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Application of modern tools and methods for preventing dental caries among children with congenital cleft lip and palate in need of orthodontic treatment
Author: Agadullina Zarema, clinical intern
Coordinator: Snetkova Tatyana Vladimirovna, associate professor, Ph.D, Pediatric Dentistry, Bashkir State Medical University, Russian Federation.
The purpose of our research was to study the level of oral hygiene and the development of preventive schemes among children with congenital cleft lip and palate in need of orthodontic treatment with the use of braces.
Objectives: 1.To define prevalence and intensity of caries in the observed group; 2.To estimate enamel resistance 3. To estimate the patients’ oral hygiene; 4. To estimate effectiveness of preventive measures with the use of modern means of oral hygiene. Materials and methods: We observed 12 children (8 girls, 4 boys) aged 11-15 in need of orthodontic treatment with the help of non-removable orthodontic appliances. In the observed group we determined the prevalence of caries, the level of caries intensity, enamel resistance test and hygiene index. The survey data were added into outpatient cards.
At initial examination we obtained the following results among all observed patients: the prevalence of caries in permanent teeth constituted 100%; the intensity level of caries (for PA Leus 1990) – 0,7 (high); enamel resistance test – 7 points (low); Green – Vermillion hygiene index – 3.3 points (poor). During the controlled oral hygiene the following errors were found: 1. The time of cleaning teeth did not exceed 30-40 seconds; 2. The choice of individual oral hygiene products did not correspond to the age and dental status; 3. The method of teeth cleaning was not observed; 4. The patients use only toothpaste and toothbrush to take care of their oral cavity. When the level of caries intensity is high and oral hygiene is poor, fixing brackets should be deferred for 2-4 months. This time is needed for treatment of complicated forms of caries and carrying out preventive measures.The following prevention methods have been performed: 1. Controlled oral hygiene; 2. Teaching individual oral hygiene; 3. Professional oral hygiene; 4. Exogenous prevention of dental caries and remineralizing therapy; 5. Oral cavity sanation.Taking into consideration the unique composition of the ROCS products, we have included them into a complex of preventive measures in preparation for orthodontic treatment of children with congenital cleft lip and palate.Before the treatment with non-removable orthodontic appliances training sessions were conducted with each child. They included information about oral hygiene illustrated with the help of phantoms, plaster casts, photos and video demonstrating the possible complications arising from violation of hygiene rules during the treatment with braces.Individual oral hygiene products by the ROCS brand were chosen for each patient. The package by all means included: a monofascicular toothbrush for cleaning teeth, spiral brushes for the interdental space. All patients were prescribed a ROCS toothpaste and a rinse. Also dental floss was recommended. 2 months before fixing the non-removable orthodontic appliances each patient was recommended to use a remineralizing therapy with ROCS Medical Minerals gel which was applied 1 time a day for 12 – 15 minutes, after pre-cleaning teeth with the ROCS toothpaste for adults without fluorine (for better adhesion of braces).
After preventive and treatment measures and before fixing the braces the indices were determined for the second time. The following results were obtained: enamel resistance test – 4-5 points, which corresponds to the average and the Green-Vermillion index – 2.0 points – satisfactory level of oral hygiene, which allowed us to begin treatment with braces.
Conclusions: 1. High prevalence (100%) and high intensity – (0,7 points) (Leus PA 1992) of dental caries among children with congenital cleft lip and palate have been detected.2. low enamel resistance in the observed group of patients – 7 points has been revealed; .3. The Green – Vermillion Hygiene index before prophylactic treatment corresponded to the poor – 3,3 points.4. The presented scheme of professional and individual prophylactic measures led to the improvement of the hygiene level of oral cavity in this group of patients (The Green-Vermillion index – 2,0 – a satisfactory level of oral hygiene), increase in the level of enamel resistance (4-5 points – the average).