Karnaukh E. V.

Kharkiv National Medical University

GENERAL DENTAL STATUS IN CHILDREN WITH GASTRIC ACID-DEPENDENT DISEASES OF UPPER GASTROINTESTINAL TRACT

Background. Dental caries is one of most topical problems either in general or in pediatric stomatology. Despite multiple investigations, problems of treatment and prophylaxis of caries process is one of leading in practical work of dentists, especially in case of combined pathology of gastrointestinal tract.

Diseases of digestive system play a significant role in childhood somatic pathology; all over the world, including developed countries, the prevalence of such cases is constantly increasing. One of the biggest group of chronic pathology of digestive system is formed by diseases of gastroduodenal region, among which, together with functional processes (functional or non-organic dyspepsia), most part is occupied by inflammatory and destructive changes — chronic gastritis, chronic gastroduodenitis, duodenal and gastric peptic ulcer.

Nowadays a certain relation of dental pathology and diseases of gastrointestinal tract already has been proved. Researches conducted by dentists and therapeutists testify that changes in oral cavity may be early sign of a disease. Besides, gastroenterological diseases may be important trigger factor for pathological changes in oral cavity as well.

Recently, a special attention if paid to oral symptoms of gastroenterological diseases which are characterized by gastroesohageal reflux. The influence of acid substances on oral cavity inner tissues is widely known, but information about important causative role of gastric acidity in dental health disorders is relatively recent.

Undoubtedly, pathophysiological mechanisms of dental health disorders accompanying so-called “acid-dependent diseases” (gastroesophageal reflux disease, gastritis, peptic ulcer) are much more complicated than just simply direct influence of reflucted sour medium on oral cavity structures. An exceptional role in this process is played by factors of inflammation and interaction with microorganisms. In this relation, the role of sertain endogenic anti-microbial peptides, particularly defensines, is interesting. Three main fractions of these substances are produced in humans practically only by neutrophiles (and this allows to consider them as specific marker of neutrophilic leucocytes), their main physiological role is bactericide action (by creation of ion channels and alteration of cell membranes permeability), and also conduction of chemotactic, immune-modulating, cytotoxic and even anti-viral activity.

Nowadays, the interrelation of dental tissues pathologic changes and gastroesophageal reflux in child patients is insufficiently studied, known data is contradictory in many aspects. In relation to above mentioned and taking into account the fact that this problem is insufficiently researched, known information is discrepant, evidence-based researches are rare, is is expedient and topical to conduct a research dedicated to study of clinico-pathogenical aspects in patients with gastroduodenal pathology.

Objective. Improvement of diagnosis, prophylaxis and treatment of caries of permanent teeth efficacy in children with gastric acid-dependent diseases accompanied with gastroesophageal reflux by early reveal of caries markers.

Material and methods. A prospective randomized one-time ("cross-section") cohort controlled research has been performed in 112 children aged 14 [10; 16] years, 66 boys and 46 girls. Among 88 persons with gastrointestinal pathology the diagnosis of gastroesophageal reflux disease (GERD) has been stated in 17 (19.3 %) persons, chronic gastroduodenitis (CGD) – in 56 (63.6 %) persons, duodenal ulcer disease (DUD) – in 15 (17.1 %) children. Control group included 24 almost healthy children. Non-parametric statistical analysis has been performed, critical p-level was 0.05.

Results and discussion. In all the cohort of 112 children dental caries was revealed exactly at examination or in anamnesis in the majority (j=8.5; р<0.05) of cases – 86 (76.8 %). The distribution by diseases and by presence of caries of permanent teeth allowed to reveal a significantly higher frequency of caries in gastric acid-dependent pathology comparing with control group without gastroenterological pathology: in GERD 94.1 % against 20.8 % accordingly; in CGD 91.1 % against 20.8 % accordingly; in DUD 93.3 % against 20.8 % accordingly. With the exception of patients with GERD, in case of gastrointestinal pathology caries was reliably more frequently revealed in male persons than in female (in CGD 62.7 % against 37.3 % accordingly; j=2.6; р<0.01, in DUD 71.4 % against 28.6 % accordingly; j=2.3; р<0.01). In control group there was controversial tendency, 20 % against 80 % accordingly; j=2.0; р<0.05.

By nosology both in general and separately among boys and girls there were most of all children with CGD: among boys 62.7 % against 2.0 % in control, р<0.05; 62.7 % against 15.7 % in GERD, р<0.05; among girls 54.3 % against 22.9 % in GERD, р<0.05. Caries of permanent teeth was reliably more frequent in children aged 15 and more years (j≥2.7; р<0.01). Both by nosology in general and separately in persons of different age groups children with CGD dominated.

Caries significantly more frequently developed by increase of GERD course duration (in both groups, р<0.01), same for DUD (in both groups р<0.05); General in case of gastroenterological pathology the growth of caries frequency was reliable by comparison of groups with course duration of less than 1 year against 1-3 years (р<0,05).

Conclusion. General dental status in children with gastric acid-dependent diseases of upper gastrointestinal tract (gastroesophageal reflux disease, chronic gastroduodenitis, duodenal ulcer disease) is characterized by often caries, especially in those diseases which are accompanied by gastroesophageal reflux. Further perspectives of research in this direction is characterisctics of biochemical and immunological parameters of oral fluid in children with pathology of upper gastrointestinal tract.