MINISTRY OF EDUCATION AND TRAINING
THAI NGUYEN UNIVERSITY

TRINH DUC MAU

THE SITUATION OF PERIODONTAL DISEASE AND
THE EFFECTIVENESS OF INTERVENTION ON
PATIENTS TREATED WITH OPITEADDICTION BY
METHADONE IN THAI NGUYEN

Speciality: Sociology hygiene and health organization
Code number: 62720164

SUMMARY OF MEDICINE DOCTORAL THESIS

THAI NGUYEN, 2019


The dissertation was completed at
UNIVERSITY OF MEDICINE AND PHARMACY
THAI NGUYEN UNIVERSITY

Supervisor:
1. Prof. Dr. Trinh Dinh Hai
2. Assoc. Prof. Dr. Nguyen Quy Thai

Critic 1: ………………………………………… ..
Critic 2: ………………………………………… ..
Critic 3: ………………………………………… ..

The dissertation will be defended nationally to the Evaluation

2. Evaluate the effectiveness of some interventions to prevent
periodontal disease in patients treated with opiate addiction by
methadone in Dai Tu and Thai Nguyen districts.
NEW CONTRIBUTIONS OF THE THESIS
1. The dissertation topic provides new data on the incidence of
periodontal disease, gingivitis, periodontal inflammation and
some related factors in people receiving substitution treatment for
opioid addiction by methadone in Thai Nguyen .
2. Coordinate with Dai Tu methadone treatment facility,
effectively implement a number of periodontal disease prevention
interventions for community-based methadone opioid addiction
treatment providers including:
- Health education communication solution
- Mechanical engineering solutions
- Solution to use chemicals
- Solutions to improve capacity for Dai Tu methadone health
workers in primary health care about dentistry.


2
3. Intervention activities help addicts to raise awareness,
change attitudes and practices of oral health care to prevent
periodontal disease, and help health workers improve their
knowledge about board care. early on oral health.
4. Performance results after intervention to knowledge,
attitude, practice of periodontal disease increased compared to
before intervention. The rate of gingivitis, inflammation around
the teeth, and poor oral hygiene all decreased compared to before
the intervention.
STRUCTURE OF THE THESIS

Patients with alternative treatment for opioid addiction with
methadone at Dai Tu methadone treatment facility, aged from 20
to 59, have at least 1 hexadecimal region still functional, without
other acute diseases, copper voluntary intention to participate in
research.
2.2. Time and place of study
2.2.1. Time
- Research describing the situation: March and April 2015
- Intervention study: 12 months (from April 2015 to April 2016)
2.2.2. Place
- Select the intervention location: The facility for treating
methadone Dai Tu.
- Select the control location: Pho Yen methadone treatment
facility
2.3. Research Methods
3.3.1. Method and design
- Using descriptive research methods and community intervention
studies, combining quantitative and qualitative research.
- Design of cross-sectional descriptive research and
experimental simulation design
2.3.2. Sample size and sample selection
2.3.2.1. Sample size and sample selection in descriptive study
* Sample size in descriptive study: Applying formula [11]:
p(1-p)
n = Z2(1-α/2)=
–––––––
d2
Inside:
n: Sample size
Z (1-α / 2): The Z value obtained from table Z corresponds to

will be reduced by at least 15%, ie the rate of periodontal disease
is about 75% (p2 = 0.75).
α: threshold of probability of making a mistake of type 1,
determining α = 0.05 corresponding to the reliability factor at
95%.
β: probability of making a mistake of type 2, determining β =
0.1 respectively 1 - β = 0.9 corresponding to a sample force of
90%.
Look up the table, select test 2 sides, we get Z2 (α, β) = 10.5
Replace the number we have:
0,895(1- 0,895) + 0,75(1- 0,75)
n = 10,5 ––––––––––––––––––––––––– = 140
(0,895 – 0,75)2
- Sample size of intervention group is at least 140 people.
- Reference group size: Select all
* Choose a template: Select all


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2.3.2.3. Sample size, sample selection in qualitative research
in the intervention group
* Sample size of group discussion: 4 sessions, 6-8 people /group
- Group 1: Leaders of the Health Center, leaders of treatment
facilities and health workers of methadone treatment facilities: 02
(before and after the intervention).
- Group 2: Representatives of addicts, drug addict
relativeness, drug addicts in Rehabilitation Club: 02 (before and
after intervention).
* Choose group discussion form:
- Group 1: Leadership representative, health staff: As the

oral hygiene index (OHI-S).
- Relationship between the time of taking methadone and the
state of oral hygiene (OHI-S).
- Relationship between gender; Smoking habits with
periodontal disease.
- Relationship between ages; Time to take methadone with
periodontal disease according to the highest CPI.
- Relationship between the need to treat the teeth around the
community with the time to take methadone.
2.4.2. Index of evaluation of effectiveness of some
interventions to prevent periodontal disease (target 2)
* Input index:
- Index of knowledge: oral hygiene; how to brush teeth;
causes of gum bleeding; manifestations of gingivitis; causes of
periodontitis and manifestations of periodontitis.
- Index of attitude: the need to go to a Dentist; the use of
brushes and toothpaste; the need for guidance on oral care of
Dentist; poor oral care; prevent diseases periodontitis; Periodic
examination to detect and treat periodontal disease.
- Practical index of dental health care: brushing teeth during
the day; how to brush teeth; the time of each brush and the time
to change the brush.
* Output index:
- The change of knowledge after intervention: knowledge of
oral care; how to brush teeth; causes of gum bleeding;
manifestations of gingivitis; causes of periodontitis and
manifestations of periodontitis..
- The change of attitude after intervention: the attitude about
the need to go to the Dentist; the use of brushes and toothpaste;
the need for guidance on oral care of Dentist; poor oral hygiene;

- Communication objects: Addicts and drug addicts relativeness
- Number of communication sessions: 8 sessions (07 sessions
for addicts and 01 session for drug addicts relativeness
representatives)
- Content: Basic knowledge of oral diseases and prevention of
oral diseases.
* Training:
- Training subjects: Health staff of Dai Tu methadone
treatment facility, directly involved in management, treatment
and distribution of methadone.
- Number of training sessions: 01 session
- Content: General principles of oral health education and
prevention of periodontal disease for the community.
2.6.2. Intervention with mechanical engineering solutions
- Technique: Brush teeth in accordance to improve Bass
method [99]
- Time to brush teeth every 2-3 minutes
2.6.3. Intervention with chemical solutions


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Instructions for addicts to rinse their mouths after brushing their
teeth with pre-mixed mouthwash or diluted brine if at home.
2.6.4. Intervention by solutions to improve the initial capacity
of oral health care for health workers
Training on knowledge and guidance on early detection of
periodontal disease, simple tartar extraction technique for medical
staff at Dai Tu methadone treatment facility.
2.7. Examination of the periodontal condition, criteria and
evaluation criteria

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Chapter 3. RESEARCH RESULTS
3.1. Current situation and some factors related to periodontal disease
Table 3.3. Status of oral hygiene (OHI-S) in opioid addicts
Place
Total
Dai Tu
Pho Yen
(n = 696)
(n=338)
(n =358)
p
Dental hygiene
n
%
n
%
n
%
Least
(OHI-S=3,1-6,0)

678

97,4

329

97,3


Pho Yen
(n = 696)
(n=338)
(n =358)
p
Deseases
n
%
n
%
n
%
Ging
ivitis
Perio
donti
tis

Have
Is not
Have

682
14
578

98,0
2,0
83,1


>0,05
>0,05

Comment: 98% of addicts get gingivitis; 83.1% of periodontitis,
the difference between Dai Tu and Pho Yen is not statistically
significant with p>0.05
Table 3.5. Beneficial status (GI) in opioid addicts
Place
Total
Dai Tu
Pho Yen
(n = 696)
(n=338)
(n =358)
p
Gingivitis
n
%
n
%
n
%
Heavy
(GI=2,0-3,0)

567

81,5

281

2
0,6 12
3,3
Comment: 81.5% of addicted people suffer from severe
gingivitis, the difference between Dai Tu and Pho Yen is not
statistically significant with p>0.05.


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Table 3.7. Relationship between age and periodontal
disease (n = 696)
Deseases
Age
≥40 years
old

(68.7%) with the group of
addict and periodontitis (GI) is significant with p
p
CPI 4
(95%CI)
methadone
n
%
n
%
≥2 year
1,86
266 60,7 172 39,3
(1,37
with dentist and community. If there is a program of
communication support, free practice, we are ready to participate
as a core, to coordinate, to remind members inside and outside
the club to participate. The club is ready to integrate, bring the
content of oral health care into the daily, monthly content of the
club, encourage people to join ..."
Ms. NTKO, facility health worker treating methadone Dai Tu


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Results of in-depth interviews with addicts: they lack
knowledge, little attention is paid to dental care and periodontal
disease, and drug addicts are looking forward to participating in
dental care activities. ''I voluntarily went to take methadone.
Every day, after finishing taking the methadone, go back to work.
Many teeth are broken, since the take methadone, are much more
teeth broken too, reason of teeth broken are methadone taken”.
When asked if there is a free program to guide and to brush their
teeth every day before taking the methadone, they answer
‘‘willing to participate in orderto teeth better, even if I have to
seek Dentist to teeeth treatment, I agree also ”.
Mr. NVT, the patient took methadone
* Results on a number of factors involved in qualitative research

Patients do not have good knowledge, attitude and practice of
periodontal disease, unknown about the cause of disease, factors
affecting the disease and consequences of disease to health.
Practice brushing teeth still depends on inspiration. Some people
just brush their teeth in the morning, not paying attention to the
time of brushing their teeth, often using toothpicks after eating.

Total
Good
Not good
Total

Before the
intervention
After the
intervention

p

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%
202
59,8
136
40,2
338
100
257
86,8
39
13,2

brush teeth after intervention
Knowled
ge

Time

Good
Not good
Total
Good
Not good
Total

Before the
intervention
After the
intervention

p

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%
215
63,6


p20.05.
After the intervention, the change in knowledge of the
intervention group at good level from 63.6% before the
intervention increased to 82.4% (up 18.8%), this increase was
statistically significant with p3
56,8
intervention
Total
296 100,0
303
100,0
p
p30,05
Comment: Before intervention, the difference in knowledge of
gingivitis manifestations between the intervention group and the
control group was not statistically significant with p1>0.05. After the
intervention, the change of knowledge in the intervention group was
good from 36.7% before intervention increased to 52.4% (up
15.7%), this increase was significant with p3
58,1
358
100,0
113
37,3
190
62,7
303
100,0
p4>0,05

p
p1>0,05

p20.05. After the intervention, the
change of knowledge about causes of periodontitis in the
intervention group was good from 38.1% to 60.5% (up 22.4%),
this increase was statistically significant with p3
76,3
70
23,7
296
100,0
p30,05

p
p1>0,05

p20.05. After the intervention,

242
71,6
96
28,4
338
100,0
269
90,9
27
9,1
296
100,0
p30,05

p
p1>0,05

p2
SL
%
299
88,5
39
11,5
338
100,0
290
98,0
6
2,0
296
100,0
p3

p

Intervention
group (Dai Tu)
%
n

299
88,5
39
11,5
338
100,0
294
99,3
2
0,7
296
100,0
p3

Before the
intervention
After the
intervention

Good
Not good
Total
Good
Not good
Total

p

Intervention
group (Dai
Tu)
n
%
162
47,9
176
52,1
338
100,0
205
69,3
91
30,7

intervention group on after meal
Time

Practice

Before the
intervention
After the
intervention
p

Good
Not good
Total
Good
Not good
Total

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%
129
38,2
209
61,8

p20.05.
After the intervention, the change in practice of the
intervention group was good from 38.2% to 54.7% (up
16.5%), this increase was statistically significant with p3
358
100,0
112
37,0
191
63,0
303
100,0
p4>0,05

p
p1>0,05

p20.05. After the intervention, the change in
practice of the intervention group was good from 37.9% to
55.7% (up 17.8%), this change was statistically significant
with p3
n
%
190
53,1
168
46,9
358
100,0
148
48,8
155
51,2
303
100,0
p4>0,05

Time

p
p1>0,05

p20.05. After the
intervention, the practice change on the brushing method of
the intervention group was good from 46.4% to 59.8% (up
13.4%), this change was statistically significant with p3
Efficiency index (%)
Effective intervention (%)

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n

%

n

%

329

97,9

349

98,0

7
336
172

2,1

intervention reached 28.1%.
Table 3.32. Effectiveness interferes with gingivitis rate
Time

Before the
intervention
After the
intervention

Gingi
vitis

Have
Is not
Total
Have
Is not
Total

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%
n
%
336


p1>0,05

p2
286

82,6

55

16,4

60

17,4

336

100,0

346

100,0

139

47,3

198

65,3

155


interven
tion

Periodo
ntitis

Have
Is not
Total
Have
Is not
Total

p
Efficiency index
(%)
Effective
intervention (%)

Intervention
group (Dai Tu)
n
%
287
84,9
51
15,1

Control group
(Pho Yen)

100,0
p4
implementing intervention measures”.
Mr. VHN, leader of Dai Tu medical center
CONCLUDE
1. Current situation and some factors related to
periodontal disease
* Reality:
- 97.4% of people with oral hygiene are at low level
- 98% of addicts suffer from gingivitis
- 83.1% of addicts suffer from inflammation around the
teeth
- 81.5% of addicts have severe gingivitis; 16.5% have mild
and moderate gingivitis.
* Related factors:
- Age is associated with periodontal disease (p