Oral dysbiosis: symptoms and treatment in adults and children

Author of the article:

Soldatova Lyudmila Nikolaevna

Candidate of Medical Sciences, Professor of the Department of Clinical Dentistry of the St. Petersburg Medical and Social Institute, Chief Physician of the Alfa-Dent Dental Clinic, St. Petersburg

More than 300 varieties of microorganisms live in the oral cavity (streptococci, lactobacilli, fungi of the genus Candida, staphylococci, etc.), which make up its microflora, or microbiota. Constant humidity, optimal temperature and pH values, the presence of food residues - all this creates favorable conditions for the proliferation of various types of microbes.

The composition of the oral microbiota is individual for each person, so the concept of “normal microflora” is also individual. Many opportunistic microorganisms that make up the normal microflora of the oral cavity play an important role in the etiology and pathogenesis of caries, diseases of the mucous membrane and periodontal tissue. The microbiota of the oral cavity is involved in the primary processes of food digestion and absorption of nutrients, in the synthesis of vitamins, and in maintaining the proper functioning of the immune system.

The qualitative and quantitative composition of microflora usually changes little throughout a person’s life, but under certain factors this is possible. In this case, they speak of an imbalance of microflora, that is, dysbacteriosis, when the proportion of normal microflora decreases, and the growth of pathogenic microorganisms increases.

The ailment itself, designated by the term “dysbacteriosis,” is not a disease and is not included in the official international classifications of diseases. It should be considered as a set of symptoms indicating the presence of pathological processes in various body systems. Occurs in adults and children. Let's talk about oral dysbiosis: how it manifests itself, why it is dangerous, how to treat it.

Stages of development of dysbiosis in the oral cavity

Some researchers identify several stages in the formation of oral dysbiosis:

Stage 1 - dysbiotic shift (compensated dysbiosis). Characterized by an increase in the number of one type or several types of pathogenic microorganisms in the oral cavity. At this stage there are no manifestations;
Stage 2 - subcompensated dysbacteriosis. There are fewer lactobacilli, and barely noticeable manifestations appear;
Stage 3. The lactobacilli needed by the body are replaced by pathogenic microorganisms;
Stage 4. Yeast-like fungi begin to actively multiply in an unnatural niche for them.

At stages 3 and 4 (decompensated dysbacteriosis), inflammatory elements, ulcers, and excessive keratinization of the oral epithelium may occur.

All this can lead to the development of stomatitis, periodontitis, and periodontal disease. An infection of the nasopharynx may occur.

Therapeutic tactics for vaginal dysbiosis

Dysbacteriosis of the reproductive organs develops due to damage to the vagina by opportunistic flora. The main inhabitants of the genital organs are lactic acid rods. In normal condition, they make up 95% of the vaginal flora. The rest are opportunistic bacteria.

For a number of reasons - antibiotic treatment, stress, hormonal changes - opportunistic flora begins to actively multiply. The woman experiences discharge and there may be itching and burning in the vagina. In a smear with normal leukocyte counts, a mixed or fungal or coccal flora is determined.

Therapeutic tactics are similar to the treatment of intestinal dysbiosis:

Suppression of pathogenic flora with antibiotics, antifungal or antibacterial drugs in the form of vaginal suppositories, creams, tablets. In difficult cases, oral or injection antiseptics are indicated.
Popular drugs in gynecological practice are those based on metronidazole, clindamycin, povidone-iodine, and fluconazole.
At the second stage of treatment, the administration of drugs that stimulate the production of lactic acid is indicated. These can be probiotics and symbiotics for oral administration - for example, Ecobiol capsules - or suppositories for vaginal use.
Additionally, it is recommended to change your diet, normalize your sex life, and monitor hygiene. In difficult cases, a comprehensive examination is indicated with determination of hormonal status, bacterial culture of discharge, and PCR diagnostics.

Symptoms of oral dysbiosis

Symptoms designated by the term “oral dysbiosis” occur in many different diseases and syndromes, so the disease is difficult to diagnose. Let's name the signs of an imbalance in the oral microflora:

bad breath (halitosis);
metallic taste, burning sensation in the mouth;
the development of candidiasis, or thrush - a white coating on the tongue and mucous membranes of the cheeks;
inflammation of the mucous membranes and gums;
swelling, redness and soreness of the tongue;
The appearance of so-called jams in the corners of the mouth is characteristic.

The pathology of normal microflora in the mouth is fraught with the danger of endogenous infections.

The listed manifestations are due to the following changes:

colonization resistance (local immunity) of the mucous membrane is disrupted - yeast-like fungi easily adhere to the surface of the epithelium, where there are optimal conditions for reproduction;
the bacterial antagonism of normal microflora changes significantly - normally, antagonistic microbes do not allow pathogenic fungi to actively multiply, but with dysbiosis, the former are destroyed, which provokes rapid proliferation of Candida fungi;
In patients, a significant shift in local protective factors is detected - the weakened defense does not cope with its function, so the volume of pathogenic microflora increases unhindered.

Reasons for the development of oral dysbiosis

As a rule, oral dysbiosis develops due to the proliferation of yeast-like fungi Candida albicans. These fungi have an adhesive ability to the epithelial cells of the oral mucosa, and the presence of carious cavities in teeth creates conditions for their long-term existence.

With prolonged antibiotic therapy or immunodeficiency, the obligate microflora that suppresses the development of fungi dies due to which candidiasis develops. Proteases, neuraminidases and other enzymes synthesized by fungi play an important role in pathogenesis.

Yeast fungi attach to the epithelial cells of the oral mucosa, and sucrose, glucose, maltose and other carbohydrates further increase adhesion activity. The strength of attachment (adhesiveness) of the fungus determines its ability to spread. For example, C. albicans attaches to epithelial cells 1.5 times faster than other species, and the more antibiotics a person takes, the stronger the adhesion.

The yeast-like fungus destroys tooth enamel and “settles” in carious cavities and further contributes to the development of fungal stomatitis and tonsillitis. Lactic acid produced by lactobacilli prevents the proliferation of yeast-like fungi, so microorganisms cannot multiply uncontrollably.

However, they are given this opportunity if a person takes antibiotics (especially broad-spectrum antibiotics) or suffers from immunodeficiency conditions. Candidiasis can cause local lesions of the oral cavity or provoke multiple lesions of internal organs (generalized candidiasis).

The development of oral dysbiosis can be caused by:

intestinal infections;
chronic inflammatory diseases of the gastrointestinal tract;
a diet limiting the consumption of animal protein;
lack of vitamins;
allergic diseases;
use of medications (hormonal contraceptives, steroids, antiviral drugs);
smoking and drinking alcohol.

To confirm the diagnosis, bacteriological tests are performed:

Dysbacteriosis in pregnant women

bacterial culture of saliva or scrapings from the gums. The analysis makes it possible to determine the degree of contamination of the oral cavity with pathogenic microorganisms;
urease test. Reveals the ratio of urease and lysozyme (if the indicator is more than one, then this indicates the development of dysbacteriosis);
Gram staining. The quantitative ratio of gram-positive and gram-negative microbes is checked;
determining the amount of bacteria in exhaled air and comparing the indicator with a smear taken from the oral cavity.

Reasons for the formation of oral dysbiosis

The reasons that lead to disturbances in microbiocenosis in the mouth are, for the most part, the same as for dysbacteriosis in other areas of the gastrointestinal tract. These include:

prolonged and uncontrolled use of antibiotics;
use of antibacterial and antiseptic agents for mouth rinsing. Long-term use of bactericidal rinses, antimicrobial toothpastes, and local antiseptics like chlorhexidine leads to the destruction of not only harmful, but also beneficial bacteria in the oral cavity. At the same time, the resistance of pathogenic flora to antibiotics increases;
infectious and inflammatory diseases, intoxication and weakening of the macroorganism against their background;
hypovitaminosis - lack of vitamins.

Often the cause of dysbiosis in the mouth is incorrect or insufficient oral hygiene. A factor that provokes a violation of the microflora of the oral cavity is smoking.

Treatment

Depending on the stage of the disease and its causative agent, therapy is prescribed, which may include:

sanitation of the oral cavity. Plaque and tartar must be removed from the teeth, and carious cavities must also be filled, since they act as a breeding ground for pathogenic bacteria;
taking antiseptics or antimycotics to eliminate pathogenic microorganisms;
taking immunostimulants. These drugs help increase local and systemic immunity;
consumption of vitamins. Vitamins A, E, C help restore the oral mucosa. In addition, with pathology, the absorption of nutrients is impaired, and vitamin complexes help to avoid a lack of vitamins and minerals.

The causative agents of disease are most often fungi of the genus Candida, Escherichia coli, Proteus, and enterococci.

Depending on the causative agent of the disease, antibacterial or antimycotic drugs are prescribed. To destroy bacterial microflora in the oral cavity, the following can be used:

"Tantum Verde". It has an antiseptic and anti-inflammatory effect and also reduces pain. The active substance is benzydamine hydrochloride. Available in the form of a spray, lozenges, and solution. You need to take the product every three hours;
"Orasept." The active ingredients are phenol (fungicidal and antifungal action) and glycerin (relieves irritation). Available in spray form;
"Yox." Contains povidone-iodine, allantoin, levomenthol, due to which it has antiseptic and anti-inflammatory properties. The drug is active against gram-positive and gram-negative cocci, protozoan viruses, and yeast. Available in solution and spray;
"Chlorhexidine." Has a bactericidal effect. So, rinse the mouth with a 0.5% solution for 30 seconds, then spit out the liquid.

If dysbiosis of the oral cavity has developed due to a fungus, then the drug “Candide” is prescribed, the active component of which is clotrimazole, which has an antimycotic and antibacterial effect. The product destroys mold and yeast-like fungi, gram-positive and gram-negative bacteria. The solution is used to wipe the affected areas of the mucous membrane.

In severe cases of the disease, the doctor prescribes narrow-spectrum drugs that are aimed at combating a specific type of bacteria. So, when staphylococcus is detected, macrolides or pyobacteriophage (Josamycin, Clarithromycin) are prescribed, enterococci are destroyed with macrolides, penicillins, nitrofurans (Furazolidone), drugs nalidixic acid, sulfonamides will get rid of Proteus, and for Pseudomonas aeruginosa, Gentomycin is indicated.

Also, treatment of oral dysbiosis involves the use of prebiotics and probiotics. Prebiotics stimulate the development of beneficial microflora. They are not digested or absorbed in the stomach and intestines, but are broken down by the microflora of the large intestine, that is, they are food for bifidobacteria and lactobacilli.

Prebiotics include di- and trisaccharides, oligo- and polysaccharides, amino acids, peptides, polyhydric alcohols, enzymes, fatty acids, antioxidants and others.

Biotics can be naturally or artificially synthesized

Natural prebiotics are found in cereals and bran, seaweed, vegetables, fruits and dried fruits, leafy greens, and dairy products (lactulose and lactose). They love beneficial bacteria and inulin contained in garlic, onions, bananas, chicory, and wheat. Synthesized prebiotics can be purchased at the pharmacy (Duphalac, Normaze, Laktofiltrum).

Probiotics contain live beneficial bacteria that prevent the development of pathogenic microflora. Pharmaceutical preparations may contain one strain of bacteria (lactobacteria, bifidobacteria) or several types of microorganisms that enhance each other’s effects. Probiotics include “Acilact”, “Bifidumbacterin”, “Lactobacterin”, “Linex”, “Polibacterin”, “Hilak forte”.

Products are available in capsules, tablets, powders, suspensions, and suppositories. The duration of their intake varies depending on the generation of the probiotic (from 4 weeks to 7 days). “BioGaia” is effective for oral dysbacteriosis. This medicine contains lactobacilli. It is used sublingually (placed under the tongue or chewed), which means it has only a local effect.

Live microcultures are also found in kefir, yoghurt, curdled milk, kumiss, cottage cheese, buttermilk, quick-ripening cheese, sauerkraut and other drinks prepared using starter culture or enzymes. More than 10 types of beneficial bacteria are involved in the production of kefir; fermented baked milk and yogurt contain mesophilic and thermophilic bacteria, acidophilus bacilli; 1 gram of cheese contains almost 100 million beneficial bacteria.

When treating oral dysbiosis, it is necessary not only to increase the consumption of foods containing beneficial probiotics and prebiotics, but also to exclude fast carbohydrates, fast food, fatty, fried and salty foods from the diet.

The more sweets a person eats, the more yeast-like fungi attach to epithelial cells, which means it is more difficult to get rid of them

Influence of the state of the oral microflora on other organs and systems

The connection between the general condition of the body and dental health is known. Thus, those patients who have oral diseases are more likely to develop cardiovascular diseases. Clinical studies confirm the presence of oral bacterial microflora in the blood and atherosclerotic plaques. Periodontopathogenic microflora is the main source of local and systemic chronic inflammatory process. Acts as a risk factor for the development of coronary heart disease.

In addition, scientists have discovered a connection between bacteria living in the mouth and the occurrence of migraines.

Another dangerous consequence of disruption of the oral microflora is the aggravation of intestinal and esophageal cancer. One study found that bacteria living in the mouth can trigger the development of colon cancer.

Changes in the oral mucosa in diseases of the gastrointestinal tract

Changing the language

In diseases of the gastrointestinal tract, the condition of the tongue is best studied.
The appearance of the tongue, as many authors believe, can have important diagnostic value and indicate existing pathology of the digestive tract. Changes in the tongue in diseases of the gastrointestinal tract are of a nonspecific nature, manifested by the formation of plaque, swelling, desquamation, atrophy of the papillae, paresthesia, impaired taste sensitivity, and are also quite labile; they can disappear during the period of remission of the underlying disease or during its treatment. Coated tongue is most often detected. Plaque consists mainly of keratinized epithelial cells, bacteria, fungi, and food debris. The severity of plaque depends on various reasons. The amount of plaque on the tongue increases with a decrease in its self-cleaning, mainly during chewing. When assessing the degree of tongue coating, it is important to take into account the composition and consistency of the food consumed, as well as the regularity of individual hygiene measures and other factors. The amount of plaque on the tongue varies throughout the day: there is more in the morning than in the afternoon and evening, since the amount of plaque decreases after eating. Disruption of the process of normal (physiological) keratinization and desquamation of the epithelium also determines the amount and density of plaque. Thus, with atrophy of the filiform papillae of the tongue, there is little or no plaque. With hypertrophy of these papillae, a hard-to-remove thick layer of plaque is formed on the surface of the tongue, consisting mainly of stuck together keratinized filiform papillae.

The condition of the tongue may indicate disorders of the digestive system. Coated tongue is one of the characteristic symptoms of diseases of the gastrointestinal tract. Thus, with exacerbation of gastritis, peptic ulcer, enterocolitis and colitis, the amount of plaque increases, it covers the entire back of the tongue, localizing mainly in its posterior sections. Plaque formation, as a rule, is not accompanied by subjective sensations. Only with a thick, dense layer of plaque on the tongue can a feeling of discomfort and a slight decrease in taste sensitivity occur. Usually the coating on the tongue is grayish-white in color, but it can take on various shades (yellow, brown). The color of plaque is mainly due to dyes in food products, medications or exacerbations of gastrointestinal diseases: peptic ulcer, chronic hepatitis, cholecystitis (yellow, brown).

A swollen tongue is an important sign of gastrointestinal diseases. As a rule, swelling of the tongue is detected by a doctor during examination, since it does not cause pain, except in cases of significant swelling when biting the tongue when eating or talking. The edematous condition is determined upon examination by pronounced tooth marks on its lateral surfaces, as well as an increase in its size. An objective research method to determine the presence of edema is the McClure-Aldrich blister test. Using a blister test, you can determine the state of latent edema, which will allow you to diagnose early (preclinical) changes. V.A. Epishev (1970) described a violation of hydrophilia of the oral mucosa in chronic gastritis. With anacid gastritis, a decrease was found, and with hyperacid gastritis, an increase in the time of resorption of the blister test was established. It should be taken into account that in which a violation of water metabolism is detected.

Changes in the papillae of the tongue are often recorded in pathologies of the digestive tract. The pathogenesis of these changes is mainly due to trophic disorders, as well as a violation of the vitamin balance due to insufficient absorption and synthesis of vitamins B1, B2, B6, B12 by the intestinal microflora.

Depending on the severity and color of the tongue papillae, hyperplastic glossitis can be differentiated from atrophic one.

Hyperplastic glossitis is observed more often in patients with gastritis with high acidity, with exacerbation of peptic ulcer disease. Glossitis is characterized by hypertrophy of the papillae of the tongue, a dense coating, and an increase in the size of the tongue due to severe swelling.

Atrophic glossitis is found in gastritis with secretory deficiency, hepatitis, gastroenteritis, colitis. With this form of glossitis, atrophy and smoothness of the papillae of the tongue and the absence of plaque are observed. Sometimes the atrophy of the papillae is pronounced, the tongue is smooth and shiny. It may be hyperemic (erythematous) or pale pink. In some cases, the tongue has a “varnished” appearance with bright red spots and stripes, reminiscent of Meller's glossitis. Atrophy of the papillae of the tongue can cause a burning sensation, soreness, and tingling when eating hot and spicy foods.

Desquamation of the epithelium of the tongue is quite often found in diseases of the gastrointestinal tract and can be of varying degrees of severity. Desquamation occurs more often in patients with chronic gastritis with secretory insufficiency, chronic colitis, and liver diseases. It is characterized by the appearance on the back of the tongue of foci of desquamation of the epithelium of filiform papillae. With secretory insufficiency and infectious lesions of the liver, desquamative glossitis is often combined with atrophy and smoothness of the papillae of the tongue. These changes, as a rule, do not cause painful sensations and patients often do not suspect their existence, only sometimes complaining of burning and pain when eating irritating foods. The appearance of foci of desquamation during an exacerbation of a chronic disease of the gastrointestinal tract and their disappearance during remission are characteristic.

Paresthesia of the tongue often accompanies diseases of the digestive system. There is a burning, tingling, tingling sensation on the tongue. These sensations often accompany desquamative glossitis, but can occur without visible changes in the tongue.

Impaired taste sensitivity is determined by the method of functional mobility of its receptors. It is known that the number of functioning receptors depends on the age and condition of the digestive tract. Normally, maximum activity of taste buds is detected on an empty stomach. After eating, their level of mobility decreases. The reaction of the taste buds of the tongue appears in response to incoming excitation impulses from the receptors of the gastric mucosa in a centrifugal manner. In case of peptic ulcer, stomach tumors, due to a disorder of its secretory and motor functions, the reflex connection between the receptors of the tongue and the stomach is disrupted. This is manifested by various changes in the functional mobility of taste receptors (increased activity and lack of demobilization after eating, etc.). Disturbances in taste sensitivity can also occur with changes in the papillary apparatus of the tongue (heavily coated tongue, atrophy or desquamation).

Lesions of the oral mucosa

Erosive and ulcerative lesions of the oral mucosa, developing in diseases of the gastrointestinal tract, are predominantly a consequence of trophic disorders. There are a large number of reports on the presence of erosions and ulcers on the oral mucosa due to gastric ulcers, liver diseases, colitis, enterocolitis, etc. There is a known connection between recurrent aphthous stomatitis and gastrointestinal pathology. Approximately 50% of patients with diseases of the gastrointestinal tract (chronic gastritis, gastric and duodenal ulcers) suffer from recurrent aphthous stomatitis of varying severity.

Changes in the color of the oral mucosa can occur against the background of gastrointestinal pathology. During the period of exacerbation of peptic ulcer, enterocolitis, colitis, catarrhal gingivitis, glossitis or stomatitis often develop, the severity of which depends on the duration and frequency of exacerbations of the underlying disease. The oral mucosa in the affected area is characterized by hyperemia with symptoms of cyanosis due to the chronic course of the process. In this case, patients complain of a burning sensation in the mouth, changes in the color of the mucous membrane, and sometimes pain when eating irritating foods. The most pronounced phenomena are catarrhal gingivitis and stomatitis during exacerbation of chronic colitis. During the period of remission of gastrointestinal diseases, the symptoms of catarrhal gingivitis or stomatitis become mild or completely disappear.

It should be remembered that such changes in the oral mucosa can be manifestations of other diseases and conditions of the body (infectious, including fungal, allergic, cardiovascular, hypovitaminosis). In this regard, for successful diagnosis and selection of treatment methods, a thorough examination of the patient is necessary.

Salivation disorders can manifest as hyper or hyposalivation. Studies by a number of authors have proven that patients with gastric and duodenal ulcers experience morphological and functional changes in the minor salivary glands. With peptic ulcer disease in the initial stage (for up to a year), as well as its exacerbation, salivation increases with the subsequent development of hyposalivation. Patients begin to complain of dry mouth. Clinically, impaired salivation is often combined with other previously described changes in the oral cavity, characteristic of gastrointestinal pathology.

Diagnosis and treatment of oral dysbiosis

Oral cavity dysbiosis syndrome in the initial stages of development is detected during laboratory tests. To diagnose oral dysbiosis, microbiological examination of a smear from the oral mucosa or saliva is used. When diagnosing, the number of opportunistic microorganisms in the test material is determined.

Important: it is necessary to accurately establish the root cause of the disease, which a comprehensive examination of the body will help with, and treat the primary disease.

For pathologies of the gastrointestinal tract that affect the condition of the oral cavity, they are first treated.

If the balance of the oral microflora is disturbed, treatment is mainly used in the form of sanitation and taking medications to normalize the microflora in the mouth. However, all drugs that are used to treat oral dysbiosis are considered drugs with unproven effectiveness. The following is used as therapy for this condition:

eubiotics - needed to increase the number of beneficial bacteria in the mouth;
immunomodulators - increase local immunity and prevent the growth of pathogenic microorganisms;
antimicrobial and antifungal agents.

Probiotics for oral dysbiosis

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Prevention of dysbiosis in the mouth

Prevention of oral dysbiosis includes the following measures:

use of antibiotics only as prescribed by a doctor in the recommended course;
use of alcohol-free and antiseptic rinses for daily oral hygiene, for example, ASEPTA Parodontal Fresh with plant extracts and microelements;
smoking cessation: it is advisable to eliminate smoking altogether;
strengthening local immunity: timely sanitation of the oral cavity, maintaining oral hygiene. You also need to strengthen your general immunity.

The main advice for normalizing the microflora of the oral cavity: do not feed the bad microbiota and do not destroy the good one.

Let's summarize: we have given a definition of oral dysbiosis, which is understood as a violation of the ratio between normal and pathogenic microflora in the direction of increasing the latter. They indicated that this condition is not an independent disease, but only a complex of symptoms. The stages of formation of oral dysbiosis, symptoms and causes of disturbances in the microflora of the oral cavity were named. Also from this article you learned how to treat oral dysbiosis and how to prevent its occurrence.

Traditional medicine

Folk remedies will help get rid of oral dysbiosis:

homemade curdled milk. You need to boil a liter of milk and add a few pieces of dried black bread to it, leave to infuse in a warm place for a day. Use yogurt within a week;
strawberries Berries stimulate salivation, which leads to the release of substances that destroy pathogenic microorganisms. Thus, conditions are created for the reproduction of obligate microflora;
bloodroot. Potentilla decoction has soothing, anti-inflammatory and antiseptic properties. A spoonful of the dried plant is poured with two glasses of boiling water and boiled for half an hour. You need to drink the decoction twice a day before meals.

To prevent the development of dysbiosis, it is necessary to monitor oral hygiene, adhere to a healthy diet, and promptly treat gastrointestinal diseases. Since doctors consider medication use to be the main factor in the development of pathology, the use of antibiotics, hormonal and antiviral drugs should be monitored by the attending physician. If drug therapy is long-term, then prophylactic administration of drugs based on bifidobacteria and lactobacilli is advisable.

Experts' opinion

Asept products have proven effectiveness. For example, multiple clinical studies have proven that the two-component mouth rinse ASEPTA ACTIVE more effectively combats the causes of inflammation and bleeding compared to single-component rinses - it reduces inflammation by 41% and reduces bleeding gums by 43%.

Sources:

The role of anti-inflammatory rinse in the treatment of periodontal diseases (L.Yu. Orekhova, A.A. Leontyev, S.B. Ulitovsky) L.Yu. OREKHOVA, Doctor of Medical Sciences, Prof., Head of Department; A.A. LEONTIEV, dentist; S.B. ULITOVSKY, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I. P. Pavlova
Report on clinical trials to determine/confirm the preventive properties of commercially produced personal oral hygiene products: mouth rinse "ASEPTA PARODONTAL" - Solution for irrigator." Doctor of Medical Sciences Professor, Honored Doctor of the Russian Federation, Head. Department of Preventive Dentistry S.B. Ulitovsky, doctor-researcher A.A. Leontiev First St. Petersburg State Medical University named after academician I.P. Pavlova, Department of Preventive Dentistry.
Report on determining/confirming the preventive properties of commercially produced personal oral hygiene products: Asepta toothpaste used in combination with Asepta mouthwash and Asepta gum balm Head. Department of PFS Doctor of Medical Sciences Professor S.B. Ulitovsky St. Petersburg State Medical University named after Academician I.P. Pavlova. Faculty of Dentistry. Department of Preventive Dentistry.