94
Резюме
Беременность
связывают
с
учащением случаев гингивального
воспаления,
которые
могут
трасформироваться в пародонтит
вплоть до серьезных деструктивных
поражений
пародонта
и
альвеолярных костей. В патогенезе
поражения
пародонта
при
беременности
важное
значение
придается
изменению
баланса
половых
гормонов,
патологии
беременности, обострения фоновой
соматической патологии и т.д.
Сравнительное
изучение
микроциркуляции
пародонта
беременных
и
небеременных
свидетельствует об отрицательном
влиянии
беременности
на
микроциркуляцию
интактного
пародонта
и
потенцировании
имеющихся
нарушений
при
сочетании
беременности
и
воспалительных
(гингивит)
и
воспалительно-деструктивных
(пародонтит) поражений пародонта.
По мере развития беременности
микроциркуляторные
нарушения
непрерывно прогрессируют и не
купируются в раннем послеродовом
периоде.
Summary
Pregnancy is associated with
increased
incidence
of
gingival
inflammation, which in certain cases
can
trasformirovatsya
into
periodontitis, up to serious destructive
lesions of periodontal and alveolar
bone.
In
the
pathogenesis
of
periodontal
pregnancy
importance
attached
to
rebalance
hormones,
pregnancy pathology, acute somatic
pathology background, etc.
Comparative study of periodontal
microcirculation
pregnant
and
nonpregnant
evidence
about
the
negative effects of pregnancy on the
microcirculation
of
the
intact
periodontal and potentiation of existing
violations, combined with pregnancy
and inflammatory (gingivitis) and the
inflammatory
and
destructive
(periodontitis) periodontal lesions . As
your
pregnancy
progresses
microcirculatory
disturbances
continuously progressing and
not
cropped in the early postpartum period
.
EFFICACY OF THE PROFESSIONAL DESENSITIZING TOOTHPASTE
SENSITIVE PRO-RELIEF (COLGATE) IN THE TREATMENT OF
HYPERESTHESIA OCCURRING DUE TO THE USE OF FIXED
ORTHODONTIC APPLIANCES IN CHILDREN
M. G. Shchegolyova, S. L. Starikova
The treatment of orthodontic
abnormalities
with
various
fixed
orthodontic
appliances,
including
braces, is currently widely used.
Despite
the
importance
of
orthodontic treatment, it should be
taken into account that the structural
elements of orthodontic appliances can
95
have a direct traumatic effect on the
tissues of the oral cavity, as well as
serve as retention areas where a soft
plaque may accumulate. When braces
are used, significant deterioration of
dental hygiene, mastication function,
self-cleaning ability is reported, oral
hygiene measures are impeded, blood
circulation in the microcapillary vessels
of the periodontal tissues is disturbed
that results in an increased incidence of
dental caries and occurrence of
periodontal diseases. Solubility of the
surface layer of tooth enamel beneath a
clasp and an orthodontic arch wire is
much higher as compared to the intact
areas. Fitting of the fixed appliances
results in the changes of metabolic
processes in the enamel [1, 2], which is
especially dangerous for the teeth with
immature enamel, since it is associated
with morphological disorders of a tooth
structure (see Fig. 1).
Fig. 1. Patient Kh., 15 years old. The areas of enamel demineralization on the
front teeth of the lower jaw after the removal of braces
The abovementioned local risk
factors trigger the development of
hyperesthesia of the hard dental tissues
(HHDT) on one hand and create
favorable
conditions
for
the
development of periodontal diseases
the other hand. [3].
No less important in the development
of HHDT is gum recession as well as
over-drying of the hard dental tissues
and gum retraction when rubber dam is
applied at the step of fitting fixed
retainers after orthodontic treatment
during the period of retention (see Fig.
2).
96
a)
b)
Fig. 2. Patient L., 16 years old:
a) during orthodontic treatment for retention of tooth 21;
b) after orthodontic treatment - recession of the gum adjacent to tooth 21.
HHDT
occurring
after
the
removal of braces causes children to
suffer and impedes oral hygiene
measures.
Therefore, the need for the
treatment of hyperesthesia with topical
remineralizing agents arises. Thus, the
use of the professional desensitizing
toothpaste
Sensitive
Pro-Relief
(Colgate), which was shown to have
high therapeutic efficacy in clinical
testing in adult patients, seems to be of
some interest in children [3,4,5].
The obvious advantage of this
toothpaste is its natural formula that is
based on the combination of amino
acid arginine, a component of saliva,
and calcium carbonate. It should be
noted that the synthesis of arginine is
often insufficient in children and
adolescents.
Innovative Pro-Argin technology
provides hermetic sealing of the
dentinal tubules with calcium that
offers resistance to various physical
and chemical challenges, including
exposure to dietary acid contained in
juices and drinks with low pH level
that are especially popular in children
and teenagers.
Materials and methods
To investigate the efficacy of the
professional desensitizing toothpaste
Sensitive Pro-Relief (Colgate), 31
orthodontic patients of both sexes
between 14 and 18 years of age,
diagnosed with a localized form of
dentin hyperesthesia grade I-II after the
removal of braces, were examined.
The patients were allocated to
two
groups
using
the
simple
randomization method:
I - main group (21 people);
II – reference group (10).
On clinical checkup, an objective
periodontological examination revealed
that the patients in both groups were
identical as to the baseline condition of
periodontal tissues presenting the signs
of mild or severe chronic localized
gingivitis: hyperemia, swelling and
97
deformation of the papillae and
marginal gingiva, grade I-II bleeding.
Many patients had gum recession
ranging from 1 to 2 mm.
Immediately after the removal of
braces and fitting the retainers, patients
in the main group used the professional
desensitizing toothpaste Sensitive Pro-
Relief (Colgate), which belongs to the
agents that physically block the
tubules.
The patients in the reference
group had their teeth polished with a
standard
polishing
paste.
A
desensitizing
toothpaste
with
the
chemical mode of action was rubbed in
once and prescribed for individual oral
hygiene.
The patients in the both groups
were recommended to use a toothbrush
of a «Sensitive» class - Colgate 360
0
Sensitive Pro-Relief.
All study participants were
informed of the terms and conditions of
the study, the parents of the patients
gave their written informed consent for
participation in the testing of the
medicated toothpaste Sensitive Pro-
Relief.
Yu. A. Fedorov’s classification
was used for the diagnostics of the
HHDT, [6], according to which grade I
hypersensitivity means that the tissues
of a tooth respond to thermal stimuli
(cold, heat), grade II - teeth respond to
thermal and chemical stimuli (salty,
sweet, sour, bitter), grade III – the
tissues of a tooth respond to thermal,
chemical and mechanical stimuli.
For obtaining more detailed
information on the patients’ subjective
feelings and for objectification of the
collected data, we used a verbal rating
and scale that allows the patients to
express their subjective feelings in
standard units: the lack of response to a
stimulus - 0, weak response - 1,
moderate response - 2, strong response
- 3 standard units [7].
For objectification of the hard
dental tissues sensitivity level, the
index of teeth hyperesthesia intensity
(ITHI) was used, which was calculated
in points as follows:
ITHI = Sum of indices for each tooth
Number of teeth with hyperesthesia
The value of the index for each
individual tooth is estimated by the
rating scale in points: 1 point - teeth
respond only to thermal stimuli, 2
points - response to thermal and
chemical stimuli, 3 points – the tissues
of a tooth respond to all kinds of
stimuli, including tactile.
Oral hygiene status was assessed
using the Green-Wermillion index.
The condition of gingiva was
assesses using the PMA index.
Since the working pH of the
toothpaste Sensitive Pro-Relief ranges
from 6.5 to 8.9, oral fluid pH was
measured in all patients to eliminate the
influence of this parameter on the
results of the study. The measurements
were performed according to a standard
method using serial digital device pH
meter-millivoltage meter PH-150.
The patients in the main group
received
basic
treatment,
which
included the removal of dental plaque
98
and prescription of anti-inflammatory
therapy.
Then
the
professional
desensitizing toothpaste Sensitive Pro-
Relief was rubbed in the sensitive areas
of the teeth for 3 seconds two times
during a session. Thereafter, the
patients were recommended to comply
with an oral hygiene regimen that
included twice daily brushing with a
medicated toothpaste possessing anti-
inflammatory properties and ultrasoft
toothbrush Colgate 360
0
Sensitive Pro-
Relief within 30 days.
The patients in the reference
group received similar basic treatment.
Then
they
had
a
desensitizing
toothpaste with a chemical mode of
action rubbed in the sensitive areas of
the teeth two times during a session
and were prescribed to rub in the same
paste daily for 30 days. Thereafter, the
patient received recommendations on
the daily hygienic oral care similar to
that in the main group of patients.
Clinical studies were performed
before
and
after
rubbing
in
desensitizing toothpastes depending on
the study group, as well as on Day 6-8
and Day 28-30 day after the initiation
of treatment.
The data collected underwent
statistical processing. To determine the
efficacy of treatment, mean values of
the indexes and pH were compared in
the main group and the reference
group. A two-sample t-test (P = 0.95)
was used to compare the mean values
for the following pairs of samples:
"Before treatment - After a week" and
"After a week - on Day 30."
Results of the study and their
discussion
The results of the clinical study
in
patients
with
hyperesthesia
diagnosed after the removal of braces
are presented in Table 1.
Table 1.
Change in the clinical parameters of the oral cavity on the steps of treatment for
hyperesthesia
Group
s of
patien
ts
Green-
Wermillion index
PMA index
pH
ITHI
Befor
e
treat
ment
Afte
r a
wee
k
On
Da
y
30
Befo
re
treat
ment
Afte
r a
wee
k
On
Da
y
30
Befo
re
treat
ment
Afte
r a
wee
k
On
Da
y
30
Befor
e
treat
ment
Afte
r a
wee
k
On
Da
y
30
Refere
nce
group
1.54
±
0.27
0.97
±
0.20
0.5
4 ±
0.2
1
1.12
±
0.18
0.60
±
0.17
0.0
9 ±
0.0
3
6.88
±
0.14
6.97
±
0.13
6.9
9 ±
0.1
3
1.17
±
0.14
0.73
±
0.36
0.4
±
0.3
7
Main
group
1.34
±
0.19
0.83
±
0.16
0.4
7 ±
0.1
3
1.08
±
0.12
0.57
±
0.11
0.1
0 ±
0.0
2
6.93
±
0.11
7.03
±
0.09
7.0
6 ±
0.0
9
1.2 ±
0.07
0.16
±
0.18
0.1
±
0.1
3
99
After the removal of braces, the
patients
in
the
both
groups
demonstrated an improvement in oral
hygiene and normalization of the
periodontal status. Significant changes
in the Green-Wermillion (see Fig. 3)
and PMA indices (see Fig. 4) in pairs
"Before treatment - After a week" and
"After a week – on Day 30” were
reported.
Fig. 3. Dynamic of the Green-Wermillion index after the removal of braces
Fig. 4. Dynamic of the PMA index after the removal of braces
In all the subjects, the values of
oral fluid pH remained within the
working range for the toothpaste
Sensitive Pro-Relief. In all the cases
slight changes in oral fluid pH were
observed after a week and on Day 30
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
Reference group
Main group
Before treatment
After a week
On Day 30
0
0,2
0,4
0,6
0,8
1
1,2
Reference group
Main group
Before treatment
After a week
On Day 30
100
after the initiation of the treatment
course.
Based on the objective dental
examination of 31 patients complaining
of hard dental tissues hypersensitivity
occurring after the removal of braces,
the signs of grade I or grade II
hyperesthesia were found. The reaction
to the temperature stimuli (cold test)
was the most overt. According to the
history data, pain in some patients was
triggered not only by the inhalation of
cold air and teeth brushing, but even by
food intake.
The patients in the main group
were reported to have absolutely no
complaints
of
hyperesthesia
immediately after rubbing in the
desensitizing toothpaste Sensitive Pro-
Relief. Diagnostic tests involving
various stimuli confirmed the result in
85% of patients in this group.
The comparison of the obtained
results with those in the reference
group revealed a significant relief of
the symptoms of dentin hyperesthesia
that confirmed therapeutic efficacy of
the desensitizing toothpaste Sensitive
Pro-Relief. At Day 7 and Day 30,
examination of the patients allocated to
this group showed a stable clinical
effect, since the vast majority of
patients (90% by Day 30 of the study)
still had no complaints of dentin
hypersensitivity
and
objective
examination showed no reaction to
various types of stimuli (see Fig. 5).
101
Fig. 5. Dynamic of the index of teeth hyperesthesia intensity after treatment
Moreover, all the patients have
noted a pleasant smell and taste of the
toothpaste that has a great importance
for the use of this product in pediatric
dentistry.
The patients in the reference
group had no antisensitive effect after
rubbing in the desensitizing toothpaste
at visit 1. Only by Day 7 of treatment,
the symptoms of hyperesthesia to
various stimuli disappeared in 30% of
the patients; by Day 30 the number of
patients in whom these symptoms have
resolved increased to 60%. It should be
noted that the patients in this group
reported a gradual decrease in the
intensity of pain ranging from the
strong to weak during treatment.
Thus, the use of the desensitizing
toothpaste with s chemical mode of
action
produced
a
satisfactory
antisensitive effect only by Week 4 of
treatment. Complete relief of pain was
achieved in 60% of the patients, with
40% of the patients retained a weak
painful reaction to a cold stimulus.
In the both groups, significant
changes in ITHI were reported in the
pair "Before treatment - After a week,"
while ITHI reduction by Day 30 after
treatment
was
not
statistically
significant, as compared to the value
seen a week after the initiation of
treatment.
The
clinical
studies
have
demonstrated
high
desensitizing
activity
of
the
professional
desensitizing toothpaste Sensitive Pro-
Relief in the treatment of hyperesthesia
syndrome occurring in children after
the removal of braces.
Conclusions
1. In the event of hyperesthesia
of the hard dental tissues in children
occurring
in
association
with
orthodontic treatment involving braces,
preference
should
be
given
to
desensitizing toothpastes that not only
provide the obstruction of open
dentinal tubules and enamel defects but
also have a remineralizing effect.
0
0,2
0,4
0,6
0,8
1
1,2
Reference group
Main group
Before treatment
After a week
On Day 30
102
2. The professional toothpaste
Sensitive Pro-Relief has an immediate
and sustained desensitizing effect on
the tissues of a tooth that lasts for 30
days, as evidenced by a significant
reduction in the indices of teeth
hyperesthesia.
3.
Pleasant
organoleptic
properties, natural formula of the
toothpaste Sensitive Pro - Relief, and
the
possibility
of
achieving
an
immediate desensitizing effect in one
visit create an additional positive
motivation for the use of this product in
pediatric dentistry.
References
1. Suntsov V.G. Leontiev V.K.,
Distel V.A., Wagner V. D. Dental
prophylaxis in children. - Moscow:
Medical Book. - 2001. - Pg. 206-212.
2. Kosenko D.K., Denga O.V.
Comprehensive prevention of major
dental diseases in children undergoing
orthodontic treatment. / / Visnyk
stomatologii. - 2010. - № 3. - Pg. 78-
84.
3.
Beloklitskaya
G.F.,
Asharenkova O.V. Antiplaque and anti-
inflammatory activity of the meducated
antisensitive
complex
Colgate
Sensitive
Pro-Relief
(professional
toothpaste)
in
the
treatment
of
hyperesthesia
associated
with
generalized
periodontitis.
/
/
Sovremennaya stomatologiya. - 2011. -
№ 2. - Pg. 38-43.
4.
Beloklitskaya
G.F.,
Savchenko N.V., Gorban Ya.S. New
desensitizing toothpaste Sensitive Pro-
Relief (Colgate) in the treatment of
hyperesthesia syndrome in patients
with generalized periodontitis. / /
Sovremennaya stomatologiya. - 2010. -
№ 2. - Pg. 41-46.
5.
Beloklitskaya
G.F.,
Savchenko N.V. Possibility of using a
new desensitizing toothpaste Sensitive
Pro-Relief (Colgate) in the treatment of
hyperesthesia of the hard dental tissues
in patients with gastroesophageal reflux
disease.
/
/
Sovremennaya
stomatologiya. - 2010. - № 4 (53). –
Pg. 3-6.
6. FedorovYu.A, Drozhzhina
V.A. Clinical presentations, diagnostics
and treatment of non-carious lesions of
teeth. New data on the incidence,
clinical presentations and specifics of
treatment for non-carious lesions of
teeth. / / Novoe v stomatologii .. -
1997. - № 10 (special edition). – pg.
145.
7. Bіloklitskaya G.F., Kopchak
O.V. Basic aspects of etіology,
pathogenesis, clinical presentations and
treatment of cervical hyperesthesia:
Methodological recommendations. -
Kyiv., 2008. – pg. 26.
Summary
The possibility of relieving
hyperesthesia of the hard dental tissues
in children undergoing orthodontic
treatment
with
braces
has
been
demonstrated.
