The results of our study indicate that the dental status of schoolchildren in Chernivtsi region is characterized by a high prevalence of major dental diseases with a predominance of dental caries and chronic catarrhal gingivitis. The prevalence of caries is 86.6% in 12-year-olds and 93.8% in 15-year-olds, which reflects a clear age-related accumulation of caries-causing factors. The intensity of caries according to the "CPV" index increases 1.4 times in the older age group and reaches maximum values in 15-year-old girls - (4.53±0.24), which indicates a progressive and sex-age nature of the lesion. A high prevalence of chronic catarrhal gingivitis was established, which is detected in 46.98% of 12-year-old children with a further increase in the intensity of inflammation according to the PMA index by 1.5 times (up to (35.48±1.07)% in the older group). According to CPITN, bleeding gums are recorded in 42.25% of young children with an average number of affected sextants (2.53±0.16), and hard dental deposits are detected in 29.15–32.4% of those examined, with an increase in the number of affected sextants by 38.71%, which indicates the progression of periodontal pathology. It was found that the hygienic condition of the oral cavity is insufficient in all age groups. The Silness-Loe index in 12-year-olds is (1.41±0.05) versus (1.08±0.05) in 15-year-olds, which indicates a worse formation of hygiene skills at a younger age. Similarly, the Stallard index indicates a systemic insufficiency of personal hygiene regardless of age and gender. The biochemical status of the oral fluid is characterized by suppression of local immune defense: the level of sIgA decreases to 0.25-0.29 μg/ml, the concentration of lysozyme - to 2.73-3.13 μg/ml. At the same time, the activity of β-glucuronidase increases by 2.96-3.17 times in children with caries and primary gingivitis compared to the comparison group, which indicates the activation of inflammatory-destructive processes and dysbiosis. An imbalance of the mineral composition of the oral fluid was established: the calcium level increases by 7.6% (up to 1.41±0.02 mmol/l), while the concentration of phosphates in the older group decreases by 62.38%, which is accompanied by a decrease in mineralizing potential by
1.6 times. At the same time, there is an age-related decrease in buffer capacity by 14.8-20.0% and an increase in the viscosity of oral fluid by 1.79-3.58 times.
According to the assessment of behavioral factors (EGOHID), a decrease in the frequency of brushing teeth twice a day by 27.37% in 12-year-olds and by 18.0% in 15-year-olds was found, as well as a decrease in preventive dental visits by 20-23.33%, which is combined with a decrease in quality of life indicators by 1.52-1.83 times. A significant influence of regional hydrochemical factors was established: in most river basins of the Chernivtsi region, an increased calcium content in drinking water and a deficiency of fluoride (especially in the Dniester and Cheremosh rivers) were found, which forms a persistent imbalance of mineral supply and increases the risk of demineralization processes in children. A multilevel treatment and prevention complex aimed at correcting mineral metabolism, microbiocenosis and increasing the resistance of the oral cavity has been developed and tested. The effectiveness of the complex is confirmed by a decrease in β-glucuronidase activity by 2.96 in children aged 12 and 3.17 times in 15 years, an increase in mineralizing potential by 1.6 times and a decrease in the growth of dental morbidity by 18.0-27.37%. In the dissertation work, for the first time in the conditions of the regional specificity of the Chernivtsi region, a correlation-pathogenetic model of the formation of dental pathology in schoolchildren aged 12 and 15 years has been developed and scientifically substantiated, which integrates clinical, immunological, biochemical, and environmental factors and allows them to be assessed as an interconnected system. Based on the model, the concept of regional dental risk was first formulated, according to which the combined influence of micro- and macroelement composition of drinking water, immunological and biochemical indicators determines the intensity and nature of lesions of hard dental tissues and periodontal tissues. It was established that the mineral composition of drinking water is a key associated factor that has statistically significant relationships with clinical indicators of dental pathology. In particular, pronounced inverse correlations were found between the fluoride content and the indices of KPV (r=-0.74; p<0.05) and PMA (r=-0.78; p<0.05).
