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International audience; Background Recent evidence suggests that dietary habits influence the development and severity of periodontitis. The present cross-sectional study evaluated the association between different types and quantity of alcoholic beverage consumption (alone and interacting with smoking) and the probability to suffer from severe periodontitis in the French e-cohort NutriNet-Sante. Methods The study population consisted of 35,390 adults (mean age: 49.04 +/- 13.94 years), who filled oral health questionnaires and completed at least three non-consecutive 24-hour dietary records. Data on type and frequency of alcoholic beverage consumption were obtained from a semi-quantitative self-reported alcohol frequency questionnaire; the daily quantity (g/day) was estimated from the 24-hour dietary records. The probability of severe periodontitis (main dependent variable) was assessed by calculating the modified periodontal screening score (mPESS) from selected questions. Results A total of 7263 individuals (20.5%) presented a high probability of suffering from severe periodontitis (high-mPESS). After adjusting for confounding factors, the frequency of alcoholic beverage consumption was significantly higher among high-mPESS group than their low-mPESS counterparts, especially for hard liquor/spirits (1.9 +/- 1.4 days/week for high-PESS versus 1.6 +/- 1.1 days/week the low-PESS [P < 0.0001]). The mean daily quantity of ethanol was also higher in high-mPESS versus low-mPESS individuals (11.2 +/- 15.6 versus 7.9 +/- 12.3 g/day;P = 0.011). A stronger association with self-report severe periodontitis was noted when alcohol consumption exceeding > 20 g/day for women and > 30 g/day for men was combined with smoking habit (OR = 7.30 [95% CI: 6.1-8.73]). Conclusion The present results support an association between alcoholic beverage consumption and self-report severe periodontitis, particularly when it is associated with current smoking.

To study the association between chewing capacity-a prerequisite for eating- and the level of cardiovascular health (CVH).This is a cross-sectional analysis conducted on 5430 study participants from the Paris Prospective Study 3 that were subjected to an oral examination by trained dentists at study recruitment between 2008 and 2012. Chewing capacity was determined by the number of functional tooth units (FTUs), and ≥ 5FTUs defined adequate chewing capacity. Subjects were categorized into poor, intermediate, or ideal CVH for the 4 behavioural (smoking status, body mass index, physical activity, diet) and the 3 biological (total cholesterol, fasting glycemia, and blood pressure) factors according to the American Heart Association Life's Simple 7. Multinomial logistic regression was used to explore the association between the number of FTUs (exposure) and ideal or intermediate vs. poor CVH (main outcome).10.31% of the study participants had an ideal CVH and 7% presented an impaired chewing capacity (5 FTUs). Subjects with at least 5 FTUs (OR = 2.37; 95% CI: 1.37-4.12) were more likely to have an ideal global CVH, after adjustment for age, sex, marital status, education, deprivation, depressive status, and dental plaque. This association existed for the behavioural but not the biological CVH, with the strongest association being observed with the diet metric.This is the first study suggesting that adults with a preserved chewing capacity have an increased likelihood to be at an ideal behavioural CVH.

Impaired oral health is a well-known complication in individuals with eating disorders, although this is difficult to identify by mental health professionals. The aim of this study was to evaluate the relationship between routine blood parameters and two oral health outcomes (dental erosion, reduced periodontium) in women with eating disorders. A face-to-face interview and a clinical oral examination were carried out in a cohort of 70 women from an addiction and psychiatry hospital unit. Biochemical and hematological parameters were collected in medical records at admission. Biological factors associated with a generalized reduced periodontium (≥ 30% of sites with clinical attachment loss ≥ 3 mm) and dental erosion [a basic erosive wear examination (BEWE) score ≥ 3] were determined by logistic regression models. Forty-five women with either anorexia nervosa (n = 27) or bulimia nervosa (n = 18) were included in the study. None of the women had active periodontitis or other inflammatory comorbidity. Women with ≥ 30% of sites with clinical attachment loss ≥ 3 mm and those with a BEWE score ≥ 3 were older than women that did not exhibit a generalized reduced periodontium or dental erosion (37.1 ± 10.4 versus 28.8 ± 7.4, p

This study evaluates dental and periodontal health in anorexia nervosa and bulimia nervosa patients.Seventy females with eating disorders (36 anorexia nervosa) attending a public hospital Psychiatry and Addiction unit were compared with age-matched controls (n = 70). Full-mouth examination and oral hygiene behaviours were recorded for all participants.More frequent dental attendance and toothbrushing were observed in patients with eating disorders than in controls (p 0.01), while lower plaque index and bleeding on probing were observed in controls than in patients (p ≤ 0.03). Percentages of sites with gingival recession2 mm were higher in patients with eating disorders than in controls (2.3 ± 4.1 versus 0.0 ± 0.1, p 0.01). The BEWE score2 was significantly more frequent in bulimia nervosa patients than in anorexia nervosa patients (76.5% versus 41.7%, p 0.01). Regarding periodontal parameters, mean plaque index, bleeding on probing and clinical attachment loss were increased in anorexia nervosa patients compared to bulimia nervosa patients.The present data suggest different oral health approaches in eating disorder patients according to diagnosis type.Periodontal and dental health should be considered rigorously in patients with eating disorders. Personalized oral hygiene recommendations and treatments can be delivered according to the type of eating disorder.

Objective To review and analyze periodontal clinical parameters after bariatric surgery. Background Periodontitis, a dysbiotic inflammatory disease, has been associated with obesity. The purpose of bariatric surgery is to reduce weight and systemic inflammation. Consequently, it is of interest to systematically review the impact of bariatric surgery on periodontal status. Methods Electronic searches were conducted in MEDLINE, EMBASE, Thesis database, and the Cochrane Library databases. Gray literature and the main journals of both specialties were also reviewed. Only cross-sectional and prospective studies focusing on bleeding on probing, pocket depth, and clinical attachment levels were selected. Results After a thorough screening of 651 studies, 10 studies were selected by 2 independent reviewers. Four (n = 250) and 3 studies (n = 191) were included in the meta-analysis at 6- and 12-month follow-up, respectively. At 6-month follow-up increased periodontal inflammation (P = .03) and periodontal destruction were observed. However, 12 months after baseline, the difference between bariatric patients and control was no longer significant. Conclusion The present systematic review and meta-analysis suggests that deterioration of periodontal status may be observed in the first 6 months after surgery. Consequently, periodontal screening and management of the patient's request for bariatric surgery should be recommended to avoid further deterioration of periodontal status after bariatric surgery.

BackgroundThere is a lack of evidence on the impact of socioeconomic factors on masticatory efficiency. The present study investigates the relationship between individual and neighbourhood socioeconomic factors (main exposure) and the number of masticatory units (MUs) used as surrogate of the masticatory efficiency (main outcome).MethodsIn this cross-sectional study nested in the Paris Prospective Study 3, 4270 adults aged 50–75 and recruited from 13 June 2008 to 31 May 2012 underwent a full-mouth examination. Number of MUs defined as pairs of opposing teeth or dental prostheses allowing mastication, number of missing teeth and gingival inflammation were documented. The individual component of the socioeconomic status was evaluated with an individual multidimensional deprivation score and education level. The neighbourhood component of the socioeconomic status was evaluated with the FDep99 deprivation index. Associations were quantified using marginal models.ResultsIn multivariate analyses, having less than 5 MUs was associated with (1) the most deprived neighbourhoods (OR=2.27 (95% CI 1.63 to 3.17)), (2) less than 12 years of educational attainment (OR=2.20 (95% CI 1.66 to 2.92)) and (3) the highest individual score of deprivation (OR=3.23 (95% CI 2.24 to 4.65)). Associations with education and individual score of deprivation were consistent across the level of neighbourhood deprivation. Comparable associations were observed with the number of missing teeth. Associations with gingival inflammation were of lower magnitude; the relationship was present for deprivation markers but not for education.ConclusionPoor masticatory efficiency is associated with low educational attainment and high deprivation scores.

International audience; Background Periodontopathogens antibodies have been shown to be associated with primary myocardial events, but little is known regarding their impact on major adverse events after a prior acute myocardial infarction (AMI). The present prospective study evaluates the association between antibody levels of 4 periodontopathogens and the risk of all-cause death or non-fatal myocardial infarction (MI) at 1 year in 975 patients admitted for acute ST segment or non-ST segment elevation MI in French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI), a nationwide French survey. Methods Multiserotype ELISAs were performed to assess levels of IgG and IgA against Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia and Tannerella forsythia. Results Adjusted HRs indicate the lack of association between IgG-anti-Po. gingivalis levels (0.96 (0.78 to 1.18)), IgA-anti-Po. gingivalis levels (1.13 (0.90 to 1.42)) and the risk of all-cause death or non-fatal MI at 1 year. Additionally, no significant association was found between the occurence of an event at 1 year and immunoglobulins levels against the others periodontopathogens. Conclusions The present data indicate that circulating levels of periodontopathogens antibodies are not associated with an increased risk of major adverse events in patients with a prior AMI. Studies dealing with bacterial and clinical data are needed to assess the role of oral health in comprehensive cardiac rehabilitation programmes.

Aim The definition and assessment of risk factors, risk indicators and predisposing factors are of paramount importance in the understanding of the pathogenesis of periodontitis, as well as in its prevention and treatment. This article aims to emphasize the concepts of causal chains and the causal network of risk factors in periodontitis. Materials and Methods This is a narrative review focusing on two main questions: (1) what is a risk in periodontology? and (2) how can a risk be assessed? Results The probability of the occurrence of an adverse outcome following exposure is not sufficient to analyse the impact of a risk factor on the disease. A network model for the pathway of risk factors in the pathogenesis of periodontitis is described. This article emphasizes the concepts of causal chains and the causal network of risk factors in periodontitis. Conclusion Chronic periodontal diseases are among the most complex non-communicable diseases. A conceptual framework intended to clarify the relationship between risk and causality may improve the understanding of the underlying mechanisms of chronic diseases. The proposed causal network may provide a model to assess the role of risk factors in periodontitis.

In this paper, we present a real-time decision support system whose objective is to propose the best order of trains to run at junctions in dense areas, based on passenger punctuality. This question typically arises when two branches of a railway line (say, A and B) coming from different origins in the network merge, and trains coming from these two branches must use the same track after the junction. For each couple of trains on both branches, a choice has to be made on which train should run first after the junction: train coming from A or from B? This choice can have a significant impact on the operating performance, and, to be efficient in terms of passenger quality of service, should take into account a large amount of information on the position of trains currently running before and after the junction, their service, the number of passengers on each origin-destination pair at a given time… A first real-world experiment was carried out during fall 2015 at one of the most highly used junctions in the Parisian area. This experiment was performed using a software prototype relying on a dedicated approach combining real-time data treatment, operations research and simulation algorithms.

Aim The aim of this cross-sectional study is to explore if periodontitis is associated with alterations of the retinal microcirculation, a predictive marker of cardiovascular events. Material and Methods Of 457 subjects aged 52 years and more from the ARIC cohort were included. Retinal vascular diameters were measured and summarized as central retinal arteriolar/venular equivalents (CRAE/CRVE). Periodontitis was determined by using the CDC/AAP definition. Multivariable linear regression models were used to estimate the relationships between CRAE, CRVE and periodontitis. Results No association was found between CRAE and periodontal status. However, CRVE and severe periodontitis were positively and significantly associated. Mean CRVE (±SD) was 187.0 ± 17.2 μm in the health-gingivitis group, and, respectively, 188.5 ± 16.3 μm (p = 0.39) and 191.6 ± 16.8 μm (p = 0.04) in moderate and severe periodontitis groups, after adjustment for a propensity score based on confounders. Results were consistent when analyses were restricted to participants with diabetes mellitus (n = 66), but not diabetes-free subjects. Conclusions Severe periodontitis is associated with larger retinal venular diameter in patients with type 2 diabetes. Further studies are needed to explore the impact of diabetes mellitus on the association between periodontitis and retinal microcirculation.

Introduction La presence d’anticorps circulants diriges contre les principaux pathogenes parodontaux a ete associee a l’incidence d’evenements coronariens chez des sujets sains. En revanche, l’impact de la presence de ces anticorps en prevention secondaire de la maladie coronarienne n’est pas connu. Materiels et methodes La cohorte nationale FAST-MI a pour objectif d’evaluer la prise en charge des patients admis en unite de soins intensifs pour un syndrome coronaire aigu avec ou sans sus-decalage du segment ST, et d’evaluer son impact sur le devenir a moyen et a long terme des patients. Les taux d’immunoglobulines G et d’immunoglobulines A (IgG et IgA) diriges contre Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia et Tannerella forsythia ont ete mesures par ELISA parmi les 992 patients qui avaient donne leur consentement pour la constitution d’une collection plasmatique. L’impact des taux de chaque anticorps en continu et en tertiles, et le risque de survenue d’un deces ou d’une recidive d’infarctus du myocarde a 1 an, a ete evalue par des modeles de Cox. Resultats Aucune association significative n’a ete trouvee entre le risque d’un evenement secondaire a 1 an et les taux d’IgG et d’IgA- anti-P. gingivalis (HR ; IC95 %: 0,96 ; 0,78-1,18 et 1,13 ; 0,90-1,42). De meme, les taux d’IgG et d’IgA diriges contre P. intermedia, A. actinomycetemcomitans et T. forsythia n’etaient pas correles aux evenements secondaires. Le statut diabetique ne modifiait pas ces relations. Conclusion Contrairement a la valeur predictive retrouvee en prevention pri-maire, les taux d’anticorps circulants diriges contre les principaux pathogenes parodontaux ne sont pas associes a un evenement secondaire. Les taux d’anti-corps mesurant l’exposition passee aux pathogenes, une etude s’interessant aux variables cliniques parodontales est necessaire pour mesurer l’importance de l’hygiene bucco-dentaire dans les programmes de readaptation car-diaque. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.