1 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY * TA QUOC DAI ASSESS EFFICIENCY OF DENTAL PLATE CONTROL IN PREVENTION OF DECAY TEETH AND GINGIVITIS IN 12-YEAR-OLD PUPILS AT SOME SCHOOLS IN THE SUBURBS OF HANOI Major: Epidemiology Code: 62 72 70 01 ABSTRACT OF DOCTOR OF MEDICINE THESIS Hanoi - 2012 2 THE PROJECT WAS COMPLETED AT NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY Supervisor: 1. Associate professor. Doctor Trinh Dinh Hai 2. Doctor Dao Thi Dung Opponent 1: Opponent 2: Opponent 3: The thesis will be presented in the Institute – level Board of Thesis Evaluation at National Institute of Hygiene and Epodemiology At … o’clock, day …… month ……. Year 2012 The thesis can be found at: 1. National library 2. Library of National Institute of Hygiene and Epodemiology 3 ABBREVIATION CPITN Community Periodental index of treatment needs CI-S Calculus index simplified II Intervention index EI Efficiency index ODC Oral and Dental care IV Intervention DI-S Debris index simplified F Fluor KAP Knowledge, Attitude, Practice DP Dental plaque SD School of dentistry OR Odds Radio OS Othodonto - Stomatology OD Oral and Dental QT Quantity DT Decay teeth DMFT Decay missing, filling teeth PDT Permanent decay teeth SS Secondary school R Rate G Gingivitis ODH Oral and Dental Hygiene WHO World Health Organization 4 INTRODUCTION Decay teeth and gingivitis were two popular diseases among the oral and dental diseases in the world as well as in our country. The diseases could be suffered very early as soon as teething (6 months of old). If the diseases were not treated timely, it could produce a side-effect in site or the whole body, affecting to the physical and aesthetic development of the child in the future. In 20 recent years, thanks to the remarkable progress of science technology, it was found that the reason and pathogeneswas of the oral and dental diseases was caused by the dental plaque. Then the appropriate preventive methods was found; however, the preventive methods for the oral and dental diseases was very simple, not too difficult, did not require the expensive equipments, the high professional technicians and the low expenses, easy to implement in the community, in particular in the schools. In 2001, according to the investigation results on the oral and dental health national wide, there were 90% people suffered by the oral and dental diseases, whereas the operation of the oral and dental preventive network did not satisfy the requirements. Therefore, at the present, the oral and dental prevention was the key mission of the Othodonto – Stomatology major. In Hanoi, the investigation results on the oral and dental health in 2007- 2008 with the pupils of primary and secondary schools showed that the rate of oral and dental diseases were increased under the ages. To strengthen the school of dentistry program, as well as find out the new methods linking with the school of dentistry program aiming at raising the quality, effectiveness of oral and dental diseases prevention for the pupils, within the framework of the project “Assess the efficiency of school of dentistry activities in Hanoi in 2009-2010 of National Institute of Othodonto – Stomatology”, we researched the theme: “Assess the efficiency of dental plaque control in decay teeth, gingivitis prevention for the 12 years- old pupils at some schools in the suburb of Hanoi” to: 5 1. Describe the reality, some factors relating to the decay teeth, gingivitis, dental plaque and knowledge, attitude, practice about the oral and dental care for the 12 years-old pupils at some secondary schools in Gia Lam, Quoc Oai District, Hanoi City in 2009. 2. Assess the efficiency of dental plaque control in the decay teeth, gingivitis prevention for the 12-year-old pupils at 04 secondary schools of two researched districts. NEW CONTRIBUTIONS OF THE THESIS 1. The thesis provided the valuable reference information for the specialized scientists about the oral and dental diseases, the oral and dental care knowledge, attitude, practice and the reality of oral and dental care at some secondary schools in the suburb of Hanoi. 2. The research result presented the effective intervention model to control the dental plate, help the school medicine managers develop the effective preventive methods for the decay teeth, gingivitis in the community. STRUCTURE OF THE THESIS The theswas had 125 pages; Introduction: 03 pages; Overview of document: 34 pages; Subject and research method: 26 pages; Research result: 34 pages; Discussion: 25 pages, Conclusion and Recommendation: 3 pages. There were 44 tables, 6 figures, 1 diagram and 4 charts in the thesis. Besides, there were 139 documents in the reference, of which there were 60 documents in Vietnamese and 79 documents in English; the appendix section had 22 pages. Chapter 1 OVERVIEW OF DOCUMENTS The oral and dental diseases were the very popular diseases on the world as well as in Vietnam, of which the decay teeth and gingivitis were the most popular diseases. Previously, the decay teeth and gingivitis were very popular in the developed countries due to the diet with much sugar and milk. However, in the two recent decades, the reality of decay teeth in two groups of countries (developed and developing countries) was conversed. The rate of decay teeth in the developing countries was increased due to lack of drinking water with fluoride, the diet with much sugar, and the unvalued dental education. The developed countries considered the dental education as the national policy, fluoride the 6 drinking water, implemented the diet with less sugar, used the toothpaste with flour, filled the teeth slot so that the rate of decay teeth was significantly reduced. Previously, most of the countries in the world concentrated on the oral and dental diseases treatment, recovered the chewing function and aesthetic, so that it was very costly. Today, thanks to the remarkable progress of the science technology, it was found that the reason and pathogenesis of the dental diseases were caused by the dental plaque, and then the preventive methods were very effective. In some countries, the decay teeth, gingivitis was significantly reduced. Therefore, WHO recommended that all the countries worldwide should prevent the oral and dental diseases early at the age of pupil, which was the most feasible strategy. Vietnam was the developing country, in the recent years, the socioeconomic situation has been developed, the nutrition had many changes such as using much sugar, milk, etc, whereas the community was not aware enough about the risks, evils as well as the preventive measures for the oral and dental diseases. Many research works showed that in many local areas, the oral and dental diseases tended to be increased, while the operation of the oral and dental disease preventive network did not satisfy the requirements. Therefore, at the present, the work of preventing the oral and dental diseases was the key mission of the othodonto – stomatology major. To solve this situation, in many previous years, the othodonto – stomatology major actively performed the mission of initial oral and dental health care, of which the key mission was the school of dentistry work with 04 contents: Educate dentistry for the pupils, use the gargle with 0,2% flour weekly in the school, fill the teeth slot, examine and treat early the oral and dental diseases in the school. However, the implementation and effectiveness of this work were different under each group of ages, each period. Partly, the reason was that the knowledge, attitude and practice of the pupils on the oral and dental care were various under each period, each place; so that the rate of oral and dental diseases for the pupils was still high. The intervention researches showed that if the preventive measures for the oral and dental diseases were implemented well, the rate of oral and dental diseases would be significantly reduced. It was very practical to strengthen the preventive measures for the oral and dental diseases, particularly for the ages of pupil and useful to save the national budget, reduce the burden for the Public Health Sector; reduce the costs for the society to improve the public health. 7 On the national dentistry conference in 2010, according to the report of National Institute of Othodonto – Stomatology, over 80% of people was suffered by the oral and dental diseases, with the high rate of the disease as today, if it only concentrated on the treatment and recovery without the preventive treatment, it couldnot finish the endless treatment needs for the community; the payable costs and budget were very big and it will lose much time of the patients and doctors. However, at the present, the network of othodonto–stomatology surgeries was very little, the group of specialized doctors was not enough, the budget was narrowed. Despite thanks to the socialization, a number of private hospitals, consulting-rooms were significantly increased (but only in the cities), which solved a part of treatment demand for the people; it still costs a lot of expenses, time of the individuals and society. So that the prevention work of oral and dental diseases was very important and essential. One of the important methods in the oral and dental diseases prevention work was the Dental Plaque control method. The dental plaque or biofilm was one bacteria community living in the organized structures in the interface between a hard side and liquid existed in the teeth surface. The bacteria in the dental plaque lived in each micro-cluster in one shape of extracellular polymer substances. By using the PCR technology, it was found that there were 500 species of different bacteria in the dental plaque. The dental plaque was considered as the most important exotic agent in the oral and dental diseases. The dental plaque could make the damages because of the two impact mechanisms: Direct impact: Enamel made dental plaque become weak, disintegrate cell, peel of many gummy tissues leading to gingivitis, prostaglandine destroyed alveolar bone. Indirect impact: caused by bacteria and secretion of bacteria as a antigen. These antigens stimulus the immune reactions ion site as well as the whole body. Then, the intermediary products of the immune reactions destroy the organization of gums. The capacity making the decay teeth of the dental plate was based on its adhesion into the teeth, the capacity making acid from C 12 and C 6 and pH of oral environment. Methods to control the dental plaque: Mechanic methods: brushing teeth, cleaning spaces between teeth, sprinkling method. Chemical method: Use gargle for preventing and reducing the dental plaque with flour to reduce the decay teeth, etc. Overcome and repair the errors: Position of teeth, adjacent joints, repair the wrong teeth function. Nutrition regime and preventive propaganda. Chapter 2 8 SUBJECT AND RESEARCH METHOD 2.1. Subject, place and time of research 2.1.1. Research subject - 12 years-old pupils, regardless of gender, were willing to join in the research, excluding the pupils who change the school. 2.1.2. Research place, time: - 6 secondary schools of Gia Lam and Quoc Oai Districts, Hanoi - Research time: 5/2009 – 3/2011 2.2. Research method [32], [33], [34]. 2.2.1. Research design Cross-descriptive epidemiology methodology with analysis, intervention epidemiology methodology with control. 2.2.1.1. Cross- descriptive epidemiology methodology * Sample’s size Sample’s size was calculated by the descriptive epidemiology formula Z 2 1- /2 p (1-p ) p: 70% n = x DE  = 0.05 d 2 DE: 2 According to the formula: n = 1008 (real research: 1022 pupils) * Sampling method Main purpose selection: + Quoc Oai District: Dong Quang, Thach Than and Quoc Oai Town Secondary Schools + Gia Lam District: Co Bi Secondary School, Trau Quy Town and Da Ton. To assure the medical ethics, took all pupils of 06 schools with 1022 pupils, examined dental and oral; interviewed KAP about oral and dental care. 2.2.1.2. Intervention epidemiology methodology with control * Sample’s size Calculated by the fomula Z 2 1 - /2 [(1 – p1)/ p1 + ( 1- p2)/ p2] p 1 : 80% n 1 = n 2 = p2: 40% [ln (1 - )] 2  : 15%, According to the formula: n 1 = n 2 =259 (Real research of 02 groups:609) * Sampling method Among 6 secondary schools, we chose 04 schools and contigently distributed into 2 groups, the intervention group with 2 schools, 306 puplis: Dong Quang- Quoc Oai District (156 pupils) and Trau Quy Town- Gia Lam District (150 pupils), the comparison group with 02 schools, 303 9 pupils: Quoc Oai Town- Quoc Oai District (152 pupils) and Da Ton- Gia Lam District (151 pupils). 2.3. Research contents: 2.3.1. Reality, some factors relating to the decay teeth, Gingivitis, dental plaque and KAP about ODC for the 12 year-old pupils - Identified the reality of the decay teeth, gingivitis, dental plaque for the pupils - Identified the reality of KAP of the pupils about oral and dental care - Identified some factors relating to decay teeth , gingivitis 2.3.2. Assess the effectivess of dental plaque control in decay teeth, gingivitis prevention for the 12 year-old pupils in 04 secondary schools of 2 researched districts. - Tested the dental plaque control intervention method for the research subject: Cooperating 03 methods: dentistry education method, mechanic method: guide brushing with supervision under the innovated Bass method and chemical method (use gargle). - Assessed the effectivess of dental plaque control by the oral and dental diseases reality, by the PI debris indexes (using color indicator), CI-S index, DI-S, OHI-S and KAP about the oral and dental care of the pupils. 2.4. Intervention assessement: - Directly interviewed the pupils by questionaire - Examined teeth of pupils (by bill of WHO) for assessement - Assessed eefficiency index and intervention index: Used efficiency index to assess some changed indexes (rate %) after intervention in comparison with before intervention: Efficiency index (EI) (%) = / p 1 – p 2 / x 100 p 1 + p 1 : Rate before intervention + p 2 : Rate after intervention Used intervention index (II) (rate %) to assess the intervention effect between the intervention group and the comparison group: Intervention index (%) = Efficiency index (intervention group) – Efficiency index (comparison group) Compared the result of the collected indexes before and after intervention and give the essential conclusions. Chapter 3 RESEARCH RESULTS 10 3.1. Reality of decay teeth, gingivitis, dental plaque, knowledge, attitude, practice about oral and dental care and some factors related to oral and dental diseases for the pupils 3.1.1. Reality of decay teeth, gingivitis and dental plate for the pupils 3.1.1.1. Reality of decay teeth Table 3.1. Permanent decay teeth rate of the pupils under district - Rate of pupils who were permanent decay teethof both two districts was low 31.1% 3.1.1.2. Reality of gingivitis Table 3.3. Number of pupils who were gingivitis under district Gingivitis Quoc Oai (n = 510) Gia Lam (n = 512) Total (n = 1022) QT Rate (%) QT Rate (%) Qt Rate (%) Non-gingivitis (CPITN=0) 295 57.8 318 62.1 613 60.0 Gingivitis (CPITN = 1;2) 215 42.2* 194 37.9** 409 40.0 - CPITN =1 86 8.4 71 7.0 157 15.4 - CPITN =2 129 12.6 123 12.0 252 24.6 p * - ** <0.05 (Quoc Oai and Gia Lam) - Rate of gingivitis (CPITN=1.2) of the 12 years-old pupils in both two districts was medium 40.0%. 3.1.1.3. Dental plaque reality of the pupils Table 3.5. PI debris index reality of the pupils under district Place PI ≤ 2 PI > 2 QT % SL % 38,4 23,8 31,1 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Rate (%) Quoc Oai Gia Lam General Research Places [...]... of the gingivitis at the level of 2.9 times as much as the pupils who did ODH well with OR = 2.9; p < 0.05 4.2 Evaluate the DP control efficiency in the DT and gingivitis prevention of the pupils 4.2.1 Evaluate the DP control efficiency in the DT and gingivitis prevention of the pupils 4.2.1.1 Evaluate DP control efficiency 22 The PI demonstrated through Table 3.29 showed that: The PI ≤ 2 after IV of. .. coating, etc), within 8 years, the gingivitis rate reduced by 50.0% The result of our research applied for 12 year -old pupils in one year with the method of DP control showed that the gingivitis reduced by 20.0%, the DP reduced (because some pupils had the enamel at the level: 2; 3; therefore, it was needed to take the enamel, the gingivitis would end) and then the DT was controlled 4.2.2 Evaluate the. .. reducing the oral and dental diseases of the pupils in the group of intervention and then affirmed that DP control was obviously effective in preventing the DT and gingivitis CONSCLUSION 1 The reality of DT, G and DP; knowledge, attitude, practice on the ODC and some factors related to the pupils oral and dental disease - The reality of DT, Gingivitis: The common rate of permanent DT of 12 year -old pupils. .. that the intervention was effective with II = 107.5% - The efficency of DT prevention: After the intervention, the DT rate of IV group (31.5%) was lower than that of Group of Symptom (39.3%), the difference had the meaning of statistics (p . control in decay teeth, gingivitis prevention for the 12 years- old pupils at some schools in the suburb of Hanoi to: 5 1. Describe the reality, some factors relating to the decay teeth, gingivitis, . Assess the efficiency of dental plaque control in the decay teeth, gingivitis prevention for the 12- year -old pupils at 04 secondary schools of two researched districts. NEW CONTRIBUTIONS OF THE. of the decay teeth, gingivitis, dental plaque for the pupils - Identified the reality of KAP of the pupils about oral and dental care - Identified some factors relating to decay teeth , gingivitis