Mineral density of hypomineralised and sound enamel

Molar Incisor Hypomineralisation (MIH) is a structural anomaly that affects the quality of tooth enamel and has important consequences for oral health. The developmentally hypomineralised enamel has normal thickness and can range in colour from white to yellow or brown. The purpose of the present study is to compare the mineral density of hypomineralised and normal enamel. The sample included eight MIH teeth from seven patients. MIH teeth were scanned using high resolution microtomography. Non-parametric statistical tests (Wilcoxon test for paired samples) were carried out. Hypomineralised enamel has decreased mineral density (mean 19%; p < 0.0001) compared to normal enamel. This weak enamel has implications in clinical management of MIH lesions

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery

ImportanceBefore surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.ObjectiveTo evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.Design, setting, and participantsRandomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.InterventionPatients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.ResultsOf the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.Conclusions and relevanceAmong patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.Trial registrationClinicalTrials.gov Identifier: NCT03374449

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Distinction between demarcated hypomineralised lesions of enamel and taphonomic staining by means of enamel microanalyses

Les diagnostics d’hypominéralisations molaire-incisive (HMI) et de colorations post-mortem de l’émail sont peu fiables et reproductibles dans des séries archéologiques. Notre guide de diagnostic a permis de distinguer les hypominéralisations de l’émail des colorations taphonomiques. L'émail hypominéralisé est caractérisé par des taux de β-carbonate plus élevés et une densité minérale plus faible. Les colorations taphonomiques présentent une concentration plus élevée en manganèse, en fer, en cuivre et en plomb, mises en évidences par des analyses en fluorescence X. Les dentures d’individus immatures issus de 21 séries archéologiques ont été examinés et comprenaient : 4 séries françaises, Sains-en-Gohelle (Pas-de-Calais), Cognac-Saint-Martin (Charente), Beauvais (Oise) et Jau-Dignac-et-Loirac (Gironde) provenant de cimetières médiévaux et post-médiévaux et 17 séries anglaises (Londres) provenant de cimetières romains, médiévaux et post-médiévaux. Nous avons dénombré 555 individus dont l’âge au décès est compris entre 5 et 19 ans et dont la datation chronologique s’étale sur une période allant du 1er au 19ème siècle. Au total, sur les 290 individus avec au moins une première molaire permanente (PMP) présente, 42 avaient au moins une opacité délimitée de l’émail sur une PMP (soit 14,5%). Parmi les 17 individus dont les dents ont été analysées, les tests statistiques n’ont mis en évidence que 9 cas de HMI, soit 52,9% de l’effectif. Une prévalence de 9,3% de HMI a été estimée dans nos séries archéologiques ce qui avoisine les prévalences connues à l’heure actuelle dans les populations du vivant en Europe. Les défauts du développement de d'émail sont souvent utilisés comme indicateurs de la santé générale dans les populations archéologiques passées. La possibilité de trouver des HMI dans des populations anciennes minimise l’importance de certaines hypothèses étiologiques contemporaines (par exemple les dérivés de dioxines, les bisphénols ou les antibiotiques) sans exclure l'aspect multifactoriel possible de l'anomalie.Developmental enamel defects are often used as indicators of general health in past archaeological populations. It can be difficult to macroscopically distinguish subtle hypomineralised enamel opacities such as Molar Incisor Hypomineralisation (MIH) from post-mortem staining. The diagnostic guide developed enables the differentiation of developmental hypomineralisation of enamel from taphonomic discolorations. Hypomineralised enamel had higher β-carbonate rates and lower mineral density. Taphonomic discoloration had higher concentration of manganese, iron, copper and lead, determined by means of X-ray fluorescence analyses. Sub adults from 21 archaeological series were examined and included: 4 French series, Sains-en-Gohelle (Pas-de-Calais), Cognac-Saint-Martin (Charente), Beauvais (Oise) and Jau-Dignac-et-Loirac (Gironde) from medieval and post-medieval cemeteries and 17 English series (London) from Roman, medieval and post-medieval cemeteries. We recorded 555 individuals aged between 5-19 years dating from 1st to 19th century. Among 290 specimens with at least one first permanent molar (FPM) present, 42 showed at least one FPM opacity (14.5%). Among the 17 individuals whose teeth were analysed, statistics highlighted 9 cases of MIH (52.9%). MIH prevalence of 9.3% was estimated among the archaeological series which is close to prevalence in living populations in Europe. The identification of MIH among past populations downplays contemporary aetiological hypotheses (e.g. dioxins, bisphenols, antibiotics) without excluding multifactorial aetiology of this pathology

Distinction entre processus pathologique de type hypominéralisation molaire-incisive et processus taphonomique par différentes méthodes de micro-analyse de l’émail dentaire

Developmental enamel defects are often used as indicators of general health in past archaeological populations. It can be difficult to macroscopically distinguish subtle hypomineralised enamel opacities such as Molar Incisor Hypomineralisation (MIH) from post-mortem staining. The diagnostic guide developed enables the differentiation of developmental hypomineralisation of enamel from taphonomic discolorations. Hypomineralised enamel had higher β-carbonate rates and lower mineral density. Taphonomic discoloration had higher concentration of manganese, iron, copper and lead, determined by means of X-ray fluorescence analyses. Sub adults from 21 archaeological series were examined and included: 4 French series, Sains-en-Gohelle (Pas-de-Calais), Cognac-Saint-Martin (Charente), Beauvais (Oise) and Jau-Dignac-et-Loirac (Gironde) from medieval and post-medieval cemeteries and 17 English series (London) from Roman, medieval and post-medieval cemeteries. We recorded 555 individuals aged between 5-19 years dating from 1st to 19th century. Among 290 specimens with at least one first permanent molar (FPM) present, 42 showed at least one FPM opacity (14.5%). Among the 17 individuals whose teeth were analysed, statistics highlighted 9 cases of MIH (52.9%). MIH prevalence of 9.3% was estimated among the archaeological series which is close to prevalence in living populations in Europe. The identification of MIH among past populations downplays contemporary aetiological hypotheses (e.g. dioxins, bisphenols, antibiotics) without excluding multifactorial aetiology of this pathology.Les diagnostics d’hypominéralisations molaire-incisive (HMI) et de colorations post-mortem de l’émail sont peu fiables et reproductibles dans des séries archéologiques. Notre guide de diagnostic a permis de distinguer les hypominéralisations de l’émail des colorations taphonomiques. L'émail hypominéralisé est caractérisé par des taux de β-carbonate plus élevés et une densité minérale plus faible. Les colorations taphonomiques présentent une concentration plus élevée en manganèse, en fer, en cuivre et en plomb, mises en évidences par des analyses en fluorescence X. Les dentures d’individus immatures issus de 21 séries archéologiques ont été examinés et comprenaient : 4 séries françaises, Sains-en-Gohelle (Pas-de-Calais), Cognac-Saint-Martin (Charente), Beauvais (Oise) et Jau-Dignac-et-Loirac (Gironde) provenant de cimetières médiévaux et post-médiévaux et 17 séries anglaises (Londres) provenant de cimetières romains, médiévaux et post-médiévaux. Nous avons dénombré 555 individus dont l’âge au décès est compris entre 5 et 19 ans et dont la datation chronologique s’étale sur une période allant du 1er au 19ème siècle. Au total, sur les 290 individus avec au moins une première molaire permanente (PMP) présente, 42 avaient au moins une opacité délimitée de l’émail sur une PMP (soit 14,5%). Parmi les 17 individus dont les dents ont été analysées, les tests statistiques n’ont mis en évidence que 9 cas de HMI, soit 52,9% de l’effectif. Une prévalence de 9,3% de HMI a été estimée dans nos séries archéologiques ce qui avoisine les prévalences connues à l’heure actuelle dans les populations du vivant en Europe. Les défauts du développement de d'émail sont souvent utilisés comme indicateurs de la santé générale dans les populations archéologiques passées. La possibilité de trouver des HMI dans des populations anciennes minimise l’importance de certaines hypothèses étiologiques contemporaines (par exemple les dérivés de dioxines, les bisphénols ou les antibiotiques) sans exclure l'aspect multifactoriel possible de l'anomalie

Etude des principales hypothèses, étiologiques de l hypominéralisation molaires incisives sur un échantillon de 130 patients

L hyperminéralisation des molaires et des incisives (HMI) est une anomalie de structure qualitatice de l émail dentaire, a priori d origine systémique, qui affecte une ou plusieurs des premières molaires définitives et qui est éventuellement associée à une atteinte des incisives permanentes (Wheerheijm, 2011). Les chiffres de la prévalence se situent entre 3 et 25% ce qui au vu des dégâts pouvant être occasionnés constitue un véritable problème de santé publique. Notre étude a pour objectifs d isoler des hypothèses étiologiques les plus fréquentes, d établir un lien entre certaines hypothèses étiologiques et la sévérité des atteintes, la localisation des atteintes et la présence d autres anomalies dentaires, d évaluer la prévalence de l HMI dans la fratrie d un patient atteint et de déterminer la localisation préférentielle de ces défauts. Nous avons réalisé une étude rétrospective de mai 2010 sur 77 patients porteurs de l HMI et leurs fratries au sein du CHU de Bordeaux et de deux cabinets libéraux à orientations pédiatriques. Les parents ont répondu à un questionnaire rempli par l é=examinateur avec appui du carnet de santé. La répartition des défauts a été notée selon leurs degrés de sévérité. Nos résultats sur les hypothèses étiologiques font apparaître des corrélations entre l hypoxie lors de l accouchement et la survenue de l HMI (OR=6,1 ; IC=1.7-21.85), entre les naissances par césarienne et l HMI (OR= 2,9 ; IC=1.2-6.9) ainsi qu entre les otites et l HMI (p=0,05). L hypoxie peut comprendre une mise sous ventilation assistée, un accouchement prolongé, une procidence du cordon. Certains auteurs ont montré qu il pouvait y avoir une hypoxie pour le nouveau-né lors d une opération par césarienne. Nous montrons également que les premières molaires et les incisives permanentes maxillaires sont plus fréquemment atteintes que les mandibulaires et que pour 78% des patients atteints par l HMI au moins une incisive est touchée. Il est important de souligner l intérêt d isoler des hypothèses étiologiques. Cela nous permettrait de mettre en place un dépistage et une prévention ciblée et adaptée en amont.Molar-incisor-hypomineralisation (MIH) is defined as the developmentally derived dental defect that involves hypomineralisation of 1 to 4 permanent first molars (FPM) that is frequently associates with similarly afected permanent incisors (Wheerheijm, 2001). The prevalence of the defect is between 3 and 25%, which given the damage that may result is a real public health problem. Our study aims to isolate the most common etiologic hypotheses, to establish a link between etiological hypotheses and severity of damade, localization of damage and the presence of other dental anomalies, to assess the prevalence of MIH in siblings of a patient and to determine the preferential localization of these defects. We conducted a retrospective study from may 2010 to october 2011 of 77 patients with MIH and their siblings in the Bordeaux University Hospital and two private center of pediatric dentistry. Paents answered a questionnaire completed by the examiner with support from the health record. The distribution of defects was observed according to their degree of severity. Our results on the etiological hypotheses show correlations between hypoxia at birth and the onset of the HMI (OR=6,1 ; IC=1.7-21.85), betwenn cesarean births and MIH (OR= 2,9 ; IC=1.2-6.9), and between the ear and the HMI (p=0.05). Hypoxia can include setting a ventilator, prolonged labor, cord prolapse. Some authorshave shown that there could be hypoxia in the newborn at a cesarean operation. We found that the maxillary first permanent molars and incisors are more are more frequently affected than mandibular ones and in 78% of patients with MIH, at least one incisor is affected. It is important to support the importance of isolating etiological hypotheses. This would allow us to develop detection and targeted and appropriate prevention.BORDEAUX2-BU Sci.Homme/Odontol. (330632102) / SudocSudocFranceF

Infiltrant resin and enamel infractions: two case reports of a novel and minimally invasive approach

To date, no consensus exists regarding the management of enamel infractions (cracks and craze lines), which may be associated with sensitivity. Two clinical cases are presented on the management of enamel infractions using a modified erosion-infiltration protocol for resin infiltration. Initially indicated for the treatment of early caries lesions, Icon (DMG) low-viscosity resin infiltrant has also been used to mask unesthetic developmental defects of enamel in anterior teeth. Treatment using this modified infiltration protocol immediately eliminated tooth sensitivity associated with the enamel infractions. Resin infiltration has the potential as a minimally invasive and effective treatment for the management of sensitivity associated with enamel infractions

Peripartum events and molar-incisor hypomineralisation (MIH) amongst young patients in southwest France

International audienc

Peripartum events and molar-incisor hypomineralisation (MIH) amongst young patients in southwest France

International audienc

Hypominéralisations molaires-incisives : enquête de terrain

National audienc