THE AIM OF THE STUDY:The study by the method of tissue polymerase chain reaction of the species composition of the microbiota of lesions of the oral mucosa in patients with bullous lesions.MATERIAL AND METHODS:Biopsy specimens of the oral mucosa of 51 patients were studied by the polymerase chain reaction method, of which 14 patients with pemphigus vulgaris, 17 patients with pemphigoid bullosa, and 20 patients with the bullous form of ruber lichen planus. 4 types of microorganisms have been identified - Fusobacterium, Streptococcus pneumoniae, Candida albicans, Ureaplasma spp. and viruses - Human Papillomavirus 16, Epstein-Barr virus and Citomegalovirus.RESULTS:In the study of the microbiota of bullous lesions, associations of microorganisms and viruses were established in a significant number of cases. Associations of Str.pneumoniae and C. albicans were quite common in patients with pemphigus vulgaris in 26.3%, pemphigoid bullosa in 20.0%, and in patients with the bullous form of ruber lichen planus in 14.3% of cases. In patients with pemphigus vulgaris, the association of Str.pneumoniae, C. albicans and EBV was noted in 31.6% of cases. In patients with the bullous form of ruber lichen planus in a high percentage of cases (28.6%), the associations of Str. pneumoniae, EBV and CMV.CONCLUSION:Identification at earlier stages of management of patients with bullous lesions Str. pneumoniae, Candida albicans, and Fusobacterium associated with herpes viruses should be regarded as one of the triggering mechanisms of an autoimmune conflict, which subsequently causes a specific clinical picture of these diseases.

Autoimmune bullous lesions are a group of inflammatory diseases affecting the skin and mucous membranes, with a severe chronic course. Microorganisms that colonize the skin and mucous membranes and make up the microbiome can influence the course of inflammatory diseases. The purpose of this study was to investigate the oral mucosal microbiome in patients with bullous lesions by polymerase chain reaction (PCR). Materials and methods. We studied scrapings from the surface of lesions of the oral mucosa in 25 patients with pemphigus vulgaris, 35 patients with pemphigoid bullosa and 40 people with bullous form of ruber lichen planus. Fusobacterium, Str. pneumoniae, Candida albicans, Ureaplasma, and 3 types of viruses: human papilloma virus 16, Epstein-Barr virus, and cytomegalovirus were determined. Results. Str. pneumoniae was detected most frequently in patients with bullous lesions: in 42.5% of cases in patients with pemphigus vulgaris, in 58.3% of cases in patients with pemphigoid bullosa and in 68.8% of cases in patients with bullous form of ruber lichen planus. Candida albicans was second most frequently detected: in 33.0% of patients with pemphigoid bullosa, in 28.6% of patients with pemphigus vulgaris, and in 25.0% of patients with bullous form of ruber lichen planus. Among viruses, Epstein—Barr virus was most frequently detected in patients with bullous lesions of oral mucosa (in 66.7, 75, and 50% of patients with pemphigus vulgaris, pemphigoid bullosa, and bullous form of ruber lichen planus, respectively). However, cytomegalovirus was practically undetectable in scrapes in patients with pemphigoid bullosa and ruber lichen planus. The frequency of detection of associations of bacteria, fungi and viruses in scrapes in patients with pemphigoid bullosa reached 38.5%. Conclusions. The obtained data indicate a pronounced violation of oral microbiocenosis and microbial dysbiosis of the oral mucosa in patients with bullous lesions.

The article is devoted to the study of immunohistochemical parameters in patients with bullous lesions of the oral mucosa. The biopsy samples of the oral mucosa were studied in 57 patients, including patients with pemphigoid bullosa (38 people) and pemphigus vulgaris (19 people). The results of immunohistochemical studies indicate the cellular mechanisms of damage to the epithelium, in which IL-1, IL-6 and HPV16 are involved.

OBJECTIVE Based on the data available in modern literature, to conduct a study on the epidemiology, etiology and pathogenesis of bullous lesions of the oral mucosa (pemphigus vulgaris, pemphigoid bullosa, lichen ruber planus).MATERIAL AND METHODS:The article is based on the study of materials of foreign and domestic research databases Pubmed and Elibrary. Used literature data over the past 15 years.RESULTS:According to domestic and foreign studies, among dermatological diseases, the most frequently detected diseases are: lichen ruber planus, pemphigoid bullosa and pemphigus vulgaris. The initial signs of these diseases are often neglected, both in patients and doctors, which leads to irreversible changes and severe course of the pathological process. In this connection, the number of patients with these lesions of the oral mucosa increases every year in all countries of the world. Bullous lesions of the oral mucosa are inflammatory and destructive diseases characterized mainly by recurrent course, variety of clinical manifestations, resistance to various therapeutic drugs. The specific features of the course of these diseases are explained both by the anatomical and physiological features of the oral mucosa, and by the etiologic and pathogenetic mechanisms of development. Currently, autoimmune processes play a leading role in the genesis of diseases, developing in response to changes in the antigenic structure of epidermal and epithelial cells under the influence of various damaging agents.CONCLUSION:Thanks to the study, it was found that currently there are no data confirming the presence of microbial contamination of the tissues of the oral mucosa in the pathology under study. Not enough information on the factors of the immune response, in particular, on proinflammatory cytokines in the tissues of the oral mucosa.

In order to analyze the complexity and cost of methods of modern orthodontic treatment for children in the mixed bite period as well as to determine the necessary costs for eliminating dentoalveolar anomalies in primary school children taking into account the prevalence of anomalies we studied the duration and frequency of orthodontist visits during treatment using the 2x4 technique, a removable plate with artificial teeth, a ring with a spacer, a plate with a front bite pad, a plate with a shutter for the tongue, and Twin-block appliance, Dilar mask in combination with an expansion apparatus, plates with a screw, appliance with a hyrax expansion screw. Based on the complexity the salary of the orthodontist and other personnel, the costs of maintaining the doctor’s workplace and the dental technician are calculated. The cost of consumables at the clinical and dental stages was determined considering the purchase prices and the cost of a specific manipulation by weighing or measuring. When calculating the necessary funding for early orthodontic treatment modern data on the prevalence and structure of orthodontic pathology in children during the mixed bite period were used. It was found that the complexity of modern orthodontic treatment during the mixed bite period varies from 5.55 hours (spacer with a ring for premature loss of a temporary tooth) to 10.73 hours in the treatment of a distal bite with a twin-block device. The cost of orthodontic treatment in mixed bite varies from 12.6 thousand rubles (a spacer with a ring for premature loss of a temporary tooth) to 33.4 thousand rubles for the treatment of a mesial bite using a Dilar mask in combination with an expanding device. Given the prevalence of dentoalveolar anomalies in children during mixed bite period, the necessary financial costs for orthodontic treatment per child examined should be at least 30 thousand rubles, and at least 40 thousand rubles for a child with a dentoalveolar anomaly.

In this article the indicators of innate immunity in oral fluid were studied in 75 patients with bullous lesions of the oral mucosa (pemphigus vulgaris (18), pemphigoid bullosa (25) and bullous form of lichen ruber planus (32)) before and after complex treatment with the inclusion of photodynamic therapy. Indicators of the level of proinflammatory cytokines IL-1β, IL-2, IL-6, TNF-α and immunoglobulins A, M, G were determined. 10 people who turned to a dentist for the treatment of caries and its complications served as control; somatic pathology and signs indicating the presence of autoimmune diseases of the oral mucosa, they were not revealed. This study established the relationship between the level of proinflammatory cytokines and immunoglobulins with the severity of the clinical course of bullous lesions, which causes the use of photodynamic therapy in the complex treatment of these diseases of the oral mucosa.

The possibility of using immunohistochemical study and the method of tissue PCR in the complex diagnosis of vesicular lesions of the oral mucosa has been studied. A total clinical and laboratory examination included 57 patients, including: patients with pemphigoid bullosa (32), pemphigus vulgaris (25). Results of immunohistochemical study indicate cellular mechanisms of epithelial damage, in which IgG, C3d fragments of the complement take part, receptors for cytokine-2, as well as antibodies against E-cadherin protein. Identification of microorganisms in pathologically altered tissues by the method of PCR should be regarded as one of the triggers of the antigenic factor in the vesicular lesions of the oral mucosa. The obtained data convincingly prove the necessity of application of these methods in complex diagnostics of vesicular lesions of the oral mucosa.

Based on personal clinical experience the authors provide clinical guidelines for periodontal anesthesia. The by-step protocol for intraligamentary and intraseptal anesthesia is presented. The basic mistakes in technique and possible complications are described. Recommendations for a local anesthetic choice and dosage for different groups of teeth are given.

The article presents data from a study aimed at improving the efficiency of complex treatment of mucositis of the oral mucosa, induced by chemotherapy and radiotherapy in patients with cancer, based on the results of clinical and laboratory examination. It had carried out a comprehensive clinical and laboratory examination and treatment of 12 patients after a course of radiation and chemotherapy for cancer of the mouth and tongue. The results allow to recommend this treatment guideline of patients with mucositis of the oral mucosa in the oncology background for implementation in practical healthcare.

The aim of the study was to prove the rationale for antiviral therapy combined with surgical procedures for treatment of severe oral leukoplakia. Complex clinical and laboratory evaluation and treatment was performed in 56 patients divided in 2 groups. Control group was presented by 13 patients receiving dental treatment, local and systemic keratoplastic formulations. Main group involved 43 patients in which conventional treatment protocol was completed by antiviral therapy and surgical procedures. Leukoplakia diagnosis was based on clinical findings, histological and immunohistochemical studies as well as optic coherent tomography data. The obtained results evidently prove the necessity for including antiviral therapy and surgical procedures in treatment scheme of severe oral leukoplakia.

The aim of the study was to assess likopid effectiveness in complex treatment of oral dysbiosis. The study included 76 patients: 23 patients receiving antifungal and antimicrobial treatment, eubiotics and bacteriophages and 53 patients in which the above mentioned therapy was combined with licopid as immunocorrective agent. Laser flow cytometry was used to examine oral fluid bacteriostatic properties. The results of the study confirm licopid to be useful for complex treatment of oral dysbiosis.