CLINICAL ESTIMATION OF EFFECTIVENESS OF PREVENTIVE MEASURES, DIRECTED TO THE INCREASING OF ENAMEL RESISTANCE IN CHILDREN WITH MALOCCLUSION DURING TREATMENT WITH FIXED ORTHODONTIC APPLIANCES

Abstract

The usual hygienic status of the patient's oral cavity is disturbed during the treatment of malocclusion with fixed orthodontic appliances, especially in the first weeks of treatment, when the ratio of the components of the oral microflora changes, and the elements of the appliance become a source of accumulation of dental deposits with the appearance of new atypical retention areas for adhesion of dental plaque. The long-term preservation of those deposits contributes to the increase pH of dental plaque, which leads to enamel demineralization. In most cases, orthodontic treatment is carried out without considering the level of enamel resistance, the cariogenic situation in the patient's mouth, the microbial aspects of the mouth and the aggressiveness of dental plaque, the peculiarities of oral hygiene and the patient's psychological characteristics. Therefore, during orthodontic treatment for children with malocclusion, it is necessary to provide optimal conditions for the formation of resistant enamel to the carious process, by implementing a substantiated complex of differentiated preventive measures. The purpose of our research is to work out and clinically evaluate a complex of preventive measures with the aim to increase enamel resistance in children with malocclusion during treatment with fixed orthodontic appliances. Research methods. We analyzed the effectiveness of the proposed complex of measures in 53 children aged 12-15 years who were being treated with fixed orthodontic appliances with different levels of resistance. The children were divided into two groups: the main group and the control group. The main group included 27 children with malocclusion (15 children with caries-resistant enamel, 12 with conditionally resistant and caries-susceptible enamel); the control group consisted of 26 children with malocclusion (12 children with caries-resistant enamel, 14 with conditionally resistant and caries-susceptible enamel). The evaluation of the effectiveness of preventive measures was carried out on the basis of the analysis of indicators of the condition of the teeth hard tissues (the intensity of caries of the permanent teeth according to the DMF and ICDASII1-2 indices, TER values. Scientific novelty. In this study, it was revealed that increase of the caries intensity of the permanent teeth in the children of the main group with malocclusion and caries-resistant enamel was by 56.99 % lower, in the group of children with conditionally resistant and caries-susceptible enamel – by 62.01 % lower compared to the children of the control group after 24 months application of the proposed preventive complex and jbservation. It was established that in children with caries-resistant enamel and caries-susceptible enamel, the reduction of the increase in caries intensity in 12 months was 64.07 %, and after 24 months – 64.59 %, in children with conditionally resistant and caries-susceptible enamel – 55.38 % and 62.01 %. Carrying out preventive measures in accordance with the proposed scheme made it possible to increase the resistance of enamel, which was manifested by a decrease in the value of TER, in children of the main group with enamel resistant to dental caries, after 24 months – by 6.10%. On the other hand, an increase in TER values by 40.38 % was determined in children of the control group. In the children of the main group with condition-resistant and caries-susceptible enamel, after 24 months of observation, the TER value decreased by 28.00 %, while in the children of the control group, it increased by 51.59 %. Conclusions. The proposed complex of preventive measures for increasing of the enamel resistance in order to prevent caries of the permanent teeth in children who are being treated with fixed orthodontic appliance increases the resistance of enamel, and therefore can be recommended for implementation among patients of this group, especially among children 12-15 years old. An individual approach to the appointment of exogenous prevention will allow to increase the level of enamel resistance in children during orthodontic treatment with fixed appliances, thereby achieving a high anti-caries effectiveness of the complex.