Oral Infections and Pregnancy: Knowledge of Gynecologists/Obstetricians, Midwives and Dentists.

PURPOSE: To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants. MATERIALS AND METHODS: A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients. RESULTS: Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic. CONCLUSION: The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia.

[Dental care during pregnancy]. / Enquête sur la prise en charge de la femme enceinte au cabinet dentaire.

AIM: to understand and analyze knowledge and practices of dentists regarding dental care during pregnancy using a questionnaire which focuses on the knowledge of the relationship between oral infections and complications of pregnancy, the attitude of practitioners on the implementation of dental care during pregnancy and the training of practitioners. RESULTS: 53.9% of pregnant women are not referred by an obstetrician. Only 59.8% of practitioners believe that dental anesthesia is not contraindicated, and most practitioners believe that the best time for care is the second trimester or after pregnancy. During pregnancy, practitioners realize the motivation for hygiene (90.7%), drainage of an abscess (82.2%), scaling (76.1%), the placement of a splint (74.1%), the treatment of caries (70%), and the removable prosthesis (67.2%). CONCLUSION: these results indicate the existence of a gap between the care of pregnant women and the state of the art in dental science, despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second and third trimester. Moreover, the results highlight the need to reinforce the initial training of dental students, but also to develop the training for practitioners in this field.

Clinical outcomes after nonsurgical periodontal therapy with an Er:YAG laser device: a randomized controlled pilot study.

OBJECTIVE: The purpose of this study was to compare the short-term effects of nonsurgical periodontal treatment with the short-term effects of Er:YAG laser debridement (ERL) and manual scaling and root planning (SRP) in nonsmoking patients with chronic periodontitis. METHODS: Nineteen nonsmoking patients (mean age 60.7) with chronic generalized periodontitis were randomly treated with ERL or SRP in a split-mouth design. Clinical attachment level (CAL), periodontal pocket depth (PPD), and bleeding on probing (BOP) were recorded. Immediately after completion of the treatment procedure, patients used a visual analogue scale (VAS) to grade the degree of discomfort experienced during treatment. RESULTS: Both groups showed significant reductions in their PPD, CAL, and BOP values 2 months after treatment. The sites treated with Er:YAG laser demonstrated mean PPD changes that varied from 5.00 ± 0.63 to 3.54 ± 0.83 mm, mean CAL changes that varied from 5.19 ± 0.69 to 3.86 ± 0.94 mm, and BOP changes that varied from 26.57 ± 12.54 to 13.17 ± 7.52 mm. Sites treated with manual SRP demonstrated mean PPD changes that varied from 4.91 ± 0.55 to 3.51 ± 0.98 mm, mean CAL changes that varied from 5.08 ± 0.59 to 3.95 ± 1.16 mm, and BOP values that varied from 24.81 ± 7.65 to 15.41 ± 6.32 mm. Comparison of the two techniques demonstrated the statistically significant superiority of Er:YAG only for the CAL scores (p<0.05). CONCLUSIONS: Within the limits of this study, ERL may be posited as an alternative to mechanical treatment in the management of chronic periodontitis. In addition, ERL may be performed on patients who are sensitive to the use of injectable anesthetics. Future studies, with larger samples, are needed to determine the long-term clinical outcomes of ERL.

Treatment of periodontal defects in dogs using an injectable composite hydrogel/biphasic calcium phosphate.

An injectable composite silanized hydroxypropyl methyl cellulose/biphasic calcium phosphate (Si-HPMC/BCP) has been investigated in humans with promising results. The aim of this study was to evaluate his efficacy for treating periodontal defects (canine fenestration and premolar furcation) in dog models. At 3 months, we observed that bone formation around BCP particles in furcation model is more discernible but not statistically significant in defects filled with Si-HPMC/BCP compared to healing in control. We suggest that BCP particles sustain the bone healing process by osteoconduction, while the Si-HPMC hydrogel enhances intergranular cohesion and acts as an exclusion barrier. Furthermore, bone ingrowth is not so distinctive in superficial defects where the biomaterial appears unstable. These results with Si-HPMC/BCP are encouraging. In addition, this biomaterial is easy to use and simplifies the process of filling periodontal lesions. However, more researches are needed to improve the viscosity and hardness to adjust the material to the specificities of periodontal defects.

Laser-induced fluorescence for subgingival calculus detection: scientific rational and clinical application in periodontology.

OBJECTIVE: To review the data available on the laser-induced calculus fluorescence phenomenon and the calculus detection devices as well as to determine the clinical relevance of using commercialized calculus detection devices in periodontal treatment. METHODS: In vitro or in vivo English publications found on Medline. RESULTS: In vitro and in vivo studies showed that the devices on the market had a satisfactory detection capacity. Very few studies demonstrated that the erbium:yttrium-aluminium-garnet (Er:YAG) laser debridement, when performed with automatic calculus detection, could lead to improvements at the clinical level, and the outcome was similar to that obtained with conventional treatments. CONCLUSIONS: Although preliminary data were encouraging, there was a lack of scientific data concerning the calculus detection devices. Therefore, future studies are crucial for determining the clinical relevance of such equipment.

Tooth desensitization with an Er:YAG laser: in vitro microscopical observation and a case report.

Tooth hypersensitivity is a frequent condition that causes discomfort and sometimes severe pain. It is caused by exposure of spots of dentinal tubules to the oral environment. Conventional desensitizing agents (professional pastes, toothpastes, mouthwashes) aim to obliterate the exposed dentinal tubules. Laser desensitization was introduced as an alternative efficient tool for the immediate treatment of tooth hypersensitivity. We explored in vitro the microscopical occluding effects of the Er:YAG laser on exposed dentinal tubules. The clinical application of this technique is also described.

Experimental animal models in periodontology: a review.

In periodontal research, animal studies are complementary to in vitro experiments prior to testing new treatments. Animal models should make possible the validation of hypotheses and prove the safety and efficacy of new regenerating approaches using biomaterials, growth factors or stem cells. A review of the literature was carried out by using electronic databases (PubMed, ISI Web of Science). Numerous animal models in different species such as rats, hamsters, rabbits, ferrets, canines and primates have been used for modeling human periodontal diseases and treatments. However, both the anatomy and physiopathology of animals are different from those of humans, making difficult the evaluation of new therapies. Experimental models have been developed in order to reproduce major periodontal diseases (gingivitis, periodontitis), their pathogenesis and to investigate new surgical techniques. The aim of this review is to define the most pertinent animal models for periodontal research depending on the hypothesis and expected results.

[Orthodontic tooth displacement: histology, biology and iatrogenic effects]. / Le déplacement dentaire orthodontique : histologie, biologie et effets iatrogènes.

Iatrogenic effects of orthodontic forces, in particular root resorption, are described in the literature. However, our knowledge on the risk of osseous defects induced by orthodontic treatment is still scarce. After an overview of histological and biological principles of orthodontically-induced tooth movement, this study focuses on the recent data concerning the occurrence and the treatment of bone resorption associated with orthodontic treatment.

Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study.

OBJECTIVE: To document the effect of gingival and dental plaque antiseptic decontamination on the rate of nosocomial bacteremias and respiratory infections acquired in the intensive care unit (ICU). DESIGN: Prospective, multicenter, double-blind, placebo-controlled efficacy study. SETTING: Six ICUs: three in university hospitals and three in general hospitals. PATIENTS: A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation, with an anticipated length of stay > or =5 days. INTERVENTIONS: Antiseptic decontamination of gingival and dental plaque with a 0.2% chlorhexidine gel or a placebo gel, three times a day, during the entire ICU stay. MEASUREMENTS AND MAIN RESULTS: Demographic and clinical characteristics, organ function data (Logistic Organ Dysfunction score), severity of condition (Simplified Acute Physiologic Score), and dental plaque status were assessed at baseline and until 28 days. Bacteriologic sampling of dental plaque and saliva was done every 5 days, and blood, tracheal aspirate, and bronchoalveolar lavage cultures were performed when appropriate. The primary efficacy end point was the incidence of bacteremia, bronchitis, and ventilator-associated pneumonia, expressed as a percentage and per 1000 ICU days. All baseline characteristics were similar between the treated and the placebo groups. The incidence of nosocomial infections was 17.5% (13.2 per 1000 ICU days) in the placebo group and 18.4% (13.3 per 1000 ICU days) in the plaque antiseptic decontamination group (not significant). No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days, mortality, length of stay, and care loads (secondary end points). On day 10, the number of positive dental plaque cultures was significantly lower in the treated group (29% vs. 66%; p < .05). Highly resistant Pseudomonas, Acinetobacter, and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination. No side effect was reported. CONCLUSIONS: Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients. However, its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria.