Theme 4.
Composition and properties of oral fluid
salivary gland.
In the mouth open excretory ducts of three pairs of major salivary glands: parotid , submandibular and hyoid . In addition, the mucous membrane of the mouth , there are numerous small salivary glands (glandula salivariae minores). For topographic feature distinguished cheek , lip , tongue , palate ( hard and soft palate) salivary glands. Small salivary glands are arranged singly or in groups, their diameter does not exceed 1-
Three pairs of major salivary glands (glandula salivariae majores), achieving significant size , beyond the mucosa and maintain communication with the oral cavity through their excretory ducts. These glands are dolchati formation , they can be felt by palpation of the oral cavity.
Parotid gland (glandula parotis) – the largest of the three major salivary glands produce serous (protein ) secret. It is located on the lateral side of the face in front of and below the ear , its clamps ( stenonova ) duct (ductus parotideus), a length of 5 –
Blood supply of the gland zapezpechuye branch of the external carotid artery (a. temporalis superficialis).
Innervation of the parotid salivary glands is carried by sensory , sympathetic and parasympathetic nerves: sensory – the branches of ear – temporal nerve (third branch of the V pair) , pretty – the external carotid plexus, parasympathetic – postganglionic fibers consisting of ear – temporal nerve , coming from the ear node. Because of the parotid glands is facial nerve.
Submandibular gland (glandula submandibularis) – Mixed Type secretion. Located in the submandibular fossa and is located on the back edge of the jaw- hyoid muscle. On the back edge of the muscle away from the gland excretory duct (ductus submandibularis), which opens napid’yazychnomu papilla .
Sublingual gland (glandula sublingualis) – mucosal type, located on top of jaw- hyoid muscle at the bottom of the mouth between the tongue and the inner surface of the mandible. Excretory duct (ductus sublingualis minores) open independently into the mouth along the hyoid folds (plicae sublingualis). Great hyoid gland excretory duct (ductus sublingualis major) goes along with the duct submandibular gland and opens or one common hole with her or nearby.
Blood supply of the submandibular salivary gland and hyoid is provided by a branch of the facial and lingual arteries. Innervation of both glands: sensual – lingual nerve (third branch V pair), parasympathetic – facial nerve (VII pair) string through the drum and sub- mandibular node, cute – plexus around the external carotid artery.
Endocrine function of the salivary glands is the production of biologically active substances such as: kallikrein , renin , nerve growth factor , epidermal growth factor, parotyn et al.
Mouth cancer are divided into:
– Small salivary glands;
– Major salivary glands.
Small salivary glands located in the mucous membrane of the mouth (tunica mucosa cavitatis oris).
Great salivary glands have three pairs:
– Parotid gland ;
– Submandibular gland ;
– Sublingual gland .
Parotid gland is located in front of and below the ear, on the side of the branches of the lower jaw and along the back edge of the masticatory muscles :
– The structure – a complex alveolar gland ;
– The nature of the secret – serous .
Parotid duct or duct Stenon – opens in cheek mucosa in the vestibule of the mouth (mucosa buccae vestibuli oris) opposite the second upper molar tooth large .
Parotid gland is :
– Surface portion ;
– Deep part.
Maybe an extra parotid (glandula parotidea accessoria), which is located on the surface of the chewing muscles , along with the parotid duct (ductus parotideus).
Submandibular gland is located in the submandibular triangle: the structure – a complex alveolar- tubular , the nature of the secret – mixed type.
Submandibular duct or duct Wharton – opens in hyoid m’yastsi .
Sublingual gland located deep in the sublingual fold :
– By structure – complex alveolar- tubular ;
– The nature of secretions – mucus type.
Her big sublingual duct opens to the hyoid m’yastsi along with submandibular duct. Sometimes the duct open together.
Small sublingual ducts open along the sublingual fold sublingual until m’yastsya .
By the minor salivary glands are:
– Labial gland;
– Buccal gland;
– Kutna cancer;
– Palatine glands;
– Tongue cancer.
Saliva (Latin saliva) – clear, colorless liquid discharge in the mouth secret salivary glands. Saliva wets the mouth, facilitating the articulation, provides the perception of taste, lubricates chewed food. In addition, saliva cleanses the mouth, has a bactericidal effect, protects against damage to the teeth. Under the action of the enzymes of saliva in the mouth починаєтьсяперетравлювання carbohydrates.
Composition of saliva
Saliva has a pH of 56 to 76. At 985% or more of water, containing salts of various acids, trace elements and some alkali metal cations, lysozyme and other enzymes deyakivitaminy. Organic substances of saliva proteins are synthesized in the salivary glands (some enzymes, glycoproteins, mucin, immunoglobulin A) and beyond. Part of saliva proteins is serum origin (some enzymes, albumin, β-lipoproteins, immunoglobulin G and M, etc.).
Most people are hruppospetsificheskih saliva antigens corresponding antigen levels. The ability to secrete saliva in stock hruppospetsificheskih material inherited. Vslyni identified specific proteins – salivoprotein that promotes the deposition fosforokaltsievyh compounds on the teeth, and fosfoproteynov – kaltsiyzv’yazuyuchyy protein with high affinity for hydroxyapatite, which is involved in the formation of tartar and plaque. Osnovnymyfermentamy saliva is amylase (α-amylase) that performs hydrolysis of polysaccharides to monosaccharides and di-, and α-hlikozidaza or maltose, split disaccharides maltose and sucrose. Also found in saliva protease, lipase, phosphatase, lysozyme, etc.
In mixed saliva is present in small quantities cholesterol and its esters, free fatty acids, hlitserofosfolipidiv hormones (cortisol, estrogen, progesterone, testosterone) and various vitamins and other substances. Minerals that are included in saliva are anions chloride, bromide, fluoride, iodide, phosphate, bicarbonate, sodium cations, potassium, calcium, magnesium, iron, copper, strontium, etc. Damping and the softening solid food, saliva provides formation bolus and facilitates swallowing saliva leakage yizhi.Pislya food already in the mouth is exposed to the primary chemical processing, in which carbohydrates are partially hydrolyzed α-amylase to maltose and dextrin. Dissolve in the saliva of the chemicals that make up the food contributes to the perception of taste taste analyzer. Saliva has a protective function by cleaning the teeth and the mucous membrane of the mouth of bacteria and their metabolic products, food debris, detritus. The protective role also in saliva immunoglobulins talizotsym. As a result, the secretory activity of large and small salivary glands moistened oral mucosa, which is a necessary condition for bilateral transport of chemicals between oral mucosa and saliva. Number of the chemical composition and properties of saliva vary depending on the nature of the pathogen secretion (eg, type of food intake), rate of secretion. Thus, by eating cookies, candy in mixed saliva temporarily increases blood glucose and lactate, with stymulyatsiyislynovydilennya in saliva dramatically increases the concentration of sodium bicarbonate, does not change or slightly reduced levels of potassium and iodine in saliva of smokers are several times more rodanydov than non-smokers.
The chemical composition of saliva is subject to daily fluctuations, it also depends on the age (the elderly, for example, greatly increases the amount of calcium, which is important for the formation of teeth and salivary stone). Changes in the composition of saliva may be associated with taking drugs and intoksykatsiyamy. Sklad saliva also changes in a number of pathological conditions and diseases. Thus, when dehydration is a sharp decrease in salivation, diabetes in saliva increases the amount of glucose, with uremia in saliva significantly zrostayevmist residual nitrogen. Reduced saliva flow and changes in saliva lead to digestive disorders, diseases of the teeth.
Saliva as a major source of income in the tooth enamel of calcium, phosphorus and other minerals affect and chemical properties, including resistance to caries. With a sharp and prolonged restriction of secretion of saliva, there has been intensive development of dental caries situation creates a low rate of secretion of saliva during sleep. When periodontal disease in saliva may decrease the content of lysozyme, proteinase inhibitors, increase the activity of proteolytic enzymes, alkaline and acid phosphatases, change the content of antibodies, which leads to a deepening of pathological phenomena in the periodontium.
The secretion of saliva
Normally, an adult day allocated to
Mixed saliva is a viscous (due to the presence of glycoproteins) liquid with a specific gravity of 1001 to 1017. Some of saliva turbidity caused by the presence of cellular elements. Fluctuations in pH of saliva depends on the hygienic conditions of the oral cavity, the nature of food, secretion rate (at a low rate of secretion of saliva pH is shifted to the acid side, when stimulated saliva – the alkaline).
Salivation is controlled by the autonomic nervous system. Salivation Centers located in the medulla oblongata. Stimulation of the parasympathetic endings causes the formation of large quantities of saliva is low in protein. In contrast, sympathetic stimulation results in secretion of small amounts of viscous saliva. Department of saliva decreases during stress, fear or dehydration and almost stops during sleep and anesthesia. Increased salivation occurs when exposed to olfactory and gustatory stimuli, and also due to the mechanical irritation of large particles of food and chewing.
Potova liquid. In the mouth there is a biological fluid, called oral fluid, which in addition to secretion of salivary glands, including flora and the products of its life, the contents of periodontal pockets yasnevu liquid deskvamovanyy epithelium migrating leukocytes in the mouth, the remnants of foodstuffs, etc. Oral fluid is a viscous liquid with a relative density of 1.001 – 1.017.
One day an adult released 1500 – 2000 ml of saliva. However, the rate of secretion varies depending on several factors: age (after 55 – 60 years salivation slows), nervous excitement, food stimulus. During sleep, the saliva secreted in 8 – 10 times smaller – from 0.5 to 0.05 ml / min than during wakefulness and during stimulation – 2.0 – 2.5 ml / min. With a decrease in salivation increases the degree of damage tooth caries. In practice dentist deals with oral fluid, as it is the medium in which reside the organs and tissues of the mouth.
The buffer capacity of saliva – the ability to neutralize acids and alkalis, by interacting hydro carbonate, phosphate and protein systems. It was established that taking a long time reduces carbohydrate foods and high-protein intake – increases the buffer capacity of saliva. The high buffer capacity of saliva is one of the factors that increase the resistance of teeth to caries.
The concentration of hydrogen ions (pH) was studied in some detail, because of the development of the theory of Miller occurrence of dental caries. Numerous studies have found that the average pH of saliva in the mouth under normal conditions is in the range 6.5 – 7.5. Installed minor fluctuations in pH during the day and night (reduced at night). The most powerful factor that destabilizes the pH of saliva is kyslotoutvoryuvalnoyi activity after administration of carbohydrate foods. “Sour” oral liquid reaction occurs very rarely, although local decrease of pH – a natural phenomenon and is due to the vital activity of the microflora of plaque, cavities, sludge saliva.
The composition of oral fluid. In oral fluid contains fluoride, the amount of which is determined by its intake orhanizm.Ionna activity of calcium and phosphorus in the oral fluid is a measure of the solubility of hydroxy-and fluorapatite. Established that saliva under physiological conditions hydroxyapatite supersaturation, which suggests it as a mineralizuyuchyy solution. It should be noted that the saturated state under normal conditions does not lead to the deposition of mineral components on the surfaces of the teeth. Present in the oral fluid proline and tyrosine inhibit spontaneous precipitation of him solutions supersaturated with calcium and phosphorus.
Also noteworthy is the fact that the solubility of hydroxyapatite in oral fluid increases significantly with a decrease of pH. The pH at which oral fluid saturated enamel appetite is seen as a critical value and, according to calculations, confirmed by clinical data, ranging from 4.5 Th 5.5. At pH 4.0 – 5.0, when oral fluid is not saturated as hydroxyapatite and fluorapatite, is the dissolution of the surface layer of enamel erosion by type (Larsen et al.) In cases where saliva is not saturated with hydroxyapatite, fluorapatite but jaded, process is type subsurface demineralization, which is characteristic of caries. Thus, the pH determines the nature of demineralization of enamel.
The organic component of oral fluid terms. It contains proteins that are synthesized in the salivary glands as well as outside. In the salivary glands produced enzymes: glycoproteins, amylase, mucin and immunoglobulin A. Some saliva is serum protein origin (amino acids, urea). Species-specific antibodies and antigens that are part of the saliva, blood group match. By electrophoresis identified 17 protein fractions of saliva.
Enzymes in mixed saliva are 5 main groups: carbonic anhydrase, esterases, proteolytic, enzymes and transferring the mixed group. Currently, oral liquid with more than 60 enzymes. Originally enzymes are divided into 3 groups: secreted salivary gland parenchyma, resulting from the enzymatic activity of bacteria resulting from the collapse of white blood cells in the oral rota.Z enzymes in saliva, above all, should provide L-amylase, which is part of the mouth hydrolyzes carbohydrates, turning them into dextrin, maltose, mannose, and others.
In saliva contains phosphatase, lysozyme, hyaluronidase, kininohenin (kallikrein) and kallikreinpodibna peptidase, RNase, DNA-polymerase and other phosphatases (acid and alkaline) involved in phosphorus-calcium metabolism, vidscheplenyy of phosphoric acid compounds, thereby providing mineralization bones and teeth. Hyaluronidase and kallikrein levels alter the permeability of tissues, including enamel zubiv. Naybilsh important enzymatic processes in the oral fluid associated with the fermentation of carbohydrates and is largely due to the quantitative and qualitative composition of microflora and cellular elements of the oral cavity: white blood cells, lymphocytes, epithelial cells and others.
Oral fluid as a major source of calcium, phosphorus and other minerals in tooth enamel affects the physical and chemical properties of the enamel of the tooth, including resistance to decay. Changes in the quantity and quality of oral fluid are essential for the emergence and progress of dental caries
After the eruption of the tooth oral fluid provides a “maturation” of the structure of enamel and changes in its composition. Saliva promotes the formation pellikuly on the enamel surface, which to some extent prevents acids. Due to the constant saturation components of saliva with age enamel solubility decreases, providing greater resistance to tooth decay.
Under physiological conditions, there is a balance between the tooth and the environment. Normally mixed saliva supersaturated with respect to almost all forms of calcium phosphate, which creates optimal conditions for their admission to the enamel. As a result, lowering the pH to 4-
Important components of oral fluid are organic compounds: proteins, carbohydrates, free amino acids, enzymes, vitamins, and some organic acids. Since saliva proteins of great importance that can bind large quantities of free calcium 1 protein molecule binds up to 130 atoms of calcium. Myosin is able to adsorb on the surface of the tooth, forming insoluble organic film that, on the one hand, protects the teeth and oral mucosa from damage, and on the other inhibits the diffusion of ions from the saliva of hard tissue.
The bactericidal properties of saliva caused by the release leykinu, lysozyme, opsoniniv, bakteriolizyniv.
Also important are the other properties of oral liquid: plazmozhortayucha and fibrinolytic capacity, creation and maintenance of humoral immunity barrier, mechanical, chemical and biological treatment of the oral cavity.
Due to the diversity of properties, oral fluid is essential in maintaining the sustainability of the environment of the mouth.
Functions of saliva
Digestive function is primarily expressed in the formation and pre-bolus. Also, the food in the mouth is exposed to the primary enzymatic processing carbohydrates partially hydrolyzed under L-amylase to maltose and dextrans.
Protective. Carried out by the diverse properties of saliva. Humidification and mucous membrane covering layer of mucus (mucin) protects it from drying out, cracking and mechanical action irritating gels. Saliva washes the surface of the teeth and the mucous membrane of the mouth by removing bacteria and products of their metabolism, food debris, detrytы. Of great importance in this case have antibacterial properties of saliva, expressed through the action of enzymes (lysozyme, lipase, RNase, DNA-polymerase, ppsonynы, leykynы et al.).
Rolling and fibrinolytic capacity of saliva is supported by those it contains thromboplastin, antyheparynovoy substance, prothrombin, activators and inhibitors fybrynolyzyna. This substance is hemokoahulyruyuschey and fibrinolytic activity, thus ensuring local homeostasis, improved regeneration of damaged mucosa. Saliva, as a buffer, neutralizing acids entering the mouth, and meadows. Finally, nazhnuyu protective role played immunoglobulins present in saliva.
Mineralizuyuschyeye action of saliva. At the heart of this process are mechanisms that prevent the release of the enamel components and facilitating their entry into the enamel with saliva.
Calcium is found in the saliva of both ionic and bound. It is believed that on average 15% of calcium is associated with Pelkami, about 30% is in the complex relations of phosphate, citrate, and only 5% – in the ionic state. It is this ionized calcium is involved in remineralization.
It is now established that the oral liquid under normal conditions (pH 6.8 – 7.0) supersaturation of calcium and phosphorus. By lowering the pH of the solubility of bone salt enamel in the oral fluid increases significantly.
For example, at pH 6.0 oral fluid becomes kaltsyydefytsytnoy. Thus, even minor fluctuations in pH are not able by themselves to cause demineralization can actively influence to support the dynamic equilibrium of tooth enamel.
Physico-chemical consistency of enamel is completely dependent on the composition and acid-base balance of the oral fluid. The main factor in the stability of apatite enamel in saliva is pH and concentration of calcium, phosphate and fluoride compounds.
Oral fluid – a labile environment and its qualitative and quantitative composition is influenced by many factors and conditions, but above all – health. With age, the secretory function of major and minor salivary glands is reduced. Breaking salivation also occurs in a number of acute and chronic diseases. Thus, when FMD disease develops excessive salivation ( 7 –
Great influence on the composition and properties of oral fluid provides hygienic oral health . The deterioration of oral care leads to an increase in plaque on the teeth , increasing the activity of several enzymes ( phosphatase, aspartic transaminazy ) , increase sediment saliva rapid multiplication of micro-organisms, which creates conditions , especially with frequent intake of carbohydrates to produce organic acids and pH change .
Protykariozna action of saliva. It was found that shortly after joining the firm mouth carbohydrate meal glucose concentration in saliva decreases, at first rapidly and then slowly . Of great importance in this play speed salivation – increased salivation promotes more active leaching of carbohydrates. In this case there is no output fluoride because they bind to the surfaces of hard and soft hkaney mouth vyvilnyayuchys for several hours . The presence of fluoride in saliva balance between de- and remineralization shifts toward the latter, which provides protykarioznyy effect. Established that this mechanism is even at relatively low concentrations of fluoride in saliva.
Effect of saliva on the acceleration output of glucose is not the only mechanism for reducing porazhaemosty caries. A more pronounced effect protykariozna ensured its ability to neutralize acids and bases , buffer effect is due to the presence of sodium bicarbonate.
Saliva normally supersaturated with ions of calcium, phosphorus and hydroksydapatyta , compounds which form the basis of tissues. Measure peresychenosti even higher in the liquid phase of plaque, which is in direct contact with the surface of the tooth. Satiety saliva ions that make up the foundation of tissues , and provides entry into the tissue , that is driving the mineralization. By reducing the pH of plaque supersaturated state of saliva ions of calcium, phosphorus and hydroksyapatytov decreases and then disappears .
In remineralization of enamel subsurface layers involved a number of proteins of saliva. Statheryna molecules and acidic proline Hyuhatyh proteins and some fosfoproteynov that bind calcium with a decrease in plaque pH , release of calcium and phosphorus ions in the liquid phase of plaque that supports remineralization .
On the other protykarioznyh mechanisms should indicate the formation of a film ( pellykulы ) on the surface ymaly salivary origin. This film prevents direct contact of enamel with acids entering the mouth, and thus eliminates the withdrawal of calcium and phosphorus from the surface .
The composition of saliva and oral fluid . Saliva consists of 99,0-99,4 % water and 1,0-0,6 % dissolved in it organic and inorganic substances. Organic constituents of saliva are calcium salts , phosphates , potassium and sodium compounds , chlorides , hydrocarbons , fluoride , thiocyanate , etc. . The concentration of calcium and phosphorus in the saliva is considerable individual variations ( 1 to 4 ), and these elements are mainly bound to proteins in saliva condition. Ionic activity of calcium and phosphorus in the oral fluid is a measure of the solubility of hydroxy– and fluorapatite . Saliva in physiological conditions at pH 6,8-7,0 supersaturated with respect to hydroxyapatite and fluoride rapatytu , which suggests it as a mineralizuyuchyy solution. Glut of saliva under normal conditions does not lead to the deposition of mineral components on the surfaces of teeth free of plaque , as present in the oral fluid – proline and tyrozynzbahacheni proteins inhibit spontaneous precipitation from solutions supersaturated with calcium and phosphorus.
By reducing the pH of oral fluid enamel solubility increases. The critical value of pH is 4.5 to 5.5. At pH 4.0 – 5.0, when oral fluid is not saturated with hydroxyapatite and fluorapatite , dissolution of enamel comes from the surface of the type of erosion ( Yu Maksimovsky ). In those cases where saliva is not saturated with hydroxyapatite , fluorapatite overcrowded but the process takes place in such subsurface demineralization, which is typical of caries. Thus, the pH of oral fluid determines the nature of demineralization of enamel.
In the saliva content of calcium ( 1.2 mmol / L) lower and phosphorus ( 3.2 mmol / l ) – higher than in the serum , the concentration of fluoride in oral fluid is determined by the intake of . The organic component of oral fluid partially synthesized salivary glands , and partly – hematogenous origin. In the salivary glands synthesized glycoproteins , amylase, mucin and immunoglobulin A, hematogenous origin of amino acids, urea. Vydospetsy – nographic antibodies and antigens that are part of the saliva, blood group match . By electrophoresis with oral fluid allocated to 17 protein fractions .
Enzymes in mixed saliva from five main groups: carbonic anhydrase , esterase , proteolytic enzymes , enzymes and transport mixed group . In oral fluid include more than 60 enzymes. Originally they were divided into 3 groups : 1) enzymes secreted by salivary gland parenchyma , 2) enzymes, bacteria , and 3) enzymes that are released in the mouth during the lysis of microorganisms in the process of disintegration of leukocytes.
a- amylase mixed saliva in the mouth partially hydrolyzes carbohydrates , turning them into dextrans , maltose, mannose , and others. ; phosphatase ( acid and alkaline ) involved in phosphorus- calcium metabolism , vidscheplyuyuchy phosphate compounds of phosphoric acid, and thus provide a mineralization enamel and dentin.
Hyaluronidase and kallikrein are enzymes that change the permeability of tissues , including tooth enamel , lysozyme provides nonspecific protection of the oral cavity .
Functions of saliva and oral fluid . Saliva plays an important role in maintaining the normal condition of organs and tissues of the mouth. It is known that when hiposalivatsiyi and especially in xerostomia (lack of saliva ) is rapidly developing inflammation of the mucous membranes of the mouth , and after 3 – 6 misyatsivvidznachayetsya multiple lesions of dental caries. Lack of oral fluid difficult chewing and swallowing food. The functions of saliva varied, but the main ones are digestive and protective.
The digestive function of enzyme is expressed in the primary processing of food and food mass formation before swallowing .
Protective function : moisture and mucous membrane covering a layer of mucus ( mucin ), which protects it from drying out, cracking and exposure to mechanical stimuli , cleaning ( flushing ) surfaces of the teeth and the mucous membranes of the mouth of microorganisms and their metabolic products , food debris , detritus. Bactericidal action carried out by enzymes ( lysozyme , lipase, RNase , DNA-polymerase , opsoniny , leykiny et al. ).
In the implementation of the protective functions of saliva play an important role hemo– coagulation and fibrinolytic systems, thromboplastin, antyhepa – rynoviy substance, prothrombin, activators and inhibitors of fibrinolysis. These compounds play an important role in local homeostasis, improving the regeneration process of damaged mucosa. The buffer capacity of saliva neutralizes acids and bases , an important protective role immunoglobulins.
Mineralizuyucha action of saliva is counter enamel demineralization and promoting mineralization.
Calcium is found in the saliva of both ionic and in the bound state. Consider that an average of 15 % calcium bound to proteins , about 30 % – in the complex compounds of phosphate , citrate , and others. and almost 5% of calcium – in the ionic state .
In the mouth open excretory ducts of three pairs of major salivary glands: parotid , submandibular, sublingual . In addition, the mucosa are many small glands that secrete watery saliva. The total mass of all these glands is about
To study the secretory function of the salivary glands used acute and chronic methods. Sharp method lies in the fact that the animal under anesthesia cannula is introduced into the Strait of salivary gland secretion and study during nerve stimulation or administration of humoral stimulators of secretion.
Chronic methods developed in the laboratory of Pavlov. In animals (mostly dogs ) during surgery to eliminate cheek Strait of one of the salivary glands ( glands make fistula ). After recovery, the animals on her cheek fixed funnel and tube suspended collect saliva. This technique makes it possible to obtain pure saliva , which is then examine
The man in the study of salivary gland function using a capsule Lashley , Krasnogorsk , which is fixed on the mucosa against salivary gland ducts .
Number of saliva depends on the dry food, the grinding, the chemical composition of substances that enter the mouth, and so on. During sleep for around 0.05 ml / min of saliva at rest – 0.5 ml / min, with a maximum secretion – about 5 ml / min. During the day a person stands 0.8-
Saliva composition : organic substances – amylase , lipase , alkaline and acid phosphatase , lysozyme , inorganic compounds: K +, Na +, Ca2 +, Cl -, HCO3 -. Ionic composition depends on the rate of secretion. mixed saliva pH ranges from 5.8 – 7.4.
Protective mechanisms of the oral cavity
The development of any pathological changes in the oral cavity head ¬ wait for the reaction is accompanied by various units of protection. The idea of the complexity of this system allows a deeper understanding of the mechanism of develop ¬ ment of diseases of the teeth, periodontal tissues and oral mucosa . Mouth has a multicomponent system for protection of patho ¬ environmental factors . Protective mihanizmy oral cavity are divided into two great game ¬ pi – and nonspecific immune, which in turn are divided into spe ¬ aspecific and nonspecific , humoral and cellular . Their function is closely inte ¬ Rowan to achieve the most important goal – to ensure the integrity of the tissues of the oral cavity, and the entire body.
Non-specific defense mechanisms of the mouth. Nespe ¬ aspecific mechanisms for the protection of the oral cavity consisting of Goethe ¬ rohennyh protective components that are functionally linked. These include the behavior of conditioned and unconditioned reflex reaction barrier function ¬ PHA surface epithelium . These reactions are combined respectively ¬ tion system functional integrity of the body.
Mouth as the initial section of the digestive tract ¬ nuye use many features that are potentially associated with impaired tissue integrity ¬ tion of the mouth or the body as a whole. Therefore, the oral cavity often used by the body as an active means of obtaining information about the environment through a system navkolysheye ¬ subject mechano -, thermo- chemoreceptors of the tongue, lips, mucous shell ¬ ing cheeks, palate, periodontal and others. When a possible violation of the integrity of tissues associated with a change in the environment , the body forms a protective response behavior. These reactions may be mo ¬ avoid the stimulus , the deviation of the head, even zimknennya ¬ lap , avoiding places that seem dangerous, and so on.
The mechanisms of protection of the oral cavity include saliva salivary glands – salivation , which is mainly due realizuyet ¬ be conditional or bezumovnoreflektornu action of the nervous system . Severe irritation thermo-, mechano– or chemoreceptors and the action oociceptors in the event of loss of tissue integrity leading to a dedicated ¬ ing large amounts of saliva, poor and enzymes that carry out the following tasks – facilitates the rapid removal of adverse substances from the mouth, regulates temperature, chemically neutralizes the adverse factors ( acid, alkali). In addition , saliva has many restorative materials ( macro minerals for the teeth ) , enzymes, regulatory factors ( epithelial growth factor ) , immune elements and so on. In addition, the oral mucosa reflex may change blood flow to activate the bio ¬ chemical, immunological, restorative processes in the areas of damage.
One of the most important security features of nonspecific protection of the oral cavity is a barrier . Fences is divided into internal and external. External owned surface epithelium of the oral cavity for ¬ , internal – microcirculatory bed of proper ¬ ing mucosa membrane of the mouth , dental pulp , which regulates receipts ¬ tion from the blood to the organs and tissues needed energy, ¬ plastych resources and timely flow of products of cell metabolism that provides stability for ¬ composition, physico– chemical and biological quality of tissue ¬ nin mouth.
Barrier resistance mucosa primarily depends on the state of the epithelium, which is active and functioning barrier to microbes , toxins , and other chemicals. Due to the presence of intracellular LIZO – fahosom and Glick proteid products , enzymes have an adverse effect on the bacteria , the epithelium , in addition to purely mechanical protection , also performs actively en ¬ tybakterialnu function ( J. S.Shvartsman ispivavt . , 1978). In addition, in some areas of the mouth ( gums, hard palate , ¬ dor sebaceous tongue ) reproduction of microorganisms limited che ¬ rez constant desquamation of the epithelium.
The value of the barrier function of the epithelium depends on the number of layers of epithelial cells. For example, the strongest barrier placed on the dorsal surface of the tongue, the weakest in the tooth- gingival sulcus offset other biological protective mechanisms of this site (moving fluid , phagocytosis , etc.).
Important role ionspecific defense plays antagonism nor ¬ mal flora of the oral cavity. It is known that streptococci, which constitute more than 30% of the microflora of the mucosa, plaque can inhibit the functioning of other bacterial species . Str. Sangvis, mutans, salivarias with Lactobacillus acidophilus prod ¬ forge microenvironment of life with significantly lower pH, which is unsuitable for Veillonella, Bacteroides, other microorganisms. Str. Mutans, str. mitior synthesize hydrogen peroxide that inhibits acts ¬ nomitsety . The accumulation of the number of microorganisms can change the proportion of the number 0 ^ Sow – stimulating settlement anaerobic species of microorganisms, which in turn inhibit the adhesion, acid totvirnu function streptococci. For example , bacteroids rozscheplyu ¬ tion Dextran , Levan , mutan , hlyutan . However neyseriyi , actinomycetes utilize polysaccharide production streptococci as an energy substrate, thereby depriving themselves streptococci and other bacteria to matrix adhesion. Veylonely can use lactic acid Str. Mutans in your metabolism , increasing the pH. Lactobacilli constitute antibiotics: laktolin , lacto- tsydyn , acidophilus that inhibit streptococcus and staphylococcus.
Bacteriocins , product Str. Mutans, better known as ” mutatsion ” active in the group streptococci green , as well as actinomycetes . Tsanhitsyny Str. Sangvis bactericidal influence on Str. Mutans.
Some bacteria inhibit the multiplication of other microbes are unaware ¬ sation way. Yes , Str. Mitis inhibits reproduction diphtheria pa ¬ face ‘, pyogenic streptococci , Staphylococcus aureus . Str. Salivarius bacteriostatic effect on streptococcus group A.
Another function of protection, especially against transient micro ¬ flora , normal microflora sells through blocking receptor surface epithelium ( A.Royt , 1991).
Nonspecific factors of humoral and cellular immunity. Oral fluid has a strong antibacterial and pro ¬ tyvirusnu effect due to the presence there of non-specific host defense factors . They are secreted by cells of the mucosa, glandular structures of the oral cavity, pharynx, neutrophils and macrophages. These include lysozyme, complement, properdyn beta- lysine, bactericides and many other humoral substances that are expressed non-specific inhibitory inactivate , lizyruyuchi and other properties that adversely affect microorganisms.
A large proportion of the products of lysozyme, which enters the po ¬ tovu liquid oral cavity provided neutrophilic granules ¬ tsytam . Saliva has a high concentration of lysozyme compared to other places we have ¬ body fluids . Lysozyme , lizyruyuchy glycopeptides ¬ tion cell wall , mainly Gram-positive bacteria, oxygen- vonezalezhnyy provides nonspecific protection mechanism . It can also lizyruvaty glycopeptides Gram-negative bacteria after removal of the lipid layer complement or cationic proteins ( A.Royt , 1991). In addition to non-specific antimicrobial activity , lysozyme largely ac ¬ tyvuye specific immune defense mechanisms , as a synergist antibodies.
Lactoferrin, transferrin prototype serum, is also actively involved in the protection of the mouth of pathogens of various infections and simultaneously controls the operation of the normal microflora (RRAmold, 1980). The protective effect of the protein based on the competition of microorganisms for joining iron. In case of excess iron ¬ virulence of some types of microorganisms ( strepto ¬ Coke , Staphylococcus aureus , microorganisms genus Candida) increases dramatically. For ¬ lactoferrin origin in the oral cavity of children studied little.
Weighted in shaping nespeyischfichnoyi antiinfectious resistance of oral mucosa , especially antiviral, interferon has . It should be noted that, as the media ¬ uring sensitized lymphocytes , interferon can modulate specific immune responses , in particular, inhibit the reaction hiperchutly –ment of delayed type . We know at least 14 interferons, which are synthesized by lymphocytes , whereas fibroblasts , epithelium and other cells produce interferon – y . Activated lymphocytes ( cyto ¬ toxic lymphocytes, killer cells , helper ), and, perhaps, the son of macrophages ¬ thesis of interferon . Viral infection of cells produce and secrete interferon him to the extracellular space, where it binds ¬ zuyetsya with specific receptors oeighboring uninfected cells.
Related interferon has antiviral activity that way. In the cell , which influenced interferon depresuyutsya of at least two genes ¬ , and begins the synthesis of two enzymes – protein and endonuclease , which reduces translation and degradation of messenger RNA as virus and host. Thus, the final result ¬ ing action of interferon is to create a barrier from uninfected cells around the cell of viral infection , which limits its expansion by ¬ . Particularly high concentrations of interferon vyyavlyayet ¬ be in the affected area after admission there with lymph node ve ¬ bast number of specific cytotoxic lymphocytes ¬ tion will destroy all virus infected cells. The most important role of interferon when the virus is a weak inducer of interferon. Worth was marked ¬ cheats that interferons play a significant role in combating it faith ¬ most, but not in the prevention of viral infection, interferon also enhance the destructive function of normal killers. in interferon secreted T -helper cells, stimulates intracellular digest ¬ ing macrophages microorganisms such as genus Candida. Hos ¬ Tanna time there is evidence of interferons as factors that will ¬ oncoproteins or antagonists inhibit the proliferative activity of cells in which mutational changes occurred .
The factors of nonspecific protection mucosa roto ¬ ing cavity also belongs to the complement (C) – a complex computer ¬ Lex proteins (20 ) , which form the cascading system (like the blood coagulation system , the formation of kinins , fibrinolysis ), provides quick ¬ ing multiple enhancing immune response to primary antigenic signal. Complement the mouth available re ¬ preferably in gingival fluid in the form of the SI , C4 , C5 and activated Basically ¬ nd an alternative route , causing an inflammatory response and in ¬ shkodzhennya periodontal tissues ( R.A.Tompson , 1983).
In addition to the factors of nonspecific protection , an important pro ¬ tektorna role to play in this saliva enzymes like amylase , alkaline and acid phosphatase , RNA –ase , DNA –ase, proteolytic enzymes and inhibitors of proteolysis (K- M.Veremeyenko et al. , 1976; L . O.Homen –ko, 1980). Saliva is represented by almost complete set of enzymes that can destroy all kinds of simple biological substrates (proteins , fats , carbohydrates ).
In the mouth of protectioonspecific cellular reactions occur mainly polinuklearnymy neutrophils and macro ¬ phages ( AL.Shuhar et al. , 1980). Macrophages are property of ¬ tion layer mucosa histiocytes , whereas neutrophils, phagocytes being mobile , a large number are found in the gingival sulcus , less – in saliva.
Polinuklearni neutrophils in the gingival sulcus is the main cell type . They ranged from 91 to 98.6 % of the free gingival fluid cells (AL Sonis et al., 1981). Worth noting consistency migration of neutrophilic leukocytes through the tooth- gingival sulcus to Oral cavity and main ¬ protective of their burden in this area . The number of migrating cells increased not only during inflammation, but also during physiological stress on the teeth , which should take into account ¬ wool during the preventive measures. Phagocytic function mainly by using specific antibodies and com ¬ plementu . In phagocytes gingival fluid identified receptors for IgG, IgM and complement (C). Also gingival sulcus, polinuklearni neutral ¬ rofily contained in the actual mucous layer, mainly in the vessels . Some of them migrate to the epithelial cell layer of stratified squamous epithelium of the oral mucosa , perform ¬ or control function with small lymphocytes and macro ¬ phages ( R.A.TOMPSON , 1983 ; Van Dyke et al., 1993).
Histiocytes ( macrophages settlers ) as opposed to circulating mak ¬ rofahiv blood – the cells that live long and whose function wi ¬ reproduced to combat those bacteria, viruses and protozoa that can exist within the host cells . Histiocytes that are passive in the oral mucosa are activated in the process of inflammation. They have a high content of hydrolases , neutral proteases secreted heavily engaged in phagocytosis. However, many obligate intracellular parasites digest ¬ lyuyutsya macrophages only after exposure to (y- interferon secreted by stimulated lymphocytes ( helper ) ( A.Royt , 1991).
Activated macrophages also play a role as initiator ¬ ry of chronic inflammation. The activated macrophage is able to secrete over 60 different factors involved in chronic inflammatory reactions ¬ them and can destroy almost any phagocytized microorganisms and cells that have acquired properties “them”.
If the host fails to destroy microorganisms that con ¬ rishnoklitynno breeding is due to chronic inflammation of the T -dependent antigens in a zone cluster occurs nahromad ¬ tion of a large number of histiocytes which secrete fibrogenic work ¬ nicks, and activate fibroblasts. Thus , stimulated formation ¬ Rennes granulation tissue and granuloma formation . Granuloma that there is an attempt by the body to limit the spread of persistent infection ¬ ( V.V.Syerov et al. , 1981).
Non-specific micro-and macrophage protection is relatively ¬ of the concept , given the participation of specific humoral (anti- tilozalezhnyh ) and cellular ( lymphokines ) mechanisms for cooperation.
Specific factors of humoral and cellular immunity. Fort ¬ tion of specific protective humoral responses to antigen by ¬ B- link provides the immune system. In the case of interaction with antigen B cells proliferate and differentiate to form blast through plasma cells that are active producers ¬ specific antibodies of different classes (IgM, IgG, IgA, IgE, IgD).
The main factor in local humoral anti-infective resistance of the mucous membrane of the mouth is IgA- antibodies , including secretory (S IgA). Sources of S IgA plasma cells saliva with small and large salivary glands and proper oral mucosa . The biological role of S IgA varied. S IgA inhibits binding of microorganisms on the surface of epithelial cells f ¬ zovoyi membrane of the mouth , thus preventing their pro ¬ nyknennyu deep into the tissues. Participation of S IgA in saliva of obstructing ¬ kriplyuvannyu microorganisms to the tooth surface is not completely elucidated , although the number of dental plaque is tremendous. S IgA antibodies capable of inhibiting the attachment of fungi and viruses to the surface epithelium. S IgA saliva can alter the metabolism of bacteria , restrict ¬ formation of colonies to reduce the virulence of pathogens , oppressed ¬ wool neyramidaznu activity streptococci bind to some exotoxin . Breaking the barrier function of S IgA may be in ¬ reason for many allergic diseases , the development of cellular immune responses with them ¬ mucosal damage . S IgA in saliva, will ¬ or major component of the “first line of defense “ is also impor ¬ ing importance in the regulation of normal microflora of the mouth, its settlement and admission to the tissues. Lack of S IgA saliva may cause undesired relationship between the microflora of the oral cavity, especially the opportunistic forms and mak ¬ roorhanizmom . This is reflected increasing number of microorganisms ¬ body naturally , posylennyayiy their corrosive properties and appearance of forms that rarely occur in healthy persons or may not occur at all. It should be noted that the system of local specific immunity , which is realized through S IgA- antibody is customary for ¬ f of base membranes of the body, relatively autonomous and governed by T-cell immunity.
Number of IgG and IgM particularly in saliva is negligible , while they in gingival fluid with serum IgA antibodies represent the entire body of answering the same about their concentration in serum. This fact indicates the difference between the surface ¬ Volyn NGO immunity oral mucosa and dental – gingival sulcus.
A large number of IgG, IgM, complement, neutrophil leu ¬ Cocytus in the tooth- gingival sulcus creates sustainable protection against invasion of microorganisms in this area. Any disorder in this system of protection ¬ spryyas possible that quantitative and qualitative changes in the microflora tooth ¬ are layers with further development of inflammatory and destructive process in ¬ nd periodontium.
IgE are actually in the mucosa. Fixing on textile basophils, they act as humoral line to protect the mucous membranes of the mouth through the synthesis of biologically active substances. Micro-organisms or their metabolic products that can disrupt line of defense created by S IgA, associated with spe ¬ aspecific IgE on the surface of textile basophils , resulting oc ¬ Tunney receive a signal on the release of vasoactive amines and heh motaksychnyh factors. This in turn facilitates the flow of this circulating blood IgG, complement, neutrophils and eosinophils, creating an opportunity for both active protection and fabric damage ¬ tion . It noted a lower concentration of IgE in the oral mucosa compared with snorkel or intestines. Number of IgE increases dramatically with APT , including the oral mucosa , lips .
Thymus -dependent cellular immune responses are made of T- lymphocytes, which are quite heterogeneous population and represented specialization Owned by function cells: T- suppressor cells , T- helper and T- killer cells, cytotoxic lymphocytes , and others.
In the mouth of T- lymphocytes in the surface misiyahsya epite ¬ potassium gingival sulcus. In other areas they perform their function ¬ tion in Lamina propria mucosa. It should be emphasized that the gum tissue ¬ us the most vivid tymuszalezhnymy limfotsyiamy . Despite vidsuhnist T cells in saliva and their role in the mechanisms of resistance antiinfectious the mouth pretty much done and T- cell regulation of secretory immunity. There is a predominance of T-helper cells in lymphoid accumulation submucosal layers of other mucous membranes, including the mouth, which enhance IgA- antibody and T- suppressor cells that inhibit the synthesis of Ig G and Ig M. The prevalence of T -helper cells for IgA- antibody submucosa has important biological significance. Increased secretion of SIgA– antigen antibody penetrated into fixing it contributes to mucosal surfaces and prevents the develop ¬ ment of other immunological reactions to possible tissue damage ¬ nin .
Recently found that the protection of the mucous membranes ¬ zde more to do with the existence of so-called lymphoid tissue associated with mucous membranes (MALT). This fabric is a diffuse accumulation of lymphocytes, plasma cells and fa ¬ hotsytiv ( including oral ), or an organized tissue ¬ nynu well decorated follicles ( reed , palate, tonsils Glot ¬ term , peyyerovi patches of the small intestine , appendix ) ,
(BJ.Underdownetal., 1986).
In connection with the establishment of the existence of a common place ¬ Volyn NGO mucosal immunity and the presence of MALT Received answer to the question , how is the stimulation of anti ¬ gene specific antibody .
For example, streptococcus , falling in crypts of the tonsils or undergoing peyyerovi plaques and using limfoyid ¬ cells and macrophages, a number of transformation induces B cells to specific antibody . Recent via the thoracic duct over ¬ go to the bloodstream and spread throughout the body . Fall ¬ ing in the salivary glands or other (eg , breast, mothers who are breastfeeding ), the liver, they differentiate into plasma cells that produce antibodies specific for Streptococcus . When passing through the epithelium formed dimer IgA, which in ¬ yednuyetsya secretory factor, which protects the IgA molecule from enzymatic lysis. Appearing with a secret cancer , antibodies specifically bind to ” spivrodychamy ” the same streptococci , inhibiting their pathogenic properties. The same happens in the diffusively located limfoidniy tissue, including actual and oral mucosa . So, are protected f ¬ zovoyi membrane throughout the digestive tract, which is of great importance as preventive protection and to form nor ¬ mal microflora, especially in the first months of life (BJ.Underdown etal., 1986).
Given the above , is of great importance func ¬ nuvannya limfohlotkovoho ring in disease prevention roto ¬ ing cavity, and importance of the local immunoglobulin ¬ nitetu other mucous membranes of the body ( digestive tract, breathing ¬ tion systems, etc ) in the context of possible pathological changes in po ¬ Tovey cavity.
The coverage of the surface protection of the mouth is not ¬ complete without mention of the important role of small lymphocytes found in the mucous membranes. They regulate the rate of mitosis of cells of the basal layer , their maturation and keratinization and zluschu ¬ ing surface epithelium (BJ.Underdown et al., 1986).
Thus, virtually all parts of the human immune system are involved in the etiology and pathogenesis of diseases of the oral cavity. Knowledgetion mechanisms of these processes can purposefully influence ¬ wool on them during the treatment of dental diseases, and in the implementation of preventive measures .
Hygiene of oral cavity
The purpose of hygienic oral care is a refined ¬ tion from her food debris , plaque , microbial and cellular childr ¬ Rita and input means to positively affect its organs and tissues. According to epidemiological studies , WHO regular double daily tooth brushing for two years reduces the intensity of caries lesions by 30-40 %. However, 60-80% of school children have poor hygienic condition of the oral cavity ¬ nyny that indicates non-compliance with hygiene requirements . This was due not only spoken ¬ irregular care , but the inability to properly brush your teeth , ignorance about the multiplicity of teeth cleaning , dur ¬ Lost brush movements and the choice of sanitary facilities. Experience ¬ Zuya shown that the required level of hygiene practices and systematic ¬ lyad Dog Oral children can only be achieved in collaboration dentists , caregivers childcare establishments ¬ frets , teachers and parents. Now, in many schools, dental clinics established offices oral hygiene . ¬ In line with teaching children the proper care of oral cavity ¬ tion study is methodical center to spread hygiene awareness among children. To this end, the exhibition also conducted hygiene means care of teeth and oral performed sana ¬ itarno and safety training methodology personnel kindergartens, schools and teachers.
For hygienic oral care ¬ yutsya used toothbrushes , pastes , powders , elixirs , solutions for mouthwashes, toothpicks and dental floss ( flosses ).
Toothbrushes used to remove food debris and plaque from all surfaces of the teeth and interdental spaces . The toothbrush includes a handle and head ( working part ), which Zak ¬ ripleni tufts of synthetic or natural bristles.
The efficiency of the toothbrush correctly determined it ¬ individual selection based on its hardness, shape and size of the working parts.
There are 5 degrees of hardness toothbrushes :
very stiff (№ 1);
hard (№ 2);
medium hard (№ 3);
Soft (№ 4);
very soft (№ 5).
Choosing a Toothbrush depends on the patient’s age , condition of teeth and gums. Children’s toothbrushes are usually made of very soft or soft fiber. Toothbrushes same degree of rigidity should be used in patients with periodontal disease. Hard and very hard brushes can recommend only those with healthy gums ¬ we are , but when they caot properly use herbs ¬ muvaty gums and lead to abrasion of hard dental tissues .
Most rational adult toothbrush head has a head ¬ focal length 25-
Children aged 2-5 years is recommended toothbrush size, po ¬ bochoyi parts of which up to
Table 31. Choosing a Toothbrush according to age
Age , years working part size , mm Tightening labor ‘ part
2-4 18 Very mild (№ 5 ), mild (№ 4)
5-7 18-23 Mild (№ ‘4), serednoyi’zhorstkosti ( HyiZ )
8 -S 25-30 medium hardness (№ 3)
11-24 25-30 medium hardness (№ 3) , hard (№ 2 ), very stiff (№ 1)
25 or more 25-30 Stiff (№ 2), medium hardness (№ 3)
Dental floss ( flosses ) are effective hygiene items for purified ¬ tion contact surfaces of the teeth. They are made of artificial ¬ fibers ( nylon, waxed and nevoschenoho silk ), may be round or flat shape . And flat waxed thread is more convenient , oc ¬ sprat it is not easily and covers a large surface of the tooth. Sometimes threads have special holders . Overseas let ¬ be a thread impregnated with fluorine and other health care institutions ¬ their means. To clean the interdental spaces ¬ ing thread length 30-
Threads soaked in 2 % sodium fluoride are both under ¬ sobom for caries prevention contact surfaces.
Children can enjoy their own flosses approximately 9-10 years.
Toothpicks apply for additional cleaning interdental spaces and lateral surfaces of the teeth. They are effective in treating a wide ¬ cal interdental spaces . Often used with toothpicks seam ¬ masses. The shape of the working parts , they can be flat , triangular or round . Toothpick itryblyzno at an angle of 45 ° to the tooth , dipping the working part in gingival sulcus , promote it, clamping ¬ ing to the surface of the tooth in the interdental gap to the contact point.
Toothpaste is a common means of oral cavity care ¬ Nino . They contain in their composition abrasive filler (chemically precipitated chalk, dicalcium phosphate, calcium pyrophosphate , aluminum silicate , etc. .) Binding component – hidroiyuloyid ( hliperol , in ¬ triyeva dymetyltselyulozy salt , sodium alginate , etc. .) Surfactants substances ( alizarynova oil , sodium lauryl sulfate , etc.). , antiseptics and deodorized matter.
In addition, the paste can be administered therapeutic and preventive pro ¬ Additives: salt, extracts of herbs mikroelemen ¬ ty, enzymes (Table 32).
Depending on whether these additives in the paste , ¬ tion of their division into two groups: hygiene, which are intended only for ¬ cle of teeth and oral cavity from food debris and plaque , and to deodorize the mouth , treatment and prevention , which as additional components are biologically active agents.
Table 4. Antimicrobial agents that are members of toothpaste and elixirs (for PD Marsh, 1993).
Toothpaste must meet certain requirements: they must be neutral, have a cleaning and polishing ¬ tyvostyamy own, have a pleasant smell, taste and appearance, giving ¬ whose cools and disinfectant effect, be harmless, have no irritation ¬ nyuvalnoho and allergic effects.
The effectiveness of tooth brushing depends on the quantity and the quality of the abrasive components that make up the paste.
Treatment and prevention toothpaste on the nature of the impact can be of two types: 1) protykariozni a) of fluoride, and b) pre ¬ Paraty calcium and phosphorus, and 2) anti-inflammatory and incentive: a) containing enzymes, b) extracts of medicinal plants; c) vitamins and bio-stimulants, d) with the addition of salt, and e) those that affect the metabolism of bone.
The most common treatment-and- prophylactic pastes are those containing fluorine compounds . These pastes are recommended for children and adults for the prevention of Carissa teeth. The structure of fluoride toothpastes administered sodium fluoride , tin, monoftorofosfat , acidulated phosphate fluoride ¬ fatamy sodium, more recently organic fluorine compounds ( aminoftorydy ) (Table 33).
According to WHO recommendations (1984) the optimal concentration of fluoride ion ¬ tion in toothpastes is 0.1 %. Toothpaste for ¬ tall to contain from 0.11 to 0.76% sodium fluoride or from 0.38 to 1.14% sodium monofluorophosphate . As part of toothpaste for children fluoride found in much smaller quantities (up 0,023 %).
Studies of preventive action fluoride toothpaste on caries demonstrated that their use reduces the gain of ca ¬ riyesu children at 15-35 %.
Choosing hygiene or health care pastes depends on the condition of the teeth and tissues of the oral cavity. Children with healthy mucosa ¬ tion coated gum and dental caries lesions with possible recom ¬ duvaty for oral care , special toothpastes that have a nice taste of , “Well , the weather ,” ” Yagodka “, ” Red Riding Hood “, ” Buratino “” Detskaya “and others. The bright design of pastes and palatability should contribute to instilling in children hygiene ¬ vychok .
When multiple lesions of dental caries, and to prevent his children is recommended to use toothpaste , ” Che– burashka “, which contains a special ingredient protykarioznyy Remodent . To this end, older children can use curative toothpaste ” Pearl “, ” Arbat “, ” Ftorodent “, ” Remodent “, “Macleans“, “Aquafresh“, “Frescodent” mysteries .
If children have periodontal disease (gingivitis , periodontitis ), cleaning teeth should be encouraged hlorofilvmisni pasta – ” Ex ¬ strategy “, ” Lesnaya “, ” Shalfeynaya ” as well as those containing extracts of various herbs – ” Daisy” ” azulene “, ” Enchantress ” and others.
Gel-like paste – a relatively new pharmaceutical form of dental ¬ nology . They have high foam blowing properties, taste good , have different colors , but their cleaning properties are lower compared to pastes containing chalk or dicalcium phosphate . Loading ¬ clerks stock inland bodies gel allows you to enter into the chemically incompatible substances as water shell and pre ¬ runs a chemical reaction between the two. Gels are used for cleaning applications and zubiv.Vmist active fluoride gels ranging from 0.1 to 1.5%. Remineralizuyucha action carried out by the gel diffusion of substances ¬ fault with his saliva, and from it – in hard tissues of the teeth. Typical gel ¬ we are “Elmex” ( Germany ), (Fluocaril “,” Fluodent “( Bulgaria), and Bland -Med ¬ ” Blendi Gel “( England).
Tooth powders are mainly cleansing effect. In terms of therapeutic and preventive action, they have no value , because the introduction ¬ ing their member medical components difficult. Recently there has been a clear downward trend in production of dental powders.
Mouthwash – additional toiletries for oral cavity ¬ nyny as a liquid . They are water or alcohol solutions to which are added various substances : vitamins , antiseptics , etc. . Elix ¬ ri produce dezodoratsiynu ( refreshing ) effect on the oral cavity ¬ well . They are normally used for rinsing after ¬ tion or teeth , and after eating to remove its leftovers.
Hygienic oral care should start from the age of two , when a child is formed temporary occlusion . Atonement ¬ beginning child is better to use only a toothbrush without toothpaste . It is important to teach your child to brush each tooth on all sides. From 4-5 years child should brush your teeth twice a day : in the morning and in the evening before bedtime.
H.M.Pahomov (1982 ) described the standard method of cleaning teeth where the tooth row of the upper and lower jaws conventionally divided into six segments. Teeth cleaning consistently first to the top , and then on the lower jaw . Pidmitayuchymy movements ( down to the upper jaw and top to bottom ) remove plaque from posterior teeth , do some rotational- translational motions and finish cleaning segment circular motions brush. Later proceed to the next segment , and so on . ( Figure 44).
When teaching children cleaning teeth advisable to count the movements of the brush. Each surface needs to be done for 10 odd movements brush with obligatory participation of the gingival margin . Cleaning distribu ¬ magnitude of chewing teeth of the upper jaw groups : chewing surfaces clean rotational- translational motion , vestibular – pidmita ¬ ted line from the gums and oral – shkrebuchymy . Then just hook consistently clean premolars and front teeth , then ¬ dyat transition to the other side of the jaw. In this same sequence clean all the teeth on the lower jaw . Complete cleaning vertical moving ¬ we brush with closed jaws in the frontal area and circular movements in the area of posterior teeth . For teeth cleaning consumes about 3 minutes , during which the movements of the even 300-320 ¬ tion tooth brush.
Quality of the cleaning of teeth can be checked by means of color traveling power ¬ plaque yodvmisnymy solutions or spe ¬ cial dyes ( erytrozyn ) and hygienic condition is determined by the index , which can give an objective evaluation .
Professional hygiene mouth cavity .
Professional hyhye – in – a set of measures to eliminate and prevent the development kariesa teeth and inflammatory illnesses , periodontal tures sky by mechanical removal of surface storage bov – over-and – on dental pidyasennyh false.
Professional hygiene comprising of:
• the motivation of the patient to fight against dental diseases –ments ;
• individual patient education -term oral health ;
• removal of a tooth -and – poddesnevyh them fat ;
• polishing of the tooth ( including root );
• eliminate factors sposobstvu –ing accumulation of plaque.
Professional hygiene provisions hone his mouth as one of the main com – ponentov preventive dental disease should be a tech – hobnob children and adolescents con ¬ nd individually and through determination fief time.
The duration of intervals between visits to the dentist for hanging – off :
• hygienic conditions polo –tion of the mouth ;
• intensity of dental caries ;
• the presence of gingivitis ;
• severity of periodontitis ;
• degree of teething.
Controlled brushing teeth – teeth cleaning is that the patient performs independently in the presence of a specialist ( taking into cha ¬ dentist , hygienist , and others. ) First patient obrabat teeth stain –ing tool and determine the IG . The patient then pure tit teeth in his usual manner , and he re- defining the IG . Ad- tsialistiv using a mirror while show – patient surfaces ¬ sti that clears enough. At subsequent visits controlled liruemyh repeated brushing teeth , assessing the skills of the patient.
The physician should explain to the child and parents causes ¬ tion and development of dental caries and periodontal – bolevaniy , the formation of dental plaque containing bacteria and their metabolic products -81 ness, and control methods for their formation . There should also be advice on the use ¬ nity of prevention and hyhy ¬ yen ( toothbrushes, toothpastes , dental floss , brush for cleaning the teeth gaps ¬ borders , language, ¬ tooth cleansing gels, rinses , etc.) and rules of use.
Professional teeth cleaning as part of the program pro ¬ laktiki caries and inflammatory periodontal disease was pre ¬ lozhena P. Axelsson et al in
Despite the excellent results ¬ ty, ” Karlshtadskoho program ” eye- zalas way , so those coming decades nite – IP- investigators were trying to work out the optimum spacing between in sescheniyami patients to keep a positive effect pro – lakticheskih programs and at the same time- mya reduce their cost. One example is the program Nexo ( Denmark ) and its modification introduced IM Kuzmina (1996) in Solntsevsky district of Moscow. START –tion of these programs is to plan the spacing between conducting professional or – stky teeth depending on the indivi – dual characteristics of the child .
In this case, the interval between con -Denis professional tooth cleaning was determined based on the following factors:
• the interest of parents and children in the program;
• porazhaemosti teeth caries in the patient;
• the degree of eruption (especially focus ¬ ing the first and second permanent molars ) and the presence of cavities on the chewing surfaces of permanent mole –ing .
Basic principles of professional teeth cleaning a particular patient:
• All teeth stained dye (usually erytrozynom ). The doctor showed the patient to place ¬ ¬ nay greater accumulation of plaque. Obu ¬ nite tooth brushing is carried out withthe individual espe ¬ tions hygienic stanuporozhnyny mouth;
• remove the remaining plaque inassistance ftoridso – abrasive polishing paste sticking , where the abrasive advan ¬ schestvenno use dioksydkremniyu . Removing plaque from chew ¬ tional surfaces of the teeth on the rotating brush drive ¬ ¬ E , and on smooth surfaces , soft rubber cap ¬ E , ¬ tion tucked polirovoch paste. As the brush, so ikovpachky are in rotation of the micromotor mechanically ¬ ¬ th tip. Aproksymalnipoverhni teeth cleaned vidnalotu flossing ;
• After cleaning all surfaces of your teeth – rectification is necessary to monitor the procedures for care . For independent quality control of cleaning storage ¬ bov at home patsyen ¬ that we can recommend the use of coloring plaque tablets.
COMPLEX SYSTEM prevention of dental diseases
A comprehensive system of prevention of dental diseases ¬ fluctuations – a system of preventive pathogenesis based measures aimed at healing the body and cavity of the mouth ¬ us by increasing their resistance and reduce the intensity of adverse factors . It includes :
a) health and educational work among the population;
b) study of the principles of nutrition ;
c) learning the rules of oral hygiene ;
d) the use of endogenous fluoride preparations ;
d) application of local prevention;
g) Early detection of dental disease ;
f) secondary prevention ( dental health ).
The main stages of its
1. Determining the sequence of child care centers, which will be implemented prevention of dental diseases. These issues ¬ tion is solved jointly by district (city) departments of health and education . At the same time takes into account the complex local conditions and the need for preventive measures.
2. Conclusion of the contract between the NHS and education , which involves mutual obligations of the parties . The leaders of education are required to provide the necessary funds for equipment
special studies, buy toiletries , visual aids , etc. Head of Health allocate and prepare the necessary staff . Principals must take the responsibility to provide in accordance with the real possibilities equip ¬ ment offices or over hygiene.
3. Training of medical personnel senior and middle managers to conduct surveys, health education activities and preventive measures. they are trained to the doctors and nursing staff of children’s dental clinics.
4.Vyvchennya klimatoheohrafichnyh and consideration factors, dietary habits , the water , life and habits. In this case, we mean the ability to influence the climate, the level of solar insolation , wind and cold regimes, soil characteristics biochemistry , degree of hardness of the water content of fluoride in it , carbohydrate intake , mode of admission, number of natural vitamins in the diet , the level of consumption of milk and milk foods , balanced meals for the main indicators of the use of a number of micronutrients , tea , its varieties and other factors that may affect the level of dental disease .
5.Epidemiolohichne screening of children to identify the level of exposure of common dental diseases ( CPV codes , PI, PMA, the need for treatment ). Based on survey data
You can calculate the necessary forces for prevention and treatment, and to distribute all children in clinic groups to differentiate the amount of therapeutic and preventive work.
Epidemiological survey consists of three successive stages:
– Preparation period ;
– The actual examination;
– Analysis of results
The preparatory phase includes:
– Training of personnel;
– Choice groups;
– Selection of the area of
According to WHO recommendations examine the key age groups (5-6 years , 12 years, 15 years, 35-44 year, 65 years and older).
Each area must be inspected by 50 people of rural and urban population of the same age group .
Indicators of dental status of each person to make a special card. After the examination of all the results are summarized in the table , and the findings give an indication of the presence of dental disease and the need for therapeutic , surgical, orthopedic and orthodontic treatment and prevention of specific populations of the region.
6.Osnaschennya and training facilities and the creation of conditions for the implementation of preventive measures. The essence of the event lies in the acquisition of assets and prevention items , making visual aids, training rooms ( parts of ) oral hygiene.
7. Determining the nature, scope and sequence of preventive measures in different dispensary groups. This stage is based on the results of epidemiological survey study klimatoheohrafichnyh features food, the water and other factors. According to the characteristics of the epidemiology , clinical and pathogenesis of dental diseases in the region and the conditions necessary to determine the nature , volume and consistency of preventive measures. Applications will be different in different regions and determined the initial incidence . In areas with high intensity of caries should strive to reduce it to moderate in areas of moderate – to low . In areas where low intensity decay , dentists have to monitor its stability.
8.Provedennya health education work with teachers , parents and medical staff schools. This step must precede the introduction of prevention, since only convinced of its necessity care providers in institutions can become a reliable assistant in dental work.
9.Provedennya lessons and practical training in oral health, control of the hygiene measures to improve nutrit ¬ tion . Practical exercises should always be preceded by talks and performances doctors, urging them to children ieed.
10.Zastosuvannya preventive measures that should be tailored according to epidemiological and other surveys.
11.Povtorne epidemiological survey and determine the effectiveness of interventions . This – the final stage , which is usual ¬ Tea is held every 5 years after the start of practice prevention.
The effectiveness of preventive measures provodzhuvanyh determined by comparing the data ¬ Covo initial epidemiological survey . The basic criterion for effectiveness of prevention of dental caries is the intensity level of caries in children aged 12 years and the effectiveness of the prevention of periodontal disease measured by CPITN in adolescents 15 years.
Organizational effectiveness should be judged on the level of coverage contingent preventive measures (percentage of the number of children in the team , which is implemented prevention first year of implementation ).
Medical effectiveness can be evaluated no later than 2 years after the introduction of the method to a team of children: I) the reduction of caries prevalence ¬ Popping ( as a percentage of the number of children in com ¬ lektyvi ), a mirror image of this index is the index of healthy care system ¬ – proportion to the lack of healthy tooth decay ( as a percentage of the number of students) , 2) the reduction of intensity decay (including the amount and number of carious teeth sealed – KP3 – temporary teeth, caries , sealed and extracted teeth – KPV3 – for permanent teeth ) 3 ) for the reduction of growth intensity decay ( KP3 and KPV3 ) compared with those in their da zistavlyuvanomu cohort not covered by prevention (children from the same area, the same age with the same level of nutrition and the nature of somatic morbidity ) in one year.
Implement prevention program should be differentiated ¬ rentsiyovano , depending on age. Attention should be focused on pregnant women, children younger with regular coverage of all children, and then adults.
Measures to prevent periodontal disease and tooth in pregnant women conducted at the antenatal clinics . Dentist assigned to the antenatal clinic , working closely with the obstetrician- gynecologist and therapist uses their data on clinical observation of the health of pregnant women , provides dental health .
Preventive measures , training methodology cleaning teeth in the first and subsequent visit, check the correctness of execution of cleaning , removing plaque , dental treatment ftorlaka , remineralizuyuchym solution holds dentist or trained at the dental school nurse visiting a pregnant woman at antenatal clinic once a month.
Prevention of children held in organized groups .
Dentist that serves the appropriate team of children is a plan for sanitary education among parents and child care staff ( teachers and staff kitchen).
Nurses kindergartens are trained in methods of implementing prevention programs dental ¬ logical diseases based dental clinics and offices . In the future, nurses conduct thematic sessions to promote health and hygiene awareness among parents and educators kindergarten.
Nurses , teachers and parents should control ¬ rolyuvaty daily regimen children use carbohydrates raise a habit to rinse your mouth between meals .
Dentist examines each child aged 1 year and identifies a group of children with an increased risk of dental caries for follow-up .
In regions of moderate and high intensity of dental caries among children of school age population is recommended to use ¬ rystannya local protykarioznyh means: fluoride varnish application (2 times per year) Remodent rinsing (3 times a year).
When carrying out preventive work in childcare should give attention to the prevention of bad habits.
On the basis of the program for prevention of dental diseases among children in schools is a holistic approach . Select a program can not be standardized for all schools because it depends on the staff opportunities, availability of funds , especially ¬ VOST the water .
Quite important is the right combination of sanation and prevention of physician who should serve one purpose – improvement of children and lower rates of morbidity.
In agreement with collective meals and parents should be made corrections to the cafeteria menu and home supply, measures were taken to combat the harmful
nutritional habits .
In preparing schedules of 1 to 3 classes at the beginning of the school year can be agreed with the head of the training school cha ¬ stynoyu procedure for preventive activities in primary school classrooms .
Planning and implementation of comprehensive prevention measures available at three levels , in line with the recommendations of the World Health Organization (1980).
Primary level
Objective: To prevent disease.
Methods : government , healthcare , hygiene , educational and personal to ensure the physiological processes of maturation, prevention and treatment kariesogennoy situation in the mouth.
Efficiency: reduction and frequency of dental diseases.
Location: kindergartens, schools and other educational institutions and organized children’s groups .
Key performers : heads of educational institutions , teachers valeologii , caregivers , teachers , health workers , parents , health care – under the guidance and advice of dentists.
At the level of primary prevention to solve the problem of increasing resistance of the child and oral tissues .
Secondary level
Objective: To prevent complications of tooth decay and other dental diseases.
Methods: sanitation (rehabilitation ) of the oral cavity using surgical, orthodontic , therapeutic , orthopedic treatments.
Efficiency: reducing complications of dental diseases.
Location: dental health care institutions.
Key performers : organizers health , dentist . At the level of secondary prevention solve the problem of rehabilitation of the mouth (sanitation ).
Tertiary level
Objective: Functional Rehabilitation , Cosmetic , social.
Methods : public , social, health , special methods of therapeutic, surgical, orthopedic, orthodontic treatment.
Efficiency : the return of function , beauty and other features of the human body .
Location: dental health care institutions.
Key performers : organizers health , dentist .
At the tertiary level, solve the problem of recovering the lost functions of the oral cavity (rehabilitation ).
In a complex system in the primary prevention level, the most important are health and hygiene measures.
Introduction of the programs of prophylaxis consists of the followings stages:
– previous planning of the program:
– organizational measures on introduction;
– to the choice of groups of population, which the program will be inculcated among;
– the estimations of necessity are in a personnel and resources.
The organizers of dental service must at first make the general chart of all program of prophylaxis, and then go into detail it.
This general plan is based on the results of situation analysis of dental problems and present resources. Counting up the real possibilities, it is possible to work out a detailed plan.
Planning of the programs must be carried out in accordance with the national policy of the state in the region of health protection and education. At planning and introduction of the programs of prophylaxis responsible departments of health protection regional administrations and main dentists of regions.
In the task of dental service must enter: organization of introduction of the program of prophylaxis, providing of financing, studies of personnel, verification of introduction, monitoring (supervision) and estimation of program efficiency.
At the choice of groups the special attention must be spared to the population with the high risk of origin and development of diseases: to the children, pregnant, workers of industrial enterprises and other.
Among the adult population the programs of prophylaxis can be carried out by dental services on the base of medical establishments at the place of work, during the stay in sanatoriums and permanent establishments.
In regions with large territory, where considerable differences are in intensity and prevalence of dental diseases, that population belongs to the groups of risk, where the greatest level of morbidity is.
If it is impossible to inculcate the program among all child’s population, it is necessary to attract attention on children 6-7 years, as most inclined to the caries, immediately after eruption at them of the first second teeth.
The estimation of necessity is in a personnel and resources. An amount and type of necessary personnel depends on the planned program of prophylaxis. There is the exemplary calculation of charges of time for every specialist which takes part in the program.
The estimation of program efficiency must be foreseen on the stage of its planning and implementation.
The estimation of program efficiency must be conducted not before, than in 5 years and taking into account the followings principles:
1) to the inspection at the beginning and at the end of the program the same age-dependent groups of population are subject (for example, 12-years-old children);
2) at comparison of results adequate controls groups must be used;
3) the inspection must be conducted by the calibrated command of specialists;
4) it must be the used is the same indexes for the epidemiology inspection and estimation of efficiency.
At the prophylaxis of separate diseases the implementation of comparison of results of inspection is possible among children, both those that took part in the program and not recipient prophylactic measures, or with the results of inspection of children of that age-dependent group, got to beginning of introduction.
Efficiency of dental education consists of high-quality indexes and degree of bringing in of people quantitative, in introduction of prophylactic strategy.
Diminishing of amount of the sugar consumed in a year per capita is an important index which characterizes the degree of change of feed in people after introduction of the program of prophylaxis.
The estimation of efficiency of studies to the hygiene concernes quickly enough and simply. The indexes of dental raid, which are measured before and after implementation of the program of studies to the hygiene of cavity of mouth, are indicators.
The first estimation of the program of hygienical studies can be conducted in 4-6 weeks by comparing of sizes of indexes of dental deposit to the initial values. In future an estimation is conducted with those intervals, that and for the programs of prophylaxis of caries.
For the estimation of efficiency of hygienical education of population it is possible to use other information:
1) amount of lectures, booklets and other informative materials which are given to the population;
2) amount of persons attracted in the program of studies to the hygiene of cavity of mouth at different levels;
3) amount of teeth brushes, tooth-pastes and other facilities of hygiene, sold on the average to one man in this region (on information of trade);
4) tendencies of dynamics of dental health in connection with the improvement of hygiene.
Efficiency of the programs of prophylaxis of caries of teeth in people is estimated through 5, 10, 15, 20 years. Thus compare the size of index of CSR in every key age-dependent group with information of the initial review conducted in those age-dependent groups.
If the program is inculcated among the limited contingent by the populations, estimation is conducted more frequent, comparing the dynamics of indexes of intensity of teeth (indexes of CSR and cs) caries in prophylactic and controls groups.
The increase is another index which testifies to efficiency of prophylaxis numbers of persons, which a caries is absent in.
Distinguish the intermediate and final estimate of efficiency of the programs of prophylaxis preliminary.
A preliminary and intermediate estimate allows if necessary to modify the program for achieving a maximal prophylactic effect.
A final estimation is possible only after 5, 10 or more than years and must include the estimation of medical and economic efficiency of the program.
The centre system health is the basic method of introduction of complex prophylaxis of dental diseases.
The fight for the health of child practically begins to its birth. The subsequent looking after children is conducted in accordance with the age-old groupings in preschool, schools and other children’ collectives.
In history of development of child in first epicrisis there must be the record of dentist about the amount of teeth which were cut through, their position and state of hard fabrics. Parents need to give recommendations in relation to the individual care of cavity of mouth of child, terms of address to dentist for prophylactic reviews.
At the exposure of any pathological changes it is necessary to take a child on a clinical account and work out a plan of medical – prophylactic measures jointly with a paediatrician.
For preparation to school of children of 5th life jointly a paediatrician and dentist examine with other specialists. The review of dentist in this period is very important, as allows to discover to the entry in school those or other violations in the cavity of mouth. On 7th life of child all specialists, including dentists, bring in the records in the individual card of development. Participation of dentists must foresee filling of point 10: “Amount of the erupted second teeth, presence of caries and degree of his activity (I, II, III), state of bite, state of paradontium and hygienical index”.
The dentist takes part in the centre system of children health with the chronic diseases of internals and systems in connection with that high prevalence and intensity of both caries and anomalies of bite, diseases of regional paradontium, defects of development of jaws and person concernes at them.
The centre system health foresees the planned prophylaxis of dental diseases in all age-old period recognition individual features of the common state of health of child and dental status.
To put preschool age, which do not visit children’ establishments, is served in children’ dental establishments, where a selection and forming of groups of clinical supervision is carried out. The centre system of the organized children’ collective health is conducted during planned sanation of cavity of mouth in children’ preschool establishments.
By criteria for grouping of children with the purpose of clinical supervision there must be the state of health, estimated after a presence or absence of chronic diseases with the protracted motion and degree of weight of violations of functional possibilities of organism:
I group are healthy;
II group are healthy with functional and some morphological rejections. To put it, which carried the disease or trauma, have the rejection of physical development, mionectic immunological reactivity (frequent sharp diseases), violation to sight of weak degrees;
III a group is patients with the chronic diseases at the maintainance mainly of functional possibilities of organism (the state is compensated); persons which have some disfigurations;
IV a group is patients with the chronic diseases (with the protracted motion) or to put with disfigurations, defects of development, consequences of traumas, with the decline of functional possibilities of organism (subcompensated state);
V a group is heavy patients with the bed mode (decompensated state).
The large value has the selection of groups with the boundary state are “risk factors” — changes of physiology functions, when the diagnosis of disease can not be put.
The centre system health in children’ stomatological establishments must be conducted stage-by-stage. The first stage is planned sanatsіya, second is passing to the centre system health, third, is a prophylaxis in the system of the centre system health, fourth is rehabilitation in the system of the centre system health.
The main task of the first stage is the complete scope by sanation of cavity of mouth of all child’s population served by a policlinic. Concept sanation of cavity of mouth includes treatment of not complicated and complicated teeth, caries of teeth, treatment of diseases of fabrics of paradontium and mucus shell of cavity of mouth, which are not subject to treatment of caries.
Got a doctor given during a review and sanation of cavity of mouth there is basic for forming of clinical groups of supervision and drafting of plan of the centre system of children health iext years, and also for drafting of the program of prophylactic work on an area. At a primary review in a child to the dental policlinic, in the room of healthy child, in the junior group of preschool establishment on every child the card of clinical supervision is led (form № 30). The diseases of period of pregnancy of mother, period of new-bornness, pectoral age is taken into account in history of development of child (clinical supervision). Antenatal period, the period of new-bornness and pectoral age is major for forming of hard fabrics of baby teeth.
To history of development of child (clinical supervision) of children 3—6 years bring information about frequency of chronic diseases of child, note about the group of health, take into account factors which can influence on forming of bite and structure of hard fabrics of the second teeth.
To the children of preschool age in history of development (clinical supervision) the group of health, presence of chronic diseases of internals and systems, information, concernes about development of the endocrine system. During the centre system of children health in different age-old periods a doctor pays the special attention to the exposure of initial signs which are instrumental in forming of that or other pathological process in the cavity of mouth.
Upon termination of sanation of cavity of mouth it is necessary to distribute children on groups for the subsequent clinical supervision.
T. Vinogradova (1988) suggests to make such clinical groups in different age-old periods.
To put under age 4 years is distributed on three groups: 1 are healthy children; 2 are healthy children with the factors of risk of development of dental diseases; 3 — to put, that have the dental diseases (defects of odontogeny, jaws and person, teeth, tumor of maxillufacial area); to put, which carried the trauma of maxillufacial area, odontogenic and hematogenous osteomyelitis of bones of person.
To put by age 4—6 years is distributed on such groups: 1 are healthy children and to put from And degree of activity of caries; 2 — to put with the II degree of activity of caries; to put with the anomalies of bite, which are formed, and factors of risk of their origin; 3 — children with defect and caries of different degree of activity odontogeny; to put with the paradontal syndrome of somatopathies, relapsing aphthae of mucus shell of cavity of mouth, anomalies of bite, which need apparatus treatment; such which carried the operations concerning tumors (before the removal from an account at a surgeon).
To put by age 6—15 years is distributed on three groups: 1 are healthy children; to put from And degree of activity of caries; to put with the gingivitis, conditioned by unhygienic maintenance of cavity of mouth, off-grade stopping and other local factors; to put, which have the anomalies of structure of bridles of lips and language; 2 — to put with the II degree of activity of caries; to put with gingivitis, by the conditioned anomalies of bite of, which need orthodontics treatment; 3 — to put with the chronic diseases of internals (4—5th is the groups of health); with the II degree of activity of caries, noncommunicative paradontitis, by a paradontal syndrome and parodontosis, demineralization and other defects of odontogeny; to put, that are on an apparatus and orthodontics treatment.
The task of the second stage is passing to the centre system health. This stage foresees application of facilities of primary prophylaxis of caries, expansion of arsenal of facilities and methods of the second prophylaxis of caries, expansion of contingent of children, that the centre systems health is subject. A doctor-dentist decides these tasks jointly with paediatricians in all age-old periods. The terms of clinical review depend on belonging to the certain clinical group: 1st clinical group — I one time in a year, 2nd — 2 times, 3d — 3 times per a year.
Expansion of contingent of children must go above all things due to bringing in of children of age to I year, then from 1 year to 3 years and under-fives which do not visit children’ preschool establishments. For effective introduction the programs of primary prophylaxis are needed, that every child to 1 year was examined by dentist. In this time there can be the removed defects of development of fabrics of tooth and the measures of primary prophylaxis of caries are appointed. In age from 1 to 3 years in the jaw of child there is forming of the second teeth and that is why setting to him of facilities which promote resistance of organism to the caries, provides terms for valuable remіneralіzation of the second teeth. The important value in this age is acquired by forming of skills of the proper care of cavity of mouth.
The third stage is a prophylaxis in the system of the centre system health — includes the implementation of group and individual prophylaxis taking into account the group of health of child, his physical development and state of cavity of mouth.
Group prophylactic measures are conducted at the children of midchildhood preschool. They are carried out in a school dental cabinet, in the special cabinet of hygiene of cavity of mouth or in the apartment of school, selected for prophylactic measures.
An individual prophylaxis foresees clinical maintenance of children on district principle.
Fourth stage is rehabilitation in the system of the centre system health — is carried out on principle of division of the inspected contingent of children after primary research on three basic groups: 1 are healthy; 2 are healthy, but with the factors of risk of origin of disease; 3 are persons which have the disease and pathological processes are formed.
as. Vydoinyk O.Y.
