THE CONDITION OF THE HARD TISSUES OF THE TEETH IN CHILDREN WITH ACUTE FORMS OF LEUKEMIA

Relevance. Children with oncohematological pathology have a high level of dental diseases, since the use of high doses of cytostatic drugs leads to damage to the hard tissues of the teeth. In recent years, the number of children with acute leukemia has increased in Ukraine from 2.5 to 4.1 cases per 100,000 children. In recent years, the number of children with acute leukemia has increased in Ukraine from 2.5 to 4.1 cases per 100,000 child population. Objective: to study the indicators of the intensity of caries of temporary and permanent teeth in children with acute forms of leukemia: lymphoblastic and myeloblastic. Materials and methods. Clinically examined 98 children aged 2-18 years, with acute forms of leukemia. The examined children were divided into groups: the first group – 61 children with acute lymphoblastic leukemia, and the second – 37 children with acute myeloblastic leukemia. Served as control 63 practically healthy children. The analysis of the structure of the constituent elements of the indicators of the intensity of decay teeth caries (df) in children 2-5 years old and caries of permanent teeth (DMF) in children 6-18 years old was performed. The constituent elements of the cf indicator are “d” – carious teeth that are subject to treatment, “f” – filled teeth. The constituent elements of the DMF indicator are “D” – carious teeth that are subject to treatment; “f” – filled teeth; “M” – extracted teeth. Results. When studying the intensity of caries of temporary and permanent teeth in children with acute lymphoblastic leukemia, it was found that in children 2-5 years old, cf is equal to 6.64 affected teeth per child. In this case, the “d” element was 75.30%, compared with the control group of children, where the “f” element was 45.28%. Element “f” was 24.6%, and in the control group it was significantly higher and was equal to 54.92%. In children with acute lymphoblastic leukemia 6-18 years old, the CFE is 5.34 teeth. At the same time, the “D” element was 53.13%, and in the control group – 11.06%. Element “f” was 44.24%, in the control group – 85.9%. Element “M” in the main group was equal to 2.63%. When studying the intensity of caries in temporary and permanent teeth in children with acute myeloid leukemia, it was determined that in children 2-5 years of age, cf is equal to 6.25 affected teeth per child. In this case, the “d” element was 80.64%, in comparison with the control group, where the “d” element was 45.28%. Element “f” was 19.36%, and in the control group it was significantly higher and equal to 54.92%. In children 6-18 years old, the CFE is 5.53 teeth. At the same time, the element “d” in the main group was 41.5%, and in the control group – 11.06%. Element “f” was equal to 57.8%, in the control group 85.94%. Element “M” in the main group was equal to 0.6%. Conclusion. Children with acute forms of leukemia have high rates of caries intensity in temporary and permanent teeth.


Relevance.
Studies conducted by domestic scientists confirm the high prevalence of major dental diseases among children in Ukraine. This is especially true in children with oncohematological pathology. Among the nosologies included in this group, acute leukemias are one of the common diseases of hematopoietic tissue that occur in childhood. In recent years, the number of children with acute leukemia in Ukraine has increased from 2.5 to 4.1 cases per 100,000 children [3,7]. Acute myeloblastic leukemia, which accounts for 15-20% of all forms of leukemia, most often affects children aged 12-14 years and older. Acute lymphoblastic leukemia in 75% is diagnosed at the age of 2 to 5 years and at the age of 15 to 18 years. Most often, according to statistics, boys get sick. The use of high doses of cytostatic drugs leads not only to lesions of the oral mucosa, as indicated by numerous studies, but also to the damage to the hard tissues of the teeth [1; 2; 4; 5; 8; 9].
Objective: to study the intensity of caries of temporary and permanent teeth in children with acute forms of leukemia: lymphoblastic and myeloblastic.

MATERIALS AND METHODS
The study involved 98 children aged 2 to 18 years with acute forms of leukemia, who were treated in the Department of Pediatric Oncohematology of the Kiev Regional Oncological Dispensary. The examined sick children were divided into groups. The first group -61 children with acute lymphoblastic leukemia, of them from did not suffer from chronic diseases and rarely (1-2 times a year) suffered from ARI. They went to the Dental Clinic of the National Medical University for oral hygiene. The analysis of the structure of the constituent elements of indicators of the intensity of caries of deciduous teeth (dp) in children 2-5 years old and permanent teeth (DMF) in children 6-18 years old was performed. The constituent elements of the cf-index are: "d" -carious teeth to be treated; «f» -filled teeth. The components of the DMF index are; «d» -carious teeth to be treated; «f» -filled teeth; «M» -extracted teeth.

RESULTS AND DISCUSSION
When studying the intensity of caries of temporary and permanent teeth in children with acute lymphoblastic leukemia, it was determined that in the group of children from 2 to 5 years of age cf-index was equal to 6.64 affected teeth per child. In the group of children from 6 to 18 years, the intensity of dental caries (DMF) was equal to 5.34 teeth. Analysis of the structure of the components of the intensity of dental caries (df) in children 2-5 years is presented in table 1.
These tables show that in children from 2 to 5 years with acute lymphoblastic leukemia, the element «c» was 75.30%, compared with the control group of children, where the element «c» was equal to 45.28%.
The element «f» was in children from 2 to 5 years -24.6%, and in the control group was much higher and equal to 54.92%.
Analysis of the structure of the constituent elements of the cf-index of temporary teeth shows that in this group of children the element "d" prevails over the element "f".
In children 6-18 years of the main group, the element "C" was equal to 53.13%, and in the control group -11.06%. Element "f" was 44.24%, in the control group -85.9%. Element "M" in the main group was equal to 2.63% (Table 2).
Thus, in children with acute lymphoblastic leukemia, the intensity of the component "D" prevails over the component "F", which indicates a lack of treatment and prevention work among this group of children.
Children aged 2-5 years with acute myeloblastic leukemia were equal to 6.25 affected teeth per child. In children 6-18 years DMF was 5.53 teeth. Thus, the intensity of caries in children with acute myeloblastic leukemia, according to WHO criteria, was high in all age groups.
When studying the clinical course of caries, a decompensated form of acute caries with a significant amount of secondary caries in sealed teeth and a rapid complication of caries, especially in temporary teeth, was more often observed. An atypical placement of carious cavities in temporary teeth in children has been established. They were located not only on the masticatory and proximal surfaces, but also on the humps and cervical areas.
When examining the condition of the teeth in children 2-5 years with acute myeloblastic leukemia, it was found that the element «c» was 80.64%, compared with the compared control group of children, where the element "d" was 45.28%. The element «f» was 19.36%, and in the control group -much higher and equal to 54.92%. That is, in this group of children the element "d" prevails over the element «f» (Table 3).

THE CONDITION OF THE HARD TISSUES OF THE TEETH IN CHILDREN WITH ACUTE FORMS OF LEUKEMIA
According to the generally accepted clonal theory of leukemogenesis, the pathogenesis of the development of acute leukemias is likely to begin in the perinatal period. That is, the time at which the number of leukemic clones reaches the number at which leukemia is clinically manifested, is from one year to ten (average 3.5 years) [6]. This coincides with the intensive bookmarking and mineralization of hard tissues of both temporary and permanent teeth in children. This is an important factor in the formation of caries-favorable enamel in this contingent of children.
Analysis of the structure of the constituent elements of DMF teeth in children 6-18 years shows that the element "d" in the main group was 41.5%, and in the control group -11.06%. Element "f" was 57.8%, in the control group -85.94%. Element "M" in the main group was equal to 0.6% (Table 4).
Comparative analysis showed that component «E» is significantly higher in children with acute lymphoblastic leukemia, compared with the group of children with acute myeloblastic leukemia -2.63% vs. 0.6% (Tables 2, 4).