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8Received by the Editor 20.12.2020
IRSTI 76.29.55+76.29.47
UDC 616.314-002-022.7
FEATURES OF THE COURSE OF DENTAL CARIES IN YOUNG CHILDREN
А. Kulmakhanbetova1'2
1Shymkent medical Instituty, Kazakhstan. 160012, Shymkent city, Baitursynov street, 7/7
2Khoja Ahmet Yassawi Kazakh-Turkish International University, Kazakhstan, 161200, Turkestan region, Turkestan city, B. Sattarkhanov Avenue, building 29B
Dental caries in young children is a serious problem in all countries of the world, which is associated with a tendency to increase the severity and frequency of the disease. In this regard, we conducted a literature review aimed at an in-depth study of the problems of caries in young children.
Keywords: children, dental caries, microorganisms.
ОСОБЕННОСТИ ТЕЧЕНИЯ КАРИЕСА У ДЕТЕЙ РАННЕГО ВОЗРАСТА
Кулмаханбетова А.М.1'2
1Шымкентский медицинский институт, Казахстан, 160012, Шымкент, улица Байтурсынова, 7/7
^Международный казахско-турецкий университет имени Ходжи Ахмеда Ясави, Казахстан, 161200, Туркестанская область, город Туркестан, проспект Б. Саттарханов, строение 29В
Ранний детский кариес является существенной проблемой во всех странах мира, что обусловлено тенденцией к увеличению тяжести и частоты заболевания. В связи с этим, нами было проведено литературный обзор, направленное на углубленное изучение проблемы раннего детского кариеса.
Ключевые слова: дети, кариес, микроорганизмы.
ЕРТЕ ЖАСТАГЫ БАЛАЛАРДАГЫ КАРИЕС АГЫМЫНЬЩ ЕРЕКШЕЛ1КТЕР1
кулмаханбетова А.М.1'2
1Шымкент медицина институт!, ^азакстан. 160012, Шымкент каласы, Байтурсынов кешеа, 7/7
2^ожа Ахмет Ясауи атындагы Хальщаральщ казак^р^ университет^ ^азакстан, 161200, ТYркiстан облысы, ТYркiстан каласы, Б. Саттарханов дацгылы, 29Б гимарат
Ерте жастагы балалардын кариес элемнщ барлык елдершде манызды мэселе болып табылады, бул аурудын ауырлыгы мен жишпн арттыру YPдiсiне байланысты. Осыган байланысты, б1з ерте жастагы балалар кариесiнiн мэселелерiн терен зерттеуге багытгалган эдеби шолу жасадык.
ТYЙiндi сездер: балалар, кариес, микроорганизмдер.
Dental caries in young children is a serious problem in all countries of the world [1-4]. The development of the disease in children under 30 months differs from the development of caries in older children. First of all, the mammary glands of the upper jaw are affected (cases of damage are detected in the first year of a child's life) [5,6]. Further, when teeth appear, the first and second milk molars of the upper and lower jaw are affected by caries. Most often, the carious process develops on the scales of the upper and lower jaws. Unlike the bones of the lower jaw, which are usually not affected, the mammary glands of the upper jaw are very sensitive to caries, since the flow of saliva from the sublingual and submandibular salivary glands, contact with the tongue and lips during eating protects against food retention on the smooth surfaces of these teeth, which prevents the development of caries cavities [7].
Caries in young children begins with the appearance of white spots on the smooth surfaces of the teeth in the gum area. As the carious process develops, the hard tissues of the tooth are destroyed and a carious cavity is formed. Destruction circularly spreads and leads to the destruction of dental crowns along the segments of each jaw [8,9]. Children with caries in the milk bite are sensitive to caries and have a permanent bite [10,11].
According to who, 15% of children aged one year have teeth affected by caries, by the age of three, the prevalence of caries reaches 46%, by six - 96% [12,13]. The prevalence of ESS varies worldwide and ranges from 18.5% to 77% [14].
A comparative review of epidemiology has shown that the prevalence of ESS varies by population. Thus, in North America, the prevalence of caries in children of early and preschool age is 11,0% - 72,0% [15]. Moreover, Anderson L. et al. 2010, most caries lesions remain incurable: 31% of preschool children aged 3-6 years in new Hampshire had incurable caries, the overall prevalence of caries is 40%. In the United States, the prevalence of caries among children aged 1 to 3 years (including primary caries) increases from 9% to 77%, and without primary caries-from 2% to 20% [16].
In England, the prevalence of ESS is 6,8% - 12% [17,18], in Denmark - 8% - 9,3% [19]. In Belgium, dental caries increases from 7% in children 1-3 years old to 31% in children 5 years old [20]. In Italy, the prevalence of caries also increases with the age of children: 15,4% in children aged 3 years, 24,2% in children aged 4 years, and 31,1% in people aged 5 years [21]. In Lithuania, the prevalence of caries among 4 - year-olds is 78,7%, the intensity is 4,9 (according to CP) [22], in Latvia, it is 48% for 2-6-year-olds [23].
The prevalence of ESS in Japan among children aged 18 months is 2,8%, among children aged 3 years-25,9% [24]. In Australia, the prevalence of caries among children aged 2-3 years is 17,0% [25,26].
In developing countries (Brazil, Argentina, India, Colombia, etc.), the prevalence of caries varies from 19.9% to 85.0%, depending on ethnic and socio-economic status [27]. The distribution in Jakarta (Indonesia) is ESS 52,7% [28], Pakistan-51% [29], Egypt-60,4% [30], Iran - 19,5% -44,0% [31]. Singh S., 2011, draws attention to the large number of children with untreated teeth in South Africa: 46.6% among children aged 4-5 years, 55,1% among children aged 6 years, the prevalence of caries is 50,6% and 60.3%, respectively [32].
Data on the prevalence of caries in India vary. According to a study conducted in Bahadurgarh, the prevalence of caries is 42,3%, in Davanger - 19,2%, in Udupi-19,4%, in Gurgaon - 68,7% [33]. The prevalence of ESS in children 1-2 years old in Sri Lanka is 32,9%, in children 5 years old - 65% [34]. In Malaysia, early childhood caries is determined by the intensity of the lesion in 65% of children aged 3-5 years, according to the ESS 3.8. In Brazil, according to a 2007 study involving 12,117 children aged 18-36 months, at least one carious cavity was found in 26,9% of children, and focal demineralization of tooth enamel was found in 33,9% - 55,3%. In Colombia, a high level of caries prevalence and intensity was found in children aged 2,5-4 years: 74,9% [35].
According to T.V. Popruzhenko et al. [36] a high prevalence of ESS was detected in Belarus: 25% in two-year-olds, 50% in three-year-olds, 73% and 83% in four and five-year-olds.
Thus, early childhood caries is a serious problem in all countries of the world, which requires studying the effectiveness of various measures to prevent it.
Dental caries is a serious infectious multi-factor disease of the tooth tissue, which affects many people, and only 3% of people are resistant to caries. The caries development model for children aged received the name "caries in bottles", as the main point of caries development at the age of majority is a special and long-term night feeding of children with bottle and sweet drinks. At the same time, the risk of developing the ESC is related not only to the "bottle" feeding of children, but also to the special consumption of sweetness between the main meals, the baby's feeding of the breast without its own feed (older than 12 months), the child's feeding proper food and hygienic care for teeth. An important role in the development of caries is played by parents ' lack of knowledge about the oral hygiene of infants and the need for proper hygienic care of children's teeth, socio-economic problems of the family, the mother's oral cavity, and the lack of
a habit of regularly visiting the dentist. In the study of Iida N., the development of caries in children is promoted by the poverty of the family and the mother's smoking. Khamadeeva et al., 2008, noted the high role of behavioral factors in the occurrence of caries in young children: low level of oral hygiene, the use of a bottle when feeding a child older than 15 months, night food in the form of sweetened beverages [37].
It is proved that caries is associated with the overall health of children. D'oliveira et al., 2005, low-weight babies have shown that babies born by caesarean section are susceptible to tooth decay. A link was found between middle ear infection, respiratory tract infection in the first year of a child's life and the development of ESS [38]. According to Alaki S. M. author, 2009, taking antibiotics in the first year of a child's life leads to a sharp increase in the risk of developing caries. A survey of children older than 12 months showed that children who took antibiotics from 13 to 18 months of life had an increased risk of developing caries. It is proved that the prevalence and intensity of caries in children with asthma is higher than in healthy people.
Of great importance in the development of caries is the insufficient supply of fluorides to the child's body. Increased sensitivity to caries was found in children and adults living in places with low levels of fluoride in drinking water (less than 0,5 mg / l). It is proved that tooth enamel that occurs under conditions of severe fluoride deficiency has low acid resistance, and the constant presence of fluorides in the oral cavity in low concentrations increases remineralization and reduces demineralization of hard tooth tissues. Therefore, the use of fluorides is the main measure for the prevention of dental caries [39].
The results of the third national study in the field of Health and nutrition in the United States showed that the spread of caries in children is due to age, ethnic group, level of education of parents and economic policy of the family. In the thick of all caries there are children from families who have a low socio-economic status and belong to racial minorities. According to the Center for control and Prevention of diseases in the United States, the prevalence of caries among children aged 2-5 years is 27,9%, Mexican - 55,4%, African - 43,4%, or Spanish - 38,6%. Spread of caries in children from families, the level of income exceeds or Raven 200% from the great living minimum, is 32,3%, children from families with the level of income 100-199% from the great living minimum - 48%, children from families with the lowest level of income (more than 100% from the great living minimum) - 54,3% [40].
A number of studies have revealed the sensitivity of children and adults living in regions with unfavorable environmental conditions to caries.
According to N. V. Rozhdestvenskaya [41], the incidence of caries of baby teeth in children depended on the motivation of parents to prevent and treat diseases: with high motivation, the prevalence of caries at the age of one year was 31%, in two - year - olds - 47%, in intensity, CP -1,24 and 2,81, with low motivation - 52% and 72%, 2,75 and 5,61, respectively.
There is evidence that genetic factors contribute to caries sensitivity. A number of fragments (biomarkers) in human DNA have been identified that occur in 90-100% of children with active caries, but with the development of caries in a child, the problem of binding alleles to the human leukocyte antigen is debated.
Despite many factors that affect the likelihood of developing caries in early childhood, the main cause of caries in children is caries-causing microorganisms. Primary infection in children occurs when passing through the birth canal. First, the oral cavity contains bifidobacteria that have the ability to aggregate cariesogenic microorganisms, and then They colonize coli, enterococci, green streptococci, Staphylococcus epidermidis, Corynebacterium pseudodifhtericum and Candidi albicans. After a few weeks, the oral cavity is colonized by anaerobic bacteria, spirochetes, hemophiles, and nisseria [42].
Gram-positive coccus (Str. salivarius, sanquis, mutans) belongs to the mandatory flora of the oral cavity. They decompose lactate, pyruvate, acetate and other carbohydrates well into carbon dioxide and water, and have an anti-carious effect. Gram-negative Bacillus Lactobacillus (L. casei, L. acidophilus, L. salivarius, etc.). They break down carbohydrates to form lactic acid, maintaining viability at a low pH level of the environment. Gram-negative anaerobic and microaerophilic
bacteria often belong to the Bacteroidaceae family and colonize in infected dentin. They form sugar into gas, and Peptones into amino acids.
Walsh L. and others. [43] 1 mg showed that dental plaque contains up to 200 million microorganisms. The composition of food largely affects the quantitative and qualitative composition of the oral microflora: an increased content of sucrose leads to the proliferation of streptococci and lactobacilli, and glucose does not have such an effect. The decomposition of food contributes to the accumulation of carbohydrates, amino acids, vitamins and other substances used by microorganisms as a nutrient substrate in the saliva and gingival fluid.
Microorganisms in the oral cavity are colonized in large numbers in the teeth, mucous membrane, gaps, saliva, and back of the tongue. There are few microorganisms on the smooth surface of the walls of the oral cavity. In children with a healthy oral cavity, the microbial picture of caries is more complex and diverse than in children with caries, and in children with an active course of caries, there are more caries-causing microorganisms.
The main etiological significance in the development of caries is p. mutans (SM) and Str. Sobrinus. The prevalence of SM colonies in infancy exceeds 25% -64% in toothless children, by 24 months - 84%, in adults-85%. SM adhesion to the tooth surface and the ability to form plaque are important components of virulence. According to T. Klinke 2011, SM on the tooth surface releases acids faster than the buffer capacity, neutralizing the local decrease in acidity by more than 5,5, which leads to the destruction of enamel.
SM plays an important role in the development of early caries. SM can be transmitted through vertical or horizontal transmission to the baby's mouth even without teeth. The number of SM colonies in the mother's mouth at an early stage of the child's development is an important factor influencing the beginning of SM colonization in the child's mouth. The possibility of colonization and transmission of SM cells depends on a number of factors: the number of colonies of microorganisms in the host's oral cavity, the frequency of colonization by microorganisms in the child's oral cavity, and the minimum dose of microorganisms that contribute to the development of caries. Mothers who carry SM are at high risk of infecting their children early in life. Poor oral hygiene and frequent consumption of large amounts of sweets increase the likelihood of mother-to-child transmission.
According to recent research, Neonatological factors contribute to an increased risk of SM seeding through vertical transmission. Children born by caesarean section are infected with SM earlier than children born by natural birth. Researchers suggest that natural childbirth protects the baby from early sm colonization. The interval between sm colonization and the development of carious lesions, according to various studies, is from 13 to 16 months. For children at high risk of developing caries (low-weight children born prematurely), this period is much shorter.
S. Alaluusua according to a 2011 study, children with teeth with SM at the age of 2 years suffered from active forms of caries up to 4 years with values of 10,6 KPU, and in children who later colonized the oral cavity, the KPU index was within 3,4. SM accumulates in the child's mouth during a period called the "window of infection" ("window of infectivity"), which corresponds to the interval between shots of the lower incisors (6 months) and upper second molars (24 months).
Other microorganisms, including lactobacilli and yeast-like fungi (especially the candida family), are involved in the development of caries and directly in the development of caries. Lactobacilli and yeast-like fungi are able to secrete acids, less and in smaller quantities than candida ablicans Lactobacilli. Lactobacilli and bifidobacteria play an important role in the development of caries, but they are not the beginning of it. Lactobacilli inhibit the growth of cariesogenic SM strains, especially in children with low caries activity [44].
Fungi of the genus Candida also play an important role in the cariesogenic effect on the tooth, since they can secrete organic acids during the fermentation of carbohydrates. In children with carious cavities, C. dubliniensis and C. ablicans are often divided. However, there is currently insufficient data in the scientific literature on the effect of yeast-like fungi on the oral biocenosis of children. The study of this type of microflora is most often carried out in a group of elderly people.
For the occurrence of caries, it is necessary not only the action of caries-causing microorganisms, but also the constant presence of carbohydrates in the oral cavity. The higher the carbohydrate content, the higher the level of Lactobacillus in saliva. Carrying out carbohydrate metabolism, SM intensively produces lactic acid, which leads to the appearance of caries. The properties of plaque depend on the composition of the food consumed. If the content of easily fermentable carbohydrates in food is high, then Lactobacilla is in symbiosis with a high content of Lactobacilla, synthesizing extracellular polysaccharides that help increase the stability of the SM tooth matrix. As a result of carbohydrate exchange by streptococci, lactic acid is formed, which reduces the pH of plaque and oral fluid, causing demineralization of tooth enamel [45].
Thus, the problem of dental caries in young children is necessary for evaluating modern ideas about their use in dental practice.
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Corresponding author: Kulmakhanbetova A.M. - Assistant at the Department of Preventive Medicine and Dental Disciplines of the Shymkent Medical Institute, the International Kazakh-Turkish University named after Khoja Ahmed Yasavi +77026512379 Pediatria-1@mail.ru
