Evaluation de la douleur et de l'anxiété lors de soins dentaires chez les patients hospitalisés en psychiatrie.

OBJECTIF: La santé bucco-dentaire des patients en psychiatrie est problématique, puisque le recours au chirurgien-dentiste demeure inférieur de 25 % à la population générale. En partant de ce postulat, nous avons souhaité comprendre en quoi l'anxiété et la douleur du patient peuvent impacter la prise en charge bucco-dentaire et le bon déroulement des soins. MÉTHODE: Cette étude a été menée sur 100 patients hospitalisés en psychiatrie. Grâce à différentes échelles, nous avons évalué leur niveau d'anxiété et de douleur, mais aussi leur coopération aux soins. RÉSULTATS: L'anxiété ne constitue pas un frein à la prise en charge, et diminue significativement après les soins. Le comportement durant les soins bucco-dentaires des patients hospitalisés en psychiatrie semble similaire à celui de la population générale. CONCLUSION: Notre étude permet de mieux appréhender les soins dentaires en psychiatrie et devrait contribuer à placer les soins dentaires au centre de la prise en charge somatique en psychiatrie.

[Children's consultations for dental emergency. Retrospective study in Île-de-France]. / Consultations pour urgence bucco-dentaire chez les enfants : étude rétrospective en Île-de-France.

BACKGROUND: In France, the children oral health status has improved but the use of care remains insufficient. The complexity of the acts, the access to care difficulties and the programs of prevention and care for children lack of knowledge contribute to late care and often, in emergency. This study aims to describe the young patients' characteristics consulting in dental emergency and analyse the modalities of recourse. METHODS: A retrospective study was conducted on medical records. An extraction of data was carried out concerning all children under the age of 16, admitted to the Dental Emergency Functional Unit of the Pitié-Salpêtrière Hospital Group in 2015. Several variables of interest were analysed: socio-demographic characteristics, the time of the visit and the diagnostic category (tooth pathologies, facial trauma, infections, periodontal diseases and other emergencies). Descriptive and bivariate analyses were conducted. RESULTS: On the 62,500 dental emergency consultations in 2015, 5359 were for patients under 16 years of age (8%). Data were available for 5044 children. Among these, children aged 6 to 11 accounted most of consultations (43.9%). There were more boys (57.2%). The most frequent emergency diagnoses were related to a tooth pathology (42.9%) and traumatic event (38.4%). Consultations were more held on the evening schedule on weekdays and the day on weekends. Patients aged 0 to 5 years consulted more at night (P<10-3) and were, proportionally, the most affected by traumatic events (39.2%). Children aged 6 to 11 and 12 to 16 years consulted more often during the day (P<10-3), for emergencies related to a carious event (43.9% and 43.6%). Patients residing in Seine-Saint-Denis accounted for 22.6% of total visits and those living in Paris accounted for 20.8%. CONCLUSION: A large proportion of children presenting for dental emergencies, have most of the time, only the need for usual care. An offer of dental care, adapted to the territory needs, is necessary for the children dental health management. Preventive measures from an early age and early recourse would be favourable.

[Oral care recommendations for patients with oral autoimmune bullous diseases]. / Recommandations pour la prise en charge buccodentaire des patients atteints de maladies bulleuses auto-immunes avec atteinte buccale.

BACKGROUND: Autoimmune bullous diseases (AIBD) may cause chronic oral lesions that progress insidiously. AIMS: To provide recommendations for optimal oral-dental management of patients presenting AIBD with oral involvement. PATIENTS AND METHODS: In the absence of scientific studies with high levels of proof, these recommendations have been drawn up at two meetings by a committee of experts on AIBD comprising 7 dermatologists, 1 stomatologist, 1 maxillofacial surgeon, 2 odontologists and 4 parodontologists. RESULTS: The oral lesions associated with AIBD may be classified into three grades of severity: severe (generalised erosive gingivitis affecting at least 30% of dental sites), moderate (localised erosive gingivitis affecting less than 30% of dental sites) and controlled (no erosive oral lesions). Good oral-dental hygiene suited to the severity of the oral lesions, must be practised continually by these patients so as to avoid the formation of dental plaque, which aggravates symptoms. Dental and parodontal care must be considered in accordance with the severity grade of the oral lesions: in severe cases, the dental plaque must be eliminated manually with a curette, but several types of care (descaling, treatment for tooth decay, non-urgent extractions, etc.) must be suspended until the grade of severity is moderate or until the disease is stabilised.

[Common chapter dedicated to taking care about the preparation of irradiation of head and neck carcinoma]. / Chapitre commun à la prise en charge et à la procédure de préparation des traitements des cancers de la tête et du cou.

The treatment of head and neck carcinoma by radiotherapy with or without chemotherapy or targeted agents requires a rigorous preparation, sometimes complex, frequently time consuming to guaranty to the patient to reduce as much as possible acute toxicity as well as late complications. These rules are valuable whatever the location of the primary with some anatomic variations. Intensity modulated radiotherapy and its rules are currently the standard of care for this disease. The follow-up of the patients during their treatment is similar.

[Should we teach bioethics to students in dentistry as part of public studies? An example in the Faculty of Dentistry at the University Paris Descartes]. / Faut-il enseigner la bioéthique aux étudiants en odontologie dans le cadre de la discipline santé publique ? Une expérience à la faculté de chirurgie dentaire de l'université Paris Descartes.

BACKGROUND: The dental student is committed to being an actor in public health and his/her mission must deal with the wishes of the patient and the ethical requirements of the society. In order to improve physical and mental health on an individual and collective level, the University has a responsibility to develop a real culture of public health early in the academic curriculum. This context raises the question of the usefulness of ethics education for students in dental school. METHODS: The Faculty of Dentistry at Paris Descartes University is engaged in a pilot process to reform dental studies, taking into account official and ministerial directives. An educational program on ethics delivered during the course of 10 semesters is broken down into lectures, practical lessons, and active training in one of four Paris hospitals. RESULTS: Teaching bioethics in the public health context puts the student at the center of an active process where each student is responsible for personal involvement in five proposed teaching methods: lectures, seminars, directed education, and reference research using the University's intranet portal. CONCLUSION: The result of 3 years of experience teaching bioethics in public health discipline is positive. The dental students are encouraged to develop skills to analyze an effective strategy for dental care where ethics becomes a cardinal value. In this sense, the teaching of bioethics that is at the heart of public debates is perfectly adapted to the public health discipline. Ultimately, it could be integrated into the teaching of all subjects.