Age related impairments in ingestion from a large population based-sample.

OBJECTIVES: Epidemiological data regarding the evolution of problems related to mastication and swallowing with age are lacking. This study aims to (i) describe changes in oral function with age, using data from a large French population, (ii) validate online, self-report uses of an ICF questionnaire in older persons, and (iii) assess whether impairment is related to avoidance of certain foods, xerostomia, body mass index (BMI) and oral health related quality of life (OHRQoL). METHODS: Volunteers aged ≥18 years with internet access completed a series of questionnaires on sociodemographic, anthropometric and oral health characteristics (oral function, Xerostomia Index (XI), OHRQoL, reasons for avoidance of certain food). Oral function was assessed using items derived from the International Classification of Functioning (ICF). Five ICF items related to ingestion function and six items related to activities and participation were used. A validation study was undertaken to identify those with poor chewing ability and low salivary flow amongst older participants reporting impairment. FINDINGS: 39 597 individuals were included. The prevalence of individuals with impairment for ICF items related to ingestion function and oral activity (eating, drinking and speaking), and the percentage of participants with poor OHRQoL increased significantly with age (p < 0.001). Each ICF item was significantly associated with OHRQoL (p < 0.001), XI (p < 0.001), BMI (p < 0.001) and avoidance of certain food due to chewing or swallowing difficulties. CONCLUSION: Overall, 21.5% and 13.5% of the study population had chewing and/or biting impairments respectively, which might affect food selection and consumption. These findings raise individual and population-based issues. Further studies are needed to assess whether impairment in oral function might increase frailty in older individuals, and also to compare data with those from other countries.

Aesthetic and Functional Rehabilitation of Patients with Genetic Microdontia: A Multidisciplinary Approach.

This case report presents the treatment of a 33-year-old patient with a genetic, generalized microdontia of permanent teeth. Microdontia is a developmental dental anomaly of the teeth characterized by a decrease in their size. In the literature, treatment has been multidisciplinary, often utilizing orthodontics and implantology. However, for adult patients with generalized microdontia who do not benefit from these treatments as much, a combination of adhesive dentistry, endodontics and removable prostheses remains a therapeutic alternative to consider. Given the specificities of the patient and the nature of the care, the objective of this treatment option was to manage the patient's comfort while guaranteeing quality of care. A feature of this treatment was the use of general anesthesia for endodontic treatments and exodontia. Chairside CAD/CAM and adhesive dentistry reduced the chairside time and preserved healthy dental tissue.

Comprehensive Dental Treatment under General Anesthesia Improves Mastication Capability in Children with Early Childhood Caries-A One-Year Follow-Up Study.

BACKGROUND: Using the granulometry of ready-to-swallow food boluses, this study investigated the evolution of masticatory capability of children with Early Childhood Caries (ECC) after comprehensive dental treatment under general anesthesia (GA). METHODS: Sixteen children with ECC were assessed before and over one year after dental treatment under GA, in comparison with 12 children with a Healthy Oral State (HOS). Oral health criteria, quality of life, body mass index, and frequency of orofacial dysfunctions were recorded. Masticatory kinematic parameters and median food bolus particle size (D50) at swallowing were assessed while masticating raw carrot (CAR), cheese (CHS), and breakfast cereals (CER). The impact of posterior teeth extractions was analyzed. RESULTS: Quality of life and orofacial functions improved after dental treatment. Chewing frequency for all three foods increased without reaching the values of children with HOS, while D50 values for CAR and CHS decreased. After one year, children with posterior teeth extractions exhibited higher D50 values for CAR and CHS than children with only conservative treatment. One third of children with ECC were overweight or obese. CONCLUSIONS: Comprehensive dental treatment improved children's mastication, and their BMI subsequently increased. Links between mastication and nutrition should be investigated further in children.

Dental Trauma Management in a Young Teenager through Endodontics and Implantology: A Case Report.

Endodontic treatment is often the first-line procedure to manage the immediate or long-term aftermath of dental trauma, particularly in cases of luxation or avulsion. Failure to manage trauma in the short or medium term leads to significant functional or aesthetic consequences, especially in the adolescence period. Under this specific conditions, endodontic treatment could provide a temporary solution by keeping teeth with poor prognosis on the arch while waiting for better anatomical conditions for implantology. This clinical case aimed to describe the management of a maxilla-facial dental trauma and the following consequences in a 10-year-old male patient. Clinical and radiological examination showed complete extrusive luxation of 11 and 21 and intrusive luxation of 12 and 22. Endodontic treatment of 11 and 21 was performed six months after the trauma. Two years later, the patient was referred to the endodontic department because pink spot lesions appeared on 12 and 22 due to cervical invasive resorptions (class III for 12 and class II for 22). Endodontic treatment of 12 and filling with resin composite of 22 were performed. During the following two years, complication management finally led to placement of four OBI® (Euroteknika, Sallanches, France)-type mini-implants after avulsion of all four maxillary incisors. Palliative endodontic treatment helped maintain the prosthetic space and the volume of supporting tissue needed for future implant placement. The interest of using delaying procedures (palliative endodontic treatments and mini-implants) was to allow the patient to complete growth. Managing early treatment failure of trauma in adolescents has to be pluridisciplinary and should take into account the evaluation of the treatment's difficulty, the prognosis of the endodontic treatment, the available bone volume and the pubertal growth stage.

Radiological Evaluation of Stainless Steel Crowns Placed on Permanent Teeth in Patients Treated under General Anaesthesia.

Evidence-based evaluations of dental treatment are needed to support the development of special care dentistry services. This retrospective study was designed to collect and analyse X-ray images of permanent teeth restored with stainless steel crowns (SSC) in patients treated under general anaesthesia. Between 2013 and 2019, 360 permanent molars were crowned with SSCs in 198 adult patients. One calibrated investigator used an original validated tool to evaluate four radiographic criteria for molars restored with SSCs: (i) marginal adaptation; (ii) interdental proximal contact; (iii) the presence of glass ionomer cement overflow; and (iv) the loss of alveolar bone. Overall, no defect or a minor defect was reported for the majority of SSCs for the criteria "Marginal adaptation" (62.5%, n = 320), "Proximal contact" (82.2%, n = 236) and "Cement overflow" (95.8%, n = 337). Alveolar bone resorption was reported in 8.3% of cases, n = 14, after a mean period of 8.9 ± 14.3 months. It was shown that the restoration of permanent teeth using SSCs placed under general anaesthesia presents a low risk of periodontal morbidity in the medium term when assessed radiographically.

Revisiting Orstavik's PAI score to produce a reliable and reproducible assessment of the outcomes of endodontic treatments in routine practice.

INTRODUCTION: Orstavik's periapical index is widely used for radiographic assessment of periapical status. This study analyses the reliability and reproducibility of a modified guide for the interpretation of the periapical index (PAI) scores recorded by undergraduate students. MATERIALS AND METHOD: Two groups of 4th-year students were asked to assess the PAI scores of 100 X-rays two or three times depending on the group. The reliability of their judgment was evaluated by comparing the students' assessments to those of a standard, based on the evaluations made by three teachers. Short-term stability was evaluated for two lengths of interval separating the Test and Retest phases, respectively, 1 week for Group 1 and 2 weeks for Group 2. Long-term stability was evaluated by having Group 1 repeat the Retest phase after 15 months. RESULTS: Overall mean success rates ranged from 61% to 65% according to the student group and the study phase. Intergroup comparisons showed no statistical difference. The reliability of the PAI score evaluation by students was excellent in both groups. Short-term and long-term stability were also excellent regardless of the duration of the interval between the study's phases. DISCUSSION: The image misinterpretations are discussed according to the study phases and the PAI score values. CONCLUSION: Undergraduate students can be trained to use the modified guide for scoring PAI for self-evaluation of the outcomes of the root canal treatments and re-treatments they are asked to perform during their clinical sessions.

A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health.

Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18-57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

A Combination of Full Pulpotomy and Chairside CAD/CAM Endocrown to Treat Teeth with Deep Carious Lesions and Pulpitis in a Single Session: A Preliminary Study.

A higher chance of carrying out a successful full pulpotomy may depend on whether the coronal restoration can be completed within a single appointment. The development of chairside CAD/CAM (Computer Aided Design and Manufacturing) technology has made it possible to carry out indirect restoration of endodontically treated teeth in a single session. This study aimed to evaluate the long-term outcome of a full pulpotomy with Biodentine™ immediately covered with a chairside CAD/CAM endocrown on teeth affected by pulpitis and deep carious lesions. The investigation involved a cohort of 30 molars that were treated by pulpotomy and CAD/CAM endocrown. Clinical and radiological examinations were scheduled at 1, 6, and 12 months postoperatively. Overall, all treatments were effective at any time during the follow-up. The results of this study need to be confirmed with a longer-term follow-up to allow for comparison with the literature. This original combination of endodontic and restorative treatments provides an Endo-prosthetic continuum in a single session, with the objective of long-term success in terms of tooth health.

Long-term Outcomes of Full Pulpotomy in Permanent Molars for Patients Treated in a Single, Short Session under Special Conditions.

INTRODUCTION: Endodontic procedures for patients requiring treatment in a single, short session need to be validated. This study aimed at evaluating the long-term outcome of full pulpotomy in permanent molars performed with reinforced zinc oxide-eugenol cement (Intermediate Restorative Material [IRM], Dentsply Sirona, Versailles, France) immediately restored using stainless steel crowns under general anesthesia. METHODS: The absence of clinical signs and symptoms and the evolution of the periapical index between the treatment date and the longest follow-up time were used to grade the pulpotomy outcome as "effective," "uncertain," or "ineffective." The impact of different criteria on the pulpotomy outcome was tested (ie, the etiology of the lesion, tooth maturity, endodontic difficulty related to the coronal shape and the root canal shape, and endodontic difficulty related to the radiographic root canal appearance). RESULTS: Among the 608 teeth (338 patients) treated in a single session with IRM full pulpotomy and stainless steel preformed crowns, 263 (143 patients) were evaluated after a median follow-up period of 24 months. Overall, 89% of the pulpotomies were effective, 7.6% were of uncertain outcome, and 3.4% were ineffective. No tested criteria influenced the rate of effectiveness. CONCLUSIONS: Long-term outcomes of IRM pulpotomy are similar to those of calcium silicate-based cement pulpotomy observed in the literature. This procedure should not be restricted to patients treated under general anesthesia because it is relevant for all special conditions that impose the provision of endodontic treatment in a single, short session, such as dental care emergencies during humanitarian crises or pandemic periods.

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes.

AIMS: This work discusses the procedures and outcomes of restorative and endodontic treatments performed under general anesthesia, with examples from the Unit of Special Care Dentistry at the University Hospital of Clermont-Ferrand. METHODS AND RESULTS: The restorative and endodontic treatment techniques used in the Special Care Unit are described. These techniques are compared to existing reports in the literature of treatment procedures under general anesthesia. Little evidence was found in the literature regarding sealants or restorative protocols. A few studies described root canal treatment and pulpotomy protocols carried out under general anesthesia, and the results of these met academic outcome standards. CONCLUSION: Patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment. The provision of restorative treatment under general anesthesia is essential to avoid an excessive number of extractions in patients unable to receive treatment in the chair. Restorative care provided under general anesthesia should be standardized and evaluated in the same way as treatment performed under local anesthesia. In this way, the provision of conservative dental care under general anesthesia could be promoted and the maintenance of a functional dentition encouraged.

The "Plan" phase of a Deming cycle: Measurement of quality and outcome of root canal treatments in a university hospital.

INTRODUCTION: In many countries, dental students are taught in private or university hospitals where they treat patients under the supervision of teachers. Assessing the quality of root canal treatments (RCT) would provide information about the quality of care patients receive when treated by students. METHODS: This study describes the six-step "Plan" phase of a Plan-Do-Check-Act (PDCA) cycle that identifies and analyses clinical practices in endodontics in a university dental hospital service. RESULTS: Step 3 reported that the proportion of RCTs of adequate quality reached 57.1% and this proportion was significantly decreased when specific indicators for treatment difficulties were present. The proportion of successful RCTs after 1 year was 65.6%, and its variation was influenced by the preoperative periapical status rather than the quality of RCTs. The consensual meeting in Step 6 proposed to introduce three new procedures for the further Do, Check and Act phases of the PDCA cycle. CONCLUSION: This study encourages systematic evaluation of RCTs and provides the first step of the methodology that can be reproduced in private and hospital practices where students are asked to treat patients.

A Review of Criteria for the Evaluation of Pulpotomy Outcomes in Mature Permanent Teeth.

INTRODUCTION: During the past decade, with a view to understanding pulp biology better and developing bioactive materials, pulpotomy has been reinvestigated as a definitive treatment in mature permanent teeth. Pulp chamber pulpotomy or coronal pulpotomy is widely used in deciduous and immature permanent teeth, and there is thus a need for trials to evaluate the outcome of pulpotomy as a therapeutic procedure on mature permanent teeth in accordance with Good Clinical Practice guidelines. This study aimed to review publications reporting the outcomes of pulpotomy when indicated as a definitive treatment in mature permanent teeth and to discuss the relevance of the criteria that could be used in clinical practice or research. METHODS: A review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was conducted on publications found by both PubMed and backward research. RESULTS: Seven clinical trials, 9 cohort studies, and 15 cases reports have been included. Overall, goals, criteria for inclusion, and criteria for outcomes of pulpotomy varied among studies. The relevance and the reliability of the success or failure criteria of pulpotomy were discussed regarding the possible evolution of the radicular pulpal status that could be expected after pulpotomy. Finally, criteria for the evaluation of the outcome of pulpotomy are proposed. CONCLUSIONS: The use of standardized outcome criteria would facilitate further meta-analyses, aiming to assess whether pulpotomy should be considered as a true alternative therapy to root treatment.

Increasing the number of inter-arch contacts improves mastication in adults with Down syndrome: a prospective controlled trial.

Feeding difficulties due to their condition have been widely described for babies, children and adults with Down syndrome (DS). A previous study demonstrated that, compared with wearing a placebo appliance, wearing an occlusal appliance increased inter-arch dental contacts, improved the oral health status of adults with DS and normalised their mandibular rest position. This longitudinal prospective controlled trial aimed to evaluate whether increasing inter-arch contacts in adults with DS would lead to improved masticatory efficiency. Fourteen subjects with DS (mean age±SD: 28.5±9.3years) and twelve controls without DS (24.6±1.0years) were video recorded while chewing samples of carrot and peanuts with and without an oral appliance that was designed to equalise the number of posterior functional units (PFUs) in both groups. Three parameters were collected during mastication for 15cycles and until swallowing: food refusals, food bolus granulometry (D50) and kinematic parameters of the chewing process (number of cycles, chewing duration and cycle frequency within the chewing sequence). In the DS group, increasing the number of PFUs led to a decrease in bolus particle size, to fewer masticatory cycles needed to produce a bolus ready for swallowing and to a decrease in the occurrence of food refusal, while mean chewing frequency did not vary. In the control group, bolus granulometry and chewing time increased with appliance wear while mean chewing frequency decreased. These changes clearly indicate a functional improvement in subjects with DS. This study also demonstrated a causal relationship between the number of functional pairs of posterior teeth and improved mastication. Any evaluation of feeding behaviour in persons with DS should consider inter-arch dental contacts as an explicative variable for feeding problems and their nutritional and respiratory consequences.

A follow-up study of pulpotomies and root canal treatments performed under general anaesthesia.

OBJECTIVES: A previous study considered whether the proportions of clinically satisfactory root canal treatments (RCT) done under general anaesthesia (GA) or under local anaesthesia were equivalent, but the proportion of treatment with long-term satisfactory endodontic outcomes remains unknown. Moreover, no evaluation of pulpotomies performed under GA has been reported. MATERIALS AND METHODS: From 614 endodontic treatments (ETs) performed on permanent teeth under GA, 225 [193 RCT and 32 pulpotomies (P)] were examined after follow-up periods of 1-6 months (71 cases), 6-24 months (77 cases) and over 2 years (77 cases). Changes in the periapical index between the treatment date (T0) and the control time (T1) allowed the treatment to be classified as "success," "uncertain outcome" or "failure." Explicative variables for success of ET were the duration of follow-up and tooth-related criteria expected to affect the outcomes of endodontic treatment. RESULTS: Overall, 87 % of ETs were scored as "success," while 9 % were uncertain and 4 % were failures. There was no difference in the distribution of success in relation with the type of tooth, the pulpal status, the level of endodontic difficulty, the periapical status or the technical quality of RCT. The proportion of endodontic cases with high level of difficulties was higher in the P group than in the RCT group. CONCLUSION: Longer follow-ups and higher numbers of cases are needed to analyse the factors affecting success and failure in endodontic treatments performed under GA. CLINICAL RELEVANCE: The relatively high rates of success of pulpotomies and RCT support undertaking endodontic treatment under GA.

Is endodontic treatment performed under general anaesthesia technically acceptable?

OBJECTIVES: Undertaking endodontic treatment under general anaesthesia (GA) is often described as difficult and hazardous, but no study reports on safe and efficacious conditions for endodontic treatment under GA. This study aims to evaluate whether compromises made for the endodontic treatment of permanent teeth under GA are acceptable. It describes the quality of endodontic treatment undertaken in two series of consecutive patients treated either under GA or local anaesthesia (LA). MATERIALS AND METHODS: Post-operative data sheets and periapical radiographs were collected for 255 permanent teeth treated under GA during a 4-year period (GA group, 125 patients with special needs) and for 246 permanent teeth treated under local anaesthesia over 7 months (LA group, 180 healthy patients). The radiographic criteria for quality of endodontic treatment (RCQET) were considered satisfactory when (1) the root filling was within 2 mm of the apex; (2) the filling displayed no voids or defects; and (3) all the visible canals had been obturated. The type of tooth, pulpal status and periapical status were considered independent variables for RCQET. RESULTS: The proportion of satisfactory RCQET reached 63% in both groups and differed by type of tooth, being significantly lower for molars than for other teeth. CONCLUSION: From a technical point of view, compromises made for the endodontic treatment of permanent teeth under GA are acceptable. Further studies should be conducted to evaluate the long-term success of endodontic treatment performed under GA. CLINICAL RELEVANCE: This study supports the feasibility of endodontic treatment for patients treated under GA.

Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers.

BACKGROUND AND OBJECTIVE: The prevalence of malnutrition increases with age because of many factors. Edentulousness leads to the avoidance of many types of foods. The aim of this study was to determine whether elderly complete denture wearers have a higher risk of malnutrition than dentate controls. MATERIAL AND METHODS: A Mini-Nutritional Assessment (MNA) and a 3-day dietary record were compiled for a group of fully dentates (21 women and 29 men; mean age 70.1 ± 6.1) and for a group of complete denture wearers (31 women and 16 men; mean age 70.1 ± 8.1). Socio-demographic data and scores on the General Oral Health Assessment Index (GOHAI) questionnaire were collected. RESULTS: Inter-group comparison of MNA scores showed that more subjects in the edentulous group (21.3%) risked malnutrition than in the dentate group (0%). The variability of the MNA could be explained for 22% by dental status, 7% by loneliness and 4% by the GOHAI score (regression analysis). Both groups had insufficient energy intakes and deficits in vitamins and micronutrients; moreover, edentulous subjects had lower intakes than dentate subjects. CONCLUSION: The use of conventional dentures increases the risk of malnutrition in the elderly.