Dentist’s approach to management of oral mucosa lesions in children with Behcet’s disease

Abstract

Relevance . Behcet's diasease (BD) is a rare pediatric pathology, children compose 2-3% of all patients with Behcet's disease. Dentists are the first to encounter this severe disease, they provide continuous observation of children with chronic recurrent aphtous stomatitis (RAS), which has a prolonged course, frequent recurrences and resistance to the administered treatment. Elaboration of a program of collaborative examination and treatment of children by dentists, rheumalologisls and pediatricians was required. Purpose - to increase the level of diagnosis and treatment of Behcet's disease in children through the interdisciplinary approach to rehabilitation of the disease. Materials and methods . We examined children hospitalized to rheumatology department of University Children’s Clinical Hospital of Sechenov First Moscow State Medical University. There were 21 children aged between 6 and 17 with Behcet’s disease who were referred to a dentist, pediatrician and rheumatologist for a comprehensive examination of the whole body. The developed plan included assessment of disease localization and genetic predisposition, detection of a trigger and time of first manifestations of the primary diagnostic sign of RAS and manifestation time of subsequent clinical signs of the disease, laboratory tests and histomorphologic evaluation of damaged mucosa. Results . Upon application of the suggested plan of examination in children with Behcet’s disease it was found out that 18 (85.7%) children had nationality of the Silk Road. In 100% of children chronic recurrent aphtous stomatitis was the first symptom of the disease with severe course in 14 (66.67%) children, monthly relapses in 7 (33.34%) children and chronic relapses in 6 (28.57%) children. Among other symptoms of Behcet’s disease in children eye lesions are the most frequent (90.9%), the digestive system is affected in 90.9%, excretory organs are affected in 72.7%, and articular syndrome is frequently encountered (45.4%). Anemia, elevated ESR, immune index changes, decrease of total number of T-lymphocytes and T-helpers, elevated level of circulating immune complex (CIC), elevation of specific classes of immunoglobulins (especially IgA), hemotoxic activity of neutrophils and decrease of secretory IgA in saliva were detected on additional examination of children with Behcet’s disease (only severe RAS). Conclusions. Thus, Behcet’s disease has not been sufficiently studied yet, that’s why late diagnosis is observed. The disease proceeds as incomplete Behcet’s syndrome during 5.4+0.04 years in girls and 4.1+0.09 years in boys, manifesting itself only by chronic recurrent aphtous stomatitis in 100% of cases which is the first diagnostic symptom of the disease. The comprehensive diagnostic plan, developed by us, is offered to dentists who observe children with oral mucosa diseases. Diagnosis and treatment of Behcet’s disease in children require an interdisciplinary approach by doctors of different specialties and an obligatory involvement of a dentist.