RU2803445C1 - Personal oral hygiene product for children with a confirmed diagnosis of celiac disease and a method of its use - Google Patents

Abstract

FIELD: medicine; pediatric dentistry.

SUBSTANCE: invention can be used for individual oral hygiene in children with a confirmed diagnosis of celiac disease. The following is proposed: means of individual oral hygiene for children with a confirmed diagnosis of celiac disease with the following composition: 0.12–0.15 wt.% of bicarbonate; 0.08–0.1 wt.% of sulfates (SO₄ ^2-); 0.025–0.034 wt.% of chlorides Cl^-; 0.025–0.035 wt.% of calcium Ca²⁺; 0.0045–0.0055 wt.% of magnesium Mg²⁺; 0.06–0.08 wt.% of sodium + potassium (Na⁺ + K⁺); 0.003–0.0045 wt.% of silicic acid H₂SiO₃, 0.0001–0.0002 wt.% of cinnamon essential oil, 0.0001–0.0002 wt.% of orange essential oil, water is the rest. Also a method of individual oral hygiene is proposed for children with a confirmed diagnosis of celiac disease using the above means and characterized by irrigation of the oral cavity after each meal.

EFFECT: increased effectiveness of individual oral hygiene for children with a confirmed diagnosis of celiac disease in comparison with the standard method of oral hygiene by brushing teeth with toothpaste.

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Description

The invention relates to the field of medicine, namely pediatric dentistry, and can be used for individual oral hygiene in children with a confirmed diagnosis of celiac disease.

Nowadays, when examining a child with a high cariogenic situation in the anamnesis, a disease such as celiac disease is increasingly encountered. Celiac disease develops from a combination of several factors in genetically predisposed patients. With this disease, the mucous membrane of the duodenum and small intestine is affected. A combination of factors leads to the development of malabsorption syndrome in combination with many extraintestinal diseases, including dental ones. Violation of absorption processes in the intestine leads to a decrease in the level of microelements, proteins and vitamins in the blood and other body fluids.

Over the past decades, more and more authors have directed their research to dental pathologies manifested in patients with celiac disease. Oral fluid is of great importance for maintaining the stable condition of hard dental tissues. It represents the secretion of the salivary glands, the breakdown of migrating leukocytes, the microflora of the oral cavity and its metabolic products, and oral detritus. Changes in the composition of saliva can lead to disruption of the structure and chemical composition of dental tissues, as well as contribute to the development of diseases of the mucous membrane in children with a confirmed diagnosis of celiac disease.

The general status of the child’s body determines the condition of the dental tissues during the period of their formation, development and during the further functioning of the teeth in the oral cavity. It is known that chronic diseases of the digestive tract, which are accompanied by a deficiency of proteins, fats, carbohydrates, mineral salts and vitamins, have an extremely adverse effect on the formation of hard dental tissues, and a violation of the hormonal and immunological status leads to chronic diseases of the mucous membranes of the oral cavity.

It is not uncommon for patients with celiac disease to experience aphthous stomatitis, the mechanism of its occurrence is practically unknown. [K.A. Kolesnik, I.G. Romanenko, D.V. Dudar “Frequent relapses of aphthous stomatitis as a manifest sign of celiac disease”, 2018. “Clinical significance of celiac disease in patients with recurrent aphthous stomatitis” / S. Yaşar, B. Yaşar, E. Abut, S. Z. Aşiran // Turk. J. Gastroenterol. - 2012]. In addition to recurrent aphthae, according to the literature, cheilitis, stomatitis, glossitis, and periodontopathies were diagnosed with celiac disease. According to the literature, the most common periodontal disease in the prepubertal and pubertal periods is catarrhal and hypertrophic gingivitis.

Italian scientists studied the prevalence of calcium metabolism disorders and bone defects in 54 children (average age 7 years) with celiac disease who were not treated [cit. C. Zanchietal, 2008]. Compared to the control group, patients with celiac disease had significantly lower concentrations of calcium and vitamin D, but significantly higher concentrations of parathyroid hormone. Most of the children examined were found to have osteopenia and changes in the hard tissues of the teeth. Therefore, according to the authors, when diagnosing celiac disease in childhood, it is necessary to evaluate bone metabolism. The relationship between the symptoms of celiac disease and dental diseases suggests the importance of research in the field of pediatric dentistry.

A comparison of the cariogenic situation in the oral cavity in children with celiac disease and children without this disease is described in a study by Satygo E.A. and Goncharova O.V. The authors note that children with celiac disease have higher rates of dental caries than children who do not have this disease [Satygo EA, Goncharova OV. Analysis of the leading pathogenic factors of dental caries in children with celiac disease. Dentistry = Dentistry.2020;99(3):71-73. (In Russ.).] [Satygo E.A., Goncharova O.V. Analysis of the leading pathogenetic factors of dental caries in children with celiac disease. Dentistry. 2020;99(3):71-73.] [https://doi.org/10.17116/stomat20209903171].

There is an undeniable relationship between the properties of oral fluid and the resistance of tooth enamel [Nemirovskaya M.A. Resistance of tooth enamel, some properties of oral fluid and the concentration of 25-hydroxycalciferol in the blood serum in children with celiac disease // Postgraduate Bulletin of the Volga region. - 2022. - T. 22. - No. 1. - pp. 28-31. doi: 10.55531/2072-2354.2022.22.1.28-31 (In English) Nemirovskaya M.A. Enamel resistance, properties of oral fluid and the concentration of 25-hydroxycalciferol in blood serum in children with celiac disease // Aspirantskiy Vestnik Povolzhiya. - 2022. - Vol. 22. - N. 1. - P. 28-31. doi: 10.55531/2072-2354.2022.22.1.28-31], which shows the need to develop a unique method of individual oral hygiene in children with a confirmed diagnosis of celiac disease.

Currently, various hygiene products are used for individual oral hygiene. The standard and most common method of personal hygiene among the population is considered to be removing plaque 2 times a day using a toothbrush of varying degrees of hardness and toothpaste. Previously, researchers have not proposed any other hygiene methods for children with a confirmed diagnosis of celiac disease other than the standard one. But, taking into account the peculiarities of the pathology of the gastrointestinal tract in children with a confirmed diagnosis of celiac disease, they need a special method of individual oral hygiene, which has several directions of action. Known patented analogues of the claimed invention were also considered.

A means of preventing oral diseases is known (Mouthwash: patent RU2190387, Russian Federation, application 2001117252, application 06/19/2001, published 10/10/2002), containing ascorbic acid, citric acid, succinic acid, sodium fluoride, malavit, oil mint, eftiderm, glycerin and water. The components are taken in a certain quantitative ratio. The product has anti-inflammatory and antimicrobial effects.

The disadvantage of this product is the need for a high frequency of use of the preventive hygiene product, as well as the presence of beekeeping products and a non-steroidal anti-inflammatory drug in its composition, which determine the likelihood of allergic reactions and other side effects. In addition, the mouthwash is a multi-component product that can cause adverse events in the gastrointestinal tract in children with celiac disease.

There is also a known method for the prevention of oral diseases (Sadykova O.M., Kuklina A.K., Kropaneva E.K., Markov A.A. The influence of Fateevskaya mineral water on the condition of the oral cavity / Science Time. - 2015. - No. 10(22). - P. 318-324), which consists in the use of Fateevskaya mineral water, which is introduced into the main hygiene product - toothpaste.

The disadvantages of this method include the short-term effect of mineral water on the oral mucosa when brushing teeth, the low content of mineral components in Fateevskaya water, the absence in the water of a number of lipids, amino acids and vitamins that have a beneficial effect on the oral mucosa and help improve salivation, the complexity of the process of introducing mineral water into toothpaste.

The closest to the claimed invention is a method of individual oral hygiene (Method for the prevention of gingivitis and hyposialia in patients with juvenile rheumatoid arthritis: patent RU2685787, Russian Federation, application RU2017141192, application November 27, 2017, published April 23, 2019), including the use of Saki brine solution lakes in a dilution of 1:5, which is prescribed in the form of rinses with holding the solution in the mouth for 1-3 minutes, in the morning and evening after brushing your teeth - for 7-10 days.

The disadvantages of the closest analogue include:

The rinse aid (solution) must be taken into the mouth, rinsed and spat. Thus, special conditions are required for its use, at least a sink. At school, this creates additional problems, which is why children simply refuse this procedure.

-application of the method for a limited period of time (7-10 days)

- the analogue has a superficial effect on epithelial tissues, while children diagnosed with celiac disease need mineralization of hard dental tissues;

- the analogue does not claim the effect of improving the properties of oral fluid, including the rate of salivation, whereas for patients diagnosed with celiac disease, constant improvement of the properties of oral fluid is necessary.

The technical problem is the need to develop a means and method for individual oral hygiene for children with a confirmed diagnosis of celiac disease who do not have the above disadvantages.

The technical result is to increase the effectiveness of individual oral hygiene for children with a confirmed diagnosis of celiac disease.

The technical result is achieved in that the personal oral hygiene product for children with a confirmed diagnosis of celiac disease, including water, bicarbonates, magnesium, sodium and potassium, according to the invention additionally contains sulfates, chlorides, calcium, cinnamon essential oil and orange essential oil in the following ratio of components , wt,%:

hydrocarbonates 0.12-0.15 sulfates (SO42-) 0.08-0.1 chlorides Cl- 0.025-0.034 calcium Ca2+ 0.025-0.035 magnesium Mg2+ 0.0045-0.0055 sodium+potassium (Na++K+) 0.06-0.08 silicic acid H2SiO3 0.003-0.0045 cinnamon essential oil 0.0001-0.0002 orange essential oil 0.0001-0.0002 water rest

The proposed product was made by using Slavyanovskaya mineral water, to which 1 drop each of cinnamon essential oil and orange essential oil was added.

Also, the technical result is achieved through a method in which the oral cavity is irrigated with the above-mentioned product after each meal. A total of 3 ml of solution is used for one irrigation.

The inventive method is carried out as follows.

The basis is a standard method of brushing teeth with an age-appropriate brush with a toothpaste that does not contain sodium lauryl sulfate, twice a day. After each meal, the oral cavity is irrigated with a spray with essential oils. The optimal composition of liquid for oral irrigation was developed during the study.

Irrigation is carried out as follows: the patient, with previously washed hands, pulls back the cheek and sprays the teeth sequentially, starting from the first segment of the upper jaw and ending with the fourth segment of the lower jaw after each meal. One dose of spray for each segment of teeth. Oral irrigation is used as an additional means of oral hygiene in children at high risk of developing caries. This allows you to increase the mineralizing potential of the oral fluid, increase the rate of salivation, reduce the viscosity of saliva, stabilize the pH of the oral fluid, and ensure the renewal of the normal microflora of the oral cavity. Thanks to the application method, the consumption of the product is much more economical than the nearest analogue.

The proposed method and means of additional oral hygiene in children with a confirmed diagnosis of celiac disease are new and help reduce the risk of developing caries in children with celiac disease, especially if they do not follow a gluten-free diet.

The claimed invention is illustrated by examples.

Example 1. Patient A., 10 years old.

The diagnosis of celiac disease was made at the age of 8, following a gluten-free diet is difficult, the bite is removable, the teeth are sanitized. Narrowing of the upper jaw. Caries + filling + extracted tooth (KPU) + intensity of caries of permanent teeth - 3.7, salivation rate 0.1 ml/min, pH of oral fluid - 7.9 (units), mineralizing potential of saliva -1.3 (point) , enamel resistance - 6.91 (point), hygiene index - 70.1%.

In this example, a product with the following composition was used, wt.%:

hydrocarbonates 0.12 sulfates (SO42-) 0.08 chlorides Cl- 0.025 calcium Ca2+ 0.025 magnesium Mg2+ 0.0045 sodium+potassium (Na++K+) 0.06 silicic acid H2SiO3 0.003 cinnamon essential oil 0.0001 orange essential oil 0.0001 water rest

Training in oral hygiene in a standard way and training in the use of liquid for oral irrigation were provided. It is recommended to use toothpaste without sodium lauryl sulfate. Control examination and professional hygiene (brush + paste) once a month, spraying the oral cavity after each meal. After 6 months, the salivation rate was 0.2 ml/min, the pH of the oral fluid was 7.5 (units), the mineralizing potential of saliva was -1.9 (points), enamel resistance - 5.17 (points), hygiene index - 47.1 % in patient A, 10 years.

Example 2. Patient B., 8 years old.

The diagnosis of celiac disease was made at the age of 4, adherence to a gluten-free diet is difficult, the bite is removable, the teeth are sanitized. Narrowing of the upper jaw. Caries + filling + extracted tooth (KPU) + intensity of caries of permanent teeth - 3.5, salivation rate 0.1 ml/min, pH of oral fluid - 8.1 (units), mineralizing potential of saliva -1.3 (point) , enamel resistance - 6.74 (point), hygiene index - 71.3%.

In this example, a product with the following composition was used, wt.%:

hydrocarbonates 0.15 sulfates (SO42-) 0.1 chlorides Cl- 0.034 calcium Ca2+ 0.035 magnesium Mg2+ 0.0055 sodium+potassium (Na++K+) 0.08 silicic acid H2SiO3 0.0045 cinnamon essential oil 0.0002 orange essential oil 0.0002 water rest

Training in oral hygiene in a standard way and training in the use of liquid for oral irrigation were provided. It is recommended to use toothpaste without sodium lauryl sulfate. Control examination and professional hygiene (brush + paste) once a month, spraying the oral cavity after each meal. After 6 months, the salivation rate was 0.2 ml/min, the pH of the oral fluid was 7.4 (units), the mineralizing potential of saliva was -1.9 (points), enamel resistance - 5.34 (points), hygiene index - 49.2 % in patient B, 8 years old.

In summary, these clinical examples show that the use of oral irrigation fluid leads to improved oral health outcomes, which in turn leads to a reduced risk of caries in children with celiac disease, especially those not following a gluten-free diet.

Additionally, the effectiveness of the proposed method was compared with the standard method of individual oral hygiene in patients with a confirmed diagnosis of celiac disease. 27 children with a confirmed diagnosis of celiac disease were examined. 12 children (group 1) were examined using a standard method of oral hygiene, 15 children (group 2) used the inventive method of individual oral hygiene.

Efficiency was determined according to the following criteria:

- determination of the oral hygiene index according to O’Leary (1969). All surfaces of all teeth were stained with a water-based dye. The dye stained the dental plaque, and the ratio of the painted surfaces to all surfaces of the teeth was calculated. (Table 1)

- determination of the pH of oral fluid was carried out using test strips for determining the pH of biological fluids. A strip of paper was evenly moistened with saliva in the child's mouth for 3-5 seconds, then the color change was compared with the color samples supplied by the manufacturer of the test strips. (Table 1)

- determination of salivation rate using the formula: CC(ml/min)=V/t, where V is the volume of saliva released (ml), t is the time of saliva collection (min); collection of saliva in graduated sterile tubes for 10 minutes without stimulation on an empty stomach. (Table 1)

- study of the mineralizing potential of saliva according to the method of P.A. Leusa; mixed saliva was taken directly into the oral cavity using a sterile pipette; 3 drops of saliva were applied from a pipette onto a clean, grease-free glass slide and dried at room temperature; the resulting preparations were studied under low magnification; The assessment of the mineralizing potential of saliva was carried out taking into account the entire area of dried drops and was expressed in an average score, depending on the types of crystal formation. (Table 1)

- determination of the level of structural and functional resistance of enamel was carried out as follows: the vestibular surface of one of the upper central incisors was cleared of plaque; dried and isolated the tooth from saliva; a drop of 1% hydrochloric acid solution with a diameter of 1.5-2 mm was applied to the center of the vestibular surface of the tooth using a micropipette; after 5 seconds the drop was washed off with distilled water; the tooth surface was dried with a cotton ball; 1 drop of a 1% solution of methylene blue was applied to the area of enamel that was etched; the dye was immediately removed with a dry cotton ball in one movement, pressing the ball tightly to the surface of the tooth; The acid resistance of the enamel was assessed in daylight based on the color intensity; the color of the stained area was compared with the shades of a standard 10-point scale (Table 1).

Table 1. Comparative data on indicators of the cariogenic situation in the oral cavity in children with celiac disease at the beginning of the study and after 6 months At the beginning of the study (state after the first procedure) In 6 months Oral hygiene in a standard way (group 1) Oral hygiene using the claimed method (group 2) Oral hygiene in a standard way (group 1) Oral hygiene using the claimed method (group 2) Hygiene index (%). 74.37±4.78 70.15± 3.42 69.28±4.61 47.19±3.21 Salivation rate (ml/min). 0.11±0.02 0.13±0.01 0.12±0.01 0.21±0.02 Oral fluid pH (pH units) 7.91±0.31 7.73±0.52 7.72±0.34 7.24±0.41 Mineralizing potential of saliva (score). 1.31±0.01 1.31±0.01 1.45±0.02 1.97±0.01 Enamel resistance (score). 6.92±0.41 6.91±0.42 6.54±0.37 5.17±0.38

The comparative table shows that at the beginning of the study, the average pH values of the oral fluid in children with celiac disease were 7.91±0.31 in group 1 and 7.73±0.52 in group 2. After 6 months, this indicator was 7.72±0.34 in group 1, 7.24±0.41 in group 2 (Table 1).

The average rate of salivation in the examined children with a confirmed diagnosis of celiac disease at the beginning of the study was 0.11 ± 0.02 ml/min in group 1, 0.13 ± 0.01 ml/min in group 2. After 6 months, this indicator was 0.12±0.01 ml/min in group 1, 0.21±0.02 ml/min in group 2 (Table 1).

The mineralizing potential of saliva at the beginning of the study in group 1 was 1.31 ± 0.01 points, in group 2 this figure was 1.31 ± 0.01 points. After 6 months, this indicator was 1.45 ± 0.02 points in group 1, 1.97 ± 0.01 points in group 2 (Table 1).

The hygiene index in the examined children with a confirmed diagnosis of celiac disease at the beginning of the study was 74.37 ± 4.78% in group 1, 70.15 ± 3.42% in group 2. After 6 months, this figure was 69.28 ± 4.61% in group 1, 47.19 ± 3.21% in group 2 (Table 1).

The average value obtained during the test of structural and functional resistance of enamel in children with a confirmed diagnosis of celiac disease was 6.92±0.41 points in group 1, 6.91±0.42 points in group 2. After 6 months, this indicator was 6.54 ± 0.41 points in group 1, 6.17 ± 0.38 points in group 2 (Table 1).

Our research shows that there is a high risk of developing caries in children with celiac disease, especially if they do not follow a gluten-free diet. The inventive method of oral hygiene in children with a confirmed diagnosis of celiac disease significantly reduces the indicators of the cariogenic situation in the oral cavity, thereby reducing the risk of developing oral caries in this category of patients.

Claims (3)

1. A personal oral hygiene product for children with a confirmed diagnosis of celiac disease, including water, bicarbonates, magnesium, sodium and potassium, characterized in that it additionally contains sulfates, chlorides, calcium, cinnamon essential oil and orange essential oil in the following ratio of components, wt .%: hydrocarbonates 0.12-0.15 sulfates (SO ₄ ^2- ) 0.08-0.1 chlorides Cl ^- 0.025-0.034 calcium Ca ²⁺ 0.025-0.035 magnesium Mg ²⁺ 0.0045-0.0055 sodium+potassium (Na ⁺ +K ⁺ ) 0.06-0.08 silicic acid H ₂ SiO ₃ 0.003-0.0045 cinnamon essential oil 0.0001-0.0002 orange essential oil 0.0001-0.0002 water rest 2. A method of individual oral hygiene for children with a confirmed diagnosis of celiac disease using the product according to claim 1, characterized in that the oral cavity is irrigated after each meal.