EVALUATION OF THE EFFECTIVENESS OF TREATMENT OF CHRONIC CATARRHAL GINGIVITIS IN CHILDREN WITH DIABETES MELLITUS IN LONG-TERM OBSERVATIONS
Epidemiological studies in recent years indicate a significant prevalence with an increasing tendency to periodontal disease in the structure of all dental diseases in children. The prevalence of chronical catarrhal gingivitis (CCG) is about 90% of all forms of the disease [1–6].
Local and general factors play a significant role in the pathogenesis of periodontal diseases. Data from clinical and experimental studies indicate a close relationship between periodontal diseases and the dysfunction of endocrine system.
According to the literature, as well as the results of our own paraclinical studies, it is proved that the leading role in the development of periodontal diseases in diabetes mellitus (DM) is played by the activation of oxidation processes with a development of the oxidative stress. Analysis of the antioxidant system (AOS) of the oral fluid in children showed the development of complex maladaptive mechanisms in the middle of the system with a lack of both antiperoxide and antiradical components, and justified the need to improve the traditional treatment method for CCG within both general and local levels.
The aim of the study. To evaluate the effectiveness of the proposed treatment method for children with chronical catarrhal gingivitis and diabetes mellitus.
Materials and methods. In order to achieve the aim, 50 children with CCG aged 12 years were treated. All patients with diabetes underwent the hospitalization in the department of endocrinology of the municipal institution “Regional Pediatric Clinical Hospital” in Chernivtsi. Also, 18 somatically healthy children were taken for the treatment of CCG. Children with diabetes were divided into two distinct groups. Thus, the first group (control) included 18 somatically healthy children with CCG, while the second group (comparison) consisted of 25 children with a background of CGG and diabetes mellitus. Children of groups 1 and 2 were treated in accordance with the protocols of the Ministry of Health of Ukraine for the provision of medical care in the specialty “Pediatric therapeutic dentistry”. The third group (main) included 25 children with CGG and diabetes, who underwent the treatment with the oral use of drug “Kvertulin” 1 tablet 3 times a day, “Imupret” 25 drops 3 times a day, and multivitamin complex “Pikovit” 1 tablet 1 time a day after meal until complete resorption in the oral cavity, overall for 20 days. Besides that, a solution of tooth elixir “Exodent” was prescribed for irrigation of the oral cavity (1 tsp per ¼ cup of water after each meal and toothbrushing for 1-2 minutes).
Dental examination of children was carried out by conventional clinical methods in accordance with WHO recommendations.
Evaluation of the CCG treatment effectiveness was performed by comparing the initial results (I examination) with the results immediately after its completion (II examination), after 1 (III examination), 3 (IV examination), and 6 (V examination) months.
Research results and their discussion. In all examined children after the treatment there was an improvement in the hygienic condition of the oral cavity in comparison with the indicators before treatment. Immediately after treatment the best values of Green-Vermillion hygienic index were observed in children in the control group, in which the rate change occurred from 1,65±0,10 to 0,23±0,14 (reduction was 87%). In children of the main group, the values of the hygienic index improved from 1,87±0,66 to 0,38 ±0,08 (reduction of the indicator was 80%), while in children of the comparison group, the change in the indicator occurred from 1,85±0,15 to 0,41±0,08 (reduction - 78%).
During the examination of children, a month after the second survey, there was a tendency to decrease of indicator studied in all groups of subjects. It was the best in children of the control group and was 0,36±0,65, and the worst - in children of the comparison group (0,61±0,16). In patients of the main group it was better than in children of the comparison group and corresponded to 0,56±0,13.
6 months after treatment, the tendency of hygiene deterioration persisted. The hygienic index of Green-Vermilion in children of the control group was 0,62±0,16, which was 2,6 times lower than the initial values before treatment. In children of the main group the hygiene index was equal to 0,84±0,04 and was 2,2 times lower than before treatment, and in children of the comparison group the indicator was 0,98±0,05, which was 1,8 times less than before treatment.
In the dynamics of observation according to the results of CCG treatment, the indicators of periodontal indexes in children of the observation groups differed significantly. Thus, in children of the main group, immediately after treatment, the decrease in the PMA index occurred by 97% (from 41,18±13,34% to 1,23±0,72%), and in children of the comparison group by 85% (from 41,23±12,40% to 5,85±0,68%). In children of the control group it was determined by 100% elimination of the inflammatory process.
During the assessment the condition of periodontal tissues by the PMA index after 3 and 6 months, recurrence of CCG was observed in all study groups. In children of the main group after 6 months of treatment and deteriorated PMA index was 15,08±0,56% and significantly lower – 2,7 times less than before treatment. Children in the comparison group had worse treatment results, the PMA index of this group was equal to 20,1 ±0,58%, which was 2 times less than before the treatment.
Sextants with bleeding gums were absent in 19 children (76%) of the main group after the treatment, while in children of the comparison group - in 9 subjects (36%). Children from the control group did not have sextants with bleeding after treatment at all. At 1, 3 and 6 months after treatment, a gradual increase of this symptom was observed in children of the study groups, as well as a significant difference in indicators depending on the method of treatment. In 6 months after performed medical and preventive actions the quantity of sextants with bleeding in children of the main group decreased 4 times (from 4,44±0,71 to 1,08±0,49), in children of comparison group 2 times (4,40±0,86 to 1, 96±0, 45).
In children of all study groups, the number of sextants with tartar disappeared after treatment. However, in children with diabetes, this symptom recovered faster than in somatically healthy ones, and during the III and IV examinations this symptom was observed in children of the main group 0,24±0,43 and 0,28±0,46 respectively, and in children of comparison groups – 0,36±0,48 and 0,40±0,50.
After 6 months, the number of sextants with tartar was significantly lower than before the conducted treatment and amounted to 0,32±0,47 in children of main group, 0,32±0,47 in children of comparison group, and 0,11±0,32 in children control group.
Conclusions. The results of observations convincingly prove the high efficiency of the developed treatment and prevention complex for children with CCG and diabetes. The combined use of CCG correction measures with antioxidant status ensured the stability of clinical outcomes, as evidenced by periodontal indexes data, and once again demonstrates the important role of oxidative stress in the development of periodontal diseases in patients with diabetes mellitus. However, the generally accepted method of treatment in this group of children had low efficiency due to the lack of pathogenetic effects on main components in the development of the disease. Despite the improvement of oral hygiene in the study groups, which was preserved during the observation term, the pathological process in gums in children with diabetes, who were treated with traditional methods, was restored, confirming the secondary role of local factors of gingivitis in children with diabetes.
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