Hryhorova: Periodontal Tissues State and Psychophysiological Addiction: the Effectiveness of Treatment and Rehabilitation Complexes in Patients with Maxillofacial Area Injuries and Diseases



Problem statement and analysis of the recent research

The study of physiological characteristics of addictive states (state of addiction to psychoactive substances) and their impact on the pathology course is under clinical study. However, nicotine psychophysiological addiction (NPPA) is known to be the most common [2, 7, 9, 10]. NPPA impact has not been systematically studied in the clinical findings of dental surgery, although some scientists usually analyzed the impact of smoking in the clinical studies of patients with injuries and inflammatory diseases (ID) of maxillofacial area (MFA), especially when displaying the causes of complicated course of postoperative/post-mobilization period [1, 12].

In population and clinical periodontology smoking is known to be considered as a factor of negative impact on general clinical dental health (GCDH) [1, 3, 6, 12], However, the impact of intensity and cigarettes smoking history on the formation of periodontal treatment needs and NPPA impact on the structure and effectiveness of individual treatment and rehabilitation programs, including patients of specialized hospital of surgical dentistry, has not been studied yet.

The objective of the research was to study the effectiveness of complex treatment by studying the changes in the needs for periodontal treatment under the influence of various treatment and rehabilitation complexes in patients depending on the presence of psychophysiological addiction (addiction states).

Materials and methods

326 people at the stage of clinical monitoring (CM) were involved into the study. Community Periodontal Index of Treatment Needs (CPITN) was estimated at CM stages in patients with ID MFA (584 measurements were performed in 147 individuals in the preoperative, early, late and remote postoperative period) and in individuals with MFA injuries (716 determinations were performed in 179 people at the pre-mobilization, the first, the second and post-mobilization periods) with the use of standard light probe with a ball with a diameter of 0.5 mm on its tip and black stripe at a distance of 3.5-5.5 mm from the tip of the probe. Conventionally, oral cavity was divided into six sextants restricted by teeth with code numbers 18÷14, 13÷23, 24÷28, 38÷34, 33÷43 and 44÷48. According to the method [1, 12] sextant was examined only if it contained two or more teeth and there were no indications for their removal; if only one tooth was left in a sextant, it was included to the previous sextant. Index teeth probing with probing force up to 20 g was conducted to determine probing pocket depth, the presence of subgingival calculus and bleeding gums. The obtained data were entered into GCDH estimation cards according to the codes:

  • 4 points – the pocket was more than 6 mm (black section of the probe was not visible);

  • 3 points – the pocket was 4-5 mm (gingival margin was located at the black stripe of the probe);

  • 2 points – the sensation of the calculus during probing but all the black section of the probe was visible;

  • 1 point – bleeding immediately after probing;

  • 0 – healthy gums.

Smoking cigarettes as a manifestation of psycho-physiological dependence (addiction) was studied in terms of the smoking history, intensity and calculation of “smoker index” [2, 10]. Frequency of smoking cigarettes and smoker index was higher in patients with MFA injuries (p<0.05). Smoking duration index (SDI) that is the ratio of the duration of smoking (years) up to the age at the time of the research (years) was also higher in patients with MFA injuries (0.296±0.004 units among 118 patients with injuries and 0.272±0.006 among 58 patients with ID of MFA). Both groups of patients were divided into subgroups based on the presence / absence of addictive states as the facts of immune-metabolic and bioenergetic processes disorders in this category of patients are well known for the clinicians [3-5]. In addition to comprehensive treatment provided by appropriate clinical protocols for patients with injuries (ITRC0) and ID of MFA (DTRC0), in some cases (29 people with MFA injuries and 21 people with ID of MFA) improved treatment and rehabilitation complex was applied (prescription of B vitamins, calcium drugs and drugs of angioprotective and capillary stabilizing action) both for patients with MFA injuries (ITRC1) and with ID of MFA (DTRC1). Body-oriented physical rehabilitation was the basis for rehabilitation [4, 5, 11].

Results and Discussion

We analyzed the periodontal treatment needs of 179 people with injuries and 147 people with ID of MFA in relation to the presence of nicotine addiction physiological conditions (diagnosis of which was made according to the method of smoker index evaluation) and applied TRC. Thus, CPITN constituted 2.67±0.12 units among 89 patients of the control group (ITRC0) with MFA injuries and diagnosed PPA before the treatment. It significantly (р<0.05) increased at the end of CM and constituted 3.28±0.14 units indicating deterioration of GCDH and, therefore, increase in the need for periodontal treatment. However, CPITN index remained relatively stable (from 2.41±0.07 units to 2.57±0.10 units) among 29 patients who underwent ITRC1.

Table 1

The need in the periodontal treatment at the stages of patients’ clinical monitoring depending on the presence of psychophysiological addiction

Presence / absence of psychophysiological addiction (PPA) Groups of patients
MFA injury ID of MFA
ITRC0 ITRC1 DTRC0, DTRC1
abs. M±m, u abs. M±m, u abs. M±m, u abs. M±m, u
At the beginning of the treatment
PPA absence 39 1.64±0.11 22 1.56±0.08 75 1.81±0.07 24 1.72±0.07
PPA presence 89 2.67±0.12 29 2.41±0.07 37 2.56±0.09 21 2.27±0.08b
Total by subgroups 128 2.14±0.09 51 1.81±0.04b 102 2.13±0.11 45 1.96±0.08
Total by nosogroups 1.94±0.08 2.07±0.10
At the end of clinical monitoring
PPA absence 39 2.17±0.06a 22 2.11±0.07a 75 2.19±0.04a 24 2.03±0.07a, b
PPA presence 89 3.28±0.14a 29 2.57±0.10b 37 2.73±0.10 21 2.24±0.05b
Total by subgroups 128 2.87±0.10a 51 2.38±0.06a, b 102 2.37±0.06a 45 2.12±0.09b
Total by nosogroups 2.61±0.08a 2.24±0.08a, b

Note.

a - significant differences in comparison with the same index at the early postoperative/mobilization period, at р≤0.05

b - significant differences in comparison with the same index in the comparison group, at р≤0.05

CPITN index constituted 2.56±0.11 units before the treatment among 37 patients of the control group with ID of MFA (DTRC0) with diagnosed PPA and it did not significantly (р<0.05) differ at the end of CM constituting 2.73±0.10 units. CPITN index did not significantly change among 21 patients with DTRC1 (it constituted 2.27±0.08 units and 2.24±0.05 units, respectively), and it significantly changed from the control group at the end of CM (it constituted 2.73±0.10 units and 2.24±0.05, respectively).

Fig. 1.

Changes in the level of periodontal treatment need in case of injuries and inflammatory diseases of maxillofacial area depending on the nicotine psychophysiological addiction and applied treatment and rehabilitation complex

gmj-23-gmj.2016.3.28-g1.jpg

Generally, deterioration of the condition and increase in the need for periodontal treatment was noted in case of MFA injuries (CPITN index constituted 1.94±0.08 units before the treatment and 2.61±0.08 after the treatment), while significant statistical differences for patients with ID of MFA were absent (CPITN index constituted 2.07±0.10 units before the treatment and 2.24±0.08 after the treatment).

Taking into account these circumstances, we detected the effectiveness of treatment differentiated by the presence of nicotine PPA and treatment and rehabilitation approach.

Conclusions

  1. Nicotine psychophysiological addiction is a significant precondition for the effective treatment of patients with MFA injuries and in case of ITRC1 use its greater efficiency is achieved by reducing the need for periodontal treatment by 27.6%. Higher efficiency is achieved in patients with nicotine physiological addiction on the background of ID of MFA in case of DTRC1 use by reducing the need for periodontal treatment by 21.8%.

  2. Diagnosis and taking into account the type of psychophysiological addiction during the application of TRC may be considered as additional criteria of comprehensive treatment individualization providing a possibility to take into account patients’ psychophysiological state.

Prospects for further research

Prospects for further research involve the study of other physiological determinants influence on the effectiveness of treatment and rehabilitation measures.

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