Karnaukh E. V.

Kharkiv National Medical University

Clinical peculiarities of caries
in children with acid-dependent diseases
accompanied by gastroesophageal reflux

Background. Last years the problem of oral (dental) consequences of gastrointestinal diseases accompanied by gastroesophageal reflux attract more and more researches. The oral cavity has close anatomical and physiological relations with other parts of digestive system. The action of different acidic substances on tissues of oral cavity is widely known, but only recently the stomach acidity has been stated as cause of intraoral changes.

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-sectional") 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 has been stated in 17 (19.3 %) persons, chronic gastroduodenitis – in 56 (63.6 %) persons, duodenal ulcer disease – in 15 (17.1 %) children. Control group included 24 almost healthy children. Permanent decayed, missing, filled index (DMF), simplified oral hygiene index (OHI-S), papillary-alveolar-marginal index (PMA), test of enamel resistance (TER) have been evaluated. Non-parametric statistical analysis has been performed, critical p-level was 0.05.

Results and discussion. In all 112 examined children the value of DMF was 1 [1; 3], varying in the diapason of 0–7. Comparison of DMF value among all children with gastroenterological pathology and almost healthy children of control group represent reliably higher values in case of gastric acid-dependent diseases: 2 [1; 4] against 0 [0; 0] accordingly, р<0.01. Some differences did not reach statistically significant level, while showing appropriate trends. Thus, DMF in children with duration of gastroenterological anamnesis of less than 1 year against 1–3 years has a trend of growth while the duration of gastroenterological pathology increases, р=0.07.

The value of OHI-S in all 112 children was 0.7 [0.5; 1.7], and in patients with gastrointestinal pathology it had higher values than in control group, 0.8 [0.7; 1.8] against 0 [0; 0,1] accordingly, р<0.01. Ranking by the value of OHI-S revealed the general tendency of first rank place in gastroesophageal reflux disease, second – in duodenal ulcer disease, third, lowest – in chronic gastroduodenitis. Taking into account nosology and duration of course showed the following. In children with duration of less than 1 year higher values were characteristic for duodenal ulcer disease against chronic gastroduodenitis (1.8 [1.7; 1.8] against 0.7 [0.7; 0.8] accordingly, р=0.02); in cohort of 1–3 years of duration — additionally chronic gastroduodenitis against gastroesophageal reflux disease (0.7 [0.7; 0.8] against 2.7 [2.7; 3.5] accordingly, р<0.01) and duodenal ulcer disease against gastroesophageal reflux disease (2.0 [1.7; 2.7] against 2.7 [2.7; 3.5] accordingly, р<0.03). Similar trend was stated for the duration of gastroenterological anamnesis of above 3 years. The value of OHI-S in case of duration of gastroenterological pathology of 1–3 years had a tendency to increase comparing with duration of less than 1 year bot in general without taking into account of nosologic attribute (р=0.07) and in gastroesophageal reflux disease (р=0.14) and also in duodenal ulcer disease (р=0.25).

Evaluation of gums inflammation by PMA index showed that intensity of gingivitis did not exceed moderate severity, and in the majority of cases was mild. In background gastroenterological pathology РМА value exceed control values, 9.0 [6.0;21.5] % against 0 [0; 0] %, р<0.01. The structure of РМА values in consideration of nosology and duration of disease course was characterized by highest levels in gastroesophageal reflux disease, which in general without consideration of duration of gastrointestinal tract pathology were reliably different from the value in chronic gastroduodenitis (28 [26; 31] % against 6 [5; 9] % accordingly, р<0.01) and in duodenal ulcer disease (28 [26; 31] % against 21 [18; 23] % accordingly, р<0.01); the only one cohort where differences did not reach statistically significant levels, appeared to be children with short (below 1 year) course where difference was detected only between chronic gastroduodenitis and duodenal ulcer disease. In addition, statistical tendencies were revealed on PMA comparison in children with duodenal ulcer disease and duration of less than 1 year against term of 1–3 years (р=0.14), and among patients with gastroesophageal reflux disease and disease duration of 1–3 years against the term of above 3 years (р=0.29).

Evaluation of enamel stability by TER showed variation of parameter in 10–90 %. In children with gastroenterological pathology the value of TER index exceeded control values, 40 [40; 60] % against 10 [10; 15] % accordingly, р<0.01. Enamel resistance had some peculiarities in separate nosologic groups depending on duration of gastroenterological diseases. Thus, this parameter was significantly higher in gastroesophageal reflux disease comparing with chronic gastroduodenitis (90 [80; 90] % against 40 [40; 40] % accordingly, р<0.01) and comparing with duodenal ulcer disease (90 [80; 90] % against 60 [60; 70] % accordingly, р<0.01); analogously in separate anamnestic groups with an exception of the duration below 1 year, where TER was reliably higher in duodenal ulcer disease comparing with chronic gastroduodenitis (60 [60; 60] % against 40 [40; 40] % accordingly, р=0.02). Apart of this, statistic tendency was revealed for differences of TER between general parameters by duration below 1 year against the term of 1-3 years (р=0.15), below 1 year against the term of more than 3 years (р=0.11).

Conclusion. Clinical peculiarities of caries in children with acid-dependent diseases of upper gastrointestinal tract (gastroesophageal reflux disease, chronic gastroduodenitis, duodenal ulcer disease) accompanied by gastroesophageal reflux are characterized by most severe changes in case of gastroesophageal reflux disease, moderate – in chronic gastroduodenitis, relatively mild – in duodenal ulcer disease. Further perspectives of research in this direction are connected with evaluation of general systemic factors of dental caries development in children with gastric acid-dependent diseases.