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Bramantoro T, Mardiyantoro F, Irmalia WR, Kristanti RA, Nugraha AP, Noor TEBTA, Fauzi AA, Tedjosasongko U. Early Childhood Caries, Masticatory Function, Child Early Cognitive, and Psychomotor Development: A Narrative Review. Eur J Dent 2024; 18:441-447. [PMID: 38049121 PMCID: PMC11150055 DOI: 10.1055/s-0043-1774326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Dental caries is known as a global public health issue that has been affecting general health apart from its painful nature. Hence, it is undeniable that caries affecting young children or known as early childhood caries, also have an effect on children's general health. One of the interesting findings about caries is that it can also affect child growth and development, specifically on their cognitive and psychomotor ability. Untreated caries are linked to cognitive development through both neural and vascular pathways, with masticatory function as the key. Meanwhile, its effect on psychomotor development might be related to nutritional intake, which might slightly decline on those with caries. This review is aimed to describe the current findings of caries effect on early child development, from masticatory disturbance to further impacts on cognitive and psychomotor development. The overall conclusion of this review is that untreated severe caries in children are potentially associated negatively with their growth and development.
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Affiliation(s)
- Taufan Bramantoro
- Department of Dental Public Health, Faculty of Dental Medicine Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fredy Mardiyantoro
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Brawijaya University, Malang, East Java, Indonesia
| | - Wahyuning Ratih Irmalia
- Dental Public Health & Primary Health Care Research Group, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Risma Aprinda Kristanti
- Department of Biomedical Science, Medical Study Program, Faculty of Medicine and Health Science, UIN Maulana Malik Ibrahim Malang, Malang, East Java, Indonesia
| | - Alexander Patera Nugraha
- Department of Orthodontic, Faculty of Dental Medicine Universitas Airlangga, Surabaya, East Java, Indonesia
| | | | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Udijanto Tedjosasongko
- Department of Pediatric Dentistry, Faculty of Dental Medicine Universitas Airlangga, Surabaya, East Java, Indonesia
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Bramantoro T, Irmalia WR, Santoso CMA, Mohd Nor NA, Utomo H, Ramadhani A, Kristanti RA, Nugraha AP. The Effect of Caries on the Chewing Ability of Children: A Scoping Review. Eur J Dent 2023; 17:1012-1019. [PMID: 36513344 PMCID: PMC10756727 DOI: 10.1055/s-0042-1758066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Childhood caries might have several effects on the children's general health and growth, including chewing ability. This study aims to identify the evidences found regarding the effect of caries on the chewing ability of children through a scoping review. A scoping review literature search was performed in three databases (Scopus, PUBMED, and Web of Science) without restricting the publicized year. The selected articles were using human as its subjects and aiming to analyze the effects of caries on mastication ability in children. Ten articles matched the inclusion criteria of this review. All the articles suggested a deleterious effect of caries on masticatory performance, maximum bite force, swallowing threshold, and even masticatory behavior. Two of them stated that the effect was reversible by giving dental treatment. This scoping review concludes a negative effect of caries on the children's chewing ability.
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Affiliation(s)
- Taufan Bramantoro
- Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Nor Azlida Mohd Nor
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Haryono Utomo
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Aulia Ramadhani
- Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Risma Aprinda Kristanti
- Student of Doctoral Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Biomedical Sciences, Medical Study Program, Faculty of Medicine and Health Sciences, UIN Maulana Malik Ibrahim Malang, Malang, East Java, Indonesia
| | - Alexander Patera Nugraha
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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Scudine KGOD, de Moraes KN, Miyagui SA, Lamy E, Lopes MF, Mamani MH, Castelo PM. Understanding the relationship between orofacial structures and feeding habits of preschoolers: A multivariate analysis. J Texture Stud 2023; 54:470-480. [PMID: 36849700 DOI: 10.1111/jtxs.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/24/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
The understanding of the relationship between orofacial structures and feeding habits in preschoolers is helpful for health professionals and those dedicated to food science. The hypothesis tested was whether this relationship is already present even at a very young age. This cross-sectional study included 91 healthy caries-free children (50 girls/41 boys; 3.4-6.2 years; mean 4.1 years) and a comprehensive evaluation of the stomatognathic system was performed: dietary intake, facial and occlusal morphology, gustatory sensitivity, bite and lip forces, and orofacial myofunctional aspects (mastication, swallowing and breathing functions). Principal component analysis summarized the variables related to the form and function of the orofacial aspects; further, K-means analysis identified two clusters of participants with similar aspects. Cluster 1 ("Low orofacial myofunctional functioning"; n = 51) was characterized by children who showed the worst performance of mastication, swallowing and breathing functions and whose parents reported the consumption of sweets, cookies, chocolate, but not fresh fruits the day before, in addition to the higher bottle-feeding and pacifier use duration. This cluster also showed higher sweet taste threshold. Cluster 2 ("High orofacial myofunctional functioning"; n = 40) showed lower bottle-feeding and pacifier use duration, higher gustatory sensitivity, greater maxillo-mandibular dimensions, and better orofacial function performance. The variables sex and BMI did not associate to clusters profile. The frequencies of open bite and current sucking habit (pacifier) also differed between clusters. The results showed that an association between form and function of the structures that comprise the stomatognathic system and dietary intake is already present in children with primary dentition.
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Affiliation(s)
| | - Kizzy Nascimento de Moraes
- Department of Oral Rehabilitation, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Sania Aparecida Miyagui
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elsa Lamy
- MED Mediterranean Institute for Agriculture, Environment and Development and CHANGE-Global Change and Sustainability Institute, Universidade de Évora, Évora, Portugal
| | - Mariana Fernandes Lopes
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maribel Hilasaca Mamani
- Department of Pediatric Dentistry, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Tournier C, Forde CG. Food oral processing and eating behavior from infancy to childhood: evidence on the role of food texture in the development of healthy eating behavior. Crit Rev Food Sci Nutr 2023:1-14. [PMID: 37267128 DOI: 10.1080/10408398.2023.2214227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Eating behaviors develop in early life and refine during childhood, shaping long-term food choice and dietary habits, which underpin optimum growth and health. The development of Food Oral Processing (FOP) is of major importance in the establishment of eating behaviors at two scale levels: for the initial acceptance of food texture and for the longer-term development of eating behaviors associated to food intake. To date, both processes have been studied as independent topics and the current review proposes a parallel vision on their development from the onset of complementary feeding to later childhood. Individual factors affecting these FOP-related behaviors as they relate to food texture acceptance are discussed, alongside examples of interventions aiming at modifying them. Opportunity to better consider food textures when designing foods for children is addressed. Altogether, the review demonstrates the critical role of food texture in the development of a child's FOP skills, eating habits, and dietary patterns. These scientific knowledges need to be considered for the development of healthier eating behavior. We identify research gaps that need to be addressed and highlight the need to design foods that can support the development of healthy oral processing and eating behaviors among infants and children.
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Affiliation(s)
- Carole Tournier
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, Dijon, France
- INRAE, PROBE Research Infrastructure, ChemoSens Facility, Dijon, France
| | - Ciaran G Forde
- Sensory Science and Eating Behaviour, Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Linas N, Peyron MA, Cousson PY, Decerle N, Hennequin M, Eschevins C, Nicolas E, Collado V. Comprehensive Dental Treatment under General Anesthesia Improves Mastication Capability in Children with Early Childhood Caries-A One-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:677. [PMID: 36612993 PMCID: PMC9819280 DOI: 10.3390/ijerph20010677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Using the granulometry of ready-to-swallow food boluses, this study investigated the evolution of masticatory capability of children with Early Childhood Caries (ECC) after comprehensive dental treatment under general anesthesia (GA). METHODS Sixteen children with ECC were assessed before and over one year after dental treatment under GA, in comparison with 12 children with a Healthy Oral State (HOS). Oral health criteria, quality of life, body mass index, and frequency of orofacial dysfunctions were recorded. Masticatory kinematic parameters and median food bolus particle size (D50) at swallowing were assessed while masticating raw carrot (CAR), cheese (CHS), and breakfast cereals (CER). The impact of posterior teeth extractions was analyzed. RESULTS Quality of life and orofacial functions improved after dental treatment. Chewing frequency for all three foods increased without reaching the values of children with HOS, while D50 values for CAR and CHS decreased. After one year, children with posterior teeth extractions exhibited higher D50 values for CAR and CHS than children with only conservative treatment. One third of children with ECC were overweight or obese. CONCLUSIONS Comprehensive dental treatment improved children's mastication, and their BMI subsequently increased. Links between mastication and nutrition should be investigated further in children.
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Affiliation(s)
- Natacha Linas
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Service d’Odontologie, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Marie-Agnès Peyron
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- CRNH Auvergne, Human Nutrition Unit (UNH), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Pierre-Yves Cousson
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Service d’Odontologie, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Nicolas Decerle
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Service d’Odontologie, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Service d’Odontologie, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Caroline Eschevins
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Service d’Odontologie, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Valérie Collado
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Service d’Odontologie, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
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Ozturk S, Ozsin Ozler C, Serel Arslan S, Demir N, Olmez MS, Uzamis Tekcicek M. Orofacial functions and oral health: An analysis on children aged 5-8 years old. J Texture Stud 2021; 53:31-40. [PMID: 34482536 DOI: 10.1111/jtxs.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study is to assess the orofacial function performance and oral health status of healthy children as well as their potential correlations. In this descriptive study, the oral functions of four hundred systemically healthy children who applied for the pediatric dentistry clinic were evaluated. Three scales, namely Karaduman Chewing Performance Scale (KCPS), Pediatric version of the Eating Assessment Tool (PEDI-EAT-10), and Nordic Orofacial Test Screening (NOT-S) protocol, are used to collect the data. These children's carious lesions were evaluated by using the decayed, missing, filled tooth/surface (DMFT/S, dmft/s) indices, the International Caries Detection and the Assessment-II System (ICDAS-II). In total, 400 (6.5 years [78.02 months]) children were participated in the study. Their KCPS scores indicate that 58.0% of the children were at level 0 and 35.8% were at level 1. The results of the KCPS levels and the DMFT, dmft, DT, dt, MT, mt (as =0 and ≥1) were found to be statistically significant; p = .044, p = .009, p = .008, p = .000, p = .032, and p = .003, respectively. The total PEDI-EAT-10 score of 13.4% of the children was found to be 3 or higher, suggesting that they experience a problem in swallowing. According to the NOT-S, the most affected domains were "habits" (51.0%), "facial expression" (49.3%), and "chewing and swallowing" (45.3%). Among healthy children without a defined problem in swallowing and orofacial functions, the oral health status may affect orofacial functions. Decayed (particularly, extensive caries existence) or missing tooth may have critical importance for adequate chewing in children. Especially in the presence of so many decayed or missing teeth, evaluating the orofacial functions through different scales may considerably contribute to early diagnosis of functional problems.
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Affiliation(s)
- Seyma Ozturk
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Cansu Ozsin Ozler
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merih Seval Olmez
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Meryem Uzamis Tekcicek
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Pereira LF, de Deus Moura Lima M, de Moura MS, Nogueira NG, Lima CCB, de Fátima Almeida Deus Moura L. Does outpatient dental treatment have impact on the quality of life of children with early childhood caries? Clin Oral Investig 2021; 26:1605-1612. [PMID: 34409493 DOI: 10.1007/s00784-021-04133-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
AIM To assess the impact of outpatient dental treatment on oral health-related quality of life (OHRQoL) of children and their families. MATERIALS AND METHODS This prospective observational study was conducted with children with untreated dental caries, recruited from a public university/the pediatric dentistry clinic of a public university in the northeastern Brazil. Sociodemographic data were collected, a clinical examination was carried out before and after dental treatment, and the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was applied to those responsible for the children, before and after dental treatment. Descriptive and bivariate statistics were used, and the Wilcoxon and Student's t tests were applied (p < 0.05). RESULTS The study included 64 children, of both sexes, aged between 3 and 5 years old. The majority had a dmft index higher than or equal to 6 (60.9%), with a mean value of 7.11 (± 4.11). Sociodemographic conditions such as sex, age, and socioeconomic status had no impact on their OHRQoL (p > 0.05). The mean total ECOHIS questionnaire scores and those of its domains decreased after completion of the treatments (p < 0.05), except for scores in the self-image and distress domains of the parents (p > 0.05). This study reinforces the relevance of adopting oral health policies aimed at the prevention and treatment of ECC. CONCLUSION Outpatient dental treatment had a positive impact on the OHRQoL of children and their families. CLINICAL RELEVANCE The possibility of evaluating the services provided by the pediatric dentistry clinic.
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Affiliation(s)
- Laiane Fernandes Pereira
- Postgraduate Program in Dentistry, Federal University of Piaui, Campus Universitário Ministro Petrônio Portella-Bloco 5, Teresina (Piaui), 64049-550, Brazil
| | - Marina de Deus Moura Lima
- Postgraduate Program in Dentistry, Federal University of Piaui, Campus Universitário Ministro Petrônio Portella-Bloco 5, Teresina (Piaui), 64049-550, Brazil
| | - Marcoeli Silva de Moura
- Postgraduate Program in Dentistry, Federal University of Piaui, Campus Universitário Ministro Petrônio Portella-Bloco 5, Teresina (Piaui), 64049-550, Brazil
| | - Natália Gonçalves Nogueira
- Postgraduate Program in Dentistry, Federal University of Piaui, Campus Universitário Ministro Petrônio Portella-Bloco 5, Teresina (Piaui), 64049-550, Brazil
| | - Cacilda Castelo Branco Lima
- Postgraduate Program in Dentistry, Federal University of Piaui, Campus Universitário Ministro Petrônio Portella-Bloco 5, Teresina (Piaui), 64049-550, Brazil
| | - Lúcia de Fátima Almeida Deus Moura
- Postgraduate Program in Dentistry, Federal University of Piaui, Campus Universitário Ministro Petrônio Portella-Bloco 5, Teresina (Piaui), 64049-550, Brazil.
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Guo Q. Understanding the oral processing of solid foods: Insights from food structure. Compr Rev Food Sci Food Saf 2021; 20:2941-2967. [PMID: 33884754 DOI: 10.1111/1541-4337.12745] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 01/25/2023]
Abstract
Understanding the relationship between the structure of solid foods and their oral processing is paramount for enhancing features such as texture and taste and for improving health-related factors such as management of body weight or dysphagia. This paper discusses the main aspects of the oral processing of solid foods across different categories: (1) oral physiology related to chewing, (2) in-mouth food transformation, (3) texture perception, and (4) taste perception, and emphasis is placed on unveiling the underlying mechanisms of how food structure influences the oral processing of solid foods; this is exemplified by comparing the chewing behaviors for a number of representative solid foods. It highlights that modification of the texture/taste of food based on food structure design opens up the possibility for the development of food products that can be applied in the management of health.
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Affiliation(s)
- Qing Guo
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,National Engineering Research Center for Fruit and Vegetable Processing, China Agricultural University, Beijing, China.,Key Laboratory of Fruits and Vegetables Processing of Ministry of Agriculture and Rural Affairs, China Agricultural University, Beijing, China
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Schwartz C, Person O, Szleper E, Nicklaus S, Tournier C. Effects of Apple Form on Energy Intake During a Mid-Afternoon Snack: A Preload Paradigm Study in School-Aged Children. Front Nutr 2021; 8:620335. [PMID: 33842520 PMCID: PMC8032931 DOI: 10.3389/fnut.2021.620335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/25/2021] [Indexed: 12/24/2022] Open
Abstract
Consuming foods with a form or a texture that requires longer oral processing is a way to decrease food intake. Although this approach is promising for leveraging healthier eating patterns in adults, it has never been explored in children. This study evaluated whether starting a mid-afternoon snack by eating either apple segments or applesauce would modify hunger and subsequent food intake during this meal. Forty-four children (8-10 years old) participated in two videotaped mid-afternoon snacks, during which they received one of the two forms of apple as a food preload followed 10 min later by ad libitum consumption of sweetened cottage cheese. They self-reported their level of hunger throughout consumption, and the weight of cottage cheese consumed was determined at the end of the snack. Children's chewing capabilities and eating traits were parent-reported. Eating a raw apple increased oral exposure time and decreased bite size compared to eating applesauce. However, neither the reported hunger nor consecutive food intake were modified. Regardless of the meal, children eating fast had a higher ad libitum energy intake. The individual eating rate for the cottage cheese was correlated with the eating rate observed for applesauce but not for apple segments, the latter being associated with children's chewing difficulties. This study suggests that the form of a fruit offered at the start of a mid-afternoon snack does not impact food intake; the findings clearly call for more exploration of satiation mechanisms related to food texture properties among children and indicate the need to consider children's oral processing skills.
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Affiliation(s)
- Camille Schwartz
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Ophélie Person
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Emilie Szleper
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Carole Tournier
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
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