Treatment of appendicitis without surgery. What should be done

Some people do not even think that the treatment of appendicitis without surgery is not a myth. After all, when acute pains and vomiting begin, it is too late to think about conservative therapy. But, nevertheless, the treatment of appendicitis is possible. True, you need to start long before the inflammatory process begins. We will learn how to identify appendicitis at an early stage, and how it can be cured.

What is appendicitis

This is an inflammation of a rudimentary organ that remained in some mammals in the process of evolution - the appendix. It does not perform any role, so when you remove it, the person does not lose anything. It is logical that if the appendix is ​​not needed, it can be removed. But no one needs extra surgical interventions, so people live peacefully until inflammation begins. The reasons may be different, but the main factor is one - purulent processes due to the development of pathogenic microflora.

In principle, there is nothing difficult in removing appendicitis. This is an ordinary operation, which in the overwhelming majority of cases goes well and without consequences. But if you still do not want to go to the operating table, you can try conservative treatment. This is possible only in the early stages of appendicitis, because during the transition to acute form an operation is already indispensable.

The very first signs of appendicitis

For some reason, most people are inattentive to their health and go to the doctor only when they are already completely unbearable. If you want to treat appendicitis, and not remove, then you should listen to your body and respond to the slightest changes. The early symptoms (or, better to say, the signals) of appendicitis are not so obvious as to pinpoint the problem. But, having found these signs in yourself, you can consult a doctor and get an accurate diagnosis.

If you observe all of these symptoms (or most), it will not be superfluous to contact the clinic. Perhaps these are the earliest manifestations of appendicitis, and the disease is still amenable to conservative treatment.

By the way! It is easier for men to recognize appendicitis, because women sometimes mistake pain for gynecological (like ovulation, pulling sensations in the ovaries, etc.).

What to do if appendicitis is found

The first thing to do is change your diet. The harmful products listed above should not only be limited, but excluded. During meals, you need to chew thoroughly so as not to provoke constipation and decay processes. It will be ideal to eat according to the schedule, at a strictly defined time every day.

And between breakfast, lunch and dinner, have a snack with vegetables rich in fiber. You can eat an apple or avocado, nibble on a carrot or cucumber. Also, you need to add ginger, garlic, lemons, honey, basil to the diet.

Another measure for the prevention of acute appendicitis is a regular examination by a doctor. Accurate diagnosis will allow you to track the risk of inflammation and analyze the course of treatment; determine if there are positive shifts or not.

Traditional medicine against appendicitis

Treatment of appendicitis folk remedies very popular because people trust alternative medicine because of its good indicators of its impact. We will highlight the most effective from the many recipes.

Options for medicinal decoctions for oral administration

Let's start with a few herbal teas recipes.

It is necessary to treat appendicitis with decoctions for at least 10 days. If necessary, you can lengthen the period.

Home ointment

Let's prepare an ointment at home. You will need 1 egg, vinegar 70%, butter. Place the egg in a glass beaker and completely fill it with vinegar. If the egg suddenly pops up, take another (this means that it is stale). You need to cover the glass and wait about 20 hours. During this time, the shell will dissolve. Then you need to take out the egg with a spoon (it will retain its shape), remove the film from it and "return" the egg to vinegar. Stir everything with a fork, add 100 butter and beat again until smooth. Put in the refrigerator. The ointment will be ready in 2 hours.

Smear the lower abdomen with such a remedy once a day. The top of the applique is covered with paper and a towel (or wear high-waisted pajama pants). Keep it all night. Take a shower in the morning. It is necessary to treat appendicitis in this way within 7 days. Acute appendicitis cannot be treated in this way!

Attention! If traditional treatment does not give results, but only makes it worse, then the inflammation has already begun. You should immediately consult a doctor to prevent the acute stage and calmly prepare for a planned operation.

Can appendicitis be treated with medication?

Pills for appendicitis have not yet been invented, because the presence of the disease alone is considered an indicator for surgery. Someone tries to drink antibiotics or pain relievers, but this only gives a temporary effect, and sometimes even complicates the course of inflammation. It is especially harmful to take analgesics for acute appendicitis, because it will be more difficult for the doctor to diagnose during hospitalization.

Supplementing the treatment of appendicitis with tablets is possible only if the inflammation has not yet begun. Medications can help mild laxatives. This is a good prevention of constipation. Do not take activated charcoal. Yes, the nausea triggered by appendicitis will be eliminated, but then it will be difficult for you to focus on the degree of symptom change.

Yet the best way The treatment of an inflamed appendix is ​​surgery. No one can guarantee a cure after applying conservative methods. But the process of inflammation can develop very quickly, and appendicitis threatens to develop into peritonitis - inflammation of the abdominal cavity. It can only be treated surgically, and it will be many times more difficult than simply cutting out the appendix.

The aging process of the skin starts from about 25 years of age and, unfortunately, it is most noticeable on the face. The main factor influencing this process is not age, but above all - the internal state of the body, which is immediately displayed on the skin. Another factor is the lack of moisture in the skin due to the negative effects of the sun. Lack of sleep, unbalanced diet, poor ecology - also negatively affect the skin. Of course, it is impossible to eliminate all these factors, and plastic surgery, although it gives good results, has long term rehabilitation. Therefore, many are beginning to look for ways to rejuvenate without surgery.

Over time, the skin ages, and it does not matter whether the cause of this condition is age, genetics or poor ecology - in any case, it needs intensive care. In addition, metabolic processes slow down and the production of hyaluronic acid is reduced. But it is very important - it retains moisture in the cells. If there is not enough hyaluronic acid, the skin becomes dehydrated, it loses its elasticity, becomes dry, and appears.

Non-injection methods of rejuvenation

This category includes peels (superficial, medium, deep), rf-lifting and a procedure using a laser - skin resurfacing. They differ in the mechanism of action: acids, radio and light waves, mechanical action. Each rejuvenation technique stimulates the production of elastin and collagen, activating the internal reserve of the skin.

• Chemical peeling... In order to understand how chemical peeling works, you can imagine how a regular scrub works on the skin. The keratinized layer of the skin is carefully removed, and new skin appears on the surface. Chemical peeling works in a similar way, except that acid is applied to the skin in different concentrations, depending on the type of peeling and the depth of penetration. Due to this, not only the upper layer of the epidermis is exfoliated, exposing younger skin, but also the synthesis of elastin and collagen is activated, due to which there is an improvement in skin tone, narrowing of pores, a lifting effect, and smoothing of wrinkles. By the way, almost all types of surface peeling can be done not only in the salon, but also at home.

• Laser resurfacing. In fact, it is nothing more than mechanical. Using a special apparatus, the upper layer of the epidermis is removed from the skin. The procedures are performed in stages, which allows you to achieve high results with minimal trauma to the skin of the face, but it will still take several days for rehabilitation for the crusts to come off. This is a rather aggressive method, but it can remove deep wrinkles, scars, acne and acne marks. After the third procedure, the skin is noticeably tightened, the face contour is improved, collagen synthesis is stimulated.

• Radio wave lifting. This is a fairly common procedure called rf lifting. It is carried out using radio frequency pulses applied at different powers. These impulses stimulate the intercellular membranes, thereby activating the synthesis of elastin and collagen.

• Photorejuvenation. This procedure can be compared with, only the beam is used light. Photorejuvenation is recommended as a prevention of age-related skin changes (aging, the appearance of pigmentation, loss of elasticity and firmness), as well as to eliminate aesthetic problems (freckles, acne and acne scars). Often, the procedure is prescribed in combination with injection methods of rejuvenation, and we will tell you about them right now.

Injection methods of rejuvenation

The mechanism of the procedures consists in the introduction of enriched formulations under the skin that stimulate the synthesis of elastin and collagen, due to which the process of natural rejuvenation begins. Injections give short-term but effective results.

There are several types of beauty injections:

• With hyaluronic acid. These include mesotrepia and biorevitalization. The main difference between the procedures is that when carrying out mesotherapy, multi-component therapeutic cocktails are used, including hyaluronic acid, vitamins, oligoelements, minerals, antioxidants, and when carrying out biorevitalization, only hyaluronic acid is used, the concentration of which is 1.5-3 percent. Therefore, it is required to undergo a course of mesotherapy, since it has a cumulative effect, or a course of 4 biorevitalization procedures, the effect of which is observed after 1-2 sessions. Both anti-aging procedures have a temporary effect, and therefore they will need to be repeated every six months or a year.

The use of hyaluronic acid for injection is considered the most harmless and safe. However, this is not quite true. In addition to the available standard contraindications, which will be discussed a little later, you should be aware that too frequent use of hyaluronic acid can affect the natural ability of cells to synthesize it. Therefore, it is recommended to combine injections with other procedures or to postpone their use at a later date.

• Botox or dysport are exactly the same drugs with the only difference in the manufacturer. The drug is a powerful type A neutroxin capable of blocking facial muscles. Doctors warn that injections are addictive. Botox does not activate absolutely any internal processes in the skin, does not nourish or moisturize. But still this procedure was, is and will be in demand. This is due to the fact that the procedure is not expensive, and the effect of smoothing wrinkles lasts for six months, and then the face regains its original appearance, and therefore the procedure will need to be repeated again. You should know that with each subsequent botulinum injection procedure, the effectiveness decreases markedly. That is, after the first procedure, the result is maintained for 6 months, and after subsequent sessions - no more than 2 months.

So, we briefly talked about the main non-surgical anti-aging procedures, the number of which is increasing every year. Cosmetologists are introducing new, more advanced, safe and effective techniques.

But it is important to be careful, because, going to a particular procedure, and having a ghostly image in front of you, you can completely forget about your own skin reserves, its ability to restore and renew. No matter how convincing the arguments of doctors about the benefits and effectiveness of the procedures are, many drugs are addictive, and as a result, the skin is simply not able to renew itself, after which it ages catastrophically.

If you have firmly decided that non-surgical wrinkle correction will make you happy, do not rush to trust your face to a doctor from a clinic located near your home, just because it has a convenient location. Carefully study the range of services of several clinics; look at photographs of real patients in a file cabinet, and not on a website where most of the pictures are downloaded from the Internet; specify how many of these procedures were performed by the doctor, and only then agree to a rejuvenation session.

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Antimicrobial therapy without surgery: the role of antimicrobial agents in the treatment of chronic periodontitis in adults

Chronic periodontitis adults is a disease that cannot be completely cured. The course of this disease can be stopped by performing correct treatment, however, the disease itself resembles diabetes or hypertension. After identifying these conditions, treatment is aimed at stopping the progression of the disease, and full cooperation of the patient with the doctor is necessary. The patient himself must make every effort to prevent worsening of the condition.

Chronic periodontitis in adults develops as a result of the action of microorganisms that are introduced from the side of the groove in patients who are predisposed to the disease. It is necessary to take measures either to eliminate the predisposing factors, or to reduce the number of microorganisms and their metabolic products to the level when the patient's immune system will be able to effectively fight against such a pathological load.

Chronic periodontitis in adults develops as a result of bacteria living in plaque. Plaque can be tightly attached to the surface of the tooth, or it can be loosely attached subgingival plaque. Plaque is a living, highly organized and complex ecosystem. The number and activity of bacteria inside the plaque increase until a critical mass is reached, when the body can no longer cope with them. The critical mass is individual for each patient and for each area of ​​the oral cavity. The patient's immune system plays an important role in the body's defense, as well as genetic factors, local factors and other systemic defense mechanisms.

The main task in the treatment of periodontal diseases is to reduce the number of microorganisms to a level acceptable to the body. Many clinicians prefer surgery, others use more antimicrobial agents, and most use a combination of the two. The choice of treatment method depends on many factors. These factors include: the severity of the disease, the ability and willingness of the patient to participate in the treatment of periodontitis.

INDICATIONS

Indications for non-surgical treatment of mild to moderate chronic periodontitis in adults with the use of antimicrobial agents are:

• Refusal of the patient from surgical intervention.
• The patient's lack of desire or ability to provide good self-hygiene of the oral cavity.
• Pockets with a depth of 5 mm or less.
• The presence of single pockets deeper than 5 mm.
• Presence of anatomical conditions that prevent surgical intervention.

GOALS

The goals are:

• Stopping the disease by reducing the bacterial load to a level corresponding to the healthy state of the periodontium.
• Regeneration of lost periodontal tissues for long-term preservation of existing teeth.
• Maintaining healthy state for a long period after stopping the disease.

This chapter presents a treatment program for chronic periodontitis in adults. This program consists of six steps and can be used to correct most of the problems associated with chronic periodontitis.

Correctly administering antimicrobial therapy without surgery takes a significant amount of time and attention to detail.

Six stages of treatment:

• Analysis of a clinical case.
• Patient briefing.
• Professional elimination of bacterial plaque.
• Self-hygiene of the oral cavity.
• Re-examination.
• Supportive care

Clinical studies have shown that non-surgical treatment of chronic periodontitis in adults can be highly effective. However, it is necessary to conduct constant examinations of the patient, and in some difficult-to-treat areas or when the disease reappears, sometimes more aggressive therapy is required.

STEP 1: CLINICAL CASE ANALYSIS

The analysis of a clinical case includes all the necessary measures for:

• Diagnosis.
• Identifying the cause of the disease.
• Forecast definitions.
• Development of a treatment plan.

Briefly, the analysis of a clinical case can be presented in the following sequence of events.

• A visual examination consists of determining the color, contour and density of the gum tissue. Any deviations from the norm should be noted and documented.
• At six points around each of the teeth, the depth of the periodontal pockets should be measured. By itself, the depth of the pockets is not a sign of the disease, however, the deeper the pocket, the greater the likelihood of the presence of a pathological condition.
• Bleeding or exudation should be documented. These signs are often indicators of disease activity. Sometimes bleeding occurs some time after probing, and then it may go unnoticed due to the patient swallowing blood. Therefore, the assessment of bleeding is carried out by going back after probing every 4-6 teeth. Bleeding on careful probing is one of the most important symptoms of inflammation.
• It is necessary to determine the area of ​​the keratinized attached gingiva. Lack of keratinized gingiva needs to be documented.
• The degree of tooth mobility should be determined and documented.
• It should be noted the teeth on which the traumatic occlusion is.
• Areas of plaque accumulation should be identified and documented and the hygiene index noted.

A number of clinical tests have been developed. When they become commercially available, they can become part of the diagnostic process.

After collecting all the necessary data, a diagnosis can be made. When developing a treatment plan, it is useful to consider the following classification of periodontal diseases:

Once the correct diagnosis has been established, you can begin to develop a treatment plan based on the type of clinical presentation.

STEP 2: PATIENT INSTRUCTION

Dental professionals have been successful in educating the public on how and why dentists eliminate tooth decay, replace missing teeth and improve smile aesthetics. Patients, however, find it difficult to accept the fact that periodontal treatment cannot "cure" the disease. As a result, patients do not understand the importance of the causes of periodontal disease, the importance of their own role in treatment, the possibility of therapy, and the need for lifelong supportive care. However, there is a moment when all the patient's attention is paid to the dentist. This happens during the clinical examination. This time should be used not only for examining the patient, but also for instructing him. Each patient has the right to know what has been done, what are the causes of the disease, clinical symptoms, general prognosis and prognosis for each of the teeth, as well as possible ways to eliminate problems.

The second stage of non-surgical treatment consists of informing the patient about periodontal disease and the role of the dentist and the patient in the treatment of the disease. It is necessary to motivate the patient to help the dentist with the treatment. In addition, the patient should be informed about possible alternative therapies and the consequences of not having any therapy.

STEP 3: PROFESSIONAL BACTERIAL PLAQUE REMOVAL

The stage of professional removal of bacterial plaque includes procedures aimed at reducing the effect or completely eliminating the primary and secondary etiological factors of the disease. Bacteria and their metabolic products play a major role in the development of periodontal disease.

Of course, there is a relationship between various systemic and local etiological factors, including smoking, occlusive trauma, iatrogenic factors, and others. The main task of this stage is to create biologically acceptable conditions for the surrounding tissues and the body as a whole on the pathologically altered tooth surface and in the pocket.

Professional plaque removal consists of mechanical and antimicrobial therapy. Treatment of each of the quadrants for moderate periodontitis requires at least one hour, and for severe periodontitis, it may take longer.

Mechanical treatment consists of removing deposits, detoxifying (smoothing) the root surface and polishing. These activities are carried out to achieve the following goals:

• Reducing the number of subgingival pathogens.
• Elimination of irregularities.
• Detoxification of root surfaces.
• Achieving a positive balance between the critical mass of pathogenic bacteria and the body's protective capabilities.

The listed manipulations must be performed as carefully as possible. Most studies show that the removal of deposits and smoothing of the roots takes about 10 minutes to achieve a biologically acceptable incisor, canine and premolar condition. Typically, the clinician spends 2 to 6 hours flattening the roots in mild to moderate periodontitis. There are some limitations when performing the third stage of non-surgical treatment. Effective removal plaque from all surfaces of the teeth is limited primarily by the shape of the curettes used. Studies have shown that even after processing one tooth for 30 minutes, it is not possible to completely remove calculus and plaque.

After removing deposits and smoothing the root surfaces (under anesthesia), the teeth in this quadrant are polished with rubber cups and pastes or using special equipment, for example, Prophyjet. The main goal is to free the tooth surface from deposits. It is imperative to polish all surfaces of the tooth as apically as possible.

Since it is almost impossible to completely remove plaque and calculus from root surfaces in the presence of medium to deep pockets, it is necessary to additionally use antimicrobial agents. Such a combination of mechanical and antimicrobial therapy allows you to minimize the bacterial load, which allows the body's defenses to independently resist the disease.

ANTIMICROBIAL AGENTS

Antimicrobial agents are used as an adjunct to the mechanical removal of plaque and calculus. An effective antimicrobial agent must meet the following criteria:

• Minimal side effects.
• Effectiveness against subgingival and supragingival microflora.
• The ability to reach the bottom of the pocket.
• The ability to achieve therapeutic concentration.
• The ability to remain in the pocket for a sufficient period of time to effectively suppress the microbial population.

Antimicrobial agents can be attributed to two generations: first and second.

First generation antimicrobials

First-generation antimicrobial agents can reduce bacterial load and gingivitis by 20-50%. First generation drugs do not have the ability to maintain a therapeutic concentration over a long period of time. Thus, in order to achieve the desired result, such agents require frequent use. First generation drugs include:

• Basic oils. Thymol, eucalyptus, menthol and methyl salicylate dissolved in alcohol (26.9 °) with pH = 4.3. Antimicrobial agents can affect the bacterial cell wall. Studies have shown that frequent use leads to prevention of plaque formation and reduces the severity of gingivitis by 40-50%.
• Acetylpyridine chloride. Usually, it is contained in a concentration of 0.05% in an alcoholic solution (18%). Acetylpyridine alters the function of the bacterial cell wall. Short term studies have shown efficacy and a 35% reduction in plaque formation.

Second generation antimicrobials

Second-generation antimicrobials have the ability to work over a long period of time, prevent plaque formation and reduce the severity of gingivitis by 70-90%.

Chlorhexidine digluconate is a second generation antiseptic that has been used effectively and safely to prevent plaque formation and treat gingivitis for over 20 years. Chlorhexidine is used at a concentration of 0.12% in an alcoholic solution (11.6%) for rinsing the mouth and for subgingival irrigation. The mechanism of action of the drug lies in the fact that positively charged chlorhexidine molecules bind to negatively charged components of bacterial pellicles and salivary proteins. Thus, the drug suppresses the formation of pellicles. In addition, chlorhexidine prevents bacteria from adhering to the surface of the tooth and inhibits the growth of gram-positive and gram-negative bacteria and fungi. The drug is gradually released from the connection with saliva proteins and has an antiseptic effect within 8-12 hours. Studies have shown that chlorhexidine inhibits plaque formation by 68-90% and the development of gingivitis by 60-90%. Moreover, a chlorhexidine-containing agent has been developed for use in periodontal pockets. Its use will be discussed in the section on topical antimicrobials.

Fluorine (1.64%) is also classified as the second generation of antimicrobial drugs. Studies have shown that subgingival application of 1.64% fluoride alone for 2 days without the use of other methods of treatment completely eliminated motile microorganisms after 4 days. The same study showed only partial recovery of microflora after 10 weeks.

Such long-term suppression of microorganisms improves the result of professional and self-hygiene and contributes to the suppression of the pathological process. Second-generation antimicrobials are used in every repeat treatment in all patients. Subgingival chlorhexidine irrigation can be performed using a blunt needle that is inserted to the bottom of the pocket and applied around each tooth. As an irrigator, various means from special devices to ordinary syringes can be used. Modern ultrasonic devices for removing deposits make it possible to use chlorhexidine as a cooling and washing solution.

Betadine (iodine-based solution) has been used successfully for subgingival irrigation. The drug is most effective when used as an irrigation solution for an ultrasound machine.

Gradual local release of antimicrobial agents

Tetracyclines

A number of studies have been carried out on the effectiveness of drugs with the possibility of a gradual local release of tetracycline. One such agent is polyvinyl acetate fibers impregnated with tetracycline (Actisite; Alza Pharmaceuticals, Palo Alto, California). After removing deposits and smoothing the root surfaces, tetracycline threads are placed under the gum using a special investment tool. The strands release tetracycline gradually over 10 days. After 10 days, the threads are removed. The combination of scaling, root smoothing and the use of tetracycline sutures results in a more significant reduction in the depth of periodontal pockets and decreased bleeding on probing than without tetracycline sutures.

Another effective remedy is a gel containing doxycycline hydrochloride (Atridox; Atrix Laboratories, Fort Collins, Colorado). In the study of the effectiveness of the gel, it was used without preliminary removal of deposits and smoothing of the root surfaces. The drug was injected under the gum using a syringe and a blunt-pointed needle. The gel hardens on contact with the liquid and, as it resorbs, gradually releases doxycycline, creating a high concentration of the latter in the pocket liquid. The gel is held in the lumen of the pocket with a protective bandage or biological glue. Since the gel gradually dissolves, there is no need to remove it. However, the dressing must be removed after 7-14 days. Multicenter clinical trials have shown that subgingival use of a resorbable doxycycline-containing gel is as effective as removing scale and smoothing the root surface.

In Europe and Japan, studies were carried out on a drug that is a combination of minocycline hydrochloride powder and a bioresorbable polymer. The preparation was used as an adjunct to the removal of deposits and smoothing of root surfaces. The drug was placed in the pocket using a cannula.

STEP 5: REVIEW

Re-examination is the “main line” in decision making. This is a kind of "crossroads" of the patient's treatment regimen. The task of periodontal treatment at the moment is to eliminate the underlying cause of the disease and stabilize the condition. Thus, the purpose of the re-examination is to assess the fulfillment of these tasks. In addition, when conducting a second examination, it is necessary to determine further steps to prevent the development of an infectious process, if it was not possible to stop it at the preliminary stages of treatment.

During a follow-up examination, you can change your original treatment plan. Evaluate the effectiveness of therapy (including professional plaque removal and self-hygiene) in the patient. The change in the treatment plan is carried out depending on the data obtained.

Re-examination is carried out no earlier than 4 weeks after the last removal of deposits and smoothing of the root surfaces. Re-examination consists of a combination of the same measures that were carried out during the first examination of the patient:

• Visual inspection.
• Measurement of the depth of periodontal pockets and assessment of attachment.
• Determination of bleeding and exudation during probing.
• Determination of the zone of the attached gums.
• Determination of tooth mobility.
• Occlusion assessment.
• Plaque detection. Microbiological control.

The color, contour and character of the gums should be close to normal. The depth of the pockets may decrease, remain the same, or increase. When analyzing the depth of pockets, it is necessary to take into account the presence of bleeding during probing. The location of the gingival margin may change, and successful treatment usually results in precisely the apical displacement of the gingival margin. The level of attachment can be improved by the attachment of the epithelium to the biologically acceptable root surface. The level of attachment is the main parameter for assessing the state of the periodontium (stable or unstable). If there is a stable level of attachment, the patient can retain the teeth for a longer period of time. Bleeding on probing remains one of the most reliable signs of inflammation. Bleeding usually disappears as the inflammatory process subsides and the epithelium of the groove is restored. The presence of repeated bleeding during probing is most likely a sign of an active pathological process. In such a case, appropriate aggressive treatment should be considered.

Improvement in gum health is characterized by an increase in the area of ​​keratinized gums. This usually occurs as a result of the elimination of inflammation.

Mobility is most often due to the presence of inflammation, occlusive trauma, and loss of periodontal support. When inflammation is eliminated, the mobility of the tooth is significantly reduced. The elimination of occlusal trauma also leads to a decrease in mobility. Increased mobility is a symptom of a worsening condition and requires further treatment. The bite is constantly changing. Eliminating the inflammation leads to a slight displacement of the teeth, which means a change in occlusion. Reevaluation of the occlusion and its periodic correction may be indicated. During each of the follow-up visits, the level of self-hygiene of the oral cavity is assessed. This allows the dentist to determine how well the patient is currently doing hygiene, but it does not tell how well the patient is doing hygiene every day. The presence of bleeding on probing, especially in the presence of shallow grooves or in the absence of plaque, most likely means that the patient does not provide satisfactory oral hygiene and brushed his teeth only before coming to the dentist. During each follow-up examination, the patient should be motivated to maintain a high level of oral hygiene.

During a second examination, the dentist decides what to do next. The interval between sessions of supportive periodontal treatment is determined after reaching a stable periodontal condition. If it is not possible to stabilize the condition in one or more areas, more aggressive treatment should be prescribed. To do this, you can use a decision-making algorithm.

The features of additional aggressive treatment in individual areas depend on the data obtained during the second examination. Not all patients respond the same to the same treatment. Moreover, different parts of the oral cavity in the same patient respond differently to treatment. It is necessary to determine the effectiveness of treatment at the time of the examination. If there is no effect of treatment, additional therapy should be prescribed (for certain areas of the oral cavity).

When conducting additional individual aggressive therapy, many methods can be used:

• Supportive periodontal treatment. If the depth of the periodontal pockets decreases (or if the depth remains at the same level, but there is no bleeding), the dentist may consider the treatment performed as successful. In the future, a thorough periodic supportive periodontal treatment is required. Reexamination is an extremely important part of supportive care as not all areas can remain stable.
• Strengthening self-hygiene of the oral cavity. The accumulation of bacterial plaque (subgingival or supragingival) is the main cause of persistent bleeding on probing. It is necessary to re-instruct the patient on oral hygiene and ask the patient to show the learned skills in front of the dentist.
• Repeated removal of deposits and smoothing of the root surface. Different areas in the mouth of the same patient respond differently to treatment. Perhaps in areas where the desired result could not be achieved, some plaque and stone remained. In such cases, the instrumental processing of the roots should be repeated. Despite the incomplete removal of plaque and calculus from some roots of teeth with pockets of medium depth, an improvement in the condition is determined. Decreasing the pocket depth gives the dentist more options to remove residual deposits.
• Use of local antimicrobial agents in difficult-to-treat areas. Installation of tetracycline threads, resorbable chips with chlorhexidine, gel with doxycycline or minocycline under the gums allows you to create a high concentration of antimicrobial agents in the periodontal pocket. Studies have proven the effectiveness of these drugs in the treatment of periodontitis.
• Resection surgical interventions. In those sextants or quadrants where there was an increase in the depth of the pockets or, despite the absence of a change in depth, but bleeding persists, resection interventions will provide better access to the roots and remove all deposits. At this stage, the dentist may refer the patient to a periodontist for surgery.
• Regenerative surgical interventions. Carrying out regenerative periodontal interventions allows you to achieve success in the right choice patients. Such operations are indicated in the absence of the desired result after non-surgical treatment and in the presence of deep intraosseous defects. The success of regenerative interventions depends on the manual skills of the surgeon. If the clinician does not feel confident in performing periodontal interventions, it is recommended that the patient be referred to a periodontist.
• Systemic antibiotic therapy. If, after professional removal of deposits, severe multiple bleeding remains during probing, it is necessary to consider the possibility of prescribing systemic antibiotic therapy. The systemic administration of antibiotics can also be indicated in cases where the periodontal condition worsens, despite all attempts by the dentist to stop the pathological process, as well as when the severity of clinical manifestations does not correspond to the severity of etiological factors. Microbiological tests are recommended to select the appropriate antibiotic. After the appointment of antibiotic therapy, constant monitoring of the patient should be carried out. Referral to a periodontist is often indicated.
• Referral of the patient to the periodontist. A general dentist should only treat patients for whom he or she does not experience discomfort. The clinician must strive to achieve a good outcome and a favorable prognosis. Some dentists feel confident in treating patients with severe periodontitis, while others prefer to treat patients only in the early stages of periodontitis. Under no circumstances should a treatment be carried out that leads to a worsening of the patient's condition. If the clinician experiences uncertainty or discomfort during the treatment of a patient, or in the absence of positive dynamics after treatment, the possibility of referring the patient to a periodontist should be considered.

STEP 6: MAINTENANCE TREATMENT

Clinical research data show that it is impossible to achieve success in the treatment of periodontitis without an adequate program of supportive periodontal therapy. The correct supportive care program is the most important success factor for nonsurgical antimicrobial treatment.

Periodontal ABC
Peter F. Fedi, Arthur R. Vernino, John L. Gray

The first warning - girls, women - do not self-medicate! Do not take any pills without visiting your gynecologist. If you choose an abortion without surgery, ask the gynecologist for a certificate of completion of the training course, as well as whether the doctor-gynecologist has to use the medical method of abortion.

What should be done?

For a non-surgical abortion, you need to visit a gynecologist at least three times. At the first appointment, the gynecologist will consult the woman, make ultrasound procedure(Ultrasound), in order to establish the correct gestational age (abortion without intervention is carried out for a maximum of seven weeks), as well as to accurately determine whether a pregnancy is developing in the uterus. The patient must confirm in writing that she intends to interrupt unwanted pregnancy... To do this, she needs to sign an informed consent to terminate the pregnancy by medical abortion. Before having an abortion without surgical treatment, the patient needs to be tested to determine the blood group, a blood test for the Rh factor, Wasserman's reaction (RW), and a smear for flora. If there are no contraindications, the gynecologist will suggest drinking three Mifepristone tablets (three two hundred mg = six hundred mg). It is worth remembering that you should not eat two hours before and two hours after taking Mifepristone. The next visit to the doctor should be in thirty-six to forty-eight hours. The gynecologist will be obliged to tell you about where you need to go or call about a change in your condition. In some cases, spotting from the genital tract may begin already at this stage. The most important thing is that there is no vomiting - otherwise the pills will not work.

The second visit takes place one and a half to two days after the first intake of Mifepristone. Mifepristone acts in such a way that the ovum simply exfoliates from the walls of the uterine cavity. This is followed by the stage of expulsion of the ovum from the uterine cavity. To do this, the patient will have to take three tablets that will have to contract the uterus - Misoprostol. Taking these pills is the same as for Mifepristone - you cannot eat two hours before and two hours after taking the pills. It is very important to prevent vomiting so that the tablets remain in the body.

The patient will have to spend the next two hours in the clinic. It is during this period that most women begin to notice spotting from the genital tract. If the patient has already left the clinic and found that spotting has begun, she must call the gynecologist by phone. Taking misoprostol can cause pain, fever, chills, nausea, vomiting, diarrhea, and heavy bleeding. To relieve pain symptoms, sit or lie down comfortably. An abortion requires the support of medical personnel. For pain in such cases, you can take antispasmodics (for example, no-shpa) or analgesics (baralgin, and others). Do not relieve pain with drugs from the group of non-steroidal anti-inflammatory drugs - they will only reduce the effect of Misoprostol tablets.

Fever may rise after taking Misoprostol. It is characteristic that it lasts no more than two hours. To reduce the fever, it is enough to take paracetamol. If the temperature stays above 38 ° C and more than four hours, this is not associated with taking pills. We recommend that you contact your gynecologist immediately - you may have an infection. The doctor may prescribe antimicrobial drugs.

The occurrence of nausea and vomiting may be directly related to pregnancy. Abortive drugs most often only cause nausea, not vomiting.

An abortion will be accompanied by bleeding similar to menstrual bleeding. However, profuse bleeding is extremely rare. With profuse bleeding, about two sanitary pads are soaked for an hour maximum size... If this bleeding lasts more than two hours in a row, you need to consult a gynecologist.

The third, last visit for this procedure must necessarily take place 10-14 days after taking the first pill. If the patient is not worried about anything, she still needs to appear for examination. This will prevent the appearance of an infectious process in the uterus, as well as help to get rid of other serious complications of incomplete abortion.

Potential complications.

Complications can appear if an incomplete abortion has occurred or if a woman missed a timely repeated consultation with a gynecologist. Some patients believe that if everything went well for them without any inconvenience, it means that there is no need to come for an examination (meaning the third consultation with a gynecologist). In such patients, it is rather difficult to track if they develop complications - it is quite possible that the remnants of the ovum in the uterine cavity will not be detected in time.

During the third visit to the gynecologist, the effectiveness of medical termination of pregnancy will be assessed, that is, the doctor will be able to say there was a complete abortion, or an incomplete abortion, or the pregnancy was preserved. At medical abortion efficiency is 95-96%. If the patient is still pregnant, she may be offered to complete the abortion surgically.

During a medical abortion without surgery, the patient should not leave the city or village, she should always have a connection with her attending gynecologist. The patient is not recommended to have severe physical exercise, sex life, going to the pool, sauna either. You should definitely give up alcohol in any of its manifestations.

A week after taking Mifepristone, 80% of women have a complete abortion. After two weeks, 96.6% of patients experience a complete miscarriage. The next menstruation will have to start according to the patient's normal cycle, although a delay of up to ten days is not excluded.

It is equally effective for combating existing wrinkles, and serves as an excellent preventive measure against skin laxity and the appearance of new skin folds. After all, the muscles of the face are amenable to training, just like all other muscles.

If you do facial exercises every day, giving it 10 minutes in the morning and in the evening, you can achieve quite tangible results. The face will become younger, wrinkles will straighten out, swelling will decrease, the corners of the lips will rise, tighten and acquire a sharper contour of the oval of the face. And all this without surgery or injections.

Systematically performing this complex, some time after the start of training, you will find that these exercises have a positive effect on the quality of the skin - its turgor increases, elasticity and elasticity are restored. It does this by improving the nutrition and blood supply to the skin, which is a natural consequence of exercise. Before charging, be sure to cleanse your face and apply the moisturizer or nourishing cream you usually use.

Warm up

As expected, we will start exercising with a little warm-up and warming up the muscles. To do this, we will slap ourselves with the back of our palms on the cheeks, along the entire oval of the face, and walk along the zone of the double chin. Light in a circular motion With your fingertips, walk from the middle of your forehead to your temples, along the hairline. Now - lightly pat yourself on the cheeks 10 times with your palms.

This warm-up activates the blood supply to the tissues of the face, including the muscles, which means that it improves the delivery of oxygen and nutrients to them, activates lymphatic drainage, reduces swelling, improves the oval of the face, and picks up "flews".

From wrinkles on the forehead

Place the fingers of both hands closed together on the forehead horizontally so that they converge in the middle of the forehead. Press lightly on the skin and lower it down to the eyebrows. At the same time, try to raise your eyebrows upward, showing resistance. Hold this position for 5 seconds, then relax. Repeat the exercise 10-15 times.

From eyebrow wrinkles

Press your index fingers to the beginning of your eyebrows and try to frown your eyebrows by moving them towards the bridge of your nose, without frowning. Try to keep your fingers in place, creating additional stress for the muscles due to resistance. Hold this position for 5 seconds, then relax. Repeat the exercise 10-15 times.

From wrinkles around the eyes

Place your index fingers horizontally on your lower eyelid and pull the skin down slightly. Without letting go of your fingers, slowly raise your eyes to the ceiling, just as slowly close your eyes. Linger with closed eyes 5 seconds, then open your eyes and relax. Repeat 10-12 times. Place your thumbs upright at the outer corner of your eyes. Slightly pull the skin towards the auricle, holding this position for 5 seconds. At this moment, rotate the eyeballs in a circle with the eyelids closed - 5 times in one direction and the same amount in the other direction.

From wrinkles around the mouth

Take in more air in your mouth, puff out your lips, press down on your mouth with your palms, as if trying to keep the air inside. Hold this position for 5 seconds. Repeat the exercise 10-15 times.

Rub upper lip on the bottom, as if you just put on lipstick and spread it over your lips.

From the nasolabial fold

Press the corners of your lips with your thumb and forefinger. Say the letter "Y", trying to pull your lips forward, at the same time, try to hold the corners of your lips in place with your fingers to create tension in the muscles. Do the same while pronouncing the letter "I", "O". Repeat 5 times with each letter.

Place your thumbs along the nasolabial fold, press lightly on them. Smile as you lift the corners of your lips while resisting with your thumbs. Hold the smile for 5 seconds, Repeat the exercise 10-12 times.

From the double chin

Imagine having a heavy load attached to your chin like a crane. You need to make a lot of effort to move it from place to place. Move the load mentally from left to right, with intermediate stops - then lifting it, then putting it in place. And vice versa - from right to left. Repeat 5-6 times.

Clasp your hands together at the back of your head. Tilt your head low, keeping your chin to your chest. Lift her out of this position, resisting with your hands. Relax. Repeat 10-12 times.

Important

These exercises should be performed in front of a mirror, sitting on a stool or hard chair and not leaning on the back. This is necessary in order to maintain good posture. By the way, good posture helps to get rid of such a defect as a double chin.