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Гигиена полости рта

 

Гигиена полости рта у детей, находящихся на ортодонтическом лечении

Гигиена полости рта у детей, находящихся на ортодонтическом леченииРаспространенность заболеваний тканей пародонта среди детского населения с каждым годом увеличивается. По данным эпидемиологического обследования детей в возрасте 6, 12 и 15 лет, проведенного в г. Барнауле по методике ВОЗ, распространенность заболеваний пародонта выглядит следующим образом:

в 6 лет – 6,96%; в 12 лет – 50%; в 15 лет – 56%.


Среди заболеваний пародонта у детей чаще встречается хронический катаральный гингивит, основной причиной развития которого является зубной налет. Неудовлетворительное гигиеническое состояние полости рта детей – следствие еще недостаточно отработанных навыков ухода за зубами. Наличие же у детей зубочелюстных аномалий также может ухудшать качество гигиены полости рта, особенно на этапе лечения ортодонтическими аппаратами.

Съемные ортодонтические аппараты при длительном использовании могут вызывать травмирование тканей десны как базисом аппарата, так и различными металлическими элементами, входящими в конструкцию.

Кроме того, ортодонтическая аппаратура способствует ретенции пищевых остатков и налета, что также может негативно сказаться на состоянии твердых тканей зубов и тканей пародонта.

Правильная тактика ведения ортодонтического больного и специальная гигиена полости рта детей с зубочелюстными аномалиями улучшают уровень гигиены и обеспечивают профилактику развития заболеваний тканей пародонта. Поэтому вопрос выбора средств гигиены для ухода за полостью рта у пациентов с зубочелюстными аномалиями и деформациями остается очень актуальным.

Однако на сегодняшний день спектр предлагаемых средств гигиены очень велик и родителям детей, находящихся на ортодонтическом лечении подчас очень сложно адекватно подобрать зубную пасту, которая бы максимально эффективно боролась за улучшение гигиенического состояния полости рта таких пациентов.

 Гигиена полости рта у детей, находящихся на ортодонтическом лечении Гигиена полости рта у детей, находящихся на ортодонтическом лечении
 Гигиена полости рта у детей, находящихся на ортодонтическом лечении Гигиена полости рта у детей, находящихся на ортодонтическом лечении


Мы заинтересовались этой проблемой и попытались найти наиболее подходящее средство гигиены для полости рта детей, находящихся на лечении съемными ортодонтическими аппаратами. Для сравнения нами были взяты три вида зубных паст:

Паста, содержащая фермент бромелаин в составе комплекса минералин.

Бромелаин, являясь протеолитическим ферментом, обладает противоналетным и антиадгезивным действием (Афиногенов Г. Е. и соавт., 2006).

Паста, содержащая в своем составе антисептик триклозан, который подавляет процесс бляшкообразования и оказывает бактериостатическое и бактерицидное действие в отношении ряда грам-положительных и грам-отрицательных бактерий (Соловьева А. М. и соавт., 1997).

Паста, содержащая аминофторид и ксилит, который по данным литературы также оказывает противоналетное и антибактериальное действие (Petzold M., 2001; Cahen et al., 1982; Сарап Л. Р. с соавт., 2005).

Нами было обследовано три группы пациентов в возрасте от 6 до 12 лет, находящихся на лечении съемными ортодонтическими аппаратами:

1 группа - пациентам было рекомендовано чистить зубы и ортодонтические аппараты два раза в день зубной пастой с бромелаином.
2 группа - использовала для ухода за полостью рта и аппаратами зубную пасту, содержащую антисептик триклозан.
3 группа - применяла зубную пасту, содержащую аминофторид и ксилит.

Обследование пациентов проводилось по общепринятой методике, включающей сбор жалоб, анамнез жизни, анамнез заболевания, внешний осмотр и локально полости рта с использованием стандартного набора стоматологических инструментов.

Уровень гигиены полости рта оценивался при помощи гигиенических индексов OHI-S и PHP до и после двухнедельного применения зубной пасты.
Степень воспаления тканей пародонта оценивалась индексом PMA в том же временном режиме.

В группе №1, где использовалась зубная паста с бромелаином, динамика клинических показателей полости рта выглядела следующим образом (табл. 1):

Средняя интенсивность кариозного процесса в данной группе составила 4,7 ± 0,81.

Уровень гигиены полости рта до использования вышеназванной зубной пасты составлял 1,48 ± 0,10, что соответствовало удовлетворительной гигиене полости рта, а через две недели применения достоверно улучшился и составил 0,82 ± 0,05, что соответствует хорошей гигиене.

Индекс эффективности гигиены РНР исходно составлял 0,69 ± 0,02, что соответствовало удовлетворительной гигиене полости рта, а через две недели достоверно уменьшился до 0,28 ± 0,03, что характеризовало хорошую гигиену полости рта.

Индекс РМА до использования зубной пасты с бромелаином составлял 7,86 ± 1,57, а через две недели достоверно уменьшился до 2,77 ± 0,7.

Таблица 1
Изменение клинических показателей полости рта у детей, применявших зубную пасту на основе бромелаина

Изучаемые показатели
До применения зубной пасты
Через 2 недели применения зубной пасты
КПУ
4,7 ± 0,81
4,7 ± 0,81
OHI-S
1,48 ± 0,10**
0,82 ± 0,05**
PHP
0,69 ± 0,02**
0,28 ± 0,03**
PMA
7,86 ± 1,57**
2,77 ± 0,7**

**статистически значимое различие (р < 0,01)
В группе №2, где использовалась зубная паста с триклозаном, динамика клинических показателей полости рта выглядела следующим образом (табл. 2):

Средняя интенсивность кариозного процесса в данной группе составила 5,09 ± 0,72.

Уровень гигиены полости рта до использования данной зубной пасты составлял 1,62 ± 0,11, что соответствовало удовлетворительной гигиене полости рта, а через две недели применения достоверно улучшился и составил 1,1 ± 0,10, что соответствует хорошей гигиене полости рта.

Индекс эффективности гигиены РНР исходно составлял 0,65 ± 0,04, что соответствовало удовлетворительной гигиене полости рта, а через две недели достоверно уменьшился до 0,39 ± 0,03, что характеризовало хорошую гигиену полости рта.

Индекс РМА до использования зубной пасты с триклозаном составлял 6,57 ± 1,36, а через две недели достоверно уменьшился до 2,94 ± 0,76.

Таблица 2
Изменение клинических показателей полости рта у детей, применявших зубную пасту с триклозаном

Изучаемые показатели
До применения зубной пасты
Через 2 недели применения зубной пасты
КПУ
5,09 ± 0,72
5,09 ± 0,72
OHI-S
1,62 ± 0,11**
1,1 ± 0,10**
PHP
0,65 ± 0,04**
0,39 ± 0,03**
PMA
6,57 ± 1,36*
2,94 ± 0,76*

*статистически значимое различие (р < 0,05)
**статистически значимое различие (р < 0,01)

В группе №3, где использовалась зубная паста с аминофторидом, динамика клинических показателей полости рта выглядела следующим образом (табл. 3):

Средняя интенсивность кариозного процесса в данной группе составила 5,67 ± 0,82.

Уровень гигиены полости рта до использования данной зубной пасты составлял 1,29 ± 0,12, что соответствовало удовлетворительной гигиене полости рта, а через две недели применения достоверно улучшился и составил 0,86 ± 0,12, что соответствует хорошей гигиене полости рта.

Индекс эффективности гигиены РНР исходно составлял 0,55 ± 0,06, что соответствовало хорошей гигиене полости рта, а через две недели достоверно уменьшился до 0,29 ± 0,05, что также соответствует хорошей гигиене полости рта.

Индекс РМА до использования зубной пасты с аминофторидом составлял 4,04 ± 1,27, а через две недели уменьшился до 1,51 ± 0,47, однако данные различия не достоверны.

Таблица 3
Изменение клинических показателей полости рта у детей, применявших зубную пасту с аминофторидом

Изучаемые показатели
До применения зубной пасты
Через 2 недели применения зубной пасты
КПУ
5,67 ± 0,82
5,67 ± 0,82
OHI-S
1,29 ± 0,12*
0,86 ± 0,12*
PHP
0,55 ± 0,06**
0,29 ± 0,05**
PMA
4,04 ± 1,27
1,51 ± 0,47

*статистически значимое различие (р < 0,05)
**статистически значимое различие (р < 0,01)

Гигиена полости рта у детей, находящихся на ортодонтическом леченииИндексы, оценивающие уровень гигиены полости рта OHI-S и PHP, достоверно улучшаются во всех исследуемых группах в результате двухнедельного применения различных средств гигиены, участвующих в исследовании. Это можно объяснить, с одной стороны, предварительным обучением детей чистке зубов и ортодонтических аппаратов, с другой стороны – мотивацией к гигиене.

Однако противовоспалительное действие отмечено только после применения зубных паст, содержащих бромелаин и антисептик. Но в детском возрасте применение зубных паст, содержащих антисептик, ограничено возрастом и сроком применения (не более двух недель). Ортодонтическое же лечение съемными аппаратами занимает в среднем один-два года. Поэтому, на наш взгляд, более перспективным в отношении сохранения хорошего состояния твердых тканей зубов и тканей пародонта у детей, находящихся на лечении съемными ортодонтическими аппаратами, является применение зубных паст на основе ферментов (например, бромелаина).

Ю.В. ДОБРЫГИНА, асс. кафедры стоматологии детского возраста Алтайского ГМУ
Л.Р. САРАП, к.м.н., зав. кафедрой стоматологии детского возраста Алтайского ГМУ
Т.В. КУПЕЦ, руководитель научно-информационного отдела группы компания «Диарси», Москва   

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