Мultipurpose treatment of chronic generalized catarrhal gingivitis in children with cystic fibrosis

Размещено на http://www.allbest.ru/

Размещено на http://www.allbest.ru/

МULTIPURPOSE TREATMENT OF CHRONIC GENERALIZED CATARRHAL GINGIVITIS IN CHILDREN WITH CYSTIC FIBROSIS

Kharkiv National Medical University (Kharkiv)

This study is a fragment of scientific research «The nature, structure and treatment of major dental diseases»; the number of state registration is № 0116U004975, which is performed at the Pediatric Dentistry, Pediatric Maxillofacial Surgery and Implantology Department of Kharkiv National Medical University.

The high level of dental diseases into child's population is one of the actual medical problem. Scientific researches are focused mainly on determining the mechanisms of the relationship between somatic and dental diseases, which are mutually worsening the course of the disease. Today, many studies have shown a high prevalence of periodontal diseases among children with somatic pathology [1,6].

Chronic generalized catarrhal gingivitis (CGCG) is recorded in children with cystic fibrosis, already at an early age. Cystic fibrosis is a rare hereditary disease. It is caused by a mutation of the gene for the cystic fibrosis transmembrane conductance regulator protein, and is characterized by multiorgan disorders, severe course and complicated prognosis. This disease has clinical manifestations in the oral cavity, like many other systemic lesions [5,22].

The high prevalence and early manifestation of CGCG is caused by a combination of many factors. Secondary changes arising due to somatic disease, poor oral hygiene and dental status, reduction of the protective properties of the oral fluid, a compromised immune mechanisms are aggravating pathogenetic factors for gum diseases. Chronic colonization of respiratory tract by pathogenic microflora, which transited into the oral cavity and contributes to the development of inflammatory diseases of periodontal tissues is typical for patients with cystic fibrosis [18,24].

In conditions of insufficient oral hygiene, the amount of dental plague increases. It prevents the access of oral fluid inside the biofilm and implementation of the protective functions. There is a replacement of species of microorganisms and the emergence of anaerobic species with distinct pathogenic properties. These bacteria produce endotoxins and enzymes that directly damage the cells of periodontal tissues and contribute to the weakening of defense mechanisms [10].

Pathogenetic mechanisms of cystic fibrosis lead to disruption of normal physiological processes in the oral cavity in particular, the reduced level of salivation, increased oral fluid viscosity inhibited local immunity.

Contents of antibodies and proteins with adhesive properties and are able to participate in antimicrobial protection is violated at insufficient secretion of saliva. Exfoliative and angular cheilitis, chronic cracked lips, сandida stomatitis, other damages of the oral mucosa with clinical manifestations of swelling, petechiae are observed in patients [2,9,12,15].

Factors, which are caused by a significant impact of somatic disease on periodontal condition, can be considered as risk factors of CGCG development in these patients. At selection the preventive measures it is important to find out the possibility of influence on these factors. Despite numerous studies in the development of treatments and preventive CGCG in children with cystic fibrosis, the problem has not been given attention.

The aim of the study. Evaluate the clinical efficacy of the proposed complex of etiotropic preventive and treatment measures of CGCG in children with cystic fibrosis.

Materials and methods. To achieve this goal a clinical dental examination of 15 children aged 4 to 17 years with a confirmed diagnosis of cystic fibrosis has been conducted. Chronic generalized catarrhal gingivitis moderate severity was diagnosed in all children.

The patients' survey included the determination of Fedorov-Volodkina hygiene index (HI), PMA- index, the procedure of unstimulated oral fluid collection, determination the rate of salivation and oral fluid stretching [20,14].

Determination of secretory immunoglobulin sIgA and lysozyme activity in oral fluid was performed to assess the condition of local immunity.

Research of sIgA was conducted by imunoenzymatic methods with analyzer «Lablayn-90», a kit of reagents «ХЕМА» (Russian Federation), using procedures of manufacturer [3]. Determination of lysozyme's activity was performed by lytic bacteria method. A suspension of Micrococcus lysodeickicus was used as a substrate [8,21].

Complex of treatment and preventive measures was developed under the protocols of medical care, specialty «Pediatric dentistry» [19].

catarrhal gingivitis children dental

Table.

Dynamics of investigated parameters after application of the complex preventive and treatment measures, (M ± m)

- the difference is statistically significant (p <0,01).

- the difference is statistically significant (p <0,05).

Professional oral hygiene was carried out after education of oral care and individual selection of means and methods of hygiene. Processing of teeth with gel was performed in order to reduce the initial adhesion of microorganisms on the surface of tooth enamel and increased its resistance. The main components of the gel were: chlorhexidine (bactericidal, anti-inflammatory effect), aminofluor (reduction of metabolic activity of microorganisms, biofilm formation and prevention of tooth decay, the impact on the formation of secretory immunity) and betaine (support the balance of oral mucosa). A mixture of 12,5% acridonacetic acid solution and 0.9% sodium chloride solution in a ratio of 1:3 were appointed as mouth baths [13,17,16].

Electro- and ultrasound therapy were appointed for all patients, considering the antibacterial, anti-inflammatory, hemodynamic, immunomodulatory, stimulating of salivation effect of these physiotherapeutic procedures. Because there are no histological changes in the structure of the ear salivary glands in cystic fibrosis, physiotherapy techniques were applied to the area of these glands, with solution, containing 0,01% of miramistin (a broad spectrum of antimicrobial action, strengthening of anti-inflammatory, trophic, immunomodulating effect of the galvanic current). Complex of treatment and preventive measures was used within 10 days [4,23].

Statistical analysis of the results was performed using generally accepted statistical methods [7,11] the calculation of the arithmetic mean (M) and average error (m). Probability of the results was assessed by Student's criterions of authenticity.

Differences of indicators in comparative groups considered «as a likely» at p <0.05.

Results and discussion. During the analysis of the indicators of study, we found: at the first inspection the HI in a group was 2,48±0,02, that corresponds to «unsatisfactory» oral hygiene. «Good» oral hygiene was not registered in any child. PMA index was 41,2%, that corresponds to middle degree of gum inflammation. Oral fluid stretching value was 0,87±0,32 units, and the rate of salivation was 0.18±0,02 ml/min. The immunological parameters showed the following values: sIgA - 93,52±4,16 ml/liter, lysozyme activity - 10,19±0,38 standard units/liter.

Improve the condition of oral hygiene and periodontal status was observed after application of the complex preventive and treatment measures. Reduction of manifestations of gingivitis was detected: compaction of the gingival margin, reducing of edema and congestive hyperemia of the gums, bleeding reduction. The obtained results of the studied parameters show the significant improvement in hygiene and periodontal status, oral fluid rheology and level of local immunity (Table).

The analysis of the studied parameters showed positive dynamics on their initial values. A fairly significant reduction of hygiene and periodontal indices were determined (HI by 29,8% (p <0,01) and PMA by 21,1% (p <0,05)). The rate of salivation grew by 48,5% (p <0,01). The following data indicates significant (p <0.01) improvements of sIgA (19%), and lysozyme activity (17%) (Fig.).

Conclusion. The prevalence of CGCG in children with cystic fibrosis requires an integrated approach to solving the problem. Treatment, which conducted in children with cystic fibrosis, showed a positive impact on such etiological factors of CGCG as the level of oral hygiene, rheological and immunological properties of oral fluid. Likely to significantly improve of the studied parameters compared to their initial values during the observation period was determined.

The application of the developed health care complex that combines application of gel is based on chlorhexidine, aminofluor and betaine, a solution of mixture the 12,5% acridonacetic acid and 0,9% sodium chloride for oral baths and ultrasound and electrotherapy with 0,01% miramistin as a solution in therapy of CGCG, enhances defense mechanisms of the oral cavity and reduce gingivitis in children with cystic fibrosis.

Further research. The dynamic observation of patients in this group with the purpose of correction of individual treatment and preventive measures, is planned.

References

1. Безвушко Е.В. Взаємозв'язок карієсу зубів із соматичною патологією у дітей, які проживають у районах, різних за екологічною ситуацією / Е.В. Безвушко, І.В. Микичак // Український стоматологічний альманах. - 2012. - № 4. - С. 115-118.

2. Детская терапевтическая стоматология: Национальное руководство / Под ред. В.К. Леонтьева и Л.П. Кисельниковой. - М.: ГЭОТАР-Медиа, 2010. - 890 с.

3. Инструкция по применению набора реагентов для иммуно-ферментного определения секреторного IgA в биологических жидкостях «Секреторный IgA - ИФА» / [Инструкция к набору]. - М.: Хема-Медика, 2013. - 17 с.

4. Калантаров ГК. Особенности течения катарального гингивита на фоне лечения мирамистином / ГК. Калантаров // Журнал научных статей «Здоровье и образование в XXI веке» (Серия медицина). - 2012. - Т 14, № 2. - С. 118-120.

5. Капранов Н.И. Современная диагностика и лечение муковисцидоза / Н.И. Капранов, Е.И. Кондратьева, В.Д. Шерман // Медицинский Совет. - 2014. - № 8. - С. 44-49.

6. Кузняк Н.Б. Стоматологічний статус дітей із супутньою соматичною патологією / Н.Б. Кузняк, О.І. Годованець // Буковинський медичний вісник. - 2010. - Т 14, № 1. - С. 45-47.

7. Лапач С.Н. Статистические методы в медико-биологических исследованиях с использованием Excel / С.Н. Лапач, А.В. Чубенко, П.Н. Бабич. - К.: Морион, 2000. - 320 с.

8. Левицкий А.П. Лизоцим вместо антибиотиков / А.П. Левицкий. - Одесса: КП ОГТ, 2005. - С. 18.

9. Маев И.В. Микрофлора полости рта с различной pH смешанной слюны у больных с кислотозависимыми заболеваниями / И.В. Маев // Медицина критических состояний. - 2008. - № 3. - С. 31-34.

10. Микроорганизмы в заболеваниях пародонта: экология, патогенез, диагностика / А.С. Григорьян, С.Ю. Рахметова, Н.В. Зырянова. - М.: ГЭОТАР-Медиа, 2007. - 56 с.: ил.

11. Москаленко В.Ф. Біостатистика / В.Ф. Москаленко. - К.: Книга плюс, 2009. - 256 с.

12. Новицька І.К. Стан функціональної активності слинних залоз і розповсюдженість стоматологічної патології у дітей пубертатного періоду / І.К. Новицька, Д.К. Косенко // Досягнення біології та медицини. - 2014. - № 1. - С. 45-46.

13. Посохова В.Ф. Комплексная защита десен и зубов / В.Ф. Посохова, В.П. Чуев // Обозрение. Медтехника. - 2011. - № 3 (74). - С. 23.

14. Профилактика основных стоматологических заболеваний / Т.В. Попруженко, ТН. Терехова. - М.: МЕДпресс-информ, 2009. - 464 с.: ил.

15. Пульмонология: нац. руководство / под ред. А.Г Чучалина. -- ГЭОТАР-Медиа, 2009 - 957 с.

16. Романцов М.Г Циклоферон -- опыт применения в детской практике / М.Г Романцов, Л.Г Горячева, А.Л. Коваленко // Детские инфекции. - 2008. - № 4. - С. 62-68.

17. Семиниченко А.Г Динамика активности лизоцима ротовой жидкости у больных хроническим генерализованным пародонтитом (ХГП) при различных методах консервативной терапии / А.Г Семиниченко, А.Р. Антонов // Международный журнал прикладных и фундаментальных исследований. - 2012. - № 5. - С. 87-88.

18. Смольская И.В. Клиническая и микробиологическая эффективность ополаскивателя для полости рта «Дентавит» целебный бальзам у детей с муковисцидозом / И.В. Смольская, ТН. Терехова, Е.И. Гудкова [и др.] // Стоматологический журнал. - № 1. -- 2009. - С. 9-12.

19. Стоматологія (терапевтична, ортопедична, хірургічна, дитяча). Ортодонтія. Протоколи надання медичної допомоги: зб. норм. док. / МОЗ України, Київський МНІАЦ мед. стат. - К.: МНІАЦ медичної статистики, МВЦ «Медінформ», 2012. - 236 с. - (Нормативні директивні правові документи).

20. Терапевтическая стоматология детского возраста / Л.А. Хоменко, Л.П. Кисельникова, Н.И. Смоляр [и др.] / под ред. Л.А. Хоменко, Л.П. Кисельниковой. - К.: Книга плюс, 2013. - 864 с.

21. Ферментативный метод определения дисбиоза полости рта для скрининга про- и пребиотиков: метод. рекомендации / А.П. Левицкий, О.А. Макаренко, И.А. Селиванская [и др.]. - Киев: ГФЦ, 2007. - 26 с.

22. Шадрін О.Г Муковісцидоз у дітей раннього віку [Електронний ресурс] / О.Г Шадрін // Новости медицины и фармации. Гастроэнтерология. - 2009. - № 279 (тематический номер). - Режим доступу до журн.: http://www.mif-ua.com/archive/ article_print/8446.

23. Шеина А.Н. Использование мирамистина в физиотерапевтической практике (Учебно-методическое пособие) / А.Н. Шеина, М.Г Лутошкина // Журнал физиотерапия, бальнеология и реабилитация. - 2012. - № 6. - С. 51-56.

24. Laskaris G. Periodontal Manifestations of Local and Systemic Diseases: Colour Atlas and Text / G. Laskaris, C. Scully. - Springer Science & Business Media, 2012. - R 347.

УДК 616.311.2-002.2:616-003.218-008.817-056.7-08-059

КОМПЛЕКСНЕ ЛІКУВАННЯ ХРОНІЧНОГО ГЕНЕРАЛІЗОВАНОГО КАТАРАЛЬНОГО ГІНГІВІТУ У ДІТЕЙ, ХВОРИХ НА МУКОВІСЦИДОЗ

Резюме. Стаття розглядає досвід застосування запропонованого авторами лікувально-профілактичного комплексу, який поєднує застосування гелю, що містить хлоргексидину біглюконат, амінофторид та бетаїн, розчину суміші 12,5% розчину кислоти акридоноцтової і 0,9% розчину натрію хлориду для ротових ванночок, ультразвукової та електротерапії із засобом, що містить 0,01% розчину мірамістину, у терапії хронічного генералізованого катарального гінгівіту (ХГКГ) у дітей, хворих на муковісцидоз. Як і багато інших системних уражень, це захворювання має клінічні прояви у порожнині рота. Уже у ранньому віці у дітей, хворих на муковісцидоз, реєструється ХГКГ спостерігаються також патологічні зміни слизової оболонки порожнини рота, ексфоліативний і ангулярний хейліт, хронічні тріщини губ, кандидозний стоматит. Проведене лікування виявило позитивний вплив на етіологічні фактори ХГКГ (рівень гігієни порожнини рота, реологічні та імунологічні властивості ротової рідини). Спостерігалося зниження проявів гінгівіту: ущільнення ясенного краю, зменшення набряку та застійної гіперемії, зменшення кровоточивості ясен. Визначено вірогідно значуще покращення досліджуваних показників у порівнянні з їх вихідними значеннями протягом терміну спостереження.

Ключові слова: муковісцидоз, діти, хронічний генералізований катаральний гінгівіт, лікування.

УДК 616.311.2-002.2:616-003.218-008.817-056.7-08-059

КОМПЛЕКСНОЕ ЛЕЧЕНИЕ ХРОНИЧЕСКОГО ГЕНЕРАЛИЗОВАННОГО КАТАРАЛЬНОГО ГИНГИВИТА У ДЕТЕЙ С МУКОВИСЦИДОЗОМ

Резюме. В статье рассмотрен опыт применения предложенного авторами лечебно-профилактического комплекса, сочетающий применение геля на основе хлоргексидина биглюконата, аминофторида и бетаина, раствора смеси 12,5% раствора кислоты акридонуксусной и 0,9% раствора натрия хлорида для ротовых ванночек, ультразвуковой и электротерапии с лекарственным средством, имеющем в составе 0,01% раствор мирамистина, в терапии хронического генерализованного катарального гингивита (ХГКГ) у детей, больных муковисцидозом. Как и большинство системных поражений, это заболевание имеет клинические проявления в полости рта. Уже в раннем возрасте у детей, страдающих муковисцидозом, регистрируется ХГКГ, выявляются также патологические изменения слизистой оболочки полости рта, эксфолиативный и ангулярный хейлит, хронические трещины губ, кандидозный стоматит. Проведенное лечение продемонстрировало положительное влияние на такие этиологические факторы ХГКГ как уровень гигиены полости рта, реологические и иммунологические свойства ротовой жидкости. Наблюдалось снижение проявлений воспаления тканей десны: уплотнение десневого края, уменьшение отека и застойной гиперемии, уменьшение кровоточивости десен. Установлено достоверно значимое улучшение исследуемых показателей в сравнении с их исходными значениями на протяжении периода наблюдения.

Ключевые слова: муковисцидоз, дети, хронический генерализованный катаральный гингивит, лечение.

UDC 616.311.2-002.2:616-003.218-008.817-056.7-08-059

МULПPURPOSE TREATMENT OF CHRONIC GENERALIZED CATARRHAL GINGIVITIS IN CHILDREN WITH CYSTIC FIBROSIS

Abstract. Today, many studies have shown a high prevalence of periodontal diseases among children with somatic pathology. Cystic fibrosis is a rare hereditary disease has clinical manifestations in the oral cavity. Chronic generalized catarrhal gingivitis (CGCG) is recorded in children with cystic fibrosis, already at an early age. Exfoliative and angular cheilitis, chronic cracked lips, сandida stomatitis, other damages of the oral mucosa with clinical manifestations of swelling, petechiae are observed in patients.

The aim of the study. Evaluate the clinical efficacy of the proposed complex of etiotropic preventive and treatment measures of CGCG in children with cystic fibrosis.

Materials and methods. A clinical dental examination of 15 children aged 4 to 17 years with a confirmed diagnosis of cystic fibrosis has been conducted. Chronic generalized catarrhal gingivitis moderate severity was diagnosed in all children.

The patients' survey included the determination of Fedorov-Volodkina hygiene index (HI), PMA- index, the procedure of unstimulated oral fluid collection, determination the rate of salivation and oral fluid stretching. Determination of secretory immunoglobulin sIgA and lysozyme activity in oral fluid was performed to assess the condition of local immunity.

Complex of treatment and preventive measures was developed under the protocols of medical care, specialty «Pediatric dentistry» and was used within 10 days.

Professional oral hygiene was carried out after education of oral care and individual selection of means and methods of hygiene. Processing of teeth with gel was performed. The main components of the gel were: chlorhexi- dine, aminofluor and betaine. A mixture of 12,5% acridonacetic acid solution and 0.9% sodium chloride solution in a ratio of 1:3 were appointed as mouth baths. Ultrasound and electro-therapy with solution, containing 0,01% of miramistin, were appointed for all patients.

Results and discussion. Reduction of manifestations of gingivitis, such as a significant improvement in hygiene and periodontal status, oral fluid's rheology and level of local immunity was detected after application of the complex of preventive and treatment measures.

Conclusion. The prevalence of CGCG in children with cystic fibrosis requires an integrated approach to solving the problem. The application of the developed complex, that combines application of gel is based on chlorhexidine, aminofluor and betaine, a solution of mixture of 12,5% acridonacetic acid solution and 0,9% sodium chloride solution in a ratio of 1:3 for oral baths, ultrasound and electro-therapy with solution, containing 0,01% of miramistin in therapy of CGCG, enhances defense mechanisms of the oral cavity and reduce gingivitis in children with cystic fibrosis.

Keywords: cystic fibrosis, children, chronic generalized catarrhal gingivitis, treatment.

Размещено на Allbest.ru