RU2718273C1 - Method for preventing dental diseases in children with autism spectrum disorders (asd) - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to dentistry, and can be used for preventing dental diseases in children with autism spectrum disorders (ASD). Papillary-marginal alveolar index (PMA) is determined. If PMA is up to 25 % of childcare provider with ASD are asked to fill questionnaire. Answers "frequently" are evaluated as 1 point, "rarely" - 2 points, "never" - 3 points and are summed up (ΣO). Hygienic index (HI) of the oral cavity is determined. Child under 6 years old has a HI by Fyodorov-Volodkina, and the values of up to 1.7 HI are considered to be average, while values of 1.7 HI are considered to be low. Green-Vermilion HI is used in child over 6 years of age, and if the values of the index are up to 2.2 HI, they are considered to be average, and if values are 2.2 and more low. If the mean HI and ΣO are 16 points or more, the child is referred to the first preventive group, which is inspected and professional oral hygiene every 5 months. If the HI and ΣO are 16 or more points or more, or the HI and ΣO are average, from 11 to 15 points, the child is referred to the second preventive group, which is inspected every 5 months, occupational oral hygiene and remineralizing therapy with Tooth Mousse every day for three weeks. At low HI and ΣO from 11 to 15 points or average HI and ΣO from 6 to 10 points, the child is referred to the third preventive group, which is examined every 4 months, professional oral hygiene and remineralizing therapy by Tooth Mousse preparation daily at night for three weeks, and after each odd visit, after the remineralizing therapy is completed, the teeth are treated with a fluorine-containing preparation. If HI and ΣO are low from 6 to 10 points, the child is referred to the fourth preventive group, which is examined every three months, oral hygiene and remineralizing therapy with Tooth Mousse are performed daily for three weeks, and after each odd visit, after remineralizing therapy, teeth are treated with a fluorine-containing preparation.EFFECT: method enables maintaining the oral cavity of a child with ASD in a satisfactory condition and enables to perform timely treatment using minimally invasive techniques without using anaesthesia by evaluating the complex of the most significant indicators.1 cl, 4 tbl, 6 ex

Description

The invention relates to medicine, namely to dentistry, and can be used in dentistry for the prevention of the development of dental diseases of children aged 3 to 10 years of both sexes suffering from autism spectrum disorders (ASD).

An increase in the incidence rate of the child population of Russia is one of the most pressing health problems. The dynamics of some nosological forms are often negative. In most cases, the presence of general somatic pathology, in particular, neuropsychiatric disorders, such pathologies as autism affect the condition of the child’s oral cavity, have a significant effect on the course of major dental diseases. One of the urgent problems of pediatric dentistry is the determination of the relationship between concomitant diseases of the child and his dental status.

The dental incidence of children with disabilities is significantly higher than that of somatically healthy children. This is due to a number of factors: with a slowdown in the rate of perception, underdevelopment of the cognitive sphere, impaired behavioral reactions and, as a consequence, poor compliance with the necessary hygienic procedures. This factor is directly related to the high prevalence and intensity of the carious process. When analyzing the causes that affect the development of diseases of the oral mucosa and periodontal condition in patients with neuropsychiatric pathology, some authors consider the absence or deterioration of oral hygiene as a predominant etiological factor, rather than the severity and duration of the underlying disease. Also, the effect of the use of specific pharmacological preparations is not always taken into account. A number of publications note that even with adequate oral hygiene and a short prescription of somatic pathology, dental caries and periodontal disease are more common among children with disabilities than in healthy ones.

In childhood, to concretize the implementation of preventive measures, it is recommended to adhere to the method of T.F. Vinogradova, when the intensity of caries is determined by the degree of caries activity using indices kp (during the temporary bite), KPU + kp (during the period of a shift bite) and KPU (during permanent bite), where the index of dental damage by caries is determined by the quantitative values of KPU = K + P + U, K is the number of carious (untreated) teeth, P is the number of filled (treated) teeth, Y is the number of removed s teeth or tooth roots to be removed, the index of "KP" teeth, which is calculated as the sum of decayed, and sealed with temporary teeth.

The distribution into groups is carried out depending on the intensity of the lesion, and the assignment of a child to a particular group depends on the average intensity of caries indicators of the corresponding age group living in the area.

At the first degree of activity - compensated - the intensity index does not exceed the average intensity of caries of the corresponding age group living in the area.

With the second degree of activity - subcompensated - the intensity of caries is higher than the average intensity value for the corresponding age group by three sigmal deviations.

At the third degree of activity - decompensated - the intensity of caries exceeds the maximum indicator for this age group by three sigmal deviations.

For our region, when assessing the intensity of caries by the degree of activity of the carious process, it is estimated by the following indicators:

1 degree - an index up to 5 (compensated);

2 degree - an index from 5 to 8 (subcompensated);

3 degree - an index of more than 8 (decompensated).

Immediately after assigning a child to a particular group, the frequency of examinations and rehabilitation is recommended as prophylaxis. The first group is examined and sanitized once a year, the second group of children - twice a year, the third group of children - three times a year (after 3-4 months).

The disadvantage of this approach is the lack of a personalized approach to the prevention of dental diseases in children with comorbid and polymorbid pathology.

Since treatment of children with ASD is often fraught with significant difficulties, and often only possible with the use of general anesthesia. Children with ASD sometimes have problems not only with oral hygiene, but also behavioral characteristics that can be associated with the hygienic condition of the oral cavity.

The objective of the invention is to develop a method for the prevention of the development of dental diseases in children with autistic spectrum disorders, taking into account the child’s behavioral characteristics, which allows, after rehabilitation, to maintain the oral cavity in a satisfactory condition, and in the event of a carious process in the oral cavity of the child to perform treatment without general anesthesia, those. using minimally invasive techniques.

The technical result of the proposed method is to maintain the oral cavity of a child with ASD in a satisfactory condition and to provide the opportunity, if necessary, to perform timely treatment using minimally invasive techniques.

The technical result is achieved by the fact that in the method for the prevention of dental diseases in children with autism spectrum disorders (ASD), a papillary-marginal alveolar index (RMA) is determined, and with RMA, up to 25% of a child care provider with ASD is asked to fill out a questionnaire that includes questions about the study of subjects licking them or putting them in their mouths, does the child like to lie / sit on the floor, how often does the child salivate, does the child wipe his mouth with food, when he gets dirty, is the child accustomed to the toilet, does the child touch the floors e organs with their own hands, while the answers “often” are estimated at 1 point, “rarely” - at 2 points, “never” - at 3 points and summed up, getting the total score of the questionnaire (ΣО), then determine the hygiene index (GI) of the cavity mouth, with an average GI and ΣO of 16 points or more, the child is assigned to the first prophylactic group, which every 5 months is examined and professional hygiene of the oral cavity, with low GI and ΣO of 16 points and more or an average GI and ΣO of 11 to 15 points the child is assigned to the second preventive group, which every 5 months is spent on moth, professional oral hygiene and remineralizing therapy with Tuss Mousse daily for three weeks at night, with low GI and ΣО from 11 to 15 points or average GI and ΣО from 6 to 10 points of the child belong to the third preventive group, which every For 4 months, an examination, professional oral hygiene and remineralizing therapy with Tuss Mousse are carried out daily at night for three weeks, and after each odd visit, fluorinated teeth are treated at the end of remineralizing therapy. With this drug, with low GI and ΣО, from 6 to 10 points, the child belongs to the fourth prophylactic group, which is examined every three months, performs professional oral hygiene and remineralizing therapy with Tuss Mousse every day for three weeks, and after each odd visit at the end of remineralizing therapy perform dental treatment with a fluorine-containing drug.

It is preferable to determine the GI in a child under 6 years of age using a hygiene index according to Fedorov-Volodkina, and with values up to 1.7 GI is considered average, and with values of 1.7 or more, it is considered low, in a child older than 6 years, use the green index of Green Vermilion at index values up to 2.2, GI is considered average, and at values of 2.2 or more - low.

Preferably, Bifluorid 12 is used as the fluorine-containing preparation.

The method is as follows:

Inspect the child with ASD. If necessary, reorganization is carried out.

The papillary-marginal-alveolar index (RMA) is determined, which allows one to judge the extent and severity of gingivitis. The number of examined teeth with the integrity of the dentition depends on the age of the examined: 6–11 years - 24 teeth; 12-14 years old - 28 teeth; 15 years and older - 30 teeth. In case of tooth loss, they proceed from their actual presence. Evaluation of the inflammatory process in each tooth is as follows: 1 - inflammation of the papilla; 2 - inflammation of the gingival margin; 3 - inflammation of the alveolar gum. The index is calculated by the following formula: PMA = S × 100/3 × N, where S is the sum of the indicators in points, N is the number of teeth examined. If the index value is 25% or less, which indicates a limited prevalence of the pathological process (RMA up to 25% is characteristic for the absence or limited prevalence of gingivitis), then the caregiver who came with the child for an appointment (usually this is the person who has better contact with the child and knows him well, it can be a parent, relative or other adult raising a child with ASD), they suggest filling out a questionnaire about the child’s behavioral characteristics:

Put any sign in the column with the answer option that best matches the answer to the question about your child:

Question Often Rarely Never Does your child study objects by licking them or putting them in their mouths? Does your child like to lie / sit on the floor? How often does your child salivate? Does the child wipe his mouth with food when he gets dirty? Does your child have a toilet? Does your child touch the genitals with his own hands?

Answers “often” are estimated at 1 point, “rarely” - at 2 points, “never” - at 3 points and summarized.

With the obtained questionnaire (ΣО) amount of 6-10 points, it is believed that a child with ASD has behavioral features that provoke oral diseases and a worsening of the local oral immunity; at 11-15 points, a child with ASD has behavioral characteristics that are prone to diseases the oral cavity, with 16 points or more, the features of the child’s behavior do not directly lead to diseases of the oral cavity.

An oral hygiene index (GI) is then evaluated. For a child under 6 years old, use the Fedorov-Volodkina hygiene index, and for a child older than 6 use the Green-Vermilion hygiene index.

To determine the index according to Fedorov-Volodkina, the vestibular surface of six central lower teeth is examined, staining these teeth with the help of special solutions (Schiller-Pisarev, fuchsin, erythrosine) and assessing the presence of plaque with assigning codes according to the following criteria: 1 - plaque was not detected ; 2 - staining of one quarter of the surface of the tooth crown; 3 - staining of the half surface of the tooth crown; 4 - staining of three quarters of the surface of the tooth crown; 5 - staining the entire surface of the tooth crown. Then, to evaluate the plaque present in this patient, the codes obtained by examining each of the stained teeth are added up, and the sum is divided by 6. At values up to 1.6, GI is considered average, and at values of 1.7 or more - low.

To determine the Green Vermilion index, 6 teeth are examined (16, 11, 26, 31, 36, 46). Visually or using staining solutions (Schiller-Pisarev, fuchsin, erythrosine), the presence of plaque and tartar on the vestibular surfaces of 16, 11, 26, 31 teeth and lingual surfaces of 36, 46 teeth is assessed by putting down plaque evaluation codes (0 - dental no plaque was detected, 1 - soft plaque covering not more than 1/3 of the tooth surface, or the presence of any number of stained deposits (green, brown, etc.), 2 - soft plaque covering more than 1/3, but less than 2 / 3 tooth surfaces, 3 - soft plaque covering more than 2/3 of the surface tooth surface) and tartar (0 - no tartar was detected; 1 - supragingival tartar covering no more than 1/3 of the tooth surface; 2 - supragingival tartar covering more than 1/3 but less than 2/3 of the tooth surface, or the presence of separate deposits of subgingival tartar in the cervical region of the tooth; 3 - supragingival tartar covering more than 2/3 of the tooth surface, or significant deposits of subgingival tartar around the cervical region of the tooth), then both components are summed for each evaluated surface, the sums obtained add up and de ny the number of the examined surface. With index values up to 2.2, GI is considered average, and with values of 2.2 or more - low.

The educator is then taught the rules of a child’s nutrition (reducing carbohydrate-rich meals) and the rules of personal hygiene in a child’s ASD.

Define a group for the prevention of dental diseases, which should include a child with ASD.

A child with ASD is assigned to group 1 (group-1) for the prevention of dental diseases if the GP is average and the total score of the questionnaire (ΣО) is 16 or more.

A child with ASD for the prevention of dental diseases is assigned to group 2 (group-2) if the GI is low, ΣО is 16 points or more, or the GI is average and ΣО is from 11 to 15 points (extreme values are hereinafter indicated with “from” and “to "Are included).

A child with ASD for the prevention of dental diseases is assigned to group 3 (group-3) if the GI is low and ΣО is from 11 to 15 points or the GI is average and ΣО is from 6 to 10 points.

A child with ASD for the prevention of dental diseases is assigned to group 4 (group-4) if the GI is low and ΣО is from 6 to 10 points.

Prevention is carried out according to the scheme depending on the group defined for the prevention of dental diseases.

For group-1, an examination and professional oral hygiene are carried out every 5 months. Hereinafter “in n months” means that n full calendar months following the month of admission are skipped, a visit is scheduled in n + 1 month. For example, a visit in January, then the next visit in 5 months (February, March, April, May, June) will be scheduled in July. For ease of use, the visit plan is shown in table 1:

Table 1

A month from the start of the program Visit Perform one one O + G 2 3 4 5 6 7 2 O + G eight 9 ten eleven 12 thirteen 3 O + G ...

In the table: O - examination, G - professional oral hygiene

For group-2, every 5 months, an examination, professional oral hygiene and remineralizing therapy with Tuss Mousse are performed (Table 2).

table 2

A month from the start of the program Visit Perform one one O + G + TM 2 3 4 5 6 7 2 O + G + TM eight 9 ten eleven 12 thirteen 3 O + G + TM ...

In the table: O - examination, G - professional oral hygiene, TM - remineralizing therapy with Tuss Mousse at bedtime every day for three weeks.

For group 3, every every 4 months, an examination, professional oral hygiene and remineralizing therapy with Tuss Mousse are performed, and after each odd visit, teeth are treated with a fluorine-containing preparation (Table 3). Visits are considered only those visits to the dentist that are provided for by the prevention program.

Table 3

A month from the start of the program Visit Perform one one O + G + TM + F 2 3 4 5 6 2 O + G + TM 7 eight 9 ten eleven 3 O + G + TM + F 12 thirteen 14 15 sixteen 4 O + G + TM ...

In the table: O - examination, G - professional oral hygiene, TM - remineralizing therapy with Tuss Mousse for three days every night, F - applying a fluorine-containing preparation (Bifluorid 12 varnish) after completion of remineralizing therapy.

For group 4, an examination is carried out every three months, professional oral hygiene and remineralizing therapy with Tuss Mousse are performed for three weeks daily at night, and after each odd visit, teeth are treated with a fluorine-containing preparation (Table 4).

Table 4

A month from the start of the program Visit Perform one one O + G + TM + F 2 3 4 5 2 O + G + TM 6 7 eight 9 3 O + G + TM + F ten eleven 12 thirteen 4 O + G + TM ...

In the table: O - examination, G - professional oral hygiene, TM - remineralizing therapy with Tuss Mousse for three days every night, F - applying a fluorine-containing preparation (Bifluorid 12 varnish) after completion of remineralizing therapy.

Prevention is carried out constantly. Change of group (increase by one) not earlier than 13 months after the start of the dental disease prevention program according to the proposed method and only if there are changes in the behavior of the child (based on the use of the same questionnaire).

The use of the proposed method is illustrated by examples.

Example 1

Child Roman 6 years old, diagnosed with moderate autism. I turned to the dentist on 02/14/2018 with the aim of examining and sanitizing the oral cavity, complaints of tooth decay. The intensity of caries was determined according to Vinogradova (KPU, CP), a value of 6. was obtained. After determining the volume of dental sanitation, the presence of comorbid pathology, and the consultation of an anesthetist, a decision was made to reorganize the oral cavity under anesthesia. After special preparation for dental treatment under anesthesia 02/24/2018, the oral cavity was sanitized under anesthesia. It was cured with a diagnosis of pulpitis 75 85 65 55, with a diagnosis of exacerbation of chronic periodontitis removed 74 54. A follow-up dynamic examination was appointed on March 17, 2019. At the appointment on March 17, 2018, the dentist had a parental consultation and a visual examination, and a hygiene index (GI) was determined. Since the child was already 6 years old and permanent teeth 16, 26, 36, 46 erupted, the Green-Vermilion index (GI = 2.2) was used. The periodontal condition index PMA (C.Parma, 1960) 25%. Parents are asked to fill out a questionnaire for the presence of behavioral characteristics in the child. According to the results of the questionnaire, 15 points were obtained, which indicates that the child has behavioral characteristics that can contribute to the occurrence of oral diseases. Parents were told about the prevention program and received their consent to participate in it. The child is assigned to group-3, prophylaxis according to the proposed method. At visit 1 (03.17.2018), professional oral hygiene, training in dental hygiene, and a discussion with parents about personal oral hygiene products and application rules for Tuss Mousse were administered every night for three weeks, which was scheduled. At the end of the remineralizing therapy, 04/07/2018, Bifluorid 12 fluoride-containing varnish was re-treated. On visit 2 (08/10/2018), an examination was performed, professional oral hygiene was performed, and Tuss Mousse was prescribed daily for three weeks at night. Visit 3 (01/21/2019): an examination was performed, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night. After completing the Tousse Mousse applications (02/11/19), Bifluorid 12 fluoride-containing varnish was remotaged.

 The following results were obtained:

Parameters Visit 1 Visit 2 Visit 3 GI 2.2 1.4 1,6 Secretory immunoglobulin A (sIgA) 2,5 7.8 8.1 Lysozyme 10,2 36,4 37 The balance factor of local immunity factors 2.98 1,2 1.4

Thus, in a child with ASD there are no complaints on dynamic examinations, 75 85 65 55 - the fillings are viable during the period of prophylaxis, after a year of chalk spots and carious cavities on the teeth were not revealed.

Example 2

Child Egor 4 years old, the diagnosis of moderate autism. We went to the dentist for the purpose of consultation. From the anamnesis, the child is at the dentist for the first time. At the reception on July 4, 2018, the dentist had a consultation with his parents and a visual examination, and a hygiene index (GI) was determined. Since the child is 4 years old, the Fedorov-Volodkina index was used (GI = 1.6). The intensity of caries was determined according to Vinogradova (KPU, CP), a value of 0 was obtained. The periodontal status index PMA (C.Parma, 1960) 25%. Parents are asked to fill out a questionnaire for the presence of behavioral characteristics in the child. According to the results of the questionnaire, 16 points were obtained, which indicates that the child does not have behavioral characteristics that can contribute to the occurrence of oral diseases. Parents were told about the prevention program and received their consent to participate in it. The child is assigned to group-1, prophylaxis is started according to the proposed method. At the first examination (04.07.2018), professional oral hygiene and training in hygienic toothbrushing were carried out.

On visit 2 (01/17/2019), an examination was carried out, professional oral hygiene was performed. During visual and instrumental examination of the oral cavity, chalk-like spots and carious cavities were not revealed on the teeth.

At the 3rd examination (07/05/2019), an examination was carried out, professional oral hygiene was performed.

The following results were obtained:

Parameters Visit 1 Visit 2 Visit 3 GI 1,6 1,2 1,2 Secretory immunoglobulin A (sIgA) 7.0 7.5 7.5 Lysozyme 30,2 33,4 36.1 The balance factor of local immunity factors 2.98 1,5 1.4

Thus, in a child with ASD during dynamic examinations, there are no complaints during the period of prophylaxis; after a year, there are no chalk-like spots or new cavities on the teeth.

Example 3

Child Pavel 8 years old, diagnosed with moderate autism. We went to the dentist for the purpose of examination and consultation. From the anamnesis, the child visited the dentist, was at the appointment a year ago. At the appointment on May 14, 2018, the dentist had a parental consultation and a visual examination, and a hygiene index (GI) was determined. Since the child was already 6 years old and permanent teeth 16, 26, 36, 46 erupted, the Green-Vermilion index (GI = 2.2) was used. The periodontal condition index PMA (C.Parma, 1960) 25%. The intensity of caries was determined according to Vinogradova (KPU, kp), a value of 2 was obtained. Two cavities were found in Paul’s on 74, 54 teeth. In connection with the imminent physiological shift, dynamic observation 74, 54 is recommended. Parents are asked to fill out a questionnaire for the presence of behavioral characteristics in the child. According to the results of the questionnaire, 17 points were obtained, which indicates that the child does not have behavioral characteristics that can contribute to the onset or development of oral diseases. Parents were told about the prevention program and received their consent to participate in it. The child is assigned to group-2, prophylaxis is started according to the proposed method. At the first examination (05/14/2018), professional oral hygiene, training in hygienic brushing of the teeth and a conversation with parents about personal oral hygiene products and the rules for applying Tuss Mousse daily for three weeks were conducted. The visit is scheduled for November 2018.

On visit 2 (11/07/2018), an examination was carried out, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night. During visual and instrumental examination of the oral cavity, chalk-like spots and carious cavities were not revealed on the teeth. The next scheduled visit in 5 months.

At visit 3 (05.06.2019), professional oral hygiene, training in dental hygiene, and a discussion with parents about personal oral hygiene products and the rules for applying Tuss Mousse daily for three weeks were conducted. During visual and instrumental examination of the oral cavity, chalk-like spots and carious cavities were not revealed on the teeth. The visit is scheduled for November 2019.

The following results were obtained:

Parameters Visit 1 Visit 2 Visit 3 GI 2.2 1.8 1,6 Secretory immunoglobulin A (sIgA) 4,5 7.2 7.6 Lysozyme 18.2 31,4 35.1 The balance factor of local immunity factors 2,4 1,6 1.4

Thus, a child with ASD under dynamic examinations has no complaints. After a year, chalk spots and new cavities on the teeth were not detected, tooth 74 fell out.

Example 4

Vova’s child is 6 years old, with a moderate diagnosis of autism. We went to the dentist with complaints of pain and swelling in the 64 tooth area. From the anamnesis, the child visited the dentist, was at the appointment 6 months ago. At the appointment on February 24, 2018, a visual examination was performed at the dentist. The intensity of caries was determined according to Vinogradova (KPU, CP), a value of 4 was obtained. Vova found carious cavities on a 74, 54, 55 tooth and a complete destruction of 64 and the presence of fistulous passage.

After determining the volume of dental sanitation, consultations with an anesthetist due to the presence of comorbid pathology, a decision was made on sanitation of the oral cavity under anesthesia. After special preparation for dental treatment under anesthesia, 02/18/2018, pulpitis was cured with a diagnosis of 74, 54, 55, with a diagnosis of exacerbation of chronic periodontitis, 64 teeth were removed. Assigned 03/17/2018 re-dynamic inspection. Parents are asked to fill out a questionnaire for the presence of behavioral characteristics in the child. According to the results of the questionnaire, 11 points were obtained, which indicates that the child has behavioral characteristics that can contribute to the onset or development of oral diseases. Parents were told about the prevention program and received their consent to participate in it. Prevention started by the proposed method. Visit 1 (03/17/2018), the Hygiene Index (GI) was determined. Since the child is already 6 years old and permanent teeth 16, 26, 36, 46 erupted, the Green-Vermilion index (GI = 1.6) was used. The periodontal condition index PMA (C.Parma, 1960) 25%. The child is assigned to group-2, therefore, professional oral hygiene, training in hygienic brushing of the teeth and a conversation with parents about individual oral hygiene products and the rules for applying Tuss Mousse daily for three weeks were carried out. A visit in 5 months is scheduled for September 2018.

Visit 2 (September 7, 2018), an examination was carried out, professional hygiene of the cavity was performed, applications were prescribed with Tuss Mousse daily for three weeks at night. The next scheduled visit in 5 months.

Visit 3 (03.03.2019) was conducted professional oral hygiene, training in dental hygiene and a discussion with parents about personal oral hygiene products and the rules for applying Tuss Mousse daily for three weeks at night. A visit in 5 months is scheduled for September 2019.

The following results were obtained:

Parameters Visit 1 Visit 2 Visit 3 GI 1,6 1.4 1.4 Secretory immunoglobulin A (sIgA) 4,5 6.5 7 Lysozyme 18.2 32,4 33.6 The balance factor of local immunity factors 2,4 1,6 1,6

Thus, in a child with ASD during dynamic examinations, there are no complaints during the period of prophylaxis; after a year, there are no chalk-like spots or new cavities on the teeth.

Example 5

Child Roman 8 years old, diagnosis of moderate autism. We went to the dentist for the purpose of examining and sanitizing the oral cavity, complaints of destruction 55, 54, 65, 64.7 4, 75. The intensity of caries was determined according to Vinogradova (KPU, kp), the value is 7. After determining the volume of dental sanitation, consult a doctor -anesthesiologist the presence of comorbid pathology, a decision was made to reorganize the oral cavity under anesthesia. After special preparation for dental treatment under anesthesia 02/12/2018, the oral cavity was sanitized under anesthesia. Pulpitis was treated with a diagnosis of 75 85 65 55, with a diagnosis of exacerbation of chronic periodontitis, 74 54 64 were removed. A follow-up dynamic examination was scheduled on 03/21/2019. At the reception on March 21, 2019, the dentist had a consultation with the parents and a visual examination, and a hygiene index (GI) was determined. Since the child was already 6 years old and permanent teeth 16, 26, 36, 46 erupted, Green-Vermilion was used (GI = 1.6). The periodontal condition index PMA (C.Parma, 1960) 25%. Parents are asked to fill out a questionnaire for the presence of behavioral characteristics in the child. According to the results of the questionnaire, 10 points were obtained, which indicates that the child has behavioral features that provoke diseases of the oral cavity and a deterioration in the state of local immunity of the oral cavity, continuous prevention of dental diseases is required. Parents were told about the prevention program and received their consent to participate in it. The child is assigned to group-3, prophylaxis is started according to the proposed method. At visit 1 (03/21/2018), professional oral hygiene, training in hygienic brushing of the teeth and a conversation with parents about individual oral hygiene products and the rules for applying Tuss Mousse daily for three weeks were conducted. Three weeks later, an appointment was appointed for rheotherapy with Bifluorid 12 fluoride varnish. After 3 weeks (04/11/2018), Bifluorid 12 fluorine-containing varnish was re-treated. A visit was scheduled after 4 months. On visit 2 (08/07/2018), an examination was carried out, professional oral hygiene was performed, applications were prescribed with Tuss Mousse daily for three weeks at night. The next scheduled visit in 4 months. Visit 3 (January 24, 2019): an examination was carried out, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night, upon completion, come to rheotherapy with a fluorine-containing drug. 02/14/2019: Rheotherapy with Bifluorid 12 fluoride varnish. The visit is scheduled in 4 months. On visit 4 (06/08/2019), an examination was carried out, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night. The next scheduled visit is scheduled for November 2019.

Parameters Visit one 2 3 4 GI 1,6 1.4 1.3 1.4 Secretory immunoglobulin A (sIgA) 4,5 6.9 7.5 7.1 Lysozyme 10,2 35,4 36.1 36 The balance factor of local immunity factors 2.98 1,2 1.4 1.4

Thus, in a child with ASD during dynamic examinations, there are no complaints during the period of prophylaxis; after a year, there are no chalk-like spots or new cavities on the teeth.

Example 6

Arish's child is 8 years old, the diagnosis of moderate autism. From the anamnesis, the child is at the dentist for the first time. I turned to the dentist on 02/14/2018 with complaints about the presence of multiple caries in milk and permanent teeth. The intensity of caries was determined according to Vinogradova (KPU, CP), a value of 12. was obtained. After determining the volume of dental sanitation, consulting an anesthetist with the presence of a comorbid pathology, a decision was made to sanitize the oral cavity under anesthesia. After special preparation for dental treatment under anesthesia 02/24/2018, the oral cavity was sanitized under anesthesia. Pulpitis was diagnosed with a diagnosis of 75 85 65 55, with a diagnosis of caries 16 26 36 46, with a diagnosis of exacerbation of chronic periodontitis, 54 64 74 84 were removed. A second dynamic examination was prescribed. At the appointment 03/27/2018, the dentist consulted the parents and examined the child visually, and determined the hygiene index (GI). Since the child is already 6 years old and permanent teeth 16, 26, 36, 46 erupted, the Green-Vermilion index (GI = 2.4) was used. The PMA periodontal condition index is 25%. Parents are asked to fill out a questionnaire for the presence of behavioral characteristics in the child. According to the results of the questionnaire, 6 points were obtained, which indicates that the child has behavioral features that provoke oral diseases and a worsening of the local immunity of the oral cavity, continuous prevention of dental diseases is required.

The child is assigned to group-4, prophylaxis is started according to the proposed method. Visit 1 (03/27/2018): professional oral hygiene, training in hygienic brushing of the teeth and a conversation with parents about personal oral hygiene products and the rules for applying Tuss Mousse daily for three weeks were conducted. Three weeks later, an appointment was appointed to cover the teeth with fluorine-containing drug Bifluorid 12. 04/17/2018 a rheumatism treatment with fluorine-containing varnish Bifluorid 12. Scheduled a visit in 3 months. Visit 2 (07/27/2018): an examination was performed, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night. The next scheduled visit in 3 months. Visit 3 (11/24/2018): an examination was performed, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night. 12.15.18 (after the completion of the Tousse Mousse applications): Rheumatherapy with Bifluorid 12 fluoride varnish. The visit is scheduled in 3 months. Visit 4 (03/12/2019): an examination was performed, professional oral hygiene was performed, applications of Tuss Mousse were prescribed daily for three weeks at night. The next scheduled visit in 3 months. Visit 5 (07/16/2019): an examination was carried out, professional oral hygiene was performed, Tuss Mousse applications were prescribed daily for three weeks at night, attendance at the endotherapy after completion of the course of applications.

Visit Parameters one 2 3 4 5 GI 2,4 1.8 1,6 1,6 1.4 Secretory immunoglobulin A (sIgA) 4,5 6.9 7.5 7.7 7.5 Lysozyme 10,2 35,4 36.1 36 35.9 The balance factor of local immunity factors 2.98 1,2 1.4 1.4 1.4

Thus, in a child with ASD during dynamic examinations, there are no complaints, the fillings are in satisfactory condition during the period of prophylaxis, after a year of chalk-like stains and new carious cavities on the teeth were not detected.

According to the proposed method, prevention is carried out in 24 children with ASD. In all cases of observation, it was possible to maintain the oral cavity of a child with ASD in a satisfactory condition and to provide the opportunity, if necessary, to perform timely treatment using minimally invasive techniques.

Claims (2)

1. A method for the prevention of dental diseases in children with autism spectrum disorders (ASD), characterized in that they determine the papillary-marginal alveolar index (RMA), and with RMA, up to 25% of the caregiver of a child with ASD is asked to fill out a questionnaire that includes questions about the study of subjects licking them or putting them in their mouths, does the child like to lie or sit on the floor, how often does the child salivate, does the child wipe his mouth with food, when he gets dirty, is the child accustomed to the toilet, does the child touch the genitals with his hands kami, while the answers “often” are estimated at 1 point, “rarely” - at 2 points, “never” - at 3 points and summed up, getting the total score of the questionnaire (ΣО), then determine the oral hygiene index (GI), and in children under 6 years of age, they use GI according to Fedorov-Volodkina and at values up to 1.7 GIs are considered average, and with values of 1.7 or more, they are considered low, in children over 6 years old, they use GI Green-Vermilion and with index values up to 2, 2 GIs are considered medium, and with values of 2.2 or more, low; further, with an average GI and ΣО of 16 points or more, the child is assigned to the first prophylactic group, which is examined and professional oral hygiene every 5 months; with low GI and ΣO of 16 points or more, or average GI and ΣO of 11 to 15 points, the child belongs to the second preventive group, which is examined every 5 months, professional oral hygiene and remineralizing therapy with Tuss Mousse every night for three weeks with low GI and ΣO from 11 to 15 points or an average GI and ΣO from 6 to 10 points, the child is assigned to the third preventive group, which is examined every 4 months, professional oral hygiene and remineralizing therapy with Tuss Mousse daily at night for three weeks, and after each odd visit at the end of the remineralizing therapy, teeth are treated with a fluorine-containing preparation; with low GI and ΣО, from 6 to 10 points, the child belongs to the fourth prophylactic group, which is examined every three months, performs professional oral hygiene and remineralizing therapy with Tuss Mousse every night for three weeks, and after each odd visit, completion of remineralizing therapy, teeth are treated with a fluorine-containing preparation. 2. The method according to p. 1 characterized in that the varnish Bifluorid 12 is used as the fluorine-containing preparation.