Articol Ilea

COMORBIDITIES PREVALENCE IN SOCIALLY ASSISTED PATIENTS IN THE SANODENTAPRIM PROGRAMME

Aranka Ilea1*, Dan Buhăsel2, Minodora Moga3, Claudia Feurdean4, Anca Ionel5, Arin Sava6, Ondine Lucaciu7, Adina Sârbu8, Radu Septimiu Câmpian9

1MD, DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

2DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

3DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

4DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

5DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

6DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

7DMD, Lecturer at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

8DMD, Assistant Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

9DMD, MD, Professor at Oral Rehabilitation, Oral Health and Management of Dental Office Department , Head of Oral Rehabilitation, Oral Health and Management of Dental Office Department, Dean of Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania

*Correspondent author: Ilea Aranka, Oral Rehabilitation, Oral Health and Management of Dental Office Department , Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8, Victor Babeş st., CJ-400012 Cluj-Napoca, Romania. Tel: 0746151210; Fax: 0040-0264596291; E-mail: arankailea@yahoo.com, cseh.aranka@umfcluj.ro

 

Rezumat

Introducere

       Având în vedere că odată cu creşterea speranţei de viaţă a populaţiei la nivel global , dar şi din România, pacienţii din cabinetele de medicină dentară suferă adesea de diverse boli asociate pentru care se află sub medicaţie cronică. Obiectivele studiului au fost să evalueze prevalenţa bolilor asociate şi medicaţia cronică urmată, la un lot de pacienţi asistaţi social.

 Material si metodă

        La sudiu au participat un număr de1176 de pacienţi asistaţi social din programul SANODENTAPRIM în perioada 15 aprilie 2010 – 1 decembrie 2010. S-au studiat foile de observație, biletele și adeverințele medicale de la medicul de familie sau medicul specialist curant.

Rezultate

       Pacienţii din lotul luat în studiu au prezentat o prevalenţă a comorbidităţilor de 92%. Cele mai frecvente afecţiuni asociate au fost cele cardiovasculare (36%). Un procent de 84% dintre  pacienţii luaţi în studiu erau sub medicaţie cronică.

Concluzii

   Riscurile pacientului cu afecțiuni generale trebuie evaluate după o anamneză minuțioasă coroborată cu examinările paraclinice, iar la nevoie colaborarea cu medicul curant.  Efectele secundare ale medicaţiei cronice necesită o atenție deosebită ,cu atât mai mult cu cât unele clase de medicamente  interferează cu tratamentele stomatologice.

Cuvinte cheie: afecţiuni asociate, comorbidităţi, medicaţie cronică, prevalenţa, asistat social

 

Abstract

Introduction

       Considering that once with the growth of population’s life expectancy on the world’s level but also in Romania, the patients in dental office often suffer from associate diseases for which they are under chronic medication. The objectives of the study were to evaluate the prevalence of the associate diseases and chronic medication for a group of socially assisted patients.

 Material and method 

        In this study were involved a number of 1176 socially assisted patients from the SANODENTAPRIM programme during the period from 15 April, 2010 to 1 December, 2010. There were studied the observation files, medical notes and certifications from the general practioner or from the attending specialist doctor.

Results

       The patients from the studied group presented a prevalence of comorbidities of 92%. The most frequent associate diseases were the cardiovascular ones (36%). A percentage of 84% from the studied patients were under chronic medication.

Conclusions

       The risks of the patient with general disease have to be evaluated according to a detailed anamnesis corroborated with paraclinical examinations and if needed, to the collaboration with the attending doctor. The adverse effects of the chronic medications need a special attention, especially when certain classes of medicines interfere with dental treatments.

Keywords: associate diseases, chronic medication, prevalence, socially assisted

Introduction

       The relationship between the general diseases and the pathology of the stomatognathic system are multiple and in both directions. The oral health has consequences upon the general health and it is well known the correlation between the dental foci and the cardiovascular diseases or, recently, between the parodontal disease and cardiovascular disease [1]. The gravity of the parodontal disease together with the high value of the reactive C protein with high sensitivity (hPCR) could be predictive for the imminence of installation of an acute cardiovascular accident [2]. Also the general diseases have an echo upon the oral health. General condition could have oral manifestation and could influence the evolution, the manifestations and the responses to the therapy instituted in the oro-maxillo-facial diseases. In the study realized by Anders Holmlund, Gunnar Holm and Lars Lind it is shown that the life expectancy is related to the number of teeth on the dental arcades, the mortality to a cardiovascular disease growing to the patients with less than 10 dental units remaining [3].

       Knowing the general diseases of the patient is crucial also for the dentist. The decision of the opportunity, of the time of intervention, the specific preparation and the type of applied treatment depends on the presence or lack of associate diseases, the degree of metabolic, functional compensation or on the patient’s hemodynamic balance. In this sense it is important to evaluate the prevalence of the associate diseases for the patients who accessing the services of dental medicine. These data are very important especially if we refer to  put in relation this information with social aspects.

       SANODENTAPRIM is a program for socially disadvantaged patients (retired with incomes below 1000 RON, retired due to illness, the unemployed, patients with disabilities, people with varying degrees of disability that requires a registered nurse) and runs through the partnership between the Town Hall of Cluj-Napoca and Faculty of Dentistry of the University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca. Under this program, patients benefit from free dental care.

           Considering that the data concerning the prevalence of the general diseases in Romania are very few and incomplete, the authors proposed to evaluate this aspect for a group of socially assisted patients who accessed the SANODENTAPRIM programme. The prevalence represents the frequency of the disease cases (new and old) existing in a population defined at a certain moment – the actual prevalence – or during a certain period – the periodic prevalence. The prevalence is a specific indicator of the study of morbidity by chronic diseases. In the case of prevalence, the observation unit is the new and old case of disease. 

      The need of oral rehabilitation is different from one patient to another and it is determined by the gravity of the dental/parodontal diseases and the diseases from the oro-maxillo-facial area. The socially assisted patient has low revenues and this is the reason why they are accessed the services of dental medicine in the private system in so small proportion or even void. The social insurance system in Romania concerning the dental medicine has low budget, each insured patient having the amount of about 3 RON per year. This social programme SANODENTAPRIM offers the possibility for these social disadvantaged groups to access free the services of dental medicine . The primary prevention and the early interception of these diseases of the stomatognathic system may reduce the need of complex oral rehabilitation.

 Objectives

  1. Assessing the prevalence of comorbidities to the socially disadvantaged patients who accessed the SANODENTAPRIM programme between April 15, 2010 and December 1, 2010.
  2. Evaluate the types and classes of chronic medicines used by these patients.

Material and method

           The retrospective study of the prevalence of associate diseases was made upon a number of 1176 patients having accessed the SANODENTAPRIM programme during the period of April 15, 2010 – December 1, 2010. There have been studied the observation files, the medical notes and certifications from the family doctor or from the attending doctor. These files were completed after the anamnesis, clinical and paraclinical examinations of the patients by the dentists, specialist doctors or students during the stages at Oral Rehabilitation Department.

Results

         From the group of 1176 patients, the women accounted for 59% as can be seen in fig. no.1. The age histogram shows that the majority of patients had ages between 60 and 65 years as can be noticed in fig.no.2. The actual prevalence of the associate diseases in the study group was high and accounted for 92% as shown in fig. no. 3. The specific prevalence on different types of affections is represented in figure no. 4. The most frequent comorbidities were those of the cardiovascular system (36%), some of the patients presenting two or more associate diseases. Cardiovascular diseases were followed by liver diseases with a prevalence of 12%. From the cardiovascular diseases, the most prevalent was the High Blood Pressure (HBP) (69%) as can see in fig. no. 5. Similar prevalence within the hepatic diseases was represented by the viral hepatitis type A (19%) and type B (18%) as can see in fig. no. 6. Among the most frequent drugs allergy were the antibiotics allergy (41%) followed by anesthetic drugs allergy (18%) as can see in fig. no.7. The Diabetes Mellitus type 2 was the most frequent (63%) according to the average age of the study group as can noticed in fig. no. 8. The most frequent endocrine disorders were represented by hypothyroidism (30%) followed very closely by hyperthyroidism disorders (29%) as it shown in fig.no.9. Hypoacuses (38%) was the most common ORL illness, but 19% of the patients from the study group suffered from infectios ORL diseases like chronic otitis, chronic rhinitis or nasal sinusitis, as can be seen in fig. no.10. The nephrolithiasis (47%) was the most frequent kidney disorder, but 5% of the patients had chronic kidney failure as it shown in fig.no.11. Among the respiratory disorders, the most frequent was the asthma (63%), but 37% of the patients reported pulmonary tuberculosis in their medical history, as can be noticed in fig. no.12. Among the neurologic disorders the most frequent one was the epilepsy (72%), but 20% of the patients had strokes in their medical history as can be seen in fig. no.13.

          From the 1176 patients, a percentage of 84% were under chronic medication for the actual disorders  as can see in fig. no.14. From the most frequent drugs used by patients, almost half of them were represented by ß-blockers and diuretics as it shown in fig. no.15.

Discussions

      From the 1176 patients, most of them were female entities, that shows a better compliance of women to dental treatments and a higher interest for the oral health. Most of the patients were aged between 56 and 65. The actual prevalence of comorbidities was great (92%) because in the study group the majority were elders. The number of the associate diseases was of 1593, passing over the number of patients in the study group, which shows that certain patients had one or more associate comorbidities.

       The specific prevalence on different disorders showed that among the heart diseases, HBP represented the greatest weight (24.84%) compared to the coronary heart disease, of which prevalence was of 3.96% or to the chronic cardiac failure with 2.16%. The HBP prevalence in Latin America, India and China was between 52.6% and 79.8 % in urban society and between 42.6% and 56.9% in rural society [4]. The prevalence of cardiac failure in Eastern areas of Africa was of 41%, and the coronaries heart disease in Latin America was of 69% and in North Africa of 75% [5]. Our results are lower than studies referred to above, probably due to the smaller size of our sample.

     The prevalence of the hepatic disorders was of 12% from which 2.16% were infections with Viral Hepatitis C (VHC) and 1.92% with Viral Hepatitis B (VHB). Our study shows values lower than those of the Chinese researchers. The prevalence of infection with VHB in China is approximated to 10% on the general population level and of 3.2% for VHC [6].

     The prevalence of Diabetes Mellitus was of 9%. These results are at about half way from the data of the New Zeeland. The prevalence of Diabetes Mellitus in the New Zeeland is of 20.9% and the study was conducted on 53911 adult patients [7].

     The prevalence of respiratory disorders was of 6% from which 3.78% were represented by the asthma. The registered data among the Italian population shows values almost twice bigger. The prevalence of the asthma among the Italian population in 2010 was of 6.6% [8].

     The prevalence of neurologic disorders was of 2% from which 1.44% was represented by epilepsies. The values obtained are almost two times higher as the valued reported among the Turkish population.The prevalence of epilepsy in Turkey was reported between 0.08/1000 inhabitants to 8.5/1000 inhabitants, in the Arabian countries it was of 0.9/1000, and in Sudan of 6.5/1000 inhabitants [9].

     The discrepancies of the data obtained compared to the scientific literature may be assigned to the following factors:

-the size of the study sample much smaller (even 53 times smaller than some studies)

-not all the patients presented medical certifications to attest the associate disorders

-the patient’s omission to declare certain associated conditions (either intentionally or no intention)

-the limited experience of the students and resident doctors in collecting the data.

        From the 1176 patients, percentage of 84% were under chronic medication, which supposes additional risks for these patients in the dental office due to the adverse events of these drugs and to the interference with dental treatments. The medication with ß-blockers, diuretics and converting enzyme inhibitors accounted for 60%. Chronic anticoagulant therapy require specific training of the patient in order to achieve the bleeding treatment in conjunction with the attending doctor.

Conclusions

  1. The prevalence of comorbidities was high (92%) among the patients from the SANODENTAPRIM programme.
  2. The specific prevalence on disorders was smaller than the data from the scientific literature due to the size of the study group and to the way of data collecting.
  3. The adverse events of the chronic medication need a special attention especially if certain classes of drugs interfere with dental treatments.
  4. The risks of the patient with general disorders have to be evaluated after a detailed anamnesis corroborated with paraclinical examinations and if needed, with the cooperation of the attending doctor.
  5. The risks of the patient with comorbidities in the dental office are determined by functional, metabolic and hemodynamic imbalances.
  6. The need of specific training of the patient with comorbidities in order to perform bleeding treatments for remove the dental foci or perform other treatments.

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