Peculiarities of Phosphorine Calcium Exchange in the Pathogenesis of Dental Caries in Children with Diabetes of the First Typ

The main purpose.Assessment of caries resistance of hard tissues of the teeth (oral cavity) and the state of phosphoric calcium metabolism in children with type 1 diabetes mellitus, taking into account the mineralizing potential of oral fluid and antimicrobial protection of the oral cavity.

Materials and methods. A general clinical, dental, laboratory examination of 127 children with type 1 diabetes mellitus, aged from 7 to 12 years, with an endocrinopathy experience of eight months to ten years was conducted. The obtained data were compared with the results of a survey of 37 "healthy" and "practically healthy" children of this age category. When assessing the dental status of children, a hygienic index was used (Y. A. Fedorov, V. V.Volodkina, 1970), the EC + kp index (EC- Expert Committee, 1962), the OHI-S simplified hygienic index (Green, Vermillion, 1964).The intensity of the enamel of teeth demineralization processes was assessed by using an enamel resistance test (V. R.Okushko, L. I. Kosareva, 1984), vital staining (coloring) (LA Aksamit, 1978). The electrometry of the hard tissues of the teeth was carried out by the electro-diagnostic apparatus of "Dent Est" (V. K.Leontiev, G. G.Ivanova, 1985). Laboratory diagnosis of salivary parameters included the study of calcium (total ionized), inorganic phosphorus, alkaline phosphatase, osteo-calcine, parathyroid hormone, 25 hydroxy-vitamin D3, lactoferrin. Micro-crystallization and mineralizing potential of the oral fluid were determined according to Leus P. A. (1977).

Results. In the early stages of development of type 1 diabetes, children have a compensated and sub-compensated form of the carious process, an increase in the permeability of the enamel, a slight predominance of demineralization processes in the solid tissues of the teeth over the processes of remineralization, which indicates self-regulation of the mechanisms of mineral metabolism while maintaining physiological re-mineralizing properties of the oral fluid.In the late stages of development of type 1 diabetes mellitus, high intensity and decompensated form of the course of carious lesions, low structural and functional resistance of enamel, expressed processes of demineralization of hard tooth tissues are established. The emergence of this complex in children with an endocrinopathy experience for more than five years indicates the depletion of salivary gland functionality, the violation of mobilization salivary systems in response to the occurrence of a cariogenic situation in the oral cavity, a change in calcium homeostasis, a decrease in enamel resistance to organic acids, saliva to crystallization.

The conclusion. The growing positive dynamics of index growth in children with long-term type 1 diabetes mellitus, indicating a worsening of the dental status, requires adherence to the principles of rational nutrition, quarterly professional dental caries with the use of modern and effective oral care products, the introduction of active forms of hygienic training and education, taking into account the mineralizing potential of oral fluid, as well as careful monitoring acquired manual skills.

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