Effiectiveness of Etiotropic Therapy in Patients with Chronic Recurrent Oral Candidiasis: a Randomized Controlled Clinical Trial

Background. Effective treatment of oral candidiasis is especially relevant due to the increase in patients with recurrent fungal lesions of the oral cavity caused by the growing number of Candidaspp. strains refractory to antimycotic drugs. The paper presents the results of the study on the clinical efficacy of etiotropic therapy in patients with chronic recurrent course of oral candidiasis.Objective. To assess the effectiveness of etiotropic therapy in patients with chronic recurrent oral candidiasis.Methods. A randomized controlled clinical trial was conducted in 56 patients with chronic recurrent oral candidiasis aged 45 to 74 years. Examination and treatment of patients was performed at the Department of Dentistry of Volgograd State Medical University and at Volgograd Regional Clinical Dental Polyclinic (Volgograd, Russia). Study timeline: September 2020 — November 2022. Patients were divided into 2 groups depending on the antimycotic drug used: in the main group, patients took voriconazole, in the control group — fluconazole. In addition to etiotropic therapy, patients of both groups were prescribed complex treatment aimed at stimulating the immune protection of the body, restoring vitamin and mineral deficiency, and correcting the imbalance of the oral ecosystem. The patients underwent local symptomatic therapy: antiseptic treatment with 0.06% chlorhexidine bigluconate solution, anesthesia with 15% lidocaine gel, and 3.44% retinol oil solution to stimulate epithelization. Oral sanitation and professional hygiene were recommended for patients to prevent oral candidiasis. In order to restore chewing function, patients were referred to prosthodontic treatment. The main reference point of the study was to assess the effectiveness of the therapy, both by clinical criteria and by evaluating the results of bacterial culture test in order to record the quantitative, species and susceptibility profile of Candidaspp. strains in 3 weeks, 6 and 12 months after the end of treatment. Analysis and statistical processing of the obtained data were performed using Excel program to MS Windows 10 (Microsoft Corp., USA).Results. The most common pathogenic agent of chronic recurrent forms of oral candidiasis is C. albicans (69.6%), followed by C. non-albicans species — C. krusei (10.7%), C. tropicalis (10.7%) and C. glabrata (8.9%). Analysis of the quantitative characteristics of Candidaspp. using bacterial culture test revealed a high and moderate number of Candidaspp. CFU in most clinical isolates before treatment, and no such cases in patients of the main group after treatment. The susceptibility test of yeast fungi to fluconazole and itraconazole showed the presence of isolates with dose-dependent susceptibility, and the resistance of individual samples C. krusei to fluconazole and C. glabrata (16.7% and 60%, respectively) and to itraconazole (33.3% and 100%, respectively). All Candidaspp. isolates were found to be highly susceptible to voriconazole. The efficacy of the combined treatment of an episode with voriconazole is 95.4%. Continued suppressive therapy with voriconazole resulted in relapse prevention in 98.3% of patients. Etiotropic therapy with voriconazole provided a stable clinical effect (92.7%) after a year of follow-up.Conclusion. The results of the study confirm the effectiveness of etiotropic therapy with voriconazole for chronic oral candidiasis complicated by a recurrent course, especially in case of detected C. non-albicans or fluconazole- and itraconazole-resistant C. albicans, or if it is impossible to identify the pathogenic agent

Andsystem in dentistry: a reasoned choice

Currently, therapeutic dentistry is developing by leaps and bounds. With the huge number of new filling materials, techniques that appeared in the dental market, before dentist faces the task proper, reasoned choice. In this paper, we conducted a comparative analysis of adhesive strength of different composition and properties of materials for restoration of the tooth crown using andsystem. The extracted teeth were divided into two groups: group I - used titanium standard pins, which are fixed glass ionomers cement; group II - fiberglass pins for fixing which used cement Relyx U200. Was conclusively proven the best adhesion of the composite to the tooth hard tissues using self-adhesive composite cement in combination with fiberglass pins

Multiple dens evaginatus and talon cusp: classification, pathophysiology, prevalence, clinical problems and treatment. Report of a two cases

Relevance. Currently, an odontogenic anomaly of tooth development, which is referred to as a bump on the crown surface of the affected crown, is encountered more and more often at the dental reception. and premolar Leong. Often this malformation is combined with spatula incisors (talon cusp). The prevalence of this strain in the Asian group of the population, whose representatives in the territory of the Russian Federation constitute a significant part of the population, makes it necessary and relevant knowledge of this pathology by dentists. Aim is to draw the attention of dentists to the features of treatment of Dens evaginatus due to the high prevalence of this pathology. Materials and methods. The paper describes the clinical cases of patients with Dens evaginatus (DE) with a description of the treatment plan in order to prevent the development of complications at the dental admission with the wrong approach to the treatment of this pathology. A comprehensive examination and treatment of patients was carried out, in accordance with the data obtained using CBCT, a treatment plan was drawn up. The main treatment method for DE is to prevent erasing and breaking off the DE bump, especially in teeth with unformed roots. Results. The obtained results indicate a high prevalence and frequency of occurrence of this pathology at the dental admission, which, if improperly treated, may cause complications leading to loss of viability of the tooth pulp.Conclusions. Based on the results of the study, it can be concluded that C-shaped channels are often found in the lower premolars in the Asian group of the population, which present the greatest difficulty in endodontic treatment

Comparative characteristic of the effectiveness of instrumental treatment of teeth with a C-shaped root canal

Aim. Compare the effectiveness of dental instrumentation with a C-shaped root canal system with two different endodontic systems: XP-endo and Gentlefile. Materials and methods. The study was performed on 30 teeth removed by medical reasons (18 premolars and 12 second molars of the lower jaw). Samples were divided randomly into 2 equal groups. Separately, three C-shaped mandibular premolars were processed with XP-endo and Gentlefile systems and manual steel files for scanning electron microscopy. For comparison, one rough premolar was taken. The C-shaped configuration was confirmed by cone-beam computed tomography. The quality of endodontic treatment of root canals was assessed by the microstructure of the surface of the root dentin using a scanning electron microscope, as well as the depth of penetration of the dye into various zones of the root dentin. When working with the XP-endo system, the mean value of the area of stained dentin in the apical third was 11.56 ± 3.15, in the middle – 37.65 ± 9.3, in the coronal – 45.3 ± 12.3. In the Gentlefile group, the painted area of root dentin in the apical third was on apical 3.5 ± 1.39, in the middle- 8.5 ± 2.42, in the coronal – 12.8 ± 1.65. Differences are significant (p ≤ 0.05). SEM photographs of samples of the treated Gentlefile showed coarser dentinal surfaces, the presence of a smeared layer, fewer open dentinal tubules than by XP-endo. Results of the study showed that the endodontic system XP-endo better treats the surface of the dentin root canals with the C-shaped configuration, compared with the Gentlefile

FEATURES MICROCIRCULATION MOUTH WITH INFLAMMATORY-DESTRUCTIVE DISEASES

Currently, dentistry is developing by leaps and bounds. With a huge number of new diagnostic and treatment methods, to a dentist there is a problem proper, reasoned choice. No exceptions are and diseases of the oral mucosa. Increasing interest on the diagnosis of the microvasculature acquires laser Doppler flowmetry. Since inflammatory-destructive diseases of the oral mucosa is necessary to provide not only local therapeutic treatment, namely to work on one of the causes of this disease. In this paper we evaluated the microcirculation in patients with oral lichen planus by laser Doppler flowmetry. These data show not only the deterioration of the microcirculation in the hearth direct inflammation, but not altered in clinically mucosa symmetrical areas