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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
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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
Volume 02 Issue 05-2022
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Pages:
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(2021:
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(2022:
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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
Volume 02 Issue 05-2022
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VOLUME
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Pages:
68-76
SJIF
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MPACT
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(2021:
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)
(2022:
5.605
)
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–
1272874727
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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].
Volume 02 Issue 05-2022
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FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
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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:
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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
Volume 02 Issue 05-2022
73
FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
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VOLUME
02
I
SSUE
05
Pages:
68-76
SJIF
I
MPACT
FACTOR
(2021:
5.14
)
(2022:
5.605
)
OCLC
–
1272874727
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IF
–
6.986
Publisher:
Frontline Journals
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
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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SSUE
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Pages:
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SJIF
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MPACT
FACTOR
(2021:
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)
(2022:
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)
OCLC
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periodontitis was observed in the 1st group in
12% of cases, in the 2nd - in 48%.
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