CC BY
25
© Korotych N. M.
UDC 616.314-002.4-053.5
Korotych N. M.
RISK FACTORS FOR DENTAL CARIES DEVELOPMENT IN CHILDREN
HSEE OF Ukraine «Ukrainian Medical Stomatological Academy» (Poltava)
korotich nat@mail.ru
The research has been carried out within the research scientific work, entitled «Enhancement of methods of prevention and treatment of major dental diseases in children with risk factors» code АМN 079.10, state registration number: 0111U006760.
Relevance of the topic. Dental caries is considered the major dental disease of child population in Ukraine. Notwithstanding the achievements in medicine, widespread introduction of state-of-the-art approaches and means of prevention and treatment in children's dental therapeutic medical practice the rate of dental caries and its complications is not reduced to date [1,13,19]. According to statistics 3-3,5 carious teeth are accounted for each child aged 12 years [20].
At the same time the indices are increasing in children with old or concomitant somatic diseases [4,8,11], including scoliosis, showing hormonal imbalance, amino acid and mineral metabolism disorder, decreased activity of enzymatic systems [2,5,6,14] that, indisputably, is displayed on the resistance of the hard tooth tissues [9,16,18].
We hypothesize that dental care should be focused primarily on the development and improvement of methods of early detection of individual predisposition, as well as forecasting the development and progression of dental caries, especially in children. Detection of the caries-susceptibility contingent provides timely dental prophylactic medical examination and prescription of appropriate treatment and consequently, reduction of the incidence of the diseases [3,15].
Generally, the development of carious process depends on the resistance of enamel, which is conditioned by the processes of mineralization. The presence of somatic pathology weakens the host defense and creates the conditions to reduce the resistance of the hard tooth tissues.
Structural and functional acid resistance of tooth enamel with vital pulp, estimated by the enamel acid resistance test (ERT) is considered the most effective, from the point of view of predictive value, indicator of predisposition to carious lesions [10].
Therefore the assessment of the level of enamel resistance in children with dysplastic scoliosis is crucial for prediction of caries progression and development of efficient preventive measures.
Purpose. The paper was aimed at the study of prevalence and intensity of dental caries in children with dysplastic scoliosis of different severity, to estimate the structural and functional enamel acid resistance (ERT-test) of their teeth to follow up the development of complex of caries-preventive measures.
Object and methods. To meet the objectives of the study we have examined 551 children aged 7 to 15 years, assigned to two groups according to the state of their health. The main group was populated with 315 children with scoliosis of I-II degree and the control group was represented by 236 almost healthy children. Tooth decay analysis has been carried out according to conventional technique, recommended by the WHO (1989). At the same time the prevalence (%) and intensity of dental caries has been studied according to cf, CFE+cf, CFE indices (Caries Filling Extraction Index) [17].
To estimate the structural and functional enamel acid resistance 138 children aged 11-12 years with scoliosis and 65 children of the same age have been selected. ERT-test has been made according to L.I. Kosaryeva methodology, using the author's rapid modification [7]. The test assessment was made by the twelve-field halftone printing scale of blue color in %, where the index of coloring of one field was 8,3%. The results have been statistically processed by the Student's t-test [12].
Results and discussion. The study of the intensity and prevalence of dental caries in children with dysplastic scoliosis shows that these indices are higher the similar ones in controls and increase with age. In this way, if the prevalence of caries of deciduous teeth is accounted for 69,6±9,6% in children aged 7 years, and increases to 77,3±8,93% in children aged 8 years, then at the beginning of physiological change occurred in 9 years of old it decreases and at the age of 12 yеаrs it accounts for 16,22±4,28% against 24,39±6,71% in controls, indicating about the premature extraction of periodontal deciduous molars. However, no significant difference between the indices of controls has been noted.
At the same time rise of prevalence of dental caries of permanent teeth from 17,39±7,9% at the age of 7 years to 96,15±3,77% at the age of 15years has been found that significantly differs from the values in controls ^<0,05) (table 1).
Permanent teeth affected by caries have been found in children aged 7 years. CFE index=0,17±0,07. At the age of 8 years this index dramatically increases to 0,68±0,20, that significantly differs from the indices in controls. At the age of 9-10 yеаrs CFE index gradually increases and at the age of 11 it dramatically increases to 1,63±0,21 against 0,92±0,15 in healthy children. In each age group the intensity of permanent teeth caries in children with scoliosis is significantly higher than in healthy children. Thus at the age of 12-14 years the CFE index was twice higher in children with scoliosis than in healthy children and at the age of 15 yеаrs it was higher by 2,4 times. No significant difference between the level
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Table 1.
Prevalence of dental caries in children with dysplastic scoliosis
(M±m)
Age Groups Number Children with dental caries
total deciduous teeth permanent teeth
abs. %, (M±m) abs. %, (M+m) abs. %, (M+m)
7 control 25 16 64,00+9,60 16 64,00+9,60
main 23 16 69,60+9,60 16 69,60+9,60 4 17,39+7,9*
8 control 25 14 56,00+9,92 14 56,00+9,92 4 16,00+7,33
main 22 17 77,30+8,93 17 77,30+8,93 8 36,36+10,25
9 control 25 17 68,00+9,32 17 68,00+9,32 4 16,00+7,33
main 25 18 72,00+8,97 16 64,00+9,60 9 36,00+9,60
10 control 26 15 57,69+9,68 12 46,15+9,77 6 23,07+8,26
main 26 18 69,23+9,05 14 53,84+9,77 12 46,15+9,77
11 control 24 16 66,66+9,62 11 45,83+10,17 14 58,30+10,06
main 67 52 77,61+5,09 32 47,76+6,10 42 62,68+5,90
12 control 41 27 65,85+7,40 10 24,39+6,71 21 51,22+7,81
main 74 57 77,02+4,89 12 16,22+4,28 56 75,68+4,99*
13 control 25 15 60,00+9,79 15 60,00+9,79
main 30 24 80,00+7,30 24 80,00+7,30
14 control 23 15 65,22+9,93 15 65,22+9,93
main 25 23 92,00+5,43* 23 92,00+5,43*
15 control 22 15 68,20+9,90 15 68,20+9,90
main 26 25 96,15+3,77* 25 96,15+3,77*
of prevalence and intensity of dental caries in boys and girls has been found (table 2).
Additionally, the tendency in dynamics of prevalence and intensity of carious process in children with scoliosis according to the severity of the disease has been established. In this way beginning from the age of 8 years the prevalence of caries in children with scoliosis of II degree is 80-100%, that significantly exceeds the indices of children with scoliosis of I degree. The intensity of carious process is also significantly higher in children with sco-liosis of II degree. The difference is especially notable at the age of 8-10 years and 12 years, when the cf, CFE indices are higher by 2-2,5 times than the similar ones in children with scoliosis of I degree (table 3).
One of the most important indicators of the homeostasis of the oral cavity is structural and functional enamel acid resistance. It has been established that dental caries in children occurs in its decreasing. The study of level of this index in children with dysplastic scoliosis showed its decrease as compared with controls (table 4), which is proved by high prevalence and intensity of dental caries in these children. Generally, in groups of sick children and children with scoliosis of I degree structural and functional enamel acid resistance was 5,62±0,16 and 4,91±0,15, respectively, corresponding to mean level. Low enamel resistance (7,54±0,28) has been found in children with scoliosis of II degree. This index was significantly better in controls and was 3,23±0,16, indicating about high structural and functional enamel acid resistance.
Study of enamel resistance in children with dental caries and without it in main and control groups showed significant difference in this index, i. e., in children with scoliosis it is considerably worse regardless of the availability of caries. In the group of children with scoliosis of II degree the index of ERT-test was 1,5 times higher than in children with scoliosis of I degree regardless of availability of carious or intact teeth.
High structural and functional enamel acid resistance has been detected in 19 Note: * — reMabiiity of ^ffere^ of ¡ndices of mam and comroi gro^: children (13,77±2,93%) with scoliosis that * — p<0,05; ** — p<0,02; *** — p<0,01; **** — p<°,°°i. was by 4,6 times higher than in group of scoliosis (55,80±4,23%) had moderate enamel resis-
healthy children. More than the half of children with tance, low and extremely low resistance was detected
Note: * — reliability of differences of indices of main and control groups (p<0,05).
Table 2.
Intensity of dental caries in children with dysplastic scoliosis (M±m)
Age years Groups Number Intensity of dental caries according to indices
cf CFE cf+CFE
7 control 25 1,24+0,23 1,24+0,23
main 23 2,57+0,53* 0,17+0,07 2,74+0,55*
8 control 25 1,08+0,21 0,16+0,07 1,24+0,24
main 22 2,91+0,41**** 0,68+0,20** 3,59+0,52****
9 control 25 1,40+0,22 0,16+0,07 1,56+0,27
main 25 1,80+0,31 0,84+0,23*** 2,64+0,43*
10 control 26 1,04+0,23 0,31+0,11 1,35+0,25
main 26 1,23+0,25 1,04+0,24*** 2,27+0,39
11 control 24 0,58+0,14 0,92+0,15 1,58+0,24
main 64 1,12+0,18** 1,63+0,21** 2,75+0,25**
12 control 41 0,24+0,06 1,07+0,17 1,32+0,17
main 74 0,22+0,06 2,12+0,20**** 2,34+0,21****
13 control 25 1,20+0,21
main 30 2,40+0,32***
14 control 23 1,39+0,23
main 25 2,68+0,28****
15 control 22 1,68+0,27
main 26 4,07+0,39****
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249
Table 3.
Prevalence and intensity of dental caries in children with dysplastic scoliosis according to age
and degree of severity of the disease (M±m)
Age years Groups Number Prevalence of dental caries Intensity of dental caries cf+CFE
a6c. %
1 3 4 5 6
7 control 25 16 64,00+9,60 1,24±0,25
scoliosis of I degree 19 13 68,42+10,66 2,37±0,55
scoliosis of II degree 4 3 75,00+21,65 4,50±1,43*
8 control 25 14 56,00+9,92 1,24±0,24
scoliosis of I degree 18 13 72,22+10,55 2,83±0,46** ••"
scoliosis of II degree 4 4 100,00+0,00**** 7,00±0,50****
9 control 25 17 68,00+9,32 1,56±0,20
scoliosis of I degree 20 13 65,00+10,66 2,00±0,41"°°
scoliosis of II degree 5 5 100,00+0,00** 5,20±0,59****
10 control 26 15 57,69+9,68 1,35±0,25
scoliosis of I degree 21 14 66,66+10,28 1,76±0,33°
scoliosis of II degree 5 4 80,00+17,88 4,40±1,04**
11 control 24 16 66,66+9,62 1,58±0,24
scoliosis of I degree 47 35 74,47+6,36 2,29±0,26* ••••
scoliosis of II degree 17 17 100,00+0,00*** 4,00±0,45****
12 control 41 27 65,85+7,40 1,32±0,17
scoliosis of I degree 54 38 70,37+6,21 1,83±0,19* ••••
scoliosis of II degree 20 19 95,00+4,87**** 3,70±0,49****
13 control 25 15 60,00+9,79 1,20±0,21
scoliosis of I degree 21 15 71,43+9,86 2,38±0,59
scoliosis of II degree 9 9 100,00+0,00**** 3,44±0,52****
14 control 23 15 65,22+9,93 1,39±0,23
scoliosis of I degree 17 15 88,23+7,82 2,23±0,29* •
scoliosis of II degree 8 8 100,00+0,00**** 3,60±0,49****
15 control 22 15 68,20+9,90 1,68±0,27
scoliosis of I degree 16 16 93,75+6,05* 3,56±0,57** •
scoliosis of II degree 10 10 100,00+0,00** 4,90±0,29****
Notes:
1. * — reliability of difference of indices of main and control groups:
* — p<0,05; ** — p<0,01; *** — p<0,002; **** — p<0,001.
2. ° — reliability of difference of indices of I and II degree of scoliosis severity:
• — p<0,05; " — p<0,02; "" — p<0,01; "" — p<0,001.
Table 4.
State of structural and functional enamel acid resistance in children aged 11-12 yеаrs with dysplastic scoliosis of different degrees of severity ^±m)
Group of children Number (n) ERT-test indices, points
mean index in children with caries in children without caries
control 65 3,23+0,16 3,81±0,18D 2,17±0,12
main 138 5,62+0,16** 6,18±0,16**n n=109 3,41±0,15** n=29
scoliosis of I degree 101 4,91+0,15**° 5,51±0,15**'D n=73 3,36±0,14**^ n=28
scoliosis of II degree 37 7,54+0,28** 7,61±0,28**D n=36 5,00±0,00* n=1
Notes:
1. * — reliability of difference of indices of main and control groups: * — p<0,05; ** — p<0,001.
2. ° — reliability of difference of indices of I and II degree of scoliosis severity: (p<0,001).
3. H — reliability of difference of indices of children without caries (p<0,001).
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in 30,43±3,92% children with scoliosis, mostly with II degree (72,92±7,31% against 14,85±3,54% with I degree). No low or extremely low structural and functional enamel acid resistance was detected in children with scoliosis who had intact teeth and in healthy children regardless of availability of caries.
Conclusions. In summary, the studies show that the prevalence and intensity of dental caries in children with dysplastic scoliosis is significantly higher as compared with healthy children, especially in children with
scoliosis of II degree indicating about the impact of this disease on dental caries origination.
Generally, children with scoliosis have moderate and low structural and functional enamel acid resistance, which getting worse in more severe degree of scoliosis, indicating about the predisposition of hard tooth tissues to dental caries origination and provides for necessity of preventive measures towards the increase of enamel resistance in children with scoliosis.
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УДК 616.314-002.4-053.5
ФАКТОРИ РИЗИКУ ВИНИКНЕННЯ КАР16СУ ЗУБ1В У Д1ТЕЙ Коротич Н. М.
Резюме. Метою роботи було вивчення показниюв поширенос"п та штенсивнос^ карieсу у дтей, що страждають на диспластичний сколюз рiзного ступеня тяжкост^ оцшка структурно-функцюнально! кислотостмкос^ емалi (ТЕР-тест) Ух зубiв для подальшого розроблення комплексу карieспрофiлактичних заходiв. Була обстежена 551 дитина вком вщ 7 до 15 роюв з диспластичним сколюзом та 236 практично здорових дгтей.
Вкник проблем бюлогм i медицини - 2016 - Вип. 4, Том 2 (134)
251
Результати дослiдження свщчать про те, що показники поширеностi та штенсивност Kapiecy у дiтей з диспластичним сколюзом у 1,2-2 рази вищ^ нiж у здорових дiтей, особливо поммтна piзниця при II ступен тяжкоcтi cколiозy, що cвiдчить про вплив цього захворювання на виникнення кapiecy зyбiв.
Дiти зi сколюзом мають в основному середню та низьку структурно-фyнкцiонaльнy киcлотоcтiйкicть емaлi, яка попршуеться при тяжчому ступеню сколюзу, що говорить про cхильнicть твердих тканин зyбiв до виникнення кapiecy та обумовлюе необхiднicть проведення профтактичних зaходiв, спрямованих на пiдвищення резистентност емaлi у дiтей зi сколюзом.
Ключовi слова: диспластичний cколiоз, поширенють, iнтенcивнicть, кapiec, pезиcтентнicть емaлi.
УДК 616.314-002.4-053.5
ФАКТОРЫ РИСКА ВОЗНИКНОВЕНИЯ КАРИЕСА ЗУБОВ У ДЕТЕЙ
Коротич Н. Н.
Резюме. Целью работы было изучение показателей распространенности и интенсивности кариеса у детей, страдающих диспластическим сколиозом различной степени тяжести, оценка структурно-функциональной кислотоустойчивости эмали (ТЭР-тест) их зубов для дальнейшей разработки комплекса кариеспрофилактических мероприятий. Был обследован 551 ребенок в возрасте от 7 до 15 лет с диспластическим сколиозом и 236 практически здоровых детей.
Результаты исследования свидетельствуют о том, что показатели распространенности и интенсивности кариеса у детей с диспластическим сколиозом в 1,2-2 раза выше, чем у здоровых детей, особенно заметна разница при II степени тяжести сколиоза, что свидетельствует о влиянии этого заболевания на возникновение кариеса зубов.
Дети со сколиозом имеют в основном среднюю и низкую структурно-функциональную кислотостойкость эмали, которая ухудшается при более тяжелой степени сколиоза, что говорит о склонности твердых тканей зубов к возникновению кариеса и обусловливает необходимость проведения профилактических мероприятий, направленных на повышение резистентности эмали у детей со сколиозом.
Ключевые слова: диспластический сколиоз, распространенность, интенсивность, кариес, резистентность эмали.
UDC 616.314-002.4-053.5
RISK FACTORS FOR DENTAL CARIES DEVELOPMENT IN CHILDREN
Korotych N. M.
Abstract. Dental status depends on the number of factors, including the state of child somatic health and dys-plastic scoliosis, in particular.
The purpose of the paper was to study the indices of prevalence and intensity of dental caries in children with dysplastic scoliosis of different severity, to estimate the structural and functional enamel acid resistance (ERT-test) of their teeth to follow up the development of complex of caries-preventive measures.
551 children aged 7 to 15 years with dysplastic scoliosis and 236 almost healthy children have been examined.
Results. Prevalence and intensity of dental caries in children with dysplastic scoliosis is higher as compared with almost healthy children of all age periods. In this way in patients aged 8 years the prevalence of caries of permanent teeth was accounted for 36,36±10,25%; intensity according to CFE index was 0,68±0,20, whereas in controls these indices were 16,00±7,33% and 0,16±0,07, respectively. Indices got higher with age and at the age of 10 the prevalence of caries reached 46,15±9,77%, intensity was 1,11±0,29, and in controls the indices were 23,07±8,26% and 0,31±0,11, respectively. The prevalence of caries of 12 year-old children was 75,68±4,99%, intensity — 2,12±0,20, whereas in almost healthy children the indices were 51,22±7,81 and 1,07±0,17, respectively. In adolescents with dysplastic scoliosis aged 15 years the prevalence of caries increased to 96,15±3,77%, intensity — to 4,07±0,39 against 68,20±9,90% and 1,68±0,27, respectively, in control group (p<0,05).
The direct dependence of caries affection on the severity of the scoliosis has been established. In this way in scoliosis of II degree the prevalence was accounted for 96,34±4,30, intensity was 4,20±0,11, and in children with scoliosis of I degree the indices were 73,82±8,29% and 2,29±0,08, respectively.
Children with dysplastic scoliosis showed the decreased structural and functional enamel acid resistance: 4,91±0,15 points in scoliosis of I degree and 7,54±0,28 points in scoliosis of II degree indicating about moderate and low resistance. The ERT-test was significantly better (3,23±0,16 points) in healthy children. The lowest indices were found in individuals with carious teeth (6,18±0,16 points), and in children with intact teeth the ERT-test was accounted for 3,41±0,15 points; the value of ERT index in almost healthy children with caries was 3,81±0,18 points, and in intact teeth it was 2,17±0,12 points (p<0,05).
Conclusions. The findings show that the prevalence and intensity of dental caries in children with dysplastic scoliosis is significantly higher as compared with healthy children, especially in children with scoliosis of II degree, indicating about the impact of this disease on the onset of dental caries.
Generally, children with scoliosis have moderate and low structural and functional enamel acid resistance, indicating about the predisposition of hard tooth tissues to dental caries origination and provides for necessity of preventive measures towards the increase of enamel resistance in children with scoliosis.
Keywords: dysplastic scoliosis, prevalence, intensity, dental caries, enamel resistance.
Рецензент — проф. Ткаченко П. I.
Стаття надшшла 26.11.2016 року
252
Вюник проблем бюлопУi медицини - 2016 - Вип. 4, Том 2 (134)
