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Dans le cadre des maladies parodontales, il est intéressant de porter un autre regard sur les malpositions primaires et les malpositions secondaires. Le développement chez l’enfant et l’adolescent ainsi que les traces qu’il en reste chez l’adulte offrent une lecture des positions dentaires et des symptômes. L’approche somato-psychique aide à comprendre la mise en œuvre neuromusculaire et comportementale de la sphère bucco-dentaire. L’approche psycho-somatiqueprend en compte le « dénouage » qui peut se produire lors des troubles occasionnés par les maladies parodontales avec perte des tissus de soutien des dents. L’accueil et l’examen du patient doivent être guidés par le discernement afin de trouver derrière les symptômes – ces signaux émis par le corps- ce qui clignote pour signifier quelque chose. Une écoute attentive des dires du patient, mais aussi des non-dits, est essentielle afin de le percevoir dans sa dimension holistique allant du biologique à l’ontologique, en passant par la psychologie du sujet et ses comportements.

Psychobiological research is a systems approach that aims to integrate the biological, psychological and social systems that may influence health or pathology, particularly in chronic diseases and physical and/or psychiatric disorders. In this approach, we can expect to be able to deduce a ‘biological signature’ associated with particular symptom clusters. Similarly, psychosocial factors such as life events, health attitudes and behaviours, social support, psychological well-being, spirituality and personality are to be considered in terms of their influence on individual vulnerability to disease. At the psychophysiological level, it is important to understand, for example, the pathways that link the effects of chronic stress, social support and health, through the neuroendocrine and autonomic mechanisms that determine stress responses. At the macroscopic level, the role of individual socio-demographic variables such as personality, treatment modalities and health promotion through psycho-educational interventions needs to be explored.

SummaryCardiovascular disease, such as atherosclerosis, is the main cause of mortality in developed countries. Most atherosclerosis risk factors have been identified and are treated, improving patient cardiovascular status and reducing mortality, but some remain unknown. Periodontal disease is generally defined as inflammatory disease initiated by accumulation of dental bacterial plaque, leading to the destruction of tissues that support the teeth. Severe forms have a high prevalence (15% of the population) and are associated with the presence of virulent pathogens such as Porphyromonas gingivalis. Epidemiological studies have shown that severe periodontal disease negatively influences cardiovascular status. The aim of this paper was to present a synthesis of the most recent biological data related to the link between periodontal and cardiovascular disease. The potential biological mechanisms involved in these two inflammatory diseases (bacteriological theory, inflammatory theory, immune theory) were developed. According to the observed positive effects of periodontal treatment on systemic conditions, the benefit of a reinforced collaboration between dentists and cardiologists was discussed, especially for patients at risk for cardiovascular disease.

De nombreuses etudes suggerent l’existence d’un lien entre les maladies parodontales et les pathologies atheromateuses sans en expliquer les mecanismes d’action (Mattila et al. 1989 ; Beck et al. 1996). Dans une hypothese, c’est l’endotoxemie induite par une inflammation qui jouerait un role important (Johnson et al. 2005). Cette endotoxemie « a bas bruit » provoquee par l’inflammation buccale pourrait induire la liberation de mediateurs de l’inflammation et avoir un impact sur le taux systemique de ces memes mediateurs favorisant ainsi l’atherosclerose.

Periodontal disease, including bone loss, is thought to be involved in coronary artery disease. Multiple complex coronary lesions relate to multifocal destabilization of coronary plaques. We investigated whether bone loss could be associated with the presence of multiple complex coronary lesions.This cross-sectional study included 150 patients with recent myocardial infarction (1 month). Multiple complex coronary lesions were determined at coronary angiography. A panoramic dental X-ray including bone loss50% was performed. Patients with no or simple complex lesions were compared to patients with multiple complex lesions.Over 20% of patients had multiple complex coronary lesions. Patients with multiple complex lesion were less likely to be women and more likely to have multivessel disease or elevated C-reactive protein (CRP) than patients with no or single complex lesion. Bone loss50% tended to be more frequent in patients with multiple complex lesions (p = 0.063). In multivariate analysis, multivessel disease, gender and CRP were associated with multiple complex lesion. Bone loss50% increased the risk of multiple complex lesion.Bone loss was associated with complex multiple coronary lesions, beyond systemic inflammation. These findings may bear important clinical implications for the prevention and treatment of coronary artery disease.

During the last decade, there have been great strides in the treatment of gingival recession defects, especially with subepithelial connective tissue graft and guided tissue regeneration (GTR) procedures. Gingival recession represents a significant concern for patients. It is necessary to choose the most appropriate procedure in order to obtain more root coverage while avoiding clinical disadvantages. The purpose of this randomized clinical trial was to evaluate the use of a bioabsorbable bilayer collagen membrane with GTR compared to a connective tissue graft in the treatment of gingival recession defects.Twenty patients each contributing a pair of Miller Class I or II buccal gingival recessions were treated. In each pair, one recession was randomly assigned for treatment with GTR using a bioabsorbable bilayer collagen membrane and the other treated with subepithelial connective tissue graft (CTG). Clinical measurements taken at baseline (D0) and 3 and 6 months post-treatment included recession depth (RD), recession width (RW), probing depth (PD), and clinical attachment level (CAL).Data were analyzed using the non-parametric Wilcoxon matched pair test. All results were statistically significant. Both treatments resulted in a significant gain of root coverage (P0.0001), amounting to an average of 2.80 mm at 3 months in the GTR group and 3.34 mm in the CTG group. At 6 months, the decrease of the mean RD remained statistically significant: 2.70 mm (74.59% root coverage) in the GTR group and 3.19 mm (84.84% root coverage) in the CTG group. The mean RW also decreased from 4.48 mm at D0 to 2.42 mm at 6 months in the GTR group, and from 4.38 mm at D0 to 1.35 mm at 6 months in the CTG group, representing a percentage of coverage of 45.98% and 69.18%, respectively. Mean CAL gain obtained between D0 and 6 months with the GTR procedure and CTG was 3.31 mm and 3.09 mm, respectively, and was significant within groups. At 3 and 6 months, the differences in the results for RD, CAL, and RW were not statistically significant between the 2 groups. However, the difference was significant for PD at 3 and 6 months.The results suggest that a bioabsorbable bilayer collagen membrane can be used in the GTR treatment of human buccal recession defects, with no statistically significant differences between this procedure and connective tissue grafts.

Aim To evaluate the periodontal status in patients with acute myocardial infarction (AMI) and to determine whether there was a specific profile according to age. Methods A total of 197 consecutive patients with AMI were included and the oral examination included the number of teeth, endodontically treated teeth, periodontal screening index (PSI), clinical attachment level, and radiographic apical lesions (radiography examination). Patients were classified according to tertiles of age. Results The table below summarizes the specific profile according to age. The study demonstrated that patients with AMI exhibited an unfavourable dental state of health. No relationship was found between C-reactive protein levels and periodontitis. Conclusion This work demonstrates specific profiles of dental status according to age. In younger patients, the dental status was poor, and although no relationship with CRP was shown, further studies are needed to include a more specific assessment of coronary lesions and their evolution in this context of poor dental health. (Voir tableau ci-dessous) Tertile 1 Tertile 2 Tertile 3 p N 66 66 65 Mean age, y 47.7 ± 0.4 59.5 ± 0.3 72.5 ± 0.4 Men 83% 89% 75% 0.104 CRP > 3 mg/L, 52% 41% 54% 0.205 Current smoker 72% 63% 47% 0.017 Periodontal status Presence of caries 50% 28% 45% 0.037 Presence of Inflammation 64% 71% 67% 0.731 Teeth lost 8 ± 8 10 ± 8 15 ± 8 0.019 Alteration of chewing 24% 34% 67% Bone Loss 55% 71% 86% 0.001