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ANALYSIS OF THE PREVALENCE OF THE FACTORS, INFLUENCING THE DEVELOPMENT OF HYPERPLASIA OF THE ORAL MUCOUS MEMBRANE OF THE ELDERLY AND
SENILE AGE PATIENTS
1Drozdova O. V.
2Dukhanina I. V.
1Chief doctor of the dental clinic of the Moscow state medical and dentistry University.
A. I. Evdokimov of the Ministry of health of the Russian Federation,
Moscow, candidate of medical science 2Professor, Department of the Finance and investment of the Moscow state medical and dentistry University. A. I. Evdokimov of the Ministry of health of the Russian Federation,
Moscow, doctor of medical Sciences
Abstract. The study of dental health, the analysis of the prevalence of the factors, influencing the development of hyperplasia of the oral mucous membrane of the elderly and senile age patients is the important medical and social problem. In the presented article we describe the results of the study involving the analysis of the prevalence of the above factors in accordance with the classification proposed in 1972 in the Moscow state medical and dentistry University. A.I. Evdokimov. In the result of the study it was found that among the patients of elderly and senile age with precancerous and background diseases of the mucous membrane of the oral cavity the prevalence of the influence of several endogenous and exogenous factors is higher than among the patients without histological confirmation these diseases.
Keywords: factors, influencing the development of hyperplasia of the oral mucous membrane; the elderly and senile age persons.
The relevance of the study. A feature of economically developed countries in the modern conditions has been the increase in population of elderly and senile age [1, c. 3-7]. It is assumed that the increase in life expectancy accompanied by an increase in person-years lived by the population
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with poor health [4]. This trend is also noted regarding your dental health and condition of the oral cavity [2, c. 4-8].
As in other countries, Russia has seen a steady population growth of older age groups [5, c. 24]. Therefore, the study of dental health, the analysis of the prevalence of the factors, influencing the development of hyperplasia of the oral mucous membrane of the patients of elderly and senile age, is the important medico-social problem.
Need of the dentistry practice and of the health authorities at all levels in the development of measures to improve dental care for patients of elderly and senile age with hyperplastic processes in the mucosa of the oral cavity determined the relevance of the study, its purpose and objectives.
The purpose of the research: scientific-methodical substantiation of ways of improvement of the medical aid quality to implementation of the interdisciplinary approach to the organization of medical care for patients of elderly and senile age with hyperplastic processes in the mucosa of the oral cavity.
The objectives of the study included analysis of the prevalence of the factors, influencing the development of hyperplasia of the oral mucous membrane of elderly and senile patients.
Organization, material and research methods
The object of the study was comprehensive dental aid (including consultative and diagnostic) to elderly and senile patients, the subject is a dental care organization for the named persons on the basis of the interdisciplinary approach.
The observation units were the elderly and senile patients and primary medical documentation: medical card of the inpatient (f. 003/u); dental patient card (f. 043/u).
Analysis of the prevalence of the factors, influencing the development of hyperplasia of the mucous membrane of the oral cavity in patients of elderly and senile age, was conducted in accordance with the classification of factors [3], proposed in 1972 in the Moscow medical dental Institute (now Moscow state medical and dentistry University. A. I. Evdokimov).
The obtained results were subjected to statistical processing on the IBM PC program STATISTICA-6. In the process of statistical analysis there is done the calculation of relative values and their errors; mean values, standard deviations and errors of averages; the statistical significance of differences for medium and relative values, using the t-Student test for independent and related variables in pairs. Credible recognized differences when t>2.
The results of the study
In accordance with the above classification the most common endogenous factor was determined the factor of diseases characterized by high blood pressure (I10-I15). The prevalence of this factor was uniformly high and did not have significant differences among patients in whom there was no disease that is a precancer or underlying diseases for the development of cancer, - 94,92±2,92 for 100 cases. of the study of the histological material, in patients with detected pre-cancerous disease,
- 95,10±7,91, as well as in patients with established underlying diseases for the development of cancer - 94,69±8,86 for 100 cases. of the study of the histological material (pp = accordingly 0,055 h 0,057).
The second most common endogenous factor was determined as factor of the presence of the examined patients of cerebrovascular disease (I60-I69): rate among patients in whom there was no disease that is a precancer or underlying diseases for the development of cancer, amounted to 93,96±2,89 for 100 cases, in patients with identified precancer of oral mucous membrane -98,60±8,20, and in patients with underlying diseases for the development of cancer - 98,23±9,19 for 100 cases of the study of the histological material (pp = accordingly 0,045 and 0,045).
The third most common endogenous factor was determined as factor of the presence in the examined patients with coronary artery disease (I20-I25). At this frequency the influence of this factor in groups of patients, which was absent of the disease that is a precancer or underlying diseases for the development of cancer, amounted to 93,48±2,88 for 100 cases, among patients with established histological examination of the precancerous diseases of the oral mucous membrane - 97,20±8,09, and underlying diseases for the development of cancer - 97,35±9,11 for 100 cases of the study of the histological material (pp = accordingly 0,045 h 0,044).
Fourth on the prevalence of endogenous factor was determined as factor of the presence of the examined patients polymorbidity: the rate among patients who had no disease that is a precancer or underlying diseases for the development of cancer, amounted to 75,55±2,32 for 100 cases, in patients with identified precancer WAT he turned out to be 1.15 times higher and amounted to 86,71±7,21, and in patients with underlying diseases for the development of cancer is slightly lower than in the previous group,
- 81,42±7,61 for 100 cases of the study of the histological material (pp = accordingly 0,040 h 0,043).
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Next, in descending order of prevalence followed:
- combined hyperlipidemia (E78.2) - accordingly 56,95±1,75, 56,64±4,69 h 55,75±5,20 for 100 cases (all p>0,05);
- diabetes (E10-E14) - accordingly 49,28±1,51, 52,45±4,34 h 51,33±4,78 (all p>0,05);
- polyneuropathy (G60-G64) - accordingly 32,98±1,01, 34,27±2,82 h 33,63±3,12 (all p>0,05);
- gastritis and duodenitis (K29) - accordingly 24,93±0,76, 24,48±2,00 h 25,66±2,37 (all p>0,05);
- pancreatitis (K85) - accordingly 12,56±0,37, 13,99±1,13 h 13,27±1,20 (all p>0,05);
- duodenal peptic ulcer (K26) - accordingly 7,57±0,22, 9,09±0,72 and 9,73±0,87 (all p>0,05);
- peptic ulcer of stomach (K25) - accordingly 7,00±0,20, 8,39±0,66 and 7,96±0,70 (all p>0,05);
- enteritis (K52) - accordingly 6,23±0,18, 6,29±0,48 and 6,19±0,53 (all p>0,05);
- iron deficiency anemia (D50) - accordingly 4,41±0,12, 4,20±0,31 and 4,42±0,37 for 100 cases of the study of the histological material (accordingly p>0,05).
Thus, the prevalence of the influence of endogenous factors such as the presence of cerebrovascular disease, ischemic heart disease and polymorbidity conditions was significantly higher among patients with precancerous diseases and underlying diseases for the development of cancer resistance, heat resistance in comparison with the patients with above mentioned diseases of oral mucous membrane during histological examination was not confirmed.
In the result of the analysis, the most common exogenous factor was determined as factor of Smoking. The prevalence of this factor among patients in whom there was no disease that is a precancer or underlying diseases for the development of cancer, amounted to 70,95±2,18 for 100 cases of the study of the histological material, among patients who were found precancerous, - 81,82±6,80 (p=0,039), background of the disease and for the development of cancer - 82,30±7,69 for 100 cases (p=0,038).
Thus, the prevalence of Smoking among patients of elderly and senile age with precancerous and background diseases for the development of cancer resistance, heat resistance was 1.15 times higher than among the patients with above mentioned diseases were absent.
The second most common exogenous factor was determined by long-term drug therapy, especially combined pharmacotherapy: the figure was 68,17±2,10 for 100 cases of the study among patients who were not identified precancerous and background diseases for the development of cancer, 80,42±6,68 -among patients with precancerous diseases (p=0,035) and 81,42±7,61 for 100 cases of the study among patients with the identified underlying diseases for the development of cancer (p=0,033).
Thus, the prevalence of the concomitant influence of pharmacotherapy on the development in patients of elderly and senile age precancerous and background diseases for the development of cancer resistance, heat resistance, 1.18 times higher than that of patients with above mentioned diseases of oral mucous membrane was not confirmed.
Analysis of the impact of drugs of different pharmacological groups on the incidence of precancerous and background diseases for the development of cancer resistance, heat resistance, has allowed to establish that the frequency effect among the drugs was the leading beta-blockers: the incidence of their impact on the mucous membrane of the oral cavity of patients of elderly and senile age with not confirmed precancerous and background processes made 59,92±1,84 100 SL. studies with premalignant processes - 65,03±5,40 (p=0,040), with background diseases to cancer -65,49±6,11 for 100 cases of the study of the histological material (p=0,039).
Thus, the prevalence of beta-blockers causing, as is known, dry oral mucous membrane, the patients of elderly and senile age with precancerous and background diseases for the development of cancer called localization was 1.18 times higher than among the patients with above mentioned diseases were absent.
The maximum spread in its influence turned out to be drugs of the group of calcium antagonists, respectively 84,85±2,61, 84,62±7,03 and 85,84±8,02 for 100 cases of the study (all p>0,05), minimum - non-steroidal anti-inflammatory drugs (NSAIDs): accordingly 17,93±0,54, 19,58±1,60 and 19,45±1,78 for 100 cases of the study (all p>0,05), however, the frequency of their influence had no significant differences among patients with no histological confirmation of the precancerous or background status of SOPR, with confirmed precancerous, as well as the underlying diseases for the development of cancer.
The third most common exogenous factor was identified traumatic effect on oral mucous membrane, particularly the crowns of the teeth: prevalence of traumatic exposure on the mucous
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membrane of the oral cavity of patients of elderly and senile age with not confirmed precancerous and background processes made up 65,96±2,03 cases for 100 studies, with precancerous diseases -86,01±7,15 (p=0,027), that is, the 1.30 times higher than with background diseases to cancer -88,50±8,28 cases for 100 studies (p=0,025), that is 1.34 times higher. The prevalence of traumatic impact on oral mucosal membrane of sharp edges of teeth, respectively 35,19±1,07, 46,85±3,88 (p=0,045) and 45,13±4,20 cases for 100 studies (p=0,047); poorly installed dentures, respectively 14,96±0,45, 18,88±1,54 (p=0,043 and 18,58±1,70 (p=0,046).
Table 1. The prevalence of the factors, influencing the development of hyperplasia of oral mucous membrane of the patients of elderly and senile age
Research revealed no signs of precancerous or process background of the disease to the development of cancer, n=1043 The precancerous, n=143 Background disease to cancer, n=113
Abs. For 100 cases Abs. For 100 cases Abs. For 100 cases
Endogenous factors
Stomach peptic ulcer (K25) 73 7,00±0,20 12 8,39±0,66 9 7,96±0,70
Duodenal peptic ulcer (K26) 79 7,57±0,22 13 9,09±0,72 11 9,73±0,87
Gastritis and duodenitis (K29) 260 24,93±0,76 35 24,48±2,00 29 25,66±2,37
Enteritis (K52) 65 6,23±0,18 9 6,29±0,48 7 6,19±0,53
Pancreatitis (K85) 131 12,56±0,37 20 13,99±1,13 15 13,27±1,20
Diabetes (E10-E14) 514 49,28±1,51 75 52,45±4,34 58 51,33±4,78
Combined hyperlipidemia (E78.2) 594 56,95±1,75 81 56,64±4,69 63 55,75±5,20
Disease characterized by elevated blood pressure (I 10-I 15) 990 94,92±2,92 136 95,10±7,91 107 94,69±8,86
CHD (I 20-I 25) 975 93,48±2,88 139 97,20±8,09 110 97,35±9,11
Cerebrovascular disease (I60-I69) 980 93,96±2,89 141 98,60±8,20 111 98,23±9,19
Polyneuropathy (G60-G64) 344 32,98±1,01 49 34,27±2,82 38 33,63±3,12
Iron deficiency anemia (D50) 46 4,41±0,12 6 4,20±0,31 5 4,42±0,37
The polymorbidity 788 75,55±2,32 124 86,71±7,21 92 81,42±7,61
Fourth on the prevalence of exogenous factor was identified recreational use of alcohol that has been set with a frequency of 51,97±1,59, 51,05±4,23 and 50,44±4,70 cases for 100 studies (all p>0,05); fifth - constant intake of hot or spicy food: respectively 26,94±0,82, 44,76±3,70 (p=0,026) and 38,94±3,62 cases for 100 studies (p=0,021).
Thus, the prevalence of the influence of the continuous use of hot or spicy foods among patients of elderly and senile age with precancerous and background diseases for the development of
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cancer called localization was approximately 1.45 and 1.66 times higher than among patients in whom the above mentioned diseases were absent.
And finally, the minimum prevalence of the influence was a factor in the infection of patients of elderly and senile age with human papillomavirus 11 and 16 types: the figure was among patients with unconfirmed precancerous and background diseases for the development of cancer 4,79±0,13, with pre-cancerous conditions - 5,59±0,42 and underlying diseases for the development of cancer -5,31±0,45 cases for 100 studies (all p>0,05) - table 1.
The rest of the table 2.
Table 2. The prevalence of the factors, influencing the development of hyperplasia of oral mucous membrane of the patients of elderly and senile age
Research revealed no signs of precancerous or process background of the disease to the development of cancer, n=1043 The precancerous, n=143 Background disease to cancer, n=113
Abs. For 100 cases Abs. For 100 cases Abs. For 100 cases
Exogenous factors
Smoking 740 70,95±2,18 117 81,82±6,80 93 82,30±7,69
Recreational use of alcohol 542 51,97±1,59 73 51,05±4,23 57 50,44±4,70
Constant intake of hot or spicy foods 281 26,94±0,82 64 44,76±3,70 44 38,94±3,62
Long-term drug therapy, including:
NSAIDs 187 17,93±0,54 28 19,58±1,60 22 19,45±1,78
Calcium antagonists 885 84,85±2,61 121 84,62± 7,03 97 85,84±8,02
Beta-blockers 625 59,92±1,84 93 65,03±5,40 74 65,49±6,11
Combined pharmacotherapy 711 68,17±2,10 115 80,42±6,68 92 81,42±7,61
The action of traumatic factors, including:
The crowns of the teeth 688 65,96±2,03 123 86,01±7,15 100 88,50±8,28
The sharp edge of the tooth 367 35,19±1,07 67 46,85±3,88 51 45,13±4,20
Substandard installation of the prosthesis 156 14,96±0,45 27 18,88±1,54 21 18,58±1,70
The human papillomavirus 11 and 16 types 50 4,79±0,13 8 5,59±0,42 6 5,31±0,45
Conclusion:
Among patients of elderly and senile age with precancerous and background diseases of the mucous membrane of the oral cavity the prevalence of the influence of several endogenous and exogenous factors is higher in comparison with patients without histological confirmation of these diseases. This applies to such endogenous factors as cerebrovascular disease, ischemic heart disease and premorbidly clinical situations, as well as to exogenous factors - smoking, long-term combined pharmacotherapy and traumatic effects on the oral mucous membrane by the crowns and sharp edges of the teeth and poor quality of installed dentures. The prevalence of the influence of the continuous use of hot and/or spicy foods among patients of elderly and senile age with precancerous and background diseases to cancer approximately 1.45 and 1.66 times higher than among patients in whom the above mentioned diseases were absent.
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AN ANALYSIS OF STUDENTS' OPINION REGARDING THE COMMUNICATION AT THE DENTAL LABORATORY
1Milev M.
2Kostadinova T.
3Borisova S.
4Georgieva E.
1Bulgaria, Varna, Training and research sector„Dental technician",Medical College 2Bulgaria, Varna, Department of Economics and Management of Health, Medical University "Prof. Dr. Paraskev, Stoyanov" 3Bulgaria, Varna, Department of health care, Medical University
"Prof. Dr. Paraskev Stoyanov" 4Bulgaria, Varna, Training and research sector "Medical laboratory
assistant", Medical College
Abstract: At the dental laboratory, the quantity and quality of information exchanged in the process of communication among the dental technician, the dentist and the patient is of significant importance for the quality of the final product, namely the fabricated prosthetic design and carried out dental treatment. The purpose of the report is to study the quantity and quality of information exchanged in the process of training between dental technicians and students. The reason to study the opinion of the students regarding the communication at the dental laboratory is that now is the starting stage of performance of practical training under real conditions and the students have the opportunity to evaluate the working process between the dental technician and the dentist.
Keywords: communication, information, students, dental technicians
Introduction: One of the main elements of good communication is the quantity and quality of information that participates in the process of work. The more qualitative and comprehensive is the information, the more communication is more successful and the risk of errors is lower.
Team communication is bilateral and related with exchange of information including knowledge and skills. Communication among them allows trouble-free sharing of the image of the final product aiming to satisfy the patient. The strong relationship is based on mutual trust which
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