THE APPROVAL OF COMPLEX TREATMENT EFFECTIVENESS OF GENERALIZED PERIODONTITIS FOR THE PATIENTS AFTER TRANSMITTED CORONAVIRUS DISEASE AND REMAIN ON REHABILITATION
Generalized periodontitis is one of the most common dental diseases. This pathology very often occurs, progresses or exacerbates on the background of concomitant somatic pathologies, such as diabetes, obesity, aging, hypertension, and in the last year, coronavirus disease. The main mechanisms or causal relationships of these pathologies with dental status have not been studied enough. The course of generalized periodontitis includes inflammatory-dystrophic, dysbiotic manifestations that affect periodontal tissues and may have systemic consequences. Interestingly, these same factors are widely associated with the progression or severe coronavirus disease caused by the coronavirus type SARS-CoV-2. However, the assessment of oral health, including the condition of periodontal tissues for the patients diagnosed with COVID-19 has not been studied and has not been widely described in the scientific literature. The course of generalized periodontitis associated with severe COVID-19 might help to identify the risk groups and establish appropriate recommendations for the treatment and follow-up of this group of dental patients and will allow choosing the effective treatment of periodontal disease for such patients, which is one of the most pressing tasks of modern dentistry today. The study aims to evaluate the effectiveness of standard and proposed comprehensive periodontal treatment, taking into account the mobility of teeth, determining the depth of periodontal pockets, and the level of epithelial attachment for the periodontal patients with lung diseases caused by coronavirus infection in rehabilitation. We examined, observed, and treated 60 dental patients diagnosed with generalized I-II stage periodontitis (chronic course) who were treated in the hospital for pulmonary complications of COVID-19 and were in rehabilitation at the time of the study. The duration of treatment and observation is approximately 7-10 days and 30 days after discharge from the hospital. 30 patients (Group A) were treated according to the standard treatment protocol, and the other 30 patients (Group B) were treated accordingly to the proposed complex. The patients were examined based at the University Clinic of Ivano-Frankivsk National Medical University in the clinic of the Therapeutic Dentistry Department. The age of the examined patients ranged from 25 to 61 years, including 30 women and 30 men. Both standard and proposed algorithms of procedures for treating the first stage included thorough removal of all local irritants of periodontal tissues, mechanical treatment of the tooth root surface, manual and ultrasonic scaling, removal of super- and subgingival soft and hard dental deposits, smoothing of the root surface with the following polishing of the treated surfaces and applying a desensitizer. The local drug therapy, according to the standard protocol, consisted of antiseptic treatment of the oral cavity, irrigation of periodontal pockets with an antiseptic solution; application of sorbent on the gums for 10 minutes, followed by application of the pharmaceutical preparation in gel form which contains chlorhexidine in a stable concentration of 0.25% and metronidazole 10% under the insulating cap. The treatment was completed by applying "Solcoseryl-dental adhesive paste". All the patients were prescribed a multivitamin-microelement complex, as well as hyposensitizing therapy, and oral care products were individually selected. According to the algorithm of the proposed additional local drug treatment we conducted a course of instillation into the periodontal pockets, by introducing cotton swabs soaked in 2% solution of Protargol, for 7-10 15-20 minute sessions; followed by simultaneous application of Resistol solution (from Pelargonium sidoides roots extract), which was pre-dissolved in 50 ml of boiled water and was used to rinse the oral cavity and swallowed according to the scheme: 1st week – 30 drops for solution 3 times a day, 2nd week – 20 drops 3 times a day which should be continued for up to 1 month. Then we recommended to use "Gingigel", a hyaluronic acid-based gel, which is applied on the gums with clean fingers, by gently massaging and evenly distributing it on the surface of the gingival mucous membrane, 3-4 times a day for 3-4 weeks; 8 tablets of "Imudon" a day should be taken orally for 14 days, followed by subsequent reduction to 4 tablets per month, while the tablets are absorbed in the mouth with an interval of 1-2 hours. In addition, we prescribed "ELGYDIUM", a therapeutic and prophylactic toothpaste with chlorhexidine, as well as antibacterial solution of "Chlorhexidine-Denta" 0.12%, for 14 days, which is then replaced with sea salt-based toothpaste "Parodontax" and rinsing the mouth twice a day with 15% aqueous solution of "Stomatofit" according to the scheme: dilution of 10 ml of the drug in 1/4 cup of boiled water during the next months.
The received results of the clinical study revealed that generalized periodontitis associated with COVID-19 has an extremely aggressive clinical manifestation. Treatment and follow-up of dental patients with severe COVID-19 can help identify risk groups and establish appropriate recommendations for the effectiveness of standard and proposed comprehensive periodontal treatment. The comparison of the effectiveness of treatment protocols for the patients diagnosed with generalized periodontitis and those hospitalized for pulmonary complications of coronavirus did not reveal a significant difference in the obtained clinical data on the choice of treatment. Examination of areas compromised by generalized periodontitis and abutment teeth based on the obtained periotestometric data of tooth mobility, indicates a significant reduction in inflammation and strengthening of the ligaments and is a highly informative diagnostic method.
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