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Prokopov AA, Sribnaya EA, Privalov VI. Preliminary study of oral fluid by 1H and 13C NMR spectroscopy.
Endodontics today. 2016;№ 3:3-8.(In Russ.).]
14.
Митронин А.В., Дарсигова З.Т., Прокопов А.А., Алиханян А.С., Дашкова О.П.
Рентгенофлуоресцентный анализ зубов в норме и при эрозии.
Эндодонтия today.
2017; № 3:7-13.
[Mitronin AV, Darsigova ZT, Prokopov AA, Alikhanyan AS, Dashkova OP. X-ray fluorescence analysis of
teeth in normal and eroded conditions. Endodontics today. 2017; № 3:7-13.(In Russ.).]
УДК: 616.314-002.4:616.329-009.12-550.42
ОЦЕНКА РАСПРОСТРАНЕННОСТИ И ИНТЕНСИВНОСТИ КАРИЕСА У
ПАЦИЕНТОВ С ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНЬЮ
.
Ольга Бекжанова
1,a
,Севара Алимова
2,b
,Муниса Астанакулова
3,с
1
д.м.н. профессор, Ташкентский государственный стоматологический институт
2
ассистент, Ташкентский государственный стоматологический институт
Ташкент, Узбекистан
a
bekjanovaolga@mail.ru,
b
sevara_36@mail,
с
munisa.suyunova@mail.ru.
ASSESSMENT OF THE PREVALENCE AND SEVERITY OF CARIES IN PATIENTS
WITH GASTROESOPHAGEAL REFLUX DISEASE
Olga Bekjanova
1,a
, Sevara Alimova
2,b
, Munisa Astanakulova
3,c
1
Doctor of Medicine, Professor, Tashkent State Dental Institute
2
Assistant, Tashkent State Dental Institute
Tashkent, Uzbekistan
a
bekjanovaolga@mail.ru,
b
sevara_36@mail,
с
munisa.suyunova@mail.ru.
ГАСТРОЭЗОФАГЕАЛ РЕФЛЮКС КАСАЛЛИГИ БОР БЕМОРЛАРДА КАРИЕС
ТАРКАЛГАНЛИГИ ВА ЖАДАЛЛИГИНИ БАХОЛАШ
Ольга Бекжанова
1,а
,Севара Алимова
2,b
,
Муниса Астанакулова
3,с
,
1
т.ф.д. профессор, Тошкент давлат стоматология институти
2
ассистент, Тошкент давлат стоматология институти
Тошкент, Ўзбекистон
а
bekjanovaolga@mail.ru,
b
sevara_36@mail,
с
munisa.suyunova@mail.ru.
АННОТАЦИЯ
Исследование посвящено изучению особенностей клинического течения кариса у
больных с различными стадиями гастроэзофагеальной рефлюксной болезни. Результаты
комплексного клинического обследования подтверждают отягощающее влияние ГЭРБ на
течение кариеса зубов. Причем по мере прогрессирования гастроэзофагеальной рефлюксной
болезни и перехода ее от эндоскопически “негативной” в катаральную и матапластическую
стадии усугубляется тяжесть течения и интенсивность кариозного поражения.
568
Ключевые слова:
кариес зубов, гастроэзофагальгная рефлюксная болезнь,
интенсивность кариеса зубов, структура индекса КПУ.
ABSTRACT
The study is devoted to the study of the features of the clinical course of care in patients with
various stages of gastroesophageal reflux disease. The results of a comprehensive clinical
examination confirm the aggravating effect of GERD on the course of dental caries. Moreover, with
the progression of gastroesophageal reflux disease and its transition from endoscopically "negative"
to the catarrhal and metaplastic stages, the severity of the course and the intensity of carious lesions
are aggravated.
Keywords:
dental caries, gastroesophageal reflux disease, the intensity of dental caries, the
structure of the KPU index.
АННОТАЦИЯ
Тадкикот гастроэзофагеал рефлюкс касаллигининг турли боскичлари бор беморларда
кариес клиник кечишининг хусусиятларини урганишга багишланган. Кенг камровли клиник
текширув натижалари ГЭРК нинг кариес касаллигини кечишини огирлаштириши
тасдикланган.Бундан ташкари гастроэзофагеал рефлюкс касаллигининг жадаллашиши ва
эндоскопик “манфий “дан катарал ва матапластик боскичга утиши кариес жараенининг
интенсивлигини ва огирлик даражасини кучайтиради.
Калит сўзлар:
тиш кариеси, гастроэзофагеал рефлюкс касаллиги,кариес
касаллигининг интенсивлиги, КПУ индекси.
SUMMARY
The aim of the research was: To study the incidence of dental caries in patients with
gastroesophageal reflux disease in terms of prevalence and intensity.
When distributing patients with GERD, the clinical and endoscopic classification of GERD,
adopted at the IX European Gastroenterological Week in Amsterdam (2001), was taken into
account.
A high activity of the course of caries was established in patients with GERD: a
decompensated form of caries was found in 64.60 + 2.38% of patients versus the occurrence in
26.67 + 3.62% (P ≤ 0.05) of patients in the control group; in the absence of statistical differences in
the frequency of the sun compensated flow, which was, respectively, 30.94 + 2.30% versus 40.00 +
4.00% (P ≤ 0.05); against the background of a significant decrease in the frequency of the
compensated course - 4.46 + 1.03% versus 33.33 + 3.85% (P ≤ 0.05) in the control group. A detailed
analysis made it possible to establish a statistically significant increase in the prevalence of
decompensated and a decrease in the prevalence of a compensated course with an increase in the
severity of GERD.
Examination of patients with different variants of the course of GERD showed a high
(according to WHO criteria) intensity of dental caries. At the same time, the structure of the KPU
index is dominated by carious - element "K" and removed - element "U" teeth. A statistically
significant increase in the prevalence of decompensated and a decrease in the prevalence of
compensated caries with an increase in the severity of GERD was established.
Based on the study of the structure of the "K" element, a relationship was established between
the severity of carious lesions and the clinical course of GERD: with an increase in the severity of
clinical manifestations, the absolute values and specific gravity in the structure of the "K" element
of such nosological units as initial and stopped caries against the background of an increase in
absolute values and specific weights of dentine caries and cement caries
The number of patients with gastroesophageal reflux disease (GERD) is steadily growing from
year to year, and the number of patients with dental manifestations of GERD is also increasing [3,6].
569
Dental caries is the most common disease, occupies the first place in the structure of nosology
of general morbidity [1,2,4].
As you know, the state of the oral cavity organs serves as an informative indicator that
dynamically reflects changes in the state of the human div that reacts to their effects. [8.9]
In connection with the above, the purpose of these studies was: to study the incidence of dental
caries in patients with gastroesophageal reflux disease in terms of prevalence and intensity;
assessment of the need for pathogenetic therapy of dental caries in this contingent.
Materials and methods:
When distributing patients with GERD, the clinical and endoscopic classification of GERD
was taken into account, adopted at the IX European Gastroenterological Week in Amsterdam
(2001), within which the following were distinguished:
- non-erosive form of GERD (NFGERD), which occurs in about 60% of cases, it includes
GERD without signs of esophagitis and catarrhal reflux esophagitis;
- erosive and ulcerative form (EFGERD - 34–37% of cases), including its complications: ulcer
and structure of the oesophagus;
–Barrett's oesophagus (PB) (8–20% of cases) - metaplasia of stratified squamous epithelium
in the distal oesophagus into a cylindrical intestinal type, as a consequence of GERD. [5,7,10].
The number of examined and their distribution by sex and age is presented in Table 1.
Table 1
Age and sex composition of patients with gastroesophageal reflux disease
Age and
year
Control,
n=40
With NE
GRB
n=66
AGED
n=74
ROGER
n=78
PB
n=73
Total
n=391
Total
m
f
m
f
m
F
m
f
m
f
m
F
18-20
5
3
6
4
7
4
6
4
5
3
24
15
39
21-30
6
4
5
3
8
5
9
7
12
10
34
25
59
31-40
6
4
10
6
12
7
11
9
10
8
43
30
73
41-50
4
3
12
7
12
8
14
8
9
7
47
30
77
51-60
3
2
5
8
6
5
6
4
5
4
22
21
43
Всего
24
16
38
28
45
29
46
32
41
32
170
121
291
During the examinations, the following was taken into account: the prevalence of dental
caries - as the ratio of the number of persons with at least one of the signs of the manifestation of
dental caries (carious, filled or extracted teeth) to the total number of examined persons, expressed
as a percentage.
To assess the intensity of caries in permanent teeth, the following indices were used: KPU
index (s) - the sum of carious ("K"), filled ("P") and removed ("U") teeth in one patient.
Based on the nature of the intensity of the course of the disease, three forms of caries activity
were distinguished:
1. compensated (1 degree), when caries is in the spot stage for a long period, and does not
form a depression, or the formed carious cavity does not progress for a long time. This form can
also be called chronic.
570
2. subcompensated (grade 2), that is, the rate of development of the disease corresponds to
the average indicators for a particular age group. In other words, the classic form of caries.
3. decompensated (grade 3), characterized by rapid progressivity and generalization of the
lesion. Defined as an acute form of the disease.
For qualitative indicators, the number and percentage of patients were calculated for each
value of the indicator. For quantitative indicators, the mean, standard deviation, and standard error
of the mean were calculated. Comparison of the means for quantitative indicators was carried out
using the Student's t-test, then the value (P) was found - the probability of error. In our study, the
results were considered reliable at P≤0.05.
Results and discussion
As a result of mass examinations of patients with the different clinical courses of GERD and
persons of the control group, it was established that the prevalence of caries among the adult
population is 100.0%. As a result of the analysis of the KPU index, it was found that the intensity
of caries in the control group was 9.58 + 0.47 teeth affected by caries per one examined, while the
intensity of caries in patients with GERD was 14.18 + 0.65 teeth (P ≤ 0.01) ... At the same time, in
the structure of the CPU index in patients with GERD, carious teeth predominate: the average group
value of the element "K" (carious teeth) was 5.72 + 0.21 versus 2.06 + 0.08 (P ≤ 0.01) of teeth with
caries in the control group, on the contrary, patients with GERD had a significantly lower number
of filled teeth - element "P" 1.96 + 0.08 versus 4.04 + 0.12 (P ≤ 0.01) and a significantly higher
number of extracted teeth teeth - element "Y" - 6.50 + 0.31 versus 3.42 + 0.14 (P ≤ 0.01) (Tables
2.3). The revealed tendency was also traced in the analysis of the specific weight of individual
elements that make up the CPU index: in the structure of the CPU index of patients with GERD,
carious - element "K" and removed teeth - element "Y" prevailed; and in the control group, on the
contrary, the greatest specific weight was accounted for by the element "P" - filled teeth; the
corresponding ratios were - for the element "K" 40.34 + 2.44% versus 21.50 + 3.35% (P ≤ 0.01);
for the "P" element - 13.82 + 1.72% versus 42.17 + 4.03% (P ≤ 0.01) and for the "U" element,
respectively, 45.84 + 2.48% versus 36.33 + 3.92% (P ≤ 0.01) (Table 2). A similar trend of a higher
prevalence and intensity of caries in patients with GERD was registered in all studied groups of
patients.
table 2
The structure of the CPU index in patients with gastroesophageal reflux
disease and in the control group
Age and year
K
P
U
Index of KPU
Control group, n=150
18-24,
n=30
0,90±0,04/
29,80±8,37
1,22±0,06/
40,39±8,96
0,90±0,03/
29,80±8,35
3,03±0,14/
100,0
25-34
n=35
1,68±0,07/
28,92±7,66
3,04±0,13/
52,32±8,44
1,05±0,04/
18,7±6,50
5,77±0,25/
100,0
35-44
n=50
2,11±0,09/
20,19±5,68
4,59±0,18/
43,92±7,02
3,75±0,15/
35,88±6,78
10,45±0,51/
100,0
45-54
2,55±0,11/
7,82±0,33/
6,33±0,30/
16,7±0,77/
571
n=20
15,27±8,04
46,83±11,16
37,90±10,85
100,0
55-65
n=65
4,52±0,22/
24,55±11,11
4,86±0,21/
26,40±11,38
9,03±0,04/
49,05±12,91
18,41±0,88/
100,0
всего
2,06±0,08/
21,50±3,35
4,4±0,12/
42,17±4,03
3,42±0,14/
36,33±3,92
9,58±0,47/
100,0
GERB patients, n=404
18-24
n=66
2,78±0,12▪/
46,72±6,14
1,18±0,44/
19,83
1,99±0,07▪/
33,45±5,81
5,95±0,23/
100,0
25-34
n=82
3,68±0,15▪/
47,00±3,51
2,13±0,11▪/
27,20
2,02±0,09▪/
25,80±4,83
7,83±0,33/
100,0
35-44
n=170
6,86±0,25▪/
43,25±3,80
2,8±0,09▪/
13,75
6,82±0,31▪/
43,00±3,80
15,86±0,68/
100,0
45-54
n=6
8,69±0,41▪/
39,16±6,52
2,00±0,10▪/
9,01
11,50±0,44▪/
51,83±6,68
22,19±0,10/
100,0
55-65
n=30
5,71±0,23▪/
22,70±7,65
1,90±0,087▪/
7,55
17,54±0,82▪/
69,74±8,39
25,15±1,21/
100,0
всего
5,72±0,21▪/
40,34±2,44
1,96±0,06▪/
13,82±1,72
6,50±0,31▪/
45,84±2,48
14,18±0,65/
100,0
Note: the numerator is the absolute value; in the denominator - in% of the KPU index;
▪ - P <0.05 in relation to the control.
It is known that gastroesophageal reflux disease is often accompanied by pathological
changes in the hard tissues of the teeth. The leading link in the development of such syntropy is the
depletion of the buffer properties of the oral fluid, due to the throwing of acidic gastric contents and
bile acids into the oral cavity, which creates conditions for the development of pathogenic
microflora and promotes the demineralization of dental hard tissues, since their enamel begins to
lose surface calcium and phosphates. at pH below 6.2 [1.6.9]. Of no small importance are also the
violations of a number of regulatory mechanisms accompanying the pathological process: immune
imbalance, violation in the LPO-AOS system, changes in the metabolism of connective tissue,
mineral metabolism, and vitamin deficiency. The pathology of the digestive system, reducing the
nonspecific resistance of the div, contributes to the negative impact of the microflora in the oral
cavity on the hard tissues of the teeth. Thus, the pathology of the gastrointestinal tract is a risk factor
for the development and unfavourable course of chronic inflammatory diseases.
Table
4
Comparative analysis of the activity of the course of dental caries in patients
with gastroesophageal reflux disease
Activity K3
Control
group
Больные с ГЭРБ
In total
GERB
n=404
Non erosive
form n=175
Erosive form
n=126
Baretta’s
esophagus
n=103
572
n=4150
Compressed
(1
st
position)
50/
33,33±3,85
12/
6,86±1,91▪
6/
4,76±1,90▪
-
18/
4,46±1,03▪
Subcompensation
(2 nd position)
60/
40,0±4,0
65/
37,12±3,65
34/
26,98±3,95▪
х
26/
25,24±4,28
125/
30,94±2,30▪
Decompressed
(3 rd position)
40/
26,67±3,62
98/
56,0±3,75▪
86/
68,25±4,15▪
х
77/
74,76±3,87▪
хо
261/
64,60±12,38▪
Note: the numerator is the number of patients;
in the denominator - in% of the number of patients in the group;
▪ - P <0.05 in relation to control, X - P <0.05 in relation to NE GERD;
o - P <0.05 in relation to EF GERD.
Many different cariogenic factors are involved in the development of carious lesions in
patients with GERD. The dependence of the intensity of the course of dental caries on the presence
of different variants of the course of GERD in patients was revealed. The combination of constantly
acting influences in the oral cavity predisposes to the development of an active carious process.
With an unfavourable confluence, all these factors lead to the development of an initial carious
process, the activity of the course of which is largely determined by the severity of the appearance
of somatic pathology.
A high activity of the course of caries was established in patients with GERD: a
decompensated form of caries was found in 64.60 + 2.38% of patients versus the occurrence in
26.67 + 3.62% (P ≤ 0.05) of patients in the control group; in the absence of statistical differences in
the frequency of the sun compensated flow, which was, respectively, 30.94 + 2.30% versus 40.00 +
4.00% (P ≤ 0.05); against the background of a significant decrease in the frequency of the
compensated course - 4.46 + 1.03% versus 33.33 + 3.85% (P ≤ 0.05) in the control group. A detailed
analysis made it possible to establish a statistically significant increase in the prevalence of
decompensated and a decrease in the prevalence of a compensated course with an increase in the
severity of GERD (Table 4).
An important role in the systematization of various clinical forms of carious disease was
played by the International Classification of Dental Diseases, the third revision - ICD-DA, WHO,
1995 in the original [8] and translated into Russian: ICD-10C-1997. The World Health Organization
and the International Federation of Dentists (FDI) recommend that dental practitioners pay more
attention to preventive measures rather than restorations [8].
In accordance with modern concepts, the carious process develops as a result of a complex
interaction of general and local factors, which is realized in the system "microorganism - saliva -
enamel structure". Among the most significant local risk factors for caries in patients with GERD,
in addition to cariogenic microflora, including a violation of the composition and properties of
mixed saliva, the effect of bile acids, a decrease in the pH of mixed saliva, a violation of Ca P
balance, the presence of Helicobacter Pylori [5, 9, 10].
Despite a significant number of studies devoted to the problem of diseases of hard tissues of
teeth in patients with GERD, it is promising to study the relationship of systemic and local
pathogenetic mechanisms that determine the development of various diseases, as well as studies that
detail the system of diagnosis, prevention and treatment of hard tissues of teeth in this vast
contingent of patients.
573
The established high rates of activity of the carious process in patients with GERD require
an individual approach to the treatment of hard tissue pathology, taking into account the course of
the underlying disease.
Thus, the present study showed a high level of prevalence and intensity of dental caries, as
well as the predominance of extracted and carious teeth in the CPU index in patients with GERD,
which indicates the absence of a specially developed system for the treatment of hard tissues in this
large category of patients and the need to improve their dental help.
Conclusions:
1. Examination of patients with different variants of the course of GERD showed a high
(according to WHO criteria) intensity of dental caries. At the same time, the structure of the KPU
index is dominated by carious - element "K" and removed - element "U" teeth. A statistically
significant increase in the prevalence of decompensated and a decrease in the prevalence of
compensated caries with an increase in the severity of GERD was established.
2. Based on the study of the structure of the "K" element, a relationship was established
between the severity of carious lesions and the clinical course of GERD: with an increase in the
severity of clinical manifestations, the absolute values and specific gravity in the structure of the
"K" element of such nosological units as initial and suspended caries against the background of an
increase in absolute values decrease and the specific gravity of dentin caries and cement caries
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УДК: 616.131.14:616.13/14-008.853.6-612.112.93
ТУЧНЫЕ КЛЕТКИ И ГЛИКОЗАМИНОГЛИКАНЫ В СЛИЗИСТОЙ ОБОЛОЧКЕ
ПОЛОСТИ РТА ПРИ БОЛЕЗНИ БЕХЧЕТА
Даминова Н.Р.
Ташкентский государственный стоматологический институт,
доцент кафедры госпитальной терапевтической стоматологии
Ташкент, Узбекистан
Аннотация