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International scientific-online conference
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PATHOGENETIC SUBSTANTIATION AND OPTIMIZATION OF
TREATMENT OF INFLAMMATORY PERIODONTAL DISEASES IN
PATIENTS WITH GASTROINTESTINAL TRACT PATHOLOGY
Saidova Mukhlisa Akhrorovna
Tashkent State Dental Institute, PhD, Doctoral candidate in the Department of
Hospital Therapeutic Dentistry
Mukhlisa_saidova95@mail.ru, +998914438293
https://orcid.org/0000-0003-1803-6194
https://doi.org/10.5281/zenodo.14942408
Abstract:
The article analyzes the pathogenetic mechanisms linking
inflammatory periodontal diseases and gastrointestinal tract disorders. The
influence of microbiome imbalance, cytokine dysregulation, and systemic
inflammation on periodontal tissues is discussed. Particular attention is given to
the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in this patient
category. The rationale for using local NSAID formulations (gels, applications,
mouth rinses) as a promising approach to reducing inflammation and
minimizing gastrointestinal side effects is provided. The prospects of
combination therapy involving gastroprotectors, probiotics, and herbal
components are highlighted.
Keywords:
inflammatory periodontal diseases, gastrointestinal tract,
nonsteroidal anti-inflammatory drugs, local application, NSAIDs, gastropathy,
combination therapy.
Introduction
Inflammatory periodontal diseases (gingivitis, periodontitis) occupy a
leading position among dental pathologies detected in the population of
different age groups. These conditions are complex polyethological processes
based on a violation of the balance of the oral microbiota and immune-
inflammatory reactions of the div. Periodontal damage is accompanied by
destruction of connective tissue structures, resorption of the alveolar bone and
weakening of the ligamentous apparatus of the teeth, which can lead to their
mobility and subsequent loss.
Inflammatory periodontal diseases acquire special clinical significance in
patients with concomitant pathology of the gastrointestinal tract (GIT), which is
observed in 60-70% of the adult population Borovsky E.V. (2020)[1].
Gastrointestinal diseases (gastritis, peptic ulcer, gastroesophageal reflux disease,
intestinal dysbiosis, irritable bowel syndrome) have a pronounced effect on the
condition of the oral cavity, contributing to the chronization of inflammatory
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processes in periodontal tissues, changes in salivation, impaired acid-base
balance and microbial biocenosis [2,3].
In patients with gastrointestinal diseases, especially with impaired gastric
acid and dysbiosis, there is a decrease in the buffer capacity of saliva, a decrease
in its bactericidal activity, which creates favorable conditions for the
reproduction of pathogenic microflora. The most important role is played by
dysbiotic disruption of the composition of bacterial communities, both in the
gastrointestinal tract and in the oral cavity, which leads to active colonization of
periodontal pockets by bacteria of the "red complex" (Porphyromonas
gingivalis, Tannerella forsythia, Treponema denticola), producing proteolytic
enzymes, toxins and lipopolysaccharides. This, in turn, initiates the production
of pro-inflammatory cytokines such as interleukin-1b (IL-1b), interleukin-6 (IL-
6), tumor necrosis factor alpha (TNF-α), activates osteoclastic bone resorption
and supports chronic inflammation in periodontal [4, 5].
Given the pronounced effect of gastrointestinal diseases on the course of
inflammatory periodontal diseases, the development of integrated approaches
to the treatment of this group of patients is of particular importance.
Optimization of the therapeutic strategy requires not only suppression of local
inflammatory processes in periodontitis, but also simultaneous correction of
gastrointestinal pathologies [6].
The use of anti-inflammatory drugs, in particular, nonsteroidal anti-
inflammatory drugs (NSAIDs), which have analgesic, decongestant effects and
the ability to modulate cytokine activity, is considered as one of the promising
areas. However, the appointment of NSAIDs in patients with concomitant
gastrointestinal pathology is associated with the risk of developing
gastropathies and other complications, which requires careful selection of drugs,
their dosage, duration of use, as well as the use of drugs with gastroprotective
properties.
This review is devoted to the analysis of current data on pathogenetic
links between inflammatory periodontal diseases and diseases of the
gastrointestinal tract, as well as optimization of approaches to the treatment of
this category of patients. Special attention is paid to the use of anti-inflammatory
drugs, including NSAIDs, as a component of complex therapy aimed at reducing
the activity of inflammatory processes, protecting periodontal tissues and
preventing complications from the hard structures of teeth.
THE USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN
INFLAMMATORY
PERIODONTAL
DISEASES
IN
PATIENTS
WITH
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GASTROINTESTINAL TRACT PATHOLOGY: THEIR EFFECTIVENESS,
DOSAGES AND THERAPEUTIC EFFECTS
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the
treatment of inflammatory periodontal diseases is actively being investigated in
dentistry, however, the safety and effectiveness of this group of drugs in patients
with gastrointestinal (GI) pathology require special attention. This category of
patients has an increased risk of developing gastropathies, erosive and
ulcerative lesions of the gastric and intestinal mucosa against the background of
systemic NSAID use. Nevertheless, clinical studies demonstrate that the proper
use of NSAIDs in small doses or in combination with gastroprotectors can have a
pronounced anti-inflammatory effect, contributing to the stabilization of
periodontal disease.
Discussion
The use of NSAIDs in patients with inflammatory periodontal diseases and
concomitant gastrointestinal pathology has significant therapeutic potential.
However, the appointment of this group of drugs requires a special approach:
• The use of gastroprotectors in the systemic use of NSAIDs.
• Preference for selective COX-2 inhibitors (celecoxib) in patients with
peptic ulcer disease.
• Expanding the practice of topical NSAID use (gels, applications) as a safe
and effective alternative to systemic therapy.
The inclusion of NSAIDs in the complex therapy of inflammatory
periodontal diseases in patients with gastrointestinal pathology contributes not
only to reducing inflammatory processes, but also to improving the quality of life
of patients, minimizing the risk of complications from the gastrointestinal tract.
ANALYSIS OF DATA FROM CLINICAL STUDIES ON THE USE OF NSAIDS
IN THE TREATMENT OF INFLAMMATORY PERIODONTAL DISEASES IN
PATIENTS WITH GASTROINTESTINAL TRACT PATHOLOGY
To date, the role of nonsteroidal anti-inflammatory drugs (NSAIDs) as
modulators of inflammatory reactions in patients with inflammatory
periodontal diseases is increasingly being discussed in the literature. However,
the use of this group of drugs in people with concomitant diseases of the
gastrointestinal tract (GIT), including chronic gastritis, peptic ulcer,
gastroesophageal reflux disease (GERD) and intestinal dysbiosis, is particularly
difficult.
A key limitation of the widespread use of NSAIDs in patients with
gastrointestinal diseases is the risk of developing gastropathies, erosive and
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ulcerative lesions, and gastrointestinal bleeding, which is especially important
for elderly patients and people with a long history of gastroenterological
diseases.
Despite this, clinical research data indicate that with proper selection of
dosages, forms of administration and concomitant gastroprotection, the use of
NSAIDs can be an effective component of complex therapy of inflammatory
periodontal diseases, improving the clinical and biochemical parameters of
periodontal tissue.
Modern research highlights the importance of topical use of nonsteroidal
anti-inflammatory drugs (NSAIDs) in the treatment of inflammatory periodontal
diseases, especially in patients with concomitant diseases of the gastrointestinal
tract (GIT). Since the systemic use of NSAIDs is associated with the risk of
erosive and ulcerative lesions of the gastric and duodenal mucosa, the use of
topical forms of drugs allows to achieve a therapeutic effect, minimizing
undesirable side effects.
Topical use of NSAIDs in patients with inflammatory periodontal diseases
and concomitant gastrointestinal pathologies is a promising area of complex
therapy. It allows achieving significant improvements in clinical parameters,
such as reducing the depth of periodontal pockets, reducing the bleeding index,
restoring clinical attachment, while reducing the risk of developing
gastropathies and other systemic complications. Further study of combined
regimens, including local forms of NSAIDs, antiseptics and herbal components, is
important for the development of personalized approaches to the treatment of
patients with combined pathology of the oral cavity and digestive organs.
Prospects for further research:
1. Development of personalized treatment regimens. A promising
direction is to create differentiated schemes for the use of NSAIDs in patients
with inflammatory periodontal diseases, taking into account individual
characteristics, including the nature of gastroenterological pathology, age, and
severity of periodontitis. Special attention should be paid to the selection of
drugs, taking into account their selectivity for COX-1 and COX-2, as well as a
combination of systemic and local forms.
2. Long-term monitoring of the condition of periodontal and
gastrointestinal tissues. Long-term (from 6 months or more) prospective studies
will allow an objective assessment of the effect of NSAIDs on the stability of
remission of inflammatory periodontal diseases, the dynamics of bone
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resorption and regeneration, as well as the incidence of gastropathies and
exacerbations of gastrointestinal diseases.
3. Study of the potential of local forms of selective COX-2 inhibitors. The
creation and clinical testing of topical gels, films, and mouthwashes based on
celecoxib and meloxicam may become a safe alternative to systemic therapy,
especially in patients with peptic ulcer, gastritis, or GERD. Assessment of
bioavailability, the depth of penetration of active substances into periodontal
tissues and the duration of their action will optimize treatment regimens.
4. Combination of NSAIDs with gastroprotectors and probiotics
Conducting randomized controlled trials to study the effectiveness of the
combined use of NSAIDs and proton pump inhibitors (omeprazole,
pantoprazole), as well as drugs that normalize the intestinal microbiota
(probiotics), will help reduce the risk of systemic complications and improve
treatment outcomes.
5. The role of natural ingredients in adjuvant therapy. Further study of the
potential of plant extracts (ginger, linseed oil, curcumin) with anti-inflammatory,
antioxidant, and membrane-stabilizing properties remains relevant. Their
inclusion in topical preparations or use in combination with low-dose NSAIDs
may enhance the therapeutic effect and reduce adverse reactions.
6. Focus on restoring the microbiome of the oral cavity and intestines.
Recent studies have revealed a close relationship between dysbiotic changes in
the microbiota of the gastrointestinal tract and the composition of the microbial
communities of periodontal pockets. A promising direction is to evaluate the
effect of local forms of NSAIDs on the microbiocenosis of the oral cavity, as well
as the possibility of a synergistic effect when combined with probiotics and
antiseptics.
Conclusion
.
The analysis of modern data indicates the existence of a complex
pathogenetic relationship between inflammatory periodontal diseases and
pathology of the gastrointestinal tract (GIT). Violations of the biocenosis of the
oral cavity, dysbiotic changes in the intestinal microflora, systemic
inflammation, acidic conditions of the stomach and impaired barrier function of
the mucous membranes create conditions for the chronization of the
inflammatory process in periodontal tissues and the acceleration of destructive
changes in bone tissue.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the
treatment of inflammatory periodontal diseases demonstrates high clinical
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efficacy, expressed in reducing bleeding, reducing the depth of periodontal
pockets, improving clinical attachment and stabilizing destructive processes in
the alveolar bone. However, the systemic use of NSAIDs in patients with chronic
gastrointestinal diseases (gastritis, peptic ulcer, gastroesophageal reflux disease,
intestinal dysbiosis) is associated with the risk of gastropathies, erosive lesions
of the mucous membrane and bleeding, which limits the long-term use of this
group of drugs.
In this regard, the development and implementation of local forms of NSAIDs
(gels, applications, therapeutic films, rinsing solutions) is of particular
importance, which make it possible to act directly on the inflammatory focus,
achieving a high concentration of active substances in periodontal tissues, with
minimal systemic effects and reducing the risk of side effects from the
gastrointestinal tract.
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URL:
https://cyberleninka.ru/article/n/mestnoe-primenenie-nesteroidnyh-
protivovospalitelnyh-sredstv-v-kompleksnom-lechenii-erozivno-yazvennyh-
porazheniy-slizistoy
