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Резюме 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 МОЗ України Kharkiv National Medical University Харьковский национальный медицинский университет serg_shklyar@ukr.net The aim of the research was to elaborate a technique for individual prognosis of periodontal diseases among persons with occupational explosion to vibration. Materials and methods of the research. Examination of dental status (DS) was performed in the patients of both groups which were for med by copy-pair method: the first group(n0=129) comprised subjects exposed to occupational vibration, who underwent comprehensive medical examination and its results all owed 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). DS assessment was performed by the method of K. M. Kosenko (pat. 57512, Ukraine) among in-patients and control group subjects(during comprehensive medical examinations) 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 of the research and their discussion. Taking into account possible pathogenic similarity of mechanisms which form microcirculatory injuries in periodontal diseases and VD, we investigated vacuum-pressure local 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 and in evidently (р≤0,05) smaller proportion (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 VDІІ stage than in VDІ stage (correspondingly (18,2±4,7)% and (34,9±6,0)%, р≤0,05), which allows us to employ this criterion as a differentiated diagnostic one in the system of comprehensive diagnostic of VD stage. CPITN analysis according to the group of comparison determined that (31,0±4,1)% of patients with VD(VDІ – (20,6±5,1)%,VDІІ – (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. A technique of individual prognosis according to DS criteria was elaborated on the basis of examination of DS peculiarities, performed to form risk groups of periodontal diseases in subjects exposed to occupational vibration. The technique is based on the approach of sequential recognition procedure with the employment of prognosis charts with such prognosis signs as the most informative significant indices of DS in the examined subjects which we determined by the data of dispersion analysis as the most informative, reliable and pathognomonic ones. 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). 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)%, inVD 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 VDІІ stage (correspondingly (9,5±3,7)% and (21,2±5,0)%, р≤0,05). Dispersion analysis determined in dices for the prognosis chart; the chart included only in dependent recognition signs: if bonding strength (±rxy) between the factors exceeded ±0,7, one of the factors was excluded out of the prognosis signs list, even though both of the indices are informative. Employment of diagnostic chart allows to implement the prognosis technique by means of clearly defined algorithm. Pathometric algorithms (PA) of prognosis have arrange of advantages. Formal information form (FIF) was employed for prognosis; pathometric FIF can be also used for the formation of diagnostic activity group and for the formation of treatment-prophylactic activity groups, for the distribution into the groups of dynamic (dispensary) observation, differentiated by the degree of periodontal diseases development (formation) risk. DS indices in the prognosis chartered is tributed in the sequence of their decreasing information content: the most informative (the first rank place, І=2,770 beat) is the index of local vacuum-pressure resistance of periodontal capillaries, the second rank place is occupied by the index of periodontal treatment needs (І=2,510 beat), the third rank belongs to the index point, which reflects the number of carious, filled and extracted teeth (І=2,061 beat) and other factors. Corresponding prognostic coefficients have been calculated according to the ranking of each informative index, which gives a possibility to assess the risk of periodontal abnormality development in each individual dental examination of a certain subject exposed to occupational vibration by adding them consistently. Conclusions. 1.We have investigated the indices of dental status in subjects exposed to occupational vibration, which are characterized by different clinical information content and prognostic value. 2.In order to stratify the risk of periodontal diseases development we have elaborated prognostical go rithm which registers the most informative indices, among them (in the sequence of decreasing information content): a decrease in local vacuum-pressure resistance of capillaries less than 40 seconds, the value of periodontal treatment needs index more than 3,0 band the value of caries intensity more than 15 un. 3.Clinical validation of the algorithm for periodontal diseases risk stratification in subjects exposed to occupational vibration determined that its sensitivity comprised 95,0% and specificity amounted not less than 80,0% Further investigation of these issues is connected with the study of clinical, metabolic and immunologic peculiarities of patients with periodontal abnormalities exposed to occupational vibration. Література 1. Аболмасов Н.Н. Стратегия и тактика профилактики заболеваний пародонта / Н.Н. Аболмасов // Стоматология. - 2003. - № 4. - С. 34-39. | |
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