[Oral infections and pregnancy: knowledge of health professionals]. / Infections buccodentaires et complications de la grossesse: connaissances et attitudes des professionnels de santé.

OBJECTIVE: The abundance of recent studies on the relationship between oral diseases and complications of pregnancy leads to questions on knowledge of health professionals. This study aims to establish an inventory of knowledge and practice of health professionals in France on this issue. PATIENTS AND METHODS: A questionnaire on knowledge of the relationship between oral diseases and complications of pregnancy was referred to gynaecologists and obstetricians, midwives and dentists. This study was conducted at the University Hospital of Nantes and Le Mans General Hospital. RESULTS: Eighty-seven professionals of pregnancy and 259 dentists responded to the survey. Bleeding gums and pregnancy gingivitis are the oral manifestations most cited by all practitioners. There is however a difference concerning the epulis and caries risk. The most cited Pregnancy complications are risk of premature delivery and chorioamniotitis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point to the lack of continued education on this topic. DISCUSSION AND CONCLUSION: There is a good knowledge of the pregnancy complications associated with oral disease despite the lack of training of pregnancy, but the attitudes of care are not still in adequacy. It appears necessary to strengthen the training of all practitioners in this field. The design and implementation of a specific questionnaire on oral health status could allow better identification of the patients at risk by the professionals of pregnancy, and optimize so the care of pregnant women.

[Periodontal diseases and preterm birth: a pilot study]. / Maladies parodontales et accouchements prématurés: étude clinique pilote.

The aim of this work is to determine periodontal disease's prevalence in preterm delivery (before 37 weeks of gestation) and find a significant association between preterm birth and periodontal diseases. Periodontal status was determined. Status and severity were noted and correlated to term of delivery. Fifty-two patients were included in the study. Periodontal disease's prevalence was 33% for gingivitis and 44% for periodontitis. No significant correlation was found (P=0.41). Periodontal disease's prevalence is agreed with literature review. The different opinion are largely discussed. Methodological harmonization of periodontal definitions is needed to increase study's power.

[Inquiry into the oral follow-up of diabetic patients: knowledge and application of the recommendations of the Haute Autorité de Santé]. / Enquête sur le suivi bucco-dentaire des patients diabétiques: connaissance et application des recommandations de la Haute Autorité de Santé.

In 1999, the Haute Autorité de Santé (HAS) issued recommendations on the follow-up in France of diabetic patients. It recommends at least an annual dental examination with special attention on the periodontal environment. The results of studies suggest that recommendations on the monitoring of oral diabetes are few or not implemented. In this work, we sought to evaluate the application of the recommendations of the HAS for patients with diabetes and in particular the recommendations on oral follow-up, from a cross-sectional survey using questionnaires to dentists (CD), general practitioners (MG) and diabetic patients in the region of Pays de la Loire. The results of this cross-sectional study shows that the requirements for monitoring oral health of these patients are poorly known and therefore far from being massively applied by health professionals. Our study revealed a lack of knowledge among health professionals, in monitoring oral diabetic patients. The causal association between diabetes and periodontal diseases are now well established; the dentist should be more involved in the medical team during the monitoring of diabetic patients. His role involves the prevention and care oral disease early. The patient information is the first step of prevention and care that it should be issued in any consultation with a dentist and relayed by the associations of diabetic's patients who should also be better informed.

[Pigmentation and pigmented lesions of the gingival mucosa]. / Pigmentations et lésions pigmentées des muqueuses gingivales.

The pigmentation is the physiological or pathological accumulation of a pigment in a tissue. Physiological pigmentation in gingiva which is a part of masticatory mucous membranes depends on the activity of the melanocytes. These non keratinocytic cells include the melanosoma where an endogenous pigment, the melanin, is synthesized. Quantitative or qualitative disruption of mucous pigmentation leads to the apparition of pigmented lesions. When melanocytes are directly concerned, the lesions can be of intrinsic origin, such as oral mucosa melanoma, the nevus, pigmented oral lichen planus etc. Pigmented lesions can be also of extrinsic origin caused by medicaments, dental materials, tobacco etc. In this article, gingival pigmentations are described to allow practitioner to elaborate a differential and positive diagnosis of gingival pigmented lesions and to facilitate an early detection of these lesions particularly the gingival melanoma.

[Periodontal diseases, tobacco and pregnancy]. / Maladies parodontales, tabac et grossesse.

This review summarizes the impact of tobacco on the periodontium of pregnant women and the effects of periodontal diseases combined with tobacco on the pregnancy. Periodontal diseases (gingivitis and periodontitis) are gram-negative anaerobic infections. Smokers are 2-7 times more likely to develop periodontal disease than non-smokers. Tobacco, an environmental factor, undermines the host response and may facilitate the development and progression of periodontal disease. Recent epidemiological studies suggest that maternal periodontal diseases would be a risk factor of pre-term deliveries or pre-term low birth weight (PLBW). Cigarette smoking during pregnancy leads to peri-natal morbidity and mortality and it is associated with reduced birth-weight. Tobacco during pregnancy also amplifies the risk of PLBW directly and via periodontal diseases. This article highlights the etio-pathogenic interrelations between periodontal diseases and tobacco as risk factors of PLBW. The blood dissemination of periodontal bacteria and the effects of cytokines like TNF-alpha, Il-1, produced during periodontal infections could explain these obstetrical adverse events. The concept of diagnosing and treating a periodontal disease in a pregnant woman to minimizes the deleterious effects of this infection on systemic conditions represents an unprecedented challenge. Moreover, periodontist have the opportunity to take part in smoking cessation program for pregnant women.

Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients.

OBJECTIVES: To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections. DESIGN: Single-blind randomized comparative study. SETTING: A 16-bed adult intensive care unit in a university hospital. PATIENTS: Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation. INTERVENTIONS: After randomization, the treated group received dental plaque decontamination with 0.2% chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. SPECIFIC MEASUREMENTS: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week. MAIN RESULTS: Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33% days in the ICU and 10.7 vs 32.3% days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation. CONCLUSIONS: An antiseptic decontamination of dental plaque with a 0.2% chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.

Features of severe periodontal disease in a teenager with Chédiak-Higashi syndrome.

BACKGROUND: Chédiak-Higashi syndrome (C-HS) is a rare congenital disease characterized by defective neutrophil function with abnormal lysosomal inclusions, neutropenia, and reduced chemotaxis. The complete syndrome includes oculocutaneous albinism with photophobia, neurologic features, recurrent infections, and enterocolitis. METHODS: A 14-year-old male C-HS patient was referred to us because of serious periodontal destruction with acute inflamed gingiva and ulcers. Clinical and biological investigations were performed, leading to the diagnosis of C-HS. RESULTS: Laboratory findings included neutropenia and hypergammaglobulinemia. Peripheral blood smears showed giant granules in neutrophils, eosinophils, and granulocytes. Bone marrow smears showed giant inclusions in leukocyte precursor cells. These granules and inclusions were characteristic of Chédiak-Higashi syndrome. Oral radiographic status showed extensive loss of alveolar bone leading, in most cases, to tooth exfoliation. Bacteria often associated with periodontitis were detected in subgingival plaque samples, including Fusobacterium nucleatum, Campylobacter rectus, Prevotella melaninogenica, Peptostreptococcus anaerobius, and Clostridium sp. Biopsies of periodontal tissues for light and electronic microscopic examinations revealed massive bacterial invasion of the epithelial tissue, epithelial cells, and connective tissue. Ultrastructural observations of periodontal polymorphonuclear leukocytes showed defective granulation, with abnormal granules not discharging their lysosomal content against engulfed bacteria. Viable dividing bacteria were found in the cytoplasm. CONCLUSIONS: In this case, early-onset periodontitis seems to be the expression of C-HS granulocyte deficiency. Periodontal treatment of these patients is often unsuccessful. This case report illustrates the importance of the dentist in initiating clinical and biological investigations in such early aggressive periodontitis in young patients.

Colonization of dental plaque: a source of nosocomial infections in intensive care unit patients.

OBJECTIVE: To study the dental status and colonization of dental plaque by aerobic pathogens and their relation with nosocomial infections in intensive care unit (ICU) patients. DESIGN: A prospective study in a medical ICU of a university-affiliated hospital. PATIENTS: Consecutive patients admitted to the ICU during a 3-mo period. INTERVENTIONS: Dental status was assessed by the same investigator using a score adapted from the "Caries-Absent-Occluded" (CAO) index (referred to in the U.S. as DMFT [Decayed-Missing-Filled Teeth] index). The amount of dental plaque on premolars was assessed using a semiquantitative score. Quantitative cultures of dental plaque, nasal secretions, tracheal aspirates, and urine were done at admission (day 0) and every fifth day until death or discharge. An additional study was done in eight patients to serially compare dental plaque, salivary, and tracheal aspirate cultures during a 2-wk period. MEASUREMENTS AND MAIN RESULTS: Fifty-seven patients were included in the main study. Due to the variability in their ICU stay, 29 patients could be examined on day 0 only (group A), 15 patients on days 0 and 5 (group B), and 13 patients on days 0, 5, and 10 (group C). The mean dental CAO score was 16 +/- 8 and did not change during the ICU stay. The dental plaque score was < or =1 in 70% of patients on day 0; > or =2 in 50% of patients on day 5; and > or =2 in 90% of patients on day 10. Dental plaque cultures were positive at 10(3) colony-forming units/mL for aerobic pathogens in 23% of patients on day 0; 39% of patients on day 5; and 46% of patients on day 10. In groups B and C, mean dental plaque score and frequency of plaque colonization increased from days 0 to 5 and from days 5 to 10. A high bacterial concordance was found between dental plaque and tracheal aspirate cultures, and in the additional study, between salivary and dental plaque cultures. Twenty-one patients developed a nosocomial infection in the ICU. Dental plaque colonization on days 0 and 5 was significantly associated with the occurrence of nosocomial pneumonia and bacteremia (sensitivity 0.77; specificity 0.96; positive predictive value 0.87; negative predictive value 0.91; relative risk 9.6). In six cases of nosocomial infection, the pathogen isolated from dental plaque was the first identified source of nosocomial infection. CONCLUSIONS: The amount of dental plaque increased during the ICU stay. Colonization of dental plaque was either present on admission or acquired in 40% of patients. A positive dental plaque culture was significantly associated with subsequent nosocomial infections. Dental plaque colonization by aerobic pathogens might be a specific source of nosocomial infection in ICU patients.