Резюме
Кашаба М.А. Стоматологічний статус та потреба у лікуванні пародонту серед осіб, які мають професійний контакт з вібрацією та серед хворих на вібраційну хворобу.
У пацієнтів з вібраційною хворобою (ВХ) та у здорових осіб, які мають професійний контакт з вібрацією вивчено стоматологічний статус та потребу у лікуванні пародонту. За показниками гігієнічного індексу з’ясовано відмінності між пацієнтами групи контролю та хворими на ВХ і визначені достовірні відмінності за показниками гігієни порожнини рота залежно від ступеня тяжкості ВХ. Доведено, що інтенсивність враження карієсом у хворих на ВХ достовірно вища ніж у пацієнтів групи контролю, а серед хворих на ВХ вона достовірно (р≤0,05) вища при ІІ стадії. Виявлено, що хворі на ВХ характеризуються достовірним (р≤0,05) зниженням вакуумпресурної зональної стійкості капілярів ясен, що можна розглядати у якості гемодинамічних передумов формування патології пародонту. Визначено показники узагальненого індексу потреби в лікуванні пародонту (CPITN) залежно від ступеня тяжкості ВХ та серед соматично здорових осіб, які мають професійний контакт з вібрацією.
Ключові слова: стоматологічний статус, пародонт, вібраційна хвороба.
Резюме
Кашаба М.А. Стоматологический статус и потребность в лечении пародонта среди лиц, имеющих профессиональный контакт с вибрацией и среди больных вибрационной болезнью.
У пациетнов с вибрационной болезнью (ВБ) та среди здоровых лиц, которые имеют профессиональный контакт с вибрацией изучен стоматологический статус и потребность в лечении пародонта. За показабелями гигиенического индекса установлены различия между здоровыми и пациентами с ВБ, ткже определены достоверные различия в зависимости от степени тяжести ВБ. Доведено, что интенсивность поражения кариесом у больных ВБ достоверно выше чем среди пациентов группы контроля, а среди больных ВБ она достоверно выше (р≤0,05) при ІІ стадии. Выявлено, что больные ВБ характеризуются достоверным (р≤0,05) снижением вакуумпрессурной зональной стойкости капиляров дёсен, что можна рассматривать в качестве гемодинамических предпосылок формирования патологии пародонта. Определены показатели обобщённого индекса потребности в лечении пародонта (CPITN) в зависимости от тяжести ВБ и среди соматически здоровых лиц, имеющих профессиональный контакт с вибрацией.
Ключевые слова: стоматологический статус, пародонт, вибрационная болезнь.
Summary
Кashaba М.А. Dental status and periodontal treatment needs among subjects exposed to occupational vibration and among patients with vibration disease.
Dental status and periodontal treatment needs were assessed in patients with vibration disease (VD) and healthy subjects exposed to occupational vibration. Differences between the patients of control group and patients with VD were identified according to hygienic index values and evident differences according to mouth hygiene indices were determined according to the severity of VD. It was proved that caries intensity in patients with VD is evidently higher than in control group patients and among VD patients it is evidently higher in ІІ stage. Patients with VD were found to have an evident reduction in vacuum-pressure area-based resistance of gingival capillaries, which can be considered to be hemodynamic factor of periodontal pathology development. Simplified Oral Hygiene Index (CPITN) values were determined according to VD severity and among somatically healthy subjects exposed to occupational vibration.
Key words: dental status, periodontium, vibration disease.
Рецензент: д.мед.н., проф. С.П. Шкляр

УДК 616.314.17-008.1:616-001.34]-036-092-084-08

Харківський національний медичний університет

Харьковский национальный медицинский университет

проспект Ленина, 4, Харьков, 61022,Украина

Kharkiv National Medical University,

4 Lenin Avenue, Kharkiv,61022,Ukraine

serg_shklyar@ukr.net

The purpose of research is to assess dental status (DS) in different categories of subjects exposed to occupational vibration.

Materials and methods of research. DS assessment was carried out in patients of two groups, which were formed  by copy pair method: the first group (n₀=129) comprised subjects exposed to occupational vibration, who underwent comprehensive medical examination and its results allowed to exclude vibration disease (VD); the second group (n₁=129) comprised patients with VD, who underwent treatment at the specialized department of  research and development institute of occupational hygiene and diseases at Kharkov National Medical University of Ministry of Health of Ukraine  (the first subgroup - ¹n₁=63 patients with VD stage І and the second group - ²n₁=66 patients with stage ІІ).

VD development is certainly not determined only by biological age; furthermore it can be determined by the duration of occupational contact with vibration. However,  the formation of comparison groups by copy pair method on the one hand neutralized the impact of occupational factors and from the other hand gave a possibility to study directly the state of  soft and hard tissues of the oral cavity more thoroughly, which was the main task at this state of research.

 DS assessment was performed by the method of K. M. Kosenko (pat. 57512, Ukraine) among in-patients and control group subjects (during comprehensive medical examination) with the employment of: Papillary-Marginal-Alveolar Index (PMA), Simplified Oral Hygiene Index  (ОНІ-S), caries intensity (caries/filling/extraction index), with evaluation of vacuum-pressure resistance of gingival capillaries (by the method of V.I. Kulazhenko) and Community Periodontal Index of Treatment Needs (CPITN). Initial data were statistically processed with evidence determination by paired t-test.

Results and their discussion. Distribution of patients according to gender was characterized by an evident (р≤0,05) predominance of male gender in the structure of patients (correspondingly - 82,2± 4,4%) in comparison with female (correspondingly- 17,8±4,4%). According to VD stage the  proportion of male gender evidently (р≤0,05) increased; thus, in VD І stage there were (73,0±5,6)% men, and in VD ІІ stage there were (90,9±3,5)% men; the proportion of women was found to decrease, correspondingly (from (27,0±5,6)% to (9,1±3,5)%, р≤0,05).

Comparison group analysis by age showed that the greater proportion (41,1±4,3)% belonged to patients with VD aged 40-49 years and 30-39 years – (34,9±4,2)%, however, in VD І stage the proportion of patients aged 30-39 years comprised  (46,8±6,3)%, and in VD ІІ stage it was evidently (р≤0,05) less – (24,2±5,3)%. And on the contrary, in age group of 40-49 years there were evidently (р≤0,05) more patients with VD ІІ stage than in VD І stage (correspondingly (48,4±6,2)% and (34,9±6,0)%). At the same time, patients with VD included subjects at the age of over 50 years (21,7±3,6)% and according to the stage of disease, in VD II stage there were evidently (р≤0,05) more patients of this age group than in VD І stage (correspondingly (28,8±5,6)% and (14,3±4,4)%).

Clinical study of papillary-marginal-alveolar indices according to the VD severity stage proved that the groups differed by frequency and evidence of inflammatory process in periodontal tissues. Thus, VD patients were found to have evidently (р≤0,05) more frequent cases of severe gingivitis (common impairment of periodontal tissues; correspondingly, in (3,9±1,7)% in the control group and in (23,3±3,7)% VD patients. It is also necessary to mention that the  control group  comprised (83,7±3,3)% patients who required medical and preventive measures regarding direct treatment and  sanitation of periodontal tissues.

Incidence of severe gingivitis in VD ІІ stage was evidently (р≤0,05) higher than in VD І stage, whereas cases of gingivitis with minimal clinical manifestations were observed more frequently in VD І stage (correspondingly (15,9±4,6)% and (4,5±2,6)% of patients).

Patients with VD, as compared to the patients of the control group, were found to have evidently (р≤0,05) less cases with mouth hygiene index within (0,7÷1,6) un.: patients – (55,0±4,4) %, control – (79,1±3,6)%. In VD ІІ stage the proportion of such cases is less than in VD І stage (correspondingly (37,9±6,0)% and (57,1±6,2)%, р≤0,05). A reverse trend in mouth hygiene indices was found within the interval of its values (1,7÷2,5) un.; thus, in the control group the proportion of these subject comprised (13,2±3,0)% and almost three times as many among the patients with VD (32,6±4,1)%, which was also determined by VD severity (in VD І stage – (28,6±5,7)%, in VD ІІ stage – (51,5±6,2)%, р≤0,05).

Very low (unsatisfactory, ≥2,6 un.) levels of mouth hygiene were observed ten times as frequent in patients with VD, in comparison with the control group (proportion of patients comprised correspondingly (0,8±0,8)% and (7,8±2,4)%, р≤0,05). At that, evident differences in their frequency according to VD severity were not detected (in VD І stage – in (6,3±3,1)%, in VD ІІstage – in (9,1±3,5)%, р≥0,05).

Caries intensity analysis was carried out according to CFE index (caries, fillings, extracted teeth) and it showed that patients of the control group and patients with VD did not have differences according to minimal values of this index (≤5); that is, the proportion of subjects with minimal caries intensity was similar among patients of the comparison groups. Caries intensity within the values of CFE index (6÷10) un. was observed evidently more frequent among the subjects of the control group (in the control – (51,9±4,4)%, among patients with VD – (15,5±3,2)%, р≤0,05). According to VD stage the proportion of patients with this index scale was evidently higher among patients with VD І stage (in І stage – in (20,6±5,1)%, in ІІ stage – in (10,6±3,8)%, р≤0,05).

The proportion of patients with CFE index within (11÷15) un. (in the control – in (31,8±4,1)%, among the patients with VD  – in (32,6±4,1)% was determined practically with similar frequency in the comparison groups. It should be noted that in VD І stage there were evidently more such patients than in VD ІІ stage (correspondingly (41,3±6,2)% and (24,2±5,3)%, р≤0,05). The most significant difference according to the proportion of patients with CFE index within (15÷20) un. was observed in the comparison groups. For instance, (11,6±2,8)% of the examined subjects in the control group were found to have such index values, but there were practically four times as many cases of CFE index within 15-20 un. among VD patients (correspondingly (11,6±2,8)% and (34,9±4,2)%, р≤0,05); at that, evident differences in caries intensity were detected according to VD stage (in  VD І stage – (27,0±5,6)%, in VD ІІ stage – (42,4±6,1)%, р≤0,05). Distribution according to the proportion of subjects with CFE index over 20 un. is even more illustrative; such patients were diagnosed seven times more frequently among patients with VD (in comparison with the control) and, according to the stage of VD, their number prevailed in VD ІІ stage (correspondingly (9,5±3,7)% and (21,2±5,0)%, р≤0,05).

Taking into account possible pathogenic similarity of mechanisms, leading to microcirculatory impairments in periodontal diseases and VD, we have investigated vacuum-pressure area-based resistance of gingival capillaries both among the patients of the control group and among the patients with VD according to its severity.

            It was found that only in (65,9±4,2)% patients of the control group of evidently less part (26,4±3,9)% of patients with VD the duration of vacuum test up to the formation of gingival hematoma corresponded to referential values (exceeded 60 s), at that: there were twice as less of such patients among patients with VD ІІ stage than in VD І stage (correspondingly (18,2±4,7)% and (34,9±6,0)%, р≤0,05), which renders it possible to employ this criterion as a differentiated diagnostic one in the system of comprehensive diagnostic of VD stage.

A decrease in the duration of vacuum test (due to formation of hematoma) to the level of 49÷40 sec and 39÷30 sec is considered to be indicative of a relationship between the stage of VD and microcirculatory impairments of periodontal tissues. Area-based resistance of gingival capillaries in patients with VD was characterized by a more readily formation of hematoma, concerning, first of all patients with VD ІІ stage. Thus, within vacuum test duration interval of 49÷40 sec, gingival hematomas in patients with VD developed 15-16 times more frequent than among control group patients.

Simplified Oral Hygiene Index  (CPITN) analysis according to the group of comparison determined that (31,0±4,1)% of patients with VD (VD  І – (20,6±5,1)%, VD ІІ – (40,9±6,1)% of the examined subjects) and (1,6±1,1)% of control group subjects, р≤0,05 require comprehensive therapy (including prosthodontic treatment). (35,7±4,2)% of patients with VD and (36,4±4,2)% of control group subjects require comprehensive therapy with open or closed curettage.

(31,8±4,1)%  of patients with VD and (51,2±4,4)% of control group subjects were found to have supra- and subgingival calculus. In such a way, both patients with VD and subjects exposed to occupational vibration require active sanitary hygienic impact or dental treatment. The volume and course of dental correction are first of all determined by the severity of VD.

Conclusions.

1. Investigation of mouth hygiene state according to ОНІ-S indices showed that values of this index up to 0,6 un. were observed with similar frequency both in patients with VD and in control group subjects (correspondingly 4,7±1,9 un. and 7,0±2,2 un., р≥0,05); however, there were evidently more patients with these values of mouth hygiene index among patients with VD І stage than in VD ІІ stage (correspondingly (7,9±3,4) un. and (1,5±1,5)un, р≤0,05).

2. When investigating the state of oral cavity according to hygienic index values we have determined the differences between the control group patients and patients with VD and identified evident differences according to mouth hygiene index depending on VD severity..

3. Caries intensity in patients with VD is evidently higher than in control group patients and in VD patients it is evidently (р≤0,05) higher in VD ІІ satge.

4. Patients with VD were found to have an evident (р≤0,05) reduction in vacuum-pressure area-based resistance of gingival capillaries, which can be considered to be hemodynamic factor of periodontal pathology development in VD. Vacuum-pressure area-based resistance of gingival capillaries, taking into account evident differences between different stages of VD, determined by the present research, can be employed both for the prognosis of periodontal pathology development in patients with VD and for differentiated diagnosis of VD stage.

5. We have identified Simplified Oral Hygiene Index values (CPITN) in periodontium treatment depending on the stage of vibration disease severity and among somatically healthy subjects exposed to occupational vibration.

Perspectives for further investigation are related with determination of prognostic significance of DS indices in the system of rendering dental medical and preventive care.

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