Familial hypophosphatemic rickets is in most cases transmitted as an X-linked dominant trait and results from mutation of the PHEX gene, predominantly expressed in osteoblast and odontoblast. Patients have been reported to display important dentin defects, and therefore, we explored the dentin structure, composition, and distribution of extracellular matrix (ECM) molecules in hypophosphatemic human deciduous teeth. Compared to age-matched controls, the dentin from hypophosphatemic patients exhibited major differences: presence of large interglobular spaces resulting from the lack of fusion of calcospherites in the circumpulpal dentin; defective mineralization in the interglobular spaces contrasting with normal Ca-P levels in the calcospherites on X-ray microanalysis; abnormal presence of low-molecular weight protein complexes recognized on Western blots by antibodies against matrix extracellular phosphoglycoprotein (MEPE), dentin sialoprotein, osteopontin, and reduced osteocalcin (OC) level; and accumulation in the interglobular spaces of immunolabeling with antibodies against DSP, dentin matrix protein, bone sialoprotein, MEPE and OC, while chondroitin/dermatan sulfate glycosaminoglycans were exclusively located inside calcospherites. Alterations of the post-translational processing or partial degradation of some ECM appear as key factors in the formation of the defective hypophosphatemic dentin.

Objectives. This work aimed to estimate the knowledge and practice of general dentists in the governorate of Manouba regarding the management of patients at risk of infective endocarditis. Materials and Methods. A survey involving private sector general dentists in the governorate of Manouba was performed. It contained 21 questions, and it was addressed to 111 dentists. Only 82 dentists responded. To carry out the descriptive study, we used the SPSS software version 21.0. Results. Our results proved the lack of knowledge among dentists in the governorate of Manouba with regard to the management of patients at risk of infective endocarditis. An overestimation of the risk and an overprescription of antibiotic were found in order to ensure an over-protection for the patients as well as the dentist. In fact, 85.4% of these dentists prescribed antibiotic prophylaxis for the two groups of patients (high risk and moderate risk). Only 9.8% followed the right modality of antibiotic prophylaxis prescription; 4.9% of the dentists prescribed antibiotic only 1 hour before the act and 4.9% of them prescribed antibiotic 1 hour before the act and continued the treatment in case of the presence of an infectious site. Conclusion. A discrepancy towards an over-estimation of risk and overprescription of antibiotic was found between the recommendations and real practice. Similar studies in the other governorates of Tunisia are recommended in order to better understand the problem.

Objective. The aim of this clinical study was to evaluate the effectiveness of a whitening toothpaste containing 3% carbamide peroxide and lactoperoxidase. Materials and methods. Participants were instructed to brush their teeth using an enzymatic-activated dentifrice following a particular procedure for three weeks. Color was recorded before and after treatment using a VITA Easyshade spectrophotometer. Differences in L ∗ (tooth color lightness), a ∗ (displacement along the red-green axis), and b ∗ (displacement along the yellow-blue axis) were measured before and after treatment using the paired t and the Wilcoxon signed-rank tests. Color changes (ΔE) were calculated using the obtained measurements. Results. Thirty-four volunteers were included. ΔE was 4.03. For the set of 348 teeth, a greater tendency towards green (lower a ∗ ) and blue (lower b ∗ ) was observed ( p  < 0.05). There were no significant differences in lightness after treatment. Mandibular central incisors showed a greater tendency towards green (lower a ∗ ) and blue (lower b ∗ ). Bleaching effectiveness was observed in both the upper and lower central incisors and in the lateral mandibular incisors. Conclusion. Based on these results, it may be concluded that brushing with an enzymatic-activated dentifrice is effective for whitening teeth.

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Mots clés : fistule / cutané / odontogèneRésumé -Les fistules cutanées d'origine dentaire peuvent constituer un défi diagnostique. En l'absence de signes endobuccaux, l'origine dentaire n'est pas toujours évoquée d'emblée. Dans quelques cas, les examens clinique et radiologique ne permettent pas de déterminer l'étiologie et la dent causale. Faute de diagnostic correct, on est amené à réaliser un traitement inapproprié et inefficace. Les auteurs présentent un cas de fistule cutanée génienne basse, secondaire à une nécrose pulpaire de la première molaire et/ou à une péricoronarite sur la dent de sagesse. Cette double étiologie probable a prolongé le traitement et retardé la guérison. Lorsque la fistule cutanée d'origine dentaire n'est pas accompagnée de symptômes dentaires évidents et qu'il existe plusieurs dents causales éventuelles, il est parfois difficile d'identifier la dent responsable. La persistance de la fistule après le traitement initial a conduit à rechercher une autre dent causale. Key words: sinus tract / cutaneous / odontogenicAbstract -Challenging diagnosis face to cutaneous dental sinus tract. Cutaneous draining sinus tracts of dental origin often are a diagnostic challenge. A delay in correctly diagnosing these types of lesions can result in ineffective and inappropriate treatment. The authors present a case of cutaneous sinus tract on the lower cheek secondary to pulpal necrosis of the first molar and/or pericoronitis or the third molar. This double etiology has extended the treatment and delayed the healing. As patients with cutaneous facial sinus tracts of dental origin often do not have obvious dental symptoms, possible double dental etiology may be overlooked. Early correct diagnosis and treatment of these lesions can help prevent unnecessary surgical treatment.La fistule cutanée d'origine dentaire représente une voie de drainage plus ou moins longue pour une infection dentaire [1] ; il s'agit d'une entité connue et décrite depuis fort longtemps [2]. Cependant, errance diagnostique et retard de prise en charge thérapeutique sont encore fréquents, même en Médecine bucco-dentaire [3,4]. Parfois, elle est attribuée à une autre cause et tout traitement local, le plus souvent l'exérèse de la lésion cutanée, est rapidement suivi d'une ré-cidive [5].A travers ce travail, l'accent est mis sur la nécessité d'éta-blir un diagnostic étiologique correct afin d'adopter une attitude thérapeutique adéquate qui, seule, permet d'obtenir la guérison et d'éviter au patient un préjudice esthétique.