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

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.