RU2158582C1 - Method for curing periodontitis using general treatment approach - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying Normase preparation at a dose of 1 dessert spoon twice a day given during 1 month, splinting and selectively filing teeth, carrying out medicamentous treatment with nitrofurazone, hydrogen peroxide, placing periodontal bandages with butadion, methyl uracyl and indometacin ointment. EFFECT: enhanced effectiveness of treatment course.

Description

 The invention relates to medicine, can be used in practical dentistry.

 Periodontal disease is one of the most common and complex pathologies of the maxillofacial region According to the WHO, functional disorders of the dento-maxillary system caused by tooth loss from periodontal diseases, in particular periodontitis, develop 5 times more often than with caries complications.

Therapy of patients with periodontal diseases should be carried out comprehensively, purposefully and strictly individually. It includes local and general treatment. Despite the fact that local interventions are the most important part of the complex therapy of periodontitis, no less influence is needed to improve the general condition, eliminate background pathology, normalize immunity, which can be achieved by rational general treatment. Regardless of the cause of the disturbance in the periodontal tissues, the focus of local and general therapy is basically the same. Deterioration of the general condition almost always leads to an exacerbation of the pathological process in periodontal tissues. [1]
General treatment aims to increase the body's resistance, stimulate the regeneration process, stimulate the immune system, and have an anti-inflammatory effect.

Currently, the problem of the general treatment of patients with periodontitis is not completely solved due to the lack of affordable and effective drugs that do not have side effects that have a complex effect on the patient's body with periodontitis. [2]
A known method for the general treatment of periodontitis, which is an antiprotozoal drug Trichopol 0.25, which is mainly used to treat all patients with periodontitis, and is used if trichomonads are found in periodontal pockets. Trichopolum has a wide spectrum of antiprotozoal activity, is able to accumulate in the periodontal pocket, which provides a concentration of 5-7 times higher in blood serum, and also has an immunostimulating effect and has a small number of side effects. [3]
The disadvantage of this method is the lack of desensitizing and restorative effect. After taking the drug, dry mouth, nausea, loss of appetite, headache, urticaria are sometimes observed, which leads to the parallel appointment of antihistamines and antifungal drugs. The drug is ineffective against a number of other microorganisms.

Closest to the claimed method for the general treatment of periodontitis is the appointment of a native crystalline royal jelly under the tongue or inward at the tip of the knife. This drug is a biological stimulant with trophic properties, it stimulates microcirculation and tissue regeneration in the complex treatment of generalized periodontitis. [4]
The disadvantage of this method is that royal jelly has a short shelf life, it is almost impossible to buy in pharmacies, and it must be purchased directly from beekeepers, so it is difficult to assess its quality.

 The purpose of the invention relating to a method for the general treatment of periodontitis is to increase the effectiveness of conservative local treatment, to reduce the period of treatment of periodontitis due to the effect on the general condition of the body.

 This goal is achieved by the fact that the known method for the general treatment of periodontitis is to appoint 1 dessert spoon 2 times a day for 1 month as a general effect of the drug Normase. The use of this treatment method allows to ensure the previously not achieved effect of conservative treatment of periodontitis.

 Normase differs from the prototype and analogue in that it does not have the side effects characteristic of these drugs.

 The active ingredient of the drug Normase is a synthetic lactulose disaccharide. Normase, when ingested, is not absorbed or hydrolyzed in the stomach and small intestine due to the absence of a specific enzyme. Metabolism Normase occurs in the colon under the influence of bacterial microflora, especially anaerobic lactobacilli, bifidumbacteria. The main metabolites are low molecular weight organic acids (lactic, acetic, etc.), which lower the pH of the contents of the large intestine.

 The acidic environment of the colon helps to increase the population of lactobacilli, bifidumbacteria, which use lactulose as their nutrient. As a result of an increase in the normal intestinal microflora, the amount of putrefactive flora and pathogenic microbes (salmonella, staphylococcus, protea, etc.) decreases, which in turn favorably affects the state of the immune system.

 In addition, Normase promotes the conversion of ammonia in the acidic environment of the intestine into a non-absorbable ammonium ion, which is excreted from the body, which facilitates the detoxifying function of the liver, and also leads to a decrease in blood glucose [5].

 Example 1. Patient M., 64 years old, complained of bleeding gums when brushing teeth and eating, aching pain in the upper and lower jaw, tooth mobility. 3 months ago, she addressed these complaints to a periodontist, a course of professional oral hygiene was carried out, local anti-inflammatory treatment, which consisted of applying periodontal dressings with 5% butadiene ointment, was treated with Trichopol 0.25 tablets 3 times a day. 14 days. The patient noted a temporary improvement within 3 weeks after the course of treatment, after which there was a deterioration in the local condition, there were initial complaints.

Слизистая оболочка десны верхней и нижней челюсти отечна, застойно гиперемирована, цианотична, при зондировании кровоточит. Имеются пародонтальные карманы в области

5 - 6 мм,

3 - 4 мм
Подвижность зубов:

- 1 степени,
остальные зубы устойчивы.Objectively: Dental formula:

The mucous membrane of the gums of the upper and lower jaw is swollen, stagnantly hyperemic, cyanotic, bleeds when probed. There are periodontal pockets in the area

5 - 6 mm

3-4 mm
Tooth mobility:

- 1 degree
other teeth are stable.

 No dental deposits. Schiller-Pisarev test +++, Green-Vermilion hygiene index - 1 point, Russell periodontal index - 6.8. On a panoramic roentgenogram: lacunar type of resorption of the alveolar process up to 2/3 of the root length.

 Diagnosis: severe chronic generalized periodontitis.

. Произведена медикаментозная обработка десневого края раствором 3% перекиси водорода, наложена пародонтальная повязка с 5% бутадионовой мазью. Назначено: 1) Нормазе - по 1 десертной ложке 2 раза в день в течение месяца; 2) "Ундевит" - по драже 3 раза в день в течение месяца; 3) ротокан - 1 чайная ложка на стакан воды для полоскания полости рта 3 раза в день после еды в течение месяца.First visit: With a polyamide yarn fixed by eucrol, a semi-permanent tire is laid on

. The gingival margin was treated with a solution of 3% hydrogen peroxide, periodontal dressing with 5% butadiene ointment was applied. Appointed: 1) Normase - 1 dessert spoon 2 times a day for a month; 2) "Undevit" - on a dragee 3 times a day for a month; 3) rotokan - 1 teaspoon per glass of water to rinse the mouth 3 times a day after meals for a month.

 The patient was trained in oral hygiene; Parodontol toothpaste was recommended.

 Second visit: The patient does not make complaints. Hyperemia and edema of the gingival margin decreased, bleeding during sounding is preserved. Schiller-Pisarev ++ test.

 Medical treatment of the gingival margin with 3% hydrogen peroxide was carried out. A periodontal dressing with 5% butadione ointment was applied.

 Third visit: No complaints. Minor hyperemia in the gingival papilla area persists. Edema and bleeding during sounding are absent. Schiller-Pisarev test +. Medical treatment of the gingival margin with 3% hydrogen peroxide was carried out. A periodontal dressing with 5% butadione ointment was applied.

 Fourth visit: No complaints. The mucous membrane of the gums is pale pink, moist, without pathological changes. Schiller-Pisarev test -. 3 months after the course of treatment, a similar course was repeated. Subsequently, the patient had no complaints (observation period of 6 months). On a panoramic radiograph 3 months after the course of treatment, a compaction of the bone pattern of the alveolar process was noted.

 Example 2. Patient C., 49 years old, complained of bleeding gums when brushing teeth. Complaints appeared 3 years ago. I did not contact a pathologist.

Пародонтальные карманы в области

6,5 мм,

5 мм,
в области остальных зубов 4 мм со скудным серозным отделяемым.Objective: Dental formula

Periodontal pockets in the area

6.5 mm

5 mm
in the area of other teeth 4 mm with scanty serous discharge.

- 2 степени,
остальные зубы устойчивы (так как находятся в шинирующей конструкции мостовидных протезов). Имеются обильные над- и поддесневые зубные отложения в области всех зубов верхней и нижней челюсти.Tooth mobility:

- 2 degrees
other teeth are stable (as they are in the splinting construction of bridges). There are abundant supra- and subgingival dental deposits in the area of all teeth of the upper and lower jaw.

 Schiller-Pisarev test +++, Green-Vermillion Hygiene Index - 2.5 points, Russell periodontal index 5.9. On a panoramic x-ray: bone pockets in the region of the upper posterior teeth up to 2/3 of the root length, in the region of the remaining teeth there is a lacunar resorption of the alveolar process up to 1/2 of the root length.

 Diagnosis: severe chronic generalized periodontitis.

 First visit: Under application anesthesia Sol Lidocaini 10% removed supra- and subgingival dental deposits in the area of all teeth of the upper and lower jaw. Drug treatment with a 0.02% solution of furacilin. A periodontal dressing is applied with 5% indomethation ointment. Appointed: 1) Normase - 1 dessert spoon 2 times a day for a month; 2) “Vitrum” - 1 tablet once a day for a month; 3) chamomile broth - 1 teaspoon per glass of boiling water to rinse the oral cavity 3 times a day for a month.

 The patient was trained in oral hygiene; Lakalyut toothpaste was recommended.

 Second visit: The patient complains of minor bleeding gums when brushing teeth. Edema and hyperemia of the gingival mucosa have significantly decreased, bleeding during probing is preserved. Schiller-Pisarev ++ test. Drug treatment of the oral cavity with a 0.02% solution of furacilin, a dressing applied with 5% indomethacin ointment.

 Third visit: No complaints. Stagnant hyperemia in the gingival papilla area persists. Edema and bleeding during sounding are absent. Sample Schiller-Pisarev +. A medical treatment of the gingival margin with a 0.02% solution of furacilin was carried out. A periodontal dressing with 5% indomethacin ointment was applied.

 Fourth visit. There are no complaints. The mucous membrane of the gums is pale pink, moist, without pathological changes. The Schiller-Pisarev test is negative.

 In the future, the patient did not show complaints (observation period 3 months). On a panoramic radiograph after 3 months, a densification of the cortical plate of the alveolar ridge and bone pattern was noted.

 The treatment by the proposed method was 52 patients with periodontitis (49 women and 3 men) aged 20 to 67, years, including for chronic generalized mild periodontitis of 6 patients; average degree 19; severe degree 27. At the same time, the use of the proposed method allowed to achieve clinical improvement already for 3-4 visits. Monitoring of patients after the course of treatment was carried out in the period from 1 to 4 months. All the larger ones had a second course of treatment after 3 months. The immediate and long-term results showed pronounced therapeutic effectiveness of using the method in the treatment of periodontitis. Only in 1 case there was an exacerbation of periodontitis (abscessing) 1.5 months after treatment, which was explained by the complete lack of oral hygiene in this patient.

 Radiologically after 3 months there was a clear tendency to restore cortical plasty and densification of the bone pattern of the alveolar process.

 Thus, the treatment of periodontitis using the proposed method is much more effective, which translates into a reduction in the duration of treatment of this disease by 2 times in comparison with known methods. The lack of progression and recurrence of periodontitis with appropriate follow-up and repeated courses of complex treatment of the disease can reduce the number of cases of the disease with temporary disability.

Sources of information
1. Periodontal disease. Atlas // Danilevsky N.F., Magid E.A., Mukhin N.A., Milikevich V.Yu. M .: Medicine, - 1993. - 320 p.

 2. Ivanov V.S. Periodontal disease. - M .: Medicine, 1996, 205 p.

 3. Medicines used in dentistry. Directory. / Trezubov V.N., Mishnev L.M., Marusov I.V., Solovyova A.M. - S.-P.: IKF "Foliant", 1995, p. 256 - 257.

 4. Kuryakina N.V., Kutepova T.F. Periodontal disease. Training method. allowance, Ryazan, 1996, 76 pp.

 5. The normase of the Inalko firm in the practice of the clinician in the present and in the future / Vinogradova M. A., Mirgorodskaya L.N., Vinogradov I.F. / LDO MZRF, Central Research Institute, - M .: Rainbow, 2 pp.

Claims (1)

 A method of treating periodontitis, which consists in prescribing Normase to 1 dessert spoon 2 times a day for a month as a general treatment in the complex treatment of periodontitis, which also includes professional oral hygiene, splinting of movable teeth, selective grinding, drug treatment 0.02% - furatsillinom, 3% hydrogen peroxide and periodontal dressings with 5% butadiene ointment, 10% methyluracil ointment, 5% indomecin ointment.