Method for treating chronic generalized periodontitis

Abstract

FIELD: dentistry.SUBSTANCE: used in the complex treatment of chronic generalized periodontitis. From the first day of treatment, professional oral hygiene is performed, removing non-mineralized dental deposits using pastes and brushes, and removing mineralized deposits using an ultrasonic scaler generating vibrations of up to 30 kHz. At the same time, rinsing with a 0.05% chlorhexidine solution in a volume of 10 ml after each meal with an exposure of about 30 seconds for 14 days, systemic antimicrobial therapy with clarithromycin at 250 mg twice a day for a course of 7 days and procedures of transcranial electrical stimulation using the frontotemporal technique in the bipolar pulsed current mode with a strength of up to 1.5 mA, a frequency of 77.5 Hz, a duration of 20 minutes daily for 10 days and local use of a gingival tray containing sage essential oil with an exposure of 40-60 minutes once a day before bedtime, after treating the oral cavity with a chlorhexidine solution for 10 days.EFFECT: method, due to a specific scheme of complex treatment of patients with chronic generalized periodontitis, allows achieving a pronounced therapeutic effect while maintaining high safety of the procedure, eliminating the risk of side effects and increasing the safety of treatment.1 cl, 3 tbl, 2 ex

Description

[0001] The invention relates to medicine, namely to physiotherapy and dentistry, and can be used for the complex treatment of chronic generalized periodontitis, namely to increase its effectiveness and safety.

[0002] Inflammatory periodontal disease is a serious medical and social problem. According to the WHO, up to 98% of the population aged 15 to 50 years is susceptible to periodontal disease. In the 40-65 age group, chronic generalized periodontitis is the leading cause of tooth loss. In some patients, chronic generalized periodontitis is accompanied by systemic diseases (diabetes mellitus, hypertension, coronary heart disease, nervous system diseases, endocrine pathology), which require specific medications and limit pharmacotherapy in the treatment of periodontitis, including due to frequent allergic reactions (methodological recommendations of the I.I. Mechnikov Medical University, Ministry of Health of the Russian Federation).

[0003] It is known (abstract of the dissertation “Transcranial electrical stimulation in the complex treatment of patients with periodontitis: clinical and immunological aspects”, Antipova O.A., Volgograd, 2005) the use of a modern physiotherapeutic method - transcranial electrical stimulation for the complex treatment of periodontitis, which allows to increase the effectiveness of conservative treatment of patients with periodontitis, helps to normalize existing immune shifts and disturbances in the system of non-specific resistance factors, determine the optimal timing of surgical intervention.However, the proposed method of therapy does not destroy mature microbial biofilms, as a result of which the microbial reservoir in periodontal pockets remains and a high risk of relapse remains. The use of a high value of stimulating current, brought up to 3 mA, can cause pain and discomfort in patients, reduce the tolerability of procedures and increase the risk of unwanted vegetative reactions, as a result of which safety is reduced and compliance with treatment is reduced.

[0004] Online sources (e.g., published guidelines from the I.I. Mechnikov Medical University of the Russian Ministry of Health) report the use of non-invasive transcranial selective electrical stimulation of endorphin-derived brain structures (TES therapy). It relieves pain, stimulates reparative regeneration, restores and activates the immune system, normalizes microcirculation and systemic blood flow, and more. Highly effective, TES therapy compares favorably with traditional drug therapy due to its lack of side effects and a small number of contraindications. TES therapy is used in combination with other medications (analgesics, antidepressants, antibiotics, immunomodulators, etc.) for the treatment of dental diseases. TES therapy reliably and significantly reduces serum levels of the pro-inflammatory cytokine IL-1β and simultaneously enhances the production of the anti-inflammatory cytokine IL-10.This demonstrates the pathogenetically significant immunomodulatory effects of TES therapy. Pain is significantly reduced or completely eliminated in 67% of patients. This increases the effectiveness of redressal, mechanotherapy, myogymnastics, and therapeutic massage of the parotid-masticatory region. TES therapy reduces the duration of treatment and medical and social rehabilitation by an average of 35%. However, a significant proportion of patients (≈33%) continue to experience pain and signs of inflammation. The existing evidence base does not contain data on the long-term effectiveness of TES in terms of clinical manifestations, relapse rates, or quality of life.

[0005] The results of comparative studies (Kraynov S.V., Popova A.N., Firsova I.V., Myasoedova K.A., Alekhanova I.F., Vasenev E.E. Periodontology, Vol. 26, No. 3 (2021) "Clinical and laboratory substantiation of the effectiveness of transcranial electrical stimulation in the treatment of chronic generalized periodontitis in gerontostomatological practices") of two clinical groups (68 people) of 60-74 years old suffering from periodontitis showed that all patients received the same type of basic therapy. In the 2nd group, TES was prescribed. An assessment was made of the dynamics of the level of IL-1β, TNF-α, IL-10, sIgA and LDH in the gingival fluid, as well as the reduction of periodontal indices: bleeding and PMA (in %) at the following times: before treatment, on the 7th, 14th, 21st and 30th days after the start of observations.It was established that the complex treatment regimen for periodontitis, including TES (immunomodulation), has a higher clinical efficacy in comparison with traditional therapy (starting from the 14th day, statistically significant differences in clinical and laboratory parameters were noted between groups 1 and 2 (p <0.05). On the 30th day of observation, the described trends persisted: gingival fluid parameters in both groups continued to decrease. At the same time, their values ​​​​in the 2nd group were statistically significantly lower than in the 1st (the level of IL-1β (pg / ml) was: 16.90 ± 0.33 and 18.80 ± 0.38; TNF-α (pg / ml): 11.90 ± 0.37 and 14.4 ± 0.4; IL-10 (pg / ml): 11.00 ± 0.35 and 12.90±0.36, respectively) (p<0.05). TES (as a component of complex treatment) has greater clinical efficacy compared to the traditional treatment regimen for periodontitis in elderly patients.Laboratory analysis of the composition and properties of gingival fluid, as well as the selection of its most indicative immunological and biochemical components (IL-1β, TNF-α, IL-10, sIgA, and LDH), are of great importance in geriatric dentistry. This allows the periodontist not only to confirm the observed dynamics of clinical manifestations of periodontitis in the elderly but also to verify the effectiveness of immunomodulation. However, the current treatment method does not destroy mature microbial biofilms, thereby preserving the microbial reservoir in periodontal pockets and maintaining a high risk of relapse. The use of TES in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) limits the safety of the method. The emphasis is on laboratory markers (IL-1β, TNF-α, IL-10, sIgA, and LDH) and indices, without examining patient quality of life indicators. The results were assessed only for 30 days, there is no data on the duration of remission.

[0006] The method for treating chronic generalized periodontitis was chosen as a prototype (Clinical guidelines "Chronic periodontitis" (K05.3) approved by Resolution No. 1 of the Council of the Association of public associations "Dental Association of Russia" dated 12 / 20 / 2024), including professional oral hygiene with the removal of all supra- and subgingival dental plaque, curettage, rinsing periodontal pockets with antiseptic solutions (0.05% miramistin solution), application of periodontal therapeutic dressings with metronidazole (Periodontal Pack, Coe Pack, Voco Pack, Septo Pack), Diplen-denta films, systemic antimicrobial and anti-inflammatory therapy (macrolides in combination with non-steroidal anti-inflammatory drugs).However, traditional medicine does not ensure: the destruction of mature microbial biofilms due to the low penetrating ability of topical dosage forms (dressings, films, washes); a reduction in the frequency of relapses and a sustainable improvement in the quality of life of patients; safety: the use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with the risk of developing adverse reactions (dysbiosis, allergies, toxic effects on the liver and gastrointestinal tract), as well as loss of therapeutic effect with repeated courses.

[0007] Thus, the technical problem of creating a more effective and safer method of treating patients with chronic generalized periodontitis, compared to the prototype, remains unresolved. This method ensures complete relief of pain in patients, the refusal to use NSAIDs, the relief of psychological stress, the restoration of quality of life, a reduction in the risk of developing side effects, the prevention of relapses of the disease in the long term, as well as the development of a clear scheme for the use of local and systemic methods of therapy in complex treatment.

[0008] The technical result of the proposed method is the obvious increase in efficiency with long-term remission, an increase in the safety of the method for treating chronic generalized periodontitis with the destruction of mature microbial biofilms in periodontal tissues and the elimination of pathogenic microflora, a decrease in the levels of interleukin-1β and interleukin-6 in saliva and blood, and cortisol in the blood.

[0009] The technical result is achieved by a method for treating chronic generalized periodontitis, which includes professional oral hygiene with the removal of all supra- and subgingival dental deposits, rinsing with antiseptics, systemic antimicrobial therapy, and transcranial electrical stimulation, and differs from the method chosen as a prototype in that, from the first day of treatment, professional oral hygiene is carried out with the removal of non-mineralized dental deposits using special pastes and brushes and the removal of mineralized deposits using an ultrasonic scaler generating vibrations of up to 30 kHz;At the same time, rinsing with a 0.05% chlorhexidine solution in a volume of 10 ml after each meal with an exposure of about 30 seconds for 14 days, systemic antimicrobial therapy with clarithromycin at 250 mg twice a day for a course of 7 days and transcranial electrical stimulation procedures using the frontotemporal technique in the bipolar pulsed current mode with a strength of up to 1.5 mA, a frequency of 77.5 Hz, a duration of 20 minutes daily for 10 days and local use of a gingival tray containing sage essential oil with an exposure of 40-60 minutes once a day before bedtime, after treating the oral cavity with a chlorhexidine solution for 10 days.

[0010] The authors' proposed comprehensive treatment regimen for patients with chronic generalized periodontitis has a number of advantages over the prototype: firstly, the use of transcranial electrical stimulation in the bipolar pulsed current mode with a strength of up to 1.5 mA allows for a pronounced therapeutic effect to be achieved while maintaining high procedure safety and good patient tolerability (confirmed by the results of clinical trials).Secondly, transcranial electrical stimulation is used not in addition to nonsteroidal anti-inflammatory drugs, but as an alternative, eliminating the risk of adverse reactions and increasing treatment safety. Furthermore, its combination with local application of a gingival tray containing essential oils ensures the preservation and enhancement of the anti-inflammatory effect due to their synergistic action. Essential oils, despite their local administration, exert an additional systemic effect, reducing levels of proinflammatory cytokines and cortisol, which enhances the overall therapeutic outcome and makes it possible to discontinue NSAIDs.The use of a dental tray with sage and tea tree essential oils effectively eliminates pathogenic microflora and destroys mature microbial biofilms. The tray forms a sealed reservoir that maintains a high local concentration of active ingredients in the gum area and periodontal pockets. This design prevents the active components from being washed out by saliva, ensuring their long-term presence and diffusion into the biofilm matrix.

[0011] Thus, the proposed complex provides an optimal balance of safety and efficacy, improves treatment tolerability, and enhances the therapeutic effect while reducing the likelihood of adverse reactions. The efficacy and safety of the method and the synergistic effect of the combination of properties are confirmed by clinical examples and long-term (12-month) efficacy monitoring.

[0012] The method is carried out as follows.

[0013] Example 1. Clinical example of the implementation of the proposed method for treating chronic generalized periodontitis in outpatient settings of the State Healthcare Institution of the Republic of Crimea “Simferopol City Clinical Hospital No. 7”, Simferopol.

[0014] Patient B., 46, consulted a dentist complaining of constant bleeding gums when brushing and eating, swelling and cyanosis of the gums, bad breath, heavy plaque, and severe pain. Previous oral hygiene and antiseptic rinses had not improved the condition. The patient also reported high levels of psychoemotional stress. According to the classification of periodontal diseases (XVI Plenum of the All-Union Society of Dentists, 1983, as amended in 2001), the diagnosis was chronic generalized periodontitis of moderate severity.

[0015] History: The patient first noticed signs of periodontitis at age 20 (bleeding gums, inflammation, and mobility of the front teeth). No treatment was given. After childbirth, symptoms progressed. Subsequently, periodic treatment by a periodontist (scaling, applications, and physical therapy) was performed, which produced short-term results. Over the past three years, flare-ups have become more frequent, occurring every 3-4 months. The patient has no bad habits, and no associated somatic pathologies have been identified.

[0016] Objectively upon examination: mobility of teeth 13, 12, 2, 24, 25 grade I; inflammation of the marginal gum, periodontal pockets 4-6 mm deep with purulent discharge in the area of ​​the front teeth of the lower jaw; bleeding, bad breath.

[0017] Before treatment: pain intensity according to the visual analogue scale (VAS) is 7 points (“severe pain”). The final quality of life score according to the SF-36 questionnaire is 48 out of 100 (i.e. low). Microbiological examination: increased levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia were detected in periodontal pockets. Laboratory examination: in saliva IL-1β is 10.4 pg / ml, IL-6 is 11.2 pg / ml; in blood plasma IL-1β is 9.2 pg / ml, IL-6 is 11.3 pg / ml; cortisol level is 583.0 nmol / l.

[0018] The patient underwent complex treatment using the method proposed by the authors, namely: on the first day of treatment, professional oral hygiene was performed with the removal of non-mineralized dental deposits using special pastes and brushes and mineralized deposits using an ultrasonic scaler (registration certificate dated October 5, 2010 N 2010 / 0759 for the medical device Varios series dental ultrasonic scalers with accessories; manufacturer NAKANISHI INC., Japan, NAKANISHI INC., 700 Shimohinata, Kanuma-shi, Tochigi-ken, 322-8666, Japan; registration dossier number N 45372 dated July 20, 2010.2010), generating oscillations up to 30 kHz; from the first day of treatment, the following were prescribed simultaneously: rinsing with a 0.05% chlorhexidine solution in a volume of 10 ml after each meal with an exposure of about 30 seconds for 10 days; systemic antimicrobial therapy with clarithromycin 250 mg twice a day for 7 days; daily procedures of transcranial electrical stimulation using the frontotemporal technique in the bipolar pulsed current mode with a strength of up to 1.5 mA, a frequency of 77.5 Hz, a duration of 20 minutes, a course of 10 procedures. During the procedure, the patient was in a sitting position with support on the back of a chair or in a lying position. The electrodes were fixed in the forehead and temples using standard elastic fasteners. Transcranial electrical stimulation was performed using the Transair-01 device (OOO Medozon, Moscow), registration certificate of the Ministry of Health of the Russian Federation No. 29 / 03020397 / 1493-01.Also, from the first day of treatment, the use of a dental-gingival tray containing sage essential oil was prescribed, with an exposure of 40-60 minutes once a day before bedtime, after treating the oral cavity with a chlorhexidine solution for 10 days.

[0019] The gingival tray was made of Odontosil silicone material with reservoirs for essential oil. Clary sage essential oil was used in a mixture with cold-pressed olive oil (base). Five drops of clary sage essential oil were added to one teaspoon of olive oil. This mixture was applied to the gingival tray, projecting onto the alveolar mucosa in the recesses of the tray.

[0020] After completion of treatment, there were no side effects from the proposed treatment. Clinically, the patient achieved complete relief of pain (VAS - 0 points, which corresponds to "no pain"), a significant improvement in quality of life (SF-36 - 92 points out of a possible 100). Upon examination: disappearance of inflammatory manifestations, normalization of gum color and turgor, absence of purulent discharge, reduction in the depth of periodontal pockets to 2-3 mm, stabilization of dental arches, no pathological tooth mobility. Microbiological examination in the periodontal pockets did not detect Aggregatibacter actinomycetemcomitcms, Porphyromonas gingivalis and Prevotella intermedia, indicating the destruction of mature microbial biofilm, elimination of pathogenic microflora and restoration of the periodontal microbiocenosis to a level characteristic of clinically healthy tissue.

[0021] The IL-1β level in saliva decreased to 3.1 pg / ml (the statistical significance of the difference (p) was less than 0.001), and the IL-6 level decreased to 3.7 pg / ml (p was less than 0.001); both indicators reached the normal values ​​(p was greater than 0.05). In blood plasma, the IL-1β level decreased to 2.8 pg / ml (p was less than 0.001), and the IL-6 level decreased to 3.5 pg / ml (p was less than 0.001), i.e., they returned to normal, reflecting not only local suppression of inflammatory processes in the periodontium, but also a systemic reduction in the inflammatory response, confirming the comprehensive anti-inflammatory effect of the claimed treatment method. Plasma cortisol levels also reached normal values, reaching 327.4 nmol / L (p = 0.001), indicating relief of psychoemotional stress. For 12 months after completion of treatment, the patient experienced no exacerbations or signs of relapse, confirming the achievement of sustained clinical and laboratory remission.These data confirm the effectiveness and safety of the proposed method.

[0022] 2. An example confirming the effectiveness of the method and the achievement of the technical result.

[0023] The study was conducted on two groups of patients: the first group included 90 patients with chronic generalized periodontitis, who on the first day of treatment underwent professional oral hygiene with the removal of non-mineralized dental deposits using special pastes and brushes and mineralized deposits using an ultrasonic scaler generating vibrations up to 30 kHz; At the same time, from the first day, rinsing with a 0.05% chlorhexidine solution in a volume of 10 ml after each meal with an exposure of about 30 seconds for 14 days, systemic antimicrobial therapy with clarithromycin at 250 mg twice a day for a course of 7 days and transcranial electrical stimulation procedures using the frontotemporal technique in the bipolar pulsed current mode with a strength of up to 3 mA, a frequency of 77.5 Hz, lasting 30 minutes daily for 10 days were prescribed.

[0024] The 2nd group included 90 patients with chronic generalized periodontitis, whose treatment was carried out according to the proposed method: on the first day of treatment, professional oral hygiene was performed with the removal of non-mineralized dental deposits using special pastes and brushes and mineralized deposits using an ultrasonic scaler generating vibrations up to 30 kHz;At the same time, from the first day, rinsing with a 0.05% chlorhexidine solution in a volume of 10 ml after each meal with an exposure of about 30 seconds for 14 days, systemic antimicrobial therapy with clarithromycin at 250 mg twice a day for a course of 7 days and procedures of transcranial electrical stimulation using the frontotemporal technique in the bipolar pulsed current mode with a strength of up to 1.5 mA, a frequency of 77.5 Hz, a duration of 20 minutes daily for 10 days and the use of a gingival mouth guard containing sage essential oil, with an exposure of 40-60 minutes once a day before bedtime, after treating the oral cavity with a chlorhexidine solution for 10 days.

[0025] Data on the effectiveness of treatment using the proposed method and prototype are given in tables (No. 1, No. 2 and No. 3).

[0026] The comparative data in Table 1 show that the proposed method, compared with the prototype, allows to increase the effectiveness of the treatment. In particular, after the end of treatment (after 14 days), the number of patients in the 2nd group who achieved complete pain relief was 92% and was statistically significantly higher than in the 1st group (62.1%, p equal to 0.001). In the 2nd group, the average pain severity index according to VAS was 0.6 [0.0; 1.0] points. In the 1st group, the average pain severity index according to VAS was 3.0 [2.8; 3.6] points and was 5 times higher than in the 2nd group (p less than 0.001). The VAS scale is a 10-cm-long straight line. Its beginning corresponds to the absence of pain—"no pain"—and its endpoint represents excruciating, unbearable pain—"unbearable pain." The line can be either horizontal or vertical. The patient is asked to mark the line based on the intensity of their current pain.The distance between the beginning of the segment ("no pain") and the mark made is measured in centimeters and rounded to the nearest whole number. Each centimeter on the line corresponds to 1 point. At the mark of 0 cm (points) - no pain, 1-3 cm (points) - mild pain (mild impairment); 4-6 cm (points) - moderate pain (moderate impairment); 7-8 cm (points) - severe pain (severe impairment); 9-10 cm (points) - unbearable pain (absolute impairment) [Gelinas C, Puntillo KA, Levin P, et al: The Behavior Pain Assessment Tool for critically illadults: A validation study in 28 countries. Pain 2017; 158:811-821].

[0027] The average SF-36 score in Group 2 was 33.3% higher (p 0.001) than in Group 1. The SF-36 is a non-specific questionnaire for assessing patient quality of life. Its 36 items are grouped into eight scales: physical functioning, role activity, physical pain, general health, vitality, social functioning, emotional state, and mental health. The values ​​for each scale range from 0 to 100, with 100 representing complete health. All scales comprise two indicators: mental and physical well-being. The results are presented as scores on 8 scales, constructed in such a way that a higher score indicates a higher level of QOL (the maximum score is 100).

[0028] Throughout the observation period, no adverse reactions were recorded in patients in Group 2, compared to 16.1% of cases in Group 1 (p < 0.001). This confirms the safety of the authors' proposed treatment method for chronic generalized periodontitis.

[0029] At a follow-up examination 12 months after treatment, 91% of patients in Group 2 achieved stable remission, compared to only 61% in Group 1 (p = 0.002). These data further confirm the superior efficacy of this treatment method for chronic generalized periodontitis.

[0030] Table 1 shows the data on clinical efficacy indicators in the study patient groups, where p 2-1 - indicator of statistical significance of differences between the 1st and 2nd groups.

[0031]

[0032] The obtained clinical results are consistent with the microbiological and laboratory parameters: before the treatment, anaerobic periodontopathogens prevailed in the periodontal pockets of patients in groups 1 and 2: Aggregatibacter actinomycetemcomitans (23.5% and 24.2%), Porphyromonas gingivalis (19.2% and 20.3%), Tannerella forsythia (16.6% and 15.1%), Treponema denticola (13.4% and 12.8%) and Prevotella intermedia (10.3% and 10.7%), respectively; the differences between the groups were statistically insignificant (p> 0.05).

[0033] After 14 days of treatment, patients in Group 2 showed a statistically significant decrease in the levels of all anaerobic periodontal pathogens: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis decreased by 2 times, Tannerella forsythia and Treponema denticola decreased by more than 2 times, Prevotella intermedia was detected only in isolated cases, and Fusobacterium nucleatum and Porphyromonas endodontalis were completely inhibited, indicating the destruction of mature microbial biofilm and the elimination of pathogenic microflora. In patients in Group 1, a statistically significant (two-fold) decrease was noted only for Fusobacterium nucleatum and Porphyromonas endodontalis, while the levels of other periodontal pathogens remained virtually unchanged. This indicates continued dysbiotic shifts in the composition of the oral microbiome and mature microbial biofilm. In all cases, the results in Group 2 were statistically significantly better (p < 0.05) (Table 2).

[0034] Table 2 shows the dynamics of quantitative indicators of periodontopathogenic microflora in periodontal pockets in the studied groups of patients, where p 2-1 - indicator of statistical significance of differences between the 1st and 2nd groups.

[0035]

[0036]

[0037] Table 3 also shows that in Group 2, after treatment, a statistically significant decrease in the levels of proinflammatory interleukins (IL-1β, IL-6) in both saliva and blood plasma, as well as a decrease in the level of cortisol in blood plasma, was observed (Table 2). Moreover, in Group 2, the values ​​of IL-1β, IL-6, and cortisol reached normal levels (p greater than 0.05).

[0038] Before treatment, the IL-1β, IL-6 and cortisol levels in patients of groups 1 and 2 were comparable, that is, they had no statistically significant differences (p greater than 0.05). After the end of treatment, only patients of group 2 showed changes in all the studied parameters relative to baseline: a decrease in the levels of interleukin-1β and interleukin-6 in saliva and blood plasma, and the level of cortisol in blood plasma. In patients of group 1, only a statistically significant decrease in the levels of interleukin-6 and cortisol in blood plasma occurred. It is important to note that in group 2, all parameters were better compared to patients of group 1: in saliva, the interleukin-1β indicator was lower by 68.0% (p less than 0.001), interleukin-6 - by 64.1% (p less than 0.001); In the blood, the interleukin-1β level was lower by 58.8% (p equals 0.001), interleukin-6 – by 53.3% (p equals 0.001); the cortisol level was lower by 22.3% (p equals 0.032).

[0039] Table 3 shows the dynamics of interleukins and cortisol levels in the study groups of patients, where - p 2-1 - indicator of statistical significance of differences between the 1st and 2nd groups.

[0040]

[0041]

[0042] Thus, the technical problem has been solved; the claimed method ensures the achievement of a technical result, expressed in the destruction of mature microbial biofilms and the elimination of pathogenic microflora, the normalization of levels of pro-inflammatory cytokines and cortisol, and an increase in the effectiveness and safety of treatment.

Claims

A method for treating chronic generalized periodontitis, including professional oral hygiene with the removal of all supra- and subgingival dental deposits, rinsing with antiseptics, systemic antimicrobial therapy, and transcranial electrical stimulation, characterized in that from the first day of treatment, professional oral hygiene is performed with the removal of non-mineralized dental deposits using pastes and brushes and the removal of mineralized deposits using an ultrasonic scaler generating vibrations of up to 30 kHz;At the same time, rinsing with a 0.05% chlorhexidine solution in a volume of 10 ml after each meal with an exposure of about 30 seconds for 14 days, systemic antimicrobial therapy with clarithromycin at 250 mg twice a day for a course of 7 days and transcranial electrical stimulation procedures using the frontotemporal technique in the bipolar pulsed current mode with a strength of up to 1.5 mA, a frequency of 77.5 Hz, a duration of 20 minutes daily for 10 days and local use of a gingival tray containing sage essential oil with an exposure of 40-60 minutes once a day before bedtime, after treating the oral cavity with a chlorhexidine solution for 10 days.

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