A Socio-Hygienic Study of Adolescent Dental Health as a Basis for Organizing Comprehensive Health Measures at the Level of Primary Health Care

The dissertation by Semchenko Elena Gennadievna is devoted to a comprehensive socio-hygienic study of adolescent dental health in the Stavropol Territory and the development of scientifically grounded recommendations for the improvement of dental care at the level of primary healthcare. The research was conducted on the basis of a multi-stage approach, including the analysis of healthcare facility utilization data, the results of preventive dental examinations, and in-depth specialized examinations of adolescents of various social groups in the cities of Nevinnomyssk, Pyatigorsk, and Stavropol. The work is aimed at identifying the level and structure of dental morbidity, determining the need of adolescents for various types of dental care, and forming organizational-methodological measures to improve the efficiency of dental service at the municipal level.

Relevance of the Problem.

The socio-economic prospects of Russia are linked, above all, to the health of children and adolescents.

The introduction of a market economy, the growing gap between the needs of the able-bodied population for improved quality of health and the actual deterioration of health, and the absence of an ideology of investing in the health of future generations define the expediency of modernizing medical service. At the same time, the formation of a non-state sector of healthcare in market relations does not imply a reduction in the role of the state in the sphere of children's health protection.

Dental care remains the most widespread form of medical service, and dental diseases occupy the second place in the structure of the population's utilization of medical institutions in Russia and the third place in the structure of overall morbidity. Therefore, dental health is a priority task controlled by the WHO European Regional Office through the "Health for All" program.

According to WHO and domestic researchers (Kuzmina E.M., Leontyev V.K., Sokhov S.T., Makushev I.P.), the prevalence of oral diseases among children by the age of 14 reaches 60%. Dental caries affects an average of 5–6 teeth in each child. The relevance to public healthcare of the problem of forming adolescent dental health is determined by the prevalence and intensity of their dental diseases, the curtailment of preventive measures, including in dentistry, the reduction of state financing of guarantees for free dental care for the population of Russia, and the outflow of medical personnel from state institutions to the private sector.

The modernization of dental care is aimed at improving dental health and is based on a program-targeted approach to solving pressing problems. The optimization of programs for the prevention and treatment of dental diseases adapted to the specific conditions of administrative territories of Russia presupposes, first and foremost, a baseline assessment of the spread of major dental diseases according to unified diagnostic criteria in key age groups. The creation of a database of volumes of services provided makes it possible to identify the real need of various social groups of the population in specific types of dental service.

Adolescents constitute approximately 5.2% of the country's population, but the state of their health, including dental health, remains an indicator of the health of the entire society. This is due to the features of their physical development and the place that this group occupies in the life of society. During the pubertal period, not only thinking, social orientation, and self-awareness of the child develop, but also their somatic status, including dental, which requires sanitation of the oral cavity and upper respiratory tract, the pathology of which is an important component of the pathogenesis of angina, rheumatism, respiratory tract diseases, and so on.

The reorganization of healthcare is aimed at disease prevention. This requires scientifically confirmed knowledge of the situation regarding the health status of the population. Medical examinations of youth, including dental screenings, provide objective information about the health of adolescents. At the same time, adolescents are distributed across different social groups. They either study in general education schools, or in secondary specialized educational institutions, or work at state and private enterprises, etc. This requires a differentiated approach to the organization of their medical service, including dental.

At the same time, studies of the dentition status of adolescents either cover only one of the possible groups of social affiliation, or are dissociated in terms of the time of their conduct, or use different examination methodologies, which complicates the comparability of data and distorts the holistic picture of adolescent dental health.

All of this determined the goal of the work: on the basis of a comprehensive socio-hygienic study of adolescent dental health, to develop scientifically grounded recommendations for the improvement of dental care at the municipal level.

To achieve the set goal, the following tasks were solved:

- to study the level and structure of dental diseases among the adolescent population of the Stavropol Territory based on healthcare facility utilization data;

- based on preventive dental examinations and in-depth specialized dental examinations in the cities of Nevinnomyssk, Pyatigorsk, and Stavropol, to investigate and assess the level, structure, and dynamics of the prevalence of dental pathology among adolescents of various social groups;

- to determine the need of urban adolescents for various types of dental care;

- to develop proposals for the improvement of dental care for adolescents in the Stavropol Territory.

Scientific Novelty of the Research.

The scientific novelty lies in the fact that for the first time

- a multi-stage comprehensive study of adolescent dental health among residents of cities of the North Caucasus was conducted: a) based on healthcare facility utilization data; b) based on materials of preventive examination; c) based on the results of targeted dental examinations;

- the need of adolescents for restorative and orthodontic care was determined;

- scientifically grounded and developed organizational-methodological recommendations for the improvement of dental care at the municipal level on the principles of program-targeted planning were elaborated.

Practical Significance of the Work.

The practical significance consists in: a) the development of proposals for improving the efficiency and quality of dental service for adolescents of various social groups in healthcare institutions of municipal subordination; b) the improvement of the system of therapeutic dentistry at the level of the subject of the Russian Federation — the Stavropol Territory.

Propositions to be Defended.

1. Indicators of adolescent dental health from different social groups based on data from dental institution utilization, preventive examinations, and results of targeted dental examinations.

2. The structure of the need of adolescents for specific types of dental care taking into account their social status.

3. Scientifically grounded proposals for improving the efficiency and quality of dental service for adolescents at the level of primary healthcare.

Validation of Research Results.

The results of the dissertation research were reported at:

- the international conference "Healthy City — Healthy Children" (Stavropol, 2002, 2005);

- Russian scientific-practical conferences "Strategy of Reforming Regional Healthcare" (M., 2003); "Problems of Territorial Healthcare" (M., 2004); "Management of Quality of Medical Care for the Population of the Russian Federation" (M., 2005);

- the Republican meeting on the implementation of the target territorial program "Children of Russia 2003–2006" (M., 2005);

- the First Republican Scientific-Practical Conference of Otolaryngologists and Dentists of the Karachay-Cherkess Republic (1999);

- an expanded session of the Academy of Information Technologies in Education, Science, and Resort Studies (2001).

Implementation.

The provisions of the dissertation were used in the preparation of:

- the "Comprehensive Program for the Prevention of Dental Diseases Among the Child Population of the Stavropol Territory for 2002–2007";

- the target program "Education and Health 2003–2006"; the analytical report "Health of Children of Stavropol 2004";

- the draft Order of the Ministry of Health of the Stavropol Territory "On the State and Measures for Further Improvement of Dental Care for Adolescents";

- the draft "Instructions on Conducting Planned Preventive Sanitation of the Oral Cavity in Children of Preschool and School Age" of the Ministry of Health of the Stavropol Territory;

- a letter to the Main Administration of Curative-Preventive Care for Children and Mothers on the necessity of allocating rooms for dental offices in standard school building projects.

The adolescent dental office organized in Nevinnomyssk ensures the effectiveness of planned oral cavity sanitation for adolescents of all social groups over a five-year period.

The combination of oral cavity examinations with simultaneous sanitation (without prosthetics) in medical commissions at military commissariats made it possible to health-improve more than half of the draft-age young men.

The results of the research are used in the educational process at the dental faculty of the Stavropol Medical Academy.

The results of the research may be used:

- in the economic substantiation of resource provision for preventive dental measures in adolescence;

- in the formation of the state order for free dental care within the Framework Program of State Guarantees of Free Medical Care for Citizens of Russia at the municipal and regional levels;

- in the educational process — in the development of educational and methodological materials for students in institutions of higher professional education and postgraduate education in dentistry.