Previous studies have observed high DE rates for French Army personnel. The intensity, danger, and geography of the mission in Afghanistan exacerbate the negative operational impact of dental pathologies.

--Introduction: Periodontal diseases are caused by pathogenic microorganisms that induce increases in of local and systemic proinflammatory cytokines, resulting in periodontal damage. The onset and evolution of periodontal diseases are influenced by many local and systemic risk factors. Educational objective: In this article, we aim to review the results of the research on the impact of chronic stress on the occurrence, development, and response to periodontal disease treatments and on the pathophysiological mechanisms of periodontal disease. Conclusion: Chronic stress has a negative impact on the occurrence, development, and response to the treatment of periodontal disease via indirect actions on the periodontium. This can result from behavioral changes caused by stress (poor dental hygiene, smoking, etc.) and a direct neuroimmunoendocrinological action related to the consequences (particularly immunological) of the secretion of certain chemicals (e.g., cortisol) induced by the activation of the hypothalamus and the autonomic nervous system in response to stress. These factors necessitate multidisciplinary management (e.g., physician, oral surgeon, and psychologist) of patients to identify subjects with chronic stress and to employ countermeasures to decrease the impact of stress on the periodontium.

Dental fractures induced by changes in atmospheric pressure, called odontocrexis, are described in aviation dentistry articles. According to previous reports, these pathologies are induced exclusively in teeth with defective dental restorations. Nevertheless, in this case report we describe a tooth fracture occurring on an apparently sound tooth in a fighter pilot during a flight. All usual etiologies of this odontocrexis can generally be eliminated. This atypical fracture shows that all pathophysiology and contributing factors of odontocrexis are still widely unknown.

This case highlights the importance of the use of an adapted mouthpiece by divers, and the need for awareness of physicians and dentists who treat divers of the implications of scuba diving on dental and oral medicine.

Barodontalgia mostly appeared in the maxilla and during descent; therefore, a great role for barosinusitis in the etiology of oral pain while diving may be suggested. The infrequent experience of barodontalgia in divers who routinely visit the dentist once a year or more suggests that the risk of barodontalgia might decrease with the maintenance of a good oral status.

Introduction: Noma is defined as a gangrenous ulcerative stomatitis whose starting point is endobuccal. Its exact etiology remains unknown, but many risk factors have been described (malnutrition, poor hygiene, etc.). Chronic lymphoid leukemia (LLC) is a lymphoproliferative syndrome characterized by medullary proliferation of a B lymphocyte clone. It is not considered as a risk factor for noma disease. Observation: A 43-year-old patient is admitted in the odontostomatology unit of the Dapaong Regional Hospital Centre (Togo) for a deep lesion of the left cheek. The clinical examination allows to conclude the presence of a noma. Biological examinations also show a LLC at Binet stage C. In our patient, the LLC is associated with an immunosuppression and the development of infections due to the late diagnosis of the LLC. Comment: The immunosuppression and the development of infections are described in the literature as risk factors for noma disease. An association between LLC and noma could therefore exist. However, such association has been reported to date only once in the literature in 1976. Conclusion: Our observation suggests that the LLC could be a risk factor for noma disease. However, further studies based on large samples are necessary to conclude a causal association between LLC and noma.

Résumé -Administrés par voie intraveineuse, les bisphosphonates trouvent de nombreuses indications en oncologie et en hématologie (prise en charge des myélomes multiples, prévention des complications osseuses de certaines tumeurs malignes avancées, traitement des hypercalcémies malignes). Depuis 2003, de nombreuses publications ont rapporté un effet indésirable grave imputable aux bisphosphonates : l'ostéonécrose des maxillaires (ONM). Une revue de la littérature portant sur 10 ans de recherche montre que les données épidémiologiques relatives à cette pathologie restent contradictoires. L'incidence des ONM couramment acceptée (0,8 à 12 %) semble sous-estimée en raison des limites méthodologiques des études disponibles (durée de suivi des patients limitée, absence d'examen bucco-dentaire systématique, inhomogénéité des échantillons, etc.). L'absence de consensus autour des facteurs de risque de survenue des ONM résulte de ces mêmes limites méthodologiques. Ce manque de données hypothèque la compréhension des ONM et donc leur prévention et leur prise en charge thérapeutique. Un recueil systématisé et exhaustif des cas de ONM et de leur contexte de survenue (pathologie primaire, données relatives au traitement par bisphosphonates, facteurs de risque, etc.) devrait permettre de pallier ce problème.Abstract -Osteonecrosis of the jaw in patients treated with intravenous bisphosphonates: incidence and risk factors. Intravenous bisphosphonates are effective in the treatment and management of cancer-related conditions including hypercalcemia of malignancy, skeletal-related events associated with bone metastases in the context of solid tumors such as breast cancer, prostate cancer and lung cancer, and management of lytic lesions in the setting of multiple myeloma. In 2003, oral and maxillofacial surgeons first recognized and reported cases of non-healing exposed bone in the maxillofacial region in patients treated with intravenous bisphosphonates. This adverse effect was called bisphosphonate-related osteonecrosis of the jaw (BOJ). A review of literature based on ten years of research highlights a lack of reliable epidemiological data. BOJ incidence commonly accepted (0.8 to 12%) seems to be underestimated. The main raisons for conflicting results concerning BOJ incidence and risk factors are the weakness of study design, the underpowered study with the use of mixed samples (patients with different pathologies and treatments) during short follow-up. To increase level of evidence well designed studies are needed with a longer follow-up of patients, a systematic dental exam by a trained dentist, the set up of homogeneous samples, etc. The lack of reliable data prevents the scientific community from understanding BOJ and so from setting up effective prevention and treatments. A systematic and exhaustive data collection of cases of BOJ and their context of occurrence (primary disease, information concerning the treatment with bisphosphonates, risk factors, etc.) should overcome these problems.

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