Prophylaxis of dental caries in children from polluted regions

To be living at the most advanced technological area in history is to exist and face pollution one of the most serious threats to all living things on the planet. There is evidence that anthropogenic and technological pollutions cause a considerable number of health problems and stomatological in particular. This article demonstrates the results gained by administration of vitamin-macro element complex “Calcinova” and sorbent “Enterosgel” in correction of enzymes responsible for biotransformation of xenobiotics in blood serum of children from the polluted areas. It has been established the high efficiency of recommended scheme on caries prophylaxis that is proved by positive biochemical indexes in blood serum of this children observed 30 month after the beginning of the investigation. As a result of the introduced prophylaxis, we have noticed the significant improvement of biochemical indexes in children with tooth decay. The findings reflect a certain rise in activity of enzymes responsible for elimination of xenobiotics such as alcohol-dehydrogenase (ADH) and glutathione-S-transferase (GST) obtained from the blood serum of children from the main group comparing to the control group.


Introduction
The society must accept childcare as an important contribution towards societal good as children are the future wealth and continuation of society. The researches of (Horishna 2001;Kelly and Fussell 2015) demonstrated that the child's organism is the most vulnerable to different harmful environmental factors due to immaturity of their immune system, defense mechanisms, intensity of the metabolic processes as well as structural and functional characteristics.
No doubt, chronic impact of pollution leads to considerable number of illnesses. The investigations by (Antipkin 2005;Ataniyasova 2008) suggested that the most diagnosed diseases in the polluted areas are endocrine disorders, breathing, digestive and kidney problems, vegetative dystonia, genetic abnormalities, neurological reactions and behavior anomalies. The statistic of stomatological disorders is also on the growth. Epidemiological investigations conducted in regions with bad environment of Ukraine demonstrate that 33.8-96.7% of children have decayed teeth and in some parts of the country the statistic is even higher up to 100%. Intensity of caries among 12 years old children that usually are well adapted to stomatological diseases, is 4.57 ± 0.38-7.24 ± 0.40 teeth. According to data researchers (Bebeshko et al. 2003;Kuznyak and Hodovanec 2010;Kuzevlyak and Lachtin 2011;Shishniashvili et al. 2016) enamel hypoplasia fluctuates between 6.47-62.2%, periodontal disorders are diagnosed in 14.3-77.2% of child population, the data of maxilla-facial anomalies is 47.53-59.98%.
It is very much in our interest to detect ecopathology at the early stages of organism's development and to reveal the body's predisposition to xenobiotics.
The figures provided by General Statistic Department (2009) of Ivano-Frankivsk area suggest that there are two regions with the highest level of anthropogenic load. The Snyatyn region is the most badly contaminated after the Chernobyl catastrophe (density of contamination with radionuclides by Cesium-137 is 4.60 Ki/km 2 and by Strontium-90-0.31 Ki/km 2 ). In Kalush, chemically polluted region, dominate inhaled xenobiotics and the density of their attacks is 212.4 ton per 1 square kilometer. The comparison shows that in Horodenka region, for example, the density of the xenobiotics attacks is 34 kg per square kilometer that is 6.000 times less than in Kalush region. The investigation by Fomenko (2004) also demonstrate the pollution by Cesium-137 in this area is 1.3 Ki/km 2 and by Strontium-90 is 0.08 Ki/km 2 that is four times less than in Snyatyn region.
It is vital to understand the need for study of stomatological health in children, damage of the hard dental tissues caused by toxic environmental factors and to develop scientific based prophylaxis that was a goal of our investigation.

Materials and methods
We have examined 120 12 years old children affected by caries. There were 59 children from radiation polluted Snyatyn region and 61 children from chemically polluted Kalush region, both Ivano-Frankivsk areas. The main groups in each region consisted of 30 children. Each control group consisted of 29 children. The comparison group was from Horodenka region and there were 30 children also affected by caries.
There is a scheme of administration: 4 tablets a day -2 tablets after breakfast and tooth brushing; 2 tablets after supper and tooth brushing. The tablets should be slowly chewed and completely dissolved.
Aside from, children from the main groups were appointed with pharmacological agent "Enterosgel" (CREOMA-PHARM, Kyiv, Ukraine). This agent is a natural phyto-sorbent and an ion exchanger. It is prescribed one teaspoon (10 g) 3 times a day taken 2 hours before or after meal.
Children from Snyatyn and Kalush regions were appointed by this prophylaxis twice a year at the spring and autumn and the course lasted for 14 days.
Children from the control group were introduced with individual oral hygiene and caries treatment.
The efficiency of the recommended scheme was assessed by measuring activity of alcohol-dehydrogenase (ADH) and glutathione-S-transferase (GST). Analysis of ADH that participates at phase-1 of bio-transformation of xenobiotics was conducted by Mezey et al. (1968). Activity of GST in the blood, (phase-2 of biotransformation) was determined (Mannervick and Danielson, 1988).
Was taken written permission from the parents to investigate a biological material of their children. That was blood collected from the elbow vein.
The study lasted 2.5 years.

Results
The indications of ADH were smaller in children from radiation polluted Snyatyn region before appointed treatment in contrast to the comparing group and in comparison, with children from chemically polluted Kalush region. Moreover, in case of decompensated caries this difference was statistically more certain (р < 0.05). As a result of introduced treatment, there was a rise of ADH in 2,3 time observed in the main group of Snyatyn region from (0.0052 ± 0.001) to (0.012 ± 0.003) mckat/l (р < 0.05). There was also an increase of ADH in 2.8 time from (0.009 ± 0.003) to (0.025 ± 0.004) mckat/l (p < 0.001) in children from Kalush region. Both control groups show increase of ADH after the complex measures in contrast to the initial data: (0.0071 ± 0.003) mckat/l in children from Snyatyn region and (0.011 ± 0.004) mckat/l in children from Kalush region and was statistically not certain (р > 0.05).
The data appear to confirm that at the beginning of the study there was also a declined activity of GST in all children according to caries intensity: in children of Snyatyn region -from(1.82 ± 0.07) by compensate caries to (0.61 ± 0.05) un/ml by decompensated form of caries; of Kalush region -from (1.03 ± 0.08) to (0.31 ± 0.05) un/ml respectively; of Horodenka region from (1.96 ± 0.09) to (0.94 ± 0.07) un/ml. The figure of GST was lower in children from chemically polluted Kalush region in contrast to the comparison group and to the data of children from radiation polluted area (р < 0.001). The statistic of the study gives figures for a decline in the number with 2,4 time decrease of moderate activity of glutathione-S-transferase in children from chemically polluted region in contrast to the comparison group and was in 1,1 time lower than in children from radiation polluted region.
There was, however, a rise in the number with 1,3 time increase from (1.31 ± 0.04) to (1.65 ± 0.06) un/ml (р < 0.05) of GST in children of the main group of Snyatyn region recorded after the appointed correction. In the control group, on the other hand, we did not detect any significant changes of GST (р > 0.05). Children of the main Kalush group demonstrate an increase of GST in 2.1 time from (0.68 ± 0.06) to (1.45 ± 0.04) un/ml. Despite the fact that GST had climbed by numbers in the control group, it was not statistically certain (р > 0.05).
Analysis of GST-activity show that there was a notable improvement after the introduced measures as the GST has increased in children from Snyatyn region affected by compensative and sub-compensative caries in 1.2 time and in case of de-compensated caries in 1.4 time ( Table 2). The data indicates a rise if GST in 1,6 time in main group of Kalush region by compensative caries, in 2.6 time in case of sub-compensative caries and in 3.6 time by de-compensative caries in comparison with the initial statistic (p < 0.001).

Discussion
There are major factors that being important in development of stomatological health in adults and children. According to some studies, the number of reasons such as anthropogenic, medico-biological and social work together and the level of their influence depend on individual characteristics and genetic adaptation of the person (Denha et al. 2007;Sukumar 2018).
The overwhelming problem we face nowadays is the misbalance in system «manhood-environment». Economic growth and technological progress have a massive impact on the nature and human beings. Many research findings have shown the role of bad environmental factors on general health and on damage caused to the hard dental and periodontal tissues in particular (Kovach 2005;Bezvushko and Klymchuk 2006).
The majority of xenobiotic agents do not exhibit any biological influence, although they experience biotransformation that consists of three phases-activation (Phase 1), detoxication (Phase 2) and withdraw (Phase 3). Phase 1 is provided mainly by cytochrome enzymes P450 and microsomal epiphysis hydrolysate (m EPHX). The aim of Phase 2 is neutralization of hydrophilic and toxic products by hydrolyses and transferases. They provide and complete detoxication and correct sometimes the mistakes of Phase 1. According to Scheupleina et al. 2002 the enzymes glutathione S-transferase, glucuronyltransferase, sulfotransferase, acetyltransferase and methyltransferase convert toxic intermediate products of Phase 1 into polar, water soluble, not toxic compounds that can be eliminated from the body at Phase 3-biotransformation.
Before the treatment there was a decrease of alcohol-dehydrogenase in children from both polluted regions and it's lower in those with higher intensity of caries that can be explained by exhaustion of its production influenced by genotoxic factors (Tchaikovska et al. 2010). The reduction of ADH in comparison group is described as being smoother.
Research has demonstrated that after the administered prophylactic measures there was an improvement in bio- chemical indexes of Phase 1 and 2 ( biotransformation of xenobiotics) observed in the main groups of children from Snyatyn and Kalush regions. It has to be admitted that there was better improvement in correction of GST (Phase 2 biotransformation) recorded in children affected by caries from Snyatyn region. Children of the main group from Kalush region, on the other hand, demonstrate better correction of ADH at the Phase 1 that can be considered, in our opinion, as a diagnosis and treatment markers of ecopathology in children affected by negative impact of environment.

Conclusions
There has been marked progress in ADH activity recorded 30 month after the introduced treatment as a rise with 2.3 time increase observed in children from radiation polluted Snyatyn region and a rise with 2.8 time increase in children from chemically polluted Kalush region reflecting the contrast with initial level (p < 0.01). Activity of GST in the blood serum of children from Snyatyn region has also increased in 1.3 time recorded 2.5 years after the appointed treatment and in children from Kalush region in 2.1 time comparing with initial level (p < 0.001).
The biochemical changes in blood serum of children affected by dental caries reflected enhanced activity of the enzymes participating at phases 1 and 2 in detoxication of xenobiotics.