Potential relationship between periodontal diseases and eye diseases.

Periodontal diseases are inflammatory lesions initiated by oral bacteria and lead to the destruction of the supporting structures of the teeth (gingiva, periodontal ligament and alveolar bone) in susceptible patient. Via several biological mechanisms, periodontal diseases have been associated with multiple systemic diseases, such as rheumatoid arthritis, diabetes, cardiovascular diseases, Alzheimer's disease and adverse pregnancy outcomes. Similarly certain eye diseases have been associated with systemic diseases of the inflammatory pathway. We hypothesized that periodontal diseases are associated with eye diseases. Thus using literature data we find that several studies have reported that eye disorders are associated with the presence of periodontal diseases. But the mechanisms of this relationship are not clear. However the innate immune response involvement, the sharing of similar risk factors in pathogenesis and the changes of eye choroid thickness may be suggested as several hypotheses to explain this potential association.

[Managing patients with therapeutic antibodies in odontostomatology]. / Prise en charge des patients sous anticorps thérapeutiques en odontostomatologie.

Immunotherapies, particularly therapeutic antibodies, are increasingly used in the treatment of many autoimmune or oncological diseases. Patients treated with therapeutic antibodies may present with an increased risk of infection or of osteonecrosis of the jaws (ONJ). There is currently no consensus on the management of patients treated with therapeutic antibodies. These treatments are mainly used in hospitals, but they have been increasingly prescribed in ambulatory treatment for patients undergoing oral care. It is therefore important to establish therapeutic precautions for these patients. We had for aim to describe these antibody therapies, their indications, their potentially adverse effects in the oral cavity and to review the latest recommendations.

[Oral infections and pregnancy: knowledge of health professionals]. / Infections buccodentaires et complications de la grossesse: connaissances et attitudes des professionnels de santé.

OBJECTIVE: The abundance of recent studies on the relationship between oral diseases and complications of pregnancy leads to questions on knowledge of health professionals. This study aims to establish an inventory of knowledge and practice of health professionals in France on this issue. PATIENTS AND METHODS: A questionnaire on knowledge of the relationship between oral diseases and complications of pregnancy was referred to gynaecologists and obstetricians, midwives and dentists. This study was conducted at the University Hospital of Nantes and Le Mans General Hospital. RESULTS: Eighty-seven professionals of pregnancy and 259 dentists responded to the survey. Bleeding gums and pregnancy gingivitis are the oral manifestations most cited by all practitioners. There is however a difference concerning the epulis and caries risk. The most cited Pregnancy complications are risk of premature delivery and chorioamniotitis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point to the lack of continued education on this topic. DISCUSSION AND CONCLUSION: There is a good knowledge of the pregnancy complications associated with oral disease despite the lack of training of pregnancy, but the attitudes of care are not still in adequacy. It appears necessary to strengthen the training of all practitioners in this field. The design and implementation of a specific questionnaire on oral health status could allow better identification of the patients at risk by the professionals of pregnancy, and optimize so the care of pregnant women.

[Interest of periodontitis screening and treatment in pregnancy: systematic review]. / Intérêt du dépistage et du traitement des maladies parodontales chez la femme enceinte: revue de la littérature.

For 15 years, the investigation of a relationship between periodontal diseases and complications of pregnancy is explored, and allowed the publication of conflicting results. This work is a literature review of articles of high level of evidence, which aims to clarify the impact of treatment of periodontal disease on pregnancy. Among the 15 selected randomized controlled trials (RCT), nine concluded a significant reduction in pregnancy complications between the "experimental" group treated and "control" group. However, six other RCT concluded that the lack of a significant difference between the two groups has higher levels and a more robust methodology. In 2006, a RCT, published in an influent medical journal, announced that there would be no significant benefit to treat pregnant women to reduce the complications of pregnancy. The contradictions found in the different studies have led some authors of meta-analysis to allocate the RCT per groups of power, based on their methodology. Meta-analysis using this methodology concluded that there is no benefit for periodontal treatment to reduce complications of pregnancy. In conclusion, the next RCT conducted should standardize their methodological criteria, and preferably multicenter, including a large number of participants. In addition, a more precise definition of periodontal diseases for the purpose of research is necessary. Finally, the notion of success or failure of periodontal treatment must be considered.

[Periodontal diseases and preterm birth: a pilot study]. / Maladies parodontales et accouchements prématurés: étude clinique pilote.

The aim of this work is to determine periodontal disease's prevalence in preterm delivery (before 37 weeks of gestation) and find a significant association between preterm birth and periodontal diseases. Periodontal status was determined. Status and severity were noted and correlated to term of delivery. Fifty-two patients were included in the study. Periodontal disease's prevalence was 33% for gingivitis and 44% for periodontitis. No significant correlation was found (P=0.41). Periodontal disease's prevalence is agreed with literature review. The different opinion are largely discussed. Methodological harmonization of periodontal definitions is needed to increase study's power.

[Prosthetic rehabilitation after osteonecrosis of the jaws due to histiocytosis X and treatment with bisphosphonates apropos of a case]. / Réhabilitation prothétique après ostéonécrose des maxillaires due à une histiocytose X et un traitement aux bisphosphonates à propos d'un cas.

Bisphosphonates are involved in the occurrence of Osteonecrosis of Jaws (ONJ), which is a complication of these treatments. This osteonecrosis concern the alveolar bone and develops generally after an oral surgery. It can however occur spontaneously without preliminary dental extraction. Other risk factors could play potentiates the risk of ONJ. This osteonecrosis results in an osseous exposure in patient treated or having been treated by bisphosphonates, without any cervico-facial irradiation. Actually, no treatment has been the proof of its effectiveness. Preventives measures of ONJ in oral cavity are the best method before, during and after administration of bisphosphonates. In this article, we present the clinical case of a patient with histiocytois treated by bisphosphonates and having developed ONJ. The selection criteria of the prosthetic rehabilitation as well as the techniques used are detailed.

[Preferred zones of accumulation of prosthetic microbial plaque on removable complete dentures]. / Zones de prédilection d'accumulation de la plaque microbienne prothétique en prothèse amovible complète.

INTRODUCTION: Denture plaque (DP) is not visible with naked eye when it is not mineralized or not fully fixed. Describing and studying its qualitative and quantitative aspects in Complete Dentures (CD) require precisely-located sampling but selection criteria have not yet been well defined. In order to improve our treatment and preventive strategies for patients with CD, it is necessary to explore the various DP accumulation zones on CD fitting surfaces. PURPOSE: The aim of this study is to assess the DP accumulation on fitting surfaces of CD. MATERIAL AND METHODS: Distribution of DP accumulation zones was assessed by naked eye observation of the fitting surfaces on 31 maxillary and 31 mandibular CD. The prostheses were to be carried regularly since at least one year. The data were collected at the Prosthodontics department of the Annaba University Medical Center in Algeria. Prostheses were immersed for 24 hours in a plaque disclosing solution containing erythrosin 2% (Dento-Plaque Inava). The maxillary fitting surface was divided into five sectors: the post damming zone (1MaxFS), the top of the palate zone (2MaxFS), the incisor zone (3MaxFS), the maxillary tuberosity zone (4MaxFS), and the end of the canine and 1st premolar zone (5MaxFS). For mandibular fitting surfaces: trigonal and retromolar zone (1ManFS), canine and 1st premolar zone (2ManFS), and incisor zone (3ManFS). RESULTS: DP distribution was found to be homogeneous on the fitting surface of mandibular CD, however it was distributed in unequal way on the maxillary fitting surfaces. We noted a highly significant difference (p < 0.001) in the staining frequencies of the targeted zones. The most colored zone was the post damming one (1MaxFS), with a rate of 96.7%, whereas the least colored zone was the top of palate one (2MaxFS), with 35.5%. On the mandibular fitting surfaces, the rate of staining was 93.5% for the trigonal and retromolar zone (1ManFS) versus 83.8% on canine, 1st premolar (2ManFS) and incisor (3ManFS) zones. There was no significant difference (p = 0.422). CONCLUSION: The accumulation of DP was found to be homogeneous on mandibular fitting surfaces and no homogeneous on maxillary fitting surfaces. These results require further investigations in order to understand the causes of this difference. This will allow us to improve our treatment and preventive strategies for edentulous patients.

[Inquiry into the oral follow-up of diabetic patients: knowledge and application of the recommendations of the Haute Autorité de Santé]. / Enquête sur le suivi bucco-dentaire des patients diabétiques: connaissance et application des recommandations de la Haute Autorité de Santé.

In 1999, the Haute Autorité de Santé (HAS) issued recommendations on the follow-up in France of diabetic patients. It recommends at least an annual dental examination with special attention on the periodontal environment. The results of studies suggest that recommendations on the monitoring of oral diabetes are few or not implemented. In this work, we sought to evaluate the application of the recommendations of the HAS for patients with diabetes and in particular the recommendations on oral follow-up, from a cross-sectional survey using questionnaires to dentists (CD), general practitioners (MG) and diabetic patients in the region of Pays de la Loire. The results of this cross-sectional study shows that the requirements for monitoring oral health of these patients are poorly known and therefore far from being massively applied by health professionals. Our study revealed a lack of knowledge among health professionals, in monitoring oral diabetic patients. The causal association between diabetes and periodontal diseases are now well established; the dentist should be more involved in the medical team during the monitoring of diabetic patients. His role involves the prevention and care oral disease early. The patient information is the first step of prevention and care that it should be issued in any consultation with a dentist and relayed by the associations of diabetic's patients who should also be better informed.

[Preferred sites of accumulation of microbial plaque as shown by the color of the exterior surface of complete dentures]. / Mise en évidence des sites préférentiels d'accumulation de la plaque microbienne prothétique par coloration des extrados des prothèses amovibles complètes.

PURPOSE: The observation of the denture plaque for complete dentures caused many clinical works and researches, since 30 years. Most of the studies were interested, by the prosthetic under-surface. New data show that the polished (exterior) surface on the denture palate is colonized more than hard palate. The aim of our study is to locate the favorite zones of the accumulation of the denture plaque on the level of the suction polished faces of the acrylic resin. MATERIAL AND METHODS: We proceeded by immersion during 24 hours of 62 used full dentures belongs to 33 patients, with mucous membranes of various clinical aspects in a plaque disclosing solution of erythrosine type. The suction faces were divided into several zones of marking. RESULTS: We record 100% of coloring of the interdental zones on the maxillary and mandibular prosthesis. On maxillary prosthesis: 100% of the former and posterior vestibular zones are colored. The bottom of the palate is colored to 67.74%, a rate equivalent to the zones of fractures. On mandibular prosthesis: retromolar and sublingual zones, are colored to 96.77%. The former hall is colored with a rate of 90.32%. The posterior vestibular zone seems the least colored with a rate of 80.64%. CONCLUSIONS: The former area of the hall carved in an aesthetic objective is generally colored as well on the maxillary and mandibular prosthesis. We point out that this zone should not be much carved on the level of the area simulating the attached gum. Patients should be always incited to practice a mechanical hygiene, which takes part largely in the evacuation of the denture plaque on prosthetic surfaces. This revealing plaque use should integrate a clinical attitude of good practice, to motivate a patient with prosthetic hygiene or to detect zones of cracks objectifying a mechanical weakness of a prosthesis to be taken again, as well as the checking of the quality of repair joint during a routine control.

Controlled release of bisphosphonate from a calcium phosphate biomaterial inhibits osteoclastic resorption in vitro.

Calcium phosphate biomaterials such as calcium deficient apatite (CDA) have been contemplated as carrier for delivery of bisphosphonate in bone tissues. In the present work, we have investigated the in vitro biological properties of Zoledronate-loaded CDA. CDA was loaded with zoledronate according to a previously described coating process. 31P MAS NMR spectra demonstrated the effective loading of zoledronate onto CDA. Using 14C labeled zoledronate, we then demonstrated the in vitro release of zoledronate from CDA. In a first set of experiments, we confirmed that Zoledronate reduced the number of TRAP-, vitronectin receptor-, and F-actin ring-positive cells as well as the resorption activity of osteoclasts obtained from a total rabbit bone cell culture. Interestingly, Zoledronate-loaded CDA and its extractive solutions decreased the osteoclastic resorption. Finally, zoledronate-loaded CDA did not affect the viability and alkaline phosphatase activity of primary osteoblastic cells. These data demonstrate that CDA is effective for loading and release of zoledronate. The released zoledronate inhibited osteoclastic resorption without affecting osteoblasts. Our findings therefore suggest that such a drug delivery system would allow an increase in the efficiency of bisphosphonates by being locally available. Further experiments are now required to evaluate the in vivo antiresorptive activity of this concept.

[Pigmentation and pigmented lesions of the gingival mucosa]. / Pigmentations et lésions pigmentées des muqueuses gingivales.

The pigmentation is the physiological or pathological accumulation of a pigment in a tissue. Physiological pigmentation in gingiva which is a part of masticatory mucous membranes depends on the activity of the melanocytes. These non keratinocytic cells include the melanosoma where an endogenous pigment, the melanin, is synthesized. Quantitative or qualitative disruption of mucous pigmentation leads to the apparition of pigmented lesions. When melanocytes are directly concerned, the lesions can be of intrinsic origin, such as oral mucosa melanoma, the nevus, pigmented oral lichen planus etc. Pigmented lesions can be also of extrinsic origin caused by medicaments, dental materials, tobacco etc. In this article, gingival pigmentations are described to allow practitioner to elaborate a differential and positive diagnosis of gingival pigmented lesions and to facilitate an early detection of these lesions particularly the gingival melanoma.

Surface treatments of titanium dental implants for rapid osseointegration.

The osseointegration rate of titanium dental implants is related to their composition and surface roughness. Rough-surfaced implants favor both bone anchoring and biomechanical stability. Osteoconductive calcium phosphate coatings promote bone healing and apposition, leading to the rapid biological fixation of implants. The different methods used for increasing surface roughness or applying osteoconductive coatings to titanium dental implants are reviewed. Surface treatments, such as titanium plasma-spraying, grit-blasting, acid-etching, anodization or calcium phosphate coatings, and their corresponding surface morphologies and properties are described. Most of these surfaces are commercially available and have proven clinical efficacy (>95% over 5 years). The precise role of surface chemistry and topography on the early events in dental implant osseointegration remain poorly understood. In addition, comparative clinical studies with different implant surfaces are rarely performed. The future of dental implantology should aim to develop surfaces with controlled and standardized topography or chemistry. This approach will be the only way to understand the interactions between proteins, cells and tissues, and implant surfaces. The local release of bone stimulating or resorptive drugs in the peri-implant region may also respond to difficult clinical situations with poor bone quality and quantity. These therapeutic strategies should ultimately enhance the osseointegration process of dental implants for their immediate loading and long-term success.

[Gingival lichen planus]. / Le lichen plan gingival.

Lichen planus (LP) is a chronic inflammatory disease of uncertain etiology. When the gingiva is affected, the LP can appear under several clinical forms. The diagnosis of the gingival lichen planus is based on the anamnesis, the clinical observation and the histological analysis. Various medicamentous and non medicamentous treatments are used to treat gingival LP with random results, due to the lack of knowledge on the etiology and the recidiving character of the lesions. The risk of malignant transformation of gingival LP is weak but it depends on clinical forms, justifying a periodic follow-up of all patients.

[Desquamative gingivitis]. / La gingivite desquamative.

The desquamative gingivitis is the clinical term given to the gingival manifestation of mucocutaneous diseases. It is characterized by an erythematous, glazed, friable and hemorrhagic gingiva, which can be accompanied by pains. Except the gingiva, the lesions can be localised on other oral mucous membranes or on the skin. The three principal diseases at the origin of the desquamative gingivitis are by order of frequency: the cicatricial pemphigoïd, erosive lichen planus and pemphigus. The knowledge of the clinical, histological and immunohistochemical characteristics of these three affections is essential for the diagnosis and the suitable treatment of the desquamative gingivitis.

Novel biomaterials for bisphosphonate delivery.

One type of gem-bisphosphonate (Zoledronate) has been chemically associated onto calcium phosphate (CaP) compounds of various compositions. For that purpose, CaP powders of controlled granulometry have been suspended in aqueous Zoledronate solutions of variable concentrations. Using mainly (31)P NMR spectroscopy, two different association modes have been observed, according to the nature of the CaP support and/or the initial concentration of the Zoledronate solution. beta-tricalcium phosphate (beta-TCP) and mixtures of hydroxyapatite and beta-TCP (BCPs) appear to promote Zoledronate-containing crystals formation. On the other hand, at concentrations <0.05 mol l(-1) CDAs (calcium deficients apatites) seem to undergo chemisorption of the drug through a surface adsorption process, due to PO(3) for PO(4) exchange, that is well described by Freundlich equations. At concentrations >0.05 mol l(-1), crystalline needles of a Zoledronate complex form onto the CDAs surface. The ability of such materials to release Zoledronate, resulting in the inhibition of osteoclastic activity, was shown using a specific in vitro bone resorption model.

Hypochlorous acid and taurine-N-monochloramine in periodontal diseases.

Chronic periodontitis is a multi-factorial disease involving anaerobic bacteria and the generation of an inflammatory response, including the production of metalloproteinases, pro-inflammatory cytokines, and eicosanoids. Hypochlorous acid (HOCl) and taurine-N-monochloramine (TauCl) are the end-products of the neutrophilic polymorphonuclear leukocyte (PMN) respiratory burst. They act synergistically to modulate the inflammatory response. In the extracellular environment, HOCl and TauCl may directly neutralize interleukin 6 (IL-6) and several metalloproteinases, while HOCl increases the capacity of alpha(2)-macroglobulin to bind Tumor Necrosis Factor-alpha, IL-2, and IL-6, and facilitates the release of various growth factors. TauCl inhibits the production of inflammatory mediators, prostaglandins, and nitric oxide. HOCl activates tyrosine kinase signaling cascades, generating an increase in the production of extracellular matrix components, growth factors, and inflammatory mediators. Thus, HOCl and TauCl appear to play a crucial role in the periodontal inflammatory process. Taken together, these findings may offer opportunities for the development of novel host-modulating therapies for the treatment of periodontitis.

Culturing of cells from giant cell tumour of bone on natural and synthetic calcified substrata: the effect of leukaemia inhibitory factor and vitamin D3 on the resorbing activity of osteoclast-like cells.

Osteoclastic cells from giant cell tumour of bone (GCT) of bone provide a rich source for investigation of cellular mechanisms leading to formation of multinucleated cells, the resorption process and involvement of hormones and cytokines in these events. In the present study we investigated the effect of 1,25-dihydroxyvitamin D3 (VD3) and leukaemia inhibitory factor (LIF) on the resorbing potential of osteoclast of GCT origin using quantitative image-analysis of resorption lacunae in an in vitro dentine model. While VD3 unsignificantly increased the number of resorption pits and implicated surface after 7 days of GCT cell culturing, the stimulative effect of LIF was statistically significant. In cultures supplemented with LIF (5000 U/ml) the number of lacunae and resorption surface increased by 38% and 55%, respectively, when compared with control cultures. We suggest that both osteotropic agents increased osteoclastic activity, as the number of multinucleated cells was similar in control and experimental cultures. Seeding of GCT cells on biphasic calcium phosphate substratum revealed the relative inability of osteoclastic cells to resorb this synthetic material.

Rat long-term bone marrow culture as a model for transient production of multinucleated giant cells into suspension culture fraction and for steady mineralization process of adherent stromal cells.

Under in vitro conditions rat bone marrow stromal cells induced into osteogenic differentiation by beta-glycerophosphate, exogenous ascorbic acid and dexamethasone are able to produce a mineralized matrix. Here we describe adult rat long-term bone marrow cultures (LTBMC), deprived of these substances. Mineralization process in stromal adherent cells occurred after 1 month of incubation and was proved by means of X-ray electron microprobe. The high content of sulfur in the extracellular matrix surrounding the mineralized nodules suggests non-distrophic pathway of Ca/P deposition. During the first 2 weeks of incubation the extensive production of multinucleated tartrate-resistant acid phosphatase (TRAP) positive and TRAP negative giant cells occurred into the suspension fraction of the cultures. Rat LTBMC may serve as a model for the investigation of differentiation of osteoblastic progenitors and their interactions with multinucleated TRAP positive cells.