ETIOLOGICAL FACTORS IN DISEASES OF HARD TISSUES AND PERIODONTIUM IN PREGNANT WOMEN

Abstract

Pregnant women have one of the highest risks of dental disease [3]. According to a number of authors, during the physiological course of pregnancy, the prevalence of dental caries is 91.4%, periodontal tissue diseases occur in 90% of cases, lesions of previously intact teeth with a predominantly acute course of the carious process - in 38% of pregnant patients [5 ]. Secondary caries, progression of the carious process, enamel hyperesthesia occurs in 79% of pregnant women [11]. At the same time, the intensity of the increase in dental caries in terms of the absolute increase in the index of caries-filling-removal during the gestational period is 0.83 [2]. In 50% of pregnant women and women in labor, the so-called gingivitis of pregnant women is observed during the normal course of the gestational period already at 2-3 months of pregnancy [12]. From the second half of pregnancy, the pathological process becomes more pronounced and more often proceeds as a generalized catarrhal or hypertrophic gingivitis, and pyogenic granuloma often develops. As pregnancy progresses, periodontal disease progresses continuously, and only in the postpartum period does the clinical picture improve [4]. In the long term, gingivitis that occurs during pregnancy becomes chronic [9, 10]. In a pregnant woman, against the background of altered reactivity and reduced body resistance, latent odontogenic foci of infection can lead to serious complications as a result of exacerbation of the inflammatory process [7, 8]. The greatest severity of inflammatory phenomena in periodontal tissues occurs in the second trimester of pregnancy, and the critical increase in the cariogenic situation in the oral cavity occurs in the third trimester [4, 2], which not only determines the optimal timing of dental examinations during pregnancy and the postpartum period, but also the differentiation of the approach to programs for the prevention and treatment of the most significant diseases of the oral cavity for this period of pregnancy. The decisive role in the development of caries and periodontitis in pregnant women belongs to hormonal substances (somatomammotropin, progesterone, gonadotropin) produced by the placenta, changes in mineral and protein metabolism, immunological status, oral microflora [1, 5]. The timing of the increased risk of the onset and progression of periodontal diseases, as well as the increase in the intensity of dental caries in pregnant women, is not enough to state; tires. This does not negate the significance of already established factors affecting the occurrence and development of dental caries, periodontal disease during pregnancy, but is aimed at competently combining diagnostically important known and newly identified criteria into a system of practical recommendations for identifying risk groups among pregnant women. on dental health and special monitoring of them. Immunoprotective peptides of biological media, including oral fluid, are markers of the intensity of local inflammation and are responsible for the implementation of innate antimicrobial immunity [6, 12]. In the oral fluid, a whole complex of immunoprotective peptides is isolated, among which lactoferrin, cathelicidin LL-37, and α-defensin are distinguished [14]. The inclusion of immunoprotective peptides in algorithms and models for ranking the risk of progression of dental caries during pregnancy will expand the boundaries of existing recommendations in this direction. When studying systemic immunity in pregnant women with periodontal diseases, oral fluid and peripheral blood are used as biological media [8]. At the same time, retroplacental blood and umbilical cord blood containing fetal and maternal blood, despite the easy method of selection after the birth of a child and placenta, not associated with invasive manipulations, is not used as a biological medium. Meanwhile, the determination of the spectrum of inflammatory mediators, the mineral composition of retroplacental and umbilical cord blood will allow answering the questions whether inflammation of the periodontal tissues of varying severity was accompanied by the "mother-placenta-fetus" system, whether it is possible to predict from the stage of childbirth in the future the appearance of caries of milk teeth? The purpose of this study is to optimize the system of providing dental care to pregnant women using clinical and laboratory indicators.