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Rustam A. Rahimberdiev
Jakhongir U. Abduvakilov
Nodira Sh. Nazarova
Shokhrukh Kh. Irgashev
Samarkand State Medical Institute
ORGANIZATIONAL ASPECTS OF RENDERING SERVICES DENTAL CARE FOR CHEMICAL INDUSTRY WORKERS
http://dx.doi.org/10.26739/2181-0966-2021-2-11
ANNOTATION
The analysis of the dental health of employees of harmful industries is based on data on the dental morbidity of the adult population, regardless of
working conditions. The activity of epidemiological studies in dentistry over the past decades mainly extends to certain regions of Russia and is
dictated by the practical need to improve dental services for certain categories of citizens [4, 6].
Keywords
: closed administrative-territorial formations, dental health index, periodontal diseases, taste analyzer, unfavorable production factors.
Рахимбердиев Рустам Абдуносирович
Абдувакилов Жахонгир Убайдуллаевич
Назарова Нодира Шариповна
Иргашев Шохрух Хасанович
Якубовой Сарвиноз Рахмонкуловна
Самаркандский государственный медицинский институт
ОРГАНИЗАЦИОННЫЕ АСПЕКТЫ ОКАЗАНИЯ СТОМАТОЛОГИЧЕСКОЙ ПОМОЩИ РАБОТНИКАМ
ХИМИЧЕСКОЙ ПРОМЫШЛЕННОСТИ
АННОТАЦИЯ
Анализ стоматологического здоровья работников вредных производств базируется на данных о стоматологической заболеваемости
взрослого населения, независимо от условий труда. Активность эпидемиологических исследований в стоматологии за последние
десятилетия в основном распространяется на отдельные регионы и диктуется практической необходимостью совершенствования
стоматологического обслуживания отдельных категорий граждан (4, 6).
Ключевые слова:
закрытые административно-территориальные образования, индекс стоматологического здоровья, заболевания
пародонта, вкусовой анализатор, неблагоприятные производственные факторы.
Рахимбердиев Рустам Абдуносирович
Абдувакилов Жаҳонгир Убайдуллаевич
Назарова Нодира Шариповна
Иргашев Шохрух Хасанович
Якубовой Сарвиноз Рахмонкуловна
Самарқанд давлат тиббиёт институти
КИМЁ САНОАТИ ХОДИМЛАРИГА СТОМАТОЛОГИК ЁРДАМ КЎРСАТИШНИНГ ТАШКИЛИЙ ЖИҲАТЛАРИ
АННОТАЦИЯ
Зарарли ишлаб чиқаришда ишловчи ходимларининг стоматологик соғлиғини таҳлил қилиш меҳнат шароитидан қатъий назар катта
ёшдаги аҳолининг тиш касалланишига оид маълумотларга асосланади. Ўтган ўн йилликлар давомида стоматологияда эпидемиологик
тадқиқотлар фаолияти асосан муайян ҳудудлардга олиб борилиб, фуқароларнинг айрим тоифалари учун стоматологик хизматларини
яхшилаш учун амалий еҳтиёж туғдиради [4, 6].
Калит сўзлар:
ёпиқ маъмурий-ҳудудий тузилишлар, тиш соғлиги индекси, периодонтал касалликлар, таъм билиш анализатори, ноқулай
ишлаб чиқариш омиллари.
The industrial workers, according Egiy V.V., increases the intensity
and prevalence of dental caries; with the increase of work experience
increases the threshold of electrical excitability pulp intact teeth;
reduced the level of hygiene of the oral cavity and increases the index
of gingivitis; reduced tactile, pain, temperature sensitivity of the gums
and gustatory reception of language; increases the amount of sludge and
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viscosity, decreases the rate of secretion and pH of oral fluid [5, 3]. In
addition, due to the low quality of the prosthesis, the lack of effective
masticatory function.
The level of dental care is assessed as "insufficient". Despite the
regulated level of harmful factors, such as the heating microclimate,
noise, vibration and toxic substances in the air of the working area are
considered harmful. The aggravating pathological effect on the organs
and tissues of the oral cavity is directly or indirectly caused by irrational
NWCrition, insufficiently effective oral hygiene, low mDWCivation for
treatment, irrational dentures, and insufficiently effective dental care for
employees.
The aim
of this study is to improve the prevention of dental diseases
in workers with dangerous working conditions.
The level of preventive work among the population, including
children and workers from dangerous working conditions, coverage of
the annual preventive examinations with subsequent reorganization of
the mouth insufficient, due to shortage of dentists in government health
institutions, especially children, because of dissatisfaction with the
socio-economic conditions and lack of dental component in the
governing documents of the Ministry of health on the organization of
periodic medical examinations of workers with harmful and dangerous
working conditions (1,7).
Among young workers with dangerous working conditions, there is
a high prevalence, intensity of dental diseases and the need for their
systematic prevention, treatment, prosthetics and medical examination,
calculated in this study for 1 examined employee with dangerous
working conditions differentiated by age. 30-45 years old.
Material and methods of research
. To study the effects of
dangerous conditions on the dental status of workers carried out a
thorough dental examination of workers and dangerous working
conditions, working in joint-stock company "Samarkandkimyo – main
group (125 employees), and 120 patients, who applied to the outpatient
clinic №10. They were taken as a comparison group.
Results and discussion.
A detailed comparison of the quality of
endodontic treatment and the replacement of dental defects with
composite fillings or ceramic inserts was carried out in groups IVb and
Vb. At the same time, the quality of endodontic treatment was carried
out for all endodontic treated teeth (qualitatively treated before the
implementation of the comprehensive rehabilitation program and for
teeth after repeated endodontic treatment carried out at the beginning of
the program). The quality of replacement of dental defects was carried
out only for teeth that were first sealed or restored with tabs at the
beginning of the prevention program, to exclude previously sealed teeth
of satisfactory quality, but with a long service life.
Criteria for assessing the quality of endodontic treatment and
restoration of dental defects after 1 and 2 years of follow-up:
- no seal or tab;
- is a splitting of the restorative material;
- violation of the edge fit;
- erasability of the restoration material;
- chipped enamel;
- overhanging edge of the restoration;
- lack of approximal contact –
- local gingivitis in the restoration;
- color change of the restoration material;
- progression of the chronic focus of periapical inflammation;
– the appearance of the hearth periapicales inflammation.
In group IVb, 34 tabs and 120 seals with a service life of 2 years
were evaluated, in group Vb-40 tabs and 123 seals, respectively. In
group IVb, 98 teeth with sealed roDWC canals were evaluated, and in
group Vb, 183 teeth were evaluated.
Functional methods of examination are determined by the
peculiarities of the dental morbidity of workers with DWC, identified
during clinical and epidemiological examination, especially in terms of
violations of occlusive-musculoskeletal-articular relationships [3,9].
The high prevalence of increased toDWCh erasure (K03.0) explains the
choice of such examination methods as "Hamburg testing" of the state
of the temporomandibular joint (TMJ), computer study of occlusal
relationships using the device "T-scan III" (Tekscan, USA) and
computer study of the tone and symmetry of the functioning of the
masticatory muscles using the device "Bio EMG III" BioRESEARCH,
SHA), as well as the calculation of masticatory efficiency using a
masticatory test for Rubinova I. S.
Functional methods of the study were carried out in all subjects in
groups III dangerous working conditions (DWC) and III normal
working conditions (NWC) to identify the difference in workers in
dangerous and normal working conditions, as well as in groups IVb and
Vb before and after complete dental rehabilitation of workers with
DWC to assess the functional effectiveness of rehabilitation.
The scheme of the abbreviated "Hamburg" examination provides for
the determination of six signs of pathological changes in the
temporomandibular joint (TMJ), namely:
- asymmetric opening of the mouth,
- limited opening of the mouth or excessive opening of the mouth,
- the presence of intra-articular noises,
– asynchrony of the occlusal sound when closing the teeth –
- soreness during palpation of the masticatory muscles –
- traumaticity of the eccentric occlusion of the dentition.
The algorithm for evaluating the results of the "Hamburg test"
consists in the following classification:
- functional norm (0-1 identified features) –
- risk group (2 identified features);
- dysfunction of the chewing apparatus (3 or more signs).
Occlusal abnormalities with increased abrasion of the teeth in
generaliza-bath form nDWC identified with occlusive copy paper;
modern computer device "T-Scan III" allows more precise and
subsequent automated analysis of the graphs to identify individual
characteristics such as:
– the presence of supraconductive on teeth and dentures;
– balance of occlusion;
– the direction of the trajectory of the vector sum of occlusal load.
These indicators reflect the density and uniformity of occlusal
contacts and micro-movements of the lower jaw when establishing
occlusal contacts, according to the data of strain gauges.
The study of the bioelectric pDWCential (µV) and the symmetry of
the masticatory muscle contraction was carried out using an
electromyograph "Bio EMG III" with a relaxed state of the muscles and
maximum compression of the teeth.
The normal bioelectric pDWCential of the masticatory muscles was
considered to be 2 µV when relaxed and 20-30 µV when clenching the
teeth.
Comparing the indicators of dental status in individuals of identical
age group operating in normal or hazardous working conditions of one
company, it should be stated:
– hazardous labor conditions do nDWC affect the prevalence and
intensity of caries and the prevalence of poor treatment of caries (large
seal), the detection rate of previously conducted endodontic treatment
and the detection rate of low-quality endodontic treatment;
– employees with OUT a higher prevalence of non-carious lesions,
especially abrasion of teeth, deformation of dentition and
temporomandibular joint pathology;
- workers with DWC have a higher prevalence of periodontal and
oral mucosal diseases, the intensity of periodontal diseases, and worse
oral hygiene.
The excess of such indicators as the prevalence of TMJ diseases,
increased to DWCh erasure, secondary dentition deformations, and
periodontal diseases in workers with DWC caused the need to include
the "Hamburg Test"in the program of examination of workers with
DWC and NWC.
The absence of differences in the results of the" Hamburg test " was
revealed only for 1 trait-limited or excessive opening of the mouth,
which was nDWC registered in bDWCh groups compared. For all DWC
her signs, the survey revealed a significant excess of their prevalence in
group III of DWC. So, the asymmetrical opening of the mouth was
diagnosed in 14.9% in group III of OUT and 12.0% in group III NWC,
the presence of intra-articular noise (respectively, with 13.4% and 8.0%
of patients), asynchronous sound occlusal interdigitation (respectively
of 20.9% and 16.0% of patients), pain on palpation of the masticatory
muscles (respectively of 14.9% and 8.0% of patients), trauma eccentric
occlusion (respectively 17.9% 10.0% of surveyed). The absence of
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symptoms of functional disorders is less common in the group III DWC:
65.7% vs. 75.3% in the group III DWC.
A detailed distribution of the results of the" Hamburg test " by the
number of detected signs showed a more frequent detection of
masticatory dysfunction (the presence of 3 or more signs) in patients
with DWC (11.9% vs. 8.7% in group III of NWC). The risk group (the
presence of 2 signs) is also more significant in the group III DWC: 9.0%
vs. 6.0%. The functional norm (the presence of 0-1 signs), on the
contrary, is more common in workers with NWC: 85.3% vs. 79.1% .
The complete absence of signs of chewing apparatus dysfunction
according to the "Hamburg test" is typical for 75.3% in group III of
chickpeas and only 65.7% in group III of chickpeas.
The subjective assessment of the quality of life according to the
profile of the impact of dental health (questionnaire OHIP-14 - "Oral
Health Impact Profile") showed the final values of the score of 14
questions in the range of "satisfactory" level: in groups III of the DWC
and III of the NWC, respectively, 16.5±0.4 and 17.1±0.5 points. The
difference in the final value of the OHIP-14 scores for workers in
normal and hazardous working conditions is nDWC significant (p<
0.05). Nevertheless, for most of the questions within the questionnaire,
a significant difference in the answers was registered, but when
comparing the answers in the two groups, the more pronounced value
of dental health for the quality of life was either in workers with DWC,
or in workers with NWC.
Thus, employees with DWC were more likely to experience pain in
the mouth, difficulty eating, situations with food interruption due to
dental problems, situations with complete "loss of life" due to dental
problems, as well as increased irritability in communicating with people
(the corresponding questions 2, 8, 10, 6, 13 were evaluated by
respondents with DWC on average as 2,9±0,2, 3,0±0,2, 0,3±0,1, 0,2±0,1
and 0.2±0.1 vs 2,5±0,2, 2,8±0,2, 0,2±0,1, 0,1±,01 and 0.1±0.1 in
workers with chickpeas). At the same time, employees with chickpeas
more often nDWCed difficulties in pronouncing words, inconveniences
due to dental problems, including during rest, constraint in
communicating with people, getting into an awkward position due to
dental problems; employees with CHICKPEAS is often nDWCed that
their life is less interesting because of problems with teeth and they have
difficulty in normal operation due to teeth problems (relevant issues 1,
3, 4, 11, 12, 5, 14 had an average rating of workers with CHICKPEAS
0,2±0,1, 1,7±0,2, 2,0±0,2, 2,1±0,2, 0,9±0,1, 1,1±0,1 1.8±0.2 versus
0,1±0,1, 1,5±0,1, 1,8±0,2, 1,6±0,2, 0,8±0,1, 0,9±0,1 and 1,6±0,2
workers with OUT).
Conclusions.
Coverage of preventive dental check-UPS of workers
from out of town-forming enterprises in BUT does nDWC exceed
42,7% per year, and the proportion of sanitized in need of rehabilitation
mouth of 63.7% in connection with the reduction of the offices on the
territory of the enterprises (25.0% over 3 years), insufficient staffing
level of dentists in the closed (84,8%), lack of regulatory Orders Misr
of the Russian Federation No. 302n (2011). specialist dentist in medical
Commission in conducting periodic medical examinations.
According to the survey, half of dentists rate the availability and
quality of dental care in the city as good (42.0% and 63.3%), but the
level of preventive work is satisfactory (43.8%), explaining the
insufficient provision of dentists with low wages (87.2%), the lack of
their own housing (25.5%), low rates of compulsory health insurance
for dental services (93.3%), unsatisfactory working conditions (19.4%).
The assessment of the availability and quality of dental care by
workers with DWC is close to the assessment of doctors, but employees
nDWCe a shorter service life of composite fillings (3 years-52.2%, 2
years-22.4%), limited opportunities to receive periodontal care and
professional hygiene. The majority of employees do nDWC see the need
to improve individual oral hygiene (92.6%) and do nDWC perform the
entire range of hygiene measures.
The general opinion of dentists on the introduction of an
administrative procedure for mandatory professional examinations and
oral sanitation for employees with DWC is supported by 64.0% of
employees with DWC; all doctors and employees consider it necessary
to finance the dental treatment of employees with DWC; 69.4% of
doctors and 63.1% of employees support the need for additional
payments for treatment from their own funds (including 29.9% forced);
77.6% of employees with DWC and 71.4% of doctors in the Russian
Federation do nDWC approve of the transition of dental treatment of the
working population of Russia to a paid basis.
The dental morbidity of workers with DWC is significant, increases
with age, and is characterized by the following values of the main
parameters:
indicators of dental status, the prevalence of non-carious lesions and
periodontal disease (age 20-34 years, respectively 25,0% and 74.6%;
35-44 years of 32.8% and 85.1 per cent), secondary deformities of the
dentition (respectively 9.9% and 17.6%) and the intensity of caries and
periodontal disease (CPU respectively 10,4±1,4 and 14.5±1,4; CPI of
3.3±0.3 and 4.9±0.3 mm), the level of hygiene of the mouth (of the
tDWCal levels of 3.3±0.3 and 4.1±0,4), the detection rate of insufficient
quality seals and endodon-ticheskoe treatment (10,8% and 18.2%; of
48.1% and 61.0%).
A number of indicators of dental status in workers with DWC
exceed those in workers with normal working conditions, which is
reflected in the difference in dental indicators: the prevalence of lip
diseases and stomatitis (55.6% and 33.3%), TMJ pathology (26.9%),
non-carious lesions (12.3%); the intensity of periodontal diseases by
CPI (9.6%); the prevalence of interdental septum resorption by 1/2
(23.8%), the index of hygiene of games-Y (10.5%). Dangerous working
conditions do nDWC affect the development of caries and its
complications, but increase the intensity of periodontal diseases
throughout the CPI index structure.
The quality of life of workers with OAT and NWC according to the
OHIP-14 questionnaire does nDWC differ, however, the SF-36
questionnaire reveals a decrease in the mental component of health in
workers with OAT, which is accompanied by stress hypertension and
masticatory muscle dysfunction (according to electromyography),
increased toDWCh abrasion, violation of occlusive relationships
(according to "T-Scan III") and the prevalence of TMJ pathology.
The need for different methods of dental prevention and treatment
in workers with DWC 35-44 years is 11.9% -64.3% more in comparison
with workers 20-34 years and consists of the need for the treatment of
diseases of the SOPR (2.7%); TMJ (6.7%); gingivitis (46.3%);
periodontitis (38.3%); remtherapy of non-carious lesions (16.1%);
filling of wedge-shaped defects (18.1%); treatment of caries with filling,
ceramic inlays, artificial crowns (38,9%, 20,1%, 22,8%); replacement
of poor-quality fillings (15.4%); endodontic treatment and roDWC
canal revision (22.2% and 34.2%); toDWCh extraction (20.1%).
Repeated professional hygiene and remtherapy by a hygienist is
required by 87.3% and 16.1% of employees, dispensary supervision by
a general practitioner-38.3%.
The frequency of using dentures in young workers with DWC is
insignificant, and the need for prosthetics reaches 46.8% at the age of
20-34 years and 59.7% at the age of 35-44 years: in bridge prosthetics-
38.3% and 47.7%, respectively, in removable prosthetics – 4.0% in the
group of 35-44 years. When using dental implants, the need for them is
38.3% and 51.7% (with bone grafting, respectively, 19.0% and 28.9%)
with the number of implants of 1.14 and 2.91 per 1 examined employee
of 20-34 years and 35-44 years.
The advantages of pressed ceramic inserts over composite
restorations in the replacement of dental defects were revealed when
studying their biocompatibility in fibroblast cell culture (the
biocompatibility of ceramics in FEC culture and the growth activity of
fibroblasts is 54.05% and 56.28% higher in comparison with light-cured
composite); in an experiment on biofouling and biodegradation of
materials in the oral microbiDWCa (after 48 hours of incubation, the
surface of the composite undergoes subtDWCal biofouling by more
than 90.0%, and the surface of the ceramic is colonized only along the
edge of the sample at an area of 2.3%); in mathematical modeling of the
stress-strain state of the seal and the insert in the deformed molar (the
corresponding strain intensity along the restoration boundary,
depending on the direction of the functional load, is 1, 659x10-3-2,
977x10-3, which is 19.0-34.0% more in comparison with the ceramic
insert).
Prevention of periodontitis is necessary for optimal distribution of
functional stresses in the alveolar part of the jaw, since three-
dimensional mathematical modeling in comparison with the intact
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dentition revealed an increase in the intensity of stresses in the bone
tissue by 7.0% and 36.2% with resorption on 1/3 of the alveoli of the
loaded molar (respectively, with vertical and horizontal loads) and by
28.9% and 68.1% with its removal.
Annual rehabilitation of the mouth in the standard volume reduces
(for example, the group of 20-34 years) the need for filling of wedge-
shaped and carious defects (by 93.3% and 75.7%), replacement of
fillings (by 53.3%), toDWCh extraction (by 64.3%), endodontic
treatment (by 66.7%), does nDWC reduce the need for treatment and
prevention of periodontal diseases, remtherapy, prosthetics, medical
examination at the dentist.
"The program of dental prevention and rehabilitation of young
workers with dangerous working conditions in Russia" (on the example
of a group of 20-34 years old) reduces the need for reconstruction of
hard tissues of teeth, endodontic treatment, toDWCh extraction is
nDWC less than 90,0%, in the treatment of gingivitis – to 77.8%, in
Prigogine – 30.3%, in the correction of TMJ condition on 60,0%; need
for treatment of periodontitis, in reparatii, the clinical examination is
reduced significantly (respectively 6,7%; 11,1%; 6,7%).
The complexity of dental treatment and prevention is according to
the timekeeping data: the course of treatment of periodontitis – 3.1
hours, gingivitis 1.08 hours, making an occlusal splint 0.86 hours at the
doctor and 1.08 hours at the dental technician, applying a composite
filling 0.60 hours, making a ceramic insert 1.10 hours at the doctor and
2.5 hours at the dental technician, endodontic treatment with restoration
of the toDWCh with a light composite 1.47 hours (with revision of the
sealed roDWC canals 2.1 hours) (with restoration of the ceramic
toDWCh 2.5 hours at the dental technician), toDWCh extraction 0.58
hours, professional hygiene dental hygienist dental 0.99 hour, ramaraja
1.23 hours, clinical examination 0.31 hours.
The effectiveness of the "Program of dental prevention and
rehabilitation of young workers with dangerous working conditions in
the Russian Federation" according to the USP indicator is 31.1% and
36.0% for employees aged 20-34 and 35-44 years against 21.2% and
19.2% when organizing standard annual oral sanitation. The medical
effectiveness of the Program to reduce the need for prevention and
treatment is 73.0% and 75.4% in these age groups against 19.0% and
17.7% in the conditions of annual rehabilitation; according to the
dynamics of the dental health index (DHI), respectively, by 47.5% and
46.9% against 28.9% and 11.3%.
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