THE NEED FOR JOINT PLANNING OF ORTHOPEDIC DENTAL CARE IN COMPLEX TREATMENT OF PATIENTS WITH DEFECTS OF MAXILLOFACIAL LOCALIZATION
The study of the problem and satisfaction of the population with medical and dental care is extremely important. Definition of the need for specialized dental treatment of patients with defects of maxillofacial localization has become of special relevance and gained a greater social significance in the recent years.
This issue has become more relevant due to the increase in the number of oncological diseases, injuries and gunshot wounds. If neglected this may lead to anthropogenic disasters, increased social tension, local military conflicts and criminal situation and result in growing number of victims, severity of injuries and increase in associated injuries. Nowadays road traffic accidents and gunshot injuries prevail. Among the victims are men aged 25-50 years. This underlines the socio-economic importance of the problem. It has increased the needs of such patients in specialized treatment and rehabilitation based on the study of their quality of life. At present, there are few studies of quality of life of patients with traumatic diseases of maxillofacial localization of different genesis. Therefore, one must plan for the organization and provide consistent surgical and orthopedic treatment.
Today there are no certain data that allow assessing the level of defects of different genesis. This to some extent complicates the process of planning the specialized dental care. Planning involves determining the needs of all types of resources.
The aim of our work was to study the frequency of hospitalization of patients with defects of facial bones of various origins and their need for orthopedic treatment and rehabilitation.
We studied the data of statistical accounting of the Department of maxillofacial surgery of the Poltava regional clinical hospital, where the assessment of needs in the orthopedic treatment and rehabilitation of patients was made. The data contained in the reports did not reflect the information necessary for the planning and organization of orthopedic care to patients with defects of facial bones.
In our opinion to improve the accessibility, quality and effectiveness of treatment of this group of patients the following actions should be encouraged:
- check the reasons that led to the appearance of defects,
- check presence of medical documentation to ensure the continuity between the institutions of General medical and dental clinics and offices of various forms of ownership in the issues of treatment of patients with defects SLL of various geneses;
- a method for determining the need for medical personnel for an industry reception and meet the needs of maxillofacial prosthetics;
- the definition of maxillofacial prosthetics, depending on the type and complexity of surgical intervention in the maxillofacial region.
It is useful to define the term defect of maxillofacial localization as a unit of measurement of volume and need for medical attention. This must be done due to the following reasons:
- treatment and rehabilitation of this patient population involves experts of various specialties (oral surgeons, oncologists, dentists, podiatrists and orthodontists, ENT, ophthalmologists, neuro-surgeons, neurologists, psychotherapists, psychiatrists, etc.);
- absence of a rational scheme of the sequence of stages of dental care of patients with defects SLL of different genesis and continuity in the provision of all types of dental care;
- presence of regional differences in the management of patients with defects SLL;
- lack of norms of time and norms of material and labor costs for treatment of these patients;
- lack of specialists in maxillofacial prosthetics in many medical institutions. There are certain difficulties in the statistical registration of causes of defects SL. Key causes among them are:
- actual causes of defects SLL and terminological inconsistency have negative impact on the system of organization of specialized care.
- the need for a separate special records of pathological conditions should be performed by experts, because in practice, it allows to predict accurately the proportion of surgical and restorative dental care in the structure of medical care, the necessary resources and to plan the treatment and rehabilitation of each individual patient.
Information about the causes of the defect DLL is not required in the existing statistical forms and is derived from different sources.
The solution to this problem is possible by developing specific documentation for institutions with adequate facilities for surgical treatment and the subsequent prosthetic treatment and rehabilitation of patients. Exchange of information is easily accessible thanks to the development of modern technology in any region of the country. The method of statistical accounting of frequency of occurrence of defects justifies a new conceptual framework for the statistical study of pathologies of the maxillofacial localization, the exchange of medical documentation, sources of information and models in the statistical documents for the health authorities. Digital data obtained during the study showed 32,1+2.81 cases per 100 000 population. The highest number of cases was about the tumors of the maxillofacial localization and it was 19.8+3.56 per 100 000 population. Second and third places in causes of defects took traumatic injuries of facial bones and anomalies and malformations which were 4.1+0,96 and 6.2+1,87 per 100 000population respectively.
We have not yet determined significant differences in different age groups and gender characteristics. The largest share according to our clinic tumors amounted to 71.2 percent, and traumatic damages of bones of facial skeleton – 19,4%, anomalies and malformations of 9.4%. We have found that in the age group of 15-19 years defects in the bones of the face as for the anomalies and malformations are often recorded, and in the age group older than 60 years in the tumors.
It should be noted that patients with defects require an individual approach. Surgical intervention differs in nature, scope, and sometimes requires phasing and the like. The choice of treatment (surgical and follow-up orthopedic) depends on the location, extent and volume of the defect that makes impossible precise calculation of work and material resources. And as such in general such payment is required in each case.
According to the different types of defects patients require individual use of dental technology at every stage of orthopedic treatment.
Summing up, I want to invite colleagues orthopedists-dentists. Orthopedists can determine the criteria of complexity of orthopedic treatment taking into account age, sex ratios of expenses for services in each case and to develop criteria for the complexity of the prosthesis. Also you need to create a Protocol on comprehensive care (surgical and orthopedic) patients with defects of facial bones based on the way evidence-based medicine.
Keywords: defects of maxillofacial localization, statistics, planning of complex treatment.
2. Волошина Л.І. Питання вивчення якості життя в клініці ЩЛХ / Л.І. Волошина, І.В. Яценко // Сучасна стоматологія та щелепно-лицева хірургія: матеріали міжнар. наук.-практ. конф.– К., 2012. – С. 358- 360.
3. Волошина Л.И. Состояние вопроса изучения качества жизни в клинике челюстно-лицевой хирургии / Л.И. Волошина, И.В. Бойко // Стоматология славянских государств : материалы VI междунар. научно-практ. конф. – Белгород, 2013. – С.40-42.
4. Кицул И.С. Опыт изучения частоты возникновения травм и ранений, как причин ЧЛД / И.С. Кицул, А.С. Арутюнов, И.Ф. Грачев // Современные управленческие и диагностические технологии в практическом здравоохранении. - Вып.2. – Ир- кутск: РИО ИГИУВа, 2008. – С.87-90.