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CLINICAL AND MORPHOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF THE
APPLICATION INNOVATIVE THERAPEUTIC AND PROPHYLACTIC TOOTHPASTE IN THE
COMPLEX TREATMENT OF PATIENTS WITH MAJOR DENTAL DISEASES
Xaydarov Ulug’bek
Samarkand State Medical University, Uzbekistan
Axmedov Alisher Astanovich
Samarkand State Medical University, Uzbekistan
AB O U T ART I CL E
Key words:
Therapeutic and prophylactic
dentifrice, clinical study, cytomorphological study.
Received:
20.06.2024
Accepted
: 25.06.2024
Published
: 30.06.2024
Abstract:
The social and economic development
of a society is largely determined by the level of
health of its young population. The objective of
this study was to increase the effectiveness of
preventive and comprehensive treatment of
young patients with major dental diseases using
an innovative therapeutic and preventive
toothpaste based on organic gel. A group of 32
volunteers participated in the study. All patients
underwent a complex dental examination that
included
basic
and
additional
methods
(determination of indices of caries intensity,
indicators of oral hygiene (simple hygiene index
OHI-S, Silnes-Low index), evaluation of
periodontal tissue status (papillary-limbal
alveolar abscess index PMA, gingival bleeding in
inflammatory periodontal disease index BI
Müllmann), evaluation of pain (hypersensitivity)
to stimuli using a visual analog scale (VAS),
measurement of the electrical conductivity of
tooth enamel using the Dentest electrodiagnostic
device (ZAO Geosoftident), clinical evaluation of
enamel remineralization rate, spectrophotometer
"VITA (Easy Shade) (VITA) to evaluate tooth
discoloration, oral fluid immunoassay, and
cytomorphometric studies of the buccal
epithelium. The results of the clinical trials
showed that the therapeutic and prophylactic
toothpaste
has
excellent
consumer
VOLUME04 ISSUE06
https://doi.org/10.55640/eijmrms-04-06-26
Pages: 179-186
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characteristics, has no allergic or local irritant
effects on the oral mucosa, improves the natural
protection of the oral cavity, effectively cleans up
to 100% of the oral cavity, provides anti-
inflammatory effects, eliminates gum swelling and
bleeding from the first use, reduces tooth
sensitivity, reduces tooth enamel structure, and
was shown to have no toxic effect on the cells of
the buccal epithelium. The results of the clinical
trial suggest that the innovative therapeutic and
prophylactic dentifrice can be recommended for
daily use in a wide range of individuals, as well as
in patients with low tooth enamel resistance,
various periodontal diseases, and oral mucosa.
INTRODUCTION
Oral diseases occupy the third place among the general morbidity of the Russian population (the
incidence is 20-25%), are the cause of deterioration in general health and reduce the quality of life of
the population According to WHO, the prevalence of pathology of hard tissues of teeth and oral mucosa
currently reaches 95-97%. [1-5]. The most affordable way to prevent dental diseases is to use oral
hygiene products. Despite the wide variety, modern personal hygiene products have many
disadvantages. These include a drying effect on the mucous membrane of the oral cavity, the need for
long-term use for the development of a therapeutic and preventive effect, high abrasiveness, the
development of intolerance due to individual characteristics, high cost [6, 8]. Therefore, the
development of innovative therapeutic and prophylactic agents with new compositions and properties
is an urgent and interesting task for chemists and doctors various specialties (dentists, dermatologists,
immunologists, endocrinologists). During the implementation of this study, innovative therapeutic and
preventive dentists based on organogels, non-toxic and with high transdermal activity, were developed.
The permit for clinical use was issued by the Ethics Committee of the Federal Service for Supervision of
Medical and Social Development (Protocol No. 72 dated 06/23/2010). An important difference between
an innovative therapeutic and prophylactic toothbrush from conventional toothbrushes is that the base
used in its manufacture is an active conductor, which allows for more efficient, fast and complete
delivery of the active substance to the site of exposure. The biocompatibility of the base, the absence of
flavors and preservatives, anti-inflammatory and wound healing properties are the main advantages of
the developed pastes, which can be used for the treatment and prevention of teeth in all categories of
patients. The aim of the study is to increase the effectiveness of innovative therapeutic and preventive
dental paste based on organogels for the prevention and comprehensive treatment of major dental
diseases.
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Materials and methods of research:
A clinical study of innovative therapeutic and prophylactic
toothpaste was conducted on the basis of the UMMU dental clinic from April to May 2017 (the attending
physician is associate professor, Candidate of Medical Sciences Stati T.N.) on a group of 32 physically fit
volunteers aged 18 to 20 years. The study was conducted as follows. All the subjects were divided into
three groups in accordance with the classification of caries resistance levels according to V.B. Nedoseko,
according to B. Nedoseko, where the level of resistance was defined as the highest level of caries
resistance, the lowest level of caries resistance and the highest level of caries resistance, according to
B. Nedoseko. The group of people with an average level of resistance consisted of 12 people, the group
of people with a low level of resistance consisted of 11 people, and the group of people with a very low
level of resistance consisted of 9 people. 7-14 days before the start of the study, the participants were
trained in oral hygiene and personal hygiene rules by a specialist. To clean the surface of the teeth, a
toothbrush with medium hardness of bristles from the same manufacturer as in the Leonard method
was recommended. Other types of hygienic oral care were prohibited during the study period. They
also had to brush their teeth at home with organic gel toothpaste for two to three minutes at least twice
a day in accordance with the manufacturer's recommendations. The examination included the
collection of anamnesis (identification of complaints, anamnesis of life and past illnesses), visual
examination, intraoral examination, pathological examination of hard tissues of teeth and detection of
occlusive anomalies. The following indices and tests were performed during the examination: caries
intensity index (CPI index (h)), oral hygiene (simplified hygiene index, OHI-S; Silness-Lowe index),
assessment of the condition of periodontal tissues (papillary-marginal-alveolar index, PMA; the
Mulleman gum bleeding index in inflammatory periodontal diseases (MI)), assessment of pain
perception (hypersensitivity) to stimuli using a visual analog scale (VAS), measurement of electrical
conductivity of tooth enamel using an electrodiagnostic device "Dentest" (CJSC Geosoftdent).
Measurement. The COSRE test was used to evaluate the remineralizing ability of therapeutic and
prophylactic toothpastes. The bleaching efficiency was evaluated using a high-precision VITA Easy
Shade (VITA) spectrophotometer. Dental examinations were performed before the start of the study,
after the first application, 12 hours after application (to determine the rate of plaque formation), 7 and
14 days after application. The analysis of the organic properties of pastes was carried out by
interviewing participants (on a 5-point scale) after the first application and after 14 days. The patients'
subjective assessment of the paste quality, its appearance, color, smell, effect on taste sensitivity and
the presence of irritation of the oral mucosa was taken into account. Oral fluid was spontaneously
collected from all subjects and samples of buccal epithelium scraping were taken before and 14 days
after the application of toothpaste. Immunological studies of oral fluid included measuring the level of
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secretory immunoglobulin A (sIgA), cytomorphological studies of cytogenetic disorders in the buccal
epithelium, and a comparative assessment of the frequency of proliferation and destruction of nuclei.
Statistical processing of the results of all studies was carried out in the Vortex 7.0 program by the
method of variational analysis with the determination of the arithmetic mean standard deviations and
confidence intervals according to the Student's t-criterion. By default, the confidence interval of the
Vortex 7.0 application program is set t
o ≤0.01, which guarantees with a 95% probability that the
percentage values are within the range of the packet in the general population.
RESULTS AND DISCUSSION
During the survey, patients complained of carious teeth (75%), bleeding gums (45%), dental deposits
(23%), bad breath (20%) and tooth sensitivity (21%). During dental examination, the average CPI index
(h) was 7.8 ± 0.9, which was defined as the average level of caries intensity according to WHO criteria,
the Green Vermilion oral hygiene index was 1.82 ± 0.31, the Silnes-Lowe hygiene index (HI) was 1.82 ±
0.18, inflammatory periodontal diseases according to the gum bleeding index (IP) Mülleman - 1.57 ±
0.27, gingivitis index RMA - 34.87 ± 2.46%. Occlusive anomalies were detected in 55% of cases. At the
first application of the innovative therapeutic and prophylactic toothpaste and during its use, none of
the patients had any symptoms of individual intolerance (itching, burning). The organic properties of
the toothpaste were positively evaluated by all participants. According to the survey, the toothpaste
had a uniform consistency, neutral taste and smell (Fig. 1). A week after the first procedure, the oral
hygiene of all patients using innovative organic gel-based therapeutic and prophylactic toothpaste
improved, and the index values decreased significantly: The Green-Vermilion oral hygiene index was
1.05 ± 0.13%, the Silnes-Lowe hygiene index (HI) was 1.02 ± 0.05, the Mulleman gum bleeding index
(IP) for inflammatory periodontal diseases was 0.85 ± 0.15, and the PMA gingivitis index was 25.51 ±
1.64. Two weeks after the start of the toothpaste application, the patient had no complaints and there
was a decrease in bleeding gums. An examination of the oral cavity showed good hygiene, absence of
edema or hyperemia of the oral mucosa. An objective assessment showed that the Green-Vermilion oral
hygiene index decreased by 0.43 ± 0.12%, the Silnes-Lowe hygiene index (HI) was 0.53 ± 0.07, the
Mülleman gum bleeding index (IP) for inflammatory periodontal diseases was 0.55 ± 0.13, and the PMA
gingivitis index was 15.48 ± 1.6 (Fig. 2). When assessing the perception of pain to stimuli in patients at
the beginning of the study, the most pronounced pain response was observed when exposed to cold air
- 60%. After the use of therapeutic and prophylactic toothpaste based on organic gel, pain symptoms
disappeared in 21% of patients within 7 days and in 37% - within 14 days. This indicates the
remineralizing properties of therapeutic and prophylactic toothpaste based on organic gel (Fig. 3). The
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KOSRE test indicator confirmed the change in the resistance of tooth enamel after the use of therapeutic
and prophylactic toothpaste based on organic gel. The rate of remineralization (COSRE) of tooth enamel
when using the paste decreased to 32 ± 2.24 hours (Fig. 4). According to a subjective assessment, 37.5%
of the subjects noted the shine of teeth after using the therapeutic and prophylactic paste. The color of
the teeth became brighter after using this paste. This indicates that therapeutic toothpaste has the
ability to restore the protective properties of saliva. When using a therapeutic and prophylactic
toothpaste based on organogel, the frequency of occurrence of buccal epithelial cells with micronuclei
decreased by 50%, and the number of cells with protrusions remained. The evaluation of proliferation
indices indicates a decrease in the number of binucleated cells in the buccal epithelium by 25%. Among
the indicators of nuclear decay, a decrease in the number of cells with nuclear vacuoles and condensed
chromatin by 62.5 and 70%, respectively, should be noted, which indicates a decrease in destructive
changes in the nuclear membrane and the preservation of the barrier and transport functions of the
nuclear membrane. The natural form of apoptosis in buccal epithelial cells is considered to be nuclear
division. This indicator decreased by 59%, which indicates a mechanical change in the natural
destructive process of buccal epithelial cells. Conclusions: 1. The studied therapeutic and prophylactic
toothpastes have good consumer properties: they are neutral in taste and color, do not cause unpleasant
sensations (burning) in the oral cavity during and after use; 2. Therapeutic and prophylactic
toothpastes based on organic gels do not cause allergies and local irritation of the oral mucosa; 3. 3.
Clinical studies of therapeutic and prophylactic toothpastes based on organic gels have shown an
improvement in oral hygiene in patients, a decrease in the value of the Green-Vermillion index by 40%,
the PMA index by 50% and a decrease in tooth sensitivity by 37.5%. There was a decrease. The
restoration of the natural whiteness of the enamel and the strengthening of its structure were
observed.4 Cell-morphological studies of innovative therapeutic and prophylactic toothpastes have
shown the absence of toxic effects and a decrease in destructive changes in buccal epithelial cells.
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