DENTAL HEALTH

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."

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 ...

Brushing your teeth: a daily gesture for everyone and for all your life. Yet without knowing the right gestures, brushing mistakes are common. Explanations and reminders of Dr. Christophe Lequart, dentist.

The choice of the toothbrush

A brush that is too small or too big prevents you from brushing your teeth properly. Choose a brush that fits your mouth.

Avoid hard or medium toothbrushes because too stiff bristles do not allow effective cleaning between teeth. Prefer soft brushes and if you have loose teeth problems or a special sensitivity to hot or cold, prefer ultra-soft toothbrushes.

Electric toothbrushes can improve the quality of brushing (rotary action of the head is adequate) and eliminate more plaque. In addition, despite its heavier weight, the electric brush allows a better grip in the elderly and for all people who have difficulty handling an object in their hand.

Toothpaste and dental floss

The choice of toothpaste is important. Use a toothpaste containing fluorine to protect the enamel from acid attacks. Remember that fluoride has significantly reduced the number of caries and improve oral health.

From the age of 6, children can use an adult toothpaste. Avoid at all costs homemade toothpastes made from clay. They often have an abrasive effect given the particle size (grain size) of the clay used.

To complete the brushing, the use of floss or interdental brushes is essential, including in children.

The brushing technique

The most common mistakes are:

To brush your teeth in the wrong direction, that is to say horizontally and not in a roll motion (a slight rotational movement), going from pink to white.
Rub too hard and bleed the gums by too much brushing. The gesture must be moderate at the risk of eliminating part of the gum and email.
Opening the mouth too wide: this prevents proper brushing from the gum to the tooth due to contraction of the muscles around the lips. The mouth must be closed to the maximum.
For brushing the incisors, the toothbrush should be held vertically to clean between the teeth.
To brush your teeth too quickly. Experts agree on this point: the duration of brushing should be 2 minutes (for children and adults). Electric toothbrushes are increasingly equipped with a "timer", which ensures the optimal duration of brushing.
To brush your teeth more than 2 times a day. Excessive brushing can cause gum problems and weaken the e-mail.
Forget interdental spaces and gums. Remember to floss, even brushes adapted to the size of interdental spaces, especially if you are concerned by periodontal disease.
Brush your teeth, always starting at the same place. The risk ? That the rest of the mouth is less well cleaned, especially at the end of brushing. Ideally, change the order of your brushing by starting each day with a different corner.

False beliefs and bad habits

Keep your toothbrush too long. A manual toothbrush should be renewed every 3 months. Indeed, the bristles of the brush must remain flexible and straight. The removable head of an electric toothbrush should be replaced every 3 months. Be aware that new power brushes have a wear indicator (for example, referring to hair color in the head).
Store your brush in a closed space or place it horizontally on a shelf. It is best to dry it vertically and in the open air.

Forget about cleaning your brush after use.

Dry your toothbrush with a towel that will inevitably carry bacteria into the brush.
Arrange the toothbrushes of the whole family in the same pot.
Think that the teeth of toddlers do not brush. As soon as a tooth appears in your child's mouth, brushing should begin to avoid cavities. From the age of 6 months to one year, brush your teeth with a soaked pad of water once a day, at bedtime. From the age of one, you can continue brushing your teeth at night with a soft toothbrush without toothpaste. From the age of 2, we will consider 2 daily brushing (morning and evening) for 2 minutes with a toothpaste for children containing fluorine.
Brush your tongue too often and with your toothbrush. The tongue can be brushed from time to time, especially if you have a problem of halitosis (bad breath) but not every day and especially not with the bristles of your toothbrush. If you want to do it, use a suitable language cleaner.
Some additional tips
If you consume energy drinks or coffee, wait half an hour before

Caries and gum disease responsible for dental loss and painful and expensive care can be prevented by relatively simple daily hygiene. Do not hesitate to ask your dentist for advice.
Even though we are now more respectful of our dental hygiene, some progress is still possible. What are the essential rules for good dental health?

Teeth, you will brush after each meal
Dental plaque, a whitish deposit in which bacteria proliferate, causes caries and inflammations of the gums. As it is reconstituted in a few hours, it is essential to eliminate it by brushing at least twice daily.

A toothbrush with soft bristles, nylon, you will choose and change it every three months
A hard toothbrush may injure the gums and damage tooth enamel. A used toothbrush is no longer effective. Electric toothbrushes can be advantageously used, provided that the end is regularly changed.

The right technique, you will use
Place the 45 ° angled toothbrush over the teeth and gum and brush the teeth and gum together, up and down the jaw separately, going from the gum to the tooth, with a rotating motion , for three minutes.

Brushing, you will complete with silk thread
Dental hygiene
The use of a dental floss, in addition to brushing, eliminates plaque on the lateral surfaces of the teeth. For people with loose teeth or prostheses that leave spaces inaccessible to the brush, it is important to use interdental sticks or brushes; to remove plaque at the base of the teeth and stimulate the gums. Jet devices are also useful in these cases for removing food debris and massaging the gums.

The dentist, you will consult annually
An annual visit to the dentist can detect early cavities and will be an opportunity to perform a descaling to remove plaque. Two descaling sessions are reimbursed by Social Security. But sometimes more is needed. If the plaque is not detected in time, it develops deep and forms a pocket between the base of the tooth and the gum, which may cause, in the long run, a loosening of the teeth. At this stage, curettage under local anesthesia is necessary. It is not reimbursed by social security (price: 69 to 92 € uros per session).

Attention to children
The teeth of our children are fragile and precious. To preserve them from cavities and other inconveniences, here are some tips to guarantee them a brilliant smile.

The dental grooves of your children, you will seal
In adolescence the risk of dental caries is particularly high. In 80% of cases, these caries develop in the grooves of the molars. By casting a film of synthetic resin fluid on the furrows, it is possible to prevent these cavities. This treatment can be performed right out of the first molars. He is reimbursed by Social Security until he is 14 years old.

At the dental hygiene of your children, you will watch
The bottles of sweet water or milk left to the child in the evening in his bed are wreaking havoc, allowing dental plaques and early caries to develop. Similarly candies are to be avoided in the evening. Whenever possible, candies or chewing gum without sugar should be preferred.

Additional fluoride intake in the mother, during pregnancy, and in childhood may be advised by the doctor to strengthen the teeth. Finally, it is essential to make known to the child the use of the toothbrush, from the age of two or three years.

In the past, sugar was considered an exceptional food and was reserved for the sick or consumed at parties. It has become a food consumed every day since the development of industrial sugar production a century ago. For a long time, tooth decay only affected adults, and it began to reach children in parallel with the development of the sugar industry.

Today it is a disease that affects especially the child, the adolescent and the young adult; its frequency decreases after 40 years. It is a public health problem that is very costly. In France, at the age of 6, two-thirds of children already have at least one cavity.

Sugar and caries go hand-in-hand
Dental caries and food
Caries is a phenomenon of demineralization of the hard tissues of the tooth (enamel, dentin, cementum), caused by the acidic environment created by the sugars brought by the diet and certain bacteria from the dental plaque. Sugar consumption is therefore a decisive factor in the formation of caries. The most "cariogenic" sugars are fast sugars, especially sucrose, the main component of cane and beet sugar. It is the most used in confectionery. Then come glucose (derived industrially from corn, used in pastry), fructose (fruit sugar), lactose (milk sugar) and starch (slow sugar cereals and starchy), which is much less cariogenic.

See also our article: Sugars and caries

An innate attraction to the sweet taste
The taste for sugar is innate and from birth the newborn prefers sweet water to pure water. He prefers "strong" sugars, sucrose and fructose, to "weak" sugars. This predominance for sweetness will gradually decrease with the acquisition of new tastes, bitter being the longest to be accepted.

For a long time the sugar remains for the child a food apart. It has a calming effect and is the surest way to calm it down. Provoking a secretion of endorphins, it would cause a certain dependence, demonstrated by the difficult weaning of the sweet bottle of the evening ...

Hereditary caries?

Sweetened water and other sugary drinks (sodas, fruit juices) given to the bottle-feeding baby to feed or calm it are directly responsible for "bottle caries". These multiple caries of the upper teeth, caused by the prolonged contact of the sweet liquid on the teeth are typical of the young child.

In adolescents, there are "flashing caries" because the young permanent teeth are less mineralized and allow the rapid development of decay, which is only revealed at a very advanced stage.

Genetic inheritance of caries is not proven; the incidence of caries in some families is rather due to a transmission of eating habits, with a high consumption of confectionery in childhood.

In children, sugar has a high symbolic and affective value: children are rewarded or deprived of candies ... it is therefore difficult to suppress sugar but it can be limited and, above all, it can be used to flavor other flavors.

Caries prevention

Hygiene is fundamental: it prevents the formation of dental plaque and the action of bacteria.

Prevention relies on three inseparable elements:

Fluoride, given as a supplement from infancy to adolescence by the dentist's prescription, improves the resistance of teeth to decay;
Strict oral hygiene and regular dental checks every 6 months;
The limitation of cariogenic sugars; it is the least controllable factor because the sugar in all its forms is everywhere, in the cupboards and the refrigerators and in all the places which the child frequents. It retains a high symbolic and cultural value in certain populations. Yet nutritional education is achieving results in caries prevention, especially in favored classes. Like other nutritional imbalances (eg obesity), caries has become a disease of the poor.