STATE OF MICROBIOCENOSY AND DEFENSIVE MECHANISMS OF THE ORAL CAVITY OF CHILDREN IN THE DYNAMICS OF OBSERVATION AFTER THE SURGERY OF TOOTH REMOVAL FOR ORTHODONTIC INDICATIONS
Authors: Godovanets O. , Kuzniak N. , Bambuliak A. , Dmytrenko R. , Lopushniak L. 
Published: December 2024

In children, tooth extraction is performed not only in the presence of odontogenic inflammatory processes, but also for orthodontic indications. One of the main conditions for the qualitative course of the process of epithelialization of the socket after tooth extraction is a sufficiently high level of hygiene, a certain species composition of the resident microflora and the state of the protective mechanisms of the oral cavity.
The aim of the study was to identify changes in the microbiocenosis and protective reactions of the oral cavity of children after tooth extraction for orthodontic indications.
Material and methods. To establish the effectiveness of prevention and treatment of complications, two observation groups were under observation: the main group (n=30), whose children were treated with the developed drug complex, and the comparison group (n=29), where the tooth extraction operation was performed without any additional actions. It should be noted that the patients involved in the study did not have concomitant somatic pathology. To prevent post-extraction complications, we proposed a method of pharmacological influence on the condition of the tissues of the maxillofacial area of orthodontic patients before the start of the surgical stage of treatment. The complex we developed is aimed at increasing the protective capabilities and normalizing the microbiocenosis of the oral cavity of children and involves the systemic use of a vitamin-mineral preparation, an immunomodulator and a probiotic at the local level. Statistical processing of the data was carried out using the methods of variation statistics using the Statistica statistical software package. The law of distribution of the studied traits was checked for normality using the Kolmogorov-Smirnov test. The hypothesis that the law of distribution of the sample population is normal was accepted at the significance level of α=0.05. Two samples were compared using the Student-Fisher test if the hypothesis of the normal distribution of both samples was accepted. The study was conducted in accordance with the main provisions of the Convention of the Council of Europe on Human Rights and Biomedicine (4 April 1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Scientific Medical Research Involving Human Subjects (1964-2013), ICH GCP (1996), Orders of the Ministry of Health of Ukraine No.690 dated 23.09.2009, No.944 dated 14.12.2009, No.616 dated 03.08.2012. The Biomedical Ethics Commission of the Bukovinian State Medical University (Protocol No. 3 of 17 September 2021) did not find any violations of moral and legal norms during the research work. The study was performed within the framework of the research work of the Department of Paediatric Dentistry of Bukovinian State Medical University on the topic ‘Development of methods for the prevention and treatment of major dental diseases in children, taking into account the risk factors for their development’ (SR No. 0121U110122).
Results. The study of oral fluid of children who underwent tooth extraction for orthodontic indications against the background of pharmacological correction showed the restoration of its protective functions (an increase in lysozyme activity by 20.52 % (p<0.05), sIgA level by 6.26 % against the background of a decrease in total protein content by 21.34 % (p<0.05) and IL-4 concentration by 21.22 % (p<0.05)) and antioxidant protection (an increase in catalase activity by 46.4 2% (p<0.05), superoxide dismutase by 15.53 %, the level of HS groups by 24.58 % (p<0.05), G-SH by 60.87 % (p<0.05), inactivation of glutathione peroxidase by 14.08 % and restoration of glutathione reductase function by 15.21 %), which ensured the course of postoperative period without complications.
Conclusions. The oral microbiocenosis of children who used the agents proposed by us during the surgical stage of orthodontic treatment demonstrated quantitative and qualitative changes (the total microbial count decreased by 20.75 % (p<0.05)), the number of pathogenic and opportunistic bacteria decreased by 2.09 times, Str. mutans – by 3.0 times against the background of an increase in the number of lactobacilli by 2.34 times and the complete absence of Candida species, which was a prerequisite for the normal course of the wound process.