European International Journal of Multidisciplinary Research
and Management Studies
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TYPE
Original Research
PAGE NO.
8-12
DOI
OPEN ACCESS
SUBMITED
09 February 2025
ACCEPTED
12 March 2025
PUBLISHED
08 April 2025
VOLUME
Vol.05 Issue04 2025
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Pathogenetic Aspects of
Diseases of Hard Tissues,
Teeth, In Patients with
Thyroid Glands Disorder
Qosimova Dilafruz
Assistant Department of orthopedic dentistry, Samarkand State Medical
University, Samarkand, Uzbekistan
Abstract:
Thyroid diseases are increasing worldwide.
Thyroid pathology ranks second among all endocrine
diseases after diabetes mellitus. This is due to the the
influence of various exogenous factors: iodine
deficiency in the environment, the effects of various
stromogenic factors, the deterioration of the ecological
situation, and improved diagnostics of thyroid nodules.
Studying the impact of thyroid pathology on the
condition of periodontal tissues is also important
because one of its diseases - endemic goiter - is quite
widespread, especially in regions with a deficiency of a
number of natural focal factors - iodine and fluorine.
This is due to the influence of exogenous factors: iodine
deficiency in the environment, the action of various
stromogenic factors, the deterioration of the ecological
situation, and improved diagnostics of thyroid nodules.
Keywords:
Periodontium, periodontal diseases, dental
hard tissue diseases, somatic diseases, dental nail.
Introduction:
Numerous data have been accumulated
on the combination of generalized inflammatory lesions
of the periodontium with various internal organ
diseases. In their works, they confirm..."the effect of
iodine deficiency on periodontal tissue".
In our country, research is being conducted to prove the
relationship between dental hard tissue lesions and
periodontitis
with
hypothyroidism,
and
the
effectiveness of its prevention and treatment in such
patients is limited.
Thyroid dysfunction contributes to the development
and spread of caries, changes in the mineralization of
hard tissues, and periodontal pathology. It has been
noted that in women aged 18-50 years, an increase in
the diameter of enamel prisms in hypothyroidism is
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and Management Studies
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European International Journal of Multidisciplinary Research and Management Studies
observed in the enamel of intact teeth, as well as
thickening, loosening, disruption of enamel prism
shape, and dentin deformation with destruction of
tubules in caries foci, however, the nature of
morphological changes in diffuse endemic goiter
remains poorly understood [1].
Thyroid diseases are increasing worldwide. Thyroid
pathology ranks second among all endocrine diseases
after diabetes mellitus. This is due to the influence of
exogenous factors: iodine deficiency in the
environment, the action of various stromogenic
factors, the deterioration of the ecological situation,
and improved diagnostics of thyroid nodules [2].
Studying the impact of thyroid pathology on the
condition of periodontal tissues is also important
because one of its diseases - endemic goiter - is quite
widespread, especially in regions with a deficiency of a
number of natural focal factors - iodine and fluorine
[3].
In the world, based on data of interest in the
development and improvement of methods for early
diagnosis and prevention of inflammatory diseases of
the periodontal tissues in patients with thyroid
dysfunction, it is one of the urgent tasks requiring its
solution in the treatment, prevention, and prediction
of periodontal diseases, a number of scientific results
have been obtained: substantiation of pathology
occurring in a background regime, affecting general
dental diseases. It has been established that the
leading sign of sialadenosis in patients with
hyperthyroidism (86%) and hypothyroidism (72%) is an
objective decrease in the secretory activity of the
salivary glands [4,5].
In patients with thyroid dysfunction, data were
obtained on an increase in the prevalence of dental
caries in patients, allowing the dentist to formulate a
new approach to diagnosis, prevention, and treatment
[6,8].
The purpose of the study
: Based on clinical and
laboratory data, assess the structural changes in the
enamel and dentin affected by caries and increase the
effectiveness of treatment of chronic generalized
periodontitis in patients with diffuse (endemic) goiter
of mild and moderate severity.
Research objectives:
To study the condition of the hard tissues of the teeth
and periodontium in patients with diffuse endemic
goiter of mild and moderate severity;
to determine morphostructural changes in the
microelement composition in patients with diffuse
endemic goiter of mild and moderate severity using
the scanning microscopy method;
to analyze the biochemical indicators of bone
metabolism in oral fluid by determining the content of
total calcium, phosphorus, and alkaline phosphatase in
oral fluid in patients with diffuse endemic goiter of mild
and moderate severity;
to study the phagocytic, cellular, and humoral immune
status of patients with enamel and dentin
demineralization and generalized periodontitis against
the background of diffuse endemic goiter of mild and
moderate severity;
Improve measures for the prevention of caries and
treatment of patients with generalized periodontitis
against the background of diffuse endemic goiter of mild
and moderate severity.
The object of the investigation
: The object of the study
was 115 patients with caries and chronic generalized
periodontitis against the background of diffuse endemic
goiter aged 25-45 years. The control group consisted of
40 patients with caries and inflammatory diseases of the
periodontium, without somatic pathology and not
residing in the endemic zone.
Subject of research: oral fluid, periodontal tissues for
determining dental indicators.
METHODS
To achieve the goal and objectives, the following
methods were used: instrumental, clinical-functional,
laboratory, radiological, and statistical.
To fulfill the set goals and objectives of the study, a
clinical and instrumental study of the condition of
periodontal tissues was conducted in 75 patients aged
25-45 years with caries and chronic generalized
periodontitis against the background of diffuse endemic
goiter of I, II degree at the Samarkand Regional
Stomatology Polyclinic and the Samarkand Regional
Endocrinology Dispensary between 2020 and 2024. The
control group consisted of 40 patients with caries and
inflammatory diseases of the periodontium without
thyroid pathology. In the second stage, to assess the
effectiveness of the treatment and preventive measures
we proposed, patients with diffuse endemic goiter were
divided into 2 groups: the comparison group - 30
patients who received standard traditional treatment,
and the main group - 45 patients who, along with
standard treatment, received the complex treatment
we proposed.
RESULTS
The results of the work "Clinical Observations and
Analysis of Own Research" analyzed the simplified oral
hygiene index (OHI-S). In patients with endemic goiter,
an increase in this indicator was observed compared to
the control group (Table 1). A low hygiene index of
1.2±0.15 in the control group aged 25-35 indicates good
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European International Journal of Multidisciplinary Research and Management Studies
oral hygiene. This index was also higher in the 35-45
age group compared to the control group (1.8±0.20).
Table 1
Results of the Green-Vermilion oral hygiene index of the studied groups
Age
Control group
Main group
25-35
1,2±0,15
1,9±0,13*
35-45
1,8±0,20
2,6±0,31*
Average parameter
1,5±0,17
2,25±0,22*
Note. * - differences are significant compared to the control group; p<0.05
Loe, Silness index (table. 2) reflected the presence of
inflammatory phenomena manifested as gingivitis in
the 25-35 age group. Severe gingivitis prevailed in the
35-45 age group. The lowest index in the control group
was 2.22±0.11, which is 0.40 lower than in patients of
the main group. The degree of gingivitis was moderate
and severe in both groups. The gingival index was higher
in the main group than in the control group.
Table.2
Gingival GI (Loe, Silness)
Age
Control group
Main group
25-35
1,23±0,06
1,52±0,10*
35-45
2,22± 0,11
2,62±0,14*
Average parameter
1,73±0,06
2,07±0,11*
Note. * - differences are significant compared to the control group; p<0.05
During cytological examination in patients' cytograms,
the main
in the group, moderate cellularity of the cytograms
with a predominance of damaged tissue structures of
the periodontium was noted, the absence of
immunocompetent cells against a background of
moderate leukocyte infiltration, a moderate amount of
fungal mycelial threads were revealed, indicating a
decrease in protective processes in the periodontium
during the development of chronic inflammation. In
patients of the control group, immunocompetent cells
were found in moderate amounts in all preparations,
and fungal mycelium was detected in isolated cases.
Figure 1. Sitogram of the main group of patients with moderate periodontitis. A significant number
of total nuclear elements. Romanovsky-Giemsa coloring. Increase by 200.
In the study of the dynamics of blood serum cytokine
levels, significant differences were established after
treatment in the main group in the indicators of IL-1RA,
IL-
8, TNFα, and INFγ (Table 18). The concentration of
IL-1RA in the main group after treatment decreased
significantly by 51.8% (876.5±97.35) after 1 month,
and by 57.5% (774.1±85.42) after 6 months from the
baseline level (1743±162.1). The level of IL-8
significantly decreased in the main group after
treatment by 76.5% (18.22±3.11) after one month and
by 80.6% (14.88±4.17) after 6 months from the baseline
(78.5±03.03).
A
significant
decrease
in
the
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European International Journal of Multidisciplinary Research and Management Studies
concentration of TNFα was detected only after 6
months in patients of the main group by 14.8%
(2.13±0.07) of the baseline (2.48±0.06). The dynamics
of INFγ in the form of a significant 68% increase was
observed after 1 and 6 months only in patients of the
main group.
The concentration of immunoglobulins of all classes in
oral fluid varied significantly only in the main group.
The concentration of IgA in the oral fluid is indicated as
an indicator of a decrease in the inflammatory process,
most pronounced after 1 month of treatment by 80.3%
(0.102±0.02) of the initial level (0.52±0.02), which is
confirmed by the positive dynamics of clinical and
laboratory
indicators.
After
6
months,
the
concentration of IgG was 91.2% (0.08±0.02). In the
main group, the concentration of IgM in oral fluid
significantly decreased from 72.6% (0.005±0.002) after
1 month to 90.8% (0.003±0.002) after 6 months
(0.022±0.007), but in the control group, a tendency to
decrease was observed only after 6 months.
CONCLUSIONS
Chronic generalized periodontitis in patients with
diffuse endemic goiter is characterized by a prolonged
latent course with characteristic clinical manifestations
in the form of a combination of generalized gingival
recession, pronounced loss of clinical attachment, and
a potentially long-term course. In the presence of
endemic goiter, a significant increase in the frequency
of dental caries occurs. Analysis of dental CPI indicators
showed that in 100% of cases in the main group, there
were carious lesions of the hard tissues of the teeth. In
the control group, the CPI index was 9.4±1.7 and
significantly lower than in the group with diffuse
endemic goiter.
The cytological picture in periodontitis in patients with
diffuse endemic goiter is characterized by moderate
leukocyte
infiltration
and
the
absence
of
immunocompetent cells. The BMI indicators for
periodontitis in patients with hypothyroidism are 1.4
times (27.5%) higher, the BMI indicators are 1.3 times
(33.3%) higher than the corresponding indicators in
patients with chronic generalized periodontitis without
thyroid pathology (p<0.05). In the groups of patients
with moderate and severe endemic goiter, a decrease
in calcium content (0.26 mmol/l) and an increase in
magnesium (3.4 mmol/l) against a background of slight
changes in phosphorus levels (0.4 mmol/l) were found
in mixed saliva. A decrease in calcium concentration
undoubtedly affects the mineralizing ability of saliva,
which, against the background of an increase in its
acidity, will adversely affect the condition of the hard
tissues of the tooth. Chronic periodontitis against the
background
of
primary
hypothyroidism
is
characterized by disorders in immune homeostasis:
marked suppression of the factors protecting the
phagocytic link of the immune system in the form of a
significant decrease in the indicators of AP, NST-test,
and FI; insufficiency of the cellular link of immunity,
expressed in a decrease in the level of CR4-lymphocytes
and the immunoregulatory index; insufficiency of the
humoral link in the form of a decrease in the
concentration of IgM and IgA in blood serum, a decrease
in the concentration of IgM, an increase in IgA and IgG
in oral fluid. The cytokine status is characterized by an
increase in the concentration of IL-1PA in oral fluid, an
increase in the concentration of IL-8 in blood serum, and
a decrease in the level of IL-4.
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