Pathophysiological Rationale for Chronotherapy of Post-Extraction Complications

The dissertation of N.O. Khubetsova, submitted to the North Ossetian State Medical Academy in Vladikavkaz, is devoted to the pathophysiological rationale for chronotherapy of post-extraction complications. The work examines the temporal organization of physiological functions, its seasonal dynamics, and chronotype as factors determining the course of the postoperative period. Seasonal cycles of dental morbidity, the state of the hemostasis system, the biotope of the gingival sulcus, and the oral microflora are investigated in patients with complications (alveolitis, nocturnal hemorrhages) and without them. Based on a chronobiological approach, the work substantiates the application of fitolazerophoresis and bio-controlled electro- and laser therapy to improve treatment efficiency and shorten rehabilitation periods.

RELEVANCE OF THE PROBLEM. The successes achieved in the development of a new direction of classical pathophysiology of the past decade — chronopathophysiology, which studies the temporal organization of functions and processes in the organism under conditions of health and disease, transitional states from successful adaptation to disease at the stage of preclinical health impairments, and within pathological processes that constitute their pathogenetic basis, substantiate the search for new pathways to optimize treatment and correct adaptation disorders on a new chronobiological basis — chronotherapy, active chronoadaptation, chronoprophylaxis, and chronorehabilitation. The resolution of these tasks falls within the domain of experimental and clinical chronopathophysiology (Barkova E.N., 1991-2000; Khetagurova L.G., Salbiev K.D. et al., 2000-2004) at the intersection of chronobiology, which studies biological rhythms (Romanov Yu.A., 1980-2004), and chronomedicine, which studies the state of biorhythms in human diseases (Komarov F.I., Rappoport S.I., 1980-2004; Zaslavskaya R.M., 1990-2004; Arushanyan E.B., 2000; Alyakrinsky B.S., 1968-1989; Stepanova S.I., 1977, 1986, 2000) — chronopathology. Its subject is the analysis of the causes and mechanisms of deviations in the parameters and course of biological rhythms from their normal integrative interaction within the temporal organization of impaired function, and the role of these disturbances in the pathogenesis of diseases — dysregulatory pathology (Komarov F.I., Romanov Yu.A., Khetagurova L.G., 2003, 2004; Kryzhanovsky G.N., 2004). It has been established that any trauma, including surgical tooth extraction, is characterized not only by limited, localized damage, necessarily accompanied by stress, but also by accompanying systemic changes in regulatory systems: the nervous, endocrine — particularly the hypothalamic-pituitary-adrenal — sympathetic-adrenal, immune, temporal, and many other systems (Datieva F.S., 2002; Sudakov K.V., 1981-1992; Masyutin V.A., Vashetko R.V., Shirokov D.M., 1994; Meerson F.Z., 1980, 1988; Kataeva M.R., Khetagurova L.G., Kudzaev K.U. et al., 1999; Kataeva M.R., 2000; Kuznetsov S.I., Semenova I.V., 1996, 1997; Goncharov N.P. et al., 1985; Kuznetsov S.I., Semenova I.V., 1997; Harper D.G. et al., 1996).

At the same time, the degree of accompanying changes in the activity of the aforementioned systems varies and depends on the strength of the stressor, individual features of the patient's reactivity, and the state of the temporal organization of physiological functions, which ultimately determine the chronosensitivity and chronoresistance of the target tissues damaged by the trauma. During tooth extraction, the soft tissues of the periodontium are inevitably traumatized as well, which complicates and prolongs the postoperative wound treatment period. Daily rhythms of periodontal activity in healthy individuals and patients with generalized periodontitis have been described, and the dependence of the therapeutic effect on the rhythm of chronosensitivity of periodontal tissues has been demonstrated (Chencherbekova M.K., 1991, 1992). On the other hand, it has been established that phytadaptogens possess effects similar to those of bioresonance, both on the system of temporal organization of physiological functions and on wound healing processes (Dardymov I.V., 1982; Lindenbraten V.D. et al., 1981; Khetagurova L.G., Gonobobleva T.N., Belyakov I.M. et al., 1991; Datieva F.S., 2002). The effectiveness of their therapeutic action on the organism depends to a significant extent on the timing of administration — the phenomenon of chronosensitivity. Therapeutic intervention should reinforce the adaptive mechanisms of the organism, which is possible in synergy, but should not impose its own rhythms of action and mechanisms. Knowledge of the conditions of bioresonant interactions makes it possible to employ rhythmostimulation for targeted influence on the functions of the organism (Ohnyanskaya L.G., Mishin V.P., 1981; Burns J.T., Moshkin M.R., 1998). The application of external rhythmostimulation oriented toward the patient's chronotype and the state of the biorhythms of their physiological functions will reduce the recovery time of the temporal organization of damaged functions (post-traumatic desynchronosis) and enhance the effectiveness of phytotherapy and laser therapy for post-extraction complications, which is an актуальная problem of pathophysiology.

The RELEVANCE of the present study lies in the theoretical substantiation of the application of chronotherapy methods in the comprehensive treatment of complications during tooth extraction (alveolitis, nocturnal hemorrhages).

The GOAL of the study is to investigate the pathophysiological features of postoperative dental desynchronosis and to improve the efficiency of treatment and prevention of complications after tooth extraction through chronotherapy methods.

To achieve the stated goal, the following TASKS were addressed:

1. To assess the frequency, severity, and dependence of the number and severity of complications on the season of the year during tooth extraction based on archival data from two dental clinics in Vladikavkaz and personal observations.

2. To study the state of the temporal organization of physiological functions, its seasonal dynamics, and the chronotype of practically healthy individuals (control group) and patients with complicated and uncomplicated tooth extraction.

3. To identify the features and mechanisms of accompanying disorders of the plasma and platelet links of the hemostasis system during uncomplicated and complicated tooth extraction.

4. To conduct a comparative study of the oral microflora during uncomplicated and complicated tooth extraction.

5. To apply the results of group and individual chronoanalysis to assess acute post-traumatic desynchronosis in patients without complications after tooth extraction and those with alveolitis and nocturnal hemorrhages.

6. To pathogenetically substantiate, pilot, and implement chronotherapeutic comprehensive schemes of fitolazerophoresis and bio-controlled electro- and laser therapy for complications during tooth extraction.

SCIENTIFIC NOVELTY

In this work, for the first time:

1. A chronobiological approach was applied to assess the dependence of the frequency and severity of complications after tooth extraction on the patient's chronotype and season of the year.

2. The role of hemostasis system disorders in the nature and course of complications after tooth extraction was elucidated.

3. A quantitative and qualitative assessment of the composition of microbial associations of the periodontal pocket in patients with complicated and uncomplicated tooth extraction was performed.

4. New data on the pathogenesis of acute postoperative dental desynchronosis were obtained, and chronomedical technologies for optimizing standard treatment and rehabilitation of patients with post-extraction complications using bio-controlled fitolazerophoresis were developed.

THEORETICAL AND PRACTICAL SIGNIFICANCE OF THE WORK.

The work holds theoretical significance because it formulates and argues the concept of the features of changes in the temporal organization of physiological functions in the form of acute postoperative dental desynchronosis in individuals with complicated and uncomplicated tooth extraction, and demonstrates its dependence on the patient's chronotype, season of the year, hemostasis status, and periodontal biotope.

The practical significance of the results lies in the development of chronotherapeutic methods for correcting acute postoperative dental desynchronosis, which made it possible to correct the damaged regulatory mechanisms of the postoperative period and, through a chronobiological approach, to enhance the effectiveness of laser and phytotherapy for alveolitis and nocturnal hemorrhages.

Recommendations for healthcare institutions on the application of fitolazerophoresis and bio-controlled physiotherapy for post-extraction complications were developed and piloted at the dental clinics of SOGMA and in Vladikavkaz. Their implementation led to improved treatment outcomes and quality of rehabilitation, ensuring positive medical-social and economic effects.

MAIN PROVISIONS OF THE WORK FOR DEFENSE

1. An important pathogenetic link of complications after tooth extraction — acute postoperative dental desynchronosis — has been identified, and its specific symptoms and seasonal features characterizing the severity of surgical trauma from the perspective of chronoadaptation have been determined.

2. A combined study of the coagulopathies accompanying desynchronosis and the state of the gingival sulcus biotope during complicated and uncomplicated tooth extraction expanded the understanding of the pathogenesis of alveolitis and nocturnal hemorrhage, and made it possible to pathophysiologically substantiate new links of pathogenetic chronotherapy.

3. The application of adaptogenic phytococktails "Biorytm-E" and "Biorytm-RS" and phytomedicines "Antitrauma-1" and "Antitrauma-2" in the technology of fitolazerophoresis in combination with quantum bio-controlled laser chronotherapy using the "Mustang" and "ALTO-therapeut" apparatuses made it possible to individualize the comprehensive treatment of alveolitis and nocturnal hemorrhage on a chronobiological basis, thereby improving treatment outcomes and shortening rehabilitation periods.