Therapeutic care dental based on three main principles: prevention, care and monitoring.

Prevention

This is to prevent the development of caries and their complications.
Remember that tooth decay is an infectious disease multi whose development is linked:
- The quality of the enamel, food, brushing and salivary flow.
Also achieving chemical tooth in the gastro-esophageal reflux serious.

Prevention has three components: health, food and fluorothérapie.

The hygiene
Brushing should be established as soon as possible and by parents or health care team.
It is of great importance in the prevention and especially the evening at bedtime.
It is certain that it is not always easy to achieve. Also, other means as a cotton swab moistened with water or a wet finger around to eliminate much of the plaque.



The Food

We need to promote better chewing food and lack of nibbling.
What is solid, liquid or mixed, food must minimize the contributions of sucrose. We particularly stress the adverse effect of medicines taken in the evening or at night under a syrup, or bottles that the child takes a nap during the night or liquids containing sugar, only pure water has no effect cariogenic.

The fluorothérapie

Is an essential adjunct to the prevention dosage and methods of administration are based on age and weight of the child.
The fluorine absorbed by the digestive tract, during childhood, has a positive effect on tooth morphogenesis final. It improves the quality of the enamel resist and who better to attack the bacterial plaque.
For an optimal, exposure to fluoride should continue after the eruption of teeth. This corresponds to a local fluoride ion on the tooth enamel alive.


Mainly, three sources of fluoride intake are possible
- Drinking water in the first place, but its concentration of fluoride varies widely in France. The mapping of fluoride concentrations in water is available, source by source DRASS from each department.
- Table salt fluoride is an alternative high efficiency. It is becoming more widespread.
- The third source of supply is the medicine, whether pills or drops. The daily dose is 0.05 mg of fluoride ion per kilogram of weight without exceed 1 mg per day.
Add to this the fluoride toothpaste, it is necessary that brushing with toothpaste is possible under good conditions, which is often not the case.
We must ensure that these sources do not add up because it could lead to fluorosis, corresponding to an excessive use of fluoride, which is bad for teeth as that for the skeleton.







The dental treatment
Outpatient treatment

They require special architectural and facilities should preferably be made to the ground floor of a building (access ramp, adapted examination rooms, toilets upgraded large enough to accommodate wheelchairs).
They also require staff training for a better understanding of disability and anxiety of children that:
- Pain: cavities, gingivitis, tooth wear due aubruxisme,
- A history of medical gestures particularly painful neck facial sets of probes naso-gastric intubation, tracheotomy, ventilation, etc ...


The presence of parents and / or a member of the referent team is obviously very important.
The dental problems in the vigil are linked, in addition to anxiety, the swallowing disorders that may prevent the use of rotary instruments, uncontrolled movements with difficulties for the child to remain open mouth or open mouth to the request.
The difficulties of installation on the dental chair should also be taken into account.


In addition to the care of tooth decay, other treatments may be considered in the vigil. Orthodontic treatment strict sense is rarely possible. But in some children, a simple steering Dental is always useful.
If there is disharmony maxillary tooth, extractions and germectomies will be done under general anesthesia.
Among children with bruxism with teeth to wear it proposes occlusodontie which consists of selective grinding of teeth.



Care under general anesthesia

They are considered when conditions do not allow quality care in the vigil.
Care, scalers, X-rays and extractions are made at a time.
In this regard, it seems unacceptable in our time to make a general anesthesia for extractions only leaving cavities untreated.
The duration of intervention is all the greater care that are conservative.
General anesthesia is made with nasal intubation and poses a packing in aseptic conditions optimal.
Care must be complete with fillings and final radiographs per-operative control.
The sealing of wells and furrows (sealant) faces crushing molars and premolars is an excellent prevention of cavities.
The indication of conservation or extraction of teeth definitive especially first molars is sometimes predictable but often asked during the general anesthesia, with the assistance of the orthodontist.
The gingival hypertrophy, particularly important in children with mucopolysaccharidoses is treated surgically by a technical volatilization of the lining hypertrophic laser carbon dioxide. This technique provides results stable in the medium term, with a healthy periodontium provided an oral hygiene satisfactory.
The salivary incontinence is not related to excessive production of saliva but fewer swallowing and bending the neck with a mouth open permanently.
Scopolamine through trans-dermal has sometimes been used but the number of cases too small was not able to determine their effectiveness.







Monitoring

It is an equally important as prevention. The frequency of consultations must be bi-or tri-annual and only allows regular monitoring to establish a preventive policy.


Thus, an oral examination regular child can:
- Advising the family about brushing and dietetics.
- Start search tooth decay and treat them quickly.
- Avoid outbreaks of infection and reduce pain.
- Detect anomalies as early as possible.