DENTAL HEALTH

Gums that bleed on the occasion of brushing teeth are a sign of a problem that should not be overlooked, dentists said on the eve of World Oral Health Day Monday.

From simple apprehension to true phobia, the fear of the dentist concerns more than half of the French. Most often, it is related to the fear of pain and a bad experience in childhood. It can, in some cases, cause the refusal of any dental care.
Also called stomatophobia in the most serious cases, the fear of the dentist can have serious consequences on the teeth and health in general. Relaxation techniques, medication, conscious sedation or general anesthesia ... help to overcome them.

The fear of the dentist, an extremely widespread fear

According to a recent survey, 54% of French people are worried about consulting their dentist. If for 35% it is only a slight apprehension, 19% see a real problem, 2% admitting never to consult because of that. In the majority of cases, this fear goes back to childhood, the older ones keeping the memory of a bad experience (pain, care under stress ...) that they transmit often to the youngest ones. All ages and all socio-cultural backgrounds are concerned.

Beyond the simple apprehension that leads to limiting consultations and can be translated once in place by sweaty hands or an acceleration of the heart rate, Dr. Daniel Banoun *, doctor-stomatologist, draws attention to stomatophobia: "Like all phobias, it is an intense and irrational fear, with patients coming with them, fainting in the waiting room," forgetting "their appointments or simply not taking it! the most severe stages, stomatophobia leads to a state of oral abandonment and can be accompanied by other phobias such as the fear of vomiting, blood, bites ... ".

When stomatophobia takes its toll

Refusing the consultations runs the risk of allowing problems to worsen. However, more than half of the people experiencing fears wait until a problem becomes serious or boring to consult. Even in severe pain, some prefer to use tricks, drugs and various drugs, rather than make an appointment.

In the absence of management, tartar accumulates, teeth are more and more painful, break and fall. "Pain and loss of teeth can prevent you from smiling, talking, eating, going out ... with serious consequences for your health and social life," notes Dr. Banoun, "but some patients remain unable to consult. They are ashamed of their fear and the state of their mouths, feel guilty for having waited and are afraid of the dentist's remarks.Stomatophobia causes terrible suffering, both physical and psychological. "

Untreated caries and periodontal diseases can also be the cause of heart diseases, ENT problems, diabetes imbalances ...

Solutions to reduce anxiety and be treated

- FIRST TO TALK!
Whatever the degree of anxiety, it is important to talk about it, if only to your dentist. "As physicians, we need to be concerned about the pain of our patients," says Dr. Armelle Laurenti-Griffiths **, a pediatric dentist, "and it's also in our best interest, first because a frightened patient will hesitate. to come back, then because we are always working more efficiently in a serene context ". The most stressed patients can request that their first consultation be limited to making contact.

If the mere fact of making an appointment seems insurmountable and / or stomatophobia is accompanied by other disorders, it may be useful to be supported by a psychotherapist. For Dr Banoun, however, nothing beats exchanges with other stomatophobic patients who have overcome their fears. Discussions can take place in a speaking group or on the Internet via blogs and discussion forums.

- NON-MEDICINAL TIPS AND METHODS

It is advisable 2 to avoid the excitants and to go to bed early the day before the consultation. Once in the waiting room, breathing more deeply, focusing your thoughts on pleasant subjects, listening to music ... avoids focusing your attention on the atmosphere of the office (noise, smells ...) and potential care.

Some dentists have specifically trained in one or more relaxation methods to reduce anxiety and the perception of pain (cognitive and behavioral therapies, sophrology, hypnosis, acupuncture ...). Their contact information is available on the Internet 3 or by word of mouth.

- THE MEDICINES AND THE CONSCIOUS SEED

Medications with anxiolytic or relaxing properties, prescribed by the dentist, can be taken the day before and / or before the consultation.

MEOPA 4 conscious sedation can supplement them or be used alone. Dr. Laurenti-Griffiths uses it regularly: "Just breathe in a mask and, five minutes later, you're totally relaxed, like on a cloud, the effects fade as soon as the mask is removed." MEOPA has no adverse effects, it is particularly useful for children, pregnant women, the elderly and disabled ...

Local anesthesia, of course, remains systematic for all acts that may be painful, as medications and MEOPA are mainly used to alleviate apprehensions and suppress the slightest pain such as anesthetic sting.

- NEUROLEPTANALGESIA AND GENERAL ANESTHESIA

Patients who are too distressed to respond to MEOPA and require significant but relatively short-term care may be offered neuroleptanalgesia, a mild anesthesia with analgesic and sedative medications given by infusion. Although it can be used as an outpatient, neuroleptanalgesia remains anesthetic, with its risks and contraindications.

As for general anesthesia, it requires hospitalization and is normally reserved for the most serious cases requiring the extraction of many teeth. The patient is intubated and usually kept for the night under observation. Some specialists perform additional care (periodontal care, implant placement ...) at the same time, but it is far from systematic. Otherwise, the continuation of the support continues in a "classic" way.

"Dealing with all the problems in one intervention is a great relief for stomatophobia patients," says Dr. Banoun, "they come out transformed and regain self-confidence, and some even agree to be followed later."

quality costs between € 300 and € 400, the healing abutment, € 50, wired material, from € 50 to € 60 and the disposable kit, € 30, not including running costs, "says Dr. Ardouin.

The prices vary according to the materials used and the operative techniques, but also according to the regions and the practitioners. Only a tiny part of the prosthesis is reimbursed: € 45 per crown. Check with your mutual to find out if the implants are supported.

What are the advantages of an implant compared to a bridge?

It's not the same thing: the implant serves as the root, the bridge is a prosthesis. However, placing a crown on an implant can have an advantage compared to a natural tooth bridge. With a bridge, the dentist is often forced to devitalize and crown the two adjacent teeth of the missing tooth. With the implant, this mutilation of two healthy teeth is avoided.

Is the sinus filling risky?

When the amount of bone is insufficient, the practitioner considers either a sinus filling or a bone graft. "The first is using substitute materials," says Dr. Antoun. In 1% of cases, there is a risk of local infection. The risk of tearing the sinus membrane is not zero either.

"Another possibility is taking bone (autogenous transplant, so no risk of rejection) in the jaw, which can be done in the dental office, or in the skull or hip of the patient, which requires hospitalization and anesthesia General.

Interventions too quickly decided ...

In rare cases, there may be a risk of injury to a nerve or artery that can cause hemorrhage, "warns Dr. Antoun. You must therefore be informed of the risks involved, as well as other treatment possibilities (removable prosthesis, for example).

Dr. Ducasse advises the utmost caution with regard to these heavy surgical procedures and, in his opinion, too quickly decided. Do not hesitate to ask his opinion to your ENT.

Are failures common?

The failure rate is low: from 2% to 5%. The loss of an implant, because it is poorly integrated into the bone, can have several causes: a local infection has developed, the bone has been overheated at the time of drilling or the implant has overloaded because the prosthesis was poorly adapted. "We can then remove the implant, clean the bone site and reimplant the patient three months later,"

Periodontitis is a pathology leading to the destruction of the tooth support tissue: the periodontium. Extremely common, it is nonetheless a serious disease with potentially very serious consequences. Proper care can interrupt the progression of periodontitis. The explanations of Christian Verner, lecturer at the faculty of dental surgery in Nantes.

Many people suffer from periodontitis, to varying degrees. Chronic or aggressive, periodontitis is due to multiple factors, including poor dental hygiene. Effective brushing with mouthwashes is the first therapeutic step against periodontitis.

What is a parodontite ?

Periodontitis is a periodontal disease of infectious origin, which can affect one or more teeth. It corresponds to the destruction of the periodontium, the tooth support tissue (see box below), by bacteria that have accumulated on the surface of the tooth and gum.

There are two forms of periodontitis:

Chronic periodontitis, which is the most common, and evolves slowly or moderately;
Aggressive periodontitis (about 20% of cases), which evolves more rapidly. "It happens rather in young people, under 30 years old, who have a hard time defending against certain forms of bacteria and / or who have a favorable environment (big decrease of the immunity due to a disease or a big one emotional shock for example), "says Christian Verner.
Gingivitis is the first stage of periodontitis. Thorough dental hygiene, which will remove plaque and tartar by effective brushing of the teeth and regular decalcification of the dentist, is enough to treat this inflammation of the gums. But in the absence of care, it can evolve and touch the deeper tissues of the periodontium: it is periodontitis, much more serious.

"Gingivitis is an inflammation of the gums, which causes bleeding of the gums, affects 80% of the French and is reversible Periodontitis is an inflammation of the entire periodontium, which results in a loss of attachment. the gum and the bone on the tooth.The damage is, in this case, irreversible, "says Christian Verner to differentiate between the two types of inflammation.

WHAT IS THE PERIODONTE?
The periodontium refers to the 4 tissues surrounding the tooth:
The gum, formed of oral mucosa, covered by a layer of keratin impermeable to microbes. It covers the internal and external parts of the jawbone and grips the teeth;
The alveolar bone, which surrounds the tooth and represents its main support; it rests on the basal bone that forms the jaw;
The cementum, a yellowish tissue that resembles bone and covers the root;
The alveolo-dental ligament (or desmodont), which connects the tooth to the alveolar bone. In particular, it plays a role in cushioning shocks to the tooth.

Causes of periodontitis

There are two major causes of periodontitis:

An imbalance of the bacterial flora of the mouth: pathogenic bacteria replace the naturally occurring bacteria in the mouth and attack the periodontium;
A weakening of the immune system.
Other factors may promote the appearance of periodontitis:

Smoking;

The existence of a systemic pathology (diabetes, cardiovascular disease, HIV infection);

Heredity.

The symptoms of periodontitis
In half the cases, periodontitis is chronic, it evolves slowly and often at low noise. The first visible symptom is bleeding from the gum. "A gum that bleeds is not normal.It must absolutely have the reflex to go consult his dentist," advises Christian Verner.

In the absence of care, other symptoms appear little by little, not always perceived by the patients, as the progressive destruction of the periodontium. "The gum goes down the tooth, then the gap between the teeth grows, the tooth becomes mobile and begins to move," says the dentist.

The process of destroying the periodontium is usually accompanied by bad breath and bad taste in the mouth (two signs that must alert if they are constant). Finally, periodontitis eventually causes a loosening of the tooth, and, in the worst case, a loss of the tooth.

Fortunately, this process usually takes time and can be interrupted and stabilized by appropriate care.

Periodontitis: who is affected?

Periodontitis is a fairly common pathology. The World Health Organization (WHO) estimates that 15% to 20% of middle-aged (35-44) adults worldwide experience severe periodontal disease, which can lead to tooth loss.2

In France, according to the ICSII survey carried out by the ADF under the auspices of the WHO, more than 80% of adults between 35 and 44 years of age suffer from periodontal diseases.3

Pregnant or menopausal women (due to hormonal changes) are at risk, as well as older people: "The" critical "age of dental longevity in relation to periodontal destruction is currently around 60 years old," writes ANAES (National Agency for Accreditation and Evaluation in Health).
Periodontitis: treatments to stop the progression of the disease
"The goal of managing periodontitis is to stop its progression and stabilize it over time, and when possible, we try to restructure the support fabric," says Christian Verner.

FIND A GOOD DENTAL HYGIENE

The basis of the treatment of periodontitis is "to find a good oral hygiene and adapted to the situation", explains the dentist. For that it is necessary :

Use a toothbrush, manual or electric, with soft bristles;
Adopt an effective brushing method to dislodge bacteria;
If necessary, use interdental brushes to complete the brushing by attacking the interdental plaque and therefore bacteria that may cause periodontitis;
Targeted mouthwashes and toothpastes can also be prescribed.
SURFACING, COMPLETE DESCALING OF THE MOUTH
Although it is of bacterial origin, periodontitis does not necessarily require the use of antibiotics. "Antibiotics are useful in cases of aggressive periodontitis but not in chronic forms.In these cases, we seek instead to destroy bacterial foci by a complete scaling of the mouth and by surfacing," says Christian Verner.

The surfacing is a technical act performed under local anesthesia, which aims to eliminate the subgingival calculus in the area where the bone tissue is destroyed, and to dislodge the bacteria attached to the root of the tooth laid bare after the bone loss .

SURGERY

If this treatment proves to be insufficient, it may be necessary to resort to surgery to thoroughly clean the root of the tooth and, if possible, recreate supportive tissue. The surgeon, usually a specialist (a periodontist), must open the gum to clean hard to reach places and add bone if the loss is significant. "We must not dread this act, if the indication exists, it is perfectly controlled and not painful," reassures Christian Verner.

The procedure is performed under local anesthesia, the pain is relieved by analgesics. Regardless of the management, regular check-ups (3-4 times a year) make it possible to check the correct evolution of the treatment.

Complications of periodontitis

The complications of periodontitis are relatively rare but it is important to know them. Treated too late or aggressive (see box below), periodontitis can indeed lead to loss of tooth (s). The dentist must also sometimes pull out the surrounding teeth to prevent the spread of the infection. Losses that destabilize the balance of the dentition.

More seriously, periodontitis is also a risk factor for cardiovascular diseases (infectious endocarditis, ischemic heart disease ...) and bronchopulmonary infections (COPD). It could also unbalance diabetes or cause preterm birth in pregnant women.

"These complications are due to a direct action of the bacteria but also to an indirect action: the inflammation created around the gum causes a physiological imbalance which increases the risk of systemic diseases", explains Christian Verner. For the latter, it is therefore essential to prevent the development of periodontitis to prevent the occurrence of other pathologies, just as it is essential to detect this condition in people with systemic diseases or in pregnant women, to avoid the risk of complications.

Prevention of periodontitis

The first prevention measure is through proper and regular brushing of teeth.

If it is advisable to visit your dentist once or twice a year, those with greater risk of periodontitis should consult more often. In the case of orthodontic treatment, a complete examination must be carried out every 6 months.

Finally, pregnant women should have dental follow-up during and after pregnancy.

When a tooth has to be completely replaced, or a person wearing a device wants to find "real" teeth, implants are the ideal solution.

This sophisticated, long and expensive technique is practicable in the vast majority of cases, but it must first be ensured that the bone tissue on which the implant will be attached is of good quality: neither too thin nor too soft.

The technique

Dental implant
The practitioner opens the gum and places an artificial titanium root directly into the jawbone. Then you have to wait a few months, to make sure there is no rejection phenomenon. We then reopen the gum to screw on the implant a ceramic tooth.

The inconvenients

This technique is not practicable in all cases. Better to consult a specialist in implantology to avoid unpleasant surprises ...