Treatment of Fissure Caries of Children with Severe Rheumatic Diseases with Difficulty in Opening the Mouth

[Oral pathologies in pediatric patients related to juvenile systemic lupus erythematosus and considerations in stomatological management. A review]

Introduction

Juvenile lupus erythematosus (jSLE) is a rheumatic disease that affects the functioning of internal organs and is multisystemic. It is a chronic condition and is usually associated with very significant morbidity, which is higher in children and adolescents than in adults.

Objectives

Describe and identify the most current concepts of jSLE, etiology, epidemiology of the disease, semiology, oral manifestations, as well as treatment, consequences and differences with systemic lupus erythematosus in adults (aSLE).

Materials and methods

A literature search was carried out in PubMed, Ebsco, SciELO, and ELSEVIER, using the key words, "Juvenile lupus erythematosus","dental caries", "oral manifestation", "children dentistry". Aimed at studies carried out in humans between 2010 to 2023 and the most relevant topics related to this disease were analyzed.

Results

The information that was collected corresponds to the last 13 years, with the purpose of making an update on the topic of study, 750 articles were reviewed which were analyzed with the inclusion and exclusion criteria but only 50 met these criteria articles.

Conclusion

Dental care in patients with SLEj is a challenge, since there are different considerations that we must take into account before carrying out any treatment, since they present alterations in the joints, salivary glands and failures of multiple organs. It is important to know the different differential diagnoses for unequivocal detection of the disease. In the presence of signs and symptoms based on the criteria of jSLE or early onset, a consultation with the immunology area is recommended to confirm or rule out this disease.

A STUDY OF THE INFLUENCE OF JUVENILE ADJUVANT ARTHRITIS ON DENTAL HARD TISSUES CONDITION IN EXPERIMENTAL ANIMALS

OBJECTIVE

The aim: To study the intensity and depth of carious tooth lesions in rats with experimental juvenile adjuvant-induced arthritis.

PATIENTS AND METHODS

Materials and methods: An experimental study on a model of juvenile adjuvant arthritis (JAA) in 10 one-month-old rats induced by method of A.M. Bendele was carried out. 10 rats of the same age were intact. Injection of adjutant in rats of experimental group led to the development of acute local reaction and then caused generalized joint reaction of autoimmune origin. The performed basic therapy of JAA promoted transition of acute autoimmune process to chronic. Rats were withdrawn from the experiment in 58 days and the dental-jaw blocks were made, in which the intensity and depth of carious lesions of the masticatory group of teeth were determined.

RESULTS

Results: The course of JAA was accompanied by the development of dental caries in 100% of experimental animals. It was found that the intensity of carious teeth lesions in terms of the number of carious teeth and cavities is probably higher than in intact rats (respectively 4.3 ± 0.3 vs. 2.2 ± 0.6 and 4.5 ± 0.3 vs. 2.3 ± 0.7, p <0.001). In rats with JAA, mostly middle and deep carious cavities were revealed, at the same time in intact rats - superficial and middle carious cavities were observed.

CONCLUSION

Conclusions: It has been established that adjuvant arthritis is accompanied by 100% prevalence of dental caries, high intensity of carious process, presence of middle and deep carious cavities, that confirm the negative influence of autoimmune disease on the condition of the hard tooth tissues.