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Oral disease and sodium hyaluronate

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Industry News
2018/09/26 11:42

Hyaluronic acid (HA) plays a role in water retention and lubrication and regulates osmotic pressure in clinical practice. It can protect normal cells from toxic cells and free radicals, and stimulate cell migration, adhesion, proliferation and differentiation. With the deepening of research and the accumulation of clinical experience, the application of HA in the oral field has gradually attracted attention. In the work, the author has compiled some clinical information about the application in the dental department for your sharing.

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First, temporomandibular joint disorders

Temporomandibular joint disorder (TMJD) is one of the common diseases in the oral and maxillofacial region. The main symptoms are temporomandibular joint murmur, joint pain and abnormal jaw movement. Intra-articular drug injection is one of the conservative treatments for this disease. In recent years, there have been many reports that intra-articular injection can effectively treat temporomandibular joint disorders. Exist in synovial fluid and articular cartilage, which has the function of lubricating, protecting and nourishing joint structure; reducing the levels of matrix metalloproteinase-2 and 3 in synovial fluid of patients, alleviating the destruction rate of articular cartilage matrix, thereby exerting its The treatment of temporomandibular joints.

 

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George Azevedo Lemos found in the study that high molecular weight sodium hyaluronate can make the temporomandibular joint, reduce the histological changes and thickness of the articular disc, make the collagen fibers more tidy, and reduce the levels of MMP-2 and MMP-3, so together with A number of clinical reports have confirmed that the injection of 1 ml of sodium hyaluronate gel into the diseased joint cavity can significantly improve the short-term and long-term maximum mouth opening, which can significantly improve the clinical overall evaluation of the disease in a short period of time.

 

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Selected as: Lemos G A, Rissi R, Pimentel E R, et al. Effects of high molecular weight hyaluronic acid on induced arthritis of the temporomandibular joint in rats [J]. Acta Histochemica, 2015, 117(6): 566-575.

Second, plaque gingivitis

>The disease is a chronic infectious disease of the gum tissue, which is currently treated mainly by oral hygiene education and oral scaling. Because HA has antibacterial, anti-inflammatory and anti-edema effects, both gingivitis and gingivitis can improve the gingivitis index and reduce the damage of hard tissues and periodontal tissues caused by repeated scaling.

 

The patient should be instructed to use the sodium hyaluronate gel to apply the affected area to a thickness of not less than 3 mm. After application, the patient should avoid eating, drinking or washing for 1 hour. The gel is placed in the sac at the edge of the gums, up to the level of the gingival margin, which can be better preserved in the sulcus, unlike the solution that flows out of the sulcus.

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In application, Nadiger Sapna reported that the use of sodium hyaluronate gel in gingivitis was applied to the affected area with 1 ml of smear, and the inflammatory cells were less infiltrated than conventional saline patients. Silvia Victor Rodrigues was used in the clinical study of plaque gingivitis, respectively, water, chlorhexidine, sodium hyaluronate diluted solution for gargle, observed after 7 days, using sodium hyaluronate diluted solution gargle in patients with plaque less than use There were no significant differences between the water patients and the observation group using chlorhexidine. It can be seen that hyaluronic acid is also effective in the application of gingival infections such as plaque gingivitis.

 

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Selected as: Sapna N, Vandana K L. Evaluation of hyaluronan gel (Gengigel;) as a topical applicant in the treatment of gingivitis [J]. Journal of Investigative & Clinical Dentistry, 2011, 2(3): 162-170.

 

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Selected as: Rodrigues S V, Acharya A B, Bhadbhade S, et al. Hyaluronan-containing mouthwash as an adjunctive plaque-control agent [J]. Oral Health & Preventive Dentistry, 2010, 8(4): 389-94.

Third, chronic periodontitis

For the treatment of periodontitis, simple mechanical treatment can achieve good clinical results for most patients, but for a small number of patients need comprehensive treatment, not only mechanical sterilization, but also with antibacterial treatment. HA with high molecular weight can inhibit the proliferation of gingival epithelial cells, fibroblasts and lymphocytes, shorten the inflammatory process of periodontitis, and improve the condition of the lesion.

 

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Periodontitis is an inflammatory reaction caused by pathogenic microorganisms. It is mainly treated with surgical or non-surgical methods based on sclerotherapy and root planing to remove plaque and calculus. For most patients, the above method combined with local topical application of about 1 ml of sodium hyaluronate gel under the gums, combined with periodontal support treatment can prevent the progression of periodontitis and eliminate clinical symptoms. HA regulates the hydration of extracellular matrix, has anti-edema effect, inhibits the activity of metalloproteinase, tumor necrosis factor and its receptor, and has anti-inflammatory effect.

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Figure selection: Parveen D, Reet K. Hyaluronic Acid: A Boon in Periodontal Therapy [J]. North American Journal of Medical Sciences, 2013, 5(5): 309.

Fourth, tooth extraction wounds and implant wound healing

Tooth extraction is a procedure that removes the teeth from the socket. It is a common operation in oral and maxillofacial surgery. For the extraction of dental caries, periodontal disease, and wisdom teeth. In addition to the systemic and local factors such as physicochemical, hormonal and pharmaceutical factors, osteoporosis is also affected by osteopontin (OPN), bone morphogenetic protein (BMP-2) and blood vessels. Regulation of a series of growth factors such as vascular endothelial growth factor (VEGF).

 

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After filling the sodium hyaluronate gel 1-1.5ml into the extraction socket, the HA enzyme in the extraction cavity decomposes the high molecular weight HA into a low relative molecular mass HA, which promotes by stimulating the osteogenic induction factor. At the same time, HA also stimulates the migration and proliferation of endothelial cells, thereby promoting angiogenesis, increased osteoblasts from blood vessels, and increased bone formation.

Mendes et al. injected a high-mass mass HA gel into the rat extraction, and analyzed histological and morphological changes in the healing process of the extraction socket. On the 7th day after tooth extraction, the root tip 1/3 and the root 1 The number of trabecular bone in the /3 area increased significantly; on the 21st day after tooth extraction, the number of trabecular bones in the extraction socket increased, and the deposition of bone matrix and cell arrangement were more orderly; meanwhile, after tooth extraction 2 Within -7 days, the overall expression of OPN and BMP-2 in the extraction was enhanced, and the expression of OPN and BMP-2 in the 1/3 of the root tip was particularly obvious.

 

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Figure selection: Mendes R M, Silva G A, Lima M F, et al. Sodium hyaluronate accelerates the healing process in tooth sockets of rats. [J]. Archives of Oral Biology, 2008, 53(12): 1155-1162.

Dental implants are made by stomatology. Artificial roots with high physiological compatibility are implanted into the alveolar bone and bone-bound. It has strong retention and stability and can be like real teeth. "Long" in the mouth, realistically imitating human natural teeth, chewing function is comparable to real teeth, but its beauty is better than natural teeth, so it is known as "the third pair of teeth of humans", is the world of stomatology Recognized as the preferred method of repairing missing teeth. With the promotion of dental implant technology, the healing of implants has also received increasing attention.

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HA can significantly reduce the redness and swelling of the wound, and reduce the pain response of the patient. The reason is that HA has an important role in debridement and anti-inflammatory and promote wound healing during wound repair. Its metabolites can promote angiogenesis and fibrillation. Cell proliferation and regulation of collagen synthesis.

Fabio Galli from Italy found in a multi-center clinical observation that if the sodium hyaluronate gel is used for partial filling after dental implants, it can better reduce redness and swelling, reduce exudation, anti-inflammatory and implant Post-healing has a certain promoting effect.

 

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Five, recurrent aphthous ulcer

Recurrent aphthous ulcer (RAU), also known as recurrent aphthous stomatitis, recurrent oral ulcer, recurrent aphthous ulcer, is the highest incidence of oral mucosal disease, common cold, indigestion, nervousness Depressed and unfavorable conditions can occasionally cause the disease to occur, which occurs in the lips, cheeks, tongue, etc., and can occur in any part of the mucosa, but it is rare in the keratinized complete attachment and hard palate.

 

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All of the high molecular weight sodium hyaluronate can be used in recurrent oral ulcers. It is precisely because the high molecular weight HA can act as a barrier film to protect the mucosa against irritants in the oral environment. The improvement of inflammation is HA. Anti-inflammatory and anti-edema properties.

 

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Figure selection: Parveen D, Reet K. Hyaluronic Acid: A Boon in Periodontal Therapy [J]. North American Journal of Medical Sciences, 2013, 5(5): 309.

Nolan et al reported that the use of sodium hyaluronate gel for the treatment of RAU, 2 to 3 times a day, can immediately relieve symptoms and promote ulcer healing. Reflected in the observation of the VAS rating scale, there is a clear improvement in pain symptoms. Lee et al. conducted a prospective study of the efficacy and safety of topical application of sodium hyaluronate gel in the treatment of RAU. That is, 33 cases of RAU patients were locally applied with a 0.2% HA gel 0.5~1ml twice daily for 2 weeks. The subjective and objective evaluation indexes of the patients were recorded. The results showed that 75.8% of patients had an improvement in pain visual analogue scale, 57.6% of patients had a decrease in the number of objective ulcers, 78.8% had a narrowed ulcer area, and all patients had significantly improved signs of inflammation and no adverse reactions.

 

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Selected as follows: Lee J, Jung J, Bang D. The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers: comparison between recurrent aphthous ulcers and the oral ulcers of Behçet's disease [J]. Journal of the European Academy of Dermatology & Venereology, 2008, 22(5): 590.

It can be seen that the polymer sodium hyaluronate gel can be applied not only to anti-adhesion but also to excellent oral diseases due to its good biological properties and superior biological properties. Efficacy.