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А. М. Чернова, Е. А. Винокурова, А. В. Аксентьева, Т. С. Сигильетова, Н. Б. Чабанова, В. А. Плати-цын, К. А. Астафьева//Медицинская наука и образование Урала. - 2015. - № 3 (83). - С. 147-149.
Vakoliuk Olena Borisovna, Bukovynian State Medical University, Assistant professor of the Department of Surgical and Pediatric Dentistry Kosteniuk Snishana Virshelovna, Bukovynian State Medical University, Assistant professor of the Department of Surgical and Pediatric Dentistry E-mail: dronykivan@ukr.net
The problem of early childhood caries in modern dentistry
Abstract: Early calf's teeth caries is a significant problem nowadays. The disease prevalence varies up to 70 % and more in children from different countries, regions and different social layers. Investigators share the same opinion about the specificity and even uniqueness of the early childhood caries.
Keywords: early childhood caries, teeth treatment.
Early childhood caries has been widely studied by modern investigators. It means early (after the first teeth erupt) calf's teeth caries in preschoolers
and pupils [1].
Early calf's teeth caries is a significant problem nowadays. The disease prevalence varies up to 70 % and more in children from different countries, regions and different social layers [2]. Investigators share the same opinion about the specificity and even uniqueness of the early childhood caries.
Age 5-6 years is the key period which allows defining dental diseases according to the WHO methodologies [3]. Though, a 6-year-old child's state of teeth is not the criterion of the early childhood caries development but the consequence. The best definition of an early childhood caries is given by the American Dental Academy and American academy of Pediatric dentistry: "Early childhood caries is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age". According to American Dental Academy the term «Severe Early Childhood Caries» refers to «atypical» or «progressive» or
«acute» or «rampant» patterns of dental caries. These notions include such characteristics:
• any sign of smooth-surface caries of the calf teeth in the children younger than 3 years;
• any smooth surface of the incisors and canines is injured by caries or filled in the child aged 3-5 years old;
• index of injured, lost or filled teeth is 4 in the 3-year-old children, 5 in 4-year-olds, 6 in 5-year-olds [4; 5].
A famous investigator of the early childhood caries P.J. Berkowitz characterizes this process as a World health care problem [6]. As the calf's teeth significantly influence the facial bones development, are important in the development of the speaking function, food ingestion, and emotional communication. This can be a result of early injury and teeth lose. Children have occlusion problems, lose weight, self-appraisal problem. Besides, we have to admit the irrespective achievements in the childhood caries development investigations. This is why it is significant to define some aspects in etiology, pathogenesis, clinical course, treatment and preventive measures of the early childhood caries.
Section 1. Clinical medicine
A child (aged from 19 to 31 months) gets the cariesgenic microorganisms (Streptococcusmutans) from parents and elder children [7]. That is why their dental health state is important for babies. It's not advisable to lick the child's spoon and nipple.
The most cariesgenic if the food rich in refined carbohydrates (sugar, glucose, fructose, honey). The determinative point of the caries development is not just the fact of eating such food but the high frequency and long lasting food ingestion [6]. American academy of Pediatric Dentistry states that main reasons connected with the early childhood caries development is feeding the child on demand, night bottle feeding, and also long-lasting (more than one year) breast feeding.
The caries development risk can be caused by the teeth peculiarities (immaturity ofyoung enamel, enamel hypoplasia, morphological and genetical peculiarities. It can be caused by disease which a pregnant woman may have (chronic extragenital diseases, anemia, gestosis in pregnancy), premature birth, child's diseases, medicine dose (sugarcontaining syrops and sugar containing syrups and inhalers), the child's immature immunities. The associated risk factors matter too — unsatisfactory life conditions, incomplete family, low level of parents' education, low birth weight [1; 7].
In babies the upper incisors are injured first of all, later canines and other teeth. Caries locates in the precervical area of the upper incisors and fissures of the first and second temporary molars. Caries quickly progresses, develops on the surface and covers the persistent to caries teeth surfaces. Caries cavities in most cases have a cup-shape without a tendency for a pathological process. A quick damage of the temporary tooth is being admitted as a result of its weak mineralization, absence of the protective reaction from the side of the morphologically and functionally immature pulp. A feature of early childhood caries is the plurality of the injured temporary teeth and symmetrically placed caries defects. The hard tissues injury is not deep but quickly spreads on the surface of the enamel, which easily splinters [8].
Methodology of the early childhood caries treatment is quite traditional and not always effective. The treatment is carried out without filling
(non-operational methods of treatment) or by dissection of cariotic cavity with further filling. The non-operational methods of childhood caries treatment are the remineralization therapy and impregnation method. Reminaralization therapy and use of fluorinated drugs is recommended in the primary teeth injuries. Taking into account child's age and behavior during the treatment process it should not be long-lasting — covering the injured surfaces by fluorinated lac, gels, deep fluorination of enamel. Quite popular is impregnation method of the temporary teeth caries treatment (use of silver). Silver nitrate together with organic compounds develops albuminates, which make a protection layer on the dentine's surface. Silver has a bactericidal effect due to the de-naturation of proteins of bacterial cells. Silver ions sink into dentinal canals in the depth 0.5 mm. and block them (oligodynamic effect of silver), which facilitates stabilization of the caries process. Silvering of the surface caries of the temporary teeth is done 3-4 times a day or in one day. The impregnation course is repeated every 3-4 months. Criterion of the effective impregnation is a firm colouring of the injured tissues of the temporary tooth in black.
Filling the teeth is still the most popular method of the childhood caries treatment. Though, a significant problem of the early childhood caries treatment is the peculiarities of the child's psychoemotional reaction on medical manipaulations, which makes the whole complex ofprocedures impossible. Treatment under general anesthesia is not medically reasoned for all the children and under all circumstances. Such treatment has certain medical conditions and limitations, though it doesn't always create a long-lasting positive result. Medical conditions for teeth treatment under general anesthesia are the following [9]: children with a complicated cooperation and plural tooth caries with complications; faint-fit children, inclined for polyvalent allergy, asthma, macroglossia, pathology of cardiovascular system, traumatic brain injury, epileptic attacks; children who need urgent dental aid; necessary painful manipulations due to the medical conditions to anesthesia.
This is why a concept of temporary teeth restoration in young children seems to be optimal. Recently the American academy of Pediatric dentistry
outlines a method of a "temporary therapeutic restoration", which has positive responses in stomatology [10]. The sense of the concept is — in the case when a traditional preparation of the caries cavity and final restoration is impossible, we implement a temporary restoration by glass ionomer cement after removal the carious tissues by a hand instrument or a low speed nozzle.
An effective and tested method of saving temporary molars is the use of thin-walled standard steel crowns, produced by different manufacturers.
Complex system of preventive measures is developed according to modern opinions on etiology and pathogenesis of the main dental diseases. A complex regional program is developed by the organizers of the regional dental aid. Not only should stomatologists accomplish the program but also the education workers, sanitary epidemic stations, women's health consultants, pediatrics, health centers [11].
Complex preventive measures of early childhood caries include qualitative mouth hygiene, starting after the first tooth erupt; endogenic use of the fluorine drugs; local use of fluorine and mineralization drugs; fissure hermetization of molars; educating principles ofsound nutrition; early detection of dental diseases; secondary preventive measures (sanation of oral cavity), pearents' dental health care. All the researches of the phenomenon share the same opinion. "However many children are being examined not earlier than pre-school period, a doctor has plenty things to do in establishing risk factors of the early childhood caries and possible educating of people, who take care of a child and decrease risks of such a disease" [7].
Thus, methods of early childhood caries even nowadays need to be improved. Another requirement is a stomatologist's knowledge and experience for effective treatment and preventive measures of early childhood caries.
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