Organizational Forms of Preventive Dentistry for Patients with Respiratory Diseases

The dissertation by Grishina V.A. is dedicated to the development and implementation of organizational forms of preventive dentistry for patients with respiratory diseases in the practice of primary healthcare. The research was conducted at the Central Scientific-Research Institute of Organization and Informatics of Healthcare. The study analyzes the prevalence of dental diseases among the population of Saratov, examines the features of dental pathology depending on the nosological forms of respiratory diseases, as well as the volumes and quality of preventive dental care. Based on the obtained results, functional-organizational models of dental care for patients with respiratory diseases in the outpatient-polyclinic stage have been developed, including a model of the prevention and oral hygiene office, as well as methodological recommendations for managing such patients in polyclinic conditions.

Relevance of the Problem

The preventive direction in the protection of population health is becoming a priority of modern medicine at present.

In recent years, active development of dentistry with the introduction of new technologies has begun in the country. The fact of deteriorating dental health of the population, which leads to significant medical, social, and economic damage to society, is well known (N.K. Avilov, 1983; A.V. Alimsky, 1983, 1985, 1991, 1995; A.E. Antipenko, 1997; P.I. Vyalkov, 1999; E.O. Danilov, 1997; V.K. Leontyev, 1997, 1999, 2000; G.Yu. Utkina, 2000; A.P. Shapiro, 1991). An intensive path of dentistry development with a predominant focus on treatment cannot solve the main task of reducing the dental morbidity of the population (V.K. Leontyev, 1998; T.V. Kunitsyna, 2002). One of the problems of improving dental care is the organization of the preventive direction in dentistry, which was reflected in the resolution of the 4th Congress of the Russian Association of Dentists (2000).

Dental diseases in the context of somatic pathology are of particular importance, the correction of which favorably affects the state of somatic health of patients (O.G. Avraamova, 1998; A.V. Alimsky, 1998; V.F. Vorontsin, 2001; K. Leontyev, 1998). Pathological processes arising in the human body in connection with somatic diseases often manifest through changes in the mucous membrane of the oral cavity and teeth and, in most cases, are the first clinical signs of internal organ diseases. Having its own structural and functional peculiarities unlike other mucous membranes of the human body, the oral mucosa is a powerful receptor field that perceives reflex influences from any internal organ. In many states of the body, teeth and the mucous membrane are involved in the pathological process to varying degrees.

Research on the prevalence of dental diseases in the context of respiratory diseases (RD), which are acquiring increasing medical and social significance and occupying the first place in the scale of somatic pathology across different age groups, is clearly insufficient. Instructional-methodological developments on the issues of implementing organizational forms of preventive dentistry in the activities of primary healthcare are virtually absent. This research is dedicated to these issues.

Research Objective

Development and implementation of organizational forms of preventive dentistry for patients with respiratory diseases in the activities of primary healthcare for the population.

Research Tasks

1. To study the prevalence and character of dental diseases among patients with respiratory diseases in the population of Saratov (based on medical documentation, screening, and expert assessment of outpatient cards).

2. To study the peculiarities of dental pathology depending on the nosological forms of respiratory diseases.

3. To analyze the volumes of preventive dental care provided to patients with the most prevalent internal organ pathology in healthcare institutions of Saratov.

4. To analyze the quality and effectiveness of preventive dental work in healthcare institutions of Saratov.

5. To develop informational support for measures on the prevention of dental diseases among persons with respiratory diseases in the pre-hospital stage.

6. To develop a model of a preventive dentistry office at the territorial polyclinic stage.

Scientific Novelty

During the research, for the first time:

1. The prevalence and structure of dental morbidity among patients with respiratory diseases (RD) by healthcare utilization and based on automated screening data in the Saratov region were studied;

2. The peculiarities of the prevalence and forms of dental pathology depending on the nosological forms of respiratory diseases and the age-sex characteristics of patients with respiratory diseases were identified;

3. An organizational-methodological complex for the prevention of dental diseases among persons with respiratory diseases in the pre-hospital stage was developed and implemented;

4. A model of a preventive dentistry office was created at the territorial polyclinic stage.

Scientific and Practical Significance of the Work

The organizational model of preventive dentistry for patients with respiratory diseases developed during the research made it possible to ensure targeted and timely detection of caries, periodontitis, and gingivitis.

As a result of the dissertation research, methodological recommendations approved by the Ministry of Health of the Russian Federation were developed, the main provisions of which have been implemented in two polyclinics in the city of Saratov. Dental examination was included in the dispensary care plan for persons with respiratory diseases, with a dental consultation and sanitation of teeth and the oral cavity when necessary. This group of measures led to a reduction in the number of relapses of pulmonological diseases by 44% among men and 35% among women.

The proposed functional-organizational models of observation for patients with respiratory diseases and preventive dentistry were implemented in the practice of Polyclinic No. 3 and Polyclinic No. 1 of the Road Clinical Hospital.

Based on the materials of the research, instructional-methodological recommendations titled "Management of Patients with Respiratory Diseases in Polyclinic Conditions" were compiled.

The results of the dissertation research and instructional-methodological recommendations are used in the educational process at the Department of Polyclinic Therapy and Therapeutic Dentistry of Saratov State Medical University.

Main Propositions to be Defended

1. The prevalence and character of dental diseases among patients with respiratory diseases in the population of Saratov.

2. The peculiarities of dental pathology depending on the nosological forms of respiratory diseases and the age-sex characteristics of patients with respiratory diseases, and the volumes of preventive dental care.

3. The volumes, quality, and effectiveness of preventive dental care for patients with the most prevalent internal organ pathology in healthcare institutions of Saratov.

4. Informational support for measures on the prevention of dental diseases among persons with respiratory diseases in the pre-hospital stage and the model of a preventive dentistry office at the territorial polyclinic stage.