The theoretical summarization and new solution of the actual scientific and practical issue in contemporary dentistry are provided featuring an advanced effectiveness of diagnostics, management and prognostication of disturbances in tooth formation (DTF) along with prevention of respective complications in children.
The highest prevalence of DTF was revealed in children of the Northern region
(36.30 %), prevalence in the Western, Eastern, and Southern regions was established as 26.77 %, 21.52 % and 22.22 %, respectively. The lowest prevalence was at that in the Central region of Ukraine, namely 19.76 %. Significant differences in the DTF prevalence were confirmed in children from the 3rd and 2nd health groups, i.e. the systemic enamel hypoplasia (SEH) was determined in 30.43 % and 19.53 %, and molar-incisor hypomineralisation (MIH) in 5.87 % and 12.40 %, respectively.
Three forms of SEH were identified, namely the spotted, erosive, and furrow-form ones. The SEH spotted form was more prevalent (84.78 %), whilst erosive and furrow-form variants were diagnosed in 7.90 % and 7.32 % of cases, respectively.
The MIH of three severity degrees was revealed in children, however with a more prevalent moderate degree (50.78 %). Mild and severe MIH was diagnosed in 34.38 % and 14.84 % of the study subjects, respectively. Severe and moderately severe MIH was diagnosed in children of the Western, Central, and Northern regions of Ukraine with the highest prevalence (1.19 %) among the 3rd group of health in the Northern region. Mild and moderately severe disease was more prevalent (6.6 % and 4.75 % of cases, respectively) in children of the 2nd group of health in the Northern region.
Among the case history factors the complicated maternal pregnancy (gestoses and diseases in the 2nd half of pregnancy), abnormal labor, bottle feeding, first-year illnesses accompanied by hypoxia, connective tissue involvement and toxic effects of medications (e.g. prescribed antibiotics, etc.) were the most critical ones predisposing to the occurrence of DTF.
A significant deterioration in dental status, depending on the region of residence and presence of concomitant diseases was found in children suffering an DTF. The worst indices of oral hygiene (Oral Hygiene Index Simplified (OHI S) = 1.5±0.66), dental caries experience (Decayed, Missed, and Filled permanent teeth – DMF index = 6.24±2.55) and indicators of periodontal tissue state (Intact Sextants Prevalence – CPI = 21.50±19.54 %) were revealed among the residents of the Northern region.
Based on the revealed features of an DTF course the criteria have been identified and diagnostic algorithms for SEH and MIH were introduced for application in children targeting the certain groups of teeth with taking into account case history data, nature of non-carious teeth lesions and presence of caries as an DTF complication.
Significant (p<0.05) disorders of mineral metabolism were revealed featuring a decreased Ca and P levels in oral liquid in children with MIH attributed to the 2nd and 3rd groups of health, including persons with compromised radiation history, and a decreased phosphate content in children with SEH (2nd group of health).
The Test of Enamel Resistance (TER) values were in the range from (4.01±1.95) (group № 6) to (5.44±1.76) (group № 2).
Significant impairment of general immunity was diagnosed being more pronounced in children with a 3rd group of health having an DTF.
A significant (p<0.001) reduction of telomere relative length in peripheral blood lymphocytes was found in children with compromised radiation history having SEH, indicating an increase in apoptosis intensity in the immune cells.
Taking into account the SEH clinical forms and MIH severity diagnosed using the above-mentioned algorithms, the treatment-and-prophylactic protocol was elaborated targeting the DTF complications in children of the 6-12 years old age group.
Given the stage of the tooth root formation, location of the lesion (spot/defect within enamel or dentine), and the percentage of complications (dental caries) calculated using the computer application a differentiated drug administration was proposed (protocols I, II, and III) for children having an (SEH, MIH).
The «Health Care Delivery Protocol for Children Having MIH» is recommended for use in healthcare institutions of Ukraine.
Key words: children, disturbances in tooth formation, systemic hypoplasia of enamel, molar incisor hypomineralisation of enamel, calcium, phosphates, secretory immunoglobulin A, lactoferrin, relative telomere length, ionizing radiation.
