L`ENFANT MALADE

UFR Odontologie
/ UNIVERSITE de BORDEAUX \
Odontologie Pédiatrique
ENFANT!MALADE
► $&!04Y*+!'"43!1&3&-*1W
L'enfant!malade!doit!être!reçus!au!cabinet!dentaire!comme!un!enfant!ordinaire,!avec!les !
mêmes ! égards. ! Il ! est ! important ! dans !les ! cas ! de ! pathologies ! lourdes ! de ! ne ! pas ! faire ! de!
surtraitement!et!de!savoir!avant!tout!encourager!l’enfant!dans!sa!lutte!contre!la!maladie!et !
de!le!soulager!en!cas!de!douleur.!
!Une!bonne!connaissance!de!son!état!général!est!indispensable!pour!l’élaboration!du!plan!de!
traitement ! et ! la ! conduite ! des ! soins. ! Nous ! devons ! savoir ! apprécier ! les ! 3 ! risques ! majeurs !
infectieux,!hémorragique!et!toxique!et!nous!devons!être!particulièrement!vigilants!quand!le !
problème!dentaire!peut!inOluencer!la!pathologie!générale.
! Par ! ailleurs! certaines ! affections ! peuvent ! avoir !des ! répercussions ! directes ! sur !la ! sphère !
buccoJdentaire!et!demande!une!prise!en!charge!ou!un!suivi!particulier.!
► /+"-
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j\QQQe;H;?Me@Lm"/"&3m;H;?MJ;L;G?NL;A?eHM@m! !!
Yves DELBOS, MCU-PH Bordeaux
Frédéric VAYSSE MCU-PH Toulouse
Rachid FAWZI, Prof. Assistant, Rabat
Marie-Pierre SARACANIE-THOMAS, ex AHU Bordeaux
SP?Me>?F<IMuOg<IL>?;ORye@L!!P!xex!g!;IaN!yww€
1 / 26

UFR Odontologie
/ UNIVERSITE de BORDEAUX \
Odontologie Pédiatrique
1. LES CARDIOPATHIES CONGENITALES
1.1. RAPPELS
n!$B?T!F?M!?H@;HNMb!F?M!;NN?CHN?M!=;L>C;KO?M!MIHN!?MM?HNC?FF?G?HN!P;FPOF;CL?M!=IHAYHCN;F?Me
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<X9LME?L>Q
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06- ! 9V>< ! *- ! >R^MU ! @N9GQQGQQ>K>LR!
V9JVUJ9GP>
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Q9UB!$*"
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n !+<H ! :8G;@DE8I?@<H ! :DC>QC@I8A<H ! CDC ! :M8CD>PC<H ! HDCIT ! ;8CH ! A8 ! EAJE8GI ! ;<H ! :8HT!
DEQGQ<H!N!A8!C8@HH8C:<!d!?FF?M!H?!JLYM?HN?HN!>IH=!J;M!>?!LCMKO?!>j?H>I=;L>CN?!<;=NYLC?HH?e!
-?M !=;L>CIJ;NBC?M! =IHAYHCN;F?M! =S;HIAXH?M!MIHN!>IH=!F?M !M?OF?M!U!LCMKO?!>j?H>I=;L>CN?!
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NIO=B?!JLY@YL?HNC?FF?G?HN!F?!D?OH?!;>IF?M=?HNe!$?M!J;NBIFIAC?M!MIHN!YA;F?G?HN!U!LCMKO?!
>j?H>I=;L>CN?!<;=NYLC?HH?e
1.2. MANIFESTATIONS BUCCO-DENTAIRES.
n!&FF?M!J?OP?HN!ZNL?!d!
g!(CHACPCN? ! =S;HINCKO? ! o=IFIL;NCIH ! <F?ONY? ! >?M ! GOKO?OM?M ! J;L ! ;OAG?HN;NCIH!
=;JCFF;CL?!>?!FsBYGIAFI<CH?!LY>OCN?pe
g!3NIG;NCN?!oCH†F;GG;NCIH!>?!F;!GOKO?OM?!<O==;F?pe
g!(FIMMCN?!oFYMCIHM!CH†F;GG;NICL?M!>?!F;!F;HAO?pe
g!&LOJNCIHM!>?HN;CL?M!L?N;L>Y?Me
g!%Y@;ONM!>?!MNLO=NOL?!>?!FsYG;CF!?N!>SM=BLIGC?M!CHNLCHMXKO?Me!
g!.;OP;CM?!BSACXH?!<O==Ig>?HN;CL?b!N;LNL?!;<IH>;HNe!
g!1;NBIFIAC?M!J;LI>IHN;F?Me
2 / 26

UFR Odontologie
/ UNIVERSITE de BORDEAUX \
Odontologie Pédiatrique
1.3. APPROCHE ODONTOLOGIQUE
1.3.1. Anamnèse
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IO!F?!GY>?=CH!NL;CN;HN!JIOL!d!
g!$IHH;\NL?!;P?=!JLY=CMCIH!F;!J;NBIFIAC?!>O!J;NC?HNb!F?M!NBYL;J?ONCKO?M!?H!=IOLM!?N!M?M!
=IGJFC=;NCIHM!YP?HNO?FF?Mb!FsCHN?LP?HNCIH!=BCLOLAC=;F?!MO<C?e
g!-OC!?RJFCKO?L!FsYN;N!>?HN;CL?!;=NO?F!>O!J;NC?HN!?N!F?M!MICHM!?HPCM;A?;<F?Me!!
n ! &HMOCN?b ! ?H ! =IFF;<IL;NCIH ! ;P?= ! F?M ! ;ONL?M ! ;=N?OLMb ! F? ! =BCLOLAC?Hg>?HNCMN? ! >Y=C>? ! F?M!
JLINI=IF?M!?HPCM;A?;<F?M!d!
g!F;!JLYGY>C=;NCIHb
g!F;!JL?M=LCJNCIH!>s;HNC<CINCKO?Mb
g!Fs;H?MNBYMC?b
g!FsCHN?LP?HNCIHe
1.3.2. Anesthésie
n!*F!Hj?RCMN?! J;M ! >? ! =IHNL?gCH>C=;NCIH!;<MIFO?!>O!P;MI=IHMNLC=N?OL! o;>LYH;FCH?p! =B?T ! F?!
J;NC?HN!=;L>C;KO?e!&H!?@@?N!d!
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g!0L!F?!GYN;<IFCMG?!<;M;F!?MN!>?!•!GAmGH!>j;>LYH;FCH?e
g ! &H†CH ! OH ! MICH ! M;HM ! ;H?MNBYMC? ! ;P?= ! P;MI=IHMNLC=N?OL ! >Y=B;LA? ! y•w ! GA!
>j;>LYH;FCH?e!h!h!h!h
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>CGCHO?L!;O!G;RCGOGe
1.3.3. Règles de prescriptions : l’antibioprophylaxie et l’antibiothérapie
An6bioprophylaxie Groupe!A Groupe!B
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":I<H!9J::D;<CI8@G<H!:DCIG<X@C;@FJQH!Z:8G;@DE8I?@<H!>GDJE<H!"!<I!#[!U
-!"H?MNBYMC?!FI=;F?!CHNL;FCA;G?HN;CL?
-!3ICHM!?H>I>IHNCKO?M!oJOFJ?!GILN;F?b!24&p
-!"=N?M!=BCLOLAC=;OR!;ONL?M!KO?!?RNL;=NCIH
-!0%'!d!=BCLOLAC?!JLYgILNBI>IHNCKO?
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UFR Odontologie
/ UNIVERSITE de BORDEAUX \
Odontologie Pédiatrique
":I<H!9J::D;<CI8@G<H!@CK8H@=H!U!"-3*#*./1./)7+"6*&
-.CM?!?H!JF;=?!>?!F;!>CAO?
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-3ICHM!?H>I>IHNCKO?M!oJOFJ?!PCN;F?p
-3ICHM!JLINBYNCKO?M!U!LCMKO?!>?!M;CAH?G?HN
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-0%'!d!.CM?!?H!JF;=?!>?!<;AO?M
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Pour!plus!de!renseignements,!consulter!le!site!de!l'HAS!:!http://www.hasJsante.fr/
1.3.4. Posologie :
!+Y8CI@9@DEGDE?MA8L@<!d ! JLCM? ! >s;HNC<CINCKO? ! OHCKO? ! >;HM ! FsB?OL? ! JLY=Y>;HN ! Fs;=N?!
NBYL;J?ONCKO?e
3sCF!HsS!;!J;M!>s;FF?LAC?!;OR!rgF;=N;GCH?Mb!IH!JL?M=LCN!d
g!"GIRC=CFFCH?!U!~|!GAmEA!per!os
3sCF!?RCMN?!OH?!;FF?LAC?!;OR!rgF;=N;GCH?Mb!IH!JL?M=LCN!d
g!$FCH>;GS=CH?!U!x|!GAmEA!per!os!o%"-"$*/&vp!IO!
g!1LCMNCH;GS=CH?!U!y|!GAmEA!per!os!o18034"$*/&vp
/#!! d ! F;! <;=NYLCYGC? ! >OL? ! zw! GCHON?M ! U !KO?FKO?M ! B?OL?M!c ! ?FF? !?MN ! >IH= !=IOP?LN? ! J;L!
Fj;HNC<CINCKO?!KOC!;!OH?!>?GCgPC?!>?!}!U!•!B?OL?Me
!+Y8CI@9@DI?QG8E@<!d!JLCM?!>s;HNC<CINCKO?!JLY=Y>;HN!?N!MOCP;HN!Fs;=N?!NBYL;J?ONCKO?e
3sCF!HsS!;!J;M!>s;FF?LAC?!;OR!rgF;=N;GCH?Mb!IH!JL?M=LCN!d
g!"GIRC=CFFCH?!U!~|!GAmEAmy{B!per!os
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g!$FCH>;GS=CH?!U!x|!GAmEAmy{B!per!os!IO!
g!1LCMNCH;GS=CH?!U!y|!GAmEAmy{B!per!os
/#!d!F;!<;=NYLCYGC?!MOL!OH?!CH@?=NCIH!>Y=F;LY?!?MN!FIHAO?!?N!G;MMCP?e!
4 / 26

UFR Odontologie
/ UNIVERSITE de BORDEAUX \
Odontologie Pédiatrique
1.3.5. Les soins
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g!5H!<CF;H!L;>CIFIACKO?!=IGJF?Ne!
n!-?M!MICHM!>ICP?HN!ZNL?!=IOLNMb!;NL;OG;NCKO?M!IO! !L?ALIOJYM!MIOM!"(!?H!=;M!>?!MICHM!
GOFNCJF?M!U!=IH>OCL?!;P;HN!OH?!CHN?LP?HNCIH!=BCLOLAC=;F?e!
n!-s;JJFC=;NCIH!>s;HNCM?JNCKO?M!FI=;OR!o<;CHM!>?!<IO=B?b!=IFFONICL?Mp!M?!@;CN!|!GCHON?M!;P;HN!
n ! -? ! =IC@@;A? ! >CL?=Nb ! F; ! JOFJINIGC? !?N! F; ! JOFJ?=NIGC? ! MIHN ! =IHNL?gCH>CKOYM ! ?H !>?HNOL?!
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=;L>CIFIAO?e!
2. LE DIABETE
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P;LC?!>jOH!J;SM!U!Fj;ONL?b!G;CM!IH!HIN?!?H!'L;H=?!OH?!@LYKO?H=?!>?!xmzwww!?H@;HNM!;NN?CHNMe!
%jOH?!G;HCXL?!AYHYL;F?b!=?M!=;M!MIHN!?H!;OAG?HN;NCIH!>OL;HN!=?M!>?LHCXL?M!>Y=?HHC?M!?N!
HIN;GG?HN!=B?T!F?M!D?OH?M!?H@;HNMe
n!-?!>C;<XN?!Mj;==IGJ;AH?!>jOH!LCMKO?!>?!=IGJFC=;NCIHM!GYN;<IFCKO?M!;CAO[Mb!L?>IONY?M!J;L!
F?!J;NC?HNb!;O!JL?GC?L!L;HA!>?MKO?FF?M!FjBSJIAFS=YGC?e!
2.1. RAPPELS SUR LE DIABÈTE
n!-?M!BILGIH?M!L?MJIHM;<F?M!>O!GYN;<IFCMG?!>?M!MO=L?M!MIHN!JLI>OCN?M!J;L!F?M!=?FFOF?M!>O!
J;H=LY;M!?N!JFOM!JLY=CMYG?HN!J;L!F?M!=?FFOF?M!>?M!\FINM!>?!-;HA?LB;HMe!-?!AFO=;AIHb!MY=LYNY!
J;L!F?M!=?FFOF?M!>?!NSJ?!qb!YFXP?!F;!AFS=YGC?!;FILM!KO?!F?M!=?FFOF?M!>O!NSJ?!r!MY=LXN?HN!
FjCHMOFCH?! KOC!?MN!BSJIAFS=YGC;HN?e!-?!>C;<XN?!CHMOFCHIg>YJ?H>;HN!M?!>Y†CHCN!=IGG?!OH?!
;NN?CHN? ! JLIAL?MMCP?! >?M !=?FFOF?M ! >? ! NSJ? ! re! $B?T ! Fj?H@;HNb ! =j?MN ! F;! >CGCHONCIHb ! PICL? !F;!
>CMJ;LCNCIH!>?!F;!MY=LYNCIH!>jCHMOFCH?!KOC!?MN!U!FjILCACH?!>O!>C;<XN?e!$?NN?!>CGCHONCIH!>?!
MY=LYNCIH!?MN!>O?!U!F;!>?MNLO=NCIH!>?M!\FINM!>?!-;HA?LB;HM!>O!J;H=LY;M!M?FIH!OH!GI>?!;ONIg
CGGOHe!
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g!-?!>C;<XN?!HIHgCHMOFCHIg>YJ?H>;HN!oNSJ?!yp!L?NLIOPY!?MM?HNC?FF?G?HN!=B?T!Fj;>OFN?e
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