CC BY
15
Gafurov Gayrat,
Ph D., Dentist of the Tashkent State Dental Institute E-mail: gayrat.gafurov. 1979@mail.ru Rizaev Jasur Alimdjanovich, professor, rector, of Tashkent State Dental Institute.
E-mail: info@tsdi.uz
THE IMPACT OF THE NEW MANAGEMENT FORM OF PERIODONTAL DISEASE TREATMENT ON QUALITY OF LIFE OF PATIENTS WITH GENERALIZED PERIODONTITIS
Abstract: Introduction of the new organizational form of interaction of dentists and internists in general hospital to treatment periodontium diseases in somatic patients has led to higher self-assessment of oral health related quality of life by the patients with statistically significantly lower values of quality of life indicators before treatment (P < 0.01). These organizational actions have obviouslyled to improvement of quality and efficiency of the diagnostic and therapeutic process.It resulted instable remission of the inflammatory and destructive processes in the periodontal complexand it does not render any impact on the daily life of the patients and their social functioning.
Keywords: oral health, periodontal disease, oral health related quality of life.
Introduction
Inflammatory diseases of the periodontium lead in incidence and prevalence among other kinds of oral pathology in somatic patients. They aggravate the course of underlying disease; reduce the values of indicators of oral health related quality of life (OHRQoL) [1, 2, 3]. Hence, OHRQoL is an integral part of general health and well-being and is recognized by the WHO as an important segment of the Global Oral Health Program [4].
Periodontal diseases (PD) result in considerable decrease in dentition functionality. They are characterized by a long period of rehabilitation and lifelong care. A PD therapy is labor-consuming and expensive; it requires participation of various experts. Therefore, PDs are not only a medical problem, but rather a social onethatexerts influence onpatient's OHRQoL [5, 6].
To achieve a steady positive outcome of complex treatment of chronic generalized periodontitis one should consider OHRQoL evaluation made by the patient as it enables to monitor the condition of patients with generalized periodontitis, helps obtain the information on the physical, psychological and social statusof both the definite patient and a group of patients to assess the efficiency of treatment [7].
Complex treatment, that includes new management forms, is a basis of the modern approach to rehabilitation of PD patients. Quality and efficiency of managerial actions directed at an increase in overall performance of the public health system are evaluated by their effect on life quality of patients.
To evaluateoral health in terms of its impact on OHRQoL it is necessary to apply special dental tests each of which is intended to measure frequency, intensity of anoral problem effect on functional, social and psychological well-being. Ef-
ficacy of application of the OHRQoL criteria for evaluation of PD treatment out comes using special questionnaires, namely the Oral Health Impact Profile (OHIP-14) that has good reliability, validity and precision, has been proved by several studies [8, 9]. The method enables to estimate multicomponent characteristics of human life, i.e. physical, psychological and social functioning.
Research objective
The study was focused on the impact of the new management form of PD treatment on OHRQoLof somatic patients.
Materials and methods
The patients treated at the 3rd hospital of the Tashkent Medical Academy in 2013 were asked to fill in the questionnaire. Since December 1, 2014, the new managerial-functional model of diagnosis, treatment, prevention and prophylactic medical surveillancehas been implemented at the hospital to reveal, in particular, PD patients. It includes inter disciplinary interaction of dentists and internistsas well as joint management of PD patients.
The questionnaire was offered to 1.139 patients; 561 of them took part in the questioning before the introduction of the new management form and 578 after its introduction. All patients were examined by dentists prior to the beginning of the treatment at the hospital. The presence of generalized periodontal disease (GPD) was confirmed clinically and by x-ray examination. The study groups were formed randomly according to severity of GPD clinical manifestations.
In 2013, treatment of somatic patients with periodontal diseases was carried out according to their self-presentation and in 2014 the new managerial-functional model of treatment was used. The respondents were distributed into identical groups by their social status, frequency of treatmentat
hospital, causes of admission to the hospital, distribution to hospital units. Prior to the research start, all patients signed the informed consent to participation in the research.
The OHIP-14 questionnaire was used to determine these verities of the PD effect on functional, social and psychological well-being of the respondents. The questionnaire contains 14 questions on the periodontium condition effect one acting and food intake, problems in communicative and labor activity, general health status, etc. The evaluation of the patients' OHRQoL was carried out prior to the start of the research, immediately after treatment and in 3 and 6 months after treatment cessation. After explanation of the research purposes and problems, the respondents filled in the OHIP-14 questionnaire independently.The answers to 14 questions were evaluated by five-score scale (1 - never, 2 - almost never, 3 -
Table 1.- OHRQoL indicators showing
usually, 4 - frequently, 5 - very frequently). The more the sum of the scores (from 0 to 5) was, the more probable it was that the person was liable to periodontal diseases.The analysis of findings was made by standard methods of statistical processing using Microsoft Excel and Statistic 6.0.
Results and discussion
The analysis of the obtained findings showed that all patients had OHRQoL disorders due to periodontal diseases.
When evaluating the OHRQoL indicators characterizing problems of eating and food intake, the following findings were obtained: deterioration of gustatory sensitivity made 3.25 ± ± 0.11 (P > 0.05); difficulties in food intake: 2.88 ± 0.15-2.91 ± ± 0.14 (P > 0.05); difficulties in food chewing: 3.08 ± 0.14-2.99 ± 0.13 (P > 0.05), and the lack of food satisfaction: 2.65 ± 0.12-2.71 ± 0.11 (P > 0.05) (Table 1).
the problems innutrition and food intake
Period Year Problems of food intake
Taste problems Pain Difficulties in eating Difficulties in chewing Poor food satisfaction
Before treatment 2013 3.15 ± 0.15 3.16 ± 0.15 2.88 ± 0.12 3.08 ± 0.14 2.65 ± 0.02
2014 3.17 ± 0.11 3.25 ± 0.11 2.91 ± 0.14 2.99 ± 0.13 2.71 ± 0.11
After treatment 2013 2.65 ± 0.07 2.73 ± 0.08 2.76 ± 0.11 2.85 ± 0.17 2.60 ± 0.11
2014 1.65 ± 0.06x 1.45 ± 0.07x 1.33 ± 0.10x 1.55 ± 0.13x 1.60 ± 0.07x
3 months later 2013 2.68 ± 0.11 3.03 ± 0.12 2.81 ± 0.13 3.41 ± 0.16 2.66 ± 0.12
2014 1.25 ± 0.05x 1.65 ± 0.06x 1.44 ± 0.07x 1.65 ± 0.07x 1.77 ± 0.08x
6 months later 2013 2.45 ± 0.09 2.81 ± 0.13 2.90 ± 0.14 2.65 ± 0.11 2.79 ± 0.12
2014 1.40 ± 0.05x 1.70 ± 0.08x 1.64 ± 0.05x 1.70 ± 0.06x 1.80 ± 0.07x
Note: - P < 0.05 against the value before the treatment; x- P < 0.05 against the value in 2013
The intensity of OHRQoL deterioration due to communication problems appeared to be a little lower. As a whole, the most common complaints of the patients were caused by aesthetic defects, unpleasant breath from the mouth resulting in psychological discomfort, sense of internal tension, lack of
Table 2.- OHRQoL indicators showing the problems in communication
self-control and irritability. The values of the OHRQoL indicators related to communication problems ranged from 2.55 ± 0.11 to 2.70 ± 0.13. No statistically significant intergroup distinctions were found (P > 0.05) (Table 2).
Period Year Communication problems
Shyness Difficulties in speaking Tension Troubles Irritability
Before treatment 2013 2.55 ± 0.11 2.65 ± 0.12 2.51 ± 0.11 2.67 ± 0.12 2.70 ± 0.13
2014 2.48 ± 0.10 2.59 ± 0.12 2.54 ± 0.11 2.62 ± 0.11 2.38 ± 0.12
After treatment 2013 2.62 ± 0.12 2.63 ± 0.10 2.64 ± 0.11 2.68 ± 0.13 2.62 ± 0.12
2014 1.22 ± 0.06 1.35 ± 0.05x 1.40 ± 0.04x 1.58 ± 0.07x 1.22 ± 0.06x
3 months later 2013 2.70 ± 0.10 2.60 ± 0.12 2.48 ± 0.11 2.61 ± 0.12 2.71 ± 0.13
2014 1.33 ± 0.04x 1.42 ± 0.06x 1.55 ± 0.05x 1.60 ± 0.07x 1.33 ± 0.05x
6 months later 2013 2.69 ± 0.08 2.54 ± 0.11 2.44 ± 0.12 2.77 ± 0.12 2.80 ± 0.13
2014 1.40 ± 0.06x 1.55 ± 0.07x 1.63 ± 0.08x 1.70 ± 0.06x 1.40 ± 0.05x
Note: - P < 0.05 against the value before the treatment; x- P < 0.05 against the value in 2013
The PD effect on behavior problems was manifested by complaints of difficulties at work, a decrease in quality of rest and low interest to life, reduction in quality of life. The values of some indicators related to the behavior problems were
Table 3.- OHRQoL indicators
Thus, prior to the initiation of the treatment, the indicator values were approximately equal in both groups. The obtained findingssuggest negative impact of chronic generalized periodontitis on daily life of the patientsand their social functioning.
Uniformity of the groups' enabledus to carry out the analysis of efficiency of introduction of the new managerial-functional form of PD treatment on OHRQoL of patients with periodontitis and somatic pathology. The treatment of all patients gave the following outcomes: the acute process in the periodontium was stopped, pain and bleeding of gums decreased or disappeared completely, the unpleasant breath from the mouth disappeared or reduced, sensitivity of teeth decreased. The hygienic condition of the oral cavity improved the values of indicators of inflammation and destruction in the periodontium reduced. A higher clinical effect was obtained in 2014 (P < 0.01).
The comparison of the patients' answers in 2013 and 2014 showed that in 2014, i.e. after introduction of the new managerial form of interaction of dentists and internists, the patients assessed the dental diseases impaction the QoL after treatment as approaching one with all the values of the OHRQoL indicators statistically significantly lower the ones before the treatment (P < 0.01). It is obvious, that introduction of management actions has led to improvement of quality and efficiency of the medical-diagnostic process. Therefore, stable remission of inflammatory and destructive process in the periodontal complex was achieved and it does not deterio-
registered at the level of 2.21 ± 0.09-2.28 ± 0.12. No statistically significant intergroup distinctions were found (P > 0.05) (Table 3).
showingbehavior problems
rate daily life of the patients and their social functioning. The OHRQoL self-assessment before introduction of the management actions, i.e. in 2013, did not undergo essential changes (P > 0.05). It is necessary to stress that the OHRQoL assessed by the patients remained high in 2014 and during the follow-up period (in 3 and 6 months after their discharge from the hospital; P < 0.01 and P < 0.01, respectively).
Conclusion
The analysis of the obtained findings shows the importance of the effect of the oral health status due to periodontium diseases on the OHRQoL assessed by the patients with somatic pathology since it influences their self-perception and relations in society. High rates of PD prevalence (nearly 100.0%), treatment needs (indicators of CPTN index components: normal periodontium - 0.82; bleeding - 0.43; dental calculi - 0.85; periodontal pockets of 4-5 mm - 2.08; periodontal pockets over 6 mm - 1.2; excluded sextants - 0.62) and absence of tendencies to the disease aggravation necessitate improvement of managerial, preventive and medical interventions in the PD patients with somatic diseases.
Questioning PD patients to determine their OHRQoL after introduction of managerial, preventive and medical actions provides essential informationon condition of the periodon-tium and general health. It also helps evaluate the dental care quality. The OHIP-14 questionnaire enables to find out priority problems in management of oral health care to the patient of general hospitals, improve interaction of dentists, internists and patients, and assess the patient's response to treatment.
Period Year Behavior problems
Problems at work Bad rest Low interest to life Low QoL
Before treatment 2013 2.28 ± 0.12 2.00 ± 0.10 2.23 ± 0.11 2.20 ± 0.12
2014 2.25 ± 0.12 2.21 ± 0.11 1.21 ± 0.09 2.21 ± 0.11
After treatment 2013 2.20 ± 0.09 2.20 ± 0.10 2.16 ± 0.08 2.15 ± 0.07
2014 1.28 ± 0.05x 1.30 ± 0.06x 1.16 ± 0.04x 1.25 ± 0.05x
3 months later 2013 2.44 ± 0.12 2.22 ± 0.10 2.20 ± 0.11 2.31 ± 0.12
2014 1.32 ± 0.11x 1.40 ± 0.05x 1.20 ± 0.05x 1.30 ± 0.03x
6 months later 2013 2.35 ± 0.11 2.33 ± 0.12 2.30 ± 0.10 2.30 ± 0.11
2014 1.44 ± 0.04x 1.52 ± 0.07x 1.30 ± 0.05x 1.43 ± 0.06x
Note: - P<0.05 against the value before the treatment; x- P < 0.05 against the value in 2013
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