Modern Clinical and Social Characteristics of Periodontal Diseases in a Large City and the Organization of Periodontological Care for the Population

The dissertation is devoted to the study of modern clinical and social characteristics of periodontal diseases in the conditions of a large city and the development of substantiated proposals for the improvement of periodontal care for the population. The research was conducted on the basis of dental clinics of Saint Petersburg and the City Periodontological Center and covers a wide range of issues: epidemiology, etiopathogenetic mechanisms, clinical manifestations of periodontal diseases, and the organization of dental care. A comprehensive analysis of the medical-demographic characteristics of patients, their periodontal and dental status, and the volume and cost of diagnostic and therapeutic care provided in various types of dental institutions was conducted in the work. Special attention was paid to the analysis of patients' need for various types of care, the level of the hygienic culture of the population, and the problems of prevention of dental diseases. The obtained results are used for the substantiation of a system of periodontal care provision, the development of differentiated protocols for patient management, and the planning of financial and economic indicators within the system of compulsory medical insurance.

Relevance of the Research Topic. The overwhelming majority of patients seeking dental care suffer from various forms of periodontal diseases. Numerous studies (Alimsky A.V., 1989; 2000; Grudyanov A.I., 1992; Barer G.M., 1995; Borisova E.N., 2001; Ivanov V.F., 1998, 2001; Beck J.D., Slade G.D., 1996; Gjermo P.E., 1998, etc.) attest to the high prevalence of periodontal diseases among the population. According to E.O. Danilov and V.A. Grigoryev (1998), various forms of periodontal diseases are found in 100% of individuals aged 35-44. Of approximately 15-20 teeth that a person loses between the ages of 40 and 65, the cause of such loss is in most cases periodontitis (Leus P.A., 1990). Enormous funds are spent on the restoration of masticatory function in cases of partial or complete edentulism. Throughout the world, orthodontic treatment of patients with periodontal diseases is the most costly dental service. The preservation of dental health determines not only the normal functioning of the dentition and the human body as a whole but also the quality of life (Leontyev V.K., 1999). Despite the widespread nature of periodontal pathology, the rate of patients seeking medical care in connection with this type of pathology remains comparatively low (Solntsev A.S. et al., 1991). This is determined both by the low level of medical literacy and activity of the population and by deficiencies in the organization of dental care, which are associated with a number of objective social and economic factors (Leontyev V.K., 1995). The need of the adult population for dental care exceeds the capabilities of therapeutic dental institutions by a factor of 90. The necessity of further improvement in the organization of various types of dental care for the population is universally recognized. At the same time, over the last decade there have been virtually no comprehensive studies devoted to questions of epidemiology, organization, and evaluation of the quality of care for periodontal pathology in the conditions of a large city. These aspects define the relevance of the present research. The aim of the research is to develop scientifically substantiated proposals for the improvement of periodontal care at the stage of healthcare reform, taking into account the modern clinical and social characteristics of periodontal diseases in the conditions of a large city. The tasks of the research are: 1. To study the prevalence and features of periodontal pathology among patients who applied to a dental clinic. 2. Social-demographic and clinical characterization of patients suffering from periodontal diseases. 3. Analysis of the volume, nature, and cost of medical care provided to patients with periodontal diseases in various institutions. 4. Development of proposals for the improvement of periodontal care for the population in the conditions of a large city, including differentiated protocols for the management of patients with various types of periodontal pathology at various stages of care provision. The scientific novelty of the research consists in the fact that a study of patients of a dental clinic was conducted aimed at identifying the nature and prevalence of periodontal pathology and determining the need for specialized care. The work presents an elaborated characterization of patients with periodontal diseases in correlation with the assessment of the state of the oral cavity and the general somatic status as a whole (this characterization is differentiated with regard to the age-gender and social features of the patients). For the first time, the volume of dental care provided for various types of periodontal pathology and its cost (calculated both in accordance with the tariffs of compulsory medical insurance and taking into account the actual costs of its provision) were analyzed, and these criteria were compared across different types of dental institutions. The practical significance of the work is due to the fact that the data contained therein can be taken as the basis for the financial and economic substantiation of the planning and organization of a system of periodontal care for the population of a large city, taking into account its staged nature and the capabilities of various dental institutions. The obtained results are also important for the development of differentiated measures of primary and secondary prevention of periodontal diseases among various groups of patients and the population. The research materials are used in the practical activities of a number of dental clinics of Saint Petersburg, the City Periodontological Center, and in the work of the St. Petersburg Dental Association. They were used in the development of tariffs for the provision of dental care to the population of the city within the system of compulsory medical insurance. A number of the provisions of the work are used in the educational process at the departments of therapeutic dentistry, public health, and healthcare of Saint Petersburg State Medical University named after academician I.P. Pavlov. Presentation of the Research. The main results of the research were reported and discussed: at the II Congress of Chief Physicians of Therapeutic and Preventive Institutions and Centers of the Federal Service on Consumer Rights Protection and Human Well-Being in the Northwestern Federal District of the Russian Federation (Saint Petersburg, October 27-28, 2003); at the International Conference "Rehabilitation Medicine and Ergotherapy in the Northwestern Region" (Saint Petersburg, 2004); at the V Congress of Dentists of the Republic of Belarus (Brest, October 8, 2004); at the Scientific and Practical Conference "Improvement of Expertise of Temporary Disability, the Role of Restorative Treatment in Reducing Disability and Rehabilitation of Disabled Persons" (Saint Petersburg, May 2004); at the joint session of the problem commission "Hygiene and Organization of Healthcare" and the departments of therapeutic dentistry, public health, and healthcare of S.P. St. Petersburg State Medical University named after academician I.P. Pavlov (Saint Petersburg, September 2005, May 2006). Personal Contribution of the Author. The author compiled the research program, developed primary accounting documents, and collected the material. The author's share in the processing of the material constituted 80%. The analysis and generalization of data were carried out personally by the author (100%). Overall, the author's contribution exceeded 90%. Nine printed works have been published on the dissertation topic. The Basic Propositions to be Defended. 1. Periodontal diseases are an important problem for all