RU2768462C1 - Method of administering medicinal substances on the oral mucosa in patients suffering from chronic kidney disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry, and can be used in treating oral mucosa of patients suffering from chronic kidney disease (CKD) both at stages of drug therapy, and in the process of rehabilitation after kidney transplantation. Method involves making thermoplastic retention trays for the upper and lower jaws and placing them on the dental arch with overlapping the alveolar portion. Trays have a depot where the medicinal preparation is introduced. Tray for the upper jaw comprises a depot with width of 1.5 cm and length of 2 cm, located when the tray is placed in the oral cavity in the region of the sagittal palatine suture, connected by a canal to another depot, dimensions of which are selected individually depending on the height of the clinical crown of teeth, which is located when the tray is placed in the oral cavity from the vestibular and oral surfaces of each tooth of the upper jaw at the level of the necks of the teeth. Tray for the lower jaw has a depot, the dimensions of which are selected individually depending on the height of the clinical crown of teeth, which is located when the tray is placed into the oral cavity from the vestibular and oral surfaces of each tooth of the lower jaw at the level of the necks of the teeth.

EFFECT: method provides prolonged exposure of the preparation and does not cause discomfort in the patient due to the use of thermoplastic retention trays having a depot for introduction of medicinal substances.

1 cl, 1 ex

Description

The method relates to medicine, namely to dentistry, and can be used in the treatment of the oral mucosa of patients suffering from chronic kidney disease (CKD) both at the stages of drug therapy and in the process of rehabilitation after kidney transplantation.

At the moment, the benefit provided to patients suffering from kidney disease does not fully cover the general somatic status, namely, damage to teeth and periodontal structures both at the stages of treatment and in the process of rehabilitation after kidney transplantation. When examining the oral mucosa of patients suffering from CKD, symptoms of bleeding, hyperplastic and ulcerative-necrotic processes, which are complicated by fungal and herpes infection, may be detected. Often there is hyperemia or cyanosis of the oral mucosa, lining and atrophy of the papillae of the tongue, keratosis, changes in the mucous membrane of the lips, seizures, as well as increased fragility and permeability of the vascular walls, causing bleeding during chewing and brushing teeth. The provision of dental care in these clinical cases is often difficult due to the inability of the patient to frequent visits to the dentist, which is necessary to maintain an adequate level of hygiene and orthodontic treatment. The wide prevalence of complications manifested in the patient's oral cavity leads to difficulties in the use of orthodontic retention structures used during the rehabilitation period.

The literature describes a method using an immediate prosthesis used in the area of the frontal group of teeth of the upper and lower jaws [RU 2 675 687, publ. 12/21/2018, Bull. No. 36]. Its essence lies in the manufacture of plaster models based on the obtained impressions of the upper and lower jaws, the removal of teeth on them in accordance with the operation plan, and the manufacture of an acrylic removable lamellar denture of the resulting defect. From the vestibular and oral sides of the prosthesis, through grooves 2-3 mm wide are cut, repeating the boundaries of the future defect in length, and a cavity 3-4 mm deep is cut from the inside along the boundaries of the future defect. The prosthesis is fitted to the plaster model, a surgical polypropylene mesh is pulled through the sawn grooves, the grooves are filled with quick-hardening plastic, followed by the final processing of the prosthesis after its polymerization. After the operation, the cavity under the mesh is filled with a medicinal substance.

The disadvantages of this method are the need to involve a dental laboratory in the manufacture of the prosthesis, which is due to the complexity of the design and the impossibility of manufacturing the described dentures in one visit, as well as the significant thickness of the bases of the dentures, which creates discomfort when used by patients suffering from CRF.

The prototype is a method of making drugs in the oral cavity [RU 2558468, publ. 06/10/2015, Bull. No. 16], implying the introduction of a drug on a postoperative wound with direct dental or jaw prosthetics, which consists in the following: in the immediate prosthesis, retention points are designed with a depth of 3-4 mm with an interval of 4 mm between them using spherical burs with a diameter of 2 mm, perform surgery, introduce a drug into the retention points with subsequent application of the prosthesis to the postoperative field, give the patient recommendations on the use of the immediate prosthesis, its hygiene and on the introduction of the drug into the retention points after eating and subsequent hygiene of the prosthesis.

The disadvantages of this method is that, although it is less labor intensive to manufacture, it implies the need for regular "replenishment" of the drug substance, caused by the lack of a sufficient depot for the drug.

The technical result is the creation of a convenient method for introducing medicinal substances to the oral mucosa in patients suffering from chronic kidney disease, which provides a long-term exposure of the drug and does not cause discomfort to the patient.

The claimed technical result is achieved by creating thermoplastic retention caps with a depot for the introduction of medicinal substances.

The method includes the manufacture of thermoplastic retention trays for the upper and lower jaws, which are placed on the dentition and cover the alveolar part. Mouth guards have a depot into which a drug is introduced. The mouth guard for the upper jaw contains a drug depot 1.5 cm wide and 2 cm long, located when the mouth guard is placed in the oral cavity in the region of the sagittal palatine suture, connected by a channel to another drug depot, the dimensions of which are selected individually depending on the height of the clinical crowns of the teeth, which is located when the mouth guard is placed in the oral cavity from the vestibular and oral surfaces of each tooth of the upper jaw at the level of the necks of the teeth. The tray for the lower jaw has a depot for the drug, the dimensions of which are selected individually depending on the height of the clinical crown of the teeth, which is located when the tray is placed in the oral cavity from the vestibular and oral surfaces of each tooth of the lower jaw at the level of the necks of the teeth.

Clinical example

To the dental clinic of the Ryazan State Medical University named after V.I. Semashko was addressed by patient A., 24 years old, who had undergone orthodontic treatment and suffered from chronic renal failure, with complaints of bleeding gums, bluing of the oral mucosa with the presence of local painless hemorrhagic spots. After the examination, the dentist-orthodontist made an individual retention mouth guard, which provides sufficient exposure of the medicinal substance necessary for exposure to the affected oral mucosa of the patient. A periodontist-stomatologist prescribed a plan of drug treatment for this patient and made recommendations.

After 14 days, the patient was scheduled for a second appointment, including monitoring the results of the treatment, assessing the convenience of using the manufactured retention mouthguard, and determining a further treatment plan. It was found that the proposed original design of this mouthguard made it possible to avoid difficulties in its use associated with pain in the places where the plastic adheres to the lesions of the oral mucosa. It was also noted that an increase in the exposure time of the medicinal substance with the help of the proposed kappa provided a faster healing process of lesions, due to the presence of retention channels of sufficient volume.

The patient was given individual recommendations for the care and hygiene of the oral cavity, with an appearance for a follow-up examination after 3 months.

Claims (1)

A method for introducing medicinal substances into the oral mucosa in patients suffering from chronic kidney disease, including the manufacture of thermoplastic retention mouthguards for the upper and lower jaws and their location on the dentition with overlapping of the alveolar part, characterized in that the mouthguards have a depot where the drug is applied, when In this case, the mouth guard for the upper jaw contains a depot 1.5 cm wide and 2 cm long, located when the mouth guard is placed in the oral cavity in the region of the sagittal palatine suture, connected by a channel to another depot, the dimensions of which are selected individually depending on the height of the clinical crown of the teeth, which is located when the mouthguard is placed in the oral cavity from the vestibular and oral surfaces of each tooth of the upper jaw at the level of the necks of the teeth, and the mouthguard for the lower jaw has a depot, the dimensions of which are selected individually depending on the height of the clinical crown of the teeth, which is located when the mouthguard is placed in the oral cavity with the vestibular and oral sex of each tooth of the lower jaw at the level of the necks of the teeth.