RU2521373C1 - Method of local treatment and prevention of primary dental diseases in elderly and aged patients with using chewable phytosubstrate - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: chewable substrate contains a chewable base and an herbal extract as an active substance, wherein as the extract, the substrate contains a condensed red-haw hawthorn polyextract 10.0 g dried to residual humidity 25%, while the base is presented by sorbitol 40.0 g, apricot gum 15.0 g, gelatin 10.0 g, citric acid 1.0 g and purified water 100.0 g. The chewable substrate is applied 3 times a day for 15 minutes for 2 weeks, taken in a quantity of 1 substrate chewable until dissolved completely at an average weight of one substrate of 4.0 g.

EFFECT: using the method enables reducing oral xerosis, prolabium, coated tongue, rate of burning mouth syndrome, burning sensation and bad taste, normalising physical-chemical characteristics of the oral fluid.

4 tbl, 1 ex

Description

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

With age, all organs and tissues of the body undergo changes, in particular the maxillofacial region, which is determined by both local and general causes.

Periodontal disease and oral mucosa in the elderly is accompanied by a high degree of lipid peroxidation and inhibition of antioxidant protection. In the saliva of such people, there is a high concentration of TBA-positive compounds, intermediates, and oxidation substrates.

Dry oral cavity is one of the common complaints of people of this age. In chronic xerostomia, it is difficult for a person to speak, chew, swallow, a sense of taste is disturbed, there is pain from spicy and solid food, a burning sensation and roughness of the mucous membrane. As a result of the decrease in the amount of saliva, the formation of soft plaque on the teeth increases and a dental plaque forms, which leads to enamel demineralization and the development of caries, and also contributes to the occurrence of inflammatory periodontal diseases. In especially severe cases, the lips are covered with dry crusts, symptoms of inflammation and ulceration of the oral mucosa appear, a secondary infection may join, including fungal and viral. Due to excessive dryness of the oral cavity, speech is difficult, it is difficult to swallow food without washing it with liquid. The lips of such patients are dry, in cracks, the mucous membrane of the oral cavity with keratinization, the tongue is folded, with atrophied papillae, there are seizures in the corners of the mouth, there is no free saliva in the oral cavity. Due to the progression of the carious process, partial or complete loss of teeth occurs.

The peculiarities of elderly people are the high prevalence and intensity of their dental pathology, which is also burdened with a bunch of somatic diseases, a decrease in their own control over the state of their dental health, and a decrease or loss of preventive and hygienic motivations.

One of the pressing problems is the fact that in elderly patients it is sometimes impossible to use the generally accepted treatment regimen for a particular disease of the oral mucosa (MOP) due to the existing concomitant pathology, which necessitates the search for innovative technologies to solve this problem. In this regard, the inclusion of drugs that can restore local immunity, improve blood microcirculation, help reduce inflammation and accelerate the restoration of the mucous barrier, while having a minimal side effect on the body as a whole, is of great importance in the treatment of diseases of MOP. Herbal medicine is currently becoming increasingly widespread, because when it is used, the risk of side effects and allergic reactions is minimal. This is especially important in the elderly. The question of the development of such phytopreparations that safely act on the pathogenesis links of one or another pathology in the oral cavity remains relevant and were convenient for use by elderly patients.

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 function of the gastrointestinal tract [patent RU 2025984, 1995].

The known method of external blockade using a 5% solution of Mexidol in patients with xerostomia against the background of inflammatory and dystrophic diseases of the salivary glands, which allows to normalize LPO and antioxidant defense [Irmiyaev A.A. Clinical and pharmacological rationale for the use of the drug Mexidol in the complex treatment of patients with xerostomia: author's abstract ... Cand. Medical science. - Moscow, 2005. - 23 s]. The disadvantage of this method is the invasiveness and complexity of the application.

Currently, it is known to use salivary replacement agents. Oralbalance is artificial saliva developed by Laclede, Inc, USA. It consists of lactoperoxidase, glucose oxidase, xylitol, lactoferrin, lysozyme. Lactoperoxidase is an antibacterial agent, lysozyme destroys the cell membrane of bacteria, lactoferrin binds to iron and inhibits the growth of bacteria, and xylitol inhibits the development of pathogenic bacteria, while acting as a sweetener [Grinin V.M. The use of Oralbalance gel in patients with xerostomia. Periodontology, Moscow, 2000: 3. - P.50-52.]. This method is quite expensive, and for patients mainly of retirement age is not always acceptable.

A known method of alleviating dry mouth with xerostomia, including the introduction into the oral cavity of a patient in need of this, a composition containing arginine in free form or in salt form, for example in the form of arginine bicarbonate, one or more of a calcium ion source, a phosphate ion source a source of potassium ions, a source of magnesium ions, a source of fluorine ions; flavoring that stimulates salivation; polyol humidifier and combinations thereof; moreover, the composition is a mouthwash, which is artificial saliva containing ions selected from calcium, phosphate, potassium, magnesium and their combinations [patent RU 2455001, 2012].

The closest analogue of the invention is a method of at least increasing the hydration of the oral cavity and relieving the symptom associated with hyposalivation, comprising preparing a topical composition for oral administration, which includes, as a salivating agent, a combination of grape seed extract and citrus fruit extract, the combination is effective as a salivary stimulant and is present in a concentration effective to relieve symptoms MA or to increase hydration of the oral cavity; the symptom associated with hyposalivation is selected from the group consisting of: dry mouth, bad breath, thick saliva, altered taste and difficulty associated with speech or swallowing; the topical composition is selected from the group consisting of chewing gum, a soluble strip, tablets, lozenges, mouthwashes, spray, toothpaste, ointments, foams, saliva enhancer and powder, which optionally are impregnated with a carrier; grape seed extract and citrus fruit extract are present in synergistic amounts or grape seed extract and citrus fruit extract are present in a concentration equal to or less than 1% by weight of the topical composition or grape seed extract and citrus fruit extract are present in a concentration equal to or less than 0 , 1 wt.% Topical composition [application RU 2011123733, published December 20, 2012].

The objective of the invention is to develop a method of treatment using chewing phytosubstrate, which allows to increase the effectiveness of the prevention and treatment of dental diseases in the elderly.

The technical result when using the invention is the improvement of clinical indicators: a decrease in dryness of the oral mucosa, red border of the lips, tongue overlay, stomalgia frequency, burning sensation and bad taste in the mouth, an increase in phosphorus and protein, a decrease in calcium, magnesium and TBA - active products in oral fluid, stabilization of physico-chemical properties of the oral fluid of elderly and senile patients.

The proposed method for the local treatment and prevention of dental diseases in the elderly and senile is as follows: apply a chewing substrate containing 10.0 g of condensed and dried to a residual moisture content of 25% thick polyextract from leaves of blood-red hawthorn (Crataegus sanguinea Pall. GOST 12.1 .007.76), 40.0 g of sorbitol, 15.0 g of apricot gum, 10.0 g of gelatin, 1.0 g of citric acid and 100.0 g of purified water. The chewing substrate is used as a candy for resorption (chewing marmalade) 3 times a day between meals for 15 minutes for 2 weeks, 1 substrate that is chewed until completely dissolved, with an average weight of one substrate of about 4.0 g.

The fruits and flowers of the blood-red hawthorn are used in medicine for functional disorders of cardiac activity, heart weakness, angioneurosis, and for hypertension as a sedative and hypotensive agent. Hawthorn fruits have antiarrhythmic, antispasmodic, anti-sclerotic, coronary-expanding effects. Hawthorn fruits and flowers contain flavonoids, organic acids, essential oils, tannins, carotene, ascorbic acid, catechins, anthocyanins, choline, carbohydrates.

In the European Pharmacopoeia, hawthorn leaves are official and are used along with fruits and flowers.

Extracts retain all the positive aspects of infusions and decoctions, and are practically devoid of flaws and allow you to save raw materials. The use of extracts significantly expands the range of complex herbal remedies, since on their basis it is possible to prepare various dosage drugs for internal and external use. In addition, the developed technological approaches make it possible to obtain extracts containing, in a concentrated form, the main active biologically active substances, which determine the high pharmacological activity and their pronounced pharmacotherapeutic effect in the corresponding pathological conditions.

To obtain a polyextract using the method of GF XI, article "Determination of the content of extractive substances".

The polyextract is obtained in three stages:

- a portion of the raw material passing through a sieve with a hole diameter of 1 mm was sequentially extracted with water, 40% and 80% ethyl alcohol in a ratio of 1:12 for 2 hours with a weak boiling of the extractant. At the end of the extraction and cooling, the weight of the flask was adjusted with the appropriate extractant to its original weight; the extract was carefully separated from the raw materials and filtered through a dry filter, preventing the ingress of raw materials on it;

- liquid extracts were concentrated on a rotary evaporator IR-M2 with a discharge of 13-16 mm Hg and combined;

- the thick polyextract was dried in an SRT-200 vacuum oven with a vacuum of 13-16 mm Hg. at a temperature of 50 ° C to a residual humidity of 25%.

The yield of the final product averaged 67%.

The resulting thick polyextract is a viscous liquid of a dark brown color, with a specific spicy smell and a sweetish-bitter taste.

Chewing phytosubstrate preparation technology: A thick polyextract is mixed with water and poured with gelatin to swell for 30 minutes. Then heated to dissolve. Sorbitol is mixed with apricot gum and citric acid and heated on a tile until fusion. A gelatin solution with the extract is poured into the cooling mixture, mixed well and laid out in a plastic or silicone mold.

The phytosubstrate is allowed to stand for 24 hours, then taken out of the mold and put to dry in a vacuum oven at a temperature of 37-40 ° C for 10-12 hours. Then stand at room temperature for another day. Store the resulting chewing phytosubstrate at a temperature of 15 ° C.

The average weight of one phytosubstrate is about 4.0 g. Phytosubstrate is packaged in aluminum foil. Shelf life 2 months.

A survey was conducted of 30 people aged 60 to 86 years who are permanently living in the Ufa boarding house for the elderly and disabled. The control groups included 60 people, 30 of them aged 20 to 30 years, and 30 from 45 to 59 years old.

The study 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 the elderly and senile. Dental examination included a medical history and complaints, external examination, assessment of the condition of the dentition, oral mucosa, periodontal tissues. The content of total protein, total calcium, phosphorus, magnesium (Vector-Best reagent kits) and TBA-active products (LGLT-MED reagent kits), its physicochemical properties before and after chewing a substrate containing leaf extract of hawthorn blood red. It was used as a candy for resorption, which caused the prolonged action of drugs. People over 60 took 1 phytosubstrate 3 times a day between meals for 2 weeks, chewed until completely dissolved. After that, oral fluid was again collected.

For elderly and senile people, the first sample of mixed saliva was taken during a dental examination, the second sample after applying 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 2.93 ± 0.11 mmol / L to 2.54 ± 0.12 mmol / L, magnesium from 0.86 ± 0.07 mmol / L to 0.46 ± 0.03 mmol / L phosphorus from 1.87 ± 0.08 mmol / L to 2.29 ± 0.15 mmol / L, protein from 1.47 ± 0.12 g / L to 1.67 ± 0.11 g / L, with a decrease in TBA-active products from 0.32 ± 0.02 to 0.27 ± 0.01, with an increase in saliva salivation rate from 0.19 ± 0.01 ml / min to 0.29 ± 0.01 ml / min, an increase in pH from 5.88 ± 0.07 to 6.44 ± 0.04, a decrease in viscosity from 1.07 ± 0.02 mm ² / s to 1.03 ± 0.03 mm ² / s, the effectiveness of prevention is estimated 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: CC = 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 main group of people were dry mouth 93.3 ± 4.1% of cases (in the control groups 16.67-tl, 9% (45-59 years) and 0% (20-30 years)) red border 50 ± 1.9% (in the control groups 10 ± 1.2% (45-59 years) and 0% (20-30 years)), bad taste in the mouth 43.33 ± 2.29% (in groups control 30 ± 2.43% (45-59 years) and 3.33% (20-30 years)), burning sensation in the oral cavity 40 ± 1.72% (in the control groups 13.33 ± 1.56% ( 45-59 years) and 0% (20-30 years)), stomalgia of various origins 73.33 ± 2.1% (in the control groups 23.33 ± 1.4% (45-59 years) and 6.67% (20-30 years)), also difficulties in chewing were noted by 80 ± 2.89% versus 10% (control group 45-59 years old), in the group of 20-30 years old Daubney no complaints. The noted complaints were significantly higher than in the control groups (p <0.05). After chewing a substrate with a polyextract of leaves of blood-red hawthorn, patients noted a decrease in dryness of the mucous membrane of the lips and oral cavity, pain, burning sensation and unpleasant taste in the mouth.

The mucous membrane of the oral cavity was pale in the main group of people - 86.67 ± 6.2% (in the control groups 10% (45-59 years) and 0% (20-30 years)), edema in the group over 60 years old - 76 , 67 ± 7.72% (in the control groups 13.33% (45-59 years) and 6.67% (20-30 years), hyperkeratosis was detected in 63.33 ± 8.8% of cases (in the control groups 33 , 33% (45-59 years) and 0% (20-30 years), language coverage - 86.67 ± 6.2% of cases (in the control groups 40% ”(45-59 years) and 16.67% ( 20-30 years)).

Salivation rate in people 60 years of age and older was initially - 0.19 ± 0.01 ml / min, after a course of chewing phytosubstrate - 0.29 ± 0.01 ml / min, in the control groups 45-59 years and 20-30 years, the salivation rate was 0.47 ± 0.03 ml / min and 0.27 ± 0.01 ml / min, respectively (the difference is significant, p <0.05 is given relative to the group before and after chewing the substrate with a polyextract of hawthorn leaves) (table .one). the pH of the oral fluid of the main group of people before herbal medicine 5.88 ± 0.07, after - 6.44 ± 0.04 (significant difference p <0.05), indicators in the control groups - 6.43 ± 0.06 (45- 59 years) and 6.9 ± 0.04 (20-30 years) (difference significantly p <0.05). The oral fluid viscosity of the main group of people before chewing phytosubstrate is 1.07 ± 0.02, after - 1.03 ± 0.03 (the difference is not significant p> 0.05), in the control groups, the viscosity of the oral fluid was 0.98 ± 0.01 (45-59 years) and 0.95 ± 0.01 (20-30 years) (difference significantly p <0.05) (Table 2-3).

Protein in the oral fluid in individuals of the main group before the use of phytosubstrate was 1.47 ± 0.12 μmol / L, after - 1.67 ± 0.11 μmol / L (the difference is not significant p> 0.05); control groups of patients 45-59 years old and 20-30 years old - 2.33 ± 0.09 μmol / L and 2.08 ± 0.11 μmol / L, respectively. TBA-active products in the oral fluid in individuals of the main group before the use of phytosubstrate was 0.32 ± 0.02, after - 0.27 ± 0.01 (the difference was significantly p <0.05); in the control groups of patients 45-59 years old and 20-30 years old, the indicator turned out to be 0.15 ± 0.01.

Calcium in the oral fluid in people of the main group before the use of phytosubstrate was 2.93 ± 0.11 mmol / L, after - 2.54 ± 0.12 mmol / L (the difference was significantly p <0.05); control groups of patients 45-59 years old and 20-30 years old - 2.16 ± 0.04 mmol / L and 1.79 ± 0.07 mmol / L, respectively. Magnesium in the oral fluid in individuals of the main group before the use of phytosubstrate was 0.86 ± 0.07 mmol / L, after - 0.46 ± 0.03 mmol / L (the difference was significantly p <0.05); control groups of patients 45-59 years old and 20-30 years old - 0.69 ± 0.02 mmol / L and 0.67 ± 0.03 mmol / L, respectively. Phosphorus in the oral fluid in individuals of the main group before the use of phytosubstrate was 1.87 ± 0.08 mmol / L, after - 2.29 ± 0.15 mmol / L (the difference was significantly p <0.05); control groups of patients 45-59 years old and 20-30 years old - 3.82 ± 0.11 mmol / L and 4.04 ± 1.18 mmol / L, respectively (Table 4).

Thus, the evaluation of the effectiveness of the use of a chewing substrate containing 10.0 g of a thick polyextract from the leaves of hawthorn blood-red, 40.0 g of sorbitol, 15.0 g of apricot gum, 10.0 g of gelatin, 1.0 g of citric acid and 100 , 0 g of purified water, in the prevention and treatment of dental diseases in the elderly and senile, showed positive results.

Clinically, this was manifested by a decrease in dryness of the oral mucosa, red border of the lips, tongue overlay, stomalgia frequency, a burning sensation and an unpleasant aftertaste in the mouth.

A biochemical study of the oral fluid showed an increase in phosphorus and protein, a decrease in calcium, magnesium and TBA - active products.

The invention is illustrated by the following clinical example. Patient V., 80 years old, is a guest of the Ufa boarding school for the elderly and disabled, complained of dry mouth and red border of the lips, pain and burning sensation of the mucous membrane of the lips and cheeks, the inability to use the existing denture on the lower jaw, on difficulty speaking and eating. Objectively: the red border of the lips is dry, there is a jam in the corner of the mouth on the right, painful when opening the mouth and palpation, the mucous membrane of the oral cavity is swollen, pale, dry, the tongue is covered with plaque, there are areas of hyperkeratosis of the mucous cheeks along the closing line of the teeth and along transition folds of the upper and the lower jaw. Indicators before the use of phytosubstrate: Ca 3.14 mm / L, P 1.62 mm / L, Mg 0.38 mm / L, protein 0.87 g / L, TBA 0.41 μ / L, saliva salivation rate 0, 17 ml / min, pH 6.1, saliva viscosity 1.15 mm ² / s.

After using a chewing substrate containing 10.0 g of a thick polyextract from the leaves of blood red hawthorn, 40.0 g of sorbitol, 15.0 g of apricot gum, 10.0 g of gelatin, 1.0 g of citric acid and 100.0 g of water purified, 3 times a day for 15 minutes between meals for two weeks: Ca 2.69 mm / L, P 2.89 mm / L, Mg 0.34 mm / L, protein 1.62 g / L, TBA 0.25 μ / l, saliva salivation rate 0.3 ml / min, pH 6.2, saliva viscosity 1.03 mm ² / s. Clinically, positive dynamics are noted: dryness of the oral cavity and the red border of the lips decreased, the seizure of the corner of the mouth on the right is less pronounced, the patient does not notice pain on palpation and opening the mouth. On examination: the mucous membrane of the cheeks and lips is moderately moistened, pale pink, the number of foci of hyperkeratosis decreased, the tongue is folded, less overlaid. The patient notes improved fixation of the removable denture on the lower jaw, relief when chewing and swallowing food, when pronouncing words.

Thus, the proposed method with the use of a chewing substrate containing a thick polyextract of leaves of hawthorn blood-red, can improve the physico-chemical characteristics of the oral fluid, as well as clinical indicators.

A method of local treatment and prevention of major dental diseases in the elderly and senile with chewing phytosubstrate

Table 1 The rate of discharge of mixed saliva in the studied groups of people Mixed saliva Before using phytosubstrate After applying phytosubstrate Control group (45-59 years old) The control group (20-30 years) Salivation rate (ml / min) 0.19 ± 0.01 0.29 ± 0.01 0.47 ± 0.03 0.27 ± 0.01 Note: the significance of differences (p <0.05) is given relative to indicators before and after the use of phytosubstrate.

table 2 pH of mixed saliva in the studied groups of people Mixed saliva Before using phytosubstrate After applying phytosubstrate Control group (45-59 years old) The control group (20-30 years) pH 5.88 ± 0.07 6.44 ± 0.04 6.43 ± 0.06 6.9 ± 0.04 Note: the significance of differences (p <0.05) is given relative to indicators before and after the use of phytosubstrate.

A method of local treatment and prevention of major dental diseases in the elderly and senile with chewing phytosubstrate

Table 3 The viscosity of mixed saliva in the studied groups of people Mixed saliva Before using phytosubstrate After applying phytosubstrate Control group (45-59 years old) The control group (20-30 years) Viscosity (mm ² / s) 1.07 ± 0.02 1.03 ± 0.03 0.98 ± 0.01 0.95 ± 0.01 Note: the significance of differences (p <0.05) is given relative to indicators in the main and control groups.

Table 4 Biochemical indicators of mixed saliva in the studied groups of people Before using phytosubstrate After applying phytosubstrate Control group (45-59 years old) The control group (20-30 years) Ca (mmol / L) 2.93 ± 0.11 * 2.54 ± 0.12 * 2.16 ± 0.04 1.79 ± 0.07 Mg (mmol / L) 0.86 ± 0.07 * 0.46 ± 0.03 * 0.69 ± 0.02 0.67 ± 0.03 P (mmol / L) 1.87 ± 0.08 * 2.29 ± 0.15 * 3.82 ± 0.11 4.04 ± 1.18 Protein (μmol / L) 1.47 ± 0.12 1.67 ± 0.11 2.33 ± 0.09 2.08 ± 0.11 Tbc 0.32 ± 0.02 * 0.27 ± 0.01 * 0.15 ± 0.01 0.15 ± 0.01 Note: * p <0.05 relative to the group before and after chewing phytosubstrate.

Claims (1)

A method for the local treatment and prevention of major dental diseases in the elderly and senile, including the use of a chewing substrate containing a chewing base and an extract of a medicinal plant as an active substance, characterized in that the extract contains 10.0 g of condensed and dried to residual humidity 25% of the polyextract from the leaves of hawthorn blood-red, and as a basis 40.0 g of sorbitol, 15.0 g of apricot gum, 10.0 g of gelatin, 1.0 g of citric acid and 100.0 g of water purified, while chewing the substrate is used 3 times a day for 15 minutes for 2 weeks, 1 substrate, which is chewed until completely dissolved, with an average weight of one substrate of about 4.0 g.