CC BY
0Kitsak T.S.
Bukovinian State Medical University, Assistant, the Faculty of Dentistry
CONDITION OF THE PERIODONTAL TISSUE IN CHILDREN WITH COMORBID PATHOLOGY OF
THE THYROID GLAND
ABSTRACT
Introduction. Nowadays the problem of thyroid pathology, its effect on health and intellectual development of the population, first of all children, is extremely topical [6, 10, 7]. A number of Ukrainian regions including Bukovyna are evaluated according to the WHO criteria as territories with mild and moderate degree of iodine deficiency which is a cause of so-called iodine deficiency diseases among them thyroid pathology is a leading one [9]. According to the findings of the Municipal Children's Hospital (Chernivtsi) diffuse goiter occurs in 75% of cases among all endocrine diseases which in their turn occupy the second position in the structure of dispensary examination of the children population of the town [8].
It should be noted that this problem goes beyond the borders of our state. During the last decade diseases caused by iodine deficiency in the environment have become the most spread non-infectious pathology both among children and adults in the whole world. Approximately 2 billion people are estimated by the WHO to live under conditions of iodine deficiency, and it is a third of the world population [11].
According to the findings of some authors, occurrence of dental caries and periodontal diseases sometimes achieve 90-100% [4]. A number of authors indicate the interrelation between thyroid pathology and underlying dental diseases [3]. Pathology of the thyroid gland is known to be accompanied by decompensated forms of caries, more severe course of periodontal diseases, accelerated frequency of non-caries injuries of the hard dental tissues and dentoalveolar abnormalities etc. [1,2].
Diffuse nontoxic goiter (DNG) is the most spread disease of the thyroid gland among children. Although, modern literature contains insufficient information concerning the spread and structure of dental diseases among children with this nosology. It is this fact that stipulated the purpose and tasks of our study.
Keywords: children, dental status, iodine deficiency, diffuse nontoxic goiter, thyroid gland, periodontium.
Objective of the study was to study the spread and intensity of periodontal tissue injuries in children under conditions of DNG.
Materials and methods. To solve these tasks 180 children at the age of 12 were examined including 150 of them with DNG and 30 practically healthy children. Four groups of observation were formed: I group - somatically healthy children (30 individuals); II group -children with DNG of Ia degree (50 individuals); III group - children with DNG of Ib degree (50 individuals); IV group - children with DNG of II degree (50 individuals).
Distribution of children by sex in the groups of observation demonstrated homogeneous sampling by gender features. Thus the content of the four groups was the following: I - 30 children (16 girls and 14 boys); II group - 50 children (25 girls and 25 boys); III group - 50 children (26 girls and 24 boys); IV group -50 children (27 girls and 23 boys).
Dental examination of children was conducted by means of generally accepted methods [5]. To evaluate condition of the periodontal tissue papillary-marginal-alveolar (PMA) index was used and the number of injured sextants was estimated. Hygienic condition of the oral cavity was examined by means of oral index of hygiene - simplified (OIH-S).
Variation statistics methods and Student criterion were used.
Results of the study and their discussion. Occurrence of periodontal diseases among somatically healthy children was 63,3 %, and it was approximately 12% lower than that of the examined children with DNG, and it had a reliable difference from all the groups of the study.
In the structure of periodontal tissue diseases chronic catarrhal gingivitis (CCG) prevails, and its occurrence is the highest in III group - 94 % and II group-92%, and with the values 88 % in IV group and 87 % in the control group.
The disease is mostly of a chronic course, exacerbation of the process was in 10,5 % of the examined. Acute catarrhal gingivitis was diagnosed only in 1 child (3,33 %) from the control group and in 6 children with thyroid pathology (4,0%). Chronic inflammation of the gums was clinically manifested by stagnant hyperemia, swelling and bleeding from the gums.
Hypertrophic gingivitis in case of thyroid pathology contrary to catarrhal one was found less frequently, although its fibrous forms dominated over granulating ones. In the anamnesis both forms of chronic gingivitis were characterized by frequent exacerbations (every 23 months).
The signs of periodontitis were found only in 2% among the children of IV group. This disease was not found in other groups.
PMA index in II and III groups was found to be practically equal and was about 35%. While thyroid pathology increased the degree of its severity was 42,8% in comparison with the control index 20,3 %. Summing up the results of PMA index it should be noted that moderate gingivitis prevailed among children with DNG, while in the control group mild form was found.
Detection of bleeding index in children demonstrated the difference available between the indices in all the groups of observation with increase of severity of this pathology (p<0,05).
Although, contrary to the previous index the change of indices according to the degrees of severity
was different: the fastest growth of bleeding symptom was found between II and IV groups (68,57 %). The idea is suggested that in children with the examined pathology progressing CCG is connected, first of all, with disorders of the structure and function of the blood vessels and adjacent tissues which occurs in case of long thyroid dysfunction.
According to the WHO recommendations the per-iodontal tissues were analyzed by the number of injured sextants, the results are presented in Table 1. Detection of the number of injured (by Shiller-Pisarev test) and healthy sextants demonstrated inverse results which deteriorated with increasing severity of the pathology.
The degree of periodontal
Bleeding of the gums in children of II-III groups was 28,11 % higher, in IV group -74,13 %; the indices of dental calculus were in 2,5 and 4 times higher respectively. The data obtained were the evidences of biased visual examination and less accurate estimation of severity in comparison with score interpretation. Therefore, during examination occurrence and severity of the process in children seem to be less than they really are.
These criteria were evaluated separately among girls and boys. Periodontal tissues were more injured among girls, which is indicative of the beginning of the period of puberty often accompanied by juvenile gingivitis.
Table 1
Group Subgroups according to sex Bleeding Dental calculus Shiller-Pisarev test Healthy gums
I group total 2,01±0,18 0,02±0,001 2,45±0,23 3,55±0,29
boys 1,82±0,15 0,01±0,002 2,42±0,19 3,58±0,31
girls 2,2±0,23 0,03±0,001 2,48±0,21 3,52±0,23
II group total 2,45±0,21 0,08±0,003 2,89±0,25 3,11±0,20
boys 2,3±0,19 0,07±0,005 2,63±0,17 3,37±0,32
girls 2,6±0,22 0,09±0,003 3,15±0,30 2,85±0,23
III group total 2,7±0,23 0,06±0,002 3,8±0,27 2,2±0,18
boys 2,5±0,19 0,05±0,005 3,4±0,29 2,6±0,23
girls 2,9±0,28 0,07±0,006 4,1±0,35 1,9±0,14
IV group total 3,5±0,24* 0,1±0,02* 4,3±0,41* 1,7±0,12*
boys 3,4±0,30* 0,08±0,01* 3,8±0,28* 2,21±0,23*
girls 3,6±0,36* 0,12±0,07* 4,7±0,36* 1,3±0,09*
The results obtained are indicative of a reliable increase of all the periodontal indices and tests which are evidences of deterioration of periodontal tissue condition in children with comorbid pathology of the thyroid gland. Diseases of the periodontal tissues are known to have multifactor nature with prevailing inflammatory or dystrophic processes. To determine etiopathogenic mechanism promoting pathology of the periodontal tissues under conditions of DNG we have analyzed possible periodontogenic risk factors.
Hygiene of the oral cavity by OHI-S index is unsatisfactory in all the groups of the study and control that can be a trigger mechanism to form diffuse inflammatory process in the gums.
Local causing factors of inflammatory process are caries, dental and maxillary abnormalities etc. Our studies conducted are indicative of the fact that the more degree of severity of DNG is in children the more caries and non-treated carious cavities are found. As to dental and maxillary abnormalities and deformities their frequency had the tendency to increase in case of thyroid pathology, but it was not as fast as it was with caries.
As to the structure of orthodontic pathology attention is drawn to rather high frequency of abnormalities of separate teeth, and abnormal eruption and number of teeth in children from the groups studied in comparison with the control. There is a general tendency to domination of such dental and maxillary abnormalities and deformities as conglomeration of teeth, narrowing of the upper jaw. Malocclusion was found with similar
frequency both in somatically healthy children and those having thyroid pathology.
There fore, examined children afflicted with DNG have necessary provoking factors causing inflammatory process in the gums of local and diffuse character. Although, availability of non-typical clinical manifestation of chronic catarrhal and chronic hypertrophic gingivitis, pronounced bleeding symptom and frequent relapses of the disease suggest that inflammatory process of the gums occurs in morphologically and functionally changed periodontal tissues. Disorders of local and systemic protective mechanisms of the oral cavity in children with thyroid pathology are not excluded.
Conclusion. The results of the study conducted give evidence that children with DNG have greater percentage of periodontal tissue injury which is indicative of the necessity for further paraclinical study of dental status under conditions of comorbid pathology of the thyroid gland to detect cause-and-effect relations.
Prospects of further studies. The results of clinical and paraclinical examinations of children will promote to elaborate the scheme of therapeutic measures in case of chronic catarrhal gingivitis in the given group of children and its efficacy under clinical conditions will be evaluated.
References
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Надь Ю.Г.
Кандидат медицинских наук, эндокринолог, ООО МедЛаб,
Санкт-Петербург, Россия
ВЗАИМОСВЯЗИ ГИПОПРОЛАКТИНЕМИИ И СИНДРОМА ШИЕНА
RELATIONSHIP HYPOPROLACTINEMY AND SYNDROME SHien
Nagy Ju.G., MD, PhD, an endocrinologist, OOO Medlab, Saint-Petersburg, Russia
АННОТАЦИЯ
В работе исследованы особенности и взаимосвязи нарушения секреции пролактина (гипопролактине-мии) и Синдрома Шиена, или послеродовой гипопитуитаризм, возникажщий на фоне апоплексии гипофиза (септико-эмболический или ишемический инфаркт) или после родов, осложненных сепсисом, тром-боэмболиями и массивной кровопотерей. Синдром аналогичный синдрому Шиена-Симмондса описан при кровопотерях другого генеза, в том числе и у мужчин, истинная частота этой патологии не известна, поскольку она может протекать в стертой форме, под «маской» гипофункции щитовидной железы или даже вегетативно-сосудистой дистонии по гипотоническому типу. Наиболее частыми причинами нарушения секреции пролактина(ПРЛ) в сыворотке крови являются пролактин - секретирующие аденомы гипо-физа[4,6], выявляемые у женщин и мужчин репродуктивного возраста, которые обуславливают формирование гипогонадизма, сексуальной дисфункции, бесплодия, нарушений психо-эмоциональной сферы. Актуальность проблемы обусловлена распространенностью гиперпролактинемии (до 35%) и не достаточно изученной частотой гипопролактинемии.
ABSTRACT
In the paper the characteristics and relationship disorders of prolactin secretion (Hypoprolactinemy) and Shien Syndrome, or postpartum hypopituitarism, as a result of pituitary apoplexy (septic embolic or ischemic attack) or after delivery, complicated by sepsis, thromboembolism, and massive blood loss. The syndrome of the same syndrome Shien-Simmonds with blood loss of other genesis, including men, the true incidence of this disease is not known, because it can occur in the form of worn under the "mask" hypothyroidism or vegetative-vascular dystonia on hypotonic type. The most common causes of violations of the secretion of prolactin (PRL) in serum are prolactin - secreting pituitary adenoma [4,6], is diagnosed in men and women of reproductive age, which cause the formation of hypogonadism, sexual dysfunction, infertility, disorders of the psycho-emotional sphere. The urgency of the problem is due to the prevalence of hyperprolactinemy (35%) and not sufficiently studied the frequency gipoprolactinemy.
Ключевые слов: гипопролактинемия, синдром Шиена
Keywords: Hypoprolactinemy, Syndrome Shien
До середины 80-х годов было описано около 1500 случаев заболевания, однако А.С. Калини-ченко и соавт. (1987) считают, что частота синдрома Шиена составляет 0,1 %, но после массивных
послеродовых или постабортных кровотечений достигает 40 %. Синдром Шиена развивается у каждой 4-й женщины после кровопотери. Во время родов до 800 мл, у каждой 2-й - при крово потере до
