Complicated Caries Research Articles

Analysis of modern methods of endodontic treatment of complicated caries according to the literature

The result of endodontic treatment depends on many factors: on the level of professional training of a dentist, the material and technical equipment of the workplace, competent diagnosis and chosen treatment tactics, which is largely impossible without the use of modern scientific achievements. The article provides an overview of the current literature on the treatment of complicated caries. The methods of treatment of pulpitis and periodontitis using modern methods and tools are described, which significantly improves the effectiveness of treatment.

SOME INDICATORS OF DENTAL CARE IN PRIVATE INSTITUTIONS OF THE KIROVOHRAD REGION

Relevance. Global upheavals in the country affected the activities of dental institutions, including private ones. Aim of this study. Analysis of the dynamics of dental caries treatment indicators in the adult and children's populations in private institutions of the Kirovohrad region. Materials and methods. According to reference books, an analysis of the indicators of caries treatment and complicated dental caries in private institutions of the Kirovohrad region in 2018, 2020, and 2022 was carried out. Research results. In 2018, 134,408 teeth with caries were treated in the population, 131,669 teeth (98% of all) in adults, and 2,739 teeth (2%) in children. In 2020, 142,589 teeth were treated, which is 5.7% more than in 2018. For adults, 140,094 teeth (90.3%) were treated, 6% more than in 2018, and for children, 2,495 teeth (1.7%) were treated, which is 8.9% less. In 2022, 93,164 teeth were treated in the entire population, which is 34.7% less than in 2020. For adults, 89,771 teeth (96.4%) were treated, 35.9% less than in 2020, and for children, 3,393 teeth (3.6%) were treated, which is 26.5% more than in 2020. In 2018, the proportion of teeth treated for caries to all visits was 90.9%, in 2020 – 92%, and in 2022 – 77.7%. For adults, the proportions were 91%, 92.7%, and 76.9%, and for children, 85.6%, 66.7%, and 109.9%. In 2018, a total of 38,926 teeth were treated for complicated caries, 38,442 (98.8%) in adults, and 484 (1.2%) in children. In 2020, 39,522 teeth were treated (1.5% more than in 2018), 39,067 (1.6% more) in adults, and 455 teeth (6% less) in children, with the proportions remaining the same as in 2018. In 2022, the number of treated teeth in the population decreased by 20.1% to 31,593 teeth, for adults by 21.1% to 30,832 teeth, and for children, it increased by 40.2% to 761 teeth. In 2022, 97.6% of the treated teeth were in adults and 2.4% in children. The specific proportion of complicated caries to teeth treated for caries in the population was 29%, 27.7%, and 33.9% in 2018, 2020, and 2022, respectively. For adults, the proportions were 29.2%, 27.9%, and 34.3%, and for children, the indicator increased from 17.7% in 2018 to 18.2% in 2020 and 22.4% in 2022. Conclusions. Private institutions in the Kirovohrad region were almost unaffected by the quarantine. However, in 2022, there was a decrease in indicators for the entire population and adult patients, but an increase for children.

RESULTS OF TREATMENT OF PATIENTS WITH PERIAPICAL LESIONS USING HIGH-INTENSITY LASERS AND A DENTAL MICROSCOPE

The frequency and prevalence of periodontal lesions, problems of etiology, diagnosis of pathogenesis and various treatment methods indicate the importance of this problem in modern dentistry [1, 3, 6, 10]. According to the authors, chronic periodontitis ranks third among dental diseases: in the age group of 34-47 years, the proportion of this form of complicated caries reaches 50%. In 40% of cases, this condition is caused by a carious lesion, and in 60% it occurs as a complication of endodontic treatment, that is, due to the penetration of organic residues beyond the apical opening of the root and the subsequent development of periodontitis [4, 6-8].

DENTAL CARIES IN CHILDREN OF POLTAVA BEFORE AND DURING THE FIRST YEAR OF WAR (retrospective analysis over 20 years)

Due to the military conflict and the COVID-19 pandemic, Ukraine and the city of Poltava are facing challenges in medical services, including dentistry. Analyzing the dynamics of caries treatment in children in Poltava before and during the war is crucial for assessing the impact of wartime on the municipal dental care system. The aim of this study is to analyze the dynamics of caries treatment in children based on annual reports from the Municipal Pediatric Clinical Dental Polyclinic before and during the wartime. A retrospective analysis of the statistical reporting of the Municipal Pediatric Clinical Dental Polyclinic for the years 2002, 2012, and 2018-2022 was conducted. During the analysis, annual indicators of the Polyclinic were studied, including the total number of visits, number of primary visits, number of treated teeth due to caries and its complications in temporary and permanent teeth. Calculations included the average number of visits per person, the proportion of complicated caries in temporary and permanent teeth, and the quality indicator of complicated caries treatment. The study revealed a 51.43% decrease in clinic visits over the last 20 years. In 2022, there was a sharp increase in primary visits to 24,655, possibly due to internally displaced children. The number of filled permanent teeth increased by 25% in 2022 compared to 2021. The proportion of complicated caries in temporary teeth significantly rose from 0.23 to 0.84 from 2002 to 2022. Additionally, there was a 25% increase in the absolute values of the quality indicator of complicated caries treatment in temporary teeth from 2002 to 2012 and a 12% increase up to 2022, indicating a rise in the number of cases of treating complicated caries in temporary teeth by extraction. These findings highlight the need for further research on the war's impact on the prevalence of caries and its complications in the pediatric population. This research is crucial for developing effective strategies for the prevention and treatment of dental diseases.

ANALYSIS OF DENTAL CARE INDICATORS FOR CHILDREN BASED ON DATA FROM THE PEDIATRIC DENTAL CLINIC OF POLTAVA CITY

In the period from 2020 to 2023, the dental care system in Ukraine underwent significant changes considering the effects of healthcare reforms, the COVID-19 pandemic, and the ongoing conflict. The objective of this article is to assess the changes in the provision of general dental care at the Pediatric Dental Polyclinic in Poltava City over the past five years based on a retrospective analysis of statistical reports from 2019 to 2023. In 2019, emergency dental care accounted 9.69% of all visits. Complicated caries of permanent teeth was found in 2.28% of filled teeth, with light-cured resin fillings representing 29.52% of them. Periodontal diseases were detected in 0.62% of visits. Preventive examinations comprises a significant portion of visits, 86.43% of visits; 94.66% of children who needed dental sanitation received full treatment. Preventive measures including fissure sealing, remineralizing therapy, and supervised tooth brushing played a significant role in these outcomes. In 2020, the number of visits dramatically decreased, but the share of emergency dental care increased to 11.65%, compared to 2019 (p < 0.0001). The number of filled teeth decreased, while the percentage of complicated caries of permanent teeth increased to 4.09% (p < 0.0001). The proportion of fillings made of light-cured resins rose to 40.19%, representing a 1.36-fold increase (p < 0.0001). Preventive examinations accounted for 26.47% of visits, and 88.47% of examined children in need of dental sanitation were fully treated. However, the share of preventive measures and the number of visits for children with periodontal disease dropped. In 2021, the number of preventive examinations increased to 49.49% of visits. The percentage of complicated caries of permanent teeth in the filling structure rose to 4.93% compared to 2020 (p < 0.0001). The share of fillings made of light-cured resins reached 51.19%, and the rate of children receiving treatment under anesthesia increased (p < 0.0001). Indicators of preventive measures, which received less attention during quarantine, continued to decline. In 2022, complicated caries of permanent teeth constituted 4.96% of fillings that was higher than in 2021 (p < 0.0001). The proportion of preventive examinations significantly decreased to 33.45% (p < 0.0001), and the percentage of treated children among those who needed treatment dropped to 77.5%. Pedodontists started paying more attention to periodontal disease, preventive care, and treatment under anesthesia, which increased significantly. In 2023, the share of complicated caries of permanent teeth increased to 5.53% (p < 0.0001). The number of children treated under local or general anesthesia increased by 2.5 times. The number of visits for children with periodontal disease and indicators of preventive measures also increased (p < 0.001). In 2023, the share of preventive examinations was 36.28%, and the percentage of treated children among those who needed help decreased compared to 2022 (p < 0.0001), reaching 79.29%. The closure of school dental offices due to Covid-19 significantly reduced the number of patients in the pediatric dental polyclinic in 2020, leading to a significant decline in planned sanitation for children and preventive measures. In 2021, despite further decreases in visits, planned sanitation for children improved. In 2022, due to the treatment of internally displaced persons, the quantitative performance indicators of the polyclinic improved. From 2019 to 2023, there was an increase in the number of light-cured fillings, reflecting a trend in modern dentistry. Indicators for the treatment of periodontal disease, preventive measures, and treatment with anesthesia increased since 2022. During 2020-2023, there was a growth in the number of filled permanent teeth due to complicated caries, possibly due to budget funding for such dental aid in the polyclinic or because young patients may delay seeking medical attention. In 2023, the trend of decreasing the number of patients who were completely treated during planned sanitation was overcome. Further analysis of dental aid indicators for children is necessary for planning and funding to reduce the impact of socio-economic factors on children's health.

The effect of the irrigation solutions on dentin organic components: Pilot study

INTRODUCTION. Tooth decay and its complications are prevalent dental issues among adults. Endodontic treatment is the standard of care for complicated caries, specifically pulpitis and periodontitis. Endodontic irrigants, which are placed in the root canal lumen for a specific duration, can affect the intracanal dentin structure (organic and inorganic substances) in various ways. The use of polyhexanide-based antiseptic products in endodontics is a promising idea to overcome microbial resistance and minimize microbial-related endodontic treatment failures.AIM. The aim of this study is to investigate the qualitative impact of standard irrigation solutions and a polyhexanide-based composition on the collagen matrix of dentin.MATERIALS AND METHODS. The study investigated the effect of nine solutions on the dentin of the tooth root. Twelve intact maxillary third molars extracted for orthodontic reasons were taken for the study. The teeth were fixed in a 10% neutral formalin solution for at least one day and were decalcinated. 5–10 μm thick sample sections were made and stained with picrosirius (Picrosirius Red, Biovitrum, Russia) before being examined under polarized light. The histological slice was analyzed using a Carl Zeiss (Germany) software and hardware complex based on ZEN v3.0 and light microscope Axioimager M.1. All microphotos were loaded into the Fiji distribution program of ImageJ for microscopy pixel classification.RESULTS. Upon analysis of the diagrams, it appears that there is a lower amount and density of stained dentin collagen array after exposure to sodium hypochlorite solutions of 3% and 1.5%, as well as polyhexanide.CONCLUSIONS. The data obtained from the histogram analyzer of samples stained with picrosirius suggests that polyhexanide may have a qualitative effect on the organic structure of hard tissues, particularly collagen.

ETIOLOGY AND DENTAL STATUS IN PATIENTS WITH DENTITION DEFECTS IN THE RESIDENTS OF THE TRANSCARPATHIA

The aim of the study. To evaluate the dental status of patients with dentition defects, residents of the Transcarpathia, and to establish the causes of their occurrence. Materials and methods. The dental status was determined in 450 middle-aged people, residents of the Transcarpathia. The etiology of dentition defects was established, and an index assessment of hygiene, inflammatory and destructive changes in the periodontium, resorption of alveolar processes, and bone type was performed. The mathematical analysis and verification of the results, as well as the calculation of the arithmetic mean and standard errors were performed using the Statistica 6.0 software. Results and discussion. In the case of bounded edentulous spaces of 1–2 adjacent teeth, complicated caries prevailed in the etiology in 57.0 %; in the case of bounded edentulous spaces of 3 or more adjacent teeth, periodontal tissue diseases prevailed in 58.0 % (25.8 % – 16 in the upper jaw, 32.2 % – 20 in the lower jaw). In free-end edentulous spaces, periodontal tissue diseases prevailed among the etiologic factors: unilateral – in 75.0 %, bilateral – in 79.4 %. The hygiene was not satisfactory, the presence of moderate and severe gingivitis and periodontitis was observed with the prevalence of D2 bone type in 53.3 % of patients with bounded edentulous spaces, and 54.5 % of patients with free-end edentulous spaces. Conclusions. In the middle-aged adult population of the Transcarpathia, bounded edentulous spaces account for 26.6 %, and free-end edentulous spaces account for 73.4 %.

ANALYSIS OF QUANTITATIVE INDICATORS OF THE TREATMENT OF TEETH CARIES IN HEALTH CARE INSTITUTIONS OF THE KIROVOGRAD REGION

Relevance. Reforming the health care of the country affected some indicators of dental care for the population.
 Aim of this study. Analysis of quantitative indicators for the treatment of caries and complicated dental caries in the population of the Kirovohrad region for 2018-2021.
 Materials and methods. Analyzed data from statistical reports of health care institutions of the Kirovohrad region, subordinated to the Ministry of Health of Ukraine.
 Research results. In 2018 and 2019, 524 409 and 49 223 teeth were treated for caries among the population of the region, in 2020 and 2021, the indicators dropped sharply to 239 162 and 169 315 teeth, the decrease, compared to 2018, occurred in 2.2 and 3, 1 time. The dynamics were repeated with regard to adults and children. The values of the specific weight of the number of treated teeth with caries to dental visits of the population of the region in 2018 and 2019 were the same – 54.8%, then they decreased to 49.9% and 47.7%. This dynamic with fluctuations is defined for both adults and children. Due to complicated caries, 125 179 and 120 168 teeth were treated in 2018 and 2019, while 65 750 teeth were treated in 2020, and 41 973 teeth in 2021, which is 1.9 and 3 times lower than in 2018. In adults and children, there was also a decline in indicators over the years. The value of the specific weight of the number of treated teeth with complicated caries to the number of all treated teeth for caries in the entire population increased from 23.9% and 24.4% in 2018 and 2019 to 27.5% in 2020, and in 2021 there was decrease to 24.8%. The same dynamics were established for adults, while the rate for children increased and reached a maximum in 2021.
 Conclusions. A trend of decreasing indicators of the number of treated caries and complicated dental caries in the population of the Kirovohrad region for the years 2018-2021 has been revealed.

SITUATION OF DENTAL CARIES AND GINGIVITIS AMONG ETHNIC MINORITY STUDENTS AT BOARDING SECONDARY SCHOOLS IN TUYEN QUANG PROVINCE IN 2017

Objectives: To describe the current status of dental caries and gingivitis among ethnic minority students at boarding secondary schools in Tuyen Quang province in 2017. Methods: A cross-sectional descriptive study on 1,665 ethnic minority students at 6 boarding secondary schools in Tuyen Quang Province. The characteristics of the incidence of dental caries and gingivitis were evaluated according to gender; the rates of caries of primary and permanent teeth were evaluated according to school; the rates of caries and the index of lost fillings of primary and permanent teeth, dental caries, the prevalence of tartar, and bleeding gums were evaluated according to school. Results: The rate of dental caries accounted for 59.3%, of which the rate of permanent tooth decay accounted for 52.3%; the rate of baby tooth decay was 44.6%. Among students with tooth decay, 44.4% had enamel caries; dentin caries rate accounted for 34.2%, and 21.5% had complicated caries. The index of decayed, missing, filled, teeth (DMFT) was 1.93, of which permanent teeth were 1.61, lost teeth were 0.20, and filling teeth were 0.11. The index of DMFT of milk teeth was 1.48, the index of decayed teeth was 1.21, the missing teeth were 0.15, and the filling teeth were 0.13. Gum disease accounted for 46.3% of the students studied. The rate of students with tartar was 34.1%. The average rate of students with bleeding gums was 12.3%. Conclusion: Dental caries, gingivitis, and tartar accounted for a relatively high rate among ethnic minority students at boarding secondary schools in Tuyen Quang Province.

ON THE TOPIC OF ADVISABILITY OF ENDODONTIC TREATMENT OF RETAINED (PERSISTENT) PRIMARY TEETH

Treatment of complicated caries in children and adolescents has a number of features, which is determined by age-related anatomy and the limited functioning time of temporary teeth, as well as the timing of their root resorption. Today, the treatment of pulpitis of preserved temporary (persistent) teeth is of particular clinical interest. Persistent (delayed) teeth are temporary (baby) teeth that are preserved in the dentition after the physiological time of their replacement and are capable of functioning for 10 years or more. In most cases, the presence of retained temporary teeth is due to congenital edentia of permanent teeth, retention or death of their rudiments. There is no data in the literature on the features of the anatomical structure of persistent teeth and recommendations for their endodontic treatment. At the same time, in the treatment of this pathology, the methods of pulpotomy (devital amputation, impregnation method) and pulpectomy (pulp extirpation, vital method) are widely used, followed by obturation of the root canals with resorbable filling materials. Taking into account the above, we conducted a retrospective analysis of 192 orthopantomograms of patients with congenital permanent adentia and the presence of 289 persistent teeth. The anatomical features of the structure of the root canals of persistent teeth have been determined. The results of treatment of 44 preserved temporary teeth with chronic fibrous pulpitis in 27 patients of childhood and adolescence using the method of vital extirpation followed by restoration of the crown parts of the teeth using therapeutic and orthopedic methods are presented. Long-term treatment results up to 60 months were assessed. Meanwhile, the results obtained indicated the absence of signs of root resorption in persistent teeth over a long period of time from the period of their physiological change, as well as the features of the anatomical structure of root canals, similar to that of permanent teeth, and allowing endodontic treatment of preserved teeth using classical for permanent teeth pulpectomy method. The results of clinical observation and X-ray examination in the long term after treatment allow us to conclude that the approach used is highly effective, which reduced the risk of periapical complications and created conditions for the longterm functioning of persistent teeth.

Changes in rheological parameters of blood, microcirculation, and accumulation of antibiotic in the focus of acute inflammation of patients with maxillofacial phlegmon

BACKGROUND: Despite the modern development of dentistry, the frequency of purulent inflammatory diseases of complicated caries tends to increase. Up to 60%–70% of patients had odontogenic phlegmon in maxillofacial hospitals. With the spread of the process to the neck and mediastinum, mortality reaches 60%, and with the generalization of infection leading to septic shock, it increases to 90%. This study aimed to examine the state of rheological parameters and blood microcirculation in cases of acute purulent inflammation in patients with maxillofacial phlegmon based on blood viscosity, analysis of the microcirculatory bed according to laser Doppler flowmetry, and concentration of the antibiotics in the blood. This study will allow us to analyze pathophysiological changes and coordinate adequate drug therapy.
 AIM: To examine the state and rheological properties of blood in the microcirculation and antibiotic concentration in cases acute purulent inflammation in patients with maxillofacial phlegmon to improve the effectiveness of treatment.
 MATERIALS AND METHODS: The study enrolled 20 patients. Their age ranged from 28 to 62 years, and there were 13 (65%) men and 7 (35%) women. The average body weight of the patients in the study group was 79–95 kg. All patients under endotracheal anesthesia underwent phlegmon dissection. During the operation and treatment, microcirculation, blood viscosity, and laser Doppler flowmetry were evaluated, and the antibiotic concentration in the inflammation area was assessed.
 RESULTS: The results of the study of 20 patients were analyzed. As a result of studying the rheological parameters of blood obtained from the peripheral vein in patients with phlegmon of the maxillofacial region of various localization, changes in blood viscosity towards thickening compared with normal values were revealed.
 CONCLUSION: With acute purulent inflammation of the maxillofacial region, pathophysiological changes occur in the microcirculatory bed, which must be considered when prescribing adequate antibacterial therapy.

ОСЛОЖНЕННЫЙ КАРИЕС В ПОСТОЯННЫХ НЕСФОРМИРОВАННЫХ ЗУБАХ У ДЕТЕЙ: ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ

A literature review is presented on the problem of complicated tooth decay in permanent teeth with unformed roots in children, which is one of the main ones in pediatric dentistry.
 Objectives — to evaluate the effectiveness of treatment methods for complicated caries in permanent immature teeth in children.
 Methodology. A review of scientific papers in the medical resources PubMED, MEDLINE, eLibrary.ru, Complete, Scopus, Springer was conducted. The article presents two clinical cases using: the method of direct coating of pulp in the tooth 2.4 in a girl 8 years old; method of revascularization in the tooth 1.1 in a girl 7 years old.
 Results. These clinical cases indicate that the method of direct coating of pulp is effective even with sufficient pronounced destruction of the permanent tooth and contributes to the full formation of the root, and the method of revascularization contributes to the development of the root even in cases where the sprout zone of the root is damaged in the forming tooth, adequate treatment was started after a long period of time.
 Conclusions. Literary sources and clinical cases show the high survival rate of teeth with unformed roots with complicated caries and the further functioning of teeth for a long time. Most often, when treating teeth with unformed roots and necrotic pulp, a method aimed at apexification is used, but nevertheless, a promising replacement for the treatment of teeth with apical periodontitis is the revascularization method.

Complicated caries of permanent teeth in children: status of the problem and modern solution ways

The issue of improving dental care protocols for children with multiple (decompensated) and complicated caries of permanent teeth, their full rehabilitation is particularly relevant, especially in periods of social cataclysms (the COVID-19 pandemic, martial law, etc.). The purpose of this study was an assessment of the dental caries experience, analysis of modern approaches to diagnosis, treatment, prevention and rehabilitation of complicated caries of permanent teeth among children in Kyiv. The material of the study was data from medical histories of 236 children aged 7-18 years. During the analysis of the obtained data, the dental caries experience, % of cases of toothache complaints and part of the need for replacement or correction of restorations after the treatment of complicated caries were calculated. The prevalence of caries of permanent teeth among 7-18-year-old children (n=236) in the period 2020-2023 was 42-95%, the dental caries experience – 1.73-6.4, the frequency of diagnosis of complicated caries – 4.8-37,1%, the prevalence of toothache – 31%, the part of the need for replacement of restorations after treatment of complicated caries – 62%. The obtained indicators confirm the absence of a downward trend compared to similar data for more than 15 years of observation. Diagnosis, treatment and full rehabilitation of complicated caries of permanent teeth in children is complex, multi-stage and requires the practical experience and patience of a dentist and the usage of the most modern materials and technologies. To date, there are no clear scientifically based protocols for the restoration of permanent teeth, in particular with incomplete root formation, after endodontic treatment. The usage of modern technologies of orthopedic dentistry and materials science (3D scanner, 3D printer, T-scan, polymers) will allow to significantly improve the quality of comprehensive treatment and rehabilitation of children with complications of caries of permanent teeth.

COMPARATIVE CHARACTERISTICS OF DENTAL CARIES AND ITS COMPLICATIONS IN CHILDREN OF POLTAVA REGION

Despite the high level of development of dental technologies, caries, and its complications occupy a leading place in the structure of dental pathology in children nowadays. This is a difficult social, scientific, and practical problem, which determines the relevance of this research.
 The aim of the study was to carry out a comparative analysis of caries and complicated caries indices of children in Poltava and the suburb.
 Materials and methods. A dental examination was carried out on 905 children 8-10 years old who studied in schools of Poltava and the suburbs. We determined the following indicators in children: the intensity of caries according to decay-missing-filled (DMF) indices in permanent, temporary, and deciduous teeth, the intensity and prevalence of complicated caries, and the need for treating.
 Research results and their discussion. Our epidemiological research work evidence that there is no statistically significant difference in the intensity of caries according to the DMF index between children in Poltava and in the suburb (p≥0.05). They were statistically significant in the comparison between the indicators of the gymnasium in the village Rozsoshentsy and schools in villages Shcherbany and V. Trostyanets and educational establishments of Poltava (р≤0.05).
 At the same time, the intensity and prevalence of complicated caries is statistically higher (p≤0.05) in children from suburbs, than in children from Poltava. The difference was statistically significant when comparing all groups, except indicators between the gymnasium in the village Rozsoshentsy and school № 10 in Poltava (р≤0.05).
 Conclusions. We can explain it by the low level of dental awareness of the Ukrainian population, and the closure of dental offices in schools. It leads to the impossibility of constant monitoring of dental health in children.

PREVENTION AND TREATMENT OF CARIES AND ITS COMPLICATIONS IN TEMPORARY TEETH IN A DENTAL CLINIC

Damage to the hard tissues of the teeth is most common among children. This applies to both temporary and permanent bite. Untimely prevention and treatment of caries leads to the progression of the process in the tissues of the tooth, the occurrence of complications.
 The aim of the study was to explore the possibility of using various methods of treatment and prevention of caries in deciduous teeth and its complications in children in a dental clinic.
 For the period from 2020 to 2023, 1659 patients aged 2-6 years old applied to the dental clinic. Each patient was examined, individual training was given to them and their parents in oral hygiene, a treatment plan was drawn up and preventive measures were taken. Recommendations were given on rational nutrition. Sealing was applied in temporary molars within a year after their eruption. After 2 years, 90% of patients did not reveal caries of temporary molars.
 In children of this age group, the treatment of diseases of the teeth’ hard tissues can be carried out using local anesthesia, under nitrous-nitrogen-oxygen sedation and under general anesthesia. The choice of treatment method will be influenced by the total amount of sanitation and the compliance of the child. In 72% of patients, the intervention was performed under general anesthesia. The use of this method in the clinic makes it possible to treat a certain number of teeth in one visit and work with a cohort of children who are not ready for the usual conditions of admission.
 The most common pathology treated was caries, accounting for 89% of the children who visited the clinic.
 Used photopolymer composite filling materials.
 A complication of caries (inflammation of the pulp or periodontal tissues) was treated in 64% of patients who sought dental care. Each patient underwent an X-ray examination, an orthopantomogram, or targeted images, depending on the age of the child, to decide on the choice of treatment method (tooth preservation or extraction). So, 5.4% of the teeth that needed intervention by a pediatric dentist were subject to extraction. Complicated caries is accompanied by significant destruction of the tooth crown, which requires appropriate treatment approaches. In such cases, standard crowns were more often used, which made it possible to restore the anatomical shape of temporary molars, their function and achieve a long-term treatment effect until the period of physiological changes in the teeth.
 There are several options for crowns that can be used in pediatric dentistry standard steel crowns (stainless steel crowns), for the restoration of the chewing group of teeth, metal crowns with plastic veneer, for the restoration of the anterior group of teeth and crowns based on a framework of zirconium dioxide, which are universal and biocompatible with periodontal tissues.
 Admission of children to the dental clinic allows the use of modern methods of diagnosis, anesthesia, treatment, and preventive measures. An important point is the cooperation of a pediatric dentist with the patient's parents, which is the key to obtaining maximum positive results, restore chewing function, aesthetic appearance, achieve an increase in the resistance of hard dental tissues and prevent caries and its further development.

Обзор работы государственной стоматологической службы Тверской области в 2021 году

Taking care of the health of the population of the Tver region is an important direction of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of the citizens of the Tver region, to increase the role of preventive care of dental diseases, to form a model of organization of the dental industry that ensures the availability and quality of dental care, to increase the efficiency of dental services, the volume, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science. The aim of the research is the analysis of the statistical data of the stomatological service of the state public health institutions of the Tver region. Materials and methods. Analysis of the statistical data reflecting demographic indexes, statistics of the stomatological service structure, staffing, distribution of dentists among the institutions of the Tver region, quality of dental care, the main indexes of the stomatological service of the Tver region, indexes of treatment and preventive work. Results. The present study is devoted to the analysis of the activity of state medical institutions of health care of the Tver region that provide dental care to the population of the Tver region. The indices of the provision of dentists in this region (not taking into account orthopedists and orthodontists) makes 3,82 posts for 10 thousand population (426,25 rates in total). Indicators of provision of the region’s population with dentists are 4,3 positions per adult population of the region. The deficit specialties have been revealed: pediatric dentists, orthodontists, in the regional institutions there is a shortage of orthopedists. The share of occupied staff positions in the specialty of pediatric dentistry was 49%, which reflects the need for training in this area. The difficulties in the organization of preventive examinations of the children’s population were revealed, and the low percentage of the examined persons. Conclusions. The municipal, district and regional medical institutions of health care rendering dental treatment to the population are functioning on the territory of the city of Tver and the Tver region in general. The statistical analysis has revealed a number of difficulties that require further action on the part of the medical community and public organizations. It is necessary to develop comprehensive measures to solve the shortage of pediatric dentists at the level of the Ministry of Health and educational institutions. The difficulties of preventive examinations among the population of different groups are highlighted. It is important to strengthen the preventive profile in order to reduce the cases of complicated caries, tooth extraction. Development of hygienic direction will increase awareness of the population about the peculiarities of dental and oral hygiene, methods of prevention and treatment of dental diseases.

ОСОБЕННОСТИ ТЕЧЕНИЯ ОСТРЫХ ОДОНТОГЕННЫХ ВОСПАЛИТЕЛЬНЫХ ПРОЦЕССОВ ЧЕЛЮСТЕЙ ВДЕТСКОМ ВОЗРАСТЕ

The goal.Studying the clinical course’s features of acute odontogenic inflammatory processes of the jaws in children, describing species composition of pathogens, determination sensitivity to antibiotics of various groups in acute odontogenic inflammatory processes of the jaws in childhood. Materials and methods.The case histories of 900 patients were analyzed, microbiological research methods were carried out (microscopic examination of clinical samples with Gram staining, culture method, determination of the sensitivity of theisolated pathogen to antimicrobial drugs).Results.The most common odontogenic inflammatory processes of the jaws were observed in children aged 4–5 years. In48,85 % of cases in a milk bite and in 67,92 % of cases in a permanent bite, the cause of the development of an odontogenic inflammatory process was complicated caries of the mandibular molars. 56% of children had a general condition. The leading causative agent of the inflammatory process of the jaws was in 65,6 % of cases hemolytic streptococcus. In other cases, Streptococcus Viridans(6,1 %), pneumococci (4,3 %), candida (3 %), Staphylococcus aureus(2,8 %), Moraxella cataralis(1,2 %), etc. were detected in the mixed microflora of purulent exudate. The drugs of choice for empirical antibiotic therapy for odontogenic inflammatory process caused by beta-hemolytic streptococcus group A are vancomycin (antibiotic sensitivity –99 %), fluoroquinolones (antibiotic sensitivity –98 %), beta-lactams (antibiotic sensitivity –91 %). The highest percentage of resistance of this microflora was noted to macrolides (41 %), and to clindamycin (33 %). The rapid spread of the purulent-inflammatory process in the maxillofacial region in acute odontogenic processes in children, the resistant microflora of the odontogenic purulent focus require a competent approach when providing emergency care.Conclusions.The obtained has great practical importance for the choice of rational antibiotic therapy.

Evaluation of the effectiveness of the state policy aimed at increasing the attractiveness of rural areas for the settlement of young dentists

The article suggests a hypothesis that the implementation of the Zemsky Doctor program does not lead to a sufficient increase in the attractiveness of young specialists moving to rural areas, which in turn reduces the availability of oral sanitation in the CRH and indicates the presence of a dental aspect of social inequality. To confirm or refute the truth of the hypothesis, two tasks are set: 1. To assess the role of the Medical Institute of the Belgorod State National Research University as a factor determining the settlement of dentists in rural areas. 2. To analyze the dynamics of the number of fillings placed for pulpitis and periodontitis in Prokhorovsky, Rakityansky, Volokonovsky dental departments for 2017 and 2021. The solution of the tasks set allowed us to speak about the truth of the formulated hypothesis. The revealed features of the personnel of the dental departments of the CRH indicate the absence of a significant influence of the medical institute on the staffing of the CRH by young specialists. The results obtained in the process of comparative evaluation of the number of fillings made for complicated caries revealed a widespread decrease in the intensity of endodontic treatment observed in different CRH.

POSSIBILITIES OF DIFFERENT APPROACHES USING DURING DENTAL RESTORATION IN PRESCHOOL CHILDREN

Caries of temporary teeth in children occurs already from the first year of life, and the prevalence and intensity of early childhood caries tend to increase with age. Therefore, its treatment in children of early childhood and preschool age is a difficult but very important task for a dentist. The purpose of our study was to compare different approaches to oral hygiene in children of early childhood and preschool age. We examined 25 children aged 2 to 6 years who had suband decompensated caries and belonged to 2 health groups. These children were divided into two groups depending on the approach to dental treatment. The first group consisted of 10 children who were treated in outpatient settings. The second group consisted of 15 children who underwent oral rehabilitation under general anesthesia. The children of the first group were 5-6 years old persons, the second group included 2-5 years old children. Treatment of children of the 1st group, who had a positive attitude to dental manipulations, was carried out under local anesthesia in an outpatient setting. In the 2nd group of children who had either a negative attitude to dental treatment or an early age, rehabilitation was carried out under general anesthesia. Isolation of the working field was carried out using a rubberdam system. Universal nano-ceramic material SeramX SphereTEC one (Dentsply) was used for permanent fillings. When diagnosing pulpitis, treatment was carried out by the method of vital amputation or extirpation. Bio MTA Plus (Cerkamed P.P.H, Poland) was used as biological material during amputation, and Metapex filling material (Meta Biomed) was used to fill root canals during extirpation. Riva LC (SDI Limited, Australia) was used as a gasket for pulpitis.
 Research results and their discussion. We could not (in the most cases) provide quality treatment to the children of the 1st group, despite the fact that they had an older age, a lower intensity of caries, and a lower percentage of complicated caries. Although there is a significant number of dental visits (from 4 to 9) compared to children of the 2nd group, who were completely rehabilitated in the oral cavity in one visit.
 Conclusions. As the results of the clinical study demonstrated, it is better to treat children in early childhood and preschool age who have a high intensity of caries under general anesthesia. This will allow the doctor to carry out the high-quality treatment according to modern protocols with a predictable result and will save the child from a negative experience of dental treatment, which in the future will make it possible to safely carry out rehabilitation of the oral cavity in an outpatient setting.

Use of allogeneic canned osteoplastic drugs for the treatment of chronic periodontitis

BACKGROUND: Despite significant scientific advancements in the development of new methods for the diagnosis and treatment of caries and periodontal diseases using modern technologies, medications and restorative materials, the incidence of complicated caries has increased in recent years. This can be attributed to poor efficiency with regard to dental examinations, particularly in school classrooms.
 AIM: To study the clinical efficacy of allogeneic osteoplastic drugs such as Kostma, Deprotex, and Orgamax in the treatment of chronic periodontitis.
 MATERIAL AND METHODS: The study sample included 135 patients diagnosed with chronic periodontitis who underwent endodontic treatment using allogeneic drugs with osteoplastic and antimicrobial properties. Of these, 36 patients underwent treatment using bone, 46 were treated with Deprotex, and 53 received Orgamax. Drug efficacy was compared using osteo-densitometry, and active regeneration and replacement of the defect with newly formed bone tissue was seen to take place. Orgamax was seen to induce reduction of the periapical focus over a shorter duration when compared to the others. Complications of an inflammatory nature were observed in 18 patients, of which 8 patients underwent tooth extraction and 10 underwent repeated treatment. Twelve patients exhibited no bone regeneration in the defect, and a total of 98 patients presented with favorable treatment outcomes (characterized by restoration of the periapical structure of bone tissue) over a period of 3 years.
 CONCLUSION: Endodontic treatment of chronic destructive periodontitis using allogeneic drugs such as Kostma, Deprotex, and Orgamax, which have antimicrobial and osteoplastic properties, facilitates bone tissue regeneration in the periapical defect, reduces the number of inflammatory complications and relapses, increases efficiency, and improves long-term treatment outcomes.