{"id":1713,"date":"2021-02-01T10:00:06","date_gmt":"2021-02-01T09:00:06","guid":{"rendered":"http:\/\/edocsoy.cluster027.hosting.ovh.net\/?p=1713"},"modified":"2023-06-14T11:59:41","modified_gmt":"2023-06-14T09:59:41","slug":"le-reflexe-nauseeux-et-dentisterie-mieux-comprendre-pour-mieux-agir","status":"publish","type":"post","link":"https:\/\/dentaleducation.be\/index.php\/2021\/02\/01\/le-reflexe-nauseeux-et-dentisterie-mieux-comprendre-pour-mieux-agir\/","title":{"rendered":"Le r\u00e9flexe naus\u00e9eux et dentisterie, mieux comprendre pour mieux agir"},"content":{"rendered":"\t\t
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Le r\u00e9flexe naus\u00e9eux est un r\u00e9flexe inn\u00e9 et vital. Il permet en effet de pr\u00e9venir l\u2019entr\u00e9e de corps \u00e9trangers dans les voies respiratoires sup\u00e9rieures (pharynx, larynx, trach\u00e9e) et digestives emp\u00eachant ainsi les corps \u00e9trangers de grande taille de les obstruer.<\/p>

Ainsi, les \u00e9l\u00e9ments \u00e9trangers, irritants ou les mat\u00e9riaux toxiques sont \u00e9ject\u00e9s par l\u2019action des muscles oro-pharyng\u00e9s dont les contractions p\u00e9ristaltiques sont spastiques, non coordonn\u00e9es et de direction invers\u00e9e.<\/p>

Le seuil d\u2019intensit\u00e9 de d\u00e9clenchement de ce r\u00e9flexe varie d\u2019un patient \u00e0 l\u2019autre et peut \u00eatre \u00e0 l\u2019origine de situations pathologiques o\u00f9 le moindre stimulus d\u00e9clenche instantan\u00e9ment naus\u00e9es et vomissements.<\/p>

Ce type de r\u00e9action, sous leur aspect aussi bien majeur que mineur constitue sans l\u2019ombre d\u2019un doute un obstacle \u00e0 la r\u00e9alisation de soins dentaires et ce dans tous les domaines confondus.<\/p>

Etiologie du r\u00e9flexe naus\u00e9eux :<\/strong><\/h2>

Le r\u00e9flexe naus\u00e9eux peut \u00eatre suscit\u00e9 par des stimuli non tactiles tels les stimuli visuels, auditifs, olfactifs. Ainsi, la simple vue du dentiste ou le son \u00e9mis par une pi\u00e8ce \u00e0 main peut provoquer chez le patient la sensation de naus\u00e9e. De m\u00eame l\u2019odeur de certaines substances dentaire, fum\u00e9e de cigarette, parfums, etc.\u2026 ont \u00e9t\u00e9 d\u00e9crites par certains patients comme starter de la sensation de naus\u00e9e et vomissement. Il est int\u00e9ressant cependant \u00a0de constater que le passage de nourriture ne provoque pas de r\u00e9flexe naus\u00e9eux.<\/p>

L\u2019\u00e9tiologie du r\u00e9flexe naus\u00e9eux est multifactorielle ; un grand nombre de causes, tant psychologiques que physiques furent d\u00e9crites comme \u00e9l\u00e9ments d\u00e9clencheurs. Il est cependant d\u00e9licat d\u2019\u00e9tablir une limite entre les deux car ces param\u00e8tres sont \u00e9troitement li\u00e9s. Parmi celles-ci :<\/p>

1\u00b0) Troubles locaux et syst\u00e9miques: ( obstruction ou \u00e9coulement nasal, catarrhe, sinusite, polypes nasaux, congestion des muqueuses du tractus respiratoire sup\u00e9rieur, s\u00e9cheresse buccale,\u2026)<\/p>

2\u00b0) Facteurs anatomiques:anomalies anatomiques et sensibilit\u00e9s oropharyngiennes ont \u00e9t\u00e9 propos\u00e9s comme facteurs pr\u00e9disposant au r\u00e9flexe naus\u00e9eux<\/p>

3\u00b0) Facteurs psychologiques: \u00a0 La composante fonctionnelle d\u2019une affection peut \u00eatre fortement influenc\u00e9e par une r\u00e9action individuelle \u00e0 des \u00e9v\u00e8nements stressants, cela constitue \u00ab l\u2019apprentissage \u00bb dont les m\u00e9canismes sont habituellement d\u00e9crits sous 2 formes : le condtionnement classique et le conditionnement op\u00e9rant<\/p>

Pr\u00e9vention et th\u00e9rapeutique anti naus\u00e9euse :<\/strong><\/h2>

Le r\u00e9flexe naus\u00e9eux est un ph\u00e9nom\u00e8ne g\u00eanant tant pour le patient que pour le praticien. Pour faciliter les soins dentaires, ce dernier doit \u00eatre contrecarr\u00e9. Plusieurs traitements ont \u00e9t\u00e9 propos\u00e9s dans la litt\u00e9rature scientifique :<\/p>

Hypnose<\/strong><\/h3>

De nombreuses techniques d\u2019hypnose permettant de mettre le patient dans un \u00e9tat modifi\u00e9 de conscience peuvent \u00eatre utilis\u00e9es en dentisterie. Dans le cas du r\u00e9flexe naus\u00e9eux, une technique d’hypnose a \u00e9t\u00e9 d\u00e9crite o\u00f9 il est demand\u00e9 au patient d’imaginer un interrupteur imaginaire ou encore un bouton pouvant r\u00e9gler le niveau du r\u00e9flexe dont il aura le contr\u00f4le; ce qui va rassurer le patient et le maintenir calme<\/p>

En combinant les techniques d’hypnose et les exercices de d\u00e9sensibilisation \u00e0 la maison, le patient peut am\u00e9liorer le contr\u00f4le qu’il a sur son r\u00e9flexe naus\u00e9eux.<\/p>

Technique de respiration<\/strong><\/h3>

Il y a controverse quant au fait que le r\u00e9flexe naus\u00e9eux est une r\u00e9ponse r\u00e9flexe impliquant l’\u0153sophage mais aussi la trach\u00e9e lors de la respiration.<\/p>

Pendant les soins dentaires, on demande au patient d’inspirer lentement et profond\u00e9ment par le nez puis d’expirer rapidement de mani\u00e8re forc\u00e9e sans interruption entre les 2 phases. Cela va permettre au patient d’\u00eatre en hyperventilation et de se relaxer.<\/p>

Acupuncture<\/strong><\/h3>

L’acupuncture est originaire de la m\u00e9decine traditionnelle chinoise bas\u00e9e sur l’utilisation de fines aiguilles que l’on ins\u00e8re au niveau cutan\u00e9.<\/p>

Cette technique va \u00eatre appliqu\u00e9e sur un point sp\u00e9cifique “anti-naus\u00e9eux” se trouvant au niveau de l’oreille \u00a0car le nerf vague est \u00e0 proximit\u00e9 de ce point et celui-ci intervient dans le processus de d\u00e9glutition. Le point est \u00e9galement adjacent \u00e0 une branche du nerf trijumeau. En stimulant ce point anti-naus\u00e9eux, il va y avoir une inhibition de l’activit\u00e9 des muscles impliqu\u00e9s dans le r\u00e9flexe<\/p>

Traitements pharmacologiques<\/strong><\/h2>

S\u00e9dation par inhalation de protoxyde d\u2019azote ou la s\u00e9dation consciente<\/strong><\/h3>

L’utilisation du protoxyde d\u2019azote en tant que s\u00e9datif volatil est connue pour avoir des effets anxiolytiques et des effets antalgiques au niveau des douleurs dentaires.<\/p>

Cela va permettre au patient d’\u00eatre dans un \u00e9tat de relaxation total et diminuerait donc le r\u00e9flexe.<\/p>

Anesth\u00e9siques locaux<\/strong><\/h3>

L’utilisation topique d’anesth\u00e9siques locaux a \u00e9t\u00e9 fortement critiqu\u00e9 par certains \u00a0auteurs \u00a0mais ceux-ci affirment que leur utilisation r\u00e9duit fortement le r\u00e9flexe naus\u00e9eux<\/p>

Anesth\u00e9sie g\u00e9n\u00e9rale<\/strong><\/h3>

Cette option doit \u00eatre utilis\u00e9e en dernier lieu lorsque les autres traitements ne fonctionnent pas car les risques sont trop importants par rapport au soin \u00e0 effectuer.<\/p>

Utilisation de NaCl<\/strong><\/h3>

En saupoudrant un peu de sel (NaCl) sur le bout de la langue, le r\u00e9flexe naus\u00e9eux \u00a0diminue chez 95% des patients<\/p>

D\u00e9sensibilisation des “trigger zone”<\/strong><\/h3>

Pour d\u00e9sensibiliser les “trigger zone”, nous pouvons utiliser les techniques cit\u00e9es pr\u00e9c\u00e9demment, c’est-\u00e0-dire les anesth\u00e9siants locaux, la d\u00e9sensibilisation syst\u00e9matique coupl\u00e9e \u00e0 l’hypnose en donnant un miroir et un embout de la pompe d’aspiration, et l’utilisation d’une proth\u00e8se. Le r\u00e9flexe va donc diminuer petit \u00e0 petit.<\/p>

Dans le cas plus pr\u00e9cis des proth\u00e8ses d’entra\u00eenement, le patient va s’habituer au port d’une proth\u00e8se amovible avant de recevoir la d\u00e9finitive. Celles-ci se pr\u00e9sentent en l’absence de dents artificielles et de palais. Elles doivent \u00eatre port\u00e9es 4 \u00e0 5 heures par jour pendant 1 semaine pour conditionner le patient \u00e0 garder une proth\u00e8se en bouche.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Techniques de distraction<\/strong><\/h3>

C’est une m\u00e9thode basique mais efficace dont l’une d’elle est la technique de KROL . Lorsque l’attention du patient est d\u00e9tourn\u00e9e, les naus\u00e9es pourront \u00eatre contr\u00f4l\u00e9es.<\/p>

On demande au patient de lever une jambe \u00e0 l’horizontal sans support et de la maintenir. Quand le patient commence \u00e0 fatiguer, on doit fournir un effort de conscience plus important pour garder le pied sur\u00e9lev\u00e9.<\/p>

Lorsque le praticien prend une empreinte par exemple, le patient doit se concentrer sur l’obligation de garder sa jambe lev\u00e9e. Si la fatigue est trop grande, on lui demande de changer de jambe.<\/p>

Si le r\u00e9flexe naus\u00e9eux se fait sentir, on lui demande de lever le pied et la t\u00eate en m\u00eame temps.<\/p>

Il existe d’autres m\u00e9thodes de distraction telles que : la conversation avec le patient, se concentrer sur la respiration (inspirer par le nez et expirer par la bouche), compter rapidement jusqu’\u00e0 50 puis lire \u00e0 haute voix…<\/p>

Le r\u00e9flexe naus\u00e9eux bien que indispensable \u00e0 la survie d\u2019un individu peut s\u2019av\u00e9rer probl\u00e9matique lors de la dispense de soins dentaires et \u00eatre traumatisant tant pour le patient que pour le praticien. Ses m\u00e9canismes sont complexes et son \u00e9tiologie multifactorielle ; il appara\u00eet qu\u2019il n\u2019y a donc pas de traitement universel en mati\u00e8re de gestion des patients naus\u00e9eux.<\/p>

Une grande vari\u00e9t\u00e9 de strat\u00e9gies de gestion ont \u00e9t\u00e9 d\u00e9crites et celles-ci devraient \u00eatre s\u00e9lectionn\u00e9es, combin\u00e9es et adapt\u00e9es \u00e0 chaque patient, et ce afin de suivre les besoins individuels de chacun. Cela est rendu possible uniquement sur base d\u2019une anamn\u00e8se d\u00e9taill\u00e9e.<\/p>

Dans plusieurs situations, une combinaison des diff\u00e9rentes techniques de traitement est n\u00e9cessaire; mais malheureusement dans une faible minorit\u00e9 de cas, une gestion efficace n\u2019est pas toujours possible.<\/p>

\u200d<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Le r\u00e9flexe naus\u00e9eux est un r\u00e9flexe inn\u00e9 et vital. Il permet en effet de pr\u00e9venir l\u2019entr\u00e9e de corps \u00e9trangers dans les voies respiratoires sup\u00e9rieures (pharynx, larynx, trach\u00e9e) et digestives emp\u00eachant ainsi les corps \u00e9trangers de grande taille de les obstruer. Ainsi, les \u00e9l\u00e9ments \u00e9trangers, irritants ou les mat\u00e9riaux toxiques sont \u00e9ject\u00e9s par l\u2019action des muscles […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ocean_post_layout":"full-width","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"on","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"off","ocean_display_footer_bottom":"off","ocean_custom_footer_template":"0","ocean_post_oembed":"","ocean_post_self_hosted_media":"","ocean_post_video_embed":"","ocean_link_format":"","ocean_link_format_target":"self","ocean_quote_format":"","ocean_quote_format_link":"post","ocean_gallery_link_images":"off","ocean_gallery_id":[1706],"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1713","post","type-post","status-publish","format-standard","hentry","category-post","entry","owp-thumbs-layout-horizontal","owp-btn-normal","owp-tabs-layout-horizontal","has-no-thumbnails","has-product-nav"],"acf":[],"yoast_head":"\nLe 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