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PUBLISHED DATE: - 15-07-2024
https://doi.org/10.37547/TAJMSPR/Volume06Issue07-03
PAGE NO.: - 12-18
DIAGNOSTIC AND PROGNOSTIC
SIGNIFICANCE OF GINGIVAL FLUID
CYTOKINES IN THE DEVELOPMENT OF
INFLAMMATORY PERIODONTAL DISEASES
Adilov K.Z.
Researcher, Tashkent State Dental Institute, Uzbekistan
Rizaev J.A.
Researcher, Tashkent State Dental Institute, Uzbekistan
Adilova Sh.T.
Researcher, Tashkent State Dental Institute, Uzbekistan
INTRODUCTION
According to WHO, inflammatory periodontal
diseases (IPD) are one of the most common dental
diseases in the world after dental caries. The
highest incidence rate occurs at the age of 15
–
19
years (55
–
89%), as well as 35
–
44 years (65
–
98%).
According to the data [32,41], the adult population
level in various cities of the Republic of Uzbekistan
in the age group of 15-18 years is 69 - 80 %, and in
the age group 35-44 years 92 - 99%.
The main reason for the development of IPD
is the association of opportunistic microorganisms
of dental plaque and their metabolic products,
which can have a direct or indirect effect on
periodontal tissue [2,21,36,38].
The microbiota of the gingival sulcus is
represented by more than 500 strains of bacteria.
RESEARCH ARTICLE
Open Access
Abstract
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However, out of the entire variety of
microorganisms, only 3 to 20 of them are
periodontopathogenic. The most common are
actinobacilus
actinomycetemcomitans
,
porphyromonas gingivalis , bacteroides forcythus ,
spirochetes , prevotella intermedia , eikenella
corrodens , veilonella recta , treponeva denticola ,
capnocytophaga in various associations and others
[11,21,47,50]. Depending on the form of
inflammation in periodontal tissues, the species
composition of the microbiota also changes. Thus,
with catarrhal gingivitis, the predominantly coccal
flora predominates (s. salivarius (66.7%), s.
epidermidis (61.9%), s. Heamoliticus (57.7%),
peptostreptococcs (52.3%)), with mild chronic
periodontitis - bacillary morphological variant
[17,37,44].
Depending on the duration of exposure, dental
plaque
microorganisms,
having
antigenic
properties, can cause both inflammation in
periodontal
tissues
and
a
chain
of
immunopathological
reactions.
Lipopolysaccharides of gram-negative bacteria and
mucosaccharides of gram-positive bacteria have
the greatest antigenic activity [4,16,21].
The Main Findings and Results
An important role, in addition to microbial invasion
in the development of inflammatory periodontal
diseases, is played by both general somatic
pathology (diseases of the gastrointestinal tract,
cardiovascular system, endocrine system, etc.), and
local periodontopathogenic factors, such as (the
composition of saliva, dental deposits, the presence
of orthopedic and orthodontic structures,
pathology
of
the
dental
system,
etc.
[4,7,10,18,21,34].
It is known that general and local factors that can
reduce the div’s immune defense play a
significant role in the development of
inflammatory periodontal diseases. Violations of
the barrier properties of the epithelium can
facilitate the penetration of microorganisms into
tissues and stimulate the development of the
inflammatory process. Immunocompetent cells,
such as leukocytes, macrophages and lymphocytes,
are activated and produce various enzymes and
inflammatory mediators, which leads to damage to
periodontal tissues [22,48].
In chronic catarrhal gingivitis and other forms of
periodontitis, the div's immune response can be
mediated by the activation of various types of
lymphocytes, including T-lymphocytes to the
immune response [16,21,40]. With prolonged
exposure to pathogens on periodontal tissue and
an increase in the inflammatory process,
immunopathological reactions may occur with the
participation of autoimmune mechanisms of
periodontal damage. With prolonged exposure of
the pathogen to periodontal tissue and progression
of the severity of the process, a transition occurs
from the inflammatory nature of periodontal tissue
damage to immunopathological reactions with an
autoimmune mechanism of periodontal damage
associated with the activation of T2 helper cells
[3,25].
Overall, understanding the interactions of
microorganisms, the immune system, and other
factors in the development of periodontal disease
helps to better understand disease mechanisms
and develop effective treatment and prevention
strategies.
In the initial stage of inflammation, the number of
macrophages that trigger the immune response
increases, the chemotaxis of immune cells and the
phagocytic activity of neutrophils are activated.
However, as the process becomes more chronic,
the picture changes. In patients with chronic forms
of inflammatory periodontal diseases, there is a
decrease in the phagocytic activity of immune cells.
In chronic catarrhal gingivitis in the acute stage, the
number of functional phagocytes, their phagocytic
activity and bactericidal function decreases [10]. In
patients with chronic generalized periodontitis, a
profound depression of these indicators is
observed [1].
Some studies indicate increased chemotactic
activity of neutrophils in moderate to severe
periodontitis. Changes in the cytological picture in
inflammatory periodontal diseases are also noted,
such as a decrease in segmented neutrophils and
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changes in phagocytic activity depending on the
severity of the disease [8].
Indeed, changes in the immune system during
inflammatory periodontal diseases can be quite
diverse. An increase in the number of lymphocytes
in the inflammation site in mild and moderate
forms of chronic catarrhal gingivitis and
generalized periodontitis has been noted in several
studies [3,5,27].
Regarding humoral immunity, there is evidence
indicating a decrease in the content of total T-
lymphocytes and the Th / Ts indicator , which
indicates the development of an immunodeficiency
state. With gingivitis and periodontitis, a decrease
in the number of B-lymphocytes is also observed
[2,35].
Regarding immunoglobulins, different studies
provide conflicting results. Some indicate an
increase in the concentration of IgA, IgM and a
decrease in IgG in the initial forms of the disease,
and then a change in the ratio as the condition
worsens. Other studies indicate a significant
increase in the levels of all immunoglobulins,
except IgE , in gingivitis, but a decrease in the
concentrations of IgA, IgM , IgG in chronic
periodontitis [35].
One of the central links in the pathogenesis of
inflammatory periodontal diseases are cytokines,
which explains cytokine IPD development concept.
Cytokines play an important role in the
pathogenesis
of
inflammatory
periodontal
diseases. They are endogenous regulators that
coordinate the interaction of various components
of the immune system and other div systems. The
production of cytokines can be aimed at both
immune defense and tissue destruction at the site
of inflammation [23, 28].
Studies show that the content of cytokines in oral
and gingival fluids does not always correlate with
their levels in the blood, which indicates the
activation of local immunity [39]. Increased levels
of pro-inflammatory cytokines (for example, IL-
1β,
IL-6, IL-8, IL-17, IL-18, IF-
γ, TNFα) and a decrease
in anti-inflammatory cytokines (for example, IL-4
and IL-10) were detected in chronic catarrhal
gingivitis
and
generalized
periodontitis
[15,29,30,45].
IL-
1β plays an important role in the development
of the primary immune response to the
introduction of pathogenic periodontal microbiota.
Its functions include the initiation and regulation of
inflammatory processes, activation of various cells
of the immune system and stimulation of the
synthesis of other cytokines. The level of IL-
1β in
the gingival fluid correlates with the depth of the
periodontal pocket and contributes to the
generalization of the inflammatory process [5, 7].
Molecular genetic predisposition may also
influence the course and severity of inflammatory
periodontal diseases. Studies of IL-
1β gene
polymorphism show differences in the distribution
of alleles in patients with different forms of
periodontitis. For example, some studies indicate
more pronounced polymorphism of the IL-
1β gene
in patients with severe forms of periodontitis
[5,7,12,18,20].
Tumor necrosis factor-
α (TNFα) plays a significant
role in the development of inflammatory
periodontal diseases. This cytokine, produced by
macrophages and monocytes, performs a number
of important functions, including enhancing the
proliferation of lymphocytes, increasing the
synthesis of acute phase proteins, increasing the
permeability of the vascular endothelium,
activating free radical oxidation and suppressing
delayed-type hypersensitivity. It has been
established that the concentration of TNF-
α
increases in the gingival fluid even before the first
clinical manifestations of periodontal diseases
[19,49].
The level of TNFα in the gingival
fluid increases
even before the first clinical signs of periodontal
disease appear. This cytokine has a cytotoxic effect
and, together with other cytokines such as IL-
1β
and IL-6, activates the production of the enzyme
collagenase and other factors that contribute to the
destruction of collagen in periodontal tissues . It
also activates osteoclasts and blocks osteoblasts,
thereby promoting the formation of periodontal
pockets [4, 46].
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Increased concentrations of IL-6 also play an
important role in the development of inflammatory
processes in the periodontium. It is involved in
lymphocyte differentiation, receptor expression,
and the production of other cytokines such as IL-2.
IL-6 is also responsible for the production of IL-2
by T lymphocytes, which regulates the immune
response [10,33].
CONCLUSION
With different degrees of severity of inflammatory
periodontal diseases, the concentrations of anti-
inflammatory cytokines, such as IL-4 and IL-10,
change. These cytokines promote the humoral
immune response and can block proinflammatory
cytokines such as IL-
1β and TNFα [9,14,24,31,42].
The information provided concerns changes in the
immune system during inflammatory periodontal
diseases. It is important to note that the diversity
and inconsistency of data on immune reactivity are
associated with different methods for assessing
immune activity, the presence of systemic
pathologies and types of inflammatory reactions
[6,13].
The study of the immunological and molecular
genetic mechanisms of the development of
inflammatory periodontal diseases associated with
the influence of cytokines plays an important role
in the understanding and treatment of these
diseases. The concept of cytokine origin of
inflammatory periodontal diseases (IPD) allows for
a more in-depth study of the processes occurring in
periodontal tissues. Analysis of the cytokine profile
of oral and gingival fluids can indeed help in
assessing the activity and severity of the disease,
which in turn helps in choosing the optimal
treatment strategy for each individual patient.
Personalized therapy based on cytokine profiles
can improve treatment outcomes and disease
prognosis [27].
Thus, the available scientific data on the cytokine
profile of inflammatory periodontal diseases make
it possible to develop individualized approaches to
treatment, determine the effectiveness of the
treatment and improve the prognosis of the
disease. This opens up new prospects for the
development of more accurate and effective
methods for diagnosing and treating periodontal
diseases.
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