The state of the periodontal tissue in children with insulin dependent diabetes mellitus

The study aimed was to study the state of periodontal tissues in 18 somatically healthy children and 109 children with type 1 diabetes, taking into account the duration and severity of the underlying disease. The examination results showed that changes in periodontal tissues are more pronounced in children with somatic pathology than in children without concomitant pathology. We have established that with a duration of diabetes more than five years, the papillary-marginal index was probably higher than in children with a duration of diabetes less than five years. The dependence of periodontal tissues on the level of glycemic control was monitored. In children with an optimal level of glycemic control, a soft degree of chronic catarrhal gingivitis was found, suboptimal - mild and moderate, and in children with a high level of glycemic control, a soft, moderate and severe course of HCG was detected. The number of sextants with bleeding also depended on the duration and severity of the course main disease.

pediatric dentists on guard with the aim of timely diagnostics, prevention, and treatment of both diabetes mellitus and diseases of periodontal tissues (Carneiro et al., 2015;Vynohradova et al., 2015;Zelinska et al., 2020).Therefore, our goal was to study the condition of periodontal tissues in children with insulin-dependent diabetes mellitus (IDDM) and compare it with the parameters of somatically healthy individuals' children.

MATERIALS AND METHODS
In the period from September 2022 to March 2023, we investigated the state of periodontal tissues in 18 children who did not have general diseases and 109 children with diabetes who were examined and treated in the endocrinology department of the Regional Clinical Hospital (Chernivtsi, Ukraine) regarding insulin-dependent diabetes mellitus: 65 children were ill up to five years, 44more than five years.Taking into account the level of glycemic control, one child had optimal glycemic control (OGC), 66 children had suboptimal glycemic control (SOGC), and 42 children had high risk for life (HRFL) (Picture 1).

Picture 1 Scheme of dental examination of children of observation groups
The condition of the periodontal tissues in children was assessed by the PMA gingival index and the communal periodontal index SRI.The papillary-marginal-cellular index (PMA) in the Parma modification makes it possible to determine the initial changes in periodontal tissues -the degree and prevalence of inflammation in the gums.Procedure: using a mirror and a probe, the presence of an inflammatory process near each tooth was visually assessed.Formula for calculation: PMA = (sum of points)/(3×number of teeth) x100%.

Interpretation of the index:
up to 25% -A mild degree of gingivitis; 25 -50% -Average degree of gingivitis; more than 50% -A severe degree of gingivitis.
Communal periodontal index SRI considers the state of the following indicators of periodontal status: bleeding gums, calculus, and periodontal pockets.A specially developed light CPI probe with a ball at the end, 0.5 mm in diameter, is used.It has a black mark between 3.5 and 5.5 mm and a black ring at 8.5 mm and 11.5 mm from the probe tip.The oral cavity was divided into six sections, which included the following groups of teeth: 18-14, 13-23, 24-28, 38-34, 33-43, 44-48.In patients younger than 20, only six index teeth were examined -16, 11, 26, 36, 31, 46, and only bleeding gums and tartar were recorded.The results of the study were evaluated according to the following criteria: 0 -There are no signs of damage; 1-Bleeding gums; 2-Calculus (The black zone of the probe is above the level of the gums); 3-Periodontal pocket with a depth of 4-5 mm (The gingival margin is located at the level of the probe's black mark); 4-Periodontal pocket with a depth of 6 mm or more (The black zone is not visible on the search).
In accordance with WHO recommendations, the gradation shown in Table 1 was used to assess the prevalence and intensity of bleeding and the presence of tartar in adolescents.

RESULTS AND DISCUSSION
Determining the degree of severity of chronic catarrhal gingivitis indicates that children without somatic pathology did not have severe forms of its course (Picture 2).A mild degree prevailed among them (77.8%

%
There was no significant difference in the RMA rate in somatically healthy children and children with diabetes with mild severity of gingivitis.Numerical values the papilla-marginal-alveolar index with a moderate intensity of the process in the periodontal tissue of children with IDDM differed reliably from those without the underlying disease (р<0.05).A reliable difference in the parameter examined was found in the case of moderate and severe forms of chronic catarrhal gingivitis in children depending on the duration of diabetes mellitus.Children who suffer from DM for over five years present more considerable changes in the periodontal tissues.This is confirmed by the research of other authors (Casavalle et al., 2016;Godovanets et al., 2020;Vynohradova et al., 2015).
The state of the periodontal tissue in children with DM is associated with the level of their glycemic control.Patients with optimal levels of glycemic control presented a mild degree of chronic catarrhal gingivitis (CCG) only.Those with suboptimal levels -mild and moderate degrees, and children with the glycemic control level and a high risk for life -mild, moderate, and severe degrees.Thus, a severe degree was found in 8 children, estimated as 19.05%, and a mild degree -in 6 (14.29%).The presence of bleeding was studied taking into account the number of sextants in children of different groups and the degree of severity of inflammation of catarrhal gingivitis (Picture 3).Thus, in children suffering from IDDM, the number of sextants with bleeding appeared to be 1.88 times higher than that in children with chronic catarrhal gingivitis without underlying pathology.We observe an increase in the number of sectarians with bleeding in children with diabetes compared to somatically healthy children.
The amount of sextants with bleeding depends on the severity and duration of the underlying disease.The indicator of probable difference was shown in children with optimal and suboptimal levels of glycemic control, regardless of the severity of gingivitis.
That is, children with SOGC presented 1.85 times higher amounts of sextants with bleeding than children with OGC.We have a significant difference in the case of the optimal level of glycemic control and the level of glycemic control with a high risk for life (p<0.05).This difference increases in patients with OGC and HRFL and reaches 2.35 times.A reliable difference in the parameter (sextants of bleeding) in children with SOGC and HRFL was not found (р>0.05).
Picture 3 СРІ values of the children examined (М±m)

CONCLUSIONS
The results of the examination indicate that in the presence of diabetes, periodontal tissue changes are more pronounced than in somatically healthy children.Thus, when diabetes mellitus lasts longer than five years with moderate and severe degrees of chronic catarrhal gingivitis, the papilla-marginal-alveolar index is reliably higher than that in children with a duration of the underlying diseases less than five years.The state of the periodontal tissue depends on the level of glycemic control.Patients with optimal levels of glycemic control presented a mild degree of chronic catarrhal gingivitis only, those with suboptimal levels -mild and moderate degrees, and children with the glycemic control level and a high risk for life -mild, moderate, and severe degrees.Thus, children with more severe manifestations of diabetes mellitus present more considerable pathological changes in the periodontal  tissue.The number of sextants with bleeding increased in children with IDDM compared to somatically healthy children.The amount of sextants with bleeding depends on the severity and duration of the underlying disease.

Ethical approval
The research proposal was approved by the by the Medical Ethics Committee of Bukovynian State Medical University, Chernivtsy, Ukraine (registration number: 15.04.23/7).
diseases are quite common among children.Their number and intensity are increasing compared to other historical periods (Yanko et al., 2017; Kaskova et al., 2020; Sorochenko et al., 2016).Diseases of periodontal tissues are an actual problem of modern dentistry due to their widespread and progressive course.Local and general factors were differentiated in the etiology of periodontal tissue diseases.However, such a distribution is conventional since these diseases can be associated both with themselves and the child's body on the whole.Condition of somatic health plays a considerable role in the pathogenesis of periodontal tissue diseases (Khomenko et al., 2016; Kaskova et al., 2019).The data from clinical and experimental studies indicate close relations between periodontal tissue diseases and functional disorders of the endocrine glands.Periodontal pathology is known to be one of the first manifestations of diabetes mellitus (DM) (Casavalle et al., 2016; Godovanets et al., 2020; Barrett et al., 2017).Changes in the periodontal tissue of children should put Evaluation criteria: 1 point -Inflammation of the papilla; 2 points -Inflammation of the gingival margin; 3 points -Inflammation of the attached part of the gums.

Table 1
Prevalence and intensity of periodontal tissue diseases in adolescents according to WHO All research was conducted in compliance with the principles of bioethics.Examination of children was carried out taking into account the main provisions of the Helsinki Declaration on Biomedical Research.Statistical data processing was carried out by the method of variational statistics according to the student's criterion and using Statistica 7.0 software (StatSoft, Inc).The difference between the comparison groups was considered probable at p≤0.05.