defined: liquid antimicrobial agents, commercial tablet cleansers, natural plant extracts and incorporation of quaternary ammonium methacryloxy silicate, all of which demonstrated superior efficacy compared to the placebo/negative control. However, the different methods were not compared with each other. (4) Conclusions: Biofilm control on acrylic orthodontic removable appliances can be performed using the different cleaning and disinfection methods considered in the included studies. Further studies are needed to define the most effective technique. Registration: PROSPERO CRD 42021269297.

Analysis the Link between Periodontal Diseases and Alzheimer's Disease: A Systematic Review.

The hypothesis of an infectious connection from the oro-pharyngeal sphere to the brain underlines the interest in analyzing the link between periodontal disease and Alzheimer's disease. The aim of this systematic review was to examine the link between Alzheimer's disease and periodontal disease in patients aged 65 and over. Databases (PubMed (MEDLINE), the Cochrane Library, and Embase) were analyzed for relevant references up to 21 June 2021. The authors independently selected the studies and extracted the data. The quality of included studies was checked using the National Institutes of Health's quality assessment tools. Five studies were included. The selected studies described in their results an increase in F. nucleatum in Alzheimer's disease patients (adjusted p = 0.02), and its incidence was linked to C. rectus and P. gingivalis (adjusted HR = 1.22 (1.04-1.43), p = 0.012) as well as A. naeslundii (crude HR = 2.0 (1.1-3.8)). The presence of periodontitis at baseline was associated with a six-fold increase in the rate of cognitive decline over a 6-month follow-up period (ADAS-Cog mean change = 2.9 ± 6.6). The current review suggests an association between periodontal disease and Alzheimer's disease. The treatment of periodontal disease could be a way to explore Alzheimer's disease prevention.

Prioritization of predisposing factors of gingival hyperplasia during orthodontic treatment: the role of amount of biofilm.

BACKGROUND: The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm. METHODS: This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement". RESULTS: A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR: 3.5, 95% CI: 1.1-10.55) and duration of treatment (OR: 2.03, 95% CI: 1.01-4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment. CONCLUSIONS: Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.

[Oral care and the Coronavirus COVID-19 epidemic]. / Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

[Oral care and the Coronavirus COVID-19 epidemic] / Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

Hierarchizing caries risk factors among first-year university students in Nice (France): a cross-sectional study.

BACKGROUND: The purpose of this study was to rank the risk factors for dental caries among first-year university students in Nice (France). METHODS: All first-year students are required to undergo a compulsory preventive medical examination. Among these students, volunteers were offered a dental visit. Information was collected through an interview followed by an oral examination. We assessed the volunteers' oral hygiene habits (daily toothbrushing frequency, type of toothbrush used, frequency of toothbrush replacement, place of toothpaste purchase, and flossing), daily health-related behaviors (number of main daily meals, daily sugary intakes, smoking, alcohol consumption, consumption of cannabis or other drugs), oral-health-related behaviors (self-reported oral health, dental visits during the past year, reason for the last dental consultation, and failure to seek dental care due to financial reasons), and oral health issues (dental crowding, oral hygiene, presence of caries, presence of pit and fissure sealant remnants). The dependent variable was the presence of at least one untreated carious lesion. The data were subjected to univariate analyses to select explanatory variables, and subsequently, a logistic regression was performed. RESULTS: Six hundred twenty-nine students aged 18.8±1.6 years were enrolled in this study. The sex ratio was 0.72, with a strong predominance of the female gender. Only 59.3% of the students had never experienced dental caries, while 22.4% had already undergone restorative procedures and did not have any carious lesion at the time of the examination, and 11.6% presented with carious lesions and had never been treated by a dentist. Lastly, 6.7% had carious lesions despite evidence of prior restorative procedures. The multivariate analysis revealed the following pejorative risk factors: failure to seek dental care due to financial reasons (OR:3.06, 95% CI: 1.40-6.70), poor oral hygiene revealed during the oral examination (OR:2.59, 95% CI: 1.60-4.20), and poor self-reported oral health (OR:2.43, 95% CI: 1.24-4.77). Conversely, the analysis revealed the following protective factors: preventive visits to the dentist (OR:0.63, 95% CI: 0.41-0.99), the use of an electric toothbrush (OR:0.36, 95% CI: 0.17-0.77), and sealant remnants (OR:0.22, 95% CI: 0.05-0.97). CONCLUSIONS: The highest-ranking caries risk factor for the study population was the financial barrier.