RU2151593C1 - Method of treatment of parodontium and mouth mucosa - Google Patents

Abstract

FIELD: medicine, stomatology. SUBSTANCE: method involves the use of enzyme-containing cleansing ointment that has laevomycetin, furacillin, chymotrypsin, kalanchoe juice, polyethylene glycol and glycerol taken in the definite ratio of components. Method involves the use of application procedure. EFFECT: decreased treatment time.

Description

 The invention relates to medicine, namely to dentistry, and can be used in outpatient treatment of periodontal diseases and oral mucosa.

 Known methods for treating periodontal tissue diseases such as ulcerative, ulcerative necrotic gingivitis, ulcerative lesions of the oral mucosa and lips using proteolytic enzymes - trypsin, chymotrypsin, chymopsin, ribonuclease, when localized, they break down necrotic tissue and fibrinous plaque, thin out viscous exudate, without damaging healthy tissues, have anti-inflammatory and decongestant effects. Use in the form of applications on the affected areas or for instillations in the periodontal pockets (Roshchina LI, Maksimovskaya LN Medicines. Dentistry. - M., 1993. - S. 72-73.).

 Locally use Kalanchoe juice, which has an anti-inflammatory effect, helps to cleanse wounds from necrotic tissues, stimulates their healing (Mashkovsky M.D. Medicines. - M., 1996. - Part 2. - P. 179.).

 For the prototype, the drug that is closest in essence and used for the treatment of ulcerative and ulcerative necrotic lesions of the mucous membrane of the oral cavity and lips, ointment Iruksol (manufactured by Yugoslavia) was selected. 1.0 g of ointment contains 0.6 IU of clastridiopeptitase A, concomitant enzymes, 10 mg of chloramphenicol, the rest is a lipophilic ointment base. Ointment is applied 2 times a day for 1-14 days, depending on the severity of the pathological process (Marchenko A.I., Kononovich E.F., Solntseva T.A. Pharmacotherapy in dentistry. - Kiev: Health, 1986. - P. 74.).

 The aim of the invention is to reduce the treatment time, lengthening the stage of remission and accelerating the epithelialization process.

 This goal is achieved in that the complex of conventional therapy includes treatment by the method of applications lasting 30 minutes for 10-12 procedures with an ointment of an enzymatically cleansing composition (wt.%): Chloramphenicol 0.01, furatsilin 0.0002, chymotrypsin 0.001, Kalanchoe juice 0, 1, polyethylene glycol with a molecular weight of 1500 0.60-0.65, glycerol 0.288-0.238, and a mass of 1.0 g. An ointment is obtained by dispersing chloramphenicol, furatsilina, chymotrypsin with glycerin, Kalanchoe juice and molten polyethylene glycol.

 A method for the clinical treatment of periodontal disease and oral mucosa of aphthous stomatitis, catarrhal, ulcerative gingivitis, periodontitis of varying severity is as follows: patients are removed dental deposits before treatment, thorough oral antiseptic treatment is performed. Put in the affected area a applicate with ointment enzymatically cleansing in an amount of 1.0, and also injected into the periodontal pockets, incubated for 30 minutes. After 30 minutes, the applicate is removed, the rejected necrotic mass is removed, and about 0.5 g of ointment is applied with a cotton swab. The patient is not recommended to eat, rinse the mouth for one and a half to two hours.

 Under observation were 30 patients aged 20 to 50 years. Patients with a diagnosis of aphthous stomatitis, ulcerative gingivitis, generalized periodontitis in the acute stage of varying severity. Patients were divided into 2 groups. One group (14 people) received treatment with Iruxol ointment, the second group (16 people) received enzymatically cleansing ointment.

 The treatment was carried out by the application method, 1.0 g of ointment was used. The number of applications - the course of treatment continued depending on the severity until a therapeutic effect was obtained from periodontal tissues, which was confirmed by the absence of inflammatory phenomena, epithelization of erosion and aphthae, determination of RAM, vacuum test.

 Our observations showed that in the treatment of patients of the first group with a diagnosis of chronic generalized periodontitis of moderate severity (8 people) who received treatment with the application method of Iruxol ointment, the treatment period was 10 procedures. When treating patients of the second group with the same diagnosis (10 people) with an enzymatically cleansing ointment, the treatment period was 8 procedures. The clinical effect is most pronounced in patients of the second group, where after 2 procedures hyperemia disappeared, purulent-serous discharge from periodontal pockets ceased, and after 6 procedures the patients did not complain of discomfort in the oral cavity, bleeding of the gums stopped, teeth were stable, the vacuum test returned to normal , Pisarev-Schiller test - / - /. All signs of inflammation disappeared, the stage of remission was reached. After 6 months, there was no relapse. In 2 patients, a relapse was observed after 12 months, but proceeded in a milder form. In one patient, after 6 months, exacerbation occurred, the course of treatment was repeated.

 In 4 patients from the first group, relapse was observed after 6 months, and after 12 months, 6 people turned and treatment was repeated for them. In the treatment of patients of the first group (6 people) with a diagnosis of moderate to severe aphthous stomatitis with Iruxol ointment, by applying an applicate to the gum, lubricating the tongue 2 times a day, there was a decrease in hyperemia, swelling, disappearance of the fibrous film after 3 days. After 5 visits, the eroded areas were at the stage of epithelization, bleeding of the gums when touched was not observed. After 14 days of treatment, recovery was achieved.

 When treating patients (6 people) of the second group with a diagnosis of aphthous stomatitis of varying severity using an enzymatic cleansing ointment after 2 visits, cleansing from fibrous plaque, a decrease in hyperemia, and swelling were observed. After 4 visits, the eroded areas were in the epithelialization stage. After 10 days of treatment, recovery was achieved.

 Patients of the first and second groups were monitored for 12 months. Relapse occurred in patients of the first group after 4-6 months - 4 people, in patients of the second group after 6 months - 1 person, after 12 months - 2 people.

 Example 1. Patient D 32 years. The diagnosis of chronic generalized periodontitis of moderate severity in the acute stage. Complaints of increased tooth sensitivity, bleeding gums.

Objectively: the necks of the teeth are exposed, significant deposition above and the subgingival tartar, the gums are swollen, cyanotic, fibrotic, and easily bleeds when touched. Pisarev-Schiller test / + /, PMA index 50%, RAM 40%, vacuum sample $\genfrac{}{}{0ex}{}{\text{60}}{\text{70}}$ $\genfrac{}{}{0ex}{}{\text{fifty}}{\text{70}}$ , pathological gingival pockets (3-3.5 mm), serous-purulent contents. Under microscopy, a significant number of leukocytes, oral trichomonas.

 The course of treatment was carried out: removal of dental plaque, adherence to oral hygiene, insillation in the periodontal pockets of the ointment enzymatically cleansing with subsequent applications of 10 procedures. After 4 visits, bleeding of the gums disappeared, hyperesthesia of the hard tissues of the teeth, gingival pockets without exudate decreased, size 1.5-2 mm.

 After the course of treatment, the vacuum sample is within normal limits, RAM 60%, PMA 20%, Pisarev-Schiller test / - /. The gum is pink in color and tightly covers the neck of the teeth.

 After 6 months, there was no relapse.

 Example 2. Patient L. 40 years. The diagnosis of acute stomatitis, proceeding in a severe form.

 When handling complaints of severe malaise, weakness, fever, headache.

On examination: body temperature 38 ^o C, submandibular and cervical lymph nodes are enlarged. The oral mucosa is hyperemic, swollen. Aphthae with patches of eroded surface were found, especially in hard palate, where patches of necrotic tissue were observed. Microscopic examination of the smear shows giant multinucleated cells.

 Treatment: lubrication of the lips, hard and soft palate, tongue with a thin layer of enzymatically cleansing ointment 6 times a day (on the first day), the next 2 times a day. General therapy: biseptol, heavy drinking.

 When re-examined after one day: the body temperature is subfibril, the general condition has improved. Lymph nodes are enlarged moderately, painful. By area, an increase in the erosive surface, a decrease in the size of the aft.

 After 3 days of treatment: normal body temperature, weakness. Eroded-necrotic areas cleared.

 After 4 days - eroded areas in the epithelialization stage.

 After 7 days of treatment, most erosion is epithelized. On the 10th day of treatment: no complaints. On examination: the oral mucosa is pink, moist, aphthae and erosion are epithelized. Blood and urine tests are normal. Achieved recovery.

 After 6 months, there was no relapse.

 Example 3. Patient K., 37 years old. The diagnosis of generalized periodontitis of moderate severity in the acute stage.

 Complaints of bleeding gums, suppuration, bad breath.

On examination: traumatic occlusion is absent. The necks of the teeth are exposed, deposition over and the subgingival tartar, the gum is swollen, hyperemic, easily bleeds when touched, suppuration from the periodontal pockets, the depth of the pockets is up to 3-3.5 mm. With smear microscopy, a large number of white blood cells. Pisarev-Schiller test / ++ /, PMA index - 55%, vacuum sample is accelerated $\genfrac{}{}{0ex}{}{\text{40}}{\text{35}}$ $\genfrac{}{}{0ex}{}{\text{45}}{\text{35}}$ .

 The course of treatment was carried out: removal of dental plaque, toilet with a 3% solution of hydrogen peroxide, the introduction of iroxol ointment into the gingival pockets with subsequent applications, 12 treatments per treatment course.

 After 6 visits, bleeding of the gums disappeared, suppuration ceased, and the gingival pockets were clean.

 After 12 procedures, no complaints.

 The gum is pink, tightly covers the neck of the teeth. Pisarev-Schiller test / - /, the vacuum test is normal. The stage of remission has been reached. Treatment after 6 months with exacerbation of periodontitis. The treatment was repeated.

 Example 4. Patient S. 21 years. The diagnosis of moderate aphthous stomatitis. Complaints of bleeding gums, pain when eating. At the initial examination: the mucous membrane of the oral cavity is hyperemic, swollen, found on the inflamed mucous membrane of the aphthae with parts of the eroded surface covered with fibrinous grayish-white bloom, sitting tight, surrounded by a thin hyperemic rim. In the tongue on the surface of the aphtha, a fibrinous film formed by necrotic masses is observed. After treating the oral cavity with a 0.5% solution of furatsilin, Iruxol ointment was treated by applying an applicate to the gum in the form of a gauze dressing, lubricating the tongue with ointment. The ointment was applied 2 times a day. After 2 days, hyperemia, swelling of the mucosa decreased. There was a decrease in the size of the aft, the fibrous film disappeared.

 After 6 visits - eroded areas in the epithelialization stage, when touching bleeding gums is not observed.

 On the 8th day of treatment, the mucosa is slightly hyperemic, aphthae in the epithelialization stage.

 After 10 days of treatment - the oral mucosa is clean, the gums are pink, dense. In the language at the site of the aphtha, a slightly hyperemic area. Epithelization continues.

 After 14 days of treatment, the patient did not show complaints, and recovery was achieved.

 The patient's appeal after 4 months about the appearance of aphthae in the tongue. The treatment was repeated.

 Based on the foregoing, the use of the invention provides a reduction in the treatment of chronic periodontitis in the acute stage of varying severity, aphthous stomatitis, lengthens the stage of remission, accelerates the process of epithelization.

Claims (1)

A method of treating periodontal diseases and oral mucosa by applying an enzymatically cleansing ointment to the affected area, characterized in that the treatment is carried out by the application method, lasting 30 minutes, for 10 to 12 procedures with an ointment composition, wt.%:
Chloramphenicol - 0.01
Furatsilin - 0,0002
Chymotrypsin - 0.001
Kalanchoe juice - 0.1
Polyethylene glycol with mol. m. 1500 - 0.60 - 0.65
Glycerin - 0.288 - 0.238
weighing 1.0 g.