ENZYME THERAPY FOR THE COMPLEX TREATMENT AT PATIENTS WITH TEMPOROMANDIBULAR JOINT DISEASES

Abstract

The purpose of the study. To evaluate the clinical efficacy and safety of use of the serratiopeptidase at patients with temporomandibular joint (TMJ) diseases. Materials and methods. The study involved 36 patients (m-11, w-25) with diseases of the temporomandibular joint (TMJ), the average age of which was 45.2 ± 7.3 years, who were treated at the Dental Medical Center of Bogomolets NMU. The patients were divided into 2 groups: main – 18 people, comparison – 18 people. Patients received NSAIDs, chondroprotectors, combination of preparations of the calcium and vitamin D3. Patients in the main group additionally took serratiopeptidase 10 mg 1 tablet 3 times a day for 30 days. Examination of patients was performed according to the classical method of examination of patients with diseases of the TMJ. The dynamics of clinical manifestations in patients were evaluated at 7, 21, 30 days of treatment. The degree of mouth opening, the volume of movement of the mandible, noted the presence of sounds (noises) in the joint were took into account during objective examination. The presence, severity of pain in the TMJ were determined by the verbal scale of pain intensity assessment – Verbal Descriptor Scale (VDS). The obtained laboratory data were referenced in the International System of Units and processed by variational statistics using MedStat and EZR v.1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan, 2017), which is a graphical interface to RFSC (The R Foundation for Statistical Computing, Vienna, Austria). Results. There was a decrease of the pain both at rest and during chewing at all (100%) patients in both groups after 7 days of treatment, respectively 2.1 ± 1.1 and 4.3 ± 0.9 points. Patients from both groups during follow-up visits had an increase in mouth opening up to 3.7 ± 0.7 cm, improved jaw movements, decreased crunching and crepitus in the joint. Patients from the main group at follow-up visits after 1 month of the observation had significantly better rates of pain reduction at rest and during chewing: 0.6 ± 0.4 and 2.1 ± 1.1 points, respectively (p < 0,05) – resting state; 1.6 ± 1.1 and 3.3 ± 1.0 points (p < 0.05) – during active jaw movements. The same pattern was observed in the improvement of the jaw movements and mouth opening in the patients of the main group, compared with the comparison group, respectively 4.4 ± 1.0 cm and 3.9 ± 0.8 cm (p < 0.05). Conclusions. The use of serratiopeptidase in complex treatment of patients with diseases of the TMJ reduces the pain in the joint both at rest and during active movements of the mandible, allows to improve the volume of movements in the TMJ and the degree of mouth opening to 4.4 ± 1.0 cm, compared to the comparison group (p < 0.05). Significant gradual reduction of pain, improvement of mouth opening, reduction of crunchiness and crepitus in the TMJ in both groups were found throughout the study (p <0.05).