RESEARCH
Relevance. A lot of researchers consider that COVID-19 patients may develop fungal infections at the middle or late stages of the disease, which may in turn deteriorate the course of the main disease. Our purpose was to analyze the signs of oral fungal infections in coronavirus patients with different levels of oral hygiene and receiving various treatment.
Materials and methods. 90 new coronavirus patients (CT-1, CT-2) of mean age 53.98 ± 1.06 y.o. were examined during the study. The prevalence of Candida yeast-like fungi and contamination were analyzed in three patient groups according to the oral hygiene level and the main disease therapy. The oral hygiene level was assessed by O*Leary plaque score index; all teeth were dyed and the ratio of the stained surfaces to all surfaces was calculated.
Results. The three group results showed that Candida fungi were significantly more often encountered in patients with O*Leary plaque index of more than 50% in comparison with patients with O*Leary plaque control index from 0 to 50%. Clinical signs of candidiasis, such as tongue coating, peeling of the lips, cracks at the lip corners, are more often diagnosed in patients with low oral hygiene level (more than 50% of the surfaces stained).
Conclusion. If tests for opportunistic fungal infections are positive in COVID-19 patients, especially in case of concomitant neutropenia, indications for additional antifungal therapy should be considered. Clinical signs of oral candidiasis and high contamination of the oral cavity with Candida fungi, as well as the oral hygiene level, can be the early markers of co-infection in COVID-19 patients.
Relevance. The high prevalence of microvascular complications in children with type I diabetes mellitus (DM) has a serious impact on the quality of life and can result in a lower working capacity and early disability. The negative effect of the drug therapy, inability to fully comply with the acceptable age-related safety limits, specific metabolism and pharmacokinetic features in childhood – all these reveals the need to improve the patterns for comprehensive treatment of periodontal diseases in children with type I diabetes.The purpose was to explain the clinical and functional effectiveness of the combined enzyme and magnet & laser therapy in comprehensive treatment of the periodontal microcirculatory disorders in children suffering from type I diabetes.
Materials and methods. The study involved 97 children diagnosed with type I diabetes, aged 12-17 y.o., with the present disease history from 6 months to 12 years. The microcirculation was assessed by laser Doppler flowmetry. Microcirculatory disorder correction was performed by a local exposure to a running low-frequency pulsed magnetic field combined with enzyme therapy.
Results. The dynamic magnetic therapy has proven to increase the effectiveness of capillary blood flow in children with early signs of vascular congestion and hyperemia, while Phlogenzym, a polyenzyme formulation, needs to be added in cases of vascular congestion and ischemia.
Conclusion. The effectiveness of physiotherapeutic and pharmacological effect of Phlogenzym along with the dynamic magnetic therapy shows that it can be recommended as an alternative to the conventional anti-inflammatory, antiseptic and antibiotic therapy during the pre-surgical treatment and post-surgical follow-up care as well as at the maintenance phase, both in an inpatient and outpatient setting.
Relevance. At present, the problem of the prevalence of overweight is becoming increasingly important in countries with a high standard of living, especially among the urban population. The social significance of this problem is determined by the threat of the development of diseases of the cardiovascular system, gastrointestinal tract, musculoskeletal system, as well as diabetes mellitus, which in turn are serious risk factors for the development and progression of periodontal pathology. One of the stages in the treatment of periodontal diseases is professional oral hygiene, the tactics of which, the effectiveness and stability of the results obtained also depend on taking into account the individual characteristics of the organism. Objective – to assess the effect of overweight (ICD 10 - K63.5) on the manifestation of periodontal disease and the clinical effectiveness of professional oral hygiene as a stage of initial periodontal therapy in the presence of diabetes mellitus.
Materials and methods. The study involved 83 patients with diabetes mellitus type I aged 25 to 45 years with overweight and normal constitution, with chronic generalized periodontitis of mild and moderate severity. All patients underwent a standard complex of professional oral hygiene. Re-examination was carried out after 1 month.
Results. The severity of clinical manifestations of periodontitis in patients with diabetes mellitus and overweight was higher than in the group of patients with normal constitution. The analysis of the effectiveness of professional oral hygiene as one of the stages of conservative periodontal therapy revealed differences in the response from the organism as a whole, and periodontal tissues in particular in the examined groups, demonstrating the pathological effect of excess body weight on the decrease in the effectiveness of hygiene measures.
Conclusion. The identification of differences in the examined groups confirms the importance of overweight as an aggravating component in patients with periodontal disease and diabetes mellitus type I and dictates the need for a more detailed study of this parameter in the management of patients in this group and predicting treatment results, as well as creates the need for development and implementation of a comprehensive treatment and prevention strategy, including the assessment and monitoring of body mass index, promotion of a healthy lifestyle, elimination of modifiable risk factors.
Relevance. Aim – to assess the impact of psychosocial stress on the clinical outcomes in severe periodontitis patients treated with Nonsurgical Periodontal Therapy (NPT).
Materials and methods. Patients received 2 psychological questionnaires to score their stress levels, while clinical data were obtained 1 week before and six weeks after the completion of NPT.
Results. A total of 55 patients were consecutively included in the study and subsequently categorized into different stress levels (low stress level n = 22 and moderate/high stress level n = 33). All clinical parameters were found to be comparable at baseline between groups. While reduction in full-mouth bleeding scores was found to be statistically significantly lower in group with higher stress levels, a similar improvement in the other clinical parameters was observed at the completion of NPT.
Conclusion. Psychosocial stress seems to influence negatively the results of NPT and highly stressed patients may represent a risk category for disease progression.
Relevance. The level of the patient adherence significantly influences the effectiveness of the treatment. Aim – to determine the level of adherence to the doctor’s recommendations and prescriptions in periodontal patients.
Materials and methods. 360 periodontal patients of both sexes and different ages filled in a questionnaire to quantitatively assess the treatment adherence, outlined in 1st Russian consensus on the quantitative assessment of the treatment adherence, 2017. The adherence to the therapy, medical management, life style changes and the overall treatment adherence were determined.
Results. The low level of the overall treatment adherence was revealed in 36% of the questioned subjects. The adherence to the life style changes was significantly low in almost all patient groups, thus, determining the low level of adherence to treatment. Only patients over 60 showed a higher adherence to all doctor’s recommendations. Male patients demonstrated a lower level of the overall adherence as well as adherence parameters separately.
Conclusion. The adherence evaluation allows customizing the approach to the selection of the recommendations and treatment schemes according to a patient adherence level as well as determining possible ways of adjustment of the motivation level.
Relevance. Lichen planus is a chronic recurring dermatosis, characterized by unspecified etiopathogenesis, a variety of trigger factors, a severe, often permanent course, a tendency to malignancy of the lesion elements, and often refractory to the treatment. The most difficult clinical problem is the search for effective methods of treating continuously recurring severe forms of lichen planus and red border of the lips, refractory to corticosteroids. Objective – to improve the quality of treatment for severe forms of lichen planus of the oral mucosa and red border of the lips based on the use of various physical methods in complex therapy.
Materials and methods. Depending on the complex of medical procedures, all patients were divided into four groups, the patients of which respectively underwent traditional drug treatment; complex treatment using ozone therapy; complex treatment using photophoresis of red LED radiation and a topical steroid, as well as complex treatment using combined physiotherapy and ozone therapy in combination with photophoresis.
Results. The inclusion of physical methods in the complex treatment of patients with severe forms of lichen planus of the mucous membrane of the mouth and lips made it possible to accelerate the time of epithelization of erosive-ulcerative elements and achieve a stable remission of the disease.
Conclusion. The obtained clinical data allowed us to draw conclusions about the appropriateness of using physical methods in the treatment of severe forms of lichen planus of the oral mucosa and lips using the effectiveness of combined physiotherapy.
Relevance. Oral health problems, particularly periodontal diseases, are frequent complications in people with alcohol dependence syndrome (ADS). The assessment of the periodontal, immune status and the tongue condition in ADS patients by the set of indices is promising.
Materials and methods. The periodontal and immune status and the tongue condition were examined in 114 men, of whom 47 were patients with stage II ADS and 67 were subjects without a history of ADS. Pearson's chi-squared test, Mann–Whitney U test, logistic regression, factor analysis were used for statistical analysis.
Results. ADS patients have significantly worse oral hygiene (p < 0.001) and 35.5 times higher probability of moderate to severe gum inflammation (p < 0.001). Sextants with bleeding (39.0%) and calculus (25.9%) prevailed among ADS patients whereas most of sextants were healthy (85.8%) in the comparison group. Significant inter-group differences were found for all CPI codes except code 4 (p < 0.001). The dorsal surface tongue coating (63.8%) and minor hyperkeratosis (27.7%) prevailed among ADS patients, while in the comparison group, there were no changes in 34.3% of subjects and coating was present in 38.8% (p = 0.003). The risk of satisfactory to poor oral hygiene was 3.7 times (p = 0.007) higher and the risk of moderate to severe gum inflammation was predicted to be 6.5 times (p = 0.015) higher if the examined subjects had changes in the tongue mucosa. The obtained differences in the level of IgG, TNF-α and cortisol prevailed in ADS patients (p < 0.001).
Conclusion. In ADS patients, the severity of periodontal diseases, changes in the tongue mucosa and mucosal immunity imbalance are statistically significant. The considered dental markers of chronic alcohol intoxication are proposed to be used at the treatment and checkup dental visits to screen individuals at risk of alcohol use disorder.
Relevance. Reparative processes in the extraction socket include hemostasis, inflammation, proliferation and tissue remodelling. These processes are caused by mediators which determine interactions in the immunoregulatory, cytokine network. After the tooth extraction, pro- and anti-inflammatory mediators are unbalanced. The number of macrophages, lymphocytes, neutrophils releasing lysosomal enzymes increases in the surrounding tissues, and it leads to cleaning of the extraction socket from the damaged tissues and microorganisms. The growth factors are of great importance for reparative processes. The level of cytokines, chemokines and growth factors in biological fluids is the assessment criterium of various physiological and pathological processes and effectiveness of the treatment procedures. Purpose – to assess the activity of the wound healing processes by studying the level of cytokines/ chemokines and growth factors in the extraction socket.
Materials and methods. The data received on examination of 40 patients was used in the study. 20 of the patients had their teeth extracted for chronic periodontitis and the socket healing was studied by clinical and laboratory findings (seven mediators of immunoregulatory processes were studied). The comparison group consisted of 20 subjects without periodontal pathology.
Results. Clinical data, typical for the normal socket healing, are characterized by the certain content of immunoregulatory mediators (IL1β and IL6 – proinflammatory cytokines, IL8 and MCP1 – chemokines, RAIL1 – anti-inflammatory cytokine, VEGF and TGFβ1- growth factors). The content of proinflammatory cytokines and chemokines was detected to increase in the socket on the first day after the extraction, which indicates the activity of the local inflammatory process. The level of RAIL 1 and VEGF and TGFβ1 growth factors increases in the extraction socket five days later.
Conclusion. The post-surgical activity of the inflammatory and regenerative processes in the tissues is revealed by the level of cytokines/ chemokines on the first day after surgery and the level of growth factors and RAIL1 in the socket discharge on the fifth day after surgery.
Relevance. Dental disease management in type II diabetic patients suffering from xerostomia and an effective selection of oral care products moisturizing the mucus membrane have been a crucial problem for a long time. Typical for xerostomia symptoms such as dry mouth, burning tongue, pain during swallowing and eating solid food disorder interfere with choosing effective hygiene measures. The selection of a proper toothpaste that can help in effectively maintaining moisture environment in the mouth, and create comfort in the oral cavity plays a significant role.The aim of the study was to evaluate the clinical efficacy of a toothpaste containing xylitol and alginate (R.О.С.S.) in patients with generalized chronic periodontitis (GCP) and type II diabetes, suffering from xerostomia.
Materials and methods. 40 patients, (mean age 58 ± 5.1 years, min = 52.5, max = 64) with moderate GCP and type II diabetes, suffering from xerostomia were studied. All patients underwent questioning, dental examination, periodontal status scoring, salivary flow rate assessment and saliva pH test. Patients were randomly divided into two groups: experiment and control. Monitoring was carried out for 3 months. All patients received professional tooth cleaning, after which the experimental group was instructed to use a toothpaste containing xylitol and alginate during three months, while the control groups was instructed to keep using their own toothpaste. Patients were reexamined after 3 months.
Results. The experimental group which used the xylitol and alginate toothpaste demonstrated improvement in all parameters: periodontal status, salivary flow rate and saliva pH in comparison with the control group. No irritating effect on the sensitive mucous membrane was recorded.
Conclusion. The presence of xylitol, alginate and a natural plant component (chamomile extract) in the toothpaste seem to provide notable anti-inflammatory and moisturizing effects. The tested toothpaste contains no antiseptics, fragrances or detergents. The absence of irritating effect on the sensitive mucous membrane allows its use without limiting the duration of use.
Relevance. The necessity of somatic health evaluation in patients with local inflammatory periodontal processes is determined by frequent relapses of the periodontal diseases. Low effectiveness of the widespread treatment methods and the lack of long-term remission of the disease is caused by the insufficient assessment Based on the clinical examination, diagnosis and laboratory tests, to determine the correlation between the somatic pathology and adaptability of the adult body in patients with localized periodontitis due to trauma.
Materials and methods. Advanced examination was carried out in 169 subjects, aged 45-75 y.o., with mild to moderate localized periodontitis due to trauma. The somatic condition was assessed by laboratory and functional tests.
Results. 1-2 somatic diseases were revealed in 39.3% of patients with mild localized periodontitis caused by trauma (periodontal pocket depth up to 4 mm). 3 and more comorbidities were detected in 35.3% of patients. Gastrointestinal problems, cardiovascular diseases, allergic conditions, anemiа and respiratory diseases were most frequently encountered. In moderate localized periodontitis caused by trauma and periodontal depth of 4-6 mm, 23.9% of patients had 1-2 comorbidities, while 62.7% of patients had 3 and more diseases. Gastrointestinal problems, cardiovascular diseases, anemia, allergic conditions and urogenital diseases were more frequent. A strong correlation was revealed between the type of adaptive reaction and the degree of localized periodontitis caused by trauma. Thus, the risk of moderate localized traumatic periodontitis development increases by 1.8 times in tense adaptive reaction, and by 3.45 times - in poor adaptation reaction.
Conclusion. Functional condition of the body adaptability, which is essential for the development of the treatment strategy, could be determined by the evaluation of the physical condition, peripheral blood tests (entropy of WBC differential, C-reactive protein) in patients with localized periodontitis caused by trauma. The adaptive reaction tension and decrease were detected in patients with 3 or more comorbidities.
CASE REPORT
Relevance. Immediate implant placement with immediate temporisation is method of choice in case of central incisors extractions. In nowadays there are many protocols aimed on optimisation of the immediate prosthetic result. Some of them are based on using CAD/CAM technology, others stress the importance of peri-implant grafting procedures as a means of clinical success. The aim of the study is to analyse tactic of treatment in cases of immediate implant prosthetic replacement of maxilla central incisors using assessment of clinical example and elaboration of the optimal treatment option.
Materials and methods. We conducted the evaluation of the 54 year old male patient with the use of clinical and paraclinical examination methods (OPG, CBCT). Implant placement in the position of the teeth 1.1, 2.1 was performed utilising new NobelParallel Conical Connection TiUltra (NobelBiocare, USA) 4.3*13 mm followed by implant supported Procera Zirconia prosthesis. We used international indices PES and it’s modification WES for the assessment of the achieved results.
Results. The final result received following scores: PES index = 7, WES index = 8.
Conclusion. Choice of implant design is a major influencing factor on the immediate implant placement prognosis. Utilising Nobel Active implant in the described clinical situation combining its placement with grafting of the connective tissue taken from the tuberosity area led to the decrease in total treatment time and achievement of the superior esthetic and functional result.
ISSN 1726-7269 (Online)