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A
BSTRACT
The continuous development of modern periodontology, its enrichment with new scientific materials
makes it possible to identify the leading links in the pathogenesis and features of the most frequent clinical
manifestations of periodontal diseases, to provide the most etiologically and pathogenetically accurate
periodontal care. In recent years, traditional complex treatment regimens require new constructive ideas.
K
EYWORDS
Gingivitis, periodontitis, bone resorption, gingival epithelium, glycosaminoglycans.
Journal
Website:
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s.org/journals/index.ph
p/fmspj
Copyright:
Original
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4.0 licence.
Research Article
EVALUATION OF THE USE OF GLYCOSAMINOGLIKANS IN
ELIMINATION OF BONE TISSUE CHANGES IN CHRONIC
DISEASE PERIODONTITIS
Submission Date:
May
10, 2022,
Accepted Date:
May 20
, 2022,
Published Date:
May
30, 2022
Crossref doi:
https://doi.org/10.37547/medical-fmspj-02-05-06
Nazarova Nodira Sharipovna
Doctor of Medical Sciences, Associate Professor, Samarkand State Medical University, Uzbekistan
Mirzakulova Lola Tokhirovna
Samarkand State Medical University, Uzbekistan
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I
NTRODUCTION
Glycodent gel and other preparations for the local
treatment of gingivitis and periodontitis are an
important part of the complex treatment of local
drug therapy - gingivitis and periodontitis.
Purpose
: to determine the effectiveness of
Glycogent gel in the treatment of gingivitis and
periodontitis.
M
ATERIALS AND METHODS
The study included 45 patients with periodontal
diseases of the regional dental clinic. As a control
group, 30 people without periodontal pathology.
More than 50% of the population has symptoms
of gingivitis and periodontitis, and more than
10% have symptoms of stage III periodontitis.
Statistics show that the highest incidence is in the
35-44 and 15-19 age groups. The pathogenesis of
inflammatory
and
inflammatory-dystrophic
diseases of periodontal tissue is a systemic and
complex process, because the development of
pathological changes in periodontal tissue causes
many and varied processes at the level of the
whole organism, i.e. cells, biological fluids (blood,
saliva), periodontal tissues (cell organelles,
extracellular component) [ 1,7].
Pathochemical, morphological, immune, and
biological changes that occur in the periodontium
are accompanied by metabolic disorders, leading
to disruption of protein synthesis in periodontal
tissues, which in turn leads to the onset and
development of periodontal tissue destruction.
Infectious factors play a key role in the
development of inflammatory processes in
periodontal tissues.
The diverse microflora located on the surface of
the mammary epithelium is able to actively
interact with the tissue elements located under
the epithelium. the calculated tooth and all its
components cannot be considered separately [5].
. From the point of view of infectious theory of the
mechanisms of occurrence of periodontal disease,
the concept of endo-periodontal syndrome, in
particular, the possibility of infection of the intact
tooth pulp from periodontal tissues, has long
been on the list of current controversial issues of
periodontology.
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It is known that one of the main moments in the
development of inflammatory and inflammatory-
dystrophic diseases of periodontal tissue is the
violation of the structural and functional
components of the periodontium - proteoglycans,
which are gradually broken down under the
influence of bacterial hyaluronidases. This leads
to a violation of the barrier function of
periodontal connective tissue and a decrease in
the number of functional molecules of
proteoglycans sulfated by glycosaminoglycans.
It is these changes that negatively affect the
functional state of the protective barrier to the
entry of bacteria into the internal structures of
the gum stroma and alveolar bone structures and,
accordingly, slow down the repair of tissues.
However, several data indicate the successful
experimental use of drugs containing sulfated
glycosaminoglycans for the topical treatment of
gingivitis and periodontitis. In 2007, Dubna-
Biopharm LLC (Russia) introduced Glycodent
periodontal gel based on glycosaminoglycan
(chodroitin sulfate) with the addition of
peppermint oil and chlorhexidine bigluconate.
and tests are being conducted extensively to
determine the effectiveness of other common
tools [3,4].
In the pathogenesis of some diseases of the
skeletal system (osteopenia, osteoporosis,
osteomalacia), as well as disorders of the process
of reparative osteogenesis lie a violation of
calcium homeostasis in the div. There is data in
the literature on the treatment of bone defects
under the influence of calcium-containing drugs,
including the drug "Calcemin".
Complex treatment of general periodontitis
includes the following stages:
I.
Elimination of etiological factors and factors
affecting the periodontium, professional
hygiene, treatment of symptomatic gingivitis
with local drugs, correction of traumatic
occlusion, grinding of moving teeth;
II.
Surgical
treatment
with
subsequent
rehabilitation measures;
III.
Treatment of dentures by prosthetics and
permanent grinding of teeth;
IV.
Maintenance therapy, including dispensary
monitoring of periodontal tissue status.
R
ESULTS
Its main functions are to reduce microbial
infection, eliminate the inflammatory process,
reduce swelling and pain, restore normal
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homeostasis, stimulate reparative processes and
restore normal function of periodontal tissues.
Antibacterial agents in solution form are widely
used among various drugs that have a local effect
on non-specific inflammatory foci in periodontal
tissues.
Special requirements have been developed for all
antiseptic drugs used in periodontology.
First, it has a wide range of antibacterial effects,
without adverse effects on the div; decreased or
lost resistance of strains as a result of the use of
drugs, as well as the ability to destroy bacterial
biofilms..
They also take into account the long-term effects
of drugs with low toxicity, high adsorption and
the ability to fully restore the oral biocenosis [8].
The results of conservative treatment of
inflammatory
and
inflammatory-dystrophic
periodontal disease as a result of the use of
various types of drugs-pastes, gels, ointments and
films are very successful, their prolongation is
achieved by immobilization of active substances
in various polymer carriers. These topical agents
ensure uniform release of the active substance
from the drug form, which allows its application
in the systemic circulatory system without a
sharp increase, while achieving a high therapeutic
concentration in the field of local application.
Gel forms of drugs used in periodontology are soft
compositions for topical application, which are
single, two and multi-phase dispersed systems
with a liquid dispersion medium. Their
rheological properties are due to the storage of
gel-forming substances at low concentrations.
Among the gel forms are widely used drug
"Metrogil Denta" (Unique Pharmaceutical
Laboratories) and many analogues of other
manufacturing companies. These drugs are based
on chlorhexidine and metronidazole, sometimes
with the addition of other plant and synthetic
active substances in different concentrations
produced.
Glycosaminoglycan-based pharmaceuticals have
been used successfully in local treatment of
gingivitis and periodontitis in recent years.
According to various authors, ready-made dosage
forms (pastes, gels, ointments) have anti-
inflammatory, anti-inflammatory, periodontal
protection and promote wound healing.
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A number of studies have linked the use of drugs
based on hyaluronic acid. The researchers
’interest in the properties of hyaluronic acid is
explained by the fact that almost all cells in the
human div produce it.
It is formed in the cell membrane and is pushed
directly into the extracellular matrix. The matrix
enriched with hyaluronic acid stimulates cell
migration, enhances neoangiogenesis and affects
the function of keratinocytes. Due to its high
viscosity, hyaluronic acid performs protective
functions and slows down the penetration of
bacteria and viruses, which are crucial in wound
healing.
In the work of Chepel and co-authors, a positive
assessment of the clinical efficacy of medicinal
compounds consisting of sorbent silicon,
antiseptic miramycin and hyaluronic acid.
In the mid-1990s, the firm Gedeon Richter
developed a drug called Kuriozin, a combination
of hyaluronic acid and zinc, which was originally
designed to treat trophic leg ulcers of various
etiologies.
In foreign periodontal practice, the drug is used
correctly, both in pure form and in combination
with other drugs [11].
Hyaluronic acid-based product formulation
adapted for dentistry is Gialudent gel (Omega
Dent, RF).
In recent years, the Italian drug "Gengigel"
(Ricerfarma, Italy) containing 0.2% hyaluronic
acid is being actively studied.
Gengigel
reduces
the
permeability
of
microtubules, improves oxygen supply to tissues,
normalizes energy metabolism, reduces the level
of tissue hypoxia, provides protective function by
improving the structure of the gingival
epithelium.
There is little research in the literature on the use
of topical preparations based on chondroitin
sulfate. In particular, there is evidence that the
use of the above-mentioned Glycodent gel, which
contains
chondroitin
sulfate,
glycerin,
chlorhexidine bigluconate, peppermint oil and
hydroxyethylcellulose, has shown positive
results.
Dulaeva and co-authors demonstrated the
experience of clinical evaluation of Glycodent
periodontal gel in the treatment of periodontal
tissue injuries from ligature splints in jaw
fractures. The researchers, who observed positive
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dynamics, noted that bimaxyl accelerated the
rehabilitation of patients after tire removal.
Conservative treatment of gingivitis and
periodontitis is not limited to the use of local
means.
Among the many physiotherapeutic methods, the
study of the effects of laser light on periodontal
tissue remains an urgent task of modern
periodontal science.
Lasers provide the formation of electromagnetic
radiation in different optical ranges. They have
high levels of monochromaticity, coherence,
polarity, and intensity.
However, different duration of pulses leads to a
number of factors that do not tend to create local
potentially hazardous conditions in cells or in
specific locations of the target cells [11].
The first starting point for the biological effects of
low-intensity laser radiation is a local heating
factor that leads to a thermodynamic effect rather
than a photobiological reaction.
Local heating leads to the release of calcium ions
from the intracellular depot, after which Ca 2+
copper is excited in the cytosol of the cells and
initiates calcium-dependent processes. Later, a
complex of adaptive and compensatory reactions
to the less studied surface in tissues develops
secondary effects.
Basic cell reactions to laser radiation:
Activation of cell metabolism and increase their
functional activity.
Enhance blood microcirculation and improve
tissue nutrition.
Numerous studies show that laser radiation plays
a sensitizing and stimulating role not only in
periodontal tissue, but also in cellular reactions
aimed at restoring and normalizing the
bioenergetic state of the whole div.
Laser radiation increases enzymatic activity,
catalase activity, and membrane permeability,
which
significantly
accelerates
transport
processes in tissues.
Increased oxygen metabolism leads to a decrease
in hypoxia, which of course leads to inflammatory
processes. In pathological conditions, low-
intensity laser radiation enhances reparative
processes by altering the cell composition in the
area of inflammation by increasing the number of
neutrophils.
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In addition, hormonal, mediated connections of
natural adaptive mechanisms are activated [6].
After exposure to laser radiation, the div's
immune system protection is enhanced, which is
confirmed by an increase in hemagglutinin,
hemolysins, lysozyme titer, activation of
interferon,
increased
synthesis
of
immunoglobulins, changes in the structure and
function of lymphocyte plasma membranes.
Low-intensity laser radiation reduces the
concentration of lipid peroxidation products in
the blood. At the same time, by activating the
antioxidant system, radiation increases the level
of catalase in the serum and activates the cellular
elements
of
mononuclear
phagocytes
(macrophages).
As a result, the morphofunctional state of
erythrocyte cell membranes and the recovery of
the lipid spectrum of lymphocyte membranes are
accelerated. When laser radiation affects
periosteal tissue, it has a significant effect on the
blood circulating in the lacunae of bone tissue.
This provides a local and intensive effect due to
the generality of the blood circulation. Based on
modern evidence-based medical trends, many
questions today are related to the antimicrobial
effects of laser radiation.
There is no clear idea about the effect of
therapeutic lasers on the oral microflora.
Therefore, the bactericidal effect of laser
radiation in this direction is of only experimental
and theoretical importance.
In recent years, a new physiotherapeutic method
is used in medical and dental practice -
photophoresis, which involves a combination of
laser radiation and drugs applied to the skin or
mucous membranes. In order to increase
osteoregeneration in facial skull injuries,
Gerasimenko and co-authors 5% along the
fracture lines of the lower jaw bone
Photophoresis (infrared laser radiation) and thin
application of "Chondroxide" ointment used
ultraphonophoresis [4].
We concluded that photophoresis enhances
microcirculation as a result of regression of the
inflammatory component, helps reduce pain, and
activates trophic and osteoreparative processes
in fracture projection.
While studying the penetration of chondroxide
ointment using semiconductor membranes, the
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authors found that the penetration of chondroitin
sulfate increased by 6–8% after 2 min when
exposed to an initial laser radiation power of 5–
15 mW compared to the conventional application
method. , And after 10 minutes they found that it
was 12-15% higher. At an initial power of 25–30
mW, this difference was 16–17% after 2 min and
reached 19–20% after 10 min.
In the clinical phase of the study, the authors
found that the maximum increase in radiation
during the passage through biological tissues
(ear, cheek) at a starting power of laser beams in
the red and infrared range from 1 to 50 mW
corresponds to a power of 10-15 mW. identified.
These properties allowed the researchers to
hypothesize that the ointment interacts with a
biological object and that its penetration into
tissues under appropriate conditions is
significantly higher than normal diffusion.
Chondroxide ointment by Gerasimenko et al. Is
intended for external use only on the skin surface.
Ointment should not be applied to the mucous
membrane in inflammatory processes of the oral
cavity.
According to the literature, tissue permeability is
much lower when photographed with ointments
than with gel-shaped agents.
Through mathematical modeling, Prikuls et al
found that the rate of photoinduced diffusion at 3
minutes of photophoresis of gel-containing
agents was 50% higher than that of drugs without
laser irradiation in the application method.
Such evidence suggests that drug molecules
applied to the gum surface require additional
energy to overcome the potential barrier at the
mucosal layer tissue and the outer cavity
boundary.
This is due to the relatively low permeability of
the mucous membrane tissue membranes to the
molecules of the drug composition [3].
The combination of low-intensity laser beams and
preparations that synergistically enhance each
other’s efficiency stimulates cell membrane
molecules, thereby increasing its permeability. In
the complex treatment of gingivitis and
periodontitis, in addition to local drugs, it is
advisable to use drugs that have a general effect.
Given the high role of microbial factors, antibiotic
therapy plays a key role in the complex treatment.
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The peculiarity of the use of antibiotics is that
they not only show antibacterial activity, but also
neutralize the effect of collagenase of microbial
strains formed in damaged periodontal tissues.
In turn, disorders of local metabolic processes of
alveolar bone tissue in general chronic
periodontitis require the use of targeted
osteotropic therapy to normalize periodontal
bone tissue repair and osteometabolism.
Alveolar tumors of the jaws should be considered
the youngest bone otnogenetic form of the
organism, because the appearance and formation
of skeletal bones occurs in the prenatal period,
while alveolar tumors of permanent teeth occur
at 6 years of age.
This fact confirms the significant weakness of the
alveolar tumor bone tissue and its high sensitivity
to internal and external factors.
In the pathogenesis of general periodontitis plays
an important role in the alveolar tumors of the
jaws: impaired bone metabolism: increased
osteoclastic resorption rate, decreased osteoblast
activity, imbalance between resorption and bone
tissue formation.
Consequently, an increase in catabolic processes
and a decrease in biosynthesis lead primarily to
changes in the organic parts of periodontal tissue
as well as all components of this complex.
Against the background of osteoporotic changes
in skeletal bones, inflammatory-dystrophic
diseases of the periodontium are increasing.
Today, there are three directions among the
general principles of treatment of patients with
such periodontal changes:
The etiological direction involves the treatment of
this
underlying
disease.The pathogenetic
direction involves the normalization of bone
formation processes.
Symptomatic direction, including pain relief and
others.In turn, the pathogenetic therapy of
osteoporotic processes includes less than three
groups of drugs [7].
Means that reduce resorption processes in bone
tissue
(antiresorbents):
bisphosphonates,
calcitonins, estrogens, selective modulators of
estrogen receptors.
Drugs that enhance bone formation: synthetic
parathyroid hormone, fluorides, anabolic
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steroids, androgens, somatotropic (growth)
hormone.
Drugs that affect the processes of bone
regeneration: strontium ranelate, vitamin D and
its active metabolites, ossein-hydroxyapatite
complex, ipriflavon.
Bisphosphonates (BP) are first-line drugs in the
treatment of osteoporosis, stopping osteoclast
activity and potentiating antirheumatic factors.
The ability of bisphosphonates to suppress
pathological resorption and stimulate bone
formation determines their therapeutic effect in
osteoporosis.
To date, there are several hypotheses on the
effects of strontium on bone condition, which are
being studied.
Thus, the antirheumatic effect of strontium
ranelate manifests itself by reducing the
differentiation of preosteoclasts into osteoclasts,
enhancing bone formation by stimulating the
replication of preosteoblasts and increasing the
number of osteoblasts, as well as increasing the
expression of osteoprotein in osteoblasts.
However, the effect of this drug on the jaw bones
has not been adequately studied.
The main link in the prevention and treatment of
chronic generalized periodontitis is the
maintenance of normal levels of calcium and
vitamin D3 in the div. Calcium is involved in the
regulation of a number of physiological processes,
including protein biosynthesis.
It has been proven that disorders of calcium
metabolism in the div can occur not only in the
processes of osteoporosis, but also in a number of
somatic diseases. Calcium deficiency in the diet
leads to an increase in parathyroid hormone
levels, which enhances the processes of bone
resorption and calcium excretion.
As a result, osteopenic changes develop in the
bones, leading to impaired calcium metabolism
and the onset of osteoporosis.
Hormonal drugs, including calcitonin drugs
(myacaltic, calcitriol, sibacalcin) play a key role in
the treatment of alveolar bone resorption in the
treatment of disseminated periodontitis [9].
These drugs have a strong effect on the regulation
of the entire endocrine system. The literature
contains data on the effect of glycosaminoglycans,
including glucosamine hydrochloride-based
drugs, on the inflammatory-dystrophic process of
periodontal tissues. Glucosamine is a specific
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substrate that reduces the formation of
superoxide
radicals
and
tissue-damaging
enzymes
(collagenases,
phospholipases),
prevents the action of glucocorticoids on
chondrocytes and disrupts glucosaminoglycan
synthesis.
Glucosamine is actively involved in the
construction of collagen fibers and the
intercellular matrix in general, stimulates the
proliferation of chondrocytes and other
connective
tissue
cells,
increases
their
biosynthetic activity and improves vascular
microcirculation in tissues. Due to the chemical
structure of its molecule, it has an antioxidant
effect, which is characterized by high reactivity
and the predominance of reducing properties
over oxidizers. Unlike drugs containing
glucosamine hydrochloride, the attention of
researchers is drawn to pharmaceuticals based
on chondroitin sulfate, which have proven
themselves in various areas of practice.
Chondroitin sulfate is a high molecular weight
mucopolysaccharide that reduces the activity of
enzymes that break down the composition of
connective and connective tissues, as well as
enhances regeneration processes.
Chondroitin sulfate reduces the activity of the
inflammatory process in the early stages and
helps to reduce the pain reaction. In the Western
literature, chondroitin sulfate has been found to
increase OPG expression in human subchondral
bone osteoblast cells, leading to an increase in
OPG / RANKL ratio and a decrease in bone
resorption.
This is of great importance because it helps to
prove the hypothesis that osteoporosis is an
inflammatory disease. There is insufficient data in
the literature on the use of chondroitin sulfate-
based drugs for the treatment of dental diseases,
including periodontal disease. Anisimova has
developed a treatment regimen that includes
Calcemin (a calcium-based vitamin-mineral
complex) and Teraflex (glucosamine XS) for the
treatment of lower jaw fractures against the
background of periodontitis. The best indications
for the treatment of bone injuries and
stabilization of periodontal tissue were better in
the group of patients receiving these drugs than
in the group of patients treated according to the
general treatment regimen.
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C
ONCLUSIONS
In-depth analysis of new methods of organizing
the problems of development and course of
inflammatory-dystrophic
diseases
of
the
periodontium, pathogenetic mechanisms of their
development and the search for complex
therapeutic approaches in accordance with
complex medical and social realities is a
requirement of today.
The increase in morbidity against the background
of osteopenic conditions also requires the
development of an optimal strategy of complex
treatment, which includes the impact on the main
joints of the pathogenesis of general
periodontitis, osteopenia and osteoporosis. It
requires a more in-depth study of local and
general action drugs used in the treatment of
gingivitis and periodontitis, as well as
biocomposite osteoplastic materials based on
sulfated and non-sulfated glycosaminoglycans.
All of the above allows us to conclude that the
science of periodontology for many years has
come a long and effective path of highly
specialized analytical development, and has also
developed methods and tools, theoretical
concepts, technologies for the effective treatment
of gingivitis and periodontitis. Having reached a
new stage of development, periodontology
returns to a comprehensive theoretical and
practical approach to integrative medicine.
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Rizayev Jasur Alimdjanovich, Nazarova
Nodira Sharipovna. Assessment of
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Zhasur
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Rahimberdiev Rustam Abdunosirovich,
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53
FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
(ISSN
–
2752-6712)
VOLUME
02
I
SSUE
05
Pages:
41-54
SJIF
I
MPACT
FACTOR
(2021:
5.14
)
(2022:
5.605
)
OCLC
–
1272874727
METADATA
IF
–
6.986
Publisher:
Frontline Journals
and pharmaceutical research. Volume 2
Issue 12, 2020, Р 35-39.
4.
Nazarova
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Rakhmberdiev Rustam Abdunosirovich,
Bakirov
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Rustam
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Gulchekhra
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Medical Research. Journal of Biomimetics,
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Submitted: 2021-05, Vol. 53, pp 85-92
Accepted: 2021-05-11.
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Alisher Norbutaev, Nodira Nazarova.
Assessment of the results of the level of
oligopeptides of average molecular mass
in the oral fluid of employees in the
production of ammonium and nitrate
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Rizayev Jasur Alimjanovich, Nazarova
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Nasreddinova
Maxzuna Taxsinovna. (2021). Improving
The Treatment Of Paradontic Diseases
With The Help Of Immunomodulating And
Probiotic Drugs. The American Journal of
Medical Sciences and Pharmaceutical
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10.
Rizayev Jasur Alimdjanovich, Nazarova
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changes in the condition of periodontal
tissues in workers exposed to exposure to
epoxy resin. The American journal of
medical sciences and pharmaceutical
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Volume 02 Issue 05-2022
54
FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
(ISSN
–
2752-6712)
VOLUME
02
I
SSUE
05
Pages:
41-54
SJIF
I
MPACT
FACTOR
(2021:
5.14
)
(2022:
5.605
)
OCLC
–
1272874727
METADATA
IF
–
6.986
Publisher:
Frontline Journals
11.
Ризаев Ж.А., Назарова Н.Ш. Состояние
местного иммунитета полости рта при
хроническом
генерализованном
парадонтите.
Вестник
науки
и
образования 2020. № 14 (92).Часть 4. С
35-40.
12.
Alisher Norbutaev, Nodira Nazarova.
Ammiak va nitrat selitrasi ishlab
chiqarishda
ishlaydiganlar
og‘iz
suyuqligida o‘rta molekulyar og‘irlikdagi
oligopeptidlar darajasining natijalarini
baholash . Society and innovations. 25
October 2021, Р. 168-176.
