Jean-paul Goulet | Université Laval (original) (raw)

Papers by Jean-paul Goulet

Journal of Oral Rehabilitation, 2016

Self-management (SM) programmes are commonly used for initial treatment of patients with temporom... more Self-management (SM) programmes are commonly used for initial treatment of patients with temporomandibular disorders (TMD). The programmes described in the literature, however, vary widely with no consistency in terminology used, components of care or their definitions. The aims of this study were therefore to construct an operationalised definition of self-management appropriate for the treatment of patients with TMD, identify the components of that self-management currently being used and create sufficiently clear and non-overlapping standardised definitions for each of those components. A four-round Delphi process with eleven international experts in the field of TMD was conducted to achieve these aims. In the first round, the participants agreed upon six principal concepts of self-management. In the remaining three rounds, consensus was achieved upon the definition and the six components of self-management. The main components identified and agreed upon by the participants to constitute the core of a SM programme for TMD were as follows: education; jaw exercises; massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. This Delphi process has established the principal concepts of selfmanagement, and a standardised definition has been agreed with the following components for use in clinical practice: education; self-exercise; self-massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. The consensus-derived concepts, definitions and components of SM offer a starting point for further research to advance the evidence base for, and clinical utility of, TMD SM.

Oral Surgery, Oral …, 2003

The aim of this study was to reevaluate the link between Candida albicans and denture-related sto... more The aim of this study was to reevaluate the link between Candida albicans and denture-related stomatitis according to a modified Newton classification, which reflects the classic types of inflammation as well as the extent to which the tissue is affected. Two groups of denture wearers were evaluated for denture-related stomatitis. The presence and number of yeasts on the dentures, the identification of the Candida species present, and the amount of plaque coverage were determined. Putative risk factors were included in the study. Relations between these variables and stomatitis were analyzed statistically. According to Newton&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s classification, the presence of yeast on the denture was not linked to whether subjects had stomatitis. But with our classification, higher prevalence of yeast carriers, yeast colony number, and plaque coverage were found on the dentures of individuals with the most extensive inflammation, regardless of Newton type. Among risk factors evaluated, wearing dentures at night and smoking were associated with the most extensive inflammation. We also demonstrated that the presence of C albicans as well as the cohabitation of different Candida species was more frequent in denture-related stomatitis. The differences were statistically significant. Statistical analysis of microbiologic data from different denture-related stomatitis categories according to our modified classification showed that the presence of yeast on dentures was significantly associated with the extent of the inflammation, rather than with the Newton type. Our findings suggest that the inflammatory process of stomatitis favors the colonization of Candida. These results could have new implications for diagnosis and management of the condition.

criteria for headache attributed to temporomandibular disorders

Annals of Surgical Oncology, 2011

The use of neoadjuvant systemic therapy (NST) for the treatment of primary breast cancer has cons... more The use of neoadjuvant systemic therapy (NST) for the treatment of primary breast cancer has constantly increased, especially in trials of new therapeutic regimens. In the 1980 s, NST was shown to substantially improve breast-conserving surgery rates and was first typically used for patients with inoperable locally advanced or inflammatory breast cancer. Investigators have since also used NST as an in vivo test for chemosensitivity by assessing pathologic complete response. Today, by using pathologic response and other biomarkers as intermediate end points, results from trials of new regimens and therapies that use NST are aimed to precede and anticipate the results from larger adjuvant trials. In 2003, a panel of representatives from various breast cancer clinical research groups was first convened in Biedenkopf to formulate recommendations on the use of NST. The obtained consensus was updated in two subsequent meetings in 2004 and 2006. The most recent conference on recommendations on the use of NST took place in 2010 and forms the basis of this report. Since the last consensus meeting on neoadjuvant systemic therapy (NST) in 2006, knowledge has increased on intrinsic subtype responses, different chemotherapy and trastuzumab regimens' response evaluation, and the use of sentinel lymph node biopsy (SLNB). 1 The aim of this update was to integrate this new knowledge into the current practice of NST in primary breast cancer. METHODS In September 2010, an international panel of representatives of breast cancer clinical research groups was convened in Biedenkopf, Germany, for a fourth meeting on NST in operable breast cancer (Table 1). The panel comprised experts in medical oncology, breast surgery, diagnostics, pathology, radiation oncology, and modern genomic methods in breast cancer (six members from the United States and 13 from six different European countries). The presentations

Cephalalgia, 2012

Aims: We assessed and compared the diagnostic accuracy of two sets of diagnostic criteria for hea... more Aims: We assessed and compared the diagnostic accuracy of two sets of diagnostic criteria for headache secondary to temporomandibular disorders (TMD). Methods: In 373 headache subjects with TMD, a TMD headache reference standard was defined as: self-reported temple headache, consensus diagnosis of painful TMD and replication of the temple headache using TMD-based provocation tests. Revised diagnostic criteria for Headache attributed to TMD were selected using the RPART (recursive partitioning and regression trees) procedure, and refined in half of the data set. Using the remaining half of the data, the diagnostic accuracy of the revised criteria was compared to that of the International Headache Society's International Classification of Headache Diseases (ICHD)-II criteria A to C for Headache or facial pain attributed to temporomandibular joint (TMJ) disorder. Results: Relative to the TMD headache reference standard, ICHD-II criteria showed sensitivity of 84% and specificity of 33%. The revised criteria for Headache attributed to TMD had sensitivity of 89% with improved specificity of 87% (p < 0.001). These criteria are (1) temple area headache that is changed with jaw movement, function or parafunction and (2) provocation of that headache by temporalis muscle palpation or jaw movement. Conclusion: Having significantly better specificity than the ICHD-II criteria A to C, the revised criteria are recommended to diagnose headache secondary to TMD.

Medical Science Monitor, Jul 23, 2004

Oral candidiasis is a collective name for a group of disorders caused by the dimorphic fungus Can... more Oral candidiasis is a collective name for a group of disorders caused by the dimorphic fungus Candida albicans (C. albicans). Host defenses against C. albicans essentially fall into two categories: specific immune mechanisms and local oral mucosal epithelial cell defenses. The rationale of this study was to investigate the involvement of IL-18 in the inflammatory response against oral candidiasis. We first used human oral mucosa tissue and saliva to assess the production of Il-18. Second, we engineered human oral mucosa using only normal human oral epithelial cells and fibroblasts. Tissues were infected with C. albicans at different time points. Tissue and saliva analyses demonstrated that constitutively produced and secreted IL-18 was up-regulated following Candida-infection. With our engineered model, we showed that C. albicans significantly increased the secretion of active IL-18 by infected epithelial cells. Interestingly, a significant secretion of IFNg functionally supported t...

A living thing is distinguished from a dead thing by the multiplicity of the changes at any momen... more A living thing is distinguished from a dead thing by the multiplicity of the changes at any moment taking place in it Herbert Spencer This report provides general guidelines for the structure of a curriculum, followed by specific advice on the principles of learning and teaching, the process of restructuring and change leadership and management. It provides examples of several educational philosophies, including vertical and horizontal integration. It discusses the use of competence, learning outcomes, level of degree and assessment and provides a number of recommendations. It does not seek to be prescriptive of time allocation to disciplines within a curriculum. Although this report has been written primarily for those who will develop an undergraduate curriculum, the information may be sufficiently generic to apply to the recent development in graduate entry (‘shortened dental ’ or ‘accelerated’) courses and to postgraduate degree planning and higher education certificate or diplo...

Journal of oral and facial pain and headache, 2009

The authors of the Focus Article1 present a critical appraisal of the Research Diagnostic Criteri... more The authors of the Focus Article1 present a critical appraisal of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and its classification system. They recognize the impact that the cornerstone paper published by Dworkin and LeResche in 1992 has had on clinical research.2 Research has since yielded important changes and the authors raise a number of important issues, some being very well supported while others are more debatable. The authors conclude that the time has come to update and broaden the scope of the RDC/TMD, which should be more clinically oriented and better oriented to treatment decision making. My commentary addresses the major points from each of the four sections of the Focus Article.

The orofacial region consists of heterogeneous tissues that make diagnosing and treating pain con... more The orofacial region consists of heterogeneous tissues that make diagnosing and treating pain conditions a challenging task. Vital to these processes are well-structured classification systems that cover the breadth of chronic orofacial pain conditions and provide diagnostic criteria to enhance our ability to properly identify and categorize clinical events in an agreed pattern. A revision of the classification systems for orofacial pain disorders developed respectively by the International Association for the Study of Pain, the International Headache Society, the American Academy of Orofacial Pain, and the American Academy of Craniofacial Pain reveals a number of deficiencies and inconsistencies ranging from terminology to the structure itself and the set of diagnostic criteria. To improve communication and enable effective collaborative work, we are at the crossroads for the development of a new multiaxial classification system using ontological principles to build a realistic and...

BACKGROUND Oral candidiasis is a collective name for a group of disorders caused by the dimorphic... more BACKGROUND Oral candidiasis is a collective name for a group of disorders caused by the dimorphic fungus Candida albicans (C. albicans). Host defenses against C. albicans essentially fall into two categories: specific immune mechanisms and local oral mucosal epithelial cell defenses. The rationale of this study was to investigate the involvement of IL-18 in the inflammatory response against oral candidiasis. MATERIAL/METHODS We first used human oral mucosa tissue and saliva to assess the production of Il-18. Second, we engineered human oral mucosa using only normal human oral epithelial cells and fibroblasts. Tissues were infected with C. albicans at different time points. RESULTS Tissue and saliva analyses demonstrated that constitutively produced and secreted IL-18 was up-regulated following Candida-infection. With our engineered model, we showed that C. albicans significantly increased the secretion of active IL-18 by infected epithelial cells. Interestingly, a significant secret...

SUMMARY For research purposes, the refinement of existing clinicalexamination methodology and the... more SUMMARY For research purposes, the refinement of existing clinicalexamination methodology and the addition of more objectivemethods (e.g., algometry) to quantify subjective signs andsymptoms could benefit any study dealing with repeatedmeasurements over a period of time. Each individual item andany new method would be tested for reliability and validity bycomparing it with an acknowledged gold standard to identifyits advantages and any possible shortcomings. Unfortunately,the only current gold standard for TMD is a global clinicalexamination and history by an expert examiner, thus makingthe validation process somewhat circular. Finally, researchersmust recognize that their efforts to achieve precision andaccuracy will likely lower the utility of their eventual researchexamination for day-to-day clinical purposes.New TMD indices have been developed to define, quantify,and score the degree of TMJ dysfunction based on clinicalexamination findings (Smith, 1981a,b;Duinkerkeeta/., 1986a;F...

This article discusses the relative contraindications to the use of vasoconstrictor in patients c... more This article discusses the relative contraindications to the use of vasoconstrictor in patients currently medicated with tricyciic antidepressants, monoamine oxidase inhibitors, phenothiazines and P-blockers. It reviews drug interactions and emphasizes potential detrimental systemic effects that epinephrine contained in !ocal anesthetics can have when administered concomitantly with these drugs. Finally, special considerations are expressed concerning patients who abuse illicit drugs such as cocaine. (ORAL SURG ORAL MED ORAL PATHOL 1992;74:692-7)

Dental pain triggered by temperature differential is a misrecognized condition and a form of dent... more Dental pain triggered by temperature differential is a misrecognized condition and a form of dental allodynia. Dental allodynia is characterized by recurrent episodes of diffuse, dull and throbbing tooth pain that develops when returning to an indoor room temperature after being exposed for a long period to cold weather. The pain episode may last up to few hours before subsiding. Effective treatment is to properly shield the pulpal tissue of the offending tooth by increasing the protective layer of the dentin/enamel complex. This review underscores the difference in dentin hypersensitivity and offers a mechanistic hypothesis based on the following processes. Repeated exposure to significant positive temperature gradients (from cold to warm) generates phenotypic changes of dental primary afferents on selected teeth with subsequent development of a "low-grade" neurogenic inflammation. As a result, nociceptive C-fibers become sensitized and responsive to innocuous temperature gradients because the activation threshold of specific TRP ion channels is lowered and central sensitization takes place. Comprehensive overviews that cover dental innervation and sensory modalities, thermodynamics of tooth structure, mechanisms of dental nociception and the thermal pain are also provided.

Journal of Dental Education

The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine ... more The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine and dentistry. However, dentists have not traditionally been taught psychosocial screening as part of their predoctoral education. The aim of this systematic review was to provide an overview of published studies on the implementation of screening for psychological comorbidity in dental and dental hygiene education. The term "psychological comorbidity" refers to the degree of coexisting anxiety, depression, or other mental health problems in a patient presenting with a physical condition. The review followed a protocol registered in PROSPERO (CRD42016054083) and was carried out in accordance with the PRISMA guidelines. The methodological quality of the included studies was assessed using a ten-item tool developed for medical education. The electronic search in PubMed, Scopus, and PsycINFO from the inception of each database until December 31, 2016, together with a hand search, identified 1,777 articles. After abstracts were screened, 52 articles were reviewed in full text applying inclusion and exclusion criteria; four articles remained for the qualitative synthesis. Generally, the reported data on specific methods or instruments used for psychological screening were limited. Only one of the included articles utilized a validated screening tool. The results of this systematic review show that published data on the implementation of psychological patient assessment in dental and dental hygiene education are limited. To address this gap, the authors recommend short screening tools such as the Graded Chronic Pain Scale and the Patient Health Questionnaire for Depression and Anxiety. Educating dental and dental hygiene students about easy-to-use, reliable, and validated screening tools for assessing psychological comorbidity warrants more research attention and greater implementation in educational curricula.

Contemporary Oral Medicine