Preclinical motor chunking and fine motor skill learning in fixed prosthodontics: Contribution of 3D printing and satisfaction of dental students

INTRODUCTION

In fixed prosthodontics, simulators are essential to students for a progressive transition from preclinical to clinical condition. With the 3D printing technology, we developed resin bars allowing students to better visualise by motor chunking technique. Main objectives of this work were to describe this teaching methodology used in preclinic among different promotions of second, third and fourth dental years and to evaluate students' feedback.

MATERIALS AND METHODS

Two hundred seventy resin strips were digitally designed and printed in resin. All participants from second, third and fourth had to fulfil a User Experience Questionnaire (UEQ) after the preclinical work. The scales of this questionnaire covered the complete impression of the user experience. Both classical aspects of usability (efficiency, insight and reliability) and aspects of user experience (originality, stimulation) were measured.

RESULTS

For the second dental years, 'Attractiveness', 'Stimulation' and 'Novelty' were considered 'Excellent'. For the third dental year, novelty average was considered as 'Excellent'. For the fourth dental year, 'novelty' was considered as 'Good'.

DISCUSSION

The resin plates used in this study are original and stimulating for the students, especially for the second-year dental students who found the exercises useful for their learning. This method can also be used by creating scenarios close to the clinical situations encountered in dentistry departments (more dilapidated teeth, preparation of inlays, post and core, etc.). This 3D printed simulation model is not intended to replace the Frasaco® models but is a complement to the learning process.

Dental public health: Context, challenges, and perspectives

The discipline of “dental public health” derives its epistemological legitimacy from the unique position of dental surgeons within the realm of health care. It serves as a crucial bridge between the domain of public health and the field of dental science. The development of “dental public health” holds a twofold significance. First, it acknowledges and assesses the evolving landscape of public health, societal changes, determinants of overall health, environmental challenges, and global concerns. Its purpose is to guide policy decisions, education, research, and dental practices toward the greater good, ensuring equitable access to care and fostering technical and social innovation. Second, “dental public health” has the potential to contribute to the broader health care domain by transferring the diverse insights gained from dental surgery and its historical context. The independence of dental surgery, while sometimes posing challenges to interdisciplinary collaboration, also offers opportunities for progress through innovative solutions. In an era of patient partnerships and a growing emphasis on equality, diversity, and inclusion, it is imperative to consider the inclusion of patient representatives within the “dental public health” community. This inclusion can further enhance the discipline’s capacity to address contemporary health care challenges effectively.

Towards planetary oral health

It is time to consider the protection of our environment as a major public health issue in oral medicine. Evidence shows that activities related to dental practice, such as patient transportation, use of rare materials and chemicals, or energy consumption, affect our ecosystems and contribute to the global degradation we are increasingly observing. The degradation of our environment is considered the greatest threat to our health. Exposure of oral tissues to multiple environmental factors can lead to pathological conditions. In addition to these direct effects, there are more complex phenomena, leading to co-deficits in the health of populations. The example of the sugar industry illustrates the systemic failures resulting in the double degradation of the environment and the health of individuals. Face with these dynamically interacting phenomena, human communities must consider systemic responses such as those described in this article. The dental community will need to do its part and consider global oral health as a central issue. This conceptual work will help define the innovations and action needed to ensure equitable practice that respects planetary limits.

The pedagogical value of parallel charts for dental students in clinical education: A qualitative study

INTRODUCTION

Narrative medicine is a novel approach aimed at attending to the socio-emotional aspects of illness and care. Parallel charts represent one of the tools of narrative medicine and are brief accounts of care in which practitioners can express their feelings and emotions towards patients and treatments. They are, therefore, intended to collect practitioners' feedback in the form of "narrative" tools to encourage reflection.

MATERIALS AND METHODS

This is a single-centre observational pilot study comprising the setting up and analysis of parallel charts in two classes of 5th and 6th year students in a Paediatric Dentistry Department in France. Forty-four students completed 126 parallel charts. A qualitative, thematic, analysis was conducted and the charts were also classified according to the three types of description of illness made by Arthur Kleinman.

RESULTS

This work showed that dental students mainly compiled parallel charts from a disease-centred perspective. The qualitative analysis identified the various themes addressed by the student: relationship with patients and managing children's anxiety, student stress, relationship with the environment or with lecturers.

CONCLUSION

The qualitative analysis highlighted the usefulness of compiling parallel charts by the students to allow them to express both positive and negative feelings, and thus to adopt a self-evaluative approach regarding their practices based on emotional impact. Parallel charts may improve patient-practitioner relationship, but more extensive studies over longer periods of time need to be undertaken.

The Hôtel-Dieu Saint-Jacques of Toulouse: Oldest Dental Site still in Activity?

The Hôtel-Dieu Saint-Jacques of Toulouse (in Southwest France) is an ancient hospital officially existing since the 16th century and initially dedicated to the treatment of the poor and the destitute. In the 18th century, it became a hospital in the "modern" sense of the word, by maintaining health and trying to cure diseases. The first official traces of professional dental care in the Hôtel-Dieu Saint-Jacques by a dental surgeon date from 1780. From this period, the Hôtel-Dieu Saint-Jacques had a dentist to treat "paupers" in the early years. The first "officially" recorded dentist was named Pierre Delga, known for having treated the French Queen Marie-Antoinette for a difficult extraction. Delga also provided dental care to the famous French writer and philosopher Voltaire. The aim of this article is to relate the history of this hospital along with French dentistry, and to advance the hypothesis that the Hôtel-Dieu Saint-Jacques, now a hospital site of the Toulouse University Hospital, is probably the oldest building in Europe still in activity and still hosting a dentistry department.

Relationship between internet research data of oral neoplasms and public health programs in the European Union

BACKGROUND

Tobacco and alcohol are the main risk factors for oral squamous cell carcinoma, the low survival rate of which is a public health problem. European-wide health policies (a prevention campaign, tobacco packaging) have been put in place to inform the population of the risks associated with consumption. Due to the increase in smoking among women, the incidence of this disease remains high. The identification of internet research data on the population could help to measure the impact of and better position these preventive measures. The objective was to analyze a potential temporal association between public health programs and interest in oral cancers on the internet in the European Union (EU).

METHODS

A search of data from Google ©, Wikipedia © and Twitter © users in 28 European countries relating to oral cancer between 2004 and 2019 was completed. Bibliometric analysis of press and scientific articles over the same period was also performed. The association between these data and the introduction of public health programs in Europe was studied.

RESULTS

There was a temporal association between changes in tobacco packaging and a significant increase in internet searches for oral cancer in seven countries. Unlike national policies and ad campaigns, the European awareness program Make Sense has had no influence on internet research. There was an asymmetric correlation in internet searches between publications on oral cancer from scientific articles or "traditional" media (weak association) and those from internet media such as Twitter © or Wikipedia © (strong association).

CONCLUSION

Our work highlights seven areas around which oral cancer awareness in Europe could be refocused, such as a change in the communication of health warnings on cigarette packs, the establishment of a more explicit campaign name regarding oral cancer, the involvement of public figures and associations in initiatives to be organized at the local level and the strengthening of awareness of the dangers of tobacco in the development of oral cancer.

Recent Advances in Cone-beam CT in Oral Medicine

BACKGROUND

The cone-beam computed tomography (CBCT) technology has continuously evolved since its appearance in oral medicine in the early 2000s.

OBJECTIVES

To present recent advances in CBCT in oral medicine: i) selection of recent and consensual evidence-based sources, ii) structured summary of the information based on an iterative framework and iii) compliance with ethical, public health and patient-centered concerns.

MAIN FINDINGS

We will focus on technological advances, such as sensors and reconstruction algorithms used to improve the constant quality of the image and dosimetry. CBCT examination is now performed in almost all disciplines of oral medicine: currently, the main clinical disciplines that use CBCT acquisitions are endodontics and oral surgery, with clearly defined indications. Periodontology and ear, nose and throat medicine are more recent fields of application. For a given application and indication, the smallest possible field of view must be used. One of the major challenges in contemporary healthcare is ensuring that technological developments do not take precedence over admitted standards of care. The entire volume should be reviewed in full, with a systematic approach. All findings are noted in the patient's record and explained to the patient, including incidental findings. This presupposes the person reviewing the images is sufficiently trained to interpret such images, inform the patient and organize the clinical pathway, with referrals to other medical or oral medicine specialties as needed.

CONCLUSION

A close collaboration between dentists, medical physicists, radiologists, radiographers and engineers is critical for all aspects of CBCT technology.

Is the dental profession ready for person-centred care?

Introduction In the last decades, health professions have progressively moved towards person-centredness. Dentistry, however, lags behind the other health professions and remains deeply anchored in a biomedical vision.Aims Our objective was thus to better understand how dentists perceived person-centred care (PCC) and identify the challenges they may face in implementing it.Methods We conducted qualitative descriptive research in the province of Quebec, Canada; it was based on in-depth interviews with 11 general dental practitioners working in private clinics.Results Thematic analyses reveal that dentists had little interest in understanding the life and stories of their patients. Furthermore, their openness to share decision-making was limited to procedures that they considered of relatively low value and less for procedures they considered of higher value, such as indirect restorations.Discussion We argue that dentists' reluctance to understanding and shared decision-making is rooted in the old-established identity of dentistry as an art. Dentists indeed considered the dental craft as sacred - an art form with unbreakable axioms that defined quality of care.Conclusion It is time for the dental profession to reflect on its ideological foundations and reconsider its identity. This reflection is crucial to respond to the needs of a changing society that is losing its confidence in the profession.

What do we know about portable dental services? A scoping review

BACKGROUND

Delivering dental care to patients in their home or residential institutions is known as "portable dentistry". The demand for portable dental services is on the rise, but dentists remain reluctant to adopt portable practices.

OBJECTIVES

To explore the literature on portable dental services and understand (a) the process of planning and delivering portable dental services and (b) the benefits and challenges of portable dentistry for service providers and patients.

METHODS

A systematic scoping search was conducted. We retrieved 3994 documents, 28 of which were included in the final synthesis. Three authors read the papers and conducted thematic content analyses independently.

RESULTS

We present a synthesis of the literature and proposed a model of portable dentistry containing three levels with the patient is at the centre surrounded by concentric rings representing the dentist (dental team) and society. At each of these levels, our model is further subdivided into three components: 1) organisation of the service; 2) arrival and set-up of the service; and 3) delivery of the service. In addition, each level includes 1) human factors, which are related either to the dental professional or the patient; 2) non-human factors, which refer to either the equipment or the physical environment; and 3) financial factors, which are related to cost and remuneration.

CONCLUSIONS

We propose a model for portable dentistry that dentists and dental educators interested in this practice should find useful.

A scoping review on dental clinic accessibility for people using wheelchairs

AIMS

We aimed to explore the scientific literature on accessible dental clinics for wheelchair users. More specifically, we sought out literature addressing how the human environment and physical space shape the dental services of accessible dental clinics.

METHODS

We conducted a scoping review (May 2019) in Embase, PubMed, Web of Science, and the Avery index of architectural Periodicals (3994 articles). We followed Arksey and O'Malley's recommended procedures; after screening, we retained 17 articles. We performed a critical appraisal, followed by thematic content analyses of extracted data.

RESULTS

The articles originated mainly from the United States and United Kingdom. Only three reported original research. We illustrated the results within a three-step dental care pathway cycle. In each step, the interaction between accessibility of the physical and human environments (ie, the layout/design of the clinic and the attitudes and skills of the dental professional, respectively) contributed to the overall accessibility. We also found that empirical evidence on clinics' accessibility was lacking: many articles resorted to broad "one size fits all" recommendations and fragmented information on accessibility. Finally, the voice of wheelchair users was missing.

CONCLUSION

There are knowledge gaps in terms of dental clinics' accessibility. We thus invite researchers to conduct original studies with dental professionals, wheelchair users, and their caregivers.

Prevalence of sensitive teeth and associated factors: a multicentre, cross-sectional questionnaire survey in France

BACKGROUND

As far as we know, little data, whether obtained from self-administered questionnaires or upon dental clinical examination, has been published on the prevalence of sensitive teeth (ST) in the French adult population. The objectives of the present work were to estimate ST prevalence and characteristics in the general population of France and to explore the associated factors.

METHOD

A multicentre cross-sectional study was conducted between November 2011 and March 2013 in six French cities. Adult passers-by in public places were invited to answer an electronic questionnaire on a tablet computer. Only people who declared having at least one natural tooth were included in the study. A logistic regression model was used for the multivariate analysis.

RESULTS

The prevalence of ST during the previous 12 months reported by the sample of 2413 participants was 42.2% [95% CI: 40.2-44.1%]. The final logistic regression model showed significant statistical associations between ST and female gender, use of tobacco, consumption of soft drinks, limited access to oral care and poor oral hygiene habits (p < 0.05).

CONCLUSIONS

This study provides prevalence data on ST in a general population in France, which seems to remain high despite the existence of many therapies. It should alert professionals to a clinical manifestation that is becoming increasingly prevalent and that they will have to take into consideration to help reduce the discomfort arising from it.

Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

BACKGROUND

We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations.

METHODS

We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants.

RESULTS

When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants; (2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks-apprehension about long waiting times was mentioned by several participants.

CONCLUSIONS

Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation.

The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial

OBJECTIVES

To assess the effect of periodontal treatment on clinical and biochemical parameters of rheumatoid arthritis (RA) and quality of life (QoL) in patients with moderately active RA who were diagnosed with periodontitis.

METHODS

In this open-label randomised controlled trial, RA subjects (n = 22) were allocated to "immediate" or "delayed" periodontal treatment (full-mouth non-surgical scaling and root planing, systemic antibiotics, and oral hygiene instructions). The main outcome was the 3-month change on the Disease Activity Score 28 based on the Erythrocyte Sedimentation Rate (DAS28-ESR). The Health Assessment Questionnaire and the General Oral Health Assessment Index were used to assess general and oral health QoL, respectively.

RESULTS

Periodontal health significantly improved after periodontal treatment (P = 0.03). Periodontal treatment appeared to be safe but led to no significant effects on the DAS28-ESR (adjusted mean difference with 95% confidence interval (aMD) of -0.03 [-0.98; 0.92]). There was no evidence of improvement in the general QoL after periodontal treatment and no significant effect was found for the oral health QoL, despite a positive trend in the "psychological impacts" domain (aMD of 0.13 [-0.07; 0.33], P = 0.20).

CONCLUSIONS

Although no clinical effect of periodontal treatment on RA was identified, this trial provides important data to support periodontal care in RA patients. Periodontal treatment is safe and reduces oral inflammation with a possible effect on oral health QoL. Since both periodontitis and RA are complex and multifactorial chronic diseases, it is likely that patient-centred approaches involving both oral health professionals and rheumatologists will contribute to optimal patient care. ISRCTN79186420.

Comparison of student's perceptions between 3D printed models versus series models in paediatric dentistry hands-on session

INTRODUCTION

Dental education emphasises the acquisition of technical skills. Recent advances in 3D printing technologies have enabled the emergence of new educational tools usable in hands-on work sessions. The possibility to print 3D models from CT scans of patients is now available to dental practitioners. The aim of this study was to develop and evaluate a 3D printed model for paediatric dentistry training and compare it to the reference model used in our faculty.

MATERIALS AND METHOD

3D models were obtained by modifying and printing the CT scan of a young patient using the Voco® Solflex 350 3D® printer and Voco® V-print resin. Thirty-four students were asked to perform a pulpotomy and preparation for a stainless steel paediatric crown on tooth 85 on both the 3D printed model and the industrial model (Frasaco®), and then to answer a questionnaire. The data were analysed using R software.

RESULT

Both models obtained high scores. The learning potential and its applicability to clinical practice showed no statistically significant difference. Although the colour and the simulation of the proximal area disturbed the students (P = 0.009), the 3D models were seen as a good idea (P = 0.012). When it came to model design, the students appreciated the simulation of caries on 3D models (P = 0.0001) and considered the use 3D of models as a more realistic experience (P = 0.017).

DISCUSSION

Although this study has some limitations (number of participants, choice of the models to be compared), it constitutes the first attempt to compare students' perception of 3D and series models. It shows that 3D technology makes it possible to obtain models of similar quality while offering a more realistic experience.

CONCLUSION

There are still many ways in which these models could be improved. For example, modifying the quality of resins could improve the milling sensation, and the design could be improved to achieve better contact points. Nevertheless, these 3D models offer the possibility to give the patient a more central place in the education of future practitioners.

The intriguing evolution of effect sizes in biomedical research over time: smaller but more often statistically significant

Background

In medicine, effect sizes (ESs) allow the effects of independent variables (including risk/protective factors or treatment interventions) on dependent variables (e.g., health outcomes) to be quantified. Given that many public health decisions and health care policies are based on ES estimates, it is important to assess how ESs are used in the biomedical literature and to investigate potential trends in their reporting over time.

Results

Through a big data approach, the text mining process automatically extracted 814 120 ESs from 13 322 754 PubMed abstracts. Eligible ESs were risk ratio, odds ratio, and hazard ratio, along with their confidence intervals. Here we show a remarkable decrease of ES values in PubMed abstracts between 1990 and 2015 while, concomitantly, results become more often statistically significant. Medians of ES values have decreased over time for both “risk” and “protective” values. This trend was found in nearly all fields of biomedical research, with the most marked downward tendency in genetics. Over the same period, the proportion of statistically significant ESs increased regularly: among the abstracts with at least 1 ES, 74% were statistically significant in 1990–1995, vs 85% in 2010–2015.

Conclusions

whereas decreasing ESs could be an intrinsic evolution in biomedical research, the concomitant increase of statistically significant results is more intriguing. Although it is likely that growing sample sizes in biomedical research could explain these results, another explanation may lie in the “publish or perish” context of scientific research, with the probability of a growing orientation toward sensationalism in research reports. Important provisions must be made to improve the credibility of biomedical research and limit waste of resources.

The effects of periodontal treatment on diabetic patients: The DIAPERIO randomized controlled trial

AIM

To assess whether periodontal treatment can lead to clinical, glycaemic control and quality of life improvements in metabolically unbalanced diabetic patients (type 1 or type 2) diagnosed with periodontitis.

METHODS

In this open-labelled randomized controlled trial, diabetic subjects (n = 91) were given "immediate" or "delayed" periodontal treatment (full-mouth non-surgical scaling and root planing, systemic antibiotics, and oral health instructions). The main outcome was the effect on glycated haemoglobin (HbA_1C ) and fructosamine levels. The General Oral Health Assessment Index and the SF-36 index were used to assess quality of life (QoL).

RESULTS

Periodontal health significantly improved after periodontal treatment (p < 0.001). Periodontal treatment seemed to be safe but had no significant effects on glycaemic control based on HbA_1C (adjusted mean difference with a 95% confidence interval (aMD) of 0.04 [-0.16;0.24]) and fructosamine levels (aMD 5.0 [-10.2;20.2]). There was no obvious evidence of improvement in general QoL after periodontal treatment. However, there was significant improvement in oral health-related QoL (aMD 7.0 [2.4;11.6], p = 0.003).

CONCLUSION

Although periodontal treatment showed no clinical effect on glycaemic control in this trial, important data were provided to support periodontal care among diabetic patients. Periodontal treatment is safe and improves oral health-related QoL in patients living with diabetes. ISRCTN15334496.

What is preventing dentists from providing person-centred care?

Most healthcare professions have shifted the way they teach clinical approaches from a biomedical to a person-centred perspective. Yet, dentistry remains strongly anchored in a biomedical world.The objective of this project was to understand the barriers practicing dentists face to provide what we consider person-centred care. We conducted a qualitative descriptive study that comprised semi-structured interviews with dentists in private practice in the Greater Montreal area. After the analysis, we identified six barriers:•     Fear of interpersonal conflict: participants thought that engaging in genuine conversations with patients would lead to situations of disagreement and even conflicts.•     Fear of litigation: dentists considered that the legal and licensing infrastructure would judge the treatment they provide through a strict biomedical framework.•     Fear of loss of money: participants thought that providing person-centred care was more time consuming and thus financially penalizing. •    Pleasure to excel technically: some dentists did not consider offering interventions that provided less procedural pleasure than technical ones.•    Narrow interpretation of health: participants considered the biomedical dimension as the only important dimension.•    Lack of information: participants knew nothing or very little about person or patient-centred care. They seemed willing to integrate it into their practice had they had known more about it.These findings should help academic institutions to design their programs on person-centred care and respond to the fears expressed by professionals.Also, legal infrastructures must recognize the paradigm shift from the biomedical to the person-centred. 

Person-Centered Care: Perspectives of free dental clinic users in Montréal, Canada

There has been a relatively slow incorporation of person-centered care into dental care. Despite the efforts to sustain this approach in dental health care delivery, the perspectives of patients have yet to be considered, especially those using free dental clinics. Our objectives were: (1) to describe the perspectives of adults unable to access private dental clinics when using free dental clinics, (2) to document their suggestions for improvements to dental care. This qualitative descriptive study included 13 adults using a free dental clinic. To select participants, we adopted a maximum variation sampling strategy regarding age, sex, marital status, education level and employment status. We used in-depth, semi-structured interviews to collect data and thematic content analysis to analyze the verbatim transcripts. Participants were generally satisfied with the dental care they received in private and free dental clinics. However, they did not appreciate the long wait times at free clinics, and were bothered by the cost at private clinics. They emphasized a desire for quality time with the dentist allowing for more informed and shared decisions about their care, regardless of the clinic they visited. Participants want to feel cared for through a trustworthy relationship with the clinician, and suggested incorporating a walk-in concept into free clinics to address access to care. Adults using free dental clinics have various experiences with private and public dentistry, but they all need clinicians who adopt a comprehensive approach when providing information. This could improve patients’experiences through a more person-centered approach to dental care.

Discrete Distribution Based on Compound Sum to Model Dental Caries Count Data

Methods for analysing dental caries and associated risk indicators have evolved considerably in recent decades. The use of zero-inflated or hurdle models is increasing so as to take account of the decayed, missing, and filled teeth (DMFT) distribution, which is positively skewed and has a high proportion of zero scores. However, there is a need to develop new statistical models that involve pragmatic biological considerations on dental caries in epidemiological surveys. In this paper, we show that the zero-inflated and the hurdle models can both be expressed as a compound sum. Using the same compound sum, we then present the generalized negative binomial (GNB) distribution for dental caries count data, and provide a numerical application using the data of the EPIPAP study. The GNB model generates the best score functions while handling the lifetime dental caries disease process better. In conclusion, the GNB model suits the nature of some count data, in particular when structural zeros are unlikely to occur and when several latent spells can lead to new countable events. For these reasons, the use of the GNB distribution appears to be relevant for the modelling of dental caries count data.

Effect of a Person-Centered Course on the Empathic Ability of Dental Students

Person-centered or patient-centered care (PCC) focuses on the individual's needs and concerns. Although PCC is widely acknowledged as a core value of modern medicine, there has been a lack of research on how dental curricula could engage future dentists in PCC approaches. The aim of this study was to assess the impact of a PCC course on empathy in dental students. A controlled study was conducted with fourth-year dental students in four dental faculties in France in 2014-15. The test group (n=63) received 20 hours of PCC training including arts-based approaches, narrative dentistry activities, and workshops on communication based on the Calgary-Cambridge guide. There was no change in the curriculum of the control group (n=217). Pretest and posttest measures with the Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) were compared for the two groups. The comparisons showed no significant differences on the TEQ or JSPE (p=0.25 and p=0.08, respectively). However, there was a higher proportion of students with more than an eight-point decrease in TEQ values in the control group (p=0.02). The stabilization of empathic ability in the test group may have counteracted the tendency for natural erosion of empathy among students during their clinical activities. These results suggest that PCC training constitutes a promising approach to developing dental students' empathic ability, but there is a need to assess the effects of such training over longer periods.

Spatial and temporal structure of the clinical research based on mesenchymal stromal cells: A network analysis

BACKGROUND AIMS

Using innovative tools derived from social network analysis, the aims of this study were (i) to decipher the spatial and temporal structure of the research centers network dedicated to the therapeutic uses of mesenchymal stromal cells (MSCs) and (ii) to measure the influence of fields of applications, cellular sources and industry funding on network topography.

METHODS

From each trial using MSCs reported on ClinicalTrials.gov, all research centers were extracted. Networks were generated using Cytoscape 3.2.2, where each center was assimilated to a node, and one trial to an edge connecting two nodes.

RESULTS

The analysis included 563 studies. An independent segregation was obvious between continents. Asian, South American and African centers were significantly more isolated than other centers. Isolated centers had fewer advanced phases (P <0.001), completed studies (P = 0.01) and industry-supported studies (P <0.001). Various thematic priorities among continents were identified: the cardiovascular, digestive and nervous system diseases were strongly studied by North America, Europe and Asia, respectively. The choice of cellular sources also affected the network topography; North America was primarily involved in bone-marrow-derived MSC research, whereas Europe and Asia dominated the use of adipose-derived MSCs. Industrial funding was the highest for North American centers (90.5%).

CONCLUSIONS

Strengthening of international standards and statements with institutional, federal and industrial partners is necessary. More connections would facilitate the transfer of knowledge, sharing of resources, mobility of researchers and advancement of trials. Developing partnerships between industry and academic centers seems beneficial to the advancement of trials across different phases and would facilitate the translation of research discoveries.

An Innovative, Comprehensive Mapping and Multiscale Analysis of Registered Trials for Stem Cell-Based Regenerative Medicine

We aim to provide an innovative, comprehensive way of mapping the profusion of stem cell-based clinical trials registered at ClinicalTrials.gov to explore the diversity of the fields of application and the temporal complexity of the domain. We used a chord diagram and phylogenetic-like tree visualizations to assist in data mining and knowledge discovery. The search strategy used the following terms: "stromal OR stem OR mesenchymal OR progenitor." The Medical Subject Headings (MeSH) thesaurus was used to more finely classify diseases treated by stem cells, from large fields of application to specific diseases. Of the 5,788 trials screened, 939 were included, 51.1% of which were related to mesenchymal stem cells (MSCs). No real specificity emerged as to the therapeutic uses of the different types of stem cells. More than half the MSC studies concerned allogeneic MSCs and received more support from industry than autologous MSC studies (p < .001). Over time, the uses of cultured cells have increased greatly, particularly since 2009. Cells derived from adipose tissue are also increasingly used in trials compared with bone marrow cells. The use of adipose-derived stromal cells was predominantly autologous (p < .001), restricted to European countries (p < .01), and supported by industry (p = .02) compared with other MSCs. Details about MeSH keywords are available at http://multireview.perso.sfr.fr/. In conclusion, mapping may reveal a lack of global strategy despite the regulations and the related costs associated with good manufacturing practices. A systematic approach to preclinical data, intended to objectively and robustly reveal the most appropriate fields with the most efficient cells, is needed. Repeated exchanges between the bench and the bedside are necessary.

SIGNIFICANCE

Except for a few trials concerning specific tissue stem cells used in their corresponding tissues, this global analysis revealed no real specificity of stem cell uses (including mesenchymal stromal cells). This raised the question of the physiopathological rationale for these uses and the lack of a global strategy despite the regulations and the related costs associated with good manufacturing practices. This original method, leading to the development of new concepts from already available data, would help policymakers to optimize resources and investments in terms of public health priorities. Such an approach should draw parallels between in vitro, in vivo, and human data. Exchanges in both directions between preclinical and clinical research could optimize the parameters of clinical trials step by step.

Clinical research activity in periodontal medicine: a systematic mapping of trial registers

AIM

The primary aim of the study was to systematically map registration records on periodontal medicine in clinical trial registers. The secondary aim was to assess the evolution of periodontal medicine in clinical periodontal research as a whole.

MATERIAL AND METHODS

We searched all registration records related to periodontology in the World Health Organization International Clinical Trials Registry Platform. For registration records classified in the field of periodontal medicine, we assigned the 2015 MeSH(®) term for the most precisely corresponding systemic condition.

RESULTS

Fifty-seven systemic conditions have been hypothesized to be linked with periodontal diseases, covering nearly 2% of the diseases indexed in MeSH. In addition to diabetes, cardiovascular disease or preterm birth, other systemic conditions have been the subject of registration records, such as anaemia, liver diseases, dyspepsia or ankylosing spondylitis. A trend towards increasing diversification of systemic conditions has appeared over time. About a third of registration records in clinical periodontal research deals with periodontal medicine.

CONCLUSIONS

Periodontal medicine now constitutes an important part of clinical periodontal research. Research activity in periodontal medicine has grown continuously since the early 2000s, and exploration of registers gives a useful up-to-date snapshot of this constantly evolving field of research.

Humanizing clinical dentistry through a person-centred model

The clinical approach in dentistry stems from a biomedical model of health that is anchored in positivism. This biomedical model was never explicitly developed or reflected on, but rather implicitly acquired as a product of historical circumstance. A reductionist understanding of health served dentistry well in the past, when health afflictions were mostly acute. Today, however, in the age of chronic illnesses, the current clinical approach is no longer adequate: patients and dentists are both dissatisfied, and there are problems with dental education and dental public health. After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based. We call this model "Person-Centred Dentistry". Our proposed model is rooted on the notion of sharing of power between the dentist and the patient: a sharing of power in the relationship and epistemology. This leads to an expanded understanding of the person and the illness; a co-authoring of treatment plans; and interventions that focus not only on eliminating disease but also on patient needs. 

Person-Centred Dentistry: When Do We Start?

Objectives: Although most health professions have adopted person-centred approaches in the last decades, dental professionals still rely on traditional paternalistic models. The objective of this research was to develop a model of person-centred care in dental practice.Methods: Adopting an action-research approach, we started our process by adapting Stewart and colleagues' model of person-centred care to the field of dentistry. We then implemented and tested the new clinical approach in a private dental office of Montreal, Canada. During several months, an academic researcher observed the clinical activities of a dental practitioner, who was also the first researcher. At the end of each appointment, the observer and the practitioner shared their observations about the encounter and evaluated the clinical approach. Both suggested improvements to the model and implemented solutions to the next patients. After 39 rounds of observation-evaluation-improvement, a form of saturation was reached in the development of the clinical approach.Results: The clinical encounter goes through four different stages. The first stage is how the relationship is built through an open dialogue on illness, fears and expectations. The second stage consists in gathering clinical information through examination, tests and questioning. The third stage is a disease-centered presentation of the results of the examination. The final stage is the development of a treatment plan after establishing a common ground through frank discussions and shared decision making. From this approach, a model emerged consisting in a stage of understanding, followed by planning, intervention, then back to understanding. This cycle takes place within the context of a patient-dentist relationship with mutual trust. This relationship, central to the encounter, acknowledges the whole-person dimension and psychosocial context of each party.Conclusions:  We hope this model will inspire other professionals and teaching institutions to develop their own approaches by using it as a theoretical framework.

Asynchronous dentofacial development and dental crowding: a cross-sectional study in a contemporary sample of children in France

Background

The causes of dental crowding are not fully understood, but it may result from an evolutionary trend towards reduced facial volume, without a proportional reduction in tooth sizes. Most previous studies conducted among modern humans have revealed a very low or non-existent correlation between tooth size and jaw size. Cross-comparison between dental age and facial skeletal age could help to provide better knowledge of the dynamic process of dental crowding. The primary objective of this research was to study the synchronism of dental maturation and skeletal facial growth in a sample of modern children living in France. The secondary objective was to assess the link between dentofacial asynchronism and dental crowding.

Results

The random sample comprised 28 subjects (16 girls, 12 boys). Mean chronological age was 13.5 years (±2.1; range 9.2–17.6). Mean dental age was 14.2 years (±2.8; range 7.5–17) and mean facial skeletal age was 12.8 years (±2.6, range 7–22). In the estimations of dental age and facial skeletal age, there was no evidence of systematic bias. There were 10 subjects (9 girls, 1 boy) with asynchronous dentofacial development. Finally, there were 13 subjects (8 girls, 5 boys) with dental crowding. A significant association was found between delayed facial skeletal growth/advanced dental maturation and dental crowding (P = 0.01).

Conclusions

Dental maturation and facial growth are not necessarily synchronous. Further understanding of the interactions between dental maturation and facial growth could have crucial implications in biological anthropology, as well as for the clinical practice of orthodontists. From an anthropological perspective, this study suggests that asynchronous dentofacial development could, at least partially, explain the frequency of dental crowding in modern populations.

[Perceived oral health and use of dental services during pregnancy: the MaterniDent study]

INTRODUCTION

The main objective of the MaterniDent study was to determine the nature and frequency of dental problems experienced by pregnant women and their associated factors. The secondary objective was to determine the frequency of dental visits during pregnancy and to identify associated factors.

METHODS

The MaterniDent study was a multicenter cross-sectional study conducted among 904 postpartum women in three French maternity wards. Data were collected using self-administered questionnaires. Measured variables included socio-demographic, health and behavioral characteristics.

RESULTS

57% of women reported having experienced at least one dental problem during pregnancy, while 20% had experienced dental pain during pregnancy. Multiparity, vomiting, soda consumption and increased sugar consumption during pregnancy were significantly associated with dental pain (p<0.05). 56% of women did not visit a dentist during pregnancy, 26% consulted a dentist for a perceived problem, and 18% visited a dentist for a check-up. Younger pregnant women and those without supplemental insurance were less likely to see a dentist for a preventive dental visit (p <0.05).

DISCUSSION

A significant proportion of women experienced a dental problem during pregnancy, although they did not necessarily consult a dentist to treat the problem. Given the impact of oral diseases for both mother and child, prevention and professional dental care during pregnancy should be promoted.

Oral health-related quality of life among outpatients with rheumatoid arthritis

OBJECTIVES

The aims of the Oral Status And Rheumatoid Arthritis (OSARA) cross-sectional study were to study the oral health-related quality of life and to assess the associated factors in a population of outpatients with rheumatoid arthritis in France.

METHODS

The data were collected by five trained and standardised dentists who asked each subject the questions of a socio-demographic, behavioural and medical questionnaire, which was completed with the medical records, and performed the dental examination. Each subject filled out two self-assessment questionnaires: the Health Assessment Questionnaire and the General Oral Health Assessment Index.

RESULTS

Seventy-three subjects were included. The mean age of the participants was 60.2 ± 11.9 years and 75.3% were women. For 58.3% of the subjects, their self-perceived oral health-related quality of life was described as poor. The logistic regression analysis found that a small number of teeth and marked difficulties in dressing and grooming were associated with bad oral health-related quality of life [ORa = 10.5 (1.96-56.19) and ORa = 4.3 (1.15-15.77), respectively].

CONCLUSIONS

More care should be given to the prevention of dental diseases in order to improve the oral health-related quality of life of patients with rheumatoid arthritis and their self-esteem, which will already be heavily affected.

Frequency and risk indicators of tooth decay among pregnant women in France: a cross-sectional analysis

INTRODUCTION

Little is known on the prevalence of tooth decay among pregnant women. Better knowledge of tooth decay risk indicators during pregnancy could help to develop follow-up protocols for women at risk, along with better prevention strategies. The aim of this study was to assess the frequency of tooth decay and the number of decayed teeth per woman in a large sample of pregnant women in France, and to study associated risk indicators.

METHODS

A secondary cross-sectional analysis of data from a French multicentre case-control study was performed. The sample was composed of 1094 at-term women of six maternity units. A dental examination was carried out within 2 to 4 days post-partum. Socio-demographic and behavioural characteristics were obtained through a standardised interview with the women. Medical characteristics were obtained from the women's medical records. Risk indicators associated with tooth decay were identified using a negative binomial hurdle model.

RESULTS

51.6% of the women had tooth decay. The mean number of decayed teeth among women having at least one was 3.1 (s.d. = 2.8). Having tooth decay was statistically associated with lower age (aOR = 1.58, 95%CI [1.03,2.45]), lower educational level (aOR = 1.53, 95%CI [1.06,2.23]) and dental plaque (aOR = 1.75, 95%CI [1.27,2.41]). The number of decayed teeth was associated with the same risk indicators and with non-French nationality and inadequate prenatal care.

DISCUSSION

The frequency of tooth decay and the number of decayed teeth among pregnant women were high. Oral health promotion programmes must continue to inform women and care providers about the importance of dental care before, during and after pregnancy. Future research should also assess the effectiveness of public policies related to oral health in target populations of pregnant women facing challenging social or economic situations.

Maternal dental caries and pre-term birth: results from the EPIPAP study

OBJECTIVE. The aim of this study was to analyse the association between maternal dental caries and pre-term birth (PTB), with a particular focus on the infection-suspected causes of pre-term births. MATERIALS AND METHODS. A secondary analysis was performed on data from the EPIPAP study, a French multi-centre case-control study. Cases were 1107 women giving birth to a singleton live-born infant before 37 weeks of gestation and controls were 1094 women delivering at 37 weeks or more. A sub-group of cases was defined as women with spontaneous labour and/or pre-term premature rupture of membranes (PPROM, n = 620). A full-mouth dental examination was performed after delivery. The main factor of interest was the presence of decay on at least one tooth. RESULTS. Crude associations between presence of tooth decay and PTB or spontaneous PTB/PPROM were significant (OR = 1.21 [1.01-1.45] and OR = 1.25 [1.01-1.55], respectively). After adjustment for two sets of potential confounders (four pre-term birth risk factors and four social characteristics), for periodontitis status and for inter-examiner variability, tooth decay was not significantly associated with either PTB or spontaneous PTB/PPROM (aOR = 1.10 [0.91-1.32] and aOR = 1.14 [0.91-1.42], respectively). CONCLUSIONS. This study failed to demonstrate a significant association between tooth decay and pre-term birth. However, future well-designed studies are needed to further assess the link between dental caries and adverse pregnancy outcomes.

Ethics in systematic reviews

Since its introduction by the Nuremberg Code and the Declaration of Helsinki, the place held by ethics in biomedical research has been continuously increasing in importance. The past 30&emsp14;years have also seen exponential growth in the number of biomedical articles published. A systematic review of the literature is the scientific way of synthesising a plethora of information, by exhaustively searching out and objectively analysing the studies dealing with a given issue. However, the question of ethics in systematic reviews is rarely touched upon. This could lead to some drawbacks, as systematic reviews may contain studies with ethical insufficiencies, may be a possible way to publish unethical research and may also be prone to conflict of interest. Finally, informed consent given for an original study is not necessarily still valid at the systematic review level. There is no doubt that routine ethical assessment in systematic reviews would help to improve the ethical and methodological quality of studies in general. However, ethical issues change so much with time and location, and are so broad in scope and in context that it appears illusory to search for a universal, internationally accepted standard for ethical assessment in systematic reviews. Some simple suggestions could nevertheless be drawn from the present reflection and are discussed in the paper.

Treating periodontal disease may improve metabolic control in diabetics

DATA SOURCES

The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, ZETOC, ISIWeb of Knowledge and LILACS databases were searched together with hand searches of the journals Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003).There were no language restrictions.

STUDY SELECTION

This review included randomised controlled trials of people with type 1 or 2 diabetes mellitus (DM) with a diagnosis of periodontitis. Suitable interventions included mechanical periodontal therapy with or without adjunctives and oral hygiene education.

DATA EXTRACTION AND SYNTHESIS

The titles and abstracts of all identified papers were examined by two review authors' independently. All included trials were assessed for risk of bias. Data were collated in evidence tables, grouped according to research design and assessed for possible meta-analysis on the basis of homogeneity of main characteristics.

RESULTS

Seven studies were included and three studies had results pooled into a meta-analysis. The effect for the mean percentage difference in HbA1c for scaling/root planing and oral hygiene (+/- antibiotic therapy) versus no treatment/usual treatment after 3/4 months was -0.40% (95% confidence interval (CI) fixed effect -0.78% to -0.01%), representing a statistically significant reduction in HbA1c (P = 0.04) for scaling/root planing. One study was assessed as being at low risk of bias with the other two at moderate to high risk of bias. A subgroup analysis examined studies without adjunctive antibiotics -0.80% (one study: 95% CI -1.73% to 0.13%; P = 0.09), with adjunctive antibiotics in the test group -0.36% (one study: 95% CI -0.83% to 0.11%; P = 0.14), and with antibiotics in both test and control groups after 3/4 months -0.15% (one study: 95% CI -1.04% to 0.74%; P = 0.74).

CONCLUSIONS

There is some evidence of improvement in metabolic control in people with diabetes, after treating periodontal disease. There are few studies available and individually these lacked the power to detect a significant effect. Most of the participants in the study had poorly controlled type 2 DM and there was little data from randomised trials on the effects on people with type 1 DM. Improving periodontal health is an important objective in itself. However, in order to understand the potential of this treatment to improve glycaemic control among people with diabetes, larger, carefully conducted and reported studies are needed.