Correlation plot of the abundances of the bacterial species, corrected for age, interdental space and individual-specific effects.

<p>The pink, white, and blue squares indicate positive, zero, and negative correlations, respectively.</p

Workflow of the experiment.

<p>Workflow of the experiment.</p

Characteristics of the IDBs in relationship to the classification of the access diameter for the interdental space.

<p>Characteristics of the IDBs in relationship to the classification of the access diameter for the interdental space.</p

Quantification of the pathogens according to age and sex.

<p>Total counts from each pathogen were averaged across sites in each subgroup. Error bars represent standard deviations. Comparisons: * p<0.05, by using SUDAAN 7.0 (procedures DESCRIPT and REGRESS) to account for clustering (multiple sites within the subjects).</p

Distribution (mean ± sd) of the number of interproximal sites according to the diameter of the interproximal brush in 99 adults.

<p>Distribution (mean ± sd) of the number of interproximal sites according to the diameter of the interproximal brush in 99 adults.</p

Species-specific and ubiquitous real-time PCR primers for 6 pathogens, the annealing temperature, and the limit of quantification.

<p>Species-specific and ubiquitous real-time PCR primers for 6 pathogens, the annealing temperature, and the limit of quantification.</p

Quantification of carious pathogens in the interdental microbiota of young caries-free adults

<div><p>Background</p><p>The majority of caries lesions in adults occur on the proximal tooth surfaces of the posterior teeth. A comprehensive study of the composition of the oral microbiota is fundamental for a better understanding of the etiology of interdental caries.</p><p>Methods</p><p>Twenty-five caries-free subjects (20–35 years old) were enrolled in the study. The interdental biofilm of four interdental sites were collected. The real-time polymerase chain reaction (PCR) methodology were used to quantify (i) the following bacteria: <i>Streptococcus spp</i>., <i>Streptococcus mutans</i>, <i>Lactobacillus spp</i>., <i>Enterococcus spp</i>., and <i>Enterococcus faecalis;</i> (ii) the fungus <i>Candida albicans;</i> and (iii) <i>total bacteria</i>.</p><p>Results</p><p><i>Streptococcus</i> spp. was the most abundant species, followed by <i>Lactobacillus</i> spp. and <i>Enterococcus</i> spp. <i>Streptococcus</i> spp. and <i>Lactobacillus</i> spp. were detected at all tested sites and <i>Enterococcus</i> spp. at 99% of sites. <i>S</i>. <i>mutans</i> was detected at only 28% of the tested sites and <i>C</i>. <i>albicans</i> was detected at 11% of sites. <i>E</i>. <i>faecalis</i> was never detected. In 54.5% of the biofilm inhabited by <i>C</i>. <i>albicans</i>, <i>S</i>. <i>mutans</i> was present. Moreover, 28% of the ID sites co-expressed <i>S</i>. <i>mutans</i> and <i>Lactobacillus</i> spp. The studied pathogens were organized into two correlated groups of species. Strikingly, the fungus <i>C</i>. <i>albicans</i> and the bacteria <i>Enterococcus</i> spp. cluster together, whereas <i>Streptococcus</i> spp., <i>S</i>. <i>mutans</i> and <i>Lactobacillus</i> spp. form one distinct cluster.</p><p>Conclusion</p><p>The interdental biofilm of young caries-free adults is comprised of pathogens that are able to induce interproximal caries. That several of these pathogens are implicated in heart disease or other systemic diseases is an argument for the disruption of interdental biofilms using daily oral hygiene.</p></div

Table_1_Severe pain management in the emergency department: patient pathway as a new factor associated with IV morphine prescription.docx

BackgroundAcross the world, 25–29% of the population suffer from pain. Pain is the most frequent reason for an emergency department (ED) visit. This symptom is involved in approximately 70% of all ED visits. The effective management of acute pain with adequate analgesia remains a challenge, especially for severe pain. Intravenous (IV) morphine protocols are currently indicated. These protocols are based on patient-reported scores, most often after an immediate evaluation of pain intensity at triage. However, they are not systematically prescribed. This aspect could be explained by the fact that physicians individualize opioid pain management for each patient and each care pathway to determine the best benefit–risk balance. Few data are available regarding bedside organizational factors involved in this phenomenon.ObjectiveThis study aimed to analyze the organizational factors associated with no IV morphine prescription in a standardized context of opioid management in a tertiary-care ED.MethodsA 3-month prospective study with a case–control design was conducted in a French university hospital ED. This study focused on factors associated with protocol avoidance despite a visual analog scale (VAS) ≥60 or a numeric rating scale (NRS) ≥6 at triage. Pain components, physician characteristics, patient epidemiologic characteristics, and care pathways were considered. Qualitative variables (percentages) were compared using Fisher’s exact test or the chi-squared tests. Student’s t-test was used to compare continuous variables. The results were expressed as means with their standard deviation (SD). Factors associated with morphine avoidance were identified by logistic regression.ResultsA total of 204 patients were included in this study. A total of 46 cases (IV morphine) and 158 controls (IV morphine avoidance) were compared (3:1 ratio). Pain patterns and patient’s epidemiologic characteristics were not associated with an IV morphine prescription. Regarding NRS intervals, the results suggest a practice disconnected from the patient’s initial self-report. IV morphine avoidance was significantly associated with care pathways. A significant difference between the IV morphine group and the IV morphine avoidance group was observed for “self-referral” [adjusted odds ratio (aOR): 5.11, 95% CIs: 2.32–12.18, p ConclusionThis bedside case–control study highlights that IV morphine avoidance in the ED could be associated with ambulatory pathways. It confirms the decreased choice of “NRS-only” IV morphine protocols for all patients, including non-trauma patterns. Modern pain education should propose new tools for pain evaluation that integrate the heterogeneity of ED pathways.</p

Distribution of characteristics in interproximal sites (30/subject), denoted in bars, corresponding to 99 adults*.

<p>(A) Distribution of interproximal sites (99 x 30 = 2970 sites) from 99 adults according to the type of tooth. (B) Distribution of interproximal diameter access in 2408 sites with spaces. (C) Distribution of bleeding after interproximal brush in 2408 sites. * Note that the teeth are numbered.</p

Univariate and multivariate associations^a between studied variables and interproximal bleeding after IDB (n = 2408 sites).

<p>Univariate and multivariate associations<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0155467#t005fn001" target="_blank">^a</a> between studied variables and interproximal bleeding after IDB (n = 2408 sites).</p