DYNAMICS OF INDICATORS OF ORAL DYSBIOSIS IN CHILDREN WITH SPECIAL NEEDS ON THE BACKGROUND OF TREATMENT

Abstract

The problem of dental diseases in childhood and today remains one of the most relevant in modern dentistry, despite significant achievements in the study of etiology, pathogenesis, methods of diagnosis, treatment and prevention of lesions of hard tissues of teeth and inflammatory diseases of periodontal tissues. Special attention is required for children with special needs, in whom functional disorders of the nervous system, chronic somatic diseases, changes in neuroendocrine regulation and immunological reactivity of the body create prerequisites for the development of significant violations of the microecology of the oral cavity. Purpose of this study. To assess the dynamics of oral dysbiosis in children with special needs against the background of treatment by determining the activity of lysozyme and urease in the oral fluid. Materials and methods of research. The study involved 66 children aged 7 to 18 years, which were divided into two groups: primary (n = 31) ‒ children with special needs (cerebral palsy, Down syndrome, autism, various forms of mental retardation with mild, moderate or severe cognitive decline), had clinical signs of damage to hard tissues of teeth and inflammatory periodontal diseases (chronic catarrhal gingivitis or periodontal syndrome) and comparison group (n = 35) – children of appropriate age without systemic developmental disorders with clinically intact hard tooth tissues and periodontium or treated teeth. Results of the study and their discussion. Analyzing the digital data, it was found that before the start of treatment, the activity of urease in the oral fluid of children with special needs was significantly higher compared to the comparison group, which indicates a significant increase in the level of microbial contamination of the oral cavity and the development of dysbiotic disordersь. Conclusions. The use of the developed therapeutic and prophylactic complex, which included professional oral hygiene, dental sanitation in conditions of general anesthesia, the use of enzyme toothpastes, the local use of sorbent and anti-inflammatory drug, as well as calcium-containing gel, calcium citrate and probiotic, contributed to a significant decrease in the activity of urease and an increase in the level of lysozyme in the oral fluid. The most pronounced positive effect was observed 3 months after treatment. Under the influence of the measures taken, the degree of dysbiosis in children of the main group significantly decreased during the entire observation period, which indicated the normalization of the microbiological balance and the improvement of the state of local oral protection factors. Better treatment results were achieved in children with mild to moderate cognitive impairment, which was manifested by a more pronounced decrease in urease activity, higher lysozyme values, and a lower degree of dysbiosis throughout the follow-up period. The obtained results confirm the feasibility of an integrated approach to dental rehabilitation of children with special needs and indicate the need to individualize preventive programs depending on the level of cognitive capabilities of the child.