Emmanuel Nicolas

Factors affecting dental fear in French children aged 5–12 years

BACKGROUND While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. OBJECTIVE We set out to evaluate factors affecting dental fear in French children. METHODS Dental fear was evaluated using a visual analogue scale (DF-VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5-11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well-being related to oral health, dental experience, and oral health education were collected via a structured interview. RESULTS Dental fear was scored low in 75.7% (DF-VAS 0-3), moderate in 16.7% (DF-VAS 4-6), and high in 7.6% (DF-VAS 7-10). DF-VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. CONCLUSIONS This study shows that for children aged 5-12 years, prior experience of the dental setting can act as a positive component of dental fear.

Inequalities in oral health for children with disabilities: a French national survey in special schools.

Background Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available. Method Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives. Results DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25–4.86 for COHI; OR = 2.01, 95% CI = 1.77–2.28 for COCNI; OR = 5.25, 95% CI = 4.55–6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7–4.6 for COHI; OR = 1.52, 95% CI = 1.38–1.69 for COCNI; OR = 1.53, 95% CI = 1.39–1.69 for COPI). Conclusion Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.

A national cross-sectional survey of dental anxiety in the French adult population

BackgroundDental anxiety is a public health problem but no epidemiological study has been undertaken in France to evaluate its prevalence. The aim of this study was to estimate the prevalence, severity and associations of dental anxiety in a sample of the French adult population.MethodsA convenience sample of 2725 adults (mean age = 47 years, SD16, minimum = 16, maximum = 101 years), representative of the French population with regard to age and urban distribution, completed a French version of the Corah Dental Anxiety scale (DAS) and a questionnaire relating to their dental appointments.ResultsModerate dental anxiety (14≥DAS≥13) was revealed for 172 persons (6.2%), while 195 (7.3%) had severe dental anxiety (DAS≥15), giving an overall prevalence of dental anxiety of 13.5%. Prevalence was lower proportionally with age (P < 0.001) and was higher in French overseas territories and in the countryside (P < 0.01). Farmers and low skilled workers were significantly more anxious than executives and shopkeepers (P < 0.001). Anxiety was associated with avoidance of care (p < 0.001) and lack of regular dental appointments (p < 0.001).ConclusionDental anxiety in France appears to concern a similar proportion of the population as in other industrialised European, Australasian or North American countries. Recommendations for prevention and management of dental anxiety are made with reference to dental education and health care services in France.

Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers

BACKGROUND AND OBJECTIVE The prevalence of malnutrition increases with age because of many factors. Edentulousness leads to the avoidance of many types of foods. The aim of this study was to determine whether elderly complete denture wearers have a higher risk of malnutrition than dentate controls. MATERIAL AND METHODS A Mini-Nutritional Assessment (MNA) and a 3-day dietary record were compiled for a group of fully dentates (21 women and 29 men; mean age 70.1 ± 6.1) and for a group of complete denture wearers (31 women and 16 men; mean age 70.1 ± 8.1). Socio-demographic data and scores on the General Oral Health Assessment Index (GOHAI) questionnaire were collected. RESULTS Inter-group comparison of MNA scores showed that more subjects in the edentulous group (21.3%) risked malnutrition than in the dentate group (0%). The variability of the MNA could be explained for 22% by dental status, 7% by loneliness and 4% by the GOHAI score (regression analysis). Both groups had insufficient energy intakes and deficits in vitamins and micronutrients; moreover, edentulous subjects had lower intakes than dentate subjects. CONCLUSION The use of conventional dentures increases the risk of malnutrition in the elderly.

The Masticatory Normative Indicator

There is no established quantitative, objective method to differentiate individuals with good masticatory function from those lacking this attribute. The aim of this study was to specify a normal range of median particle size values for masticated raw carrots collected just before being swallowed. The masticatory normative indicator (MNI) value thus obtained was based on seven studies carried out by different investigators using different methods for measuring particle size in carrot boluses. A simple mathematical transformation of variables and the choice of an interval of ±1.96 times the standard deviation gave 4.0 mm as the upper limit of normal median particle size for carrots in a population of young persons with good oral health. This value identifies boluses that may be considered as resulting from impaired mastication, as illustrated in healthy individuals with experimentally hampered mastication, denture wearers, and individuals presenting with obesity or Down syndrome.

A review of the safety of 50% nitrous oxide/oxygen in conscious sedation

Few studies into conscious sedation with 50% nitrous oxide/oxygen premix (50% N2O/O2) have been conducted in accordance with Good Clinical Practice in Clinical Trials. Of the 140 articles retained in this review, the incidence of adverse events (AEs) varied in the range of 0 – 68% according to the indications. When other drugs and/or local anaesthesia were used concomitantly, the relative risk for nausea and vomiting increased whereas it decreased for vertigo or hallucinations. Only one study examined potential causal relationship between serious AEs and the 50% N2O/O2 gas itself, giving a risk for a serious AE directly due to the gas of 3/10,000 administrations. No analysis of the effect of the method of administration was possible, nor could conclusions be drawn relating to the risk of occupational exposure.

Modification of behavior with 50% nitrous oxide/oxygen conscious sedation over repeated visits for dental treatment a 3-year prospective study.

Abstract: In various medical domains, inhalation of nitrous oxide (N2O) in oxygen (O2) is indicated to alleviate pain and anxiety during routine treatment. Repeat treatment may often be indicated. Little data are available, however, to evaluate the long-term efficacy and side effects of reiterated N2O/O2 sedation. The aim of this study was to compare behavior during dental treatment under a premix of 50% N2O/O2 between first experience and repeat experiences of sedation in a cohort of uncooperative patients. Five hundred forty-three patients (age range, 1-94 years; mean, 17 ± 16 years) experiencing conscious sedation for dental treatment for the first time were recruited at a special care unit during 3 years. A modified Venham scale was used to evaluate patient behavior at 5 steps during each session. Completion of planned treatment and occurrence of adverse side effects of sedation were additional criteria. Patients experienced sedation for the first time for 378 sessions, and the session was a repeat experience in 843 cases (number of visits: range, 1-6). Patient cooperation significantly improved during visits at first contact with the dentist and when applying the mask (P < 0.0001, between sessions 1 and 2). Between the first and the third sessions, the percentage of very uncooperative patients decreased from 23% to 3.7% at first contact with the dentist and from 22.3% to 8.5% on application of the mask. Experience of reiterated dental treatment under sedation with 50% N2O/O2 premix helps uncooperative patients to cope with dental treatment in the long term.

Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

The impact of implant treatment on oral health related quality of life in a private dental practice: a prospective cohort study

BackgroundVery few studies on the impact of implant therapy on Oral Health Related Quality of Life (OHRQoL) in partially edentulous patients have been published.AimThis study aimed at analysing the improvement of OHRQoL of patients who underwent dental implant treatment using the “functional”, “psychosocial” and “pain and discomfort” categories of the Geriatric Oral Health Assessment Index (GOHAI).MethodsWithin a prospective cohort of patients rehabilitated with Straumann dental implants, the OHRQoL of 176 patients (104 women and 72 men) was assessed using the GOHAI questionnaire, at two different times, before and after implant placement. The degree of oral treatment was categorised into three classes: “Single Tooth Implant” (n = 77), “Fixed Partial Denture” (n = 75), “Fixed or Retained Full Prostheses” (n = 24). The participants’ characteristics (gender, age, tobacco habits, periodontal treatment, time between both evaluations) were assessed.ResultsBefore treatment, the GOHAI score was lower for participants with fewer teeth (F = 19, P < 0.001). After treatment, no difference was observed between participants; significant improvements were observed in the GOHAI scores obtained (repeated measures, analysis, (F = 177, P < 0.001)) for each of the GOHAI fields studied (functional, psychosocial and pain & discomfort), regardless of the degree of treatment. The best improvement was observed in patients who needed complete treatment (P < 0.001). The presence of preliminary periodontal treatment, tobacco habits, age and gender of the participants did not have a significant impact on OHRQoL. Changing the time between the two evaluations (before and after treatment) had no impact on the changes in the GOHAI score.ConclusionsImplants enhanced the OHRQoL of participants that needed oral treatment.

Evaluation of safe and effective administration of nitrous oxide after a postgraduate training course

BackgroundConscious sedation is used in dentistry to improve access and quality of care in patients who have difficulty coping with treatment. The aim of this prospective study was to describe a postgraduate training course in conscious sedation for dentists, with specific evaluation of the safe and effective administration of a 50% nitrous oxide in oxygen premix.Methods45 practitioners were trained between 2002 and 2004. They carried out 826 sessions of inhalation sedation in 662 patients. The clinical competency of this group was compared with an expert group.ResultsThere was no difference between trainees and experts in ability to complete the planned dental treatment under sedation (89.6% vs 93.2%). Trainees were less successful than experts for patients with intellectual disability (87.4% vs 94.2%, p < 0.01). For both groups, the degree of cooperation improved between initial induction and each perioperative step (Wilcoxon test, p < 0.01). However, for trainees, Venham behaviour scores varied with the type of patient (Kruskal Wallis test, p < 0.001). No major adverse effects were recorded. Trainees reported more minor adverse effects than experts (13% vs. 5.3% respectively, Fisher exact test, p < 0.001)ConclusionThe trainee practitioners provided effective and safe inhalation sedation. This challenges the current French restriction of the 50% nitrous oxide in oxygen premix to the hospital setting. Further emphasis is required on the teaching of behaviour management skills for patients with intellectual disability.