Клініко-морфологічне обґрунтування лікування хронічного катарального гінгівіту у хворих без супутньої патології

Abstract

У даній статті показані морфологічні зміни усіх ланок мікроциркуляторного русла ясен у хворих на хронічний катаральний гінгівіт. Обґрунтоване використання для медикаментозної терапії досліджуваної патології композиції “Діоцинкохім” та пасти на її основі, доведені переваги запропонованого способу перед традиційним; В данной статье показаны морфологические изменения всех звеньев микроциркуляторного русла десны у больных хроническим катаральным гингивитом. Обоснованно использование для медикамен­тозной терапии исследуемой патологии композиции “Диоцинкохим” и пасты на ее основе, доказаны преиму­щества предложенного способа перед традиционным; According to generalized information of recent epidemiological researches of independent experts from the WHO, the 90-95 % of the adult population has the inflammatory periodontal diseases, which currently occupy a leading position in the structure of dental diseases. It should be noted that one of the main etiological factors that leads to the periodontal pathology (in addition to infectious) is a disturbance of the regional hemodynamic and microcirculation, so the search of new methods of treatment of chronic catarrhal gingivitis, which are aimed at normalization of microcirculatory gingival disorders is reasonable. The purpose is to improve the efficiency of medicamentical therapy of chronic catarrhal gingivitis using the composition “Diotsynkohim” and paste on its base. The object of the study were 20 patients with chronic catarrhal gingivitis. Gingivitis was diagnosed according to conventional clinical criteria. The microcirculatory gingival disturbances were determined using the morphological methods by studying of biopsies using light and electron microscopy. Depending on the treatment plan, patients were divided into two groups: basic and control. The basic group in­cluded 12 patients who were treated using the composition “Diotsynkohim” and paste on its base. The control group included 8 patients who were treated using 0.06 % solution of chlorhexidine and gel “Metrogyl-Dent”. The results of our morphological study of the patients’ gums with chronic catarrhal gingivitis showed the pronounced structural changes of all components of connective tissue and microvasculature. With chronic gingivitis the basal layer of epithelial cells grows unevenly as outgrowths which get into the connective tissue. The hemodynamic disorders are pronounced irregularly by hyperemia of blood vessels, hemorrhages, edemata and lymphostases. Arterial microvessels and capillaries are irregularly narrowed because of edema of endothelial cells. There is the increase of permeability of the capillary endothelium and the conditions for increasing of platelets’ ability to aggregation are made. There is the adhesion of erythrocytes to luminal surface of capillaries’ endothelial cells. In addition, there are considerable structural disturbances in venous microvessels and material changes in the rheological properties of blood, attendant by stagnant phenomena and disturbances of vascular permeability that leads to hydration of interstitial space.It should be noted that these structural disturbances of all parts of the microvasculature and gingival stroma is reversible on the assumption of carrying the pathogenetic treatment that is aimed at correcting of microcirculatory disturbances. The criteria of the recovery of patients with chronic catarrhal gingivitis were the following indicators: the disappearance of unpleasant subjective sensations, no bleeding gums, iodonegative reaction on Schiller-Pisarev test, normalization and stability of indexes PMA and IG, no false periodontal pockets, normalization of parameters that characterize the microcirculatory percent. After analyzing of these parameters, it can be concluded that patients who was treated using the composition “Diotsynkohim” and paste on its base have considerable improving of microcirculatory processes in gingival tissues.