MEDYCZNE I SPOŁECZNE UZASADNIENIE DLA ZOPTYMALIZOWANEGO MODELU ZAPEWNIANIA OPIEKI ORTODONTYCZNEJ W POPULACJI DZIECIĘCEJ NA POZIOMIE REGIONALNYM
Iryna А. Holovanova, Natalia A. Lyakhova
UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY, POLTAVA, UKRAINE
Introduction: Prevention and treatment of orthodontic pathology is a topical issue in modern dentistry. This type of pathology occurs in 14.4-71.7% of patients and the number of patients every year increases. One of the most important factors in the development of disturbances of the formation of the tooth-jaw system is the neglect of measures aimed at the prevention of tooth-jaw anomalies and deformations.
The aim: To develop and provide medical and social substantiation of an optimized model for the provision of dental orthodontic care to the children’s population at the regional level.
Materials and methods: The research uses methods of modeling, system analysis and system approach. The model is based on the analysis of world-wide experience on the problem of organizing and providing orthodontic care to children and the results of conducted researches (prevalence, risk factors, organization of medical care, parents’ awareness and awareness of doctors).
Results: Based on the results of the obtained data, a model for the provision of dental orthodontic care to the children’s population at the regional level was constructed. The main goal, structure, tasks and principles of the proposed model are determined. The main areas of interaction between the elements of the model are the development of state strategies, monitoring of the main indicators of dental health and planning of priority measures to optimize the provision of assistance.
Conclusions: The effective functioning of the model for providing of dental orthodontic assistance for the children’s population at the regional level will allow to optimize the organization of orthodontic care and to make more effective the system of prevention of dental diseases, to improve the state of dental health of the children’s population, to promote the level of somatic health of children.
Wstęp: Zapobieganie i leczenie schorzeń ortodontycznych jest istotnym problemem współczesnej stomatologii. Ten typ zaburzeń występuje u 14,4−71,7% pacjentów, a ich liczba wzrasta co roku. Jednym z najważniejszych czynników w rozwoju zaburzeń formowania się układu zębów i kości szczęki jest niewykorzystywanie środków mających na celu zapobieganie powstawaniu anomalii i deformacji tego układu.
Cel pracy: Stworzenie i zapewnienie medycznego i społecznego uzasadnienia dla zoptymalizowanego modelu zapewniania opieki ortodontycznej w populacji dziecięcej na poziomie regionalnym.
Materiał i metody: W badaniu wykorzystano metody modelowania, analizy systemów i podejścia systemowego. Model oparty jest na analizie ogólnoświatowego doświadczenia dotyczącego problemu organizacji i zapewniania opieki ortodontycznej dzieciom i wyników przeprowadzonych badań (częstości występowania, czynników ryzyka, organizacji opieki zdrowotnej, świadomości rodziców i świadomości lekarzy).
Wyniki: W oparciu o wyniki wyciągnięte ze zgromadzonych danych został opracowany model zapewniania opieki ortodontycznej w populacji dziecięcej na poziomie regionalnym. Ustalono główny cel, strukturę, zadania i zasady proponowanego modelu. Główne obszary interakcji pomiędzy elementami modelu to stworzenie państwowych strategii, monitorowanie głównych wskaźników zdrowia pod względem stomatologicznym i planowanie priorytetowych środków do optymalizacji zapewniania opieki.
Wyniki: Efektywne funkcjonowanie modelu zapewniania opieki ortodontycznej w populacji dziecięcej na poziomie regionalnym umożliwi zoptymalizowanie organizacji opieki ortodontycznej i zwiększenie efektywności systemu zapobiegania chorobom zębów, by ulepszyć stan zdrowia pod względem stomatologicznym w populacji dziecięcej oraz zwiększyć poziom zdrowia somatycznego dzieci.
Public Health Forum 2018;IV(XII)3(46):154-158
Prevention and treatment of orthodontic pathology is a topical issue in modern dentistry. This type of pathology occurs in 14.4-71.7% of patients and the number of patients every year increases [1−4]. One of the most important factors in the development of disturbances of the formation of the tooth-jaw system is the neglect of measures aimed at the prevention of tooth-jaw anomalies and deformations. The process of bite formation can be broken due to ineffective prevention or its absence during embryonic development of the fetus and in time of breastfeeding, insufficient prevention during the period of dairy and alternate bite, high prevalence and intensity of caries, its complications, injuries, tumors [5-8]. These factors lead to significant morphological disorders in the maxillofacial area, functional pathology, periodontal tissue diseases and early teeth loss [9-11].
The organization and implementation of prevention of violations of the formation of the tooth-jaw system occurs in both public and private dental institutions that provide medical care to the children. There is no doubt that preventive measures are not so cost-effective for private structures, which in most cases undergo orthodontic treatment, and requires high activity of an orthodontist doctor in carrying out sanitary and educational work. In state structures formally supported “remnants” of medical dispanserisation, and for preventive care there is not enough time due to insufficient number of orthodontists in the staff of the clinic.
These circumstances determine the relevance and necessity of a comprehensive investigation devoted to the study of dental morbidity and system analysis of the state of dental care of children in administrative territories, which will allow to improve the state of the system of dental care of children in the new economic conditions of Ukraine, and the creation and substantiation of an optimized model for the provision of dental orthodontic care to the children’s population at the regional level.
To develop and provide medical and social substantiation of an optimized model for the provision of dental orthodontic care to the children’s population at the regional level.
Based on our findings of the imperfections of dental orthodontic care, we have developed a model, the basis of which is the main resource – state policy with a law-making base. The coordination of the work of all those involved in the provision of dental orthodontic services in order to create a unified medical space that would provide a solution to the priority problem of increasing the accessibility and quality of dental orthodontic care and has influenced the parents’ commitment to this treatment and the improvement of the dental health of the children’s population has become a key the idea of achieving the goal.
The establishment of a legislative basis for dental orthodontic services, which primarily involves the creation of a reserve of funds from local, national budgets, or the health insurance system of the population, which completely changes the system of health care organization, became the first component of our model. Resources in state policy on dental orthodontic care have become:
1. Personnel position:
a. Encouraging orthodontists to work in rural and in unattractive areas;
a. Creation of conditions for continuous professional training of doctors of orthodontics, as well as general practitioners and pediatricians;
b. Conducting an audit of doctors to identify the best one and create competitive conditions.
2. Organizational position:
a. Creation of national and regional programs for the prevention of orthodontic diseases;
b. Selection of privileged population groups for orthodontic treatment, both in public and private clinics;
c. Organization of cabinets of professional hygiene;
d. Involvement of middle medical workers (dental hygienists) in medical examinations, sanitary and preventive maintenance work.
a. Financial support for the participation of private orthodontists in national and regional programs for the prevention of orthodontic diseases;
b. Guaranteed amount of dental orthodontic care on the basis of target state order;
c. Allocation of funds for orthodontic care for children from local budgets.
All these measures will certainly affect the improvement of the technical support of dental care institutions. Optimization of the level of technical support will affect the:
1. On-stage updating of dental equipment (tools, equipment, etc.);
2. Using IT technologies, to achieve the creation of a single register of patients with dental diseases, in particular with orthodontic defects.
3. Creation of the “Single Electronic Medical Card” of the patient («SEMC»).
The short-term results of all these actions will be an increase in parents’ commitment to orthodontic care for their children (Fig. 1). State policy in the field of orthodontic care).
The second component of the model is the cooperation of physicians (subject) and parents (object) in the provision of dental orthodontic care.
Orthodontic care should be provided not only by orthodontists, but also by doctors of different specialties.
Antenatal period. Measures for the prevention and detection of risk factors for the occurrence of orthodontic pathology should begin before the birth of the child. Firstly, it concerns a general practitioner and an obstetrician-gynecologist who are observe a woman before pregnancy and during pregnancy. They carry out sanitary and educational work with a pregnant woman about a healthy lifestyle, a healthy diet, elimination of bad habits, and also provide treatment of somatic diseases and elimination of risk factors for the future child. This work is carried out both personally and in the schools of responsible parenting, where women learn to rational breastfeeding, which makes it impossible to use dummies.
At the same time, the family doctor and the obstetrician-gynecologist should identify the antenatal risk factors that can lead to the occurrence of various diseases in the child (including orthodontic pathology). We have identified factors that need attention:
• Hereditary orthodontic pathology
• Using of dummies
• Artificial breastfeeding
• Concomitant somatic diseases of the child
All identified risk factors must be recorded, and after the birth of the child, this information should be included in the “Single Electronic Medical Card” in order to save the information for its further use by doctors who will subsequently conduct the child (pediatricians, other specialists, including dentists of various specialties). All risk factors are grouped according to types (medical, socio-economic, environmental, individual, climate-geographic) that is necessary for the formation of target screening groups.
The age from 0 to 1 year is marked by the continuation of family cooperation with a family doctor and pediatrician who supports the woman’s confidence in the necessity of breastfeeding, conducts sanitary and educational work on a healthy lifestyle and rational nutrition of the child and emphasizes the need for an early visit to a children`s dentist. At this stage, detection of postnatal risk factors with their grouping into target groups for screening and information entry in «SEMC» is continues.
Age from 1 to 3 years. The child is subject to mandatory review of a child`s dentist no later than at the age of one year. The child’s dentist detects dental disease (caries), mucosal and periodontal disease, orthodontic pathology, determines dental risk factors (short frenum of tongue or lips, etc.), which are recorded in the «SEMC», and, if necessary, performs sanitation of the oral cavity.
At the age of 1 to 3 years, the key role in collecting of information about risk factors belongs to the pediatrician (family doctor) who continues to form a target groups and, if it necessary, directs the patient to a child`s dentist and orthodontist. In this period, somatic diseases are being treated, especially those that can lead to orthodontic pathology, such as otorhinolaryngology, for the normalization of the function of the maxillofacial area (respiration, swallowing, etc.). It is also important to carry out sanitary and educational work on dental diseases
The child’s dentist carries out sanitation of the oral cavity, detects orthodontic pathology during the patient`s visit, sighting examines children by age, detects dental risk factors, continues forming of target groups, directs relevant groups to the orthodontist for examination, conducts sanitary and educational work (explains the need for treatment of dental diseases).
An orthodontist conducts screening in target groups: detects orthodontic pathology, selects groups for further observation, and begins the formation of dispensary groups. If necessary, the doctor prescribes measures aimed at normalizing the functions of the maxillofacial area (myogymnastics, etc.), directs for consulting for other specialists.
Dentistry hygienists carry out medical examinations (detection of caries, orthodontic pathology, mucosal and periodontal disease, identification of risk factors, formation of target groups, referral to children’s dentist and orthodontist), conduct sanitary and educational work; they work in the offices of professional hygiene of the oral cavity, including mobile ones.
Age 3 to 17 years
At the age from 3 to 17 years, the pediatrician (family doctor) continues to collect information about risk factors, referral to children’s dentist and orthodontist, treatment of somatic diseases, including those that can lead to orthodontic pathology. The sanitary-educational work on dental diseases is carried out.
The child’s dentist during treatment reveals orthodontic pathology, examines children by age, reveals dental risk factors, directs relevant groups to the orthodontist for examination, conducts sanitary and educational work (explains the need for treatment of dental diseases), carries out sanitation of the oral cavity.
Dental hygienists conduct preventive examinations once a year in organized children’s collectives (detection of caries, orthodontic pathology, mucosal and periodontal disease, identification of risk factors, referral to children’s dentist and orthodontist), sanitary and educational work in kindergartens and schools; they work in the offices of professional hygiene of the oral cavity, including mobile ones.
In the three-year age, the first scheduled review of the orthodontist doctor is carried out. An orthodontist reveals an orthodontic pathology, conducts a selection of groups for further observation, begins the formation of dispensary groups. If necessary, the orthodontist prescribes measures aimed at normalizing the functions of the maxillofacial area (myogymnastics, etc.), directing patients to other specialists. At the same time, screening in target groups is conducted. The following scheduled examinations for the detection of orthopedic pathology or violations from the maxillofacial area are performed by the orthodontist at the age of six years (the period of the formed milk bite) and in the 12-13 years (the period of the formed bite).
Throughout the entire period of childhood (from 3 to 17 years), the orthodontist continues screening in target groups in order to identify risk factors, the formation of target groups, referral to the children`s dentist and other specialists. Carries out the treatment of orthodontic pathology. Formed dispensary groups and observation groups accordingly (Fig. 2. Optimized model for providing of dental orthodontic assistance for the children`s).
Thus, the difference between the proposed model for providing orthodontic care from the existing one is contained in the following.
1. Observation and fixation in the medical documentation of the parents of the detected antenatal factors of the risk of orthodontic pathology before and during pregnancy, close cooperation and exchange of information between the family doctor who is observing pregnant woman and obstetrician-gynecologists who are looking for pregnant and taking delivery.
2. Creation of the “Single Electronic Medical Card”, which will contain not only medical information (cases of diseases, treatment, results of surveys), but also information about all the risk factors for dental diseases (antenatal and postnatal) in the child and preventive measures that were applied. This information will be constantly replenishing and analyzing, what helps to improve the health of the child.
3. Continuous detection of postnatal risk factors for the onset of orthopedic pathology by pediatricians (family doctors), fixation in the «SEMC», the formation of target groups for screening, informing orthodontists and pediatric dentists about children with risk factors for dental diseases (including orthodontic) are provided.
4. Conducting of a screening by orthodontists in target groups with risk factors, for the detection of orthodontic pathology.
5. Conducting scheduled examinations of children by orthodontists in “key age” – at the age of three, six, and twelve years.
6. Attracting of dental hygienists to medical examinations of children in organized groups (except for “key” years), which will enable orthodontists to pay more attention to treating work.
7. Involvement of dental hygienists in preventive work (mineralization of figures, professional cleaning of teeth, etc.).
8. Involvement of dental hygienists in sanitary and educational work among parents of children in organized children’s collectives and conducting of this work in small groups for greater efficiency.
9. Creation of cabinets of professional hygiene of the oral cavity (including mobile ones), where dental hygienists will work.
10. Carrying out training of family doctors and pediatricians on the prevention of dental diseases and sanitary and educational work among parents of children.
11. Carrying out sanitary and educational work on dental diseases by family doctors and pediatricians.
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Conflict of interest:
The Authors declare no conflict of interest.
Natalia A. Lyakhova
Ukrainian medical stomatological academy,
23 Shevchenko Str., Poltava 36004, Ukraine
Fig. 1. State policy in the field of dental orthodontic assistance for the children`s.