[Prevalence of dental caries: national pilot study comparing the severity of decay (CAO) vs ICDAS index in Senegal]. / Prévalence de la carie dentaire: étude pilote nationale comparant l'indice de sévérité de la carie (CAO) vs ICDAS au Sénégal.

UNLABELLED: This pilot study has for main objective to measure the applicability and the utility of ICDAS index in a context of prevention in developing countries. Dental caries prevalence was evaluated among schoolchildren using DMF (WHO basic method) vs. ICDAS index in Senegal. MATERIALS AND METHOD: A representative stratified random cluster sample of 677 primary and college schoolchildren aged 12 and 15 years was examined for caries prevalence. The clinical examination was conducted in two steps for each. The investigator proceeded at first to the inventory of the number of teeth decayed (D), missing (M) or filled (F) according to the WHO basic method. Then, after cleaning and drying all teeth, a two-digit ICDAS code was used to record data at each dental surface. RESULTS: Caries prevalence (96%) was higher than expected in Senegal. ICDAS index provides 43% moreover information than DMF. The need for prevention (ICDAS1: 66%/72% and ICDAS2: 54%/58%) and intercept (ICDAS3: 40%/42% and ICDAS4: 31%/33%) are higher than the need of curative treatment (ICDAS5: 18%/23% and ICDAS6: 27%/33%) respectively among primary and college schoolchildren. CONCLUSION: Preventive programs are urgently needed in Senegal. It's necessary to lead epidemiological studies in other African countries for determining caries prevalence using the ICDAS criteria to harmonize oral health regional planning.

Illness-related behaviour and sociodemographic determinants of oral health care use in Dabou, Côte d'Ivoire.

OBJECTIVES: The aims of this study were to describe adults' oral health behaviour and identify the sociodemographic determinants that influence people to seek oral care in Côte d'Ivoire, in a context of promoting a more accessible health care system. METHODS: The design was a cross-sectional pilot survey undertaken in the department of Dabou, Côte d'Ivoire. A stratified sampling procedure with proportional allocation size was used, based on four different criteria: place of residence; type of dwelling; distance between the chosen locality and the dental clinic; and, the presence of a medical centre in the locality. The sample consisted of 927 people (18 years or older) who were interviewed by questionnaire. Data were collected at face to face interviews, using the method of itineraries. RESULTS: 34% of the population had not accessed a dental practitioner during the past 12 months. The reasons for not seeking care were: self-medication, lack of money and a perception of not needing care. A dentist or a traditional healer had been sought by 33%. The choice of therapy was influenced by educational level and having health insurance (p < 0.05). The main reasons for attending a traditional healer were linked to educational level, the type of dwelling and the participants' place of residence (p < 0.05). Choosing to see a dentist was associated with age, the type of dwelling and the distance between the chosen locality and the dental clinic (p < 0.05 CONCLUSION: The socioeconomic situation of the participants was a determining factor for seeking care. Improving access to health care should be part of the global fight against poverty and the reduction of social inequalities.

FDI Global Caries Initiative; implementing a paradigm shift in dental practice and the global policy context.

The implementation of a new paradigm for caries management is necessary for the profession to respond effectively to changing population health needs. The FDI Global Caries Initiative (GCI) is a 10 year programme aimed at developing and implementing a new paradigm for caries management, one that would contribute to a common vision of health. The article reviews the global health policy landscape and examines how it might influence and shape the implementation of the GCI.

DMF from WHO basic methods to ICDAS II advanced methods: a systematic review of literature.

BACKGROUND: Evaluation of caries status has changed with emergence of modified ways of managing the condition. There is a need to assess the relationship between the old and new methods of registering caries. OBJECTIVE: To identify the ICDAS II codes to be used to record the D-component of the DMF index as defined in the WHO Basic Methods, 1997 publication. METHOD: A review of literature published between January 2002 and January 2012 was undertaken using "ICDAS" as keyword in an electronic search. Only epidemiological studies that used ICDAS II as an evaluation criterion calculated the DMF indices and gave the ICDAS II codes for the diagnosis of caries lesions, were included. RESULTS: Fourteen studies met the inclusion criteria. The DMF designations that corresponded with the WHO definition were D(3-6)MF (10 studies), D(4-6)MF (4 studies) or D(5-6)MF (3 studies). The D-component referred to cavitated carious lesions (7 studies) or dentine caries (7 studies), but there was no consensus on the ICDAS II codes that are used to define them. Only the ICDAS II codes 5 and 6 had unanimous support; they were always counted as "Caries", but there was less certainty for codes 3 and 4. The only study on fields that compared both methods showed D(3-6) to be the always associated with the D-component of the DMF index as defined in the WHO Basic Methods. CONCLUSION: There was disagreement of the ICDAS II codes to be used for the DMF calculation; and when there was a need to compare DMF values between studies, the diagnosis threshold should be verified to be the same.

Caries risk management: effect on caries incidence in a sample of Lebanese preschool children.

OBJECTIVES: This clinical prospective study describes how caries preventive measures applied according to caries risk affect new caries incidence in a group of preschoolers, as compared to a group where standardized caries prevention is applied, regardless of risk. METHOD AND MATERIALS: Healthy children, aged four years or less, recruited at the Faculté de Médecine Dentaire, Université Saint-Joseph, Beirut, Lebanon were assigned, after parental consent, to an experimental or a control group. Caries risk was determined based on a parental questionnaire, salivary levels of Steptococcus mutans (Sm) and Lactobacillus (Lb), salivary buffer capacity, plaque levels and carious lesions prevalence, then subjects were classified into four caries risk categories. In the experimental group, preventive measures designed for each risk category were applied periodically, whereas control subjects received only standardized preventive measures at regular intervals. All subjects were reevaluated for Sm, Lb, salivary buffer capacity, plaque and new carious lesions after 24 months. RESULTS: Statistically significant reductions in salivary Sm (p=0.001) and Lb (p=0.003) levels, plaque scores (p=0) and caries incidence (p=0.003) were observed in the experimental group. In the control group, no significant differences were observed between initial and final Sm (p=0.18) and Lb (p=0.109) levels or plaque scores (p=0.255), and caries incidence was not significantly reduced (p=0.584). CONCLUSION: The present study's results suggest that caries preventive measures applied according to caries risk may reduce caries risk factors and new caries incidence in preschool-aged children. These findings deserve further investigation to benefit early childhood caries prevention on a larger scale.

[Traditional practices and exploitation of medicinal plants in odontostomatology in Ivory Coast]. / Pratiques traditionnelles et valorisation des plantes médicinales en odonto-stomatologie en Côte d'Ivoire.

Traditional medicine of which is a part traditional odontology occupies an important place within the African societies. It often constitutes the first appeal (80 % of the population) because of the high cost of the care, the incapacity of the human and material resources but also the faiths of the populations. This reality makes valuation of the traditional odontology a necessity. This study comes within this framework. It's a contribution for a better knowledge of practices and plants used in traditional odontology in Ivory Coast. So, after a presentation of some traditional knowledge's and their fields of application, the authors review studies made on the efficiency of plants in the prevention of tooth decay and the treatment of some oral diseases. The objective of these researches is to elaborate effective and financially affordable traditional improved drugs.

Caries prevalence and caries risk in a sample of Lebanese preschool children.

OBJECTIVES: This study describes early childhood caries prevalence and caries risk in a group of Lebanese preschoolers. METHOD AND MATERIALS: 99 healthy children, aged four years or less, were recruited at the Dental medicine faculty, Saint-Joseph university, Beirut, Lebanon. After parental consent, questionnaires investigated children's dietary and oral hygiene habits and parents' education and health behaviors. Oral examinations, with bite-wing radiographs when necessary, determined decayed-filled surfaces and plaque scores. Salivary testing assessed buffer capacity and streptococcus mutans (Sm) and lactobacillus (Lb) presence. The three tests (questionnaire, oral examination, salivary testing) established a caries risk assessment tool, determining subjects' caries risk scores, classified as low (C0), moderate (C1), high (C2) or very high (C3). RESULTS: 25.3% of subjects were caries-free, 24.2% had 4 carious lesions or less, 28.3%, 5 to 9 lesions and 22.2% over 10 lesions. 11.1% of plaque scores were low to mild, 18.2% moderate, 46.4% high, and 24.3% very high. Salivary buffer capacity was: 29.3% high, 57.6% medium and 13.1% low. High levels of Sm, (66.7%) correlated with plaque presence and proximal caries. High levels of Lb (52.5%) correlated with plaque presence and smooth-surface caries, and correlated significantly with occlusal caries. Regular tooth brushing yielded lower plaque, but not significantly lower caries levels. Systemic fluorides were associated with lower plaque and caries scores. Children of educated parents with regular dental visits and oral hygiene had lower plaque and caries scores. Caries risk distribution was: CO: 16.2%, C1: 29.3%, C2: 15.1% and C3: 39.4%. CONCLUSION: Most subjects had at least one carious lesion (74.7%), and 70.7% showed high to very high plaque scores. Over half the sample presented high or very high caries risk. These findings deserve further investigation of the Lebanese preschoolers' population.

Antiviral Activity of Reagents in Mouth Rinses against SARS-CoV-2.

The oral cavity, an essential part of the upper aerodigestive tract, is believed to play an important role in the pathogenicity and transmission of SARS-CoV-2. The identification of targeted antiviral mouth rinses to reduce salivary viral load would contribute to reducing the COVID-19 pandemic. While awaiting the results of significant clinical studies, which to date do not exist, the commercial availability of mouth rinses leads us to search among them for reagents that would have specific antiviral properties with respect to SARS-CoV-2. The challenges facing this target were examined for 7 reagents found in commercially available mouth rinses and listed on the ClinicalTrials.gov website: povidone-iodine, chlorhexidine, hydrogen peroxide, cyclodextrin, Citrox, cetylpyridinium chloride, and essential oils. Because SARS-CoV-2 is an enveloped virus, many reagents target the outer lipid membrane. Moreover, some of them can act on the capsid by denaturing proteins. Until now, there has been no scientific evidence to recommend mouth rinses with an anti-SARS-CoV-2 effect to control the viral load in the oral cavity. This critical review indicates that current knowledge of these reagents would likely improve trends in salivary viral load status. This finding is a strong sign to encourage clinical research for which quality protocols are already available in the literature.

Photolysis of the carbon monoxide complex of myoglobin: nanosecond time-resolved crystallography.

The biological activity of macromolecules is accompanied by rapid structural changes. The photosensitivity of the carbon monoxide complex of myoglobin was used at the European Synchrotron Radiation Facility to obtain pulsed, Laue x-ray diffraction data with nanosecond time resolution during the process of heme and protein relaxation after carbon monoxide photodissociation and during rebinding. These time-resolved experiments reveal the structures of myoglobin photoproducts, provide a structural foundation to spectroscopic results and molecular dynamics calculations, and demonstrate that time-resolved macromolecular crystallography can elucidate the structural bases of biochemical mechanisms on the nanosecond time scale.

Energy transduction on the nanosecond time scale: early structural events in a xanthopsin photocycle.

Photoactive yellow protein (PYP) is a member of the xanthopsin family of eubacterial blue-light photoreceptors. On absorption of light, PYP enters a photocycle that ultimately transduces the energy contained in a light signal into an altered biological response. Nanosecond time-resolved x-ray crystallography was used to determine the structure of the short-lived, red-shifted, intermediate state denoted [pR], which develops within 1 nanosecond after photoelectronic excitation of the chromophore of PYP by absorption of light. The resulting structural model demonstrates that the [pR] state possesses the cis conformation of the 4-hydroxyl cinnamic thioester chromophore, and that the process of trans to cis isomerization is accompanied by the specific formation of new hydrogen bonds that replace those broken upon excitation of the chromophore. Regions of flexibility that compose the chromophore-binding pocket serve to lower the activation energy barrier between the dark state, denoted pG, and [pR], and help initiate entrance into the photocycle. Direct structural evidence is provided for the initial processes of transduction of light energy, which ultimately translate into a physiological signal.

Cost-effectiveness modeling of dental implant vs. bridge.

AIMS: We assess the cost-effectiveness of dental implant first-line strategy vs. fixed partial denture strategy in patients suffering from one single missing tooth. MATERIALS AND METHODS: The model used a simulation decision framework over a 20-year period. Potential treatment switches can occur every 5 years. Transition probabilities come from literature, epidemiological reports or expert opinions. They have been programmed using specific distribution ranges to simulate the patients' and practice variability, and to take into account parameter uncertainty. Direct medical costs have been assessed according to a cost survey. Probabilistic sensitivity analyses were conducted using 5000 Monte-Carlo simulations, generating confidence intervals of model outcomes. RESULTS: We found that mean cost-effectiveness of the bridge strategy is higher than the implant strategy. CONCLUSION: Implant as the first-line strategy appears to be the 'dominant' strategy, considering the lower overall costs and the higher success rate.

Strategies to promote better access to over the counter products for oral health in Europe: a Delphi survey.

OBJECTIVES: 'Over The Counter' (OTC) is a pharmaceutical product or medicine whose distribution or the administration does not require medical authorisation, and which can be used by consumers on their own initiative. This can be to prevent, relieve or treat symptoms or moderate pathologies and whose use, under the forms, packaging and authorised formulation are safe for the consumer. A Delphi consultation in the perspective of coming to a consensus was initiated to identify the current and future orientations on the best strategies of administration of OTC products for oral health in Europe. METHODS: A Delphi Survey was conducted with 54 experts from 23 countries in Europe. Each indicator statement was considered to be in consensus if the expert's opinion rating was of 4 or 5 for more than 75% in a scale of seven categories. The first questionnaire concerned self medication and the situation of OTC prescriptions in 2006. The second included 19 statements focused on the possible role of OTC products in dental practice. Both qualitative and quantitative analyses were created. RESULTS: There was a strong consensus that the population's common practices towards OTCs should be modified. Practitioners should possess communication qualities allowing them to share their power and to advise patients of their decision-making concerning oral care. CONCLUSIONS: The Delphi Survey was successful in underlining that dentists have to be involved in oral health OTC prescription which, currently, seems unsatisfactory. OTC products and especially fluoride toothpaste improve oral health but have to be available, accessible and used advisedly.

[Oral health surveillance in Africa: current review of policies and strategies]. / Surveillance de la santé buccodentaire en Afrique : revue actuelle des politiques et stratégies.

BACKGROUND: This article aims to analyze the situation of oral health surveillance in Africa, as certain trends in political and regional strategies and to initiate a reflection on future orientations of African health information systems. METHODS: A literature review from 1997 to 2008 was performed using PubMed/Medline, The Cochrane Library and Pascal. A search with the same terms and expressions was performed on Internet using the website Google Scholar and WHO. Keywords and headings corresponding to a list of terms and expressions related to the oral health surveillance were "health information systems", "oral health surveillance", "politics", "strategies" and "indicators for Africa". RESULTS: Fifty-eight articles were analyzed and results concerned insufficiencies and stakes of oral health surveillance systems for the African region. Many political recommendations and strategies contribute to better comprehension of problematic and new orientations for oral health surveillance systems, as new public health issues develop together with new challenges for the African region. CONCLUSION: Many perspectives related to an integrated approach to the prevention of chronic diseases based on risk factors and availability of the STEP-wise approach recommended by the WHO for the use of essential oral health indicators in Africa. These perspectives argue for potential development of a regional information system.

[Essential indicators of orodental health in Africa. Applicability in Ivory Coast]. / Indicateurs essentiels de santé bucco-dentaire de la région Afrique. Applicabilité en Côte d'Ivoire.

INTEREST OF THE PROBLEM: The objective of this study is to highlight the gaps from a consideration of the essential indicators in the national system of sanitary information of Ivory Coast. Modalities of their applicability in the surveillance of the oral health are also discussed. POSITION OF THE PROBLEM: The use of the essential indicators answers the necessity of setting up a system of surveillance of the common factors of risk based on standardized information which will allow comparisons between countries. However, the applicability of these indicators is not enough known and the quantitative measure to test their reliability and their validity was not realized yet to allow their easy consideration in global Infobase. METHOD: This study is based on the documentary analysis of the catalogue on selection of the essential indicators, and the database of the national program of oral health. RESULTS: Twenty-two essential indicators are applicable in the national information system. In particular, ten indicators are easily applicable without technical difficulties and twelve are averagely applicable. CONCLUSION: The essential indicators are pertinent for the surveillance of the oral health in Côte d'Ivoire. However, future researches are necessary to test their validity in the national information system. Also, similar pilot studies could be realized in the other African contexts to establish an operational and standardized frame to collect relevant and valid information.

Structural dynamics of myoglobin.

Protein structure is endowed with a complex dynamic nature, which rules function and controls activity. The experimental investigations that yield information on protein dynamics are carried out in solution; however, in most cases, the determination of protein structure is carried out by crystallography that relies on the diffraction properties of a large number of molecules, in approximately the same conformation, arranged in a three-dimensional lattice. Myoglobin, maybe the most thoroughly characterized protein, has allowed the formulation of general principles in the field of protein structure-function correlation and, since the late 1990s, it has been possible to obtain directly some insight into the complex dynamic behavior of myoglobin and other proteins by Laue diffraction. This chapter describes some of the technological features involved in obtaining reliable data by time-resolved Laue crystallography, with subnanosecond time resolution. A synopsis of the more significant findings obtained by laser photolysis of myoglobin-CO crystals is also presented, emphasizing the more general aspects of dynamics relevant to the complex energy landscape of a protein.

Report of the EGOHID I Project. Selecting a coherent set of indicators for monitoring and evaluating oral health in Europe: criteria, methods and results from the EGOHID I project.

OBJECTIVES: The EGOHID I (European Global Oral Health Indicators Development) project started in 2002 under the European Health Monitoring Programme. The aim was to develop a set of indicators for monitoring and describing oral health morbidity and different facets of oral health care systems in Europe. The challenge was to define valid indicators that would cover common concerns and would have the same meaning throughout the different European health care systems. METHODS: EGOHID included i) a review of existing recommendations on oral health indicators, ii) a European study of the availability of national/or regional statistics to construct recommended indicators; iii) a consensus process using aggregation of preferences methods to select a list of essential indicators; iv) the production of a catalogue for information users, including descriptions for all indicators. RESULTS: A set of 40 indicators in oral public health were identified which, even though restricted to a minimal essential list, still addressed four key dimensions. The 40 indicators were described in four categories. Part A. indicators for monitoring the oral health of children and adolescents; Part B. indicators for monitoring the oral health of general population; Part C. indicators for monitoring oral health systems and Part D. indicators for monitoring oral health quality of life. This work has enabled a feasibility study (EGOHID II, which is now in progress), which is an essential part of an overall project, since it will allow Member States to evaluate their capability to use these indicators. CONCLUSIONS: The EGOHID 1 project was successful in identifying a set of 40 indicators which drew on and consolidated previous work. Consensus was achieved from a wide group of stakeholders on precise indicators in areas where uncertainty about appropriate indicators was high; some areas were also targeted for future development.

4q25 microdeletion encompassing PITX2: A patient presenting with tetralogy of Fallot and dental anomalies without ocular features.

Axenfeld-Rieger syndrome (ARS) is a heterogeneous clinical entity transmitted in an autosomal dominant manner. The main feature, Axenfeld-Rieger Anomaly (ARA), is a malformation of the anterior segment of the eye that can lead to glaucoma and impair vision. Extra-ocular defects have also been reported. Point mutations of FOXC1 and PITX2 are responsible for about 40% of the ARS cases. We describe the phenotype of a patient carrying a deletion encompassing the 4q25 locus containing PITX2 gene. This child presented with a congenital heart defect (Tetralogy of Fallot, TOF) and no signs of ARA. He is the first patient described with TOF and a complete deletion of PITX2 (arr[GRCh37]4q25(110843057-112077858)x1, involving PITX2, EGF, ELOVL6 and ENPEP) inherited from his ARS affected mother. In addition, to our knowledge, he is the first patient reported with no ocular phenotype associated with haploinsufficiency of PITX2. We compare the phenotype and genotype of this patient to those of five other patients carrying 4q25 deletions. Two of these patients were enrolled in the university hospital in Toulouse, while the other three were already documented in DECIPHER. This comparative study suggests both an incomplete penetrance of the ocular malformation pattern in patients carrying PITX2 deletions and a putative association between TOF and PITX2 haploinsufficiency.

Oral health indicators for children and adolescents: European perspectives.

AIM: The purpose of the European Global Oral Health Indicators Development Project (EGOHIDP) was to support the exchange of expectations and experiences among experts in the field of oral health statistics and their audience, in particular policy makers, resulting in recommendations for a list of essential oral health indicators. EGOHIDP was supported by the Health and Consumer Protection Directorate-General of the European Commission to point out a short list of essential indicators for Oral Health. METHODS: Systematic review of the existing indicators and consensus process between a group of experts in oral health related areas. RESULTS: The short list of 40 oral health indicators was determined (rate of agreement >70%) among the European experts members of the project. Twelve items focus on Oral Health of children and adolescents: they are described in the present paper. CONCLUSION: Further developing phases aimed to establish standardised methodological criteria for the collection of oral health data are also described.

Factors Associated with HIV Status Disclosure in HIV-Infected Sub-Saharan Migrants Living in France and Successfully Treated with Antiretroviral Therapy: Results from the ANRS-VIHVO Study.

To estimate rates and identify correlates of HIV disclosure in migrants from sub-Saharan Africa (SSA) successfully treated, a sub-analysis was conducted in HIV-1 native SSA migrants, living in France with undetectable viral load on antiretroviral, included in the VIHVO adherence study. Logistic regression models assessed factors associated with HIV disclosure. Among 246 individuals (40 % male, median age 41), 79 % of those in a steady heterosexual partnership (n = 167) had disclosed their status to their partner, 55 % of the total 246 to a relative, and 33 % to (an)other person(s). Disclosure to one's steady partner was associated with a follow-up duration since HIV diagnosis of more than 5 years, a higher literacy level, a better social context and marital status. Women were more likely to disclose their HIV status to relatives. Interventions targeting this population should be provided to improve disclosure which in turn ensures better social support, testing of the partner and lower rates of undiagnosed HIV.

A pancreatic lipase with a phospholipase A1 activity: crystal structure of a chimeric pancreatic lipase-related protein 2 from guinea pig.

BACKGROUND: The guinea pig pancreatic lipase-related protein 2 (GPLRP2) differs from classical pancreatic lipases in that it displays both lipase and phospholipase A1 activities; classical pancreatic lipases have no phospholipase activity. The sequence of GPLRP2 is 63 % identical to that of human pancreatic lipase (HPL), but the so-called lid domain, is much reduced in GPLRP2. A phospholipase A1 from hornet venom (Dolml PLA1) is very similar to HPL and GPLRP2 but is devoid of lipase activity; Dolml PLA1 also contains a reduced lid domain and lacks a region termed the beta9 loop, which is located in the vicinity of the HPL and GPLRP2 active sites. The structure determination of a chimera of GPLRP2 and HPL and domain building of Dolml PLA1 were undertaken to gain a better understanding of the structural parameters responsible for the differences in lipase versus phospholipase activity among these structurally related enzymes. RESULTS: The crystal structure of a chimeric mutant of GPLRP2, consisting of the catalytic domain of GPLRP2 and the C-terminal domain of HPL, has been solved and refined to 2.1 A resolution. This enzyme belongs to the alpha/beta hydrolase fold family and shows high structural homology with classical pancreatic lipases. The active site is closely related to those of serine esterases, except for an unusual geometry of the catalytic triad. Due to the reduced size of the lid domain, the catalytic serine is fully accessible to solvent. Part of the beta9 loop, which stabilizes the lid domain in the closed conformation of the classical HPL, is totally exposed to the solvent and is not visible in the electron-density map. CONCLUSIONS: The structures of the related enzymes, GPLRP2 and HPL and the model of Dolml PLA1, provide insights into the role played by the loops located above the active site in controlling substrate selectivity towards triglycerides or phospholipids. In GPLRP2, the lid domain is reduced in size compared to HPL, and hydrophilic residues are exposed to solvent. GPLRP2 is thus able to accommodate the polar head of phospholipids. The beta9 loop is still present in GPLRP2, making it possible for this enzyme to still accommodate triglycerides. In Dolml PLA1, the beta9 loop is absent, and this enzyme is unable to process triglycerides retaining only the phospholipase A1 activity.