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ISSN2079-8334. Ceim медицини та бюлогп. 2019. № 1 (67)
обгрунтування антиоксидантно1 та репарационной ролi препарату «Емоксипину» при данш патологи. Вивчалася виражешсть променевих реакцiй у хворих, яю отримували променеве лiкування в режимi звичайного фракцiонування i при мультифракцюнуванш дози. У спостереженнi брало участь 27 хворих з дiагнозом рак сечового мiхура i яким проводили дистанцшну променеву терапiю за радикальною програмою. Аналiзуючи отриманi результата, можна вщзначити, що застосування дистанцшно! променево! терапи в режимi мультифракцюнування денно! дози достовiрно (р = 0,05) знижуе променевi реакци слизово! сечового мiхура. Так, реакци 3 ступеня (виразков^ розрiзняються в 4,31 рази на користь (дослщно!) групи де використовували режим мультифракцiонування i заливки препарату «Емоксипину». Реакци 2 ступеня (ерозивно-десквамозний) вiдрiзняються в 1,24 рази i також говорять на користь II групи, але цей показник не достовiрний. Реакци 1 ступеня (катаральнi) вiдрiзняються в 3,72 рази, що мае достатню ймовiрнiсть на користь лiкування проведеного в 11-й груш хворих. Дiя шсталяцш сечового мiхура у хворих з променевими циститами, обтяженими шфекцшним процесом, в порiвняннi з традицшними методами терапи дозволило скоротити час перебування хворих в стацiонарi на 6-7 дшв.
Ключовi слова: рак сечового мiхура, антиоксиданти, дистанцiйна гамма-тератя, променевi реакцп, променевi ушкодження, цистит.
Стаття надiйшла 22.07.18 р.
обоснование антиоксидантной и репарационной роли препарата «Эмоксипин» при данной патологии. Изучалась выраженность лучевых реакций у больных, получавших лучевое лечение в режиме обычного фракционирования и при мультифракционировании дозы. В наблюдении принимало участие 27 больных с диагнозом рак мочевого пузыря и которым проводили дистанционную лучевую терапию по радикальной программе. Анализируя полученные результаты, можно отметить, что применение дистанционной лучевой терапии в режиме мультифракционирования дневной дозы достоверно (р=0,05) снижает лучевые реакции слизистой мочевого пузыря. Так, реакции 3 степени (язвенные) различаются в 4,31 раза в пользу (опытной) группы где использовали режим мультифракционирования и заливки препарата «Эмоксипин». Реакции 2 степени (эрозивно-дескваматозные) отличаются в 1,24 раза и также говорят в пользу II группы, но этот показатель не достоверен. Реакции 1 степени (катаральные) отличаются в 3,72 раза, что имеет достаточную вероятность в пользу лечения проведенного во II группе больных. Действие инсталляций мочевого пузыря у больных с лучевыми циститами, отягощенные инфекционным процессом, по сравнению с традиционными методами терапии позволило сократить время пребывания больных в стационаре на 6-7 дней.
Ключевые слова: рак мочевого пузыря, антиоксиданты, дистанционная гамма-терапия, лучевые реакции, лучевые повреждения, цистит.
Рецензент Саричев Л.П.
DOI 10.26724/2079-8334-2019-1-67-60 UDC 616.314.13:612.313.3]-053.3
EFFECT OF PH AND MINERALIZING PROPERTIES OF THE ORAL FLUID ON ENAMEL ACID RESISTANCE IN CHILDREN
E-mail: mandziuk_tetiana@bsmu.edu.ua
The present study was aimed to investigate the indices of pH, microcrystallization of the oral fluid in 7-9-year-old children with caries and without it, and possibility of occurrence of carious lesions with further use of the obtained results concerning the necessity to initiate preventive measures. The course of caries in 7-9-year-old children occurs against the ground of decrease of pH and saliva microcrystallization indices, and it is caused by reduced dental resistance to caries which is evidenced by the results of examination of the enamel acid resistance according to the enamel resistance test. The analysis of the obtained results demonstrated existence of a reverse correlation in 7-9-year-old children with caries between the index of enamel acid resistance and mineralizing potential (r= 0.73 - strong index) and pH (r= 0.66 - reverse considerable) of the oral fluid. These children presented direct strong connection between pH index and saliva mineralizing potential (r= 0.79). The results obtained promote the necessity to perform primary and secondary prevention directed to the improvement of homeostasis indices in the oral cavity which will enable to decrease prevalence and intensity of caries in children.
Key words: caries, intact teeth, oral cavity pH, saliva microcrystallization, enamel acid resistance.
The study is a fragment of the research project "Improvement ofpreventive and therapeutic methods of treating the main stomatological diseases in children with risk factors", state registration No. 0111U006760.
Caries is the most spread dental disease found among the world population long ago [2]. Occurrence of the pathology is caused by the action of certain factors producing both external and internal effect on the condition of the hard tissues of temporary and permanent teeth [3,4].
The oral fluid pH changes is one of the risk factors promoting occurrence of dental caries. This index is a regulator of homeostasis in mineral components, and in case it is deviated into acid side a mechanism resulting in dental enamel demineralization is launched. Physiological norm of oral fluid pH is 6.60- 7.08 [5, 6]. Reduced mineralizing properties of the oral fluid lead to decreased acid resistance of the enamel and thus cause occurrence of carious process [7]. Therefore, examination of the indices of the oral fluid microcrystallization and enamel resistance enable to administer preventive measures with the purpose to prevent occurrence of caries in children [8, 9, 10].
© L.F. Kaskova, T.B. Mandziuk, 2019
The purpose of the study was to investigate the indices of pH, microcrystallization of the oral fluid in 7-9-year-old children with caries and without it, and possibility of occurrence of carious lesions with further use of the obtained results concerning the necessity to initiate preventive measures.
Materials and methods. The total of 134 children aged 7-9 years with the 1st period of changing occlusion were examined at the organized children's groups in Poltava. Stomatological examination was carried out according to the common algorithm. Caries intensity in all the children was determined by Caries Filling Extraction (CFE) and CFE+cf Indices. Hydrogen Index (pH) was determined by means of indicator paper strip pH 0-12 (produced by «Lachema», Czech Republic). For this purpose the indicator paper strip was placed into the oral fluid for a short time and 2 minutes later oral fluid pH was determined by color changes of the universal indicator paper.
Mineralizing potential of the oral fluid was assessed by its microcrystallization (P. A. Leus, 1977) [2]. Oral fluid was taken by means of a sterile dropper from the bottom of the oral cavity, minimum 2 hours after meals and rinsing with distilled water. Three drops of the oral fluid were put on the microscope slide treated with ethyl alcohol and dried at a room temperature. After the drops were dried they were examined under the microscope "Biolam Lomo P14" with magnification 2x6 in the reflected light. The oral fluid/saliva mineralizing potential was assessed as an average depending on the determined types of saliva microcrystallization (SMC) considering the whole area of drops on the microscope slide. Mineralizing
£ SMc
potential was calculated by the formula SMP = 3 , where SMP - saliva mineralizing potential and; E SMC - the total types of saliva microcrystallization.
Microcrystallization was assessed according to H.M. Sayfulina, O.R. Pozdeyev (13) in mean score depending on the types of crystal formation: 0.1- 1.0 - very low level; 1.1- 2.0 - low; 2.1- 3.0 - satisfactory; 3.1-4.0 - high; 4.1-5.0 - very high.
To determine resistance of the dental enamel to caries the enamel resistance test by V.P. Okushko, L.I. Kosarieva was applied. The degree of enamel staining was assessed in its comparison with a color polygraphic 10-grade scale. According to the color of enamel staining the following levels of enamel resistance were differentiated:
- high enamel resistance to caries (1-3 grades) - pale blue staining;
- moderate enamel resistance (4-5 grades) - light blue color of staining;
- reduced enamel resistance to caries (6-7 grades) - blue color of staining;
- very low enamel resistance to caries (8-10 grades) - dark blue color of staining.
The obtained results were processed by the variation statistics method. The indices with p<0.05 were considered to be reliable.
Correlation dependence was studied by availability, direction and connection strength on the basis of Pearson liner coefficient. In addition, Spearman's and Kendall rank correlation coefficients were determined. In case the correlation coefficient was negative the connection of the obtained data was considered to be reverse, in other cases - direct. The results were interpreted according to Cheddok scale: less than 0.3 - poor correlation connection; from 0.3 to 0.5 - moderate; from 0.5 to 0.7 - average; from 0.7 to 0.9 - high; more than 0.9 - very high [10].
Table 1
Saliva pH value in 7-9-year-old children with caries of temporary and permanent teeth
and with intact teeth (M±m)
Age in years pH value in units P
Mean value In children with intact teeth In children with caries (CFE+cf)
7 6.85±0.02 n=58 6.95±0.02 n=27 6.75±0.02 n=31 <0.001
8 6.81±0.02 n=45 6.98±0.05 n=7 6.78±0.02 n=38 <0.01
p7-8 >0.05 >0.05 >0.05
9 6.82±0.02 n=31 6.97±0.03 n=5 6.79±0.02 n=26 <0.01
p7-9 >0.05 >0.05 >0.05
p8-9 >0.05 >0.05 >0.05
total 6.83±0.01 n=134 6.97±0.02 n=39 6.77±0.01 n=95 <0.001
Results of the study and their discussion. The mean value of saliva or oral fluid pH in children aged from 7 to 9 years is 6.83±0.01units which corresponds to that of the norm (table 1). The highest index was found in 7-year-old children (6.85±0.02 units), in 8-year-old and 9-year-old children it ranged 6.81±0.02 and 6.82±0.02 units. We have not found a reliable difference of indices in the age aspect. Further distribution of children into the groups with caries and without it found certain differences of the examined
index at all the age periods. Thus, children with caries demonstrate reliably lower indices in every age group compared with children without caries, and their values correspond to weak-acid level. In children without caries, the index ranges within 6.95-6.98 units, thus corresponding to that of the norm. Similar tendency is seen among children who are afflicted only with caries of temporary or permanent teeth in comparison with healthy children. That is, the pH mean value in children with caries is always within the weak-acid range, and in children without caries within that of weak-alkaline.
Further step of our study was investigation of saliva mineralizing properties closely associated with pH value. Saliva mineralizing ability influences on the condition of the hard dental tissues, that is enamel acid resistance which reduction results in demineralization followed by progressing of carious process. Our research has demonstrated that a mean value of saliva microcrystallization in 7-9-year-old children ranges within 1,99±0,11-2,31±0,18 and did not differ reliably in children of different ages (table 2).
Table 2
Saliva microcrystallization value in 7-9-year-old children with caries of temporary and permanent teeth and with intact teeth (M±m)
Age in years Microcrystallization index (grades) P
Mean value In children with intact teeth In children with caries (CFE+cf)
7 2.31±0.18 n=58 2.96±0.09 n=27 1.74±0.07 n=31 <0.001
8 2.10±0.09 n=45 3.00±0.25 n=7 1.93±0.07 n=38 <0.001
P7-8 >0.05 >0.05 >0.05
9 1.99±0.11 n=31 2.93±0.35 n=5 1.81±0.06 n=26 <0.001
P7-9 >0.05 >0.05 >0.05
P8-9 >0.05 >0.05 >0.05
total 2.16±0.06 n=134 2.97±0.09 n=39 1.83±0.04 n=95 <0.001
Comparison of the index in children with caries and without it found its reliable difference in every age period. In children with caries saliva mineralizing properties are always lower than those of children with intact teeth, and a mean value is 1.83±0.04 and 2.97±0.09 respectively.
The index was studied separately in 7-9-year-old children with caries of temporary teeth and caries of permanent teeth. Irrespective the fact that children are afflicted with caries of temporary or permanent teeth, microcrystallization index was always better in children without caries which is indicative of higher mineralizing properties of the oral fluid in children with intact teeth. Children with caries of temporary teeth had microcrystallization index 1.82±0.04 against 2.79±0.07 - in children with intact teeth, and with caries of permanent teeth - 1.69±0.06 and 2.33±0.06 respectively.
Enamel acid resistance depends on the peculiarities of the oral fluid being continuously in contact with the hard dental tissue. The mean value of the enamel resistance test in 7-9-year-old children is 4.07±0.11 (table 3). Reliable differences of the index were found in the groups of children with caries and without it (4.67±0.10 and 2.59±0.09 respectively). Against the ground of worsening of pH and saliva microcrystallization indices the enamel acid resistance decreases as well. We did not find reliable difference of the enamel resistance test among children of different ages. The worst enamel acid resistance was found in 7-year-old children with caries of permanent teeth (5.13±0.30) and it corresponds to moderate enamel resistance.
Table 3
Values of enamel resistance test in 7-9-year-old children with caries of temporary and permanent teeth and with intact teeth (M±m)
Age in years Enamel resistance test index (score) P
Mean value In children with intact teeth In children with caries (CFE+cf)
7 3.78±0.18 n=58 2.56±0.10 n=27 4.84±0.15 n=31 <0.001
8 4.42±0.18 n=45 2.57±0.2 n=7 4.76±0.15 n=38 <0.001
P7-8 <0.05 >0.05 >0.05
9 4.13±0.20 n=31 2.8±0.37 n=5 4.35±0.19 n=26 <0.05
P7-9 >0.05 >0.05 >0.05
P8-9 >0.05 >0.05 >0.05
total 4.07±0.11 n=134 2.59±0.09 n=39 4.67±0.10 n=95 <0.001
The analysis of the obtained results demonstrated the existence of a reverse correlation in 7-9-year-old children with caries between the index of enamel acid resistance and mineralizing potential (r= 0.73 -strong index) and pH (r= 0.66 - reverse considerable) of the oral fluid. These children presented direct
ISSN2079-8334. Ceim медицини та бюлогп. 2019. № 1 (67)
strong connection between pH index and saliva mineralizing potential (r= 0.79). In this respect our data are consistent with those of other researchers [5-7].
As it follows from the results presented in the tables, the course of caries in 7-9-year-old children occurs against the background of decrease in pH and saliva microcrystallization indices, and it is caused by the reduced dental resistance to caries which is evidenced by the results of the enamel acid resistance examination according to the enamel resistance test [4, 5, 10].
The results obtained promote the necessity to perform primary and secondary prevention aimed to the improvement of homeostasis indices in the oral cavity which will enable to decrease incidence and intensity of caries in children.
1. Kaskova L, Amosova L, Artemyev A, Berezhna O. Osobennosti stomatologicheskogo statusa naseleniya territorii Ukrainy v raznye istoricheskie ehpohi. Medicinskie novosti Gruzii. 2014;12(237):35-39. [in Russian]
2. Leus P. Diagnostika, lechenie i profilaktika kariesa zubov. Minsk: Registr, 2018. 218s. [in Russian]
3. Luchynskyi M. Vplyv nehatyvnykh faktoriv dovkillia na riven stomatolohichnoi zakhvoriuvanosti dytiachoho naselennia. Visnyk problem biolohii i medytsyny. 2014; 1(2):221-223. [in Ukrainian]
4. Novytskaia YK. Karysprofylaktycheskaia effektyvnost remyneralyzuiushcheho helia dlia polosty rta. Visnyk stomatolohii. 2012; 2:118-119. [in Russian]
5. Syrotkina O, Udod O. Strukturno-funkcionalna kyslotostiykist emali u prohnozuvanni karioznoho urazhennya zubiv. Pytannya eksperymentalnoyi ta klinichnoyi medytsyny. 2013; 17(2): 290-294. [in Ukrainian]
6. Stadnyk U, Cherepyuk O, Lysak T. Kharakterystyka deiakykh fizychnykh ta mikrobiolohichnykh vlastyvostey RR u ditey doshkilnoho viku v zalezhnosti vid intensyvnosti kariesu tymchasovykh zubiv. Visnyk problem biolohii i medytsyny. 2016. 3(130): 347-350. [in Ukrainian]
7. Cherepyuk O, Stadnyk U, Musiy-Sementsiv Kh. Znachennya pH ta koncentratsiyi Lactobacillus v rotoviy ridyni u ditey doshkilnoho viku. Innovatsiyni texnolohiyi v stomatolohiyi. Tezy dopovidey naukovo-praktychnoyi konferentsiyi. 2016; 108-109. [in Ukrainian]
8. Chukhray N, Axmad Kh. Pokaznyky kariesu zubiv u ditey iz rehionu z pidvyshchenym umistom ftoru v pytniy vodi. Ukrayinskyi stomatolohichnyi almanakh. 2011;5:74-77. [in Ukrainian]
9. Khomenko L, Sorochenko H. Kliniko-laboratornaya otsenka effektivnosti lechebno-profilaktycheskikh zubnykh past v profilaktike kariesa. Saratovskyi nauchno-medytsynskyi zhurnal. 2011; 1: 22 - 25. [in Russian]
10. Khomutova G. Tradytsyonnye i perspektivnye podkhody k profilaktike kariesa. Lechashchyi vrach. 2015; 9:84-85. [in Russian]
ВПЛИВ PH I МШЕРАЛ1ЗАЦШНИХ ВЛАСТИВОСТЕЙ РОТОВО1 Р1ДИНИ НА КИСЛОТОСПЙКЮТЬ ЕМАЛ1 У Д1ТЕЙ Каськова Л.Ф., Мандзюк Т.Б., Годованець O.I.,
Уласевич Л.П., Кузняк Л.В. Метою нашо! роботи було вивчення показниюв рН, мкрокристагазащ! ротово! рщини у д1тей 7-9 роюв з кар1есом i без нього та !х вплив !хшх показниюв на кислотостшюсть емал1 та можливють виникнення карюзних уражень з подальшим використанням отриманих результата на визначення необхщносп проведення профшактичних заxодiв. Переб^ карieсу у дтей 7-9 роюв вщбуваеться на фон зниження показника рН та мкрокристагазащ! ротово! рщини та обумовлений зниженням стшкосп зубiв до карieсу, про що свщчать результати дослщження кислотостшкосп емалi за показником тесту емалево! резистентности Аналiз отриманих результата продемонстрував юнування зворотно! кореляцй у дтей 7-9 роюв з карieсом мiж показником кислотостшкосп емалi i мiнералiзувальним потенщалом (r= 0,73 - сильний показник) та рН (r= 0,66 -обернений значний) ротово! рщини. Також виявлений прямий сильний зв'язок мiж показником рН i мiнералiзувальним потенцiалом ротово! рiдини (r= 0,79) у цих дтей. Отриманi даш спонукають до необxiдностi проведення первинно! та вторинно! профiлактики, направлено! на покращення показниюв гомеостазу порожнини рота, що дасть можливють знизити поширенють та штенсивнють карieсу у дтей.
Ключовi слова: карiеe, iнтактнi зуби, рН ротово! рщини, мiкрокристалiзацiя ротово! рщини, кислотостшюсть емалi
Стаття надшшла 20.07.18 р.
ВЛИЯНИЕ РН И ИНЕРАЛИЗАЦИОННЫХ СВОЙСТВ РОТОВОЙ ЖИДКОСТИ НА КИСЛОТОУСТОЙЧИВОСТЬ ЭМАЛИ У ДЕТЕЙ Каськова Л.Ф., Мандзюк Т.Б., Годованец А.И., Уласевич Л. П., Кузняк Л. В.
Целью нашей работы было изучение показателей рН, микрокристализации ротовой жидкости у детей 7-9 лет с кариесом и без него и их влияние их показателей на кислотостойкость эмали и возможность возникновения кариозных поражений с последующим использованием полученных результатов на определение необходимости проведения профилактических мероприятий. Течение кариеса у детей 7-9 лет происходит на фоне снижения показателя рН и микрокристализации ротовой жидкости и обусловлен снижением устойчивости зубов к кариесу, о чем свидетельствуют результаты исследования кислотостойкость эмали по показателю теста эмалевой резистентности. Анализ полученных результатов показал существование обратной корреляции у детей 7-9 лет с кариесом между показателем кислотостойкость эмали и минерализувальним потенциалом (г = 0,73 - сильный показатель) и рН (г =0,66 - обратный значительный) ротовой жидкости. Также обнаружена прямая сильная связь между показателем рН и минерализующим потенциалом ротовой жидкости (г = 0,79) у этих детей. Полученные данные побуждают к необходимости проведения первичной и вторичной профилактики, направленной на улучшение показателей гомеостаза полости рта, что позволит снизить распространенность и интенсивность кариеса у детей.
Ключевые слова: кариес, интактные зубы, рН ротовой жидкости, микрокристализация ротовой жидкости, кислотоустойчивость эмали.
Рецензент Ткаченко П.1.
