Denis Bourgeois

Quantitative Molecular Detection of 19 Major Pathogens in the Interdental Biofilm of Periodontally Healthy Young Adults

In oral health, the interdental spaces are a real ecological niche for which the body has few or no alternative defenses and where the traditional daily methods for control by disrupting biofilm are not adequate. The interdental spaces are the source of many hypotheses regarding their potential associations with and/or causes of cardiovascular disease, diabetes, chronic kidney disease, degenerative disease, and depression. This PCR study is the first to describe the interdental microbiota in healthy adults aged 18–35 years-old with reference to the Socransky complexes. The complexes tended to reflect microbial succession events in developing dental biofilms. Early colonizers included members of the yellow, green, and purple complexes. The orange complex bacteria generally appear after the early colonizers and include many putative periodontal pathogens, such as Fusobacterium nucleatum. The red complex (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) was considered the climax community and is on the list of putative periodontal pathogens. The 19 major periodontal pathogens tested were expressed at various levels. F. nucleatum was the most abundant species, and the least abundant were Actinomyces viscosus, P. gingivalis, and Aggregatibacter actinomycetemcomitans. The genome counts for Eikenella corrodens, Campylobacter concisus, Campylobacter rectus, T. denticola, and Tannerella forsythensis increased significantly with subject age. The study highlights the observation that bacteria from the yellow complex (Streptococcus spp., S. mitis), the green complex (E. corrodens, Campylobacter gracilis, Capnocytophaga ochracea, Capnocytophaga sputigena, A. actinomycetemcomitans), the purple complex (Veillonella parvula, Actinomyces odontolyticus) and the blue complex (A. viscosus) are correlated. Concerning the orange complex, F. nucleatum is the most abundant species in interdental biofilm. The red complex, which is recognized as the most important pathogen in adult periodontal disease, represents 8.08% of the 19 bacteria analyzed. P. gingivalis was detected in 19% of healthy subjects and represents 0.02% of the interdental biofilm. T. forsythensis and T. denticola (0.02 and 0.04% of the interdental biofilm) were detected in 93 and 49% of healthy subjects, respectively. The effective presence of periodontal pathogens is a strong indicator of the need to develop new methods for disrupting interdental biofilm in daily oral hygiene.

Rationale for the prevention of oral diseases in primary health care: an international collaborative study in oral health education.

Ensuring that members of society are healthy and reaching their full potential requires the prevention of oral diseases through the promotion of oral health and well-being. The present article identifies the best policy conditions of effective public health and primary care integration and the actors who promote and sustain these efforts. In this review, arguments and recommendations are provided to introduce an oral health collaborative promotion programme called Live.Learn.Laugh. phase 2, arising from an unique partnership between FDI World Dental Federation, the global company Unilever plc and an international network of National Dental Associations, health-care centres, schools and educators populations.

LLL2: an international global level questionnaire on toothbrushing and use of fluoride toothpaste.

PURPOSE To determine the evolution of toothbrushing frequency and use of fluoridetoothpaste in the FDI-Unilever partnership Live.Learn.Laugh. phase 2 programme using a self-reported questionnaire. METHODS The study was conducted in 23 countries. The key focus of this partnership was to educate people about the benefits of twice-daily brushing with fluoride toothpaste and to support people in adopting this important oral health behaviour. The partnership offers a choice of four project options to the local partnership team of the National Dental Association and local Unilever-operating companies. A self-report questionnaire was used in all participating subjects in local projects to evaluate the brushing frequency, the brushing timing and the use of fluoride toothpaste. RESULTS After implementation of the project interventions, a clear improvement in the reported frequency of brushing twice a day, regardless of the type of project, was observed. Subjects also increased day and night brushing and the use of fluoride toothpaste. CONCLUSION The strategy of using mothers to increase healthy behaviours in oral health achieved the greatest increase in twice-daily toothbrushing, followed by the intervention in schools.

Efficacy of interdental calibrated brushes on bleeding reduction in adults: a 3‐month randomized controlled clinical trial

This study investigated the effect of interdental brushes on the reduction of interproximal bleeding in adults without periodontal disease. Forty-six adults were enrolled in a 3-month, observer-blinded, parallel-group randomized control trial. The test group used a standard manual toothbrush twice daily and an interdental brush daily. The control group used a standard manual toothbrush. At each visit, a calibrated colorimetric probe was used in all interdental spaces to determine the appropriate size of the interdental brush required, the brush of the corresponding size was introduced into the interproximal space, and the presence of bleeding was recorded. The outcome was the frequency of bleeding after application of the appropriate interdental brush. All participants were evaluated 1 wk, 1 month, and 3 months after the baseline visit. The overall preventive fraction with respect to bleeding frequency was 46% at 1 wk and 72% at 3 months. More bleeding reduction was observed in anterior sites than in posterior sites (80% vs. 69%, respectively). Participants with low baseline bleeding frequency presented with less bleeding (OR = 2.3). This study shows that daily use of calibrated interdental brushes reduces interdental bleeding. These findings may support interdental cleaning as an effective means to help individuals maintain and/or achieve optimal oral health.

Access to Interdental Brushing in Periodontal Healthy Young Adults: A Cross-Sectional Study

Purpose Interdental diameter space is largely undefined in adults, which compromises the decision support for daily interdental cleaning during routine practice in individual oral prophylaxis. This study assesses the distribution of diameter access of interdental spaces in an 18- to 25-year-old adult population free of periodontal disease. Methods In March-April 2015, a cross-sectional study using random sampling was performed at the University Lyon 1, France. The interproximal dental spaces of 99 individuals were examined using a colorimetric calibrated probe associated with the corresponding calibrated interdental brush (IDB). Results Of the 2,408 out of 2,608 sites, the overall accessibility prevalence of any interdental brushing was 92.3%. In total, 80.6% of the sites required interdental brushes with smaller diameters (0.6–0.7 mm). In anterior sites, the diameter of the interdental brushes used was smaller (55.8% of IDB with 0.6 mm) than the diameter of the interdental brushes used in posterior sites (26.1% of IDB with 0.6 mm) (p < 0.01). The adjusted ORs indicate a significant association with the location of the sites (approximately doubling the risk of bleeding, i.e., OR = 1.9, in posterior sites). Conclusions Most interdental sites can be cleaned using interdental brushes. Even in healthy people, interdental hygiene requirements are very high. Strengthening the oral hygiene capacity by specifically using interdental brushes can have an effect on the health of the entire population. Screening of the accessibility of the interdental space should be a component of a routine examination for all patients.

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

Background 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. Methods 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: Streptococcus spp., Streptococcus mutans, Lactobacillus spp., Enterococcus spp., and Enterococcus faecalis; (ii) the fungus Candida albicans; and (iii) total bacteria. Results Streptococcus spp. was the most abundant species, followed by Lactobacillus spp. and Enterococcus spp. Streptococcus spp. and Lactobacillus spp. were detected at all tested sites and Enterococcus spp. at 99% of sites. S. mutans was detected at only 28% of the tested sites and C. albicans was detected at 11% of sites. E. faecalis was never detected. In 54.5% of the biofilm inhabited by C. albicans, S. mutans was present. Moreover, 28% of the ID sites co-expressed S. mutans and Lactobacillus spp. The studied pathogens were organized into two correlated groups of species. Strikingly, the fungus C. albicans and the bacteria Enterococcus spp. cluster together, whereas Streptococcus spp., S. mutans and Lactobacillus spp. form one distinct cluster. Conclusion 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.

Oral health behaviour and lifestyle factors among overweight young adults in Europe

Being overweight is a risk factor for many chronic diseases including oral diseases. Our aim was to study the associations between oral health behavior, lifestyle factors and being overweight among young European adults, 2011–2012. The subjects constituted a representative sample of adult population aged 18–35 years from eight European countries participating in the Escarcel study. The participants completed a self-administered questionnaire on dietary habits, oral health behavior, smoking, exercise, height, and weight. Overweight was defined as body mass index (BMI) ≥ 25 kg/m2 using the World Health Organization criteria. Mean BMI was 23.2 (SD 3.48) and 24.3% of the study population were overweight. Those who were overweight drank more soft drinks (p = 0.005) and energy drinks (p = 0.006) compared with those who were non-overweight. Brushing once a day (OR 1.6; 95% CI 1.3-2.0), emergency treatment as the reason for last dental visit (OR 1.6; 95% CI 1.3–1.9) and having seven or more eating or drinking occasions daily (OR 1.4; 95% CI 1.1–1.7) were statistically significantly associated with overweight. Associations were found between oral health behavior, lifestyle and overweight. A greater awareness of the detrimental lifestyle factors including inadequate oral health habits among overweight young adults is important for all healthcare providers, including oral health care professionals.

Strategies to promote better research on oral health in Africa: A Delphi consensus study.

Background: Research on oral health contributes to improved health outcomes; it is an indispensable tool in health policy. But how to fill the gaps in research oral health and to strengthen its capacity is the question. The main objective of the present study is to identify the current status of oral health research and potential strategies, thereby strengthening the research infrastructure and capacity. Delphi consultation, in the perspective of assisting decision-makers to identify strategies to promote better research on oral health in Africa, was initiated. Design and Methods: The panels of 30 experts were asked to complete the questionnaire with 42 items into four groups by web survey. Each indicator statement was considered to be in consensus if the experts opinion rating was of “A or B” for more than 75% in a scale of seven categories. Quantitative analysis was made from the answers of Delphi round. Results: There was a strong consensus about three items concerning the role of oral health research, the development of research policy for oral health going through an effective governance of research institutes, migration of researchers and fund raising. Conclusion: This study shows strong many dispersal opinions by experts, but highlights the need for to improve the effectiveness of oral health research capacity strengthening activities. Africas researchers, policy makers and partners will have to give special attention to ensuring that knowledge generated from oral health research is acted on to improve health for all.

Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017.

Effective sterilization of reusable instruments contaminated by Creutzfeldt–Jakob disease in dental care is a crucial issue for public health. The present cross-sectional study investigated how the recommended procedures for sterilization were implemented by French dental practices in real-world settings. A sample of dental practices was selected in the French Rhône-Alpes region. Data were collected by a self-questionnaire in 2016. Sterilization procedures (n = 33) were classified into 4 groups: (1) Pre-sterilization cleaning of reusable instruments; (2) Biological verification of sterilization cycles—Monitoring steam sterilization procedures; (3) Autoclave performance and practitioner knowledge of autoclave use; (4) Monitoring and documentation of sterilization procedures—Tracking and tracing the instrumentation. Answers were provided per procedure, along with the global implementation of procedures within a group (over 80% correctly performed). Then it was verified how adherence to procedure groups varied with the size of the dental practice and the proportion of dental assistants within the team. Among the 179 questionnaires available for the analyses, adherence to the recommended procedures of sterilization noticeably varied between practices, from 20.7% to 82.6%. The median percentages of procedures correctly implemented per practice were 58.1%, 50.9%, 69.2% and 58.2%, in Groups 1, 2, 3 and 4, respectively (corresponding percentages for performing over 80% of the procedures in the group: 23.4%, 6.6%, 46.6% and 38.6%). Dental practices ≥ 3 dental units performed significantly better (>80%) procedures of Groups 2 and 4 (p = 0.01 and p = 0.002, respectively), while no other significant associations emerged. As a rule, practices complied poorly with the recommended procedures, despite partially improved results in bigger practices. Specific training regarding sterilization procedures and a better understanding of the reasons leading to their non-compliance are needed.