Karnaukh E. V.

General systemic factors of dental caries development in children with gastric acid-dependent diseases

Kharkiv National Medical University

Background. A certain relation between diseases of gastrointestinal tract and pathologic processes in oral cavity is known today. But concrete general systemic factors of dental caries development in children with gastric acid-dependent diseases underlying this relation remain to be not clear enough.

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. Additionally to basic standard examination, investigations of helicobacter infection, acidity in esophagus and stomach were performed, evaluation of dental status by indices: DMFS (decayed, missed, filled), OHI-S (oral hygiene simplified index), PMA (papillary-marginal-alveolar index). Control group included 24 almost healthy children. Non-parametric statistical analysis has been performed, critical p-level was 0.05.

Results and discussion.

In confirmation of the role of relatively prevalent helicobacter infection in the development of caries permanent teeth in children with acid-dependent pathology it was revealed that the frequency of persons infected with H. pylori has been growing among patients with gastroesophageal reflux disease (52.9 %, j=2.0; р<0.05), with chronic gastroduodenitis (69.6 %, j=4.3; р<0.01), especially – with duodenal ulcer disease (86.7 %, j=4.5; р<0.01).

However, an interesting result was related to the role of the factor of H. pylori infection in the development of patients dental status. Thus, the rise of intensity of caries was detected by DMFS index in children infected with Helicobacter pylori: in gastroesophageal reflux disease – up to 7 [6; 7] standard units, in duodenal ulcer disease – up to 4.5 [4.0; 5.0] standard units, in chronic gastroduodenitis – up to 1 [1; 2] standard units, all parameters exceeded control values (р<0.05).

In general, the DMFS index was higher in infected with H. pylori (2 [1; 3] standard units against 1 [0; 2] standard units, p<0.05). Among children infected with Helicobacter pylori the statistically significant difference was revealed, comparing with gastroesophageal reflux disease, in chronic gastroduodenitis, 1 [1; 2] standard units against 7 [6; 7] standard units (p<0.05) and in duodenal ulcer disease, 4 [3; 4] standard units against 7 [6; 7] standard units (p<0.05). Similarly, significant difference has been detected between DMFS medians in chronic gastroduodenitis and duodenal ulcer disease (1 [1; 2] standard units against 4 [3; 4] standard units accordingly, p<0.05).

The value of oral hygiene index OHI-S with taking into account the nosological criterion and infection with H. pylori demonstrated similar patterns: in gastroesophageal reflux disease – up to 3.3 [2.7; 3.6] standard units, in duodenal ulcer disease – up to 2.2 [1.7; 2.7] standard units, in chronic gastroduodenitis – up to 0.7 [0.7; 0.8] standard units, all parameters exceed controls (р<0.05). The tendency to higher value of OHI-S index was revealed in duodenal ulcer disease comparing with gastroesophageal reflux disease without H. pylori infection (р=0.09).

Evaluation of the degree of gums inflammation by PMA index with taking into account the nosology and helicobacter infection was characterized by the following peculiarities: there has been a growth of the parameter in gastroesophageal reflux disease – up to 29.0 [25.5; 35.5] %, in duodenal ulcer disease – up to 20.5 [20.0; 21.0] %, in chronic gastroduodenitis – up to 5 [4; 9] %, all parameters exceeded control values (р<0.05).

The estimation of enamel resistance by the standard test of enamel resistance had certain peculiarities in separate nosological groups with taking into account of H. pylori infection, growing up to 90 [80; 90] %, in duodenal ulcer disease – up to 40 [40; 60] %, in chronic gastroduodenitis – decreasing to 5 [4; 9] %.

The statistical difference was significant between control and gastroesophageal reflux disease (10 [10; 15] % against 90 [80; 90] % accordingly, p<0.05), control and chronic gastroduodenitis (10 [10; 15] % against 40 [40; 40] % accordingly, p<0.05), control and duodenal ulcer disease (10 [10; 15] % against 60 [60; 70] % accordingly, p<0.05). Especially big differences were detected in children with Helicobacter infection between control and gastroesophageal reflux disease (10 [10; 15] % against 90 [80; 90] % accordingly, p<0.05), control and chronic gastroduodenitis (10 [10; 15] % against 7 [5; 9] % accordingly, p<0.05), control and duodenal ulcer disease (10 [10; 15] % against 40 [40; 40] % accordingly, p<0.05).

The esophageal acidity was evaluated in children. In patients with gastroenterological pathology the acidity of esophageal contents was 2.6 [2.0; 2.8] and varied from 1.2 to 5.2, having certain differences depending on nosology.

The stomach acidity was also estimated in children (3,1 [1,3; 3,7]).

Conclusion. General systemic factors of dental caries development in children with gastric acid-dependent diseases (gastroesophageal reflux disease, chronic gastroduodenitis, duodenal ulcer disease) are characterized by significant role of helicobacter infection and acidity in stomach and esophagus in the development of this gastroenterological pathology. Further perspectives of research in this direction is logico-statistical basis of prognostic algorhythm for dental caries risk evaluation in children with gastric acid-dependent diseases and results of its clinical introduction.