Martine Hennequin

Significance of oral health in persons with Down syndrome: a literature review

Down syndrome (DS) is an autosomal chromosomal anomaly resulting from trisomy of all or a critical part of chromosome 21. It affects approximately 1 in 700 to 800 live births. Despite the development of prenatal diagnosis, the incidence of DS births is predicted to remain static or even to increase over the next decade, partly due to increased maternal age in Western societies1–3. Many of the medical and physiological characteristics of DS have direct consequences for the oral health of subjects affected and indirect consequences for the quality of life of persons with DS and their carers. This article aims to give an overview of the current literature concerning the orofacial problems confronting patients with DS, and to explain the different treatment modalities available.

Accuracy of estimation of dental treatment need in special care patients

OBJECTIVES To assess the ability of carers and dental professionals to estimate treatment need in a group of children and adults with special needs. METHOD A retrospective study of a series of 103 special needs patients who had received restorative dental treatment under general anaesthetic was undertaken. The initial reason for attendance and the time lapse between first symptoms and decision to consult were established. The parent or carer was asked to estimate treatment need and to assess the degree of discomfort suffered by the patient. The dentist evaluated treatment need by means of a pre-operative treatment plan. These results were compared to actual treatment performed. RESULTS Treatment need was severely underestimated by both carer and dentist. The degree of advanced pathology found in the population would suggest that pain suffered was also underestimated. CONCLUSIONS Access of patients with special needs to dental care may be limited by the ability of their carers to evaluate their oral condition and/or by the persons inability to express their pain or discomfort.

Safety of Inhalation of a 50% Nitrous Oxide/Oxygen Premix

AbstractBackground: A 50% nitrous oxide/oxygen (N2O/O2) premix is widely used to alleviate pain or anxiety during brief care procedures in various medical domains. In some countries, recent changes in regulation status for medical gases state that they should be considered as drugs. Consequently, more valuable data gained from exhaustive clinical surveys are needed. This prospective study, conducted in the same conditions imposed for testing a drug, aims to analyse the factors that affect tolerance of the 50% N2O/O2 premix in a wide range of clinical indications. Methods: In a 4-year prospective survey, 35 942 data sheets were received from 191 French hospital paediatric (82%) and adult units (18%). Of these, 35 828 sheets were sufficiently complete to be included in the study. The number and the type of adverse events declared to the manufacturer were analysed. Results: A total of 1581 (4.4%) adverse events were reported on 1384 data sheets, which were mostly gastrointestinal and neuropsychiatric disorders (86%). The main factors associated with adverse events were age, concomitant drug administration and longer duration of inhalation. Among the 27 (0.08%) reported serious adverse events, only 9 (0.03%) were possibly attributed to the N2O/O2 premix. Among the serious adverse events that were not attributed to the gas, a concomitant drug association and insufficient patient surveillance occurred in 12 and 2 cases, respectively. Conclusion: This survey confirms the pharmacological safety of the 50% N2O/O2 premix in a wide variety of clinical indications and emphasises the need for rational training of medical personnel in its administration.

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.

Effects of Different pH Values of Citric Acid Solutions on the Calcium and Phosphorus Contents of Human Root Dentin

In a group of mandibular incisors, the calcium and phosphorus contents of the cervical, middle, and apical thirds of the roots were determined using an electron microprobe analyzer, before and after treatment with citric acid solutions of different concentrations. The treated surfaces were examined using a scanning electron microscope. The relative calcium and phosphorus loss values obtained from the samples treated with pH 0.8, 1.1, 1.3, 1.5, and 1.7 solutions were significantly different from those obtained in the control group. The demineralizing effect of the pH 0.8 and pH 1.3 solutions was the same, with both of these being less effective than the pH 1.1 solution.

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.

Prevalence of oral health problems in a group of individuals with Down syndrome in France.

This cross‐sectional study describes oral health problems in a sample of children with Down syndrome (DS) compared with their siblings. Data were collected using the Oral Assessment ‐ Down Syndrome questionnaire, a validated French language evaluation to be completed by the childs carer. Parents attending a national meeting anonymously answered a questionnaire for their child with DS and for the sibling closest in age and returned their replies by post. Data concerning 204 individuals with DS (103 males, 101 females; mean age 9.6 years) and 161 of their siblings (80 males, 81 females; mean age 11.8 years) were returned. The association between DS status, age, and oral health was analysed. There was a greater frequency of oral health problems in those with DS with regard to function, clinical signs, disability, and development. The prevalence of chewing problems did not improve with age, the prevalence of bleeding gums and mouth breathing increased with age, and that of tongue protrusion reduced with age. Most parents rated the general and oral health of their children with DS highly, although worse than for their siblings.

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.