Inflammatory Processes In Periodontal Tissues Research Articles

ПРИМЕНЕНИЕ ИНГИБИТОРОВ МЕТАЛЛОПРОТЕИНАЗ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЙ ПАРОДОНТА

Periodontitis is the most common inflammatory disease that leads to the destruction of the supporting tissues of the tooth. Therapeutic treatments aimed at reducing the effects of matrix metalloproteinases (MMPs) may be an effective adjunct to the treatment of periodontitis. The review examines the role of proteolytic enzyme inhibitors in the treatment of inflammatory periodontal diseases. General information about the ability of tetracyclines to inhibit MMPs is discussed. The purpose of the study was to examine the use of MMP inhibitors as a treatment for periodontal disease. Material and research methods. A scientific review of studies was carried out in Russian and English using information portals and platforms eLIBRARY.ru, Web of Science, PubMed and Scopus. The search was carried out using the following keywords: matrix metalloproteinases; oral diseases; tissue inhibitors of metalloproteinases. Of the 55 initially identified articles, after the initial analysis, 19 publications devoted to the study of MMP inhibitors associated with periodontal diseases were selected. Results of the study. Analysis of the literature allows us to conclude that the elimination of local irritants of periodontal tissues, the use of a therapeutic and prophylactic complex of measures using MMP inhibitors will have an advantage over traditional methods of treatment, will contribute to longer remission and prevent the progression of the inflammatory process in periodontal tissues, positively influence its course and reduce treatment time. The use of metalloproteinase inhibitors is an effective therapeutic strategy in the treatment of periodontal diseases. Conclusions. The therapeutic potential of metalloproteinase inhibitors may help prevent tissue damage in inflammatory periodontal diseases.

ВЛИЯНИЕ ИРРИГАТОРА НА ВЫРАЖЕННОСТЬ ВОСПАЛИТЕЛЬНЫХ ПРОЦЕССОВ В ТКАНЯХ ПАРОДОНТА У ПАЦИЕНТОВ НА АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ

Introduction. Anticoagulant therapy is prescribed for surgical interventions in the heart and blood vessels, atrial fibrillation, thromboembolism and thrombophlebitis of various etiologies, myocardial infarction, new coronavirus infection. This group of patients is characterized by a decrease in physical and social activity, and motivation to care about their own health. As a result, poor oral hygiene can cause gum bleeding, which is often mistaken for a side effect of the anticoagulant being taken. Without proper attention, the process risks moving into severe stages of the development of periodontitis, which has a direct impact on the course of cardiovascular diseases. Maintaining a level of personal oral hygiene is especially important. An additional tool, in addition to a toothbrush and toothpaste, is an irrigator - a device that creates a pulsating stream of water, which under pressure washes and removes food debris and soft plaque. Aim. To evaluate the effect of the irrigator on the severity of inflammatory processes in periodontal tissues in patients on anticoagulant therapy. Methodology. 30 patients were examined (15 using warfarin, 15 using new oral anticoagulants) according to the following criteria: complaints of bleeding gums, degree of gum bleeding according to Mullemann, hygiene index, objective periodontal index (OPI – patent No. 265521 of 2018). Signs were assessed by statistical methods before professional oral hygiene and after 1.5 months of using irrigators OMIO-350, OMIO-450, OMIO-560 to maintain personal hygiene and prevention. Results and its discussion. After using the irrigator, complaints of bleeding gums remained in 4 patients out of 16 examined. The average hygiene index decreased by 48.7%, the objective periodontal index decreased by 42.9%. In most patients, bleeding disappeared or decreased in intensity. Conclusions. The positive effect of irrigators, as an additional means of personal hygiene, on periodontal tissue and improvement of oral health in patients has been proven.

IMMUNOLOGICAL ANALYSIS OF ORAL FLUID IN PATIENTS WITH GENERALIZED PERIODONTITIS

The objective of this study is to conduct an immunological analysis of oral fluid, specifically focusing on determining the interleukin status among patients with generalized periodontitis and underlying metabolic syndrome. Materials and methods. For immunological studies, 3 groups were formed: main group, comparative and control groups. The main group included 30 individuals with generalized periodontitis and metabolic syndrome, the comparison group included 30 people with generalized periodontitis without somatic pathology; 20 healthy individuals with intact periodontium made up the control group. The content of pro-inflammatory cytokines IL-1β, IL-6, TNF-α and anti-inflammatory cytokines IL-4, TGF-β1 in the oral fluid of the subjects of the examination groups was determined by the method of solid-phase enzyme immunoassay using reagents of the company "Simko" (Ukraine).
 Results. According to average values obtained, the highest levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) were found in individuals with periodontal pathology and metabolic syndrome. The value of the IL-1β content in the oral fluid of the main group was 1.1 times higher than the similar indicator of the comparison group, and 1.4 times higher than the indicator of the control group. The mean IL-6 content in the oral fluid of patients with metabolic syndrome was 1.3 times higher compared to individuals without the systemic disease. Interestingly, the disparity was more pronounced in healthy individuals, with IL-6 levels differing by 2 times.
 Conclusion. Patients with metabolic syndrome and periodontal pathology have significant disturbances in cytokine regulation. Cytokines are key factors in the formation of a local inflammatory reaction, therefore, an increase in the concentration of pro-inflammatory IL-1 β can be considered an immune response to the inflammatory process in periodontal tissues.

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ ПРЕПАРАТА НАПРАВЛЕННОЙ БИОКОРРЕКЦИИ И ПРЕПАРАТА, СОДЕРЖАЩЕГО ЛАКТОФЕРРИН, В КОМПЛЕКСНОМ ЛЕЧЕНИИ ХРОНИЧЕСКОГО ГЕНЕРАЛИЗОВАННОГО ПАРОДОНТИТА У ПАЦИЕНТОВ С ПЕРВИЧНЫМ ГИПОТИРЕОЗОМ

Subject In the traditional complex treatment of inflammatory periodontal diseases, antibacterial, antiseptic and anti-inflammatory agents are of paramount importance. These products allow you to obtain not only a positive clinical result, but can also manifest their negative properties, having an ambiguous effect on the microbiome of the oral cavity and periodontal tissue. The use of targeted biocorrection drugs and immunocorrectors has a significant local anti-inflammatory effect with minimal side effects. Their use in the complex treatment of chronic generalized periodontitis has not been studied enough.
 Aim. To evaluate the effectiveness of using a targeted biocorrection drug and a phytocomplex with lactoferrin in the complex treatment of chronic generalized periodontitis in patients with primary hypothyroidism.
 Material and methods. We observed 90 patients with the main diagnosis of primary hypothyroidism aged 44–59. The patients were divided into 3 groups: in group No. 1, 30 patients received traditional primary periodontal therapy, in group No. 2, 30 patients in whom this therapy was combined with a directed biocorrection drug, in group No. 3, 30 people for whom traditional primary periodontal therapy was combined with a directed biocorrection drug and a drug containing lactoferrin. The comparison group included 30 gender and age-matched patients with chronic generalized periodontitis without thyroid pathology. All patients underwent clinical, X-ray and index evaluation of periodontal tissues. 
 Results. In patients of group No. 1, after traditional treatment, clinical and index evaluation data indicated the persistence of inflammatory processes in periodontal tissues. In groups No. 2 and No. 3 on the background of traditional treatment and additionally administered.
 Conclusions. The addition of a traditional treatment regimen for chronic generalized periodontitis with a targeted biocorrection drug and a drug containing lactoferrin is justified and effective.

APPROACHES TO THE ISSUE OF SCREENING FOR DISEASES OF THE ORAL MUCOSA: A PRESENT VIEW

Pathological processes in the oral mucosa in the structure of visits to the therapeutic dentistry clinic occupy a significant niche among all initial visits. In this regard, in the treatment of diseases of the oral mucosa, it is important to include in the complex of diagnostic and preventive measures, which would make it possible to diagnose the pathological process at the preclinical stage, and would be characterized by minimally invasiveness, long-term accuracy, ease of use and would help accelerate the recovery of the mucous membrane. and microcirculation, while having minimal side effects on the body as a whole and providing the possibility of dynamic observation.
 The purpose of the research is to analyze literature sources in order to comprehensively monitor modern approaches to the issue of screening for diseases of the oral mucosa.
 Materials and methods. Review and analysis of scientific and medical literature based on Scopus, Web of Science, MedLine, PubMed, NCBI databases, the study of which does not exceed 5-7 years, including literature reviews and results of clinical studies.
 Research results. In a number of nosological units, changes in the oral mucosa are of a specific nature, when the appearance can make a diagnosis and determine treatment tactics. However, in most cases, the diagnosis of diseases manifested in the oral mucosa is complicated, since the clinical picture is nonspecific and is often aggravated by additional unfavorable local factors. The cellular composition from the lesion, reflecting the dynamics of changes in the mucous membrane during its epithelization, is one of the objective tests for assessing the general condition of the body. Therefore, the study of the processes of differentiation of oral mucosa with an in-depth analysis of the cytological features of various anatomical areas in normal conditions and morphological and cytospecific changes in the presence of an inflammatory process in periodontal tissues is a relevant and promising area of research.

Experimental Determination of the Stability of the «Flamena» Gel Pharmacological Structure under the Influence of Low-Intensity Laser Radiation

In modern dentistry, the problem of the prevention and treatment of peri-implantitis is relevant. Proposed methods of treating patients with peri-implantitis do not stop the pathological process with the possibility of achieving long-term remission. Liposomal complexes with dihydroquercetin make it possible to influence the pathogenetic links of the inflammatory process in periodontal tissues with the prospect of normalizing blood circulation and regeneration processes in the affected area. It has been established that the complex simultaneous effect of low-intensity laser radiation and a pharmaceutical (laserophoresis) provides the possibility of more significant penetration of the drug components into periodontal tissues. The study of the laserophoresis of the liposomal complex with dihydroquercetin in the treatment of patients with peri-implantitis is relevant. However, in the modern literature, there is a lack of studies on the effect of low-intensity laser radiation on the pharmaceutical structure of drugs based on the above-mentioned basis.

The effect of the gel with tricolor violet extract on the activity of the antioxidant defense system in rats with a model of parodontitis

The authors investigated the antioxidant properties of the gel with tricolor violet extract when used in rats with an experimental pаrodontitis model. To simulate periodontal pa-thology, white laboratory rats were given a solution of ethylenediaminetetraacetic acid (2%) daily with drinking water and three times a week; the drug "Warfarin Orion" was administered per os for 30 days. Animals were randomly divided into four equal groups of 10 each. Group 1 - intact rats; group 2 - rats with a model of pаrodontitis; group 3 - rats with a model and applications on the mucous membrane of the alveolar process gel "Pla-cebo". Group 4 - rats with a pаrodontitis model and applications on the mucous mem-brane of the alveolar process of the gel with the violet extract. In periodontal tissues and blood serum, we studied the level of inflammation markers - malondialdehyde (MDA) and diene conjugation. The state of the antioxidant defense system (AODS) was also assessed by the activity of glutathione peroxidase (GP), glutathione reductase (GR), glucose-6-phosphate dehydrogenase (G-6-PD), superoxide dismutase (SOD), and catalase. The pаro-dontitis model in rats of the 2nd group was characterized by the development of inflam-matory processes in periodontal tissues and blood, which is confirmed by changes in the pro- and antioxidant protection system. In rats of the 4th group, the content of MDA was restored in periodontal tissues. The state of the AOP system was normalized (decrease in the activity of SOD and catalase to the values of group 1), the tension in the glutathione-antioxidant defense system disappeared (the activity of GP decreased, and the activity of GR and G-6-PDH increased to the level control). In the blood serum, the content of MDA significantly reduced, and the level of DC remained higher than in group 1.In contrast, sta-bilization of the activity of marker enzymes of glutathione-antioxidant protection in blood serum (GP, GR, G-6-PDH) was noted with significant activation of the activity of SOD and catalase, with stabilization of SOD and catalase. Conclusion. The periodontal protective effectiveness of the gel with tricolor violet was es-tablished, as evidenced by the restoration of the state of protective antioxidant systems and the inhibition of lipid peroxidation processes both directly in the periodontal tissues and at the system level.

Chronic tonsillitis and periodontal diseases

Chronic tonsillitis is a multifactorial immunopathological process that contributes to the development of tonsillitis-associated pathology. In turn, this tonsillitis-associated pathology potentiates and aggravates the course of chronic tonsillitis. In the literature, there are data on the possible influence of oropharyngeal loci of focal chronic infection on the body as a whole. One of such foci that can aggravate the course of chronic tonsillitis and maintain sensitization of the body are periodontal pockets formed during the inflammatory process in periodontal tissues. Highly pathogenic microgranisms of periodontal pockets secrete bacterial endotoxins, stimulating the immune response of the human body. Bacteria and their waste products cause intoxication and sensitization of the whole organism. A vicious circle is formed, which is quite difficult to break. To study the effect of chronic inflammatory process in periodontal disease on the course of chronic tonsillitis. 70 patients with chronic tonsillitis were examined. Together with a dentist-periodontist, an assessment of the state of the dental system was carried out, according to the results of which all patients with chronic tonsillitis were divided into 2 groups: with and without periodontal diseases. In patients with periodontitis, highly pathogenic flora is found in periodontal pockets. When examining patients with chronic tonsillitis, it is important to assess the condition of the dental system, to calculate dental indices, the key of which are periodontal and bleeding index. It is necessary to recommend comprehensive treatment for patients with CT and periodontitis by otorhinolaryngologists and periodontists. It is necessary to recommend comprehensive treatment by otorhinolaryngologists and dentists to patients with chronic tonsillitis and periodontitis.

Changes in the oral microbioty with losing teeth

BACKGROUND: The influence of the presence/absence of teeth and periodontium preserved at their existence as a balance factor in the oral cavity including the local immunity of the mucous membranes is practically not reported in the literature.
 AIM: The study aimed to examine the microbial community of the oral cavity at the loss of natural teeth.
 MATERIAL AND METHODS: Forty-five individuals aged 6174 years were under observation and divided into three study groups. The control group had partial loss of natural teeth. Group 2 had partial loss of teeth on both jaws and suffered from severe chronic generalized periodontitis. Group 3 had partial tooth loss on both jaws and suffered from chronic periapical inflammatory processes (chronic granulomatous periodontitis) in the absence of acute, chronic, or exacerbation of the chronic inflammatory process in periodontal tissues. In this study group, all upper and lower jaw teeth were extracted for oral sanitation before orthodontic treatment. The microbiota was assessed before surgical sanitation of the oral cavity (before tooth extraction) and 3035 days after the last tooth extraction, i.e., at complete tooth loss on the upper and lower jaws.
 RESULTS: On initial examination, the detection frequency of five red complex periodontopathogens (Prevotella intermedia, Bacteroides forsythus, Treponema denticola, Actinobacillus actinomycetemcomitans, and Porphyromonas gingivalis) ranged from 27% to 53%, which was significantly higher than that of the control group (13%27%). In 1 month after complete tooth extraction, the detection of these microorganisms in the experimental groups (with periodontitis and periodontitis) reliably decreased (P. intermedia, 20%; B. forsythus, 20%; T. denticola, 20%; A. actinomycetemcomitans, 20%; P. gingivalis, 33%), which was not significantly different from that of the control group.
 CONCLUSION: Complete extraction of teeth did not affect the presence of Staphylococcus spp. and Streptococcus spp. in the saliva of patients with periodontal diseases but led to a significant reduction in the presence of periodontopathogens and Candida sp. in the saliva of older people.

Clinical and Immunological Efficacy of an Eucalyptus Leaf Preparation in Chronic Periodontitis Treatment: A Randomized Interventional Longitudinal Clinical Study

Background. The prevalence of inflammatory-destructive periodontal diseases remains to be a global problem. Long-term topical application of chlorhexidine bigluconate and metronidazole is known to involve various side effects, thereby requiring widening the spectrum of herbal preparations used for treating chronic periodontitis.Aim. To evaluate the efficacy of Chlorophyllipt in the treatment of chronic generalized periodontitis by studying cytokine concentration dynamics in the gingival fluid.Methods. A randomized controlled clinical study of outcomes achieved in 50 patients with chronic generalized periodontitis treated in Dental Polyclinic No. 3, Krasnodar Кrai, was carried out. The control group included 20 clinically healthy people. Patients diagnosed with chronic generalized periodontitis were divided into the main (n = 25) and comparison (n = 25) groups. The main group received basic therapy and conventional conservative treatment with the addition of Chlorophyllipt. The comparison group received basic therapy and conventional conservative treatment. The therapy efficacy was estimated based on clinical indicators and IL-1β, IL-1Ra, IL-8, and TNF-α cytokine levels in the gingival fluid before treatment and after 14 days, three days, and six months of treatment. Statistical analysis was performed using the SPSS version 15 software (USA).Results. All clinical parameters improved significantly in both chronic periodontitis groups after 14 days, three days, and six months of treatment in comparison with their levels before treatment (p < 0.001). At the same time, the conventional conservative treatment with the addition of Chlorophyllipt reduced inflammatory processes in periodontal tissues and gum bleeding at earlier stages. In the main group IL-1β, cytokine levels after 14 days of treatment were 19% lower than in the comparison group (p = 0.025), while IL-1Ra cytokine levels were 52% higher (p = 0.023). Six months after treatment, IL-1β and TNF-α cytokine levels were 14% and 32% lower than in the control group, respectively (p2 = 0.021 and p2 = 0.008), while IL-1Ra cytokine levels were 39% higher (p =0.019). All these results were statistically significant.Conclusion. Due to the established clinical and immunological efficacy, Chlorophyllipt can be included in the conventional conservative therapy of chronic generalized periodontitis. The determined levels of IL-1β, IL-1Ra, and TNF-α cytokines in chronic periodontitis patients can be used when assessing the response of periodontal tissues towards therapeutic interventions.

НЕКОТОРЫЕ ОСОБЕННОСТИ СТОМАТОЛОГИЧЕСКОГО СТАТУСА ПАЦИЕНТОВ С ПРОЯВЛЕНИЯМИ ТИПИЧНОЙ И ЭРОЗИВНО-ЯЗВЕННОЙ ФОРМЫ КРАСНОГО ПЛОСКОГО ЛИШАЯ СЛИЗИСТОЙ ОБОЛОЧКИ РТА

The purpose of the study is to evaluation of peculiarities of complaints, symptoms and clinical manifestations of typical asymptomatic (L43.80) and erosive-ulcerative (L43.82) forms of lichen planus (LP), its manifestations on the oral mucosa, depending on the age and sex of patients.
 Material and methods. In the present study, 111 patients with OLP were divided into a main clinical group with erosive-ulcerative form of OLP (L43.82, n = 86) and a comparison group with typical asymptomatic form of OLP (L43.80, n = 25) based on the complex of dental examination and simple randomization method. Mann–Whitney and chi-square tests, including Yates' correction, were used to assess the statistical significance of differences between the groups. 
 Results. Patients with the typical asymptomatic form of OLP (L43.80) often had grayish-white, flat papules up to 2 mm in diameter on the unchanged mucosa of the cheeks and dorsal surface of the tongue in the absence of complaints. In the erosive and ulcerative form (L43.82) of OLP, the complaints of pain, intensifying at intake of hard, spicy and hot food, feeling of tightness, roughness, burning, slight dryness prevailed, papules, erosions of irregular or polygonal ulcers were simultaneously observed on swollen, hyperemic mucosa of cheeks, corners of mouth and lateral surface of tongue. The studied pathology prevailed in 81.98% of cases in persons of young working age. Depending on the form of OLP, the intensity of caries according to the CPU index corresponds to a high or very high degree of caries process, the state of oral hygiene according to the OHI-S index of poor or poor hygiene, the inflammatory process in periodontal tissues according to the PMA index of mild or medium degree of inflammation (p < 0.001). Conclusion: thus, the identified features of complaints, symptoms and manifestations of oral mucosal lichen planus should be taken into account by general practitioners when conducting outpatient appointments.

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.

Hemostasis disorder as a reason of periodontitis in patients with diabetes mellitus

In diabetes mellitus II type hyperglycemia contributes to the development of endothelial dysfunction. It leads to hypercoagulation and severe microcirculation disorders, which are the cause of ischemia in periodontal tissues and the development of inflammatory processes. The aim of the study hemostasis indicators associated with endothelial dysfunction to study the etiology of periodontitis in patients with type II diabetes mellitus. Materials and methods. 46 people aged 50–80 years were examined. 20 patients planned hospitalized, with compensated type II diabetes mellitus without complications and other diseases and 26 healthy people were examined as a control group, comparable in age and sex to the patients with SDS. Blood was taken when patients were admitted to the hospital before the treatment. For all studied parameters, a multiple and pairwise comparison was carried out. Results. Considerable changes in endothelial function were found in patients with DFS. There was a significant increase in the concentration in blood serum of indicators such as d-dimers (10.5 times more compared with the control values), factor XIIa (8.4 times more), Willibrand factor (2 times more). The increase in the concentration of fibrinogen, INR and antiplasmin in the plasma of patients with DFS was also revealed. In addition, there was a significant decrease in antithrombin content by 17% compared to control values. Conclusions. The hemostatic system is involved in a wide variety of pathogenetic links in the inflammatory process in periodontal tissues. Due to endothelial disfunction and the damaging effect of hyperglycemia on the cell membranes, hemostasis is activated, so it leads to the thrombosis. This is the cause of severe microcirculation disorders, which further contribute to changes in the periodontal tissues and to the development of inflammatory processes in patients with type II diabetes mellitus.

Prognostic model of early inflammation development in periodontal tissues by biochemical parameters of oral fluid in patients with orthodontic appliances

One of the main etiological risk factors and pathogenetic mechanisms for the development of inflammatory diseases of the periodontal disease is a bite pathology or dentofacial anomalies. Therefore, in recent years, scientists make attempts to find new markers that would allow to predict the course of the disease at the preclinical stage of its diagnostics, which would allow to take preventive treatment. In recent years, individual proteins of the mouth, which include matrix metalloproteinases (MMP-8), which can hydrolyze the main proteins in extracellular space and lactoferrin, catelitsidine, KLOTHO protein should be considered leading markers. The purpose is to predict the emergence of early inflammation in periodontal tissues in patients with non-removable orthodontic appliance by studying protein content in the oral fluid in the dynamics of treatment. Among the 113 patients surveyed by us, which underwent orthodontic treatment with non-removable appliance, according to clinical and laboratory studies, 82 people (72,57%) had signs of early inflammation of periodontal tissues. All exa­mined young people were students or students of educational institutions who appealed for advice and treatment to a dental clinic. Biochemical studies of oral fluid and their analysis was conducted at the beginning of orthodontic treatment and 3 and 6 months after the delivery of non-removable orthodontic appliance. The oral fluid was collected in the morning, and the quantitative determination of proteins in it was carried out by the IFA method. In order to assess the probability of prognostication of early inflammation in patients with orthodontic appliance, there was made rank correlation analysis with the determination of the correlation coefficients of the disparity (rs), ROC analysis with the deter­mination of Optimal Cut-Off Point (OСР) – the value of the indicator for prediction and simple and multiple logistic regressions with the calculation of the odds ratio and the construction of a prognostic model (logistics regression equation). For the analysis of factors, on the basis of which it is possible to predict early inflammation of periodontal tissues in patients with orthodontic appliance, a correlation analysis was performed, which showed that the largest changes were in the biochemical parameters of the mouth, namely: MMP-8 (rs=0.58; p<0.001), lactoferin (rs=0.45; p<0.001), catelitsidine (rs= -0.59; p<0.001) and KLOTHO protein (rs= -0.58; p<0.001), with which statistically significant correlations were established. ROC analysis was used to evaluate the discriminatory capacity of the markers investigated, which showed the presence of statistically significant correlations with early signs of inflammatory process in periodontal tissues. As a result of the correlation analysis, it has been found that the most significant changes in the inflammatory process in periodontal tissues were in the biochemical parameters of the mouth, such as MMP-8 (rs=0.58; p< 0.001), lactoferin (rs=0.45; p< 0.001), catholicidine (rs= -0.59; p< 0.001) and Klotho protein (rs= -0.58; p< 0.001), with which statistically significant correlations of average force were detected. The chances of patients with non-removable orthodontic appliance for the development of inflammation in the periodontal tissues are increased by 4. times.

Дослідження цитокінового спектру ротової рідини хворих із генералізованим пародонтитом на тлі метаболічного синдрому

The purpose of the study was to study the state of cytokine regulation of oral fluid in patients with generalized periodontitis and metabolic syndrome. Materials and methods. For this study, 3 groups of surveys were formed. The main group included 30 people with generalized periodontitis on the background of metabolic syndrome; 30 people with generalized periodontitis, without somatic pathology, formed a comparison group. The obtained results were compared with the data of 20 practically healthy individuals with intact periodontium who were included in the control group. The content of pro-inflammatory cytokines IL-1β, IL-6, TNF-α and anti-inflammatory cytokines IL-4, TGF-β1 in the oral fluid of the study groups was determined by solid-phase enzyme-linked immunosorbent assay. Results and discussion. According to the research, on average, the highest levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) were observed in patients with periodontal disease on the background of metabolic syndrome. We investigated increase in the concentration of proinflammatory IL-1β. The average value of IL-6 in the oral fluid of patients with metabolic syndrome exceeded this figure in persons not burdened with somatic pathology by 1.3 times, the difference with healthy individuals was more significant: the indicators differed by 2 times. That can be considered an immune response to the inflammatory process in periodontal tissues. The next stage is the beginning of the cytokine cascade, which is characterized by increased production of IL-6 and TNF-α – inducers of acute phase protein synthesis. TNF-α causes an increase in the number of free radicals and can lead to intensification of apoptosis. Due to the fact that anti-inflammatory IL-4 blocks the induced expression of pro-inflammatory IL-6 and TNF-α, a decrease in its level in oral fluid can be considered an unfavorable factor in the course of inflammatory-dystrophic periodontal lesions in patients with syndrome X. Given that TGF-β1 is an immunosuppressive factor, a decrease in its concentration indicates a deficiency of local factors of immune protection in patients with periodontal disease on the background of metabolic syndrome. Conclusion. Patients with metabolic syndrome and periodontal disease have significant disorders of cytokine regulation, which are complicated by age: expression of proinflammatory IL-1β, IL-6, TNF-α on the background of reduced anti-inflammatory cytokines IL-4 and TGF-β1. Such changes in cytokine homeostasis indicate chronic inflammation, insufficient efficiency of regenerative processes in tooth-retaining tissues, and, as a consequence, lead to a more severe course of periodontal disease in people with metabolic syndrome

Особливості цитокінового статусу та активність запального процесу в осіб з генералізованим пародонтитом на тлі хронічного тонзиліту

Introduction. The relationship of pathological processes occurring in the periodontal tissues and pharyngeal area had great importance due to the similarity of their etiological and pathogenetic stages. Recent studies have shown that cytokines are triggers of the inflammatory process in periodontal tissues and predictors of progression of pathological changes in them. Therefore, while studying the pathogenesis of generalized periodontitis on the background of chronic tonsillitis, it is important to assess the synergistic effect of proinflammatory cytokines, which can be markers of local changes and diagnostic criteria for severity and activity of pathological inflammatory process in periodontal tissues. The aim of the study was to study the level of proinflammatory cytokines and acute phase proteins in the serum of patients with generalized periodontitis on the background of chronic tonsillitis. Material and methods. The clinical and immunological study involved 97 patients aged 18 to 59 years, of which formed 3 study groups: group I – 32 people with periodontal disease on the background of chronic tonsillitis (CT); group II – 35 people with periodontal lesions without concomitant CT; control – 30 clinically healthy individuals. Results. The study of cytokine status in the serum showed a probable increase in levels of proinflammatory cytokines γ-IFN, TNF-α, IL-1β, IL-6 in patients of study group I compared with other groups, indicating a «cytokine explosion». There was a tendency of the hyperergic reaction formation and generalization of inflammatory process. The reflection of the degree of inflammatory process in patients with gingivitis and periodontitis on the background of chronic tonsillitis was an increased concentration of bone resorption marker IL-1β, which was determined as highest in group I with gingivitis and generalized periodontitis initial – I stage. The maximum level of C-reactive protein was determined in group I (4.4 times higher than in the control). Conclusions. Particular attention should be paid to patients of group I with periodontal disease on the background of CT, where level of the studied parameters was the highest compared to the data of other study groups. It should be added that depending on the degree of inflammatory and dystrophic-inflammatory processes in periodontal tissues an increased overproduction of IL-1β in serum could be reliably considered as an indicator of activity and progression of periodontal disease accompanying with chronic tonsillitis. Key words: periodontium, periodontitis, gingivitis, chronic tonsillitis, inflammation, cytokines.

THE ROLE OF ADAPTIVE-STRESS RESPONSE IN THE PATHOGENESIS OF PERIODONTAL DISEASES

The aim: The purpose of this work is to analyze the literature data of scientific research of Ukrainian and foreign scientists to assess the pathogenetic mechanisms of the adaptive stress response to the condition of periodontal tissues. Materials and methods: Bibliosematic and analytical methods were used in the trial. The materials of the trial are international experience in studying the pathogenetic mechanisms of the interaction of psycho-emotional disorders and the development of periodontal lesions. Conclusions: Chronic stress and depression suppress the immune system, cause the hormonal imbalances, lead to metabolic disorders in tissues and increase the risk of dystrophic and inflammatory processes in periodontal tissues, which in turn lead to reduced masticatory function, tooth loss, severe emotional instability and significant reduction in quality of life. Psycho-emotional disorders in patients slow down the treatment of inflammatory processes in periodontal tissues and contribute to the early recurrence. Thus, the problem of studying the adaptive stress response of the organism requires further research for deeply understaningits role in the etiology and pathogenesis of dental diseases and justify effective treatment and prevention measures for its correction.

THE ROLE OF ADAPTIVE-STRESS RESPONSE IN THE PATHOGENESIS OF PERIODONTAL DISEASES.

The aim: The purpose of this work is to analyze the literature data of scientific research of Ukrainian and foreign scientists to assess the pathogenetic mechanisms of the adaptive stress response to the condition of periodontal tissues. Materials and methods: Bibliosematic and analytical methods were used in the trial. The materials of the trial are international experience in studying the pathogenetic mechanisms of the interaction of psycho-emotional disorders and the development of periodontal lesions. Conclusions: Chronic stress and depression suppress the immune system, cause the hormonal imbalances, lead to metabolic disorders in tissues and increase the risk of dystrophic and inflammatory processes in periodontal tissues, which in turn lead to reduced masticatory function, tooth loss, severe emotional instability and significant reduction in quality of life. Psycho-emotional disorders in patients slow down the treatment of inflammatory processes in periodontal tissues and contribute to the early recurrence. Thus, the problem of studying the adaptive stress response of the organism requires further research for deeply understaningits role in the etiology and pathogenesis of dental diseases and justify effective treatment and prevention measures for its correction.

Evaluation of endogenous intoxication indicators in the dynamics of experimental periodontitis and immobilization stress

The aim of our work was to investigate the peculiarities of changes in endogenous intoxication rates: medium mass molecules (MMM) and erythrocyte intoxication index (EII) in the blood of guinea pigs in the formation of combined pathology - experimental periodontitis (EP) and immobilization stress (IS).The results of biochemical studies showed that at all stages of development of combined pathology - experimental periodontitis and immobilization stress there is a consistent increase in the degree of endogenous intoxication, which dominated on the 15th day of the experiment, namely increased content of medium mass molecules (МMМ254 , MMM280) and EII in the blood by 58.5% (p≤0.05), 80.3% (p≤0.05) and 95.7% (p≤0.05), respectively, compared with the first group of animals is a clear manifestation of the formation of endogenous intoxication. These changes are obviously the result of insufficient elimination of toxic products on the background of the inflammatory process in periodontal tissues and stress.

CHARACTERISTICS OF CYTOKINE PROFILE OF ORAL FLUID IN PATIENTS WITH CHRONIC SIMPLE MARGINAL GINGIVITIS

Biomarkers of inflammation can be used as indicators for monitoring the treatment of periodontal diseases, as well as for finding the safest and most effective drugs with different mechanisms of action. The concentration of biomarkers in saliva was determined by enzyme immunoassay and chemiluminescent analysis. The obtained results reflect the degree of activity of inflammatory processes in periodontal tissues that occur in gingivitis and reveal an imbalance in the processes of free radical oxidation and antioxidant protection of the oral cavity.