SOCIAL ASPECTS OF THE INFLUENCE OF COMPLEX DENTAL FOCAL SANITATION ON SPECIFICALLY DEFINED GROUPS

SUMMARY The compex dental focal sanitation is a novel method in dental medicine, which entails specific dental diagnostic and treatment (2). The relationship between focal doctrine from dental origin and systemic disease directs our attention to some unexpected causes. The aim of this study is to observed the opinion of patients about focal dental diagnostic and treatment in order to better organize and improve dental care. 88 patients compromised patients (43 on hemodialysis and 45 with renal transplants) completed tailored survey.


INTRODUCTION
Patients with chronic renal disease (CRD), worldwide and particularly in Bulgaria, progressively increased.The number of people in end stage of renal disease (ESRD) is increasing too, and they require renal replacement therapyhemodialysis or renal transplantation.With development of transplantation medicine these patients hope for better treatment and better quality of life (1,4,5).
At the end of 2009 Faculty of dental medicine -Sofia receives support to realize a project, financed by the Fond of National Science.This project is created and built in the PhD thesis of Dr. Maria Dencheva from FDM-Sofia.The Faculty of Dental Medicine (FDM), Sofia is specialize in the diagnostics and treatment of dental foci from the maxillofacial area of patients with progressive renal deficiency.
Our aim was to record the opinion of the patients about dental treatment and eventual improvement.This was established by the project named, "Optimizing of complex dental focal sanitation by patients on hemodialysis and with renal transplants," supported by the NFS.

MATERIALS AND METHODS
The study builds on the one carried out by Dr.The patients filled in the survey on the day of the first visit after the treating physicians gave a detailed explanation of the project aims.The surveys for patients under 18 were filled in by their parents.

Statistical methods
All analyses were performed using SPSS 17.0.1.The level of statistical significance was P < 0.05.

Main conclusions of survey:
The analysis of the self-assessment of dental health shows that a relatively equal number of patients from the two groups have given a satisfactory or good assessment of their dental health -40% from each group-fig.1.A far smaller number gave an assessment of "very good" -17%.The smallest number gave a very poor self-assessment -4%.According to Dencheva (3) there is a connection between the objective status and subjective assessment of the patients.People have good judgment of their condition and the existence of caries, parodontitis and periodontitis.

Fig.1. Selfassesment of dental health
The majority of participants in the survey have graduated from high school (51%).39% hold university degrees and 10% have basic education.
The attitude to dental health is actually indicative of the patients' motivation to take into consdieration the recommendations for regular and other dental exams.A disconcerting fact is that most patients go to the dentist only when they are experiencing pain and visible changes in the maxillo-facial area-tabl.1 A statistically significant difference between men and women emerges with regard to the first response -ð = 0,048, i.å.men on hemodialysis and transplants almost always go to the dentist when they need urgent help tabl.When asked the patients who directed them to this dental focal sanitation center, the majority of patients (56,8%) answered that they did this willingly, not because their GP doctor (doctor on general practice) recommended it.Most patients learned about the center from other people.
Another important aspect is how how well and detailed the dental practitioners explains the connection between dental focal infections and the negative effect on the entire body, specifically in there is a systemic disease.There is a positive tendency in this direction compared to Dencheva's study of 2010 (where 77,2% of HD patients and 70,6% of transplant patients gave a negative response to the same question).In this study 56% from the patients responded affirmatively, that means that the patients understood and have knowledge how much is important their oral health and they have information concerning connection between oral foci and general health (Fig. 2).This could be due to the project team's active work to realize connections with experts from different medical domain, who can provide detailed information concerning dental health.

Fig. 2.
Another accent was to determine what patients perceive as the best place to get dental treatment.Over half of the participants (52%) believe that hemodialisis (HD) and transplant patients should receive dental care at a specialized treatment center.Such a center is located at the Faculty of dental medicine in Sofia.33% think it is best to get treatment at a private dental clinic, and 15% -at a hospital.
The most frequent dental manipulation that patients underwent under this project was dental cavity obturation (HD-48,9%, and TP-44,2%) tabl.4.But the question is, is it really the most necessary dental treatment, because the preliminary statistical data from the clinical dental examination show that in patients with replaced renal function is 5 times more recommended and necessary to The awareness of financed dental health services by our health Ministry is the first base of which may be required additional health requirements.This study showed that the majority of patients (56%) do not know what the National Health Insurance Fond (NHIF) covers like dental procedures.However the level of knowledge is not different in various patient populations.It appears that female patients are more knowledgeable about the services and treatments that the NHIF covers (ð= 0,043) tabl.5.good oral hygiene and professional dental care.Our study shows that the most common oral hygiene tools for HD and transplant patients are toothbrushes, toothpaste and chewing gum.

Did the medical staff
explain to you the relationship between damaged tooth structures and common diseases?Yes No It is better to visit: Private dental clinic A specific structure in the hospital Specialized center for dental treatment of medically compromised patients What kind of manipulations do you undergo in the dental office most frequently: Tartar cleaning Dental obturation Tooth extraction Treatment of pulpitis and periodontitis Do you know which dental services are covered by the National health insurance fund (NHIF)?Yes No Do you think they are sufficient?Yes No What is your recommendation to increase the scope of dental manipulations, financed by the NHIF: Professional dental cleaning of calculus and debris More frequent dental examinations Other (please describe) What kind of resources for oral hygiene do you use: drops How many times do you brush your teeth?Once Twice 3 times daily I do not brush them every day

2 .
Òàble 2. Compare the opinion between the hemodialysis and transplant groups of patients, divided also by sex, concerning respect to dental health

Òàble 5 .
À comparison between groups on hemodialysis and renal-transplant patients and by sex in relation to the level of knowledge of dental treatments covered by the NHIF Ñomparison between the hemodialysis and transplant groups and by sex with respect to preferred treatment locations.