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Individual and professional hygiene of the eyes of the patient and the dentist

ID: 2017-01-455-A-12261
Оригинальная статья (свободная структура)
Saratov State Medical University n.a. V.I. Razumovsky, Dental Faculty

Резюме

The aim of the research was to study dentists’ professional competence in the field of oral cavity hygiene in Saratov dental clinics, and also to study dental literacy of people of different ages in matters of oral cavity health. On the basis of the survey the conclusions were drawn. 

Ключевые слова

individual and professional oral hygiene, dental plaque, ultrasonic teeth cleaning, air-powder abrasive method

Статья

Введение. Индивидуальная и профессиональная гигиена являются залогом здоровья полости рта. Большую роль в этом играют как врачи-стоматологи, которые обучают детей индивидуальной чистке зубов и грамотно проводят профессиональную гигиену полости рта, так и сам пациент, осознающий важную роль регулярного выполнения этих процедур. Профессиональная гигиена стала неотъемлемой частью и важным направлением в стоматологии. Именно благодаря регулярному выполнению этой процедуры удаётся избежать патологии твёрдых тканей зуба и тканей пародонта [1]. Результат профессиональной чистки зависит от профессиональных навыков врача-стоматолога. Но с достаточно быстрым ростом цен на оборудование и на различные препараты, требующиеся для этого, профессиональная гигиена стала более дорогостоящей и менее доступной, что в свою очередь приводит к повышению уровня стоматологических больных.

Цель: выявление уровня значимости индивидуальной и профессиональной гигиены для людей и эффективности работы врачей-стоматологов в повышении стоматологической грамотности своих пациентов и уровня здоровья их полости рта.

Задачи:

1-изучить уровень информированности молодого и взрослого населения в вопросах индивидуальной и профессиональной гигиены полости рта;

2-изучить грамотность стоматологов в реализации своей лечебной деятельности;

3-изучить наиболее распространённые способы профессиональной гигиены и их востребованность в стоматологических клиниках Саратова

Материалы и методы. Анализ научных статей, научной литературы. Анкетирование детей начальной школы (89 человек), детей старшей школы (99 человек), студентов вузов (62 человека), взрослого населения (118 человек). Сбор информации о проведении профессиональной гигиены в 26 стоматологических клиниках города Саратов.  

Результаты и обсуждение. Регулярное посещение стоматолога, своевременное лечение, обучение индивидуальной гигиене и регулярные профилактические мероприятия с детского возраста во многом определяют здоровье ребёнка в будущем. Создание крупных стоматологических участков, включающих несколько школ, а так же внедрение бригад, состоящих из врачей-стоматологов, гигиенистов стоматологических для проведения мероприятий по профилактике заболеваний является одним из определяющих факторов формирования высокого уровня стоматологического здоровья детей. При этом отмечается как клиническая, так и кадровая эффективность. Происходит уменьшение количества нуждающихся в санации, увеличивается доля детей, имеющих здоровые зубы, снижается интенсивность поражения зубов [3]. Стоматологическая грамотность этих детей будет выше, чем у учеников школ, не входящих в стоматологические участки. Здоровье полости рта  таких детей полностью зависит от их родителей.

Было проведено анкетирование детей начальной и старшей школы (89 и 99 человек соответственно) для определения уровня знаний детей о своих зубах. 14% детей начальной школы и 3% детей старшей школы ни разу не посещали врача стоматолога, и подавляющее большинство – 64% и 68% соответственно обращались за помощью к специалисту только при наличии острой зубной боли. При ответе на вопрос об использовании предметов и средств гигиены были получены следующие результаты - диаграмма 1,2. Ответы детей начальной школы оценивать объективно нельзя.

О регулярности чистки зубов дети младшей и старшей школ ответили следующим образом: 1%  детей вообще не чистят зубы, 16% чистят зубы 1 раз в день, 74% -2 раза в день, 8%- 3 раза в день и 1% - 4 раза в день. 40% чистят зубы до завтрака, а 60% - после завтрака. 58% детей ответили, что врач-стоматолог не учил их правильной чистке зубов. На вопрос, кто же повлиял на их отношение к здоровью полости рта, получены следующие результаты: 45% - родители, 16%- СМИ, 16%-врач - стоматолог, 23%- врач-педиатр.

Из приведенных выше данных можно судить о том, что врачам-стоматологам необходимо больше внимания уделять обучению детей правильной и регулярной чистке зубов, регулярным осмотрам, а родителям вести контроль над этим и больше заботиться о здоровье своих детей.

Профессиональная чистка полости рта включает в себя тщательное удаление минерализованных и неминерализованных зубных отложений со всех поверхностей зубов с последующей обработкой зубов и дёсен профилактическими средствами. Эта процедура может являться как первичной профилактикой стоматологических заболеваний, для предупреждения возникновения патологии со стороны твёрдых тканей зуба и комплекса тканей, окружающих зуб, так и с лечебной целью при заболеваниях пародонта [2]. Например, профессиональная чистка должна проводиться регулярно (1-2 раза в год) у работников вредных производств и с особо опасными условиями труда (предприятия ядерно-энергетического и оборонной отраслей промышленности) [4,10-12].

Существует три метода удаления зубного камня: механический, химический, физический. Был проведён анализ способов удаления зубных отложений  в 26 частных стоматологических клиниках  и ни одна клиника не пользуется механическим и химическим способами удаления зубных отложений.  В 23 клиниках проводится ультразвуковая чистка зубов и  воздушно-абразивная обработка, в 2 клиниках используется только ультразвуковая чистка и в 1 клинике только  метод Air-flow. Из этого следует, что механический и химический способы уходят в прошлое. Но необходимо уделять особое внимание проведению в первую очередь механического метода удаления камня и только во вторую очередь - ультразвукового. Вся проблема заключается в том, что у 90% стоматологов отсутствует навык в работе ручными инструментами (ручным скалером), что не позволяет в полной мере добиться полного устранения  микробной биоплёнки, которая является основным фактором заболевания пародонта [5-8].

Профессиональная гигиена должна проводиться пациентами каждые полгода в кабинете стоматолога - терапевта, пародонтолога или гигиениста стоматологического.  12 клиник из 26 имеют в составе персонала гигиенистов стоматологических.

В протоколе ведения больных профессиональная гигиена является первым этапом в лечении кариеса (уровень убедительности доказательств А) для предупреждения его рецидива. 13 клиник из 26 ответили, что это правило является обязательным и входит в план лечения кариеса зубов. 

Профессиональная гигиена имеет следующий недостаток: ультразвуковая чистка ослабляет прочность адгезивного соединения композитов с эмалью, дентином и прессованной керамикой [9]. Поэтому врачу-стоматологу необходимо выбирать наиболее рациональный способ профессиональной гигиены зубов своих пациентов в соответствии с его клинической ситуацией.



Следующим этапом работы являлось определение уровня грамотности методом анкетирования студентов (62 человека) и взрослого работающего населения (118 человек) в вопросах здоровья их полости рта. 60% студентов и 51% взрослых обращаются к врачу-стоматологу только при острой зубной боли, и только 21% и 32% соответственно регулярно проходят осмотр каждые полгода. О регулярности чистки зубов получены следующие результаты (диаграмма 3,4).

При этом только 6% взрослых и 40% студентов чистят зубы после завтрака. О предметах и средствах гигиены результаты приведены в диаграммах 5, 6.

Вопрос о профессиональной чистке вызвал затруднения у большинства опрошенных, т.к. при ответе на вопрос о том, что включает в себя данная процедура, были получены различные варианты ответов – удаление зубных отложений, отбеливание, покрытие зубов фтор - лаком, регулярные осмотры, замена старых пломб на новые. Из этого следует, что лишь небольшая часть из них проходит эту процедуру, а именно 24% студентов (из них 45%-1 раз в год и 55% по мере образования зубных отложений) и 47% взрослых (из них 52% по мере образования зубных отложений, 29% 1 раз в год и 19% 2 раза в год). После профессиональной чистки врачи давали следующие рекомендации: пользоваться пастой R.o.c.s., зубной нитью, ополаскивателем, уменьшить количество употребляемого кофе, меньше курить, в течении суток не употреблять красящие продукты, регулярно проводить чистку зубов, посещать стоматолога каждые 6 месяцев, использовать ирригатор и полоскать полость рта после каждого приёма пищи. При этом 39% взрослых и 45% студентов не получили рекомендаций от врача после проведенной процедуры. На вопрос - почему пациенты нерегулярно проходят и вообще не проходят эту процедуру, студенты и взрослые ответили: 20% и 12% считают процедуру бессмысленной, 33% и 29% дорогостоящей, у 18% и 15% отсутствует время на её проведение, 29% и 31% не нуждались в процедуре; 13% взрослых ответили, что им лень.

При анализе ценовой составляющей комплексной чистки зубов 2 челюстей наблюдается весомый разброс цен от 1 440 до 6 000 рублей. Причем, в эту стоимость входит последующее покрытие зубов фтор-лаком только в 8 клиниках и в 6-наложение повязки на десну. Остальные клиники предоставляют данные услуги только за дополнительную оплату, что в свою очередь приводят к отказу пациента из-за дороговизны и к снижению качества проведенной работы врачом-стоматологом. Владельцы стоматологических клиник это понимают, и, чтобы привлечь большее количество пациентов, периодически проводят акции на данный вид стоматологических услуг. Например: если пациенту проводят лечение кариеса, то ему сделают профессиональную чистку зубов за 1500 рублей, а не за 2700; вводят систему дисконтного накопления; пациенты, регулярно проходящие данную процедуру каждые полгода, получают скидку 20% на неё.

            Выводы:

  1. После проведенного анкетирования детей младших и старших классов школ, студентов и взрослого работающего населения сделан вывод об их низкой информированности в вопросах здоровья полости рта. Необходимо больше внимания уделять обучению правильной и регулярной чистке зубов, регулярным осмотрам и санации у врача-стоматолога.
  2. Можно отметить недостаточный уровень работы врачей-стоматологов в повышении уровня знаний людей о правильной индивидуальной чистке зубов, необходимости регулярной санации и проведении профессиональной гигиены полости рта.
  3. Самыми распространенными способами удаления зубных отложения в частных стоматологических клиниках города Саратов являются ультразвуковая чистка зубов и  воздушно-абразивная обработка.  

Литература

  1. Гордеева Н.О., Егорова А.В., Магомедов Т.Б., Венатовская Н.В. Методология снижения риска патологии твердых тканей зубов при ортодонтическом лечении несъёмной аппаратурой // Саратовский научно-медицинский журнал – 2011, том 7, N 1, C.230-233.
  2. Гаража Н.Н., Камельчук Я.В., Болдырева С.Г. Зубные отложения. Гигиена полости рта // Клиническая стоматология. – 1995. – С. 6-9
  3. Чебакова Т.И. Клиническая и кадровая эффективность внедрения гигиенистов стоматологических в школьную стоматологию Новосибирска//Клиническая стоматология. -2015. – Т. 76 №4. –С. 4-6
  4. Фомичев И.В., Флейшер Г.М. Роль гигиениста стоматологического в комплексной программе профилактики стоматологических заболеваний для работников вредных и с особо опасными условиями труда // Клиническая стоматология. -2015. -№2. – С.54-59
  5. Ревазова З.Э., Вагнер В.Д. Использование врачами-стоматологами методов диагностики заболеваний пародонта. //Стоматологическое образование. -2013. -№ 46. - С. 60-63
  6. Ревазова З.Э., Вагнер В.Д. Отношение врачей-стоматологов к удалению зубных отложений при лечении заболеваний пародонта //Российская стоматология. -2013. –№3. –С.23-27
  7. Ревазова З.Э., Вагнер В.Д., Дмитриева Л.А., Мурадян Р.Р. Объём лечебно-профилактических мероприятий, проводимых врачами-стоматологами при пародонтите // Стоматология для всех. -2013. -№4. –С.48-50
  8. Ревазова З.Э., Вагнер В.Д. Проведение врачами-стоматологами профилактических мероприятий при лечении заболеваний пародонта // Dental Forum. -2014. -№1. –С.32-36
  9. Кузнецов Д.Л., Мельник А.А., Лазе Р., Петрикас О.А., Петрикас И.В. Влияние ультразвуковой гигиенической обработки зубов на прочность адгезивной фиксации реставраций // Стоматология. -2013. –Т.92№2. –С.36-39.
  10. Фирсова И.В., Суетенков Д.Е., Егорова А.В. и др. Показатели стоматологического здоровья у детей и подростков Саратова и Саратовской области // Саратовский научно-медицинский журнал. 2013. Т. 9. № 3. С. 484-486.
  11. Караков К.Г., Хачатурян Э.Э., Власова Т.Н. и др. Роль коррекции индивидуальной гигиены полости рта в профилактике патологии пародонта // Аллергология и иммунология. 2016. Т. 17. № 1. С. 62-63.
  12. Алямовский В.В., Модестов А.А., Дубинина Л.М., Кан В.В. Гигиеническое воспитание и показатели интенсивности кариеса зубов у различных групп населения Красноярского края // Сибирское медицинское обозрение. 2007. № 4 (45). С. 58-61.
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