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Opportunities in the prevention of dental caries in children with disabilities


Author: Spinei Aurelia
Degree:doctor habilitat of medicine
Speciality: 14.00.21 - Stomatology
Year:2018
Scientific adviser: Ion Lupan
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 12 September, 2018
Approved by NCAA on the 23 November, 2018

Abstract

Adobe PDF document – 1.80 Mb / in romanian

Thesis

CZU 616.314-002-084-053.2

Adobe PDF document 16.00 Mb / in romanian
320 pages

Keywords

dental caries, children, prevention, disability, dental enamel, biofilm, antimicrobial photodynamic therapy, fluorides

Summary

Volume and structure of the research thesis: the thesis comprises 199 pages and consists of introduction, 6 chapters, general conclusions and recommendations, bibliography of 304 sources, 67 tables, 128 figures and 10 annexes. On this subject were published 64 scientific papers, including 1 monograph. Key words: dental caries, children, prevention, disability, dental enamel, biofilm, antimicrobial photodynamic therapy, fluorides

Field of study: dentistry Purpose: to study the risk factors and morbidity of dental caries, as well as the opportunities to increase the effectiveness of the methods of primary dental caries prevention in children with disabilities. Objectives. To assess the level of caries morbidity and its impact on the quality of life of children with disabilities. To predict dental caries (DC) development in children with various types of disabilities. To study the role of bone and calcium-phosphorus metabolism, as well as the immune factors in DC morbidity. To analyze the streptococci impact on the cariogenic capacity of the dental biofilm. To elucidate the particularities of dental enamel ultrastructure, chemical composition and their role in DC development. To assess the effect of antimicrobial photodynamic therapy (APDT) on the strains of streptococci identified in dental biofilm under in vitro conditions. To estimate the effect of APDT on the cariogenic capacity of dental biofilm in children with a high caries risk. To elucidate the carioprotective effectiveness of complex and individualized preventive care for children with disabilities.

Scientific novelty and originality: for the first time in the Republic of Moldova, the degree of DC was determined, the main caries risk factors were identified and the impact of dental diseases on the quality of life in children with different types of disabilities was assessed. For the first time, based on the preclinical and clinical researches, a multidisciplinary approach was developed and argued in the complex individualized prevention of DC in children with disabilities. Applied scientific problem of major importance solved in the research: the foundation of a new vision regarding the impact of a complex of cariogenic factors, the changes in the oral cavity ecosystem, subtle metabolism disorders and the macroorganism which helped develop the theoretical support for the multidisciplinary approach in terms of prognosis and personalized preventive care in order to reduce DC in children with different disabilities. The elaboration of the APDT method with the application of local photosensitising agents, supplemented with probiotics administration, has generated a new therapeutic approach in the management of oral biofilms and offers new opportunities in implementing effective methods of DC prevention in children with disabilities and high caries risk. The elucidation of the impact of perinatal and chronic hypoxia, disturbance of the calcium-phosphorus metabolism and immune system disorders on the degree of DC required the usege of a new, complex and personalized method of DC prevention in children with disabilities. The conceptualization of the individualized complex preventive treatment has led to the creation of a new scientific direction in the prevention of DC in people with disabilities and high caries risk.

Theoretical significance and applied value: the theoretical knowledge about the pathogenic interconnections between chronic hypoxia, calcium-phosphorus metabolism, immune system, and the degree of DC morbidity in children with disabilities was expanded, which led to the creation of the theoretical support for a multidisciplinary approach in terms of prognosis and individualized preventive care to reduce DC morbidity. The data obtained in the present study allowed the elaboration of the original APDT method with the application of local PS supplemented with probiotics administration and DPF of the dental enamel, carried out within the complex and personalized cariopreventive care of children with different disabilities and high caries risk.

Implementation of the research results: the research results were implemented in the curative, didactic and research activity of the Department of Pediatric Oral and Maxillofacial Surgery, Pedodontics and Orthodontics of "Nicolae Testemitanu" SUMPh, Integrated Specialized Consultative Department of PMSI Mother and Child Institute, PMSI Municipal Dental Center for Children, Chisinau and the Republican Rehabilitation Center for Children and within “The Oral Health Program for Children with Disabilities and Special Educational Requirements during 2012-2014”, approved by the Ministry of Health of the Republic of Moldova.