MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY TRINH DUC MAU THE SITUATION OF PERIODONTAL DISEASE AND THE EFFECTIVENESS OF INTERVENTION ON PATIENTS TREATED WITH OPITEADDICTION BY METHADONE IN THAI NGUYEN Speciality: Sociology hygiene and health organization Code number: 62720164 SUMMARY OF MEDICINE DOCTORAL THESIS THAI NGUYEN, 2019 The dissertation was completed at UNIVERSITY OF MEDICINE AND PHARMACY THAI NGUYEN UNIVERSITY Supervisor: Prof Dr Trinh Dinh Hai Assoc Prof Dr Nguyen Quy Thai Critic 1: ………………………………………… Critic 2: ………………………………………… Critic 3: ………………………………………… The dissertation will be defended nationally to the Evaluation Committee at University of Medicine and Pharmacy, Thai Nguyen University at … on …., 201 The dissertation is available for reference at: - The library of Thai Nguyen University of Medicine and Pharmacy - Learing resource centre of Thai Nguyen University - The National Medical Library BACKGROUND Periodontal disease is one of the most common diseases, affecting about 20-50% of the global population In Vietnam, over 90% of adults have gingivitis and inflammation around the teeth [7] Periodontal disease is a chronic bacterial infection that involves destruction of dental support structures, including gums, ligaments and alveolar bone [73] In Vietnam, research on periodontal disease on drug addicts is very small The research topic of periodontal disease and intervention to reduce the incidence of periodontal disease for drug addicts so far has not seen any published author According to statistics, there are 5329 drug addicts with management records in Thai Nguyen province, including 3859 people in the community and 1148 people absent in the locality [3] Thai Nguyen has not yet studied, there is no specific solution to reduce the rate of periodontal disease for opiate addicts We conduct the topic with two objectives: Describe the situation and some factors related to periodontal disease on patients treated with opiate addiction by methadone in Thai Nguyen Evaluate the effectiveness of some interventions to prevent periodontal disease in patients treated with opiate addiction by methadone in Dai Tu and Thai Nguyen districts NEW CONTRIBUTIONS OF THE THESIS The dissertation topic provides new data on the incidence of periodontal disease, gingivitis, periodontal inflammation and some related factors in people receiving substitution treatment for opioid addiction by methadone in Thai Nguyen Coordinate with Dai Tu methadone treatment facility, effectively implement a number of periodontal disease prevention interventions for community-based methadone opioid addiction treatment providers including: - Health education communication solution - Mechanical engineering solutions - Solution to use chemicals - Solutions to improve capacity for Dai Tu methadone health workers in primary health care about dentistry Intervention activities help addicts to raise awareness, change attitudes and practices of oral health care to prevent periodontal disease, and help health workers improve their knowledge about board care early on oral health Performance results after intervention to knowledge, attitude, practice of periodontal disease increased compared to before intervention The rate of gingivitis, inflammation around the teeth, and poor oral hygiene all decreased compared to before the intervention STRUCTURE OF THE THESIS The thesis is 134 pages long, including the following sections: Issue pages Chapter 1: Overview of 29 pages Chapter 2: Subjects and research methods 25 pages Chapter 3: Research results (34 tables, pictures, diagram) 32 pages Chapter 4: Discussion 38 pages Conclusion pages Recommendation 01 page References: 119 (Vietnamese: 35; English: 84; documents in the last years: 83) Appendix: SOME MAIN PART OF THE THESIS Chapter SUBJECTS AND METHODS OF RESEARCH 2.1 Research subjects 2.2.1 Object of study description - Quantitative research objects: Patients on methadone substitution treatment for opioid addiction at methadone treatment facilities, aged between 20 and 59, have at least hexadecimal region still functioning and not suffering from diseases Other acute, agree to voluntarily participate in the study - Qualitative research subjects: Leadership in methadone treatment facilities; Health officials directly manage and treat patients; Representing family members of drug addicts, agreeing to participate in research Exclusion: People who treat opioid addiction with other nonmethadone drugs, are suffering from other acute diseases, lose their entire teeth, are unable to answer (mute, deaf ) 2.1.2 Object of intervention research Patients with alternative treatment for opioid addiction with methadone at Dai Tu methadone treatment facility, aged from 20 to 59, have at least hexadecimal region still functional, without other acute diseases, copper voluntary intention to participate in research 2.2 Time and place of study 2.2.1 Time - Research describing the situation: March and April 2015 - Intervention study: 12 months (from April 2015 to April 2016) 2.2.2 Place - Select the intervention location: The facility for treating methadone Dai Tu - Select the control location: Pho Yen methadone treatment facility 2.3 Research Methods 3.3.1 Method and design - Using descriptive research methods and community intervention studies, combining quantitative and qualitative research - Design of cross-sectional descriptive research and experimental simulation design 2.3.2 Sample size and sample selection 2.3.2.1 Sample size and sample selection in descriptive study * Sample size in descriptive study: Applying formula [11]: p(1-p) n = Z2(1-α/2)= ––––––– d2 Inside: n: Sample size Z (1-α / 2): The Z value obtained from table Z corresponds to the value of α selected Z (1-α / 2) = 1.96 (corresponding to 95% confidence level) p: The incidence of periodontal disease is 89.5%; p = 0.895 (According to Dang Thi Tho in 2003 research) [30], because until now we have not seen any research published on the prevalence of periodontal disease in drug addicts d: The desired accuracy is 0.035 0,895 x 0,105 n = (1,96)2 ––––––––––––– = 294 (0,035)2 Thus, the minimum sample size at each treatment facility is 294 people * Sample selection in descriptive study: Select all addicts listed on the daily list to take methadone, voluntarily participate in the study 2.3.2.2 Sample size and quantitative sampling in intervention studies * Sample size in intervention research: Applying formula [11]: p1(1 - p1) + p2(1 - p2) n = Z2(α,β) –––––––––––––––––– (p1 – p2)2 Inside: n: size of the study sample p1: the rate of periodontal disease according to previous research at the Hanoi Center for Social Work Education is 89.5% (p1 = 0.895) [30] p2: the desired rate of periodontal disease after intervention will be reduced by at least 15%, ie the rate of periodontal disease is about 75% (p2 = 0.75) α: threshold of probability of making a mistake of type 1, determining α = 0.05 corresponding to the reliability factor at 95% β: probability of making a mistake of type 2, determining β = 0.1 respectively - β = 0.9 corresponding to a sample force of 90% Look up the table, select test sides, we get Z2 (α, β) = 10.5 Replace the number we have: 0,895(1- 0,895) + 0,75(1- 0,75) n = 10,5 ––––––––––––––––––––––––– = 140 (0,895 – 0,75)2 - Sample size of intervention group is at least 140 people - Reference group size: Select all * Choose a template: Select all 2.3.2.3 Sample size, sample selection in qualitative research in the intervention group * Sample size of group discussion: sessions, 6-8 people /group - Group 1: Leaders of the Health Center, leaders of treatment facilities and health workers of methadone treatment facilities: 02 (before and after the intervention) - Group 2: Representatives of addicts, drug addict relativeness, drug addicts in Rehabilitation Club: 02 (before and after intervention) * Choose group discussion form: - Group 1: Leadership representative, health staff: As the person in charge, working in the relevant job position and cmmmunity spockesman - Group 2: Representatives of addicts and family members: being agile, voluntarily participating and spoksmen * Sample size of in-depth interview: 12 sessions - Representatives of health center leaders: 02 (before and after intervention) - Representative of Dai Tu methadone treatment facility: 02 times (before and after the intervention) - Representatives of medical staff of methadone treatment facilities from directly treating and managing drug addicts: sessions (before and after intervention) - Representatives of addicts: 02 (before and after intervention) - Representatives of drug addicts relativenese: 02 (before and after intervention) - Drug club representative: (before and after intervention) * Choose a sample of in-depth interviews: The people who are in charge of work, who are responsible for the content of oral health care, responsible speech for themselves and the community 2.4 Research index 2.4.1 Indicators of status and some factors related to periodontal disease (goal 1) * Current situation of age, gender, occupation, education level, smoking habits, oral hygiene status (OHI-S), gingivitis rate, periodontal inflammation, benefit status (GI) * Related factors: - Relationship between ages: with benefit status (GI); with oral hygiene index (OHI-S) - Relationship between the time of taking methadone and the state of oral hygiene (OHI-S) - Relationship between gender; Smoking habits with periodontal disease - Relationship between ages; Time to take methadone with periodontal disease according to the highest CPI - Relationship between the need to treat the teeth around the community with the time to take methadone 2.4.2 Index of evaluation of effectiveness of some interventions to prevent periodontal disease (target 2) * Input index: - Index of knowledge: oral hygiene; how to brush teeth; causes of gum bleeding; manifestations of gingivitis; causes of periodontitis and manifestations of periodontitis - Index of attitude: the need to go to a Dentist; the use of brushes and toothpaste; the need for guidance on oral care of Dentist; poor oral care; prevent diseases periodontitis; Periodic examination to detect and treat periodontal disease - Practical index of dental health care: brushing teeth during the day; how to brush teeth; the time of each brush and the time to change the brush * Output index: - The change of knowledge after intervention: knowledge of oral care; how to brush teeth; causes of gum bleeding; manifestations of gingivitis; causes of periodontitis and manifestations of periodontitis - The change of attitude after intervention: the attitude about the need to go to the Dentist; the use of brushes and toothpaste; the need for guidance on oral care of Dentist; poor oral hygiene; prevent diseases around the teeth; Periodic examination to detect and treat periodontal disease - Change in practice after intervention: practice on oral health care; post-feeding oral care; number of times to brush teeth during the day; how to brush teeth; the time of each brush and the time to change the brush * Output index affecting the periodontal disease: - Effect of intervention on oral care index (OHI-S) - Effect of interfering with gingivitis rate - Effective interventions to benefit status according to GI index - Effective intervention to the rate of periodontitis 2.4.3 Organize monitoring of research activities - Periodic monitoring: time / month - Regular monitoring when organizing communication, group discussion and in-depth interviews - Unsupervised monitoring: done at any time - Supervision of human resources: PhD students, research team members, staff directly treating, managing and distributing methadone drugs 2.5 Descriptive research content - Direct interview of research subjects - Clinical examination to detect dental disease, periodontal disease, related factors, oral hygiene indicators 2.6 Content of intervention research 2.6.1 Intervention by health communication-education solutions * The media: - Communication objects: Addicts and drug addicts relativeness - Number of communication sessions: sessions (07 sessions for addicts and 01 session for drug addicts relativeness representatives) - Content: Basic knowledge of oral diseases and prevention of oral diseases * Training: - Training subjects: Health staff of Dai Tu methadone treatment facility, directly involved in management, treatment and distribution of methadone - Number of training sessions: 01 session - Content: General principles of oral health education and prevention of periodontal disease for the community 2.6.2 Intervention with mechanical engineering solutions - Technique: Brush teeth in accordance to improve Bass method [99] - Time to brush teeth every 2-3 minutes 2.6.3 Intervention with chemical solutions Instructions for addicts to rinse their mouths after brushing their teeth with pre-mixed mouthwash or diluted brine if at home 2.6.4 Intervention by solutions to improve the initial capacity of oral health care for health workers Training on knowledge and guidance on early detection of periodontal disease, simple tartar extraction technique for medical staff at Dai Tu methadone treatment facility 2.7 Examination of the periodontal condition, criteria and evaluation criteria Tools, methods of examination and evaluation of criteria according to regulations [7], [28], [114] 2.11 Data analysis methods 2.11.1 Quantitative data - Collected data is checked, encrypted and entered by Epi-data software - Analysing data: Using SPSS 20.0 software on computers - Comparison between test use rates χ2 - Comparison of differences has statistical significance at p40 year 209 71,1 3,22 old (2,34