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A
BSTRACT
During menopause, irreversible changes in the hormonal function of the ovaries occur, the concentration
of estrogens decreases.
It is during this period that a progressive increase in various diseases is noted [8]. The study of the dental
status in menopausal women has proven the existence of a relationship between a decrease in estrogen
concentration and a sharp increase in dental diseases [4]. Because the oral mucosa and salivary glands
contain estrogen receptors, changes in hormonal levels can be seen directly in the mouth. Leimola-Virtanen
et al confirmed the presence of estrogen mRNA and immunoreactive protein in the oral mucosa and
salivary glands, which also confirms its biological role [11].
Thus, the climacteric period is characterized by a disorder of metabolism and function in the tissues of the
oral cavity [6]. As a result, tooth loss, periodontal disease, increased bone resorption of the alveolar
processes are observed.
Journal
Website:
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s.org/journals/index.ph
p/fmspj
Copyright:
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attributes
4.0 licence.
Research Article
ASSESSMENT OF CLINICAL AND MORPHOLOGICAL CHANGES
IN THE ORAL ORGANS AND TISSUES IN POST-MENOPAUSE
WOMEN
Submission Date:
May
10, 2022,
Accepted Date:
May 20
, 2022,
Published Date:
May
30, 2022
Crossref doi:
https://doi.org/10.37547/medical-fmspj-02-05-08
Nazarova Nodira Sharipovna
Associate Professor, Department of Dentistry, Faculty of Postgraduate Education, Uzbekistan
Islomova Nilufar Bustanovna
Assistant of the Department of Orthopedic Dentistry, Samarkand State Medical University, Uzbekistan
Volume 02 Issue 05-2022
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K
EYWORDS
Menopause, generalized periodontitis, postmenopausal period, diseases of the oral mucosa.
I
NTRODUCTION
The purpose of the study
: to study the clinical
and
microbiological
manifestations
and
mechanisms of development of dental diseases in
postmenopausal women.
M
ATERIAL AND METHODS
We examined 40 postmenopausal women with
various diseases of the oral cavity. The control
group of patients were women who are not in the
postmenopausal period with dental diseases.
R
ESULTS AND DISCUSSIONS
All participants of the study underwent a
comprehensive examination: hygienic and
periodontal indices (OHI-S hygiene index, PI
periodontal index), pH of mixed saliva was
measured, sialometry was performed according
to the method of M.M. Pozharitskaya, studied the
microflora of the oral cavity by PCR (polymerase
chain reaction).
When collecting anamnesis, it was revealed that
most often women of group I complained of
bleeding gums (13.3%) and bad breath (6.7%).
Group II patients complained of bleeding gums
(66%), bad breath (43.9%), exposure of the roots
of the teeth (15.3%), tooth mobility (16.1%), and
40% of women had complaints of dry mouth.
While 26.7% of postmenopausal women taking
HRT complained of bleeding gums, 18.1%
complained of dry mouth and bad breath.
According to the results of the survey,
postmenopausal women taking HRT 2.3 times
less complained of bleeding gums (27.7%) and
dry mouth (17.1%) compared with women not
taking HRT (63%; 40% respectively). 18.1% of
women taking HRT noted bad breath, which is 2.5
times less than women not taking HRT (43.9%),
but 3 times more than in the control group (5.8%
). Postmenopausal women, regardless of whether
they take HRT or not, were 3 times more likely to
have a white coating on the tongue (18.1%,
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15.3%, respectively) than women in the control
group (6.7%). Burning sensation in the oral cavity
was noted by 5.7% of women in group II and 3.9%
in group III.
Attention was also paid to the TMJ, noting the
symmetry of the face and movements of the
mandible when opening the mouth, pain when
moving the mandible, and the range of vertical
and lateral movements of the mandible. In 22.6%
of group I 49, in 40% of group II and 45.7% of
group III women, a deviation was observed,
manifested by a displacement of the lower jaw to
the side at the beginning and a return to the
midline in the middle of opening the mouth by 2
mm. None of the subjects had limited range of
vertical and lateral movements. 2.9% - group I,
14.3% - group II and 11.5% - group III sometimes
noted clicks during the movement of the lower
jaw.
When examining the oral cavity, such non-carious
lesions of the teeth as erosion were noted, which
were detected in 2.8% of women in group II.
Wedge-shaped defects were noted in 17.1% of
group I, 54.3% of group II and 62.8% of group III
women. Pathological tooth wear was detected in
17.1% of group II and 14.2% of group III women,
but there were no significant differences between
the groups (p > 0.05).
The
clinical
examination
included
the
determination of the KPU index, the OHI-S
hygiene index, the periodontal index PI, the
measurement of the pH of the mixed saliva,
sialometry, and the assessment of the microflora
of the oral cavity by PCR (polymerase chain
reaction).
In the study of the intensity of tooth decay by
caries, it was found that in group I, the average
value of the KPU index = 13.58 ± 6.35 (moderate
level of caries intensity), in group II, KPU = 18.8 ±
6.17 (very high level of caries intensity) , and in
group III, the KPU index = 16.45±6.2 (high level of
caries intensity).
When examining the level of oral hygiene, it was
found that the OHI-S hygiene index, which takes
into account both the amount of plaque and
tartar, in group I was 1.83 ± 1.1, in group II - 2.89
± 0.89, in group III - 3.24±1.6. A statistically
significant difference was found between groups
I and II, groups II and III (p < 0.05), and between
groups I and III there were no significant
differences in relation to the values of group
parameters (p > 0.05).
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To determine the severity of periodontal disease,
the periodontal index PI was used, which showed
that its value in women who do not take HRT is
2.31±1.29, which corresponds to the average
degree of periodontal pathology and is 2 times
more than in women taking HRT and 5 times
more than in the control group. In women taking
HRT, the value of the periodontal index PI is
1.16±0.75, which corresponds to the initial and
mild degree of periodontal pathology, and in the
control group - 0.46±0.56.
An objective examination of patients showed
increased saliva viscosity, combined with
foaminess in 51.4% of women not taking HRT,
and in 25.7% of women taking HRT.
Sialometry according to the method of M.M.
Pozharitskaya allows you to determine the
amount of mixed unstimulated saliva. The
greatest hyposalivation in the oral cavity was
observed in women not taking HRT, and the
average for the group was 2.1 ± 0.28 ml at a rate
of 4.1 ml.
In the study of the pH of mixed saliva in women in
group I, the average value reached 7.04±0.35, in
group II, pH=6.48±0.33, and in group III, the
average pH=6.94±0.36.
Analysis of samples of the contents of periodontal
pockets showed that A. actinomycetemcomitans,
a gram-negative non-motile facultative anaerobic
coccobacillus, was found in 22.9% of women in
group I, 51.4% in group II and 37.1% in group III.
It was found that A. actinomycetemcomitans
occurs 1.4 times more often in women who do not
take HRT compared to women taking it and 2.2
times more often than in the control group. At the
same time, a significant difference (p < 0.05) is
observed only between groups I and II.
The frequency of occurrence of T. denticola,
which is able to organize associations with other
bacteria, especially with P. gingivalis and T.
forsythia, is 37.1% in group I, 54.3% in group II
and 51.4% in group III, but no significant
difference (p > 0.05) between groups was found.
T. forsythia, which most strongly promotes cell
apoptosis, was found in 51.4% in group I, in 80%
in group II, and in 45.7% in group III. A significant
difference was found between groups I and II, II
and III. Periodontopathogen P. gingivalis, as the
most aggressive bacterium, was found in 11.4% of
women in group I, 77.1% in group II and 28.6% in
group III, respectively. It was shown that P.
gingivalis occurs 6.7 times more often in group II
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than in group I and 2.7 times more often than in
group III.
P. intermedia was found in 11.3% of women in
group I, in 74.3% in group II and in 25.7% in
group III, respectively. P. intermedia is 6.6 times
more common in group II than in group I and 2.9
times more common than in group III. At the same
time, there is a significant difference between P.
gingivalis and P. intermedia (p < 0.05) between
groups I and II, II and III. There was no significant
difference between the qualitative composition of
the microflora of periodontal pockets in groups I
and III (control and the group of women taking
HRT) (p> 0.05).
Most often, in women not taking HRT, P.
gingivalis, P. intermedia, and T. forsythia were
detected, in contrast to women taking HRT. A.
actinomycetemcomitans and T. denticola as part
of the subgingival microflora were found
regardless of the use of HRT and were detected in
a smaller number of patients.
The study also revealed Epstein-Barr virus in
11.4% of women in group I, 20% in group II and
17.1% in group III. Herpes simplex virus was
found in 17.1% of the women of group I, 25.7% of
group II and 28.6% of group III. Candida albicans
was found in 5.7% of women of group I, 25.7% of
group II and 20% of group III, and a significant
difference was found between groups I and II, II
and III (p < 0.05).
In all patients of the control group, in whom a
periodontopathogen was detected, the amount
was relatively low and did not exceed 105
units/ml.
Spearman's rank correlation method was used to
identify the relationship between the degree of
clinical indicators and the composition of the
microflora of periodontal pockets.
The relationship between an increased number of
A. actinomycetemcomitans in the contents of the
periodontal pocket with a low level of oral
hygiene according to the OHI-S index
(r=0.503027) and with the severity of
periodontitis (r=0.505208) was revealed. A
negative correlation was observed with the pH of
the mixed saliva (r=-0.456773).
T. denticola
No correlation was found between the amount of
T. denticola in periodontal pockets and clinical
parameters.
P. gingivalis
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The content of P. gingivalis moderately correlated
with the level of oral hygiene (r=0.469771). A
negative relationship between the content of P.
gingivalis and the pH of mixed saliva (r=-
0.491576) was revealed.
T. forsythia
The amount of T. forsythia in the contents of
periodontal pockets moderately correlated with
the level of oral hygiene (r=0.376309), and to a
greater extent with the severity of periodontitis
(r=0.552702). A negative correlation was also
found with the pH of the mixed saliva.
P. intermedia
The level of P. intermedia depended on the
severity of periodontitis (r=0.416681).
According to the results of the study, a
statistically significant relationship was revealed
between oral hygiene and the severity of
periodontitis with the quantitative composition
of periodontopathogens of group II (p < 0.05).
Findings
. Thus, the greater sensitivity of the
above indices is associated with the peculiarities
of the pathogenesis of menopause, namely with
estrogen deficiency. The content of estrogen
receptors on the oral mucosa plays a direct role in
the development of dental diseases [9]. During
menopause, the angioprotective effect of
estrogens weakens, followed by damage to the
structures of the hemomicrocirculatory bed. Also
during this period, the production of osteoclasts
increases, the production of osteoblasts
decreases, the absorption of calcium in the
intestine decreases, the lack of vitamin D, which
leads to increased bone resorption.
Due to estrogen deficiency, there is a decrease in
intestinal absorption of calcium in the div,
which in turn leads to disturbances in the
regulation of calcium-phosphate metabolism and
increased calcium release not only into the blood
serum, but also into saliva [6]. Therefore, a high
concentration of calcium in the saliva of
menopausal women can lead to faster plaque
mineralization and, consequently, to an increase
in stone formation, which has a direct impact on
the progression of gingivitis and periodontitis
[9;1]. Thus, the pathogenesis of menopause
affects the state of all structures of the oral cavity.
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Publisher:
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