49
ОБЗОРНЫЕ СТАТЬИ
treatment of patients with cleft lip, alveolus and
palate // J. Cranio-MaxiillofacSurg. – 2006. – Vol.
34 (Suppl 2), – Р. 22-26.
18. Koch H., Gbolahan O.O., Ogunmuyiwa S.A., Osinaike
B.B. Randomized Controlled Trial comparing Dressing
and No Dressing of Surgical Wound after Cleft Lip
Repair // J. Contemp. Dent. Pract. – 2015. – Vol. 16,
№7. – Р. 554-558.
19. Stellmach W.J., Bos M., Hopman J. et al. Decolonisation
of meticillin-resistant Staphylococcus aureus (MRSA)
carriage in adopted children with cleft lip and palate //
J. Glob. Antimicrob. Resist. – 2016. – Vol. 9, №7. – Р.
28-33.
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УДК: 616. 315-007-0. 89. 844-053.2
http://dx.doi.org/10.26739/2091-5845-2019-24
THE ROLE OF STUDYING
LOCAL IMMUNITY IN CHILDREN
WITH CONGENITAL CLEFT LIP
AND PALATE
Amanullaev R.A., Ikramov G.A.,
Shomurodov E.T.
Tashkent State Dental Institute
Annotation
Despite the large number of surgical methods for
eliminating defects of the palate, the authors note the
development of anatomical and functional disorders in the
future. Surgical intervention on the tissues of the hard and
soft palate leads to the disruption of the existing barrier -
protective complex of the oral cavity. Saliva contains specifi c
and non-specifi c defense factors. Immunoglobulins, T - and
В -lymphocytes act as factors of specifi c protection. Factors
of non-specifi c protection are represented by: interferons;
lysozyme; lactoferrin; macrophages, neutrophils, etc. The
oral cavity has a powerful system of humoral immunity,
which contains secretory immunoglobulin A, which has a
wide spectrum of protective action.
Аннотация
Несмотря на имеющееся большое количество хирур-
гических методик по устранению дефектов неба, авто-
ры отмечают развитие в дальнейшем анатомо-функци-
ональных нарушений. Оперативное вмешательство на
тканях твердого и мягкого неба приводит к нарушению
сложившегося барьерно - защитного комплекса поло-
сти рта. Слюна содержит факторы специфической и
неспецифической защиты. В качестве факторов спец-
ифической защиты выступают иммуноглобулины, Т-
и В-лимфоциты. Факторы неспецифической защиты
представлены: интерферонами; лизоцимом; лактофер-
рином; макрофагами, нейтрофилами и др. Ротовая по-
лость имеет мощную систему гуморального иммуните-
та, которая содержит секреторный иммуноглобулин А,
обладающий широким спектром защитного действия.
Ключевые слова:
Врождённая расщелина верней
губы и небо, методы лечения, Местный иммунитет по-
лости рта.
Congenital cleft of the upper lip and palate - a
malformation that occurs as a result of impaired fetal
morphogenesis. Treatment of Congenital cleft of the upper
lip and palate is an urgent problem of pediatric maxillofacial
surgery [2, 6, 12].
Despite the signifi cant development of surgery for
congenital cleft lip and palate, the outcome of surgical
treatment is not always satisfactory. According to different
authors, the number of persons with postoperative
complications ranges from 16 to 52% [7,13]. A high
percentage of postoperative complications undoubtedly
indicates a lot of unresolved issues and the relevance of
this problem. Great importance is given to the state of
health, type of cleft, the method of operation, the technical
readiness of the surgeon, the postoperative management of
patients [2,7,14].
Rehabilitation of patients with secondary defects of the
hard and soft palate is accompanied by special diffi culties.
Despite the large number of surgical methods for eliminating
defects of the palate, the authors note the development of
anatomical and functional disorders in the future. Surgical
intervention on the tissues of the hard and soft palate leads
to the disruption of the existing barrier - protective complex
of the oral cavity [1,6].
In addition, the issue of preoperative preparation and
postoperative care remains a controversial issue to this day.
Improvement of existing and development of new methods
of treatment, which would be highly effective and at the
same time economically acceptable, is required.
Congenital cleft of the upper lip and palate is an
anatomical defect that affects one of the important protective
functions of the immune system, especially if the child
is prone to diseases of otorinolaringologi organs and the
upper respiratory tract [4,15]. Normal lymphopharyngeal
ring from the moment of birth protects the child from
respiratory viruses, bacteria, fungi. One of the fi rst
scientists who formulated and advanced the theory of the
50
STOMATOLOGIYA
importance of local immunity of the oral cavity in 1925
was A.M. Frequently. He emphasized the independence of
the mechanisms of local immunity from systemic and the
importance of local immune mechanisms of the oral mucosa
in the development of infectious diseases. Normally, oral
cavity contains conditionally pathogenic (gram-positive and
gram-negative) microorganisms, their number is of great
importance. The oral cavity in a child performs a number
of inalienable functions: sucking, swallowing, digestive,
respiratory, salivary [1,10]. The main and necessary also
includes maintaining the normal state of the oral mucosa.
Saliva contains specifi c and non-specifi c defense factors.
Immunoglobulins, T - and V-lymphocytes act as factors of
specifi c protection. The barrier function of immunoglobulins
is manifested by: ensuring the binding and neutralization
of microorganisms on the surface of mucous membranes;
inhibiting the adhesion of pathogens and reducing the risk
of penetration into the div; binding of the complement and
preventing the development of infl ammation; the interaction
of antigen-binding centers of antibodies with epitopes of
antigens; potentiation of the activity of non-specifi c defense
factors. Factors of nonspecifi c protection are represented by:
interferons (increase antiviral protection of epithelial cells
and activate natural killer cells and macrophages); lysozyme
(has a bactericidal effect, eliminates pathogens, blocks viral
particle transcriptase); lactoferrin (reduces the degree of
colonization of sideophilic bacteria due to their binding to
iron); macrophages, neutrophils, etc. The oral cavity has
a powerful system of humoral immunity, which contains
secretory immunoglobulin A, which has a wide spectrum
of protective action (antimicrobial, antiviral, antitoxic).
Specifi c cell protection is carried out by T-lymphocytes
of the submucosa [2,5]. The species composition of the
microfl ora of the oral cavity is quite stable, but the number of
microorganisms varies signifi cantly depending on the nature
of the food, the condition of the oral cavity, tissues and the
presence of somatic diseases, dental caries. In recent years,
much attention has been paid to the study of immunity in
children with respiratory pathology. Ciliated epithelium and
mucociliary clearance contribute to the removal of foreign
particles. Air is also heated in the nasal cavity. In the follicles
of the tonsils form T and B lymphocytes, macrophages. The
early age of children is characterized by the peculiarity of
the function of the immune system, the high proliferative
activity of lymphocytes, the predominance of the fraction
of undifferentiated lymphocytes. At this age, there is a
reorientation of the immune response to infectious antigens
from the prevalence of the Th 2 response, typical of newborns
and children in the fi rst months of life, to Th 1, which is typical
of adults. The anatomical defect of the lympho-pharyngeal
ring contributes to the dysfunction of the microbiocenosis
and local immunity of the mucous membranes of the
oropharynx and nasopharynx [4, 7, 11]. Thus, in children
with chronic adenoiditis in nasal secretions and saliva,
the total amount of secretory immunoglobulin (slgA),
lysozyme, and also serum IgA was signifi cantly reduced.
The defi cit of secretory immunoglobulin A, dysfunction of
the normal microfl ora, contributes to the development of
infl ammatory diseases of the skin and mucous membranes
of the upper respiratory tract. Children with cleft palate fall
into the category of frequently ill children, as they begin
to suffer from respiratory diseases almost from the fi rst
months of life. Diseases such as SARS, acute respiratory
infections, rhinitis, bronchitis, starting from birth, occur in
waves until the operation period. In frequently ill children,
violations in the interferon production system (IFN) are
also detected. In a study conducted by a group of authors,
in frequently ill children, 80% of cases showed a 2-fold
reduction in the ability of cells to synthesize gamma-IFN
compared to infrequently ill children. Given the defect of
local protection, it can be assumed that the presence of
pathogenic microfl ora, especially Gram-negative, will be
important in the development of frequent infl ammatory
diseases of the roto-and nasopharynx in this group of
children.
In children with congenital isolated cleft lip and palate,
microbiological studies of pharyngeal smears were
performed to select a rational antibiotic therapy. It was
revealed the predominance of gram-negative microfl ora in
the oral cavity. To prevent the development of intercurrent
diseases and postoperative complications, according to the
results of the study, parenteral cephalosporins of the third
and fourth generation should be used in the preoperative
and postoperative periods, oral cefi xime and protected
aminopenicillins should be used [1,4].
The choice of drugs used to treat diseases of the
oral mucosa is great, but not all of them meet the basic
requirements - rapid, effective, painless healing of the oral
mucosa. Therefore, it seems relevant to search and clinical
approbation of emerging new drugs of local action, which
by their pharmacological properties can be used in dental
practice in the treatment of diseases of the oral cavity in
children. Currently, probiotics are of increased interest
among dentists. The bacterial fl ora of plaque is currently
regarded as the primary factor causing periodontal lesions
in gingivitis and periodontitis [3].
The main task in the development of treatment regimens
for periodontal diseases is to address the issue of systemic
or local use of antibacterial drugs. Different antimicrobial
and antiseptic preparations used in dental practice totally
affect all parts of the oral biocenosis. However, their
bacteriostatic effect persists for a very short time , while
often due to antibacterial treatment the biocenosis of the
oral cavity changes and there is an increase in the resistance
of pathogenic microfl ora to antibiotics. Infl ammatory
diseases of periodontal tissues, as a rule, are accompanied
by oral dysbiosis, the severity of which corresponds to the
degree of lesion.
At the same time, against the background of pronounced
growth of pathogenic and conditionally pathogenic
microorganisms, the concentration of representatives of
normal microfl ora decreases. Therefore, the development
and use in the course of treating infl ammatory periodontal
diseases of means that help restore the normal microfl ora
51
ОБЗОРНЫЕ СТАТЬИ
of the oral cavity and, in particular, periodontal tissues,
is considered a necessary condition for increasing the
effectiveness of treatment. One of the promising directions
in this regard is the use of biologics, the active principle of
which are representatives of the normal microfl ora of the
oral cavity [4, 10].
The scientifi c novelty of the study is that for the fi rst
time in dental practice in the treatment of infl ammatory
periodontal diseases, a comparative evaluation of the
effectiveness of various drugs from representatives of
the symbiotic fl ora has been carried out. When used
in the course of complex treatment of periodontitis of
tableted forms of acylact eubiotics, bifi dumbacterin and
lactobacterin, no signifi cant differences in the effectiveness
of their use within one degree of periodontal lesion is not
established [3,11].
For the fi rst time in the treatment of patients with chronic
generalized periodontitis, the combined use of lacto-and
bifi dus-containing drugs was carried out. The simultaneous
use of acylact and bifi dumbacterin restores oral lactofl ora
more effectively than the use of each of the drugs separately
[8, 16].
For the fi rst time, tableted bacterial preparations were
used in the treatment of infl ammatory periodontal diseases.
It has been established that acylact, bifi dumbacterin or
lactobacterin should be used in the form of resorption tablets
for periodontitis of mild and moderate degrees, as well as
for all degrees of periodontitis at the stage of maintenance
therapy as a regulating bacteriocoenosis and immunotropic
agent.
For the fi rst time in the treatment of periodontitis, a
scheme was proposed for the differentiated use of various
bacterial preparations and their various dosage forms,
depending on the degree of periodontal damage, as well as
on indicators of local immunity of the oral cavity.
The effect of bacterial preparations on the restoration of
oral microfl ora sensitivity to antibiotics during periodontitis
was studied. When using acylact, bifi dumbacterin and
lactobacterin, antibiotic sensitivity is restored with mild
periodontitis at 90%, with moderate periodontitis at 75%,
and with severe periodontitis in 50% of cases [4, 11].
The tactics of the use of bacterial preparations in
the treatment of infl ammatory periodontal diseases is
substantiated. According to clinical and microbiological
indicators, it has been established that the use of
lactobacterin at the stage of active treatment against the
background of treatment of the underlying disease is more
effective than when it is used only during the period of
maintenance therapy. The greatest effi ciency of using
lactobacterin simultaneously with antibacterial therapy has
been shown [10, 17].
It has been justifi ed to conduct targeted bacterial therapy
to correct the composition of the microfl ora of the oral
cavity during periodontitis of various degrees of severity
at different stages of treatment and rehabilitation in order
to increase the effectiveness of complex treatment [6, 18].
A scheme for the differentiated use of bacterial
preparations and their various dosage forms is proposed,
depending on the severity of periodontal disease and on
indicators of local immunity of the oral cavity.
The methods of using various dosage forms of bacterial
preparations for infl ammatory periodontal diseases have
been substantiated. The optimal time parameters for the
treatment of periodontitis were determined using tablet and
ampullated forms of bacterial preparations [3, 17].
The necessity of supporting bacterial therapy after a set
of active interventions in the treatment of periodontitis with
the aim of signifi cantly prolonging the period of remission
is substantiated.
The article discusses the role of the probiotic product
in strengthening the anti-infective defense of the div.
As a result of the conducted research, the positive effect
of the probiotic product Actimel on the parameters of the
innate immune system has been established: non-specifi c
stimulation of the local intestinal immunity; increased
metabolic activity of phagocytes; increased production of
IL-2 and IFN-γ.
For fi ve decades, scientists argued about what exactly
probiotics are. However, in 2002, fi nally, a consensus was
found, thanks to which the World Health Organization was
able to adopt the defi nition of probiotics. So, according
to the WHO, probiotics are non-pathogenic for humans
microorganisms that are able to restore the normal
microfl ora of organs, as well as detrimental effects on
pathogenic and conditionally pathogenic bacteria. In other
words, probiotics are microbes, which normally make up
the microfl ora of various human organs [4, 8, 12].
Thus,Comprehensive and phased treatment of young
children about congenital non-through crevice of the upper
lip and palate, including preoperative preparation, modifi ed
uranoplasty and remedial measures aimed at eliminating
the effects of this pathology, optimizes conditions for the
normal growth and development of the child’s div.
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УДК: 616.317-002-08
http://dx.doi.org/10.26739/2091-5845-2019-3
СОВРЕМЕННЫЕ
ПОДХОДЫ К ЛЕЧЕНИЮ
ЭКСФОЛИАТИВНОГО ХЕЙЛИТА
Астанакулова М.М., Бекжанова О.Е.
Ташкентский государственный стоматологический институт
Аннотация
Для лечения эксфолиативного хейлита используются
средства, воздействующие на этиологические факторы,
патогенетические механизмы и симптомы заболева-
ния. Медикаментозное воздействие включает лечение
местных проявлений на слизистой красной каймы губ,
а системное – комплекс мер, купирующих системные
факторы развития заболевания: лечение фоновой сома-
тической патологии, применение нейролептиков, кор-
тикостероидов, метотрексата, детоксикационной тера-
пии, а также нетрадиционных методов.
Ключевые слова:
эксфолиативный хейлит, сомати-
ческая патология, медикаментозное воздействие, ком-
плексное лечение.
Annotation
The treatment of eksfoliative cheilitis is in use of agents
infl uencing on etiological factors, pathogenetic mechanisms
and symptoms of diseases. Drug treatment includes the
treatment of local manifestations on the mucosa of the red
lip rim, and the systemic one - in a complex of measures
that arrest the systemic factors of the disease development:
treatment of background somatic pathology, the use of
neuroleptics, corticosteroids, methotrexate, detoxifi cation
therapy, and non-traditional methods of treatment.
Лечение заболеваний слизистой оболочки рта, в
частности эксфолиативного хейлита (ЭХ), является
одной из актуальных проблем современной стомато-
