RU2503458C1 - Method of local treatment and prevention of primary dental diseases in children with chronic renal pathology using chewable phytosubstrate - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to dentistry, and may be used for the local treatment and prevention of the primary dental pathologies in hemodialysis-dependent children suffering a terminal stage of the chronic renal failure. That is ensured by using a chewable substrate containing bee wax 4.0 g and cultivated angelica root 0.4 g 3 times a day for 15 minutes for 2 weeks.

EFFECT: method enables improving and stabilising the clinical measures of the active products of the oral fluid due to a synergetic effect of the substrate components.

4 tbl, 1 ex

Description

The present invention relates to medicine, in particular to dentistry.

Chronic renal failure (CRF) is a severe somatic disease leading to disability. Especially difficult is CRF in childhood. In a growing organism, pronounced metabolic, immune, endocrine processes occur against the background of intoxication. The gradual loss of kidney function, a prolonged state of uremia is accompanied by the occurrence of changes in various organs and systems of the child's body. Violation of water-electrolyte metabolism leads to a decrease in the amount of saliva secreted. The salivary glands partially take on the function lost by the kidneys. Due to the delay in the body of urochrome and the phenomena of anemia, a yellowish color of the mucous membrane of the soft and hard palate, cheeks, lips appears. The language is often taxed. A “glandular form” of stomatitis may develop. Subjectively, this is manifested by a feeling of soreness, burning. The mucous membrane of the oral cavity becomes dry, pale, thinned, easily injured by rough food and teeth. The processes of reparative regeneration are reduced, and therefore on the mucous membrane of the cheeks, the bottom of the oral cavity, tongue, superficial whitish spots are formed - hyperkeratosis, parakeratosis. In addition, due to the use of a number of drugs, hyperplastic changes in the oral mucosa develop, most often manifested in children and adolescents with chronic renal failure and poor oral hygiene, which in turn is a risk factor for septicemia, endocarditis and endoarteritis at the site of hemodialysis vascular access.

It is known that hemodialysis not only increases the rate of salivation, but also improves the composition of saliva. However, for a number of reasons, primarily economic, it is impossible to provide all patients with daily hemodialysis. A simpler and cheaper method is needed that can improve the condition of the oral cavity and the salivary glands in patients with end-stage chronic renal failure. Unfortunately, the arsenal of drugs that reduce thirst and increase the excretion of saliva in the domestic market is not very large. In addition, the composition of these drugs does not always allow us to recommend them for use in these patients [Fox P.C. Systemic therapy of salivary gland hypofiinction / P.C. Fox // Dental Res. - 1987. - Vol 66. - Special No. - p.689-692].

A known composition for the preparation of chewing gum "Health-2" containing an aqueous solution of mummy and zira in the form of powder in the amount of 0.05 and 0.065 g, respectively, per serving of the composition for single use, as well as an oligomer - vinyl acetate, powdered sugar, cocoa butter, ethyl alcohol, beeswax, essential oil. Chewing gum "Health-2" has therapeutic properties that reduce the incidence of the oral cavity, larynx, regulate the functions of the gastrointestinal tract [patent RU 2025984, 1995]

The closest analogue of the invention is a method for the treatment and prevention of dental diseases with end-stage chronic renal failure by using menthol-containing chewing gum without sugar "Wrigley" sweetened with sorbitol or xylitol in the intervals between meals on one plate of chewing gum for at least 10 minutes 6 times a day within 2 weeks [Orekhov D.Yu. Clinical and biochemical substantiation of the provision of dental care for patients receiving hemodialysis: abstract. dis. ... cand. honey. sciences. - Moscow, 2009. - 21 p.]. The disadvantage of this method is the insufficient therapeutic effect of chewing gum containing a synthetic polymer as a chewing base, and menthol and sweeteners as an active additive, i.e. substances that are not always indicated for children with end-stage CRF.

The objective of the invention is to develop a treatment method that improves the prevention and treatment of dental diseases in children with chronic renal failure in the terminal stage, undergoing hemodialysis.

The technical result when using the invention is the improvement of clinical indicators: a decrease in the dryness of the oral mucosa, bleeding gums and burning sensations, an increase in calcium, phosphorus, magnesium, protein and TBA - active products in the oral fluid through the use of therapeutic chewing substrate, stabilization of improved physical and chemical properties of oral fluid after hemodialysis.

The proposed method of local treatment and prevention of dental diseases in children with chronic renal failure is as follows: apply a herbal preparation containing 4.0 g of beeswax and 0.4 g of angelica root. The drug is used as a chewing substrate (chewing gum) for two weeks 3 times a day for 15 minutes after hemodialysis.

The roots of Angelica officinalis (ArchangelicaofficmalisHoffin) (GOST 21569-76) contain 0.35-1.9% of essential oil, 80-90% of which is represented by monoterpene compounds. 13-28% of the terpene fraction is represented by beta-fellanren, 2-14% by alpha-fellandren and 14-31% by alpha-pinene. A total of 118 components were identified in angelica root essential oil.

Bicyclic sesquiterpenoids (alpha and beta pipenes) have locally irritating, antiseptic, expectorant and diuretic biological activity. Bizabol has anti-inflammatory, anti-tumor, bactericidal, fungicidal properties. More than 36 coumarins have been identified in angelica roots, the spectrum of biological activity includes antioxidant, membrane-stabilizing, antibiotic, anabolic, photosensitizing, cytostatic, antifungal activity. Contains macro and micronutrients.

Beeswax is a solid granular substance secreted by the wax glands of young bees when they use honey or pollen. It contains more than 300 different compounds (esters, free fatty acids, hydrocarbons, water, aromatic substances, almost all macro- and microelements). In wax, 13-15 free fatty acids, 12-17% are saturated hydrocarbons. It also contains carotenoids - 12.8 (4096 ME) per 100 g of wax, which is 400 times more than in carrots. Beeswax is recommended as an anti-inflammatory, wound healing, softening medicine, used to cleanse the oral cavity and strengthen the gums.

The therapeutic effect of the chewing substrate is manifested due to the fact that the substrate contains beeswax as a chewing base, and as a biologically active additive, angelica roots, as well as the synergistic effect of its constituent components. In addition, the proposed chewing substrate does not contain synthetic polymers, alcohol-containing components, which are undesirable for children with end-stage CRF.

The proposed phytosubstrate is prepared as follows. At room temperature, beeswax, molten in a water bath, is mixed in an amount of 4.0 g and 0.4 g of powdered powdered angelica root.

A study was conducted of 52 children with chronic renal failure in the terminal stage, who are on outpatient program hemodialysis in the center of hemodialysis and kidney transplantation of the Republican Children's Clinical Hospital (Ufa) aged 15-18 years. The control group included 30 children of the same age without kidney disease and other chronic diseases.

Hemodialysis was performed on an artificial kidney machine Fresenius 4008Н, 5008S, 5008 with dialyzers F4-F7, FX40, FX60 under standard conditions using a bicarbonate solution containing dialysed liquid sodium in a concentration of 21.0 g / l, calcium 0.9 g / l Hypocoagulation on dialysis was carried out by the administration of fraxiparin, fragmentin, heparin. Treatment of nephrogenic anemia was carried out using venofen, amaltofer-fol. Calcium metabolic disturbances were corrected by preparations of calcium carbonate up to 900 mg / day. Calcium-D3-Nycomed, rockaltrol up to 0.25 μg / day. The dialysis program for patients was individual, taking into account the "dry weight", weight gain in the interdialysis period and other parameters, was 9 hours a week for 2 sessions - 2. Kt / v was - 1.3-2. Children were included in the study with the informed consent of each and their parents.

A study was made of the dental status, physico-chemical properties of the oral fluid, as well as the determination of total calcium, phosphorus, magnesium in the oral fluid in children undergoing hemodialysis. Dental examination included external examination, assessment of the condition of teeth, oral mucosa, periodontal tissues. The content of total protein, total calcium, phosphorus, magnesium (Vector-Best reagent kits) and TBA-active products (AGAT-MED reagent kits), its physicochemical properties before the hemodialysis session, during the first hours after the procedure, as well as after chewing phytopreparation containing 4.0 g of beeswax and 0.4 g of angelica for 2 weeks after hemodialysis. It was used as chewing gum, which caused the prolonged action of drugs. Children with chronic renal failure after hemodialysis chewed the substrate for 15 minutes, after which they collected oral fluid.

In children with chronic renal failure, the first sample of mixed saliva was taken during a dental examination before hemodialysis, the second sample after hemodialysis, the third after hemodialysis and the use of chewing substrate for two weeks 3 times a day for 15 minutes. We studied the physicochemical properties of mixed saliva - salivation rate, viscosity, pH. In samples of mixed saliva, the amount of calcium, magnesium, phosphorus, protein, and TBA-active products was determined. With a change in calcium from 2.67 ± 0.12 mmol / L to 1.75 ± 0.03 mmol / L, magnesium from 1.88 ± 0.05 mmol / L to 1.09 ± 0.05 mmol / L phosphorus from 5.4 ± 0.27 mmol / L to 2.56 ± 0.21 mmol / L; protein from 1.2 ± 0.04 g / L to 0.7 ± 0.07 g / L; an increase in the salivation salivation rate from 0.19 ± 0.003 ml / min to 0.41 ± 0.004 ml / min, a decrease in pH from 7.22 ± 0.04 to 7.2 ± 0.03, viscosity from 1.06 = 1 = 0.03 mm2 / s to 0.061 ± 0.046 mm2 / s, the effectiveness of treatment and prevention was rated as positive.

The saliva viscosity was determined with a VPZh-4 glass viscometer.

To determine the rate of salivation used the method of T.L. Redinova. The salivation rate was determined by the following formula: SS = V / t = {ml / min}, where V is the volume of saliva excreted to the nearest ml; t is the saliva collection time in minutes.

The main complaints in the group of children with chronic renal failure were dry red border of the lips 73.1 ± 6.2% of cases (in the control group 6.7 ± 3.4%), dry mucous membrane of the oral cavity 84.6 ± 5.0% (in the control group 6.7 ± 3.4%), bad taste in the mouth 57.7 ± 6.7% (no complaints in the control group), burning sensation in the oral cavity 19.2 ± 5.5% (in the group no complaints), the noted complaints were significantly higher than the indicators in the control group (p <0.05). After chewing a phytopreparation - wax-angelica substrate, patients noted a decrease in dryness of the mucous membrane of the lips and oral cavity, bleeding of the gums, a burning sensation and an unpleasant taste in the mouth.

The oral mucosa was pale in the group of children with chronic renal failure - 65.4 ± 6.6% (in the control group 3.3: 1: 3.3), edematous in the group of children with chronic renal failure - 76.9 ± 5.8% , hyperkeratosis was detected in 19.2 ± 5.5% of cases, swelling of the tongue - 61.5 ± 6.7% of cases, tongue overlay - 78.8 ± 5.7% of cases (in the control group, these manifestations were absent).

The prevalence of dental caries in children with chronic renal failure on hemodialysis was 92.3%; in the control group, the prevalence of caries was 56.7%; the intensity of dental caries in children with chronic renal failure who were on hemodialysis was 2.89 ± 0.01% (in the control group 1.27 ± 0.02%), the difference was significant (p <0.05).

The salivation rate in children with chronic renal failure before the hemodialysis procedure was 0.19 ± 0.003 ml / min, within an hour after hemodialysis - 0.26 ± 0.002 ml / min, after hemodialysis and after chewing a herbal preparation - substrate with angelica - 0.41 ± 0.004 ml / min (the difference is significant, p <0.05 is given relative to the group after dialysis and after chewing the substrate with angelica), the control group - 0.45 ml / min (Table 1). The pH of the oral fluid before hemodialysis is 7.22 ± 0.04, after hemodialysis - 7.2 ± 0.03 (the difference is not significant p> 0.05), after chewing the substrate with beeswax and angelica - 7.09 ± 0, 03 (the difference is not significant p> 0.05), in the pH group - 6.6. the viscosity of the oral fluid before hemodialysis is 1.06 ± 0.03, after hemodialysis - 0.061 ± 0.046 (the difference is not significant p> 0.05), after hemodialysis after chewing a herbal preparation - substrate with angelica, the viscosity was - 1.03 ± 0.04 (the difference was significantly p <0.05), in the control group, the viscosity of the oral fluid was 0.96 ± 0.05 (Table 2-3).

Protein in the oral fluid before hemodialysis was 1.2 ± 0.04 μmol / l, after hemodialysis - 0.7 ± 0.07 μmol / l, after hemodialysis after chewing phytopreparation substrate with angelica 1.17 ± 0.22 μmol / l (difference significantly p <0.05); control group - 1.75 ± 0.11 μmol / L. TBA-active products in the oral fluid before hemodialysis were 0.5 ± 0.05; after hemodialysis - 0.23 ± 0.03; after hemodialysis after chewing the substrate - 0.37 ± 0.01 (difference significantly p <0.05); control group - 0.18 ± 0.11.

Calcium in the oral fluid before hemodialysis was 2.67 ± 0.12 mmol / l; after hemodialysis - 1.75 ± 0.03 mmol / l; after hemodialysis after chewing the substrate - 2.33 ± 0.08 mmol / L (difference significantly p <0.05); control group - 2.18 ± 0.08 mmol / l. Magnesium before hemodialysis was 1.88 ± 0.05 mmol / L; after hemodialysis - 1.09 ± 0.05 mmol / l; after hemodialysis after chewing the substrate - 1.4 ± 0.04 mmol / l (difference significantly p <0.05); the control group - 1.15 ± 0.06 mmol / L. Phosphorus in the oral fluid was 5.4 ± 0.27 mmol / L; after hemodialysis - 2.56 ± 0.21 mmol / l; after hemodialysis after chewing the substrate - 5.68 ± 0.11 mmol / l (difference significantly p <0.05); in the control group - 4.18 ± 0.3 mmol / l (Table 4).

Thus, the evaluation of the effectiveness of the use of chewing substrate containing beeswax and angelica root drug in the prevention and treatment of dental diseases in children with chronic renal failure on hemodialysis, showed positive results.

Clinically, this was manifested in the period after hemodialysis - a decrease in dryness of the mucous membrane of the lips and oral cavity, a decrease in bleeding of the gums, a burning sensation and an unpleasant taste in the mouth. According to the studied biochemical parameters in children after hemodialysis, an increase in the oral fluid of calcium, magnesium, phosphorus, protein and TBA-active substances was noted. An increase in salivation rate, a significant decrease in pH and oral fluid viscosity were revealed.

The invention is illustrated by the following clinical example.

Patient A., 15 years old, was treated at the hemodialysis unit in the Republican Children's Clinical Hospital with a diagnosis of chronic renal failure, terminal stage. Indicators before hemodialysis: Ca 2.58 mm / L, P 5.64 mm / L, Mg 1.65 mm / L, protein 1.2 g / L, TBA 0.52 μ / L, saliva salivation rate 0.17 ml / min, pH 7.22, saliva viscosity 1.04 mm ² / s.

After hemodialysis: Ca 1.92 mm / L, P 5.21 mm / L, Mg 1.15 mm / L, protein 0.65 g / L, TBA 0.21 μ / L, saliva salivation rate 0.24 ml / min, pH 7.21, saliva viscosity 0.49 mm ² / s.

2 weeks after hemodialysis and the use of chewing substrate containing beeswax and angelica root drug: Ca 2.29 mm / l, P 2.42 mm / l, Mg 1.34 mm / l, protein 1.2 g / l, TBA 0.32 μ / l, saliva salivation rate 0.38 ml / min, pH 7.08, saliva viscosity 1.02 mm ² / s.

Thus, the use of chewing substrate containing beeswax and angelica root officinalis, allowed to stabilize the improvement of physico-chemical parameters of the oral fluid after hemodialysis.

Table 1 The rate of release of mixed saliva in the examined groups of children Mixed saliva Before hemodialysis After hemodialysis After hemodialysis + chewing substrate containing beeswax and angelica root drug. Control group Salivation rate (ml / min) 0.19 ± 0.003 0.26 ± 0.002 0.41 ± 0.004 0.45 ± 1 Note: the significance of differences (p <0.05) is given for children before hemodialysis and after the hemodialysis procedure + chewing substrate containing beeswax and angelica root drug.

table 2 pH of mixed saliva in children of the studied groups Mixed saliva Before hemodialysis After hemodialysis After hemodialysis + chewing substrate containing beeswax and angelica root drug. Control group pH 7.22 ± 0.04 7.2 ± 0.03 7.09 ± 0.03 6.6 ± 0.01 Note: the significance of differences (p <0.05) is given for children before hemodialysis and after hemodialysis + angelica. Table 3 The viscosity of mixed saliva in children of the studied groups Mixed saliva Before hemodialysis After hemodialysis After hemodialysis + chewing substrate containing beeswax and angelica root drug. Control group Viscosity (mm2 / s) 1.06 ± 0.03 0.061 ± 0.046 1.03 ± 0.04 0.96 ± 0.05 Note: the significance of differences (p <0.05) is given for children before hemodialysis and after the hemodialysis procedure + chewing substrate containing beeswax and angelica root drug. Table 4 Biochemical indicators of mixed saliva in children of the examined groups Before hemodialysis After hemodialysis After hemodialysis + chewing substrate containing beeswax and angelica root drug. Control group Ca (mmol / L) 2.67 ± 0.12 1.75 ± 0.03 2.33 ± 0.03 2.18 ± 0.08 Mg (mmol / L) 1.88 ± 0.05 1.09 ± 0.05 1.4 ± 0.04 1.15 ± 0.06 P (mmol / L) 5.4 ± 0.27 2.56 ± 0.21 5.68 ± 0.11 4.18 ± 0.3 Protein (μmol / L) 1.2 ± 0.04 0.7 ± 0.07 1.17 ± 0.22 1.75 ± 0.11 Tbc 0.5 ± 0.05 0.23 ± 0.03 0.37 ± 0.01 0.18 ± 0.01 Note: p <0.05 relative to the group after hemodialysis and after chewing a substrate containing beeswax and angelica root drug.

Claims (1)

A method for the local treatment and prevention of major dental diseases in children with end-stage chronic renal failure on hemodialysis, including the use of a chewing substrate for 2 weeks, characterized in that they use a chewing substrate containing 4.0 g of beeswax and 0.4 g angelica root officinalis 3 times a day for 15 minutes.