Optimization of pathogenetic therapy of caries of teeth in children sufficiating first type of diabeted diabetes, taking into account the methodological principles of personalized medicine
Aim. To substantiate the expediency of applying a personalized approach in carrying out caries prophylactic measures and pathogenetic therapy in children suffering from type I diabetes, taking into account the state of calcium-phosphorus metabolism and the experience of endocrinopathy. Materials and methods. A dental, laboratory and diagnostic examination of 87 children suffering from type I diabetes, aged 7 to 12 years, with the experience of the disease from three months to ten years. The obtained data are compared with the results of a survey of 34 children of I, II health groups in this age group. Evaluation of the dental status is carried out using index indices (hygiene index, KPU, OHI-S). In the study of the resistance and acid resistance of tooth enamel, a TER-test and electrometry of hard tissues were used with the aid of the Dent Est apparatus. Laboratory salivoscopy included the study of calcium (total, ionized), phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, 25-OH vitamin D3, lactoferrin. Microcrystallization and mineralizing potential of the oral fluid was determined by P.A.Leus (1977). In the quantitative determination of cariogenic bacteria Streptococcus mutans, Lactobacillus in the oral fluid, ready-made diagnostic kits Dentocult SM Strip mutans and Dentocult LB were used. Results. Taking into account calcium-phosphorus metabolism and calcium-regulating hormones, microcrystallization and mineralizing potential of saliva, the level of nonspecific resistance, as well as the degree of bacterial dissemination of cariogenic microflora of the oral fluid in children at various stages of development of type I diabetes, a comprehensive program has been developed including caries prophylactic measures and pathogenetic therapy based on the individualized needs of the child for vitamin-mineral compounds, depending on the length of time illnesses. Conclusion. The introduction of a personalized integrated program (fluorine-containing and reminer-releasing agents, vitamin-mineral complex, artificial saliva solution with antibacterial enzymes) reduces the risk of caries, inhibits the development of existing carious lesions, helps restore the saturation of oral fluid with macro-, microelements, reduces enamel permeability capacity, increases the resistance of the surface enamel layer to cariogenic factors.