Thực trạng bệnh quanh răng và hiệu quả can thiệp trên người bệnh điều trị thay thế nghiện các chất dạng thuốc phiện bằng methadone tại thái nguyên tt tiếng anh

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

Committee at University of Medicine and Pharmacy, Thai Nguyen
University at …. on …., 201

The dissertation is available for reference at:
- The library of Thai Nguyen University of Medicine and Pharmacy
- Learing resource centre of Thai Nguyen University
- The National Medical Library


1
BACKGROUND
Periodontal disease is one of the most common diseases,
affecting about 20-50% of the global population. In Vietnam,
over 90% of adults have gingivitis and inflammation around the
teeth [7]. Periodontal disease is a chronic bacterial infection that
involves destruction of dental support structures, including gums,
ligaments and alveolar bone [73]. In Vietnam, research on
periodontal disease on drug addicts is very small. The research
topic of periodontal disease and intervention to reduce the
incidence of periodontal disease for drug addicts so far has not
seen any published author.
According to statistics, there are 5329 drug addicts with
management records in Thai Nguyen province, including 3859
people in the community and 1148 people absent in the locality
[3]. Thai Nguyen has not yet studied, there is no specific solution
to reduce the rate of periodontal disease for opiate addicts. We
conduct the topic with two objectives:
1. Describe the situation and some factors related to
periodontal disease on patients treated with opiate addiction by
methadone in Thai Nguyen.

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

The thesis is 134 pages long, including the following sections:
Issue 2 pages
Chapter 1: Overview of 29 pages
Chapter 2: Subjects and research methods 25 pages
Chapter 3: Research results (34 tables, 7 pictures, 1 diagram) 32 pages
Chapter 4: Discussion 38 pages
Conclusion 2 pages
Recommendation 01 page
References: 119 (Vietnamese: 35; English: 84; documents
in the last 5 years: 83)
Appendix: 7
SOME MAIN PART OF THE THESIS
Chapter 2. SUBJECTS AND METHODS OF RESEARCH
2.1. Research subjects
2.2.1. Object of study description
- Quantitative research objects: Patients on methadone
substitution treatment for opioid addiction at methadone treatment
facilities, aged between 20 and 59, have at least 1 hexadecimal
region still functioning and not suffering from diseases Other acute,
agree to voluntarily participate in the study.
- Qualitative research subjects: Leadership in methadone
treatment facilities; Health officials directly manage and treat
patients; Representing family members of drug addicts, agreeing
to participate in research.
Exclusion: People who treat opioid addiction with other nonmethadone drugs, are suffering from other acute diseases, lose
their entire teeth, are unable to answer (mute, deaf ...)


3
2.1.2. Object of intervention research

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

the value of α selected
Z (1-α / 2) = 1.96 (corresponding to 95% confidence level)
p: The incidence of periodontal disease is 89.5%; p = 0.895
(According to Dang Thi Tho in 2003 research) [30], because until
now we have not seen any research published on the prevalence
of periodontal disease in drug addicts.
d: The desired accuracy is 0.035


4
0,895 x 0,105
n = (1,96)2 ––––––––––––– = 294
(0,035)2
Thus, the minimum sample size at each treatment facility is
294 people.
* Sample selection in descriptive study: Select all addicts
listed on the daily list to take methadone, voluntarily participate
in the study.
2.3.2.2. Sample size and quantitative sampling in intervention
studies
* Sample size in intervention research: Applying formula [11]:
p1(1 - p1) + p2(1 - p2)
n = Z2(α,β) ––––––––––––––––––
(p1 – p2)2
Inside:
n: size of the study sample
p1: the rate of periodontal disease according to previous
research at the Hanoi Center for Social Work Education is 89.5%
(p1 = 0.895) [30]
p2: the desired rate of periodontal disease after intervention

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


5
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

person in charge, working in the relevant job position and
cmmmunity spockesman.
- Group 2: Representatives of addicts and family members:
being agile, voluntarily participating and spoksmen.
* Sample size of in-depth interview: 12 sessions
- Representatives of health center leaders: 02 (before and after
intervention)
- Representative of Dai Tu methadone treatment facility: 02
times (before and after the intervention).
- Representatives of medical staff of methadone treatment
facilities from directly treating and managing drug addicts: 2 sessions
(before and after intervention).
- Representatives of addicts: 02 (before and after intervention)
- Representatives of drug addicts relativenese: 02 (before and
after intervention).
- Drug club representative: 2 (before and after intervention).
* Choose a sample of in-depth interviews: The people who are in
charge of work, who are responsible for the content of oral health care,
responsible speech for themselves and the community.
2.4. Research index
2.4.1. Indicators of status and some factors related to
periodontal disease (goal 1)
* Current situation of age, gender, occupation, education
level, smoking habits, oral hygiene status (OHI-S), gingivitis rate,
periodontal inflammation, benefit status (GI) .
* Related factors:


6
- Relationship between ages: with benefit status (GI); with

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;

prevent diseases around the teeth; Periodic examination to detect
and treat periodontal disease.
- Change in practice after intervention: practice on oral health
care; post-feeding oral care; number of times to brush teeth
during the day; how to brush teeth; the time of each brush and the
time to change the brush.


7
* Output index affecting the periodontal disease:
- Effect of intervention on oral care index (OHI-S)
- Effect of interfering with gingivitis rate
- Effective interventions to benefit status according to GI index
- Effective intervention to the rate of periodontitis.
2.4.3. Organize monitoring of research activities
- Periodic monitoring: 1 time / month
- Regular monitoring when organizing communication, group
discussion and in-depth interviews
- Unsupervised monitoring: done at any time
- Supervision of human resources: PhD students, research
team members, staff directly treating, managing and distributing
methadone drugs.
2.5. Descriptive research content
- Direct interview of research subjects
- Clinical examination to detect dental disease, periodontal
disease, related factors, oral hygiene indicators.
2.6. Content of intervention research
2.6.1. Intervention by health communication-education solutions

* The media:

- 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


8
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

Tools, methods of examination and evaluation of criteria
according to regulations [7], [28], [114]
2.11. Data analysis methods
2.11.1. Quantitative data
- Collected data is checked, encrypted and entered by Epi-data
software.
- Analysing data: Using SPSS 20.0 software on computers.
- Comparison between test use rates χ2
- Comparison of differences has statistical significance at
p<0.05
- Analyzing the relationship between related factors using OR
- Effective interventions are evaluated through effectiveness
index (EI) and intervention effectiveness (Intervention efficiency)
- Effective index calculated separately for two groups
according to the general formula:
p1 – p2
Effectiveness indext (%) = ––––––––– x 100 [11], [23]
p1
In which:
- p1 is the magnitude of the research problem before
intervention
- p2 is the magnitude of the research problem after intervention
- Intervention effectiveness (%) = Efficiency (Intervention) –
Efficiency (Conltrol)
2.11.2. Qualitative data
The contents of in-depth interviews and group discussions
were carefully documented by the fellows and the research team
during the discussion or interview.

9
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

349

97,5

>0,05

Good and medium
(OHI-S=0,1-3,0)

18

2,6

9

2,7

9

2,5

>0,05

Comment: 97.4% of people with oral care are poor, the
difference between Dai Tu and Pho Yen is equivalant (p>0.05).
Table 3.4. Proportion of gingivitis and inflammation
around the teeth
Place
Total
Dai Tu

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

336
2
287

99,4
0,6
84,9

346
12
291

96,6
3,4
81,3

Is not

118

16,9

51

15,1

67

18,7

>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

83,1

286

79,9

>0,05

Light and medium
(GI=0,1-1,9)

115

16,5

55

16,3

60

16,8

>0,05

No gingivitis

14
2,0

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.


10
Table 3.7. Relationship between age and periodontal
disease (n = 696)
Deseases
Age
≥40 years
old
<40 years
old
Total

Periodontal disease
Have
Not have
n
%
n
%
202
68,7
92
31,3

236

58,7

166

41,3

438

62,9

258

37,1

OR
(95%CI)

p

<0,05

1,53
(1,112,09)

Comment: The relationship between the age of the study
subjects and the periodontitis was significant with p<0.05;
OR=1.53 (95% CI= 1,11-2,09). The difference in the
incidence of periodontitis between the group of ≥40 years old

(68.7%) with the group of <40 years old (58.7%) was
statistically significant with p<0.05.
Table 3.8. Relationship between oral hygiene index
(OHI-S) with benefit status (GI) (n = 696)
Dental
hygiene
according
to OHI-S
Least (OHI-S
= 3,1-6,0)

Gums status (GI)
Gingivitis
No gingivitis
n
%
n
%
665

98,1

13

Total

OR
(95%CI
)

<0,05

26,72
(7,1699,72)

1,9

Good and medium

(OHI-S = 0,13,0)

p

12

66,7

6

33,9

677

97,4

19

2,7

Comment: The relationship between the OHI-S index in the

addict and periodontitis (GI) is significant with p<0.05;
OR=26.72 (95% CI=7,16-99,72). The proportion of drug
addicts in the gingivitis group with poor OHI-S index (98.5%)
is higher than the group with good and average OHI-S index
(55.6%), this difference is statistically significant with p<0.05.


11
Table 3.12. Relationship between the age and periodontitis
with highest of CPI (n = 696)
Disease around the teeth
Age

CPI 3 and CPI 4

CPI 2
n
%
85
28,9

p

OR
(95%CI)

n
%
>40 year
209

71,1
3,22
old
(2,34<0,05
4,44)
≤40 year
174
43,3
228 56,7
old
Total
383
55,0
313 45,0
Comment: There are relation between the age of the

addicted and the periodontitis by CPI is statistically significant
with p<0.05; OR = 3.22 (95% CI = 2.34 to 4.44). The
incidence of periodontitis in the age group> 40 had CPI 3 and
CPI 4 (71.1%) higher than that of the age group of 40 years
with CPI 3 and CPI 4 (43.3%). The difference was statistically
significant with p<0.05.
Table 3.13. Relation between time taking methadone and
periodontitis with highest of CPI (n = 696)
Disease around the teeth
Time to
CPI 3 and
OR
take
CPI 2

p
CPI 4
(95%CI)
methadone
n
%
n
%
≥2 year
1,86
266 60,7 172 39,3
(1,37<0,05
<2 year
117 45,3 141 54,7
2,54)
Total
383 55,0 313 45,0
Comment: There are relation between the time of taking
methadone of the addict and the periodontitis according to the
CPI number is statistically significant with p<0.05; OR = 1.86
(95% CI = 1.37-2.54). The incidence of periodontal disease in
the methadone group ≥2 years is higher than that of CPI 3 and
CPI 4 (60.7%) compared to those taking methadone <2 years
with CPI 3 and CPI 4 (45.3%). The difference was statistically
significant with p<0.05.


12
3.1.2. Current situation and some related factors in qualitative research

* Results on the status of periodontal disease:
Results of group 1 discussion include leaders of health
centers; leaders and health workers Methadone treatment
facilities: The number of addicts treated with methadone is
increasing, but oral care situation and periodontitis in addicts
have not received the attention from health facilities. The
periodontal disease is high proportion, the drug addicts have poor
communicate with the community. "The periodontal disease has
not been care by the Medical Center, because there is no dentist
to perform. The Health Center does not have the resources to
detect and have no funds to treat oral diseases ”.
Results of in-depth interviews with leaders on methadone
treatment center on the status of oral care: ''The methadone center
has main working are management and delivery of drugs,
monitoring methadone treatment for addicts, and blood
examination which related to liver, kidney, and HIV. The center
has no plan and facilities for communication, no banners,
documents, technical support equipment for dental care for this
particular clients. Among more than 300 addicts who regularly
go to take methadone at the center, most of them were suffer from
oral diseases ... "
Mr. VHN, leader of Dai Tu medical center
Results of in-depth interviews with health workers who
directly deliver methadone and management of the Rehabilitation
Club: Health workers do not have knowledge of periodontal
disease. Oral care is habit and changing habit on oral care were
changing are impacted by mass media. Monthly clubs has some
communication activities but these has no material, no content for
oral care activities: ''Addicts only pay attention to take methdone
on time, rarely pay attention to the oral care and to be affaired

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


13
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.

The drug addicts themselves do not have a sense of oral care.
Mainly job of them are farming, some other jobs but the their
income is not stable, still depends on the family, afraid to
communicate with the community.
The rate smoking of people addicted is high, not paying
attention to clean oral care, especially after eating. Economic
difficulties.
The patients' families hardly know about the periodontal
disease and are not interested in oral hygiene of this object. Also
avoid, limit reminders of hygiene problems for drug addicts
because of the age of drug addicts mainly from 30-40, families
mainly work in farming and freelance jobs.
The health sector has no plans, no resources, no staff with
expertise in dentistry, no funds to examine and detect and
implement solutions to prevent periodontal disease.

3.2. Results of implementation of intervention solutions
3.2.1. Results of interventions to change knowledge, attitudes and practices


14
Table 3.15. The change of knowledge of oral care after
eating
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
%
202
59,8
136
40,2
338
100
257
86,8
39
13,2

296
100,0
p3<0,05

n
%
160
44,7
198
55,3
358
100,0
144
47,5
159
52,5
303
100,0
p4>0,05

p
p1<0,05

p2<0,05

Comment: After intervention, the oral care knowledge after
eating of the intervention group was good from 59.8% before
intervention increased to 86.8% (up 27%), this increase was
statistically significant. with p3<0.05.
Table 3.16. The change of knowledge about how to proper

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

123
36,4
338
100,0
244
82,4
52
17,6
296
100,0
p3<0,05

n
%
230
64,2
128
35,8
358
100,0
184
60,7
119
39,3
303
100,0
p4>0,05

p
p1>0,05

p2<0,05

Comment: Before intervention, the difference in knowledge
about proper brushing between the intervention group and
control group was not statistically significant with p1>0.05.
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<0.05


15
Table 3.18. Change in knowledge about gingivitis
manifestations after intervention
Time

Knowledg
e

Intervention
group (Dai Tu)

Control group
(Pho Yen)

p
n
%
n

%
Good
124
36,7
134
37,4
p1>0,05
Before the
Not
good
214
63,3
224
62,6
intervention
Total
338 100,0
358
100,0
Good
155
52,4
131
43,2
p2<0,05
After the
Not good
141
47,6
172

56,8
intervention
Total
296 100,0
303
100,0
p
p3<0,05
p4>0,05
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<0.05.

Table 3.19. The change of knowledge about the cause
Periodontitis of after intervention group
Time

Knowledge

Good
Not good
Total
Good
After the
intervention Not good
Total
p

Before the
intervention

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%
129
38,1
209
61,9
338
100,0
179
60,5
117
39,5
296
100,0
p3<0,05

n
%
150
41,9
208

58,1
358
100,0
113
37,3
190
62,7
303
100,0
p4>0,05

p
p1>0,05

p2<0,05

Comment: Before the intervention, the difference in knowledge
about the causes of periodontitis of the two groups was not
statistically significant with p1>0.05. 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<0.05.


16
Table 3.20. The change in knowledge about periodontitis
after intervention group
Time

Knowledge

Good
Not good
Total
Good
Not good
Total

Before the
intervention
After the
intervention

p

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%
190
56,2
148
43,8
338
100,0
226

76,3
70
23,7
296
100,0
p3<0,05

n
%
220
61,5
138
38,5
358 100,0
199
65,7
104
34,3
303 100,0
p4>0,05

p
p1>0,05

p2<0,05

Comment: Before the intervention, the difference in
knowledge about the manifestations of perriodontitis between
the intervention group and the control group was not
statistically significant with p1>0.05. After the intervention,

the change in knowledge of the intervention group was good
from 56.2% to 76.3% (up 20.1%), this increase was
statistically significant with p3<0.05.
Table 3.22. The change of attitude about using the brush,
toothpaste of after intervention group
Time

Attitude

Before the
intervention
After the
intervention
p

Good
Not good
Total
Good
Not good
Total

Intervention
group (Dai Tu)

Control group
(Pho Yen)

n
%

242
71,6
96
28,4
338
100,0
269
90,9
27
9,1
296
100,0
p3<0,05

n
%
264 73,7
94
26,3
358 100,0
231 76,2
72
13,8
303 100,0
p4>0,05

p
p1>0,05

p2<0,05

Comment: Before intervention, the difference in attitude of
using toothpaste brush between the intervention group and
control group was not statistically significant with p1>0.05.
After the intervention, the change of attitude of the
intervention group was good from 71.6% to 90.9% (up
19.3%), this change was statistically significant with p3<0.05.


17
Table 3.23. The change of attitude after intervention group
about the poor on oral care are causes of periodontitis
Time

Attitude

Good
Before the
Not good
intervention
Total
Good
After the
Not good
intervention
Total
p

Intervention
group (Dai Tu)

SL
%
299
88,5
39
11,5
338
100,0
290
98,0
6
2,0
296
100,0
p3<0,05

Control group
(Pho Yen)

SL
%
330
92,2
28
7,8
358 100,0
283
93,4
20
6,6

303 100,0
p4>0,05

p
p1>0,05

p2>0,05

Comment: Before the intervention, the attitude of poor oral
care is the causes of periodontitis between the intervention
group and the control group with no statistical significance
with p1>0.05. After the intervention, the change in attitude of
the intervention group was good from 88.5% to 98% (up
9.5%), this change was statistically significant with p3<0.05).
Table 3.24. The change of attitude about proper brushing
to prevention of periodontitis after intervention group
Time

Attitude
Good
Not good
Total
Good
Not good
Total

Before the
intervention
After the
intervention

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<0,05

Control group
(Pho Yen)

n
%
336
93,9
22

6,1
358
100,0
293
96,7
10
3,3
303
100,0
p4>0,05

p
p1>0,05

p2>0,05

Comment: Before intervention, the difference in proper
brushing attitude to prevent periodontal disease between the
intervention group and control group was not statistically
significant with p1>0.05. After the intervention, the attitude
change of the intervention group was good from 88.5% to
99.3% (up 10.8%), this change was significant with p3<0.05.


18
Table 3.26. The changing practice of after intervention
group on the time oral care of during the day
Time

Practice

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

296
100,0
p3<0,05

Control
group (Pho
Yen)
n
%
194 54,2
164 45,8
358 100,0
159 52,5
144 47,5
303 100,0
p4>0,05

p

p1>0,05

p2<0,05

Comment: Before intervention, the difference between the
time of practicing oral care between the intervention group and
the control group was not statistically significant with p1>0.05.
After the intervention, the change of practice time of the
intervention group was good from 47.9% to 69.3% (up 21.4%),
this change was statistically significant with p3<0,05.
Table 3.27. The change of practice on oral care of after

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

338
100,0
162
54,7
134
45,3
296
100,0
p3<0,05

n
%
144
40,2
214
59,8
358
100,0
102
33,7
201
66,3
303
100,0
p4>0,05

p

p1>0,05

p2<0,05

Comment: Before intervention, the difference in practice on
post-feeding oral care between the intervention group and
control group was not statistically significant with p1>0.05.
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<0.05.


19
Table 3.28. The change of the number of brushing times
during the day after the intervention
Time

Practice

Good
Before the
intervention Not good
Total
Good
After the
Not good
intervention
Total
p

Intervention
group (Dai Tu)

n
128

Control group
(Pho Yen)

%
37,9

210
62,1
338
100,0
165
55,7
131
44,3
296
100,0
p3<0,05

n
146

%
40,8

212
59,2

358
100,0
112
37,0
191
63,0
303
100,0
p4>0,05

p
p1>0,05

p2<0,05

Comment: Before intervention, the difference in the times
number of brushing of the study subjects between the
intervention group and control group was not statistically
significant with p1>0.05. 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<0.05.
Table 3.29. The practice change on how to brush teeth
after intervention
Practice

Intervention
group (Dai Tu)

Control group

(Pho Yen)

Good
Before the
Not good
intervention
Total
Good
After the
Not good
intervention
Total
p

n
%
157
46,4
181
53,6
338
100,0
177
59,8
119
40,2
296
100,0
p3<0,05

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

p2<0,05

Comment: Before intervention, the difference in practice of
brushing between the intervention group and control group
was not statistically significant with p1>0.05. 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<0.05.

20
3.2.2. Effective intervention around teeth
Table 3.31. Effective intervention to the level of oral care
according to OHI-S index
Dental
hygiene

Time

Least
Before the
intervention

(OHI-S=3,1-6,0)
Good and medium
(OHI-S=0,1-3,0)

Total
After the
intervention

Least
(OHI-S=3,1-6,0)
Good and medium
(OHI-S=0,1-3,0)

Total

p

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

100,0
58,1

7
356
262

2,0
100,0
86,5

124
41,9
41
13,5
296
100,0 303 100,0
p3<0,05
p4<0,05
39,8
11,7
28,1

p
p1>0,05

p2<0,05

Comment: After the intervention, the change in the rate of
poor oral hygiene decreased from 97.9% to 58.1%. Effective

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

99,4
346
96,6
2
0,6
12
3,4
338
100,0
358
100,0
219
73,9
283
93,4
77
26,1
20
6,6
296
100,0
303
100,0
p3<0,05
p4>0,05
25,7
3,3
22,4

p

p1>0,05

p2<0,05

p
Efficiency index (%)
Effective intervention
(%)
Comment: After intervention, the change in gingivitis rate in the
intervention group decreased from 99.4% to 73.9%. Effective
intervention reached 22.4%


21
Table 3.33. Effective interventions to the extent of
gingivitis according to GI index
Time
Before
the
interve
ntion
After
the
interve
ntion

The level of
gingivitis
Heavy

(GI=2,0-3,0)
Good and medium
(GI=0,1-1,9)
Total
Heavy
(GI=2,0-3,0)
Good and medium
(GI=0,1-1,9)

Total
p
Efficiency index (%)
Effective intervention (%)

Intervention
group (Dai
Tu)
n
%

Control
group (Pho
Yen)
n
%

281

83,6

286

82,6

55

16,4

60

17,4

336

100,0

346

100,0

139

47,3

198

65,3

155

52,7

105

34,7

p

p1>0,05

p2<0,05
294 100,0 303 100,0
p3<0,05
p4<0,05
43,4
20,9
22,5

Comment: After intervention, the change in the rate of severe
gingivitis in the intervention group decreased from 83.6% to 47.3%.
Effective intervention reached 22.5%.
Table 3.34. Effectiveness interferes with incidence of
periodontitis according to CPI
Time
Before
the
interven
tion
After
the

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)

n
%
291
81,3
67
18,7

338

358

100,0

p1>0,05

100,0

170
57,8
124
42,2
296
100,0
p3<0,05

226
74,5
77
25,5
303

100,0
p4<0,05

31,9

8,4
23,5

p

p2<0,05


22
Comment: After intervention, the change in the rate of
inflammation around the teeth according to CPI in the
intervention group decreased from 84.9% to 57.8%. Effective
intervention reached 23.5%.
3.2.3. Intervention results in qualitative research
Discussion results of group 1: '' The organization of
implementing and implementing interventions for prevention
of periodontal disease at methadone treatment facilities for
addicts in accordance with characteristics of the subjects ,
compact, easy to implement, less costly to operate. The
content, time and location of activities are suitable for the
participants. The monitoring and inspection process is carried
out regularly ”.
Discussion results of group 2: easy-to-apply and easy-tomaintain interventions in the community. Through the 12month intervention, from where there is no good knowledge,
no interest and no good practice of oral hygiene, addicts have
changed their attitude about dental care, self-tooth brushing.

The day after breakfast, before taking methdone and being
ready to continue to maintain oral health, at the same time
voluntarily went to see and break out tartar at the medical
facility, the family members were not afraid to remind to brush
their teeth before go out of the house. ''The addicts voluntarily
participate when they realize the practical value for
themselves that is brought to them by the community.
Participants confirmed that these are easy to implement,
maintain and able to replicate some other methadone
treatment facilities in the area”.
Results of in-depth interviews Leaders of the Center for
Health on assessing the ability to maintain and replicate the
implementation of interventions for prevention of periodontal
disease: the application of intervention solutions is necessary
and effective. fruit. The results have reduced the incidence of
periodontal disease, the interventions easily replicated and
implemented in the community to create good habits of dental
care and prevention of periodontal disease. ''The intervention


23
measures applied in methadone treatment facilities for addicts
are high community, many people are under the leadership of
the Health Center, leaders of treatment facilities and health
workers at the grassroots level. treatment, addicts and their
family members care. Therefore, bringing high efficiency in
preventing periodontal disease, creating good habits of
regular brushing. Participants in the intervention work well,
transforming well in awareness of oral health. Reduce the
incidence and level of disease compared to before

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<0.05; OR=1.53).
- Oral hygiene index is related to the benefit condition
(p<0.05; OR = 26.72).
- The age associated with periodontal disease is calculated
according to the highest CPI (p<0.05; OR = 3.22).
- Time to take methadone is related to periodontal disease
according to the highest CPI (p<0.05; OR = 1.86)
2. Results of implementation of intervention solutions
- The impact on changing knowledge, attitudes and
practices:
+ Good knowledge about: Oral hygiene increased by 27%;
How to brush teeth increased by 18.8%; Causes of bleeding
benefit increased by 17.2%; Expression of gingivitis increased