As a manuscript
Malykhina Marina Anatolyevna
STUDY OF DENTAL MICROFLORA AT VARIOUS DEVELOPMENT OF CARIES INTENSITY IN CHILDREN
dissertation for the degree
candidate of medical sciences
The work was performed at the State educational institution of higher professional education “Voronezh State Medical Academy named after N.N. Burdenko »of the Ministry of Health and Social Development of the Russian Federation.
Supervisor: Doctor of Medical Sciences, Professor
Gubina Lidia Konstantinovna
Official opponents: Doctor of Medical Sciences, Professor
Mamedov Adil Askerovich
Doctor of Medical Sciences
Shumilovich Bogdan Romanovich
Leading organization: State educational institution
Higher Professional Education "Smolensk State Medical Academy" of the Federal Agency
on healthcare and social development of the Russian Federation.
The defense will take place “___” _______________ 2010 at ___ hours at a meeting of the dissertation council D 208.009.01 at the State educational institution of higher professional education “Voronezh State Medical Academy named after N.N. Burdenko ”of the Ministry of Health and Social Development of the Russian Federation at the address: 394036, Russia, Voronezh, ul. Student, 10.
The dissertation can be found in the library of the State educational institution of higher professional education “Voronezh State Medical Academy named after N.N. Burdenko ”of the Ministry of Health and Social Development of the Russian Federation at the address: 394036, Russia, Voronezh, ul. Student, 10.
Abstract sent "___" _______________ 2010
dissertation council A.A. Glukhov
GENERAL DESCRIPTION OF WORK
The relevance of research
One of the most common diseases is damage to the hard tissues of the tooth - caries.
According to epidemiological surveys, the prevalence of caries varies significantly from 22% to 88% (L. S. Persin, V. M. Elizarova, S. V. Dyakova, 2003) and has no tendency to decrease. Moreover, according to some authors (V. G. Suntsov, A. Zh. Tarifulina, V. I. Samokhina, 2005), a certain increase in the incidence rate has recently been observed, despite the ongoing preventive and therapeutic measures (Yu. A. Fedyarov 2000, Meneghetti B., 2006). According to E. M. Kuzmina (2001), in six-year-old children, the prevalence of caries is 73%, and the average intensity reaches 4.8.
The widespread prevalence of caries in children determines the relevance of finding ways to prevent this disease. Currently, along with such factors as a violation of the homeostasis of the body, the nature of nutrition and the state of oral hygiene, no one doubts that the occurrence of caries is impossible without plaque microorganisms.
Today, the microflora of the oral cavity and the plaque formed by them are considered as a determining factor in the occurrence of the main dental diseases - caries and inflammatory periodontal diseases.
Tooth decay is a source and source of infection and allergization in the child’s body, because with food the child constantly swallows a large number of microorganisms, as well as decomposition products of tooth tissues and food, which are retained in the cavity. In addition, these same microorganisms, their toxins and their metabolic products are absorbed into the bloodstream through the mucous membrane of the mouth and at the junction of the tooth. Constant infection of the body and its sensitization contribute to the development of rheumatism in children, diseases of the kidneys, joints, gastrointestinal tract, chronic sinusitis and impaired vision.
The above justifies the need to study the species and quantitative composition of plaque microorganisms at different intensities of caries. The data obtained will allow to reasonably carry out therapeutic and preventive measures for varying degrees of intensity of caries in children.
Purpose of the study
Improving the effectiveness of treatment and preventive measures in children with dental caries during the period of occlusion by developing and applying a new scheme to reduce bacterial colonization of plaque.
- To evaluate the level of oral hygiene and the intensity of caries in seven-year-old children.
- To study the species and determine the quantitative composition of microflora of dental plaque in children with various degrees of caries intensity and levels of oral hygiene.
- To identify the relationship between the species and quantitative composition of microflora of dental plaque with the intensity of caries, and the level of oral hygiene in children.
- To develop a methodology for application and a treatment regimen for caries using the antibacterial drug Povidone - iodine.
Scientific novelty of research
The species and quantitative composition of the microflora of dental plaque was studied at various degrees of caries intensity and levels of oral hygiene in children during occlusion changes.
The relationship of oral hygiene, varying degrees of caries intensity with the species and quantitative composition of plaque microflora in seven-year-old children was revealed.
A new method of antibacterial tooth treatment with Povidone - iodine and a treatment regimen for children with high caries intensity has been developed and tested.
The practical significance of the work
A complex examination of children is proposed, including the determination of the species and quantitative composition of microflora of dental plaque in children during occlusion changes.
The relationship of oral hygiene indices, the degree of caries intensity with the specific and quantitative composition of plaque microflora in seven-year-old children was studied.
A technique and scheme for the use of Povidone - iodine in the complex treatment of children with caries was developed and proposed for use in the practice of pediatric dentistry.
These studies will reduce the quantitative content of plaque microorganisms that affect the development of the carious process and reduce the intensity of caries in children.
The main provisions of the dissertation submitted to the defense
- A comprehensive examination program has been created with microbiological studies of dental plaque in children during occlusion changes, which will provide the possibility of etiopathogenetic treatment of caries.
- A study of the microflora of plaque in seven-year-old children revealed a dependence of the species and quantitative composition of microorganisms on the intensity of dental caries and the level of oral hygiene.
- The developed methodology for the use of Povidone - iodine and the treatment regimen can reduce the quantitative content of microorganisms in plaque in children.
4. Monitoring the intensity of dental caries, the level of oral hygiene and microflora of plaque after using Povidone-iodine revealed a decrease in the intensity of dental caries and an improvement in the hygiene of the oral cavity in children.
The main provisions of this work were reported and discussed at the conferences: Regional scientific and practical conference "Actual issues of dentistry" (Lipetsk, 2007), Regional scientific and practical conference "New technologies in dentistry" (Lipetsk, 2008), Interregional scientific and practical conference "Actual issues of medical prevention and the formation of a healthy lifestyle ”(Lipetsk, 2009), at a joint conference of employees of the departments of therapeutic, propaedeutic, orthopedic dentistry and the department of dentistry children age VGMA them. N.N. Burdenko (Voronezh, 2010).
The research results have been introduced into the practical activities of the City Children's Dental Clinic Municipal Institution in Lipetsk, and are used in the educational activities and the treatment process of the Department of Pediatric Dentistry of the Voronezh State Medical Academy named after N.N. Burdenko »of the Ministry of Health and Social Development of the Russian Federation.
On the topic of the dissertation, 8 scientific papers were published, including in 3 journals recommended by the list of the Higher Attestation Commission of the Russian Federation.
The structure and scope of the dissertation
The dissertation is presented on 165 pages of typewritten text, consists of an introduction, a review of the literature, a chapter of materials and research methods, research results and discussion, conclusions and a list of references, including 284 sources, including 120 foreign authors. The work is illustrated by 34 tables and 28 figures.
MAIN CONTENT OF WORK
Materials and research methods
In accordance with the goals and objectives of the study, the study of oral hygiene, the prevalence of caries and the intensity of dental caries in children, microbiological examination of dental plaque, group and individual training in oral hygiene skills, antibacterial dental treatment, monitoring of the dental status of children and evaluation of treatment results.
The research program was standardized and included comprehensive dental research - an assessment of oral hygiene, the intensity and prevalence of dental caries, and a microbiological examination of plaque.
To evaluate oral hygiene, objective indicators were used that characterize the quantity and quality of dental deposits. In our study, the hygienic index IGR - U was used (Green G., Wermillion G., 1964).
To determine the severity of the carious process, the concept of caries intensity (KPI index) was used. In children with interchangeable bite, the sum of the individual indicators for permanent and primary teeth was used (KPU + kpu index).
The incidence of dental caries was determined by calculating the increase in intensive caries in children at the stages of the study.
Colonization of plaque was studied according to the results of microbiological studies. The biological substrate in various dilutions was seeded on differential diagnostic media: blood agar - for counting the total microbial seeding, milk - yolk - salt agar for staphylococci, sugar broth for streptococci, Endo medium for enterobacteria and pseudomonads, vitelline - alkaline agar for enterococci - plant medium for lactobacilli, serum agar for neiseria, Saburo medium for fungi of the genus Candida.
Crops were incubated in an incubator for 18-24 hours, at 370 C, Saburo medium for about 3 to 5 days at a temperature of 280 C. Anaerobes were cultured in a microaerostat of the Gas-Pak system (OXOID, England).
After incubation, the isolated strains checked the morphology and tinctorial properties. Biological typing of microorganisms was carried out according to biochemical properties.
Identification of the isolated strains of microorganisms was carried out on the basis of morphological, cultural and biochemical characteristics in accordance with the Bergey Guide to Bacteria - 9th edition (1997).
Analysis of the research results was carried out using the computer program “AWP - bacteriologist”.
Statistical processing of the research results was carried out in the environment of the STATISTICA 5.0 package using the statistical and engineering analysis program MS Excel, in the Windows 2000 environment for Pentium computers.
An analysis of the intensity of caries in six-year-old children in Lipetsk for the period from 1996 to 2009, which established that the prevalence of dental caries in children, although it decreased from 94.4% to 85.7%, remains high. There is also a clear tendency to reduce the intensity of caries from 7.94 in 1996 to 4.84 in 2009, which is a consequence of the ongoing prevention program.
For the period from 2007 to 2009 in the municipal institution "City Children's Dental Clinic" of the city of Lipetsk, 78 children aged 7 years were examined.
After a comprehensive dental examination, the children were divided into groups taking into account the intensity of caries. The first group consisted of 16 children with intact temporary and permanent teeth. The second group included children with caries intensity (KPU + kpu) 2.9 + 0.13, in the amount of 31 people. The third group of children was 31 people with a caries intensity of 5.74 + 0.23.
Each group of children was divided into subgroups depending on the hygienic condition of the oral cavity: with good oral hygiene (index IHR - Y = 0.00 - 0.6), satisfactory (index IHR - Y = 0.7 - 1.6) and bad (GAME index - Y = 1.7 - 2.5 or more).
A survey of oral hygiene in 16 children without dental caries showed that the index of oral hygiene in 8 children was 0.00 - 0.6, in 6 children - 0.7 - 1.6 and in 2 children - 1.7 - 2.5. The average level of hygiene was 0.95 + 0.23.
As a control group, we examined 31 children aged 7 years. When determining the hygienic condition of the oral cavity, the GHI index - In 7 children was 0.00 - 0.6, in 21 children - 0.7 - 1.6 and in 3 children 1.7 - 2.5. The average level of hygiene was 1.13 + 0.08. When determining the intensity of caries, it was found that the CPU + CPT of the teeth was 2.9 + 0.13.
A group of children with a high level of caries intensity also comprised 31 people. The oral hygiene index of 0.00 - 0.6 was in 5 children, 0.7 - 1.6 in 14 people and 1.7 - 2.5 in 10 children, more than 2.5 in 2 people. The average hygiene level was 1.54 + 0.11.
The results of microbiological studies of dental plaque
To determine the species and quantitative composition of microorganisms
dental plaque in children, in three groups, selected taking into account the intensity of dental caries, we conducted 519 microbiological studies at the initial examination and 785 after treatment.
Plaque was taken on an empty stomach, before morning brushing. Prior to sampling, the oral cavity was thoroughly rinsed twice with sterile distilled water. To prevent contamination, the teeth were isolated from saliva with sterile cotton swabs, the surface of the teeth was dried with sterile cotton swabs.
The material was taken with sterile excavators from the buccal surfaces 1.6, 2.6 of the teeth, lingual surfaces 3.6, 4.6 of the teeth and vestibular surfaces 1.1 and 3.1. In the absence of permanent teeth, the fence was carried out with a chewing or central group of teeth of a temporary bite. Plaque was removed from the instrument on sterile cotton buds - the invasive sterile EUROTUBO (DENTALAB. Rubi. Spain), which were placed in a sterile plastic case and delivered to the Testing Laboratory Center at the Federal State Healthcare Institution “Center for Hygiene and Epidemiology in Lipetsk region. "
When studying the species composition of plaque microorganisms in children with intact teeth, it was found that the species composition of plaque microorganisms in this group of children was Lactobacillus spp., Streptococcus salivarius, Streptococcus sangius, Streptococcus mitis, Streptocococcus mutans, Moraxella sppec, Enter. Enterococcus faecium (Table 1).
Plaque microbiocenosis in a group of children with intact teeth