EVALUATION OF CARIOGENIC SITUATION IN CHILDREN WITH TYPE 1 DIABETES MELLITUS GIVEN THE MINERALIZING POTENTIAL OF SALIVA AND ENAMEL RESISTANCE

Abstract

Aim.This study was conducted to evaluate the caries resistance of hard tooh tissues and the state of the calcium and phosphorus  metabolism in children with type 1 diabetes mellitus given the  mineralizing potential of saliva and antimicrobial protection of the oral cavity.Materials and methods. There was conducted a general clinical, dental, laboratory examination of 127 children with type 1 diabetes  mellitus aged 7 to 12 years with the endocrinopathy experience from eight months to ten years. The obtained data were compared with  the results of the examination of 37 "healthy" and "practically  healthy" children of this age category. When assessing the dental  status of children, were used the hygienic index (Y.A. Fedorov, V.V.  Volodkina, 1970), the CFE/ cf index (WHO Expert Committee, 1962), the simplified hygienic index OHI-S (Green, Vermillion, 1964). The  intensity of the enamel demineralization processes was assessed  using the enamel resistance test (V.R. Okushko, L.I. Kosavera, 1984)  and vital staining (L.A. Aksamit, 1978). The electrometry of  hard tooth tissues was carried out by the electrodiagnostic apparatus "Dent Est" (V.K. Leontiev, G.G. Ivanova, 1985).The  laboratory diagnostics of the salivary indicators included the study of calcium (total, ionized), inorganic phosphorus, alkaline  phosphatase, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D3, lactoferrin. The microcrystallization and  mineralizing potential of saliva were determined according to Leus  P.A. (1997).Results.At the early stages of type 1 diabetes mellitus development children have a compensated and subcompensated form of the  carious process, the increase in the enamel permeability, a slight  predominance of the demineralization processes over the  remineralization processes in solid tooth tissues. It indicates that  self-regulation of the mineral metabolism mechanisms takes place  while maintaining the physiological remineralizing properties of  saliva. At a late stage of type 1 diabetes mellitus development a high intensity and decompensated form of the carious lesions are  established as well as low structural and functional enamel  resistance and pronounced processes of hard tooth tissues  demineralization. The emergence of this complex in children with the experience of endocrinopathy for more than five years indicates the depletion of salivary gland functionality, the disturbance of  mobilization salivary systems in response to the occurrence of the  cariogenic situation in the oral cavity, the change in calcium  homeostasis, the decrease in enamel resistance to organic acids and the absence of saliva crystallization.Conclusion.The growing positive dynamics of index growth in children with long-term type 1 diabetes mellitus, indicating the  deterioration of the dental status, requires adherence to the  principles of rational nutrition, quarterly professional caries preventive measures using modern and effective oral care  products, the introduction of active forms of hygienic training and education taking into account the mineralizing potential of saliva as well as careful monitoring of the acquired manual skills.