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special education (I=4.28); besides the factors indicated the pathogenic significance in the development ofparodontitis was revealed in the age of pregnant woman not less than 18 years (I = 1.94) and more than of 36 years old (I = 1.17).
The data presented confirm that the leading factors in the development of generalized parodontitis in the pregnant women are simultaneously with general (hygiene of oral cavity, social state, somatic pathology and reproductive health) the factors occurring during pregnancy, among which the more significant pathogenic role belongs to anemia ofpregnant women, gestosis, hemorrhage in the first trimester, colpitis, acute infection of pregnant women, placental insufficiency.
Prognosis for development of generalized parodontitis ofpregnant women with use of developed algorithm is determined with use of mathematic summary of the prognostic coefficients (PC) to achievement of the prognostic threshold.
According to the theory of relativity the prognosis is not considered as regulations, and should be taken as hypothesis of the most probable development of the pathology (particularly, exacerbation of the progressing of the inflammatory-destructive periodontal lesion) in the further.
With taking into account of desired errors for establishment of diagnosis, prognosis of the pathological process the threshold values of prognostic coefficients are determined. The exceed of one of prognostic hypotheses which corresponds to the required exceed of the frequency of the correct prognoses over the frequency of errors is considered as threshold meaning. At 5 % level of error probability the threshold values of the prognostic coefficients (PC) account for: PC + thresh. = + 13.0; PC - thresh. = -13.0.
The threshold values of PC divide all diapason of the prognosis into 3 intervals:
• Sum of PC < -13.0 — favourable;
• Sum of PC from -13.0 to 0 — indefinite favourable;
• Sum of PC from 0 to 13.0 — indefinite unfavourable;
• Sum of PC > 13.0 — unfavourable.
For individual prognosis and determination of the required volume of therapeutic-diagnostic measures in the pregnant
2.
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women with risk of periodontal disease development there have been developed criteria of the efficacy of the therapeutic-diagnostic measures in the pregnant women with various risk for development of generalized parodontitis.
The data on integral evaluation of the factors determining occurrence of parodontitis of the pregnant women may be used for performance of concrete therapeutic-prophylactic measures.
Knowing the character and degree of the effect of some factors it is principally possible to define probability of the occurrence of the parodontitis of the pregnant women.
The solution of the questions of such kind by the technique proposed includes the following stages:
1. Identification of the factors influencing on the occurrence of the parodontitis.
Evaluation of the degree of the effect of risk factors on the risk index.
Determination of the probability of the occurrence of the periodontal pathology taking into account the prognostic coefficients of the various factors.
Conclusions
Thus, development of the prognostic coefficients by the most important and characteristic for pregnant women risk factors, particularly where there is danger of the occurrence of the periodontal pathology, present the opportunity for physician-stomatologists and obstetrician-gynecologists:
1. To determine probability of the occurrence of the periodontal pathology, to select the groups, factors, contributing most of all to development of parodontitis, to reveal the most prognostically significant factors. To explain necessity of the measures taking for treatment and prevention.
To more rationally effect on the main unfavourable factors, determining occurrence of the periodontal pathology. To develop individual program of the therapeutic-preventive measures, providing reduction and stopping occurrence of the periodontal pathology of the pregnant women.
2.
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4.
References:
1. Yermukhanova G. T., Esim A. Zh., Sharifkanova M. N., Oradova A. Sh., Ramankulova L. S. The somatic and stomatological health condition of the pregnant women//Vestnik Kaz. NMU. - 2013. - № 5. - P. 28-34.
2. Kiselnikova L. P., Popova N. S. Stomatologic status and prevention of stomatologic diseases in the pregnant women//Institute stomatologic - 2011. - № 1. - P. 90-91.
3. Kosenko I. B. Stomatological morbidity in pregnant women: results of the sociological study and medical examination//Vestnik medicinskogo stomatologicheskogo instituta. - 2011. - № 2. - P. 6-8.
4. Al Jehani YousefA. Risk Factors of Periodontal Disease: Review of the Literature//Int. J. Dent. - 2014.
5. Carrillo-de-Albornoz A., Figuero E., Herrera D., Bascones-Martinez A. Gingival changes during pregnancy: II. Influence of hormonal variations on the subgingival biofilm//J. Clin. Periodontol. - 2010. - № 37. - P. 230-240.
6. Vogt M., Sallum A. W., Cecatti J. G. Morais S. S. Factors associated with the prevalence of periodontal disease in low-risk pregnant women//Reproductive health. - 2012. - Vol. 9, № 3. - P. 1-8.
Mirsalikhova Feruza, PhD, Assistant to chair, Tashkent State Dental Institute, Department of children's therapeutic stomatology E-mail: [email protected]
Modern aspects of prevention of dental caries in children
Abstract: The status of healthy primary teeth for child health and dental health later in life has long been undervalued. This insolence has since changed considerably. Protective programs that have lead to an improvement in the dental health of
children and youths have been in existence for years in many nations. Early childhood caries, however, is still the most common continuing disease in young children in global. Caries is, as is mostly known, an infectious disease affected by bacteria, mainly Streptococcus mutans and Streptococcus sobrinus, in the oral cavity. The running of specific probiotic bacteria in order to stop the root of caries is a new method to avoidance of early childhood caries disease.
Keywords: caries, prevention dentistry, child dentistry, microbiology.
In modern dentistry, the problem of dental caries and periodontal diseases in children remains relevant, due to considerable intensity, high prevalence, a large number of complications of these diseases and increasing needs in dental care [1; 4; 19]. Great importance is attached to the search for effective ways of targeted prevention, and its implementation at all levels [3; 6; 12].
In a number of industrialized countries over the past 15-20 years there was a trend to a decrease in the intensity of dental caries, through the development and implement of prevention programs [2; 9; 11; 16].
The leading factor of tooth caries is cariogenic microflora of the mouth, though, when considering the broader, short-circuit, as a chronic infectious disease that is the result of an imbalance of multiple risk and protective factors. The main factors that play a role in the development of short-circuit in early childhood, is the structure of the temporary occlusion of teeth and saliva, cariogenic bacteria, the presence of carbohydrates and easily fermentable time factor [4; 8; 14; 19].
A characteristic feature of milk occlusion are biologically immature tooth enamel, making teeth more vulnerable to the action of acid. The maturation of the enamel after the eruption of teeth is due to the presence of saliva remineralization activity. It provides not only saliva remineralization, and purification of carbohydrates, as well as due to a bactericidal and protective immune factors to maintain the health of the oral cavity [5; 6; 10; 21].
Formation of oral microflora occurs in stages. The fruit of the womb is almost sterile oral cavity. After the birth of contact with the environment starts the process of settlement of the microbiota. The process of teething is conducive to more intensive colonization of oral bacteria as a result of the formation of the grooves and niches. Saliva constantly washing all surfaces of the oral mucosa, is not only a source of nutrients for the growth of bacteria, but also the protection factor. However, oral bacteria colonization baby is easier than in adults, due to immaturity of immune mechanisms functional secretory immunity. Thus, lower levels of antibodies in saliva and the presence of a particular form sIgA1, enzymes that can degrade a number of pathogens contaminating the mouth increases the risk of infection [7; 13; 17; 25].
The initial colonization of oral streptococci (mostly, Str mitis, Str salivaris.) And further — actinomycetes defines further the diversity of the microbial landscape. In general, the formation of a healthy oral microflora ends to 4 years [1; 8; 15; 24].
A number of bacteria, "living" in the oral cavity, are responsible for the development of short-circuit and periodontal disease, and is a completely different group ofmicroorganisms. Initiating launch caries process is associated most often with streptococcus — Str. mutans and Str. sobrinus. They are produced from glucose sticky mass on the surface of the tooth, which is a habitat for other bacteria, contributing to the further development of caries infection [9; 17; 23].
A distinctive feature of cariogenic micro flora is its absence in the oral cavity of newborns. The presence of cariogenic microorganisms in the newborn child is associated with primary infection; the main source is the mother of the child or those persons who care for them. The main route of transmission — contact: through saliva by using common utensils, hygiene principles of non-compliance.
Previously it was thought that the colonization of cariogenic microflora in the oral cavity could not be toothless infants. However, recent clinical studies that the cariogenic microorganisms capable of forming colonies in tongue grooves. There is also evidence that the earlier the infection occurred, the higher risk and intensity of the caries process [1; 5; 8; 18].
There is a strong correlation between the level of decay-causing microorganisms in the saliva of the mother and the child's risk of infection. Therefore, even before the birth of the child to all family members need to sanitize your teeth carefully and take care of the oral cavity [4; 17; 21].
The first diagnostic sign of future fault is the large number of dental plaque is difficult to shoot with a yellowish tint (this feature should pay attention when inspection of the dispensary-year-olds). Then early carious lesions are detected in the form of chalky spots, usually on the front surface of the incisors of the upper jaw in the cervical area. These hubs very quickly (2-3 months) acquire a light yellow color, and in this place, carious defects occur in the future. The caries process is characterized by the speed of the flow, spread wide (planar cavities), multiple lesions of teeth in the order of their eruption, and often leads to prematur tooth loss [6; 16; 20; 23].
Providing dental care for children of early school age — not an easy task due to the high emotional instability and fatigue of children. A small volume of the cavity of the mouth, increased salivation, and increased gag reflex often make the process of treatment of carious teeth is technically difficult. In addition, usually the parents start dental care very late, when the majority of teeth affected by caries.
However, one should not underestimate the importance of temporary teeth. They are necessary for the formation of correct articulation and the formation of the facial skeleton. Teeth caries in early childhood may cause generalized oral infections and even lead to the defeat of the rudiments of permanent teeth enamel mineralization process that continues throughout early childhood period. The loss of a milk tooth — this is definitely a psychological trauma for the child, so the prevention and treatment of faults early childhood should be given serious consideration. In our country so far widely used method of silvering milk teeth, comprising the application three times the silver salt solutions (nitrate or diaminftorida). This method is based on the antibacterial effect of silver atomic forming insoluble salts on the surface ofthe enamel. It helps to slow down the process ofthe growth of bacteria and reduce the formation of plaque on the affected tooth. It is also believed that due to the silvering is provided obturation of dentinal tubules in the lesion. Timely use of silvering method allows achieving stabilization of the caries process [4; 7; 9; 11; 16; 25].
However, before resorting to the silvering of the teeth, the dentist has to make sure that the surface is not infected. In the case of an extensive distribution and/or rapidly evolving disease, process in the tooth depth of the application of the method of silvering ineffective and tooth decay will progress to the subsequent development of complications.
One of the significant drawbacks silvering method is the appearance of black spots on the teeth, which is usually retained until a change occlusion. This can be a source of psychological problems for the child, resulting in the future may become excessive timidity, indecisiveness and even the "inferiority complex" [6; 12; 14].
It should be stressed that today there is a real alternative to the silvering method. The Department of Pediatric Therapeutic Dentistry applied method of treatment of temporary teeth in children during the first years of life, based on minimally invasive surgery concept. The advantages of this concept are early diagnosis and minimize the occurrence of short-circuit risk factors, the conduct of all therapeutic measures against the background of the preventive effects of treatment with the inevitable — the use of minimally invasive techniques dissection preserving the maximum amount of hard tissue. The algorithm providing conservative dental care for children with teeth caries includes normalization of oral hygiene, removal of the carbohydrate factor, the widespread use of local remineralization therapy [1; 9; 15; 24].
The advantages of this tactic of patients are technically simple in execution of all phases, no need for expensive equipment, the possibility of all the manipulations without anesthesia, sparing attitude to the child's psyche. The main criteria for the success of the activities are the interest and discipline the parents of patients. In the presence of extensive caries and associated complications is conducted dental health under general anesthesia, followed by a mandatory appointment of conservative treatment and preventive measures for the prevention of relapse.
In the short-circuit prevention should distinguish two main aspects: minimizing risks and strengthening the body's defenses. As already described above, are major risk factors for the presence of cariogenic bacteria (Str. Mutans) and the presence of easily digestible carbohydrates.
The following steps are recommended to reduce the risk factors:
• Dental monitor the condition of the oral mother's mouth, if necessary — rehabilitation during and after pregnancy;
• Eliminating the possibility of cross infection through the saliva of the mouth cavity of the child (not to lick the nipple, spoon, baby cup, etc.);
• Advising parents on issues contributing to the prevention of short-circuit, including a thorough oral hygiene of the child, the formation of healthy eating habits and above all easy to reduce the consumption of fermentable carbohydrates with foods products;
• Informing parents about the risk factors for early fault in infants, which include long-term and uncontrolled feeding of the child during laying bed with a bottle, the constant "sucking" or a mixture of milk and others.
The first 3 years oflife are the most effective to reduce the importance and implementation of short-circuit risk factors, because it is taking place in the early formation of the microflora of the mouth and the maturation of the immune system. It is believed that if the in first 3 years Str. Mutans the settlement did not happen in the mouth, in the future, this process takes much more difficult due to the balanced composition of the local indigenous microflora, the maturation of local protective factors. Conversely, if contamination has occurred, Str. mutans life remain in the oral microbiota. Therefore an early age can be considered almost the only possibility to prevent colonization of the oral cavity Str. mutans.
Probiotics — a new trend in the short-circuit prevention in children
Probiotics (PB) — are live microorganisms which, when consumed in sufficient quantities have a positive effect on the health of the host organism. The use of probiotic bacterial strains to normalize the intestinal microflora is used for many years with the aim of not only prevention, but also treatment of diseases. The most common in pediatric practice are lactobacilli (LAB) and bifidobacteria (BB). These bacteria are, as representatives of the normal
microflora of the mouth, have no role in the initiation of fault, even though they belong to ferment carbohydrates. It produces a number of LAB antimicrobial components, such as organic acids, bacte-riocins, adhesion inhibitors, normalizing microbial landscape. The study Sookhee S. et al. it was shown that the antibacterial activity of LAB due to a significant percentage of cases are normalized oral microflora, including inhibiting the growth of Str. mutans.
Selectively inhibit the growth of Str. mutans and thus, can be used with the aim of preventing short circuit. To determine the potential ability to produce substances that inhibit the growth of Str. mutans and Str. sobrinus, studies were conducted when these streptococci were incubated in vitro with LAB, isolated from saliva and plaque sufferers RS and from healthy volunteers. As a result, 23 types allocated LAB, including L. rhamnosus, which completely inhibited the growth of mutant streptococci.
Confirmation of the effectiveness anticaries action PB are also 5 controlled trials, 4 of which were randomized, placebo-controlled, and showed a significant reduction in the number Str. mutans in the saliva. The studies used 53103 L. rhamnosus ATCC [24; 25] L. reuteri ATCC 55730. The first and most revealing, and large-scale study in infants treated with PB L. rhamnosus ATCC 53103 5-10 • 105 dairy product, conducted in Finland. The aim of the study was to analyze the effect of PB on the number Str. mutans and the risk of short circuit in general. The study involved 594 children from 18 preschools at the age of 1 to 2 years, that is 5 days per week for 7 months received the same milk product containing (study group) and not containing (control) L. rhamnosus. The average intake of the mixture was 240 ml. per day. It should be noted that the dairy base because of the presence of calcium and the number of colloidal inorganic and organic substances is an ideal origin "conductor" BOP body in order to short-circuit prevention. To determine the oral microbiota collected samples of dental plaque and saliva for 1 hour before breakfast — before the start of the study and after its completion. At the age of 5-6 years, the newly defined microbiological pattern in the saliva. Fault risk is defined as a combination of microbiological and clinical criteria.
The risk was considered high if the CPU index (the number of carious, sealed and extracted teeth) was> 0 and Str. mutans seeded at > 105 KOE/ml; average, if the CPU index is > 0 or Str. mutans was determined at concentrations < 105 KOE/ml; low, when there was fault and displays the values Str. mutans were < 105 KOE/ml.
The results showed that a significant reduction in short-circuit risk was in all age groups, eat foods with L. rhamnosus, who component fault activity decreased from 40 to 34 %, while in the control group rate of RS activity increased with age (from 39 up to 43 %). The most significant reduction in short-circuit of the index observed during the intervention (use of the product). The most significant effect was observed in the group of children 3-4 years old, at the time when the activity of early childhood is the highest short-circuit.
The effect of L. rhamnosus to improve oral health can be explained by two mechanisms. The use of L. rhamnosus leads to a temporary colonization of the oral cavity [27], which corresponds to the criteria applied to the PB, which include the absence of a permanent settlement. Continued use of the BOP L. rhamnosus, thus, necessary to maintain prophylactic effect.
The second mechanism is effective in ensuring the health of the oral cavity can be associated with specific characteristics of this strain PB. Several studies in vitro, showed that L. rhamnosus produces substances which inhibit the growth of Str. mutans, while itself L. rham-nosus does not ferment sucrose, which is an important factor, and very effective in preventing short-circuit, especially in infants.
In summary, it should be noted that early childhood is a very common fault pathology of children during the first 5 years of life. Early and intensive development of caries due to anatomical and morphological features leads to early loss of deciduous teeth, and may be a source of infection. Important factors in the short-circuit prevention is the normalization of the microbial landscape ofthe oral cavity, reducing the use of readily fermentable carbohydrates, arriving with food, and, of course, proper oral hygiene. In the absence of breastfeeding choice subsequent mixture becomes a key factor in the prevention of short-circuit. L. rhamnosus is a natural antagonist Str. mutant, which plays a key role in the initiation of the caries process. The mixture NAN 3, 4 containing L. rhamnosus 106 KOE/ml in combination with optimal carbohydrate component shown lactose and maltodextrin (low dextrose equivalent) can be one of the possible ways of reducing the risk of faults during the first years of life.
Active participation of pediatricians can provide invaluable assistance in the short-circuit prevention of early childhood. This is possible primarily by increasing the level of knowledge of parents on health and the early diagnosis of dental diseases. In the first months
oflife must be trained to inspect the mother of his mouth and teeth, to conduct primary prevention of short-circuit, as described above. In case ofunwanted changes on the teeth should be timely to appeal to children's dentist, which will use conservative methods of treatment for the rehabilitation of the oral cavity and to minimize the risk of infectious complications. When using the method of "minimally invasive therapy," "relapse" caries observed after 2 years in 6.9-12.8 % of cases, while the "traditional" method in 28,815,4 %, ie 4 times more frequently. In conclusion, I would like to emphasize once again that the disciplined conduct of all of the above recommendations carious process can be stabilized. Because of preventive measures, there is remineralization of initial lesions. It is accompanied by shine of enamel in white spots, also notes the suspension of the development of carious defects, the affected hard tissues are sealed, distinguished from healthy tissue, so during short circuit gets compensated character. This tactic allows not only suspending (or even eliminating) the development of cariogenic situation, but in most cases, avoid, or move to a later date technically complex and uncomfortable for the child treatments fault and its complications.
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