RU2550970C2 - Method of treating chronic generalised periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to dentistry and concerns treating chronic generalised periodontitis. Implementing the above method is ensured by a complex preparation in the form of an ointment of the following composition: Vaselin - lanolin base (1:1) - 88.5 g, 70% ipecac infusion - 5.0 g, 70% scholar tree - 5.0 g, Ecdysterone - 0.02 g; eucalyptus oil - 1.0 g. The oil is applied as a therapeutic periodontal applicate on a gingival surface following application anaesthesia with 10% lidocaine, chairside oral hygiene, drug-induced treatment of the gingival margin with 1% Iodinolum and separation of salivary glands in the oral cavity, once a day for 2 hours for 4 weeks; the patients are recommended not to eat or drink for two hours. The preparation composition particularly provides capillary-reinforcing, anti-inflammatory, reparative and anaesthetic action.

EFFECT: method of treating is easy to use, physiologically-friendly, and provides the complete recovery.

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Description

The invention relates to medicine, namely to dentistry, and for the treatment of chronic generalized periodontitis, which is an urgent problem of modern dentistry.

According to the epidemiological dental examination, the prevalence of inflammatory periodontal diseases reaches 90-95% in the adult population and 80-83% in adolescents. In Russia, there is a tendency to reduce the age barrier in patients with generalized forms of periodontal disease, and with a predominance of destructive forms. The progression of inflammatory periodontal diseases can lead to partial or complete loss of teeth, general sensitization of the body, and the development of odontogenic foci of infection. Pathological changes in periodontal tissues are accompanied by a violation of microcirculation and metabolic processes, the development of autoimmune reactions.

Some authors believe that chronic generalized periodontitis, despite the sufficient monomorphism of the main clinical manifestations, is an etiologically and pathogenetically heterogeneous disease. Periodontal diseases can develop under the influence of both local causes (plaque microorganisms, occlusal trauma, etc.), and the combined effects of local and general (endogenous) factors against changes in the body's reactivity.

According to several authors, it is known that chronic odontogenic infection is an important factor in the development of somatic pathology. Numerous studies have shown that the focus of infection in the oral cavity is often associated with pathology of internal organs: chronic bronchitis and bronchial asthma, arthralgia, arterial hypertension, damage to the blood system and many other diseases.

In modern literature, the data presented indicate that metabolic processes in the periodontal tissues resulting from a number of exo- and endogenous influences and dysfunction of the enzymatic systems cause a violation of the periodontal blood supply. Blood microcirculation plays a key role in providing trophic tissue and compensatory processes in the development of inflammatory and ischemic lesions of periodontal tissues. The circulatory system supplies periodontal tissues with oxygen, nutrients, and removes waste products from them. But a decrease in stroke and minute volumes of the heart and arterial hypotension can lead to a drop in perfusion pressure in the vessels of the musculoskeletal system of the tooth and, as a result, the development of dystrophic changes in them. The latter are the cause of a decrease in periodontal tissue resistance.

Therapeutic measures for periodontitis are primarily aimed at eliminating periodontal pathogens (removal of dental deposits, selective grinding of teeth, plastic of the vestibule and frenum, etc.), as well as relief of inflammatory phenomena in the gums, elimination of periodontal pockets, stabilization of the dentition, and normalization trophism, microcirculation and protective reactions in periodontal tissues.

The arsenal of drugs is diverse, but most of them are synthetic (chemotherapeutic) products. For the treatment of periodontal diseases, local and general medicines are used to reduce inflammation, accelerate reparative processes in the gum tissue and normalize redox mechanisms. Against the background of the constant use of medicines containing antibiotics, there is a risk of the emergence of resistant forms of pathogenic microorganisms, and the likelihood of developing oral dysbiosis increases.

For the prevention and treatment of periodontal disease and oral mucosa, a drug is known that contains: gooseberry pulp oil, eucalyptus oil, liquid paraffin, chlorhexidine bigluconate, sodium carboxymethyl cellulose, methyl paraben, propyl paraben and water. The drug has anti-inflammatory antibacterial and regenerative effects [RF Patent 2416420, А61К 36/185, А61К 36/61, А61К 31/155, А61Р 1/02].

The disadvantage of using antiseptics is low resistance to dissolution in the gingival fluid, dysbiosis after application and a short remission period are possible.

A known method of treating periodontitis, combined with peptic ulcer of the stomach and duodenum, including applications on periodontal tissues and ingestion of 40% alcohol tincture of the drug collection, consisting of calendula flowers, pharmacy chamomile flowers, bird of highlander grass, with ecdysterone dissolved in it. The drug accelerates the reparative processes in the periodontal and mucous membranes of the stomach and duodenum, reducing immediate and long-term complications due to the immunostimulating, protein-synthesizing and bactericidal effect [RF Patent 2205653, АКК 35/78, 2003].

The disadvantage of using this drug is the lack of capillary and analgesic effects.

The closest analogue for the treatment of periodontal diseases is recommended a patented drug, including: clove oil, a complex of biologically active substances of licorice roots, eucalyptus leaves, medicinal sage leaves, medicinal lemon balm herb, St. John's wort perforated, marjoram ordinary grass, tarragon grass, yarrow grass, seed coriander fruits, cinnamon rose hips, fresh lemon fruits, rhizomes and roots of Rhodiola rosea, chamomile flowers, pharmacy flowers uly, nettle leaves, celandine herbs, oak bark cheremchatogo, Sophora japonica fruit, herbs Echinacea purpurea, the fruit of sea buckthorn degreased and unripe fruits of walnut. The drug is used in the form of rinses and applications. It has anti-inflammatory, hemostatic, astringent, capillary-strengthening, regulating adaptogenic and immunomodulatory effects, which leads to a reduction in treatment time [RF Patent 2147223, A61K 7/26, 2000].

Despite the fact that the search for effective medications and methods of treatment has been carried out for a long time, however, the result of their use is reduced, in most cases, to some improvement in the condition of periodontal tissues.

We set ourselves the goal of developing a new method of treating chronic generalized periodontitis using the proposed phytocomplex, which would provide capillary-strengthening, anti-inflammatory, reparative, analgesic effects, was simple to manufacture, relatively inexpensive, and did not have undesirable effects.

The task is implemented using a temporary drug, which is an ointment base, which includes 70% of tinctures from plants, ecdysterone and eucalyptus oil:

Vaseline - lanolin base (1: 1) - 88.5 g

70% tincture of meadowsweet - 5.0 g

70% tincture of Japanese saphora - 5.0 g.

ecdysterone - 0.02 g

eucalyptus oil - 1.0 g

The drug was prepared as follows. To the prepared mixture of petrolatum and lanolin (1: 1), taken in the prescribed amount, 10.0 g of a mixture of 70% tavolga tincture and 70% Japanese saffron tincture was added and this mixture was thoroughly emulsified, having previously dissolved 0.02 g of ecdysterone in a tincture mixture. 1.0 g of eucalyptus oil was added to the resulting ointment and homogenized.

Ecdysterone exhibits and provides ointments with a strong reparative, octoprotective, tonic, analgesic and other effects, Japanese saphora is responsible for pronounced capillary-strengthening, anti-inflammatory, bactericidal and other types of action, and the meadowsweet gives the ointment a distinct bactericidal and anti-inflammatory effect on the periodontal wall. The listed main effects of the components of the ointment provide it with an excellent therapeutic effect, and essential eucalyptus oil exhibits, among other things, a preservative effect.

Clinical studies of the proposed method of treatment using the phytocomplex were carried out at the Department of Therapeutic and Pediatric Dentistry, GBOU VPO Ryazan State Medical University of the Ministry of Health of Russia. 81 patients aged 32 to 68 years with chronic generalized periodontitis were treated, including 39 men (48.1%) and 42 (51.9%) women.

The diagnosis of chronic generalized periodontitis was made on the basis of survey data, clinical and radiovisiographic studies.

To assess the hygiene status, a simplified hygiene index according to J.C. was used. Greene, J.R. Wermillion (1964). The method consists in assessing the surface area of a tooth covered with plaque and / or tartar, does not require the use of special dyes. The vestibular surface 11, 16, 16, 31 and the oral surfaces 36, 46 were examined.

Codes and evaluation criteria for plaque:

0 - plaque not detected;

1 - soft plaque covers no more than 1/3 of the tooth surface, or the presence of any number of stained deposits (green, brown, etc.);

2 - soft plaque covers more than 1/3, but less than 2/3 of the tooth surface;

3 - soft plaque covers more than 2/3 of the tooth surface.

Plaque Index (OUT) = Sum of indicators / 6

Codes and evaluation criteria for tartar:

0 - tartar was not detected;

1 - supragingival tartar covers no more than 1/3 of the tooth surface;

2 - supragingival tartar covers more than 1/3 of the tooth surface, or the presence of individual deposits of subgingival calculus in the cervical region of the tooth;

3 - supragingival calculus covers more than 2.3 tooth surfaces, or significant deposition of subgingival calculus around the cervical region of the tooth.

Tartar Index (IZK) = Sum of indicators / 6

Simplified Hygiene Index (IGR-U) = OUT + IZK

Evaluation criteria for oral hygiene by the Green-Vermillion index:

Group Index Index level Hygiene level 0-0.6 low good 0.7-1.6 average average 1.7-2.5 tall bad 2.6 very tall very bad

Determination of the periodontal index (PI - according to Russel A., 1956).

The periodontal index makes it possible to take into account the presence of both gingivitis and other symptoms of periodontal pathology: tooth mobility, the depth of the clinical pocket, etc.

Use the following ratings:

0 - no changes and inflammation;

1 - mild gingivitis (gum inflammation does not cover the entire tooth), there are no changes on the radiograph;

2 - gingivitis without damage to the attached epithelium (clinical pocket is not determined), there are no changes on the radiograph;

4 - the disappearance of trailing cortical plates on the tops of the alveolar process according to the radiograph, on the radiograph the initial degree of resorption of the vertices of the interdental septa;

6 - gingivitis with the formation of a clinical pocket, there is no dysfunction, the tooth is not movable, on the radiograph horizontal resorption of the interdental septum by ½ of the root length;

8 - pronounced destruction of all periodontal tissues, the tooth is mobile, can be displaced.

 On the roentgenogram, the resorption exceeds ½ of the root length of the tooth, there may be bone pockets.

The condition of the periodontium is assessed for each existing tooth. In doubtful cases, put the highest possible rating. To calculate the index, the learned estimates are added up and divided by the number of available teeth according to the formula:

PI index = sum of scores for each tooth / number of teeth in the examined

The index value is estimated as follows:

0,1-1,0 - the initial and mild degree of periodontal pathology;

1.5-4.0 - moderate to severe degree of periodontal pathology;

4.0-8.0 - severe periodontal pathology.

Papillary hemorrhage index (PBI) according to Saxer and Muhlemann (1975) was used to assess gum bleeding.

Sounding is carried out in four quadrants. Sounding in the 1st and 3rd quadrant is performed from the oral side, and in the 2nd and 4th - from the vestibular side. The index value is determined separately for each quadrant, and then the average value for the entire bite is displayed.

The PBI is evaluated as follows:

0 degree - no bleeding;

1 degree - the appearance of individual point bleeding;

2 degree - the presence of numerous point bleeding or linear bleeding;

Grade 3 - filling the interdental gingival triangle with blood;

Grade 4 - after probing, intense bleeding appears, blood flows through the tooth or gum.

PBI can be defined as the bleeding number (= the sum of all values) or as an index (average severity) using the formula: PBI = Bleeding number / number of measurement points.

A radiovisiographic study was conducted with the aim of making a diagnosis (the severity of the disease).

Based on changes in bone tissue, a diagnosis was made.

The initial stages of periodontitis: osteoporosis in the area of the interdental septa, the expansion of the periodontal gap in the cervical region, the disengagement of the vertices of the interdental septa, the destruction of the cortical (closure) plate in the region of the vertices of the interdental septa.

Periodontitis of mild severity: destruction of the interdental septum 1/3 of the root length.

Periodontitis of moderate severity: destruction of interdental septa at 1/2 root length.

Severe periodontitis: destruction of interdental septa over 1/2 root length.

The results of the study were evaluated in terms of 1 to 6 months. Both immediate and long-term results of treatment showed a pronounced therapeutic effect of the proposed treatment of chronic generalized periodontitis.

Treatment of chronic generalized periodontitis included local therapy according to the following method: after application anesthesia with 10% lidocaine solution, professional oral hygiene, drug treatment with 1% iodinol solution, the salivary gland ducts were isolated in the oral cavity and a periodontal ointment of the developed ointment was applied to the affected gingival surface 2 hours. Patients were advised to abstain from food and water for 2 hours. The course of treatment was 4 weeks, the procedure was carried out 1 time every day.

Example 1

1 visit (May 29, 12)

Patient V., 52 years old, complained of bleeding gums when brushing your teeth, tooth mobility.

Anamnesis of the disease: Complaints of this nature have been disturbing for 10 years, for the first time noted bleeding gums when brushing your teeth in childhood.

Anamnesis of life: stage II hypertension.

Objectively: the marginal gum of the upper and lower jaw is stagnantly hyperemic, loose, edematous, bleeds upon probing. Gingival recession in the area of all teeth of the upper and lower jaw to 1/3 of the root length.

The depth of the gingival pockets in the tooth area (in mm)

5 5 5 3 3 3 3 2 2 2 2 3 3 5 5 5 eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 four 5 four four four 2 2 2 2 2 2 2 2 four four one

Tooth mobility: 17, 16, 26, 27, 36, 37, 73, 44, 45, 46, 47 - II degree.

In the area of all teeth of the upper and lower jaw, deposits of over - and subgingival tartar were noted. IGR-U = 2.6 (very poor level of hygiene). PBI = 32. PI = 2.6.

On the orthopantomogram of all teeth of the upper and lower jaw, horizontal destruction of bone tissue to ½ of the root length.

Diagnosis: periodontitis generalized moderate chronic course.

Treatment: under application anesthesia Sol. Lidocaini 10% carried out the removal of dental plaque with an ultrasound machine. Medication with 1% iodinol solution. Polishing of the necks of teeth with a circular brush with Detartrien paste; coating of teeth with fluorine varnish. Overlay of periodontal applicat developed ointment. A course of treatment was prescribed - 1 time daily, for 4 weeks.

Appointed: medium hard toothbrush, Parodontax toothpaste, rinsing the mouth with calendula infusion.

Recommended: refrain from eating and drinking water for two hours.

2 visit (2.07.12)

Patient V., 52 years old, came for a follow-up examination for periodontitis of generalized moderate chronic course after the end of the course of treatment with the drug. There are no complaints.

Objectively: the marginal gum of the upper and lower jaw is compacted, pink in color, there is no bleeding when probing. IGR-U = 0.1. PBI = 0.

6 months after the treatment (October 31, 12), there were no complaints, the mucous membrane of the gums is pale pink, does not bleed when probed, which indicates the normalization of periodontal tissues during treatment.

Example 2

1 visit (05/11/12)

Patient K., 35 years old, turned to the Department of Therapeutic and Pediatric Dentistry, GBOU VPO Ryazan State Medical University of the Ministry of Health of Russia with complaints of bleeding gums when brushing teeth.

Medical history: first noted bleeding gums when brushing teeth 7 years ago. Against the background of the treatment, a temporary improvement was noted.

Anamnesis of life: without features.

Objectively: the mucous membrane of the marginal gum and interdental papilla in the area of the teeth of the upper and lower jaw is edematous, hyperemic, bleeds when probed. The depth of the gingival pockets in the tooth area (in mm).

3 four four 3 2 2 3 3 3 3 3 3 2 four four four eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 2 3 four 3 3 3 2 3 3 3 3 2 2 four four 3

In the area of all teeth of the upper and lower jaw above and subgingival dental deposits, occupying up to 1/3 of the tooth surface. IGR-U = 1.3 (average level of hygiene). PBI = 14. PI = 1.7.

On the orthopantomogram in the area of the teeth of the upper and lower jaw - horizontal destruction of the interdental septa from 1/3 to 1/2 of the root length.

Diagnosis: periodontitis generalized moderate chronic course.

Treatment: under application anesthesia Sol. Lidocaini 10% carried out the removal of dental plaque with an ultrasound machine. Honey. treatment with 1% iodinol solution. Polishing the neck of the teeth with a circular brush with Detartrien paste, coating the teeth with fluoride varnish, applying a periodontal applicator of the developed ointment to the gum. A course of treatment was prescribed - 1 time daily, for 4 weeks.

Appointed: medium hard toothbrush, Parodontax toothpaste, rinsing the mouth with calendula infusion.

Recommended: refrain from eating and drinking water for two hours.

2 visit (06/15/2012)

After the course of treatment with the drug.

There are no complaints.

Objectively: the mucous membrane of the gums is pale pink in color; it does not bleed when probed. IGR-U = 0.6. PBI = 0.

6 months after the treatment (10/9/12 g), there were no complaints, the mucous membrane of the gums is pale pink in color, does not bleed when probed, which indicates the normalization of periodontal tissues during treatment.

Thus, the patented method of treating periodontitis of generalized moderate chronic course using the means proposed by the authors provides a pronounced capillary-strengthening, anti-inflammatory, reparative, analgesic effect while maintaining this effect for a long time. During the treatment, there was not a single case of undesirable complications.

Literature

1. Ivanov B.C. Periodontal disease. 4th ed., Rev. and add. - M.: Medical News Agency, 2001. - 300 p.

2. Wolf G.F. Periodontology / Herbert F. Wolff, Edith M. Rateitzzhak, Klaus Rateyzhak; trans. with him. - M .: MEDpress-inform, 2008 .-- 548 p.

3. Tsepov L.M. Diagnosis, treatment and prevention of periodontal disease / L.M. Tsepov, A.I. Nikolaev, E.A. Mikheeva. - 3rd ed., Rev. add. - M .: MEDpress-inform, 2008 .-- 272 p.

Claims (1)

A method of treating chronic generalized periodontitis, which consists in the use of a complex preparation in the form of an ointment of the following composition: petrolatum - lanolin base (1: 1) - 88.5 g, 70% tavolga tincture - 5.0 g, 70% tincture of Japanese - 5.0 g, ecdysterone - 0.02 g; eucalyptus oil - 1.0 g, which is applied in the form of a periodontal therapeutic application to the affected gingival surface after application anesthesia with 10% lidocaine solution, professional oral hygiene, drug treatment of the gingival margin with 1% iodinol solution and isolation of the salivary glands in the oral cavity, once per day for 2 hours for 4 weeks, recommending that patients refrain from eating food and water for two hours.