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Khabibullo A. Akilov,
Jasur A. Rizaev,
Olga E. Bekzhanova,
Elyer A. Rizaev,
Kamron J. Olimdzhanov
Tashkent institute of postgraduate medical education
Tashkent state dental Institute
Samarkand state medical institute
MULTIVARIATE ANALYSIS ON PERIODONTAL DISEASES
http://dx.doi.org/10.26739/
2181-0966-2020-3-1
ANNOTATION
The multifactorial nature of the etiology of periodontal diseases dictates the need to consider the probability of their development
and features of the clinical course using multifactorial and risk assessment models.
Models for predicting variants of the course of pathology are the basis for making decisions about methods and means of prevention
and prescribing individual therapy. This was the basis for the assessment of the "total risk of generalized periodontal disease".
Key words:
oral cavity, periodontal disease, mucous membranes, diffuse periodontitis. words: oral cavity, periodontal disease,
mucous membranes, diffuse periodontitis.
Ақилов Хабибулло Aтаулаевич,
Ризаев Жасур Aлимджанович,
Бекжанова Олга Есеневна,
Ризаев Элйер Aлимджанович,
Олимжонов Камрон Жасур ўғли
Тошкент врачлар малакасини ошириш институти
Тошкент давлат стоматология институти
Самарқанд давлат тиббиёт институти
ПAРAДОНТAЛ КAСAЛЛИКЛAРНИНГ МУЛТИФУНКЦИAЛИ ТAҲЛИЛИ
АННОТАЦИЯ
Периодонтал касалликлар этиологиясининг мултифакториал хусусияти уларнинг ривожланиш эҳтимоли ва кўп факторли
моделлар ва хавфни баҳолаш моделларидан фойдаланган ҳолда клиник курс хусусиятларини ҳисобга олиш зарурлигини
белгилайди. Патология курсини башорат қилиш моделлари профилактика усуллари ва воситалари тўғрисида қарор қабул
қилиш ва индивидуал терапияни тайинлаш учун асосдир. Бу "умумий периодонтал касалликнинг умумий хавфини" баҳолаш
учун асос бўлди.
Калит сўзлар:
оғиз бўшлиғи, парадонт касаллиги, шиллиқ қават, тарқалган парадантоз
Акилов Хабибулло Атаулаевич,
Ризаев Жасур Алимджанович,
Бекжанова Ольга Есеневна,
Ризаев Эльер Алимджанович,
Олимджанов Камрон Жасур угли
Ташкентский институт усовершенствования врачей
Ташкентский государственный стоматологический институт
Самаркандский государственный медицинский институт
МНОГОФУНКЦИОНАЛЬНЫЙ АНАЛИЗ ЗАБОЛЕВАНИЙ ПАРАДОНТА
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АННОТАЦИЯ
Многофакторность этиологии заболеваний пародонта диктует необходимость учитывать вероятность их развития и
особенности клинического течения с использованием многофакторных моделей и моделей оценки риска. Модели
прогнозирования вариантов течения патологии являются основой для принятия решений о методах и средствах
профилактики и назначения индивидуальной терапии. Это послужило основанием для оценки «общего риска
генерализованного пародонтоза».
Ключевые слова:
полость рта, пародонтоз, слизистые оболочки, диффузный пародонтит.
The multifactorial nature of the etiology of periodontal
diseases dictates the need to consider the probability of their
development and features of the clinical course using
multifactorial and risk assessment models. [5,3,9,11].
Models for predicting variants of the course of pathology
are the basis for making decisions about methods and means of
prevention and prescribing individual therapy. This was the basis
for the assessment of the "total risk of generalized periodontal
disease".
In practice, modeling of population patterns is often used
to solve problems of the healthcare system, for example, to
evaluate the effectiveness of different treatment and prevention
approaches [1, 7,8,11, 20]. This was the basis for the assessment
of the "total risk of generalized periodontal disease".
It is obvious that the prevalence of risk factors for
periodontitis may differ significantly in different populations due
to heterogeneity in terms of medical and demographic, national
(hence
genetic),
geographical
and
socio-economic
characteristics. [1,4, 6,9,12, 14,19].
The solution of the problem lies in determining the
integral indicator of the load of risk factors for generalized
periodontitis, which takes into account the prevalence of risk
factors and their contribution to the occurrence of the disease.
The purpose of this study is to analyze the population
determinants of the risk of developing generalized periodontitis.
Materials and methods
Epidemiological surveys of the adult population of
Uzbekistan aged 20 and more than 60 years were carried out. The
epidemiological study was conducted in the period from 2015 to
2019. The total sample size was 1,036 people, including 555
(53.57%) women and 481 (46.43%) men.
The study was performed in accordance with the
standards of epidemiological research in dentistry and the
principles of the Helsinki Declaration. The study Protocol was
approved by the Ethics Committee. Prior to inclusion in the
study, all participants received written informed consent to
participate in the study and assess the periodontal condition.
The prevalence of periodontal diseases in each gender
and age group was judged by the value of the CPITN index.
Scaling of risk factors was carried out in two categories:
0-absence and 1 - presence of a trait.
The reliability of inter-group differences was calculated
in relation to the odds (RR) and 95% confidence interval (CI) of
the frequency of risk factors in the comparison groups. Pearson's
χ2 criterion was used for statistical processing of categorical
variables. To assess the combined effect of the primary
presence/absence of generalized periodontitis on the frequency
of combined outcomes, a multi-factor analysis of variance was
used. In addition, the combined effect of these factors was
estimated using logistic regression analysis with a RAS score of
the event probability AND 95% confidence interval (CI).
Encoding in regression analysis of the variable
"combined outcome": 0-no, 1-Yes; variable "primary
presence/absence of GP": 0-no GP, 1-GP is; variable "gender":
0 – women, 1 – men. The critical level of statistical significance
was assumed to be 0.05.
The values of b-coefficients in the logical regression
analysis were evaluated as an indicator of the contribution of the
risk factor to the prevalence of periodontitis.
Further, the prevalence of risk factors in gender and age
groups and in the whole sample was calculated. The load of
periodontitis risk factors was calculated as the sum of products
of the prevalence of risk factors with their contribution to the
risks of periodontitis by the formula
P = ∑(RC) n, (1)
where P is the load of periodontitis risk factors; R is the
prevalence of the risk factor, %; C is the contribution of the risk
factor to the prevalence of CHD.
Then the difference between risk factors in gender and
age groups compared to the General sample was calculated using
the formula
∆R = RGR. – RV., (2)
where ∆R is the difference of the load as risk factors in
age-sex groups compared to the total sample according to the
formula; RGR. – loading risk factors in age-sex groups; Pb. -
load of risk factors in the General sample.
Based on the b-coefficient obtained in the course of linear
regression analysis, the difference between risk factors in gender
and age groups was translated into population risk values using
the formula
P% = ∆RV, (3), where P% is an additional risk of
periodontitis to the population due to risk factors, %; – b is the
ratio of GP frequency to load by risk factors in linear regression
analysis.
The critical level of statistical significance and the p-level
for selecting a variable were assumed to be 0.05.
Results and discussion
As can be seen from the presented materials, the male sex
causes a statistically significantly higher frequency of
periodontitis (RR 1,498; at 95% CI 1,181 – 0.190); the
prevalence of generalized periodontal lesions is also associated
with low social status (RR 1,579; at 95% CI 1,223 – 2,003) and
non – compliance with oral hygiene (RR 1,393; at 95% CI 1,084
– 0.790); at periodontitis, a significantly higher rate of bad
Smoking habit (RR 2.869; at 95% CI 2.178-3.750) and chronic
somatic pathology compared to individuals without a burdened
somatic history (or 1.977; at 95% CI 0.848-1.366); the
prevalence of the disease is aggravated by low social and living
conditions (RR 1.131; at 95% CI 0.891 -1.436); the
predominance of carbohydrates in the diet ( RR 1.537; at 95%
CI 1.178-2.005) and low (below the subsistence minimum) per
capita income (RR 1.946; at 95% CI 1.523 – 2.478) (table 1).
Table 1
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The relationship between social risk factors and the possibility of developing generalized periodontitis
in terms of the ratio of chances and regression analysis data
Risk factor
OR
S
DI (SI) - DI-
SI
5%-95%
χ2
Pearson
р
Б
Х1
Male
1,498
0,121
1,181-0,190
14,204
<0,001
0,0185
Х2
Social status
1,579
0,122
1,224-2,003
6,725
<0,01
0,0524
Х3
Oral hygiene
1,393
0,128
1,084-1,790
58,246
<0,001
0,300
Х4
Smoking
2,869
0,141
2,178-3,780
58,628
<0,001
0,103
Х5
Chronic somatic
pathology
1,976
0,121
0,848-1,366
52,236
<0,001
0,252
Х6
Social and living
conditions
1,191
0,122
0,891-1,436
11,993
<0,001
0,106
Х7
Food
1,537
0,136
1,178-2,005
7,867
<0,006
0,25
Х8
Average per capita
income
1,946
0,123
1,523-2,478
29,508
<0,001
0,130
Only these risk factors were used for further analysis.
Using regression analysis, the contribution of risk factors for
periodontal diseases to the presence/absence of the disease in the
population was determined.
In terms of impact on the occurrence of periodontitis, the
factors are as follows: in 1st place is the non-compliance with
hygiene of the oral cavity, the contribution factor is 0.301 units;
2 - the presence of chronic somatic diseases – by 0.252 units.; on
the 3rd - the predominance of carbohydrates in the diet – to 0.252
units.; 4-volume - low income increases the presence of
periodontitis 0,139 unit; 5-Tom low income – by 0.139 units.; 6-
is - Smoking – by 0.106 unit; on the 7th –low social status
increases the risk of periodontitis in the population by 0.0524
units of ed. and on the 8th–male sex, leading to an increase in the
prevalence of periodontitis on periodontal diseases by 0.0185
units of ed. (table 1).
The statistical significance of the equations verified by
multiple correlation coefficient R = 0,86; the coefficient of
determination R2 is equal to 0,725, the proximity of the
determination coefficient R2 is close to unity the high
significance of the regression equation in explaining the
behavior of Y. And Fisher's F-test, equal 34,534. Since the actual
value of F> Fkp, (34,534 ≥ 2,02), the coefficient of determination
is statistically significant and the regression equation is
statistically reliable (i.e. the bi coefficients are jointly
significant). It was found that in the studied situation, 74.61% of
the total variability of Y is due to changes in xj factors.
Table 2 shows the prevalence of periodontal pathology
and risk factors for generalized periodontitis in the gender and
age groups and in the sample as a whole. The prevalence of
periodontitis in the entire population is 66.67% and increases
progressively from 18.37 in the younger age group of 20-24
years to 98.35% in the population over 65 years.
Table 2
Prevalence of risk factors and load of risk factors in the surveyed population
Risk factor
Age groups
All
population
20-24
25-34
35-44
45-64
55-64
>65
GP prevalence
18,34
49,73
60,85
80,0
90,91
98,35
66,67
Х1
Gender male
55,0
64,40
61,88
63,53
59,92
56,30
59,95
Х2
Social. status
48,17
42,93
59,41
76,47
51,65
61,50
56,07
Х3
Oral hygiene
18,18
26,18
34,65
41,18
45,45
50,70
36,33
Х4
Smoking
13,76
32,47
39,60
73,53
41,32
19,05
35,36
Х5
Chron.somat.
pathology
22,94
36,65
43,56
46,78
61,98
70,42
45,15
Х6
Physical social.
conditions
9,17
20,94
30,20
42,35
68,18
90,14
44,50
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Х7
Prevail.
carbohydrates
in nutrition
13,70
23,56
32,67
44,12
33,06
31,46
29,37
Х8
Low income
46,30
41,88
34,65
42,35
49,59
75,12
48,79
Load
15,38
37,42
48,09
57,96
59,26
66,37
48,97
Difference
-34,60
-11,52
-0,88
8,99
10,29
17,40
The prevalence of risk factors in age groups also has
significant fluctuations. Relative homogeneity is registered by
gender (fluctuations in the range of 55.00% - 63.53 %); at the
same time, the social status is higher in older age groups; with
increasing age, there is a more careful observance of oral
hygiene, an increase in the frequency of bad Smoking habits; a
sharp increase in the frequency of somatic pathology, social
conditions and per capita income; at the same time, 13.76% of
the population aged 20-24 years and 31.46 – 44.12% of the
population in the age groups over 60 years and 45 – 54 years give
preference to carbohydrates in their diet.
The obtained equation of logical multi-factor regression
showed that the presence of the studied risk factors explains the
frequency of generalized periodontitis in the adult population by
74.61%.
b-coefficients-links between GP frequency and load
risk factors in linear regression analysis were used to calculate
population risk using the formula (3).
The calculated load of risk factors and the difference in
the load in the gender and age groups compared to the General
sample are shown in table 2. the Load of risk factors calculated
using logistic regression analysis is equal to 48.97 for the entire
surveyed population. With age, the burden of risk factors
increases from 15.38 in the population aged 20-24 years to 75.12
in the age group over 65 years (table 2).
An additional risk in the younger age groups below the
average for the population in the age group 20 – 24 year – 34,60;
25 – 34 – 11.52; population index age group – as close to the
average for the population – below - -0,88 and increases by 8.99
age group 45 – 54 years by 8.99; 55 – 64 years – 10, 20 and more
than 65 years – of 17.40.
The data obtained allows us to calculate the load of risk
factors.
Conclusion
According to numerous studies of domestic and foreign
authors, periodontal diseases make a significant contribution to
the health of the population, which determines the need to
develop and implement methods for the diagnosis and treatment
of combined pathology. [1, 2,8, 10, 11, 12, 16,18]. In this case,
the integration of population risk is based on the analysis of both
the differences in the prevalence of risk factors and the
assessment of their contribution to the development of
periodontal diseases.
Ranking factors by the degree of influence on the
prevalence of pathology allows us to quantify risk management,
focused on identifying the causal relationships of risk factors
with the presence of periodontal pathology and to implement
adequate preventive measures to reduce the prevalence
List of references
1.
Абдулмеджидова Д.М. Факторы риска развития заболеваний пародонта у взрослого населения // Российский
стоматологический журнал. 2017; 21 (2): 72-75. DOI 10.18821/1728-2802 2017; 21 (2): 72-75
2.
Блашкова С.Л., Мартьянова М.В. Роль средств гигиены в предупреждении кариеса и заболеваний пародонта у лиц
молодого возраста // Российская стоматология. 2016;9(4): 51-53
3.
Бекжанова О.Е., Ризаев Э.А. Методические подходы к лечению заболеваний пародонта у пациентов с соматической
патологией // Проблемы биологии и медицины. 2019 №3 (111). С. 221-224.
4.
Валиева Р.М., Негаметзянов Н.Г., Исмаилов Р.М. О роли гигиены полости рта // Вестник КазНМУ. 2017. №1– С.230
– 233.
5.
Грудянов А.И., Ткачёв О.Н., Авраамова Т.В. Взаимосвязь пародонтита и заболеваний сердечно-сосудистой системы
// Стоматология. 2017; 96(1): 4-7.
6.
Кильмухаметова Ю.Х., Батиг В.М., Абрамчук И.И. Заболевания пародонта на фоне соматических патологий //
Молодой учёный. 2017. - № 26 (160). - 57- 62.
7.
Крючков Д.Ю., Романенко И.Г, Крючкова О.Н., Джерелей А.А., Горобец С.М. Пародонтит, как вероятный фактор
риска прогрессирования атеросклероза // Крымский терапевтический журнал. 2017. - №3. – 58 -61
8.
Максимов С.А., Индукаева Е.В., Артамонова Г.В. Интегральная оценка риска ишемической болезни сердца в
эпидемиологических исследованиях (ЭССЕ-РФ в Кемеровской области). Сообщение I: возрастно-половые
детерминанты // Профилактическая медицина. – 2015. - №6. – С.34 -40.
9.
Максимов С.А., Цыганкова Д.П, Артамонова Г.В. Применение регрессионного анализа и деревьев классификации
для расчета дополнительного популяционного риска ишемической болезни сердца Анализ риска здоровью. 2017. №
3. – 31 – 40.
10.
Наумова В.Н., Туркина С.В, Маслак Е.Е. Взаимосвязь стоматологических и соматических заболеваний обзор
литературы // Волгоградский научно-медицинский журнал. - 2016. – №2. - С.25 – 28.
11.
Проданчук А.И. Заболевания пародонта и соматическая патология // Молодой ученый. 2015. №6. — С. 290-293. —
URL https://moluch.ru /archive/86/16252/ (дата обращения: 15.06.2019).
12.
Abduvakilov, J., & Rizaev, J. (2019). Characteristic Features of Hemostasis System Indicators in Patients with
Inflammatory Periodontal Diseases Associated with Metabolic Syndrome. Journal of Advanced Medical and Dental
Sciences Research, 7(4), 13–15. https://doi.org/http://dx.doi.org/10.21276/jamdsr
|
№3 | 2020
12
13.
Самсонов А.С., Куташов В. А. Использование классификационно прогностического моделирования для
прогнозирования риска развития депрессивных расстройств // Саратовский научно-медицинский журнал 2017; 13
(1): 168–174.
14.
Улитовский С.Б. Основы профилактики заболеваний пародонта // Медицинский cовет . - 2014. - №7. – С.68 – 72.
15.
Цепов Л.М., ЦеповА Е.Л., Цепов А.Л. Пародонтит: локальный очаг серьёзных проблем //Пародонтология. - 2014. –
Т.19.- №3(72). – С.3 -6.
16.
Чеминава Н.Р.Обоснование комплексной программы профилактики заболеваний пародонта у студентов
медицинский вузов: Автореф. дис. …канд.мед.наук.-Санкт-Петербург, 2018. – 22с.
17.
Ababneh K.T., Hwaij M.Z.F.A., Khader Y.S. Prevalence and risk indicators of gingivitis and periodontitis in a Multi-Centre
study in North Jordan: a cross sectional study. BMC Oral Health. 2012; 12 (1): 1.
18.
Bhattacharya, P.T. Nutritional Aspects of Essential Trace Elements in Oral Health and Disease: An Extensive Review / P.T.
Bhattacharya, S.R.Misra, M. Hussain // Scientifica. – 2016. – doi: 10.1155/2016/5464373.
19.
Joveini Н., Dehdari T., Ardebili H.E. Factors Associated with Hookah Smoking among University Students // [et al.] //
Electronic Physician. – 2016. – Vol. 8, № 12. – P. 3403-3408.
20.
Riemenschneider Н., Balázs Р., Balogh Е. Do socio-cultural factors influence medical students’ health status and health-
promoting behaviors? A cross-sectional multicenter study in Germany and Hungary // BMC Public Health. – 2016. – Vol. 16.
– P. 576.
