Сучасні погляди на особливості стоматологічного статусу та стану ротової рідини у хворих на цукровий діабет

Abstract

В статті представлено дані літературних джерел, що відображають дискусійні питання проблеми впливу цукрового діабету І та ІІ типу на стан твердих тканин зубів, пародонта, ротової рідини. Численні метаболічні, мікроциркуляторні, нейрогуморальні та імунологічні порушення, зміна біофізичних та біохімічних параметрів ротової рідини, незадовільний стан гігієни порожнини рота в сукупності сприяють розвитку карієсу зубів та інших стоматологічних захворювань у таких хворих. У той же час, бракує достовірних результатів аналізу залежно від низки чинників; В статье представлены данные источников литературы, отражающих дискуссионные вопросы проблемы влияния сахарного диабета I и II типа на состояние твердых тканей зубов, пародонта, ротовой жидкости. Многочисленные метаболические, микроциркуляторные, нейрогуморальные и иммунологичес- кие нарушения, изменение биофизических и биохимических параметров ротовой жидкости, неудовлетворительное состояние гигиены полости рта, в совокупности способствуют развитию кариеса зубов и других стоматологических заболеваний у таких больных. В то же время, недостаточно достоверных результатов анализа в зависимости от ряда факторов; The literature data regarding the controversial issues on the influence of diabetes mellitus type I and II on the status of teeth hard tissues, parodontium and oral fluid were presented in research work. In Ukraine 1.2 million patients are registered with diabetes mellitus, but their number is significantly higher due to undiagnosed (latent) diabetes. The diabetes mellitus type II amounts to 85-90% of incidences. The sustained progressive metabolic, microcirculatory, neuro-humoral, immunological disorders and development of severe diabetic complications caused early disability of the patients and deterioration in the life quality are the typical features of diabetes mellitus type I and II. The concepts concerning the characteristics and frequency rate of teeth hard tissues affections in case of diabetes mellitus type I and II at different ages are rather contradictory. Numerous results of clinical studies indicate the low prevalence of dental caries in patients with diabetes mellitus I type, but the presence of local etiologic factors, primarily the poor hygiene condition of the oral cavity on the background of insufficient metabolic control of underlying disease doubles the risk of dental caries development. According to other researches it was determined that the dental caries intensity in patients with diabetes mellitus type I and II is equivalent to the caries intensity in individuals without somatic diseases history. The prevalence of root (cement) caries in patients with diabetes mellitus type II amounts to 6.7-10%. The rapid bacterial colonization of tooth surfaces was observed in patients with diabetes mellitus that was caused by high glucose level in saliva and crevicular fluids, but pathogenic microflora does not have specific differences. The progressive growth of cariogenic, parodontogenic and fungal flora provides the local immunity disorders and xerostomia. In patients with diabetes mellitus type I and II the changes in biochemical and biophysical parameters of oral fluid were determined that caused the disorder of all its functions. The changes of lysozyme content in saliva (activity decreases in 1.5 times), immunoglobulin A, G, M, lactoferine, increased levels of proinflammatory (IL-1, IL-6, IL-8, tumor necrosis factor) were registered; decreased levels of antiinflammatory (IL-4, IL-10) cytokines, the changes in the activity of antioxidant enzymes, increased levels of alkaline and acidic phosphatase, creatinine, urea, increased activity of the enzymes alanine aminotransferase, aspartate aminotransferase,reduced content of immunoreactive insulin were specified. The examination of oral fluid pH in patients with diabetes mellitus revealed pH shifting to the acid side (pH=6.1 - 6.3) in decompensated state of disease and finding it in the normal range (pH=6.8-7.2) in compensated condition. The significant increase of cariogenic bacteria Str. mutans and Lactobaccilius in mixed saliva of patients with diabetes mellitus in decompensation state was observed. The increase of the calcium ions concentration and ions reducing phosphorus, magnesium, zinc, potassium, sodium was registered, but the results of other studies indicate the decrease in the concentration of calcium ions and increasing the ions concentration of potassium, magnesium, zinc, sodium in patients with diabetes mellitus type I and II with subcompensated and decompensated form of caries. The different prevalence and intensity of dental caries in case of diabetes mellitus type I and II was revealed. Thus, the analysis of the current literature data determined that diabetes mellitus, which is becoming a «noninfectious » epidemic of XXI century with the rapid spread among the world population was directly associated with the condition of teeth, parodontium, oral fluid and, consequently, on the dental morbidity rate in individuals with this endocrine pathology. The direct dependence between diabetes mellitus type I and II and probability of diseases development of oral cavity organs was stated experimentally. The results of clinical studies indicate the high prevalence of dental diseases in patients with diabetes mellitus type I and II, and at the same time, there are no statistically reliable results of such indicators analysis regarding the age of patients and duration of this endocrine pathology, diabetic complications, hypoglycemic therapy taking into account metabolic control.