Dental care of disabled people: Descriptive cross-sectional study of social and medico-social establishments / Suivi bucco-dentaire des personnes handicapées : étude transversale descriptive en établissements sociaux et médico-sociaux

The first objective of this study, concerning the intervention of a dentist in social and medico-social establishments (SMSE), was to diagnose the oral care needs of disabled people (DP). The second objective was to raise awareness of a prevention and follow-up protocol among caregiving staff. We carried out this descriptive cross-sectional study from October 2016 to October 2018, in twenty SMSEs in Essonne. It involved a cohort of 663 volunteer DP, i.e., over 81 percent of the DP accommodated in these establishments. We analyzed DP's oral hygiene and health indicators, as well as changes in professional practices following simulation workshops, using Pearson's Chi-square test and Cramer's test to assess the existence of relationships between variables and their intensity, respectively. Of the 96 percent of DP who accepted a full screening, three-quarters had dental plaque and two-thirds had gingival inflammation, these pathologies being more frequent in the over-20s (p< 0.001 | Cramer's V=0.26). Only 14 percent had good oral health. Six months later, seventeen SMSEs had recorded dental check-ups in their medical records, and eight SMSEs had introduced brushing after dinner and breakfast, compared with ten and seven respectively before the intervention. This study confirmed the need for SMSEs to carry out dental screening. The involvement of establishments in monitoring the oral hygiene of DP must be strengthened.

Cette étude, menée dans le cadre de l'intervention d'un chirurgien-dentiste en établissements sociaux et médico-sociaux (ESMS), a eu comme premier objectif de poser un diagnostic sur les besoins en soins bucco-dentaires des personnes handicapées (PH). Le second objectif a été de parvenir à sensibiliser le personnel soignant à un protocole de prévention et de suivi. Cette étude transversale descriptive a été menée d'octobre 2016 à octobre 2018, auprès de 20 ESMS de l'Essonne et a concerné une cohorte de 663 PH volontaires, soit plus de 81 % des PH accueillies dans ces structures. Les indicateurs en hygiène et santé bucco-dentaire des PH, ainsi que l'évolution des pratiques professionnelles suite aux ateliers de mise en situation ont été analysés, via le test du Khi-deux de Pearson et celui de Cramer évaluant respectivement l'existence de relations entre variables et leur intensité. Parmi les 96 % des PH ayant accepté un dépistage complet, 3/4 présentaient de la plaque dentaire, 2/3 une inflammation gingivale, ces pathologies étant plus fréquentes chez les plus de 20 ans (p< 0.001 | V de Cramer= 0.26). Seuls 14 % avaient un bon état bucco-dentaire. Six mois après, 17 ESMS ont enregistré les suivis bucco-dentaires dans les dossiers médicaux et 8 ESMS instauré un brossage après le dîner et le petit déjeuner contre respectivement 10 et 7 avant l'intervention. Cette étude a conforté la nécessité de mener en ESMS des dépistages dentaires. L'implication des ESMS dans la surveillance de l'hygiène bucco-dentaire des PH reste à renforcer.

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.

[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.