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THE ROLE OF GENERAL SOMATIC PATHOLOGY IN THE
DEVELOPMENT OF PERIODONTAL DISEASES
Tillyakhodjaev S.M.
Tashkent State Dental Institute, Uzbekistan
Periodontal pathology is one of the most common problems in modern
dentistry, which is a serious medical and social problem all over the world. At the
same time, the diagnosis and treatment of this disease is one of the most difficult
problems of dentistry, since for many years the questions of etiology, pathogenesis
and even the name of the disease remain controversial, which has given rise to many
classifications. It is known that any chronic disease is the final stage of a long
pathophysiological process that occurred in the div under the influence of adverse
factors that have a direct or indirect impact on the development of the disease.
Periodontal pathology is one of the most complex and common problems in
modern dentistry, so the relevance of its solution is not in doubt. According to the
World health organization (WHO), periodontal diseases occur in different regions:
from 55.0 to 99.0% in the age group from 15 to 20 years, and in the group from 35
to 44 years, this figure varies from 65.0 to 98.0 %.
According to WHO, the factors that cause human diseases consist of
hereditary (they account for 20 %), environmental conditions (they make up 25%)
and lifestyle (55%).
Numerous scientific studies suggest that in the etiology of periodontal
diseases, in addition to the general immune status, the presence of general somatic
diseases, genetic predisposition, and others, one of the main reasons is an
unsatisfactory state of oral hygiene. Fedorov Yu.A. and Koren V.N. note that with
regular oral care, periodontal diseases are observed much less frequently (30.4%),
while with non - systematic care they occur in 37.5%, and in the absence of it - in
48.5% of cases. This directly affects the local immune status of the oral cavity, since
all forms of inflammatory periodontal diseases occur against the background of
progressive pathological changes in it.
At the same time, not one but several microorganisms play a role in the
formation and progression of periodontitis, which secrete several complexes -
associations of microbes associated with periodontal diseases:
1.
Porphyromonas gingivalis, Bacteroidies forsihus, Treponeme! denticola;
2.
Streptococcus sanguinis, Streptococcus mitis, Streptococcus oralis
etc.;
3.
Actinomyces odontolyticus, Actinomyces naeslundii, Veillonellaparvulla;
4.
Prevotella intermedia, Fusobacterium nucleatum, Campilobacter rectus
Numerous studies of domestic and foreign scientists have proved that there is
a certain relationship between inflammatory periodontal diseases and any general
somatic pathology. Examples of such diseases are pathologies of the cardiovascular
system, diabetes mellitus, atherosclerosis, diseases of the gastrointestinal tract,
respiratory tract, central nervous system, immunodeficiency, etc.
Thus, in the General structure of concomitant internal pathology in
generalized periodontitis, diseases of the cardiovascular system (CCC) occupy up to
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68%, depending on the type of pathology: hypertension-26%, ischemic heart disease
(IHD) - 10.5%, neurocirculatory disorders - 68 %. It is also worth noting that with
the progression of chronic periodontitis, the index of peripheral vascular resistance
of the periodontal complex increases, while additional deterioration of blood flow is
reliably established in patients with various forms of IHD, including in combination
with type 2 diabetes.
The relationship between the oral cavity and the gastrointestinal tract is a
predisposing factor to the development of periodontal diseases. It was found that in
patients with gastroesophageal disease, chronic pancreatitis, gastric ulcer and
duodenal ulcer, the prevalence of periodontitis is one and a half times more common
than in healthy individuals. In addition, modern researchers have proved that after a
course of treatment of dysbiosis in patients with generalized periodontitis of stage I
and II, there is a positive dynamics of local immunological indicators, which is
another confirmation of the close relationship between diseases of the oral cavity
and the gastrointestinal tract.
Pathogenetic generality is also observed in diseases of the ENT organs and
the oral cavity. A significant effect is a decrease in the protective properties of the
oral mucosa in patients with bronchial asthma. Relieving asthma attacks requires the
administration of medications, in particular inhaled glucocorticoids.
It is proved that these drugs cause a decrease in the local immunity of the oral
cavity, which creates favorable conditions for the reproduction of the oral microflora
and other pathogenic factors.
Patients who are being treated for chronic kidney disease due to intensive anti-
inflammatory therapy have mild inflammation in the periodontal area. There are
some changes in metabolism in the periodontium. In more severe clinical cases,
patients experience marginal periodontal recession and hyperesthesia of the hard
tissues of the teeth, even with a mild degree of periodontitis. In children, nephrogenic
osteodystrophy is manifested by changes in bone and cartilage tissue that resemble
rickets in clinical signs, so this pathology is called "renal rickets". In adults,
osteomalacia develops, in the mechanism of development of which the main role
belongs to the violation of vitamin d metabolism.
There is also such a thing as" hepatic rickets", or" hepatic osteomalacia",
which occurs in chronic hepatitis and cirrhosis. This pathology occurs when the liver
is affected in childhood. The disease is accompanied by stunting, stunting, and even
dwarfism. In the mechanism of osteoporosis in liver lesions, vitamin D is also
important, namely its endogenous insufficiency. Atrophy of the alveolar bone
increases in patients with chronic liver damage
Pathology of the pituitary-adrenal system is also one of the etiological factors
in the development of periodontal diseases. It is known that the use of
glucocorticoids leads to partial resorption of the bone tissue of the alveolar bone.
Cortisol reduces the activity of osteoblasts of the alveolar bone, causes the
destruction of collagen fibers, and accelerates osteoclastic resorption of bone tissue.
Increased atrophy of the alveolar bone under the influence of glucocorticoids
is explained by their catabolic effect. Inhibition of bone structure, increased
production of glucocorticoids may be due to a hyperplastic process in the adrenal
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glands or increased production of adrenocorticotropic hormone in the anterior
pituitary (Cushing's disease).
A similar effect occurs as a result of a primary or secondary increase in the
activity of the parathyroid glands that produce parathyroid hormone. This pathology
often develops with hypoestrogenemia as a result of early extinction or shutdown of
the function of the sexual glands in women. In this endocrinopathy, changes in the
periodontium reflect primarily osteoporosis in the skeleton.
The importance of the nervous system in the dynamics of inflammation is not
in doubt. Under the action of any pathogenic factor, the nervous system and its
trophic function are activated first or secondarily. It was found that with short-term
negative emotions in the periodontal tissues, there is a long-term increase in vascular
tone. In the blood, the content of glucocorticoids increases, which have a catabolic
effect, which leads to a slowdown in the recovery processes in cells. In tissues, lipid
peroxidation is activated, which increases the content of free radicals, which have a
toxic effect on cells. Chronic emotional stress also has a negative effect on
periodontal tissues. At the same time, there is a violation of metabolism in the
periodontium, primarily of lipids, and the formation of lipid peroxides increases.
They have a pathogenetic effect on periodontal tissues and accelerate involution.
As you know, acquired immunodeficiency syndrome affects many organs and
systems, and, of course, this disease has manifestations in the oral cavity. Periodontal
lesions are typical in HIV-infected individuals. Usually, periodontal lesions develop
at low values of the CD4/CD8 ratio, their severity depends on the degree of reduction
in the number of CD4 cells to a greater extent than on the degree of development of
dental plaques or the presence of certain microorganisms.
Many authors note that the starting link in the development of periodontal
diseases is microcirculation disorders. The microcirculatory system reacts to the
appearance of various pathogenic factors long before the appearance of clinical
symptoms of inflammation, as it is a very sensitive system. The development of
chronic microcirculatory changes in the periodontium is associated with a violation
of the leukocyte-platelet-endothelial balance. In pathology, when blood cells pass
through the microcirculatory channel, their aggregation and adhesion to the vascular
endothelium is observed, which may lead to blockage of the capillary network with
the development of hypoxia of periodontal tissues. It is worth noting that the
pathogenetic factor is not morphological, but functional changes in the periodontal
vessels that lead to hypoxia. Under these conditions, there is a significant reduction
in the delivery of oxygen to the periodontal tissues to such a level that it will not be
enough to maintain the function, metabolism, and structure of the cell.
One of the main tasks facing the doctor is to organize hygienic measures for
each patient, which provide methods for monitoring the hygienic state of the oral
cavity. This is the basis of sanitary and educational work. Another important aspect
of the periodontist's work is a comprehensive approach to treatment and
understanding of the need for a more extensive examination of organs and div
systems of patients with periodontal diseases.
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References.
1. Gafforov, Sunnatullo A., et al."Clinical characteristics and diagnosis of
chronic generalized periodontitis in patients with connective tissue dysplasia."
Russian Journal of Dentistry 26.3 (2022): 219-228.
2. Усманова, Шайра Равшанбековна, and Абдугаффур Ахатович
Хаджиметов. "Патогенетические особенности течения генерализованного
пародонтита у пациентов с хроническим
нарушением мозгового
кровообращения." Казанский медицинский журнал 97.5 (2016): 720-723.
THE USE OF A DRUG BASED ON HYALURONIC ACID IN THE
COMPLEX TREATMENT OF PERIODONTAL DISEASES
Batirov B. А., Shokirova F.F., Sofieva N.B., Murodov X.U.
Tashkent State Dental Institute, Uzbekistan
Introduction.
The use of a drug based on hyaluronic acid in the complex
treatment of periodontal diseases. Inflammatory and destructive periodontal diseases
occupy a leading place in the structure of dental morbidity (Grudyanov A. I.,
Fomenko E. V., 2010). According to the world health organization, functional
disorders of the dental system caused by the loss of teeth from periodontal diseases
develop almost 5 times more often than with complicated caries [1].
The high prevalence and intensity of periodontal diseases, premature loss of
teeth, decreased performance, violation of the psycho-emotional sphere, along with
the appearance of foci of conditioned diseases in the div and, not always, the high
effectiveness of treatment with a variety of medications, encourage further search
for the most effective medications in the complex therapy of this pathology [2]. The
leading direction in the development of methods for the treatment of inflammatory
and destructive periodontal diseases is local anti-inflammatory, antimicrobial
therapy with the creation of conditions for the restoration of destroyed periodontal
structures. Among the local medications
actions give preference to those that can be kept in the pocket for a long time,
having a therapeutic effect. In this regard, preparations based on hyaluronic acid
with the inclusion of antibacterial agents are of interest [3].
Purpose.
The aim of the work was to conduct a clinical and laboratory study
of the effectiveness of the drug based on hyaluronic acid in the complex treatment
of periodontitis.
Materials and methods.
We examined and treated 39 patients (20 men and
19 women aged 25 to 55 years) with chronic generalized periodontitis of mild and
moderate severity, whose complex therapy included a drug based on hyaluronic acid
(the main group). The control group was a group of patients of the same age with a
similar diagnosis who received traditional treatment (control group) [4]. The results
of treatment were evaluated according to the data of clinical research methods in
dynamics: examination, determination of the depth of periodontal pockets, the
Fedorov-Volodkina hygiene index (IG), the PMA index, the Shiller-Pisarev test, the
