Dysbacteriosis of the oral cavity. How to restore the microflora of the oral cavity

However, one of the most unpleasant is. This is due to the fact that microbial pathology is visible to other people, and is also able to repel them from such patients.

It should be understood that each person has a strictly individual composition of the microflora of the oral cavity, however, there are a number of signs that are a signal that dysbacteriosis in the mouth has taken a dangerous form.

Dysbacteriosis of the oral cavity is divided into several stages. Each degree may differ slightly from the reference options, however, even the slight appearance of signs can symbolize the beginning of the pathological process.

First degree

The first degree of dysbacteriosis is the displacement of the biotic constant, which is microscopically manifested by a strict increase in the activity of only one type of conditionally pathogenic organisms. Dysbacteriosis of the oral cavity does not manifest itself at this stage, which greatly complicates early diagnosis pathology and initiation of adequate treatment.

Second degree

The second stage is characterized by the beginning of the development of pathogenic bacteria due to a general decrease in immune status patient. Intensive reproduction of pathogenic microorganisms leads to inhibition of activity and overall decline the number of lactobacilli. The second stage of oral dysbacteriosis, the symptoms are general character, it is impossible to identify any regularities.

Third degree

The third degree is characterized by a general increase in the number of pathogenic bacteria, and opportunistic bacteria are almost completely destroyed. At this stage, dysbacteriosis of the oral mucosa may begin, which then results in the last, fourth stage. It is accompanied by active reproduction of yeast-like fungi. At this stage, dysbacteriosis in the mouth is of a general nature and is manifested by inflammatory reactions, ulcerative processes, horny degeneration of the epithelial membranes, etc.

Oral dysbacteriosis - symptoms

Dysbacteriosis of the oral mucosa is a signal that there are other sources of pathology inside the body, so it is necessary to carry out complex diagnostic procedures for the whole organism. Sometimes patients try to limit themselves to a visit to the dentist, but this approach to the problem is fundamentally wrong.

Symptoms at the initial stages of the development of pathology:

Burning sensation in the mouth;
Manifestation of unpleasant taste sensations;
Appearance bad smell from mouth;

At first, these complaints are subjective, so inexperienced medical professionals may not pay attention to them, which will lead to the development of pathology. Later, oral dysbacteriosis can be determined visually.

At the third stage, signs of catarrhal stomatitis appear, which are manifested by edematous phenomena of the mucous membranes, whitish deposits, and increased salivation. Further, small-focal ulcerative processes may appear, which are accompanied by a short-term increase in temperature.

Oral dysbacteriosis, symptoms and treatment may be accompanied by gingivitis varying degrees(gum disease) and periodontitis. In a chronic course, without effective treatment, the infection can spread downward, causing inflammation in the tonsils and pharynx.

Therapy of oral dysbacteriosis

Dysbacteriosis of the oral cavity and its treatment is specific for more late stages, at times when there is extremely little normal microflora left. In the early stages, it is important to find the pathological source that led to the development of this pathology. Remember that carrying out only symptomatic and local treatment ineffective and unacceptable - it is a sign of illiteracy of the attending physician.

Most often, the source of the pathology of the oral cavity is in the gastrointestinal tract, so you should start by examining this particular area of your body. Often, oral dysbacteriosis manifests itself in immunodeficiency states and chronic infectious processes. When making this diagnosis, mandatory consultations of a gastroenterologist, a therapist, and sometimes an infectious disease specialist are prescribed.

To determine how to treat oral dysbiosis , appoint general analysis blood and urine, and additional methods diagnostics. All of them are aimed at determining the cause of the disease. Often the cause can be identified during routine history taking. At risk of oral dysbacteriosis are persons who do not follow the rules of personal hygiene, uncontrollably use products with increased amount sugars, irrational antibiotic therapy and excessive use of local antiseptics.

Dysbacteriosis of the oral cavity, its treatment is carried out by sanitation of the oral cavity and the use of drugs that inhibit the activity of microflora:

Types of drugs

Local antiseptics - inhibit the reproduction and spread of pathogenic bacteria; the remedy is applied by rinsing the mouth several times during the day;
The use of antibiotics and antimycotics- means that inhibit and destroy pathogenic bacteria and fungi, which are the cause of unpleasant symptoms;
Eubiotics- contain living microorganisms that are part of the normal microflora;
Vitamin and mineral complexes– contribute to the acceleration of tissue regeneration and activation of all metabolic processes in the body;
Drugs-immunomodulators- contribute to the activation of local immune reactions, which inhibits the growth of pathogenic bacteria;

As you can see, dysbacteriosis in the mouth, its treatment is complex character and operates in multiple stages.

Unfortunately suppression and destruction pathogenic microflora in the mouth will not lead to a complete cure - the disease will turn into chronic form, since the source of the destruction of normoflora will remain in the body.

As you can see, oral dysbacteriosis is a complex pathology that requires professional medical care. Many negligent dentists try to help patients cure the chronic form of such dysbacteriosis on their own, without destroying the cause of the disease.

Such patients are forced long time aimlessly spend their own financial resources due to the illiteracy of a dentist. Do not follow the lead of such "specialists", as you can cause significant harm to your body.

Thanks to television advertising, many of us are aware of the existence of useful and harmful bacteria and the meaning of such concepts as "dysbacteriosis" and "microflora". But not everyone knows that dysbacteriosis can be not only a problem of gastroenterology and gynecology. According to statistics, 70% of people have oral dysbacteriosis. This condition causes many unpleasant symptoms, such as halitosis and the formation of ulcers on the mucosa. Let's see what oral dysbacteriosis is, what symptoms it has, how it is diagnosed and treated.

What is dysbacteriosis?

More than 500 strains of bacteria live in the human oral cavity, among which are both beneficial and harmful, and some of them are "permanent inhabitants" of the oral mucosa, while others enter them with food, drinks, are brought from other parts of the body, for example, from the skin, intestines, nasopharynx. The first category of microorganisms forms the so-called obligate (permanent) microflora, and the second - non-permanent, facultative. The permanent "residents" of the mucous membranes of the mouth include staphylococci, streptococci, lactobacilli, bacteroids, prevotella. Among representatives of facultative microflora, pathogenic or opportunistic pathogens, which cause the development of various diseases of the oral cavity. These include Escherichia coli, Pseudomonas, Klebsiella.

When the balance of beneficial and harmful bacteria is disturbed, dysbacteriosis develops.

Under the influence of various factors, the concentration of pathogenic microorganisms in the oral cavity increases, respectively, useful - decreases, there is a dysbacteriosis of the oral cavity. Dysbacteriosis is not a disease, but a condition in which there is an imbalance in the microflora. Often you can find another name for this pathological condition - dysbiosis.

Note: the normal microflora of the oral cavity is an individual concept. Some opportunistic microorganisms are able to live on the mucous membranes of a healthy person without causing him any inconvenience. In addition to bacteria, protozoa, viruses and fungi can be found in the mouth.

How does oral dysbacteriosis manifest itself?

The severity of unpleasant symptoms depends on the stage of development of dysbacteriosis. At the initial stages of development, the number of one or two types of pathogens grows, this condition is called a dysbiotic shift. At this stage of development, dysbacteriosis can practically not give itself away. You can recognize oral dysbacteriosis by photos taken with an electron microscope. Due to the absence of pronounced symptoms, the patient does not go to the doctor in time, which further leads to the development of chronic oral dysbiosis.

At stage 2, the number of lactobacilli decreases, at stage 3, pathogenic microorganisms will take their place. At stage 4, active growth of yeast in the oral cavity occurs. At stages 3 and 4, as a rule, unpleasant symptoms of dysbiosis appear.

Symptoms of dysbacteriosis in the early stages may not be pronounced.

As we have already said, one of the symptoms, upon detection of which dysbacteriosis can be suspected, is bad breath. In addition to the smell, there may be an unpleasant aftertaste in the mouth, which appears regardless of the intake of food and drinks. A person may be disturbed by the production of saliva and have a feeling of dryness. The following disorders may indicate oral dysbacteriosis:

inflammation of the mucosa, redness of its individual areas, burning sensation;
inflammation of the gums, them;
dense plaque on the tongue and the surface of the teeth;
the appearance of vesicles and ulcers on the oral mucosa and tongue;
education - painful cracks and peeling of the skin;
dysbacteriosis of the tongue (its inflammation, soreness, redness, swelling).

The above symptoms can be observed in various dental diseases, for example, bleeding and inflammation of the gums is a symptom, and the appearance of plaque and ulcers is, therefore, doctors rarely distinguish dysbiosis as a separate disease. But dysbacteriosis could precede the development of these diseases and become the cause of their occurrence. What provokes the development of dysbacteriosis itself? Let's talk about this further.

Why does oral dysbacteriosis develop?

Very often, oral dysbacteriosis develops synchronously with intestinal dysbiosis. These two states are closely related: correct work The gastrointestinal tract effectively absorbs vitamins from food. With intestinal dysbiosis, the body lacks micronutrients, which negatively affects the health of the oral cavity.

One of the main reasons for the development of oral dysbacteriosis is the frequent and improper use of dental and gum care products. The first enemies of good microflora are gum rinses containing antiseptics and alcohol. They dry out the mucous membrane, lead to increased sensitivity of the gums.

The use of mouthwashes with antiseptics in the composition can provoke the development of dysbiosis.

Antiseptics are added to therapeutic rinses designed to eliminate the symptoms of gingivitis and stomatitis. Their regular use for more than 3 weeks is unacceptable. Alcohol can be added to preventive rinses as a solvent. However, this component is best avoided, as it can adversely affect the balance of microflora.

Note: There is an opinion, which has not yet received sufficient evidence, that the alcohol in the rinse can increase the likelihood of developing oral cancer.

The following factors can affect the balance of oral microflora:

dental diseases in the chronic stage;
reduced immunity;
an unbalanced diet or wrong mode food intake;
antibiotic therapy;
hypovitaminosis and beriberi;
chronic diseases of the gastrointestinal tract;
environmental situation (content of harmful impurities in the air);
intensity of the salivary glands;
anomalies in the development of the lips and teeth.

Smokers and people who abuse alcohol have a higher risk of developing dysbacteriosis, as they disrupt the process of saliva production. Due to constant dryness or, conversely, increased salivation, the likelihood of dysbiosis increases.

Treatment of dysbacteriosis

Dysbiosis of the oral cavity must be eliminated. If the problem is ignored, the symptoms may worsen, the patient will develop periodontitis, periodontal disease, stomatitis,. These diseases can cause premature loss of teeth, the development of infection in the nasopharynx.

With symptoms of dysbacteriosis, patients, as a rule, turn to the dentist. To make a diagnosis, a swab is taken from the mucous membrane or a saliva test is performed. Most likely, consultation of other specialists will also be required: a gastroenterologist, a therapist, an infectious disease specialist, a nutritionist. You may need to take a blood and urine test.

A swab from the oral mucosa may be required to make a diagnosis.

The main thing that needs to be done when symptoms of dysbacteriosis are detected is to identify its cause and eliminate the provoking factor. Main therapeutic measures with oral dysbacteriosis:

sanitation of the oral cavity (removal of tartar and plaque, treatment of gums, inflammation of the tongue and mucous membranes, elimination of foci of chronic infection in the oral cavity);
taking vitamins (they will accelerate the recovery of damaged tissues);
taking probiotics that increase the number of beneficial bacteria;
rejection bad habits(smoking, drinking alcohol);
drafting proper diet nutrition;
the use of antiseptic drugs prescribed by the dentist (they will reduce the number of pathogenic microorganisms);
taking immunostimulants to increase local immunity of the oral cavity;
taking antifungal drugs, antibiotics (prescribed in rare and advanced cases);
regular oral care using safe products;
abstaining from oral sex.

For the treatment of dysbacteriosis of the oral mucosa and tongue, on average, about 2 weeks are required. If the patient's condition is severe, it may take about a month to recover. The speed of restoring the balance of the microflora of the mouth is affected by the correctness of the diagnosis, the appointment of therapy and the responsible attitude of the patient to treatment. Be healthy!

Numerous microorganisms live in the oral cavity and nasopharynx (anaerobes - oxygen lovers are a hundred times more than aerobes - living without oxygen). These are bacteroids, porphyromonas, prevotella, eubacteria, fusobacteria, bifidobacteria, lactobacilli, actinomycetes, Haemophilus influenzae, Neisseria, spirochetes, leptotrichia, streptococci, staphylococci, peptococci, peptostreptococci, veillonella, Candida fungi, protozoa (Entamaeba gingivalis and Trichomonas tenax) and other organisms . Antimicrobial components of saliva (antibodies and lysozyme) inhibit the action of foreign microbes. fibronectin(related in properties to gram-positive bacteria) coats the mucous membrane and inhibits the growth of gram-negative bacteria. All types of microflora living in symbiosis with humans are in a certain quantitative ratio with each other.

When abused antiseptic preparations and antibiotics for the treatment of various diseases of the oral cavity and pharynx (throat) can disrupt the balance of microflora, that is, cause a bias in the quantitative ratio of beneficial and conditionally pathogenic microorganisms (moreover, towards an increase in pathogenic species). And against this background, dysbiosis (dysbiosis) develops.

Dysbacteriosis itself later becomes the cause of inflammatory processes in the oral cavity, throat and nasopharynx. If there is a tendency to such frequent diseases as Angina, Tonsillitis, Pharyngitis, or oral candidiasis develops, then it can be suspected that the microflora is disturbed, and it needs to be restored. In addition to measures to support immunity and the intake of an additional amount of beneficial bacteria (Lacto- and Bifidobacteria), bacteriophages are successfully used. In order to know which type of bacteriophage to use, they take an analysis for bakposev (smear from the oral cavity and nasopharynx). Next, it is determined whether the found strain of bacteria reacts to this bacteriophage and, upon confirmation of the phage sensitivity of bacteria, the bacteriophage is started.

For the treatment and prevention of dysbacteriosis of the oral cavity, pharynx, nasopharynx, the following are suitable: Pyobacteriophage polyvalent purified ( sextaphage), Staphylococcal bacteriophage, Streptococcal bacteriophage, Pyobacteriophage combined. They are used in the form of rinsing, irrigation of mucous membranes, instillation into the nose. When rinsing, it should be borne in mind that the bacteriophage foams a lot, so you need to take it into your mouth a little. Rinsing with bacteriophage solution is carried out with subsequent swallowing of the solution.

Bacteriophage in ENT practice.

In inflammatory or purulent - inflammatory processes in ENT diseases in the nose, nasopharynx, pharynx or ear (for example: Angina, Tonsillitis, Pharyngitis, Laryngitis, Sinusitis, Sinusitis, Otitis), there is also the possibility of using a bacteriophage. For the treatment of otitis media, bacteriophage is used in the form of turundas moistened with a solution or washing the middle ear cavities. For the treatment of inflammation in the sinuses of the nose, the nasal cavity, nasopharynx are washed with a bacteriophage, or the turundas moistened with the bacteriophage are left in the nose for a while. Turunds are left for an hour and a half, then they are changed several times during the day. Since a certain bacteriophage targets only a certain type of bacterium, it is necessary to select a bacteriophage according to the pathogenic bacterium that caused purulent or inflammatory process. To do this, take a smear from the site of the lesion and do a bakposev. And only after the pathogen is identified, the phage is selected.

It is necessary to pay attention to the fact that, since the bacteriophage is stored in a refrigerator (not in a freezer!), the solution must be warmed in the hands before use, or held for a short time at room temperature. But only that part of the solution that you use, and the entire vial with the remaining contents is again put in the refrigerator.

Dysbacteriosis of the oral cavity is characterized by a change normal composition microflora in this area. With a dysbiotic failure, harmful organisms begin to attack not only the mucous membranes, but also the bone component.

As a result, the dentition loses its strength, and in the absence of treatment, active destruction of tissues begins with damage to all structures of the oral cavity.

Dysbacteriosis is an imbalance between conditional and pathogenic microflora, when harmful bacteria begin to predominate in quantitative or qualitative composition, provoking a number of complications.

The growth of pathogenic microflora can be influenced by both external and internal factors. With dysbiosis, the active reproduction of microorganisms of opportunistic flora leads to a decrease in the functionality and quantitative composition of bifidobacteria. At the same time, representatives of the pathogenic flora can produce without changes.

The composition of the microflora in the mouth

The most common inhabitants of the oral cavity are bacteria. There are more than 500 strains of them. In addition, the mucous membranes are inhabited by protozoa, fungi and viruses. The number and composition of microflora organisms of each person is individual. All inhabitants of the oral cavity can be divided into 2 groups:

Obligate or permanent environment. These bacteria are constantly in the human mouth. The most common are lactobacilli, streptococci, staphylococci, prevotella, bacteroids.
Facultative or inconsistent microflora. Its penetration occurs when eating, migration of organisms from the nasopharynx, intestines, and skin. Typical representatives of this group are Pseudomonas, Escherichia coli, Klebsiella.

Causes of imbalance

A number of factors, both external and internal, can lead to the development of oral dysbacteriosis:

Features of the clinical picture

The appearance of certain symptoms depends on the degree of development of dysbacteriosis in the mouth. There are 4 stages of the disease:

Latent phase. Dysbiotic shift is characterized by a slight change in the number of one strain of pathogenic microorganisms. There are no symptoms.
Subcompensated stage characterized by a decrease in lactobacilli. The signs of the disease are blurred.
Pathogenicity of monocultures. Lactobacilli are diagnosed in minimum quantity, the oral cavity is inhabited by an optional pathogenic environment. Signs of dysbiosis are well distinguishable.
Decompensated form of the disease. In this stage, in addition to severe symptoms, the growth of yeast-like fungi occurs.
The very first sign of the disease is the appearance. Further there is a burning sensation. Added to these symptoms is disruption.

In a neglected state, with dysbacteriosis of the oral mucosa, the following symptoms are observed:

the presence of and ;
the appearance of bubbles, with a simultaneous increase in body temperature;
swelling, hyperemia and soreness of the tongue;
dryness of the skin of the face, in particular the area around the lips. The appearance, peeling of nearby surfaces is characteristic.

Diagnostic criteria

The diagnosis of dysbacteriosis is often difficult, this is due to the absence of obvious manifestations on initial stage diseases and individual differences in the composition of the microflora of the oral cavity of each person. However, if dysbiosis is suspected, the dentist sends a swab from the surface of the mucous membranes or an analysis of the patient's saliva for microbiological examination.

The material is taken on an empty stomach. There should be no food particles on the surface of the enamel, otherwise the result of the study will be unreliable.

In addition, the patient must donate blood and urine. Additional examinations are prescribed according to the test results. Sometimes several specialists are involved in the further course of the disease. It can be a therapist, gastroenterologist, immunologist, nutritionist, infectious disease specialist.

Therapy Methods

Depending on the indicators of the examination and the nature of the pathogen, the treatment of oral dysbacteriosis may include:

In addition to taking appropriate drugs to improve the effectiveness of therapy during the treatment period, it is recommended to observe the following rules:

give up bad habits: smoking and drinking alcohol;
refrain from oral sex;
reconsider nutrition, paying special attention to plant products;
after each meal, you need to clean the oral cavity from the remnants of food.

The duration of treatment depends on the stage of the disease, the presence of foci of inflammation and the existing complications. On average, this period is 2-4 weeks.

Possible consequences

In the absence of timely adequate therapy the patient begins the process of destruction of bone tissue, appears

Preventive measures

To avoid oral dysbacteriosis and its complications, it is not enough just to clean the oral cavity twice a day. It is necessary to approach the solution of the issue comprehensively:

you need to correctly compose a diet, avoiding prohibited foods that destroy the protective membrane of the mucous membranes;
it is necessary to treat diseases in a timely manner internal organs, any inflammatory process in the body affects the human immune system, which leads to a decrease in resistance to pathogenic microflora;
it is necessary to periodically take vitamin complexes;
It is recommended to stop drinking alcohol and smoking.

The appearance of dysbacteriosis in the oral cavity negatively affects the condition of the mucous membranes and bone tissue of the dentition. In the absence of proper treatment, you can quickly lose a beautiful and snow-white smile.

The main indicator of their vital activity is the condition of the mucous membranes.

As a result of violation correct microflora oral cavity, there is a formation certain symptoms that form the concept of dysbacteriosis in the mouth. Normal microflora oral cavity is an individual concept for everyone. Normally, each person has various microorganisms in the oral cavity, among which there may be: fungi of the genus Candida, streptococci, lactobacilli, staphylococci.

Dysbacteriosis of the oral cavity does not occur by itself, it often manifests itself as a result of developed dysbacteriosis intestinal tract. It also occurs in the presence of chronic diseases of the digestive organs. A common cause of intestinal dysbacteriosis is prolonged and uncontrolled use of antibiotics.

With proper functioning of the intestine, its microflora favors the absorption of vitamins A, E, D, and also produces vitamins of group B. With developed dysbacteriosis, there is a lack of these vitamins, which is displayed on the oral cavity. The reason for the formation of dysbacteriosis may be the use various means mouthwash, lozenges, local antiseptics, toothpastes.

Factors for the development of dysbacteriosis:

The presence of allergic dermatosis;

Disturbed or improper diet;

Chronic diseases of the gastrointestinal tract;

Inflammation or infection in the intestines.

Signs of oral dysbiosis:

development of candidiasis white coating on the tongue and inside of the cheeks);

Recurrent herpes infection that affects the lips and mouth

Relapses of aphthous stomatitis;

Cracks in the corners of the mouth;

Inflammation of the pharynx and oral cavity.

Stages of development of oral dysbacteriosis

At the first stage of development of dysbacteriosis, there is an increase in the number of one or more types of pathogenic organisms in the mouth. This is called a dysbiotic shift, and there are no manifestations.

At the next stage, the number of lactobacilli decreases and barely noticeable manifestations appear.

At 3 stages instead of necessary for the body lactobacilli, appears a large number of pathogenic microorganisms.

During stage 4, yeast-like fungi actively multiply.

In the last two stages of the development of the disease, ulcers, inflammation and excessive keratinization of the epithelium of the oral cavity may occur.

Oral dysbacteriosis symptoms and treatment

The degree of development of the disease provokes the appearance of certain symptoms. There are several types of dysbacteriosis: subcompensated, compensated, decompensated.

With a dysbiotic shift (compensated dysbacteriosis), there are no symptoms and the disease can only be detected using laboratory methods. When diagnosing, the number of conditionally pathogenic organisms is determined, while the normal flora of the mouth does not suffer.

Symptoms of oral dysbacteriosis in the form of a burning sensation in the mouth, the appearance of halitosis or a metallic taste indicate subcompensated dysbacteriosis. Studies reveal a reduced level of lactobacilli, an increased volume of pathogenic microflora and the presence of pathogenic microorganisms.

The appearance of seizures, infections in the mouth, inflammation of the tongue, gums indicates decompensated dysbacteriosis.

As a result of all of the above, the patient develops periodontal disease, stomatitis, periodontitis. By running these diseases, you can lose several teeth. It is also possible to develop an infectious lesion of the nasopharynx. In such situations, the normal flora disappears, and opportunistic pathogens increase in its place.

Treatment of dysbiosis is necessary only in the most extreme situations. In other cases, you need to general diagnostics organism, detect the presence of intestinal diseases and treat them.

If you have been diagnosed with oral dysbacteriosis, then you need to be examined by a general practitioner, gastroenterologist, infectious disease specialist and take urine and blood tests.

Often the cause of dysbiosis is improper care of the oral cavity, the large and irrational use of antiseptics and antibiotics, and a passion for sweets.

If the symptoms of oral dysbacteriosis are confirmed by a diagnosis, treatment is then mainly used in the form of sanitation and taking drugs to normalize the microflora in the mouth. Also used as therapy:

Vitamins - which increase tissue regeneration;

Eubiotics - used in order to increase the number of beneficial bacteria in the oral cavity, use Acelact as baths (after that use Bifidumbacterin);

Local antiseptics will help to reduce the level of pathogenic microflora;

Immunomodulators - prevent the growth of pathogenic organisms and increase local immunity;

Antimicrobial and antifungals, antibiotics - used for severe inflammation.

At effective therapy it is necessary first to reduce the severity of the disease (soreness will decrease and the burning sensation will decrease), after which the level of beneficial microflora should be normalized.

In order to completely cure dysbacteriosis, it is necessary to eliminate the cause of its occurrence. Dysbacteriosis in the mouth requires treatment mandatory, otherwise the state will be strengthened and have additional consequences.

Dysbacteriosis in the mouth: how and how to treat the mucosa?

If you want your oral cavity to always be in excellent condition, use Super 5 Probiotic. Its formula is designed to maintain and form the correct microflora of the oral cavity.

This drug is designed to different ages maintain a healthy oral cavity. It comes in the form of lozenges and has a pleasant fruity taste.

Each tablet contains about 2 billion beneficial bacteria, which contribute to the rapid restoration of the correct oral microflora.

These tablets do not contain yeast or fructooligosaccharides.

Preventive measures for ARVI;

Prevention of periodontal disease, caries, strengthening of gums;

With thrush in the oral cavity;

To normalize the microflora in the mouth.

Children from 4 to 12 years old: dissolve 1 tablet after meals, 1 time per day.

Over 12 years: 1 tablet after meals, morning and evening.

Pathogenic flora in the mouth causes tartar, halitosis, caries, plaque on the teeth, inflammation of the gums. The probiotic strains found in Super 5 Probiotic will help you get rid of all these unpleasant manifestations, the drug belongs to the category of probiotics for the mouth.

Dysbacteriosis of the oral cavity after taking antibiotics

The use of broad-spectrum antibiotics adversely affects the intestinal microflora. This is due to the fact that it destroys all microorganisms, both bad and good. As a result, an environment conducive to the reproduction of pathogenic organisms develops in the intestine.

As you know, from the above information, intestinal problems can also cause the development of dysbacteriosis in the mouth.

Therefore, after undergoing antibiotic treatment, it is necessary to restore the correct intestinal microflora. It will be effective to use antibiotics along with probiotics, for example, Flora m & d probiotics, which will not allow pathogenic flora to multiply.

For effective preventive measures probiotics should be used along with antibiotics.

Symptoms and treatment of oral dysbacteriosis: how to get rid of bacteria on the mucosa and eliminate bad breath?

The mucous membrane of the oral cavity contains a large amount of microflora, which is individual in each person: there are both conditionally pathogenic and completely harmless microbes. If this delicate balance is disturbed, oral dysbacteriosis is formed in the body, which can be complicated by other infectious diseases.

What is dysbacteriosis in the oral cavity?

Dysbacteriosis is a chronic pathological condition resulting from an imbalance between the number of beneficial and harmful microorganisms, in which harmful ones predominate. Dysbacteriosis in the oral cavity, the treatment and diagnosis of which is not particularly difficult, is currently found in every third person.

Most affected by the bacterium are children of preschool age, the elderly and people with weakened immune systems: cancer patients, patients with HIV and primary immunodeficiency. In adults healthy people symptoms of dysbiosis are rare.

Causes

Oral dysbacteriosis is a multifactorial disease that develops due to the influence of a whole group of completely different factors. Each of them separately from each other may not cause negative consequences, but with a joint interaction, the disease is guaranteed to occur.

The main factors causing the disease:

long-term use of antibiotics in the treatment of chronic diseases;
primary or secondary immunodeficiency;
intestinal infection, heavy metal poisoning;
inflammatory diseases of the gastrointestinal tract;
diet low in animal protein and vitamins;
allergic diseases of various origins: urticaria, dermatoses and dermatitis, Quincke's edema;
taking hormonal contraceptives or steroid drugs;
taking anti-inflammatory drugs for more than two weeks;
excessive intake of nicotine in the body: active and passive smoking;
alcohol abuse.

Diagnostics

To accurately diagnose oral dysbiosis in a patient, a series of simple bacteriological tests must be performed. You also need to analyze the symptoms that indicate dysbacteriosis.

Laboratory methods for diagnosing dysbacteriosis:

Bacteriological analysis and sowing on nutrient media of biomaterial - saliva or scraping from the gums. This method allows you to accurately determine the level of infection of the oral cavity with pathogenic pathogens.
The urease test is based on the ratio of the amount of urease and lysozyme: with an increase in this number by more than one, one can accurately judge the presence of dysbiosis in the body.
Gram stain and microscopy of a smear from the oral cavity. In the course of this method, a quantitative account is made of gram-positive and gram-negative microbes, and on the basis of the data obtained, a conclusion is made about the presence of a bacterial imbalance.
The express method is based on determining the amount of a particular bacterium in the air released, followed by comparing this figure with a smear of the oral cavity. If the ratio is more than one, then the diagnosis is reliable.

Stages of disease development and symptoms

For any pathological process occurring in the body, a certain staging is characteristic. Dysbacteriosis of the oral cavity has a rather slow and prolonged course, which makes it possible to clearly distinguish between all stages and their characteristic clinical picture.

There are three stages in the course of the disease:

stage of compensation. Pathological process only begins to develop, there is a slight increase in the concentration of pathogenic pathogens. The body successfully copes with the threat on its own. In the presence of good immunity, the disease recedes at this stage, and the only manifestation is the smell from the mouth.
subcompensation stage. Defense mechanisms begin to give a breakdown, the number of harmful microorganisms increases. Clinically, this stage is manifested by a burning sensation in the mouth, dry mucous membranes, plaque on the tongue, and bad breath is also observed. In the photo of patients, you can see the pale gray color of the skin.
stage of decompensation. It is accompanied by a complete depletion of compensatory mechanisms and a decline in the immune system. Pathogenic microorganisms make up the majority of the oral microflora. The symptoms are pronounced: ulcerations appear in the oral cavity, the gums bleed, the tonsils and soft palate become inflamed, the process of absorption and assimilation is disturbed nutrients, there is a putrid odor. With progression, the process can go to the throat.

How to treat?

Drugs for oral dysbacteriosis

Currently, two groups of drugs are widely used: probiotics and prebiotics. Both groups are successfully used to treat various stages of dysbiosis.

Probiotics contain a large number of beneficial bacteria and prevent the colonization of the mucous membranes by harmful microorganisms. Lactobacterin, Biobacton and Acilact are some of the most famous representatives of the group. Long term treatment ranges from several weeks to several months.
Prebiotics aim to correct pH and help create optimal conditions for the reproduction of normal microflora. Hilak Forte, Dufalac and Normaze are applied in a course for two to three weeks.

Folk remedies

Long before the advent of the pharmacological industry, people resorted to the services traditional medicine. Many methods that help cure oral dysbacteriosis are relevant to this day.

The most effective folk methods:

Homemade yogurt. A few pieces of dried black bread are added to a liter of boiled milk. The resulting mixture is infused in a dry and warm place for a day, after which it is completely ready for use. Dysbacteriosis disappears within one week.
Strawberry. Fresh berries stimulate salivation, thus contributing to the production of beneficial microorganisms and creating a favorable environment for their reproduction. A glass of fresh berries before meals will restore the imbalance.
Potentilla decoction. This plant has a huge sedative and anti-inflammatory property, which leads to its use in dysbiosis. A tablespoon of Potentilla is poured into two glasses of water and boiled for thirty minutes. Consume twice a day.

Preventive measures

Preventive measures against dysbacteriosis are divided into three main areas:

increase in the overall resistance of the body;
regular consultation with a specialist about chronic diseases;
stabilization of the microbial flora of the oral cavity.

The body's resistance to infections can be increased through the use of regular physical activity, the use of hardening techniques and yoga exercises. Giving up bad habits will also have a beneficial effect on the overall health of a person.

When taking antibacterial, anti-inflammatory and hormonal drugs, the terms of use should be strictly observed according to the instructions for the drug and / or the doctor's prescription. It is also recommended to take a course of probiotics and lactobacilli in parallel, which contribute to the regeneration of microflora.

A simple diet will help restore and maintain the normal balance of the microflora of the mucous membranes: it is recommended to give up fast food, fatty, salty and fried foods, exclude packaged juices and carbonated water. It is necessary to include more fresh vegetables and fruits in the diet, increase the consumption of fresh water.

Dysbiosis of the pharynx

Numerous microorganisms live in the oral cavity and nasopharynx (anaerobes - oxygen lovers are a hundred times more than aerobes - living without oxygen). These are bacteroids, porphyromonas, prevotella, eubacteria, fusobacteria, bifidobacteria, lactobacilli, actinomycetes, Haemophilus influenzae, Neisseria, spirochetes, leptotrichia, streptococci, staphylococci, peptococci, peptostreptococci, veillonella, Candida fungi, protozoa (Entamaeba gingivalis and Trichomonas tenax) and other organisms . Antimicrobial components of saliva (antibodies and lysozyme) inhibit the action of foreign microbes. Fibronectin (related to Gram-positive bacteria) coats the mucosa and inhibits the growth of Gram-negative bacteria. All types of microflora living in symbiosis with humans are in a certain quantitative ratio with each other.

With the abuse of antiseptic drugs and antibiotics for the treatment of various diseases of the oral cavity and pharynx (throat), it is possible to disrupt the balance of microflora, that is, cause a bias in the quantitative ratio of beneficial and conditionally pathogenic microorganisms (moreover, in the direction of increasing pathogenic species). And against this background, dysbiosis (dysbiosis) develops.

Dysbacteriosis itself later becomes the cause of inflammatory processes in the oral cavity, throat and nasopharynx. If there is a tendency to such frequent diseases as angina, tonsillitis, pharyngitis, or oral candidiasis develops, then it can be suspected that the microflora is disturbed and needs to be restored. In addition to measures to support immunity and the intake of an additional amount of beneficial bacteria (Lacto- and Bifidobacteria), bacteriophages are successfully used. In order to know which type of bacteriophage to use, they take an analysis for bakposev (smear from the oral cavity and nasopharynx). Next, it is determined whether the found strain of bacteria reacts to this bacteriophage and, upon confirmation of the phage sensitivity of bacteria, the bacteriophage is started.

For the treatment and prevention of dysbacteriosis of the oral cavity, pharynx, nasopharynx, the following are suitable: Pyobacteriophage polyvalent purified (Sextaphage), Staphylococcal bacteriophage, Streptococcal bacteriophage, Pyobacteriophage combined. They are used in the form of rinsing, irrigation of mucous membranes, instillation into the nose. When rinsing, it should be borne in mind that the bacteriophage foams a lot, so you need to take it into your mouth a little. Rinsing with bacteriophage solution is carried out with subsequent swallowing of the solution.

Bacteriophage in ENT practice.

In inflammatory or purulent-inflammatory processes in ENT diseases in the nose, nasopharynx, pharynx or ear (for example: Angina, Tonsillitis, Pharyngitis, Laryngitis, Sinusitis, Sinusitis, Otitis), there is also the possibility of using a bacteriophage. For the treatment of otitis media, bacteriophage is used in the form of turundas moistened with a solution or washing the middle ear cavities. For the treatment of inflammation in the sinuses of the nose, the nasal cavity, nasopharynx are washed with a bacteriophage, or the turundas moistened with the bacteriophage are left in the nose for a while. Turunds are left for an hour and a half, then they are changed several times during the day. Since a certain bacteriophage targets only a certain type of bacterium, it is necessary to select a bacteriophage according to the pathogenic bacterium that caused the purulent or inflammatory process. To do this, take a smear from the site of the lesion and do a bakposev. And only after the pathogen is identified, the phage is selected.

Dysbacteriosis of the pharynx is not a reason for antibiotic therapy!

N.V. Bozhko (1), PhD, assistant,

T.V. Markitan (1.2) , PhD student,

1. Department of Otorhinolaryngology NMAPE named after P.L. Shupyk, Kyiv,

2. Medical center "SantaLen", Kyiv

The question that almost every one of us has to ask at least once in a lifetime and that almost any doctor has to answer repeatedly is: what do normal results of the analysis of the microbiological composition of the studied medium look like and how to properly treat a patient if it is disturbed? Familiar, isn't it? Indeed, this topic is relevant for doctors of any specialty: dermatologists, gastroenterologists, pulmonologists, gynecologists, urologists, surgeons. This is especially true for otolaryngologists. Interest in the microbiocenosis of ENT organs is due to many factors - this is quite a big one. specific gravity of these diseases among the pathologies of adults, and an extremely high incidence among children. It is also important that the interpretation of the results of microbiological research, unfortunately, is not always correct, and the treatment, accordingly, is adequate. Unfortunately, we, as practicing doctors, have to deal with just such a situation (for example, streptococcus was found in a child, which is a variant of the norm, but he was prescribed antibiotic therapy, which caused dysbacteriosis and only aggravated the situation). Therefore, there is a real need:

In providing professional material on detailed analysis species composition of microbiocenosis of ENT organs;

In determining the characteristics of normal and pathogenic microflora;

In finding out the cause of its violation and ways to combat dysbacteriosis.

So, normally, all children are born exclusively sterile, i.e. do not have a single representative of the microflora. But already from the first seconds of birth, the newborn comes into contact with the environment. Quite quickly, his skin and mucous membranes, communicating with the external environment, are colonized by a variety of microorganisms (from the air, upon contact with the mother, medical staff etc.), which will accompany a person throughout his life. To understand the inevitability of such a joint coexistence, we present several undeniable mathematical indicators. Total microorganisms that are found in an adult reaches 1014, which is almost an order of magnitude (!) More than the number of cells of all human tissues; the weight of beneficial microbes in the large intestine (in dried form) is up to 1.5 kilograms. Such an ecological system (a person + the microflora inhabiting him) is very dynamic, the impact on it can be both beneficial for the body and have extremely negative consequences.

And now directly about upper microflora respiratory tract and oral cavity. It is important to understand that ENT organs are no exception in terms of microbial sterility, i.e. normally we can (and should!) Identify certain microorganisms in the nose, pharynx and outer ear. These microbes in conditions of maintaining immune resistance not only do us no harm, but, on the contrary, have positive influence. They form the so-called biofilm(thickness from 0.1 to 0.5 mm) - the polysaccharide framework of which, consisting of microbial polysaccharides and mucin, prevents the colonization of the body by pathogenic microorganisms. Due to the release of biofilms by microorganisms of various acids, alcohol, lysozyme (an antibacterial substance) and stimulation of the formation of immunoglobulin A, the development of pathogenic microbes is inhibited. In addition, normal microorganisms prevent the release of toxins by pathogenic bacteria.

An illustration of the work of "beneficial" microorganisms is, for example, the following fact: with each breath, we inhale about microbes on average, and thanks, in particular, to biological factors of nonspecific protection in the pharynx, their number is reduced to 300, these microorganisms are not detected in the larynx and underlying sections. generally.

This once again confirms the importance of a balanced microflora for the full functioning of the whole organism.

The normal microflora of a person is divided into obligate (permanent, resident - one that is stable and permanent) and transient (temporary - one that is on the mucous membrane for a short time).

So, the normal microflora of the ear:

- in outer ear there may be staphylococci, corynebacteria, less common bacteria of the genus Pseudomonas, mushrooms of the genus Candida.

It is important that earwax has a bactericidal effect;

– middle ear normally does not contain microbes, but they can get there through the Eustachian tube (from the nasopharynx) or due to perforation (defect) eardrum from the outer ear canal;

– inner ear sterile.

Normal nasal microflora: corynebacteria (diphtheroids), neisseria, coagulase-negative staphylococci, beta-hemolytic streptococci. As a transient microflora may be present: Staphylococcus aureus, Escherichia coli, beta-hemolytic streptococci.

Normal microflora of the pharynx: the microbiocenosis of the pharynx is even more diverse, since the microflora of the oral cavity and the airways are mixed here. Representatives of the resident microflora are: Neisseria, diphtheroids, and hemolytic streptococci, enterococci, mycoplasmas, coagulase-negative staphylococci, moraxella, bacteroids, borrelia, treponema, actinomycetes.

In the upper respiratory tract, streptococci and neisseria predominate, in addition, there are staphylococci, diphtheroids, hemophilic bacteria, pneumococci, mycoplasmas, and bacteroids.

The mucous membrane of the larynx, trachea, bronchi is normally sterile.

It should be said that the above species spectrum of microorganisms is not unchanged. Its composition depends on many factors: concomitant pathology, age, environmental conditions, working conditions, nutrition, previous diseases, injuries and stressful situations, etc.

The species and quantitative composition of the microflora of the ENT organs is shown in Table 1.

Table 1. Species and quantitative characteristics of the microflora of ENT organs

Notes: CN - coagulase-negative; CFU - colony forming units.

Given the anatomical and functional unity of the oral cavity and ENT organs (for example, beta-hemolytic streptococcus can be found in the lacunae of the palatine tonsils or carious cavities of the teeth and cause systemic complications in the form of myocarditis, glomerulonephritis, etc.), we consider it appropriate to also provide a specific and quantitative characteristics of the microflora of the oral cavity (Table 2).

Table 2. Species and quantitative characteristics of the microflora of the oral cavity

Note: CFU are colony forming units.

The situation when the composition and function of normal microflora is disturbed is known to everyone as dysbacteriosis (Fig. 1).

Dysbacteriosis is a bacteriological concept that characterizes a change in the ratio of representatives of the normal microflora, a decrease in the number or disappearance of certain types of microorganisms due to an increase in the number of others and the appearance of microbes that are usually found in small quantities or are not detected at all.

The reasons for the violation of the qualitative and quantitative composition of the microflora are diverse, but I would like to draw the reader's attention to the fact that dysbacteriosis is inherently a secondary phenomenon, i.e. this condition is always provoked by something. From this it follows logically that it is necessary not to treat the dysbacteriosis itself, but to eliminate the cause of its occurrence. For example, you can take medications for years (probiotics, antibiotics, immunostimulants, etc.), but against the background of chronic decompensated tonsillitis or adenoiditis, the result is hardly achievable, and if it is achievable, then it will definitely be temporary.

Therefore, before moving on to listing the main factors contributing to the development of dysbacteriosis, let us once again emphasize a very important point: if you find signs of dysbacteriosis then be sure to search its causes and, consequently, its liquidation.

So, here is what most often provokes a violation of the normal microbiological balance in the ENT organs:

Acute and chronic diseases of the whole body, and especially the ear, throat, nose and mouth;

Adverse physical factors (hypothermia, insolation, etc.);

Physical, intellectual and psycho-emotional overstrain;

Taking antibacterial, hormonal and cytostatic drugs;

Malnutrition, hypovitaminosis;

According to statistics, dysbacteriosis is accompanied by such nosological forms of diseases as chronic adenoiditis, rhinitis, tonsillitis and pharyngitis, as well as diseases of the hormonal system, gastrointestinal tract, helminthic invasion, pathology of the urinary and cardiovascular systems s.

Having dealt with the cause of dysbacteriosis, we proceed to treatment. Therapy must be strictly

individual and aimed primarily at eliminating the source of the problem. For example, until adenoiditis is adequately treated (conservatively or operatively), it is hardly possible to get rid of dysbacteriosis. The question of the need to take an antibiotic is determined solely by the course of the underlying disease: if pharyngeal dysbacteriosis is caused by the presence of chronic pancreatitis, then antibacterial agents are inappropriate here; if dysbacteriosis is associated with running form chronic sinusitis or adenoiditis - most likely, you cannot do without this group of drugs. Inflammatory foci in the nasopharynx and oropharynx must be eliminated - carious teeth are treated, adenoid vegetations, palatine tonsils sanitized, etc. Remember that they can not only cause local inflammatory and infectious processes and oropharyngeal dysbacteriosis, but also be a source of autoinfection and autointoxication of the whole organism. Convincing data indicate that the occurrence of a number of diseases of the respiratory, gastrointestinal, cardiovascular systems, musculoskeletal system is due to focal infection in the oropharynx. That's why sanitation of the oral cavity and ENT organs is a prerequisite and the first step towards recovery in many pathological processes.

Do not forget about measures to prevent the development of infectious and inflammatory processes in the oropharynx and ENT organs. Thus, the standard preventive measures are: daily hygiene measures(nose toilet), regular visits to the doctor, rational nutrition, hardening, creation of an optimal microclimate (humidity, temperature), treatment of concomitant pathology.

In addition to the above preventive measures, taking probiotics can help solve the problem of infectious and inflammatory diseases of the upper respiratory tract and restore the normal microbiocenosis of the mucous membrane. These are preparations, which include cultures of only bacteria that are useful to us, that is, those that normally inhabit the mucous membrane, thereby providing protection against pathogenic microorganisms. Such treatment, which in most cases is a necessary and indispensable component of complex treatment, is called biotherapy.

Particular attention is drawn to the probiotic, which begins to "work" already in the oral cavity. In a number of countries (Japan, USA, Sweden), since 2004, a number of clinical research the effectiveness of the strain Lactobacillus reuteri Prodentis in inflammatory diseases of the oropharynx. For example, 40 volunteers from the Department of Dentistry at the University of Hiroshima (Japan) were divided into two groups. Group I (20 students) took L. reuteri Prodentis first 14 days, then placebo 14 days. Group II (20 students) took placebo for the first 14 days, then 14 days L. reuteri Prodentis. Results: in group I, there was a marked decrease in the number Streptococcus mutans in saliva (up to 80% compared to baseline) after 2 weeks of probiotic intake. After discontinuation of the drug for the next 2 weeks in the saliva of patients of group I level S. mutans practically did not increase, which indicates a stable therapeutic effect L. reuteri Prodentis by colonization of the oral mucosa. In group II in the first 2 weeks (when taking placebo), the level S. mutans in saliva increased by 20% compared with the original. Over the next 2 weeks, when group II patients took L. reuteri Prodentis, level S. mutans they significantly decreased (up to 80% compared with the original). Therefore, strain L. reuteri Prodentis is effective against S. mutans and its use can be considered as a method for the prevention and treatment of caries (H. Nikawa et al., 2004).

The next study examined the effect L. reuteri Prodentis on the number of periodontal pathogens. After 21 days of taking the drug, the number of periodontal pathogens significantly decreased compared with the placebo group, which indicates the effectiveness of the probiotic (M.R. Vivekananda et al., 2010).

We also studied the influence L. reuteri Prodentis in patients chronic periodontitis. Already after 30 days, the severity of bleeding and the depth of periodontal pockets significantly decreased, which indicates the effectiveness of this strain in the treatment of periodontitis of initial and moderate severity (M. Vicario et al., 2013).

Total per strain L. reuteri Prodentis by the end of 2012 conducted 22 studies involving 971 patients, of which 19 studies involving 871 patients were randomized, double-blind/blind, placebo-controlled.

A wide range of probiotics, which include a strain L. reuteri, in the countries of Europe, Asia, America is represented by the Swedish company BioGaia AB.

BioGaia probiotic is used in patients of all ages (including newborns) and is used for various pathological conditions in otolaryngology, gastroenterology and dentistry.

Thus, the probiotic BioGaia Protectis (drops, tablets) contains L. reuteri extracted from breast milk and normally present in every person. Action L. reuteri begins already in the oral cavity and continues along the entire length of the gastrointestinal tract, maintaining and regulating the physiological balance of microflora. Probiotic BioGaia Protectis is approved for use in children from the first days of life, even in premature newborns. In addition, important in pediatric practice and organoleptic characteristics of BioGay - drops have a neutral taste and smell, do not contain components of cow's milk protein and lactose, which allows them to be used in children even with allergic conditions (diathesis, atopic dermatitis).

Probiotic BioGaia Prodentis - patented formula containing 2 strains L. reuteri(Protectis and Prodentis) to promote recovery healthy microflora oral cavity, which is used for the prevention and complex treatment of diseases of the oropharynx, as well as for the normalization of microflora throughout the gastrointestinal tract. Microorganisms in the composition of the drug:

Break down lactose, while producing lactic and acetic acids;

Promote the formation of the antimicrobial substance reuterin and other substances that have antagonistic activity against pathogenic and conditionally pathogenic microorganisms in the digestive tract;

Suppress the pro-inflammatory cytokine TNF-, providing a reduction in inflammation;

They are fixed to mucin and biofilm;

They colonize the mucosa, starting from the oral cavity.

L. reuteri increase natural defenses digestive system, create favorable conditions for the formation of normal intestinal microbiocenosis. Immunostimulating action L. reuteri associated with the ability to activate the intestinal immune system as the body's first line of defense against infections. They have a natural resistance to gastric juice and bile salts and are not destroyed under their influence when passing through gastrointestinal tract. The composition of the probiotic BioGaia allows, if necessary, to take it simultaneously with antibiotics, antifungal drugs, corticosteroids, antiviral and chemotherapeutic agents.

Therefore, the use of the probiotic BioGaia will not only normalize the intestinal microbiocenosis, thereby increasing the immunogenic activity of the body and indirectly affecting the process of restoring the microbiocenosis of the pharynx, but also directly affect the pharyngeal mucosa, contributing to its settlement. beneficial microorganisms. Thus, healthy "competition" of bacteria that are part of the probiotic BioGaia Prodentis (2 strains of L. reuteri: Protectis and Prodentis) leads to the displacement of pathogenic microorganisms and in some cases this alone is enough to eliminate dysbiosis. In most cases, probiotics are used as part of the complex therapy of pharyngeal dysbacteriosis and should be its mandatory component. In addition, these drugs are indicated as prophylactic after transferred viral diseases, before and after surgical interventions(for example, adenotomy, tonsillectomy), as well as during any episode of a decrease in general or local immunity.

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A method for the treatment of chronic pharyngitis against the background of intestinal dysbacteriosis

The invention relates to medicine, in particular to therapy, can be used to treat chronic pharyngitis on the background of intestinal dysbacteriosis. The mucous membrane of the pharynx is sequentially treated for 6 days with a solution of lysozyme at a concentration of 5 mg / ml for 2 minutes, aqueous solution trypsin at a concentration of 5 mg / ml for 2 minutes, Lugol's aqueous solution 1: 2 and boiled water with an interval of 1 minute with simultaneous correction of intestinal dysbacteriosis by using probiotics on the background of a diet enriched with dietary fiber, polyenzyme preparations, vitamin and phytotherapy for 30 days .

The invention relates to medicine, namely to otorhinolaryngology, gastroenterology. According to the authors, chronic pharyngitis, as a rule, is not independent disease but only a reflection on the mucous membrane of the pharynx of the disease state of other organs and systems of the body. Anatomical and physiological features of the middle and lower divisions the pharynx, formed as a result of embryogenesis that is the same as the digestive tract, gives the pharynx the status of the beginning of the digestive tube, and therefore the leading etiopathogenetic role in the development of chronic pharyngitis is assigned to the pathology of the digestive system. Examination of all patients with gastroenterological pathology revealed intestinal dysbiosis. One of the consequences of intestinal dysbacteriosis may be the endogenous spread and engraftment of representatives of opportunistic microflora localized in the intestine in unusual habitats. Patients of this group have a dysbiotic process of the microflora of the oral cavity and pharynx. A number of authors point to a close correlation between throat dysbacteriosis and dysbiotic disorders in the intestine and note that disturbances in the composition of the intestinal microflora are primary in relation to throat dysbacteriosis. Therefore, the various medical methods topical treatment of chronic pharyngitis, such as 0.25-0.5% solution of resorcinol for rinsing the throat, 1-2% solution of silver nitrate or 2-3% solution of protargol or collargol to lubricate the mucous membrane of the pharynx without taking into account the microbiocenosis of the pharynx and intestines in most cases remain insufficiently effective, since they do not lead to the complete disappearance of subjective complaints of patients, normalization of the pharyngoscopic picture, frequent relapses of this disease are observed. The prototype of the proposed method is the use of the drug-eubiotic lactobacterin. This drug is a lyophilisate of live lactobacilli, which is used for various gastrointestinal diseases. The authors of the prototype method use lactobacterin only as a means of preventing inflammatory diseases of the upper respiratory tract. The essence of the prototype method is to stabilize the microecological balance of the pharynx and nose, excluding the correction of microbial imbalance (dysbacteriosis) of the intestine. In order to increase the colonization resistance of the organism to pathogenic and opportunistic bacteria, patients were prescribed lactoacterin orally according to the scheme - 1 tablet 1 hour before breakfast, 1 tablet 1.5 hours after dinner for a week. The disadvantage of the prototype method in the opinion of the authors is the impact only on the microflora of the pharynx and nose without taking into account changes in the microecology of the intestine. The authors propose a method for the treatment of chronic pharyngitis, taking into account the microbiocenosis of the pharynx and intestines, which consists in the local treatment of pharyngitis through the sequential use of lysozyme, trypsin, Lugol's solution (an application for the invention "Method of treating chronic pharyngitis" has been filed. Authors: E. V. Strelets, N.A. Grafskaya, G.M. Portenko.. Priority date 15.03.99), with simultaneous correction of intestinal dysbacteriosis. The implementation of the method is as follows. Sequential treatment of the mucous membrane of the pharynx with drugs includes several stages. Patients independently rinse the pharynx with an aqueous solution of lysozyme at a concentration of 5 mg / ml for 2 minutes, then after 1 minute with an aqueous solution of trypsin at a concentration of 5 mg / ml for 2 minutes, then after 1 minute with an aqueous solution of Lugol at a dilution of 1: 2 (1 part Lugol's aqueous solution: 2 parts of boiled water). After 1 minute, patients rinse the throat with boiled water. The course of local treatment is 6 days. To consolidate the effect obtained, the treatment of the identified gastroenterological disease in the therapist and intestinal dysbacteriosis was carried out simultaneously. At the same time, probiotics were prescribed (bifikol - a dried suspension of live co-grown bifidobacteria and coli strain M-17, 5 doses 2 times a day for 30 days). Probiotics were used on the background of a diet enriched with dietary fiber (some patients took enterol type prebiotics 0.2 2 times a day for 30 days or Khilak-forte 20 caps 2 times a day for 2 weeks), biokefir was also used for 100 ml per day. Correction of intestinal dysbacteriosis was carried out according to the general rules against the background of taking polyenzyme preparations (panzinorm, mezim-forte - 1 table 3 times a day with meals throughout the course). All patients with this pathology underwent vitamin therapy (undevit - 2 others 3 times a day for 10 days of each month, up to 3 courses). To consolidate the treatment, they resorted to herbal medicine in the form of decoctions of medicinal herbs (chamomile flowers, plantain, sage, yarrow leaves - 1 tablespoon 3 times a day for 4 weeks). Subsequently, at the end of the course of treatment, microbiological control was carried out. For practical evidence of the effectiveness of the proposed method, a group of patients with chronic pharyngitis was taken. Of the 32 patients examined by us with chronic pharyngitis, intestinal dysbacteriosis varying degrees severity was detected in 28 people (87.5%), which was accompanied by clinical manifestations, changes in coprological and bacteriological examination feces. Identified dysbacteriosis was represented by stage I in 22 people (78.5%), stage II in 6 (21.5%). Considering the microbial landscape of feces, colidisbacteriosis (compensated) was detected in 15 patients (53.5%), staphylococcal - in 5 people (17.9%), fungal - in 8 (28.6%). The course of treatment of chronic pharyngitis against the background of intestinal dysbacteriosis was 30 days. Before treatment according to the proposed method, the total microbial count in the study of smears from the mucous membrane of the posterior pharyngeal wall was 10 4 CFU/tampon, after treatment, CFU/tampon. 2 weeks after the end of the course of treatment, a control bacteriological culture feces. When analyzing the obtained bacteriograms, recovery was observed normal biocenosis of the large intestine in 23 patients (82.1%) out of 28. Subjective improvement in the condition (reduction of perspiration in the throat, the disappearance of the feeling of "lump" and pain in the throat when swallowing), an objective improvement in the condition of the mucous membrane of the posterior pharyngeal wall (during pharyngoscopy, normalization of moisture was observed and color, disappearance of the compartment or dryness of the mucous membrane, a decrease in the size of lymphoid granules and lateral folds of the pharynx) was noted in all treated patients with chronic pharyngitis against the background of intestinal dysbacteriosis. Examples of the practical implementation of the method. Example 1. Patient E., 24 years old, examination card 5, complained of soreness and pain in the throat, history notes irregular stools. With pharyngoscopy, hyperemia of the mucous membrane of the posterior pharyngeal wall is determined with an injection of dilated vessels, viscous mucus. Together with a gastroenterologist, chronic catarrhal pharyngitis, dyskinesia of the large intestine of the hypomotor type, intestinal dysbacteriosis of the 1st degree were diagnosed. The complex treatment of chronic pharyngitis against the background of intestinal dysbacteriosis consisted of local treatment by sequentially rinsing the pharynx with an aqueous solution of lysozyme for 2 minutes, then after 1 minute with an aqueous solution of trypsin for 2 minutes and then after 1 minute with an aqueous solution of Lugol at a dilution of 1: 2 with boiled water. water, followed by rinsing with boiled water once a day for 6 days with simultaneous correction of intestinal dysbacteriosis, including taking bifikol 5 doses 2 times a day for 30 days, hilak-forte 20 cap. 2 times a day for 2 weeks, biokefir 100 ml per day, panzinorm 1 tab. 3 times during meals for 30 days, undevita 2 others 3 times a day, decoction of plantain leaves 1 tbsp. 3 times a day for 4 weeks. In bacteriological examination of smears from the posterior pharyngeal wall, the total microbial count before treatment according to the proposed method was 7 CFU/tampon, and after the course - 8 CFU/tampon. After 2 weeks of the end of the course of treatment, a control bacteriological culture of feces was performed. When analyzing the obtained bacteriogram, restoration of the normal biocenosis of the large intestine was noted. As a result of the complex treatment, the patient noted a subjective improvement in his condition (perspiration and pain in the pharynx disappeared), with pharyngoscopy, normalization of the moisture and color of the mucous membrane of the posterior pharyngeal wall was observed (viscous mucus, hyperemia disappeared and the number of injected vessels decreased). Example 2 Patient Sh., aged 21, examination card 16, complained of a sore throat, a sensation of a "lump" in the throat, in the anamnesis notes recurrent mild pain in the epigastric region. With pharyngoscopy: hyperemia of the mucous membrane, many lymphoid granules on the back of the pharynx. Together with a gastroenterologist, chronic hypertrophic pharyngitis was diagnosed, chronic gastritis with reduced secretion, intestinal dysbacteriosis II degree. When sowing smears from the posterior pharyngeal wall and bacteriological examination of feces for dysbacteriosis, the growth of fungi of the genus Candida was revealed, and therefore antifungal drugs were included in the treatment. The complex treatment of chronic pharyngitis against the background of intestinal dysbacteriosis included a course of local treatment according to the method of the proposed method by sequentially rinsing the throat with solutions of lysozyme, trypsin, Lugol, as well as simultaneous correction of intestinal dysbacteriosis (Diflucan 100 mg / day for 7 days, bifikol 5 doses 2 times a day for 30 days, Khilak-forte 20 caps 2 times a day for 2 weeks, biokefir 100 ml per day, Mezim-forte 1 table 3 times a day with meals for 30 days, undevit 2 others 3 times a day, decoction of yarrow leaves 1 tbsp 3 times a day for 4 weeks). Before treatment, the total microbial count in the study of smears from the posterior pharyngeal wall was 9.CFU/tampon, and after treatment according to the proposed method - 4.CFU/tampon. 2 weeks after the end of the course of treatment, bacteriological examination of the sea otter dysbacteriosis noted the restoration of normal microbiocenosis of the large intestine, the patient indicated a subjective improvement in the condition (the sore throat, the feeling of a "lump" in the throat disappeared), with pharyngoscopy, the disappearance of hyperemia of the mucous membrane of the posterior pharyngeal wall was noted, a decrease in the size of lymphoid granules with resorption of some of them. The proposed method for the treatment of chronic pharyngitis against the background of intestinal dysbacteriosis was well tolerated by the patients. side effects not found. The claimed method for the treatment of chronic pharyngitis against the background of intestinal dysbacteriosis has the following features: 1. simultaneously normalizes the microbiocenosis of the pharynx and intestines; 2. has an extended spectrum of binding dead bodies of various microorganisms; 3. reduces the recurrence of the disease and gives a faster and more lasting effect. 4. does not possess side effect. Sources of information 1. L. I. Kalshtein. Pathology of ENT organs in some gastroenterological diseases. Dushanbe.: Irfon, 1969. 2. A.Yu.Ovchinnikov. Modern complex examination and treatment of patients with concomitant pathology of the pharynx and stomach. Thesis for the competition degree candidate of medical sciences. Moscow, 1983. 3. T.V. case., 8, - p. 53-55. 4. B.L.Frantzuzov, S.B.Frantzuzov. Drug therapy diseases of the ear, nose and throat. - Kyiv: Health, 1988. 5. N. N. Lizko, Yu. M. Ovchinnikov, V. K. Ilyin and others. Lactobacterin as a means of preventing inflammatory diseases of the upper respiratory tract./ Actual problems otorhinolaryngology. Republican collection of works. Issue XXXVIII, - M., p. 6. K. G. Apostolidi. Comparative evaluation of the effectiveness of methods of endoscopic microsurgery and classical methods rhinosurgery for diseases of the nasal cavity and paranasal sinuses. Abstract of the dissertation for the degree of doctor medical sciences. - M., 1998. 7. E.V. Strelets, N.S. Maksimova, E.N. Egorova. Immobilization of lysosomal enzymes and their substrates by halogenation. / "International Jaurnal ON Immunorehabilitation". - 4, - p.187.

A method for the treatment of chronic pharyngitis against the background of intestinal dysbacteriosis, including stabilization of the microecological balance of the upper respiratory tract with probiotics, characterized in that chronic pharyngitis is treated in a complex manner by sequential treatment of the pharyngeal mucosa by rinsing for 6 days with a solution of lysozyme at a concentration of 5 mg/ml for 2 minutes, an aqueous solution of trypsin at a concentration of 5 mg / ml for 2 minutes, an aqueous solution of Lugol at a dilution of 1: 2 and boiled water with an interval of 1 minute with simultaneous correction of intestinal dysbacteriosis by prescribing probiotics against the background of a diet enriched with dietary fiber, polyenzyme preparations, vitamin and herbal medicine for 30 days.