Connaissances et attitudes face à la prise en charge des maladies parodontales nécrotiques : enquête auprès des chirurgiens-dentistes de Dakar (Sénégal)

Les maladies parodontales nécrotiques nécessitent une prise en charge rapide et efficace pour ne pas compromettre le potentiel de cicatrisation du parodonte. L'objectif de ce travail était d'évaluer les connaissances et attitudes des chirurgiens dentistes de Dakar face aux maladies parodontales nécrotiques. Matériels et méthodes. Il s'agissait d'une enquête transversale descriptive concernant les chirurgiens dentistes de la région de Dakar. L'étude a inclus les chirurgiens dentistes de la région de Dakar inscrits aux tableaux de l'ONCDS de 2015 et ceux du Service de Santé des Armées. Résultats. L'échantillon était constitué de 122 dentistes sur un total de 238 soit un taux de participation de 51,26%. La majorité des praticiens (39,34%) avait une durée d'exercice comprise entre 1 à 5 ans. La formation continue était suivie par 52,45 % des dentistes. La majeure partie (73,77 %) des chirurgiens dentistes ignoraient que les maladies parodontales nécrotiques font partie de la nouvelle classification des maladies parodontales. Concernant le traitement d'urgence de ces pathologies, 91,80 % des praticiens prescrivaient systématiquement des antibiotiques, 67,21 % faisaient une détersion des lésions avec des compresses et 55,74 % pratiquaient un débridement mécanique et irrigation à la polyvidone iodée pendant la phase aigue de la maladie. Conclusion. La prise en charge des maladies parodontales nécrotiques n'est pas toujours conforme aux recommandations scientifiques actuelles. Il convient de faire de la formation continue des chirurgiens dentistes du Sénégal, un impératif éthique et légal

[Prevalence of halitosis in patients with dental prostheses in Senegal]. / Prevalence de l'halitose chez des patients sénégalais porteurs de prothèses dentaires.

INTRODUCTION: Bad breath is a disease affecting 25% of the world's population. Despite the widespread nature of this problem, people's knowledge about this condition is poor. OBJECTIVE: The purpose of this study was to determine the prevalence of halitosis in a cohort of 62 Senegalese subjects with dental prostheses. METHODS: Breath analysis was based on measurement of volatile sulfur compounds (VSC) using a halimeter. Halitosis was diagnosed ifVSC level was > or = 125 ppb. RESULTS: Mean VSC level was 157.7 +/- 152.6 ppb. The prevalence of halitosis was of 35.4% overall, 72.7% in persons with fixed dentures and of 27.3% in persons with removable prostheses. CONCLUSION: The relatively high prevalence of halitosis observed in this study indicates a need to enhance patient awareness of daily hygiene measures for dental prosthesis.

[Comparative study of two anti-antiretroviral protocols used for treatment of a cohort of HIV 1-positive patients followed at the Institute of Public Health and Hygiene in Dakar, Senegal]. / Etude comparative de deux protocoles de traite- ment antirétroviral des patients VIH-1 positifs de la cohorte suivie à l'lnstitut d'hygiène sociale de Dakar, Sénégal.

In the last ten years, the discovery of several antiretroviral drugs has greatly contributed to improving the survival and quality of life of HIV-infected persons. The purpose of this retrospective study was to compare the effectiveness and tolerance of two anti-retroviral combinations, i.e., Lamivudine + Zidovudine and Efavirenz versus Lamivudine + Zidovudine and Nevirapine. The files of HIV1-infected patients treated between July 2003 and December 2004 (18 months) and followed at the Institute of public health and hygiene in Dakar were reviewed. A total of 70 patients, i.e., 35 in each protocol group, were included. The following data were collected for each patient: age, sex, locality, elements to assess tolerance, and elements to assess effectiveness (CD4 count, viral load and opportunistic infection immuno-failure). Results indicated that the immunovirologic effectiveness of the two protocols was identical with regard to mean CD4 count, i.e., 327 cells/mm3 for AZT+3TC+EFV versus 334 cells/mm3 for AZT+ 3TC+NVP (p < 0.05). Immuno effectiveness was better for Lamivudine + Zidovudine + Efavirenz than Lamivudine + Zidovudine + Nevirapine. Significant therapeutic advances in recent years have improved survival and quality of life in patients under retroviral treatment. There are currently many anti-retroviral molecules available and several relatively well codified therapeutic protocols.

[Prevalence of Helicobacter pylori detected by real-time PCR in the subgingival plaque of patients with chronic periodontitis]. / Prévalence d'helicobacter pylori détecté par PCR en temps réel dans la plaque sous-gingivale des patients atteints de parodontite chronique.

BACKGROUND: Helicobacter pylori plays a significant role in gastric disease. The aim of the present pilot study was to evaluate the prevalence of H. pylori detected by real-time polymerase chain reaction (real-time PCR) in the sub-gingival plaque of chronic periodontitis patients and to determine periodontopathogens profile of positive sites at H. pylori. METHODOLOGY: 109 subgingival samples collected from 17 subjects with chronic periodontitis were studied. The DNA was extracted from the oral samples and analyzed for the presence of H. pylori by real-time PCR (LightCycler) using 16S rRNA#120 primers which targeted the 16S rRNA gene. DNA from H. pylori DSM 4867 was used as a positive control. Seven bacteria implicated in chronic periodontitis were selected to explore the presence of these periodontopathic species in the oral positive sites for H. pylori. RESULTS: 16 of 109 samples (14.7%) were positives of H. pylori. All the positives sites were also positives to Fusobacterium nucleatum and Eikenella corrodens, 62.5% to Porphyromonas gingivalis, 31.25% to Treponema denticola, 25% to Prevotella intermedia, 12.5% to Aggregatibacter actinomycetemcomitans and 6.25% to Tannerella forsythia. CONCLUSIONS: H. pylori may be present in the subgingival plaque samples of patients with chronic periodontitis who are resident in a developing country. F. nucleatum and E. corrodens could coaggregate with H. pylori in the subgingival dental plaque.

[Prosthetic rehabilitation: needs in Senegalese dental offices]. / La réhabilitation prothétique: évaluation des besoins dans les cabinets dentaires du Sénégal.

Knowledge of dental prosthetic needs will develop strategies for prevention and treatment through a package of individual, community and professional policies. The aim of this study was to evaluate prosthetic needs in Senegalese dental offices. The survey was conducted among people aged 15 years and more attending Senegalese dental clinics. The mean number of missing teeth was 4.4. Only 55.3% of the sample expressed the need for dentures and 81.8% had a diagnosed need for prosthesis. A statistically significant difference was noticed between the needs diagnosed and the expressed needs (p < 0.0001). Finally, this study reveals that the need for prosthetic treatment is real in the Senegalese dental offices.

Concentrated and linked epidemics of both HSV-2 and HIV-1/HIV-2 infections in Senegal: public health impacts of the spread of HIV.

The objective of this article is to report seroprevalences on HIV and herpes simplex virus 2 (HSV-2) in female sex workers (FSW) and in two sentinel populations of pregnant women living in Senegal. Serosurveys of HIV and HSV-2 were conducted in two unselected sentinel populations from Dakar, Senegal, and its provinces, including in 2003 only pregnant women and 2006 pregnant women and FSW. The population study involved 888 pregnant women and 604 FSW. In pregnant women, HIV and HSV-2 seroprevalences were, respectively, 1.01% and 15.65%. There was no association between HSV-2 and HIV infection, whatever the age. In contrast, the seroprevalence of HIV infection in the group of FSW was high, reaching 22.9% in women over 30 years old. FSW above 20 years of age harboured much higher HSV-2 seroprevalences that those found in pregnant women of similar age groups. In FSW, strong associations between HSV-2 and age, and among HSV-2 and HIV-1 as well HIV-2, were evidenced. In conclusion, HIV epidemic remains concentrated in high-risk groups of the Senegalese population, such as the FSW population in which the seroprevalence of HSV-2 infection is very high. Intervention against STI including HSV-2 is urgently needed to prevent the spreading of HIV epidemic.

[Periodontal status of Senegalese patients with Sjögren's syndrome. A case control study at the Service of Internal Medicine]. / Santé parodontale et syndrome de Gougerot Sjögren. Etude cas-témoins au service de médecine interne.

The aim of this study is to compare the periodontal status of patients with Gougerot-Sjögren syndrome (GSS) to healthy subjects in order to investigate the relation between periodontal disease and GSS. To achieve this aim, one hundred and three patients, among whom 36 with primary GSS and 67 with secondary GSS, were selected and compared with one hundred and three (103) control subjects. The hygiene level was evaluated with Silness and Löe plaque index (PI) and inflammation level with Löe and Silness gingival index (GI). Probing depth and clinical attachment loss was measured with Williams periodontal probe. Mean plaque indices were identical for both groups (1.27 +/- 0.1 versus 1.22 +/- 0.1, p = 0.67). Compared with control subjects, the inflammation index scores were significantly higher among SSG patients (IG = 1.1 +/- 0.1 versus 0.44 +/- 0.2, p < 0,001). The logistical regression model applied to the whole sample showed that patients with GSS had a higher risk of developing periodontal disease (IG : OR 5.508, state 95% CI [1.66-9.60] ; PP : OR = 4.51 95% CI [1.692-12.024]). A training program for GSS patients seems essential, in order to manage the deleterious effects of defective oral-dental ground. It would allow convincing patients about the interest of prevention through regular surveillance and care.

[Conditions of dental extractions in areas health centers of Senegal]. / Etude des conditions de l'extraction dentaire dans les centres de santé des districts du Sénégal.

Dental extraction is a surgical act frequently carried out in the African dental structures. It requires the rigorous respect of the conditions of asepsis and antisepsis. Equipments and anaesthetic and avulsional products must be also sufficient. Our study undertaken among 46 dental services in areas health centers of Senegal aimed to determine the conditions under which dental extractions are carried out. The principle results of our study showed that 93% of dental practitioners wore sterilized gloves. 49% of the dentist's care activity consisted in dental extractions. 50% of the practitioners re-use anaesthetic needles, 2% re-use anaesthetic carpules. We noticed that the dental structures were facing a deficit of materials and products of extraction. Face to the outbreak of serious illnesses as infections of HIV and Hepatitis B, the practitioner and his team must be sensitized and trained to struggle against the transmissible infections and to carry out the dental extraction only if the conditions of asepsis and antisepsis are joined together. A pleading towards the medical authorities must be done to support the services in equipments and periodic renewals of the materials and products of extractions.

[Relationships between masticatory performance and nutritional state in complete denture wearers]. / Relations entre Performance Masticatrice et Etat Nutritionnel chez des Sujets Porteurs de Prothèses Complètes.

UNLABELLED: For many authors masticatory dysfunctions are related to reduction in dietary intake with malnutrition as a possible consequence. The aim of the present study was to further investigate the relationships between masticatory performance and nutritional state in complete denture wearers. METHOD: Masticatory performance was assessed using a granulometric method in 74 subjects divided into 2 subgroups according to their dental status (normal dentition and complete dental wearers). Nutritional status of study subjects was analyzed with Mini Nutritional Assessment (MNA). RESULTS: There were a significant association between wearing denture and Nutritional Status as assessed by MNA. Using this scale, a risk of malnutrition was found in 80% of subjects wearing complete denture and in 26% in the normal dentition sub group (p < 0.0001). There were also a positive and significant correlation between, the particle size distribution and masticated test food and nutritional status. CONCLUSION: Complete denture wearers are at greater risk of malnutrition than did subjects with normal dentition.

[Periodontal status in a sample of Senegalese women using hormonal contraception]. / Etat parodontal d'une population de femmes Sénégalaises sous contraception hormonale.

Hormonal contraception is based on the use of synthetic hormones containing variable doses of oestrogen and progesterone making it possible to avoid pregnancy in a temporary and reversible way. The objective of this study is to evaluate the periodontal status of a sample of Senegalese women under hormonal contraceptive. One hundred women using contraception since at least 6 month were paired on the age, the socio-economic profile and oral hygiene with a control group. Oral hygiene (plaque index (PI) of Silness and Löe), the inflammation (gingival index (GI) of Löe and Silness), probing depth and clinical attachment loss were recorded. With equal hygiene, the scores of the gingival index were significantly higher among women under contraceptive (p < 0.001). Inflammation was significantly more marked for the women who used contraception in injectable form compared to the control group (p < 0.001). Probing depth (3.01 +/- 0.04) and clinical attachment loss (3.19 +/- 0.08) were significantly more important among women under contraceptive (p < 0.001). The women under contraceptive seem to set up a group at risk for developing a periodontal disease, it is thus necessary to systematise periodontal appraisal before and during contraceptive use period.

[Study of mastication in denture wearers among various ages]. / Etude des parametres physiologiques de la mastication chez des sujets ages porteurs de protheses adjointes completes.

INTRODUCTION: Recent studies have shown that it was possible for subjects with masticatory deficiency chewing achieve a satisfactory level of fragmentation of food by acting on some physiological parameters as the number of cycles and the time devoted to a sequence of mastication. METHOD: The objective of this work is to study the effects of the wearing of complete prostheses, of ageing on the physiological parameters from the chewing on a population of 110 subjects. RESULTS: The results show an important effect of the dental status. Indeed denture weaers need twice more cycles than controls of the same age to make a ham portion ready to be swallowed. Significant an age effect with regard to the number of cycles was also noted. The rheology of food affects the number of cycles which increases with the hardness of food.

[Periodontal conditions in young sickle cell anemia Senegalese patients]. / Etat parodontal du jeune sénégalais drépanocytaire homozygote.

INTRODUCTION: The oral cavity holds a complex microbial flora including periodontal pathogens. The infectious complications are common in sickle cell anaemia, which reaches 1% of the population in Senegal. The objective of this study is to assess periodontal conditions in young Senegalese sickle cell anaemics. PATIENTS AND METHODS: A sample of 82 subjects aged between 15 and 34 years with mean at 25.2 years +/- 4.6 was made up, including 35 homozygous and 47 non homozygous. Plaque index, gingival index and papillary bleeding index, tooth mobility and clinical attachment loss were assessed. Partial correlation between periodontal indexes and haemoglobin and hematocrit controlling for plaque index was performed. RESULTS: No significant statistical differences were found for periodontal indexes and clinical attachment loss between the two groups, even if homozygous show higher values. Periodontitis is less frequent in homozygous and odd ratio show protective effect of sickle cell anaemia (OR = 0.381, IC at 95% = [0.130; 1.1 18]). Tooth mobility is significantly increased in homozygous with mean at 1.0 +/- 0.8 versus 0.5 +/- 0.4 in control group (p = 0.000). Partial correlation show significant negative association between haematocrit and papillary bleeding index in homozygous (p = 0.045). CONCLUSIONS: The hypothesis that sickle cell anaemia can affect periodontal conditions and worsen periodontal diseases is to be considered even if it has not been proved as risk factor. Increased tooth mobility could be marker of periodontal risk in homozygous.

[Influence of orthodontic anomalies on periodontal condition]. / Influence des anomalies orthodontiques sur l'état parodontal.

INTRODUCTION: Three main reasons are routinely cited to justify the provision of orthodontic treatment: improvement of facial and dental aesthetics and of dental health and function. However, association between malocclusions and periodontal condition is still controversial. The aim of the present study was to further investigate the correlation between certain orthodontic anomalies and periodontal condition. MATERIALS AND METHOD: One hundred and one subjects were included in this study. Information regarding oral hygiene habits and accessibility to professional oral health care were obtained from each subject. Malocclusions were assessed with the Indice of Orthodontc Treatment Need (IOTN) and the Index of Complexity, Outcome and Need (ICON) and periodontal with the Community Periodontal Index for Treatment Need (CPITN). Spearman Rank correlation order was used to test for any association between malocclusions and periodontal condition. Significance was set at the 5% level. RESULTS: Contact point displacements (malpositions) are positively and significantly correlated to CPITN in the mandibular arch. There was also significant negative correlation between spacing and CPITN in the maxilla. Openbite and overjet assessed by IOTN have a significant positive correlation with the periodontal condition as assessed by the CPITN. In contrast no correlation was found with dental crossbite (IOTN and ICON). At last, there was significant correlation between overbite and periodontal condition. CONCLUSION: Significant correlations were found between malocclusions and periodontal condition. Within the limitation of this study one can suggest that malocclusions are risk marker for periodontal diseases. However, this study by virtue of its protocol cannot allow us to makeany inference about a cause/effect relationship between malocclusions and periodontal condition.

[Treatment of localized gingival hypertrophy induced by orthodontic appliances using modified Widman flap. A case report]. / Traitement de l'hypertrophie gingivale localisée associée au port de dispositifs orthodontiques par lambeau de Widman modifié. Rapport de cas.

Gingival enlargement is a condition that commonly develops during orthodontic treatment. Orthodontic appliances are irritation and retention plaque factors holding up oral hygiene and control of gingival inflammation. This case-report shows localized gingival hypertrophy in young Senegalese female undergoing orthodontic treatment with fixed appliances. Modified Widman flap associated with osseous recontouring have led to morphological conditions of gingiva allowing better plaque control and orthodontic treatment going on. Comfort and controlled haemostasis after periodontal surgery make this procedure a good choice for treatment of gingival hypertrophy. Collaboration between orthodontist and periodontist is required for successful therapeutic.

[Study of the characteristics of the food bolus in elderly subjects with complete dentures]. / Etude des caractristiques du bol alimentaire chez des sujets agés porteurs de prothèses complètes.

Many studies have shown that wearing of complete dentures impairs masticatory function. The aim of this study was to investigate the influence of complete denture wearing and ageing on masticatory performance. Masticatory performance was assessed by a granulometric method on 110 subjects divided into 3 groups according to dental state and age. The results show edentulous subjects have a masticatory performance worse than their congeneric of the same age. Indeed, the median of the distribution of the size of the particles is more important at the carriers of prostheses than at the toothed old subjects (P < 0.0001). On the other hand the extent of the distribution does not vary significantly between these 2 groups of subjects. The parameters of the masticatory performance do not vary in a statistically significant way between the old subjects and the young controls. There is thus no significant effect of the age on the parameters of the performance masticatory.

[Periodontal status and diabetes: evaluation of 80 patients with diabetes mellitus in Conakry Teaching Hospital]. / Evaluation de l'etat parodontal au cours au diabète : a propos de 80 patients au CHU Donka de Conakry.

INTRODUCTION: Dental and periodontal diseases are frequent in diabetics. Few studies were carried out on oral pathologies of the diabetics in Africa. The objective of this study was to assess periodontal conditions in a population of diabetics followed in a hospital environment by comparing them with non diabetics. PATIENTS AND METHOD: In a cross-sectional study realized from January to April 1999, 80 diabetic patients followed in the Service of Endocrinology were compared to 35 non-diabetic patients, chosen among the patients attending in the Service of Internal medicine of the Donka Teaching Hospital in Conakry in the same period. Both groups were compared according to the simplified oral hygiene index (OHIS) and community periodontal index of treatment needs (CPITN). RESULTS: There was no difference between diabetics and nondiabetics according to the OHIS. Diabetics CPITN index was higher compared to non-diabetics (p = 0.019). In diabetics, scores of CPITN increase significantly with duration of diabetes mellitus (p = 0.019). Also correlation was found between OHIS and the duration of diabetes. Glycemic control was significantly correlated with OHIS (p < 0.001) and CIPTN (p < 0.001). CONCLUSION: Diabetic patients have more periodontal treatment need than controls. Better collaboration between diabetologist and odontostomatologist is needed to preserve the oral health of diabetics.

[Gingival hypertrophy during orthodontic treatment: contribution of external bevel gingivectomy. Case report]. / L'hypertrophie gingivale au cours du traitement orthodontique: apport de la gingivectomie à biseau externe. Rapport de cas.

Gingival enlargement is a condition that commonly develops during orthodontic treatment. Orthodontic appliances are irritation and retention plaque factors holding up oral hygiene and control of gingival inflammation. Two cases of gingival hypertrophy in young Senegalese females undergoing orthodontic treatment with fixed appliances are described and treated by gingivectomy. This surgical procedure have led to morphological conditions of gingiva allowing better plaque control and the orthodontic treatment going on. Periodical controls in child and adolescent are required for healthy periodontium during orthodontic therapy. Collaboration between orthodontist and periodontist is one of the most important keys to successful treatment.

[Evaluation of gingival condition in homozygous children and adolescents with sickle cell anemia in Senegal]. / Evaluation de l'etat gingival chez l'enfant et l'adolescent drepanocytaires homozygotes au Senegal.

Sickle cell anaemia is an inherited disorder of haemoglobin synthesis leading to haemolytic anaemia. It touches more than 50 million people in the world and 10% of the population in Senegal. Only the homozygous form is symptomatic and appears by painful crises of vaso-occlusive type. There is a lack of works carried out or published in Senegal about potential link between periodontal conditions and sickle-cell anaemia. The main objective of this study is to assess the gingival conditions in Senegalese children and adolescents homozygous sickle cell anaemic. Secondary, the gingival state is correlated with oral hygiene and rate of reticulocytes to determine their relationship. Fifty homozygous attending the Albert Royer Paediatric Hospital of Dakar and unscathed of other systemic pathologies, were examined. The patients are old between 3 and 16 years with an average age 9.4 years +/- 3.8. The gingival state is assessed by measurement of the gingival index (GI) and index of sulculary bleeding (SBI). Partial correlation is performed between the two indexes and average of reticulocytes. The gingival index mean is 1.7 +/- 0.6 and 66% of the patients present a severe inflammation, which is more frequent in the age bracket from 3 to 12 years. The SBI mean is 1 +/- 1.1 and 68% of the patients present gingival bleeding, which is moderate to severe in 18%, with a greater frequency in the age bracket from 13 to 16 years. Strong correlation is found between plaque index, GI and SBI. Damage of gingival state seems not to be linked to the high average of reticulocytes controlling for oral hygiene. Children and adolescent homozygous have an inflammatory periodontium associated to poor oral hygiene, which highlights their needs in periodontal treatments. Early tracking and preventive treatment of periodontal diseases during systematic oral visits must be required.

Parodontites et maladies respiratoires au centre hospitalier national universitaire de Fann (Sénégal)

Introduction : Les parodontites sont des pathologies infectieuses associées à différentes maladies générales dont les pathologies respiratoires. L'objectif de ce travail était d'évaluer la distribution des parodontites chez les sujets atteints d'affections respiratoires en milieu hospitalier. Matériels et méthodes : Il s'agissait d'une étude descriptive transversale basée sur un recrutement de patients hospitalisés ou venus en consultation au Service de Pneumologie de l'hôpital Fann. Les patients atteints de tuberculose n'ont pas été inclus. La distribution de l'atteinte parodontale a été évaluée par les mesures des profondeurs de poche (PP) au sondage et la perte d'attache clinique (PAC) à l'aide de la sonde parodontale de Williams. Résultats : Un échantillon de 70 patients dont 25 femmes et 45 hommes a été sélectionné pour cette étude. La moyenne d'âge était de 42 ans ± 4,2.La prévalence des pneumopathies bactériennes était de 54,3%, celle des Broncho Pneumopathies Chroniques Obstructives (BPCO) de 22,9%. Des profondeurs de poche ≥4mm ont été retrouvées chez 50% des sujets et 64,7% ont présenté une perte d'attache clinique ≥2mm.Les profondeurs de poche étaient plus importantes chez les patients atteints de pneumopathie bactérienne et de BPCO. Conclusion : La prévalence élevée des parodontites nécessite une collaboration entre pneumologue et parodontologiste afin de limiter les effets délétères d'une mauvaise condition orale sur la santé générale

Morbidity and nutrition patterns of three nomadic pastoralist communities of Chad.

As a part of an interdisciplinary research and action programme, morbidity and nutritional patterns were assessed in three nomadic communities: Fulani and Arab cattle breeders and Arab camel breeders, of two prefectures in Chad. The predominant morbidity pattern of Chadian nomadic pastoralists (representing approximately 10% of the total population of the country) had not been documented so far. A total of 1092 women, men and children was examined by a physician and interviewed during two surveys in the dry season and one in the wet season (1999--2000). Participants with no complaint were rare. Pulmonary disorders (e.g. bronchitis) were most often diagnosed for children under 5 years of age. Of the adult participants, 4.6% were suspected of tuberculosis. Febrile diarrhoea occurred more often during the wet season when access to clean drinking water was precarious. Malaria was only rarely clinically diagnosed among Arabs during the dry season, whereas Fulani, who stayed in the vicinity of Lake Chad, were also affected during this period. A 24-h dietary recall showed that less Arab women than men consumed milk during the dry season (66% versus 92%). Malnutrition was only documented for 3 out of 328 children (0--14 years). Arab women in childbearing age had a higher proportion of children not surviving when compared to Fulani women (0.2 versus 0.07). This study identified several implications for reseach and interventions in nomadic settings. Innovative and integrated health services for nomads can possibly be extended to many settings as nomadic pastoralists have in common a similar way of life driven by the needs of their animals.