RU2482859C1 - Method of treating periodontitis and inflammatory diseases of oral mucosa - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and aims at treating periodontitis and inflammatory diseases of the oral mucosa. What is used is a drug in the form of a gel of the following composition, wt %: fir oil 0.1-0.3, sage oil 0.1-0.2, peppermint oil 0.1-0.3, glycerin 14.0-20.0, sodium alginate 4.0-5.0, pectin 2.5-4.0, polyvinylpyrrolidone 2.0-3.0, lidocaine hydrochloride 1.7-2.5, Dimexidum 0.5-1.0, silver ions 0.001-0.004, methylene blue 0.01-0.02, purified water to 100. In chronic mild periodontitis, the preparation is applied on the inflammation area in the amount of 0.05-0.2 g every second day, 4-6 procedures. In moderate periodontitis, the preparation is applied on the inflammation area in the amount of 0.05-0.2 g, administered directly into each gingival pocket by 0.005 g for 4-6 days.

EFFECT: method provides a high therapeutic effect with no discomfort to the patient.

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Description

The invention relates to medicine, namely to therapeutic dentistry.

The treatment of inflammatory diseases of periodontal and oral mucosa to this day continues to be one of the urgent problems of dentistry. There is a large arsenal of therapeutic and prophylactic agents. However, the frequency of this pathology does not decrease, but tends to increase.

In the etiotropic therapy of inflammatory periodontal diseases, antibiotics and antiseptics are widely used, but such antibacterial therapy can upset the balance of microflora in the oral cavity and also prevent the formation of the body's immune responses to pathogenic bacteria (Grigoryan A.S., Grudyanov A.I., Rabukina N. A., Frolova O.A. Periodontal Diseases. - M.: Medical News Agency, 2004, p.239-289). At the heart of pathogenetic treatment, a large role belongs to anti-inflammatory drugs, namely steroidal and non-steroidal drugs. Preference is given to ointments containing glucocorticocoids (1% hydrocartisovic, 0.5% prednisone) and official drugs, which include hormones ("Fluorocort", "Lorinden", "Gyoksizon", etc.) and non-steroid drugs. These include Indomethacin, Ketorolac, Diclofenac Sodium, but these drugs cause irritation of the gastrointestinal tract, allergic reactions, development of anemia, leukopenia, hemorrhage are possible (Tsepov L.M., Nikolaev A.I., Mikheeva EA Diagnosis, treatment and prevention of periodontal diseases. - M.: MEDpress-inform, 2008, p.171-173).

Herbs and periodontal medicines have found widespread use in dentistry in the treatment of diseases of the mucous membrane and periodontium. The growing popularity of herbal medicine is due to a number of objective reasons. Herbal medicines usually act milder than synthetic ones, they have fewer undesirable side effects, including less likely to cause allergic reactions (A. Grudyanov, Remarks on scientific reports on periodontology. - Dentistry. 1996. - No. 2. - S.28-30). The presence of biologically active substances, trace elements in the majority of herbal preparations of plant origin allows them to be used for the prevention and treatment of periodontal and oral mucosa.

To do this, you can use herbal remedies (tincture of calendula, eucalyptus, chamomile, sage, plantain) in the form of oral baths and applications (Ivanov B.C. Periodontal disease. - M.: Medical News Agency, 1998. P. 271). The disadvantage of this method is the low effectiveness of the treatment associated with the rapid loss of activity of drugs due to the constant exposure to saliva, and a significant duration of treatment. The well-known "Composition for the prevention and treatment of diseases of the oral cavity and the care of teeth and oral cavity" (US Pat. RF 2180555 C2). This composition is an aqueous extract of herbs of chamomile pharmacy, Hypericum perforatum, dried marshmallow, Echinacea purpurea, sage leaves, common oak bark, calamus roots. The disadvantage of this composition is its weak analgesic and antiseptic effect.

Closest to the claimed is a tool for the treatment of periodontal disease and inflammatory diseases of the oral mucosa, a tool containing in its composition an aqueous extract of calendula, hydroxyethyl cellulose, propylene glycol, nipangin, Trilon B, water ("Composition for the treatment of periodontal disease", Pat. RF 2199999 C2). The disadvantage of this drug is the lack of a combination of its analgesic, anti-inflammatory and antiseptic effects at the same time, which affects the duration of treatment (treatment 7 + 7 days with kappa), as well as

low adhesive properties of the product. Therefore, the method of treatment prescribed the use of mouthguards, the manufacture and use of which is burdensome for patients.

The aim of the invention is to increase the effectiveness of local treatment of periodontal disease and reduce treatment time. To solve this problem, a group of inventions is proposed, united by a common inventive concept.

The essence of the invention lies in the fact that in the method of treatment, including applying a therapeutic agent to the affected area of the mucous membrane, according to the invention, the therapeutic adhesive gel “Phytodental” is used as said agent, which is applied to the area of inflammation in an amount of 0.05-0.2 g for 15 minutes for 4-6 days, it has a complex of medicinal properties (antiseptic, wound healing, anti-inflammatory, analgesic).

The specified therapeutic adhesive gel (called "Fiodental") is obtained according to the developed technology using natural components based on it.

The composition obtained by this technology of the drug in wt.% Ranges from:

fir oil 0.1-0.3 sage oil 0.1-0.2 peppermint oil 0.1-0.3 glycerol 14.0-20.0 sodium alginate 4.0-5.0 pectin 2.5-4.0 polyvinylpyrrolidone 2.0-3.0 lidocaine hydrochloride 1.7-2.5 dimexide 0.5-1.0 silver ions 0.001-0.004 methylene blue 0.01-0.02 water up to 100

Fir oil has a bactericidal, wound healing and anti-inflammatory effect, increases immunity; peppermint oil has an analgesic effect, gives the gel a refreshing taste; sage oil has a disinfectant, anti-inflammatory, astringent, hemostatic effect; lidocaine hydrochloride - anesthetic; Dimexide has the ability to penetrate through biological membranes and facilitate the penetration of other medicinal substances through them, has an analgesic, anti-inflammatory and moderate antiseptic effect; polyvinylpyrrolidone - a thickener that is able to bind toxins and metabolic products; methylene blue has an antiseptic effect, is used as a dye; silver has a wide spectrum of antimicrobial activity in relation to gram-positive and gram-negative microflora, lack of resistance to it of most pathogenic microorganisms, and good tolerance to patients.

To create a gel form that allows you to precisely apply and hold the medicine on the gum, in the gingival groove or in the gingival pocket, gel-forming agents were introduced into the composition: polysaccharides, plant products: apple pectin; sodium alginate obtained from seaweed - they have adhesive properties; glycerin - hydrophilic, plasticizer; polyvinylpyrrolidone thickener, able to bind toxins and metabolic products.

The Fitodental gel is prepared according to the following technology (according to the above composition of the Fitodental product): they take a weighed portion of glycerin and weighed in it weighed with fir oil, peppermint oil, sodium allginate, pectin and polyvinylpyrrolidone, everything is mixed - a paste forms (composition No. 1).

A sample of water containing silver ions is taken, and samples of dimexide, lidocaine hydrochloride, methylene blue are dissolved in it (composition No. 2).

Composition No. 1 is introduced into composition No. 2 with vigorous stirring. A gel forms, which is left for 10-12 hours at room temperature for swelling. Next, the gel is Packed in tubes of 10-20 g or in syringes.

They accumulate water with silver ions in a laboratory setup with a capacity of 2 l / h on two silver electrodes of the Cp brand. 99.99 (current 10.4 mA, voltage 6.4 V). Diffusion of silver ions occurs from a positive electrode (anode) into water. The result is water with silver ions in a concentration of 10-40 mg / L.

These natural components for treatment are used simultaneously and complement the effect of each other when applied in the form of applications on the affected area of the oral mucosa. This can be done not only in the dental office, but also at home, which significantly increases the effectiveness of the treatment of herbal medicine for inflammatory diseases of the oral mucosa, and the treatment time is reduced.

The treatment method is as follows: the Fiodental gel is squeezed out of the tube onto a cotton swab or clean finger and applied as an application to the area of inflammation of the oral mucosa in the amount of 0.05-0.2 g and by introducing the gel through a syringe with a blunt metal end into periodontal pockets . Duration of application is 15 minutes. For treatment at home, the patient performs applications 2 times a day 30 minutes before meals. The duration of treatment is 4-6 days (without mouthguards).

Duration of application is 15 minutes - the gel is retained on the mucous membrane due to good adhesion and its low solubility. The presence of dimexide in the agent promotes the rapid penetration of therapeutic components through the mucous membrane. Studies have shown that this penetration begins after one minute. For treatment at home, the patient performs applications 2 times a day 30 minutes before meals. The duration of treatment is 4-6 days.

The proposed method was used to treat a group of patients from 27 patients with periodontitis of varying severity and inflammation of the oral mucosa. In this case, the course of treatment was 4-6 days.

The treatment is carried out as follows: after removal of the supra- and subgingival tartar using an ultrasonic scaler, antiseptic treatment of periodontal pockets is carried out, then the gum is applied using the Phytodental adhesive medical gel, which is applied to the area of inflammation of the oral mucosa in the amount of 0.05 -0.2 g for 15 min for 4-6 days, and additionally inject the gel into the periodontal pockets for chronic periodontitis.

The high efficacy of this complex product that combines analgesic, anti-inflammatory and regenerative effects can be judged by the proposed clinical examples (tables 1 and 2). When examining patients, indexes were used to assess the condition of periodontal tissues (L.M. Tsepov, A.I. Nikolaev, E.A. Mikheeva “Diagnosis, treatment and prevention of periodontal diseases.” M .: MEDpress-inform, 2008, p.60- 66). Diagnosis of diseases was carried out in accordance with the international classification of diseases ICD-10 C.

Dynamics of periodontal tissue condition indicators in patients with moderate periodontitis chronic periodontitis (treatment up to 6 days).

Table 1 Group name Number of patients Dynamics of indicators Papillary-Marginal-Alveolar Index (RMA) Numerical value of the Schiller-Pisarev test (iodine number of Svrakov) Before treatment
Score% After treatment Score,% Before treatment After treatment Primary (Experienced) 19 2
28.2-35.6 0
1.6-1.8 2.8-4.0 1.0-1.2

Dynamics of periodontal tissue condition indicators in patients (group of 5 people) with mild chronic periodontitis (treatment up to 5 days).

table 2 Indicator Periodontitis of mild severity Before treatment After treatment PMA Index (%) 15.2-18.4 1.2-1.8 the value of the Schiller-Pisarev test (score) 1.6-2.0 0.5-0.7 Hygiene Index (score) 2.1-2.3 1.1-1.3

Example 1. Patient M., 39 years old, complained of soreness, bleeding gums, which intensified the last 4 months. During examination, the following are revealed: the gum is hyperemic, swollen, minor deposits of tartar. Diagnosed with mild periodontitis. RMA index - 16%, hygiene index - 2.2, Schiller-Pisarev test positive - 1.9. The treatment was carried out: irrigation of the oral cavity and periodontal pockets with a solution of chlohexedine, curettage of periodontal pockets. Appointed: the application of a therapeutic agent to the affected area of the mucous membrane of the gel "Fitodental", which is applied to the area of inflammation in the amount of 0.05-0.2 g for 15 minutes for 5 days. During the examination, a significant improvement was noted: the gum is pale pink, dense, does not bleed, the Pisarev-Schiller test is 0.6, the PMA is 1.6%, the hygiene index is 1.1.

Example 2. Patient B., 52 years old, complained of pain in the gums, recurrent bleeding of the gums, bad breath. An objective examination: pronounced cyanosis of the interdental gingival papillae, loose fit to the teeth. The gum bleeds when touched, periodontal pockets 2-3 mm deep. A significant amount of dental deposits above and subgingival. GI indices - 2.2; RMA index - 34.1%, Schiller-Pisarev test - 3.5. Diagnosis: chronic generalized periodontitis of moderate severity.

The treatment was carried out: irrigation of the oral cavity and periodontal pockets with an antiseptic solution, removal of dental deposits, curettage of periodontal pockets. Appointed: Phytodental gel is applied to the area of inflammation in an amount of 0.05-0.2 g and introduced into each periodontal pocket in an amount of 0.005 g for 6 days. During the examination, a significant improvement was noted: the gum is pale pink, dense, does not bleed, the Pisarev-Schiller test is 0.6, the PMA is 1.6%, the hygiene index is 1.1.

Example 3. Patient S., 36 years old. Complaints about periodically appearing on the oral mucosa are single sharply painful aphthae. Diagnosis: chronic recurrent aphthous stomatitis. The patient was admitted with complaints of a sharply painful “ulcer” on the mucous membrane of the cheek. When viewed on the mucous membrane of the cheeks on the right, one aphtha is determined with a size of 0.6 × 0.5 cm, upon palpation it is sharply painful. Local applications for the aphtha gel area “Phytodental” were prescribed daily for 15 minutes 2 times a day. It was recommended to carry out applications 30 minutes before a meal. The analgesic effect occurred after 1-2 minutes and lasted for an hour. Afta completely epithelized on the 4th day of treatment.

Thus, based on the results of these clinical examples, it follows that the application of the proposed method, using the medicinal gel "Fitodental", can improve efficiency and reduce treatment time. Means "Fitodental" can be produced in industrial conditions at pharmaceutical enterprises, is a convenient dosage form for its manufacture and effective use in the clinic and at home.

Claims (1)

A method for the treatment of periodontitis with the help of a medicine containing a drug in the form of a gel, the following composition, wt.%:
fir oil 0.1-0.3 sage oil 0.1-0.2 peppermint oil 0.1-0.3 glycerol 14.0-20.0 sodium alginate 4.0-5.0 pectin 2.5-4.0 polyvinylpyrrolidone 2.0-3.0 lidocaine hydrochloride 1.7-2.5 dimexide 0.5-1.0 silver ions 0.001-0.004 methylene blue 0.01-0.02 water peeled to 100,
characterized in that in case of mild chronic periodontitis, the indicated drug in the form of a gel is applied to the area of inflammation in an amount of 0.05-0.2 g with an interval of 1 day in a course of 4-6 procedures, in case of moderate periodontitis, the drug in the form of a gel is applied to the area of inflammation in the amount of 0.05-0.2 g and injected directly into each periodontal pocket of 0.005 g for 4-6 days.