Dental caries in children with severe diseases of the central nervous system caused by perinatal hypoxia

Abstract

Introduction. The association of systemic diseases with the hypoxia syndrome during the child’s growth periods increases the risk of pathological changes in the tissues, characterized by the increase in the activity of anaerobic glycolysis processes with the intensification of lactic acid formation. Similar phenomena also occur in the dental tissues in the process of development, the cells of the salivary glands, subsequently generating a cariogenic situation. Although several authors have reported the increase in dental caries (DC) and cases of enamel hypomineralization in children with central nervous system (CNS) diseases caused by perinatal hypoxia, the role of phosphocalcium metabolism disorders, especially of bioenergetic processes, in triggering of the carious process have not been sufficiently studied, and the establishment of a possible interdependence will allow the development of new strategies for the prevention and treatment of dental pathology. The objective of the study was to study the relationship between dental caries and markers of phosphocalcium and bone metabolism in children with severe diseases of the central nervous system caused by perinatal hypoxia. Materials and methods. In order to achieve the set objectives, a case-control clinical study was carried out on a sample of 1272 children. Dental caries preva lence indices (PI) and carious experience indices were evaluated in 636 children with CNS diseases caused by perinatal hypoxia (L1), compared to 636 conventionally healthy children (L0). To highlight the impact of metabolic disorders on DC susceptibility of children with severe CNS diseases, biochemical markers of redox processes, bone metabolism, phosphocalcium and anaerobic glycolysis products were studied in blood serum and oral fluid (OF). Results. In children with severe CNS diseases, increased values of PI indices (79.40±0.84%, p<0.001) and caries experience (4.03±0.088, p<0.001) were appreciated, compared to conventionally healthy children. The chronic disorder of redox processes, phosphocalcium metabolism at the macroorganism and local level was detected, which significantly influences the degree of CD damage in children with severe CNS pathology, confirmed by: increased lactate level and lactate dehydrogenase activity, reduced activity of heat-labile alkaline phosphatase in the serum blood and in OF, as well as the statistically significant increase in tartrate-resistant acid phosphatase activity in the blood serum, the statistically significant decrease, below the normal limits, in the level of Ca, Mg and vitamin D3 in the blood serum, as well as the significant reduction of the Ca/Pi ratio in the FO. Conclusions. The detection of important caries risk factors and indicators of the aggressive evolution of DC, such as the increase in the concentration of anaerobic glycolysis products and the deregulation of phosphocalcium and bone metabolism in children with CNS diseases caused by perinatal hypoxia, requires the deepening of interdisciplinary studies and the complex approach in planning cariopreventive measures, developed by multipurpose teams of medical specialists