RU2583938C1 - Method for diagnosing lichen planus, leukoplakia, glossalgia and device therefor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to therapeutic dentistry, and can be used as method and device for diagnostics of diseases of oral mucosa, namely for differential diagnosis of flat zoster, leukoplakia and glossalgia. Method is implemented by calculating values of electrochemical potentials on the oral mucosa, where silver-chloride electrode is placed in sublingual region, and active electrode is applied to tongue back, recording maximum values of electrochemical potentials. If value is equal to 366.83±5.0 mV, diagnosed is typical shape of flat zoster, while if value is equal to 315.61±6.9 mV, erosive-ulcer, while value is equal to 333.56±4.3 mV, leukoplakia is diagnosed, while value is equal to 350.4±5.2 mV, glossalgia is diagnosed. Device for measuring electrochemical potentials, which consists of measurement unit, enclosed in housing, silver chloride reference electrode, having at end of detachable sterile electrolytic key presented by endodontic cannula filled with physiologic saline, and end of active electrode has round, flat shape with diameter of 8 mm.

EFFECT: advantage of device used in method consists in improvement of accuracy of measurements, without injuring action on oral mucosa during investigation and exclusion of toxic effect of potassium chloride (KCl).

2 cl, 2 dwg, 4 ex

Description

The invention relates to medicine, namely to therapeutic dentistry, and can be used to diagnose diseases of the oral mucosa.

Diseases of the oral mucosa (COP) are one of the urgent problems of modern dentistry [Gazhva SI, Shkarednaya OV, Pyatova ED An integrated approach to the treatment of diseases of the oral mucosa in patients with chronic gastritis // Dentistry. - 2013; No. 6 - S. 16-19]. Difficulties arising in the diagnosis of COP diseases are largely due to the lack of evidence-based methods and the corresponding measuring equipment [Gazhva SI The prevalence of dental diseases of the oral mucosa and their diagnosis / S.I. Gazhva., T. B. Stepanyan., T. P. Goryacheva // International Journal of False and Basic Research, - 2014 - No. 5 - P. 41-44].

A known technique for measuring electric potentials on the oral mucosa developed and approved by the Ministry of Health for the BPM-03 biopotentialometer for use in dentistry for the diagnosis of diseases of the oral mucosa is that electrolytic keys of electrodes of electrodes and electrodes must be brought into contact with the sublingual region and compensate for the asymmetry potential. The end face of the electrolytic key of the EP is installed on the studied area and after 3-5 seconds the readings of the device are recorded, while strictly observing the requirements for excluding the contact of the end of the electrolytic key with biologically active points (BAP). No more detailed description has been found in the available literature. How is the diagnosis of diseases of the oral mucosa carried out, it is not clear, in addition, the BMP-03 biopotential meter is not widespread and has long been discontinued [I. Lebedenko. Study of electrochemical potentials in the oral cavity / manual for dentists / I.Yu. Lebedenko, O.I. Manin O.I. - M., 2011, S. 17-21]. This method is taken as a prototype.

The objective of the method is the diagnosis of lichen planus, leukoplakia, glossalgia by the method of determining electrochemical potentials (ECP).

The technical result consists in determining the difference in electrochemical potentials corresponding to flat lichen, leukoplakia, glossalgia.

This is achieved due to the fact that the silver chloride electrode is located in the sublingual region, and the active electrode is applied to the back of the tongue, registering the maximum values of electrochemical potentials, and at a value of 366.83 ± 5.0 mV, a typical form of lichen planus is diagnosed, at equal to 315.61 ± 6.9 mV, erosive-ulcerative, with a value of 333.56 ± 4.3 mV, leukoplakia is diagnosed, and with a value of 350.4 ± 5.2 mV, glossalgia is diagnosed.

100 patients with various diseases of the oral mucosa took part in the ECP study: 25 people with flat and erosive-ulcerative ulcers, 25 people with leukoplakia, and 25 people with glossalgia. The control group of patients was 25 people. The maximum values of ECP were revealed on the site of the mucous membrane of the tongue. According to the results of a statistical study, the maximum values of ECP were revealed in the area of the mucous membrane of the tongue.

Based on the results obtained, it can be concluded that the tongue is the main diagnostic organ in the oral cavity with this technique and can be used for differential diagnosis of diseases of the oral mucosa. The ECP values of the back of the tongue with a typical form of lichen planus were 366.83 ± 5.0 mV, and with an erosive-ulcerative form - 315.61 ± 6.9 mV, with a difference in electrochemical potentials equal to 333.56 ± 4.3 mV, they diagnose leukoplakia and with a difference in electrochemical potentials with a result of 350.4 ± 5.2 mV, they diagnose glossalgia.

The method is as follows: the patient is placed electrodes: silver chloride in the sublingual region, and the active electrode is sequentially applied to the back of the tongue, registering the maximum values of electrochemical potentials, and when the value is 366.83 ± 5.0 mV, a typical form of lichen planus is diagnosed, with a value of 315.61 ± 6.9 mV, erosive and ulcerative, with a value of 333.56 ± 4.3 mV, leukoplakia is diagnosed, and with a value of 350.4 ± 5.2 mV, glossalgia .

Clinical example 1.

Patient K., 59 years old, turned to the Department of Geriatric Dentistry at the Moscow State Medical and Dental University in the department of diseases of the oral mucosa with complaints of burning sensation in the mouth when eating irritating food, a feeling of tightness, roughness and an unusual appearance of the mucous membrane of the cheeks. All changes appeared 3 years ago after the stress. Concomitant diseases: chronic cholecystitis, peptic ulcer of the duodenum. When examining the oral cavity, the lining of the tongue is noted. On the mucous membrane of the cheek on the right along the closing line of the teeth, a section of the altered epithelium is noted, whitish in the form of papules, which are not removed when scraping. The absence of teeth 2.6, 3.4. Estimated diagnosis: Candidiasis of the oral cavity, lichen planus.

The patient was measured electrochemical potentials of the oral mucosa in the back of the tongue. Based on the registration data, ECP = 367 mV was diagnosed with lichen planus typical form.

Clinical example 2.

 Patient M., 52 years old, applied to the Department of Geriatric Dentistry at the Moscow State Medical and Dental University in the department of diseases of the oral mucosa with complaints of burning and tingling on the tip and lateral surface of the tongue. Difficulty during a conversation and reduction of pain during meals. The history revealed prolonged stress, physical overwork, and depressive states. Concomitant diseases: hepatocholecystitis, menopause, hypertension. When examining the oral cavity, pronounced changes in the oral mucosa were not detected. At the tip of the tongue, a site of hyperkeratosis is noted. The sharp edges of the teeth were revealed 3.6, 3.7,4.7. Estimated diagnosis: Neuralgia of the glossopharyngeal nerve, Candidiasis. Based on the registration data ECP = 351 mV, a diagnosis is made

Glossalgia.

Clinical example 3.

Patient P, 49 years old, was sent to the Moscow State Medical and Dental University to the Department of Geriatric Dentistry in the Department of Oral Mucosal Diseases by an orthopedic dentist. There are no complaints. Smoking experience over 20 years, about 15 cigarettes per day. Concomitant diseases: gastric ulcer, COPD. When examining the oral cavity on the mucous membrane of the retromolar region and the lateral surfaces of the tongue, lesions of a rounded shape are noted, covered with a hard-to-remove white film. The absence of teeth 2.6, 3.7, 4.6. Destroyed tooth surfaces 3.6, 4.8 (IROPZ = 0.7).

Estimated diagnosis: Lichen planus (typical form), Flat leukoplakia.

Based on the registration data, ECP = 333 mV was diagnosed with Flat leukoplakia.

Clinical example 4.

Patient S., 49 years old, turned to the Department of Geriatric Dentistry at the Moscow State Medical and Dental University in the department of diseases of the oral mucosa with complaints of burning and discomfort in the mucous membrane of the right cheek. Painful sensation that occurs during conversation and eating. The history revealed prolonged stress, physical overwork, and depressive states. The patient at times notes the appearance of painful erosion, epithelizing spontaneously. Concomitant diseases: gastrointestinal tract disease, type II diabetes mellitus. Examination of the oral cavity revealed violations of the integrity of the mucous membrane of the mouth of the right cheek in the form of erosion of about 3 mm, covered with fibrinous plaque. There is an increase in the abrasion of the anterior group of teeth of the lower jaw.

Estimated diagnosis: Chronic aphthous stomatitis, lichen planus erosive and ulcerative form.

Based on the registration data, ECP = 316 mV was diagnosed with lichen planus erosive-ulcerative form.

The known biopotential device BPM-03, manufactured according to GOST 20790-82, is intended for rapid diagnosis of galvanic syndrome and diagnosis of diseases of the oral cavity. The biopotential meter includes a measuring unit 1 and a set of electrodes connected to the measuring unit at the INPUT (EA and EV sockets). BPM-03 has a set of electrodes in its composition, including an EVP-04 electrode (silver-silver comparison half electrode 2) and EMU (active electrode 3, which contains nickel wire, is used to study metallic inclusions in the oral cavity). The principle of operation of the device is based on measuring bioelectric potentials between intact and pathological sections of the mucous membrane and determining the electrochemical potential of metal inclusions [17/0/1 / 16-97.htm]. The BMP-03 biopotential meter is not widespread and has long been discontinued [I. Lebedenko. Study of electrochemical potentials in the oral cavity / manual for dentists / I.Yu. Lebedenko, O.I. Manin. - M., 2011, S. 17-21]. This device is selected for the prototype (Fig. 1). However, in terms of diagnosing diseases of the oral mucosa, its disadvantages are: trauma (the active electrode is needle-shaped), toxicity - a solution of potassium chlorine (KCL), which is contained in a silver chloride electrode, can freely spread over the oral mucosa, in addition, KCL has a toxic impact on the human body. Potassium ions lower heart rate, contractile activity, conduction, automatism and myocardial excitability.

The well-known digital computerized multitest APPA109N with galvanic isolation from the electric network (), to which the following standard set of test leads (red and black) with double insulation are connected, is double-insulated: length 1.3 m; 10 A (1000 V / Cat. II); 2 mm probe - 4 mm insulated male type connector (with a bend of 90 degrees); 3-sided embossed overlay for easy retention; removable caps for protection against accidental short circuits in the circuit (with caps: 1000 V / cat. III, 600 V / cat. IV cat). However, this set of electrodes does not allow to take the values of electrochemical potentials on the oral mucosa.

The objective of the invention is to improve the diagnosis of COPD diseases: lichen planus of a typical and erosive-ulcerative form, leukoplakia and glossalgia.

The technical result consists in increasing the accuracy of measurements, the complete absence of traumatic effects on the oral mucosa during the study and the toxic effects of potassium chloride (KCl).

This is achieved due to the fact that the silver chloride reference electrode has a removable sterile electrolytic key at the end, represented by an endodontic cannula filled with physiological saline, and the end of the active electrode has a round, flat shape with a diameter of 8 mm.

The exclusion of traumatic effects on the oral mucosa during the study is ensured by the fact that the end of the active electrode has a round, flat shape. According to the results of the studies, it was found that the diameter of the active electrode, equal to 8 mm, is the most optimal for obtaining accurate SEC data, since a smaller contact area of the electrode with the COP will lead to an increase in electrical resistance, reduce the SEC and will not allow for accurate measurement. It is possible to exclude the toxic effects of potassium chloride (KCl) due to the fact that there is no direct contact between KCl and the oral mucosa. When passing through saline solution filling the endodontic cannula, KCl is neutralized.

Improving the accuracy of measurements is due to the fact that, as you know, the outlet of the endodontic cannula has a diameter of 0.7 mm, which ensures uniform flow of the contents of the cannula. If the outflow of the solution is uneven, this will lead to the interruption of the contact between the COP and the electrode and to the defective SEC during the next contact. The resulting voltage results will be non-linear. This, in turn, will lead to a decrease in measurement accuracy.

The device (Fig. 2) consists of a measuring unit 1 enclosed in a housing (for example, an APPA109N digital computer-based multi-test with galvanic isolation from an electric network), a silver silver comparison electrode 2 and an active electrode 3. The silver chloride comparison electrode 2 has an endodontic cannula at the end, containing saline and having an outlet of 0.7 mm in diameter. The active electrode 3 has a round flat shape with a diameter of 8 mm

The device operates as follows: they turn on the DC mode at a voltage of 20 v, register the patient in the computer software database of this device, place a silver chloride comparison electrode 2 in the sublingual region, and an active electrode 3 on the back of the tongue and record the maximum values of electrochemical potentials.

Claims (2)

1. A method for diagnosing lichen planus, leukoplakia, glossalgia by calculating the values of electrochemical potentials on the oral mucosa, characterized in that the chlorine silver electrode is placed in the sublingual region, and the active electrode is applied to the back of the tongue, registering the maximum values of electrochemical potentials, and at a value equal to 366.83 ± 5.0 mV, diagnose a typical form of lichen planus, with a value of 315.61 ± 6.9 mV, erosive and ulcerative, with a value of 333.56 ± 4.3 mV, diagnose leukoplakia, and with the value avnom 350,4 ± 5,2 mV, - glossalgia. 2. A device for measuring electrochemical potentials, consisting of a measuring unit enclosed in a housing, a silver chloride comparison electrode and an active electrode, characterized in that the silver chloride comparison electrode has a removable sterile electrolytic key at the end, represented by an endodontic cannula filled with physiological saline, and the end of the active The electrode has a round, flat shape with a diameter of 8 mm.

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