Peculiarities of the premedication scheme of dental outpatient manipulations in patients with malignant neoplasms of various geneses

Abstract

Summary. This article sheds light on the main problem of the occurrence of pain syndrome in patients with oncology at the stage before and after active specialized treatment and substantiates the key aspects of developing a premedication scheme during the dental rehabilitation of these patients. Pain syndrome accompanies most diseases and interventions in the maxillofacial region, complicating the course of the underlying disease and complicating the dentist's work. Improvement of local analgesia for dental manipulations and surgical interventions for SCD in patients with oncology at the stage of and after active specialized treatment is also an urgent and understudied issue in medicine. The presence of complex pathological changes in the form of paraneoplastic syndrome and secondary changes in the macroorganism due to antitumor radiation and chemotherapy can affect the pain threshold, pharmacokinetics and pharmacodynamics of local anaesthetics in most patients.

The aim of the study – improving the treatment of dental diseases in patients with oncological diseases through the development and clinical substantiation of the algorithm of premedication tactics, during analgesia of dental manipulations in patients with oncology.

Materials and Methods. 87 patients of working age from 30 to 60 years old were under observation. Among them, 47 are female and 40 are male. 27 of them suffered from acute serous and purulent periodontitis, 35 – from exacerbation of chronic periodontitis, 25 – from acute purulent odontogenic periostitis and had simultaneous removal of several teeth or roots. All patients were under inpatient treatment in the oncology dispensary and in dispensary records at the clinic, and also needed surgical and dental treatment in connection with the established nosology. 50 patients made up the main group, which underwent a scheme of premedication and analgesia

Results and Discussion. The obtained results indicate the presence of problems with the oral cavity in 100.0 % of patients undergoing specialized anticancer chemotherapy, as well as the presence of a sufficiently high need for specialized dental treatment. The high frequency of registration of pain sensations, and, accordingly, their quality of life impairment indicates the need to prescribe additional non-steroidal anti-inflammatory drugs with an analgesic effect and the use of local anaesthetics for pain relief during meals. The obtained data coincide with the results of clinical studies by a number of authors from near and far abroad. In the main group, pain sensations completely disappeared in 85.00 % of patients, and in 15.00 % of cases pains of weak intensity remained. That is, the use of premedication together with local anaesthesia allowed for 15.00% of cases to improve the analgesia of SCLD tissues in patients with concomitant oncology. Psychological testing of patients with existing malignant diseases of various localizations, in whom, at the stage of active treatment of the main disease, inflammatory diseases of SCD (periodontitis, acute purulent odontogenic periostitis of the jaws) were diagnosed according to the HADS method showed that the highest level of anxiety was observed when the patient developed acute purulent periostitis - 9.23±0.36 (М=8.90) HADS points, before emergency care, the lowest level was in patients with acute apical periodontitis – 6.83±0.38 (М=6.50) points. After treatment in the first group of patients, the level of anxiety decreased to 5.3±0.25 (M=5.00) points, in patients with acute apical periodontitis – to 3.14±0.18 (M=3.00). It can be assumed that the increasing anxiety of patients with acute purulent periostitis is associated with changes in appearance and the need for additional dissection of the foci of purulent inflammation during treatment.

Conclusions. The study of the time intervals of the onset and effective effect of local anaesthesia of the tissues of SCD showed that the combination of local anaesthesia with the original scheme of premedication made it possible to approximate the time of onset of anaesthesia in acute purulent periostitis of the jaws and acute apical periodontitis to such indicators in somatically healthy patients (5.70±0 .30 (M=5.15) min and 5.30±0.30 (M=5.00) min and 3.41±0.31 (M=3.30) min and 3.30±0.21 (M=3.00) min respectively). The duration of analgesia with the use of premedication increased in all studied types of acute inflammatory pathology and was longer than in the control group by 6.00–27.50 min.