Peur-anxiété-phobie du dentiste :Mise au point et analyse d’un outil fédérateur des différentes techniques matérielles et comportementales permettant une prise en charge idéale des patients :études cliniques

Dental anxiety remains to this day an under-studied problem even though it represents one of the main obstacles to patients dental attendance. Through the work carried out in this doctoral thesis, several dimensions of this problem have been brought to light. Having more information on the stimuli of dental anxiety according to age allows the practitioner to adapt his care. In a survey, we found that, for 3 to 6 years old, the representation of acts that frightened them more than the act itself (seeing the syringe, seeing blood, etc.). From ages 7 to 12, pure representation is replaced by a mixture of sensations probably due to their own experience (tooth extraction, decay, etc.). In adolescence, the procedure takes on greater importance than local anaesthetic items.One feature that was largely missing however was the item concerning the dental dam shows a percentage of missing data at 75%. This observation confirmed the importance of highlighting a clinical observation felt by practitioners using the dental dam: the dam relaxes the patients. This system of dental operating field is a real asset in our practice both technically and behaviorally. It is a help for cooperating patients as well as for non-cooperating patients. Significant results in patient relaxation have been obtained both awake and under conscious sedation.Unknown to patients because underused by practitioners, the dental dam represents a very interesting aid and completes the therapeutic arsenal for the management of fear in the dentist.Another very interesting tool is conscious sedation by inhalation of a mixture of nitrous oxide and oxygen (SC). Regardless of the system used, the observed success rate is very high (94.5%). This system deserves to be further developed because it brings a real improvement in the care of patients.However, this system is not suitable for all patients as it has limitations. It is a light sedation and the patients observed in the study corresponded to a population resulting from a preoperative consultation which made it possible to pose its indication. To better understand the profile of non-cooperative patients, in rupture of care, a retrospective study was carried out to describe certain objective characteristics of these patients which could direct the practitioner towards one or the other therapeutic option. Young children presenting in SC are on average just over 4 years old and have an average caries index of 6.68, while young children in AG are younger, less than 4 years old, and have an average caries index of 11.97. These patients therefore often present with severe polycaries in early childhood.As pediatric dentists, we have a considerable role to play in the care of these patients who are out of care. The support we provide to these patients can have an impact on their dental future but also on health in general.Pediatric dentistry is a teamwork that finds its highest level when all the actors of the therapeutic relationship work in the same way for the well-being of the patient. If the practitioner and the patient are obvious elements of this team, the parents represent an essential and unavoidable gear of the therapeutic triad.Many tools are at our disposal to evaluate the behavior of patients, but sometimes we lack a scale that allows us to measure exactly what we want. And this was the case when we wanted to compare the behavior of the children with that of the accompanying parent. Analysis of the data from our study showed that a scale with important descriptors, such as the modified Venham scale and the corresponding one we created for parents, is valid in the context of a scientific study by observers. trained in its use but less so for observers without sufficient training. In the context of daily practice, the use of a less detailed scale would perhaps give a higher correlation.Behavior is a good indicator in the choice of care for the child, but it is not everything. Indeed, the established therapeutic relationship is decisive in the choice. This choice is also influenced by the level of dental involvement, particularly in the event of multiple infections due to dental abscesses which could lead to serious complications with repercussions for the general health of the patient.In all the studies carried out, age is a significant objective criterion. The cooperation, the operating time, the level of autonomy are directly related to the age of the patient. The older the child, the better he can understand the care provided, communicate with the practitioner, tolerate longer sessions, and be involved in his care. Its autonomy is also increased.“Do not scare” is comparable to “Do no harm” from the Hippocratic oath. The specificity of the dentist, a bit like the family doctor, is to maintain a long-term therapeutic relationship with his patients. It is up to us, dentists, to put everything in place to ensure a good therapeutic relationship. The different elements described in this doctoral thesis form a veritable therapeutic arsenal that can be considered as a unifying tool for fear management accessible to any dentist.Doctorat en Sciences dentaires