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UDC 616.314-77:616-089-07
OPTIMIZATION OF THE PROCESS OF ADAPTATION TO REMOVABLE LAMINAR DENTURES IN ELDERLY PATIENTS
Altai State Medical University, Barnaul O.V. Oreshaka, I.O. Grokhotov
The article presents the analysis of the effectiveness of local ozone therapy in elderly patients using removable laminar dentures. Topical application of ozone contributed to the improvement of a number of clinical laboratory parameters of the tissue state of denture-baring area and oral cavity, which generally increased the effectiveness of prosthetic treatment in patients using removable dentures and improved the long-term prognosis. Key words: ozone, denture-bearing area, removable dentures.
Removable laminar dentures are widely used in prosthetic dentistry, although their negative effect on the tissues and organs of the oral cavity has been studied quite well [2]. Ozone therapy is one of the prospective methods of treatment in dentistry being a new and rapidly developing area of medicine [3]. The complex of ozone therapeutic effects allows to successfully apply it even in severe clinical cases [6, 7], thus, in our opinion, the use of this method in therapeutic treatment by removable dental prosthetics could also be quite effective.
Research objective: to optimize the process of adaptation to removable laminar dentures in elderly patients by means of local implementation of the ozonized olive oil.
Materials and methods
There was conducted the clinical laboratory study of the dental status in 92 elderly patients at the age from 60 to 70 years, who were exposed to prosthetics by removable laminar dentures for the first time. All participants of the research were divided into four groups: two study groups (23 patients in each group by partial and total teeth absence), in which during the first 10-14 days after the superimposition of removable laminar dentures there were performed applications of ozonized olive oil под under the denture base, and, respectively, two comparison groups.
There was evaluated the intensity of caries lesions according to DFM and DFM(f) indexes, the hygienic state of the oral cavity according to Fedorov-Volodkina index, the indexes of PMA and Myulleman-Sakser. There was also determined the level of cariogenicity of dental plaque according to Hardwik-Menlo modified by prof. Nedose-ko. The study of functional parameters of salivary discharge included the determination of the speed of secretion of unstimulated saliva, its viscosity, pH and antioxidant activity. The cytological examination of the oral swabs from the denture-bearing area was performed along with the determination of indexes of differentiation and epithelial keratinization, and also the microbial cell adsorption reaction.
The blood supply level of the mucous membrane was evaluated by means of laser Doppler flowmetry. The microbiological study was conducted by traditional and instrumental methods with determination of the quantitative and qualitative microflora composition. There was also carried the analysis of questionnaires filled by patients during the process of removable denture use to determine the terms of adaptation. The qualitative data are presented in the form of Md; (Q1-Q3). The significance of the differences between the data was determined by means of Mann-Whitney U-test for independent groups, the differences were considered significant by p<0,05. The analysis of the material was conducted by means of Statisti-ca 6.0 programs (StatSoftInc., USA).
Results and discussion
The analysis of changes of DFM and DFM(f) indexes did not reveal significant differences between the groups. However, after the superimposition of removable dentures the hygienic state of oral cavity of the patients without additional treatment worsened during 1,5 months (2,4; 1,8-3 points), especially in comparison with the identical index in patients after the application of local ozone therapy (1; 1,3-1,83 points). Moreover, in patients of the study group the initial level of DFM index constituted 72%; 45-74%, and in 2 weeks of ozone implementation, despite the presence of removable laminar dentures in the oral cavity, it significantly lowered up to 48,5%; 33-55% (p<0,05 in relation to the initial value), by 1,5 months - to 38%; 30-46% (p<0,05 in relation to 2 weeks of study), increasing a bit by 3 months (45%; 26-56%), which generally indicates a significant reduction of gingival inflammation. Against this background, the dynamics of the values of gingival bleeding index in patients of the study group also turned out to be significantly positive, which corresponds to the data of literature [1, 4, 5].
The analysis of the cariogenicity of dental plaque indicated its significant decrease (1,83; 1,42,1 points at the initial level, 1,3; 1,1-1,8 points - in 14 days, p<0,05 in relation to the initial value). The re-
suits of the microbiological study demonstrated significant differences in the state of microflora of the oral cavity against the background of local ozone therapy and without. Namely: the presence of removable laminar dentures without additional treatment (group of comparison) in the majority of cases lead to the growth of CFU (colony-forming
units) of already existing representatives of normal flora, and in a number of cases - to the appearance of new strains. The patients of the study group showed the stable composition of microflora due to the soft antibacterial effect of low ozone concentrations (Figure 1).
Figure 1.
Reduction of bacterial content of the oral cavity by local ozone therapy (left - before treatment, right - in 10 days after
treatment), X100 zoom, hematoxylin and eosin staining
The study of the speed of saliva secretion and its viscosity did not reveal significant differences among the patients of the compared groups. In the majority of patients the speed of saliva secretion increased during the first 2 weeks after the superimposition of dentures against the background of the decrease of its viscosity. By 3 months the speed of saliva production lowered, the viscosity, on the contrary, grew. However, there were observed significant differences in pH values of the oral fluid registered in long terms (higher values in patients exposed to local ozone therapy). The study of the antioxidant activity of the oral fluid showed the higher level in patients after ozone implementation and depletion of antioxidant reserves by traditional prosthesis.
The cytological study showed that in patients of the study group local ozone therapy had a favorable effect on the epithelial state of the mucous membrane of the denture-bearing area, which was expressed in the growth of the degree of its differentiation and preservation of the initial level of keratinization. Nonspecific resistance of the mucous membrane determined by the microbial cell adsorption reaction increased significantly after the conducted treatment. The dynamics of the blood supply level of the mucous membrane of the denture-bearing area is presented in Table 1.
According to the questionnaire analysis, generally, the terms of adaptation in case of local ozone therapy reduced to by 26,5% by partial and 26,3% by total removable prosthesis.
Table 1
Influence of local ozone therapy on the dynamics of perfusion index (M, pf.u.) of the mucous membrane of the denture-bearing area in elderly patients by prosthetic treatment by removable laminar dentures
Studied groups Initial value Terms of study
14 days 1,5 month 3 months 6 month
Patients with partial removable dentures, n=46 Study group, n=23 20,21; 19,8724,3 20,26; 20,125,2* 20,24; 20,1223,6* 19,5; 18,520,26* 18,6; 17,421,3
Comparison group, n=23 20,46; 20,0125,1 19,24; 18,726,3 19,2; 17,23-21,14 18,06; 17,2320,01** 17,8; 16,519,52**
Patients with total removable dentures, n=46 Study group, n=23 22,1; 18,9-24,2 21,7; 19,8-25,1* 20,8; 19,522,1* 19,2; 17,421,3 18,2; 17,119,6
Comparison group, n=23 21,04; 18,2123,25 20,14; 18,4523,12 19,2; 17,520,91 18,6; 17,219,6** 17,2; 16,418,9
Note: * - significant differences in relation to the comparison group, p<0,05, Mann-Whitney U-test for independent samples, ** - significant differences in relation to the initial level, p<0,05, Mann-Whitney U-test for independent samples.
The analysis of the obtained results showed, that by traditional prosthetic treatment of patients with removable laminar dentures there occur numerous negative changes of clinical laboratory indexes of the state of oral cavity: worsening of the hygienic state, increase of gingival inflammation spread, disorders of natural processes of the oral mucous cavity regeneration and blood supply, some shifts of the functional parameters of salivary discharge and reduction of the antioxidant ability, and also the indications of microbial imbalance of the oral cavity.
The majority of the examined patients showed a significant improvement of the hygienic state of the oral cavity after the course of ozone therapy, which was evaluated according to Fedorov-Volod-kina index in patients with partial removable dentures, while in patients with total teeth absence it was evaluated according to the state of the dentures itself by Ambjornsen method. The obtained effect in patients with partial denture defects is presumably connected with the reduction of the activity and adhesive ability of the mucous microflora (which is indirectly confirmed by the reduction of the caries activity of dental plaque). The influence can also be caused by the direct cleaning effect of ozone due to oxidation and decay of dental plaque organic components. The decrease of activity and spread of inflammatory processes in peri-odontal tissues also plays a role, which enables the conduction of hygienic measures for patients at home.
The expressed positive effect of local ozone therapy was observed by the study of gingival state. Such results are explained by the influence of ozone directly on several pathogenetic elements of periodontal disease, namely: reduction of inflammation, improvement of capillary blood flow, activation of antioxidant defense system, antimicrobial effect, especially expressed by the influence on the anaerobic flora playing an important role in the development of periodontitis.
The analysis of the antioxidant ability of mixed saliva showed that in patients with removable laminar dentures the antioxidant defense grew significantly after the course of ozone therapy with further preservation of this level and in long terms. The stated effect is determined by the stimulation effect of ozone as the source of active oxygen forms on the production of enzymes of antioxidant defense. Further, after the end of the treatment course, this effect plays an important role in the realization of long-term results of ozone therapy, as the pathogenesis of numerous pathological conditions in the oral cavity includes imbalance of pro-and antioxidant systems.
The cytological study revealed significant differences in the epithelial state of the mucous membrane of denture-bearing area in patients both with partial and with total removable dentures.
The stated changes allow to assume that ozone has a favorable effect on the regeneration of mucous membrane due to the improvement of tissue microcirculation, tissue oxygenation, activation of oxygen depending enzymatic processes and reduction of inflammation. To our mind, the stated results are extremely important for the solvation of the problem of adaptation of patients to removable dentures, as their negative effect, first of all, is reflected on the mucous membrane of the denture-bearing area, which is initially not intended for functioning in such conditions.
The data of laser Doppler flowmetry, which were used to evaluate the parameters of tissue microcirculation in the mucous membrane of the denture-bearing area, showed an expressed positive effect of the ozone therapy. These data are explained by such ozone effect as biochemical activation of the functions of erythrocytes, increase of call membrane flexibility, improvement of tissue oxygenation (including the endothelium of blood vessels), activation of nitrogen oxide synthesis, which leads to the vascular distention.
The analysis of the results of microbiological study showed, that in patients of the study group at early stages (14 days, 1,5 months) there had not been revealed significant shifts in the qualitative and quantitative microflora composition. This was expressed in the principal preservation of the initial strains indicated before the treatment, and also preservation or slight reduction of their titers. The current results show, that despite the express bacterial ozone effect, by particular schemes of its implementation (such as presented in the study) it can be used not only to suppress pathogenic strains by the already developed pathology, but also by particular concentrations for the prevention of unfavorable shifts in the qualitative and quantitative composition of the resident microflora. Thus, there is realized the preventive function of ozone consisting in the prevention of microbial imbalance and further - of various diseases connected with it.
The results of questionnaire implied for subjective evaluation of the process of patients' adaptation to removable dentures showed high effectiveness of the ozone therapy. Such conclusion can be made on the basis of lower occurrence and quicker disappearance of key complaints appearing in patients during the denture use. Predominantly, due to the above state positive effects, the most significant difference between the patients of the study and comparison groups referred to such complaints, as pain under the denture, disability to chew, irritation due to the presence of the denture.
Conclusion
Thus, the results of the carried study allow to draw a conclusion on a significantly positive effect of local ozone therapy on a number of clin-
ical laboratory parameters of oral cavity in elderly patients using removable laminar dentures, namely: improvement of the hygienic state of the oral cavity and the dentures, significant reduction of gingival inflammation in the area of remaining teeth, acceleration of regeneration of epithelial mucous membrane of oral cavity and preservation of the initial level of its blood saturation, stabilization of the qualitative and quantitative composition of normal microflora and antioxidant ability of the oral fluid. In total, these data allow to state the effective influence of ozone on the process of adaptation to removable dentures.
References
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2. Zhulev N. Ye. Partial removable dentures (theory, clinic and laboratory technique). Nizhny Novgorod: Publishing office of Nizhny Novgorod State Medical Academy, 2000.
3. Maslennikov O.V., Kontorshchikova K.N., Gribkova I.A. Guideline for ozone therapy. Nizhny Novgorod: Publishing company "Vektor-Tis", 2008.
4. Ryba O.B. The microbiological efficacy estimation of different types of chronic periodontitis' anti-inflammatory therapy. Saratov journal of medical scientific research. 2008; 3: 88-89.
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Contacts:
Corresponding author - Oreshaka Oleg Vasilyev-ich, Doctor of Medical Sciences, Professor, Head of the Department of orthopedic dentistry of the FS-BEI HE Altai State Medical University of the Ministry of Health of the Russian Federation, Barnaul. 656015, Barnaul, Depovskaya Ulitsa, 13a. Tel.: (3852) 241472. Email: oreshaka@yandex.ru
