The dissertation presents a theoretical generalization and a new solution to the current scientific problem of modern dentistry - increasing the effectiveness of dental caries prevention in patients with type 1 diabetes by optimizing approaches to local caries preventive measures through the differentiated use of fluoride-free products depending on
the structural and functional acid resistance of teeth enamel and and the state of diabetes mellitus compensation.
The research was aimed at studying the prevalence and intensity of dental caries in patients with type 1 diabetes, the clinical course of caries, risk factors for caries according to the questionnaire data, clinical indicators that assess the condition of tooth enamel, oral health status, biophysical and biochemical parameters of the oral fluid, as well as the biochemical composition of blood serum. The formation of caries risk groups among patients with type 1 diabetes mellitus was proposed and optimized differentiated approaches to local caries-preventive treatment were developed depending on the risk group using nano-hydroxyapatite and xylitol products, as well as products with enzymes. The effectiveness of the proposed approaches was assessed.
The results of the study showed that patients with type 1 diabetes mellitus have a high prevalence (100 %) and the intensity of dental caries (the index of carious, filled and extracted teeth was 14.1±0.43, the index of carious, filled and extracted teeth surfaces reached 30.7±1.53). Patients with type 1 diabetes mellitus showed an average level of structural and functional acid resistance of tooth enamel according to TER (4.44±0.13), reduced rate of enamel remineralisation (4.75±0.16 days), reduced rate of unstimulated salivation (0.30±0.01 ml/min), a low buffer capacity (4.64±0.03), and the pH of the oral fluid was shifted to the acidic side (6.40±0.04). In 65 people (36.3 %), the viscosity of the oral fluid was within normal limits, in 76 people (42.4 %) it was increased, in 38 people (21.3 %) it was high. The oral fluid showed a reduced content of total and ionized calcium (0.36±0.02 mmol/l and 0.41±0.01 mmol/l, respectively), but the content of inorganic phosphorus, fluoride, magnesium, sodium and potassium were in within the normal limits and were equal to 4.96±0.15 mmol/l, 0.067±0.01 mg/l, 0.11±0.01 mmol/l, 17.4±0.32 mmol/l and 24.2±0.54 mmol/l, respectively, the calcium-phosphorus coefficient was reduced - 0.08±0.01.
It is proved that the differentiated use of the proposed caries-preventive measures in patients with type 1 diabetes at the age of 18 to 34 years after 12 months led to an increase in the structural and functional acid resistance of enamel and enamel remineralisation rate by 1.7 times, an increase in the content of total and ionized calcium, as well as calcium-phosphorus coefficient, a decrease in the increase in caries intensity by 2.7 times. The effectiveness of caries-preventive treatment in terms of reducing the growth of dental caries is 62.5 %.
Key words: type 1 diabetes mellitus, state of compensation, dental caries, prevention, structural and functional acid resistance of enamel.
