NHAN XET DAC DIEM LAM SANG VA TINH TRANG BENH VIEM QUANH RANG TAI TRITCTNG CAO DANG Y TE BINH DlTaNG Tran Tuan Anh^, Nguyen Phan Hong An*, Dao Thi Tarn* Vd Truong Nhu- Ngoc**, Nguyen T
Trang 1NHAN XET DAC DIEM LAM SANG VA TINH TRANG BENH VIEM QUANH RANG TAI TRITCTNG CAO DANG Y TE BINH DlTaNG
Tran Tuan Anh^, Nguyen Phan Hong An*, Dao Thi Tarn*
Vd Truong Nhu- Ngoc**, Nguyen Thi Thu Phu-ong**
T O M TAT
Muc tieu: Danh gia dac diem lam sang va tinh
trang benh viem quanh rang tai Tru'dng Cao Dang Y
qua: do sau trung binh tui quanh rang d nam la
3,28mm, nff la 3,19mm, tuoi tff 50 trd len: mffc mat
bam dfnh trung binh vung rang ham la 4,03 mm va
vung rang cya la 3,79 mm Ket luan: do sau trung
giiJa hai gidi nam va nff, tang dan tlieo dp tuoi Dp sau
till quanh rang ham tren va ham dUdl khdng c6 sy
khac biet, mffc mat bam dfnh quanh rang cung tang
dan theo dp tuoi
Tiy khoa: Viem quanh rang, tiii quanh rang, mat
bam dfnh,
S U M M A R Y
EVALUATION OF CLINICAL FEATURES A N D
STATUS OF PERIODONTAL DISEASE AT
B I N H DUONG MEDICAL COLLEGE
Objectives: to assess the clinical features and
status of periodontal disease at Binh Duong Medical
College Method: eross-seetional study Results: The
average periodontal pocket depth of male is 3,28mm
while that of female is 3,19mm, about patients than 50
aged; the average periodontal attachment loss is
4,45mm, the average periodontal attachment loss of
the molar sector is 4,03mm and that of the incisor area
is 3,79mm Conclusion: the average periodontal
pocket depth of the patient is equivalent between the
male and the female and it also increase on age range
There is no difference between the average depth at
attachment loss increase gradually together with the
age range
Keywords: periodontal disease, periodontal pocket,
I D A T VAN OE
Viem quanh rang la benh phd bien trong eac
benh rang ham mat Benh gap d mpi lya tuoi,
mpi qudc gia tren the gidi, chiem ti le cao trong
cpng ddng va mang tfnh chat xa hdi Benh khdng
* Cao dang YTeBinhL
** Vien Dao tao RHM - DH Y HN
chi gay ton thffdng tai eho ma cdn anh hffdng den sffc khoe toan than va tham my ciia benh nhan Nam 1986, WHO xep benh quanh rang la hiem hoa thff 3 cua loai ngydi sau cae benh ung thff, tim mach Tai Hoa ky, nghien ciTu ciia Walter va cpng s y da cho thay ty le viem quanh rang trong cpng ddng la 2 5 - 4 1 % [ l ] Tai Viet Nam, qua dieu tra benh quanh rang d eac tfnh phfa Nam va thanh phd Hd chf Minh, Nguyen Can
va CS cho thay t i le viem ldi d tudi tff 15-19 la 97,7%, tff 20-29 la 8 8 , 7 % [ 2 ] , [ 3 ] Benh viing quanh rang ed hai benh phd bien la viem ldi va viem quanh rang Viem quanh rang neu khong dieu tri kip thdi cd the gay mat rang hang loat Hien nay tai Binh Dffdng chffa cd nhieu nghien cffu ve van de nay, do vay chiing tdi tien hanh nghien cffu de tai nay nham muc tieu md ta dac diem lam sang va tinh trang benh viem quanh rang tai trffdng Cao Gang y te Binh Dffdng
II DOI TU'ONG VA PHU'ONG PHAP NGHIEN COXJ
2 1 Ddi tu'dng nghien cuTu: Nghien cffu
dffde thyc hien tren benh nhan den kham va dieu trj tai Bp mdn Rang Ham Mat Trydng Cao
dang y te Binh Dydng, Tieu chuan iita chpn: hdp tac nghien c y u Tieu chuan ioai trit:
nhffng ngydi dang ed benh toan than tien trien; nhffng ngffdi khdng ha to mieng dffdc; nhtitig ngffdi khdng hdp tac
2 2 Dja d i e m nghien cu'u: Bd mdn Rang
Ham Mat -Trffdng Cao Oang Y Te Binh Dffdng
2 3 Thdi gian nghien cu'u: Tff thang
07-2013 den thang 11-07-2013
- Phu'dng p h a p nghien cu'u: Md ta cat ngang
- Cd mau nghien cii'u: J\\QQ cdng thffc tinh c9
m a u ; n = Z ' , , ^
Chimg tdi tfnh dffdc cd mau nghien cffu cho moi nhdm la 71 ngffdi, thffc te chung tdi tien hanh nghien c y u d 101 benh nhan
- Phu'dng tien nghien cthj: ghe, may nha
khoa, bd dyng cu kham rang mieng thong thydng gdm; khay, gffdng gap, tham cham, cay
Trang 2tham dd quanh rang cam tay, may lay cao rang
sieu am
- Dao dffc nghien cffu: Giai thfch rd cho ddi
tffdng nghien cffu ve muc dich nghien cffu, trach
nhiem cua ngu'di nghien cffu, trach nhiem va
quyen ldi ciia ngffdi tham gia nghien cffu Nghien
cii^j chi tien hanh tren nhffng ddi tu'png tff
nguyen tham gia nghien cffu va tren tinh than
hdp tae, khdng ep budc Toan bd thdng tin thu
thap chi phuc vu muc dfch nghien cffu ma khdng
phuc vu bat cff muc dich nao khac
III Kir QuA NGHIEN cCru
3.1 D3c diem chung cua doi tu'dng
nghien cu'u
Nghien cffu dffdc thffc hien tren 101 benh
nhan, trong do nff cd 58 ngffdi chien ty le
57,4%, nam cd 43 benh nhan chiem 42,6% Giffa
cac nhom tuoi, phan bo ty le nam va nff la tffdng
dffdng Tudi benh nhan thap nhat la 18, cao nhat
la 65 Sd benh nhan tff < 34 tudi chiem ty le eao nhat la 51,5%, sau dd den nhdm tff 35 den 49 tuoi chiem 36,6% Nhdm benh nhan cao tudi, tren 50, chi chiem 11,9% Phan bo ty le benh nhan giffa cac nhdm tudi khac biet cd y nghia thdng ke vdi vdi p < 0,001
Trong cac ly do den kham ciia benh nhan viem quanh rang, hay gap nhat la ehay mau Ipi, ehiem 41,6%, sau dd den dau rang 27,7% Rat ft gap cac benh nhan di kham kiem tra dinh ky (7,9%), hdi mieng cd 6 trffdng hdp chiem 6,9%, lung lay rang cd 11 trffdng hdp chiem ty le 10,9%, cac ly do khac cd 5 trffdng hdp chiem t/
le 5,0%
3.2 Dac dlem lam sang cua b$nh VQR trong nghien cu'u
3.2.1 Do sau tui quanh rSng
Bang 3.1, Do sau tui quanh rang (TQR) theo nhom tuoi
Nhim tuoi
<34 tuoi
35 -» 49 tuoi
> 50 tuoi
Tong
N
52
37
12
101
1<I le %
51,5 36,6 11,9 100,0
06 sau TQR mm ( X ±SD)
3,13 ± 0,83 3,29 ± 1,20 3,51 ± 1,38 3,23 ± 1,09
P
<0,01
Nh$nx4t:DQ sau tui quanh rang trung binh eiia cac benh nhan trong nhdm nghien cffu la 3,23±1,09
mm Op sau tiii quanh rang khae nhau giffa cae nhdm tuoi, tud'i eang cao dp sau tiii quanh rang cang Idn, sff khac biet nay cd y nghTa thdng ke giffa cac nhdm tudi Khi phan tfch theo gidi, dp sau tiii quanh rSng trung binh d nam la 3,28 ± 1,03mm, nff la 3,19 ± 1,13mm, sff khae biet nay khdng cd y nghia thong ke vdi p > 0,05
Bang 3.2.06 sau tui quanh ranq qiu'a ranq ham tren va rang ham dudi
Nhom tuoi
<34 tuoi
35^49 tuoi
i 50 tuoi
Tdng
P
Ham tren
So rang
525
382
120
1027
eg sau TQR mm(X±SD) 3,09 ± 1,22 3,21 ± 0,85 3,36 ± 1,37 3,17 ± 1,15
Ham du'di
So rang
625
455
133
1213
Do sau TQR mm(X±SD) 3,19 ± 1,18 3,34 ± 0,82 3,55 ± 1,39 3,29 ± 1,06
>0,05
Ca ha! ham
So rang
1150
837
253
2240
Do sau TQR mm(X±SD) 3,13 ± 0,83 3,29 ± 1,20 3,51 ± 1,38 3,23 ± 1,09
< 0,001
Nh$n xit: Khdng cd sff khac nhau ve dp sau tui quanh rang giffa 2 nhdm rang ham tren va ham
dffdi Tren tffng ham rSng: dp sau tui quanh rang tang dan theo cac nhdm tudi, cang nhieu tuoi thi dp sau till quanh r3ng cang tang Sff khac biet cd y nghia thdng ke vdi p<0,001 Op sau tiii quanh rang trung binh rSng ham dffdi cao hdn ham tren xet rieng d tffng nhdm tudi Cp<0,001)
Trang 33.2.2 Mat bam dinh quanh rang
Bang3.3 Mat bam dfnh theo nhdm tudi
Nhom tuoi
<34 tuoi
35 ^ 49 tuoi
> 50 tuoi
To'ng
N
52
37
12
101
Mat bam dinh (mm) (X±SD)
3,69±1,39 4,10±1,95 4,45±1,90 3,93±1,70
P
<0,01
Nhan xet: Mifc mat bam dfnh quanh rang khac nhau giffa cac nhdm tud'i, tud'i cang cao thi myc mat
bam dfnh quanh rang eang Idn, Sy khac biet ed y nghia thdng ke vdi p<0,01 Chenh lech myc mat bam dfnh trung binh giffa nhdm tudi tren 50 va nhdm dffdi 35 tudi la 0,76mm Mffc mat bam dinh quanh rang trung binh ciia eae benh nhan trong nhdm nghien cffu la 3,93 ± 1,70 mm Theo gidi, mat
bam dfnh trung binh d nam la 4,11 ± 1,55mm, d nff la 3,90 ± 1,92mm, sff khac biet nay khong coy
nghTa thdng ke
Bang 3.4 Mii'c mat bam dinh (MBD) d ham tren va ham difdi
Nh6m tuoi
<34 tuoi
35->49 tuoi
> 50 tuoi
Tonq
P
Ham tren
So
rang
524
369
121
1014
MBD mm (X±SD) 3,65±1,42 4,01±2,01 4,39±1,94 3,87±1,72
Ham du'di
So rang
605
457
141
1203
l»lEDmm (X±SD) 3,72±1,37 4,17±2,08 4,47±1,87 3,98±1,83
>0,05
Ca hai ham
So ranq
1129
826
262
2217
MBD mm {X±SD)
3,69±1,39 4,10±1,95 4,45±1,90 3,93±1,70
< 0,001
Nhan xet: Khac biet mat bam dfnh giffa rang ham tren va dffdi khac biet khdng co y nghTaJthong ke,
Tren tffng ham rang: mffc mat bam dinh quanh rang tang dan theo cae nhdm tuoi, cang nhieu tuoi thi mffc mat bam dfnh quanh rang cang tang Mffe mat bam dfnh quanh rang trung binh rang ham dffdi cao hdn ham tren xet rieng d tffng nhdm tudi (p<0,001)
3,2.3, Cac dac
Ban
Nhom tuoi
<34 tuoi
35-> 49 tuoi
> 50 tuoi
Tong
P
diem lam sang khac va sir lien quan vdi do sau tui quanh rang
ff J,5, Do sau tui quanh rang va mu'c mat bam dinh theo nhom tuoi
06 sau tui quanh xang (mm)
So' rang
1151
835
254
2240
X ±SD
3,13 ± 0,83
3,29 ± 1,20
3,51 ± 1,38 3,23 ± 1,09
Mi^c MBD (mm)
56 rang
1129
826
262
2217
X ±SD
3,69±1,39 4,10±1,95 4,45±1,90 3,93±1,70
< 0,001
Nhan xet: Do sau trung binh tui quanh rang ty le thuan vcfi mii'c mat bam di'nh quang rang va tang
dan theo cac lihom tuoi Si/ l<hac biet co y nghia tlnong ke vdi p<0,001 Xet tren tCrng nhom tuoi, mu'c rang la tu'dng du'dng tren ca nhom nghien ciru
Bang 3.6 Do sau tui quanh rang vdi chi so OHI-S va chi so GI
Nhom tuoi
35-> 49 tuoi
> 50 tuoi
TQR (mm)
X ± S D
3,13 ± 0,83
3,29 ± 1,20
3,51 ± 1,38
JOHI-S
X ± S D
2,90 ± 0,73
3,00 ± 0,63
-GI
X ± S D
1,80 ± 0,78
2,25 ±0,91
2,55 ± 1,04 Tong I 3,23 ±1,09 I 2,59 ± 0,95 \ 1,95 ± 0,79
Nhan xet: Chi so ldi GI va chi so ve sinh rang mieng OHI-S tang theo nhom tuoi va dp sau trung binh
tiii quanh rang Benh nhan co chi so ldi va chi so ve sinh rang mieng l<em thi co dp sau till quanh rSng
Trang 4IV BAN LUAN
4 1 Bac diem chung cua doi tu'dng
nghien cu'u
Sd benh nhan nam va benh nhan nff trong
nghien ciTu la tu'dng dffdng nhau De viee danh
gia eae dae diem iam sang, can lam sang va dieu
trj eua eae ddi tffdng nghien cffu dffde toan dien,
thuan \di eho viec so sanh vdi eae nghien cffu
khac, trong nghien cffu nay chung tdi chia cae
benh nhan thanh 3 nhdm tud'i: 18-34 tuoi, 35
den 49 tudi va nhdm cac benh nhan cao tuoi
(tren 50 tudi) Banh gia cac benh nhan theo eac
nhom tudi, benh nhan < 34 tudi chiem ty le cao
nhat la 51,5%, nhdm tff 35-49 tuoi gap 36,6%,
thap nhat la nhdm benh nhan tren 50, ehiem
11,9% Chung tdi gap benh nhan tre nhat la 18
tudi, cao nhat la 65 tudi Tud'i trung binh ciia cac
benh nhan la 34,9 ± 11,3 Phan bd ty le benh
nhan giffa cac nhdm tud'i khac biet cd y nghTa
thdng ke vdi vdi p < 0,001
Ve ty le benh nhan theo cac nhdm tudi, trong
nghien cffu ciia Le Thj Hang, nhdm benh nhan
trung nien (30-49 tuoi) gap vdi b/ le cao nhat
52%, nhdm tre tudi (<3Q tudi) gap 19% [ 4 ]
Nghien cffu eua Nguyen Thj Thanh Thuy nhan
thay da so benh nhan bj tieu xffdng trong benh
viem quanh rang d Iffa tudi tff 35-54, ehiem 80%
[5] Nam 1990, Green nghien cffu ty le viem
quanh rang d Y cho biet ty le mac benh d Iffa
tudi 3 5 - 5 5 la 65,8% [ 6 ]
4.2 f)$c diem lam sang do! tu'dng
nghien cu'u
4.2.1 Dp sau tui quanh rang
Theo ket qua cho thay do sau trung binh tui
quanh rang t§ng dan theo Iffa tudi Sff khac biet
ve dp sau tui quanh rang trung binh d cac Iffa
tuoi nay la cd y nghTa thdng ke (p < 0,001) Oen
dp tudi tff 50 trd len, dp sau trung binh tui quanh
rSng trung binh !a 3,51mm Op sau trung binh tiii
quanh rSng giffa nam va nff la tffdng dffdng
nhau, nhy the co the ndi dp sau tui quanh rang
khong lien quan den gidi ti'nh Op sau trung binh
tui quanh r3ng d viing rSng cffa la 3,11 mm thap
hdn cd y nghia so vdi viing rang ham la 3,32 mm
vdi p < 0,001 Oieu nay chffng td dp sau trung
binh tui quanh rang d viing rang ham Idn hdn
vung r3ng cffa
till quanh rang giffa cae rang d ham tren va cac rang d ham dffdi thi khdng thay cd sff khac biet (p>0,05) Bang 3.8 cho thay dd sau trung binh tiii quanh rang d cac rang ham tren la 3,17 mm
va d cae rang ham du'di la 3,29 mm Nhu' vay, dp sau till quanh rang d ham tren va ham dffdi la tu'dng dffdng nhau Tren tffng ham rang, dp sau tui quanh rang tang dan theo cac nhdm tuoi, eang nhieu tudi thi dd sau tui quanh rang eang tang Cd nghTa la sy tien trien eiia benh nang dan eung vdi sy gia tang ciia tudi tac
4.2.2 i^at bam dinh quanh rang
Ve myc mat bam dfnh quanh rang, ket qua d bang 3,9 cho thay cd s y khac biet rd ret ve myc mat bam dfnh d cac nhdm tuoi, nhdm tudi cang eao thi mffc mat bam dfnh eang Idn Oen dp tudi
t y 50 trd ien, mye mat bam dfnh quanh rang trung binh la 4,45mm Nhff vay mffc mat bam dfnh quanh rang eung ed xu hffdng tang dan theo dp tudi Ket qua ciia chung tdi kha phii hdp nghien cffu cua tac gia Le Thi Hang [ 4 ] Oanh gia ve mffc mat bam dfnh quanh rang theo gidi, ket qua d bang 3.12, cho thay mffc mat bam dfnh quanh rang trung binh cac benh nhan nam la 4,11mm eao hdn so vdi d benh nhan nff la 3,90mm Khdng thay cd sff khac biet
ve mffe mat bam dfnh quanh rang giffa hai gidi nam va nff vdi p > 0,05, Mffe mat bam dfnh trung binh viing rang ham la 4,03 mm va viing rang cffa la 3,79 mm Nhff vay, mffc mat bam dfnh trung binh d viing rang ham cao hdn viing rang cffa, Cung tffdng tff nhy tydng quan giffa
dp sau trung binh tiii quanh rang d rang ham va rang eya, ehiing tdi thiet nghT cung ed the do dac diem ve chye nang cung nhff vi trf ciia eae viing rang cd khac nhau, Viing rang ham cae rang chju Iffc nhai manh hdn, ben canh dd rang ham cijng
d vi tri khd quan sat ve sinh rang mieng hdn va lai gan ndi do ciia dng tuyen nffdc bpt nen de phat sinh mang bam rang, cao rang la nhffng yeu
t d thuan ldi cho sff phat trien eiia benh ly quanh rang Ket qua ciia chung tdi eiing tffdng tff nhy trong nghien eyu eiia Le Thi Hang [ 4 ] Khi so sanh myc mat bam dfnh quanh rang giffa rang ham tren va ham dffdi, ket qua d bang 3,6 eiing cho thay khdng cd sy khac biet ve mffc mat bam dfnh trung binh giffa cac rang d ham
Trang 5trung binh rang ham tren la 3,87 mm va rang
ham dffdi la 3,98 mm, Oanh gia tren tffng ham
rang, mffc mat bam dinh quanh rang tang dan
theo cac nhdm tuoi, cang nhieu tudi thi mffc mat
bam dfnh quanh rang cang tang
4.2.3 Do sau tui quanh rang va mii'c
mat bam dinh quanh rang
Ket qua d bang 3.5 cho thay moi lien quan
cua dp sau tiii quanh rang vdi mffc mat bam dinh
quanh rang Op sau tiii quanh rang cang Idn thi
mffe mat bam dinh cang cao Oen dp tuoi tff 50
trd len, dp sau trung binh tiii quanh rang la 3,51
mm, mat bam di'nh la 4,45 m m Nhff vay, dp sau
tui quanh rang ty le thuan vdi mffc mat bam dfnh
quanh rang va thffdng mffc mat bam dfnh quanh
rang Idn hdn dp sau till quanh rang Sff khac biet
nay la cd y nghTa thdng ke (p < 0,001) Dieu dd
cd nghTa la nhffng rang bj viem quanh rang
thffdng cd ed mdt khoang co ldi, gay hd cd, chan
rang va cd the se gay dau budt eho benh nhan
hoac gay nen mdt sd nhffng bien chffng khac.Xet
tren tffng nhdm tudi, nghien cyu cho thay mffc
mat bam dinh quanh rang cao hdn dp sau tiii
quanh rang, khac biet cd y nghTa thdng ke vdi
p<0,001 Ket qua ciia chiing tdi phii hdp vdi
nghien cffu cua Le Thj Hang [4] va ciia Nguyen
Manh Chien [ 7 ]
4.2.4 T&dng quan giO'a do sau ttii
quanh rang vdi chi sd ldi (GI) va chi sd ve
sinh rang mieng ddn gian (OHI-S):
Ket qua d bang 3.6 cho thay tffdng quan ty
le thuan eua dp sau tiii quanh rang vdi cae chi sd
ldi (GI) va chi sd ve sinh rang mieng ddn gian
(OHI-S) cung nhy vdi sff gia tang cua dp tud'i
benh nhan Sff khac biet cd y nghTa thdng ke vdi
p<0,001
Dieu nay chffng td rang nhffng benh nhan ve
sinh rang mieng eang kem thi tinh trang viem ldi
cang nang eung nhff dp sau trung binh TQR cang
cao Tinh trang benh viem quanh rang cting tien
trien ciing vdi sff gia tang cua do tudi Tyc la gia
tri cua cac chi sd nay cd sff lien quan chat che vdi
n h a u ( p < 0 , 0 1 )
V KET L U A N Qua nghien cffu tren 101 benh nhan viem quanh rang, danh gia ket qua dieu tri bffdc dau benh viem quanh rang, chung tdi rut ra nhffng ket luan sau:Viem quanh rang !a mdt benh nhiem khuan man tinh, ty le benh khdng Hen quan den gidi tfnh Benh nhan den kham benh chii yeu bdl cac ly do nhff chay mau chan rang, dau rang, rang lung lay, hdi mieng Op sau trung binh tui quanh rang cua cac benh nhan la 3,23mm, tffdng dffdng giffa hai gidi nam va nff va tang dan theo
do tuoi Op sau till quanh rang viing ham tren va ham dffdi khdng cd sff khac biet Mffc mat bam dfnh quanh rang: cung tang dan theo dp tuoi, mat bam dfnh viing rang ham Idn hdn viing rang cffa; mat bam dfnh tffdng dffdng giuS hai gicfi nam va nff, giffa ham tren va ham dffdi
TAI UEU T H A M K H A O
1 W a l t e r T , Wilson (1980), "Periodontics for the
dental hygienist" Lea andFebiger, Philadenlphia
1980
2 N g u y i n Can (1994), "Benh nha chu 6 cac tinh phia Nam Viet Nam va thanh phd Ho Chi Minh, Nhffng nguyen nhan chii yeu, ke hoach dieu tn va
dy phong chii yeu", Ky yiu cong trinh nghiin khoa hpc 1994, Tai lieu hgi nghi nha khoa quoc te
41-45
3 Nguyen Van Cat (1977), 'To chye hpc vung
quanh rang", SGKRHMtap I, tr 90-110
4 Le Thj Hang (2008), "Nhan xet d|c diem lam sang va ket qua dieu trj bu'dc dau benh viem
quanh rang tai Vien rang ham mat Qudc gia", lu$n van tot nghiep thac sy y bpc, TrUdng dai hoc
Rang ham mat, Ha noi,
5 Nguyen Thj Thanh Thuy, (2004), "Nhan x^ hinh anh tieu xu'Ong d rang tren phim Xquang ky
thuat so d benh nhan viem quanh r5ng", luan vin tot nghiep thacsyyhpc, TrUdng dai hpc Y Ha npi
6 Green J.C (1990), "General phndple of epidemiology and methods for measuring prevalence and severity periodontal disease",
Contemporary periodontics, pp.97-105
7 Nguyen Manh Chien, (2008), "Nhan xet dSc diem lam sang va ket qua dieu tri b?nh viern quanh rang bang phuang phap nao tiii ldi tai benh vien Rang Ham Mat qudc gia Viet Nam nSm
2008", luan van tdt nghiep thac sy y hpc, Trffdng
dai hoc Rang ham mat Ha Ndi