RESUMO
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.
RESUMO
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.
Assuntos
Assistência Odontológica/estatística & dados numéricos , Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Paris/epidemiologia , Estudos Retrospectivos , Doenças Estomatognáticas/epidemiologia , Doenças Estomatognáticas/terapiaRESUMO
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.
Assuntos
Doenças da Boca/patologia , Doenças da Boca/terapia , Higiene Bucal , Penfigoide Bolhoso/patologia , Penfigoide Bolhoso/terapia , Consenso , França , Humanos , Doenças da Boca/imunologia , Higiene Bucal/métodos , Índice de Higiene Oral , Educação de Pacientes como Assunto/métodos , Penfigoide Bolhoso/imunologia , Índice de Gravidade de DoençaRESUMO
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.
Assuntos
Carcinoma/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia de Intensidade Modulada/métodos , Assistência ao Convalescente , Assistência Odontológica/métodos , Assistência Odontológica/normas , Humanos , Órgãos em Risco , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/normasRESUMO
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.