Pressurizing of fissure of teeth. Shows, method, classification of encapsulants. Concept about the complex system of prophylaxis.
Pressurizing of teeth
To some surfaces of tooth access of tooth brush is labored through the features of anatomic structure. It above all things touches masticatory teeth.
On their masticatory surface between humps furrows are located – fissures. They can be narrow enough and deep.
Deep fissures create to the bacteria of cavity of mouth good terms in order to gain a foothold. Bacteria, getting sugar containing products instantly propagates oneself and form the dental deposit. Tooth brush not in the state to brush such deep fissures clean, so as the diameter of bristle of brush is far greater furrow and at cleaning to its bottom to reach it is practically impossible. In many cases the bottom of fissures almost achieves a border enamel-dentine which predetermines distribution of pathological process at caries in a dentine. At some types of deep fissure, during cleaning of teeth, the hairsprings of tooth brush do not achieve their bottom, which results in the accumulation on this area of microorganisms, tailings of meal and products of cellular disintegration. Besides, the origin and development of caries of fissure goes down due to a fluorine prophylaxis only partly, as connections of fluorine at local application it is not enough diffuse through the layer of dental raid.
The permanent insufficient cleaning of deposit results in his accumulation to formation of caries. For to this prevention and conduct procedure of pressurizing of fissure.
PRESSURIZING OF FISSURES
The mechanism of the method of pressurizing consists in the isolation of fissures in the period of ripening of enamel by creation of physical barrier, which hinders to the hit in the retention areas of enamel of microorganisms of cavity of mouth and products of their vital functions, able to cause demineralization.
Most often by caries the masticatory group of teeth of, is struck which is explained:
– by weak mіneralіzation of fissure during the first 2 years after eruption
– by the labored hygiene in the area of fissure
– a tooth in the stage of eruption will not treat mastication in an act, so however has an antagonist or is not with him in the contact, that is why does not pass the sufficient natural cleaning of his occlusal surface.
For achieving most effect it will be recommended to conduct pressurizing right after eruption of tooth or during a year after eruption. It is considered in future, that an enamel mіneralіzed enough and not must seal up fissures to sense.
Terms of implementation of pressurizing
For first permanent molars – 6-7 years
For premolas – 10-11 years
For second permanent molars – 12-13 years.
For determination of testimonies to pressurizing and at the choice of method it is necessary carefully to explore an occlusal surface with the purpose of determination of form, depth, size of fissure, presence of the demineralization of enamel, pigmentation and caries.
Four types of structure of fissures
1. watering-can similar
2. cone similar
3. drop similar
4. polypoid
Watering-can similar are more opened, well mineralized, in it’s tailings of meal do not stay too long due to the free washing by a mouth liquid, are caries resistance.
Cone-shaped – is mainly mineralized due to a mouth liquid, but is had terms for the delay of food tailings and microorganisms.
Drop similar and Polypoid is their mіneralіzation passes mainly from the side of pulp. This process goes less intensively, by what mіneralіzation due to a mouth liquid and fissure long time remains hypomіneralіzed.
In clinical practice the followings methods of inspection of masticatory surface are used as a rule:
– visual – with the previous deleting of raid from an occlusal surface and drying
– instrumental – by a dull probe, so as the sharp can injure the superficial layer of enamel.
Tactic of pressurizing on the stage of ripening of enamel is based on information about the initial level of pressurizing (ILP)
– high ILP is the enamel of fissure is dense, brilliant, probe of slides for its surfaces. Such fissures are caries resistance during great while;
– middle ILP – single fissures has a chalk similar color, the delay of probe is sometimes marked in most deep fissure. Prevalence of caries in such fissures to the end of period of ripening is 80%;
– low ILP is an enamel is to brilliance, color of all fissures chalk similar, there is possibility of drawing out by the probe of the softened enamel, prevalence of caries in such teeth is 100% to the year after eruption.
In 1923 Hyatt presented conception of prophylactic odontotomy. Since different stopping materials were imposed straight in
The first generation of encapsulants was polymerized under the action of ultraviolet irradiation with a wave-length 356 nm. They were classified as ADA is “temporally accepted” in 1972 and “accepted” in 1976 Application of first generation of encapsulants was it is not enough effective through combination of many factors. For example, Alphaseal (Co Dental Amalgamated., London) considerably took in ultraviolet light which hindered to his complete polymerization on a depth. “Lite (Caulk/Dentsply) Nuva” had considerable dependence on power of light stream of lamp. Power of ultraviolet lamps not always was identical, and area a pinch light was little. Failures were also stipulated by the it is not enough exhaust method of their application and un understanding of that, what decision unfavorable factor the hit of saliva is on an enamel after the acidization. The insufficient washing and drying of enamel were the most vulgar errors in clinical practice.
The second generation of encapsulants was based on chemical consolidation (self solidifiable). The widest and System (3M of Product Dental, the USA) Sealant White Concise and Delton was successfully used (Johnson of and of Products Dental Johnson, Co, USA). Majority from them is a transparent, painted or opaque encapsulant un gap-filling. Opaque was achieved by plugging in their composition of white pigment or paint.
The encapsulants of the third generation were polymerized under the action of visible light with a wave-length 430—490 nm. Because of comfort of work and the best physico-mechanical properties exactly this group of materials is used presently the widest.
Materials for pressurizing
1. Encapsulants (sealants)
2. Glass ionomer cements (Ketak – molyar, Fugis)
3. Compomers (Seal Dyract)
Glass ionomer cements own the cariostatic action due to the selection to the fluorine, is chemically fixed on-the-spot tooth, is not required etching of enamel before procedure, however they it is not enough strong and is quickly worn away. For pressurizing it is possible to use glass ionomer cements of the second type (intended for stopping of teeth) for the loaded restorations. Some researches lead to that application of glass ionomer materials as encapsulant of fissure it can be expedient in teeth which are just cut through, at extraordinarily low mіneralіzation of fissures. Weight in such cases is related to the necessity of more protracted etching of enamel with subsequent application of composite encapsulants. Glass ionomer cements are used and in those cases when a complete isolation is impossible from saliva, at incomplete eruption of teeth, on teeth with the imperfect structure of hard fabrics, at the children of invalids. Due to possible adhesion of GIC in the conditions of moist environment, during work with them previous etching is not conducted enamels by acid.
Compomers — light cured composition materials which through the composition own some properties of glass ionomer cements, namely is something greater, than at compos, hydrophilicity and ability in a negligible quantity to select a fluorine at the contact with a mouth liquid. Compomer material of Seal Dyrect is an encapsulant (Dentsply). He is used with the indelible conditioner of NRC (Non-Rise Conditioner) and adhesion system of fifth generation of Prime&Bond NT, which provides more deep sealing up by a fissure polymer. The conditioner of NRC simultaneously partly dissolves mineral components, on it is inflicted Prime&Bond NT is inflicted, which an encapsulant is fixed to. The developers of this system examine such technique as alternative the invasion pressurizing of fissure.
Composite encapsulants can be divided on the row of signs
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On chemical composition |
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On basis Bis GMA
Oralin (SS White Dental Products) Visio Seal (ESPE) Sealite (Kerr) Estiseal (Kulzer) |
On basis UDMA but other polymers Prisma-Shield (Dentsplay) Fluro Shield (Dentsplay) |
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On the mechanism of hardening |
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Self solidifiable
Contact-Seal (Vivadent) Prisma-Shield (Dentsplay) Evicrol-Fissur (Spofa) Delton (Jonson-Jonson) |
Solidifiable under the action of light with a wave-length 480 nm (photopolymer) Fissurit, Fissurit F (VOCO) Helio Seal, Helio Seal F (Vivadent) Visio Seal (ESPE) Esti Seal LC (Kulzer) Ultra Seal (ESPE) Pit and Fissure Sealant (Bisco) Dentalex (Stoma- Technology, Kharkov) |
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After the presence of filler |
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Un gap-filling (the table of contents of filler does not exceed 26-28%) Helio Seal (Vivadent) White light Oralin (SS White Dental Products) Delton (Jonson-Jonson, USA) Visio Seal (ESPE) |
Gap-filling (the table of contents of filler is 50%) Prisma Shield (50%) Esti Seal LC (32%) Sealite (40%) Fluro Shield (50%) |
In addition, encapsulants can be divided yet by two recommendations.
· transparent
· opaque
· painted
2. On maintenance of mineralizing components, in particular to the fluorine:
– those which contain mineralizing components
· those which do not contain mineralizing components.
Encapsulants on the basis of UDMA own something by greater fluidity, less viscidity, however simultaneously and higher contraction.
Gap-filling materials own greater firmness to the wear and eliminations however un gap-filling better worm into narrow fissures and fossulas.
Transparent encapsulants allow to judge about the changes which take place under them (for example, development of caries, appearance of pigmentation), that is why their application expediently at persons with the expressed cariogenic situation. Painted (more frequent in all chalk-white) encapsulants allow to the patient or his parents to control the maintainance of material on-the-spot tooth. The opaque encapsulants of color of tooth are most aesthetically beautiful, however heavy it is to control their maintainance because of confluence with the color of surrounding surface of tooth. Some encapsulants have coloring. So for example, glass ionomer cement of Fugis 7 is produced rose tint. Compos are given it is the best to use for defence of fissure in teeth which cut through, and also at the use in a direct closeness from gums, during pressurizing of bare necks of teeth.
Requirements to the encapsulants:
– must it is easily to fill fissures, cracks
– it is good to be fixed to the surface of tooth
– to be proof to elimination
– to select a fluorine for strengthening of enamel
– to have the comfortable system of introduction
For strengthening of prophylactic action in composition of encapsulants enter a fluorine. After raising encapsulant passes liberation from him fluoride of ions which are concentrated on scopes of enamel is an encapsulant and then get to the enamel with formation of little soluble fluorapatite.
Technique of pressurizing of fissure
Distinguish 3 methods of pressurizing.
1. Simple not invasion method of pressurizing.
Rotined in the case of absolute intact fissure.
2. Invasion method of pressurizing.
Can be using for pressurizing of deep, narrow and pigmented fissures at initial caries.
3. Pressurizing is extended.
If after polishing of fissure diagnoses the carious defeats, the rotined is extended pressurizing of fissure. Thus excavation of carious defeat is obligatory without the vast preparing of cavity in enamel.
Sequence of implementation of pressurizing of fissure
An encapsulant needs to be inflicted on the carefully cleared and dried up surface of tooth that is why before his causing it is necessary to conduct the followings manipulations:
– cleaning of teeth with paste which does not contain fluoride, as he reduces the effect of acid etching of enamel, which provides for method, that in the turn conduces the fall of encapsulant and development of caries to the increase of risk
– additional cleaning of masticatory surface of tooth by circulars brushes and rubber bowls by different abrasives pastes
If an about year passed after eruption of tooth, plenty of the dense fixed raid which does not retire by a circular brush accumulates in spacious fissures. For this purpose the dispersible diamond coniferous forest befits finely.
– isolation of tooth from saliva by wadding rollers and saliva ejectors or rubber dam careful drying of surface of tooth during 30 seconds.
Not invasion method of pressurizing
Stages of implementation:
after preparation of tooth conduct etching of enamel by 35-37% phosphorus acid during 15-20 seconds
washing off of acid from the surface of tooth by an air-blast (time of washing off must answer time of etching)
– repeated isolation from saliva
– drying of bitten-into surface by air (an enamel is bitten-into must be mat, chalk similar)
– causing of encapsulant must be conducted slowly and skim on all fissure – pit net of masticatory surface, eliminating formation of blisters of air here
– photo polymerization of material (in case of the use of encapsulant of the light hardening)
– verification of occlusion
– coverage of tooth by fluorine containing preparation
Invasion method of pressurizing
Those stages are conducted, that and at a not invasion method, but after preparation of tooth the stage of opening of fissure is conducted. The entrance in fissure within the limits of enamel broadens by the thin diamond coniferous forest of middle or shallow grittiness thus, that fissure was geared-up was accessible for a visual review and implementation of the next stages of pressurizing. From the classic preparing differs to careful attitudes toward hard fabrics of tooth, especially enamels.
The method of pressurizing is extended
This method can be conducted by two methods. If at opening of fissure appears the carious defeat which has a small diameter ( not more than 1/3 distances between humps) is used sealing up of fissure with lining.
The stages of this method are followings:
– preparing by the diamond drill
– careful removal of the staggered fabrics
– a cavity is filled by glass ionomer cement
– etching of fissure
– washing and drying
– causing of encapsulant is on glass ionomer and fissure
– verification of occlusion
– causing of fluorine varnish
If at opening of fissure appears, that a defect is in the area of occlusal contacts, the technique of the extended pressurizing will be following:
– preparing by the diamond drill
– careful removal of the staggered fabrics
– the bottom of cavity is filled by glass ionomer cement
– etching of walls
– washing and drying
– causing of composite
– polymerization of compoite
– causing of encapsulant on a composite and fissure
– verification of occlusion
– causing of fluorine varnish
Against shows to pressurizing
Absolute:
– presence of middle or deep caries
Relative:
– superficial caries
– absence of the expressed fossulas and fissure of masticatory surface
– intact fissures during a few years after eruption
– incomplete eruption of masticatory surface
Pressurized fissure
COMPLEX SYSTEM OF PROPHYLAXIS OF DENTAL DISEASES
The complex system of prophylaxis of dental diseases is the system of the prophylactic nosotropic grounded measures directed on making healthy of organism and organs of cavity of mouth by the increase of level of their resistance and decline of intensity of influencing of unfavorable factors.
It includes:
a) sanitary-elucidative work among the population;
b) studies of principles of rational feed;
c) studies of rules of hygiene of cavity of mouth;
d) endogenous use of preparations of fluorine;
e) application of facilities of local prophylaxis;
f) early exposure of dental diseases;
g) second prophylaxis (sanation of cavity of mouth).
Basic stages of its organization
1. Determination is the orders of children’ establishments, the prophylaxis of dental diseases will be inculcated in which. This question decides jointly by the district (city) departments of health protection and education. Thus the complex of local terms and necessity undertakes into account in prophylactic measures.
2. Conclusion of treaty between service of health protection and education, which foresees the mutual duties of sides. The leaders of education are under an obligation to provide necessary funds for the equipment
special cabinets, purchase facilities of the personal hygiene, visual aids, etc. The leaders of service of health protection select and prepare necessary shots. Head masters must take the trouble to provide the equipment of cabinets or corners of hygiene in accordance with the real possibilities.
3. Medical personnel training of higher and middle link for the implementation of inspections, sanitary-elucidative work and prophylactic measures. They are prepared from doctors and middle medical personnel of children’ dental policlinics.
4. Study and account of climatic geographical factors, features of feed, contents of water, way of life, habits. Thus there are possibilities of influencing of climate, level of sun insolation, wind and cold modes, features of biochemistry of soils, degree of hardness of water, maintenance in her to the fluorine, consumption of easily mastered carbonhydratess, mode of their reception, amount of natural vitamins in a meal, level of the use of milk and their products, balanced of feed on basic indexes, level of the use of row of micro elements, tea, his sorts and other factors which can influence on the level of dental morbidity.
5. Epidemiology inspection of children for the exposure of level of staggered by the basic dental diseases (indexes of CSR, PI, PMA, necessity in treatment). On the basis of information of inspection it is possible to calculate necessary forces for a prophylaxis and treatment, and also to distribute all children on clinical groups for differentiation of volume of medical and prophylactic work.
The epidemiology inspection includes three successive stages:
– setup time;
– own inspection;
– analysis of results
The preparatory stage includes:
– preparation of personnel;
– choice of groups of population;
– choice of districts of implementation
In accordance with recommendations WOHP examines key age-dependent groups (5-6 years, 12 years, 15 years, in 35-44, 65 years and more senior).
In every district it is necessary to examine for 50 persons of rural and urban population of one age-dependent group.
The indexes of dental status of everybody bring in the special card. After realization of inspection all results erect in a table, and information is got allow to judge about the presence of dental diseases and necessity in therapeutic, surgical, orthopedic and orthodontics treatment and prophylaxis of population of concrete region.
6. Rigging and preparation of apartments and conditioning for introduction of prophylactic measures. Essence of measure consists in acquisition of facilities and articles of prophylaxis, making of visual aids, preparation of rooms (corners) of hygiene of cavity of mouth.
7. Determination of character, volume and sequence of prophylactic measures in different clinical groups. This stage is built on the results of epidemiology inspection, study of climatic geographical features, feed, I will make water and other factors. In accordance with the features of epidemiology, clinic and pathogeny of dental diseases in this region and local terms it is needed to define character, volume and sequence of prophylactic measures. The programs will differ in different regions and concerne initial by the level of morbidity. In districts with high intensity of caries it is necessary to aspire to the decline of her to moderate, in districts with moderate — to low. In those districts, where intensity of caries is low, dentists must watch after its stability.
8. Implementation of sanitary-elucidative work with teachers, parents and medical workers of schools. The stage is giveecessarily must precede to introduction of prophylaxis, as the employees of children’ establishments are only sure of its necessity can become the reliable helpers of dentist in-process.
9. Conducting lessons and practical employments from the hygiene of cavity of mouth, control after the level of hygiene, measures on the improvement of feed. Conversations and appearances of doctors which satisfy the children of their necessity always must precede by practical employment.
10. Applications of preventives, which must be chosen in accordance with information epidemiologys and other inspections.
11. Repeated epidemiology inspection and determination of efficiency of the conducted measures. It — is the finishing stage which is usually conducted each 5 years after the practical beginning of prophylaxis.
Efficiency of conducted prophylactic measures is determined by comparing to information of initial epidemiology inspection. The level of intensity of caries is the basic criterion of efficiency of prophylaxis of caries of teeth at children by age 12 years, and efficiency of prophylaxis of diseases of paradontium is estimated after CPITN at teenagers 15 years.
A doctor-dentist examines every child by age 1 year and selects the groups of children with the enhanceable risk of origin of teeth decay for the clinical supervision.
In regions with the moderate and high level of intensity of caries of teeth among the population to the children of preschool age the use of local anticarious facilities is recommended: applique by fluorine containing varnish (2 times per a year), rinse of “Remodent” (3 times per a year).
During implementation of prophylactic work in children’ preschool establishments it is needed to spare attention to warning of development of harmful habits.
In basis of implementation of the program of prophylaxis of dental diseases among children complex approach lies at schools. The choice of the program caot be standardized for all schools, as he depends on skilled possibilities, presence of facilities, features of composition of water.
Correct combination of sanation and prophylactic work of doctor is important enough, which must serve one purpose — making healthy of children and decline of increase of morbidity.
By agreement with organizations of collective feed and parents there must be correction to the menu of school dining-room and home feed it is used measures on the fight against harmful by eating habits.
Planning and realization of measures of complex prophylaxis possible at three levels, that conforms to recommendations of Worldwide organization of health protection (1980).
Primary level
Purpose: warning of diseases.
Methods: state, medical, hygienical, educating, personal on providing of physiology processes of ripening, warning and removing a cariogenic situation in the cavity of mouth.
Efficiency: decline of level and frequency of dental diseases.
Places of implementation: nurseries schools, schools, other educational establishments and children’ collectives are organized.
Basic performers: the leaders of educational establishments, educators, teachers, medical workers, parents, organizers, are the health protection – under guidance and consultation of dentists.
The task of increase to resistance of organism of child and fabrics of cavity of mouth decides at the level of primary prophylaxis.
Second level
Purpose: warning of complications of caries and other dental diseases.
Methods: sanation (making healthy) of cavity of mouth, using surgical, orthodontics, orthopedic methods of treatment therapeutic.
Efficiency: decline of level of complications of dental diseases.
Place of implementation: dental medical – prophylactic establishments.
Basic performers: the organizers of health protection, doctors and dentists. The task of making healthy of cavity of mouth decides at the level of the second prophylaxis (sanation).
Tertiary level
Purpose: the rehabilitation is functional, cosmetic, social.
Methods: state, social, medical, special, methods therapeutic, surgical, orthopedic, orthodontics treatment.
Efficiency: returning of cosmetic and second possibilities of organism of man functional.
Place of implementation: dental medical – prophylactic establishments.
Basic performers: the organizers of health protection, doctors and dentists.
The task of proceeding in the lost functions of organs of cavity of mouth decides at tertiary level (rehabilitation).
In the complex system of prophylaxis at primary level medical and hygienical measures take important seat.
Prevention of periodontal diseases in children
1. The need for the prevention of periodontal disease
Dental health is directly related to the level of prevention of diseases of the oral cavity. Dentists distinguish seven main features of the patients teeth, namely dental caries, plaque, gingivitis, tartar, tooth stains tooth bare roots breath. The culture of oral hygiene should always raise. Much depends on each of us. Do not forget that disease prevention is much cheaper and bezboleznenney , the more treatment. In this regard, it is worth remembering that after each brushing, and also after the adoption of food must use for rinsing the mouth. For your teeth and gums ideal for medical-profylaktychechkoe means Dentix ®. Dentix ® effectively prevents and cures: gingivitis, periodontitis, stomatitis, candidiasis and damage to the mucous membrane of the mouth. Dentix ® improves local immunity and restores the normal flora of the mouth.
Prophylaxis (from the book of oral disease / ed . L. Lukin (N. Novgorod: Type of Nizhny Novgorod State Medical Academy, 2004 .)) – A set of public, social, hygiene and health Mayors aimed at preserving health and prevention of oral diseases and the body as a whole. The main goal of prevention is to eliminate the causes and conditions of the emergence and development of diseases, and increase resistance to the action of unfavorable environmental factors. There are three types of prevention: primary, secondary, tertiary.
2. Types of prevention
Primary prevention aims to maintain healthy periodontal tissues, prevent the action factors of natural and social environment, can cause pathological changes in the periodontium. Primary prevention involves the following steps: feeding management and nutrition, exercise masticatory system for normal formation of periodontal disease, according to testimony – Early ortodontycheskoe and orthopedic treatment, building motivation for oral care (including regular use for rinsing the mouth, for example Dentix ® ) , detection and elimination of risk factors associated with anomalies attachment bridles lips, tongue, fine eve, dental health.
Secondary prevention is aimed at early detection of periodontal disease, prevention of disease progression and development of complications. Activities conducted in secondary prevention: the exclusion of traumatic factors (tartar, overhanging fillings, orthodontic and orthopedic substandard design anomalies bite cavities), occupational health, supervised tooth brushing and the use of preventive rinsing, for example, Dentix ® . It Dentix ® effectively prevents and cures: gingivitis, stomatitis, periodontitis , oral candidiasis, damage to the mucous membrane of the mouth.
Tertiary prevention is aimed at preventing the transfer of periodontal disease in severe, exacerbations, functional recovery of masticatory apparatus. It includes a series of mayors in the therapeutic, surgical, orthopedic and physiotherapy.
Prevention of periodontal disease involves a program of dental education, training and hygienic habits of the population, a balanced diet (including the composition and structure of food).
Prevention of periodontal disease is aimed at addressing the causes and risk factors. The main focus should be directed to nutrition, the use of drugs fluoride removal malocclusion and abnormal occlusion, abnormalities of structure and location of some of the soft tissues and the oral cavity, the presence of diseases of the teeth, functional overload maxillofacial region, lack of oral hygiene.
Depending on the age of the prevention of periodontal disease consists of several measures.
3. Prevention of periodontal diseases in children
1. The first year of life. Ensure proper function:
– Sucking;
– Swallowing;
– Ensure proper zimknennya lips.
2. Age 4 years (at this age should be tremy and normal jaw relationship):
– Dental health (renewal of normal form of crowns of teeth sealing and restoration of normal occlusion);
– Eliminate bad habits (licking lips, biting nails, etc.);
– Proper eating (chewing thoroughly, not squeezed).
Q. Vozrast 6-7 years:
– Elimination of bad habits;
– Formation of swallowing function (follow the correct pronunciation of sounds and so on);
– The use of rigid food;
– Myohymnastyka ;
– Oral hygiene;
– Health promotion.
4. Age older than seven years:
– Prevention and early treatment of malocclusion;
– Okklyuzyohrafyya (regular definition of masticatory load);
– Elimination of anomalies bridles;
– Oral hygiene.
Primary prevention of periodontal disease in many ways similar to the prevention of dental caries. Much attention is paid to the normalization of the power with plenty of protein, ascorbic acid, vitamin E, and P, decrease in powdery, confectionery, hard-drinking food. It is important to follow the development of the functions of breathing and swallowing a child at the time of formation of milk bite. By eliminating defects bite that change the distribution of power loads on the teeth and alveolar bone, can prevent the development of various forms of gingivitis and periodontitis .
Pathological effects on periodontal attachment allows abnormal lip frenulum (at the top gingival papilla), especially when it is a massive and dense. If small preddverya mouth there flaking ash from the neck of the tooth. As a result of developing gingivitis and periodontitis . Therefore, prevention should be to eliminate the identified causes. What is recommended by plastic bridles, massage gums, special exercise, in 6-9 years may prompt correction of tissue preddverya mouth. For the prevention of periodontal disease in children should treat hormonal dysfunctions in conjunction with pediatricians, endocrinologists.
It is important to promptly and properly treated teeth, eliminating damage to the gums and removing the cell odontogenic infection and should be done ortodontycheskoe and orthopedic treatment. Of great importance for the prevention of periodontal disease is active chewing. Hard food and chew actively promote the correct formation and development zubochelyustnoy system. People who have early signs of periodontal disease requires a diet with restriction of the use of carbohydrates and fats. Measures should be complete proteins that play an important role in the prevention of atherosclerosis that affects the occurrence of periodontal disease.
A special place in the prevention of periodontal disease belongs to the rational oral care.
When you remove the plaque is removed the main reason leading to the occurrence of specified diseases.
Drug-prevention advice is to remove plaque, polishing fillings, individual study population oral health. It is recommended to fight plaque and prevent periodontal disease using 0.2%-s aqueous chlorhexidine (Corsodyl or ) for mouthwash, and 0.5-1% s’ solution peruksusnoy acid. Overall care complex matter training vessels maxillofacial region. It is achieved by using all kinds of massage (finger massage gums, massage alveolar processes, acupressure). Necessary outpatient observation.
4. Methods for the prevention of periodontal disease
The choice of a particular method of prevention depends on local conditions, sanitary culture of people of preventive programs.
Dental education in order to create motivation for oral care, as recommended by WHO, includes a variety of activities depending on the groups:
1. Pregnant women:
A) provide information on the possibility of periodontal disease;
B) to disseminate knowledge about the methods and means brushing your teeth;
C) inform on issues of rational, balanced diet.
2. Children under 5 years:
A) involve parents in the formation of children motivation for oral care (personal example and control the ability of children to brush their teeth);
B) recommend limiting consumption of refined carbohydrates children.
3. Children aged 6 to 10 years:
A) provide information about the importance and need for oral hygiene and proper diet nutrition management;
B) convince of the need for thorough brushing and the use of quality control of oral hygiene coloring solutions;
B) offer the most effective methods of performing oral hygiene;
D) inform parents of the existence of hidden “sugars “, contained in processed foods, so that children know that food, sweets safe in terms of periodontal disease and tooth;
E) give information about the first signs of periodontal disease, especially the manifestation of bleeding gums during brushing.
4. Children aged 11 to 16 years and older:
A) explain the importance of healthy teeth in social terms;
B) to disseminate knowledge about the relationship of oral health and the health of the appearance of the first signs of periodontal disease and tooth (breath, breach of taste);
C) the need to convince the rejection of bad habits: smoking, alcohol, drugs that have a negative impact on health.
5. Adults with periodontal disease:
A) explain the diagnosis, treatment purpose and need repeated visits to the dentist;
B) inform the possibility of exacerbation of the disease after treatment for non-compliance with the rules of oral hygiene;
C) to persuade older workers to transfer knowledge and skills to children, to inspire them, as it is important to regularly brush your teeth, which is especially important is a balanced diet;
D) change misconceptions about oral hygiene, treatment of teeth and periodontal disease.
Current approaches to diagnosis and treatment of periodontal require primarily differentiated, pathogenesis informed choice of methods and tools [42]. Given the high prevalence and the rising trend of chronic somatic diseases and periodontal diseases in children, increase the effects of other risk factors (especially addictions, environmental and social disadvantage), the urgent need is to change the tactics of prevention of disease periodontal tissues in children and adolescents.
The most meaningful and manageable indicator of the risk of periodontal disease in children is the risk of bacterial contamination of different loci of the oral cavity, especially dental plaque (dental plaque biofilma – dental plaque biofilm) and zubodesnevoho or periodontal pocket (periodontal biofilma – periodontal biofilm).
Monitor the status microecology different habitats of the oral cavity is a significant component of primary prevention methods, and the first phase of etiological treatment of periodontal disease. With those purposes in periodontology traditionally used antibacterial compounds and related products [44].
When creating a new formula toothpaste manufacturers are guided by a combination of different mechanisms of action and prolongation of preventive effect. For example, Colgate ® Total 12 contains a patented formula – Triklohard TM – complex triclosan (an antibacterial component) of the copolymer, which continues its action in the mouth up to 12 hours. Triklohard TM prevents the growth and reproduction of bacteria in the mouth, has anti-inflammatory effects on the tissues of the mouth. Antibacterial Triclosan is bacteriostatic and bactericidal effect and prolongs the action copolymer triclosan for a long time. The second mechanism of action of triclosan is in violation of arachidonic acid metabolism – after topical application of a decrease in production of proinflammatory mediators leukotriene B4 and PQE2. Thanks triclosan copolymer retained on the surface of the gums and teeth and prevents fixing bacteria and the formation of plaque, thus protecting the surface of the teeth and tissues of excess quire colonization within 12 hours. As the cleansing agents in toothpaste «Colgate ® Total 12″ used silica (hydrated silicon dioxide – SiO 2). The structure of Colgate ® Total 12 also includes fluoride. Use Colgate ® Total 12 children during adolescence, when an increase in the importance of risk factors for periodontal disease formation and increased morbidity, reduces the speed and rate of formation of dental plaque and the clinical manifestations of periodontal disease, as evidenced by positive dynamics in indexes and CPI OHIP-14 [45].
Thus, the results of modern research shows that chronic forms of periodontal tissue diseases – their origin, the activity of inflammatory processes, the nature of the associated microflora – largely determine the course of other chronic multifactorial diseases – cardiovascular, respiratory, diabetes, osteoporosis, etc. At the same time common pathogenetic mechanisms of formation and progression of chronic disease of multifactorial nature causing aggravating effect of somatic diseases and periodontal condition.
Particularly relevant issues and the most important tasks is the diagnosis, prevention and effective treatment dysbiotic disorders associated with chronic periodontal tissues, dissemination and generalization of infection and provoked its constant activity immunopathological processes. The significant role of the dentist is to choose an effective tactic prevention and control excessive growth of pathogenic and pathogenic organisms, which plays a significant role in causing inflammation in periodontal tissues.
Periodontal – a complex anatomical structures surrounding the tooth root. It includes gums, periodontal bone tissue in ¬ alveoli. On the recommendation of WHO (1991), periodontal disease include all of the pathological processes that occur in it. They can ¬ horror limited to only one component of periodontal involve some or all of its structure.
Anatomical and morphological characteristics of periodontal tissues
Clearly an important part of periodontal tissues. Form ¬ lyayutsya and interdental cells (alveolar) is clear. Interdental gum rozta ¬ shovani between adjacent teeth. They consist of huboschichnyh and muscles ¬ tions buds that generally form the interdental papilla. Collar ¬ ba part cover ash alveolar (alveolar) bone. Krajowa is part of the cellular gums adjacent to the neck of the tooth.
Clearly formed from epithelial and connective tissue base. Epi ¬ body of ash – multi-layered, consisting of basal and surface of ¬ (ribbed) series. With the epithelium keratinization it appears granular layer containing grains keratogialina. If the epithelium is not ZRO-hovivaye this cell layer is absent. Gums characteristic as the state pas rakeratozu in which surface epithelial cells thorny layer sploschuyutsya under the influence of mechanical stimuli and retain the nucleus.
In the intercellular substance is a glycosaminoglycan that serve a protective function in the event of exposure of bacteria and their toxins. The cytoplasm of cells of the basal epithelium and ribbed gum contains large amounts of RNA. These cells have a high mitotic active Stu ¬ and are the basis for regeneration. In the cells of the basal layer ob ¬ rihayetsya high activity of succinate dehydrogenase and ribbed layer – lactate.
For the histological structure of the gum epithelium is composed of three distinct areas: oral (mouth), gums lining the outside,
sulkulyarnoyi (grooved) and connective (¬ tion attached epithelial) cells which are connected through the organic matrix of enamel apatite crystals. The epithelium of the gingival sulcus continues in connecting. Grooved coupling epithelium and not zrohovivaye and unlike roto ¬ Volyn NGO can rapidly renew, and he characterized as increased permeability ¬ schena due to the proximity of blood vessels. Sulkulyarnyy gingival epithelium is localized in the cervical area of the tooth and lining the gingival sulcus. It is not so easy and zrohovivaye piddayet be ¬ microorganisms and their toxins, microbial enzymes.
Gum base is made up of loose connective tissue beneath the epi ¬ dents and more dense in the deep parts of the gum, it contains the foundations ¬ well (intercellular) substances, fibers, cellular elements, blood and lymph vessels, nerve tissue elements. Among fiber gum is collagen, elastic, reticular. The main ones are collagen having different direction: longitudinal, spiral etc.. Around the neck of the tooth collagen fibers form a circular (circular) connection.
The basis of the intercellular substance consists glycosaminoglycans and glycoproteins. The protective properties of the connective tissue system is hyaluronic acid – hyaluronidase. Cellular elements con ¬ meadow fabrics are fibroblasts fibrotsyty, histiocytes. Nearby step ¬ vonosnyh vessels located in a small amount labrotsyty, isolated lymphocytes, plasma cells, tissue basophils.
In gums are well developed microvasculature:
arterioles, capillaries, venules, arterioles, is venuljarnom anastomoses. In the area of gingival sulcus capillaries do not form loops, are situated ¬ vuyutsya closer to the surface epithelium than their predetermined elevated ¬ permeability.
This is where inflammation occurs first, unless sulcus epithelium and epithelial attachment District, ¬ ty lose function.
Gingival sulcus – a slit-like space, which are situated ¬ adopts between the surface of the tooth and surrounding gum. Gingival sulcus (groove) is lined by stratified squamous epithelium, its depth of 1-
In the gingival sulcus due to increased permeability of these vessels krovonos ¬ collects the fluid that is similar in composition to blood and contains electrolytes, enzymes and cells. And the gingival sulcus and gingival fluid barrier function for performing parodon ¬.
Children gums have certain features (TF Vinogradov, 1983):
1) thinner layer of keratinizing epithelial cells, 2) the more intense you-kulyaryzatsiyu gums, resulting in their bright red color, and 3) weak ¬ tion density of connective tissue, and 4) a less pronounced grain on the upper ¬ due to slight deepening of epithelial buds, 5) deeper gingival sulcus, 6) zakruhlenist gingival margin with evidence of edema and hyperemia during teething.
In the age aspect gums with characteristic changes. Thus, during the period of temporary occlusion of gum epithelium is thin, insufficient ¬ active involve differentiated epithelial papillae was buried, not zrohovivaye epithelium, basement membrane is thin. Children under
During alternating occlusion layer of epithelium ash stovschuyetsya, epi ¬ telialni nipples become clearer shape and depth becomes ¬ ing schoyu basement membrane, collagen fibers thicken. In tso mu ¬ age ripens gradually collagen, increases the number of round-cell elements – lymphocytes, histiocytes, reduced susceptibility to diffuse reactions.
During permanent occlusion gums in children are mature differentiated ¬ tsiyovanu structure. Periodontal composed of collagen fibers, cellular elements, nerve fibers, blood and lymphatic vessels. Formation of periodontal begins in vnutrishnoschelepnyy during tooth development and continued simultaneously with the development of the roots, interdental septum, formation of cement and tooth eruption. The forming periodontal under the age of 14 years (Figure 121).
Alveolar (alveolar) begins to develop in the appendix
early fetal development of the mesenchyme that lo ¬ hears the germ of the tooth. At the 5th misyasch alveolar bone fusion occurs with the body of the jaw. Its growth and structural change pov’ya ¬ zani closely with the development of the tooth. Cellular outgrowth as gums and periodontal children has its own characteristics: a flat crest, t ¬ ment latticed plate adjacent to the tooth root more space spongy substance, where is the bone marrow, reducing the degree of mineralization, increased lymph and circulation.
During temporary occlusion bone is in its formative stages, so its picture velykopetlystyy, malodyferen-tsiyovanyy. Periodontal gap all teeth in children and adolescents 2 times wider than in adults, cortical (cortical) plate is wider, but less clear.
During AC bite near the tooth that cuts through, tops interdental walls seemed completely cut the side of the tooth. If the tooth is finally erupt, tops interdental partitions become wide ¬ ing conventional circuits. Mineralization tops interdental talks ¬ rodok and compact plate ends simultaneously with the closing of the tops of the roots of the tooth that is in the frontal area of the jaw at the age of 8-9 years, in the side -14-15 years.
During permanent occlusion formed bone tissue wherein the sponge and compact plate ma ¬ tion clear contours. Bone tissue maxillary and frontal area of the mandible has dribnopetlyastu structure and dilyan ¬ ing side of mandible – velykopetlyastu.
To establish the diagnosis of periodontal diseases in children along with clinical data should be evaluated radiological features such as the size and shape of the interdental septum, state courts ¬ radical cell plate, the structure and degree of mineralization ¬ Covo collar bone. In children, there may be many variations of normal bu ¬ dovy these anatomical structures. It is conditioned by the individual characteristics of the skeleton structure of the child’s age, the various features of all groups of teeth, the options structure vestibule of the mouth, check ¬ tical others.
The tops of the walls between teeth deciduous teeth have different paths. T ^ k, the top wall between the central incisors September ¬ hnoyi scheleiiy be bifurcated. In other parts of the top front teeth interdental walls often have a rounded form ¬ m, at least – acute. During the change of teeth due to the growth of the jaw occurring gaps between teeth. Therefore, the top barriers sleep ¬ schuyutsya. In the area of large molar teeth interdental top walls is always flat. They are projected near the enamel-cement ¬ tual limits. Petlyastist spongy substance of deciduous teeth unclear.
The structure of the alveolar bone during the eruption of permanent teeth differs from its structure after the eruption. In teething, cut the tip of the interdental septum looks oblique line in the direction of the tooth. Periodontal crack at the neck and the crown of the tooth extended fuzzy picture spongy substance. During the eruption of the cut-off is reduced.
In teething, interdental septum does not have a clear picture of the spongy substance, but compact disc clearly Collect ¬ hayetsya. These data indicate that the interdental septum in a state of adjustment.
After some teething detected contours tops interdental septum and some picture spongy substance. Sep ¬ hivky interdental bulkheads front teeth are sharp or rounded shape with a clear compact plate. Many children and adolescents septum between the central incisors, in addition to these two forms, a forked tip of varying lengths (up to
In small and large permanent molar teeth interdental top flat walls, partitions are shaped like a trapezoid.
Figure spongy substance partitions between the teeth on the lower jaw in a different area of the front and side teeth. In the area of detailed fron ¬ teeth he often velykopetlyastyy, at least – dribnopet-lyastyy. In the case where the interdental septum too narrow, ¬ spongy substance and is designed as a compact plastic strips between ¬ morter. Sometimes the sponge is not detected, instead it is designed only compact disc.
In the area of small and large molar teeth in most cases the most pronounced curvature loops spongy substance in the direction from the top interdental septum to the apex of the root. Figure lips ¬ frequent substance partitions between the teeth in the upper jaw often small – or serednopetlyastyy vertical placement of bone ¬ ing perekladok (trabeculae).
The tops of the walls between the teeth of children in many base-
be at the level of enamel-cement border or below him in the presence trem.
Bone tissue of alveolar bone consists of CD ¬ tion and spongy substance. Compact substance is of plowed-poi and vestibular (vestibular) surface of the tooth root and consists of perekladok bone (trabecular). Between the plates is spongy substance formed bone perekladok grid. Bones ¬ hydrogen brain cavity filled with bone marrow. Compact re ¬ stances as well as sponge, thoroughly imbued with blood vessels and nerves ¬ we have a close relationship with all the constituent elements of periodontal mo ¬ rez periodontal collagen fibers.
The structure includes the basics of bone protein – collagen with many oxyproline fosfoserynu and citric acid. Glycoproteins containing bone hondroyitynsulfat, hyaluronic acid and Lot ¬ krsatynsulfat.
Cement covers the tooth root and consists of calcified ground substance in which the collagen fibers. Some of these crop con ¬ woven collagen fibers in the periodontal and breakthrough (Shar-Peis) fiber bone. There cement bezklitynpyy (primary) and cellular (secondary) – at the root apex. Rose ¬ leakage of cement predetermined growth and root resorption temporary ¬ ing teeth. During temporary occlusion cellular cement vyyavlyayet ¬ be in the region of the tops of the roots of deciduous teeth. Prior root resorption cell layer of cement zbilshuyetsya.U period variables in ¬ kusu during root resorption increases the number of cells that cement ¬. During permanent occlusion formed a significant part of the roots of teeth covered with cell-free cement, a third of the roots at the top is covered with secondary cellular cement.
All items have a close histologic periodontal ligaments, which provides a variety of its functions. The main functions are utrymuvalna periodontal and that distributes pressure trophic barrier ¬ at, touch, regenerative.
Periodontal tissues in childhood in a state of post ¬ iynoyi adjustment. This morphologically imperfect periodontium in children can quickly and adequately respond to various harmful factors that cause pathological changes in it.
According to the WHO, more than 80% of children suffer from gingivitis. Different symptoms of periodontal detected at the age of 9-10 years.
Etiology and pathogenesis
According to the etiology of periodontal disease factors divided into local and general. This distribution is conditional as etiological factors can ¬ may be closely related to each other and the body of the child.
Children pronounced interaction of causes and conditions of sale. Local or general factors have different effects on immature tissues ¬ nyny periodontal ie low strength stimuli are able to significantly influence the periodontium that the child is in the process of restructuring.
Local factors
According to WHO, one of the leading factors of disease steam ¬ donta in children is dental plaque and plaque.
Dental plaque is placed on the gums and below the gumline, often in the cervical region and fissures. Formation begins with her at ¬ unity of bacteria to the enamel of the skin (pelikuly) or to the surface of the enamel.
The nature of the influence of microbial dental plaque and tooth ¬ to fly to periodontal very versatile because their main component is nentamy ¬ endotoxins, enzymes, chemoattractant factors and different antigenic substance (Figure 5). Known that the lack of protection these factors ¬ Oral bacteria can penetrate through epithelial bar’sr and cause an inflammatory reaction of offensive ¬ his development of hypersensitivity. In the blood of patients with pathology steam donta antibodies to microorganisms of dental plaque.
Pathogenic microorganisms influence on periodontal tissue can be performed as a result of their active enzymatic activity ¬ ness. Microbial enzymes can increase capillary permeability, cause depolymerization of epithelial intercellular substance, bases ¬ tion substance of connective tissue, and degradation of collagen fibers. Some strains of microorganisms producing hyaluronidase, beta hlyukonidazu, collagenase (L. Khomenko, 1980).
Bacterial hyaluronidase due to splitting hialurono-acid contributes to the destruction of epithelial connective tissue fibro-
Figure 5. Ways to inflammatory destruction of the connective tissue of the gums and periodontal (by Becker, 1979)
blasts, a dramatic expansion of microvessels and increased permeability of their walls, increased migration of leukocytes and leukocyte infiltration. The presence of collagenase in inflammation significantly in ¬ tentsiyuye local effect of hyaluronidase.
In healthy gums collagenase is inactive but can be activated by bacterial plaque. In terms of inflammatory ¬ ing this enzyme is released in an active form, which creates no ¬ mediocre conditions for manifestation of its enzymatic activity. Collagenase, hydrolyzing collagen breaks down protein stroma gum and bone tissue of alveolar bone. Collagenase produced by Bacteroides melanmogenicus, is able to cleave not only denatu ¬ Rowan, but native collagen gums.
Microbes dental plaque has a negative impact on local immunological processes, thereby increasing the activity of these enzymes hidrolitych ¬, disruption of the structure and function of soft tissues steam ¬ donta. Established that dental plaque contains proteolytic enzymes ¬ you that degrades gelatin, hemoglobin and other proteins. Ammonia, amino ¬ us, hydrogen sulfide, some dezaminovani acid formed during the hydrolysis of tissue proteins by microbial enzymes can ¬ tently compared Affairs toxic to the tissue that surround them. Along with this pro ¬ teolitychni enzymes catalyze the formation of dental plaque in the intercellular spaces of high polypeptides – kinins which cause major clinical symptoms of gingivitis: increased pro ¬ nyknosti capillaries, development of edema, hyperemia and bleeding gums. However, the enzymes may contribute to hiarodonti not own him ¬ tyvyh tissue antigens.
The state of periodontal tissues affecting vital functions of microbes products – toxins. Many species of anaerobes zubnsch entities (fuzo bacteria, bacteroids, spiryly, actinomycetes) distinguish ¬ endotoksy us that there лілоїдополісахаридонуклеїновими systems. Last su ¬ Lodi autolitychnoyu action can cause a variety of vasomotor disorders disrupt cellular metabolism, cause sensitization autoalerhizatsiyi body.
The state of dental plaque and plaque have a significant impact environmental factors. These include imuiyubiolohichna system ¬ ma gingival sulcus fluid, hydrolytic enzymes secrets of the salivary glands and oral fluid, secretory immunoglobulins, bacteriophages, STAR lots carbohydrates. These biological factors are a complex interaction Modi ¬ microflora of the mouth and can weaken or elimi ¬ nuty and pathogenic potential. Important role in maintaining bio ¬ logical balance between bacterial symbiosis and tissues roto ¬ ing oral play as general factors that regulate the metabolism of the tissues of the oral cavity and which depend on the respective ¬ reaktssh to various pathogenic effects.
Endotoxin is able to penetrate through intact gingival edge and activate the complement system, which is sometimes accompanied by the release of lysosomal enzymes. The latter can poshkodzhu ¬ wool periodontal tissues. Endotoxin stimulates hypersecretion of histamine and heparin. Histamine is a vasoactive amine potential that increases the permeability of blood vessels (redness and swelling of the gums). Heparin enhances the resorptive effects of endotoxin on bone.
Antigenic components of bacteria leading to hipersensybili-tion of leukocytes, causing pathological changes in the alveolar bone and periodontal tissue alteration with the formation of tissue autoantigens. If you violate the functional state of T lymphocytes due to the toxic effects of autoantigens starts bezkont ¬ roll activation of the immune response to an antigen that is usually EID ¬ Nacha severity of clinical disease.
In response to the action of microorganisms and their metabolic products of excretion occurring migration of leukocytes to the oral cavity ¬ nyny and infiltration of these cells gum tissue that stymulyuyet ¬ be different chemoattractant substances. Between the severity of disease and the degree of migration of leukocytes, there is a direct relationship. The main seat of the white blood cells are gingival sulcus. The bulk of the leu ¬ Cocytus migrating constitute neutrophils. A side effect of leu ¬ Cocytus detected due to the release of their lysosomal enzymes ¬ ments that can cause destructive action (L. Khomenko, 1980). The microorganisms of dental plaque, plaque and mouth stimulates the secretion of enzymes leukocytes. In a period of significant change in the periodontal tissue leukocytes constitute 60-65% of the cellular elements of destruction. Role of leukocytes in periodontal tissue destruction versatile (Figure 6).
The state of periodontal tissues adversely affects nad’yasennyy tooth ¬ ing stone. It occurs in 1% of preschool children. This is explained by the fact that in this age of the saliva in inorganic bases ¬ tion presented soluble salts of hydrochloric acid, especially sodium chloride. During alternating occlusion is observed be ¬ increase nad’yasennoho tartar. Unlike vsch Doros ¬ relief in children and adolescents deposits of tartar is not very significant, they are milder texture and are located mainly on the gums in the cervical area of the teeth. The increase in dental plaque in children is associated with a decrease in pH, changes in mineral glass ¬ dy chemistry and saliva, as well as long-term irritation and damage to the vascular apparatus ¬ tion of periodontal tissues.
The action nad’yasennoho stone on periodontal tissues is quite diverse. With its dense texture and showing a tendency to permanent storage, it causes mechanical trauma ¬ th, shaking the gums. It should also take into account the chemical effect of dental plaque on periodontal tissue based on quantitative and qualitative ¬ nd the content of microelements, which are composed of plaque forming metal oxides. The most toxic of these is pentaksyd va ¬ hope oxides of lead, copper, iron, etc.. In preventing the formation of plaque on teeth are important regular hygiene oral cavity
Figure 6. The role of leukocytes in the gingival sulcus dystrophic and inflammatory processes in periodontal tissues
nyny and child nutrition. Overloading raschonu carbohydrate food and soft food residues promotes retention retention areas on the surface of the crowns of the teeth or carious cavity ¬ nynah.
On the origin and development of periodontal disease plays a significant role presence of pathological occlusion caused by abnormalities zuboschelep-noi system dysfunction chewing, which may be due to the caries process and its complications, and nepovnotsin ¬ tion of treatment. This results in uneven load denture chewing overload and incomplete charging of individual teeth. Thus periodontal tissues permanently injured for a long time, which gradually leads to the development of these lesions. ¬ Bokij deep bite causes a significant burden on the periodontium front teeth. At the age of 11 years in 34% of children with this disease manifestation bite ¬ lyayetsya gingivitis. In addition to chronic catarrhal and hipertrofi ¬ tion is very poorly gingivitis, these children often showing signs parodon-Titus. Similar changes in the gums, but more often (60% of children) arise ¬ tion if crowding of front teeth. Changes in periodontal open bite caused by incomplete charging functional pa ¬ rodonta. It develops catarrhal and hypertrophic gingivitis in the frontal area. If orthodontic treatment is not pro ¬ usual process in periodontal progresses. Palatine location of individual maxillary incisors promotes atrophic and GOST ¬ ruktyvnyh processes in the gums and alveolar bone of the mandible antagonists. There is a direct or reflected traumatic node and other types of pathology occlusion, and in case of premature loss of adjacent teeth.
In the development of periodontal diseases are important hipody ¬ Namie dentition, absence of active chewing and full load pa ¬ valuable maxillofacial area caused by bullets ¬ cooking food processing modern man. The physiological activity of tissue ¬ nin the mouth when consumed regularly treated ¬ chopped cooking food decreases. The number of children with untrained, we masticatory muscles due to their prolonged underemployment mo ¬ rez laziness chewing or eating in a hurry.
Occurrence and progression of the pathological process in the periodontium also contributes to difficulty iasal breathing (adenoids, polyps). Hang breathing prevents gum cleaning surfaces of teeth oral fluid ¬ tion. The accumulation of plaque inflammation in supporting periodontium.
The state also affects the depth of periodontal vestibule of the oral cavity for ¬, poor anatomical formation and attachment college ¬ dechok lips and tongue (Fig. 16 – see. Colored inset).
Prysshok oral cavity is considered shallow if the distance from the gingival margin to the horizontal composition of transition ¬ ing less than
General factors
Among the general factors involved in causing periodontal HVO ¬ paper, the important role played by endocrine disease, ¬ shennya time of hormonal function of the reproductive system, diseases of the digestive ca ¬ duct, vitamin deficiencies, nervous and physical disease and more.
Among the endocrine system to merit special attention ¬ vuye diabetes, which often occurs in children aged 3.6 112 years, ie the period of intensive growth. Mostly he observed ¬ hayetsya girls 11 years and boys 13. Diagnosis of diabetes sugar Volyn NGO in the initial period labile difficult because no ¬ sustainability of glucose in the blood, which may manifest as pper, normo-and hypoglycemia. Children diabetes is heavier course than Doros ¬ relief leads to profound disturbances of carbohydrate, fat, water and electrolyte metabolism, occurrence angiopathy. ¬ angiopathy you are as periodontal and retinopathy. Parodontopatiyi o ¬ terihayutsya in children with diabetes in 50-90%. Vascular changes in the periodontal occur earlier than in other organs. Sometimes gingivitis, periodontitis or generalized diagnosed before other clinical manifestations of diabetes. Because periodontal disease is an important diagnostic indicator.
The symptom of gingivitis in children, especially with temporary occlusion has to call in a doctor suspected diabetes, resulting in bu ¬ needs careful examination pediatrician. Research on blood glucose, tolerance to it, determine the curve of glucose by means ¬ my test load shall be held more than once.
Pathological changes in the gums diabetes are primary ¬ no-dystrophic due to specific diabetic micro-angiopathy, plazmorahiyi vessel walls to the development of multiple sclerosis and hyaline-Law. This is followed by sclerosis and hyalinosis connective gum tissue noninflammatory nature. Under these conditions, the progress second by ¬ inflammation very hard and quickly leads to tissue destruction pa ¬ rodonta. It should also be borne in mind that children with this disease is significantly reduced blood levels of ascorbic acid.
Decreased thyroid function (hypothyroidism) accompanied ¬ nated fairly aggressive gum disease with simultaneous delay ¬ Coy development and eruption of teeth, the emergence of multiple cavities. Similar processes occur in the periodontium as in the case of dysfunction of the parathyroid gland.
In addition to clinically significant inflammation of the gums, are significant degenerative changes in the alveolar bone in children with hypo-fizarnyy dwarfism, endemic goiter, pituitary-Cushing.
Children with epilepsy, according to experts, are prone to you ¬ nyknennya their significant inflammatory and degenerative changes in all tissues periodontal ¬ tries. These changes explain the negative impact likars ¬ cal tools that are used for the treatment of major diseases.
A large group of periodontal diseases in children and adolescents appears vnas lidok dysfunction sex hormones in puberty iieriod. In patohe ¬ nezi gingivitis caused by hormone dysfunction plays an important role violation of the evolution and function of the epithelium of the mucous membrane of the mouth and gums. At puberty observed significant ¬ the prevalence of gingivitis. It is due to the influence of this age in the epithelium of the gum sex hormones levels are significantly increased. Noteworthy community histogenesis all mucous membranes, including the gums.
Lesions of gums and deeper periodontal tissues most often con ¬ sterihayetsya girls. They have to take place during puberty ¬ yutsya increased excretion of sex hormones – estrogen and low progesterone production. These features lead to the stimulation and the prevalence of proliferative process in the epithelium of the endometrium and other mucous membranes, including those in the gums. Under the influence of ¬ hesteronu there is a desquamation of the epithelium. The occurrence of symptoms of hypertrophic gingivitis or deskvamativny depends on the preferred ¬ reluctance estrogen or progesterone. Thus also important quantitative and qualitative changes in the ratio of sex hormones androgen and mineralocorticoid ¬ genes. There are also changes in the hypothalamic-hypo-fizarniy regulation.
Gingivitis, which occurs in peredpubertatnyy or pe ¬ riod puberty to the damage function of the endocrine glands, titled yunats ¬ one. If the gingivitis is a very long, it can go into severe forms of the disease, followed by destruction of enamel-epithelial attachment and bone alveolar bone. Most often this occurs when instability functions of the endocrine glands supplemented unhygienic condition of the oral cavity, the presence ¬ tions teeth anomalies and deformations, long-term functional overload him ¬ teeth and so on. Under these combined disorders of long before the age of 14-17 years in girls, and sometimes boys develop ¬ vyvayetsya generalized periodontitis.
The role of digestive tract diseases in the etiology and pathogenesis of periodontal diseases. The leading role played by increasing the content of ciga ¬ rovattsi levels of biologically active substances (histamine, etc..) As x ¬ tures swelling of the gums, possible primary origin of aseptic inflammation by as ¬ histamine border. Recently obtained data on the adverse effects of gastritis, gastric ulcer and duodenal ulcer in the periodontium. Thus the observed rapid generalization process and the progression of changes in the tissues of steam donta accompanied by significant changes in the immunological status of patients.
Chronic liver disease or lead to the development of hypertrophic catarrhal gingivitis. These diseases are difficult to nu ¬ treatment.
There is evidence of a significant prevalence of periodontal tissues in children with roaring ¬ matyzmi, nephropathy, tuberculous intoxication.
In diseases of the central nervous system in children watched ¬ yutsya severe periodontal lesions diagnosed at the age of 3-5 years, these lesions are caused by both general and local factors as hygienic care of these children significantly affected.
Important role in the development of periodontal diseases in children plays an ¬ sufficient vitamins when unbalanced diet (eg, ascorbic acid, retinol, tocopherol acetate, vitamin December pi ¬ B). When ascorbic acid hypovitaminosis disrupted collagen synthesis, there is a pronounced hemorrhagic syndrome, a disorder that leads to periodontal functions to maintain the tooth in the cell. Changes in insufficient quantities in the diet of ascorbic acid occurred in all periodontal tissues: gums, and bone tissue peryudonti ¬ Covo collar bone. In the latter revealed osteoid deposition, in violation of normal ¬ formation and restoration of bone tissue.
Severe periodontal lesions (idyupatychni illness Parodontol-ZIS) are observed in children with severe, uncompensated of them ¬ genetically caused diseases and syndromes (retykulop-styutsytoz, neutropenia syndrome Patyona-Lefebvre et al.).
During the test, the child’s physician should identify local factors, the level of compliance with hygiene requirements, which cause lesions pa ¬ rodonta. If the lesion is generalized iature, not linked ¬ tion of local factors, the child should examine the pediatrician to identify the disease that caused periodontal pathology. The mechanism of periodontal pathology underlying phenomena such as in ¬ shkodzhennya cellular elements, increasing the concentration of biological active substances ¬ chno, vascular tissue permeability disorders mikrotsyrkulyaschyi, exudation and cellular infiltration, destruction of co ¬ lahenu and depolymerization of ground substance of connective tissue in violation trans exchange, secondary hypoxia, acanthosis epite ¬ potassium gingival sulcus and its replacement epithelium of the oral cavity, periodontal attachment violation, the formation of periodontal pockets.
At the same time there are changes in the microvasculature of periodontal as hemostasis, vasculitis and blood clots. Dov ex ¬ fabrics impregnated proteins (albumin, fibrin fibers ¬ nohen, imunohlobulshy classes A and M) and cellular elements (lympho ¬ tsytamy and plasma cells), resulting in compaction of inflammatory infiltrates in the gums Because activation of tissue and bacterial hyaluronidase, elastase and collagenase and other enzymes, changes in the structure of the periodontal connective tissue. Cos ¬ ryuyutsya conditions for the development of pathological granulation tissue gradually involved in the process of new tissue, extending from the gum on periodontium and alveolar bone.
The system of social measures aimed at preventing car ¬ iyesu associated with maintenance of a healthy lifestyle – compliance ¬ ing management of work and leisure, scientifically substantiated ¬ quests standards of food and hygiene.
Medical measures for caries prevention aimed at devel ¬ opment and implementation of etiologic and pathogenetic validated ¬ sobiv methods and effects on the body and organs of the mouth in order to increase their resistance to decay and to reduce the adverse factors kariyesohennosti mouth.
By hygienic and educational measures to prevent caries belongs ¬ belong hygienic education of the population on dentistry, ¬ spread of knowledge about healthy lifestyles, fostering the skills of dohlya ¬ dy by mouth and by keeping them healthy.
Health education for dental prophylaxis prior hygienic training of oral care and accompanies it.
Basic principles of health education work formulated by WHO are:
– All preventative dental procedures should include elements of education;
– Need an integrated approach to every age and social groups of people;
– Material to impart skills should contaiew infor ¬ mation, to attract people’s attention;
– Dental health education should be part of their general ¬ programs of health education, because dental health ¬ depends on overall health, behavior and habits of the person and of the environment;
instruction on dental health education should be scientific iature.
There are four organizational forms of health education: Besi ¬ da patient alone, conducting interviews or group discussions;
formation of committees, groups of health promotion and medical knowledge in the workplace or school, spreading health education knowledge through the media.
Methods of dental education – a conversation, lectures, seminars, uro ¬ ing health, games and more. Lecture or a conversation about tooth decay should start zvykladennya essence of the disease and its complications. It is necessary to highlight the role of the general state of the organism in causing tooth decay, nature of food, health measures. The goal of dental health education and hygiene education is the formation of habits of the population regularly care for the oral cavity. Achieving this goal will be achieved through certain stages of knowledge – understanding ^ – ^ conviction – Skill ^ – ^ habit.
Start the sanitary-educational work on Stomatological ¬ tion prevention advisable among educators and health care providers child care centers and schools. Then you need to arrange a meeting with parents to involve them in programs aimed at improving the health of children. The most important step sanitary educational work is to complement direct work with children. Lessons conversation with pi ¬ thaw prevention of dental diseases carried differentiated ¬ rentsiyovano, considering age.
As recommended by WHO dental prevention ¬ tical measures consist of two main phases of a single preven ¬ cal process: primary and secondary prevention.
Primary prevention – a system of government, social, medical and hygienic and educational measures to eliminate the causes and risk factors for caries and ¬ and also to increase the body’s resistance to the actions of the child ¬ ing unfavorable factors of environment and consumer protection.
Secondary prevention is a complex of measures aimed at early detection of the disease, prevention of recurrence, progression and its complications.
The main objectives of primary prevention is the creation of conditions for proper formation and mineralization of hard tissues of primary ¬ nin tooth, providing physiological maturation solid flow ¬ breath tissues (secondary mineralization) and if necessary – stimulating ¬ ment of these processes, the prevention or elimination of dental caries .
There etiological (causal) and pathogenic preven ¬ tic cavities. Etiological prevention is aimed at reducing the quantity and the quality of the kariesogennoy microflora (plaque), improved self-cleaning teeth, hygiene ro ¬ mouth cavity. Pathogenetic prophylaxis of caries covers shall Toda ¬ endogenous and exogenous prevention.
Endogenous caries prevention should begin as early as en ¬ tenatalnyy during development. This is because the process of formation and mineralization of teeth begins in embryonic pe ¬ riod of child development and continuing after birth. Closing formation and primary mineralization of deciduous teeth serving ¬ Xia antenatal period of development of the child. Closing and formation of primordia ¬ permanent teeth begin on 4-5th month of pregnancy ¬ ness, the process of primary mineralization of permanent teeth crowns completed ¬ shuyetsya 7 to 8 years old.
Antenatal prophylaxis is aimed primarily at the health of pregnant women, preventing her somatic and infectious diseases during this period, as well as providing full ¬ nd food. The dentist should take part in har ¬ Nutritionist vigil pregnant.
For the prevention of dental caries in children and women during pregnancy is extremely important intakes sufficient amount of calcium, phosphorus, fluorine and other trace elements and vitamins. Thus, a pregnant woman should eat daily
In the monitoring of pregnant womeeed timely vno ¬ Siti adjustments to their diet. The reasons for this are the high ¬ cues increase caries, acute its course, clinical signs hipovita ¬ minozu, repeated pregnancy after a short time, concomitant chronic diseases. In such cases it is reasonable assignment pregnant medicines aimed at maintaining the desired calcium-phosphorus balance.
Essential in the formation of resistance to dental caries is the state of health of the child in the 1st year of life and eating it in this period ¬ vehicles. Best products for newborns is breast milk of the mother. Breastfeeding provides the body novonarodzhe ¬ ing all the necessary materials and does not require any adjustment.
In the case of artificial feeding should be the maximum offset its disadvantages. Control of feeding a child has a pediatrician.
The body of a child who is growing and developing, especially those aged 6-7 and 10-11 years, while significantly increasing height, weight, number of teeth, is experiencing an increased need for calcium salts, vitamins, proteins, fluorine. Because the child’s diet should be balanced both in quantitative and qualitative terms (Figure 39).
Older children and adults should consume during the day on average 80-
Deficiency of protein during tooth development may lead to disruption of the structure of the enamel is formed. A special role belongs ¬ pends essential amino acids (arginine, lysine, alanine, glycine, proline, tyrosine), which is broken in exchange caries.
Some importance is balanced mineral composition Har ¬ chovyh products, namely optimal ratio of calcium and phosphorus from 4:5 to 1:1.5, magnesium and calcium – from 1:3 to 1:2. Excess phosphorus and fat inhibits the absorption of calcium and protein and magnesium – activates it. The most balanced on the content of calcium, phosphorus ¬ handicap and fatty acids are goat milk and its products, ¬ tion on calcium and phosphorus – apricots, peaches, cherries, plums, cherries, sea and river fish, about calcium, phosphorus and magnesium – apples, radishes, beans, squash, cabbage, fish. The largest number of su ¬ dorozchynnyh fluorine contained in the higher grades of tea and seaweed. A large number of trace elements contained in seafood:
meat of krill, mussels, pasta “Ocean” and others. (Table 27).
The best sources of calcium are milk and dairy products that contribute to the complete mineralization of enamel. Have calcium mo ¬ sailing is 120 mg%, cheese – 135 mg%, the cheese mass – 95-160 mg%;
Most adverse effects on hard tissues of teeth commit ¬ levody carbon, most of which (sucrose, fructose, glucose) easily enzyme ¬ tuyetsya plaque microorganisms to form organic acids that can enhance the processes of demineralization of enamel. In order to reduce capacity carbohydrates kariesogennoy patients should be encouraged to reduce the total amount of sugar used, the frequency of consumption of sugar and other carbohydrates, do not keep long in the mouth sweet foods (candy, caramel, etc.) as possible to replace the easily fermented carbohydrates such non-metabolism yutsya bacteria of the oral cavity – sorbitol, xylitol, cycle-mate, aspartame, saccharin.
The recommendations of good nutrition should not forget about the food – a factor in the self-cleaning of the mouth, in ¬ tional release of soft plaque. Therefore, one way to enhance self-purification of the mouth is the use of solid “eating raw vegetables, hard fruit). Good training dentoalveolar sys ¬ subject occurs during the use of solid dry food that increases salivation. Solids recommend children to develop in them the habit of chewing, to improve the growth and development of teeth-even ¬ lepnoyi system. desirable to use fruits and vegetables after the sweet, sticky, soft foods, and in-between meals.
Also, chewing load a beneficial effect on periodontal tissue, increases the content of protective factors in gingival fluid.
Of great importance during the primary and secondary mineralization with fluoride ions. The mechanism of the protective action of fluoride on enamel is to replace the OH group on the hydroxyl ions F in enamel formation fluoride rapatytu Ca (PO,) gF ^ or calcium fluoride – CaFy It depends on the concentration of fluoride: at low often formed fluorapatite, which is resistant to acids, at concentrations above 0.1% – a layer of calcium fluoride, which covers the enamel. Fluoride inhibits the enzyme enolazu whereby interrupted cycle and glycolysis zmenshuyet ¬ be the formation of lactic acid. Fluoride inhibits bacterial metabolism in dental plaque and formation of extracellular polysaccharides (mal.40). Amount of fluoride in the body depends on its content in drinking water and food.
For the prevention of dental caries offered a large variety of tools and techniques, studied the effectiveness of prevention. These tools and techniques can be classified according to the method of their introduction into 2 main groups: means for introducing endogenous and exogenous influences.
Fluorine compounds are the most effective in preventing tooth decay, and given their protykarioznoyi mechanism of action, they are widely used for endogenous and exogenous to influence.
Diet includes time i yizhi number of receptions, interval between them, the distribution of food by ratsionu enerhoyemkistyu, chemically i yizhi weighing techniques.
Admission yizhi: the corresponding conditions, servirovka table vidvolikayuchyh absence from yizhi factors.
Proper nutrition – the first key to good health i feel, without which it is difficult to maximize the ability to work. Ancient filosofu Socrates belongs vysliv: “We do not live to eat but eat to live.”
Equilibrium in the organism, which leads to health begins with yizhi we eat. Doslidnytskyy department Centre aerobiky formulated eight fundamental principles of Rational nutrition.
1. Support the permanent relation between the basic components of food Tami proportsiyi 50:20:30. Daily use kaloriy should rozpodilyatysya this: 50% – carbohydrates, 20% – 30% bilky i – fat.
So 50% kaloriy, which we use daily falls in carbohydrates. They charged us the energy of THE GREATEST EXTENT. Carbohydrates dilyatsya into monosaccharides, disaccharides i polisaharydy. For example, monosaccharides – glucose, disaccharides – sugar (sucrose), milk sugar (lactose), polisaharydy – starch hlikohen, klitkovyna, pektynovi matter.
Starch – mistytsya beans wheat (55%), rysi (55%), potato (18%).
Klitkovyna, which is part of the i vegetables of fruit, broken down in the human gut bacterial flora with. It enhances zhovchevydilennya i output from the organism cholesterol peristalsis i provides a sense of fullness.
Pektynovi matter – is a stabilizing material. They obvolikayut intestinal mucosa i protect it from mechanical chemical i podraznykiv, bind pathogenic flora, salts of heavy metals (lead, mercury) i remove them from the organism.
Carbohydrates are the basis of our food products, such as fresh fruits, vegetables, beans, peas, potatoes, corn, bread, porridge vivsyana, Fig.
Mercury fats in everyday ratsioni near 30%. Here the main problem is to restrict zumity daily use fats to this figure.
Fat vidkladayutsya in zhyroviy i tkanyni form of energy supply material. Fat pidshkirnozhyrovoyi klitkovyny oberihayut bodies from hypothermia, and adipose tissue surrounding the internal organs, also unambiguously fixed i prevent them from displacements i injuries.
Excess body fat is often associated with ratsioni occurrence of colon cancer, breast cancer pidshlunkovoyi, i yayechnykiv rectum.
Essential fats not only quantity, but the quality of them i. Vegetable oils, which are part of sunflower oils i soy, corn oil, vegetable margarine, nuts better to eat than animal fats, because in vegetable fats are zhyrni Unsaturated acids. Saturated fatty acids are especially numerous in masli, smetani, m’yasi greasy sausages. Particularly hazardous roasted zhyrni products that contain akrooleyin.
Bilkovi products must pass near the 20% kaloriy, which we daily eat. These relate fish, veal, beef Song, lamb, pork, cheese, milk, lactic cheese, eggs.
Bilky form the basis of the structural elements of the Cell i tissues of the body of man, are part of the fermentiv participate in vyroblenni immunity. Is now well known that the decay i bilka synthesis is directly with fermentiv, with all bilky updated on protyazi 5-7 days.
Food tsinnist bilka depend on its zasvoyuvanosti. Bilky plants vazhkodostupni products for digestive fermentiv because they are absorbed in the intestine hirshe than bilky animal. But an excess of animal proteins in ratsioni leads to diseases such as gout.
2. Follow the 25-50-25 rule for determining the quantity kaloriy per reception yizhi 25% kaloriy must account for the breakfast, 50% – for dinner, 25% – for dinner. This will help maintain a healthy weight body.
3. Engage in aerobic physical exercises at the end of the day, just before dinner. In protyazi 2:00 after a hard physical stress observed loss of appetite because i THOSE who are hard at work in the other half of the day, eat less.
Regardless of the time of physical exercise in combination with rational nutrition accelerate fat loss with minimal weight znyzhenni muscular tissue, while limitovane kaloriy use can lead to its reduction.
4. Cultivate FEEL healthy fear of completeness. Excess weight is associated with risk of diseases such as cancer. Zhyrovi depot is a place of conservation of toxic substances.
5. Do not exhaust the organism by quantity kaloriy small. First of all it concerns people who limit themselves to YOURSELF kaloriyah trying to lose weight. Sometimes it gives negative consequences. If you decide to engage in physically demanding moreover, the number should be yizhi zbilshena.
6. Use the formula to calculate your an ideal weight. Too low content of fat in the organism can cause definite anomaly i violation. WOMEN who have a fat content is below 15% quite often suffer from an irregular menstrual cycle i abnormal development of pregnancy.
7. Use the formula for determining the number kaloriy necessary for the support of an ideal weight. First of all it is necessary to kaloriy number, which we daily take was balanced.
The daily demand for energy depends on the daily energy costs, which are the main RAPID exchange, learning yizhi i the physical activity.
Energy consumption Energy tsinnist i yizhi calculated in kilokaloriyah.
The main exchange – this energy body as a state of complete rest, which provides the functions of all the organs of i, the temperature of the body is supported. For young men, the average body weight (
Energy costs for the physical activity depend on the nature of production i homework from features furniture.
For enerhotratamy people are divided into 5 groups (Table 14) 8. If you are overweight, immediately go to the Individual nutrition plan, namely:
1). Especially Observe 50:20:30.
2). Reduce use kaloriy i increases their costs (
To lose
3). Eat less fat yizhi, drastically limit their intake of fried meat, butter, sausage, sausages, sour cream, cheese, mayonnaise.
4). Eat less sugar (jam, tortiv, cookies).
5). Eat more nyzkokaloriynyh products, bulk (syri vegetables, fruits, wholemeal bread, juice).
6). Viddavayte prefer meat poultry and fish. Eat less beef, pork, lamb.
7). Daily drink from 6 to 8 stakaniv water and fruit juices.
8). Should eat slowly, chew well, spending every meal for at least 20 minutes. (Just 20 minutes. Comes a feeling of fullness). The process of chewing reduces stress strain i.
9). Try to eat sensibly. Remember that hunger occurs twice. First, it causes nervovi pulses with an empty stomach, transiting last portsiy kashytsi food in the duodenum. If people took the food, in this case, there is a sense sytosti just after filling the stomach some yizhi by quantity. If a person podavlyuye first signal hunger, feeling it is, people do not pay attention to this message.
The second signal enters the central nervous system of the “hungry” blood, after the fact as a matter pozhyvni moved from her Cell, tissue organism. This signal is very Sustainable, people react to it i find time to take food. After receiving the second signal yizhi feeling of fullness of the stomach does not appear at once, but only after saturation of the blood i tissue nutrients. Hunger disappears after 2-3 hours. As a result, a person loses sensation extent, despite the fact that the stomach is full. Especially dangerous is eating before bedtime, which employs the heart, lungs, causing different diseases of the stomach.
10). It is necessary to limit your intake of salt, which often causes hipertoniyu. We must remember that the organism requires only
11). Perform regular physical exercise.
as. Vydoinyk O. Y.
