Periodontal Diseases and Pregnancy: Knowledge and Clinical Practice Habits of French Midwives.

PURPOSE: Several studies have demonstrated the role of periodontal disease as risk factor of adverse pregnancy outcomes, including preterm birth, low birthweight and pre-eclampsia. As such, midwives can play an essential role in prevention and early screening as the preferred intermediary of pregnant women. The purpose of this study was to assess the knowledge, training and daily practice habits of midwives to determine if they fulfill their role in oral health prevention. MATERIALS AND METHODS: A questionnaire was sent by e-mail to practicing midwives and fifth-year midwifery students in the Brittany region of France. Data were collected online and descriptive data analyses were conducted. RESULTS: A total of 192 practicing midwives and 13 students participated in the survey. The results showed that the majority of midwives were not familiar with the correlation between periodontal disease and adverse pregnancy outcomes and did not implement screening and prevention to a sufficient extent. CONCLUSION: The explanation for this lack of knowledge seems to come from the initial training, since the topic of oral health is almost never discussed during midwives' studies. Most agreed they needed more training on periodontal disease and adverse pregnancy outcomes. Improving and integrating oral health education into the midwife academic curriculum can enhance midwives' engagement in oral health.

Influence of Periodontal Ligament Stem Cell-Derived Conditioned Medium on Osteoblasts.

Mesenchymal stem cells (MSC) are involved in the regeneration of various missing or compromised periodontal tissues, including bone. MSC-derived conditioned medium (CM) has recently been explored as a favorable surrogate for stem cell therapy, as it is capable of producing comparable therapeutic effects. This study aimed to evaluate the influence of periodontal ligament stem cells (PDLSC)-CM on osteoblasts (OB) and its potential as a therapeutic tool for periodontal regeneration. Human PDLSC were isolated and characterized, and CM from these cells was collected. The presence of exosomes in the culture supernatant was observed by immunofluorescence and by transmission electron microscopy. CM was added to a cultured osteoblastic cell line (Saos-2 cells) and viability (MTT assay) and gene expression analysis (real-time PCR) were examined. A cell line derived from the periodontal ligament and showing all the characteristics of MSC was successfully isolated and characterized. The addition of PDLSC-CM to Saos-2 cells led to an enhancement of their proliferation and an increased expression of some osteoblastic differentiation markers, but this differentiation was not complete. Saos-2 cells were involved in the initial inflammation process by releasing IL-6 and activating COX2. The effects of PDLSC-CM on Saos-2 appear to arise from a cumulative effect of different effective components rather than a few factors present at high levels.

Knowledge, attitudes and professional practices of ortho-periodontal care of adults: a cross-sectional survey in France.

BACKGROUND: Due to increasing numbers of adult patients, orthodontists are being confronted more and more with periodontal problems. Coordination amongst orthodontists, periodontists and general dentists is useful in preventing and stopping periodontal disease. The main objectives of this survey were to evaluate the technical knowledge, techniques and attitudes employed by French orthodontists, periodontists and general dentists in adult dental care. METHODS: A cross-sectional online survey was distributed to French dentists. The questionnaire, consisting of 30 questions, was divided into six sections covering treatment programs and the forensic environment. RESULTS: One thousand one hundred twenty-two complete answers were recorded. Adults undergoing orthodontic treatment represented 19.9% of the orthodontists' patients, but only 2.67% of the general dentists' patients. Communication between clinicians was rated as good, greater than 3 out of 5. Before treatment, orthodontists were less alarmed than generalists regarding bleeding, recessions, increased probing depths, halitosis and hyperplasia. During treatment, orthodontists never or only occasionally performed palpation or probing in 54.2% and 84.6% of cases. Gingivitis and recessions were the main reasons for consultations for 22.0% and 20.1% of general dentists and periodontists after orthodontic treatment. Of the practitioners surveyed, 43% felt that they experienced a setback in the ortho-periodontal treatment. CONCLUSIONS: This study revealed discrepancies in the knowledge and attitudes of practitioners. Therapeutic management remains one of the major challenges of multidisciplinary treatments. Continuing education needs to be further developed in this field.

Osteoarthritis of the Temporomandibular Joint: A Narrative Overview.

Background and Objectives: This study reviewed the literature to summarize the current and recent knowledge of temporomandibular joint osteoarthritis (TMJOA). Methods: Through a literature review, this work summarizes many concepts related to TMJOA. Results: Although many signaling pathways have been investigated, the etiopathogenesis of TMJOA remains unclear. Some clinical signs are suggestive of TMJOA; however, diagnosis is mainly based on radiological findings. Treatment options include noninvasive, minimally invasive, and surgical techniques. Several study models have been used in TMJOA studies because there is no gold standard model. Conclusion: More research is needed to develop curative treatments for TMJOA, which could be tested with reliable in vitro models, and to explore tissue engineering to regenerate damaged temporomandibular joints.

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery.

Cleft lip and palate is the fourth most common congenital malformation. Its prevalence is about 1 in 750 to 1 in 2000 live births. The consequences of this malformation are major: maxillary growth deficit, unaesthetic appearance, phonation disorders, difficulty in eating, and psycho-social disorders. Cleft palate repair establishes the division between the oral and nasal cavities. The alveolar bone graft is a key step. Different sites of autogenous bone harvesting are used, the most common being the iliac crest. Nevertheless, the large number of complications associated with harvesting has led to the use of substitute biomaterials. Bioactive glasses, discovered in 1969, are a group of synthetic silica-based materials with bone-bonding properties. Although 45S5 granular composition is commonly used in bone surgery to repair critical defects, it is only rarely used in the repair of cleft palates because this galenic form is only moderately adapted. However, advances in bone tissue engineering allow the shaping of three-dimensional scaffolds, which support colonization by host cells. Recent advances in computer-aided design/computer-aided manufacturing (CAD/CAM) have even led to the 3D printing of scaffolds combining 45S5 bioglass with a natural and biocompatible poly-lactic acid matrix. The shape of the parts is customized and adapted to the particular shape of the critical bone defects. The objective of this literature review is to highlight the particularities of alveolar defects subsequent to facial clefts, then to detail the characteristics of the materials and technologies used to elaborate 3D matrices by bioprinting. Finally, we will explore research directions regarding their use in reconstructive surgery of cleft palates.

Antibiotic Use in Periodontal Therapy among French Dentists and Factors Which Influence Prescribing Practices.

The aim of the present survey is to investigate the use of antibiotics during periodontal therapy among French dentists with a focus on exploring potential differences between various groups of practitioners. A self-administered questionnaire was distributed to different groups of practitioners including members of (i) the French Society of Periodontology and Implantology; (ii) the College of University Teachers in Periodontology and, (iii) private practitioners participating in the French general dental practice-based research network. 272 questionnaires were included in the analysis. Prescription patterns were globally in line with the current recommendations. Systemic antibiotics are most frequently used as a first-line therapy in necrotizing periodontitis (92%) and aggressive periodontitis (53.3% to 66.1%). However, malpractice still exists, including in the management of periodontal abscesses. Antibiotics are prescribed (i) less frequently for periodontal abscesses and (ii) more frequently for generalized aggressive periodontitis by members of the periodontal society and University college (p < 0.05). Amoxicillin (59.9%) and the amoxicillin + metronidazole (59.6%) combination were the most frequently prescribed molecules. Providing a high number of periodontal treatments per week, being more recently graduated, having a post-graduate certificate in periodontology and holding or having held an academic position/hospital practice were all factors associated with a better knowledge of and/or more adequate antibiotic use.

Mesenchymal stem cell-derived small extracellular vesicles as cell-free therapy: Perspectives in periodontal regeneration.

Mesenchymal stem cells (MSC) are involved in the regeneration of the different missing or compromised periodontal tissues. MSC-derived small extracellular vesicles (sEV) have recently been explored as a favorable substitution for stem cell therapy, as they are capable of producing therapeutic effects comparable to those of their parent cells, with advantages over cell therapy. The aim of this review is to evaluate the use of mesenchymal stem cells (MSC)-derived sEV as cell-free therapy in periodontal regeneration. A review of the scientific literature on sEV and their use in periodontal regeneration was performed. The main characteristics of sEV are described, and their mechanisms of action and potential biological effects in periodontal regeneration are studied. A summary of existing preclinical studies conducted in animals is performed. The results indicate that sEV derived from MSC are emerging as a promising new therapeutic tool in the field of periodontal regeneration and may become an ideal therapeutic option. In this review, we have summarized recent advances in this regard in order to better understand this newly emerging treatment. First results in vivo are promising and show a favorable potential for cell-free therapy in periodontal regeneration.

How effective are three methods of teaching oral hygiene for adolescents undergoing orthodontic treatment? The MAHO protocol: an RCT comparing visual, auditory and kinesthetic methods.

BACKGROUND: Fixed orthodontic appliances hamper oral hygiene procedures. The consequences are gingivitis and white spot lesions. Fifty to 70% of patients treated with braces encounter these problems. Their care in the USA represents an annual cost of five hundred million dollars. Initial education and motivation for oral hygiene depend on two categories of factors: firstly, practical prophylactic measures (instruments and medication, professional care) and secondly, the educational component: choice of communication technique, frequency, and nature of hygiene instructions. This trial aims to study this last component. Its main objective is to compare three methods' effectiveness of oral hygiene education in adolescent patients treated with braces in terms of biofilm (plaque) control. The secondary objectives are the evaluation of these methods' effectiveness regarding gingival inflammation and the maintenance of hygiene during the first 6 months of treatment. METHODS: This study is a prospective randomized controlled trial of superiority. It evaluates the effectiveness of three hygiene education techniques. A total of 90 patients from the University Hospital Center of Rennes will be randomized into 3 parallel groups with a 1:1:1 ratio. Each will benefit from a different educational method: oral and/or practical. The main outcome will be the average plaque index for each group after 6 months of treatment. Additional outcomes will be the average gingival index for each group and the plaque and gingival indices over 6 months. DISCUSSION: The effectiveness of preventive procedures for optimizing oral hygiene during orthodontics is based on ambiguous literature. As a result, it is difficult to draw conclusions and to translate them into everyday practice. Sixty-eight percent of the orthodontists support the development of guidelines for education. The aim of this study is to standardize methods of oral hygiene education during orthodontic fixed treatment. The purpose of this study would be to provide practitioners with a concrete education program through guidelines dedicated to the method having the best results. TRIAL REGISTRATION: ClinicalTrials.gov NCT04444154 . Registered on 22 June 2020. SI CNRIPH ID 8011N° 20.04.27.58337. Registered on 29 July 2020.

[A new classif ication in Periodontology (Chicago 2017). Impact in Orthodontics]. / Une nouvelle classification en parodontologie (Chicago 2017). Impact en orthodontie.

In 2018, a new « Classification of Periodontal and Peri-implant Diseases and Conditions ¼ was adopted by the American Academy of Periodontology and the European Federation of Periodontology. Numerous studies in recent years have improved the understanding of periodontal diseases and their risk factors, leading to an update of the 1999 classification. Among the major changes is the development of a classification of periodontitis into different stages and grades and the notion of periodontal health, an essential prerequisite for orthodontic treatment. Based on the analysis of the 24 published articles, this work provides explanations regarding the main changes that orthodontists may face. The classification of Chicago precisely defines periodontal health and proposes a new system for characterizing periodontitis in stages and grades. It then becomes a valuable aid for the orthodontist in risk detection and periodontal screening. The knowledge of this new classification is essential for reliable communication between dentists, periodontists and orthodontists, in order to guarantee the success of orthodontic treatment.

Prevalence and Associated Factors of Self-Reported Gingival Bleeding: A Multicenter Study in France.

Gingival bleeding (GB) is a common sign of gingival inflammation which indicates the presence of periodontal diseases. This cross-sectional multicenter survey aimed to assess the prevalence of self-reported gingival bleeding (SRGB) in French adults and identify the main associated factors. A questionnaire-based interview was randomly proposed to 794 individuals in four French cities (Nancy, Montpellier, Paris, and Rennes). Subjects were recruited in preventive medicine centers (50%), railway stations, and malls (50%). The questionnaire comprised 25 items: SRGB characteristics, socioeconomic variables, oral hygiene habits, use of drugs, and anxiety level. The overall prevalence of SRGB was 63.2% [59.8%; 66.6%], with 58.7% bleeding after toothbrushing and 4.5% spontaneous bleeding. Males reported significantly lower SRGB prevalence than females (p = 0.04). The distribution of SRGB frequency was inversely proportional to age (p < 0.0001). No association between drug use and SRGB was found. The people interviewed in the preventive medicine centers reported the highest frequency of SRGB (p < 0.0001). In the multivariate logistic model, SRGB was significantly related to occupation, smoking status, brushing frequency, and anxiety level. In conclusion, SRGB was prevalent in more than half of the sample and was mainly associated with age, toothbrushing frequency, and anxiety level. Thus, providing information to patients about the importance of this oral manifestation may play an important role in preventing periodontal diseases.

Perception of Gingival Bleeding by People and Healthcare Professionals: A Multicentre Study in an Adult French Population.

Gingival bleeding (GB) is a common sign of gingival inflammation, which indicates the presence of periodontal diseases. This study aimed to describe the perception of French adults about their self-reported GB and answers of healthcare professionals regarding the GB reported by these interviewees. A questionnaire administered by one investigator in each of three public settings of four cities in France from September 2016 to November 2017. Among 794 adults interviewed, 502 (63.2%) reported a GB. Among them, 414 (82.5%) believed that GB is benign, and 309 (61.6%) declared one or more responses. The three main responses were to use mouthwash (29.3%), to change to a soft-bristle toothbrush (20.1%) and to modify the brushing technique (19.3%). Almost half (49.0%) questioned at least one healthcare professional concerning their GB: a dentist (43.0%), a physician (14.1%), and a pharmacist (8.0%). The main response of each healthcare professional was: for dentists: a "prescription of mouthwash", for physicians to say "gingival bleeding is not serious"; and for pharmacists: "to sell a mouthwash". Most of the participants considered their GB as benign and had inappropriate responses, which indicates their lack of knowledge regarding periodontal health. The same conclusions can be drawn for healthcare professionals, as reported by interviewees.

Development of a 3D human osteoblast cell culture model for studying mechanobiology in orthodontics.

OBJECTIVES: Mechanobiology phenomena constitute a major element of the cellular and tissue response during orthodontic treatment and the implantation of a biomaterial. Better understanding these phenomena will improve the effectiveness of our treatments. The objective of this work is to validate a model of three-dimensional (3D) culture of osteoblasts to study mechanobiology. MATERIALS AND METHODS: The hFOB 1.19 cell line was cultured either traditionally on a flat surface or in aggregates called spheroids. They were embedded in 0.8% low-melting agarose type VII and placed in a polyethylene terephthalate transwell insert. Compressive forces of 1 and 4 g/cm2 were applied with an adjustable weight. Proliferation was evaluated by measuring diameters, monitoring glucose levels, and conducting Hoechst/propidium iodide staining. Enzyme-linked immunosorbent assays focusing on the pro-inflammatory mediators interleukin (IL)-6 and IL-8 and bone remodelling factor osteoprotegerin were performed to evaluate soluble factor synthesis. quantitative reverse transcription-polymerase chain reaction was performed to evaluate bone marker transcription. RESULTS: The 3D model shows good cell viability and permits IL dosing. Additionally, three gene expression profiles are analysable. LIMITATIONS: The model allows analysis of conventional markers; larger exploration is needed for better understanding osteoblast mechanobiology. However, it only allows an analysis over 3 days. CONCLUSION: The results obtained by applying constant compressive forces to 3D osteoblastic cultures validate this model system for exploring biomolecule release and analysing gene transcription. In particular, it highlights a disturbance in the expression of markers of osteogenesis.

Clinical application of mesenchymal stem cells in periodontal regeneration: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the potential efficacy of mesenchymal stem cells (MSCs) in periodontal regeneration in humans on the following main outcomes: clinical attachment level (CAL), probing depth (PD), and gingival recession (GR). BACKGROUND: The clinical application of stem cells in periodontal regeneration has begun in recent years, but clinical practices are not yet standardized and no recommendations are available at this time. METHODS: Electronic database searches and hand searches were conducted. All types of studies, case series, and case reports were qualitatively described. Double-blind randomized controlled trials (RCTs) evaluating MSCs in periodontal regeneration were included in a meta-analysis if they compared administration of MSCs vs application of stem cell-free therapy in the control group, in healthy patients with periodontal defects, with a minimum of three mo of follow-up. RESULTS: Fifteen reports were included in qualitative analysis, involving 123 patients and 158 periodontal defects. Only two small RCTs at high risk of bias, with a total of 59 patients and 70 periodontal defects, were included in the meta-analysis. A small but significant difference between test and control groups was found for CAL at three mo (-0.90 mm, 95% CI [-1.51; -0.29]), but not for PD and GR. CONCLUSION: Low-quality evidence suggests that MSC-based therapy may have a small impact on periodontal regeneration. However, due to the monocentric character, the small sample size, and potential heterogeneity across the two included RCTs, these results must not be considered as definitive. High-quality RCTs are needed before any clinical use of MSCs in periodontal regeneration.

[Bone mechanobiology, an emerging field: a review]. / La mécanobiologie osseuse, un domaine émergeant : revue de littérature.

INTRODUCTION: Mechanobiology, at the interface between biology and biophysics, studies the impact of mechanical forces on tissues, cells and biomolecules. The application of orthodontic forces, followed by induced tooth displacement, is a striking example of its clinical application. OBJECTIVE: The purpose of this article was to compile a review of the literature on the subject of mechanobiology; from its detection at bone level to the presentation of stimulated intracellular pathways. MATERIALS AND METHODS: The literature search was conducted on the Pubmed database in April 2018, with associations of the terms "mechanobiology", "orthodontics", "cell culture", "physiopathology". RESULTS: Three major areas of research were selected: highlighting of the phenomenon and its application in the field of bone biology; the cellular effectors of mechanobiology and its clinical applications. The use of mechanobiology in dentofacial orthopedics opens up a new field of reflection for clinicians regarding future advances in orthodontics.

Evaluation of Functional SiO2 Nanoparticles Toxicity by a 3D Culture Model.

CONTEXT: as a kind of non-metal oxide SiO2 NPs have been extensively used in biomedicine, pharmaceuticals and other industrial manufacturing fields, such as DNA delivery, cancer therapy… Our group had developed a method based on microemulsion process to prepare SiO2 NPs incorporating photonic or magnetic nanocrystals and luminescent nanosized inorganic metal atom clusters. However, the toxicity of nanoparticles is known to be closely related to their physico-chemical characteristics and chemical composition. OBJECT: it is therefore of interest to investigate the toxicity of these novel SiO2 NPs to the cells that may come in contact. MATERIALS AND METHODS: the potential toxic effect of the functional @SiO2 NPs containing Mo6 clusters with or without gold nanoparticles was investigated, at concentrations 1 µg/mL, 10 µg/mL and 100 µg/mL each, on three different cell lines. Cell viability was measured by the MTT test in monolayer's culture whereas the cytotoxicity in spheroid model was examined by the APH assay. In a second time, oxidative-stress-induced cytotoxicity was investigated through glutathione levels dosages. RESULTS: the results indicated that both A549 and L929 cell lines did not exhibit susceptibility to functional @SiO2 NPs-induced oxidative stress unlike KB cells. DISCUSSION: SiO2 NPs containing CMB may become toxic to cultured cells but only at a very high dosage level. Therefore, this toxicity depends on cell lines and more, on the model of cell cultures. The selection of appropriate cell line remains a critical component in nanotoxicology. CONCLUSION: these results are relevant to future applications of SiO2 gold-cluster NPs in controlled release applications.

Application of self-regulation theory and motivational interview for improving oral hygiene: a randomized controlled trial.

AIM: Because patient adherence to oral hygiene is essential for periodontal treatment success, the aim of the study was to assess whether a motivational interview addressing the five dimensions of Leventhal's theory performed better than conventional basic instruction on improving compliance with plaque control among patients with periodontitis. MATERIALS AND METHODS: A randomized controlled clinical trial design was used in which a group of patients underwent a motivational interview in addition to classical consultation. A control group received only the standard consultation. The O'Leary Plaque Index was used to judge the oral hygiene at baseline and at 1 month follow-up. Patient satisfaction with the dental visit was scored using a specific questionnaire. RESULTS: At baseline, the mean full mouth plaque score varied between 55% (experimental group) and 58% (control group). Patients in the experimental group had a higher oral hygiene improvement (21 ± 20% versus 4 ± 5%, p < 0.001) 1 month post-treatment. The motivational interview resulted in greater satisfaction scores compared with those of patients in the control group: 10.55 ± 1.53 versus 8.82 ± 2.40, p = 0.014. CONCLUSIONS: This new concept of motivational interview is a promising approach and can be useful for counselling-related periodontal disorders.

Effect of hydroxyapatite and beta-tricalcium phosphate nanoparticles on promonocytic U937 cells.

OBJECTIVES: Nanoparticles from implanted materials are reported as the main cause of implant failure. Monocytes are among the first cells to colonize the inflammatory site. We evaluated the biological effects of bone substitutes presented to U937 cells in vitro as micron- or nanometer-sized particles. METHODS: The HA (550 nm) and beta-TCP (550 nm) nanoparticles were incubated with U937 cells. Cell cycle modification, specific antigens expression, and the extent of cell death were determined. RESULTS: Firstly, by using the sulforhodamine B (SRB) test and the annexin V-FITC analysis by flow cytometry, our results provide evidence of the absence of cytotoxicity, and show that nanoparticles do not induce more apoptosis than microparticles in U937 cells. Secondly, although morphologic evidence of stimulation of U937-cells was found by confocal microscopy, neither bone substitute altered the distribution of the cells into different phases of the cell cycle (Kit Cycle Test Plus DNA). These results suggest that nanoparticles do not cause promonocyte maturation in macrophages. Thirdly, the flow cytometry results showed no differences in the expression of the adherence and activation markers. SIGNIFICANCE: The results suggest that nanoparticles do not promote the differentiation of promonocytic U937 cells into macrophages and do not induce an enhanced inflammatory response.