Maternal periodontitis and the causes of preterm birth: the case-control Epipap study.

International audienceAIM: To analyse the association between maternal periodontitis and preterm birth ( or =37 weeks) at six French maternity units were included. Periodontal examinations after delivery identified localized and generalized periodontitis. Cases were classified according to four causes of preterm birth. Polytomous logistic regression analysis was used to control for confounders (maternal age, parity, nationality, educational level, marital status, employment during pregnancy, body mass index before pregnancy, smoking status) and the examiner. RESULTS: Localized periodontitis was identified in 129 (11.6%) cases and in 118 (10.8%) control women and generalized periodontitis in 148 (13.4%) and 118 (10.8%), respectively. A significant association was observed between generalized periodontitis and induced preterm birth for pre-eclampsia [adjusted odds ratio 2.46 [95% confidence intervals (95% CI)1.58-3.83]. Periodontitis was not associated with spontaneous preterm birth or preterm premature rupture of membranes or with the other causes. CONCLUSION: Maternal periodontitis is associated with an increased risk of induced preterm birth due to pre-eclampsia

Periodontal treatment to improve glycaemic control in diabetic patients: study protocol of the randomized, controlled DIAPERIO trial

<p>Abstract</p> <p>Background</p> <p>Periodontitis is a common, chronic inflammatory disease caused by gram-negative bacteria leading to destruction of tissues supporting the teeth. Epidemiological studies have consistently shown increased frequency, extent and severity of periodontitis among diabetic adults. More recently, some controlled clinical trials have also suggested that periodontal treatment could improve glycaemic control in diabetic patients. However current evidence does not provide sufficient information on which to confidently base any clinical recommendations. The main objective of this clinical trial is to assess whether periodontal treatment could lead to a decrease in glycated haemoglobin levels in metabolically unbalanced diabetic patients suffering from chronic periodontitis.</p> <p>Methods</p> <p>The DIAPERIO trial is an open-label, 13-week follow-up, randomized, controlled trial. The total target sample size is planned at 150 participants, with a balanced (1:1) treatment allocation (immediate treatment vs delayed treatment). Periodontal treatment will include full mouth non-surgical scaling and root planing, systemic antibiotherapy, local antiseptics (chlorhexidine 0.12%) and oral health instructions. The primary outcome will be the difference in change of HbA1c between the two groups after the 13-weeks' follow-up. Secondary outcomes will be the difference in change of fructosamine levels and quality of life between the two groups.</p> <p>Discussion</p> <p>The DIAPERIO trial will provide insight into the question of whether periodontal treatment could lead to an improvement in glycaemic control in metabolically unbalanced diabetic patients suffering from periodontitis. The results of this trial will help to provide evidence-based recommendations for clinicians and a draft framework for designing national health policies.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN15334496</p

Frequency and Risk Indicators of Tooth Decay among Pregnant Women in France: A Cross-Sectional Analysis

INTRODUCTION: Little is known on the prevalence of tooth decay among pregnant women. Better knowledge of tooth decay risk indicators during pregnancy could help to develop follow-up protocols for women at risk, along with better prevention strategies. The aim of this study was to assess the frequency of tooth decay and the number of decayed teeth per woman in a large sample of pregnant women in France, and to study associated risk indicators. METHODS: A secondary cross-sectional analysis of data from a French multicentre case-control study was performed. The sample was composed of 1094 at-term women of six maternity units. A dental examination was carried out within 2 to 4 days post-partum. Socio-demographic and behavioural characteristics were obtained through a standardised interview with the women. Medical characteristics were obtained from the women's medical records. Risk indicators associated with tooth decay were identified using a negative binomial hurdle model. RESULTS: 51.6% of the women had tooth decay. The mean number of decayed teeth among women having at least one was 3.1 (s.d. = 2.8). Having tooth decay was statistically associated with lower age (aOR = 1.58, 95%CI [1.03,2.45]), lower educational level (aOR = 1.53, 95%CI [1.06,2.23]) and dental plaque (aOR = 1.75, 95%CI [1.27,2.41]). The number of decayed teeth was associated with the same risk indicators and with non-French nationality and inadequate prenatal care. DISCUSSION: The frequency of tooth decay and the number of decayed teeth among pregnant women were high. Oral health promotion programmes must continue to inform women and care providers about the importance of dental care before, during and after pregnancy. Future research should also assess the effectiveness of public policies related to oral health in target populations of pregnant women facing challenging social or economic situations

Impact of social and economic characteristics on orthodontic treatment among children and teenagers in France.

International audienceThere are social inequalities in orthodontic treatment in France, associated mainly with social status, annual income, supplementary insurance, and the residence area

Les personnes âgées en institution en France et à l'étranger (état bucco-dentaire et accès aux soins)

MONTROUGE-BUFR Odontol.PARIS5 (920492101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les urgences médicales dans les pôles et services d'odontologie des centres hospitaliers universitaires français

Objectif : Cette enquête a pour but de recenser les urgences médicales survenant dans les services d'odontologie et de faire l'état des moyens, de la formation et des protocoles mis en oeuvre pour y faire face. Méthode : Elle a été menée de décembre 2007 à juin 2008 auprès des pôles et services d'odontologie des centres hospitaliers universitaires français. Un questionnaire portant sur le matériel d'urgence disponible, la formation des praticiens, les procédures d'urgence et la survenue des urgences médicales sur une période de un an a été envoyé à tous les chefs de services. Résultats : Sur les 32 pôles et services contactés, 28 ont répondu au questionnaire. Le matériel d'urgence disponible est très variable selon les services. La majorité d'entre eux ne dispose pas des médicaments recommandés ni du matériel spécialisé nécessaire tel qu'un défibrillateur. Concernant la formation des praticiens, 75 % d'entre eux n'ont eu aucune formation particulière pour la gestion des urgences médicales. Dans près de la moitié des services, il n'y a pas de procédure définie pour faire appel à des moyens de secours extérieurs au service. On relève une moyenne de 20 urgences médicales par an et par service. La majorité d'entre elles sont des malaises vagaux mais on retrouve également des accidents plus graves qui peuvent mettre en jeu le pronostic vital du patient. Conclusion : Même si l'incidence des urgences médicales semble faible dans les services hospitaliers d'odontologie, il est nécessaire que les praticiens disposent du matériel et soient formés à leur prise en charge. (Med Buccale Chir Buccale 2009 ; 15 : 87-92)

Adolescent tooth brushing frequency evolution (2006-2014), risk factors and causality hypothesis

International audienceObjectivesTo analyze the evolution of tooth brushing frequency (TBF) as well as the impact of socio-economic status and health behaviors between 2006, 2010 and 2014 among adolescents from the French Health Behavior in School-aged Children (HBSC) cross-sectional studies.MethodsWe included 18727 adolescents aged 11, 13 or 15 years old (y/o). The relationship between TBF and variables such as eating habits, health and socio-economic status markers as well as their evolution over the 3 studies were analyzed using logistic regression. We used directed acyclic graphs (DAGs) to represent the potential chain of causality between TBF, its associated factors, as well as latent variables such as the risk for oral diseases.ResultsProportion of adolescents brushing twice a day increased from 68.8% in 2006 to 70.8% in 2010 and 78.8% in 2014 (p < 0.0001). Notable predictors (p < 0.0001) were being a girl (adjusted Odd Ratio = 1.5) and even more an older girl (aOR 1.5 for 15y/o vs 11 y/o girls), having breakfast and fruits daily (aOR 1.4 and aOR 1.6), excellent perceived health (aOR 1.2), obesity or overweight (aOR 0.6), being bullied at school (aOR 0.8) and perceived family wealth (aOR 1.4 for High vs Low). Impacts of these predictors were stable over the 3 studies. DAGs highlighted the fact that a low TBF and its associated risk factors described a high-risk population for poor oral and global health. Variables at the origin of those risks seemed to be age, sex, familial environment, socio-economic environment and education.ConclusionsTBF among French adolescents improved from 2006 to 2014. This may be linked with global prevention programs developed during this time period. These programs should be associated with more specific ones targeted towards and adapted to disadvantaged populations to diminish inequalities. The use of DAGs is a powerful tool to identify the origin of those inequalities as well as the right factors to target in order to achieve efficient prevention

Parodontite maternelle et causes d’accouchement prématuré

L’objectif de l’étude était d’analyser l’association entre la parodontite maternelle et l’accouchement prématuré, selon les causes de prématurité. L’étude EPIPAP a été menée dans six maternités françaises sur 1108 femmes (cas) ayant donné naissance à un enfant prématuré (<37 semaines d’aménorrhée SA) et 1094 femmes (témoins) ayant donné naissance à un enfant à terme (≥37 SA). L’état parodontal a été défini en parodontite absente, localisée, généralisée. Les cas ont été classés selon 4 causes de prématurité (induite pour prééclampsie, induite pour retard de croissance intra-utérin, spontanée/induite pour rupture prématurée des membranes, autres causes). La parodontite généralisée était associée à une augmentation du risque d’accouchement prématuré induit pour cause de prééclampsie (ORa=2,46; IC 95 % [1,58-3,83]). Aucune association n’a été mise en évidence avec les autres causes de prématurité

Changes in tooth brushing frequency and its associated factors from 2006 to 2014 among French adolescents: Results from three repeated cross sectional HBSC studies.

ObjectivesThis study aimed to evaluate in the changes in the percentage of adolescents who brush their teeth twice a day and the association with socio-economic status and health behaviors between 2006, 2010 and 2014 among adolescents from the French cross-sectional studies of the Health Behavior in School-aged Children (HBSC) survey.MethodsOur sample included 18727 adolescents aged 11, 13 or 15 years old (y/o). The relationship between toothbrushing frequency (TBF) and eating habits, health and socio-economic status markers, family status, school perception, substance use, sedentary lifestyle and physical activity, together with their evolution over the 3 studies, were investigated using multivariate logistic regression.ResultsThe proportion of adolescents brushing twice a day increased from 68.8% in 2006 to 70.8% in 2010 and 78.8% in 2014 (pConclusionsAmong French adolescents, TBF improved from 2006 to 2014. TBF was significantly associated with other health behaviors. These associations stayed similar in 2006, 2010 and 2010. This increase in TBF may be linked with global prevention programs developed during this time period. These programs should be maintained and associated with more specific ones targeting and adapted to disadvantaged populations, in order to reduce inequalities in oral hygiene and oral health