RU2714506C1 - Method for assessing the clinical effectiveness of chronic catarrhal gingivitis in children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to studying physical and chemical properties of a biological fluid, and can be used in therapeutic dentistry for assessing the clinical effectiveness of chronic catarrhal gingivitis in children. That is ensured by biochemical examination of the oral fluid before and after treatment in the patients with diagnosed chronic catarrhal gingivitis. Capillary gas chromatography is used to determine concentrations of palmitic and linoleic acid in %. If the palmitic acid concentration changes from 12.9±1.9 to 24.0±1.7 and linoleic acid from 44.2±1.9 to 31.2±1.2, the treatment is considered to be effective.EFFECT: proposed method is simple, fast, accurate, objective, independent of subjective assessment of doctor.1 cl, 5 ex

Description

The invention relates to medicine, namely to the study of the physical and chemical properties of biological fluid, and can be used in therapeutic dentistry to assess the effectiveness of the treatment of chronic catarrhal gingivitis in children.

On the territory of the Russian Federation, periodontal pathology is observed in 98% of the examined patients. A dynamic increase in the incidence of periodontal tissues was recorded with a predominance of generalized periodontitis and gingivitis in their number. According to many sources of literature, chronic gingivitis is highly prevalent among patients, mainly adolescents. Over the past 20 years, domestic and foreign authors have paid great attention to effective methods of prevention, treatment and diagnosis of periodontal diseases. Many scientists have revealed the fact that long before the clinical manifestations of any disease, changes occur in the cellular composition of biological fluids and tissues at the molecular level, this is due to a violation of metabolic processes at the cellular level, which can be detected in the study of biological fluids by physical methods chemical analysis, for example, infrared spectroscopy, which allows you to determine the change in the content of various phosphorus-containing substances, such as inorganic phosphates, spholipids, RNA, as well as the content of triglycerides, cholesterol, free fatty acids, carbohydrates and proteins (Gordetsov, A.S. Infrared spectroscopy of biological fluids and tissues / A.S. Gordetsov // Modern technologies in medicine. - 2010. - No. 1 . - P. 84-98; Kargapolov, A.V. Infrared spectrometry in the study of oral fluid for diagnostic purposes / A.V. Kargopolov, G.M. Zubareva, V.M. Mikin // Dentistry. - 2009. - № 5. - S. 7-10.). Also known is a method for diagnosing the state of microbiocenosis, based on the determination of short-chain fatty acids, by gas-liquid chromatography (Bogdanova V.O. Evaluation of microflora metabolites in inflammatory periodontal diseases. Thesis for the degree of candidate of medical science., 2011. - Moscow, 138 p.).

Violation of lipid metabolism in the body with chronic catarrhal gingivitis is associated with a lack of catalase in red blood cells. As a result, the content of fatty acids, which are structural components of cell membranes, changes in saliva.

Known methods for assessing the lipid profile in chronic catarrhal gingivitis:

A known method for the diagnosis and prevention of gingivitis using the method of infrared spectroscopy of biological oral fluids in children (Kazarina L.N., Smetanina O.A., Gordetsov A.S., Krasnikova O.V. RF patent for the invention No. 2616903 from 18.04. 2017 “A method for the diagnosis of gingivitis in children”), including the study of a saliva sample by IR spectroscopy in the region of absorption spectra of 1200-1000 cm ^-1 . Calculation of IR spectroscopic parameters allows you to quickly and accurately establish the presence of this pathology in children according to the IR spectroscopic profile of the saliva of children, and also allow you to evaluate the long-term results of treatment.

However, this method allows only the change in the ratios of the components of the lipid composition to be determined, and does not provide information on the exact content of fatty acids, which in turn are key metabolites of lipid disturbance, therefore, information on their exact content in the oral fluid serves as a reliable prognostic marker of chronic catarrhal gingivitis.

The closest to the claimed method according to the set of essential features and the technical result achieved is a known method for evaluating the effectiveness of the treatment of chronic generalized periodontitis (RF patent No. 2632102), selected as a prototype, in which a biochemical examination of the oral fluid is performed before and after treatment in patients with diagnosed chronic generalized periodontitis and diagnosed metabolic syndrome using spectrophotometric analysis determine the lipid profile of the oral fluid, namely the concentration of triglycerides (TG), total cholesterol (OH), low density lipoproteins (LDL) and high density lipoproteins (HDL) and when the concentration of TG changes from 0.04 ± 0.01 mmol / l to 0.01 ± 0.001 mmol / L, OH from 0.08 ± 0.02 mmol / L to 0.04 ± 0.02 mmol / L, LDL from 0.04 ± 0.001 mmol / L to 0.01 ± 0.001 mmol / L, HDL from 0.08 ± 0.01 mmol / L to 0.12 ± 0.01 mmol / L, the treatment is evaluated as effective.

However, the proposed method is complicated in execution - it involves carrying out several biochemical studies at once to evaluate the lipid profile, and, therefore, requires a lot of time (within two days), which significantly delays the period of obtaining and processing the results. The disadvantage of the prototype is also that it has a limitation in use, since for the application of this method the patient must be diagnosed with metabolic syndrome.

The objective of the invention is to develop a simple and quick way to assess the effectiveness of the treatment of chronic catarrhal gingivitis in children, based on measuring the concentrations of the minimum number of fatty acids by capillary gas chromatography of the patient's saliva.

The technical result consists in obtaining an objective assessment of the effectiveness of treatment in children with chronic catarrhal gingivitis based on changes in the concentrations of only two fatty acids (palmitic and linoleic) by capillary gas chromatography of the patient’s saliva before and after the treatment.

The technical result is achieved by the fact that in the method for evaluating the effectiveness of the treatment of gingivitis, including a biochemical study of the oral fluid before and after the treatment, the fatty acid composition of the oral fluid is determined using capillary gas chromatography, namely, the concentration of palmitic and linoleic acids, and when the concentrations measured in%, palmitic acid from 12.9 ± 1.9 to 24.0 ± 1.7 and linoleic acid from 44.2 ± 1.9 to 31.2 ± 1.2, the treatment is evaluated as effective.

The proposed method for evaluating the effectiveness of the treatment of chronic catarrhal gingivitis is implemented as follows. In a patient with a diagnosis of Chronic Catarrhal Gingivitis, saliva is collected prior to treatment by spitting in a sterile test tube in the morning on an empty stomach on uncleaned teeth. Obtain 3.5-4 ml of mixed saliva. A gas chromatographic study of the obtained oral fluid is carried out. Using the method of capillary gas chromatography, the fatty acid profile of the oral fluid is determined, namely, the concentration in% of palmitic and linoleic acids. Capillary gas chromatography is carried out according to the instructions for the gas chromatographic complex "Chromos GH-1000". (The equipment used meets the technical specifications TU 9443-001-52470488-2006, No. 21064-06 in the State Register of Measuring Instruments). After treatment of chronic catarrhal gingivitis, the collection of mixed saliva and its study are repeated. And when changing the concentration in% palmitic acid from 12.9 ± 1.9 to 24.0 ± 1.7 and linoleic acid from 44.2 ± 1.9 to 31.2 ± 1.2, the treatment is evaluated as effective. In the absence of changes in the indicators of fatty acids, a severe course of the disease is predicted.

The proposed method evaluated the effectiveness of the treatment of chronic catarrhal gingivitis in 50 children with diagnosed gingivitis. The long-term results obtained indicate a correct assessment of the effectiveness of the treatment according to the proposed method.

Examples of specific implementation of the proposed method are given in the form of extracts from a medical record.

Example 1

Patient Maria I., 14 years old. Diagnosis: Chronic catarrhal gingivitis. Saliva was collected by spitting out a patient into a sterile test tube in the morning on an empty stomach on uncleaned teeth.

The proposed method was a biochemical study of the oral fluid in a patient before treatment and 6 months after treatment by capillary gas chromatography. After the study, we determined the change in the concentration (in%) of palmitic and linoleic acids, which amounted to:

- before treatment: palmitic 11.10, linoleic 42.35;

- after treatment: palmitic 22.32, linoleic 30.01.

Based on the obtained values, it was concluded that a positive treatment effect was achieved. The results are confirmed by clinical data, namely the RMA index (periodontal tissue condition assessment index) and the PHR oral hygiene performance index, whose value normally approaches 0 point or 0%. So, before treatment, the PMA index was 16.27 ± 1.39%, the pH index was 0.89 ± 0.10 points, after the comprehensive treatment of chronic catarrhal gingivitis, the index values significantly decreased, so the PMA index was 0.43 ± 0.27% , the pH index is 0.20 ± 0.02 points, which indicates a positive trend in the treatment.

Example 2

Patient Victor P., 12 years old

Diagnosis: Chronic catarrhal gingivitis.

Saliva was collected directly in the dental clinic by spitting out a patient into a sterile test tube in the morning on an empty stomach on uncleaned teeth.

The proposed method was carried out a biochemical study of the oral fluid in the patient before treatment and 6 months after the treatment by capillary gas chromatography, after which the change in concentration (%) of palmitic and linoleic acids was determined, which amounted to:

- before treatment: palmitic - 14.80, linoleic - 45.90,

- after treatment: palmitic - 25.04, linoleic - 31.91;

after which it was concluded that a good treatment effect was achieved, the concentration of indicators was close to normal. The results are confirmed by clinical data, namely the RMA index (periodontal tissue condition assessment index) and the PHR oral hygiene performance index, whose value normally approaches 0 point or 0%. Before treatment, the PMA index was 16.82 ± 1.39%; after treatment, 4.20 ± 1.36%;

The PHR index before treatment is 0.90 ± 0.10 points, after treatment, 0.3 ± 0.14 points, which indicates a positive trend in the treatment.

Example 3

Patient Nikolay K., 14 years old. Diagnosis: Chronic catarrhal gingivitis.

Saliva was collected by spitting out a patient into a sterile test tube in the morning on an empty stomach on uncleaned teeth.

The proposed method was a biochemical study of the oral fluid before and after the treatment (6 months after the start of treatment).

The following results were obtained:

- before treatment: palmitic - 13.80, linoleic - 44.90,

- after treatment: palmitic - 27.04, linoleic - 28.90.

It is concluded that there is no cure, no improvement in the fatty acid profile of the oral fluid has been achieved. Before treatment, the PMA index was 20.02 ± 0.04%; after treatment, 19.20 ± 0.36%; The pH index before treatment was 0.80 ± 0.10 points, after treatment 0.80 ± 0.14 points, which indicates the ineffectiveness of this treatment. Observation of this patient was continued taking into account the correction of treatment tactics.

Example 4

Patient Sergey M., 12 years old. Diagnosis: Chronic catarrhal gingivitis

Saliva was collected by spitting out a patient into a sterile test tube in the morning on an empty stomach on uncleaned teeth. The proposed method was an assessment of the effectiveness of treatment. A biochemical study using the method of capillary gas chromatography of the oral liquid was performed before treatment and 6 months after the start of treatment. The concentration (in%) of palmitic and linoleic acids amounted to:

- before treatment: palmitic - 12.60, linoleic - 45.50;

- after treatment: palmitic - 23.10, linoleic - 34.60.

Thus, a change in palmitic acid meets the criterion of "from 12.9 ± 1.9 to 24.0 ± 1.7," and linoleic acid does not meet the criterion of "from 44.2 ± 1.9 to 31.2 ± 1.2" . Since only one of the conditions has been fulfilled, a conclusion has been drawn on evaluating the effectiveness of treatment - no improvement in the fatty acid profile of the oral fluid has been achieved. Before treatment, the PMA index was 16.02 ± 0.04%, after treatment 15.47 ± 0.36%. The pH index before treatment was 0.60 ± 0.10 points, after treatment 0.60 ± 0.14 points, which indicates the ineffectiveness of this treatment. Observation of this patient was continued taking into account the correction of treatment tactics.

Example 5

Patient Elena K., 14 years old

Diagnosis: Chronic catarrhal gingivitis. Saliva was collected by spitting out a patient into a sterile test tube in the morning on an empty stomach on uncleaned teeth.

The proposed method was an assessment of the effectiveness of treatment. A biochemical study using the method of capillary gas chromatography of the oral liquid was performed before and after the treatment (3 months after the start of treatment in order to determine the feasibility of the study by the method of capillary gas chromatography at this time of treatment). The concentration (in%) of palmitic and linoleic acids amounted to:

- before treatment: palmitic - 12.60, linoleic - 43.30;

- after treatment (after 3 months): palmitic - 19.90, linoleic - 33.15.

The following indices were clinically obtained: before treatment, PMA was 22.02 ± 0.04%, after treatment after 3 months, 18.20 ± 0.36%; The PHR before treatment was 0.65 ± 0.10 points, after treatment after 3 months 0.48 ± 0.14 points, which indicates a positive result of treatment.

However, the values for both acids after treatment do not "fall" into the necessary ranges, therefore, it was decided to conduct the study within the period established by WHO - at 6 months and continue treatment without adjusting treatment tactics.

This patient was tested for saliva by capillary gas chromatography 6 months after the start of treatment.

The change in the concentration (%) of palmitic and linoleic acids amounted to:

- after treatment (after 6 months): palmitic - 19.40, linoleic - 33.65.

According to the proposed evaluation method, the treatment is ineffective. The results of clinical diagnostic methods also did not give a positive result.

After treatment after 6 months, the PMA index was 25.11 ± 0.01%;

The index of pH after treatment after 6 months was 0.66 ± 0.15 points, which indicates the ineffectiveness of this treatment. Observation of this patient was continued taking into account the correction of treatment tactics.

Thus, the study on the treatment period of 3 months by capillary gas chromatography is advisable, as it allows you to accurately evaluate the effectiveness of treatment and adjust the treatment tactics of chronic catarrhal gingivitis.

The measurement of concentrations of only two fatty acids simplifies the implementation of the method, which reduces the study time to 1 hour. In addition, the method of capillary gas chromatography is confidently suitable for individualization, identification of individual substances, and not their mixtures, as in the case of spectroscopic analysis methods. Also, using gas chromatography, it becomes possible to use standards of compounds with the aim of validating other methods, studying the biochemical mechanisms of pathological processes. The use of capillary gas chromatography expands the arsenal of available methods for diagnosing and evaluating the effectiveness of various pathologies, including chronic catarrhal gingivitis.

Claims (1)

A method for evaluating the effectiveness of treatment of chronic catarrhal gingivitis in children, including a biochemical study of the oral fluid before and after the treatment, characterized in that the fatty acid composition of the oral fluid is determined using capillary gas chromatography, namely, the concentration of palmitic and linoleic acids, and when the concentration is changed, measured in%, palmitic acid from 12.9 ± 1.9 to 24.0 ± 1.7 and linoleic acid from 44.2 ± 1.9 to 31.2 ± 1.2, the treatment is evaluated as effective.