EFFECTIVENESS OF COMPLEX TREATMENT FOR RADIOIODINEINDUCED SIALOADENITIS AND ITS EFFECT ON DENTAL HEALTH STATUS OF PATIENTS (PROSPECTIVE CONTROLLED STUDY)

Abstract

Aim of the study. To study the effectiveness of pathogenetically targeted methods of treatment of chronic radiation sialadenitis caused by the use of radioactive 131I, and their impact on the dental status of patients. Research methods. The study included 60 patients who underwent radioiodine therapy for highly differentiated thyroid carcinoma and developed chronic radiation sialadenitis. Two groups of thirty patients each were formed from the patients. The first group of patients (the control group) received conventional treatment. In the second group (the main group), the treatment of radiation lesions of the salivary glands was based on a developed algorithm of differentiated use of therapeutic agents. This included prolonged glucocorticoids, proteolysis inhibitors, intraductal administration of proteolytic enzymes, the use of sialoendoscopy to eliminate scar changes and persistent stricture of the excretory ducts of the parotid and/or submandibular glands and replacement therapy in the presence of grade II-III xerostomia. Before starting therapy and one year after its initiation, patients underwent a comprehensive examination to determine their clinical characteristics and dental status. Results. At baseline, no significant differences were found between the comparison groups. In 36 patients (60 %), swelling, pain and discomfort were observed mainly in the parotid glands; in 22 patients (36.7 %), these symptoms were bilateral. Clinical signs of damage to all salivary glands were present only in 16 patients (26.7 %). One year after the start of treatment, the patients in both groups demonstrated improved major clinical symptoms, with the main group showing a greater improvement (p<0.05). Significant variability was seen in the parameters of the dental condition of the patients in the comparison groups, which were conditioned by multiple factors unrelated to the prescribed radioactive iodine therapy. There were no statistically significant differences in DMF (decayed, missing, filled teeth) indices, hygiene indices, PMA (papillary-marginal-alveolar) indices or loss of epithelial attachment between the comparison groups, either at the beginning of treatment or after 12 months. Over the course of treatment, the hygiene index tended to get better in both groups, and the severity of gingival inflammation decreased (slightly more in the main group). However, these changes were not statistically significant. Conclusions. When compared to conventional methods of symptomatic and replacement therapy, the developed pathogenetically-targeted approach can reliably reduce the severity of pain, discomfort and swelling of the salivary glands, as well as manifestations of xerostomia (р<0.05). The observed tendency for an improvement in the hygiene index in both groups and a certain decrease in the PMA index (slightly more in the main group) with a slight increase in the DMF index, the depth of periodontal pockets and the loss of epithelial attachment was not statistically significant (p<0.05) due to the small number of observations. The use of conventional methods of individual and professional oral hygiene, combined with replacement therapy, prevented significant progression of caries and periodontal disorders in patients with xerostomia of both examined groups.