Le scellement de sillon est-il efficace dans la prévention de la carie des dents permanentes? : revue cochrane pour le praticien

Scénario: Un enfant de 8 ans, que vous connaissez depuis plusieurs années, se présente à votre consultation pour un contrôle de santé. Il a eu une carie en denture temporaire, qui a été soignée; depuis lors, l'enfant maintient une bonne hygiène buccale et alimentaire. Les parents vous demandent s'il serait indiqué d'appliquer un scellement de sillon pour éviter le développement de nouvelles caries chez leur enfant. Question: Le scellement de sillon (sealant) prévient-il la survenue de caries en denture permanente? Si oui, quel produit utiliser? Contexte: Depuis leur introduction dans les années 60, les programmes de fluoration ont permis un déclin considérable de l'incidence de la carie. Les scellements de sillon semblent également jouer un rôle protecteur en limitant la croissance bactérienne dans les puits et fissures des dents postérieures, zones les plus vulnérables au développement de la maladie carieuse. Néanmoins, il existe un doute sur leur efficacité en cas de risque carieux faible. D'autre part, la diversité des produits (verres ionomères, résine composite, compomères hybrides) proposés sur le marché laisse le praticien dans l'embarras du choix.

Cardiogene: an innovative multidisciplinary consultation for genetic arrhythmias

Introduction: Over the past decade clinically relevant progress has been made regarding the genetic origin of sudden cardiac death due to arrhythmic syndromes such as congenital long QT syndrome (LQTS), Brugada syndrome (BrS), catecholinergic polymorphic ventricular tachycardia (CPVT) and short QT (SQTS). An increased number of patients are diagnosed and their offspring sent for screening. In order to optimize care of these families we have set up a multidisciplinary consultation, "Cardiogene", consisting of a pediatric and an adult cardiologist and a clinical geneticist. All families are seen at a common consult in order to take the family history, genetic background and to explain the disease to patients and their families. Appropriate cardiac investigations and genetic testing are then performed and the families seen again in a multidisciplinary fashion for the results. We have reviewed all our cases over the past 5 years. Methods: retrospective review of all cases seen at Cardiogene Clinic for suspicion of arrhythmic syndromes since 2007. Results: 23 families were seen at the Cardiogene Clinic with a total of 41 children. The suspected arrhythmic syndrome was LQTS in 14 families (26 children), BrS in 7 families (14 children), SQTS in1 family (2 children) and CPVT in 1 family (3 children). Of the 41 children 17 were genetically positive for an arrhythmic syndrome: 14 were for LQTS, 3 for BrS. 24 children were genetically negative however 4 of those were phenotypically positive: 2 LQTS, 1 BrS and 1 CPVT. In 3 families the diagnosis was initially made in a child and then found in the parent. In 2 families the diagnosis was made after a sudden death of one of their children, 1 LQTS (3 week old child), 1 BrS (20 year old). Discussion: Genetic testing is an essential part of diagnosis and permits an improved targeting of patients needing follow-up and treatment. In our series, a mutation has been found in most families with LQTS. In all other genetic arrhythmias, the yield of genetic testing is less but nevertheless helpful for medical care of these pts. Conclusion: A multidisciplinary approach to genetic arrhythmias permits a better and more efficient screening and therapy in affected families. It helps families to better understand their disease and improves follow-up in the affected individuals.