DYNAMIC ENS IN REHABILITATION OF PATIENTS WITH CHRONIC PERIODONTAL DISEASES

Svetlakova E. Dynamic electroneurostimulation in rehabilitation of patients with chronic periodontal diseases / E. Svetlakova, J. Mandra, N. Jegalina // 17th ESPRM European Congress of Physical and Rehabilitation Medicine. Venice. 2010. p. 195-197.

DYNAMIC ELECTRONEUROSTIMULATION IN REHABILITATION OF PATIENTS WITH CHRONIC PERIODONTAL DISEASES

E. Svetlakova, J. Mandra, N. Jegalina
Ural State Medical Academy, Yekaterinburg, Russia

Aim

Treatment of periodontal diseases is a topical issue due to the high prevalence of periodontal diseases. Due to the lack of motivation patients tend to ignore first signs of a disease (gum inflammation, pain, bleeding). Self treatment that involves uncontrolled use of medications, bioactive nutrients and physical methods leads to temporary recovery. Due to the complexity and multistage development of pathological processes in the periodontium it becomes necessary to treat those using medications with various action mechanisms including anti-inflammatory and pain relief drugs, enzymes, medications stimulating microcirculation, correcting immune protection and many other types of drugs that act at different pathogenetic stages of the pathological process. The range of remedies that can be used for medication therapy is practically unlimited. However we should bear in mind that all drugs have side and toxic effects that can be caused by overdosage accumulation in the patient’s body, allergic reactions, idiosyncrasy and bacterial overgrowth. Physical factors can stimulate immune reactions of the body, decrease manifestations of general and local sensitization, change neurohumoral processes in the body and in the disease focus. It can enhance the local selective action of the drug and restore microcirculation. In order to improve local tissue resistance, normalize microcirculation and eliminate congestion conditions in the tissues, physicians can use massage, hydromassage, d’arsonvalization, medication electrophoresis. Timely and correct application of physical factors as part of comprehensive therapy allows either to eliminate the initial manifestation of a disease, relieve its symptoms and reduce their severity and possibility of complications or to reduce each stage of the pathological process, which makes it possible to introduce other treatment methods under the most favorable conditions.

Development of various applications of therapeutic application of impulse current is an area where much potential exists. Electric current is easy to control and many of its parameters make it an efficient irritant for structures focused in the area or reflexogenous areas and acupuncture points. Dynamic electroneurostimulation (DENS) is a new step in development of transcutaneous electroneurostimulation and acupuncture. The method involves exposure of reflexogenous zones and acupuncture points to short bipolar impulses of current at various frequency levels. Their form changes depending on the tissue impedance. DENS is delivered via portable transcutaneous electrostimulation units. The DiaDENS-PCM unit can operate within a broad range of frequencies (from 10 to 200 Hz). For diseases of the periodontium the treatment should be delivered at 60 to 77 Hz during 15 minutes. The purpose of this study was to enhance the effect of treatment delivered to patients suffering from chronic generalized catarrhal gingivitis and chronic generalized periodontitis in the mild and medium degree by applying the dynamic electroneurostimulation method at the stage of non-surgical treatment.

Methods

During one year (from January, 2009 until January, 2010) we examined and delivered non-surgical treatment to 67 patients suffering from chronic generalized catarrhal gingivitis (28 men and 39 women aged 18-25), 37 patients with chronic generalized periodontitis in the mild degree (12 men and 25 women aged 25-32), 48 patients with chronic generalized periodontitis in the medium degree (including 12 men and 36 women aged 3547). The research was conducted in the dental clinic of the Ural State Medical Academy. The study included somatically healthy patients. During their first visit the patients complained of gum bleeding while brushing their teeth (39.9% of the patients we examined), odorous breath (45.21%), itching, painful gums (53.06%). Periodontitis patients additionally complained of exposed tooth necks (11.34%), hypersensitivity of the hard tooth tissues (24.08%) and acute periods with single abscesses in case of medium degree periodontitis. The researchers focused on identifying individual oral hygiene defects (Green-Vermillion index).

The oral cavity examination included: evaluation of the tunica mucosa and the alveolar processes of the upper and lower jaws (the PMA index), the gingival papillae bleeding index (PBI) determination, occlusion and dentition status evaluation, assessment to the DMF index and detection of traumatic occlusion. We used the following functional tests: vacuum strength test of the gingival capillaries based on Kulazhenko method around the mandible central incisors, diagnostic orthopantomography (using the ORTHOPHOS unit, medium radiation dose 36 .Sv), clinical pocket measurement (mild degree periodontitis – less than or equal to 3 mm, medium degree periodontitis – less than or equal to 5 mm). The non-surgical treatment stage included instructing all patients participating in the study about oral hygiene rules, selection of individual hygiene items, professional oral hygiene, elimination of local irritating factors, oral cavity sanation and anti-inflammatory treatment of the periodontium. The patients were divided into groups based on their diagnosis. Each group was divided into two subgroups (control and main). The patients in the first subgroup received conventional treatment while in the second subgroup we included dynamic electrostimulation performed by means of a DiaDENS-PCM unit into the treatment. The course consisted of 10 daily procedures. Electrodes were applied on segmental zones on each side for 5 minutes. The stimulation power level was selected individually for each patient. The therapy effect was evaluated in 10 days, 3 months and 6 months after the first day of treatment. We used Student’s test for statistical processing of the research data.

Results

Primary examination of the oral cavity showed congestive hyperemia in all patients, oedema of the papillary (98.7%) or marginal (84%) gum, slight pastosity in 27% of patients; 100% of patients had bleeding while probing, soft plaque, supragingival calculus and 97.6% of chronic periodontitis patients had subgingival calculus. Abnormalities of occlusion or the position of individual teeth were found in 48% of patients. The DMF index for catarrhal gingivitis patients in the study group was 7.16, while in the comparison group it was 6.72; the Green-Vermillion index was 3.32 in the study group and 3.34 in the comparison group (showing unsatisfactory oral hygiene); PMA was 48.53% in the study group and 46.85% in the control group; the bleeding index was 1.41 in the study group and 1.42 in the comparison group. The haematoma formation rate was 13.9 sec. in the study group and 14.8 sec. in the comparison group. Primary examination showed no statistically significant differences in objective data, index assessment and additional functional tests were found between the study group and the comparison group.

Table I

Index assessment values for patients with chronic generalized catarrhal gingivitis

Table II

Index assessment values for patients with mild degree chronic generalized periodintitis

Table III

Index assessment values for patients with medium degree chronic generalized periodontitis.

Primary examination of the patients with chronic generalized periodontitis showed active signs of inflammation: congestive hyperemia and oedema of the papillary and the marginal gingiva and bleeding while probing; damaged dentogingival junction, the clinical pocket depth of 3 mm (in case of mild degree of the process) to 5 mm (in case of medium degree) and gingival recession up to 1-2 mm in 42% of cases. All patients had a large amount of dental plaque, supra- and subgingival calculus; their hygiene level was found unsatisfactory. 1st degree tooth mobility was found in 47% of patients with periodontitis in the medium degree. The capillary strength test showed a high rate of haematoma formation. Index assessment values for patients with chronic generalized catarrhal gingivitis in the main and control groups before treatment and on the control dates are performed in Table I. Parameters of patients with mild and medium degree chronic generalized periodontitis in both groups before and after treatment and on the control dates are in Tables II,III. In 10 days after they began their non-surgical treatment course patients in all groups mentioned subjectively they felt better and felt effect of the treatment. Objective examination showed abatement of inflammation in the periodontium and reduction of absence of dental plaque or calculus after professional hygiene. However 62% of patients in the comparison group complained of hyperesthesia of the hard tooth tissues and a feeling of discomfort after professional oral hygiene that lasted for 3 or 5 days and in some cases – up to a week. In the study groups such complaints were made only by 20% of patients who informed the researchers that the uncomfortable sensations disappeared after the second DENS procedure. We should also note that on all control dates the PMA and bleeding values in the study groups were validly lower than those in the control groups. In general we can assess the outcome of non-surgical treatment of patients suffering from periodontal diseases as satisfactory. This includes improved oral hygiene and reduced inflammation. The treatment improves blood circulation, has an anti-inflammatory effect, activates bioactive substance production and tissue metabolism and restores muscular and vascular tonus.

Dynamic electrostimulation enhances general health and fitness and makes the patient feel happier and more optimistic. Numerous studies have shown that the therapeutic effect of dynamic electroneurostimulation is based on multi-level reflex and neurochemical reactions that trigger a cascade of regulatory and adaptive mechanisms in the body. In case of diseases of the periodontium DENS therapy can be administered at any stage of the comprehensive treatment course as its part. It helps eliminate the pain syndrome, enhance the treatment effect and make it last longer, reduce probability of complications, shorten the duration of each of the stages in the pathological process as they follow each other and allows the patient to benefit more from other treatment methods. This will enhance the patients’motivation to continue their treatment and raise their confidence of a positive outcome of the therapy. When DENS therapy is prescribed it is essential that the physician and the patient make sure that all indications and contraindications for its use are complied with.