Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, Ivry/Seine, F-94200, France.
Université de Lille, Inserm, CHU Lille, U1008, Lille, F-59000, France.
BMC Oral Health. 2023 Aug 9;23(1):545. doi: 10.1186/s12903-023-03258-7.
The aim of the study was to provide an overview of the practices of French general dentists (GDs) and specialists (SDs) concerning the management of patients with inflammatory bowel diseases (IBDs), rheumatic inflammatory diseases (IRDs), and vasculitis on biologic disease-modifying antirheumatic drugs (bDMARDs), conventional DMARDs, or immunosuppressants (ISs).
An online national cross-sectional survey with 53 questions was developed by a multidisciplinary team including rheumatologists, gastroenterologists and dentists based on their clinical experience. It was refined following a test with nine dentists in private practice and in hospital before being disseminated to the members of French scientific societies and colleges of dentistry teachers over 3 months. Responses of general dentists versus specialists were compared with respect to their experience in managing patients with IRDs or IBDs, knowledge/training, type of invasive procedure performed, management of medical treatment, perioperative oral-care protocols, and frequency of postoperative complications after invasive dental care procedures.
In total, 105 practitioners fully completed the survey (participation rate 11.1%). SDs more frequently performed invasive surgical procedures and were more aware of the recommendations of learned societies than GDs. They encountered more post-operative complications for patients on bDMARDs. For both SDs and GDs, most patients were managed without stopping treatment and pre- and postoperative antibiotics were prescribed to more than 75% of patients. When medical treatment was stopped, the decision was made by the prescribing physician.
Complications were reported more frequently by SDs when highly invasive procedures were performed on patients under active drug therapy. Certain common procedures, such as scaling and root planing, appear to be safe, regardless of treatment management. However, adapted guidelines for the practice of dentistry are needed to standardize the management of patients on bDMARDS, conventional DMARDs, or ISs.
French dentists perform a wide range of oral procedures on patients on bDMARDS, conventional DMARDs, or ISs under antibiotic coverage and antiseptic mouthwashes. SDs reported more postoperative complications after extensive invasive procedures for patients under active drug therapy, despite their greater knowledge of recommendations on how to manage such patients.
本研究旨在概述法国普通牙医（GDs）和专家（SDs）在管理接受生物改善病情抗风湿药物（bDMARDs）、传统 DMARDs 或免疫抑制剂（ISs）治疗的炎症性肠病（IBDs）、风湿性炎症性疾病（IRDs）和血管炎患者方面的实践。
一个多学科团队（包括风湿病学家、胃肠病学家和牙医）根据他们的临床经验开发了一项包含 53 个问题的在线全国横断面调查。在向法国科学协会和牙科学院教师成员分发调查之前，经过 9 名私人执业和医院牙医的测试对其进行了完善。比较了普通牙医和专家在管理 IRDs 或 IBDs 患者方面的经验、知识/培训、进行的侵入性治疗类型、药物治疗管理、围手术期口腔护理方案以及侵入性牙科治疗后术后并发症的频率。
共有 105 名从业者完整填写了调查（参与率为 11.1%）。SDs 比 GDs 更频繁地进行侵入性手术，并且更了解专业学会的建议。他们遇到了更多接受 bDMARDs 治疗的患者的术后并发症。对于 SDs 和 GDs，大多数患者的治疗未被停止，超过 75%的患者接受了术前和术后抗生素治疗。当停止药物治疗时，由处方医生决定。
当对接受积极药物治疗的患者进行高度侵入性治疗时，SDs 报告的并发症更为常见。某些常见的治疗方法，如洁治和根面平整术，似乎是安全的，无论治疗管理如何。但是，需要制定牙科实践的适应指南来规范接受 bDMARDs、传统 DMARDs 或 ISs 治疗的患者的管理。
法国牙医在接受抗生素覆盖和抗菌漱口水治疗的 bDMARDs、传统 DMARDs 或 ISs 患者中进行广泛的口腔治疗。尽管 SDs 对如何管理此类患者的建议有更多了解，但他们报告称，在对接受积极药物治疗的患者进行广泛的侵入性治疗后，术后并发症更多。
