Nowadays the problem of thyroid pathology, its effect on health and intellectual development of the population, first of all children, is especially acute. According to WHO criteria a number of regions in Ukraine, including Bukovyna, are evaluated as territories with mild and moderate degree of iodine deficiency, which is a causative factor stipulating development of iodine deficiency diseases. Thyroid pathology is a leading one among them.
Peculiarities of clinical manifestation of acute odontogenous periostitis in children under conditions of diffuse simple goiter can be: pronounced swelling component, caused by thyroid status disorders in such children, and thyroid-stimulating hormone level in particular (1,93±0,07) mМО/L and T3 to (2,84±0,10) nmol/L against (1,50±0,11) mМО/L (р<0,05) and (2,68±0,15) nmol/L in somatically healthy children.
The state of the immune protective mechanisms of the oral fluid in children is characterized by 47,84 % (р<0,05) decreased lysozyme activity, 29,73 % decrease of sIgA content, 70,00 % increase of IgA content and IgG – 64,52 % (р<0,05) increase. Changes of the cytokine profile were noticeable. For example, IL-1β concentration 2,26 times increased (р<0,05) and IL-4 level 2,19 times decreased (р<0,05). The disorders found play an important role in the development of inflammatory process in the stomatognathic tissues in children suffering from diffuse simple goiter promoting realization of action of microbial factors.
The antioxidant system was found to fail in the protection of the oral fluid of children due to peroxidation degree increase, which is evidenced by an increased level of MDA 1,84 times (р<0,05), diene conjugates 2,0 times (р<0,05) against the ground of reduced catalase activity 3,93 times (р<0,05), superoxide dismutase – 85,42 % (р<0,05). Functioning of the glutathione system appeared to be imbalanced and insufficient: 49,02 % (р<0,05) decreased activity of glutathione reductase, glutathione transferase – 69,27 % (р<0,05), 73,29 % (р<0,05) increased activity of glutathione peroxidase resulting in decreased level of reduced glutathione 4,76 times (р<0,05).
The risk of inflammatory process intensification and development of complications of acute odontogenous periostitis are determined in the following cases: increased level of MDA more than 281,17 mcmol/mg of protein, diene conjugates – 1,41 nmol/mg of protein; decreased level of reduced glutathione less than 26,57 pmol/ml, НS-groups – 61,82 pmol/ml; decreased activity of superoxide dismutase to 0,46 UN/min.mg of protein, catalase – 2,01 mcmol/ min.mg of protein, lysozyme – 19,32 UN/L; decreased content of sIgA lower than 0,24 g/L, IL-4 – 6,07 pg/ml; increased level of IL-1β higher than 111,37 pg/ml.
The therapeutic method to treat acute odontogenous periostitis in children suffering from diffuse simple goiter is improved. In addition to the common measures it includes the measn of metabolic correction. Administration of medicines “IMUPRET” and “Calcemin Advance” promotes normalization of the main protective indices of the oral fluid. A high clinical effect of the suggested therapeutic method is determined which is evidenced by shorter periods of treatment (5,3±0,26) days against (8,0±0,36) days in case of the common method of treatment (р<0,05), 2-3 times decreased number of complications.
For the first time on the basis of a comprehensive study peculiarities of clinical manifestation of acute odontogenous periostitis are found in children afflicted with diffuse simple goiter.
Comprehensive clinical-laboratory examinations of children suffering from acute odontogenous periostitis with underlying diffuse simple goiter enabled to evaluate the state of local protective stress-limiting reactions making the basis of pathogenic mechanisms promoting development of the disease.
Detection of the oral fluid indices in children enabled to specify scientific information concerning peculiarities of the local immune protection and its effect on the course of odontogenous inflammatory process in the tissues of the stomatognathic system. New diagnostic and prognostic criteria to evaluate the condition of such patients were suggested for the first time.
For the first time a comprehensive treatment of acute odontogenous periostitis in children is suggested to be supplied with correction of supply by macro- and trace elements and immune response on general level in order to improve effect of the basic therapy. Local therapeutic-preventive measures are selected promoting intensification of the common treatment effect.
A practical value of the study is determined by substantiation and development of a new mini-invasive method of diagnostics and the method of pharmacological correction of metabolic disorders in the treatment of acute odontogenous periostitis in children with underlying diffuse simple goiter.
