USING OF ICDAS II CRITERIA FOR THE ASSESSMENT OF DENTAL CARIES IN CHILDREN WITH CEREBRAL PALSY Текст научной статьи по специальности «Клиническая медицина»

MEDICAL SCIENCES

ВИКОРИСТАННЯ КРИТЕРПВ ICDAS II ДЛЯ ОЦ1НКИ КАР1ССУ ЗУБ1В У Д1ТЕЙ 13 ДИТЯЧИМ

ЦЕРЕБРАЛЬНИМ ПАРАЛ1ЧЕМ

Бiденко Н.В.

д-р мед. наук, професор каф. дитячо'1 терапевтично'1 стоматологИ' та профшактики

стоматологгчних захворювань, Нацюнальний медичний унгверситет 1мет О. О. Богомольця,

м. Ки'1'в, Укра'ша. 3opiü I.A.

канд. мед. наук, доцент каф. нервових хвороб, психгатри та медично'1 психологи, Буковинський

державний медичний унгверситет, м. Чернгвцг; л1кар функцюнальноХ дгагностики Обласного медико-сощального центру реабШтаци дгтей з

оргатчним ураженням нервово'1 системи, м. Чернгвцi, Укра'ша.

Приймак Х.В.

канд. мед. наук, зав. л^вально-профтактичного вiддiлення, Мкька дитяча стоматологiчна полотка, м. Чернiвцi, Укра'ша

USING OF ICDAS II CRITERIA FOR THE ASSESSMENT OF DENTAL CARIES IN CHILDREN

WITH CEREBRAL PALSY

Bidenko N. V.,

Doctor of Medical Sciences, Professor, the Department of Paediatric and Preventive Dentistry, Bogomolets

National Medical University, Kyiv, Ukraine ORCID ID 0000-0003-1132-2446 Zoriy I.A.,

PhD, Senior Lecturer of the Department of Nervous Diseases, Psychiatry and Medical Psychology, Bukovi-

nian State Medical University, Chernivtsi, Ukraine ORCID ID 0000-0003-0938-5456 Pryimak Kh. V.

PhD, Head, Medical Prevention Department of City Children's Dental Clinic,

Chernivtsi, Ukraine DOI: 10.5281/zenodo.7560292

АНОТАЦ1Я

У дггей i3 оргашчними захворюваннями нервовш системи, такими як дитячий церебральний паратч (ДЦП) ввдзначаеться висока поширешсть та штенсивнють карieсу 3y6iB. Необхвдна оцшка карieсу з вико-ристанням сучасних об'ективних критерпв для планування та проведения л^вання та профшактики карieсy зyбiв у дней i3 ДЦП.

Мета - оцшити частоту розвитку карieсy зyбiв за критерiями ICDAS II у дней i3 ДЦП залежно ввд ступеня вираженостi рухових порушень.

Матерiали та методи. Обстежено 122 дитини (середтй вiк 8,8±3,7 року) зi спастичними формами дитячого церебрального паралiчy. Вони були роздшеш на групи вiдповiдно до Шкали основних рухових фyнкцiй (GMFCS E&R). Вам пащентам проводили неврологiчне обстеження, стан карieсy зyбiв визначали за допомогою df/DMF та критерпв Мiжиародноl системи виявлення та оцшки карiесy (ICDAS II).

Результати. Поширенiсть карiесy зyбiв у дiтей iз дитячим церебральним паралiчем склала 100%, ш-тенсивнiсть (df, DMF+df, DMF) карiесy зyбiв у середньому становила 6,27±1,19. Аналiз поширеностi кодiв 5 та 6 ICDAS II виявив сyттевi вiдмiнностi мiж хворими та практично здоровими дпъми: частота виявлення коду 5 у дней з ДЦП була у 3,8 рази вищою, шж у здорових; код 6 - вище у 7,5 рази. Б№ш висока штен-сивнiсть карюзного процесу та частота глибоких карюзних порожнин (коди 5 та 6 за системою ICDAS II) спостерпаються у дней з ДЦП з вираженими руховими порушеннями вiдповiдно за шкалою великих рухових функцш.

Висновки. Критерп ICDAS II дозволяють об'ективно оцiнити захворюваиiсть на карiес у дiтей з дитячим церебральним паралiчем. Встаиовления особливостей розвитку карiесy у дiтей iз дитячим церебральним паралiчем залежно ввд виразностi невролопчно1 симптоматики за системою ICDAS II е важли-вим фактором щодо напряму профiлактичних заходiв у ще1 групи дiтей.

ABSTRACT

Children with organic diseases of the nervous system such as cerebral palsy (CP) are indicative of a high prevalence and intensity of dental caries. It is necessary to assess the teeth decay using modern objective criteria for planning and carrying out treatment and prevention of dental caries in children with CP.

The objective is to assess the incidence of dental caries using ICDAS II criteria in children with CP depending on the severity of motor impairment.

Materials and methods. 122 children (mean age 8.8 ± 3.7 years) with spastic forms of cerebral palsy were examined. They were divided into groups according to the Scale of major motor functions (GMFCS E&R). All the patients underwent a neurological examination, the state of dental caries was determined using df/DMF and criteria of the International Caries Detection and Assessment System (ICDAS II).

Results. The prevalence of dental caries in children with cerebral palsy was 100%, the intensity (df, DMF+df, DMF) of dental caries averaged 6.27 ± 1.19. The analysis of the prevalence of codes 5 and 6 of ICDAS II revealed significant differences between sick and almost healthy children: the frequency of detection of code 5 in children with cerebral palsy was 3.8 times higher than in healthy ones; code 6 - 7.5 times higher. Higher intensity of carious process and the frequency of deep caries cavities (codes 5 and 6 according to the ICDAS II system) are observed in children with cerebral palsy with severe motor impairment.

Conclusions. ICDAS II criteria allow to objectively assess the incidence of caries in children with cerebral palsy. Establishing the features of caries development in children with cerebral palsy depending on the severity of neurological symptoms according to the ICDAS II system is an important factor in determining the direction of preventive measures in this group of children.

Ключовi слова: дгги, дитячий церебральний паралiч, Kapiec 3y6iB, критерш ICDAS II.

Keywords: children, cerebral palsy, dental caries, ICDAS II criteria.

Topicality. Dental caries in children significantly affects their quality of life, especially in children with general diseases, including neurological. The intensity and prevalence of dental disease in such children are usually higher than in healthy people. One of the most common neurological pathologies, which most often leads to disability in patients under 18 years of age, is cerebral palsy (CP) [1,4,6,11]. One of the major clinical symptoms of CP is motor function impairment associated with retarded development and improper formation of static-kinetic reflexes, tonus pathology, and paresis [11].

Examination of the dental status of children with CP is indicative of a wide occurrence and intensity of lesions of their hard dental and periodontal tissues. A number of studies [3,4,6,12,15] have demonstrated that the risk of development of dental diseases increases reliably with the increase of manifestation of neurological symptoms. It can be caused by many factors including motor and coordination impairments, limited possibility to take care of the oral cavity resulting in insufficient individual hygiene.

It is necessary to assess the teeth decay using modern objective criteria for planning and carrying out treatment and prevention of dental caries in children with cerebral palsy. ICDAS II criteria may be useful in these cases [8,14].

The objective is to assess the incidence of dental caries using ICDAS II criteria in children with cerebral palsy depending on the severity of motor impairment.

Materials and methods. 122 children (mean age 8.8 ± 3.7 years) with spastic forms of cerebral palsy who were treated at the Regional Center of Medical-Social Rehabilitation of Children with Organic Lesions of the Nervous System (Chernivtsi) were examined. The children with CP were divided into groups according to the Scale of major motor functions (Gross motor function classification - Expanded and Revised (GMFCS E&R)) [10]: the 1st group (23 children - 18,9 %) included children performing gross motor skills without restrictions, the 2nd group - 26 (21,3 %) children performing gross motor skills with restrictions; the 3rd group - 26 (21,3 %) children walking by means of a hand-held mobility device; the 4th group - 25 (20,5 %) children able to walk with physical assistance; the 5th group - 22 (18,0 %) children transported in a manual wheelchair. The majority of the children examined were diagnosed to be afflicted with spastic forms of CP: 40 (32,8%) children - with spastic diplegia, 25 (20,5%) - with hemiparetic form, 6 (4,9%) - with spastic tripar-esis, 34 (27,9%) - spastic tetraparesis, hyperkinesis was diagnosed in 10 children (8,2%) and ataxic syndrome -in 7 (5,7%) children.

The group of comparison consisted of 80 practically healthy children. The parents of all the children involved into the study were completely informed about the matter of the research and written consents were signed by them.

Caries dental lesions were assessed in all the children by means of International Caries Detection and Assessment System - ICDAS II [8,14] (Table 1).

Table 1.

ICDAS II codes and their description in order to assess primary caries of the coronal part of the tooth [7]

Code Major criteria to find caries in the coronal part of the tooth

0 Sound tooth surface: No evidence of caries after 5 sec air drying

1 First visual change in enamel: Opacity or discoloration (white or brown) is visible at the entrance to the pit or fissure seen after prolonged air drying

2 Distinct visual change in enamel visible when wet, lesion must be visible when dry

3 Localized enamel breakdown (without clinical visual signs of dentinal involvement) seen when wet and after prolonged drying

4 Underlying dark shadow from dentine

5 Distinct cavity with visible dentine

6 Extensive (more than half the surface) distinct cavity with visible dentine

According to the criteria code 0 (ICDAS = 0) corresponds to an intact tooth, codes 1 and 2 characterize initial lesions of the dental enamel (focal demoralization), code 3 corresponds to visible lesions of the dental enamel (superficial caries). Codes 4, 5 and 6 represent carious dental lesions. The criteria are developed considering the fact that every point corresponds to the following degree of lesion (intensity) of the hard dental tissues; and a direct correlation between points and intensity of lesion determined pathomorphologically is evidenced [7].

Absolute and relative amount of teeth possessing different codes by ICDAS II in different groups of children was assessed, as well as absolute and relative amount of dental surfaces among all the surfaces examined, which enables to determine prevailing caries location among the group of children involved into the study, and to some extent direct recommendations concerning therapeutic-preventive measures.

The data obtained were statistically processed by means of the applied programs MS® Excel® 2010 tm, Biostat®, Statistika® 7.0 and using pair and unpaired Student t-criterion.

Results

Discussion

Caries occurrence in children with CP was 100% contrary to healthy children from the comparison group where this index was 68,7 %. An average value of dt, DMF+dt, DMF in children with CP was 6,27±1,19, which is 2,3 times higher than that of the healthy children (2,72±1,17; p =0,038).

It should be noted that children with CP had rather high percentage of extracted teeth: 1,11% (7 teeth) in children from the 3rd group, 1,77% (11) - in the 4th group, 1,69% (9) - in the 5th one. At the same time, teeth were not extracted in children from the control group or those with CP from the 1st and 2nd groups. It can be indicative of, first of all, that teeth are decayed more intensively in children with pronounced mental and motor impairments, and secondly, the lack of a proper level (or access to get) of oral cavity treatment and saving of teeth in children with more severe general condition due to subjective and objective reasons.

At the same time, the amount of filled teeth in children with CP and practically healthy ones did not differ reliably: 82 teeth (2,8%) among all the examined teeth in children with CP and 43 (2,3%) - in somatically

healthy children. Such an amount of treated teeth in children with CP is not indicative of a proper treatment, since according to the data of our study reliably higher indices of deep carious process with its complications were found in children with CP with intense motor impairments.

Analysis of caries lesions according to ICDAS II criteria in children with CP has demonstrated the following.

Code 0 in the groups of patients was registered in 73,2% among all the examined teeth. In children from the control group code 0 was registered in 87,97%, which corresponds to the difference between caries occurrence in the patients with CP and without it.

Code 1 was not practically registered both in the groups of children with CP and among practically healthy children. It might be associated with certain difficulties in examination of sick children and finding inconsiderable damage of the normal condition of the dental enamel.

Code 2 in children with CP was found in 1,43±1,66% of all the examined teeth against 1,32±0,72% in the control group (p>0,05). There were no reliable difference found in the percentage of teeth with codes 3 and 4 between children from the control group and those with CP: code 3 in children with CP was found in 1,72±1,41% against 2,02±0,66% in healthy ones; code 4 was found in 4,49±1,54% in children with CP against 2,83±0,83% in the control group. Though in children with organic lesions of the nervous system the percentage of teeth with code 4 was 3,2 times higher as compared to the similar index in healthy children, which is indicative of a tendency to higher occurrence of hidden carious cavities and, thus, to progressing carious process in this group of patients.

Analysis of occurrence of the codes 5 and 6 by ICDAS II found reliable difference between sick and practically healthy children: occurrence of code 5 in children with CP was 3,8 times higher than that in healthy ones, it was 5,91±1,84% against 1,58±0,92% (p<0,05); code 6 -7,5 times higher (7,52±3,17% against 1,03±0,54%; p<0,05). Such correlations remained during all the periods of occlusion (Fig. 1), and difference between indices in the main and control groups was found to be the biggest in children with transitional and temporal dentition.

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Fig. 1. Occurrence of codes by ICDAS II in children with CP and practically healthy ones (n - amount of

examined teeth).

Note: n - amount of examined teeth; * - reliable differences from the indices of practically healthy children.

Figure 2 presents comparative characteristics of carious lesions of the teeth according to ICDAS II in children with CP depending on the intensity of motor impairments.

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Fig. 2. Occurrence of the codes by ICDAS II in children with CP and according to the Scale of major motor

functions.

Note: n - amount of examined teeth; * - reliable differences from the indices of practically healthy children, ** - reliable differences from the indices of children with CP belonging to the 1st group.

The prevalence of code 4 in children from the 3 rd group was found to be reliably higher (2,3 times as much) in comparison with the control and it was 6,44±1,81% against 2,83±0,83% (p=0,027). In children from the 4th and 5th groups who suffered from severe motor impairment a reliably higher percentage of code 5 was found in comparison with healthy children (7,7±2,45% in patients from the 4th group; p=0,023; and 9,31±2,34% in patients from the 5th group 1,57±0,92; p=0,0028), as well as code 6 (9,36±4,10%; p=0,048 and 15,23±5,1%; p=0,0077 respectively against 1,03±0,54% in the control) which is indicative of a considerable occurrence of extensive caries of the dentin in these groups of patients. Differences between high codes in children from the main and control groups are

registered mostly at the expense of those children who are afflicted with severe motor impairments.

Analysis of differences among children from different groups by the intensity of motor impairments found a reliable difference between code 6 in the 5th group of patients with CP and in the 1st group having inconsiderable motor impairments: code 6 was 4,2 times higher in patients from the 5th group in comparison with patients from the 1st group (15,23±5,1% against 3,62±1,59%; p=0,034). It can be indicative of an increased intensity of an active carious process with formation of extensive carious cavities closely correlating with motor deficiency in children with CP.

Similar tendencies were observed in children with temporary, transitional, and permanent dentition (Fig.

3, 4, 5). An extremely high occurrence of code 6 (deep enamel caries are of special attention. It is indicative of extensive carious cavities) in children from the 5th a quick advance of carious cavities in this group of chil-group with temporary dentition and low indices of dren (Fig. 3).

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Fig. 3. Occurrence of codes by ICDASII in children with CP from different groups according to intensity of

motor impairment in temporary dentition. Note: n - amount of examined teeth; * - reliable differences from the indices of children with CP from the 1st group; ** - reliable differences from the indices of children with CP from the 2nd group.

Dentine caries prevails considerably in children with transitional dentition (Fig. 4). Superficial caries or caries of enamel was found only among the examined children from the 1, 2 and 3 groups. It happened mostly at the

erupted recently. Its absence in children with more intensive motor impairments is indicative of a quick advance of carious lesions with formation of dentine caries.

expense of initial caries of permanent teeth

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Fig. 4. Occurrence of codes by ICDAS II in children with CP from different groups according to intensity of

motor impairment in transitional dentition. Note: n - amount of examined teeth; * - reliable differences from the indices of children with CP from the 1st group; ** - reliable differences from the indices of children with CP from the 2nd group.

In permanent dentition the teeth with code 4 prevailed. Though, with the increase of degree of motor impairment functions (the 3 rd, 4th and 5th groups) code 4 was gradually substituted by codes 5 and 6 (visible

dentine caries), which was indicative of increased severity of caries in children with deterioration of their motor activity (Fig. 5).

Fig. 5. Occurrence of codes by ICDAS II in children with CP from different groups according to intensity of

motor impairment in permanent dentition. Note: n - amount of examined teeth; * - reliable differences from the indices of the 1st group.

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1-а група 2-а група 3-я група 4-а група 5-а група (n = 19 6) ( n = 2 8 0) ( n = 2 5 2) (n=224) (n=224)

Caries intensity in children with CP, presented by various researchers, ranged from 1.85 for permanent teeth to 7.2 for temporary teeth or 6.5 on average for children 4- 17 years [9] and exceeded dmf/DMF in healthy children, as in our research. At the same time, in studies of Branco at al. [2], no significant difference was found between the condition of teeth in children with cerebral palsy and healthy people according to the ICDAS II criteria, converted into dmf/DMF. However, our study demonstrated a higher incidence ICDAS II criteria 5, 6 in children with more severe motor impairment. Therefore, it is also advisable to analyze all ICDAS II criteria, not only convertation to dmf/DMF.

The importance of motor disorders in children with CP palsy and the associated insufficient level of oral care for the development of caries has been noted by many researchers [3,5,9,13]. However, usually the study of dental status was not differentiated depending on the severity of motor disorders. At the same time, our study confirms the feasibility of assessing caries depending on the level of motor disorders. This provides an opportunity to predict the occurrence of dental problems depending on the general condition, and also allows a differentiated approach to the development of an individual prevention program for children with varying degrees of motor dysfunction.

Finding peculiarities of caries development in children with CP depending on severity of neurological symptoms is an important factor to determine the direction of preventive measures for this group of children.

Conclusions

ICDAS II criteria allow to objectively assess the incidence of caries in children with cerebral palsy.

Reliably higher intensity of caries process is found among children with CP with severe motor impairments according to the Scale of major motor functions.

Surfaces of the teeth with deep caries (codes 5 and 6 according to ICDAS II) are more often found among children with CP and severe motor impairments.

Prospects for further research. Continuation of the study of caries intensity in children with organic lesions of the nervous system, taking into account the severity of the basic disease.

Financing.

Conflicts of interest: authors have no conflict of interest to declare.

Конфлшт штеремв: ввдсутшй.

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METHODS OF PARENCHYMAL DISSECTION IN LIVER SURGERY. THE FREQUENCY OF SPECIFIC POST-RESECTION COMPLICATIONS

Rusenov D.

Dr., Clinic of liver, biliary pancreatic and general surgery Acibadem City Clinic Tokuda Hospital EAD Sofia

Sofia

DOI: 10.5281/zenodo.7560312

ABSTRACT

Liver surgery is historically one of the "youngest" areas in abdominal surgery, but at the same time it marks very rapid progress and continuous development, which continues even today.

Development of liver resection surgery has been linked to a parenchymal dissection techniques and reliable hemostasis and biliostasis.

Keywords: methods of liver resections

INTRODUCTION:

There are different methods of parenchymal dissection in liver resection surgery- „crush and clamp", ultrasonic dissector (CUSA knife), Ultrascission and other devices for performing definitive hemo- and bili-ostasis.

The performance of parenchymal dissection by the method of "finger fracture" reduces operative time and allows control of bleeding from subsegmental vessels in the operative field, which in turn allows their ligation or clipping. Was first used by W. W. Keen and was later modified and popularized by the Vietnamese surgeon T.T.Tung in 1963 year.

OBJECTIVE:

After getting acquainted with as much information as possible on the matter and based on our previous research, we formulated the following goal:

Determination of a possible prognostic role of the type of liver resection (anatomic or atypical) together with other intraoperative characteristics (parenchymal dissection method) on the risk of occurrence, frequency and severity of early postoperative specific complications.

MATERIALS AND METHODS:

For the period from January, 2007 - March, 2018 in Clinic of liver, biliary pancreatic and general surgery, Acibadem City Clinic Tokuda Hospital ,1021 interventions were performed on the liver:

Cases of intervention other than liver resection by definition were excluded ISGLS, "removal of part of the liver parenchyma due to involvement by a disease process or traumatic injury resulting in devitalization of the parenchyma".

Thus, the study did not find the cases of:

• hepatotomy;

• cystotomies and cyst resections, practically without removal of functioning or pathologically altered liver parenchyma;

• liver biopsies, alcoholization of tumors. liver biopsies, alcoholization of tumors;

• interruption of trunk branches of the hepatic artery and/or portal vein with the aim of hypoperfusion of a given area (segments, lobe);

• suture of the liver in trauma;

Thus, a total of 852 cases of liver resections were included in the series

Method of parenchymal dissection - CUSA knife, "crush and clamp", Harmonic.