Use and perception of nitrous oxide sedation by French dentists in private practice: a national survey.

AIM: The aim of this national survey was to record the use of nitrous oxide and the perceptions of French dental practitioners to this form of sedation. The use of nitrous oxide sedation (NOS) has been authorised in private dental practice in France since December 2009 but, to date, no study implementing both quantitative and qualitative methods has explored such use. METHODS: The data were collected using a Google Forms questionnaire. A mixed methodology was used for data analysis: a quantitative approach to explore the use of conscious sedation and a qualitative thematic approach (using Nvivo software) to determine the practitioner's perception of it. RESULTS: Responses were collected from 225 practitioners (19% of the target population of 1185). Most of the responders were trained in NOS use in private dental clinics. Seventy-three percent of those who trained privately actually used NOS, compared to 53% of those trained at university (p-value = 0.0052). Above all, NOS was used for children requiring restorative dentistry. The average price of the sedation was 50 Euros and it lasted, on average, for 37 min. The qualitative and thematic analysis revealed the financial and technical difficulties of implementing NOS in private practice. However, it also showed the benefits and pleasure associated with NOS use. CONCLUSION: This statistical survey of French dental practitioners offers an insight of the current state of the use of conscious sedation with nitrous oxide in private general dental practice in France. It also includes the first report of dental practitioners' perceptions of NOS use and may lead to a better understanding of the reasons why sedation is sometimes not used in private practice.

Syndrome of Hajdu-Cheney: three case reports of orofacial interest.

Hajdu-Cheney syndrome is a rare, probably autosomal dominant connective tissue disorder with a variable expressivity. It is characterized by an osteoporotic skeleton, acro-osteolysis, a proportionate short stature, and distinctive orofacial anomalies. The aim of this article is to focus on the orofacial manifestations in two sporadic cases and one familial case with Hajdu-Cheney syndrome. Several common dental and craniofacial features are described. In contrast to earlier proposed diagnostic features, these patients show persisting deciduous teeth, problematic tooth eruption, and tendency toward a Class III malocclusion.

Investigating the etiology of multiple tooth agenesis in three sisters with severe oligodontia.

OBJECTIVES: To describe the dentofacial phenotypes of three sisters with severe non-syndromic oligodontia, to report on the mutation analysis in three genes, previously shown to cause various phenotypes of non-syndromic oligodontia and in two other suspected genes. Based on the phenotypes in the pedigree of this family, the different possible patterns of transmission are discussed. METHODS: Anamnestic data and a panoramic radiograph were taken to study the phenotype of the three sisters and their first-degree relatives. Blood samples were also taken to obtain their karyotypes and DNA samples. Mutational screening was performed for the MSX1, PAX9, AXIN2, DLX1 and DLX2 genes. RESULTS: The probands' pedigree showed evidence for a recessive or multifactorial inheritance pattern. Normal chromosomal karyotypes were found and - despite the severe oligodontia present in all three sisters - no mutation appeared to be present in the five genes studied so far in these patients. CONCLUSIONS: In the three sisters reported, their common oligodontia phenotype is not caused by mutations in the coding regions of MSX1, PAX9, AXIN2, DLX1 or DLX2 genes, but genetic factors most probably play a role as all three sisters were affected. Environmental and epigenetic factors as well as genes regulating odontogenesis need further in vivo and in vitro investigation to explain the phenotypic heterogeneity and to increase our understanding of the odontogenic processes.

Dental alveolar bone defects related to Vitamin D and calcium status.

Vitamin D is important for skeletal development, growth, and homeostasis but has been sparsely studied in the oro-facial bone. Dental alveolar bone anchors teeth to mandible and maxilla bones via a periodontal ligament. Its formation and maintenance are strictly dependent on the presence of tooth organs and it is characterized by a high turnover rate. In order to study the role of Vitamin D and the calcium status on dental alveolar bone formation, microradiographic and histologic comparison of wild-type, Vitamin D receptor null mutant (VDR (-/-) hypo- and normo-calcemic mice and tissues were performed at 2 months. In hypo-calcemic VDR (-/-) mice, alveolar bone was hypomineralized and demonstrated a cellular and matrix organization, similar to the immature woven bone. In normo-calcemic VDR (-/-) mice, mineralization of dental alveolar bone appeared normal, but bone was morphologically abnormal in some specific anatomical locations. These data show that Vitamin D and calcium status may control the formation of dental alveolar bone. The differences of phenotype between hypo- and normo-calcemic VDR null mutant mice suggested a specific Vitamin D control of alveolar bone formation by the Vitamin D nuclear receptor pathway.

Expression of amelogenin in odontoblasts.

Amelogenin is the major enamel protein produced by ameloblasts. Its expression has been shown to be down-regulated in ameloblasts of vitamin-D-deficient (-D) rats. The potential expression and localization of amelogenin in odontoblasts and its regulation by vitamin D were investigated in this study. RT-PCR and semi-quantitative Northern blot analyses were performed using the odontoblast cell line MO6-G3 and microdissected dental pulp mesenchyme. Both in vitro and in vivo odontoblasts expressed various alternatively spliced amelogenin transcripts. In situ hybridization studies showed that amelogenin expression was restricted to young odontoblasts during mantle dentin deposition. Electron microscopy studies localized the amelogenin protein in the odontoblast cell process cytoplasm and mantle dentin. Amelogenin immunolabeling was stronger in -D rats, suggesting an inverse regulation by vitamin D in odontoblasts. Furthermore, amelogenin mRNA steady-state levels were significantly increased in -D dental pulp mesenchyme. In addition, a temporal-spatial lengthening of the mantle dentin stage was observed in -D animals, suggesting that developmental perturbations occur in relation to the vitamin D status and/or amelogenin expression. These data show that amelogenin is expressed by odontoblasts selectively during mantle dentin deposition. This developmental regulated expression pattern is enhanced under vitamin-D-deficiency status and in a broader context may play an important role during ameloblast and odontoblast differentiation and function.

Immunolocalization of vitamin D receptor and calbindin-D28k in human tooth germ.

The role of vitamin D in ameloblasts and odontoblasts has been studied experimentally in rodents. Dental dysplasias have also been reported in clinical studies of children with rickets. Vitamin D acts via a nuclear receptor which binds the major metabolite, 1,25-dihydroxyvitamin D3, and positively or negatively controls the expression of specific genes. The most extensively studied markers of 1,25-dihydroxyvitamin D3 action are calbindin-D9k, calbindin-D28k, and osteocalcin. Therefore, to study in more detail the potential role of 1,25-dihydroxyvitamin D3 in human dental development, 1,25-dihydroxyvitamin D3 receptor (VDR) was localized by immunofluorescence in forming teeth (8-26 wk of gestation). Calbindin-D28k was also mapped by immunoperoxidase in antenatal and postnatal forming and formed teeth. VDR were detected in both dental epithelium and mesenchyme of bud, cap, and bell stages of tooth germs. Nuclei of overtly differentiated ameloblasts and odontoblasts were also immunostained. Calbindin-D28k was present in differentiated ameloblasts and odontoblasts. The presence of VDR and calbindin-D28k in ameloblasts and odontoblasts suggests that 1,25-dihydroxyvitamin D3 may contribute to the regulation of enamel and dentin formation, as classically reported for bone formation. Finally, the early appearance of VDR supports the concept that 1,25-dihydroxyvitamin D3 may also control forward stages of tooth crown development in humans.

Ameloblasts and odontoblasts, target-cells for 1,25-dihydroxyvitamin D3: a review.

The basic features on the vitamin D endocrine system, synthesis of the main metabolite 1,25-dihydroxyvitamin D3 (1,25) and its genomic action mediated via the vitamin D receptor (VDR), are reviewed. Calbindin-D9k, calbindin-D28k and osteocalcin are presented as the most-extensively investigated vitamin D-dependent calcium-binding proteins. The action of 1,25 on the basic process of proliferation and differentiation is introduced. Then, the basis of the systemic theory of vitamin D action on teeth (clinical and experimental data and the dissimilar distribution of VDR and of potential vitamin D-dependent proteins in dental cells) are exposed. Finally, the data obtained with calbindin-D9k, calbindin-D28k, osteocalcin and VDR, which supports the theory that ameloblasts and odontoblasts are target-cells for 1,25 is presented. As a perspective, a cross-survey of the 1,25 and tooth-related literature is proposed which may indicate potential target-genes for 1,25 in teeth as done previously for calbindins-D.