EFFECT OF CARIES PREVENTIVE MEASURES ON THE DYNAMICS OF ORAL FLUID BIOCHEMICAL PARAMETERS IN PATIENTS WITH DIABETES MELLITUS
About the author:
Udod O. A., Kulish A. S.
Type of article:
Prevention of dental caries is an important aspect in the present-day dentistry. However, the traditional approaches to the dental caries prevention in persons with type I diabetes mellitus cannot be considered effective, the prevalence of dental caries in these patients does not decrease. Considering the constantly high overall drug loading, the local (exogenous) preventive measures are of high priority. The local measures for dental caries prevention more often include fluorine-containing agents, however, the excess of fluorine compounds adversely affect the condition of patients with diabetes mellitus. It is advisable to use fluorine-free agents as caries preventive measures for such patients. The aim of the study is to assess the effect of local fluorine-free caries preventive agents on the structural and functional acid resistance of dental enamel and oral fluid biochemical parameters in patients with type I diabetes mellitus. Object and methods. We examined 95 patients with type I diabetes mellitus in compensation, subcompensation and decompensation state aged from 18 to 35 years and disease duration from 1 to 24 years. The main group included 50 persons, the control group – 45. Structural and functional acid resistance of dental enamel in patients was studied with enamel resistance test, as well as oral fluid biochemical composition. Considering the degree of caries risk and compensation state for diabetes mellitus, the main group patients received local caries preventive measures, which included the use of fluorine-free agents containing nanohydroxyapatite and xylitol, as well as agents with lactoperoxidase system enzymes, and patients of the control group received traditional local fluoroprophylactic treatment. Results and discussion. The initial structural and functional acid resistance in patients of the main group was 5.26 ± 0.27 points, after 6 months – 3.52 ± 0.19 points, after 12 months – 3.14 ± 0.16 points, the indicator was improved 1.7 times (p <0.05). In the control group after 6 months the acid resistance was 4.09 ± 0.21 points, after 12 months – 3.86 ± 0.18 points, which only 1.3 times better (p <0.05) than the initial value of 5.02 ± 0.25 points. Before caries preventive measures the content of total and ionized calcium in the oral fluid in patients of the main group was significantly reduced relative to the norm and presented the indicators 0.34 ± 0.03 mmol/L and 0.42 ± 0.02 mmol/L, correspondingly, calciumphosphorus ratio was also reduced up to 0.07 ± 0.01, the content of phosphorus, fluorine and pH varied within normal limits. After 12 months, the content of total and ionized calcium in the oral fluid was increased in these patients (p <0.05) to 0.42 ± 0.02 mmol/L and 0.57 ± 0.02 mmol/L, correspondingly, calcium-phosphorus ratio was also increased (p<0.05) and amounted to 0.10 ± 0.01, the content of phosphorus and fluorine was within normal limits, however, oral fluid pH shifted from 7.12 ± 0.06 units up to 7.23 ± 0.04 units (p>0.05). In patients of the control group the initial indices of the content of total and ionized calcium in the oral fluid were 0.30 ± 0.03 mmol/L and 0.39 ± 0.02 mmol/L, respectively, after 12 months they did not change significantly (p>0.05) and amounted to 0.31 ± 0.03 mmol/L and 0.38 ± 0.02 mmol/L, correspondingly, calcium-phosphorus ratio 0.06 ± 0.01 remained at the same low level, phosphorus content ranged within normal limits, however, fluorine content was increased up to 0.71 ± 0.01 mg/L (p <0.05), oral fluid pH was 7.15 ± 0.04 units and remained at the initial level. Conclusions. The implementation of the suggested caries preventive measures in patients with type I diabetes mellitus applying fluoride-free agents with nanohydroxyapatite and xylitol, as well as agents with lactoperoxidase system enzymes, considering the caries risk and state of diabetes mellitus compensation, increases the structural and functional acid resistance of dental enamel and provides certain positive changes in the biochemical parameters of the oral fluid, characterized by the increase in the total and ionized calcium, as well as the calcium-phosphorus ratio, unlike the corresponding indicators of persons who received caries preventive treatment according to the traditional scheme
type I diabetes mellitus, local prevention of caries, acid resistance of enamel, oral fluid
- Kas`kova LF, Amosova LI, Karpenko OO. Profilaktyka stomatologichnykh zakhvoryuvan`. Xarkiv: Fakt; 2011. 392 s. [in Ukrainian].
- Akhmedova ZR, Avraamova OG, Kulazhenko TV, Zhytkov MYu, Vynnychenko YuA, Dmytrova AG, i dr. Profylaktyka karyesa zubov u vzroslуkh. The Journal of scientific articles Health and Education Millennium. 2019;21(1):10-4. [in Russian].
- Skyba OV. Patogenetychni aspekty profilaktyky ta likuvannya stomatologichnykh zakhvoryuvan` pry czukrovomu diabeti [avtoreferat]. Kyiv: NMAPO im P. L. Shupyka; 2016. 32 s. [in Ukrainian].
- Rule ZhF. Professional’naya profilaktika v praktike stomatologa. Moskva: MEDpress-inform; 2010. 368 s. [in Russian].
- Bodnar PN, Myxal`chyshyn GP, Komyssarenko YuY, Pry`stupyuk AM. Endokrynologyya. Uchebnyk. Vynnycza: Nova knyga; 2016. 488 s. [in Russian].
- Savychuk NO. Innovacijni pidkhody do profilaktyky kariyesu zubiv u ditej i vagitnykh zhinok. Sovremennaya stomatologyya. 2013;5:50-5. [in Ukrainian].
- Kemal MI, Ilknur SO, Abdullah K. Fluoride toxicity and new-onset diabetes in Finland: a hypothesis. J Exp Integr Med. 2014;4(1):3-8.
- Tokar’ VI, Zhavoronkov AA, Shcherbakov SV. Ftor i endokrinnaya sistema. Novosibirsk: Nauka; 1991. 194 s. [in Russian].
- Kupecz TV, Myrnaya EA, Leus PA. Vlyyanye myneralyzuyushhykh zubnoj pastу y gelya na mykrokrystallyzacyyu rotovoj zhydkosty. Stomatologyya detskogo vozrasta y profylaktyka. 2016;4:12-5. [in Russian].
- Leonteva EYu, Tkachuk OE, Nektarevskaya YB. Remyneralyzyruyushhaya terapyya s yspolzovanyem Tooth Mousse y MI Paste Plus. Problemу stomatologyy. 2013;1:31-5. [in Russian].
- Lukashevych YK, Gorbunova YL. Yzuchenye pokazatelej rotovoj zhydkosty beremennуkh pry mestnom prymenenyy trekhkomponentnogo kalcyj-fosfat-ftorsoderzhashhego gelya kak sredstva profylaktyky karyesa. Stomatologyya. 2018;3:19-22. [in Russian].
- Leont’ev VK, Kisel’nikova LP. Detskaya terapevticheskaya stomatologiya. Moskva: GEOTAR-Media; 2017. 952 s. [in Russian].
- Vavylova TP, Yanushevych OO, Ostrovskaya YG. Slyuna. Analytycheskye vozmozhnosty y perspektyvу. Moskva: Yzdatelstvo BYNOM; 2014. 312 s. [in Russian].
- Kosenko KN, Tereshyna TP, Levyczkyj АР. Eksperymentalne vyvchennya toksychnoyi diyi ta specyfichnoyi efektyvnosti zasobiv dlya doglyadu za porozhnynoyu rota 124 (metodychni rekomendaciyi). Derzhavnyj Farmakologichnyj komitet MOZ Ukrayiny. Kyiv; 2003. 42 s. [in Ukrainian].
- Homenko LO, Bidenko NV, Ostapko OI, Savichuk NO, Chajkovskij YuB. Dityacha terapevtichna stomatologiya. Kyiv: Knyha plius; 2018. 391 s. [in Ukrainian].
- Novykova ZhA. Soderzhanye ftora v rotovoj zhydkosty u lycz s vуsokoj yntensyvnostyu karyesa posle prymenenyya zubnуkh past s raznoj koncentracyej ftora. Visnyk stomatologiyi. 2010;2:75-8. [in Russian].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 375-378 pages, index UDK 616.314-002-02:616.379-008.64