Prosthetic treatment in the adult French population: Prevalence and relation with demographic, socioeconomic and medical characteristics.

BACKGROUND: The aim of this study was to estimate the prevalence of dental prosthetic treatment and to investigate the demographic, social, economic and medical factors associated with the use of fixed and removable dentures in a representative sample of adults living in France. METHODS: The data were obtained from the 2002-2003 Decennial Health Survey, a cross-sectional study of a representative sample of the population living in France, which included 29,679 adults. Information was collected by interview. The variables collected were fixed denture, removable denture, age, gender, number of children, area of residence, nationality, educational attainment, family social status, employment status, annual household income per capita, supplementary insurance, chronic disease, eyesight problems/glasses, hearing problems/hearing aids. Multinomial logistic regression models were used to study the relationship between prosthetic treatment and demographic, socioeconomic and medical characteristics unadjusted, adjusted for age and adjusted for all the characteristics. RESULTS: The prevalence of prosthetic treatment was 34.6% (95% confidence interval (CI): [34.1; 35.2]) for fixed prosthetic dentures and 13.8% (95% CI: [13.4; 14.2]) for removable prosthetic dentures. We showed a gradient between educational attainment and removable dentures; the odds ratio adjusted for all the variables (aOR) associated with no or primary education compared to post-secondary education was 2.56; 95% CI: [2.09; 3.13]. When annual household income per capita was low, subjects were less likely to report fixed dentures (aOR=0.68; 95% CI: [0.62; 0.75]) than those with high annual household income per capita. Individuals without insurance less often reported fixed dentures than those with private insurance. Those reporting chronic disease were less likely to report fixed dentures (aOR=0.87; 95% CI: [0.79; 0.95]) but more likely to report removable dentures (aOR=1.29; 95% CI: [1.17; 1.43]) than those without chronic disease. CONCLUSION: This study reveals social, economic and medical inequalities in fixed and removable prosthetic treatment among adults in France.

Performance of a recent light fluorescence device for detection of occlusal carious lesions in children and adolescents.

AIM: To assess the validity and reliability of a recent light fluorescence device, Soprolife® (Sopro-Acteon group) in detecting occlusal caries in children and adolescents and to compare its diagnostic performance with DIAGNOPen® (Kavo). METHODS: A multi-centre study was carried out to validate Soprolife® in 103 children, aged from 5-15 years, on 310 primary and 433 permanent posterior teeth. The sensitivity (SE), specificity (SP) and the area under the Receiver Operating Characteristic (ROC) curve (AUC) were evaluated using visual International Caries Detection and Assessment System (ICDAS) and radiographic examinations as the gold standards. The performance of the Soprolife® was compared with that of the DIAGNOPen® on the same teeth. The reproducibility was assessed using weighted Kappa coefficient. RESULTS: When all carious lesions using ICDAS 1-6 were considered, SE, SP and AUC for the Soprolife® were 88.50, 70.73 and 0.84 respectively. The validity was significantly higher for primary teeth (AUC = 0.90) than for permanent teeth (0.80); the validity of the Soprolife® (0.84) was significantly higher than that of DIAGNOPen® (0.80). The inter- and intra-examiner kappa coefficients were 0.87 and 0.85 respectively. CONCLUSION: The Soprolife® was a valid instrument providing reproducible results, particularly for primary teeth.

[Oral health and precariousness in pregnant women]. / Santé bucco-dentaire et précarité chez la femme enceinte.

OBJECTIVE: Systematic full-mouth dental examination during pregnancy is an official preventive measure recently advocated by the French Health policy. The aim of this study was firstly to evaluate the oral health related to some sociodemographic factors among pregnant women, and secondly to propose this dental examination together with the routine antenatal interview. MATERIAL AND METHOD: This cross-sectional study combined several medical questionnaires with an oral examination. It concerned all pregnant women attending their routine antenatal interview in the maternity unit of the Montpellier hospital. Socioeconomic status was assessed by Epices index. So that two groups were determined : the deprived group (D), and the non-deprived group (ND). RESULTS: Oral examination revealed that 93% of the women were suffering from at least one oral disease, 74% had a periodontal disease (9% had a periodontitis), and 74% had at least one carious tooth. The mean Epices score was 30.5 and the mean number of carious teeth was significantly higher in the group D (3.4) than in the group ND (2.35), (p=0.02). The prevalence of periodontal disease or periodontitis were not significantly different between the two groups (p=0.81 and p=0.99 respectively). After stratification on the degree of dental hygiene knowledge, it was found that knowing about an adequate dental hygiene and specific preventive measures regarding pregnancy could reduce the gap between the oral health status of the two socioeconomic groups. CONCLUSION: This study showed that performing an oral examination, at the same time than the antenatal interview, could highly improve the knowledge about dental hygiene among pregnant women and the screening of oral diseases, especially for deprived population.

Prevalence of palatine tonsilloliths: a retrospective study on 150 consecutive CT examinations.

OBJECTIVES: To evaluate the prevalence of palatine tonsilloliths. METHODS: 150 consecutive CT examinations (75 males and 75 females) were read. RESULTS: Tonsilloliths were found in 37 patients (24.6%; confidence interval 17.7-31.6%), of which 18 (48%) had a bilateral location. No influence of sex or age was observed (p = 0.37 and p = 0.57, respectively). 26 patients (70%) had more than 1 concretion. The largest tonsillolith was 7 mm. None of the tonsilloliths found were involved in the reason for prescribing the CT. The radiographic density of the tonsilloliths was between 216 and 2959 HU. CONCLUSIONS: Palatine tonsilloliths could affect approximately one-quarter of the population. This prevalence is likely to be underestimated in daily clinical practice because small concretions do not result in any functional impairment and are not visible on orthopantomographs.

Evaluation of a new test for candidiasis diagnosis in elderly people.

OBJECTIVE: The purpose of this study was to evaluate a new test for candidiasis diagnosis (fungi-dent color test) in an institutionalised elderly population. BACKGROUND: Yeasts normally exist in the human body flora and exploit a situation of weakness in the host. Epidemiologic analyses of yeast infection in the oral cavity showed that the most frequently involved species were Candida albicans. MATERIALS AND METHODS: This study included 73 persons in the short-term and long-term geriatric department of the Montpellier hospital. Oral examinations were performed and the presence of Candida was evaluated: the fungi-dent Color diagnostic method was compared both to the classical culture analysis method, considered as the gold standard, and to the visual clinical diagnostic. RESULTS: The fungi test yielded a sensitivity value of 64.6% (CI: 53.6% - 75.6%) and a specificity of 96.0% (CI: 92.0% - 100%), whereas the diagnostic method through clinical examination disclosed only 22.5% candidiasis. The area under the ROC curve was equal to 0.81. The mean pH value was significantly higher when candidiasis was present (6.15 vs 5.78, p = 0.007). CONCLUSION: Statistical analyses showed that the Fungi-dent-color test was eligible to be validated for community use, with better characteristics than a routine clinical diagnosis and with a reasonably rapid and reliable diagnostic outcome.

Association between caries experience and body mass index in 12-year-old French children.

The prevalence of overweight and obesity reached 19.7% in 12-year-old French children in the year 2005. Recently, nationwide programs have been broadly implemented in France to reduce the overconsumption of sugars, salt and fat. The aims of this study were to assess the distribution of body mass index (BMI) and D(3+4)MFT index in a sample of 12-year-old French children, and to compare several regression models in order to analyze the association between these two indices. A cross-sectional study was conducted in Montpellier, France, and the height, weight, D(3+4)MFT, sugar and soft drink consumption were recorded in a randomly selected sample of 835 schoolchildren. In order to analyze the association between BMI and DMFT, four models of regression were tested: logistic, Poisson, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB). The mean BMI was 18.9 for the whole sample and the corresponding DMFT value was 1.47. The caries prevalence was 51.7%. The best fitted models for testing the association between BMI and DMFT were ZIP and ZINB models. They showed a significant association between DMFT and sugar consumption, but not with BMI. As a result of the best fitted models (ZIP and ZINB), where BMI was not statistically associated with DMFT, we conclude, within the limits of a cross-sectional survey, that there is no association between these two variables.

Effects of L-arginine and phosphodiesterase-5 inhibitor, sildenafil, on inflammation and airway responsiveness of sensitized BP2 mice.

Nitric oxide (NO) levels are elevated in the exhaled breath of asthmatic patients and NO is considered as a biomarker of airway inflammation. However, the functions of NO in the airways are not completely understood. L-arginine, as the substrate of NO synthases, is the precursor of NO which stimulates guanylate cyclase and leads to the formation of cyclic GMP (cGMP). Sildenafil, a phosphodiestérase-5 (PDE-5) inhibitor, prevents the degradation of cGMP. In this study the effects of L-arginine and sildenafil treatment, alone or in combination, were evaluated in ovalbumin-sensitized BP2 mice. These effects concerning the airway responsiveness to inhaled methacholine (MCh) were evaluated by whole-body plethysmography (WBP), the inflammatory response evaluated by bronchoalveolar lavage fluid (BALF) analyses and lung tissue biopsies (eosinophilic inflammation associated with lung remodelling), and NO metabolite measurements (by Griess reaction) in BALF. Ovalbumin sensitization induced: (a) an inflammatory reaction with eosinophil and neutrophil influx in BALF and lung; and (b) an increased bronchial responsiveness to MCh. L-arginine treatment [50 mg/kg intraperitoneally (i.p.), for 7 days] increased the relative amount of eosinophils and neutrophils in BALF, had a tendency to increase the airway responsiveness to inhaled MCh and increased the NO metabolite level in BAL. Sildenafil treatment (20 mg/kg i.p. for 7 days) did not affect the airway responsiveness to MCh and had a lower effect compared with L-arginine on inflammatory reactions. The combination of the two treatments resulted in a dramatic enhancement of the airway responsiveness to inhaled MCh. The relative amount of eosinophils was increased and lung histology showed obvious worsened tissular lesions such as epithelial shedding and hypertrophy, hyperplasia of smooth muscle cells, and fibrosis. These findings are consistent with the notion that NO production plays a role in the development of airway inflammation and hyperresponsiveness of sensitized mice and highlighted the potential risk of the L-arginine dietary complement or PDE5 treatment in asthmatic patients.

Coronal and apical lesions, environmental factors: study in a modern and an archeological population.

Apical periodontitis (AP) are frequent findings in contemporary dental practice in association with dental pathology or dental care. They have also been studied from an anthropological background. The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population, and to evaluate the influence of environmental factors. Both the archaeological sample group and dental practice subjects were from southern France. The study included full mouth surveys of 252 individuals (2,780 teeth) from a historic necropolis and 223 subjects (5,678 teeth) randomly selected from the Gard area. Tooth wear, caries, and AP were accounted for clinically and radiographically according to specific indexes. Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP. Antemortem teeth loss and dental wear had been reduced, whereas caries rates and AP had increased between archaeological and modern population. The AP ratio was associated with the level of dental care in the modern population. Although significant variations could be observed between archaeological periods, the rupture in E3 (sixteenth and seventeenth centuries) leads to consider the associated population as a premodern. However, it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population, dental care seemed to have a strong influence on AP ratio in modern ones.

A comparative analysis of periapical health based on historic and current data.

AIM: To compare periapical health using samples from prehistoric and historic periods until the present day, and to emphasize the major risk indicators for apical periodontitis (AP). METHODOLOGY: A comparative survey to assess periapical health was performed on five samples (525 individuals) drawn from different periods of history within the time frame 2000 BC to 2000 AD. Twenty-one binary risk indicators for AP were retained for a logistic regression model. The probability of a diseased tooth was defined from a two-level response variable based on the periapical index (PAI). An individual regression model was computed with partial least squares (PLS) regression model, based on the individual mean values of the nine retained risk indicators. RESULTS: Condensing osteitis, tooth wear, caries, root fillings and the presence of inadequate root fillings were associated with the PAI levels. The maxillary molars and recent time periods (contemporaneous and seventeenth century) were also risk indicators for the pathological condition. The PLS regression for individuals demonstrated correlations between risk factors. This multidimensional analysis indicated that the mean PAI was correlated mainly with caries and condensing osteitis. Condensing osteitis was more frequent in the mandibular than in the maxillary bone (P=0.001), and correlated with tooth wear in ancient periods. CONCLUSIONS: This comparative analysis demonstrated a significantly higher prevalence of AP in the contemporary period. The most important risk indicators for that period were the presence of inadequate root fillings, carious lesions and condensing osteitis.

Alkaline phosphatase isozyme activity in serum from patients with chronic periodontitis.

BACKGROUND: High alkaline phosphatase activity (ALP) is shown in the periodontal ligament due to the constant renewal of this tissue or pathological circumstances. We have previously shown that the activity level of this enzyme could be reflected at the serum level. OBJECTIVES: Because the local production of ALP in the periodontal ligament is often of the bone-type enzyme, we studied the activity of this isozyme among the other isoforms in the serum of patients with chronic periodontitis in comparison with that of control subjects. MATERIAL AND METHODS: This study included 83 patients (59 with periodontal disease, 24 as control group) and we determined the total seric ALP activity and the percentage of the different isoforms (essentially bone, kidney and intestinal-types) by Ektachem analyser and gel agarose electrophoresis respectively. CONCLUSIONS: By comparisons between the two groups, our results showed a relationship between loss of attachment in periodontal disease and a drop in bone ALP activity in serum. Moreover, these results suggested a gender based difference as well, with lower activity more frequent in women than in men.

Association of caries experience in 12-year-old children in Heidelberg, Germany, and Montpellier, France, with different caries preventive measures.

UNLABELLED: In Germany and France, different approaches to oral health promotion have been chosen. OBJECTIVES: It was the aim of the present study to assess whether different preventive measures were positively or negatively associated with caries experience in 12-year-old children in Heidelberg, Germany, and in Montpellier, France. METHODS: In the school year 1998/99, 12-year-old children were examined in Heidelberg (n=864) and in Montpellier (n =828). D3+4MFT, D3+4MFS (D3+4=dentinal caries), prevalence of fissure sealants and use of fluorides were recorded. RESULTS: The mean D3+4MFT scores of the pupils in Heidelberg and Montpellier were 1.56 and 1.42, the proportion of caries-free children being 43.5% and 46.9%, respectively. In 63.2% of the children in Heidelberg and in 6.8% of the children in Montpellier, at least one fissure sealed tooth was found. Fluoridated salt was used by 38.8% of families of the 12-year-olds from Heidelberg and the corresponding value was 73.3% in Montpellier. Topical fluorides were applied by 39.9% of the children in Heidelberg, but only by 5.4% of pupils in Montpellier. Multiple regression analysis revealed that, in Heidelberg, fissure sealants and the combination of topical fluorides and fluoridated salt were negatively associated with the D3+4MFT values, while in Montpellier the frequency of dental visits was positively associated with the D3+4MFT scores. CONCLUSION: A further decrease in the caries experience of 12-year-old children may well be obtainable by enlarging the share of marketed fluoridated salt in Heidelberg, by increasing the application of fissure sealants in Montpellier, and by extending the use of topical fluorides in both cities.

A method of age estimation using Raman microspectrometry imaging of the human dentin.

The aim of this work is to establish a correlation between ageing and Raman spectra imaging of human teeth. Raman spectrum of an analysed sample is characteristic of its chemical components. By exploring the different dentinal areas on each tooth, we sought to find a correlation between noticeable variability on Raman spectra and the stages of dentinal evolution with advancing age. A study on 30 teeth analysed by Raman microspectrometry was used to select predictors of age, and it allowed us to determine a regression formula, with age as a dependent variable. Our data were computed by means of a statistical method called partial least squares (PLS) regression. This method was specially adapted for this kind of situation, where we have numerous predictors and relatively few observations. The regression formula was performed on a test sample of four more teeth, and we obtained a correct age estimation, with a mean error of more or less than 5 years. The main benefits of this method was a minimal and non-destructive tooth preparation, which led to an efficient age prediction, for any age group.

Serum fatty acid imbalance in bone loss: example with periodontal disease.

Among the numerous factors of bone remodelling, the local action of arachidonic acid metabolites together with cytokines, is particularly important, especially that of prostaglandin PGE2. It has been suggested that the alveolar bone destruction in periodontal disease and osteoporosis can be treated by reducing the ratio of arachidonic acid in phospholipids, which would diminish prostaglandin production. The aim of this study was to evaluate the main serum polyunsaturated fatty acids and a possible alteration in the level of arachidonic acid in patients suffering from periodontal bone loss. Of the 105 patients who participated the study, 78 were suffering from periodontal bone loss and 27 served as a control group. The fatty acids were measured in serum by gas-chromatography. The results showed that the level of fatty acids of the n-6 pathway was higher in our patients with bone loss than in the control group, whereas the reverse was observed with fatty acids of the n-3 pathway. In conclusion, our patients' bone losses are linked with an imbalance between n-6 and n-3 fatty acids, which seems to justify a diet increase in 20- and 22-carbon fatty acids.

A Raman spectroscopic investigation of dentin and enamel structures modified by lactic acid.

Confocal Raman microspectrometry allows a thorough molecular analysis of mineralised dental tissues. The output information is provided in the form of curves representing the intensity of the signal according to the frequency, and its mathematical exploitation permits all sorts of comparative and quantitative analyses. By this process, we investigated the in vitro action of lactic acid on enamel and dentin from human permanent teeth. Modifications due to the acidic attack essentially concern phosphate grouping PO(4)(3-), which represents the mineral phase in enamel and dentin (hydroxyapatite): on Raman spectra, changes in intensity of the PO(4)(3-) band are linked to the type of dentin, to its anatomical location, and to the age of the subject. The variability of the dentinal chemical structure was confirmed by a quantitative statistical analysis, revealing a significant spectral difference between coronal and root dentin.