Method of local treatment and prevention of primary dental diseases in children with chronic renal pathology using chewable phytosubstrate

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to dentistry, and may be used for the local treatment and prevention of the primary dental pathologies in hemodialysis-dependent children suffering a terminal stage of the chronic renal failure. That is ensured by using a chewable substrate containing bee wax 4.0 g and cultivated angelica root 0.4 g 3 times a day for 15 minutes for 2 weeks.

EFFECT: method enables improving and stabilising the clinical measures of the active products of the oral fluid due to a synergetic effect of the substrate components.

4 tbl, 1 ex

 

The present invention relates to medicine, in particular to the dentist.

Chronic renal failure (CRF) is a severe somatic disease leading to disability. It is especially ESRD in childhood. In a growing organism are marked metabolic, immune, endocrine processes against intoxication. The gradual loss of kidney function, prolonged state of uraemia is accompanied by changes occur in various organs and systems of an organism of the child. The disruption of water and electrolyte metabolism decreases the amount of saliva. Salivary gland partially assume the lost kidney function. In connection with the delay in the body of urochrome and symptoms of anemia appears yellowish coloration of the mucous membrane of the hard and soft palate, cheeks, lips. The tongue is often coated. Can develop "glandularia form of stomatitis. Subjectively, this is manifested by a feeling of soreness, burning. The mucous membrane of the mouth becomes dry, pale, fragile, easily injured coarse food and teeth. Reparative regeneration processes is reduced, and therefore in the mucosa of the cheeks, floor of mouth, tongue formed surface spots whitish - hyperkeratosis, parakeratosis. In addition, due to taking several drugs-fu is by hyperplastic changes of the mucous membranes of the oral cavity, manifested most often in children and adolescents with chronic renal insufficiency with poor oral hygiene, which in turn is a risk factor for septicemia, endocarditis and endoarteriite in place hemodialysis vascular access.

It is known that dialysis is not only increases the salivary flow rate, but also improves the composition of saliva. However, for a number of reasons, primarily economic, it is impossible to ensure all patients daily hemodialysis. Need a simpler and cheaper method that can improve the condition of the oral cavity and the work of the salivary glands in patients with end-stage chronic renal failure. Unfortunately, the Arsenal of tools that reduce thirst and increases saliva production, the domestic market is not very large. In addition, the composition of these products is not always possible to recommend them for use in these patients [Fox P.C. Systemic therapy of salivary gland hypofiinction / P.C. Fox // Dental Res. - 1987. - Vol 66. Special no. - p.689-692].

Known composition for the preparation of chewing gum "Health-2"containing aqueous solution mummy and cumin powder in a quantity of 0.05 and 0,065 g respectively per serving of the composition for one-time use, and the oligomer - vinyl acetate, powdered sugar, cocoa butter, ethyl alcohol, beeswax, essential oil. Chewing gum "Health-2" on the fully healing properties, allowing to reduce the incidence of oral cavity, larynx, to regulate the function of the gastrointestinal tract [patent RU 2025984, 1995]

The closest analogue of the invention is a method for the treatment and prevention of dental disease with end-stage CRF through the use of menthol-containing chewing gum without sugar "Wrigley", sugar sorbitol or xylitol in between meals one piece of chewing gum for at least 10 minutes 6 times a day for 2 weeks [Nuts DO Clinical and biochemical rationale for providing dental care to patients receiving hemodialysis: author. dis. ... candles. the honey. Sciences. - Moscow, 2009. - 21 S.]. The disadvantage of this method is the lack of therapeutic effect of chewing gum containing as chewing basis of a synthetic polymer, and as an active menthol additives and sweeteners, i.e. those substances which are not always shown children with end-stage CRF.

The objective of the invention is to develop a method of treatment that can improve the effectiveness of prevention and treatment of dental diseases in children with chronic kidney disease in the terminal stage of hemodialysis.

The technical result in the use of the invention is the improvement in clinical indicators: decrease the dryness slithis the second membrane of the oral cavity, bleeding gums and a burning sensation, increased calcium, phosphorus, magnesium, protein and TBA - active products in oral fluid by use of a therapeutic chewing substrate, stabilization improved physico-chemical properties of the oral fluid after hemodialysis.

The proposed method of local treatment and prevention of dental diseases in children with ESRD is as follows: apply phyto-containing 4.0 g of beeswax and 0.4 g of root of Angelica. The drug is used as chewing substrate (chewing gum) within two weeks 3 times a day for 15 minutes after hemodialysis.

The roots of Angelica (ArchangelicaofficmalisHoffin) (GOST 21569-76) containing 0.35 to 1.9% of essential oils, 80-90% of which is represented monoterpenoid compounds. 13-28% terpene fraction beta Pellerano, 2-14% alpha phellandrene and 14-31% alpha-pinene. Only in the essential oil of the roots of Angelica identified 118 components.

Bicyclic sesquiterpenoid (alpha - and beta-pipey) have locally-irritating, antiseptic, otharkivayuschee and diuretic biological activity. Bisabol has anti-inflammatory, anticancer, bactericidal, and fungicidal properties. In the roots of Angelica identified more than 36 coumarins, the spectrum of biological activity includes the antioxidant, membrane, antibiotic, anabolic, photosensitizing, cytotoxic, antifungal activity. Contains the macro - and micronutrients.

Beeswax - solid granular substance secreted by the wax glands of young bees in the use of their honey or pollen. There are over 300 different compounds (esters, free fatty acids, hydrocarbons, water, aromatic substances, almost all macro - and micronutrients). In wax 13-15 free fatty acids, 12-17% of saturated hydrocarbons. Also contains carotenoids - 12,8 (4096 ME) in 100 g of wax, 400 times more than in carrots. Beeswax is recommended as a remedy anti-inflammatory, wound healing, softening character used to cleanse the mouth and gums stronger.

therapeutic effect of chewing substrate is manifested due to the fact that as chewing basics substrate contains beeswax, and as biologically active additives roots of Angelica, as well as the synergistic effect of its constituent components. In addition, the proposed chewing the substrate does not contain synthetic polymers, alcohol-containing components which are undesirable for children with end-stage CRF.

The proposed photosupload obtained as follows. When to the room temperature mix melted on a water bath beeswax in the amount of 4.0 g and 0.4 g of the powder of the crushed root of Angelica.

A survey of 52 children with chronic renal failure in the terminal stage, located on the software outpatient hemodialysis in-center hemodialysis and kidney transplantation Republican children's clinical hospital (Ufa) aged 15-18 years. The control group included 30 children of the same age without kidney disease and other chronic diseases.

Hemodialysis was performed on the artificial kidney Fresenius N, 5008S, 5008 with dialyzers F4-F7, FX40, FX60 under standard conditions using a bicarbonate solution with the contents of the dialysis fluid sodium concentration - 21,0 g/l, calcium - 0.9 g/L. the Hypocoagulation on dialysis was carried out by the introduction of fraxiparina, Fragmin, heparin. Treatment nephrogenic anemia was performed using winopen, maltofer-foul. Correction of disorders of calcium metabolism were carried out by the preparation of calcium carbonate 900 mg/suckale-D3-Nycomed, rocaltrol to 0.25 µg/day. Dialysis program patients had individual with regard to "dry weight", the weight gain in mediality period and other parameters were 9 hours per week 2 sessions - 2. Kt/v was - 1.3-2. Children were included in the study with informed consent of each and their parents.

A study of dental status, physical-chemical properties of ro the new fluid, as well as the determination of total calcium, phosphorus, magnesium oral fluid in children on hemodialysis. The dental examination included an external inspection, assessing the condition of the teeth, the mucous membranes of the oral cavity, periodontal tissues. In the oral fluid was determined the content of total protein, total calcium, phosphorus, magnesium (reagent kits "Vector-best") and TBA-active products (kits "AGAT-MED"), its physico-chemical properties before the hemodialysis session during the first hours after the procedure, and after chewing herbal remedies, containing 4.0 g of beeswax and 0.4 g of Angelica within 2 weeks after hemodialysis. It was used as chewing gum that has resulted in prolongation of action of medicinal substances. Children with ESRD after hemodialysis chewed the substrate for 15 minutes, then collected oral fluid.

In children with CRF collected the first sample mixed with saliva during dental examination prior to dialysis, the second sample after dialysis, the third after dialysis and the use of chewing substrate within two weeks 3 times a day for 15 minutes. Studied physico-chemical properties of mixed saliva - speed salivation, viscosity, pH. In samples of mixed saliva was determined by the amount of calcium, magnesium, phosphorus, protein and TBA-active products. PR is the change of parameters of calcium from 2.67±0.12 mmol/l to 1.75±0.03 mmol/l, magnesium with a 1.88±0.05 mmol/l to 1.09±0.05 mmol/l, phosphorus from 5.4±0.27 mmol/l to 2.56±0.21 mmol/l, protein from 1.2±0.04 g/l to 0.7±0.07 g/l, when the speed increases salivation saliva from 0.19±0.003 ml/min to 0.41±0,004 ml/min, lowering the pH from 7,22±0,04 up to 7.2±0,03, viscous 1,06=1=0.03 mm2/s to 0,061±0,046 mm2/s, the effectiveness of the treatment and prevention was evaluated as positive.

The viscosity of the saliva was determined by a glass viscosimeter ITG-4.

To determine the speed salivation used method TL Radinovo. The rate of salivation was determined by the following formula: SS=V/t={ml/min}, where V is the volume of excreted saliva accurate to ml; t - time collection of saliva in minutes.

The main complaints in children with chronic renal failure were dry red portion of the lips 73,1±6.2% of cases (in the control group of 6.7±3,4%), dryness of the mucous membranes of the oral cavity and 84.6±5,0% (in the control group of 6.7±3,4%), unpleasant taste in the mouth 57,7±6,7% (in the control group there are no complaints), burning sensation in the oral cavity of 19.2±5.5% (in the control group there are no complaints), noted complaints significantly higher than in the control group (p<0,05). After chewing herbal remedies substrate wax-Angelica patients noted a decrease in dryness of the mucous membrane of the lips and oral cavity, bleeding gums, burning sensation and unpleasant taste in the mouth.

The mucous membrane of the mouth was pale in the group of children with ESRD and 65.4±6.6 percent (g is the SCP control 3,3:1:3,3), edema in children with ESRD is 76.9±5,8%, hyperkeratosis identified at 19.2±5.5% of cases, swelling of the tongue - 61,5±6.7% of cases, coated tongue - 78,8±5.7% of cases (in the control group, these manifestations were absent).

The prevalence of dental caries in children with ESRD who were on hemodialysis, was 92.3%in the control group the prevalence of caries was 56,7%; intensity of dental caries in children with ESRD who were on hemodialysis, was 2,89±0,01% (in the control group 1,27±0,02%), the difference was significantly (p<0,05).

The rate of salivation in children with chronic kidney disease prior to dialysis amounted to 0.19±0.003 ml/min, within one hour after hemodialysis - 0,26±0.002 ml/min, after dialysis and after chewing herbal remedies substrate with Angelica - 0,41±0,004 ml/min (difference significantly, p<0.05 is given in relation to the group after dialysis and after chewing substrate with Angelica), control group - 0,45 ml/min (table 1). The PH of oral fluid to hemodialysis - 7,22±0,04, after dialysis was 7.2±0,03 (the difference is not significantly p>0.05), and after chewing substrate with beeswax and Angelica - 7,09±0,03 (the difference is not significantly p>0,05)in group a pH of 6.6. the viscosity of the oral fluid to the dialysis was 1.06±0,03 after hemodialysis - 0,061±0,046 (the difference is not significantly p>0.05), and after haemodialysis after chewing herbal remedies substrate with Angelica viscosity amounted to 1.03±0,04 (the difference authentically p<0,05), in the group control the viscosity of the oral fluid was - 0,96±0,05 (table 2-3).

Protein in the oral fluid to the dialysis was 1.2±0.04 µmol/l, after haemodialysis - 0,7±0.07 µmol/l, after haemodialysis after chewing herbal remedies substrate with Angelica 1,17±0.22 µmol/l (difference authentically p<0,05); control group - 1,75±0.11 µmol/l of TBA-active products in the oral fluid to the dialysis was 0.5±0,05; after hemodialysis - 0,23±0,03; after hemodialysis after chewing substrate is 0.37±0,01 (the difference authentically p<0,05); control group - 0,18±0,11.

Calcium in the oral fluid to the dialysis amounted to 2.67±0.12 mmol/l; after hemodialysis is 1.75±0.03 mmol/l; after hemodialysis after chewing substrate is 2.33±0.08 mmol/l (difference authentically p<0,05); control group - 2,18±0.08 mmol/l Magnesium before hemodialysis was 1.88±0.05 mmol/l; after hemodialysis - 1,09±0.05 mmol/l; after hemodialysis after chewing substrate - 1,4±0.04 mmol/l (difference authentically p<0,05); control group - 1,15±0.06 mmol/l Phosphorus in oral fluid was 5.4±0.27 mmol/l; after hemodialysis - 2,56±0.21 mmol/l; after hemodialysis after chewing a substrate of 5.68±0.11 mmol/l (difference authentically p<0,05); in the control group 4,18±0.3 mmol/l (Table 4).

Thus, evaluation of the effectiveness of chewing substrate containing beeswax and the root of Angelica in the prevention and treatment of dental diseases in children with the MO, hemodialysis have shown positive results.

Clinically it is manifested in the period after hemodialysis in reducing dryness of the mucous membrane of the lips and oral cavity, decrease bleeding gums, burning sensation and unpleasant taste in the mouth. The study of biochemical parameters in children after hemodialysis marked increase in oral fluid calcium, magnesium, phosphorus, protein and TBA-active substances. The detected speed has been increased salivation, a significant reduction of pH and viscosity of the oral fluid.

The invention is illustrated in the following clinical example.

Patient A., aged 15, was treated in the dialysis Department in the Republican children's clinical hospital with a diagnosis of ESRD, end-stage. Indicators to hemodialysis: Sa 2,58 mm/l, P 5,64 mm/l, Mg 1,65 mm/l, protein 1.2 g/l of TBA 0,52 MK/l, the rate of salivation saliva to 0.17 ml/min, pH 7,22, the viscosity of the saliva 1,04 mm2/s

After the hemodialysis: Sa of 1.92 mm/l, R to 5.21 mmol/l, Mg (1.15 mm/l, protein 0.65 g/l, TBQ of 0.21 µg/l, the rate of salivation saliva of 0.24 ml/min, pH 7,21, the viscosity of the saliva 0,49 mm2/s

After 2 weeks of hemodialysis and chewing substrate containing beeswax and the root of Angelica: Sa to 2.29 mm/l, P 2,42 mm/l, Mg of 1.34 mm/l, protein 1.2 g/l, TBQ of 0.32 µg/l, the rate of salivation saliva of 0.38 ml/min, pH was 7.08, the viscosity of the saliva of 1.02 mm2/s

Still the way the use of chewing substrate containing beeswax and the root of Angelica, helped to stabilize the improvement of physico-chemical parameters of oral fluid after hemodialysis.

Table 1
The speed of separation of mixed saliva in the target groups of children
Indicators of mixed salivaBefore hemodialysisAfter dialysisAfter dialysis + chewing substrate containing beeswax and Angelica root medicaments.The control group
The rate of salivation (ml/min)0,19±0,0030,26±0,0020,41±0,0040,45±1
Note: the significance of differences (p<0,05) is given relative to children before dialysis and after dialysis + chewing substrate containing beeswax and Angelica root medicaments.

Table 2
the pH of the mixed slew the s children in the studied groups
Indicators of mixed salivaBefore hemodialysisAfter dialysisAfter dialysis + chewing substrate containing beeswax and Angelica root medicaments.The control group
pH7,22±0,047,2±0,03to 7.09±0,036,6±0,01
Note: the significance of differences (p<0,05) is given relative to children before dialysis and after dialysis + Angelica.
Table 3
The viscosity of mixed saliva in children in the studied groups
Indicators of mixed salivaBefore hemodialysisAfter dialysisAfter dialysis + chewing substrate containing beeswax and Angelica root medicaments.The control group
Viscosity (mm2/s) 1,06±0,030,061±0,0461,03±0,040,96±0,05
Note: the significance of differences (p<0,05) is given relative to children before dialysis and after dialysis + chewing substrate containing beeswax and Angelica root medicaments.
Table 4
Biochemical parameters of mixed saliva in children in the studied groups
Before hemodialysisAfter dialysisAfter dialysis + chewing substrate containing beeswax and Angelica root medicaments.The control group
CA (mmol/l)2,67±0,121,75±0,032,33±0,032,18±0,08
Mg (mmol/l)1,88±0,051,09±0,05 1,4±0,041,15±0,06
P (mmol/l)5,4±0,272,56±0,215,68±0,114,18±0,3
Protein (µmol/l)1,2±0,040,7±0,071,17±0,221,75±0,11
TBA0,5±0,050,23±0,030,37±0,010,18±0,01
Note: p<0,05 in relation to the group after dialysis and after chewing substrate containing beeswax and Angelica root medicaments.

The method of local treatment and prevention of major dental diseases in children with end-stage chronic renal failure, hemodialysis, including the use of chewing substrate within 2 weeks, characterized in that use chewing substrate containing 4.0 g of beeswax and 0.4 the root of Angelica 3 times a day for 15 minutes



 

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FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutical industry, namely to a preparation for prevention and treatment of osteoporosis and bone fractures. A method for prevention and treatment of osteoporosis and bone fractures involving the administration of male bee brood, D-group vitamin or vitamins, and/or active metabolites thereof, a calcium compound taken in certain proportions. The preparation for prevention and treatment of osteoporosis and bone fractures consisting of male bee brood, D-group vitamin or vitamins, and/or active metabolites thereof, a calcium compound taken in certain proportions.

EFFECT: preparation and method for treatment enable enhancing the mechanism of uniform recovery of mineral bone density and bone tissue retention ensured by maintaining the androgen level.

3 cl, 1 tbl, 21 dwg, 2 ex

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