ВОЗРАСТНАЯ ДИНАМИКА СТОМАТОЛОГИЧЕСКИХ И ЛАБОРАТОРНЫХ ПОКАЗАТЕЛЕЙ ЗДОРОВЬЯ У ДЕТЕЙ 5-6, 12, 15 ЛЕТ ГОРОДА ЕКАТЕРИНБУРГА
Аннотация и ключевые слова
Аннотация (русский):
Предмет. Состояние здоровья детей и подростков является одной из наиболее острых медицинских и социальных проблем. Известно, что при стоматологических заболеваниях изменения происходят не только в иммунологическом профиле ротовой жидкости, но и в морфологии тканей полости рта. Новые подходы к традиционному цитологическому исследованию буккального эпителия, анализ цитограммы с выделением различных типов клеток, а также выявление цитологических аномалий клеток позволяют оценить реактивность слизистой оболочки полости рта при патологических процессах. В соответствии с рекомендациями ВОЗ (2013 г.) группы детей в возрасте 5–6, 12 и 15 лет являются глобальными индикаторными возрастными группами для мониторинга тенденций заболеваний и сравнений в международном масштабе. Целью исследования — оценка состояния здоровья детей 5-6, 12 и 15 лет неинвазивными методами, на основании клинического и лабораторного обследования 179 детей, посещающих организованные детские группы. Методология. Дети прошли комплексное стоматологическое обследование, которое включало заполнение анкеты по методу ВОЗ, внешнее обследование челюстно-лицевой области и полости рта, выявление патологии твердых тканей зубов. Мы изучили изменение стоматологического статуса пациентов, показателей ротовой жидкости и базального эпителия с возрастом, чтобы прогностически использовать неинвазивные методы оценки при комплексном обследовании состояния здоровья, планировании и оценке эффективности профилактических программ. Результаты. Состояние здоровья зубов у детей 5-6, 12 и 15 лет можно оценить как удовлетворительное, в то же время стоматологические, лабораторные и цитологические показатели здоровья ухудшаются с возрастом. Выводы. Неинвазивные методы оценки стоматологического статуса пациентов могут быть использованы при комплексном обследовании здоровья детей, планировании и оценке эффективности профилактических программ.

Ключевые слова:
стоматологический статус, ротовая жидкость, щечный эпителий, обследование детей, неинвазивная диагностика, индекс КПУ, заболевания пародонта, стоматология детского возраста
Текст

Introduction

The health status of children and adolescents is one of the most acute medical and social problems [11, 13, 19]. WHO estimates that children and adolescents are among the most vulnerable groups, accounting for about 40 % of the total burden of disease [12, 14, 21, 25]. In Russia, a serious concern is caused by the deterioration of schoolchildren's health indicators and the new threats to which it is exposed to the transition to adulthood, due to rapidly changing socio-economic conditions [3, 4].

Dental diseases occupy the third place (20–25 % in terms of accessibility) among the total morbidity of the population of the Russian Federation and are the cause of deterioration of health in general, and also reduce the quality of life of the population. According to the WHO, the prevalence of pathology of hard tissues of teeth and oral mucosa currently reaches 95–97 % [20].

It is known that with dental diseases changes in general health occur changes in the immunological profile of the oral fluid and morphological changes in the tissues [5, 7]. New approaches to the traditional cytological study of buccal epithelium have been developed [2, 6, 9]. Analysis of the cytogram with the isolation of various types of cells (superficial, intermediate, parabasal), as well as the detection of cytological abnormalities of cells (micronuclei, pycnosis, etc.) allows us to evaluate the reactivity of the oral mucosa in pathological processes [22, 23]. According to WHO recommendations (2013), groups of children 5-6, 12, 15 years of age are the global indicator age groups for monitoring disease trends and comparisons on an international scale [10, 28].

The objective of the study is to conduct an age-specific analysis of the characteristics of the health status of children aged 5-6, 12, 15 by non-invasive methods. To study changes in the indicators of oral fluid, basal epithelium and dental status of patients with age.

Material and methods

The study is based on the results of a clinical and laboratory examination of 179 children 5-6, 12, 15 years old attending organized children's groups. All children were somatically healthy; parents signed informed voluntary consent to conduct the study.

Children underwent a comprehensive dental examination, which included a questionnaire according to the WHO method, an external examination of the maxillofacial region, an examination of the oral cavity, identification of pathology of hard tooth tissues, malocclusion. According to the survey, the “Map for assessing the dental status of children (2013)” was filled out [28].

The following indices and tests were performed: dental caries intensity indices — DMP, oral hygiene — OHI-S, assessment of the condition of periodontal tissues — PMA [15, 24, 27].

All examined patients underwent laboratory research, which included a physicochemical analysis of oral fluid and a cytological analysis of buccal epithelium.

Spontaneous oral fluid was obtained 2 hours after eating and rinsing the mouth with boiled water in SalivaCapsSet, IBL International GMBH tubes. Using the Multistix10 diagnostic strips and a Clinitek 500 reflective photometer, specific gravity, pH, protein, glucose and nitrite content, and the presence of leukocytes and erythrocytes were determined [1, 17, 26].

The buccal epithelium for cytological examination was collected from the inner surface of the cheek using a cytobrush and transferred to a glass slide, evenly distributing the biomaterial [8, 22]. The preparations were fixed with the dye-fixative eosin-methylene blue Leishman for 2 minutes, followed by staining with a solution of azure-eosin according to Romanovsky for 20 minutes. When counting 1000 cells of the superficial and intermediate layers, cytological abnormalities were evaluated: cells with micronuclei and two nuclei, various degenerative-dystrophic changes in the nucleus and cytoplasm (chromatin condensation, karyorexis, karyopyknosis, karyolysis and apoptotic bodies) [23].

The obtained results of all studies were processed statistically using Exel Microsoft Office 2016. The results of the study are presented as mean ± standard deviation. Student's t-test was used to determine the significance of differences; differences were considered significant at p <0.05.

Results and discussion

Questioning results. According to their own estimates, children and their parents more often noted the condition of their teeth and gums as good (40.6 %). 20 % of children during the period of a mixed dentition noted difficulty in biting off (5-6 years) and difficulty in chewing (12 years), at 15 teenagers are often was  not satisfied with the appearance of their teeth (31 %).

Most (26 %) visit the dentist 2 times a year for the purpose of examination or treatment. Parents of 5-6-year-old children often brush their child's teeth once a day (50 %) [16], children often eat fresh fruits, cakes and cookies, sweets, drink lemonade, soda, tea with sugar. Children from the age of 12 are more likely to drink coffee with sugar (5 years — 0 %, 12 years — 56 %, 15 years — 65 %). Two of the 15-year-olds admitted smoking cigarets. Parents have a high level of education.

According to the results of the dental examination, the average value of the DMP index was 3.5 ± 0.9, which is defined as the average level of intensity of dental caries. An increase is noted with age: 5-6 year-old DMP index = 3.5 (the larger component in deciduous teeth), in 12-year-old children the DMP was 3.1 ± 2.9, in adolescents of 15 years old DMP — 3.9 ± 2.8.

Determined in accordance with the WHO criteria, the Green—Vermillon OHI-S oral hygiene index was: 5-6 years — 0.75 ± 0.69, 12 years — 1.25 ± 0.77, 15 years — 0.63 ± 0.57.

Table 1

Physico-chemical properties of oral fluid in children

Таблица 1. Физико-химические свойства ротовой жидкости у детей

 

5-6 years (n=62)

12 years (n=58)

15 years (n=59)

P1-2

P2-3

P1-3

Specific gravity

1005±3,37

1010±5,12

1003±3,9

0,000314

0,006

0,0025

pH

7,3±0,71

7,1±0,65

6,9±0,54

0,030

0,017

0,005

Protein

g/l

2,3±4,9

3,1±4,4

4,8±6,5

0,061

0,034

0,014

White blood cells

cells/μl

1,03±2,8

0,46±0,95

0,79±0,97

0,035

0,030

0,068

Red blood cells

cells/μl

0,76±1,03

1,25±1,1

1,375±0,76

0,017

0,070

0,002

Nitrite

0,76±0,65

1,0±0,57

0,75±0,44

0,013

0,007

0,090

 

When analyzing the physicochemical properties of the oral fluid of children, we noted a decrease in pH with age:  5-6 years was 7.3 ± 0.71, 12 years of age — 7.1 ± 0.65, and at 15 years of age — 6.9 ± 0.54. There is a variation in protein level: at 5-6 years on average, 2.3 ± 4.9 g/ l, 12 years 3.1 ± 4.4 g/l, at 15 years 4.8 ± 6.5 g/l. Red blood cells and white blood cells in a small amount were found in isolated cases, but in general their number in the oral fluid increased with age.

Table 2

Cytological characteristic of buccal epithelium in children of different ages

Таблица 2. Цитологическая характеристика буккального эпителия у детей разного возраста

Cytogenetic indicator

5-6 years (n=62)

12 years (n=58)

15 years (n=59)

P1-2

P2-3

P1-3

Cells with micronuclei

0,01 ±0,05

0,06 ±0,12

0,07 ±0,23

0,015

0,04

0,019

Protrusion

0,41 ±0,29

0,73 ±0,52

0,12 ±0,25

0,02

0,0001

0,0003

Binuclear cells

0,17 ±0,13

0,8 ±0,19

0,83 ±0,57

0,0002

0,0015

0,006

Cells with perinuclear vacuoles

0,48 ±0,5

0,53 ±0,63

0,54 ±0,58

0,0080

0,0098

0,0075

Cells with chromatin condensation

0,10 ±0,19

0,06 ±0,09

0,37 ±0,55

0,040

0,01

0,02

Cells with vacuolization of the nucleus

2,5 ±1,49

0,27 ±0,33

2,9 ±3,2

0,008

0,0057

0,0060

Karyopycnosis

1,18 ±0,65

1,29 ±0,72

1,19 ±1,09

0,0062

0,0074

0,0096

Karyorexis

0,31 ±0,27

0,21 ±0,26

0,09 ±0,17

0,020

0,012

0,001

Karyolysis

0,35 ±0,31

0,23 ±0,24

1,03 ±1,12

0,015

0,002

0,008

Cells with apoptotic bodies

Not identified

 

In children, buccal epithelial cells with micronuclei were found in single cases. At the same time, there was a tendency to increase them, which, possibly, reflects the residence of children in environmentally unfavorable conditions.

When assessing proliferation indicators, a progressive increase in the number of binuclear cells of buccal epithelium with age is noted. Of the indicators of nuclear destruction, a stable value of cells with a transuclear vacuole Me = 0.4 is noted. Condensed chromatin — Me = 0, which indicates the absence of destructive changes in the membrane of the nucleus and the preservation of its barrier and transport functions in most of the studied children. The form of apoptosis of buccal epithelial cells is karyopicnosis. The median of this indicator was at the level of 1 in 5 years and 12 years, with an increase to 1.15 in 15 years, which indicates a change in the mechanisms of the natural process of destruction of buccal epithelial cells

Conclusion

Questionnaire results indicate the presence of risk factors for the development of dental diseases in children in all age groups.

The dental health status of children 5-6, 12, 15 years can be noted as satisfactory, while dental, physico-chemical and cytological health indicators worsen with age. The presence of risk factors for the development of dental diseases and the marked deterioration in the dental health of children indicate the need for a search for preventive measures and the introduction of a comprehensive school prevention program.

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