Prevalence and intensity of dental caries in adolescents with juvenile idiopathic arthritis

Abstract

Abstract: One of the central problems of modern dentistry is the analysis of the impact of juvenile idiopathic arthritis (JIA) - the most widespread heterogeneous rheumatic disease in pediatrics on a child's dental health. The prevalence of JIA in Ukraine is 0,37 cases per 1000 children under 17 years of age with a tendency to increase. JIA is a collective term that combines various forms of arthritis of unknown etiology, which debut in children under 16 and lasts for more than 6 weeks. The central idea in JIA management isthat treatment, timeliness, and adequacy determine the disease's prognosis and the child's further development. The primary principles in the treatment of JIA manifestations remain the principles of basic therapy of the disease, necessarily with the use of disease-modifying antirheumatic drugs. Taking into account the negative dynamics of the incidence of JIA and scientific data about the impact of the disease on the condition of hard dental tissues, conducting research in this area is of particular scientific interest to us. This study aims to determine the prevalence and intensity of the carious process in adolescents suffering from JIA, taking into account the subtypes of rheumatological disease and the possible negative impact of basic drug therapy. As part of the study, a dental examination of 80 adolescent children suffering from JIA was conducted. The control group consisted of 20 healthy adolescents. By the study design, the study participants were divided primarily by the presence of JIA; the second division was based on the presence of a specific subtype of JIA in the study participants: groups with polyarticular rheumatoid factor positive (RF+) (n=29), oligoarticular (n=24), enthesitis-associated (n=12), polyarticular RF- (n=10), undifferentiated (n=5) variants of JIA and a control group (n=20). Another division of the study participants took place according to the basic medical support: groups of patients taking methotrexate at a dose of less than or equal to 15 mg (n=43) and greater than 15 mg (n=18), a group of patients receiving adalimumab (n=20) and a control group (n=20). An examination of the oral cavity, recording of the dental formula and determination of the prevalence and intensity of the carious process in the studied groups depending on the presence of JIA, basic medical support and subtype of the disease were performed. Statistical analysis of the data was performed using the STATISTICA 10.0 program. It was noted that patients with JIA have a 1,6-fold higher intensity of dental caries compared to children without JIA (p= 0,004). Analysis of the structure of the DMF+df index allows us to state that patients with JIA have carious lesions of permanent teeth on average 2 times more often compared to the control group (p= 0,004). Analysis of the effect of basic drug therapy on the caries intensity in general and separately on each structural component of the DMF+df index showed that patients taking methotrexate at a dose of less than or equal to 15 mg have an average cariesintensity of 1,25 times higher compared to patients who take adalimumab, and a 2-fold higher intensity of the carious process compared to children without general somatic pathology (p = 0,0096 and p = 0,0008, respectively). The study also showed that patientstaking methotrexate at a dose of lessthan or equal to 15 mg have an average of 3 times higher frequency of carious lesions of permanent teeth (p = 0,0016). The analysis of the influence of the JIA subtype on the intensity of the carious process showed that patients with RF-negative polyarticular and oligoarticular variants of JIA have, on average, twice the intensity of caries compared to the control group (p = 0,0032 and p = 0,0065, respectively). In contrast, the JIA subtype does not affect the structure of caries incidence in adolescents.