Rare diseases with oral components: care course and quality of life

AIM

To describe links between the care course of individuals suffering from rare diseases and socio-behavioural risk factors and to ascertain the impact of dental conditions on the quality of life.

DESIGN

A cross-sectional comparative study involving self-reported questionnaire was performed. Care course was evaluated using predisposing, enabling and needs factors. The impacts of dental conditions on quality of life were measured with the OHIP 14 questionnaire. Proportions were compared by Chi-square test. Logistic regression for multivariate analysis assessed statistical association between variables.

RESULTS

Responses were received from 355 subjects (mean age 36.9 years, 67.6% females). Thirty-three rare diseases were recorded. Respondents were classified as group A, individuals suffering from rare diseases with a dental component (n=207, 58.3%), and group B, without dental component. Group A reported earlier diagnosis, more positive attitude toward dentists, functional limitation and higher prosthetic treatment needs. Only 17.4% of subjects having fewer than 20 teeth wear prosthetics. A higher percentage of individuals claiming pain, physical disability, psychological discomfort and social disability, was found among group B (p<0.001). Logistic regression analysis retained two impact factors: psychological disability (Exp(B)=8.66; 95% CI 1.86-40.34) and social wellbeing (Exp(B)=0.06; 95% CI 0.02-0.215).

CONCLUSION

Rare diseases with a dental component benefited from earlier identification of symptoms. Dentists could contribute to patients' quality of life by helping in early diagnosis, reducing functional limitation and improving social wellbeing.

Evaluation of a dental care program for school beginners in a Paris suburb

OBJECTIVES

Dental care for children is available in France, but the method of administration is cumbersome: care is generally provided by private dentists, and parents can claim reimbursement of at least 70% of the costs afterwards. In the Département of Val d'Oise (north of Paris and including some densely populated suburbs), a scheme is in place to provide 100% reimbursement. To encourage participation, schoolchildren are screened by dentists who advise if treatment is needed. The objective of this study was to ascertain the effectiveness of screening as a stimulus for seeking dental care.

METHODS

In two towns, 6-7-year-old schoolchildren were cluster-sampled to give 507 participants. At screening, about half of the participants were found to be in need of operative treatment. Questionnaires about demographic and other background factors were sent home. From those needing treatment, 186 (77%) sets of questionnaires were returned. These persons were the analytical basis of the study. Six months after screening, the 186 participants were examined to estimate whether they had sought and received treatment as advised.

RESULTS

The majority of the participants came from low socioeconomic and deprived backgrounds. Most of the parents were born in countries outside Europe. Only about one-quarter of the children advised to seek treatment had actually done so after 6 months. Slightly under half of those who were treated had claimed the reimbursable amount after the treatment. Of the 186 participants needing treatment, 24% had more than 4 dt + DT but 70% of these had not received any care.

CONCLUSION

These findings suggest that even when costs are totally reimbursed, most children in need of care do not receive it; the greater the need of care, the lower the likelihood of getting it. The deprived people and immigrants frequently inhabiting the Parisian suburbs seem to experience cultural, financial, linguistic, and administrative barriers to care, which impede uptake and which must be changed if these children are to enjoy improved dental health.

Quality of prosthetic care: patients' level of expectation, attitude and satisfaction

The aim of this study was to compare pre-treatment level of expectation and attitude and post treatment level of satisfaction with different types of prosthetic treatment according to socio-economic and demographic factors. 162 patients attending for a prosthetic rehabilitation completed an initial questionnaire to assess their level of expectation and attitude; after completion of their treatment, a second questionnaire was mailed to evaluate the level of satisfaction. 94 answers were returned (response rate: 62%). Results showed a high level of satisfaction after all prosthetic treatment, but a significant decrease after treatment when compared to level of expectation and attitude before treatment. Statistical analysis failed to show significant differences between prosthetic treatment, but demonstrated that the place of residence or level of income variable had some influence on the level of expectations and satisfaction. In this population, it was concluded that the pre-treatment data studied had limited value in predicting the outcome of the different prosthetic treatments performed.

Socio-economic characteristics and personal attitudes of patients attending a French prosthodontic teaching clinic

The aims of the study were to define the socio-economic characteristics of patients attending a Teaching Hospital Prosthetics Department and to determine the attitudes and aspirations of such patients. The study was performed on 162 patients who requested prosthetic treatment in a French university dental hospital department. They were asked to complete a questionnaire at the beginning of their treatment. The questionnaire was composed of 2 parts, covering respectively: firstly, social, economic, and demographic data concerning the patients, the source of referral and the primary motivation for their decision to request treatment, and secondly comments concerning their prosthetic treatment. The results show the socio-professional and socio-economic diversity of this population. In most cases, the patients were recommended to the university hospital service by their relatives or friends. Among the criteria proposed, they indicate that cost and quality of treatment were their major motivation. Analysis of the patients' comments identifies some factors responsible for the lack of efficiency associated with care and dental education.

Phenotypic characterization of the 3/A/1D-1M osteogenic cell line derived from in vivo transplantation of 3/A/1D-1 chondroprogenitor murine teratocarcinoma cells

Bone cells involved in the replacement of cartilage by bone in the endochondral ossification process are known to enter via the medullar pathway. A hypothesis for the development of osteoblasts from chondroblasts was investigated by analyzing the phenotypic characteristics of the 3/A/1D-1M cell line derived from endochondral bone ossicle which was formed after in vivo transplantation of 3/A/1D-1 chondroprogenitor mouse teratocarcinoma cells. The 3/A/1D-1M cell cultures exhibited a triphasic evolution: after reaching confluence (day 3), cultures developed well-delimited cell clusters (days 6-8), which ultimately were organized into multilayered nodules (days 12-15). Electron-microscopic examination of such nodules at day 18 showed the presence of needle-shaped crystals associated with collagen fibrils in the extracellular space. The kinetics of collagen expression, investigated by an immunofluorescence staining procedure showed that, while confluent cultures mainly expressed type III collagen (70% of cells) with some type I (30-40% of cells) and V (30-40% of cells), the type I collagen became the major isoform beginning with day 6. From day 6 onwards, NP40-extracted alkaline phosphatase (AP) activity appeared concomitantly to cell cluster formation, and reached 160 nmol/min/mg of protein at the stage of nodule maturation (day 15). The strong inhibition of enzymatic activity by levamisole and L-homoarginine (IC50 = 0.9 microM and 5 mM, respectively) and its rapid heat inactivation at 56 degrees C (IT50 = 90 s), revealed the bone specificity of AP expressed by 3/A/1D-1M cells. In confluent cultures, brief exposure to parathyroid hormone (10 nM), known to be a bone-resorbing agent, showed a 60% increase in the intracellular cAMP level. In addition, while producing mRNA for the bone-specific protein osteocalcin, 3/A/1D-1M cells also produced type II procollagen mRNA, known to be the major cartilage-related characteristic. This in vitro study demonstrates that the 3/A/1D-1M clonal cell line, originating from 3/A/1D-1 chondroprogenitor cells after in vivo passage, was able to develop differentiated osteoblastic properties as well as the residual expression of the major chondrocytic RNA messenger.

Collagen expression during teratocarcinoma cell line-induced endochondral bone tumor

Collagen immunotyping by indirect immunofluorescence was performed in order to investigate the sequential development of bone formation. Osseous tumors were obtained after subcutaneous injection of 3/A/1D-1 teratocarcinoma cell line into 129/Sv mice (Nicolas et al., 1980). Frozen sections of developing tumors were incubated with specific antibodies directed against Types I, II, III, IV, and IX collagens. On Day 9, the expression of Type I and Type III collagens was correlated with the proliferation of mesenchymal cells. From Day 10, chondrogenesis was characterized by the occurrence of cartilaginous collagens, Types II and IX, in the cartilage matrix. Type IV collagen was also detected in focal areas and revealed vascular invasion of the tumor. On Day 13, osteogenesis was demonstrated by the presence of Type I collagen in the bone matrix coating the surfaces. Immunolocalization of Type III collagen on the hemopoietic elements corresponded with the bone remodeling. The sequential transitions of collagen types confirm the development of an endochondral bone tumor. These results suggest that 3/A/1D-1 teratocarcinoma cell line constitutes a valuable system for in vitro study of endochondral bone formation and cell differentiation.