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0заболевания, во многом определяют направление и характер развития инфекционного воспалительного процесса в пародонте, а также служат одним из агентов, участвующих в формировании гнойных осложнений: в околозубных тканях больных хроническим генерализованным пародонтитом.
Изучение цитокинов, как иммуномодуляторов очевидно может приблизить к более полному пониманию возникновения инфекционно - гнойных осложнений у больных генерализованным паро-донтитом. Так результаты исследований основных регуляторных цитокинов показывают, что повышение продукции ИЛ-lß у больных с гнойными очагами более выраженное, чем ФНО-а, что подтверждает и подчеркивает важность участия ИЛ-lß в патогенезе гнойного процесса. Свой вклад в этот процесс ИЛ-lß может вносить посредством торможения синтеза специфических ингибиторов энзимов.
Вывод. У больных хроническим генерализованным пародонтитом в период появления гнойных воспалительных явлений в пародонте имеют место иммунные дисфункции, характеризующиеся дефицитом местного секреторного иммунитета повышенным уровнем провоспалительных цитокинов (ИЛ-lß и ФНО-а) и тенденцией к снижению про-воспалительного ИЛ-4.
Список литературы
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5. Ковальчук Л.В. Роль цитокинов в механизмах развития хронического воспаления в ткани па-родонта / Л.В. Ковальчук, Л.В. Ганковская, М.А. Рогова [и др.] // Иммунология. - 2006. - №6. - С.24-26.
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СТАН СТОМАТОЛОГIЧНОÏ ЗАХВОРЮВАНОСТ1 У ПРОВ1ДНИК1В ПАСАЖИРСЬКИХ ВАГОН1В ЧЕРШВЕЦЬКОГО ВУЗЛА ЛЬВIВСЬКОÏ ЗАЛ1ЗНИЦ1
Годованець О.1. Кщак Т.С.
ДВНЗ «Буковинський державний медичний утверситет», кафедра стоматологИ' дитячого в1ку, асистент
STATE OF DENTAL MORBIDITY RATE AMONG PASSENGER CAR ATTENDANTS OF CHERNIVTSI RAILROAD CENTRE OF LVIV RAILROAD
Godovanets O.I.
Kitsak T.S.
HSEE of Ukraine «Bukovinian State Medical University», Department of Childhood Dentistry, Assistant
Анотащя
На Чершвецькокому вузлi Львiвськоl залiзницi працюе 3661 залiзничник, з них провщники складають найбшьшу частку - 484 (13,2 %). Щд час виконання сво!х професшних обов'язшв проводники потяпв па-сажирського залiзничного сполучення постшно знаходяться шд впливом низки шквдливих чиннишв: рiзкi змши температурного режиму, шум та вiбрацiя, запиленють, тдвищений рiвень мжробно! забрудненостi повiтря вагонiв, порушення режиму сну та вщпочинку, психофiзiологiчнi й нервово-емоцшш наванта-ження. Рiст стоматолопчно! захворюваностi у людей, професiйна дiяльнiсть яких пов'язана з хронiчним впливом на 1хт органи шквдливих чинник1в виробництва пов'язують з ростом хрошчних супутнiх сома-тичних захворювань, змшою антиоксидантно-прооксидантно! системи тканин порожнини рота, ткробно! рiвноваги, токсичною гiпоксieю. Протягом трудово! дiяльностi на працiвникiв впливають рiзнi шкiдливi чинники виробничого середовища, тому умови працi на виробнищга значною мiрою визначаються на-
явшстю виробничих шквдливостей. Шд виробничими шшдливостями розумшть умови виробничого сере-довища, як1 за нерацюнально! оргашзацп працi впливають на стан здоров'я пращвнишв та 1хню працез-датнiсть.
Abstract
3661 railroad men are employed by Chernivtsi railroad centre of Lviv railroad, of which the car attendants constitute the largest part- 484 (13,2%). While carrying out their professional duties the passenger car attendants are constantly under the influence of a number of harmful factors: abrupt changes in working temperature range, noise and vibration, dust content, enhanced level of air microbial contamination inside the cars, disturb ance of sleep and rest schedule, physiological and neuro-emotional tension. The increase of dental morbidity rateamong people whose professional activity is connected with chronic exposure of their organs to occupational hazards is associated with the increase of chronic concomitant physical diseases, changes in antioxidant-prooxidant system of mouth cavity tissues, microbial equilibrium, and toxic hypoxia. Various harmful factors of the working environment influence the employees in the process of their working career that is why the working conditions are considerably determined by the presence of industrial hazards. The occupational hazards are determined as working environment conditions which in case of irrational organization of work affect the employees' health and their working ability.
Ключовi слова: залiзниця, здоров'я, стоматолопчш хвороб.
Keywords: railway, health, dental diseases.
Depending on the nature of the occupational hazards origin they are divided into: hazards associated with labour process which are caused by the irrational labour organization (excessive tension of the nervous system, tension of visual organs, hearing organs, great labour intensity, etc.); hazards associated with the occupational process created by the technical deficiencies of the operating machinery (industrial dust, noise, vibration, hazardous chemicals, radiation). In Ukraine, on the average 7,5-8 thousand professional diseases are registered annually, which itself shows the complexity and ambiguity of the estimates to use these indicators for making conclusions and taking organizational and administrative decisions.
The research worksaimed at identifyingthe forming patterns of health of the passenger car attendants under the influence of occupational factors for the purpose of scientific justification of low-cost and effective health improvement are of great importancesince prolonged exposure of the organism to harmful factors worsens health and results incontraction of various diseases that adversely affects the performance of official duties by the employees.
The aim of the research. To examine the state of dental hard tissues, to assess the intensity and peculiarities of clinical manifestations of both carious proces-sand noncariousaffectsof dental hard tissues among the passenger car attendants of Chernivtsi station.
Materials and research methods
To solve the tasks we have examined 52 people, including 30 passenger car attendants of Chernivtsi station (treatment group) and 22 employees not exposed to harmful factors (experimental group). All patients were divided into four age groups and examined ac-
cording to recommendations of World Health Organization on dental examination. Teeth assessment was conducted according to CFE (caries, filled, extracted) index. We have conducted the research of dental disease among passenger car attendants in four age groups - groupI- 19-24 years old, group II- 25-34 years old, group III- 35-44 years old and group IV- 45 years old and older. The treatment group was formed in each age category consisting of employees directly involved in the occupational process, and the control group including employees not involved into the production cycle. 52 people were examined altogether.
In the process of examining the dental hard tissues and the quality of their treatment we, except the total CFE index, have conducted a detailed analysis of its components, namely we have taken into account the number of teeth with uncomplicated and complicated caries concerning the C-caries index. The teeth with complicated caries, in their turn, were divided into those which can be treated and those subject to extraction.
F (filling) index components includedthe number of fillings that required replacement, including: broken fillings and restoration; fillings and restoration on aproximalsurfaces with poor contact points and overhanging edges.
The crownworks were allocated into a particular group, singling out the unsatisfactory ones (mainly including the absence of the contact points and presence of overhanging edges) from their total number.
"E" component included the absent teeth during examination.
The results of the examination were subjected to statistical analysis.
30 25
<D20
re
>
10 5 0
LU
19-24 (2,1) 25-34 (7,5) 35-44 (10,2) 45 and older (20,4)
Age group
□ CFE (E)
Research results and their consideration. We
have investigated the state of dental health of the passenger car attendants depending on their age and length of service. The prevalence of caries among the car at-tendantsis 100% throughout all age groups. The intensity of teeth affection is 20 teeth in the treatment group in the age of 19-24 years old, reaching almost 26 teeth per one examined person in the age of 45 years old and older. The growth rate of affected teeth is not great, but stable - about two affected teeth in each age group. CFE index is almost 20% less in the control group throughout all age groups and the growth of affected teeth is half less than in the control group.
The number of teeth affected by caries (C) within CFEstructure in the treatment group increases from 2,5 (12,50%) in the age of 19 - 24 years old to 6,42 (26,52%) in the third age group (35 - 44 years old) and in the fourth age group (45 years old and older) reduces to 4,77 (18,37%). This decrease is happening due to the increase in the number of extracted teeth. In the treatment group "C" component of CFE index is stable within four affected teeth in all age groups except young employees where it is 2,4 affected teeth.
The number of filled teeth in the treatment group is reduced by half from 15,0 in the first age group to 7,52 in the fourth group. In the experimental group "F" component of CFE index is stable throughout all age groups and is within 12-13 fillings per one examined person.
The intensity indicator for odontoclasis is caused by the number of extracted teeth. In the treatment group the proportion of extracted teeth (E) according to CFEindexin the first age group is 12,30% and increases to 40,37% in the fourth age group (52,67%), i.e.it is more than four times bigger. The number of extracted teeth in the control group is 2,5 times less.
The number of extracted teeth in the treatment group significantly exceeds the number of treated teeth with age. One extracted tooth at a young age corresponds to six treated teeth, and one extracted tooth corresponds to only 0,5treated one in the fourth age group. In the control group throughout all age groups (except group I where one extracted tooth corresponds to 13
treated ones) one extracted tooth corresponds to three -four treated teeth.
Conclusion. The treatment and control groups in the process of their examination were diagnosticated having complicated caries that indicates insufficient level of oral cavity sanation. However, this index in the treatment group is bigger than the analogous one in the control groups throughout I, II, III age groups by 3,90; 5,18; 2,63 times (p <0.05) respectively, and in group IV the number of teeth with complicated caries 0,28 times exceeds such number in the treatment group (p> 0.05) compared to the control one.The complicated caries in the control group is gradually developing till 34 (p> 0.05), and in the third age group (till 44) it abruptly increases by three in comparison with the first age group. Further, with age increasingit remains at the same level (p> 0.05). The development dynamics of the complicated caries in the treatment group looks differently-firstlyincrease of the number of teeth with complicated caries is diagnosed with double speed at the age till 34 (p <0.05), then the number of the affected teeth is approximately at the same level from 34 to 44 (p> 0.05), after 44 sharp decrease of the affected teeth by 2,5 times is diagnosed (p <0.05). We have conducted analysis of the state of the teeth to be treated and extracted in order to assess the complexity of the teeth affection by complicated dental caries.
As the research results show, the number of teeth with complicated caries to be treated in the first age group both throughout the treatment and control groups is the same and 1,75 times approximatelyexceeds the number of teeth to be extracted. In the second age group the number of teeth to be treatedand extracted in the treatment group is almost the same and throughout the control group the number of teeth to be treatedtwice exceeds the number of teeth subject to extraction. In the fourth age group the percentage of teeth to be treated both in the treatment and control groups is 10-15% less than of teeth to be extracted.
This indicates approximately the same lack of dental care request by the examined people, as well as insufficient quality of treatment.
Slight increase in the number of filled teeth in the treatment group is observed throughout the first to the
third age groups (from 0,66 to 1,66), with following decrease in the IV group to 1,6. The treatment group showed such increase only in the second group to 3,33, and the third and fourth age groups showed almost double decrease in the number of filled teeth.
In addition, the quality of the fillings is rather lowas at the age of 19-24 the control group showed that 17,37% of fillings require their replacement, and this figure reaches 57,64% in the treatment group. At the age from 25 to 34, the number of low quality fillings further increases by 17,33%in the treatment group, and by 18,27% in the control group. The older age group showed the increase in the number of low-quality fillings in both groups up to 50%, and their total number is reduced.
The extent of dental health service among the total number of the examined people is very low, almost 50% of initial carious affection is not treated. The quality of the fillings is "unsatisfactory". The combination of these two indicators shows the complete lack of routine dental treatment. The treatment is only carried out at 30% rate of the required extent upon the appeal for such treatment. In our opinion, such a situation arose due to the absence of clinical examination of the employees of the enterprises with hazardous production factors.
The analysis of the number of extracted teeth, on the one hand, characterizes the quality and scope of dental care rendered to the patients. On the other hand it characterizes fast progress of pathological processes in the hard tissues of the tooth and parodentiumresult-ing in their complete loss.
With age, the treatment group is characterised with significant increase of the number of extracted teeth and the dynamics of this growth is much faster than in the control group.
Thus, the increase of the extracted teeth in the treatment group is almost twice higher than in the control group (p <0.05), and proportion of the extracted teeth within CFE in the treatment group is one and a half times higher than in the control group.
The degree of caries expansion among the passenger car attendants is 100% in all age groups, the number affected teeth with caries depending on the length of service and age ranges from 20,0 to 25,97. Only half of teeth affected by cariesistreated. Depending on the age from 12% to 53% of teeth are extracted.
Lack of prevention programs at high caries affection of teeth and its complications, high prevalence of diseases of paradontresults in the increase of the need for therapeutic, surgical and orthopedic treatment.In this respect the treatment exclusively upon appeal is conducted.
We recommend restoringthe programs ofdental diseases prevention that would include dental education of the employees, learning the rules of sensible nutrition, learning the rules of the mouth cavityhygienic care, secondary prevention (planned oral cavity sana-tion), dispensary observation.
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