Subjective impact of minimally invasive dentistry in the oral health of older patients

OBJECTIVES: The aim of this study was to investigate if a minimally invasive oral health package with the use of atraumatic restorative treatment (ART) or a conventional restorative technique (CT) would result in any perceived benefit from the patients' perspective and if there would be any difference between the two treatment groups.

MATERIALS AND METHODS: In this randomised clinical trial, 99 independently living older adults (65-90 years) with carious lesions were randomly allocated to receive either ART or conventional restorations using minimally invasive/intervention dentistry (MID) principles. Patients completed an Oral Health Impact Profile (OHIP)-14 questionnaire before and 2 months after treatment. They were also asked to complete a global transition question about their oral health after treatment.

RESULTS: At baseline, the mean OHIP-14 scores recorded were 7.34 (ART) and 7.44 (CT). Two months after treatment intervention, 90 patients answered the OHIP-14 and the mean scores were 7.23 (not significant (n.s.)) and 10.38 (n.s.) for the ART and CT groups, respectively. Overall, 75.5 % of patients stated that their oral health was better compared to the beginning of treatment.

CONCLUSIONS: Although not shown by the OHIP-14, patients perceived an improvement in their overall oral status after treatment, as demonstrated by the global transition ratings in both groups.

CLINICAL RELEVANCE: Dental treatment using minimally invasive techniques might be a good alternative to treat older individuals, and it can improve their oral health both objectively and subjectively.

Minimal intervention dentistry and older patients Part 1: Risk assessment and caries prevention

Ten million people in the UK today are aged over 65. The latest projections estimate that there will be 5 1/2 million more people aged 65 and older in the next 20 years. This projected pattern of population ageing will have profound consequences for dentistry. Minimal intervention dentistry (MID) is a modern evidence-based approach to caries management in dentate patients that uses the 'medical model' whereby disease is controlled by the 'oral physician'. This approach offers considerable benefits over conventional dentistry for older patients. It encourages patients to be responsible for their oral health through the provision of both knowledge and motivation. MID encompasses risk assessment for dental disease, early detection and control of disease processes, and minimally invasive treatment. 

Clinical Relevance: Risk assessment tools can aid the general dental practitioner and the patient to develop a suitable caries prevention programme for that individual and reduce the need for future operative intervention.

Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial

BACKGROUND: As the world population ages, the requirement for cost-effective methods of treating chronic disease conditions increases. In terms of oral health, there is a rapidly increasing number of dentate elderly with a high burden of maintenance. Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group. Atraumatic Restorative Treatment (ART) could be suitable for patients in nursing homes or house-bound elderly, but very little research has been done on its use in adults.

OBJECTIVES: To compare the cost-effectiveness of ART and a conventional technique (CT) for restoring carious lesions as part of a preventive and restorative programme for older adults.

METHODS: In this randomized clinical trial, 82 patients with carious lesions were randomly allocated to receive either ART or conventional restorations. Treatment costs were measured based on treatment time, materials and labour. For the ART group, the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment. Effectiveness was measured using percentage of restorations that survived after a year.

RESULTS: Eighty-two patients received 260 restorations, that is, 128 ART and 132 conventional restorations. 91.1% of the restorations were on one surface only. After a year, 252 restorations were assessed in 80 patients. The average cost for ART and conventional restorations was €16.86 and €28.71 respectively; the restoration survival percentages were 91.1% and 97.7%, respectively. This resulted in a cost-effectiveness ratio of 0.18 (ART) and 0.29 (CT). When the cost of a hygienist to provide ART was inserted in the analysis, the resulting ratio was 0.14.

CONCLUSIONS: Atraumatic restorative treatment was found to be a more cost-effective alternative to treat older adults after 1 year, compared to conventional restorations, especially in out of surgery facilities and using alternative workforce such as hygienists. Atraumatic restorative treatment can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely.

Caries and the older patient

Ageing of the population, together with prolonged retention of teeth, has brought new challenges to dentistry. Whereas in the past oral care for the elderly was restricted to provision of dentures, older patients are now presenting with dental caries and failed restorations. These problems may have an impact on their general health and quality of life. Poor oral hygiene, xerostomia and diet are among the risk factors for caries in older patients and need to be addressed in order to achieve control of the disease. Carious lesions can be treated conservatively in many cases or may need surgical management.

CLINICAL RELEVANCE: Caries is an oral health issue among older patients and can result in tooth loss. Oral health has a great impact on general health and quality of life of elderly people.

Gerodontology--how big is the challenge in Ireland?

Population trends suggest that the Irish population is ageing, and that this population will have substantial treatment needs. These patients will be better informed than previous generations, and will demand treatment aimed at preserving a natural dentition. This will impact upon delivery of oral healthcare and manpower planning needs to consider how to address the increased demand for dental care. Poor oral health is associated with systemic health problems, including cardiovascular disease, respiratory disease and diabetes mellitus. It also has a negative impact upon quality of life, and the World Health Organisation has encouraged public healthcare administrators and decision makers to design effective and affordable strategies for better oral health and quality of life of older adults, which, in turn, are integrated into general health management programmes. Treatment concepts such as minimally invasive dentistry and the shortened dental arch concept are discussed in the context of these demographic changes and recommendations.

Caries incidence following tooth replacement for partially dentate elders

Objective: To compare caries incidence following two different tooth replacement strategies for partially dentate older patients; namely functionally orientated treatment according to the principles of the Shortened Dental Arch (SDA) and conventional treatment using Removable Partial Dentures (RPDs). Method:A randomised controlled clinical trial (RCT) was conducted of partially dentate patients aged 65 years and older. Patients were randomly allocated to two different treatment groups: the RPD group and the SDA group. Each member of the RPD group was restored to complete arches with cobalt-chromium RPDs used to replace missing teeth. Patients in the SDA group were restored to a shortened arch of 10 occluding pairs of natural and replacement teeth using adhesive bridgework. All of the operative treatment was completed by a single operator. Caries incidence was measured over a 2-year period following treatment intervention and recorded using the International Caries and Detection System (ICDAS). Result:In total, 89 patients completed the RCT (45 SDAs and 44 RPDs). Patients in the RPD group recorded a significantly higher incidence of new carious lesions (p<0.001) and recurrent carious lesions (p<0.001) compared to the SDA group. A mixed model of covariance (ANCOVA) revealed that treatment group (p<0.001) and co-morbidity (p<0.001) were significant predictors of caries incidence. Conclusion:Two years after provision of prosthodontic treatment there was a significantly higher incidence of new and recurrent caries lesions in subjects provided with RPDs compared with SDA treatment. This will have a significant impact on the ongoing maintenance costs for these two treatment groups.

The Use of ART in Elderly Patients after 2 years

Caries experience is high in the elderly, and barriers to care for older adults include fear and cost. Access to care is especially problematic in the case of frail and homebound elderly. Objective: to compare the survival of restorations placed using Atraumatic Restorative Treatment (ART) and a conventional technique using rotary instruments and a resin-modified glass-ionomer (CT) to treat carious lesions in older patients. Methods: In this randomised clinical trial, 99 independently living adults (65-90 yrs) with carious lesions were recruited from a geriatric day hospital and a community centre and randomly allocated to receive either ART or conventional restorations. They received tailored oral hygiene instructions and scaling and polishing of teeth prior to restoration placement. The survival of restorations was assessed 6, 12 and 24 months after restoration placement by an independent examiner. Results: Ninety-nine patients participated in the trial, 46 males and 53 females, with a mean age of 73.2 (SD: 6.8). In total, 300 restorations were placed, 142 ART in 51 patients and 158 conventional restorations in 48 patients, with an average of 2.8 ART (SD: 1.83) and 3.2 conventional (SD: 2.62) restorations placed per patient. After 2 years, 88 ART and 117 conventional restorations were assessed. The restoration survival percentages were 93.1% and 94%, respectively. Conclusion: ART was found to be as effective as a conventional restorative approach to treat older adults after 2 years and could be a useful tool to provide dental care for older dentate adults.

Risk indicators associated with root decay in independently living older adults

Objective: To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland.
Methods: The data reported in the present study were obtained from a prospective longitudinal study conducted on the risk factors associated with root caries incidence in a cohort of independently living older adults (n=334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. A regression analysis with the outcome variable of root caries experience (no/yes) was conducted.
Results: A total of 334 older adults with a mean age of 69.1 years were examined. 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). The results from the multivariate regression analysis indicated that individuals with poor plaque control (OR 9.59, 95%CI 3.84-24.00), xerostomia (OR 18.49, 95%CI 2.00-172.80), two or more teeth with coronal decay (OR 4.50, 95% CI 2.02-10.02) and 37 or more exposed root surfaces (OR 5.48, 95% CI 2.49-12.01) were more likely to have been affected by root caries.
Conclusions: The prevalence of root caries was high in this cohort. This study suggests a correlation between root caries and the variables poor plaque control, xerostomia, coronal decay (≥2 teeth affected) and exposed root surfaces (≥37). The significance of these risk indicators and the resulting prediction model should be further evaluated in a prospective study of root caries incidence.
Clinical Significance: Identification of risk indicators for root caries in independently living older adults would facilitate dental practitioners to identify those who would benefit most from interventions aimed at prevention.

Análise Longitudional da investigação em contabilidade sobre Relato Ambiental

Resumo Este estudo pretende contribuir para uma revisão da investigação em Contabilidade sobre a temática do Relato Ambiental, através da análise dos artigos publicados em 20 accounting top journals, entre 2006 e 2011. Foram identificados 130 artigos, tendo a maioria sido publicados no: Accounting, Auditing & Accountability Journal, Accounting Forum, Accounting, Organizations and Society e Critical Perspectives on Accounting. Do universo dos estudos identificados, foram analisados 62 artigos. Para cada artigo optamos por analisar as seguintes dimensões: os objetivos e resultados obtidos, as metodologias adotadas, a origem dos dados, os setores de atividade e países em estudo. Os estudos procuram compreender as práticas e identificar os fatores que influenciam o relato ambiental, analisar o impacto da regulamentação sobre o relato ambiental, identificar uma «teoria social», estudar os sistemas de contabilidade ambiental e analisar a relação entre o relato ambiental e o desempenho ambiental e económico. Constatámos que a maioria dos estudos apresenta uma abordagem longitudinal e utiliza preferencialmente como metodologia a análise de conteúdo. Palavras-chave: contabilidade social e ambiental; relato ambiental; revistas de contabilidade; investigação.

Vertebrate diversity in the Bussaco Mountain and surrounding areas

A biodiversidade é fundamental para o funcionamento dos ecossistemas e, além do seu valor intrínseco, fornece bens e serviços essenciais ao Homem. É consensual que as reservas naturais, por si só, não conseguirão preservar a biodiversidade de modo a que seja travada a perda de espécies que vem acontecendo a ritmos sem precedente. Assim, compreender os padrões de distribuição das espécies à escala regional ou sub-regional, ainda que em territórios não classificados, é crucial para o estabelecimento de políticas de gestão que visem a conservação da biodiversidade. O principal objectivo deste trabalho centrou-se na descrição e compreensão dos padrões de riqueza específica, distribuição e abundância de Vertebrados face aos diversos habitats que constituem a área de estudo. Constituíram, assim, objecto de estudo os anfíbios, aves, morcegos, micromamíferos e mamíferos de médio porte. A Serra do Bussaco e áreas envolventes encontram-se dominadas por vastas extensões de monocultura de Pinus pinaster e Eucalyptus globulus e por terrenos agrícolas. A Mata Nacional do Bussaco, bosque extremamente diverso, é outro importante elemento de paisagem. Pretendeu-se então analisar o efeito das práticas silvícolas actuais e da intensificação da agricultura sobre a biodiversidade, averiguando a importância de cada tipo de habitat para os Vertebrados em geral, e para algumas classes em particular. De entre os terrenos agrícolas, é bastante claro que a agricultura tradicional, com a sua típica complexidade e disponibilidade de água, constitui um habitat muito importante para a maioria dos Vertebrados, tendo também apresentado o maior valor conservacionista. No que respeita aos habitats florestais, o bosque misto apresentou consistentemente maior riqueza específica e diversidade, afirmando-se como o habitat preferido para a maioria das espécies e aquele com maior valor conservacionista. Do ponto de vista da conservação, as monoculturas, especialmente as da uma espécie exótica, revelaram-se habitats relativamente pobres. No entanto, estas conclusões referem-se às tendências gerais, sendo que taxa particulares respondem de forma diferente, atendendo aos seus requisitos específicos. A informação recolhida fornece bases essenciais para a construção de linhas de orientação que visem a integração das actividades humanas com a manutenção da biodiversidade e respectivos serviços, presumivelmente com aplicação a outras áreas geográficas.

Lichen biodiversity and biomonitoring of atmospheric pollution

Esta tese debruça-se sobre a biodiversidade de líquenes epífitos de pinhais dunares portugueses e sobre uso de líquenes como biomonitores de poluição atmosférica nesse habitat. A Mata Nacional das Dunas de Quiaios (Figueira da Foz) foi o ponto de partida dos estudos de biodiversidade efetuados nesta tese, mas alguns deles estenderam-se à maior parte da costa portuguesa. Como resultado, encontrou-se uma espécie nova para a ciência, Lecanora sorediomarginata Rodrigues, Terrón & Elix, epifítica sobre Pinus pinaster Aiton e P. pinea L, que se encontra distribuída na maior parte da costa. Esta espécie caracteriza-se morfologicamente por um talo crustáceo, de cor esbranquiçada a acinzentada ou esverdeada e que desenvolve sorálios a partir de pequenas verrugas marginais. Quimicamente caracteriza-se pela presença dos ácidos 3,5-dicloro-2'-O-metilnorestenospórico [maior], 3,5-dicloro-2 -O-metilanziaico [menor], 3,5-dicloro-2 -O-metilnordivaricático [menor], 5-cloro-2'-Ometilanziaico [traço] e úsnico [traço]; atranorina [menor] e cloroatranorina [menor]. É quimicamente semelhante a L. lividocinerea Bagl., com a qual apresenta afinidades filogenéticas com base na análise da sequência ITS do rDNA, e a L. sulphurella Hepp. Adicionalmente, espécies Chrysothrix flavovirens Tønsberg e Ochrolechia arborea (Kreyer) Almb, também se encontraram epifíticas sobre P. pinaster e P. pinea em vários pinhais ao longo da costa, representando novos registos para a flora liquénica portuguesa, bem como a espécie Lepraria elobata Tønsberg encontrada epifítica sobre P. pinaster apenas nas Dunas de Quiaios. Além disso, as espécies Hypotrachyna lividescens (Kurok.) Hale e H. pseudosinuosa (Asahina) Hale encontraram-se epifíticas sobre P. pinaster e outros forófitos nas Dunas de Quiaios, constituindo novos registos para a flora liquénica da Península Ibérica. Estes resultados põe em evidência a importância dos pinhais dunares como habitat para líquenes epífitos. Num estudo conduzido entre janeiro e julho de 2008 num pinhal dunar (Mata do Urso, Figueira da Foz), em cuja bordadura existe uma fábrica de celulose de papel, usaram-se transplantes de líquenes da espécie Flavoparmelia caperata (L.) Hale para avaliar a acumulação de trinta e três elementos putativamente emitidos por fábricas de papel e pasta de papel. A cinética da fluorescência da clorofila a foi estudada nos líquenes transplantados, através da análise dos parâmetros Fv/Fm, F0, Fm, qP, NPQ, PSII, e Exc, de forma a avaliar os efeitos decorrentes da acumulação de elementos na vitalidade dos líquenes. Pretendeu-se avaliar se a acumulação de elementos e a cinética da fluorescência da clorofila a variavam significativamente com o local e o tempo de exposição, tendo em consideração os resultados obtidos de transplantes colocados num local de referência (Dunas de Quiaios) durante o mesmo período de tempo. (Continua no verso) resumo A maior parte dos elementos — Al, B, Ba, Ca, Co, Cr, Cu, Fe, Hg, Li, Mg, Mn, Mo, Na, Ni, P, S, Sb, Sc, Sr, Ti e V — ocorreu em concentrações significativamente mais elevadas nos transplantes expostos a 500 m da fábrica. Cerca de metade dos elementos estudados — B, Ba, Cr, Fe, Hg, Mg, Mn, Mo, Na, P, Pb, S, Sb e V — encontraram-se em concentrações significativamente mais elevadas nos transplantes expostos durante 180 dias. O solo foi identificado como uma fonte parcial da maior parte dos elementos. Os parâmetros Fv/Fm, Fm, PSII e Exc variaram significativamente com o local e/ou com o tempo de exposição. Observou-se um decréscimo significativo nos parâmetros Fv/Fm e Fm nos transplantes expostos a 500 e 1000 da fábrica, e também naqueles expostos durante 135 e 180 dias. Observou-se também um decréscimo significativo nos parâmetros PSII e Exc expostos durante 180 dias. Estes parâmetros correlacionaram-se de forma negativa e significativa com a acumulação de elementos: Fv/Fm: B, Ba, Co, Fe, Hg, Mg, Mn, Mo, N, P, S, Sb e Zn; Fm: Ba, Co, Hg, Mn, Mo, N, P, S, Sb e Zn; PSII: N e P; Exc: Mn, N, P e S. Estudos acerca da diversidade liquénica efetuados nos mesmos locais onde os transplantes foram colocados no local impactado, revelaram um menor valor de diversidade liquénica a 500 m da fábrica, que foi também o único local onde se encontraram espécies nitrófilas, o que se poderá dever à deposição de amónia e/ou poeiras. À semelhança de outros estudos, este trabalho confirma que os líquenes podem ser usados com sucesso em estudos de biomonitorização, mesmo em locais florestados. Além disso, traz também informações adicionais sobre como a acumulação de elementos pode influenciar a cinética da fluorescência da clorofila a em líquenes.

Soluções para a construção de habitação em adobe a custos controlados

Dados recentes mostram que o desmatamento da caatinga, um dos principais biomas brasileiros, está atingindo níveis alarmantes, principalmente devido a sua vulnerabilidade e forte tendência à desertificação. Entre os dez municípios brasileiros que mais desmataram a caatinga, segundo o Ministério do Meio Ambiente, quatro se encontram no Ceará. Estudos mostram que entre as principais causas do desmatamento está o uso da mata nativa para lenha e carvão, sobretudo para a queima de tijolos em olarias clandestinas. Procurando estudar a questão da aplicabilidade de construções sustentáveis no Nordeste Brasileiro, o presente trabalho faz um levantamento detalhado sobre construções em terra crua (adobe) na região, em especial no Estado que mais contribuiu com o desmatamento. Em assim sendo, realizou-se uma extensa pesquisa aos acervos públicos e oito expedições rodoviárias, entre 2009 e 2011, e totalizando cerca de 7.000 km rodados, às regiões norte e nordeste do Estado do Ceará. Foram coletadas amostras de terra e de adobe para ensaios nos laboratórios da Universidade Federal do Ceará (UFC) e feita ampla documentação fotográfica com aplicação de questionários em 14localidades. Foram levantados dados de vários aspectos relevantes para a pesquisa, quais sejam: composição da terra, granulometria, processos de secagem do adobe, resistência mecânica à compressão, além de aspectos ligados ao detalhamento do revestimento, traço de rebocos e detalhes de fundação. A análise dos dados coletados permitiu compreender a construção em adobe na região, no seu contexto cultural. Esta pesquisa pode ajudar na manutenção de um sistema construtivo ambiental, cultural e economicamente sustentável, através da busca por um caminho de reavaliação das possibilidades de adaptações técnicas à casa típica do semiárido cearense.

Compósitos CNTs/biocerâmico para a estimulação elétrica óssea in situ

The present thesis aims to develop a biocompatible and electroconductor bone graft containing carbon nanotubes (CNTs) that allows the in situ regeneration of bone cells by applying pulsed external electrical stimuli. The CNTs were produced by chemical vapor deposition (CVD) by a semi-continuous method with a yield of ~500 mg/day. The deposition parameters were optimised to obtain high pure CNTs ~99.96% with controlled morphologies, fundamental requisites for the biomedical application under study. The chemical functionalisation of CNTs was also optimised to maximise their processability and biocompatibility. The CNTs were functionalised by the Diels-Alder cycloaddition of 1,3-butadiene. The biological behaviour of the functionalised CNTs was evaluated in vitro with the osteoblastic cells line MG63 and in vivo, by subcutaneous implantation in rats. The materials did not induce an expressed inflammatory response, but the functionalised CNTs showed a superior in vitro and in vivo biocompatibility than the non-functionalised ones. Composites of ceramic matrix, of bioglass (Glass) and hydroxyapatite (HA), reinforced with carbon nanotubes (CNT/Glass/HA) were processed by a wet approach. The incorporation of just 4.4 vol% of CNTs allowed the increase of 10 orders of magnitude of the electrical conductivity of the matrix. In vitro studies with MG63 cells show that the CNT/Glass/HA composites guarantee the adhesion and proliferation of bone cells, and stimulate their phenotype expression, namely the alkaline phosphate (ALP). The interactions between the composite materials and the culture medium (α-MEM), under an applied electrical external field, were studied by scanning vibrating electrode technique. An increase of the culture medium electrical conductivity and the electrical field confinement in the presence of the conductive samples submerged in the medium was demonstrated. The in vitro electrical stimulation of MG63 cells on the conductive composites promotes the increase of the cell metabolic activity and DNA content by 130% and 60%, relatively to the non-stimulated condition, after only 3 days of daily stimulation of 15 μA for 15 min. Moreover, the osteoblastic gene expression for Runx2, osteocalcin (OC) and ALP was enhanced by 80%, 50% and 25%, after 5 days of stimulation. Instead, for dielectric materials, the stimulus delivering was less efficient, giving an equal or lower cellular response than the non-stimulated condition. The proposed electroconductive bone grafts offer exciting possibilities in bone regeneration strategies by delivering in situ electrical stimulus to cells and consequent control of the new bone tissue formation rate. It is expected that conductive smart biomaterials might turn the selective bone electrotherapy of clinical relevance by decreasing the postoperative healing times.

Ecology and conservation of felids in the Brazilian pantanal

Habitat conversion and environmental degradation have reached alarming levels in the Pantanal, endangering all its biodiversity. This scenario is complicated by the fact that the biome relies on only a few protected areas, which combined do not exceed 10% of the territory. Felids, as predators, play a vital role in the maintenance of this ecosystem, but require large areas, have low population densities and, typically, are very sensitive to environmental disturbances. Amolar Mountain Ridge is considered an area of extreme importance and high priority for conservation within the biome. There are four species of felids in this region: the jaguar (Panthera onca), the puma (Puma concolor), the ocelot (Leopardus pardalis), and jaguarundi (Puma yagouaroundi). However, little is known about the ecology of these species in this region or the magnitude of interaction between the communities living around the protected areas and the animals. The goal of this study was to increase our knowledge about these felids and understand how people interact with them in order to contribute to their conservation in the network of parks within Amolar. Camera trapping surveys were carried out in two areas of the network, covering approximately 83,000 hectares, in order to identify the species of mammals occurring in the region, those that may be potential prey for the felids, and to obtain basic ecological data about both felids and prey. In addition, we conducted surveys in three riverside schools in order to assess the knowledge, perceptions and attitudes of schoolchildren regarding the four focal felids, and surveys among the adult population to assess their perceptions and attitudes towards the jaguar. We recorded a total of 33 species of mammals from both study areas. The large cats were cathemeral, reflecting the temporal activity of larger prey, whereas the ocelot was nocturnal, mirroring the activity of smaller prey. Jaguar occupancy was influenced by prey abundance, while puma occupancy was influenced by patch density in drier dense forest. Jaguars and pumas may be competitors over temporal and spatial scales, while no resource overlap was found for ocelots. Overall, both adults and children tended to have negative perceptions about the cats, which were related to the fear of being attacked. To increase awareness about the species and to maximize the effectiveness of protective measures in the network of reserves, it is recommended to develop and implement an Environmental Educational Program in the medium- to long-term in order to minimize the fear of these felids and to counsel locals on the role of felids in the maintenance of the Pantanal’s biodiversity.

Les Cahiers Anne Hébert, 13 : Legs d'Anne Hébert : Lecture, intertextualité, transmission

La critique a depuis longtemps identifié les lieux de lecture travaillés par les œuvres hébertiennes, de la Bible à Faulkner en passant par Chrétien de Troyes et les contes de fées. Mais si la lecture est un legs, un témoignage du passé qu’il est loisible d’interroger dans le présent de l’écriture, les œuvres d’Anne Hébert – l’adaptation cinématographique du Torrent en est l’illustration éclatante – constituent désormais un héritage dont les effets peuvent être analysés. Nous voudrions ici interroger ces deux modalités du legs d’Anne Hébert en nous attachant aussi bien aux traces des lectures de l’écrivaine qui parsèment son œuvre qu’à ce que cette dernière a légué en retour aux écrivains, ou cinéastes, qui lui succèdent. La présence de la bibliothèque de l’écrivaine au Centre Anne-Hébert est à cet égard à même d’ouvrir de nouvelles avenues de recherche, susceptibles de renouveler notre compréhension des œuvres. Ce n’est donc pas seulement d’intertextualité qu’il est question dans ces pages, ni de la notion ambigüe d’influence qu’elle était venue remplacer, mais bien de ce legs symbolique bien particulier que constitue la lecture. À quel héritage littéraire Anne Hébert a-t-elle puisé afin de rompre avec les discours social et littéraire du Canada français des années 1940? Quel traitement réserve-t-elle à l’héritage canadien-français, notamment religieux? Mais aussi, qu’en est-il, dans son œuvre, de cet enjeu majeur de la transmission, elle qui ne cesse de s’interroger, d’un texte à l’autre, sur les effets ineffaçables du passé à partir de son refoulement? Voilà quelques-unes des questions qui ont retenu l’attention des auteur(e)s de ce dossier, qui souhaite ainsi participer au renouvellement de la recherche sur cet aspect primordial du legs.