Indications d'avulsion des dents de sagesse mandibulaires dans le cadre militaire

Indications for the removal of mandibular third molars in a military context

¹ Adjoint au Chef du Secteur dentaire inter-armées, Draguignan
² Adjoint au Chef de Service de Chirurgie maxillo-faciale et Stomatologie de l'HIA Sainte Anne, Toulon
³ Chef de Service de Chirurgie maxillo-faciale et Stomatologie de l'HIA Sainte Anne Toulon
⁴ Adjoint au Chef de Service d'Odontologie de l'HIA Robert Piqué, Bordeaux

Résumé

La décision d'extraire ou non des dents de sagesse mandibulaires, notamment asymptomatiques, est souvent mal comprise par les personnels militaires. Cet acte chirurgical est perçu comme systématique et allant à l'encontre des recommandations des praticiens civils. L'objectif de ce travail est de mettre en exergue le fait que les décisions des praticiens militaires se prennent conformément aux recommandations de bonnes pratiques civiles avec une évaluation du rapport bénéfices/risques de l'intervention pour les patients. Cependant, les services de santé des armées, français et étrangers, doivent impérativement prendre en considération certains paramètres inhérents aux conditions de vie des militaires, notamment au cours des opérations extérieures, afin d'orienter les choix thérapeutiques dans le but de maintenir la capacité opérationnelle des Forces. (Med Buccale Chir Buccale 2008 ; 14 : 193-208).

Abstract

The removal of mandibular third molars is frequent in French and foreign armies. This doesn't mean that theses extractions are systematic for all soldiers. The military practitioners follow the same recommendations than their civilian colleagues by establishing a ratio benefits/risks for their patients. In the civilian area, the consequences of the surgical approach (extractions of third molars) are well known, but the benefits of the conservative approach are not well documented (few number of studies, biais in the constitution of groups of patients… ). This is why the indications for the removal of mandibular third molars are not always easy to take by civilian practitioners. In the army, other parameters are taken into account. The military conditions of life, especially during operations, enforce a particular ratio benefits/risks for soldiers. In fact, military dentists take operations particularities into consideration: tiredness, stress, boredom sometimes lead to decrease the oral/food/personal hygiene of soldiers. All conditions are gathered to increase mandibular third molars problems (pericoronatis for example). These pathologies are a great handicap for soldiers but also for all Units. A medical evacuation on a battle field generates a lack of operational capabilities (medical team, escort, vehicles, helicopter…) and a real risk for soldiers (improvised explosive device, road accident…). All these military particularities and their dental consequences are published through international medical journals and impact directly the indications for the removal of mandibular third molars in the military context because of the obligation of maintaining a high operational readiness. (Med Buccale Chir Buccale 2008 ; 14 : 193-208).