Justifications for differentiated approach in correction of some changes of the immunologic disorders in patients with rapidly progressing generalized parodontitis with different drug susceptibility of the parodontal bacteria

A.A Gudaryan,I.S Maschenko,S.V Shyrinkin,A.S Dorogina

doi:10.26641/2307-0404.2020.4.221409

Abstract

Rapidly progressing generalized periodontitis (RPGP) still remains an extremely important medical problem, despite certain achievements in solving most of the issues of etiology, pathogenesis and treatment. The study included 102 patients with rapidly progressing periodontitis of I-II and II-III degrees of severity, with ineffective and inconsistent results of previous treatment who were examined and treated in the clinic of the Department of Surgical Dentistry, Periodontics and Implantology of the SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine». On the basis of the diagnostic and therapeutic measures carried out, it was established that, in patients with rapidly progressing generalized periodontitis, the formation of various drug sensitivity in periodontopathogenic microorganisms to protocol antibacterial therapy is closely associated with immunological protocol diseases. The presence of drug-resistant bacteria in the periodontal tissues is combined with a more pronounced immunodeficiency in the mechanisms of systemic and local protection than when the lesions are colonized by drug-sensitive periodontal microorganisms. The revealed features of immunity disorders in patients with RPGP with drug-resistant infection to conventional antibiotic therapy are manifested by a decrease in CD3+ lymphocytes, cells with cytostatic activity (CD4+, CD16+) expressing receptors for the activation of lymphocytes CD25+, HLA-DR and apoptosis CD95+), against the background of a slight increase in CD20+, CD116+, CD54+, significant inhibition of the synthesis of SIgA, IgM, α-INF, γ-INF; a pronounced increase in the production of pro-inflammatory cytokines IL-1β and TNF-α. The need for a differentiated approach in the correction of immunological disorders in patients with RPGP depending on the detected sensitivity and resistance of periodontal pathogenic bacteria to the protocol generally accepted antibacterial therapy has been clearly proved; this provides a faster relief of the infectious and inflammatory process (on average on 3.6±0.2 day) in more than 90% of cases, normalization of the parameters of immunological reactivity in 93.3% of the observed and stable clinical remission of the disease.

Highlights

According to the results of research of sensibility of the periodontopathogenic flora of the alveolar tissues, conducted at the preliminary stage of observations, it was detected the suppression or absence at all of the drug susceptibility of bacteria, which are widely used in the protocol antibacterial therapy, in more than 70% of patients with rapidly progressive generalized parodontitis with unstable treatment findings
The integrated assessment of the state of immune mechanisms was conducted in patients of two groups, comparable by sexual and age-related principles and by the severity of manifestation of the inflammatory-destructive process in the parodontium, in addition to contamination in the alveolar tissues of drug-sensitive or drug-resistant precursors of disease to the protocol antibacterial therapy, which is a part of the integrated treatment
The first group consisted of the patients (42 persons) with previous treatment favorable results, whose periodontopathogenic bacteria remained highly sensitive to all antibacterial agents, which were used in the integrated protocol treatment of the generalized periodontitis

Summary

Introduction

Обгрунтування диференційованого підходу в корекції деяких змін імунологічних розладів у хворих на швидкопрогресуючий генералізований пародонтит з різною лікарською чутливістю пародонтальних бактерій. Наочно доведена необхідність диференційованого підходу в корекції імунологічних розладів у хворих на швидкопрогресуючий генералізований пародонтит залежно від виявлення чутливості і резистентності пародонтопатогенних бактерій до протокольної загальноприйнятої антибактеріальної терапії, що забезпечує більш швидке переривання інфекційно-запального процесу (в середньому на 3,6±0,2 дня) більше ніж у 90% випадків, нормалізацію параметрів імунологічної реактивності в 93,3% спостережуваних і стійку клінічну ремісію захворювання. The only way for the etiotropic treatment of the patients with the rapidly progressive generalized parodontitis with the proven efficiency is the application of antibiotics. The antibiotic therapy, according to the generally accepted protocol schemes, can be not very effective, what determines the further chronization of the inflammatory process in the parodontium and the acceleration of the destructive phenomena in the alveolar tissues, the occurrence of the frequent relapses of active inflammation and the formation of severe variants of generalized parodontitis [2, 7]

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Conclusion