Analysis of the dental care queries in the "Mouth-Nose" discussion forum of the French association of patients with Gougerot-Sjögren's syndromes and dryness.

BACKGROUND: Primary Sjögren Syndrome is a rare autoimmune systemic disease characterized by impaired secretory functions of the exocrine gland. One of the main clinical features is dry mouth and subsequent oral diseases, which are also found in patients with Sicca. This leads to a marked deterioration in the quality of life and the patient's search for information and solutions. Many patients turn to patients' associations that offer moments of sharing to their members, especially through online discussion forums. Today, these forums represent quality material for a sociological or biomedical analysis of patients' concerns, as close as possible to their daily lives. Our objective is to analyze the concerns of patients with SS or Sicca regarding their dry mouth especially dental care. METHODS: In this cross-sectional observation study, a quantitative analysis of the Mouth-Nose online forum discussion of the French Association of Patients with Gougerot-Sjögren's Syndromes and Dryness have been performed. After reading and re-reading, initial request themes, topics, and subtopics were established and coding was performed. Then, the 885 threads were classified depending the initial request, pragma-linguistic indices and the main topic discussed in the thread. After identifying the threads dealing with dental care, we looked at which types of care were most discussed and classified the discussions according to whether or not the patient was satisfied with their care at the dentist. RESULTS: The majority of the initial requests are posts for experiences sharing and/or advice. The topic of "dental care" is one of the main concerns of the forum users. Among the threads that concern dental care, requests to share experience with implants are in the majority. Finally, the majority of the posts on dental care relate to care in private dental practice, deals with dental implants and prevention and resulted mainly in patient satisfaction. CONCLUSIONS: Analysis of the forum reveals importance of patient concerns about prevention, and care costs due to implant treatment, which add to disease burden. Most of messages relate favorable experiences with their dentists, which is in line with the approach of sharing experiences and support characteristic of a forum.

Implanted Dental Pulp Cells Fail to Induce Regeneration in Partial Pulpotomies.

Cell-based partial pulp regeneration is one of the promising approaches to obtain newly formed functional dentin-pulp complex. It relies on the preservation of the healthy tissue while regenerating the damaged pulp. The aim of this study was to investigate whether this regenerative process could be achieved by implanting porcine dental pulp cells (pDPCs) in pulp defects in the minipig. By split-mouth model, self-assembling injectable nanopeptide hydrogel, with and without pDPCs, was implanted after cameral pulpotomy in premolars and molars. At day 21 after surgery, 3-dimensional morphometric characterization, Masson's trichrome staining, and immunolabeling for DSP and BSP (dentin sialoprotein and bone sialoprotein) were performed on treated teeth. This study demonstrated no pulp regeneration but systematic reparative dentinogenesis. In fact, regardless of the presence of pDPCs in the scaffold, an osteodentin bridge-the microarchitecture of which significantly differed from the native dentin-was systematically obtained. Furthermore, the presence of pDPCs significantly affected the microstructure of the dentin bridges. In the radicular area of each treated tooth, hyperemia in the remaining pulp and external root resorptions were observed. Under the conditions tested in this work, pulp regeneration was not achieved, which highlights the need of further investigations to develop favorable regenerative microenvironment.

Minimal intervention dentistry II: part 4. Minimal intervention techniques of preparation and adhesive restorations. The contribution of the sono-abrasive techniques.

The concept of minimal intervention in oral medicine is based on advances in biological sciences applied to the dental organ. Many cultural barriers, economic as well as technical, have thwarted the application of micro-invasive conservative techniques by the general practitioner. Emerging technologies do not remove all obstacles but promote the integration of less invasive techniques in daily practice. Sono-abrasion is a technique for the selective preparation of enamel and dentine offering excellent efficacy, quality and safety. The authors describe the therapeutic principles, the choice of instrumentation and its mode of action and discuss its interest in adhesive restorative dentistry. The illustrated clinical situations focus on the preservation and optimisation of tissue bonding for both initial lesions and advanced lesions.

Minimal intervention dentistry II: part 2. Management of caries and periodontal risks in general dental practice.

The long-term clinical management of caries and periodontal diseases requires a double approach, one that is concerned with both treatment and prevention. Dentists should recognise the risk factors and their likely triggers to be able to implement the right strategy as early as the diagnostic phase. This comprehensive assessment can easily be done in general practice. All it takes is to combine the patient's general information with the systemic and behavioural factors, and the clinical observations with the local factors. The resulting patient profile can thus effectively support treatment by providing the necessary explanations, advice or prescriptions in relation with the clinical procedures. The modifiable risk factors need to be monitored and the behaviours changed to stabilise or limit disease progression. The practitioner's active approach is meant to meet the patient's demand for preventive counselling.

Effect of a calcium-silicate-based restorative cement on pulp repair.

In cases of pulp injury, capping materials are used to enhance tertiary dentin formation; Ca(OH)(2) and MTA are the current gold standards. The aim of this study was to evaluate the capacity of a new calcium-silicate-based restorative cement to induce pulp healing in a rat pulp injury model. For that purpose, cavities with mechanical pulp exposure were prepared on maxillary first molars of 27 six-week-old male rats, and damaged pulps were capped with either the new calcium-silicate-based restorative cement (Biodentine), MTA, or Ca(OH)(2). Cavities were sealed with glass-ionomer cement, and the repair process was assessed at several time-points. At day 7, our results showed that both the evaluated cement and MTA induced cell proliferation and formation of mineralization foci, which were strongly positive for osteopontin. At longer time-points, we observed the formation of a homogeneous dentin bridge at the injury site, secreted by cells displaying an odontoblastic phenotype. In contrast, the reparative tissue induced by Ca(OH)(2) showed porous organization, suggesting a reparative process different from those induced by calcium silicate cements. Analysis of these data suggests that the evaluated cement can be used for direct pulp-capping.

Clinical evaluation of the Carisolv chemomechanical caries removal technique according to the site/stage concept, a revised caries classification system.

The objective of the present study was to assess the efficiency and benefit of a chemomechanical system for carious dentin removal, Carisolv, in general practice. A revised caries classification, the site/stage concept, was used to describe the clinical situations of all carious lesions treated. The study was performed by 12 investigators, and 120 carious lesions were treated with Carisolv. Sixty percent of the cases were treated without anaesthesia, and we found a significant correlation between chemomechanical treatment without anaesthesia and absence of pain ( P=0.01). In 78.3% of the cases, carious dentin was totally removed with Carisolv, and in 21.7%, the dentin treatment was completed by drilling. In cases performed with Carisolv alone, the time required to remove carious dentin was 11.1+/-9.51 min (mean+/-SD). Treatment time was equivalent for all sites and increased significantly with each successive stage of lesion progression ( P<0.001). In 82.5% of cases, the clinicians were satisfied with Carisolv, and in 99.2%, so were the patients. We conclude that, using clinical examination methods, Carisolv seems to remove carious dentin at all sites and stages of carious lesions but must be made more efficient for use in general practice.

[Mineralization of the dental pulp: contributions of tissue engineering to tomorrow's therapeutics in odontology]. / Minéralisation de la pulpe dentaire: apports de l'ingénierie tissulaire aux thérapeutiques de demain en odontologie.

When bioactive molecules such as bone sialoprotein (BSP), bone morphogenetic protein-7 (BMP-7, also termed OP-1) and chondrogenic Inducing Agents (CIA, A+4 and A-4) were implanted in the pulp of the first upper molars, mineralizations were induced. They were either limited to the formation of a reparative dentinal bridge closing the pulpal wound (CIA A+4), or filled the mesial part of the coronal pulp (BSP), or filled totally the pulp located in the root canal (BMP-7 and CIA A-4). Consequently, these molecules may change in the next future the every day practice in dentistry.

Osteogenic proteins (bone sialoprotein and bone morphogenetic protein-7) and dental pulp mineralization.

Bone sialoprotein (BSP) cross-linked to collagen/gelatin was implanted in the pulp of rat's upper molars. Comparison was carried out with a sham group (non implanted), with a group of rats receiving the carrier alone, and a group of molars where the perforated pulps were capped with calcium hydroxide. The cavities were occluded with a glass-ionomer cement (GIC). After 8, 14 and 30 days respectively the rats were killed by intracardiac perfusion of the fixative and processed for light microscopy. Dentin and predentin debris pushed into the pulp during the preparation enhanced self-repair processes, with large pulp remnants. The carrier alone induced slight inflammation, and calcium hydroxide the formation of a reparative dentin bridge. BSP stimulated the recruitment of cells which produced an homogeneous atubular dentin-like structure, filling after one month the mesial third of the crown pulp. Osteogenic protein (OP-1) used in the same experimental conditions induced the formation of osteodentin in the coronal pulp and the radicular part of the pulp was totally filled by a mineralized material. The differences reported here suggest two possible different therapeutic approaches with the two osteogenic proteins, BSP inducing pulp mineralization in the crown part, and OP-1 occluding the root part of the pulp.

Application of bioactive molecules in pulp-capping situations.

To evaluate the effects of bioactive molecules in pulpal wound healing, we carried out experiments using the rat upper molars as an in vivo model. Cavities were prepared on the mesial aspect, and pulp perforation was accomplished by the application of pressure with the tip of a steel probe. After the pulp-capping procedure, the cavities were filled with a glass-ionomer cement. Comparison was made between and among: (1) sham-operated controls with dentin and predentin fragments implanted in the pulp during perforation after 8, 14, and 28 days; (2) carrier without bioactive substance; (3) calcium hydroxide; (4) Bone Sialoprotein (BSP); (5) different concentrations of Bone Morphogenetic Protein-7 (BMP-7), also termed Osteogenic Protein-1 (OP-1); and (6) N-Acetyl Cysteine (NAC), an anti-oxidant agent preventing glutathione depletion. Histologic and morphometric comparison, carried out among the first 4 groups on demineralized tissue sections, indicated that, at 28 days after implantation, BSP was the most efficient bioactive molecule, inducing homogeneous and well-mineralized reparative dentin. BMP-7 gave reparative dentin of the osteodentin type in the coronal part of the pulp, and generated the formation of a homogeneous mineralized structure in the root canal. These findings indicate that the crown and radicular parts of the pulp bear their own specificity. Both BSP and BMP-7 were superior to calcium hydroxide in their mineralization-inducing properties, and displayed larger areas of mineralization containing fewer pulp tissue inclusions. The overall mineralization process to these molecules appeared to proceed by mechanisms that involved the recruitment of cells which differentiate into osteoblast-like cells, producing a mineralizing extracellular matrix. We also provide preliminary evidence that NAC induces reparative dentin formation in the rat molar model. Pulp-capping with bioactive molecules provides new prospects for dental therapy.

Bone sialoprotein-induced reparative dentinogenesis in the pulp of rat's molar.

Bone sialoprotein (BSP), an osteogenic protein (OP), mixed with a carrier, was implanted in the pulp of rat first upper molars (OP group). Cavities were prepared with dental burs and pulp perforation was carried out by pressure with the tip of a steel probe. After 8, 14, and 30 days, the rats were killed and the pulps of the OP group were compared with (1) a sham group (S group), (2) a group where the carrier was implanted alone (C group), and (3) capping with calcium hydroxide (Ca group). After 8 days, a few inflammatory cells were seen, mostly located at the pulp surface near the perforation. In the Ca group, a dentin bridge started to form, in contrast to the other groups. After 15 days, globular structures were seen in the pulps of the S and C groups. A reparative osteodentin bridge isolated the pulp from the cavity in the Ca group. Variable reactions were seen in the OP group, with some evidence of cell and matrix alignments or plugs of osteodentin in continuity with an inner layer of reparative dentin. After 30 days, irregular osteodentin formation was observed in the pulps of the S and C groups, with a tendency for globular structures to merge, but with interglobular spaces filled by pulp remnants. In the Ca group, osteodentin was observed in the mesial part of the pulp chamber. In the BSP-implanted group, the osteogenic protein stimulated the formation of a homogeneous dentin-like deposit occupying most of the mesial part of the pulp. Apparently, BSP stimulates the differentiation of cells which secrete an organized extracellular matrix more efficiently than any other capping material used so far. Altogether, the results reported here support that bone sialoprotein displays novel bioactive properties and is capable of stimulating in 1 month's time the development of a thick reparative dentinal tissue in the pulp, occluding the perforation and filling the mesial third of the pulp chamber.