Orofacial myofunctional disorder characteristics in cerebral palsy and their treatment methods

Relevance. The variety of clinical manifestations of orofacial myofunctional disorders in cerebral palsy determines the need to improve diagnosis and treatment approaches. According to the authors, the planning of rehabilitation measures for children with cerebral palsy and orofacial pathology should be individual.Materials and methods. 120 children (mean age 8.7 years) with cerebral palsy and orofacial myofunctional disorders participated in the study with subsequent assessment of dental and neurological statuses during treatment, prevention and rehabilitation.Results. The study established correlations between general motor pathology, malocclusion and changes in the speech organs depending on the clinical form of cerebral palsy. Spastic dysarthria and anarthria were detected in 82 cases, age-appropriate speech and language development - in 38. Occlusion assessment revealed malocclusion in 88 subjects, neutral occlusion – in 32.Conclusions. Modern approaches to the treatment of malocclusion and orofacial myofunctional disorders in children with cerebral palsy allow increasing the effectiveness and quality of rehabilitation, organizing the sequence and continuity of specialist actions in a multidisciplinary rehabilitation team.

Sagittal expansion of the maxilla in an adult. A clinical case

Relevance. Skeletal Class III malocclusion is one of the most difficult to correct. Genetics, environmental factors, and postembryonic development influence its etiology. Sagittal expansion of the upper jaw will ensure the correct position of the lower jaw, which in turn will improve the patient's aesthetic parameters and health. The study examines a treatment method using the Fixed anterior growth guidance appliance (FAGGA).Materials and methods. This clinical case presents a 21-year-old male with skeletal class III due to maxillary bone deficiency. The patient refused surgery to increase the size of the upper jaw and opted for orthodontic treatment. The latter was performed using a Fixed anterior growth guidance appliance (FAGGA), followed by a rapid palatal (maxillary) expansion (RME) and brackets. We removed the FAGGA after eight months. The profile and occlusion improved.Results. The change in the inclination and protrusion of the maxillary incisors improved the profile. We received 2mm of space behind the upper right canine and 1.5mm of space behind the left one and the SNA angle increased by 2 degrees. The treatment continues with RME and brackets.Conclusions. An increase in inclination and protrusion of the maxillary incisors and a slight skeletal change improved the aesthetic parameters of the facial area.

Evaluation of the preventive care effectiveness in the adults with odontogenic infection given social and hygienic risk factors

Relevance. Odontogenic infection is one of the most important problems of dental science. The variety of anti-inflammatory oral hygiene products determines the need for targeted selection of preventive toothpastes and rinses, balms, foams, elixirs, as well as monitoring and training the algorithm of hygienic measures for a patient with an odontogenic infection. The aim of the study was to study the hygienic status of the adult population for the selection of individual oral hygiene products for odontogenic infection, taking into account social and hygienic factors.Materials and methods. The study examined the prevalence of odontogenic infection in the adult population to determine the need for professional care and dental education. The study involved 198 people without somatic pathology, who were allocated into four groups according to the performed oral care and taking into account the dental status and the intensity of oral microbiota formation in the adult population. The patients were followed-up every week for one month. The study examined the simplified oral hygiene index by GreenVermillion (OHI-S), PMA index and Mühlemann and Son sulcus bleeding index, which allowed calculating the effectiveness of oral care products.Results. The preventive care effectiveness evaluation showed an increase in the cleansing effect in the adult population over the entire study period. The anti-inflammatory effectiveness analysis demonstrated positive changes: by the end of the study, the PMA index was 51.52 ± 3.40% in group 1; it increased by a factor of 3 and amounted to 44.17 ± 2.77% in group 2; 56.51 ± 4.61% – in group 3, 48.95 ± 3.60% – in group 4. The Mühlemann and Son sulcus bleeding index demonstrated the changes in the periodontal tissue condition and amounted to 52.78 ± 3.62% in group 1, 44.11 ± 3.54% in group 2, 54.97 ± 3.98% in group 3, 47.78 ± 2.73% in group 4.Conclusions. The development of oral health promotion measures determines the significance of oral care products for the prevention of odontogenic infection in the adult population, which plays a crucial role in the individual program planning for the main dental disease prevention.

The structure and prevalence of superficial carious and non-carious lesions of permanent and deciduous enamel in children who presented for routine dental care in various districts of St. Petersburg

Relevance. To increase the effectiveness of prevention and treatment protocols, it is above all necessary to consider the activity of caries, especially at the early enamel lesion stage, in the form of a white spot, to make the correct diagnosis based on a clinical examination, which assesses the location, change in surface hardness, symmetry, contour shape, depth, color and opacity of the lesion. Different causes of superficial enamel discoloration, in the form of white spots, are paramount for the restorative treatment as the quality of the enamel preparation affects the marginal fit and the durability of the restoration. However, poor oral hygiene, disturbance in eating behavior affect the course of non-carious hard-tissue diseases, which caries may complicate. Purpose – to optimize the diagnosis of initial dental enamel lesions to improve the caries prevention quality.Materials and methods. The study examined 460 children living in the Central and Krasnoselsky districts of St. Petersburg. The following indices assessed hard tissue condition: OHI-S, Greene and Vermillion; OHI by O'Leary T., Drake R., Naylor; White spot lesions index, Gorelick L, Geiger A. M, Gwinnett A. J., DMFT and df; caries activity.Results. The total prevalence of superficial (initial) lesions of hard tissues was 37.82%, i.e. 174 people out of 460 examined patients had superficial enamel lesions according to the criteria of I and II categories. The study found enamel changes in the age groups: 5-6 years (130) – 36 people (27.69%); 12 years old (175) – 62 people (35.42%); 15 years old (155) – 76 people (49.03%).Conclusions. Focusing on the caries activity signs rather than a precise differential diagnosis of the lesion nature is necessary to provide well-timed treatment and prevention upon detecting initial enamel lesion at a dental check-up.

The experimental rationale for new bleomycin-polidocanol mini-foam administration in the treatment of children with head and neck venous malformations

Relevance. Venous malformation (VM) is an abnormal development of the collecting blood vessels based on the vascular wall formation disorder, which occurs during the peripheral vascular network differentiation. According to various sources, VM prevalence ranges from 1 to 2 in 10 000 newborns. Head and neck VMs significantly reduce patients’ quality of life, causing severe functional and aesthetic impairments. Sclerotherapy is an effective treatment method for children with venous malformations. In recent years, bleomycin has been the most commonly used sclerosant. It is a glycopeptide antibiotic synthesized by Streptomyces verticillus and belongs to cytostatic medications. They successfully use it for venous malformations sclerotherapy, also in children. Purpose – the study aimed to improve the sclerotherapy method by combining the advantages of foam sclerotherapy and bleomycin.Materials and methods. 48 samples of rats’ external femoral veins were morphologically examined. We divided the rats into 2 groups depending on the administrated agent: the first group – 3% polidocanol (lauromacrogol 400), the second group – bleomycin-polidocanol mini-foam composition. The histological assessment identified the changes in the vein endothelium, necrosis of tissue structures, cell dystrophy characteristics.Results. The first group, which used the bleomycin-polidocanol mini-foam composition, demonstrated more pronounced irreversible changes in the venous vessel endothelium compared to the second group.Conclusions. The experimental study revealed that the proposed method of VM sclerotherapy using new bleomycin-polidocanol mini-foam composition is more effective than the polidocanol foam sclerotherapy. The new method is highly effective, minimally invasive, safe and can be considered an independent treatment method in children with head and neck VM.

Clinical laboratory assessment and predictability of the periodontal inflammation development in children with undifferentiated connective tissue disease

Relevance. The development of multiple organ lesions in undifferentiated connective tissue disease leads to secondary immunodeficiency, which triggers oral homeostasis disruption and activates periodontal pathogens, which produce anti-inflammatory cytokines, which trigger the mechanisms of periodontal destruction. Purpose – to establish the relationship between undifferentiated connective tissue disease in children and their predisposition to periodontal inflammation and destruction.Materials and methods. The study examined the patients, aged 15 to 17 years old, of the endocrinological department of the Children's Clinical Hospital of N. N. Burdenko Voronezh State Medical University. All examined children had the same diagnosis of undifferentiated connective tissue disease. The control group consisted of 15 children with healthy periodontium. Silness-Loe plaque index (Loe H., Silness J., 1962) at the gingival margin assessed the children periodontal status. Mühlemann bleeding index (Mühlemann H.R., Son S., 1971) [19] evaluated the bleeding. The study measured the intensity and extension of the inflammatory reaction by the cytological changes in the periodontium according to the Page and Schroeder model (Page R.C. and Schroeder M. E., 1976). The enzyme immunoassay kits from eBioscince determined the level of pro-inflammatory cytokines: interleukin (IL-1β), interferon-gamma (IFN-γ) and transforming growth factor (TGF-β1) in the oral fluid; and the anti-inflammatory cytokine, receptor antagonist interleukin IL-1 (IL-1ra), was measured using Invitrogen kit in strict accordance with Multiskan FC microplate photometer instructions (Thermo Scientific).Results. Children periodontal status evaluation did not reveal any pronounced clinical manifestations of the inflammation that could cause concern and complaints of bleeding gums. Thus, the Silness-Loe plaque index at the gingival margin was 1.70 ± 0.07 (control group 1.10 ± 0.03), the Mühlemann gingival sulcus bleeding index in children with undifferentiated connective tissue disease was 2.10 ± 0.05 (control group 0). The results of the oral fluid cytokine count in patients with undifferentiated connective tissue disease demonstrated a tendency for pro-inflammatory cytokine increase and anti-inflammatory cytokine decrease, in contrast to the control group.Conclusions. Thus, the qualitative composition of pro-inflammatory cytokines – interleukin (IL-1β), interferongamma (IFN-γ) and transforming growth factor (TGF-β1), interleukin IL-1 receptor antagonist (IL-1ra) in the oral fluid, in combination with clinical diagnostic methods in periodontal practice, can reliably predict the predisposition of people with undifferentiated connective tissue disease to periodontal inflammation and destruction. Medical checkup in children with undifferentiated connective tissue disease mainly aims to carry out comprehensive treatment and preventive measures to preserve the functions of the dental system. As children periodontal service is not allocated in the register of medical specialties in the Russian Federation, pediatric periodontal patients are followed-up in the periodontally healthy groups. However, it is evident today that periodontal passports are necessary, which indicate a genetic predisposition to inflammatory periodontal diseases.

Children with autism spectrum disorder at a dental appointment: problems, behavioral characteristics, recommendations

Relevance. Dental care is one of the principal unmet health needs of children with autism spectrum disorder (ASD). Based on the available publications, the study discusses the dental profile of a child with autism and the social factors affecting the oral health of such children.Materials and methods. A search was performed of publications for the 15 years in the Medline database using the terms autism”, behavior management/techniques”, child”, dental care for children with other abilities”, dental education”, dental disease”, pediatric dentistry” to find relevant publications.Results. In the found publications, the authors most frequently mention poor oral hygiene. However, they disagree regarding the caries occurrence rate in children with ASD. Insufficient specialized training of dentists on interaction with special children may be one of the reasons for the limited access to dental care.Conclusions. Dental treatment of an autistic child requires a thorough knowledge of comorbidity, relevant behavioral management and customization of treatment protocols according to individual needs. The effectiveness, safety and rationale of the known dental treatment strategies for children with ASD require further study and improvement.

Comparative effectiveness research of two glass ionomer cements for primary molar fissure sealing

Relevance. A glass ionomer cement (GIC) is the material for primary teeth fissure sealing in children. The research aimed to study the comparative effectiveness of two GIC pit and fissure sealants in primary molars.Materials and methods. Sixty-one children aged 2-5 years (mean 26.99 ± 0.55 months) participated in the study after obtaining the Local Ethical Committee’s permission and the parents’ informed consents. Non-invasive fissure sealing in primary molars was performed according to split-mouth design with two GIC: Fujy-9, GC, Japan (109 teeth, FV-group) and Polyakrilin, TehnoDent, Russia (106 teeth, PV-group). Follow-ups were provided after 6, 12, 18 and 24 months. Complete retention, partial retention or complete loss (%) of the sealants and the frequency (%) of fissure caries development were calculated. The chi-square criterion was used to assess the significance of the differences between the groups at p-value < 0.05.Results. In 6 and 12 months, all the cases demonstrated complete or partial sealant retention and the absence of pit and fissure caries. The following results were found after 24 months: complete GIC retention in 8.6% of molars in FV-group and 1.9% in PV-group, (p < 0.05), partial retention – 78.8% and 79.0% (p > 0.05) respectively, complete loss – 6.7% and 11.4% respectively (p > 0,05). Fissure carious lesions were found only after 18 and 24 months in 2.8% cases in FV-group and 3.8% cases in PV-group, p > 0,05.Conclusions. Both studied GICs for non-invasive primary molar fissure sealing were equally highly effective for pit and fissure caries prevention in children. Annual follow-ups in children are necessary for GIC sealant repair.

Prevention of inflammatory changes in the denture-bearing mucous membrane

Relevance. Advanced clinical and cytological studies have not been conducted yet to examine denture adhesive effect on the prevention of inflammatory changes in the mucous membrane of the prosthetic bed, and thus, the prevention of denture-related stomatitis. Purpose: to assess the clinical and functional condition of the oral mucosa beneath the denture during the adaptation period using a denture adhesive cream to prevent inflammation of the denture bed mucous membrane.Materials and methods. The study clinically and cytologically (washing, scraping) assessed the condition of oral mucosa beneath complete acrylic dentures on days 14-16 and 28-30 of the adaptation period in 15 fully edentulous patients (main group), who used an adhesive cream after they were delivered their dentures, and in 21 fully edentulous patients (control group) who did not use the cream during the denture adaptation period. All the patients were elderly.Results. At different times of the adaptation period, the study more frequently detected inflammatory changes in the denture-bearing mucosa in subjects who did not use the denture adhesive cream. The cytological study confirmed the results of the oral clinical examination, as, at the end of the adaptation period, the number of cellular elements and various microorganisms was significantly lower in the main group than in the controls, which proved the effectiveness of the denture adhesive cream for the prevention of denture stomatitis.Conclusions. Regardless of sex, patients with complete acrylic dentures, who used a denture adhesive cream, had a lower bacterial accumulation on the prosthetic bed and inflammatory changes during the adaptation period, which allowed us to recommend the adhesive cream for the prevention of denture stomatitis.

The study of the calcium and phosphorus metabolism impact on the development of demineralized enamel areas in adolescents

Relevance. The article presents the current data on the impact of calcium and phosphorus metabolism on the development of demineralized enamel areas in adolescents. The level of vitamin D3, osteocalcin, bone alkaline phosphatase isoenzyme and parathyroid hormone (PTH) in mixed saliva appeared to reflect the risk of the cariogenic situation in the oral cavity and the risk of enamel demineralization development, which are relevant in pediatric dentistry. Purpose – to reveal the relationship between the localized enamel demineralization and the calcium and phosphorus metabolism in teenagers.Materials and methods. In 45 adolescents, the study examined the vulnerability of hard dental tissues, including initial lesions and the mixed saliva mineral metabolism in teenagers. We formed the following groups to study the caries intensity level. Group 1 consisted of 12 adolescents with a DMF index of 3.8. 11 adolescents comprised group 2 and 11 adolescents – group 3 with DMF indices of 4.9 and 6.8, respectively; group 4 contained adolescents without caries.Results. The analysis of caries intensity and permanent enamel demineralization areas in adolescents and the main markers of mixed saliva mineralization revealed a correlation between the activity of the initial carious lesions and the calcium and phosphate metabolism.Conclusions. Evaluating the principal markers of calcium and phosphorus metabolism is relevant for the risk assessment of the cariogenic situation or enamel demineralization development in adolescents and preventive treatment planning.