Что нужно знать педиатру о зубах у детей: кариес, флюороз, базовые протоколы ухода

Захарова И.Н., Оробинская Я.В. Что нужно знать педиатру о зубах у детей: кариес, флюороз, базовые протоколы ухода. Педиатрия. Consilium Medicum. 2025;3:222–228. DOI: 10.26442/26586630.2025.3.203457

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Zakharova IN, Orobinskaya YaV. What a pediatrician needs to know about teeth in children: caries, fluorosis, basic care protocols: A review. Pediatrics. Consilium Medicum. 2025;3: 222–228. DOI: 10.26442/26586630.2025.3.203457

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Аннотация

В современном мире кариес – одно из наиболее распространенных хронических заболеваний детского возраста. Неудовлетворенная потребность в лечении молочных зубов высока и оказывает неблагоприятное влияние на рост, сон, питание, а также качество жизни ребенка и его семьи. Клинически доказано, что фторсодержащие зубные пасты предотвращают развитие кариеса и способствуют его контролю. Противокариозная эффективность этих средств определяется тремя ключевыми детерминантами: концентрацией фторида, частотой проведения гигиенических процедур и поведением после чистки, в том числе полосканием рта по ее завершении. При неправильном применении таких паст (проглатывании и использовании избыточного количества) существует риск формирования флюороза зубов. Корректное использование фторсодержащих средств гигиены полости рта позволяет увеличить профилактическую эффективность и минимизировать вероятность развития флюороза. В настоящем обзоре систематизированы данные, подтверждающие целесообразность регулярного использования зубной пасты с фтором для получения максимальной профилактической пользы при одновременном снижении сопутствующих рисков. В соответствии с поправками к приказу «О порядке проведения профилактических медицинских осмотров несовершеннолетних» Минздрава России от 10 августа 2017 г. № 514н, вступающими в силу с 1 сентября 2025 г., осмотры стоматологом должны проводиться ежегодно, начиная с возраста 12 мес, поэтому особенно важно участие врача-педиатра в формировании у родителей правильных установок и практик в уходе за полостью рта ребенка, по ограничению потребления сахара и местному применению фторида.

Ключевые слова: молочные зубы, ранний детский кариес, флюороз, фтор, фторсодержащие зубные пасты, грудное вскармливание, зубная паста, гигиена полости рта, Streptococcus mutans, зубная эмаль

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Caries is one of the most common chronic diseases in children. The unmet need for dental care of baby teeth is high and has an adverse effect on the growth, sleep, nutrition, and quality of life of the child and their family. It is clinically proven that fluoride-containing toothpastes prevent caries and contribute to its control. The anti-caries efficacy of these products is determined by three key factors: fluoride concentration, frequency of hygiene procedures, and post-brushing procedures, including the use of mouthwash upon completion. In the event of improper use of such pastes (ingestion and excessive use), there is a risk of dental fluorosis. Proper use of fluoride-containing oral hygiene products can increase preventive efficacy and minimize the risk of fluorosis. This review systematizes the evidence supporting the routine use of fluoride-containing toothpaste to maximize prophylactic benefits while reducing associated risks. In accordance with the amendments to the Order “On the Procedure for Preventive Medical Examinations of Minors” of the Ministry of Health of Russia dated August 10, 2017 No. 514н, which come into force on September 1, 2025, dental examinations must be carried out annually, starting from the age of 12 months; therefore, the pediatrician needs to participate in the fostering the proper attitudes and practices in the child’s oral care, local fluoride application and limiting sugar consumption.

Keywords: baby teeth, early childhood caries, fluorosis, fluoride, fluoride-containing toothpastes, breastfeeding, toothpaste, oral hygiene, Streptococcus mutans, tooth enamel

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Список литературы

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28. Alexaki F, Kostopoulou M, Koleventi K, Lygidakis NN. Does breastfeeding increase the risk of early childhood caries (ECC)? A systematic review. Eur Arch Paediatr Dent. 2025;26(4):645-56. DOI:10.1007/s40368-025-01051-4
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36. Kang BH, Park SN, Sohng KY, Moon JS. Effect of a tooth-brushing education program on oral health of preschool children. J Korean Acad Nurs. 2008;38(6):914-22 (in Korean). DOI:10.4040/jkan.2008.38.6.914
37. Toumba KJ, Twetman S, Splieth C, et al. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent. 2019;20(6):507-16. DOI:10.1007/s40368-019-00464-2
38. Kanagaratnam S, Schluter PJ. An update of the evidence on factors that influence the impact of fluoride toothpaste on dental caries in New Zealand. NZ Dental Journal. 2022;118:85-94. Available at: https://assets.nzda.org.nz/files/Archives/NZDJ_Articles/2022/September_2022/An_update_of_tht_evidenc.... Accessed: 14.07.2025.
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1. Morris AL, Tadi P. Anatomy, Head and Neck, Teeth. 2023. StatPearls. Treasure Island (FL): StatPearls Publishing, 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557543/ Accessed: 14.07.2025.
2. Hu JC, Simmer JP. Developmental biology and genetics of dental malformations. Orthod Craniofac Res. 2007;10(2):45-52. DOI:10.1111/j.1601-6343.2007.00384.x
3. Gil-Bona A, Bidlack FB. Tooth Enamel and its Dynamic Protein Matrix. Int J Mol Sci. 2020;21(12):4458. DOI:10.3390/ijms21124458
4. Ntani G, Day PF, Baird J, et al; Southampton Women’s Survey Study Group. Maternal and early life factors of tooth emergence patterns and number of teeth at 1 and 2 years of age. J Dev Orig Health Dis. 2015;6(4):299-307. DOI:10.1017/S2040174415001130
5. Drobotko LN, Zueva TE. Eruption of temporary teeth in children. Medical Council. 2022;(12):21-7 (in Russian). DOI:10.21518/2079-701X-2022-16-12-21-27
6. Hovorakova M, Lesot H, Peterka M, Peterkova R. Early development of the human dentition revisited. J Anat. 2018;233(2):135-45. DOI:10.1111/joa.12825
7. McKinney R, Olmo H. Developmental Disturbances of the Teeth, Anomalies of Structure. 2023;7. Available at: https://www.ncbi.nlm.nih.gov/books/NBK574516/ Accessed: 14.07.2025.
8. Henry G. Anatomy of the Human Body. New York City: Lea & Febiger, 1918. Available at: http://www. bartleby. com. Accessed: 14.07.2025.
9. Kreiborg S, Jensen BL. Tooth formation and eruption - lessons learnt from cleidocranial dysplasia. Eur J Oral Sci. 2018;126(Suppl. 1):72-80. DOI:10.1111/eos.12418
10. Memarpour M, Soltanimehr E, Eskandarian T. Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies. BMC Oral Health. 2015;15:88. DOI:10.1186/s12903-015-0070-2
11. Zaplatnikov AL, Kasianova AN, Maikova ID. Sindrom prorezyvaniia zubov u mladentsev: novyi vzgliad na staruiu problemu. RMZh. 2018;5(II):68-71. Available at: https://www.rmj.ru/articles/pediatriya/Sindrom_prorezyvaniya_zubov_u_mladencev_novyy_vzglyad_na_star... Accessed: 14.07.2025 (in Russian).
12. Consolini DM. Teething. MCD MANUAL Professional Version. Available at: https://www.msdmanuals.com/professional/pediatrics/care-of-newborns-and-infants/teething. Accessed: 16.08.2025.
13. American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy on early childhood caries (ECC): unique challenges and treatment options. Pediatr Dent. 2005-2006;27(7 Suppl.):34-5.
14. Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012;102(9):1729-34. DOI:10.2105/AJPH.2011.300478
15. Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: The human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140(6):650-7. DOI:10.14219/jada.archive.2009.0250
16. Nanci A. Ten Cate’s oral histology: development, structure, and function (9th ed.). Elsevier, 2018.
17. Early Childhood Caries: IAPD Bangkok Declaration. Int J Paediatr Dent. 2019;29(3):384-6. DOI:10.1111/ipd.12490
18. Manchanda S, Sardana D, Peng S, et al. Is Mutans Streptococci count a risk predictor of Early Childhood Caries? A systematic review and meta-analysis. BMC Oral Health. 2023;23(1):648. DOI:10.1186/s12903-023-03346-8
19. Kirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies. Pediatr Dent. 2019;41(2):95-112.
20. Van Houte J, Gibbs G, Butera C. Oral flora of children with „nursing bottle caries“. J Dent Res. 1982;61(2):382-5. DOI:10.1177/00220345820610020201
21. Parisotto TM, Steiner-Oliveira C, Silva CM, et al. Early childhood caries and mutans streptococci: a systematic review. Oral Health Prev Dent. 2010;8(1):59-70.
22. Kim HE, Liu Y, Dhall A, et al. Synergism of Streptococcus mutans and Candida albicans Reinforces Biofilm Maturation and Acidogenicity in Saliva: An In Vitro Study. Front Cell Infect Microbiol. 2021;10:623980. DOI:10.3389/fcimb.2020.623980
23. Wan AK, Seow WK, Purdie DM, et al. A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. J Dent Res. 2003;82(7):504-8. DOI:10.1177/154405910308200703
24. Bowen WH, Lawrence RA. Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics. 2005;116(4):921-6. DOI:10.1542/peds.2004-462
25. Holgerson PL, Vestman NR, Claesson R, et al. Oral microbial profile discriminates breast-fed from formula-fed infants. J Pediatr Gastroenterol Nutr. 2013;56(2):127-36. DOI:10.1097/MPG.0b013e31826f2bc6
26. Abanto J, Maruyama JM, Pinheiro E, et al; MINA-Brazil Study Group. Prolonged breastfeeding, sugar consumption and dental caries at 2 years of age: A birth cohort study. Community Dent Oral Epidemiol. 2023;51(3):575-82. DOI:10.1111/cdoe.12813
27. Branger B, Camelot F, Droz D, et al. Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention. Arch Pediatr. 2019;26(8):497-503. DOI:10.1016/j.arcped.2019.10.004
28. Alexaki F, Kostopoulou M, Koleventi K, Lygidakis NN. Does breastfeeding increase the risk of early childhood caries (ECC)? A systematic review. Eur Arch Paediatr Dent. 2025;26(4):645-56. DOI:10.1007/s40368-025-01051-4
29. Echeverria MS, Schuch HS, Cenci MS, et al. Early Sugar Introduction Associated with Early Childhood Caries Occurrence. Caries Res. 2023;57(2):152-8. DOI:10.1159/000529210
30. Moynihan P, Tanner LM, Holmes RD, et al. Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries. JDR Clin Trans Res. 2019;4(3):202-16. DOI:10.1177/2380084418824262
31. Walsh T, Worthington HV, Glenny AM, et al. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3(3):CD007868. DOI:10.1002/14651858.CD007868.pub3
32. Atia GS, May J. Dental fluorosis in the paediatric patient. Dent Update. 2013;40(10):836-9. DOI:10.12968/denu.2013.40.10.836
33. Gavila P, Ajrithirong P, Chumnanprai S, et al. Salivary proteomic signatures in severe dental fluorosis. Sci Rep. 2024;14(1):18372. DOI:10.1038/s41598-024-69409-0
34. Borinsky YuN, Kushnir SM, Davydov BN, Borinskaya EYu. Risk and prevention of fluorosis in infants during different types of feeding. Ros Vestn Perinatol Pediat. 2011;56(5):11-4. Available at: https://cyberleninka.ru/article/n/risk-i-profilaktika-flyuoroza-u-detey-rannego-vozrasta-pri-raznyh-.... Accessed: 14.07.2025 (in Russian).
35. Nazzal H, Duggal MS, Kowash MB, et al. Comparison of residual salivary fluoride retention using amine fluoride toothpastes in caries-free and caries-prone children. Eur Arch Paediatr Dent. 2016;17(3):165-9. DOI:10.1007/s40368-015-0220-x
36. Kang BH, Park SN, Sohng KY, Moon JS. Effect of a tooth-brushing education program on oral health of preschool children. J Korean Acad Nurs. 2008;38(6):914-22 (in Korean). DOI:10.4040/jkan.2008.38.6.914
37. Toumba KJ, Twetman S, Splieth C, et al. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent. 2019;20(6):507-16. DOI:10.1007/s40368-019-00464-2
38. Kanagaratnam S, Schluter PJ. An update of the evidence on factors that influence the impact of fluoride toothpaste on dental caries in New Zealand. NZ Dental Journal. 2022;118:85-94. Available at: https://assets.nzda.org.nz/files/Archives/NZDJ_Articles/2022/September_2022/An_update_of_tht_evidenc.... Accessed: 14.07.2025.
39. Prevention and Management of Dental Caries in Children. Available at: https://www.sdcep.org.uk/published-guidance/caries-in-children/ Accessed: 16.08.2025.
40. Leontiev VK, Maslak EE, Avraamova OG, Shevchenko OV. The results of expert consultations „Fluorides for the prevention and treatment of caries and acid erosion. New Sensodyne brand products“. Dental Institute. 2024;(3):64-6 (in Russian).
41. Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8-18. DOI:10.1177/0022034513508954
42. Prikaz Minzdrava Rossii ot 10 avgusta 2017 g. № 514n o poriadke provedeniia profilakticheskikh meditsinskikh osmotrov nesovershennoletnikh. Available at: https://normativ.kontur.ru/document?moduleId=1&documen tId=500364. Accessed: 08.08.2025 (in Russian).

Авторы

И.Н. Захарова*¹, Я.В. Оробинская^1,2

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²ГБУЗ МО «Химкинская клиническая больница» Минздрава Московской области, Химки, Россия
*zakharova-rmapo@yandex.ru

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Irina N. Zakharova*¹, Yana V. Orobinskaya^1,2

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Khimki Clinical Hospital, Khimki, Russia
*zakharova-rmapo@yandex.ru

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