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EFFICIENCY OF TREATMENT OF CARIOSIS INJURIES WITHOUT CAVITY FORMATION IN YOUNG CHILDREN Dalimova Sh.K. Email: [email protected]
Dalimova Shoirakhon Kasimdjanovna - Assistant, DEPARTMENT OF HOSPITAL AND CLINICAL DENTISTRY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: this article evaluated the effectiveness of interceptive therapy of carious lesions without cavity formation in young children with the highest risk of caries formation. In case of untimely treatment of caries, foci of acquired odontogenic infection develop, which work as sources of sensitization of the body, have an adverse effect on the direction of many diseases of internal organs and systems.
Treatment of dental caries and its complications is a difficult psychological and sensible task both for the child and his parents, and for dentists. In accordance with this, it is most important and expedient to identify carious lesions in the early stages, in the treatment of which non-surgical techniques are used. An early study of the process of demineralization of enamel to provide an opportunity to apply a technique that promotes remineralization. Keywords: caries, sealing, fissures, sealant.
РЕЗУЛЬТАТИВНОСТЬ ЛЕЧЕНИЯ КАРИОЗНЫХ ПОРАЖЕНИЙ БЕЗ ОБРАЗОВАНИЯ ПОЛОСТИ У ДЕТЕЙ РАННЕГО ВОЗРАСТА
Далимова Ш.К.
Далимова Шоирахон Касимджановна - ассистент, кафедра госпитальной и клинической стоматологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: в данной статье были оценены эффективность проведения интерцептивного терапии кариозных поражений без образования полости у детей младшего возраста с высочайшим риском становления кариеса. При несвоевременном излечении кариеса складываются очаги приобретенной одонтогенной инфекции, которые работают источниками сенсибилизации организма, оказывают неблагоприятное влияние на появление множества заболеваний внутренних органов и систем.
Лечение кариеса зубов и его осложнений является трудной психологической задачей как для ребёнка и его родителей, так и для врачей-стоматологов. В соответствии с этим важнее всего и целесообразно выявление кариозных поражений на ранних стадиях, при лечении которых применяется нехирургическая методика. Раннее исследование процесса деминерализации эмали дает возможность применить методики, способствующие реминерализации. Ключевые слова: кариес, герметизация, фиссуры,силант.
UDC 616.31-085
Relevance. Currently, young people have the highest prevalence and intensity of dental caries, there is a desire to increase the increase in complicated forms of caries [1, 3, 5]. In case of untimely treatment of caries, foci of acquired odontogenic infection develop, which work as sources of sensitization of the body, have an adverse effect on the direction of many diseases of internal organs and systems [3, 4, 8]. Treatment of dental caries and its complications is a difficult psychological and sensible task for both the child and his parents, and for dentists [7, 8]. In accordance with this, it is most important and expedient to
identify carious lesions in the early stages, in the treatment of which non-surgical techniques are used (interceptive treatment). An early study of the process of demineralization of enamel make it possible to apply a technique that promotes remineralization [2, 5, 6].
Aimwas to evaluate the effectiveness of interceptive therapy of carious lesions without cavity formation in young children with the highest risk of caries formation.
Materials and methods. To achieve the set goal, 80 young children from 1 to 3 years old were treated. The assessment of the intensity of the carious process was carried out according to the index to 1-4 belly. Oral hygiene was considered with the support of the index of assessment of dental plaque in young children, developed [1].
The aspect of involvement in the study was the presence of carious lesions (1-4 belly) in the oral cavity. Afterwards, all the children were recommended to brush their teeth with a children's paste with a concentration of 500 ppm fluoride 2 times a day, apply a calcium-phosphate-containing gel to the teeth at night every day for 1 month with an interval of 1 moon, fluoride varnish (5% NaF) 2 times per year. Before the beginning of the healing events, the babies were divided into 3 groups by the method of blind people: in group 1 (40 people), the therapeutic sealing of temporary molars with glass ionomer cement (GIC) was carried out; in group 2 (42 children) - family applications on the teeth of 0.05% chlorhexidine 1 solution, one per day in the direction of 2 months with an interval of times the moon in the direction of six months, or before the eruption of all temporary teeth; in group 3 (43 children) - daily applications of calcium-phosphate-containing gel according to the scheme indicated above.
Patients in subgroups were homogeneous in gender, age and dental status. The dynamics of the characteristics of the dental status was examined every year in the direction of 3 years.
Statistical processing of the results obtained in the study was carried out using the Excel, STATISTICA 10.0 programs. Quantitative characteristics depending on the shape of the spreading are presented in the form of the mean sense (M) and the mean square difference (SD) with the usual spreading, or in the form of the median, upper and lower quartiles (Me [LQ / UQ]). If both compared variables had the usual distribution of distribution, then Pearson's correlation coefficients were planned to determine the closeness of the relationship between them. Spearman's rank correlation coefficients were calculated in an unpleasant case for the analysis of differences. In 2 subgroups by the quantitative parameter, when the appearance of the distribution of the analyzed characteristics does not correspond to the law of usual dispersion, nonparametric methods were used: the Mann - Whitney U-test for independent subgroups, the Wilcoxon aspect for dependent subgroups. The clinical effectiveness of the compared healing methods was perceived with the introduction of the odds index (W), the odds score (OR) and its confidence interval (95% CI). The possibility of error-free monitoring, equal to 95% (p <0.05), was perceived as a dangerous degree of statistical significance.
Results and consideration. Therapeutic sealing was performed in group 1 in 18 molars with initial caries (chalky fissures) and group II in 28 teeth with pigmented fissures. Comparison of sealing performance was carried out with 38 teeth in 18 patients from group 3, who underwent daily application of calcium-phosphate-containing gel (14 molars with chalky fissures and 25 teeth with pigmented fissures). After 1 year of subsequent sealing of the chalky fissures, the sealant remained in 16 (57.1 ± 18.71%) teeth. The average shelf life of the sealant was 13.4 ± 5.45 months, Me = 12.0 [10.0 / 15.0]. Fissures were preserved without configuration in 5 teeth; their sealant remained for 4-10 months. Remineralization of enamel occurred in 7 (25.0 ± 16.36%) teeth. teeth developed a carious process: in one - within the boundaries of the enamel and in two - with the involvement of dentin. After 3 years, the integrity of the sealant was observed in 8 (32.1 ± 17.74%) teeth, intact fissures were in 14 (50.0 ± 18.90%) molars, in 4 (17.9 ± 14.49%) teeth caries was diagnosed. Thus, 82.1 ± 14.49% of the teeth with initial caries, after which the therapeutic sealing was performed, were healthy. In group 3, after 1 year, remineralization occurred in teeth with chalky fissures in 6
(50.0 ± 25.00%) cases, and a carious process developed in the same number of teeth. After 2 and 3 years, 7 (43.8 ± 24.8%) teeth remained awake, and in 9 (56.2 ± 24.8%) teeth, caries developed, which was actually statistically significantly increased than in group 1 (p <0.05). The effectiveness of therapeutic sealing of fissures with initial caries compared with daily applications of calcium-phosphate-containing gel was 68.1% after 3 years. The chance of developing caries in teeth with chalky fissures after which non-invasive sealing with glass ionomer cement is 0.39, and after that the application of calcium-phosphate-containing gel is 1.40. Theoddsratioisequalto 3.58 (95% CI 0.90-14.26).
In teeth with pigmented fissures, 1 year after which therapeutic sealing, the progression of caries was not diagnosed in any tooth in children of group 1. In literally half of the teeth (47.9 ± 14.42%), the sealant was preserved. A higher percentage of sealant preservation was found in the first molars of the lower jaw (55.0 ± 21.71%); in general, this indicator did not differ statistically significantly from that in the first molars of the upper jaw (36.8 ± 22.12%; p = 0, 12). In general, the average shelf life was 13.6 ± 5.60 months, the median was 12.5 (9.0 / 17.5) months. The molars with the lost sealant were re-sealed.
After 2 and 3 years, 7 (43.8 ± 24.8%) teeth remained healthy, and 9 (56.2 ± 24.8%) teeth developed caries, which was statistically significantly higher than in group 1 (p < 0.05). The effectiveness of therapeutic sealing of fissures with initial caries in comparison with daily applications of calcium phosphate-containing gel was 68.1% after 3 years. The chance of developing caries in teeth with chalky fissures after non-invasive sealing with glass ionomer cement is 0.39, and after application of calcium-phosphate-containing gel - 1.40. The odds ratio was 3.58 (95% CI 0.90-14.26).
In teeth with pigmented fissures 1 year after therapeutic sealing, the progression of caries was not diagnosed in any tooth in children of group 1. In almost half of the teeth (47.9 ± 14.42%), the sealant was preserved. The highest percentage of sealant preservation was noted in the first molars of the lower jaw (55.0 ± 21.71%), however, this indicator did not differ statistically significantly from that in the first molars of the upper jaw (36.8 ± 22.12%; p = 0, 12). In general, the average shelf life was 13.6 ± 5.60 months, the median was 12.5 (9.0 / 17.5) months. Themolarswiththelostsealantwerere-sealed.
After 2 years, the preservation of the sealant was also noted in 19 (47.9 ± 14.42%) teeth, however, in 9 (18.8 ± 11.28%) teeth, the pathological process progressed with the formation of a carious cavity. Process stabilization was observed in 14 (33.3 ± 13.60%) teeth. After 3 years, the preservation of the sealant was noted in 10 (25.0 ± 12.50%) molars, stabilization of the process - in 25 (54.2 ± 14.38%) teeth, progression of the carious process - in 10 (20.8 ± 15, 34%) teeth.
In group 3, 18 children had pigmented fissures (n = 25) at the baseline examination. One year after the application of calcium-phosphate-containing gel to the teeth, the carious process stabilized in 4 (16.0 ± 14.66%) teeth, and in 21 (84.0 ± 14.66%) teeth, its further development. In the next two years, there were no changes in the condition of the teeth.
The reduction of caries in the teeth in which the therapeutic sealing was carried out was 75.2% after 3 years (p <0.001). The chance of caries development in teeth with pigmented fissures after their therapeutic sealing is 0.11, with the application of calcium-phosphate-containing gel - 2.1; OR = 19.95 (95% CI 5.47-71.48).
The effectiveness of remineralization of initial carious lesions on smooth surfaces was assessed in groups 1 and 3 in comparison with that in group 2. For this purpose, we analyzed the dynamics of the state of carious lesions in the form of chalky spots on smooth surfaces of incisors and canines 1 year after the start of treatment and prophylactic measures.
In children of groups 1 and 3 of 74 teeth, remineralization of initial carious lesions was observed in 32 (43.2 ± 5.76%) teeth, in group 2 - in 36 (63.2 ± 6.39%) teeth (p = 0, 02). Also, in this group, the proportion of carious lesions with dentin attraction was lower (14.0% versus 29.7%, p <0.05). The reduction of initial carious lesions was 35.2%. The risk of progression of initial carious lesions on smooth surfaces when applying a 0.05% chlorhexidine solution is 2.25 times more effective than applying only a calcium phosphate-
containing gel (OR = 2.25). The acquired results make it possible to make a conclusion about the need to connect antimicrobial applications of 0.05% chlorhexidine solution to a set of preventive events in children with initial carious lesions. At the basic examination of children with the highest risk of caries formation, an important share in the structure of the index k 1-4 belly was occupied by carious losses without the formation of a lack of hard tissues: in group 1 - 2.53, in group 2 - 2.44, in group 3 - 2, 40. As it was prescribed above, carrying out healing and prophylactic events led to remineralization of a significant fraction of the original carious lesions and stabilization of pigmented enamel lesions. As a result, the indicator for 1-4 belly in groups 1 and 2 decreased in comparison with the initial data by 0.65 and by 1.15 in accordance with this, in group 3 it increased by 0.29. However, the average value of the indicator in the groups did not differ significantly (p1-2 = 0.92; p1-3 =
0.13. p2-3 = 0.12).
Conclusion. Carrying out therapeutic sealing of fissures of molars with initial carious lesions reduces the risk of their progression in comparison with applications of calcium-phosphate-containing gel by 3.6 times, pigmented fissures - by 19.95 times. The inclusion of a 0.05% chlorhexidine solution into the complex of healing and prophylactic events makes it possible to increase the efficiency of remineralization of the original carious lesions on smooth surfaces by 35.2%.
Children with the highest risk of caries and an intensive course of the carious process along with the destruction of cumulative risk points, the use of fluorides and calcium-phosphate-containing gel, need therapeutic sealing of chalky and pigmented fissures of molars and the application of 0.05% chlorhexidine solution.
References / Список литературы
1. Vinogradova T.F. Atlas po stomatologicheskim zabolevaniyam u detey. Uchebnoye posobiye. M.: Med. press-inform, 2010. 168 s.
2. Detskaya terapevticheskaya stomatologiya. Natsional'noye rukovodstvo / pod red. V.K. Leont'yeva, L.P. Kisel'nikovoy. M.: GEOTAR-Media, 2010. 896 s.
3. Kuryakina N.V., Morozova S.I. Kariyes i nekarioznyye porazheniya tverdykh tkaney zubov. Uchebnoye posobiye. Medu. Izd-vo Sankt-Peterburg, 2005. 110 s.
4. Sayfullina KH.M. Kariyes zubov u podrostkov. M.: Medpress, 2001. 95 s.
5. Skorikova L.A., Osadchaya G.N. Profilakticheskiye meropriyatiya pri mnozhestvennom kariyese zubov // Dental Yug, 2010. № 10. S. 30-32.
6. Infiltrating/sealing proximal caries lesions: a 3-year randomized clinical trial / S. Martignon, et al. // J. Dent. Res., 2012. Vol. 91. P. 288-292.
7. Sealing distal proximal caries lesions in first primary molars: efficacy after 2.5 years / S. Martignon, et al. // Caries Res., 2010. Vol. 44. P. 562-570.
8. TellezM. // Community Dent. Oral Epidemiol., 2013. Vol. 41. P. 79-96.
