An analysis of the results of a dental examination in the Andijan region (2017–2019) showed a high prevalence of signs of periodontal tissue damage. In these conditions, an emphasis is needed on the active implementation of prophylaxis at the individual level and the formation of new forms of organization of specialized periodontal care.
Key words: periodontal disease, dispensary observation.
Индивидуальная профилактика и лечение начальных стадий воспалительных заболеваний пародонта в рамках диспансерного наблюдения
Анализ результатов стоматологического обследования Андижанской области (2017–2019 гг.) показал высокую распространенность признаков поражения тканей пародонта. В этих условиях необходим акцент на активное внедрение профилактики на индивидуальном уровне и становлении новых форм организации специализированной пародонтологической помощи.
Ключевые слова: заболевания пародонта, диспансерное наблюдение.
In real time, an even bondage between the use of inadequate layouts for the rehabilitation of periodontal tissues and the number of negative results of dental implantation [1,4]. In our earlier research works, the test of randomly selected 40 orthopantomograms of persons with dental implants recommended, in fact, that in 95 % of cases, healing was carried out against the background of stabilization of the pathological process in the periodontal tissues, or there was a healing space with residual appearances. The results of all-encompassing healing of painful patients with acquired generalized periodontitis of mild degree 3 years after implantation are summarized [4,6]. A total of 227 implants were installed, of which 34 (14.9 %) were removed. The efficiency of implantation in painful patients with deficiencies in the dentition against the background of acquired generalized periodontitis of moderate severity is even more low [2]. Features of the morphofunctional structure of peri-implant tissues, such as the inaccessibility of bundles of collagen fibers, ligaments, physical gingival pocket, gingival water, inferiority of trophic function, make them susceptible to negative regional moments [1,5]. The conducted preparatory examination of patients, the test of publications in recent years on the tasks of organizing, healing and preventing CDD indicated the need to develop fresh organizational and methodological qualities for identifying, healing and dynamic research of persons with parodentium diseases [2,4,6].
Purpose of the study. Personal prevention and healing of the initial stages of inflammatory periodontal diseases in the framework of a dispensary study.
Materials and methods of study. In our work, we have implemented the clinical examination of persons at risk of the formation and progression of inflammatory periodontal diseases according to the 3-stage principle: 1 period — dispensary selection, which provides for the identification of patients with causes subject to dispensary registration; 2 period — dispensary registration — registration of the sick, subject to dispensary observation; Period 3 — dispensary supervision, implying the conduct of personal treatment and prophylactic events and dynamic supervision of their effectiveness. A feature of the clinical examination of a contingent at risk of formation and progression, as mentioned earlier, is the association with the presence of systemic diseases, the chronic direction of inflammatory periodontal diseases (PFS), in fact, which urgently requires long-term research and adjustment, an interdisciplinary all-encompassing alignment. Thus, clinical examination for the purpose of personal prevention of periodontal pathology will be considered more of an impeccable form of work for dentists, because it takes into account the identification of periodontal pathogenic moments that predict the appearance of pathology and preclinical forms of the disease, an ensemble of therapeutic and prophylactic and socio-hygienic events taking into account the personal individualities of the joint state of health and dental status of patients of all age groups. As a result of the selective survey and initial diagnostics in the process of dispensary selection, patients must be taken into account, distributed according to the upcoming study groups: — patients with intact periodontal disease (with a genetic predisposition); — patients with intact periodontium, having periodontal pathogenic and predisposing moments of risk in the oral cavity (supra- and subgingival soft and hard dental deposits, non-observance of active load on the periodontium, pathological configurations of organs and tissues of the oral cavity, retention moments, poor hygienic position of the oral cavity, harmful attachment, etc.; — patients with localized forms of gingivitis and periodontitis; — persons with generalized catarrhal gingivitis and periodontitis Taking into account the individual morbidity, the presence of moments of risk, we formed the appropriate groups of dispensary examination:
1) those in need of intensive prevention or treatment of CDD;
2) receiving secondary prevention or supportive treatment;
3) a rehabilitation group undergoing control examinations.
In order to conduct actual targeted personalized treatment and prophylactic events, a diagnostic ensemble was formed, in which the personal mechanisms of the formation of the pathological process in the periodontium and its external clinical manifestations had an integral reflection. Allocation of 15–20 and more significant methods of assessing the state of the periodontium was carried out with the support of the method of non-strict prior ranking. This list includes more indicative, easy-to-follow, reflecting the patient's dental status, allowing an impartial forecast of the periodontal condition.
The three-stage system of prophylactic medical examination of patients with PFS or the reasons predisposing to them takes into account the assessment of the periodontal condition using the formed ensemble of diagnostic methods in any group: — at the initial appeal to the dentist; — in the process of carrying out healing and (or) preventive measures; — with dynamic supervision of subsequent courses of healing and prevention. The ideals of research studies and the size of support at the steps of clinical examination, on the one hand, dress a unified character, taking into account the individualities of our area and are focused on more high-quality performance of LPM, on the other hand, they predict a personal alignment with justification of the frequency of research, examinations by specialists. At the turn of the dispensary study, patients were prescribed according to the evidence of events of primary, specific secondary prevention or healing, aimed at eliminating or minimizing the cumulative and regional periodontal pathogenic moments, as well as control examinations. The assignments were carried out in accordance with the list and sequence of use of the allocated research ways. When violations of the state of certain organs and systems were identified that have a pathogenetic association with pathological processes in the periodontium (according to the history and examination of the oral cavity), the examined persons were recommended consultations with specialist doctors, an equilibrium table, and events to improve the body's health. Evaluation of these regional aspects, as pathology of the architectonics of the vestibule of the oral cavity, impaired attachment of the frenulum of the lips and tongue, malocclusion, destruction of occlusal, proximal and cervical areas by caries, poor prostheses and repairs, as a prerequisite for the onset and progression of inflammation in the periodontal tissues, worked as a pretext for planning events for their destruction or minimization. These patients were referred to related specialists for orthodontic and orthopedic healing, oral cavity sanitation by dentists-therapists and doctors.
Competent oral hygiene was considered one of the main factors in the treatment and prevention of periodontal pathology. As a result, supra- and subgingival dental plaque was removed to patients who were at risk of developing CDD, a study of healthy oral hygiene was carried out, with an unsatisfactory condition of the oral cavity, therapeutic and prophylactic toothpastes were advised that prevent the formation of plaque and its transformation into dental granite. due to enzyme-containing components. For individuals with localized forms of gingivitis and periodontitis, a complete personalized layout was used, taking into account, as etiological factors, for example, the local dental status in the area of loss. To stop the local inflammatory process, disinfecting treatment was carried out, periodontal tissues were isolated from traumatic moments. The elimination of filling deficiencies, the real restoration of contact points between the teeth, the implementation of advanced orthopedic healing contributed to the creation of a criterion for the further regeneration of periodontal structures. In the presence of embodied signs of CDP pathology, we advised patients to use special, adapted to a specific medical history, pharmaceutical methods that have components of plant and natural origin that have a complex effect on all sorts of links in the pathogenesis of periodontal diseases. Control over the implementation of all personal therapeutic and prophylactic events (LPM) was carried out during repeated examinations, if necessary, the assignments were adjusted. We recommend evaluating the effectiveness of clinical examination by the upcoming high-quality and quantitative indicators of the given step: — the planned and vigorous dispensary examination (the ratio of the number of patient visits to the total number of appointments) was 85.4 %; — the completeness of the implementation of the planned personified treatment and prophylactic events (the ratio of the number of personalized medical care products produced to the total number of planned ones) — 86.6 %, which actually characterizes the highest quality of clinical examination. The indicator of joint performance of personal prevention of CDD (determined no earlier than 2 years of dispensary examination at the end of the initial, secondary and tertiary movement) was 100 %.
Conclusions. The embodiment of personified events within the framework of a dispensary study is considered more effective than the autonomous fulfillment of classical prescriptions recommended by dentists.
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