Course Of Gingivitis Research Articles

The information value of crevicular fluid immunoregulatory mediator quantitative assessment in predicting the nature of the inflammatory periodontal disease course

Relevance. Clinical and radiological assessment mainly forms the diagnosis of periodontal diseases. The diagnosis now requires speed, sensitivity and specificity since determining the patient's disease stage is fundamental to effective treatment. Crevicular fluid biomarkers can help monitor the current state of the disease, the effectiveness of treatment, and possibly predict the pathological process progression. The combination of various biomarkers will allow maximum objectivity in periodontal tissue condition assessment.Materials and methods. The study examined 72 patients with inflammatory periodontal diseases and 25 periodontally healthy subjects. We performed a conventional clinical-instrumental examination and studied pro- and anti-inflammatory interleukins (IL-1β, IL-6, IL-17, TNF-α, VEGF, IL-8, MCP-1, IL-1RA) in the crevicular fluid. The obtained materials were processed using ROC analysis.Results. Inflammatory periodontal diseases demonstrate an increase in pro-inflammatory cytokines / chemokines (IL-1β, TNF-α, IL-6, IL-17, IL-8, MCP-1) and vascular endothelial growth factor (VEGF) in the crevicular fluid, a decrease in the anti-inflammatory cytokine, IL-1RA. The levels of pro- and anti-inflammatory cytokines, cytokines/ chemokines, VEGF are associated with the periodontal destruction severity caused by inflammation. The accumulation of VEGF, IL-6, and IL-1β in the crevicular fluid predicts the clinical course of gingivitis, VEGF, TNF-α, IL-6, IL-1β – mild and moderate periodontitis.Conclusion. The present study allows us to confirm the diagnostic value of methods for obtaining and quantifying a group of immunoregulatory cytokines in the crevicular fluid as predictors and parameters of the disease progression and the development of osteodestructive changes in the periodontium.

EFFECTIVENESS OF MATRIX METALLOPROTEINASES INHIBITORS FOR PREVENTIVE TREATMENT OF GENERALIZED PERIODONTITIS

Generalized periodontitis is one of the most widespread human stomatological diseases; it is diagnosed in 11.0 % of the world's population. Despite the recognition of the microbial factor as leading in its etiopathogenesis, antimicrobial treatment of gingivitis, added with removal of dental plaque, does not prevent the further development of periodontitis. Dysbacteriosis causes inflammation which leads to an increase of proteolysis products. They are a nutrient medium for periodontal pathogenic microflora, they contribute to its growth. So, the use of anti-inflammatory drugs, such as matrix metalloproteinase inhibitors, is promising for preventive treatment of generalized periodontitis.
 The aim of the work is to conduct a clinical trial of complex treatment which includes matrix
 metalloproteinase inhibitors in patients with diffuse gingivitis and generalized periodontitis of chronic course.
 Materials and methods of the research. 60 patients with chronic course of diffuse gingivitis and generalized periodontitis of initial, I and II stages, were treated. The effectiveness of the treatment was evaluated in the early and distant term (after 1 year) according to data of the clinical and radiological examination, computer tomography, biochemical examination of oral fluid for matrix metalloproteinases-8 and -9 (MMP-8, -9) and immunohistochemical study of gingival biopsies for cytoplasmic expression of matrix metalloproteinase-1 (MMP-1).
 Results of the research. According to the data of the clinical examination, complete elimination of inflammatory symptoms in periodontal tissues was achieved in 93.3% of patients in the comparison group in 12-14 days and in 96.7% in the base group in 10-12 days. In patients in whom the developed therapeutic scheme was used, the best dynamics of the index assessment of the state of hygiene, gingiva and periodontal complex was established. The main difference between the research groups was the preservation of obtained results in 1 year after treatment in patients of the base group (p ˂ 0.05). In particular, a year later, the results of bone mineral density measurement for patients of the base group did not change from baseline, while in the comparison group there was their significant decrease (p ˂ 0.05), indicating the progression of inflammatory-destructive process in periodontal tissues.
 After treatment, a significant reduction in the level of MMP-8 and MMP-9 in the oral fluid of patients of both groups was achieved (p ˂ 0.05). In patients of the base group, in contrast to the comparison, these results were the same in the distant term (p ˂ 0.05). When assessing the cytoplasmic expression of MMP-1 in epithelial and stromal cells after treatment, zero result was in 96.7% of patients in the base group and in 80.0% – in the comparison group, and after 1 year – in 90.0% vs 63.3% respectively.
 It should be noted that the differences between the base and comparison groups were most observed for patients with gingivitis and generalized periodontitis of initial stage without destructive processes in periodontal tissues. It suggests the greatest effectiveness of the proposed treatment in the early stages of pathological process.
 Thus, based on the fact that the activity of matrix metalloproteinases characterizes the course of the inflammatory process in periodontal tissues, a decrease in their level according to biochemical and immunohistochemical studies in the base group against the comparison indicates a better anti-inflammatory effect of the developed treatment to prevent the progression of generalized periodontitis.
 Conclusion. The obtained results allow recommending the use of matrix metalloproteinase inhibitors as a preventive pathogenetic treatment for the patients with chronical course of gingivitis and generalized periodontitis of the initial stage, to inhibit the inflammatory component of the pathological process.
 Prospects for further research. It should be studied the indication for repeated courses of matrix metalloproteinase inhibitors in patients with periodontal disease.

The use of an adhesive balm with magnetic polymers, hexethydine, cytylpyridinium chloride and hyaluronic acid in the treatment of inflammatory periodontal diseases

The article presents the results of a study of an adhesive balm with magnetic polymers, hexethidine, cytylpyridinium chloride and hyaluronic acid in the treatment of inflammatory periodontal diseases. Revealed and scientifically proven its effectiveness in acute and subacute periods of the course of gingivitis and periodontitis. The study involved 40 patients aged 20 to 60 years, in whom the anti-inflammatory and hemostatic effect of the adhesive balm on the inflamed periodontal soft tissues was studied. During the monitoring of index indicators, it was revealed that the PMA index decreased from 50,72 to 16,31 by the end of the study. After 14 days, the hemostatic efficiency was 56,25%. Local allergic reactions and irritation were not observed during the study. It has been proven that an adhesive paste with magnetic polymers, hexethydine, cytylpyridinium chloride and hyaluronic acid has a bactericidal effect on the microflora of the oral cavity.

ЗНАЧЕНИЕ ЦИТОКИНОВ РОТОВОЙ ЖИДКОСТИ И ПАРОДОНТОПАТОГЕННОЙ МИКРОБИОТЫ В РАЗВИТИИ ГИНГИВИТА НА ФОНЕ ПСИХОЭМОЦИОНАЛЬНОГО СТРЕССА У КУРСАНТОВ ВЕДОМСТВЕННОГО ИНСТИТУТА

Subject. Such a cytokine as transforming factor β (TFRß) deserves special attention in stress-induced gingivitis, since there are observations indicating its ability to stimulate the differentiation of myofibroblasts, which results in an increase in collagen production, the development of fibrous changes in the gum, which ultimately lead to tooth loss.
 Goal. The aim is to determine the relationship between the development of signs of depression, the frequency of detection of periodontal pathogenic bacteria and the spectrum of cytokines that play a likely role in the pathogenesis of gingivitis in cadets of the departmental institute under conditions of psychoemotional stress.
 Methodology. Psychological testing, clinical dental and laboratory examinations of 71 cadets of the departmental institute (41 women, 30 men) aged from 18 to 23 years were conducted. The detection of depression was carried out using the A. Beck scale, reactive and personal anxiety — Ch. Spielberger — Y.L. Khanin. To assess the periodontal condition, traditional hygienic and periodontal indices (OHI-s, RNR, PMA) were used. Identification of the marker DNA of periodontal pathogenic bacteria was carried out using a polymerase chain reaction using a test kit "Multident-5" manufactured by NPF GenLab (Russia). The content of cytokines in saliva was determined by solid-phase enzyme immunoassay. For the detection of IL-1β, IL-4, IL-10, IL-12, IFNu, TNFa, sets of NPO "Vector Best" (Russia) were used, for the cytokine TFRß — from Biosource (Canada).
 Results. It was found that the development of depression and gingivitis is accompanied by changes in the cytokine status, the main pathogenetic significance is IL-1β and TFRß, and the auxiliary is IL-12 and TNFa. At the same time, the cytokines IL-1β and TNFa are associated with the severity of the course of gingivitis. 
 Conclusions. A correlation was established for the cytokines IL-1β, TNFa and TFRß with the first-order periodontopathogenic species A actinomycetemcomitans and T. forsythia.

СТОМАТОЛОГИЧЕСКИЙ СТАТУС ЖЕНЩИН С БЕРЕМЕННОСТЬЮ, ОСЛОЖНЕННОЙ ГЕСТОЗОМ

Subject of our research is dental examination and identification of the features of the dental status in women with pregnancy complicated by gestosis. There is no doubt that pregnancy is a critical period for woman’s dental health. Objectives. Determine the dental status in women with pregnancy complicated by gestosis. Methods. As part of the study of the dental status of women with pregnancy complicated by gestosis, we conducted a clinical examination of the oral cavity in 127 women. The depth of the vestibule, the level of attachment of the bridles, the state of the bite, the indices of the KPU, IK, PMA, IZN were determined. Results. Our data indicate that the complication of the course of the third trimester of pregnancy with gestosis in women is accompanied by a deterioration in periodontal status, oral hygiene, and a 100% prevalence of gingivitis. Conclusions. The results of the study made it possible to obtain clinical and dental data characterizing the effect of pregnancy complicated by preeclampsia in women in the third trimester on the course of gingivitis, which is the basis for the development of methods for optimizing and increasing the effectiveness of therapeutic and prophylactic measures in this group of patients.

Emotional stress effects on immunity, gingivitis and periodontitis.

Gingivitis and periodontitis are thought to result from an imbalance between those oral microorganisms which normally colonize tooth surfaces in close contact with the gingival margin, and the nature and efficiency of the host response. The bacteria are the triggering agents, but host defence mechanisms within the gingival/periodontal tissues seem to be responsible for most of the tissue damage and for the outcome and progression of the diseases. It has recently been shown that emotional or psychological load (stress) may influence immune activities directly via nerve messenger substances (neurotransmitters and neuropeptides) and/or indirectly via neuroendocrine (hormone) substances. This review discusses how emotional stressors and nervous and neuroendocrine responses to psychological stressors may modulate the immune response to bacteria, and thus be expected to influence the progression and course of gingivitis and periodontitis.

Microbial etiology of periodontal disease.

Abstract Longitudinal studies with humans indicate that gingivitis is associated with an increased dental plaque mass. Also, prior to the onset of gingivitis, changes in the microflora towards a more complex bacterial composition frequently occur. On the other hand, recent cross sectional cultural studies generally do not reveal clear‐cut differences between the composition of the subgingival microflora associated with healthy or inflamed gingivae. Also, some studies have demonstrated an enhanced cell‐mediated immune response during the course of gingivitis to a variety of subgingival plaque bacteria. It has also been observed that plaques allowed to form on cleaned teeth for 2 or 3 days do not differ substantially in their microbial composition. However, long‐term thorough oral hygiene performed at intervals of 48 h permits maintenance of gingival health, whereas that instituted at intervals of 72 h will lead eventually to gingivitis. Collectively, this evidence supports the concept that the etiology of gingivitis is bacteriologically nonspecific. Thus a large increase in the accumulation of bacteria on the tooth surface per se may have a greater pathogenic effect on the periodontal tissues than the relatively minor and inconsistent shifts in the microbial composition.The transition from gingivitis into periodontitis may be induced by changes in the pathogenic potential of subgingival plaque. Gram‐negative rods appear to be specifically associated with periodontitis. A growing body of evidence implicates especially Bacteriodes asaccharolyticus as one of the responsible pathogens.Juvenile periodontitis (periodontosis) seems to be a distinct disease entity. Recent findings suggest abnormalities in peripheral blood polymorphonuclear leucocytes (PMNL) of patients with juvenile periodontitis. The subgingival microflora is different from that associated with periodontitis and the findings so far implicate Actinobacillus actinomycetemcomitans as an important pathogen.The bacterial etiology of acute necrotizing ulcerative gingivitis (ANUG) is still unclear. Satisfactory cultural studies have yet to be performed. The presence of spirochetes in the ulcerative lesions of the junctional epithelium does not necessarily imply that they play an important role in this disease entity.Future research on the bacteriology of periodontal disease should concentrate on longitudinal studies; particular attention should be paid to the change of gingivitis into periodontitis whereby animals as well as humans can be used. Improvements of sampling methods as well as precise and simple identification techniques of microorganisms are required.