Validation of the French version of the Munich ChronoType questionnaire and associations between chronotype and physiological parameters.

Assessing chronotype is essential in clinical and research environments, but the Munich ChronoType Questionnaire (MCTQ), a widely utilised tool, is not available in French. Therefore, we carried out an observational monocentric study to validate the French MCTQ against the sleep diary for sleep schedules, the Morningness-Eveningness Questionnaire (MEQ) for chronotype, and polysomnography measures. We utilised the mid-sleep point on free days (MSF), adjusted for sleep debt (MSFsc), to gauge morningness/eveningness. The study included 80 participants (average age: 40.9 years, 50% female). The sleep schedules determined by the MCTQ and the sleep diary showed a high correlation. The MSFsc demonstrated a significant correlation with the MEQ, persisting even under sleep constraints such as an alarm on free days. The predictive accuracy was strong for a morning chronotype and moderate for an evening chronotype as assessed using the MEQ. In summary, the French MCTQ is a reliable tool for researchers and clinicians for assessing sleep schedules and chronotype in French-speaking populations. The MSFsc can effectively predict chronotype, even under sleep constraints. However, for the evening chronotype, self-assessment appears to be more accurate. The association with polysomnography measures enriches our understanding of the chronotype at the intersection of behaviour and physiology.

Unraveling the Life History of Past Populations through Hypercementosis: Insights into Cementum Apposition Patterns and Possible Etiologies Using Micro-CT and Confocal Microscopy.

The "teeth-as-tools" hypothesis posits that Neanderthals used their anterior teeth as a tool or a third hand for non-dietary purposes. These non- or para-masticatory activities (e.g., tool-making or food preparation prior to ingestion) have also been described in other past and extant human populations, and other Primates. Cementum is the mineralized tissue that covers the tooth root surface and anchors it to the alveolar bone. Under certain conditions (e.g., mechanical stress, infection), its production becomes excessive (i.e., beyond the physiological state) and is called 'hypercementosis'. Several studies in dental anthropology have established a correlation between the teeth-as-tools and hypercementosis. The present work aims to characterize the different patterns of cementum apposition on archeological teeth and discuss their supposed etiology. Using microtomography and confocal microscopy, the patterns of cementum apposition (i.e., thickness, location, and surface characteristics) were analyzed in 35 hypercementotic teeth (Sains-en-Gohelle, France; 7th-17th c. A.D.). Four groups were identified with distinct hypercementosis patterns: (1) impacted, (2) infected, (3) hypofunctional, and (4) hyperfunctional teeth. Characterizing hypercementosis can contribute to documenting the oral health status (paleopathology) and/or masticatory activity of individuals, even from isolated teeth. This has implications for the study of fossil hominins, particularly Neanderthals, known for their use of anterior teeth as tools and frequent and substantial occurrence of hypercementosis.

Dental sleep medicine education among undergraduate dental students in France.

INTRODUCTION: Dental sleep medicine (DSM) is an emerging discipline that studies the oral and maxillofacial causes and consequences of sleep-related problems. DSM is of upmost importance given the major medical challenge it represents. Therefore, to verify whether the future generation of dentists would be ready to face this challenge, the main objective of this study was to assess the degree of involvement of the French dental schools in teaching DSM at the undergraduate level. MATERIALS AND METHODS: All 16 dental schools in France were asked to participate in the study by answering to an online survey concerning the DSM curriculum during the 2018-2019 academic year. The survey was addressed to the head of the dental school and/or to relevant course coordinators and contained 10 questions related to the type, content and amount of DSM teaching to undergraduate dental students. RESULTS: Nine of the 16 (56.2%) French dental schools responded to the questionnaire. All these nine reported the inclusion of DSM in their undergraduate curriculum. The total average hours dedicated to teaching DSM was 5.6 h (SD 4.2; range 1-15 h). Seven of the 9 dental schools spent most of their DSM curriculum teaching time in the fifth year. All of them reviewed obstructive sleep apnoea and sleep-related bruxism and covered some topics related to therapies for sleep-related breathing disorders, such as the use of oral appliance. CONCLUSION: The results of this survey showed that, although the average hourly volume is relatively high, the DSM teaching in French dental schools appeared to be non-standardised, heterogeneous and often lacunar. It is therefore essential to develop a common curriculum and implement it in all dental schools to provide undergraduate students a comprehensive and updated teaching in DSM.

Sleep timing, workplace well-being and mental health in healthcare workers.

INTRODUCTION: Healthcare workers face an elevated risk of burnout, sleep disorders, and mental health issues, potentially stemming from the misalignment of their circadian rhythm due to nonstandard work schedules. This cross-sectional survey aims to examine the connections between sleep timing, workplace well-being (including burnout and absenteeism), and mental health outcomes (specifically depression and poor sleep) in healthcare workers. Additionally, the survey takes into account individual and professional factors, as well as the interaction with work schedules. METHODS: The study encompasses 4,971 healthcare workers from both public and private healthcare facilities in France, including nurses, nursing assistants, and physicians recruited during the third wave of the COVID-19 pandemic. The Maslach Burnout Inventory assesses burnout, the Center for Epidemiologic Studies Depression Scale measures depression, and the Pittsburgh Sleep Quality Index evaluates poor sleep. Sleep timing is categorized into morning, neutral, and evening timing, referred to as midsleep. Multivariate logistic regression analysis is conducted to explore the relationships between sleep timing and burnout, depression, and poor sleep, while adjusting for various factors. RESULTS: The findings reveal that 56.5% of participants experience burnout, 29.8% report depression, and 64.5% report poor sleep. Nurses and nursing assistants exhibit a higher prevalence of poor sleep. Morning sleep timing is associated with burnout among those with fixed schedules and with depression among those with shift schedules. Among physicians, both morning and evening sleep timing are associated with depression, while morning sleep timing is linked to poor sleep across all subgroups. INTERPRETATION: This study suggests that the misalignment between healthcare workers' internal circadian rhythm and their work schedules may contribute to an increased risk of burnout, depression, and poor sleep. Occupational health services and policymakers should recognize the potential for enhancing workplace well-being and mental health outcomes by enabling healthcare workers to maintain sleep schedules that accommodate their needs.

From improved sleep regularity to reduced sleep complaints and mental health conditions: a population-based interventional study using a smartphone-based virtual agent.

STUDY OBJECTIVES: To explore the effect of sleep regularity on sleep complaints and mental health conditions (i.e. insomnia, fatigue, anxiety, and depressive symptoms) in a population-based interventional study using a smartphone-based virtual agent. METHODS: A populational cohort based on the Kanopée application, which provided interactions with a virtual companion to collect data on sleep and make personalized recommendations to improve sleep over 17 days. A pre-intervention sleep diary and interview were used for cross-sectional analysis (n = 2142), and a post-intervention sleep diary and interview were used for longitudinal analysis (n = 732). The intra-individual mean (IIM) and standard deviation (ISD) of total sleep time (TST) were calculated to measure sleep quantity and sleep regularity. RESULTS: The mean age at baseline was 49 years, 65% were female, 72% reported insomnia, 58% fatigue, 36% anxiety, and 17% depressive symptoms. Before the intervention, irregular and short sleep was associated with a higher likelihood of insomnia (Relative risk [RR] = 1.26 [1.21-1.30] for irregular TST and RR = 1.19 [1.15-1.23] for short TST), fatigue, anxiety, and depressive symptoms. After the intervention, the IIM of the TST increased while the ISD of the TST and sleep complaints and mental health conditions decreased. More regular TST was associated with reduced insomnia and depressive symptoms (RR = 1.33 [1.10-1.52] and RR = 1.55 [1.13-1.98], respectively). CONCLUSIONS: Our results reveal a longitudinal association between sleep regularity and sleep complaints and mental health conditions. Policymakers, health professionals, and the general population should be aware that, beyond its positive effect on sleep health, regular sleep could promote mental health.

A Brief History of Tooth Wear.

Historical publications that have significantly improved the understanding of tooth wear mechanisms are reviewed with a focus on descriptions of the lesions, the evolution of their classification systems, and considerations addressing the main risk factors. Surprisingly, most important advances are often the oldest. Likewise, they are currently only marginally known, which requires a major dissemination effort.

Emotional Exhaustion, a Proxy for Burnout, Is Associated with Sleep Health in French Healthcare Workers without Anxiety or Depressive Symptoms: A Cross-Sectional Study.

Burnout is frequent among healthcare workers, and sleep problems are suspected risk factors. The sleep health framework provides a new approach to the promotion of sleep as a health benefit. The aim of this study was to assess good sleep health in a large sample of healthcare workers and to investigate its relationship with the absence of burnout among healthcare workers while considering anxiety and depressive symptoms. A cross-sectional Internet-based survey of French healthcare workers was conducted in summer 2020, at the end of the first COVID-19 lockdown in France (March to May 2020). Sleep health was assessed using the RU-SATED v2.0 scale (RegUlarity, Satisfaction, Alertness, Timing, Efficiency, Duration). Emotional exhaustion was used as a proxy for overall burnout. Of 1069 participating French healthcare workers, 474 (44.3%) reported good sleep health (RU-SATED > 8) and 143 (13.4%) reported emotional exhaustion. Males and nurses had a lower likelihood of emotional exhaustion than females and physicians, respectively. Good sleep health was associated with a 2.5-fold lower likelihood of emotional exhaustion and associations persisted among healthcare workers without significant anxiety and depressive symptoms. Longitudinal studies are needed to explore the preventive role of sleep health promotion in terms of the reduction in burnout risk.

An Ultra-Short Measure of Excessive Daytime Sleepiness Is Related to Circadian Biological Rhythms: The French Psychometric Validation of the Barcelona Sleepiness Index.

The Barcelona Sleepiness Index (BSI) is an ultra-short instrument with several advantages for assessing excessive daytime sleepiness (EDS). The present study was performed to analyze the validity of the French version of the BSI in screening for EDS. We conducted a cross-sectional study on a population of students using an online questionnaire. The French version of the BSI was developed by a rigorous forward-backward translation process. We computed the discrimination properties of the BSI to predict EDS assessed by the Epworth Sleepiness Scale (ESS), as well as correlations with other sleep measures. In total, 662 students were enrolled in the study (mean age: 20.9 years, 76.0% women). The BSI score (mean = 1.5 ± 1.0) showed a strong correlation with the ESS score (r = 0.47, p < 10−4) and acceptable discrimination of EDS assessed by ESS score ≥ 11 (AUC = 0.742) with an optimal cutoff point of 2, as in the original study. The BSI score was significantly associated with sleep deprivation and social jetlag. Therefore, the French version of the BSI is a valid ultra-short instrument for EDS screening in individuals. In addition, the BSI score may be associated with both homeostatic and circadian processes. Further studies are needed to confirm these findings in general populations and in patients with sleep disorders.

Factors associated with dental erosions in gastroesophageal reflux disease: a cross-sectional study in patients with heartburn.

BACKGROUND AND AIM: Dental erosion (DE) represents a frequent condition in adults and the elderly. The gastroesophageal reflux disease (GERD) is considered an important endogenous factor causing dental erosions. The objective of this study was to assess the prevalence of DE in GERD patients and to establish the correlation between pathogenic intrinsic and extrinsic factors of DE and their relation to GERD. METHODS: A cross-sectional study was conducted on 263 patients (median age 43). Patients with heartburn were recruited in two countries with different prevalence of GERD. Patients were recruited from France (n=158, 60%) and Romania (n=105, 40%) including 163 females and 100 males. The Basic Erosive Wear Examination (BEWE) index for diagnosis and evaluation of dental erosion was used. Based on the value of BEWE score, each patient was included in a risk group for DE development (low risk: BEWE=3-8, medium risk: BEWE=9-13, high risk: BEWE ≥14). Patients filled a questionnaire regarding GERD symptoms, medications, life style. Salivary parameters (pH and buffering capacity) were also assessed and analyzed. RESULTS: DE was significantly more frequent and more severe in GERD subjects than in the non-GERD controls. Low salivary pH but not salivary buffering capacity was associated with BEWE scores. Buffering capacity however was significantly more altered in patients with BEWE score over 9 (medium DE) than in patients with mild DE (BEWE <9). Although extrinsic factors (consumption of citrus fruits, soda drinks) were associated with DE in GERD, there was no statistical correlation with the BEWE score. From the total of 263 patients, 229 (87.1%) presented BEWE score <9, and 34 (12.9%) presented BEWE ≥9. The DE was significantly associated with the presence of GERD (p<0.001). BEWE score >9 was more frequently present in GERD patients (30 patients: 21.3%) than in non GERD patients (4 patients: 3.3%). DE were more frequent in French subjects compared to Romanian subjects. Romanians had lower BEWE scores than the French. CONCLUSIONS: DE is more frequent and more severe with GERD vs. non-GERD. DE in GERD is associated with extrinsic dietary factors like citrus fruits and soda drinks.

Development of a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination.

INTRODUCTION: A new approach to treat obstructive sleep apnea (OSA) is upper airway stimulation therapy (UAS). Electrical pulses applied to the hypoglossal nerve induce tongue protrusion, increase airway patency and decrease the frequency of apneic and hypopneic events. Thus, the main objective of this study was to design a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. METHOD: This study has designed the Tongue Adverse Event and Satisfaction Questionnaire (TAESQ) and an endobuccal examinations divided into an endobuccal lesion examination (ELE) and an endobuccal risk factor examination (ERFE). Evaluations were conducted at month 6 post-implantation. RESULTS: The study population after implantation of UAS device consisted of ten Caucasian males with a mean age of 51.9 ± 11.8 years, and a mean BMI of 28.6 ± 3.3. The AHI of the ten participants ranged from 46.7 ± 12.2/h at baseline to 14.5 ± 8.9/h with the Inspire therapy at the 6-month follow-up. The TAESQ revealed pain (30%), followed by less tongue sensitivity (20%) and tongue weakness (10%). The ELE did not reveal any lesions. The ERFE revealed that some participants had tissue and dental risk factors but not associated to more adverse events. CONCLUSION: The TAESQ, ELE and ERFE have been designed and studied on a small number of participants. These evaluations could systematically be included in the care pathway of patients treated by UAS to better investigate tongue discomfort and tongue lesion for patients treated with this technology.

Mineral density of hypomineralised and sound enamel.

Molar Incisor Hypomineralisation (MIH) is a structural anomaly that affects the quality of tooth enamel and has important consequences for oral health. The developmentally hypomineralised enamel has normal thickness and can range in colour from white to yellow or brown. The purpose of the present study is to compare the mineral density of hypomineralised and normal enamel. The sample included eight MIH teeth from seven patients. MIH teeth were scanned using high resolution microtomography. Non-parametric statistical tests (Wilcoxon test for paired samples) were carried out. Hypomineralised enamel has decreased mineral density (mean 19%; p < 0.0001) compared to normal enamel. This weak enamel has implications in clinical management of MIH lesions.

Cementochronology, to cut or not to cut?

One of the continuing problems in paleopathology and paleoepidemiology is an inability to accurately age adult skeletons. Accurate age estimations are critical to the proper evaluation of population health and are necessary in circumventing certain aspects of the osteological paradox. Cementochronology is most likely the only age indicator in anthropology that directly considers a continuously growing tissue and does not require either complex statistical manipulations or the use of a reference population. The major issues and recent advances linked to this technique are reviewed for its successful implementation. This review is a partial outcome of an international research program initiated in 2010 to develop and expand cementochronology. Because cementochronology is a reasonably straightforward histological protocol, it can be implemented in less than 24h for one tooth at a relatively low cost. The only aspect of cementochronology that requires extensive previous experience is the counting of increments. These unique aspects largely justify the regular implementation of cementochronology in paleoepidemiology and paleopathology in the confident exploration of "population health" issues and demographic inferences.

Understanding bruxism in children and adolescents.

Screening for the various forms of bruxism in children and adolescents requires a sound knowledge of the physiopathology of this parafunction in addition to the etiologic and associated factors and comorbidities. The international literature contains various suggestions for suitable treatment. The optimal therapeutic approach often involves multidisciplinary management of these young patients. Sleep bruxism (SB) is a common sleep disorder which can cause serious problems to the stomatognathic system such as damaged teeth, headaches, muscle pain and TMD. Dental professionals are responsible for the detection and prevention of these harmful impacts on the patient's oral health. However, SB is much more than a question of worn teeth. Patients with SB consult for other medical comorbidities such as nighttime breathing problems, insomnia, attention deficit hyperactivity disorder, depression, moodiness and gastroesophogeal reflux before any course of treatment is initiated. If a comorbidity is diagnosed, the treatment approach will be aimed in the first instance at the medical disorder, while concurrently managing the repercussions of SB. On the other hand, in as far as the majority of young bruxers cease to grind their teeth before adolescence or adulthood, it is feasible to adopt wait-and-see and non-interventionist strategies for young children. However, it is preferable to have a better understanding of SB, notably on account of its potential association with psychological disorders during childhood. Daytime bruxism is characterized by teeth clenching (TC). First-line treatment involves encouraging patients to monitor their harmful parafunctional behavior and, consequently, change and cease it. This protocol is not always easy to apply, particularly in younger children. In such cases, cognitive-behavioral treatments and biofeedback techniques can also be used in daytime bruxism.

Determination and validation of criteria to define hypercementosis in two medieval samples from France (Sains-en-Gohelle, AD 7th-17th century; Jau-Dignac-et-Loirac, AD 7th-8th century).

OBJECTIVE: The main aim of this article was to develop different visual criteria allowing for an objective definition of hypercementosis (cementum hyperplasia). This preliminary study must notably show how to better understand at a later stage the significance of its frequency as well as its aetiologies, especially in past populations. MATERIALS AND METHODS: we set up a study protocol (macroscopic and photographic observations) on material consisting of 2 medieval samples from France (1) Sains-en-Gohelle sample-SG (AD 7th-17th century; 407 individuals; 5756 teeth observed, 319 with hypercementosis) which was used to develop the different criteria for defining hypercementosis (2) Jau-Dignac-et-Loirac sample-JDL (AD 7th-8th century; 55 individuals; 709 teeth observed, 24 with hypercementosis) which was used to test the reproducibility of the criteria. RESULTS: From our observations we formulated different inclusion criteria with which to define hypercementosis objectively (k intraobserver≥0.96; k interobserver≥0.63). We were able to distinguish moderate (1m) and marked (1M) forms of diffuse hypercementosis, focal hypercementosis in the form of small knots (2m) or large nodules (2M), or excrescences in the form of ridges (3m) or spurs (3M). Different exclusion criteria were also determined. CONCLUSION: The definition that we propose in this study are based on various statistically validated inclusion and exclusion criteria. It is hoped that this will improve the significance of hypercementosis. More generally, this would also give a better understanding of the dynamics of cementum apposition.

Human tooth wear in the past and the present: tribological mechanisms, scoring systems, dental and skeletal compensations.

This review of human tooth wear describes the fundamental mechanisms underlying this process. Using the tribological approach they can be systematised and this in turn aids our understanding of them. In past populations wear was ubiquitous, intense, abrasive and physiological as it was related to their food and their technologies. In these populations, it affected the proximal surfaces, and the occlusal surfaces which modified the occlusal plane profoundly. To categorise this wear many different classification systems are used, from which we can determine diet, cultural changes and the age at death of individuals. They also illustrate the evolution of certain functional dental and skeletal compensations in the masticatory apparatus such as continuous dental eruption, mesial drift of the arches and incisor lingual tipping which can then be monitored. These physiological adaptations related mainly to function and ontogenesis can also be found in present-day populations where wear is moderate, although they are much less obtrusive. Apart from certain pathological cases associated with a specific parafunction, iatrogenic tooth brushing or an eating disorder and encouraged by an acid environment, they are the result of a physiological process that should not be halted. To ensure this, it is essential to prevent lesions related to tooth wear, to detect them early and establish a reliable diagnosis. Types of tooth wear that had remained unchanged since the origin of humanity have undergone profound changes in a very short space of time. Today's tribochemical pathological model has replaced the abrasive physiological model of the past.