Morpho-functional changes in periodont tissues in chronic generalized periodontitis associated with chronic viral hepatitis b and c

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Назарова N., & Шукуров S. (2022). Morpho-functional changes in periodont tissues in chronic generalized periodontitis associated with chronic viral hepatitis b and c. in Library, 22(1), 68–81. извлечено от https://inlibrary.uz/index.php/archive/article/view/8737
Нодира Назарова, Самаркандский государственный медицинский университет

доктор медицинских наук, доцент кафедры стоматологии факультета последипломного образования

Шерзод Шукуров, Самаркандский государственный медицинский университет

ассистент кафедры детской стоматологии

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Аннотация

Viral hepatitis (VH) with parenteral transmission of pathogens is one of the most serious and urgent problems of medical science and practical healthcare. . Currently, at least 9 types of human CV are known (A, B, C, D, E, G, F, TT), among which parenteral viral hepatitis deserves special attention, characterized by severe and chronic forms with an outcome in liver cirrhosis and hepatocellular carcinoma . More than 350 million people are currently carriers of this infection, and about 2 million people die every year from hepatitis-related diseases.

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A

BSTRACT

Viral hepatitis (VH) with parenteral transmission of pathogens is one of the most serious and urgent
problems of medical science and practical healthcare. . Currently, at least 9 types of human CV are known

(A, B, C, D, E, G, F, TT), among which parenteral viral hepatitis deserves special attention, characterized by

severe and chronic forms with an outcome in liver cirrhosis and hepatocellular carcinoma . More than 350

million people are currently carriers of this infection, and about 2 million people die every year from

hepatitis-related diseases.

K

EYWORDS

Chronic viral hepatitis B and C, periodontal disease, chronic generalized periodontitis, chronic gingivitis.

Journal

Website:

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s.org/journals/index.ph
p/fmspj

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.

Research Article

MORPHO-FUNCTIONAL CHANGES IN PERIODONT TISSUES IN
CHRONIC GENERALIZED PERIODONTITIS ASSOCIATED WITH
CHRONIC VIRAL HEPATITIS B AND C

Submission Date:

May

10, 2022,

Accepted Date:

May 20

, 2022,

Published Date:

May

30, 2022

Crossref doi:

https://doi.org/10.37547/medical-fmspj-02-05-09

Nazarova Nodira Sharipovna

Doctor of Medical Sciences, Associate Professor of the Department of Dentistry, Faculty of Postgraduate
education of the Samarkand State Medical University, Uzbekistan

Shukurov Sherzod Shukhratovich

Assistant of the Department of Pediatric Dentistry of Samarkand State Medical University, Uzbekistan


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I

NTRODUCTION

Chronic hepatitis is a systemic pathology in which

the oral cavity is affected with a high frequency

[8]. The spectrum of extrahepatic pathology in

chronic hepatitis includes damage to the salivary

glands and oral mucosa [4]. At the same time,

information about the frequency of development,

mechanisms of formation of inflammatory
periodontal diseases in chronic hepatitis of

various etiologies>: features of the course of

comorbidity, the effect of treatment are few and

contradictory [3,4] This determines the relevance

of studying the clinical features and diagnostic

criteria for periodontal diseases in patients with

chronic hepatitis B and C.

The development of inflammatory periodontal

diseases is closely related to disorders of the
immune defense of the oral cavity and the div as

a whole [8], therefore, the assessment of the state

of the immune system by analyzing the content of

cytokines becomes important both in studying

the mechanisms of formation and in developing

methods for treating gingivitis and periodontitis

against the background of chronic diseases.
hepatitis There is no information on the

diagnostic and prognostic value of indicators of

apoptosis and proliferation of gingival epithelial

cells and in chronic hepatitis of various etiologies

Obviously, approaches to the treatment of

inflammatory periodontal diseases against the

background of chronic hepatitis should be built

taking into account the universal pathogenetic

mechanisms of liver and periodontal damage. It

seems promising to study the effectiveness of the

use of ursodeoxycholic acid (UDCA) in the
complex treatment of inflammatory periodontal

diseases in patients with chronic hepatitis, which

has

numerous

effects,

among

which

cytoprotective,

antiapopgotic,

and

immunomodulatory effects have been proven

[1,3].

The purpose of this study

is to substantiate the

clinical and morphological state of periodontal

tissues in chronic hepatitis B and C.

M

ATERIAL AND RESEARCH METHODS

To study clinical and morphological changes in

periodontal tissues, an in-depth periodontal

examination of persons with periodontal diseases

against the background of chronic hepatitis B and


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C was carried out in the amount of 35 people - the

main group, as well as 20 patients who do not

have somatic pathology. They were taken as a

comparison group.

Diagnosis of periodontal diseases was carried out

in accordance with the terminology and

classification of periodontal diseases approved at

the XVI Plenum of the All-Union Society of
Dentists

(1983).

Patients

underwent

a

comprehensive

clinical

and

radiological

examination of periodontal tissues.

Changes in the color of the gingival mucosa, the

degree of gum bleeding [Muhlemann, 1971], the

depth of periodontal pockets (WHO, 1989), and

pathological tooth mobility were assessed

[Fleszar T J et al, 1980].

An index assessment of the state of periodontal

tissues was also carried out, using a simplified

Green-Vermilion hygiene index (1965), papillary-

marginal-alveolar index (PMA) [Parma G, 1960],
periodontal index (PI), [Rüssel A, 1967] . X-ray

examination of the dentoalveolar system

included intraoral contact images of individual

groups of teeth and orthopantomography.

Assessment of bone density of the skeleton

(densitometry) was performed by dichromatic X-

ray absorptiometry on a Prology densitometer

(USA).

R

ESULTS AND DISCUSSION

At the first stage of the study, we studied the

dental status of patients with chronic hepatitis of
viral and non-viral etiology. Extrahepatic

manifestations of chronic hepatitis were

diagnosed in 17% of patients, with significantly

more (p<0.05) in chronic HCV hepatitis (26.9%)

than in steatohepatitis (7.4%).

Dental extrahepatic manifestations of chronic

HCV infection are mainly represented by

xerostomia within the framework of Sjögren's

syndrome, which was diagnosed in 7.7% of
patients. There were complications of xerostomia

cheilitis (7.7%), glossitis (5.8%), stomatitis

(5.8%). Sjögren's syndrome was accompanied by

generalized severe periodontitis. Multiple dental

caries was noted in 78.8% of patients with

chronic HCV hepatitis and in 61.1% of patients

with chronic steatohepatitis.

The clinical and instrumental analysis of the state

of periodontal tissues made it possible to

establish that the clinical course and severity of
periodontal damage in chronic hepatitis are


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(2022:

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)

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associated with the etiology and degree of clinical

and laboratory activity of liver damage.

Inflammatory periodontal diseases are more

severe against the background of chronic active

hepatitis of viral or alcoholic etiology pronounced

cytolysis and are characterized by the
development in most patients of chronic

generalized periodontitis of moderate severity

(46.2-50%), less often generalized periodontitis

of mild (26.8-27.8%) or severe (13.5-16.5%)

degree and chronic generalized catarrhal

gingivitis (13.5-5.5%).

Chronic non-alcoholic steatohepatitis was

more often associated with mild chronic

periodontitis (52.8%), less often with generalized
moderate

periodontitis

(22.2%),

chronic

generalized catarrhal gingivitis (16.7%) or severe

periodontitis (8.3%) .

Perhaps the development of more severe forms of

periodontal disease against the background of

chronic hepatitis of viral and alcoholic etiology is

associated with the immunosuppressive effect

inherent in chronic HCV infection and ethyl

alcohol [6,7]. Damage to the periodontium in
conditions of impaired liver function due to the

toxic effects of ethanol is not excluded.

A relationship has been established between the

severity of inflammatory periodontal diseases

and the activity of hepatitis. With a high activity of

the pathological process in the liver, the signs of

periodontal damage are more pronounced than

with low activity [1].

Cholestatic syndrome is accompanied by more

pronounced changes in the periodontium and
bone destruction of the alveolar processes of the

gums. In cholestasis in patients with chronic

hepatitis and inflammatory periodontal diseases,

the level of systemic decrease in bone mineral

density of the axial skeleton and peripheral

skeleton

(osteoporosis

and

osteopenia)

correlates with the severity of the clinical
condition of the periodontium and the degree of

resorption of the alveolar processes (r = 0.683)

[4].

When studying the processes of cell renewal, it

was found that chronic periodontitis, in contrast

to gingivitis, is characterized by a predominant

increase in the proliferative activity of gingival

epithelial cells with a moderate increase in

apoptosis. In chronic gingivitis, there were no
significant changes in the proliferation and

apoptosis of gingival epitheliocytes [5].


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SJIF

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MPACT

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(2021:

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)

(2022:

5.605

)

OCLC

1272874727

METADATA

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Publisher:

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In chronic HCV-hepatitis, more pronounced

changes in the proliferation and apoptosis of

gingival epithelial cells (I Shch-b7 -38.0 ± 1.7%,

Iapopt - 0.72 + 0.06) are observed than in

steatohepatitis (I K1.67 - 31.5+1.5%, Iapopt -

0.71±0.05, p<0.05). Obviously, these changes are
determined by the nature of the inflammatory-

destructive changes in the periodontium, which is

more severe against the background of viral liver

damage.

At the second stage of our study, patients with

chronic generalized periodontitis against the

background of chronic hepatitis were divided into

two groups, equal in age, the activity of the

pathological process in the liver and gums.

Changes in the proliferative activity and apoptotic

death of gingival epitheliocytes in inflammatory
periodontal diseases are based on a violation of

local regulatory mechanisms, primarily cytokine

homeostasis.

The study of the content of cytokines in the oral

fluid showed that in chronic gingivitis there is an

increase in the content in the oral fluid of both

pro-inflammatory (IL-f, INFU) and anti-

inflammatory mediators (RAIL, IL-10), which

reflects the maintenance of a balance between

populations of immunocompetent cells mediating

cellular and humoral immune response, and

indicates the simultaneous triggering of the

inflammatory process and repair mechanisms [6].

Chronic periodontitis is characterized by a local

cytokine imbalance with a predominance of a

mediator with immunosuppressive properties

(IL-10) and a high concentration of IL-1 r. It
should be emphasized that in periodontitis, the

increase in the concentration of IL-ip exceeded

the increase in the level of RAIL, which is

undoubtedly important in the progression of

periodontal disease.

The increase in the content of the studied

cytokines in the oral fluid correlated with the

severity of periodontitis (gyl-ip ~ 0.633, rhyl =

0.518, hil_yu = 0.582), the depth of periodontal
pockets (hyl-ip - 0.558), the PMA index (hyl-1p =

0.620), the PI index (hil-ip =0.593) and the degree

of gum bleeding (hil.10=0.604).

This indicates that the change in the

concentration of IL-lp, RAIL and IL-10 in the oral

fluid can be considered as a criterion for the

severity of chronic periodontitis.

Therefore, a significant factor in the

morphogenesis of chronic periodontitis is a


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SSUE

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SJIF

I

MPACT

FACTOR

(2021:

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(2022:

5.605

)

OCLC

1272874727

METADATA

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Publisher:

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violation of the processes of proliferation and

apoptosis of epitheliocytes of the gingival mucosa.

Against the background of perverted local

cytokine regulation, the processes of cellular

renewal of the gingival epithelium shift towards

proliferation, a chronic recurrent inflammatory-
destructive process is formed in the

periodontium.

When assessing the clinical picture on the basis of

index indicators in the dynamics of the disease, it

was found that on the 15-16th day from the start

of therapy in the 1st group, almost all parameters

reflecting the severity of periodontal pathology

were significantly better than in the group with

traditional methods of therapy.

There were no side effects when using cycloferon

liniment in patients of the 1st group, the drug was

well tolerated.

Clinical examination of patients for 6 months

made it possible to state that exacerbation of
periodontitis was observed in the 1st group in

12% of cases, in the 2nd - in 48%.When studying

the processes of cell renewal, it was found that

chronic periodontitis, in contrast to gingivitis, is

characterized by a predominant increase in the

proliferative activity of gingival epithelial cells

with a moderate increase in apoptosis. In chronic

gingivitis, there were no significant changes in the

proliferation

and

apoptosis

of

gingival

epitheliocytes [5].

In chronic HCV hepatitis, there are more

pronounced changes in the proliferation and

apoptosis of gingival epithelial cells (I Shch-b7 -

38.0 ± 1.7%, Iapopt - 0.72 + 0.06) than in
steatohepatitis (I K1. 67 - 31.5+1.5%, Iapopt -

0.71±0.05, p<0.05). Obviously, these changes are

determined by the nature of the inflammatory-

destructive changes in the periodontium, which is

more severe against the background of viral liver

damage.

At the second stage of our study, patients with

chronic generalized periodontitis against the

background of chronic hepatitis were divided into
two groups, equal in age, activity of the

pathological process in the liver and gums.

Changes in the proliferative activity and apoptotic
death of gingival epitheliocytes in inflammatory

periodontal diseases are based on a violation of

local regulatory mechanisms, primarily cytokine

homeostasis.

The study of the content of cytokines in the oral

fluid showed that in chronic gingivitis there is an


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Volume 02 Issue 05-2022

74



FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
(ISSN

2752-6712)

VOLUME

02

I

SSUE

05

Pages:

68-76

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

increase in the content in the oral fluid of both

pro-inflammatory (IL-f, INFU) and anti-

inflammatory mediators (RAIL, IL-10), which

reflects the maintenance of a balance between

populations of immunocompetent cells mediating

cellular and humoral immune response, and
indicates the simultaneous triggering of the

inflammatory process and repair mechanisms [6].

Chronic periodontitis is characterized by a local

cytokine imbalance with a predominance of a

mediator with immunosuppressive properties

(IL-10) and a high concentration of IL-1 r. It

should be emphasized that in periodontitis, the

increase in the concentration of IL-ip exceeded

the increase in the level of RAIL, which is
undoubtedly important in the progression of

periodontal disease.

The increase in the content of the studied

cytokines in the oral fluid correlated with the

severity of periodontitis (gyl-ip ~ 0.633, rhyl =

0.518, hil_yu = 0.582), the depth of periodontal

pockets (hyl-ip - 0.558), the PMA index (hyl-1p =

0.620), the PI index (hil-ip =0.593) and the degree

of gum bleeding (hil.10=0.604).

This indicates that the change in the

concentration of IL-lp, RAIL and IL-10 in the oral

fluid can be considered as a criterion for the

severity of chronic periodontitis.

Therefore, a significant factor in the

morphogenesis of chronic periodontitis is a

violation of the processes of proliferation and

apoptosis of epitheliocytes of the gingival mucosa.

Against the background of perverted local

cytokine regulation, the processes of cellular
renewal of the gingival epithelium shift towards

proliferation, a chronic recurrent inflammatory-

destructive process is formed in the

periodontium.

C

ONCLUSIONS

When assessing the clinical picture on the basis of
index indicators in the dynamics of the disease, it

was found that on the 15-16th day from the start

of therapy in the 1st group, almost all parameters

reflecting the severity of periodontal pathology

were significantly better than in the group with

traditional methods of therapy.

There were no side effects when using cycloferon

liniment in patients of the 1st group, the drug was

well tolerated.

Clinical examination of patients for 6 months

made it possible to state that exacerbation of


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FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
(ISSN

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VOLUME

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I

SSUE

05

Pages:

68-76

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

periodontitis was observed in the 1st group in

12% of cases, in the 2nd - in 48%.

R

EFERENCES

1.

Аlisher

Berdikulovich

Norbutaev,

Mukhiddin Kamariddinovich Shamsiev,
Nodira Sharipovna Nazarova. Clinical and

functional changes in hard tissues of teeth

in рatients with hemophilia. The American

journal of

medical sciences and

pharmaceutical research Volume 2 Issue

12, 2020, Р 29-34

2.

Rizayev Jasur Alimdjanovich, Nazarova
Nodira Sharipovna. Assessment of

changes in the condition of periodontal

tissues in workers exposed to exposure to

epoxy resin. The American journal of

medical sciences and pharmaceutical

research №2 Р 14-17. 2020.

3.

Zhasur

Alimdzhanovich

Rizaev,

Rahimberdiev Rustam Abdunosirovich,

Nazarova Nodira Sharipovna. Ways to

improve the organization of dental

services for chemical industry workers.

The American journal of medical sciences

and pharmaceutical research. Volume 2

Issue 12, 2020, Р 35-39.

4.

Nazarova

Nodira

Sharipovna,

Rakhmberdiev Rustam Abdunosirovich,

Bakirov

Asadullo

Abdikodirovich,

Sultonov Odiljon Raimovich. The intensity

of dental caries in workers is harmful

industry. The American journal of medical
sciences

and

pharmaceutical

research.Volume 03 Issue 07-2021, P-68-

72

5.

Rustam

Rakhmberdiev,

Gulchekhra

Musaeva, Nodira Nazarova. Ways to

improve the organization of dental care for

workers in the chemical industry. Society
and innovations. Volume 01 Issue 1-2021,

P 139-144.

6.

Nazarova N.SH, Musayeva G.A, Ravshanov

I.R. Evaluation of Effectiveness of

Combined Oral and Dental Therapy in

Tobacco Growers. Journal of Research in

Medical and Dental Science 2021, Volume
9, Issue 8, Page No: 241-246.

7.

Rustem Hayaliev, Sabir Nurkhodjaev,

Nodira Nazarova, Jasur Rizayev, Rustam

Rahimberdiyev, Tatyana Timokhina, Ivan

Petrov. Interdisciplinary Approach of

Biomedical

Engineering

in

the

Development of Technical Devices for
Medical Research. Journal of Biomimetics,


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76



FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
(ISSN

2752-6712)

VOLUME

02

I

SSUE

05

Pages:

68-76

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

Biomaterials and Biomedical Engineering

Submitted: 2021-05, Vol. 53, pp 85-92

Accepted: 2021-05-11.

8.

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

saltpeter. Frontline medical sciences and

pharmaceutical journal 1(8): 2021, 24-34.

9.

Rizayev Jasur Alimjanovich, Nazarova

Nodira

Sharipovna,

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

Research, 3(08), 44–50.

10.

Ризаев Ж.А., Назарова Н.Ш., Бердиев.

Т.А. Шиша толали тузилмаларни ишлаб
чикариишда NBF гингивал гелининг

самарадорлиги.

Жамият

ва

инновациялар. 2020, октябрь С 678-

682.

11.

Н.Ш. Назарова, Т.А. Бердиев. Эпоксид

смолалар

таъсирига

учраган

ишчиларда пародонтал тукималар
холатининг

узгаришини

бахолаш.

Жамият ва инновациялар. 2020,

октябрь. С 565-569.

12.

Ризаев Ж.А., Назарова Н.Ш.,. Бердиев.

Т.А. Шиша толали тузилмаларни ишлаб

чикариишда NBF гингивал гелининг

самарадорлиги.

Жамият

ва

инновациялар. 2020, октябрь. С 565-

569.

13.

Ризаев

Ж.А.,

Назарова

Н.Ш..

Эффективность савокупного лечения

болезней парадонта и слизистой

оболочки работающих с вредными

производственныыми

факторами.

Проблемы биологии и медицины. 2020.

№3 (119) . С 85-88.

Библиографические ссылки

Alisher Berdikulovich Norbutaev, Mukhiddin Kamariddinovich Shamsiev, Nodira Sharipovna Nazarova. Clinical and functional changes in hard tissues of teeth in patients with hemophilia. The American journal of medical sciences and pharmaceutical research Volume 2 Issue 12, 2020, P 29-34

Rizayev Jasur Alimdjanovich, Nazarova Nodira Sharipovna. Assessment of changes in the condition of periodontal tissues in workers exposed to exposure to epoxy resin. The American journal of medical sciences and pharmaceutical research №2 P 14-17. 2020.

Zhasur Alimdzhanovich Rizaev, Rahimberdiev Rustam Abdunosirovich, Nazarova Nodira Sharipovna. Ways to improve the organization of dental services for chemical industry workers. The American journal of medical sciences and pharmaceutical research. Volume 2 Issue 12, 2020, P 35-39.

Nazarova Nodira Sharipovna, Rakhmberdiev Rustam Abdunosirovich, Bakirov Asadullo Abdikodirovich, Sultonov Odiljon Raimovich. The intensity of dental caries in workers is harmful industry. The American journal of medical sciences and pharmaceutical research.Volume 03 Issue 07-2021, P-68-72

Rustam Rakhmberdiev, Gulchekhra Musaeva, Nodira Nazarova. Ways to improve the organization of dental care for workers in the chemical industry. Society and innovations. Volume 01 Issue 1-2021, P 139-144.

Nazarova N.SH, Musayeva G.A, Ravshanov I.R. Evaluation of Effectiveness of Combined Oral and Dental Therapy in Tobacco Growers. Journal of Research in Medical and Dental Science 2021, Volume 9, Issue 8, Page No: 241-246.

Rustem Hayaliev, Sabir Nurkhodjaev, Nodira Nazarova, Jasur Rizayev, Rustam Rahimberdiyev, Tatyana Timokhina, Ivan Petrov. Interdisciplinary Approach of Biomedical Engineering in the Development of Technical Devices for Medical Research. Journal of Biomimetics, Biomaterials and Biomedical Engineering Submitted: 2021-05, Vol. 53, pp 85-92 Accepted: 2021-05-11.

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 saltpeter. Frontline medical sciences and pharmaceutical journal 1(8): 2021, 24-34.

Rizayev Jasur Alimjanovich, Nazarova Nodira Sharipovna, 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 Research, 3(08), 44-50.

Ризаев Ж.А., Назарова Н.Ш., Бердиев. Т.А. Шиша толали тузилмаларни ишлаб чикариишда NBF гингивал гелининг самарадорлиги. Жамият ва инновациялар. 2020, октябрь С 678-682.

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