4Academic Research in Educationaal Sciences VOLUME 2 | ISSUE 11 | 2021
ISSN: 2181-1385
Scientific Journal Impact Factor (SJIF) 2021: 5.723 Directory Indexing of International Research Journals-CiteFactor 2020-21: 0.89
DOI: 10.24412/2181-1385-2021-11-219-224
COMBINED METHODS OF TREATMENT OF PULPITES, ESPECIALLY IN
PERSONS OF OLD AGE
Ulugbek Abdumazhitovich Samatov
Department of Hospital and Clinical Dentistry Andijan State Medical Institute
ABSTRACT
The pulp of the elderly is characterized by cell poverty and fiber richness, so it is difficult to draw a line between age-related changes and pathological processes. The blood supply to the pulp in the elderly is significantly reduced. Starting at the age of 40, pulp vessels lose their tree-like branching. Plentifully supplied with odonto-and fibroblasts, histiocytes, adventitia and other cells, the pulp turns into a fibrous cord with age, practically devoid of cellular structures. The diameter and length of the root canal also decrease with age. First of all, this may be due to the physiological formation of secondary dentin, which begins (actively) after 60 years. Another age-related change is increased cement deposition, most pronounced in the area of the root apex. With age, more and more areas with resorption processes are found in the cement. The surface of the cement in the elderly is characterized by unevenness. The quantitative ratio of magnesium and fluorine in cement changes.
Keywords: senile age, pulpitis, caries, fluoride, root canal.
Introduction
One of the important directions in the development of gerontology and dentistry is the formation of a new scientific direction - herostomatology The activities of the International Association for Gerontology (IAG) contributed to the separation of the science of dentistry for older people into a separate discipline -"herostomatology"
Due to the growing proportion of elderly people among the population of most developed countries of the world, their number among patients in dental practice is also increasing [2,4] A feature of herostomatological care is the increasing number of preserved natural teeth, which is inevitably accompanied by the occurrence of pulpitis [1,5]
Pulpitis is a major medical and social problem. Inflammation of the pulp of the tooth in dental practice is quite common. In the structure of dental care, patients with
Academic Research in Educationaal Sciences VOLUME 2 | ISSUE 11 | 2021
ISSN: 2181-1385
Scientific Journal Impact Factor (SJIF) 2021: 5.723 Directory Indexing of International Research Journals-CiteFactor 2020-21: 0.89
DOI: 10.24412/2181-1385-2021-11-219-224
pulpitis account for 14-20% of the number of patients who are treated with pulp. If we take into account more than 200 million visits to the dentist per year, the urgency of the problem becomes obvious [3]
Taking into account the steady increase in the number of elderly patients, the improvement of the quality and level of dental care should be based on the results of epidemiological studies and take into account the herostomatological features of pathology in older age groups.
However, the prevalence of various forms of acute and chronic pulpitis, depending on the age of patients, has practically not been studied. Disjointed information from EI Gavrilov (1951), TF Vinogradova (1968), NA Kodola et al. (1980) indirectly indicate such a relationship.Studying the structure of the incidence of pulpitis is extremely important for theory and practice of gerostomatology and improvement of dental care for patients of different age groups
An important scientific and practical problem of herostomatology is increasing the effectiveness of therapy for patients with pulpitis.At the same time, it is necessary to note the complexity of endodontic manipulations, which often take up to half or more of a dentist's working time.But, unfortunately, the positive results of root canal treatment do not exceed 50-70 % [1.4], and according to research data from CSPRI [2.5], this indicator barely reaches 25% In 98-99% of cases, destructive processes in the periodontium are the cause of various complications, including odontogenic phlegmons of the maxillofacial area, which great danger to the health and life of the patient [3,5].
One of the promising areas for improving the quality of dental care for the population is the introduction of advanced medical technologies for early diagnosis, treatment and prosthetics of the dento-dental system; improvement of technical means and dental equipment, instrumentation, development of dental prosthetics technologies (cermets, dental implantation, etc.), new orthodontics technologies. new composite materials, development of pharmacological support of anesthesiology and pain relief
A promising direction in the development of dentistry is the use of lasers, i.e. laser therapy. according to a number of domestic and foreign authors, the use of pulsed lasers is one of the effective methods of treating dental patients [4]
This determines the need for studies to evaluate the effectiveness of the use of laser therapy in patients of different age groups with various forms of acute and chronic pulpitis.
Academic Research in Educationaal Sciences VOLUME 2 | ISSUE 11 | 2021
ISSN: 2181-1385
Scientific Journal Impact Factor (SJIF) 2021: 5.723 Directory Indexing of International Research Journals-CiteFactor 2020-21: 0.89
DOI: 10.24412/2181-1385-2021-11-219-224
Within the framework of these studies, an important aspect for the development of laser therapy in gerostomatology is to assess the likelihood of local thermal lesions and exacerbation of somatic diseases in elderly and senile people due to the effect of pulsed lasers on tooth tissues, cardiovascular and respiratory systems of elderly and senile patients.
Objective of the study: to study epidemiology and identify age-related characteristics of the clinical course of various forms of pulpitis and assess the effectiveness of its treatment using combined methods of elderly and senile age.
Materials and research methods: A total of 324 patients with various forms of pulpitis at the age from 45 to 65 years were under observation. Only 11 of them were practically healthy. Everyone else is suffering; whether one or another disease of the cardiovascular system is in the stage of compensation. The inclusion of persons with such pathology in the observed contingent was a forced measure. Persons over 45 years old are usually burdened with a wide variety of diseases, which naturally will affect the results of pulpitis treatment. Therefore, a group was assembled with approximately uniform types of general pathology. Of the diseases of the oral cavity, in addition to pulpitis, they were allowed to have in the oral cavity no more than 2-3 sealed caries of teeth, as well as prostheses replacing 1-2 missing teeth.
Research results: According to our observations, the composition of the medicinal paste has a significant effect. So, with the conservative method using zinc-oxide-eugenol. paste, the positive result was 85.71 ± 4.7% (P <0.05) in the nearest future and 90.91 ± 4.09% (P <0.05) - in the distant, and in the group where mafenid was used acetate - 95.89 ± 2.32% (P <0.05) and 97.10 ± 2.02% (P <0.05), respectively. At the same time, the nature of complications in both groups was of the same type, the differences were only in the frequency of manifestations. Complications were observed more often in the period from 2 days to 1 month in the form of residual pulpitis (direct observation) in 6.67 ± 4.47% in the control group and in 5.19 ± 2.42% in the group where mafenide acetate was u sed, or were associated with a filling defect (closest observations) 4.28 ± 6.72% and 4.1 ± 2.22%, respectively. In all groups, the results were statistically significant (P <0.05).
Our analysis of complications in the long term showed that they manifested themselves in the form of chronic periodontitis or its exacerbation (in 16.67 + 9.21% in the control group (P> 0.05) and 4.29 ± 2.32% (P <0.05) in the group with the use of mafenide acetate) and were caused mainly by a decrease in the resistance of the child's body after acute respiratory or infectious diseases. In this issue, our
Academic Research in Educationaal Sciences VOLUME 2 | ISSUE 11 | 2021
ISSN: 2181-1385
Scientific Journal Impact Factor (SJIF) 2021: 5.723 Directory Indexing of International Research Journals-CiteFactor 2020-21: 0.89
DOI: 10.24412/2181-1385-2021-11-219-224
observations coincide with the statement of T.F. Vinogradova (1988) that the reactivity of the child's body has a significant effect on the final result of pulpitis treatment with vital methods.
In case of vital amputation, in groups where zinc-oxide-eugenol was used as a therapeutic paste, positive results were observed in 94.74 ± 5.26% (P> 0.05) in the near term. and in 94.44 ± 5.56% (P> 0.05) - in distant ones. In this direction, our results coincide with the data of Berman, Massler (1958), Croll T.P., Killian S.M. (1992), which note a good therapeutic effect of this paste in temporary teeth. When mafenide acetate was included in the paste, the effectiveness of treatment in the near term of observation was 9b, 80 ± 1.19% (P> 0.001), in the distant -99.65 ± 0.67% (P <0.001), which indicates undoubted advantages method developed by us.
Our analysis in both groups did not reveal differences in the structure of complications, mainly they manifested themselves in various forms of periodontitis. Immediate results were ineffective only in one case (5.0 ± 3.0%) in the group where zinc oxide eugenol paste was used after pulpotomy.
They manifested themselves as symptoms of acute periodontitis. We attribute this to the insufficient therapeutic effect of the above paste. The greatest number of complications was observed 1 month after treatment and had the character of exacerbation of chronic periodontitis. When using zinc-oxide-eugenol paste, treatment was ineffective in 5.26 ± 3.26% of cases, and in the group where mafenide acetate was included in the therapeutic paste, 3.19 ± 1.18%. In our opinion, these complications are caused by a discrepancy between clinical and pathomorphological diagnoses. The reliability of the results was P <0.05. The cause of complications in the long term was a decrease in the general resistance of the child's body after the illness. They were 11.1 ± 5.42% in the control group (P> 0.05) and 1.89 ± 0.93% in the group where mafenide acetate was used (P <0.001). A high degree of reliability of the results obtained was observed in all groups.
According to our observations, the results of the treatment of acute pulpitis by the conservative method and vital amputation are associated with the general condition of the body and the form of impact on the pulp. In the groups where zinc-oxide-eugenol paste was used, positive results were observed in 62.5 ± 5.38% (P> 0.05), with the conservative method and in 70 + 5.53% (P> 0.05) - with vital amputation, and when using the medical complex - 79.5 ± 4.02% (P <0.05) and 86.98 ± 3.69% (P <0.05), respectively.
Academic Research in Educationaal Sciences VOLUME 2 | ISSUE 11 | 2021
ISSN: 2181-1385
Scientific Journal Impact Factor (SJIF) 2021: 5.723 Directory Indexing of International Research Journals-CiteFactor 2020-21: 0.89
DOI: 10.24412/2181-1385-2021-11-219-224
Regardless of the method of treatment, immediate complications in both clinical groups were manifested by acute pulpitis with involvement of periodontal tissues in the process (in 10.0 ± 3.0% with the conservative method and 12.5 ± 4.5% with vital amputation in the control group, and 6 , 82 ± 2.29% and 4.35 ± 2.04%, respectively - when using the medical complex), moreover, when using the traditional method, the reaction of regional lymph nodes and the phenomenon of general intoxication of the body (increased body temperature, headache) were noted. The obtained ruzults are statistically significant (P <0.05) The closest complications in the "group where zinc-oxide-eugenol paste was used were 11.11 ± 3.1% (P <0.05) with the conservative method, amputations - 14.2916.28% (P> 0.05) versus 4.88 ± 2.01% (P> 0.05) and 3.85 ± 2.04% (P> 0.05), respectively in the group , where the medical complex was used, and was also accompanied by a perifocal periodontal reaction and an increase in regional lymph nodes, which was not observed when using a medical complex, which includes benzofurocaine. These data indicate its effectiveness not only in permanent occlusion (Kamyshnikova I.O. , 1991; Bazhenova N.P., 1998), but also temporarily.
Conclusion: Analysis of the prevalence, frequency and structure of the incidence of pulpitis in individuals of different age groups revealed the existence of a dependence of the incidence of various forms of acute and chronic pulpitis on the age of patients. Despite the fact that chronic forms of pulpitis were predominant in all age groups, the incidence of acute forms of pulpitis sharply decreased with increasing age: in elderly and senile patients, chronic forms of pulpitis were found 4.5-5 times more often than acute, exacerbations of chronic pulpitis was more common in the elderly.
The results of close and remote observations of the health status of patients of young, middle, elderly and senile age who received treatment for various forms of pulpitis by the conventional method and using pulsed lasers, showed that the use of laser therapy provides a stable positive effect, which manifested itself in a significant reduction in complications and relapses of the disease.
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Academic Research in Educationaal Sciences VOLUME 2 | ISSUE 11 | 2021
ISSN: 2181-1385
Scientific Journal Impact Factor (SJIF) 2021: 5.723 Directory Indexing of International Research Journals-CiteFactor 2020-21: 0.89
DOI: 10.24412/2181-1385-2021-11-219-224
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