MAJOR DENTAL DISEASES IN GEORGIA AND MODERN APPROACHES TO PREVENTION
According to Georgian doctors dental caries and periodontal infections are the most common somatic microbial diseases in the adult population, and are due to etiological causes and other factors. Mamuka (Vladimer) Margvelashvili, PhD in Medicine and Head of the Department of Dental and Face and Jaw Surgery at the TSU Faculty of Medicine, supervised research on these issues in 2013-14. The study was carried out with Manana Kalandadze, PhD in Medicine, Associate Professor of the Department, and with Lela Tsitaishvili, PhD in Medicine. Their results showed that high epidemic indicators of the key dental diseases, coupled with negligence, contribute to a number of socio-medical and economic issues. This health crisis is reflected in the frequency of medical interventions and by the impact of disease on those who are affected. For these reasons it is vitally important to assess these indicators.
The main objective of this research was to assess the frequency and extent of dental disease in Georgia’s adult population. The study took into account climatic and geographic factors, socioeconomic conditions, hygienic and behavioural factors as well as medical, biological and other factors, with the aim of establishing modern prophylactic approaches. The researchers noted that studies on epidemiological indicators had not been updated in over 25 years. Such data would contribute to prevention. When there is a significant destruction of tooth tissues, chewing is painful and thus weakened, causing unmasticated food to enter and damage the gastrointestinal tract. This leads to irreversible transformations in gastric and intestinal mucosa. Sharp edges of decayed teeth damage the mucous membrane of soft mouth tissue. Several diseases may ensue, including gingivitis-the inflammation of the gums; glossitis-an inflammatory disease of the tongue caused by a bacterial or viral infection; stomatitis-an inflammatory disease of the oral mucosa and many other diseases. Worsening caries produce various bacterial and inflammatory diseases which can even damage the skin, the heart, eyes, lungs, kidneys and joints.
The team assessed 2370 adult men and women, who were divided into four age groups: 20-34, 35-44, 45-64 and 65-74. The project covered ten areas of Georgia: the regions of Mtskheta-Mtianti, Guria, Samtskhe-Javakheti, Shida Kartli, Adjara, Kakheti, Samegrelo, Kvemo Kartli, Imereti and the capital, Tbilisi.
Results indicate that tooth decay reaches epidemic proportions in Georgia – up to 96-100%. Decay frequency in men and women averages 11,53±7,69 in all areas studied, yet the number of tooth fillings is very low, which indicates attitudes towards dental services – especially towards restorative treatment—are negative. Unfortunately, in all regions studied, taking care of one’s dental health is not considered a priority. This indicator reveals that most of those who make dental appointments do so either to have a tooth extracted or to receive dental treatment very late, when it is impossible to treat or restore teeth and gums. Regions such as Samtskhe-Javakheti, Imereti and Samegrelo had the worst results. Most people living in these regions (79.1%, 78.0 % and 71.4% respectively) have had no appointments at all, although the reasons for this varied from region to region. In Mtskheta (50.3%), Samtskhe-Javakheti (49.2%), and Imereti (55.3%) the reason given was mainly financial, while in Kvemo Kartli (58.3%), Tbilisi (57.2%) and Shida Kartli (56.1%) the dominant reason was attitudinal – failure to see any need for dental treatment except in emergency cases or for serious discomfort.
In the population studied, tooth decay affected 99,1% of women and 98,1% of men. In the 24-34 year-old group it reached 96% and for all other age groups it was up to 99-100%. According to medics,the slight but significant difference between male and female indicators can be explained by the fact that during pregnancy and lactation women lose more minerals than men. Overall, the extent of untreated cavities in Georgia’s regions were: Tbilisi – 97%, Mtskheta-Mtianeti – 100%, Guria – 96.5% , Samtskhe-Javakheti – 100%, Shida Kartli – 99.5%, Adjara – 98.7%, Kakheti – 98.3%, Samegrelo–100%, Kvemo Kartli – 99.2%, and Imereti – 98.3%.
The analysis of periodontal diseases showed they were frequent (62%), as opposed to healthy gums (38%). Unhealthy gums were diagnosed by bleeding during probing (41%), by the existence of periodontal pockets (44%), and a loss of gum attachment to teeth (47%). Poor periodontal health was noted in 66.9% of men and 57.5% of women; bleeding at periodontal probing was observed in men (44.9%) and in women (37.2%) at rates that were similar to the indicators of periodontal pockets and the loss of teeth-gum attachment. These variables are least present in younger groups, but are significantly present in the second and third age groups.
Statistical analyses of these findings show a reliable correlation between dental disease and dental activity, socioeconomic and climatic-geographical factors, as well as attitudes towards good dental hygiene. For financial reasons, and due to somatic diseases and negative attitudes towards dental/oral hygiene, the elderly are at greater risk from dental disease. The extremely high frequency of dental diseases in Georgia is related to a low public awareness of the medical issues, and a lack of access to dental services, mainly for financial reasons. However, in spite of financial difficulties and low awareness, most people receive dental services when they are in pain or discomfort, yet scarce attention is paid to prevention.
In summary, low incomes, insufficient levels of general medical awareness and poor socioeconomic conditions explain the lack of access to dental services in Georgia. Negative attitudes towards oral/dental hygiene and the high prevalence of caries and periodontal diseases resulting in tooth loss and other diseases mean that preventive measures must be taken to change attitudes towards dental health care and to raise general medical awareness and improve access to dental services in Georgia.
Applying the research results will enable specialists of various fields to identify key trends in dental disease prevention and develop necessary guidelines.
Scholarly articles published around the thesis: 1. Periodontal Diseases among the Adult Population of Georgia and the Impact of Socio-behavioural Factors on their Prevalence. Lela Tsitaishvili, Manana Kalandadze, Vladimer Margvelashvili. Iran J Public Health. vol. 44, No. 2, Feb. 20152. 2. Assessment of caries prevalence and related risk factors among the adult population of Georgia by age and gender. Lela Tsitaishvili1, Manana Kalandadze , Vladimer Margvelashvili Dent. Med. Probl. 2014, 51, 3, 299–307. 3. The prevalence of periodontal diseases among adult population in Georgia. Tsitaishvili L. Margvelashvili M. Kalandadze M. Margvelashvili V. Georgian Med News. 2014 Sep;(234):25-32. 4. The prevalence of dental caries among the adult population of different regions of Georgia. Tsitaishvili L, Margvelashvili M, Kalandadze M, Margvelashvili V. Georgian Med News. 2014 Sep;(234):25-32.