Michèle Muller-Bolla

The Effect of Prolonged and Exclusive Breast-Feeding on Dental Caries in Early School-Age Children

To study the effects of prolonged and exclusive breast-feeding on dental caries, we followed up children participating in the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative. A total of 17,046 healthy, mother-infant breast-feeding pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics, of whom 13,889 (81.5%) were followed up at 6.5 years. At follow-up, polyclinic pediatricians transcribed the reports of a standard dental examination performed by public health dentists at age 6 years and recorded in the children’s polyclinic charts. Analysis was based on intention to treat, with a statistical model that accounts for clustering within hospitals/clinics to permit inferences at the individual level. The experimental intervention led to a large increase in exclusive breast-feeding at 3 months (43.3 vs. 6.4%, p < 0.001) and a significantly higher prevalence of any breast-feeding at all ages up to and including 12 months. No significant intervention effects were observed on dental caries. Our results, based on the largest randomized trial ever conducted in the area of human lactation, provide no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early school age.

Scanning Electron Microscopy Analysis of Experimental Bone Hacking Trauma

The authors report on their macro- and microscopy study of bone lesions made by a sharp force instrument (a single blade knife), and a sharp-blunt instrument classified as a chopping weapon (a hatchet). The aim of this work was to attempt to identify the instrument by analyzing the general class characteristics of the cuts. Each weapon was used on human bones. The results indicate that macroscopic analysis is more problematic. The microscopic analysis assessed that characteristics examined were effective in distinguishing sharp from sharp-blunt injury to the bone. The microscope facilitates analysis unachievable with macroscopic methods, some three-dimensional characteristics not visible to the naked eye being clearly defined with its use. Emphasis has been placed on the value of SEM as an anthropologists tool in bone lesion injuries.

Development of a Core Set of Outcomes for Randomized Controlled Trials with Multiple Outcomes – Example of Pulp Treatments of Primary Teeth for Extensive Decay in Children

Objectives Evidence-based comparisons of interventions can be challenging because of the diversity of outcomes in randomized controlled trials (RCTs). We aimed to describe outcomes in RCTs assessing pulp treatments for primary teeth and to develop a core set of component outcomes to be part of composite outcome defining the failure of a pulp treatment. Methods We systematically reviewed articles of RCTs comparing pulp treatments for primary molars published up to February 2012. We abstracted all outcomes assessed in each trial, then used a small-group consensus process to group similar outcomes, which were reduced to a composite outcome of failure of a pulp treatment by a 3-round Delphi process involving expert authors and dentists. Results We included 47 reports of RCTs in the review, for 83 reported outcomes (median 11 outcomes per RCT). These outcomes were grouped into 24 overarching outcome categories. We contacted 210 experts for the Delphi process and 25% to 30% participated. The process identified the following 5 component outcomes as part of a composite outcome of failure of a pulp treatment: soft-tissue pathology, pain, pathologic mobility, pathologic radiolucency and pathologic root resorption. Conclusions RCTs of pulp treatments for primary teeth investigate diverse outcomes. Our consensus process, involving clinicians but no patient, allowed for compiling a core set of component outcomes to define the composite outcome failure of a pulp treatment for primary teeth.

Dental health of 6-year-old children in Alpes Maritimes, France

AIM: To describe the dental health status of 6-year-old children using the ICDAS-II advanced method and to evaluate the association between the known caries risk factors with the cavitated caries lesion (WHO basic method) or with both non-cavitated and cavitated caries lesion caries (ICDAS II). METHODS: In this cross-sectional study, a questionnaire was used to evaluate oral health and dietary habits of children. A clinical examination and a Cario analysis test (Pierre Fabre Oral care) were performed. STATISTICS: Logistic regression analyses were used to assess the association between caries and daily tooth-brushing, dietary habits, visible plaque and salivary factors. RESULTS: There were 341 children (52% female and 6.25±0.46 years of age) in this study. Using the ICDAS-II advanced method, 39% of the children were caries-free. This proportion was larger (67.2%) using the WHO method. In multivariate models, visible dental plaque and Streptococcus mutans count were associated with caries experience registered as ICDAS-II codes 1–6 or codes 3–6. The absence of daily tooth-brushing with fluoridated toothpaste was associated only with caries experience ICDAS-II codes 3–6. CONCLUSION: The use of WHO or ICDAS-II method changed the proportion of caries-free children but not the clinical caries risk factors associated with caries experience

SLC13A5 is the second gene associated with Kohlschütter–Tönz syndrome

Background Kohlschütter–Tönz syndrome (KTZS) is a rare autosomal-recessive disease characterised by epileptic encephalopathy, intellectual disability and amelogenesis imperfecta (AI). It is frequently caused by biallelic mutations in ROGDI. Here, we report on individuals with ROGDI-negative KTZS carrying biallelic SLC13A5 mutations. Methods In the present cohort study, nine individuals from four families with the clinical diagnosis of KTZS and absence of ROGDI mutations as well as one patient with unexplained epileptic encephalopathy were investigated by clinical and dental evaluation, parametric linkage analysis (one family), and exome and/or Sanger sequencing. Dental histological investigations were performed on teeth from individuals with SLC13A5-associated and ROGDI-associated KTZS. Results Biallelic mutations in SLC13A5 were identified in 10 affected individuals. Epileptic encephalopathy usually presents in the neonatal and (less frequently) early infantile period. Yellowish to orange discolouration of both deciduous and permanent teeth, as well as wide interdental spaces and abnormal crown forms are major clinical signs of individuals with biallelic SLC13A5 mutations. Histological dental investigations confirmed the clinical diagnosis of hypoplastic AI. In comparison, the histological evaluation of a molar assessed from an individual with ROGDI-associated KTZS revealed hypocalcified AI. Conclusions We conclude that SLC13A5 is the second major gene associated with the clinical diagnosis of KTZS, characterised by neonatal epileptic encephalopathy and hypoplastic AI. Careful clinical and dental delineation provides clues whether ROGDI or SLC13A5 is the causative gene. Hypersensitivity of teeth as well as high caries risk requires individual dental prophylaxis and attentive dental management.

Scanning electron microscopy analysis of experimental bone hacking trauma of the mandible.

The authors report on a macroscopic and microscopic study of human mandible bone lesions achieved by a single-blade knife and a hatchet. The aim of this work was to complete the previous data (scanning electron microscopy analysis of bone lesions made by a single-blade knife and a hatchet, on human femurs) and to compare the lesions of the femur with those of the mandible. The results indicate that the mandible is a more fragile bone, but the features observed on the mandible are quite similar to those previously observed on the femur. This work spells out the main scanning electron microscopy characteristics of sharp (bone cutting) and blunt (exerting a pressure on the bone) mechanisms on human bone. Weapon characteristics serve to explain all of these features.

Effectiveness of school-based dental sealant programs among children from low-income backgrounds: a pragmatic randomized clinical trial with a follow-up of 3 years

AIM A split-mouth randomized clinical trial was carried out to assess the effectiveness of a school-based dental sealant (SBDS) program for French children from low-income backgrounds within 3 years of follow-up. The secondary objectives were to determine the risk factors for the occurrence of new carious lesions (ICDAS 3-6) on first permanent molars, to evaluate the effectiveness of the program according to risk factors and to assess sealant retention. METHODS The study included 276 6- to 7-year old pupils (457 pairs of first permanent molars) from Nice. The sealing was performed in first- or second-grade children. The first permanent molars were randomized into two groups: One received resin-based sealant and the other formed a nontreatment group. Carious lesions ICDAS 3-6 on permanent and primary teeth, visible plaque, streptococcus mutans and/or lactobacillus counts were recorded at baseline to assess individual caries risk (ICR). The putative confounders recorded at baseline were sex, grade level, and characteristics of first permanent molars. An intent-to-treat analysis was performed, where the study outcome was the occurrence of new carious lesions within 3 years of follow-up. Univariate and multivariate Cox proportional hazards models (hazard risk, HR) using the procedure PHREG with the option of Covsandwich were performed in SAS to assess the effectiveness of the SBDS program. RESULTS At 3 years of follow-up, 228 children (378 tooth pairs) remained in the analysis. The survival analysis showed that first permanent molars that received sealants had 67% (adjusted HR: 0.33; 95% CI: 0.24-0.46) less risk of developing new carious lesions during all the follow-up than molars without sealant. In addition, children with carious lesions ICDAS 3-6 on permanent and primary teeth, that is, high ICR, had three times the risk of having a new carious lesion than others without, independently of the sealant treatment (adjusted HR: 3.00; 95% CI: 1.55-5.75). Effectiveness of the SBDS program at 3 years of follow-up depended on the presence of carious lesions ICDAS 3-6 (HR in 173 children with carious lesions: 0.32; 95% CI: 0.23-0.46) at baseline (HR in 103 children without carious lesions: 0.42; 95% CI: 0.16-1.12). Finally, the overall retention rate was 32.3%. CONCLUSION The effectiveness of the SBDS program was demonstrated in low socioeconomic areas. Selection of schoolchildren according to the presence of carious lesions ICDAS 3-6 should be considered in a SBDS program.

Therapeutic decisions in the presence of decayed permanent first molars in young subjects: A descriptive inquiry

UNLABELLED The aim of this exhaustive descriptive epidemiological study was to determine the clinical approach to be adopted by practitioners specializing exclusively in pediatric odontology and by orthodontists when confronted with decayed molars in children and adolescents. MATERIAL AND METHOD A questionnaire was sent out to all corresponding practitioners (n=2076). Six questions related to treatment decisions taken when faced with decayed permanent first molars (unfavorable short or middle-term prognosis) in patients needing, or not, orthodontic care. The Chi(2) test was used to compare responses. RESULTS Thirty-eight per cent of pedodontists (n=38) and 12.5% (n=246) of orthodontists answered the questionnaire. Faced with a permanent first molar with an unfavorable middle-term prognosis, 75.7% needed criteria to help them reach their treatment decision. In decreasing order of importance, these criteria were: presence of the third molar, patient motivation, inter-arch relationship, patients oral hygiene, facial type, anterior jaw-teeth discrepancy and the number of molars to be extracted. Faced with a permanent first molar requiring extraction and when orthodontic treatment was not required, 31.7% of practitioners decided to close the maxillary space immediately as opposed to 13.4% who closed the space at the mandible. In the presence of a single decayed first molar, 68.7% of practitioners did not extract the antagonist or contralateral first molars. CONCLUSION These treatment decisions were not always unanimous and call for a combined approach between dental surgeon and orthodontist.

Aesthetic preformed paediatric crowns: systematic review.

BACKGROUND Different aesthetic preformed crowns (APC) are proposed to restore decayed and damaged primary teeth because the stainless steel crowns (SSCs) do not satisfy parents concerned about aesthetic. AIM The objective was to evaluate the clinical effectiveness of all types of APC for restoring primary teeth compared with conventional filling materials or other types of crowns. DESIGN Relevant articles were searched in electronic databases of PubMed via MEDLINE and the Cochrane central register of controlled trials. Two review authors independently assessed the risk of bias in the included articles and extracted data. RESULTS From 555 potentially eligible articles, seven relevant articles were included. The overall risk of bias was high for all the studies. SCCs cannot be replaced by APC, such as the open-faced SSCs and the pre-veneered SCCs, for restoring badly decayed primary molars. Zircon crowns were assessed only in primary incisors and compared with pre-veneered SCCs and resin composite strip crowns. After a follow-up of only 6 months, Zircon crowns gave significantly better results than the others with regard to gingival health and crown fractures. CONCLUSION Due to the small number of RCTs on this topic and their risk of bias, future RCTs should be carried out in primary teeth.

Split-mouth and parallel-arm trials to compare pain with intraosseous anaesthesia delivered by the computerised Quicksleeper system and conventional infiltration anaesthesia in paediatric oral healthcare: protocol for a randomised controlled trial

Introduction Local anaesthesia is commonly used in paediatric oral healthcare. Infiltration anaesthesia is the most frequently used, but recent developments in anaesthesia techniques have introduced an alternative: intraosseous anaesthesia. We propose to perform a split-mouth and parallel-arm multicentre randomised controlled trial (RCT) comparing the pain caused by the insertion of the needle for the injection of conventional infiltration anaesthesia, and intraosseous anaesthesia by the computerised QuickSleeper system, in children and adolescents. Methods and analysis Inclusion criteria are patients 7–15 years old with at least 2 first permanent molars belonging to the same dental arch (for the split-mouth RCT) or with a first permanent molar (for the parallel-arm RCT) requiring conservative or endodontic treatment limited to pulpotomy. The setting of this study is the Department of Paediatric Dentistry at 3 University dental hospitals in France. The primary outcome measure will be pain reported by the patient on a visual analogue scale concerning the insertion of the needle and the injection/infiltration. Secondary outcomes are latency, need for additional anaesthesia during the treatment and pain felt during the treatment. We will use a computer-generated permuted-block randomisation sequence for allocation to anaesthesia groups. The random sequences will be stratified by centre (and by dental arch for the parallel-arm RCT). Only participants will be blinded to group assignment. Data will be analysed by the intent-to-treat principle. In all, 160 patients will be included (30 in the split-mouth RCT, 130 in the parallel-arm RCT). Ethics and dissemination This protocol has been approved by the French ethics committee for the protection of people (Comité de Protection des Personnes, Ile de France I) and will be conducted in full accordance with accepted ethical principles. Findings will be reported in scientific publications and at research conferences, and in project summary papers for participants. Trial registration number ClinicalTrials.gov NCT02084433.