Stanje oralnog zdravlja u dece obolele od dijabetesa melitusa tip 1 u Crnoj Gori

Abstract

Uvod: Šećerna bolest se zbog svoje velike rasprostranjenosti, komplikacija do kojih dovodi i relativno skupe i kompleksne terapije, sasvim opravdano smatra ozbiljnim zdravstvenim problemom. Dijabetes mellitus je najčešći endokrini poremećaj kod dece. Osim retkih izuzetaka deca najčešće obolevaju od insulin zavisnog dijabetesa (tip I). Posebno je značajan efekat ove bolesti na oralno zdravlje, a koji se odnosi na tkiva parodoncijuma i karijes zuba. Promene na parodoncijumu variraju od gingivitisa do teških formi parodontopatija. Kod obolelih je primećena sklonost ka gubitku pripojnog epitela i nastanku parodontalnih džepova kao i nešto brža destrukcija alveolarne kosti. Obolenja parodoncijuma su 1993.g. identifikovana kao šesta komplikacija dijabetesa, a 1997.g. su uvrštena kao jedno od patoloških stanja dijagnostifikovanih kod ovih bolesnika ( Expert Commitet on the Diagnosis and Classification of Diabetes Mellitus ). Crna Gora ima najveću incidenciju dijabetes mellitusa tipa 1 na Balkanu kod dece ispod 14 g., i u stalnom je porastu. Ciljevi istraživanja. Glavni cilj istraživanja je utvrđivanje stanja oralnog zdravlja dece obolele od dijabetes mellitus-a tip I u Crnoj Gori, a koji se odnosi na: utvrđivanje rasprostranjenosti karijesa stalnih zuba, strukture KEP-a, stanja oralne higijene, salivarnog i mikrobiološkog statusa obolele i zdrave dece, utvrđivanje stepena metaboličke kontrole na sve predhodno navedene parametre kod obolele dece i na kraju, na osnovu dobijenih rezultata, predložiti plan preventivnih mera, kojim bi se omogućilo unapređenje oralnog zdravlja kod dece obolele od šećerne bolesti. Materijal i metodologija istraživanja.U istraživanje je bilo uključeno 177 pacijenata uzrasta 10 -15 godina, oba pola podeljenih u dve grupe. Prvu grupu D, njih 87, činila su deca obolela od dijabetes mellitus-a tip I. Drugu, kontrolnu grupu K, njih 90, predstavljala su zdrava deca. U istraživanje su bila uključena samo ona deca čiji su roditelji svojim potpisom dali saglasnost. Sva deca koja su učestvovala u istraživanju pregledana su standardnim stomatološkim dijagnostičkim sredstvima na suvim zubima, pri veštačkom osvetljenju na stomatološkoj stolici. Status zuba je registrovan pomoću Klein Palmerovog siastema u skladu sa kriterijumima i metodologijom SZO. Za određivanje oralne hgijene primenjivan je Plak Indeks po Silness-Loe-u i Indeks zubnog kamenca po Green-u, a za kliničku procenu stanja gingive primenjivan je Loe-Silness-ov indeks. Procena stanja parodoncijuma registrovana je primenom CPI Indeksom (Community Periodontal Index) i merenjem nivoa pripojnog epitela (NPE). Salivarni status je podrazumevao količinu izlučene stimulisane pljuvačke i puferski kapacitet pacijenata koji je određivan gotovim fabričkim testovima Dentobuff Strip Sistem (Orion Diagnostica, Espoo, Finland)...

Introduction: Diabetes is due to its high prevalence, complications that may occur relatively expensive and complex therapies, quite rightly considered a serious health problem. Diabetes mellitus is the most common endocrine disorder in children. Apart from rare exceptions, children frequently suffer from insulin-dependent diabetes (Type I). An especially important aspect is the effect of the disease on oral health, which refers to the periodontal tissues and tooth decay. Changes in periodontal tissues range from gingivitis to severe forms of periodontal disease. These changes are observed in patients with a tendency to loss of epithelial attachment and the development of periodontal pockets and a slightly faster destruction of the alveolar bone. Periodontal diseases, which occurred in 1993, are identified as the sixth complication of diabetes, and periodontal diseases in 1997 are included as one of the pathological conditions in these patients diagnosed (Expert Committee on the Diagnosis and Classification of Diabetes Mellitus). Montenegro has the highest incidence of Type I diabetes mellitus in the Balkans in children under the age of 14 years and this is constantly growing. The objectives of the research:The main aim of this study was to determine the oral health status of children with diabetes mellitus type I in Montenegro, which is related to: establishment of permanent tooth caries, the structure of the EPC, the state of oral hygiene, salivary and microbiological status of patients and healthy controls, determining the degree of metabolic control on all previously mentioned parameters in infants and in the end. Based on the results, a proposed plan of preventative measures would allow improvement of oral health in children with diabetes. Materials and methods:This study includes 177 patients aged 10 -15 years, of both sexes which were divided into two groups. The first group D, consists 87 subjects, made up of children with diabetes mellitus type I. Second, the control group K, contains 90 subjects, was represented by healthy children. The study involved only those children whose parents have signed their consent. All the children who participated in the study were examined by standard dental diagnostic tool to dry the teeth, the artificial light in the dental chair. Status tooth is registered with Klein Palmer’s system according to WHO criteria and methodology. To determine the oral hygiene applied plaque index by Silness-Loe-index and the dental calculus on the Green, a clinical assessment of the gum was applied by Loe- Silness's index. Assessment of periodontal disease was registered using the CPI (Community Periodontal Index) and by measuring levels of epithelial attachment (DEA)...