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670 The scientific heritage No 47 (2020)
ВИЗНАЧЕННЯ ОСОБЛИВОСТЕЙ ХАРАКТЕРУ Б1ОЦЕНОЗУ ТКАНИН ЯСЕН У ХВОРИХ З Р1ЗНИМ КЛ1Н1ЧНИМ ПРОЯВОМ ГЕНЕРАЛ1ЗОВАНОГО КАТАРАЛЬНОГО Г1НГ1В1ТУ П1Д
впливом проведено! комплексно! терапп
Шостенко А.А.
ДВНЗ «Буковинський державний медичний утверситет», кафедра стоматологи дитячого в1ку, асистент
DETERMINING THE CHARACTERISTICS OF THE BIOGENESIS OF GUM TISSUE IN PATIENTS WITH DIFFERENT CLINICAL MANIFESTATIONS OF GENERALIZED CATARRHAL GINGIVITIS UNDER THE INFLUENCE OF COMPLEX THERAPY
Shostenko A.
HSEE "Bukovinian state medical university", Department of pediatric dentistry, assistant
Анотащя
Генералiзований катаральний пялит - займае прюргтетне мюце серед захворювань тканин пародонту у oci6 молодого вшу, що шдтверджено багаточисельними дослвдженнями як зарубiжних, так i вiтчизняних вчених.
Abstract
Generalized catarrhal gingivitis - occupies one of the first places among diseases of periodontal tissues in young people, which is confirmed by numerous studies of both foreign and domestic scientists.
Ключовi слова: генералiзований катаральний пилит, мжробюценоз, пробютики, зубоясенна боро-зна, антибага^альна тера^.
Keywords: generalized catarrhal gingivitis, microbiocoenosis, probiotics, dento-gingival furrow, antibacterial therapy.
Generalized catarrhal gingivitis - is one of the first among periodontal diseases in young people, as shown by many studies by both foreign and domestic scientists, in the formation of which the leading factors are bacterial plaque (biofuels), toxic metabolic products of microorganismsetc. Modern literature suggests that the main etiological cause in the occurrence of generalized catarrhal gingivitis are microorganisms involved in the formation and developmentof biofuels and soft plaque.
The main pathogens are streptococci, Staphylococcus and fungi of the genus Candida.However, the question of the quantitative ratio of bacteria in the genial sulcus and the selection of major pathogens of different clinical variants of generalized catarrhal gingivitis remains open and needs to be clarified. It is believed that the development of the disease is associated with the influence of four or more pathogens that exert their pathogenic effect in different combinations. In this regard, it is especially promising to create a program of phased use of professional hygienic interventions, antibacterial, immune corrective treatment that restores the necrobiosis of gum tissue and supportive measures that are carried out after the completion of complex therapy in the longer term.
The purpose of the study is to study the state of the microbiocenosis of gum tissue in patients with generalized catarrhal gingivitis with different clinical course, to assess the impact of the proposed stage of complex therapy on clinical and laboratory indicators of the disease.
Materials and methods of research. The study involved 82 patients aged 19 to 31 years, women - 44 (54.7%), men - 38 (45.3%). Of these, 33 patients had a chronic course of the disease (group I), 49 - acute (group II). After clinical, radiological and laboratory studies, three groups of patients were formed same in
age, sex, duration of the disease, where the comparative effectiveness of traditional and proposed methods of complex therapy was further studied. Group I - patients with chronic disease, group II (comparison) and group III (main) - patients with acute generalized catarrhal gingivitis. All patients underwent an identical clinical examination, which included the investigation of complaints, history taking, and visual and instrumental assessment of dental status.
The aim state of the mouth and gums was established on the basis of the dynamics of the following tests: simplified hygiene index (OHI - S), Mullemann, Cowell's bleeding index, papillary-marginal-alveolar index (PMA).
To find the biocoenosis of the gum tissue used the classical method of bacterial cultivation with determination of quantitative and species composition of the microflora. Microbiological studies were subjected to material that was obtained from subst furrow after triple rinsing the mouth with distilled water. Using complex morphological, culturally and biochemical evidence have established a kind of bacteria isolated.
Biochemical identification of anaerobic bacteria, streptococci and gram-negative bacteria was performed using test systems company API (France). To account for the growth of microorganisms used the CFU count.
After conducting clinical, radiological and laboratory studies were developed tactics of complex therapy of generalized catarrhal gingivitis with chronic and acute course of the disease. In the first stage, patients I, II and III groups local treatment GCG conducted according to a single plan, carried out professional hygienic measures in combination with irrigation of interdental spaces and an application of the mucous membranes of the gums chlorhexidine-containing means.
In the second stage of complex treatment of chronic generalized catarrhal gingivitis patients in groups I and II received along with traditional antibacterial therapy in combination with probiotic bifidobakteryn - 5 doses 2 times a day for 10 days; immunocorrective treatment recombinant drug cycloferon (on 2 tab. for a day, for 10 days).
Patients of group III at the first stage of complex treatment continued to receive similar antibacterial therapy as patients of group I. They were additionally prescribed a broad-spectrum antibiotic - amoxiclav 250/125 for 1 tab. 2 times a day for 7 days; anti-inflammatory drug - nimesil - 1 pack. 2 times a day for 7 days; probiotic - biosporin 2 doses 2 times a day for 10 days.
Immunocorrective therapy in this group of patients was carried out after the elimination of acute inflammatory phenomena in the gum tissue and after completion of antibacterial therapy.In the remote period for the prevention of recurrence of the inflammatory process in the tissues of the gums used supportive drug therapy.Every six months, it is recommended to correct the microbiocenosis of gum tissue by prescribing a course of probiotic therapy with biosporin and immunotropic treatment - lycopid according to the before described scheme.Patients with a restored process, characterized by a chronic slow course of general immune correction with lycopene.
In patients with intact periodontal tissues, as a result of laboratory tests revealed a slight deterioration in immunological limits, local immunotherapy was performed for 6-8 days. Lycopid was administered by the application method (1 mg of the drug per 30.0 ml of saline) on a solution-soaked cotton swab, lasting from 5 to 10 minutes.
The results of the study and their discussion. Feature changes of microbiocenosis of gingival tissues in patients with chronic GCG Ito increase this category Str.Salivarius, Str.sanqvius, peptostreptococci, hemolytic streptococci and a lower presence of tooth-gingival sulcus lactobacilli.Established that the main microbial reason for chronic GCG is not one single microorganism, and the association many of these us.
When analyzing the results of microbiological studies in this group of patients revealed a significant increase in the frequency of occurrence of the Stf.Aureus, Stf. Epidermidis,Candidaalbicans, Fusobacteria spp., Enterobacter, Bacteroides spp. These microorganisms occupy a leading place in the development of exacerbations of chronic inflammatory process in the gum tissue.
Microbiological monitoring demonstrated a high efficiency of the developed stage of a professional medical therapy of GCG, especially the pointed forms of manifestation, in comparison with the traditional approach in the implementation of remedial measures. Thus, patients of group I in the control of microbiological studies after the completion of the first and second stages of treatment, in the contents of the tooth-gingival sulcus in people with liquidated inflammatory process in the gum tissue of the alleged pathogens were detected rarely, and the frequency stabilizing normals microorganisms increased to the normal value.
From the tissues of the gums disappeared bacteria such as Str. Haemoliticus, Str. Epidermidis,
Peptostreptococcus, Bacteroides spp., Enterobacter, Fusobacteria spp., decreased detection rate of Str. Salivarius 2.3 times, Str. Sangvius 6.2-fold increase in the number of detecting Lactobacillus spp. 12.4%.
At the same time holding only traditional antibacterial therapy in patients of group II did not lead to a significant decrease of frequency, identifying the specific causative agents of acute course of the inflammatory process in the gum tissue. Was observed only a tendency to cut the occurrence of Candida albicans and Stf. Aureus. After carrying out of professional hygienic measures and local antibiotic therapy some other opportunistic bacteria decreased almost in 1,5-2 times. On this background still does not have normalized frequency of detection of bacteria, stabilize normals of the gum tissue.
Conducted by combined antimicrobial treatment in patients of group III by the developed technique have contributed to the rapid elimination of specific pathogens of acute inflammation in the gum tissue in 96,3% of cases, whereas in group II only half of the patients treated with traditional medical methods. The use of immunomodulators to tsikloferon after the elimination of active inflammation in the gum tissue, contributed to the restoration of normal biocenosis of the gum tissue is also at 96.3% of patients of group III. Studies have shown that Staphylococcus aureus and fungi Candida in patients of group III after treatment was visualise extremely rare (3.7% of cases), whereas in patients of group II who received the probiotic immunocorrector bifidobakterin and cycloferon simultaneously with antibacterial therapy, after treatment, the microorganisms continued to settle in the gum tissue nearly % of patients (27,2%). After treatment noted that the medical complex of group II contributed to the normalization of biocenosis of the gum tissue in 25 of 27 (89,2%) patients. Note that in these patients the elimination of dysbiotic disturbances in tooth-gingival sulcus coincided with the elimination of inflammation in the gum tissue.
Thus, the proposed complex staged therapy of generalized catarrhal gingivitis with different clinical course that involves the use of traditional antibacterial therapy in combination with nonsteroidal anti-inflammatory drugs, antibiotics and a probiotic in the first stage of treatment and the use of immunomodulators, in a second step promotes a rapid elimination of the main symptoms of generalized catarrhal gingivitis in the acute stage and provides long-term normalization of the state of microbiocenosis of gingival tissues.
References
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1МУНОЛОГ1ЧНА ХАРАКТЕРИСТИКА ХВОРИХ НА ГЕНЕРАЛ1ЗОВАНИЙ КАТАРАЛЬНИЙ
Г1НГ1В1Т
MocmeHKO A.A.
ffBH3 «ByKoemcbKuu depwaenuu Medmnuu ymeepcumem», Ka$edpa стоматомогii дитмцого eiKy, acucmenm
IMMUNOLOGICAL CHARACTERISTICS OF PATIENTS WITH GENERALIZED CATARRHAL
GINGIVITIS
Shostenko A.
HSEE "Bukovinian state medical university", department of pediatric dentistry, assistant
Анотащя
У данш статп наведеш отримаш результати дослщження показнишв мiсцевого секреторного iмунi-тету в 82 хворих на генералiзований катаральний гiнгiвiт з хрошчним та загостреним перебiгом. Концент-рацш SIg A, Ig A, Ig G i M визначали методом ращально! iмунодифузii в гелi по G. Manchini. Використо-вували моноспецифiчнi сироватки проти названих iмуноглобулiнiв. Дослщження вмiсту ЬЛ-ip, ФНП-а i 1Л-4 у слинi проводилося за допомогою набору реагенпв Pro-Con (Санкт - Петербург), iмуноферментним методом, згiдно шструкцп. У роботi використовувалися традицiйнi статистичш методи. В роботi встанов-лено наявшсть дефiциту мiсцевого гуморального iмунiтету, дисбалансу в цитокiновiй системi, яш нерiдко виявляються своерiдним базисом виникнення дисбiозiв та наступного виникнення захворюваня.
Abstract
This article presents the results of a study of local secretory immunity in 82 patients with generalized catarrhal gingivitis with the chronic and acute course. The concentration of SIg A, Ig A, Ig G, and M was determined by the method of radial immunodiffusion in a gel according to G. Manchini. Used monospecific sera against these immunoglobulins. The study of the content of IL-ip, TNF-а, and IL-4 in saliva was performed using a set of reagents Pro-Con (St. Petersburg), enzyme-linked immunosorbent assay, according to the instructions. Traditional statistical methods were used in the work. The presence of deficiency of local humoral immunity, imbalance in the cytokine system, which often turns out to be a kind of basis for the occurrence of dysbiosis and subsequent disease.
Ключовi слова: катаральний пнпвгт, мюцевий секреторний iмунiтет, iмуноглобулiни, пародонт, ци-тошни, запалення.
Keywords: catarrhal gingivitis, local secretory immunity, immunoglobulins, periodontium, cytokines, inflammation.
A large spread of generalized catarrhal gingivitis, especially in young patients, no significant reduction in the incidence of gums, growth of sharpened and resistant to treatment clinical variants of the disease, despite the constant improvement of methods of professional activities, the introduction into clinical practice of new drugs, therapeutic and prophylactic schemes, make the problem of inflammatory gum disease one of the most urgent and not fully resolved in modern dentistry.
In modern literature, there are indications that the background of significant growth of conditionally pathogenic microorganisms of the activation of the monocyte-macrophage level of protection that starts a cascade in a complex network of mediator interactions and is accompanied by the accumulation in the fluids (saliva, blood) proinflammatory cytokines (IL-ip, TNF
- a), which is a key factor in the pathogenesis of inflammatory processes of any localization, including in the gum tissue.
At the same time, in the scientific literature on the role of proinflammatory cytokines and their antagonists (IL-4) in the pathogenesis of various clinical conditions of inflammation in the gums are out, too far from the issues of the objectification of activity therapy of generalized catarrhal gingivitis, in particular, pointed shapes, and forecast of the results of the treatment. In this regard, of particular interest is the study of the peculiarities of the local (local) immunity which would allow clarifying the pathogenesis of both chronic and Agostinho current generalized catarrhal gingivitis.
The aim of the study. Study of the state of local secretory immunity, identification of its most
