Evaluating the Efficacy of Synbiotic Mouthwash in Patients with Dyscirculatory Encephalopathy: Observational Clinical Study

Background. At present, the priority direction of medical science and practice is the prevention of dental diseases, especially in patients with somatic pathology. Patients with dyscirculatory encephalopathy develop a complex of neurological disorders, accompanied by impaired motor functions of hands, lips and chewing muscles, which leads to ineffective cleansing of the oral cavity from food residues and formation of soft and mineralized dental deposits on the dental surface. Therefore, these patients should use additional personal hygiene products.

Objective. To evaluate the efficacy of hygienic care in patients with dyscirculatory encephalopathy using mouthwash with synbiotic complex.

Methods. An observational clinical study was conducted on the basis of Neurology Unit No. 2 of Research Center of Neurology, Department of Cariology and Endodontics and Department of Biological Chemistry, A.I. Yevdokimov Moscow State Medical and Dental University. The study enrolled 82 patients aged from 45 to 74 years with cerebrovascular disease, dyscirculatory encephalopathy, decompensation (I68.7, according to ICD-10). Patients were divided into two study groups: group 1 (n = 44) — patients who used mouthwash with synbiotic complex; group 2 (n = 38) — patients who did not use mouthwash. The efficacy of mouthwash with synbiotic complex was assessed by using an index score of a simplified Greene Vermillion Oral Hygiene Index (OHI-S), Russell Periodontal Index (PI), Papillary Bleeding Index (PBI), and physicochemical parameters of the oral fluid. Statistical processing of the results was carried out using Stat Plus 7 (Analyst Soft Inc., USA).

Results. The comparative analysis proved the efficacy of mouthwash with synbiotic complex. The hygienic status improved to (1.50 ± 0.12) points, the state of periodontal tissues — to (PI = (1.94 ± 1.45) points; PBI = (1.12 ± 0.11) points). The hydrogen index (pH) of the oral fluid decreased to weakly alkaline values — (7.92 ± 0.22) points; the activity of alkaline phosphatase decreased by a factor of 1.4, lactate dehydrogenase — by half, aminotransferases — by a factor of 1.3, and D-dimer — by a factor of 1.2.

Conclusion. The obtained results demonstrate the efficacy of mouthwash as an additional means for personal hygiene. Mouthwash with synbiotic complex should be included in the daily oral hygiene care for patients with dyscirculatory encephalopathy.

1. Vecherkina ZhV, Smolina AA, Popova TA, Kubyshkina KP, Oleynik OI. Etiological aspects of dental caries and its prevention. Sistemnyi Analiz i Upravlenie v Biomeditsinskikh Sistemakh . 2020;19(2):79–86 (In Russ.). https://doi.org/10.25987/VSTU.2020.19.2.012

2. Ippolitov EV, Nikolaeva EN, Tsarev VN. Oral biofilm: inductors of congenital immunity signal pathways. Stomatologiya. 2017;96(4):58–62 (In Russ.). https://doi.org/10.17116/stomat201796458-62

3. Yatsenko AK, Pervov YY, Trankovskaya LV, Gritsina OP, Mosienko EE. Risk factors for oral mucosal diseases (literature review). Actual Problems in Dentistry. 2022;18(3):71–76 (In Russ.). https://doi.org/10.18481/2077-7566-2022-18-3-71-76

4. Bykova NI, Sirak SV, Ovsyannikova AA, Arutyunov AV, Romanenko AR, Sirak ES, Grigoryan VA, Verevkina YuV, Shamanova ZK. Index Evaluation of Clinical Efficacy of Immunomodulatory and Osteotropic Therapy for Chronic Generalized Periodontitis of Varying Severity: A Prospective Cohort Study. Kuban Scientific Medical Bulletin. 2023;30(3):34–43 (In Russ.). https://doi.org/10.25207/1608-6228-202330-3-34-43

5. Pitts NB, Twetman S, Fisher J, Marsh PD. Understanding dental caries as a non-communicable disease. Br Dent J. 2021;231(12):749–753. https://doi.org/10.1038/s41415-021-3775-4

6. Tsarev VN, Nikolaeva EN, Ippolitov EV. Periodontophatogenic bacteria of the main factors of emergence and development of periodontitis. Journal of Microbiology, Epidemiology and Immunobiology. 2017;94(5):101–112 (In Russ.). https://doi.org/10.36233/0372-9311-20175-101-112

7. Kakorina E. P., Nikitina S. Y. Features of the structure of mortality in the Russian Federation. Problemi Socialnoi Gigieni, Zdravookhranenia i Istorii Meditsini. 2019;27(5):822–826 (In Russ.). https://doi.org/10.32687/0869-866X2019-27-5-822-826

8. Writing Group Members; Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):447–54. https://doi.org/10.1161/CIR.0000000000000366

9. Parfenov VA. Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):61–67 (In Russ.). https://doi.org/10.14412/2074-2711-2019-3S-61-67

10. Vakhnina NV, Milovanova OV, Grinyuk VV. Neurological disorders in hypertensive patients. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(4):57–64 (In Russ.). https://doi.org/10.14412/2074-2711-2015-4-57-64

11. Dai R, Lam OL, Lo EC, Li LS, Wen Y, McGrath C. A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke. J Dent. 2015;43(2):171–180. https://doi.org/10.1016/j.jdent.2014.06.005

12. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O’Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, Decarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge Rv, Pantoni L, Speck O, Stephan BC, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M; STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–838. https://doi.org/10.1016/S1474-4422(13)70124-8

13. Leira Y, López-Dequidt I, Arias S, Rodríguez-Yáñez M, Leira R, Sobrino T, Campos F, Blanco M, Blanco J, Castillo J. Chronic periodontitis is associated with lacunar infarct: a case-control study. Eur J Neurol. 2016;23(10):1572–1579. https://doi.org/10.1111/ene.13080

14. Gazdanova AA, Ponomarenko TM, Solovieva SA, Lenkova NI, Ryazantseva OV, Sivkov AS, Deryugin AS, Andreeva EE. Dental manifestations of somatic diseases. Profilakticheskaya Meditsina. 2022;25(1):104–110 (In Russ.). https://doi.org/10.17116/profmed202225011104

15. Saleev RA, Abdrashitova AB, Gainullina DK, Safina NA, Mustafin IG. Features of biochemical composition of oral fluid in patients with psychoneurological disorders. Pediatric dentistry and dental prophylaxis. 2019;19(3):43–46 (In Russ.). https://doi.org/10.33925/1683-3031-201919-3-43-46

16. Tsarev VN, Nikolaeva EN, Vitovich MV, Mitereva MМ, Podporin MS. Biofilm-forming bacteria in atherosclerotic plaques in patients with cardiovascular diseases and chronic periodontitis. Clinical Dentistry (Russia). 2020;2(94):40–45 (In Russ.). https://doi.org/10.37988/1811153X_2020_2_40

17. Muratova SK, Khaidarov AM, Khozhimetov AA. Analysis of the features of the dental status and hemostasis in patients with chronic cerebral ischemia. Problems of Biology and Medicine. 2020;118(2):88–92 (In Russ.). https://doi.org/10.38096/2181-5674.2020.2.00093

18. Oleinik OI, Kalugina YV, Vusataya EV, Oleinik EA, Brykina AA. The role and place of liquid hygiene products in the system of therapeutic and preventive measures for dental and periodontal diseases. Sistemnyi Analiz i Upravlenie v Biomeditsinskikh Sistemakh. 2022;21(2):43–53 (In Russ.). https://doi.org/10.36622/VSTU.2022.21.2.018

19. Balmasova IP, Tsarev VN, Yushchuk EN, Dorovskikh AS, Malova ES, Karakov KG, Elbekyan KS, Arutyunov SD. Periodontal diseases and atherosclerosis: microecological, metabolic and immunological mechanisms of interconnection. Immunologiya. 2020;41(4):370–380 (in Russ.). https://doi.org/10.33029/0206-4952-2020-41-4-370-380

20. Brookes ZLS, Belfield LA, Ashworth A, Casas-Agustench P, Raja M, Pollard AJ, Bescos R. Effects of chlorhexidine mouthwash on the oral microbiome. J Dent. 2021;113:103768. https://doi.org/10.1016/j.jdent.2021.103768

21. Watanabe E, Nascimento AP, Guerreiro-Tanomaru JM, Razaboni AM, de Andrade D, Tanomaru-Filho M. Antiseptic mouthwashes: in vitro antibacterial activity. Acta Odontol Latinoam. 2015;28(2):180–184. https://doi.org/10.1590/S1852-48342015000200014

22. Konyaeva VV. Encephalopathy associated with covid-19: experience of clinical observations in practical work of neurologist. Lechebnoe Delo. 2020;3:43–46. https://doi.org/10.24412/2071-5315-2020-12255