Оцінка гігієнічного стану порожнини рота в дітей, хворих на інсулінозалежний цукровий діабет

Abstract

Проведено обстеження 109 дітей із хронічним катаральним гінгівітом віком 12-16 років, хворих на інсулінозалежний цукровий діабет, яке дало можливість порівняти показники гігієни порожнини рота з урахуванням терміну й тяжкості перебігу основної хвороби. Стан гігієни порожнини рота визначали за індексом Green-Vermillion. Одержані результати виявили, що з поглибленням запальних процесів у тканинах пародонта значення гігієнічного індексу збільшуються, і довели, що гігієна порожнини рота залежить від тривалості й тяжкості перебігу основної хвороби, що вказує на необхідність покращення стоматологічної допомоги дітям цієї категорії.

Проведено обследование 109 детей с хроническим катаральным гингивитом в возрасте 12-16 лет, больных инсулинозависимым сахарным диабетом, которое дало возможность сравнить показатели гигиены полости рта с учетом срока и тяжести течения основной болезни. Состояние гигиены полости рта определяли по индексу Green - Vermillion. Полученные результаты выявили, что с усилением воспалительных процессов в тканях пародонта значение гигиенического индекса увеличиваются, и доказали, что гигиена полости рта зависит от продолжительности и тяжести течения основной болезни, что указывает на необходимость улучшения стоматологической помощи детям данной категории.

One of the features of present-day structure of dental diseases among children in Ukraine is rather high occurrence of pathological changes in the periodontal tissues, which at the age of 12-15 ranges within 70-80% according to the evidences suggested by certain authors, and in some regions it reaches 95-98% [3,7]. One of the factors causing occurrence and severity of periodontal diseases among children is common somatic pathology available, and endocrine one in particular [2,4,5]. Statistical investigations conducted by the Ministry of Health of Ukraine are indicative of a continuous increase of endocrine pathology among children in Ukraine, and insulin-dependent (type 1) diabetes in particular [8]. Hygienic condition of the oral cavity is one of the important local factors and triggering mechanism promoting development of inflammation in the periodontal tissues due to intensified pathologic effect of the oral cavity microflora and reduced general reactivity of the body [1,9]. Considering a close interrelation available between rational care of the oral cavity and the periodontal tissue state, the aim of the study was evaluation of the level of individual oral hygiene in children suffering from diabetes mellitus (DM) depending on the duration of the underlying disease and glycemic control level. To solve the purpose of hygiene of the oral cavity was assessed in 109 children with chronic catarrhal gingivitis (CCG) aged 12-16 years who were examined or treated at the Children’s Endocrinological Department of the Municipal Institution “Regional Children’s Hospital” in Chernivtsi concerning DM. The children were divided into the groups according to the level of glycemic control: those with optimal glycemic control (OGC) – 1 person, with suboptimal glycemic control (SOGC) - 66 individuals, with glycemic control and high risk for life (HRFL) – 42 individuals, as well as duration of the disease: children suffering from DM less than 5 years – 65 individuals, children suffering from DM more than 5 years – 44 individuals. Oral hygiene was determined by means of oral hygiene index simplified (OIH-S) (J.C.Green, J.R.Vermilion, 1964). The data obtained were statistically processed by means of variation statistics method considering Student criterion and the use of software Statistica 7.0 (StatSoft, Inc). Difference between the groups of comparison was considered reliable with р≤0,05. Assessment of the oral hygiene in children depending on the duration of common somatic disease demonstrated reduced hygienic level and increased values of Green-Vermillion index. Thus, in children with CCG suffering from DM more than 5 years and having SOGC, hygienic index values were 1,3 times higher (1,87±0,15), which corresponds to unsatisfactory level of oral hygiene in comparison with (1,54±0,08) in children suffering from DM less than 5 years, which corresponds to satisfactory hygiene. In children with glycemic control level of HRFL and duration of DM longer than 5 years hygienic index was (2,42±0,29) which was 1,5 times higher than in children suffering from DM less than 5 years and their hygienic index was (1,64±0,08) which corresponds to unsatisfactory and satisfactory oral hygiene levels respectively. The oral hygiene was also analyzed depending on the degree of severity of the underlying disease. Thus, in children with the glycemic control level of HRFL and duration of DM more than 5 years the values of Green-Vermillion index were higher than those similar ones 1,3 times ((2,42±0,29) against (1,87±0,15) in children with SOGC, and they corresponded to unsatisfactory level of the oral hygiene in both cases. Similar tendency was found in the group of children with duration of DM less than 5 years. In children with glycemic control level of HRFL hygienic index was (1,64±0,08) and was considerably higher than (1,54±0,08) with SOGC, and 1,2 times higher (1,33±0,00) with OGC, but in all the cases it corresponded to a satisfactory level. A detailed analysis of dependence of the oral hygiene in children with different degree of CCG severity on the duration and severity of the underlying disease presented the following results. All the children with mild degree of CCG irrespective of the glycemic control level and duration of diabetes had a satisfactory level of the oral hygiene. Though, in children with duration of DM more than 5 years the values of hygienic indices were higher: with SOGC (1,58±0,08) against (1,48±0,04) when diabetes lasted less than 5 years, and (1,66±0,00) in children with HRFL against (1,54±0,08) respectively. In children with moderate severity of CCG and DM lasting more than 5 years the values of hygienic indices were 1,2 times higher with SOGC and 1,5 times with HRFL respectively in comparison with the index with SOGC and HRFL in children with the duration of somatic pathology less than 5 years. The values of Green-Vermillion index in children with severe CCG and DM longer than 5 years in anamnesis were 1,5 times higher than in children with DM less than 5 years. They corresponded to poor and unsatisfactory oral hygiene. The obtained results determined that special attention should be paid to teaching oral hygiene technique and its control in children in order to prevent periodontal tissue diseases and in the process of treatment. Assessment of the oral hygiene conducted in children suffering from DM evidences than with more intensive inflammatory processes in the periodontal tissues the values of hygienic index increase. There are certain bases to claim with good reason that oral hygiene depends on the duration and severity of the underlying disease which is indicative of the necessity to improve stomatological aid given to children from this group