Dental anxiety, a one-year evaluation / Consultation pour la prise en charge de l'anxiété dentaire, retour d'expérience sur un an d'activité

Dental anxiety is the second most common reason for patients to forgo treatment in France. Based on this observation, the odontology and psychiatry departments of Henri Mondor hospital proposed a collaborative approach to help these patients. The aim of this study is to evaluate the results of this pilot project over one year. The patients appreciated the consultation, considering it a tool to help them be able to receive care. This consultation also resulted in 17 percent of patients being offered psychological care in order to treat other problems related to dental anxiety. The idea of a network of practitioners specialized in the treatment of these anxious patients is therefore proposed, the patients having emphasized that not having to re-explain their anxieties would be a relief.

L'anxiété dentaire est la deuxième cause de renoncement aux soins en France. À partir de ce constat, les services de médecine bucco-dentaire et de psychiatrie du Groupe hospitalier Henri-Mondor ont proposé une prise en charge collaborative des patients concernés. L'objectif de cette étude consiste en un retour d'expérience sur une année de fonctionnement de ce projet pilote. Les patients qui ont bénéficié d'une prise en charge ont apprécié la consultation comme un levier pour être en mesure de recevoir des soins. Cette consultation a aussi permis de proposer une prise en charge psychologique pour 17 % des patients afin de traiter d'autres problèmes connexes à l'anxiété dentaire. L'idée d'un réseau de praticiens spécialisés dans la prise en charge de ces patients anxieux peut ainsi être proposée, ces derniers ayant soulignés leur soulagement de ne pas avoir à expliquer de nouveau leurs angoisses.

Clinical relevance of interdental papilla biopsy in chronic erosive gingivitis (desquamative gingivitis): retrospective bicentric study of 148 specimens.

BACKGROUND: Chronic erosive gingivitis, also called desquamative gingivitis, defines a clinical picture that can be generated by several inflammatory and immune diseases. Pathology is therefore essential for the differential diagnosis. However, when the gingival lesion is initial, exclusive or predominant, selecting the biopsy site and protocol may be problematic due to tissue fragility. Especially since there are few studies on the subject, the aim of our study was to assess the protocol, diagnostic relevance and tolerance of an original protocol using interdental papilla biopsy. METHODS: We conducted a retrospective bicentric study, from October 2011 to July 2019, including all patients with a chronic erosive gingivitis who had received, for diagnostic purposes, a interdental papilla biopsy. RESULTS: The contribution levels for the two hospital departments were 94.7% and 97.1%, respectively. No postoperative complication was recorded in the short or long term. CONCLUSION: The interdental papilla biopsy protocol is perfectly adapted to the anatomopathological examinations required to establish differential diagnosis of chronic erosive gingivitis. This surgical protocol is simple to perform, non iatrogenic with a very good tolerance and and accessible to all clinicians. It is highly efficient with an excellent contribution level. ClinicalTrials NCT04293718 (March 3, 2020). Health Data Hub N° F20201109083211 (November 9, 2020).

[Télédent, an oral tele-expertise experience in a penitentiary environment]. / Télédent, une expérience de téléexpertise bucco-dentaire en milieu pénitentiaire.

The oral health has an important role in the good general health state. Some populations, including those in detention, have not only increased needs, but also limited access to dental care. Télédent is an oral tele-expertise activity that facilitates the screening and prevention of oral disorders, performing as a complementary health tool for screening. With an intra-oral camera, oral images of the prisoners are recorded and then analyzed by a team from the Oral Medicine Department of the Hospital Henri Mondor, giving the UCSA of Fresnes prison a detailed dental expertise. As a result, Télédent enables a cooperation to improve the screening and oral care of prison inmates at the Fresnes Prison, decreasing costs and increasing the security.

TITLE: Télédent, une expérience de téléexpertise bucco-dentaire en milieu pénitentiaire. ABSTRACT: La santé bucco-dentaire participe au maintien d'un bon état général de l'organisme. Certaines populations, dont les personnes détenues, ont des besoins importants mais, simultanément, un accès limité aux soins dentaires. Télédent est un outil complémentaire de téléexpertise bucco-dentaire qui facilite le dépistage et la prévention des troubles oraux. À partir d'une caméra intra-buccale qui enregistre des images qui sont analysées par l'équipe du service de médecine bucco-dentaire de l'Hôpital Henri Mondor, l'Unité sanitaire du centre pénitentiaire de Fresnes dispose d'une expertise dentaire détaillée. Télédent permet ainsi une coopération entre les services qui améliore le dépistage et la prise en charge de soins bucco-dentaires, tout en diminuant les coûts et en favorisant la sécurité des patients détenus.

Ethical reflections on the principle of patient autonomy.

In a world open to the movement of people, medical ethics is today associated with the area of loyal behavior of the practitioner and oriented in the patient's interest and accountability of each. The universal vision of respect for the dignity of the sick person progresses. Yet, many behaviours are sometimes illegitimate, but not in principle legally reprehensible. One of the main principles marking the observance of patient consent is based on the autonomy given to the patient to decide for himself what appears to be adapted to his or her care. The patient must be the one who makes the final decision on issues concerning them and doctors must act to respect it. Therefore, they must accept that the patient has a different value system.

[The necessary ethical questioning regarding the caring relationship in dental telemedicine]. / Le nécessaire questionnement éthique autour de la relation de soin en télémédecine bucco-dentaire.

Technological innovations in the fields of medical imaging and communication have enabled the rise of dental telemedecine. By transforming the usual caring relationship, dental telemedicine virtualizes the medical procedure and generates a mutation of the classical relational model that rearticulates the relationship between the dentist and the patient. It introduces a positive lever that must stay up to the appraisal of the benefit-risk equation, that an ethical questioning will help to evaluate for every patient. Dental telemedicine must be understood as a mean, and not as an end. It must not be fantasized as a universal dental care model. It seems to be recommanded to investigate systematically the technological innovations and the development of protocols thanks to ethical guidelines in order to evaluate a priori and a posteriori any kind of progress that might be considered.

[Dental care for disabled people]. / Soins bucco-dentaires pour les patients handicapés.

CONTEXT: Patients with disabilities represent a population with special needs whose dental care management constitutes a public health problem. This article describes dental care of disabled people in a hospital dental care unit to highlight the difficulties encountered and propose ways to improve this care. METHODS: A retrospective descriptive study was carried out on patients followed between 2010 and 2016 as part of the partnership between the Albert Chenevier Hospital odontology department and the RHAPSOD'IF network. The data collected by means of ?follow-up sheets? described the procedures performed and any medication used. These anonymised records were analysed by Excel software. RESULTS: Dental care sessions for the 434 disabled persons consisted of visits (42 to 57%), restorations and scalings each represented 1/6 of all procedures performed (14 to 19% and 14 to 18%), and surgery and radiography each represented 1/8 of procedures (4 to 12% and 6 to 11%). There were almost no dental prostheses (0 to 1%). Most dental care sessions were performed without premedication (61 to 76%). CONCLUSION: This type of dental care requires training of families and caregivers, a good interpersonal approach and time to build a relationship of trust. Participation in a network is important to help, support, and advise the practitioner and to provide financial support.

[Oral hygiene prevention actions at Albert Chenevier hospital: Open day for schools]. / Actions de prévention bucco-dentaire à l’hôpital Albert Chenevier : journée « portes ouvertes ¼ pour les écoles.

BACKGROUND: Since 1994, the dental department of Albert Chenevier hospital in Créteil organizes an "open day" for schoolchildren in Creteil. This action is organized in collaboration with the Creteil Social Action Community Centre (CCAS) health prevention service and is part of a prevention programme designed to reduce caries prevalence in children aged 6 to 7 years. This programme helps especially children from disadvantaged groups or with disabilities. We want to report results for the last three years. METHODS: Allezard and Beauvin schools and La Nichée and Leloup special schools attended this open day, consisted of two parts. The first part concerned prevention, designed to teach children to brush their teeth. The second part consisted of screening of tooth decay. CCAS provided disposable toothbrushes, toothpaste and examination instruments. The Albert Chenevier hospital dental department provided hospital personnel, appropriate hygiene materials and premises. RESULTS: About 50% of children of all ages and from all schools presented tooth decay. The use of dental care decreased between 2011 and 2013 for Allezard and Beauvin schools. It was 100% in 2011 and 2012 for special schools and virtually zero for the Beauvin special school for disabled children. Dental care decreased from year to year for these special classes and for special schools. About 20% of children at the Allezard school had good oral hygiene. CONCLUSION: The effect of health education activities can be improved by involving the child's family. Oral hygiene must be based on a collective approach in which everyone has a role to play: children, parents, educators, teachers, principals and nursing staff should be involved to ensure continuing improvement of oral hygiene and to try to promote access to care. This preventive action therefore remains necessary and the information must be repeated.

[Is there room for improvement in the field of dental ethics?]. / La déontologie des chirurgiens-dentistes doit-elle évoluer ?

INTRODUCTION: Dental ethics, enforced by the Dental Board, are defined in the Code of Conduct for dentists included in the French Public Health Code. Dentist-patient relationships are changing, while scientific progress advances more rapidly than dental ethics. Are dental ethics still adapted to the practice of dentistry? METHODS: This study was based on the Institut BVA "The French and patients' rights" survey conducted in September 2013, together with a systematic review of the literature using the Medline, Legifrance, Lexisnexis, and Elnet.fr databases and the Paris Descartes University medical library website. RESULTS: Five essential principles were identified and a total of 210 articles were included. The results indicate that there is room for improvement in pain management, respect of human dignity, information and consent concerning healthcare, and free choice of a practitioner. CONCLUSION: Dental ethics have evolved, but further improvement is required to adapt the dentist-patient relationship to scientific progress and the patients' expectations. To ensure a truly informed choice, this article shows that dental ethics cannot vary in response to surveys or fashions, as dental practice must remain essentially based on an ethical approach that cannot be rigidly defined in a code of professional conduct.

Thoughts on donation of a tooth to science, in the course of dental care.

INTRODUCTION: Research on biological samples, including dental pulp stem cells (DPSC), has expanded considerably in recent years and is now seen as a way forward toward the possibilities of new therapies, such as craniofacial bone and tooth repair. The extraction of healthy teeth and their donation for scientific research is now well accepted by both patients and researchers alike. The present situation, as described above, presents a timely opportunity to reflect on the ethical and moral obligations of all of the stakeholders involved in this methodology. METHOD: Twenty-two patients who received dental treatment between November 2013 and February 2014 in the dental department of Louis Mourier Hospital in Colombes, France, completed a questionnaire. The questionnaire was designed to gather data in respect of giving patients optimal information necessary to acquire informed consent for extraction of teeth to be used for odontological biomedical research. RESULTS: When patients agree to donate their teeth for purposes of scientific research it is vital that they are properly informed and enabled so that they are able to give consent freely. CONCLUSIONS: The risks to patients during dental extractions are minimal. However despite the growing need for a supply of extracted teeth for dental pulp stem cell research it is imperative that any ethical questions that may be raised by potential donors guarantee the security, integrity, and respect of the intentions and aspirations of the donor. To enable the acquisition of true informed consent, this article explores how the dissemination of information relating to biomedical research in the field of dental care must remain as a duty of care and professional ethics.

[Dental care for dependent elderly people]. / Soins dentaires aux personnes âgées dépendantes.

In 1995, the faculty of dental surgery of Paris-Descartes University set up a scheme whereby students at the end of their basic training offer their assistance and skills to institutions caring for dependent elderly people. This article presents a 2011 assessment of the difficulties encountered by the students and nurses' awareness of the importance of integrating oral hygiene into patients' overall care.

[Information and consent in dental care associated with biomedical research]. / Informations et consentement au cours de soins dentaires associés à la recherche biomédicale.

INTRODUCTION: Tooth extraction as a part of dental care provides an opportunity to obtain dental pulp stem cells that could constitute new therapeutic tools for craniofacial bone and teeth repair. However, the use of tooth as a biological sample of human origin must comply with legislation and ethical rules. METHODS: A systematic literature review was conducted using Medline, Réseau Rodin, EM-Premium, Légifrance, and the Comité consultatif national d'éthique and Comité national odontologique d'éthique websites. RESULTS: A total of 32 articles were included. This review of the literature on ethical issues identified the principles allowing research to be conducted in the context of dental care, while respecting the patient's autonomy and dignity. CONCLUSION: The patient must receive clear and accurate information and must give his/her consent before using a tooth for research purposes. However, a number of problems remain unresolved. This study explains how patient information and consent in the context of biomedical research must remain an integral part of dental care based on an ethical relationship.

Ethical questions raised by the first allotransplantations of the face: a survey of French surgeons.

INTRODUCTION: More than any other allograft, the allotransplantation of the face has a symbolic character, which raises a large number of questions. The objective of this article is to make an analysis through a survey carried out among French surgeons. METHODS: A file of 909 e-mail addresses of surgeons was created so as to send out a questionnaire regarding 10 ethical issues. RESULTS: Beyond the technical prowess, the surgeons ethical reflection initially focused on the notion of consent to donation and care. They attached equal importance to all ethical questions. They spontaneously raised the issue of over-mediatization of these first transplants and the place of the transplant surgeons and their patients in the medical information. CONCLUSION: Over two thirds of the surgeons attached importance to ethical issues regarding the donor and recipient of a facial allograft. Some of the principal questions facing facial transplantation is of an ethical nature as it is an unprecedented procedure that is challenged by the axiom to first do no harm and the need of modern medicine to limit risk to as close to zero as possible. For the non-specialist, accepting psychologically the face of another individual appears to be a real issue. Contrary to that, the main demand expressed by the facial transplant recipients appears to be related to facial functions rather than appearance.

[Taking care of drug addict in odontology]. / Prise en charge du toxicomane en odontologie.

In the dental surgery practice, a drug addicted patient declares suffering from high pain and asks with insistence to be examined in emergency. The clinical examination shows a pity overall dental status: an important dental deterioration, a periodontal disease. At the end of the examination, the patient suffering withdrawal syndrome, asks with a high demand up to physical threat, to get a prescription of psychotropic medicines, and especially opiates (high dose buprenorphine). In front of this situation, the dental surgeon will face two aspects: first of all, clinical issues, as taking care of the odontological pathologies, management of the pain and of the withdrawal syndrome and second of all, the legislation issues related to its responsibility of prescription writer and the specific attitude to adjust in front of a patient with withdrawal syndrome at the dental surgery practice.