RU2429859C1 - Method of treating periodontitis - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: treating periodontitis involves conservative management: professional hygienic dental cleaning, antiseptic therapy and/or antibacterial therapy. From the 2nd day after the beginning of conservative management, 10-day oral rinsing with Baskunchak brine solution at t 36-37C for 5-7 min once a day and gingival applications of Baskunchak mud extract at t 36-37C on a gauze bandage for 5-7 min once a day. ^ EFFECT: higher clinical effectiveness in periodontitis ensured by better microcirculation in gum tissues, and increased resistance of a body exposed to biologically active substances of Baskunchak brine and mud. ^ 4 tbl, 2 ex

Description

The invention relates to medicine, namely to dentistry, can be used to treat periodontal diseases, accompanied by inflammation of the gum tissue.

Epidemiological studies carried out by the Ministry of Health of Russia showed that 78% of the examined persons aged 18 to 24 have periodontal lesions. Loss of teeth after 40 years in 60-70% is a consequence of periodontal changes, it was also found that even at a young age in 25% of cases there is bleeding gums (Kuzmina E.M., 1999).

Inflammatory forms of tissue destruction predominate in the structure of periodontal pathology (Perova M.D., 2005). One of the constant clinical and morphological manifestations of periodontitis is persistent inflammation of the marginal gums (Lemetskaya T.I., 1998).

In accordance with the concept of exogenous drug effects in periodontal disease, the main goal is to influence the microflora of the periodontal pocket, eliminate microcirculatory disorders in periodontal tissues and associated edema, normalize tissue metabolism, redox processes and the ability of periodontal tissues to regenerate (Lemetskaya T. I., 1998).

There is a method of treating periodontitis by using physical means and chemotherapeutic drugs (Iordanishvili method), which consists in prescribing hyperbaric oxygenation while taking drugs of the nootropic series, for example piracetam, in combination with an anti-Parkinsonian drug, for example midocalm (Iordanishvili A.K., Vasilyeva L.V. Method for the treatment of periodontitis - method of Jordanishvili. Application: 2008114998/14, 04.16.2008). However, this technique is difficult to use and can only be performed in a medical institution.

In addition, there is a method for the treatment of periodontitis by using a complex of therapeutic agents, which further comprises the treatment of mesenchymal stem autologous cells. The described method, like the previous one, can only be performed in a hospital setting, in addition, it is very expensive (Smolyaninov AB, Iordanishvili AK, Makeev BL The method of treatment of periodontitis. - Application: 2008115003/14, 04/16/2008).

A known analogue is a prototype of a method of treating periodontitis by the simultaneous administration of an energostim in the form of applications on the mucous membrane of the gums, irrigation of the oral cavity, electrophoresis on the gums and intramuscular injection under the mucous membrane in therapeutic doses. However, this method requires constant invasive procedures, which are very painful and traumatic for the mucous membrane of the gum (Popkov V.L., Galenko-Yaroshevsky P.A., Meladze V.N. Method for the treatment of periodontitis. - Application: 2002106527/14, 03/13/2002) .

The aim of the proposed method is to increase the effectiveness of treatment of periodontitis.

The goal of the invention is achieved by the fact that on the 2nd day after the start of traditional treatment, namely: professional hygienic cleaning of the oral cavity, antiseptic therapy and / or antibiotic therapy, the patient is prescribed rinsing the oral cavity with a solution based on brine for 10 days after a day Baskunchak Island at t ° 36-37 ° C for 5-7 min once a day and applications on the gums of the mud extract Baskunchak Island at t ° 36-37 ° C on a gauze bandage for 5-7 minutes 1 time per day, and the evaluation of the effectiveness of treatment is carried out by laser Doppler vskoy flowmetry and clinical methods.

The proposed method is as follows. After a preliminary examination, traditional treatment is carried out, including professional hygienic cleaning of the oral cavity, ensuring the removal of supragingival and subgingival dental deposits of soft food plaque; drug (antiseptic and / or antibacterial) therapy aimed at leveling the inflammatory phenomena of the gingival mucosa. Starting from the second day of treatment, rinse the mouth with a solution based on brine of Baskunchak Island at t ° 36-37 ° C for 5-7 min once a day and apply the gum extract of Baskunchak mud at t ° 36 -37 ° C on a gauze dressing for 5-7 minutes, 1 time per day, for 10 days. Rapa and dirt of Baskunchak Island are rich in magnesium sulfides, iron salts, natural antibiotics, natural hormones and biologically active substances that not only have a local effect on the oral mucosa, but, when absorbed, affect the body as a whole, increasing its resistance. The alternation of rinsing with a solution based on brine from Baskunchak Island and applications of its mud extract is due to the intensity of the impact on the body of these procedures.

In order to objectively evaluate the results of treatment, patients of both groups underwent laser Doppler flowmetry (LDF) according to the method of E.K. Krechina, V.I. Kozlova, V.V. Maslova (2007), which allows evaluating capillary blood flow in the gum tissue, as well as general clinical research methods.

LDF parameters were measured before treatment, two weeks after it. The results are presented in tables 1-4.

In patients of both groups before treatment, the microcirculation index (PM) ranged from 14.28 ± 1.26 perf. up to 13.79 ± 0.75 perf. The mean square deviation (δ) had mean values of 2.32 ± 0.31 perf.ed in acute catarrhal gingivitis, 2.05 ± 0.15 perf.ed in mild periodontitis and 1.64 ± 0.1 perf.ed. with periodontitis of moderate severity. The vasomotor activity of microvessels (K) was 16.97 ± 1.91%, 14.45 ± 1.29%, and 12.36 ± 1.1%, respectively, in acute catarrhal gingivitis, mild to moderate periodontitis (see table 1 )

Analysis of the amplitude-frequency spectrum of LDF indicates some suppression of the active mechanisms of blood flow modulation in the gum tissue during acute catarrhal gingivitis and compensatory growth of passive blood flow modulation mechanisms aimed at unloading the venous bed. With mild and moderate periodontitis, there is a decrease in both active and passive blood flow modulations (see Table 2).

When re-examining patients revealed an increase in microcirculation in patients of both groups, characterizing the level of capillary blood flow (see table 3). However, in patients of the group who used a solution based on brine of Baskunchak Island and applications of mud extract of Baskunchak Island, PM increased by 27% with catarrhal gingivitis, by 22.6% with moderate periodontitis and 22.4% with mild severity. The values of the mean square deviation characterizing the flow of red blood cells also increase after treatment (see table 3).

In patients who received traditional treatment, the increase in δ occurs by 8.6% with catarrhal gingivitis, by 19.5% with mild periodontitis and by 36.6% with moderate periodontitis, whereas with a combination of traditional treatment with alternating rinsing with a solution based on brine from Baskunchak Island and applications of mud extract from Baskunchak Island, this indicator increased by 17.2% for catarrhal gingivitis, 24.4% for mild periodontitis, and 54.8% for moderate periodontitis.

Analysis of the rhythmic structure of flaxomotions showed an increase in the contribution of active modulations of tissue blood flow, which is explained by an increase in the myogenic activity of microvessels and, as a result, an improvement in microcirculation (see Table 4).

In addition, there was an improvement in the general condition of patients and an improvement in periodontal status.

Thus, the study showed that the use of a solution based on brine of Baskunchak and mud extract of Baskunchak in combination with traditional treatment improves microcirculation in the gum tissue and allows you to get a faster effect.

The method was tested on 32 patients aged 23 to 57 years with acute gingivitis and periodontitis of mild to moderate severity who were outpatient treatment in a dental clinic in Astrakhan. The state of the microvasculature and the gingival mucosa were evaluated at the Department of Human Anatomy, GOU VPO AGMA. Two groups of patients were formed: in the first, the treatment was carried out in the traditional way, in the second, along with the traditional treatment, the proposed method of treatment was used.

The following are the results of testing the method.

Example 1. Patient K., 28 years old, complained of bleeding gums when brushing teeth. Objectively: The condition is satisfactory, the face is symmetrical, the skin is clean in color, not changed. Regional lymph nodes are not enlarged. Local status: the mouth opens in full, the mucous membrane of the gingival margin is hyperemic, swollen, there is an insignificant amount of soft plaque, stones.

Diagnosis: acute catarrhal generalized gingivitis.

Appointed: professional hygienic cleaning of the oral cavity, treatment of the oral cavity with an antiseptic (chlorgesidine bigluconate 0.05%). On the 2nd day, rinsing of the oral cavity with a solution based on brine of Baskunchak Island at t ° 36 ° C for 5 minutes was prescribed; on the 3rd day of treatment, an application of gum extract of Baskunchak's mud for 5 minutes at t ° 36 was applied ° C on a gauze dressing. In total, 5 procedures were performed within 10 days. An additional examination by the LDF method was carried out: PM - 13.79 perf. Units, δ - 2.32 perf. Units, K - 16.98%; active mechanisms of fluxomotion (vasomotion - 137.0%, vascular tone - 76.0%), passive mechanisms of fluxomotion - 84.0%, pulse fluctuations - 35%), index of fluxomotion - 1.23, intravascular resistance - 5.9 .

Two weeks later, a second examination and examination by LDF.

There are no complaints. Objectively: The condition is satisfactory, the face is symmetrical, the skin is clean in color, not changed. Regional lymph nodes are not enlarged. Local status: the mouth opens in full, the mucous membrane of the gingival margin is pale pink, fits snugly to the neck of the teeth, normal hydration. LDF data: PM - 17.44 perf. Units, δ - 2.76 perf. Units, K - 15.61%; active mechanisms of fluxomotion (vasomotion - 144.0%, vascular tone - 74.0%), passive mechanisms of fluxomotion - 69.0%, pulse fluctuations - 37.0%), index of fluxomotion - 1.42, intravascular resistance - 5, 5.

Thus, the treatment gave a positive effect: there are no signs of gingival inflammation, microcirculation in the gingival mucosa has improved.

Example 2. Patient I., 49 years old, complained of bad breath, bleeding gums when brushing your teeth. Objectively: The condition is satisfactory, the face is symmetrical, the skin is clean in color, not changed. Regional lymph nodes are not enlarged. Local status: the mouth opens in full, the mucous membrane of the gingival margin is hyperemic, swollen, pus is obtained with pressure; there is a large number of soft plaque, stones. Multiple pathological gingival pockets.

Diagnosis: periodontitis of moderate severity.

Appointed: professional hygienic cleaning of the oral cavity; antibacterial therapy (lincomycin 1 caps. 4 times a day for 5 days, Immudon 2 tablets. 4 times a day under the tongue for 5 days, chlorhexidine bigluconate 0.05% - rinse). Starting from the 2nd day of treatment, it was prescribed to rinse the oral cavity with a solution based on brine from Baskunchak Island at t ° 37 ° C for 7 minutes, on the 3rd day of treatment, an application to the gums for 7 minutes of mud extract from Baskunchak at t ° 37 ° C on a gauze dressing. In total, 5 procedures were performed within 10 days. An additional examination by the LDF method was carried out: PM - 14.1 perf. Units, δ - 1.66 perf. Units, K - 12.36%; active mechanisms of fluxomotion (vasomotomy - 105.0%, vascular tone - 90.0%), passive mechanisms of fluxomotion - 62.0%, pulse fluctuations - 34.0%), index of fluxomotion - 1.28, intravascular resistance - 4, one.

Two weeks later, a second examination and examination by LDF.

There are no complaints. Objectively: The condition is satisfactory, the face is symmetrical, the skin is clean in color, not changed. Regional lymph nodes are not enlarged. Local status: the mouth opens in full, the mucous membrane of the gingival margin is pale pink, fits snugly to the neck of the teeth, normal hydration. LDF data: PM - 16.94 perf. Units, δ - 2.56 perf. Units, K - 14.71%; active mechanisms of fluxomotion (vasomotomy - 141.0%, vascular tone - 73.0%), passive mechanisms of fluxomotion - 68.0%, pulse fluctuations - 39.0%), index of fluxomotion - 1.34, intravascular resistance - 5, 2.

Thus, as a result of the treatment, the patient's condition improved, hyperemia and swelling of the mucous membrane of the gingival margin disappeared, the depth of the pathological gingival pockets decreased.

The proposed method gives the following positive effect:

- increases the effectiveness of treatment of periodontitis;

- there is an improvement in microcirculation in the gum tissue;

- A faster positive effect of treatment is achieved;

- the method is not invasive;

- the method is easy to use, which allows you to use it at home.

Table 1 Microcirculation in the gum tissue before treatment Diagnosis Number of service PM δ TO Catarrhal gingivitis 9 M ± m 13.79 ± 0.75 2.32 ± 0.31 16.97 ± 1.91 Periodontitis is easy. Art. heavy 12 M ± m 14.28 ± 1.26 2.05 ± 0.15 14.45 ± 1.29 p <0.05 <0.05 <0.05 Periodontitis average Art. heavy eleven M ± m 14.1 ± 0.85 1.64 ± 0.1 12.36 ± 1 p <0.05 <0.05 <0.05

table 2 Indicators of hemodynamic mechanisms of microcirculation in the gum tissue before treatment Diagnosis Active mechanisms,% Passive mechanisms,% Index flux. Intravascular .--
resistance MT NT RF PF Catarrhal gingivitis M ± m 137.0 ± 9.0 78.0 ± 6.5 84.0 ± 8.1 55.0 ± 4.1 1.23 ± 0.14 5.8 ± 1.0 Periodontitis is easy. Art. heavy M ± m 111.3 ± 10.0 93.0 ± 6.3 67.9 ± 8.4 32.3 ± 4.0 1.21 ± 0.15 4.6 ± 0.6 p <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 Periodontitis average Art. heavy M ± m 105.0 ± 6.5 90.0 ± 5.0 62.2 ± 4.0 34.3 ± 2.9 1.28 ± 0.8 4.1 ± 0.4 p <0.05 <0.05 <0.05 <0.05 <0.05 <0.05

Table 3 Microcirculation in the gum tissue after treatment Diagnosis Number of service PM δ TO With the use of brine and mud extract of Baskunchak Island Catarrhal gingivitis 5 M ± m 17.52 ± 1.35 2.72 ± 0.51 15.71 ± 2.91 Periodontitis is easy. senior heavy 6 M ± m 16.78 ± 1.62 2.55 ± 0.15 15.35 ± 1.91 p <0.05 <0.05 <0.05 Periodontitis 6 M ± m 16.59 ± 0.81 2.54 ± 0.12 14.96 ± 1.23 p <0.05 <0.05 <0.05 Without the use of brine and mud extract of Baskunchak Island Catarrhal gingivitis four M ± m 17.19 ± 0.72 2.52 ± 0.31 15.70 ± 1.59 Periodontitis is easy. senior heavy 6 M ± m 16.28 ± 1.36 2.45 ± 0.17 14.95 ± 1.29 p <0.05 <0.05 <0.05 Periodontitis average Art. heavy 5 M ± m 15.91 ± 0.83 2.24 ± 0.17 13.96 ± 1.19 p <0.05 <0.05 <0.05

Table 4 Indicators of hemodynamic mechanisms of microcirculation in the gum tissue after treatment Diagnosis Active mechanisms,% Passive mechanisms,% Flux Index Intravascular. resistance MT NT RF PF With the use of brine and mud extract of Baskunchak Island Catarrhal gingivitis M ± m 144.0 ± 6.0 74.0 ± 8.5 69.0 ± 8.1 37.0 ± 7.1 1.42 ± 0.12 5.5 ± 1.7 Periodontitis is easy. senior heavy M ± m 143.3 ± 10.6 79.0 ± 7.3 68.1 ± 8.5 36.7 ± 4.3 1.39 ± 0.17 5.3 ± 0.7 p <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 Periodontitis average Art. heavy M ± m 143.0 ± 7.5 73.0 ± 8.0 67.7 ± 3.0 36.5 ± 2.9 1.38 ± 0.8 4.9 ± 0.4 p <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 Without the use of brine and mud extract of Baskunchak Island Catarrhal gingivitis M ± m 139.0 ± 9.9 75.0 ± 6.5 71.0 ± 7.1 36.6 ± 4.7 1.39 ± 0.12 5.4 ± 1.1 Periodontitis is easy. Art. heavy M ± m 131.3 ± 11.0 73.0 ± 6.5 64.9 ± 7.8 35.3 ± 4.3 1.35 ± 0.14 4.9 ± 0.7 p <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 Periodontitis average Art. heavy M ± m 135.0 ± 6.9 69.0 ± 5.2 66.2 ± 4.2 35.5 ± 2.1 1.31 ± 0.7 4.7 ± 0.9 p <0.05 <0.05 <0.05 <0.05 <0.05 <0.05

Claims (1)

A method for the treatment of periodontitis, including the introduction of drugs and applications on the gingival mucosa, characterized in that on the 2nd day after the start of traditional treatment, namely, professional hygienic cleaning of the oral cavity, antiseptic therapy and / or antibacterial therapy, the patient for 10 days, every other day, rinsing the oral cavity with a solution based on brine of Baskunchak Island at t ° 36-37 ° C for 5-7 minutes 1 time per day and application of gum extract of Baskunchak mud at t ° 36-37 ° C on gauze bandage over e 5-7 min once a day.