ELEMENTAL CONTENT - GENERAL AND ORAL HEALTH OF CHILDREN.

Aim of study - to determine the composition of the essential macro and microelements in the hair and dental hard tissues and to study the influence of their imbalance on the general and dental health of the child. To assess the state of dental hard tissues, 375 children aged 3 to 12 years were randomly examined in Batumi. Monitoring of the examined children was carried out using standard indices provided by the World Health Organization. To determine the composition of the chemical elements in hair and dental hard tissues, according to the caries status 48 children were chosen from the examined 375 children. We used X-ray fluorescent spectroscopy method to study the qualitative and quantitative content of the chemical elements in the hair and dental hard tissues. The comparative analysis of the dental experience (dmft/DMFT) and the composition of chemical elements in dental hard tissues showed a statistically significant difference depending on caries status. The effect of some essential elements on the general health of the child has also been identified. The study into the composition of the essential macro and microelements in the hair and dental hard tissues revealed a high coefficient of correlation both with the mineralization of dental hard tissues and with the general health of the growing body.

[CHANGES OF SALIVARY CORTISOL LEVELS IN CHILDREN WITH CHRONIC GINGIVITIS].

Periodontal diseases are widespread in children and adolescents. By the information of World Health Organization, 80% of children have different degrees of inflammatory periodontal diseases, that often develop from the ages of 10-11 years. Pathology of periodontal tissues is developed when there is a disproportional growth and development of tissue structure, as within the system, also in the systems and structures that provide entire organism, which itself supplements the development of periodontal diseases in juveniles. Harmonious development of children and adolescents is, on a certain level, dependent on the proper functioning of endocrine system, the functional state of which is judged by the hormones it produces, specifically cortisol. The goal of our study was to determine the level of salivary cortisol in children during puberty, also reveal the connection between the hormonal disbalance and the periodontal tissue pathologies. To achieve this, we have studied 50 students of age 11-16 years. To assess periodontal tissue state we used clinical-instrumental and roentgenologic methods, while the salivary cortisol levels were determined by the enzyme-linked immunosorbent assay (ELISA) method. Tests showed the connection between the hormonal disbalance and ongoing pathologic processes in periodontal tissue, more specifically, in children with high salivary cortisol levels, in the study group (average in males 2.29, in females 2.22) majority (67%) had severe forms of inflammatory periodontal diseases, which gives us a ground to conclude that in juveniles with the inflammatory periodontal diseases, functional reserve of adrenal gland is diminished.

INHALATION THERAPY BY RADON FROM TSKHALTUBO REGION IN CLINICAL AND BIOCHEMICAL STUDIES IN PATIENTS WITH PERIODONTITIS.

The study of clinical and biochemical processes in the oral cavity determined changes in the entire biochemical spectrum of the oral cavity in 132 patients aged 20-40 years with various forms of periodontitis. Similar follow-ups were divided into three groups in the main group with mild to moderate severity of periodontitis with a 10-day intake of radon, 43 patients were united into the control group with no pathological changes in periodontal tissue however. Inhalation and rinsing with radon-containing water causes a decrease in LDH levels in the oral cavity. In patients with mild severity it decreased by 1.29 times, and with moderate severity - by 1.16 times in the main group. The difference is statistically significant (p<0.01). which leads to a decrease in oxidative processes in the oral fluid and the restoration of the fermentation spectrum. As it is known, lactate hydrogenase is an indicator of anaerobic processes and, amylase change and the oral cavity PH, as well as the development of different forms of severity of periodontitis. In our case, the treatment with Tskaltubo water as an antioxidant medicine levels all these processes. Only in case of rinses with water of Tskaltubo, these changes are less pronounced, and in case of both inhalation and rinses they are more pronounced.

[EPIDEMIOLOGICAL CHARACTERIZATION AND PATHOGENETIC PECULIARITIES OF DENTAL CARIES IN ADOLESCENTS].

The goal of this study was to determine the spread and intensity of dental caries in the adolescents and study the characteristics of damage to create the unified method of prognosis and development risk level of the aforementioned pathology. Impact of risk factors on the mineralization of hard tissue of tooth was studied in the 381 adolescents aged 11-16. The study found that dental caries spread among the research group was high, with the 77.9% (p>0,005), and the intensity was between average (DMFT=2,3). An analysis of the differences between values of the average caries intensity and the SIC index (Significant Caries index) in relative terms showed that minimal differences were observed in adolescents 12-13 years old (1.4 times), and maximum differences in 15-16 years old (2.5 times). Among local risk factors that induce demineralizing processes of hard tooth tissues in all age groups, poor oral hygiene (86.5%) and dental anomalies (56%) are the most significant, whereas among general risk factors, the hormonal state of juvenile age (27.2%) is of primary importance. Thus, the assessment of the role and significance of common and local risk factors of the development of dental caries, considering age, will allow organizing their early prevention mechanisms and selection of the most appropriate and optimal treatment method.

[THE ROLE OF ESSENTIAL MACRO- AND MICROELEMENTS IN THE DEVELOPMENT OF SOMATIC AND DENTAL DISEASES].

The purpose of our study was to monitor the prevalence and intensity of dental caries, to establish the relationship between general and dental health and the content of essential macro- and micronutrients in the hair and teeth of children and adolescents. A comprehensive epidemiological study was conducted according to the WHO methodology in 375 children aged 3 to 12 years. It was revealed that the prevalence of dental caries increases with age and amounts to 79.6% at the age of 3-6 years, with an intensity of 5.8; at 7-9 years old - 89.5% with DMF + DF - 6.3; at 10-12 years old - 95.6% with a DMF of 5.2. To establish the relationship between general and dental health and the elemental composition of the body in 47 children, the content of essential macro - and microelements was revealed in the hair and dental hard tissues. The established regularity of the content of chemical elements allows us to assume that elemental homeostasis has a significant effect on the human body, which may be impaired by inadequate supply or incompatibility of the elements. Determination of macro - and micronutrients in hair and teeth is an integrative test in the diagnosis of human health.

COMPLEX STUDY OF MEDICINAL PROPERTIES OF RADON IN MINERAL WATER OF TSKALTUBO AND ORAL CAVITY MINERALIZATION RECOVERY IN PATIENTS WITH PERIODONTITIS.

Supersaturation of hydroxyapatite is very important in order to preserve the homeostasis of mineral metabolism in the oral cavity. This indicates to the ability of saliva to preserve the homeostasis of the tooth tissues. So it is very important to use inhalations and rinses with Tskhaltubo mineral water. It is the alpha radiation of radon contained in the water of Tskhaltubo that plays a very important role in the regulation of inflammatory processes and the preservation of homeostasis of the oral cavity. A lot of works have been published lately proving that these doses are characterized by the so-called "hormesis", so the object of our interest is to determine the mechanism of radon hormesis and its effects on preserving the homeostasis of mineral metabolism in the oral cavity. Inhalation with mineral water of Tskhaltubo and its use for rinsing in case of parodontitis leads to decrease and ultimately elimination of the developed inflammatory processes. Tests were conducted on 150 volunteers, 120 of which were sick and 30 were practically healthy (control). As a result of the research it was established that inhalations with mineral water of Tskhaltubo and its use for rinsing in case of parodontitis leads to decrease and ultimately elimination of the developed inflammatory processes of the oral cavity. The unique properties of the mineral water of Tskhaltubo are an important component of the treatment of parodontitis at the initial stage of the disease.

[BIOSUBSTRATES AS DENTAL HEALTH INDICATORS IN SCHOOL-AGE CHILDREN].

Lack of essential elements can lead to the development of general and dental diseases. To assess the level of microelements in the human body, the most informative biosubstrates are hair and dental hard tissues, in which the chemical elements are concentrated and fully reflect the quality of essential elements. We examined 34 6-12 years-old children to study the content of essential elements in biosubstrates, as in dental health indicators (in the period of formation and mineralization of most permanent teeth). The analysis was carried out by the X-ray fluorescence spectroscopy method. We studied 8 essential (Ca, Zn, K, Fe, Cu, Se, Mn, Cr) and 9 conditionally essential (S, Br, Cl, Co, Ag, V, Ni, Rb, Mo, Sr, Ti ) chemical elements in hair, and in the teeth - four essential (Ca, Zn, Mn, Fe) and three conditionally essential (Rb, Ni, Sr) trace elements. According to the study, in pupils, with compensated form of caries, was found minimal lack of essential chemical elements with the norm, and in children with decompensated form of caries - significantly low level of essential elements. In particular, the analysis of hair with the X-ray-fluorescence spectrometry method in second group children showed a significant lack of: Ca (0.8 times), Zn (1.2 times), K (1.5 times) Mn (1.8 times), etc. The low content of calcium (259025 ± 35224 ppm), iron (98.59±39.72 ppm), manganese (11.55±7.7ppm) was reported to be relatively low (p<0.05) in dental hard tissues. The exception was the zinc - its number exceeded the established norm by 28.1%, which should be explained by the fact that the zinc reduces the enamel penetration, and thus, transition of chemical elements from saliva to dental hard tissues. Thus, our study has showed that the composition of micro and macro elements in hair and dental hard tissues can be used as indicators of mineralization of dental enamel, dentine and alveolar bone. According to our results dental health changes are associated with the imbalance of chemical elements in biosubstrates.

Dental Diseases and Intestinal Dysbiosis Among Children.

OBJECTIVES: The goal of the present study correlates dental hard tissue mineralization, mucosal pathologies in the oral cavity and different degrees of intestinal dysbiosis. STUDY DESIGN: the study examined two groups: the study group (Group I) included 229 children and adolescents aged 1-17 (mean age 5±1years) with oral pathologies (caries, acute or chronic candidiasis) and confirmed dysbiosis of varying severity and stages as well. Group II (the Control Group) was composed of 50 patients aged 1 - 16 (mean age 5±1years) with oral pathologies but with no detected changes in gastrointestinal (GI) flora. Dental caries were examined by DMFT-index; the extent of dental hard tissue mineralization by vital staining (2% methylene blue) and cases of oral candidiasis was investigated by taking cultures from mucosal plaques. RESULTS: on the basis of the research outcomes the correlation between the different degrees of GI dysbiosis and dental hard tissue mineralization with pathologic expressions in the oral cavity was found. Group I was divided into two subgroups: in the first subgroup that suffered from mild dysbiosis (I and II degree) moderate dental caries was revealed, whereas in the second subgroup with III and IV degree of dysbiosis-high levels of dental caries was detected. In Group II (no GI flora disturbances), the dental hard tissue demineralization indicator was minimal; in children aged 1-3 years the incidence and prevalence of caries were low and increased with age, reaching higher values during puberty (11-16 years). CONCLUSION: It may be concluded that dysbiosis of GI microflora influences on a degree of dental hard tissue demineralization, which in turn may predispose to the formation of dental caries.

[MICROECOLOGICAL CHANGES IN THE INTESTINE AND ITS EFFECT ON THE CONDITION OF HARD TISSUES OF TEETH IN ADOLESCENCE].

On the background of microecological changes in the gastrointestinal tract, mineral and protein metabolism is disrupted, biochemical changes occur in the phosphorus-calcium metabolism in the bones of the skeleton and hard tissues of the teeth. The aim of the research was to study the activity of the caries process, characterized by progressive decalcification, under conditions of microecological changes in the intestine and its effect on the processes of endogenous calcium assimilation in adolescence. Within the frames of the research 68 adolescents aged 11 to 17 years with various degrees of pathology of the gastrointestinal tract were examined. The data of the performed studies showed that in patients with more severe changes in the intestinal micro flora, the prevalence and intensity of dental caries are significantly higher (83.4% on average DMFT 5.0) than in adolescents with mild dysbiosis (71.8% DMFT 3.2% ), and in the patients with normal intestinal micro flora - the parameters were minimal. Estimating and comparing the interrelation between the incidence of caries and the presence of diseases of the gastrointestinal tract in adolescents, a directly proportional dependence of the DMF index on age was found, but the greatest increase in the individual level of incidence of dental caries (SIC) was observed in adolescents aged 14-16 (SIC=0,42) with severe gastrointestinal pathology GIT. Thus, significant changes in dental status detected in adolescents with pathology of the gastrointestinal tract confirm the validity of complex treatment and preventive dental care, considering the processes occurring in the body and the oral cavity, as well as the systematic, purposeful dental care and the allocation of patients with gastrointestinal pathology (GIT) in a separate group.

Primary Teeth and Hair as Indicators of Environmental Pollution.

OBJECTIVES: To study the influence of environmental pollution on the mineralization of dental hard tissues by using biosubstrates: teeth and hair. : STUDY DESIGN: At the first stage epidemiological survey was conducted in polluted and less polluted areas of Tbilisi (Georgia). We studied 525 children aged 3 and 4 years. Caries prevalence and intensity was defined by the methodology of World Health Organization. At the second stage the chemical elements content was studied in hair and teeth hard tissues of 24 children by X-ray fluorescent spectroscopy method. RESULTS: The prevalence of dental caries in the polluted region was 46%, caries intensity--1.92 (± 2.842). In the less polluted region prevalence was 37%, caries intensity--1.47 (± 2.571). These data are statistically reliable (p < 0.05). The study of hair and tooth tissues showed that the toxic elements (Pb, Hg, Sn, Ti) content in these tissues was higher in environmentally unfavorable than in favorable conditions. CONCLUSION: Hair and dental tissues can be used as indicators of environmental pollution. Our survey showed that toxic elements content in dental hard tissues was higher and the level of essential elements was less in polluted than in less polluted areas of Tbilisi.

[Dysbiosis and its consequences on oral cavity in children and adolescents].

Gastrointestinal tract (GIT) diseases in children are often accompanied by changes in oral cavity, which is caused by common function of GIT and oral cavity organs. During last years, the number of dysbiosis of various severities has dramatically increased, which directly affects the oral cavity - dental hard tissue mineralization, especially in children and adolescents. The aim of our study was to identify the frequency of dysbiosis in children and adolescents and its influence on dental and general health. 279 patients aged 1 - 17 years were examined. Examinations have shown, that in patients with I-II degree dysbiosis spread and intensity (DMF index) of dental caries is significantly lower - 58,2% and 2,7 intensity, compared to III-IV degree dysbiosis, where 71,8% have caries with 4,2 intensity. According to this, dental and general health status in children and adolescents is highly dependent on severity of GI tract pathologies, particularly on qualitative and/or quantitative content of microbyotes of GI tract.

[The elemental composition of teeth hard tissues depending on the state of the environment].

At present, great attention is paid to the origin of man-made micro elemental anomalies. To monitor the state of the environment and its effects on the human body, of great importance is the determination of the amount and distribution of various chemical elements in the dentin and enamel of the teeth. To determine the essential (Ca, Zn, Mn, Ni), conditionally essential (Rb, Ni, Sr) and toxic (Pb, Hg) trace elements in the mineralized tissues of the teeth and to identify the relationship between the elemental composition of the tooth structure and the state of the general and dental health depending on the state of the environment, we have examined 29 children aged 3-4 years who have carried out analysis of hard tissue of teeth (teeth used for remote medical reasons) for the maintenance of nine chemical elements. Children living in a relatively environmentally favorable conditions essential value and conditionally essential elements in the mineralized tissues of the teeth were within normal limits, and toxic elements slightly increased limits that differ from those of children living in environmentally disadvantaged areas. In particular, these essential elements were significantly reduced (except for zinc), as indicators of toxic elements - mercury and lead, increased by 12.5% and 44.5%, respectively, which is clearly reflected on the state of dental health because noted decompensated form of tooth decay. Thus, deviations in a state of general and dental health of children associated with an imbalance of macro-and microelements in the mineralized tissues of the teeth.

[The level of matrix metalloproteinases and type IV collagen in the gingival mucosa under different clinical forms of periodontitis in pre-and pubertal periods and their prognostic value].

The purpose of the study - the analysis of the prevalence and gravity of periodontal diseases among school adolescents and detection the relationship between the degree of periodontal tissues changes and the hormonal status of the prepubertal and pubertal periods. The total number of observations - 618 Tbilisi schoolchildren at the age of 9 to 17 years. Cohort group (n=50) was divided by age: 1) 9-13 years (n=26), 2) 14-17 years (n=24). The material for morphological and immunohistochemical study were the samples of periodontal tissues, received during the tooth extraction according the orthodontic testimony. The samples of the gingival mucosa was stained by hematoxylin and eosin, in the same samples the Matrix Metalloproteinases expression and activity were determined by immunohistochemistry using a primary antibody MMP-1 and MMP-2 ("Novocastra", UK). The results of immunohistochemical reactions were estimated in scores by semiquantitative method. For the detection of type IV collagen in basement membranes the samples were stained by the "Direct Red-80" ("Sigma"). It was found that the increase of Matrix Metalloproteinases expression and the type IV collagen degeneration in basement membrane depend on the age, particularly the expression of MMP-1 and MMP-2 in the period of 14-17 years (puberty) is upwards than in the group of 9-13 years. Studies have also demonstrated the clinical significance of Matrix Metalloproteinases ММР-1, 2 activity indicating the dissociation of the extracellular substance and type IV collagen in the assessment of severity and prognosis of periodontal complex pathology in pre-and pubertal periods.

[Correlation between the ecological risk factors and significant index of caries in young children].

The influence of eco-pathogenic factors on mineralization of teeth hard tissues at early age was studied in 525 young children, 3 to 4 of ages. Tooth caries index was detected according to the indexes provided by WHO (World Health Organization): prevalence, intensity (dmf) and Significant Index of Caries (SIC). The studies revealed that the average rate of dental caries for studied group living in regions with ecologically favorable conditions is relatively lower than in ones living in regions with unfavorable conditions and equals to 39.6% and 63.6%, respectively. Comparative analysis of average and significant indexes ​ of dental caries showed that the difference is minimal in children population living in favorable conditions (1: 1.7) in comparison with the children living in ecologically contaminated regions, where the significant index exceeds the average one approximately three times as much. According to the obtained results, it should be concluded that the dynamics of dental caries is mostly expressed in young children living in regions where air-pollution (with chemically aggressive substances) index several times exceeds the maximum allowable coefficient. Consequently, development and implementation of the special programs for caries-prevention in children population with low rate of caries-resistance, living in the above-mentioned conditions is of great importance.

[Periodontal tissue pathology in pubertal children (pupils)].

The study aimed at investigation of the rate of periodontal pathologies in juvenile adolescents, the analysis of the severity of the disease and detection of the correlation between the periodontal tissue pathology and hormonal status of pre-and pubertal periods. A stomatologic (dental) status of 618 pupils, 9-15 of ages in Tbilisi General Education Schools has been studied--to detect the rate and intensity of periodontal pathologies and analyze the influence of hormonal changes of juvenile periodontal tissues. According to the obtained results we can conclude that the high rate of periodontal diseases has been fixed in pre-pubertal and pubertal schoolchildren (pupils). It should be emphasized that the degree of periodontal tissue pathologies increases with age. In addition, the mentioned pathology was more frequently fixed and expressed in girls, 12-13 of ages and in boys, 14-15 of ages. Juvenile periodontal pathologies most frequently is generalized, which most frequently is aggravated with the existence of jaw-dental anomalies and the poor oral hygiene status.

Ultrastructural and molecular-biological features of inflammatory-destructive processes in pathology of parodontal complex in children.

In children aged 11-15. under mild and moderate stage parodontitis the ultrastracture and Citokeratines 10/13 and 14 expression in epithelial lining of oral mucosa were analyzed: 1. in gingival epithelia 2. in alveolar processes epithelia. 14 cases without sings of inflammation serve as control tissue. Total number of cases - 33. After informed consent had been obtained, simples of histological tissue specimens were collected on surgical extraction of the tooth. In the control group decision on the tooth extraction was taken for the orthodontic causes. Our data indicate that: 1. Heterogenity is typical to the oral cavity epithelium: a) Ultrastructural signs of keratinization and dissociation, with typical high activity of the terminal differentiation marker cytokeratin 10/13, predominate in the keratinocytes of gingival mucosa. b) Cells with signs of germination activity predominate in the ultrastructure of mucosa alveolar processes. Such cells express cytokeratin 14, typical to nonkeratinized epithelium. 2. Tissue architectonics as well as protein contents of cytoskeleton (judging by cytokeratine expression) are speared in the parodontal pathology in children, however in contrast to alveolar mucosa, damage to the microcirculatory vessels is more pronounced in gingival mucosa. 3. Expression of cytokeratines 10/13 and 14 may indicate the process of lysis and reparation of periodontal ligament.

[The impact of ecopathologic factors on the development of dental diseases].

Environment pollution is listed as the most significant problem of the 21st century. In cities throughout the world, long periods of heavy air pollution have caused increase of illness rates. Effect of air pollution on the dental status of children in Tbilisi, Georgia (Caucasus) was studied. The research was conducted on 311 children aged 3-4 according to the standard method of WHO (caries spread, intense cavities and non cavitated teeth decay). A high rate of dental cavities (approx 98, 9%) and 8 individual cases of non-cavitated pathology of hard tissue of teeth was encountered in Tbilisi. It was found that tooth decay does not depend on the quotient of air pollution; at the same time, ecological index considerably affects the data of intense dental caries: it is higher in those parts of the city, where the pollution of the environment is high (6,0% and 3,9% accordingly). The research shows that the increase of ecotoxins in the atmosphere can affect not only the organs and system of the human organism, but also appears to be a risk factor for future dental pathology.

[Content and metabilism of nitric oxide in substrates of oral cavity and their role in pathogenesis of periodontite disease].

Content and metabolism of free NO in saliva, fluids of periodontal pockets and gingival tissue has been investigated by EPR (electron paramagnetic resonance) method with the use of nitric oxide spin-trap in patients suffering from periodontitis. It was found that increased generation of nitric oxide at early stages of periodontitis is of protective nature. However, at serious disorders of mitochondrial respiration and exaggerated formation of generators of reactive oxygen, nitric oxide converts into citotoxic peroxinitrite leading to destruction of parodontal tissue; part of free nitric oxide produces FeSNO, which in turn, supports and decreases content of free NO in gingival tissue. As a result, decreases local antimicrobial protection, hemocirculation, tissue nutrition, progresses inflammation. Periodontitis decreases local immunity due to NO deficiency in gingival tissue. Reduced content of NO in gingival tissue decreases regeneration ability of cells, which in turn, leads to deterioration on gingival tissue.

[Efficient methods of prevention and treatment of permanent first molars before completion of root formation].

Examination of first molars among 124 children, age range 7-8 years, showed high intensity of caries disease. Detection and prevention of risk factors, also practical use of prevention and treatment methods existed in clinical stomatology, especially before completion of root formation of permanent teeth, is extremely important. Results showed that deep fluoridation of fissures of permanent teeth with enamel Hermetisation Liquid (A. Knappfost) is very effective method for preventing dental caries. Caries was reduced in 96% of cases. Cultivation of cavity with above-mentioned solution, right before restoration prevents reoccurrence of caries and pulpal complications that is very important for future growth and formation of roots of permanent teeth and for functional value of permanent teeth themselves.

[Some causes of systemic demineralization of dental solid tissues in children of early age].

Among the risk factors causing generalized demineralisation of dental solid tissues in young kids (disturbances during antenatal development of embryo, frequent sickness of infant, etc.) the most important factor is the type of breath feeding of infant. Such factors as the good balance of calcium and phosphor in mother's milk contribute to the maintenance of healthy dental tissues. As our data shows in majority of kids (98%) with artificial feeding type, calcium and phosphorus levels in the blood serum and their rate (<1.30) were decreased, along with that hydrogen ion concentration in oral fluids was also decreased. All above mentioned has influence on physical-chemical reactions occurring in tooth enamel, increases enamel penetration and reduces buffer characteristics of oral fluids. Those problems are especially important for Georgia, where the level of fluoride in the drinking water is very low (0.35-0.45 mg/l).