Zorivchak T. Clinical and laboratory justification of the choice of the method of treatment of pulpitis of primary teeth

The scientific work is dedicated to solving the current scientific task of dentistry – increasing the effectiveness of the treatment of pulpitis of primary teeth, by ranking diagnostic clusters for diagnosis and choosing a treatment method, which is based on individualizing approaches to choosing an antiseptic agent for sterilization of the root canal system, taking into account the characteristics of the microbiota. The existing methods of treatment and antiseptic treatment for root canals do not adequately address the types of microorganisms in different forms of pulpitis (acute or chronic), nor do they consider the sensitivity of these microorganisms to various groups of antiseptic agents. During the content analysis of medical records, we analyzed 1025 medical records, of which 480 children (46.83%) were aged 5–6 years and 545 children (53.17%) were aged 7–11 years. During the study, we identified the characteristics of the root canal microbiota in 156 teeth with acute and chronic pulpitis. In acute diffuse pulpitis, Streptococcus viridans was cultured in 100% of cases, Staphylococcus aureus in 25 patients (83.3%), Streptococcus pneumoniae in 18 patients (60%), Enterobacter spp. in 23 patients (76.6%), and Enterococcus faecalis in 21 patients with this form of pulpitis (70%) among 30 people with a selected diagnosis. In acute purulent pulpitis, S. viridans was cultured in 100% of cases, Neisseria sicca in 15 patients (37.5%), Providencia spp. in 29 patients (72.5%), E. faecalis in 23 patients with this form of pulpitis (57.5%), Actinomycetes spp. in 31 patients (77.5%), Escherichia coli in 18 patients (45%) among 40 people with a selected diagnosis. In chronic fibrous pulpitis, S. viridans was cultured in 100% of cases, Streptococcus pyogenes among 18 patients (81.8%), Staphylococcus saprophyticus among 22 patients (100%), Enterococcus faecium among 17 patients (77.3%), Klebsiella oxytoca in 14 patients with this form of pulpitis (63.6%), Candida albicans in 16 patients (72.7%) among 22 people with the selected diagnosis. In chronic hypertrophic pulpitis, S. viridans and S. saprophyticus were cultured in 100% of 22 patients (75.8%), Citrobacter spp. in 12 patients (41.4%), and Micrococcus spp. in 15 patients (51.7%) among 29 individuals with the selected diagnosis. In chronic gangrenous pulpitis, S. viridans and S. saprophyticus were cultured in 100% of cases among 35 patients (100%), C. albicans in 17 patients with this form of pulpitis (48.6%), Actinomyces spp. in 27 patients (77.1%), Enterococcus faecium in 24 patients (68.6%), Citrobacter spp. in 19 people (54.3%) among 35 patients examined with the selected diagnosis. Indicator microorganisms that can determine the type of disease are the following: for acute serous diffuse pulpitis – S. aureus, Enterobacter spp., and S. pneumoniae; for acute purulent pulpitis – Providencia spp, E. coli, and N. sicca; for chronic fibrous pulpitis, these microorganisms are – S. pyogenes, K. oxytoca; and for chronic hypertrophic pulpitis – Micrococcus spp. Chronic gangrenous pulpitis does not have a specific microflora. According to the comprehensive data analysis, it was possible to establish that antiseptics with the greatest effect against all studied types of microorganisms included a 5% iodine solution and a 0.05% creosote solution. Most microorganisms are sensitive to 2% aqueous solution of chlorhexidine bigluconate, and some microorganisms are sensitive to 3% and 5% aqueous solutions of sodium hypochlorite. To diagnose pulpitis in primary teeth, we developed separate diagnostic clusters that account for all features of conducting both subjective and objective examinations in children, helping accurately diagnose and select an appropriate treatment method. The first cluster of criteria for diagnosing pulpitis of primary teeth in children included data from subjective history, which was based on the use of a questionnaire developed by us. The second diagnostic cluster included data from an objective examination. The third diagnostic cluster encompasses additional diagnostic examination methods, including radiation-based techniques. Additionally, one of our tasks was to develop an algorithm for selecting a treatment method for pulpitis, considering all previously described clusters. The primary diagnostic criteria for selecting a method of treating pulpitis included: the type of pulpitis, the stage of root development of the affected tooth, the health status of the oral cavity organs, and the patient's age. Key words: dentistry, caries, prevalence and intensity of caries, oral hygiene, complicated caries, pulpitis, microbiota of root canals, antiseptics, antiseptic treatment of root canals, ranked structural-logical scheme, statistical ranking, correlation dependencies.