RU2568852C1 - Method of treating hypertrophic gingivitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: professional tooth cleaning and curettage of false gingival pockets is followed by conducting an injection sclerosing therapy with 0.25% Aethoxysklerol in an amount of 2 ml into a hypertrophic area of the oral mucosa and using the furacilin ointment dressings during 5 days, daily.

EFFECT: method enables reducing oedema, bleeding gums, pain and bad breath by arresting the inflammatory process.

Description

The invention relates to medicine, namely to dentistry, and can be used to treat hypertrophic gingivitis that occurs at the stages of orthopedic and orthodontic treatment of dentofacial anomalies and deformities in children and adults.

Periodontal diseases, in particular hypertrophic gingivitis, are among the most common nosological forms and occupy second place in frequency and prevalence in dentistry.

Modern attempts to treat gingivitis and periodontitis are being made, but treatment methods have not been found that fully restore the morpho-functional state of periodontal tissues.

Since pathological changes in the periodontium occur with a sharp activation of microbial agents against the background of a decrease in specific and non-specific mechanisms of general and local protection aimed at eliminating microbial accumulations and restoring microcirculatory processes in the oral cavity.

There is a method of cryosurgical treatment of hypertrophic gingivitis by exposure to hypertrophic papillae with liquid nitrogen (NF Danilevsky, GN Vishnyak. Periodontal disease in children and adolescents, M .: Medicine, 1977, p.163, 169; NF Danilevsky , E.A. Magid, N.A. Musin, V.Yu. Milikevich, Periodontal Diseases (Moscow: Medicine, 1993, p. 186).

The disadvantages of this method are, firstly, developing in the first 24-48 hours after cryodestruction, a pronounced edematous-pain symptom, the relief of which is associated with certain methodological difficulties, and secondly, the inevitability of the formation of a wound surface after rejection of cryodestructive gum tissue, which requires epithelization the use of protective medical dressings for 3-4 days, and thirdly, private relapses of the growth of the gingival papillae, requiring repeated interventions.

There is a method of treating hypertrophic gingivitis, which consists in heparin therapy - injection into the transitional folds of 1 ml (5000 PIECES) of heparin (TV Nikitina. Periodontitis. M .: Medicine, 1982, S. 115; BC Ivanov. Periodontal disease. M. : Medicine, 1989, p. 109).

But, firstly, the duration of heparin therapy of gingivitis is a course of treatment of 10-12 injections, secondly, the need for laboratory monitoring of blood coagulation time at the stages of heparin treatment, thirdly, a delayed (3-4 days) therapeutic effect, fourthly , the possibility of developing hemorrhages, individual intolerance, allergic reactions to heparin (MD Mashkovsky. Medicines. M: Medicine, 1988, p. 75). In the long term after sclerotherapy with heparin, retraction of the attached gums and gingival papillae is possible, leading to cosmetic defects.

Closest to the proposed is a method of treating hypertrophic gingivitis, which consists in conducting preliminary professional brushing, curettage, drying the surface and conducting sclerotherapy with injections of 50-60% glucose solution, which is injected into the top of the papilla with 0.1-0.2 ml of 3- 8 times each with a break of 1-2 days (Ivanov BC Periodontal Disease. 3rd edition. - M.: Medical News Agency, 1998. - 140 s).

However, this method cannot be used if the patient has a history of diabetes, the administration of the drug is accompanied by severe pain, a large number of visits by the patient to the dentist, as well as the presence of side effects (allergic reaction, itching at the injection site) are required.

The objective of the invention is to improve the functional results of treatment, the possibility of use in patients with diabetes mellitus, reducing the number of visits by a patient to a dentist, painless administration of the drug.

The task is achieved by conducting a hygiene lesson followed by professional cleaning, curettage of false periodontal pockets, drug anti-inflammatory therapy, drying of the surface of the oral mucosa, treatment of periodontal pockets on turunds and batch rinsing with water jet of treated areas, sclerosing therapy with Etoxiskisk% 0.2% 2 ml as an injection into a hypertrophic part of the mucous membrane (interdental papilla and marginal gingival margin), by applying a watering tnoj ointments and dressings based on furatsilina.

The method is as follows.

The study was conducted in 15 patients, divided into 2 groups, aged 18 to 30 years, of both sexes - 7 men and 8 women.

The first group of patients, in the amount of 7 people, had a lesson in oral hygiene, professional brushing, curettage of false periodontal pockets, traditional anti-inflammatory drug therapy and sclerotherapy with 50-60% glucose solution, which was injected 3-8 times into the top of each papilla 0.1-0.2 ml with a break of 1-2 days for 7 days.

The main group of patients, in the amount of 8 people, held a lesson in oral hygiene, professional brushing, curettage of false periodontal pockets, traditional anti-inflammatory drug therapy, drying of the surface of the oral mucosa, treatment of periodontal pockets in the turunds, portioned washing with a stream of water of the treated areas and daily sclerosing treatment, in the form of injections, for 5 days with the preparation "Etoksisklerol" 0.25% of 2 ml in a hypertrophic area of the mucous membrane, with further m polyvalent applying ointments and dressings based furatsilina.

As a result of the treatment of patients with hypertrophic gingivitis, positive dynamics were obtained in both groups, however, the best results were observed in the main group, where in addition to the traditional drug treatment, ethoxysclerol was used.

Relief of acute inflammatory processes in patients of this group was observed at 2-3 visits. Patients noted a decrease in edema, bleeding gums, pain, lack of halitosis. Sensitivity to temperature and chemical stimuli decreased. By the 7th day of clinical observation in patients of this group, the treatment period proceeded without complications. No signs of gingival mucosa pathology were found; it had a natural color, relief, shape, and was painless on palpation. Probing the gums not in gaps, but in the cervical region of the gums fit snugly against the hard tissues of teeth.

The indices of periodontal indices decreased and corresponded to normal average indices. Samples of Schiller-Pisarev, Parma and Kechke were negative in all patients of this group (before treatment, the Schiller-Pisarev test was positive, and Parma was 28.9).

In patients of the 1st group, relief of acute inflammatory processes was observed by the 5-7th visit. Soreness, swelling and bleeding of the gums also gradually decreased. By the 15th day of clinical observation in patients of this group, the treatment period proceeded without complications. However, more than half of the patients showed signs of pathological changes characteristic of hypertrophic gingivitis, the mucous membrane of the cervical region of the teeth was partially hyperemic, sometimes bleeding, the gingival papillae were not always formed completely; the adherence of the mucous membrane to the hard tissues of the teeth was observed in less than half of the patients. Periodontal indices decreased. The Schiller-Pisarev test was weakly positive in 2 patients (9.53%), the Parma test was negative in all patients.

After 1 and 6 months after the complex treatment, there were no signs of chronic inflammation in the patients of the main group. They did not complain, the mucous membrane of the gum was pale pink, its palpation was painless, the gingival margin was completely restored, tightly adhered to the tissues of the teeth in the cervical region and interdental spaces. Clinical improvement in periodontal tissues was confirmed by the positive dynamics of changes in the clinical indices of PMA and PI. Samples of Schiller-Pisarev, Parma were negative in all patients of this group.

After 1 and 6 months after the course of treatment, patients of the 1st group still complained of bleeding gums during brushing and when eating solid food. An objective examination of the oral cavity in these patients revealed the initial signs of an inflammatory process. Indicators of periodontal indices had clinical dynamics. The Schiller-Pisarev test and the Parma test were weakly positive.

Example. Boy E., 27 years old. Diagnosis: generalized hypertrophic gingivitis of moderate severity. There is bad breath, bleeding gums, hypersensitivity to temperature and chemical irritants. An objective examination revealed hypertrophy of the marginal gums and interdental papillae in the area of all groups of teeth, and abundant dental deposits. An index assessment of the periodontal condition was: PMA - 37.44%, PI - 2.96, Schiller-Pisarev, Parma tests are positive.

Treatment: dental plaque was removed under conduction and infiltration anesthesia of a 4% solution of ubistesin, curettage was performed and antiseptic treatment of the oral cavity was carried out in the form of irrigation with 1: 5000 furatsilin solution. The patient was prescribed antibacterial, anti-inflammatory, restorative, stimulating and desensitizing therapy, as well as immunocorrective therapy in the form of the appointment of the drug "Imudon". In addition, the main course of treatment was prescribed a sclerosing drug Ethoxysclerol 0.25% in 2 ml injections into the marginal gum and interdental papillae, 5 days course, polyvalent ointment and furatsilin dressing. At the same time, the patient received recommendations on oral hygiene and control of brushing.

The relief of inflammatory processes in the patient was noted on day 3. When examining the oral mucosa, a decrease in edema, bleeding gums, pain, bad breath was determined. Sensitivity to temperature and chemical irritants decreased. The mucous membrane of the gum acquired a natural color, relief, shape, was painless on palpation, the gingival papillae were located in the interdental spaces, and in the cervical region the gum was tightly attached to the neck of the teeth. The indices of periodontal indices decreased and amounted to: RMA - 3.12%, PI - 1.25, Schiller-Pisarev, Parma tests were negative.

Control examination was carried out after 1 month. The patient did not complain. Objectively in the oral cavity: pathological tooth mobility was absent, bleeding of the gums was not observed. The condition of periodontal tissues corresponded to the concept of the physiological norm (the mucous membrane of the gums is pale pink, in the cervical region it was firmly attached to the neck of the teeth, no recession of the gingival margin was noted).

6 months after the end of the treatment, the condition of the periodontal tissues was normal, there was no bleeding of the gums. The gingival papillae formed a clear scallop in the cervical region and tightly occupied the interdental spaces. The mucous membrane of the gums was dense, painless. On the moving mucous membrane, the vascular pattern of the capillary network became more clearly manifested.

The use of sclerotherapy in the form of daily injections of Ethoxisclerol 0.25% in 2 ml in the area of the hypertrophic part of the oral mucosa for 5 days helps to stop inflammation after three treatment procedures, to reduce swelling, bleeding gums, pain, unpleasant bad breath.

Claims (1)

A method of treating hypertrophic gingivitis, including a lesson in oral hygiene, professional toothbrushing, curettage of false periodontal pockets, drug sclerotherapy, characterized in that sclerotherapy is carried out by injecting 0.25% Ethoxysclerol into a hypertrophic area of the oral mucosa with further application of a dressing based on furatsilinovoy ointment, the course of treatment is 5 days, daily.