Inflammatory Periodontal Disease Research Articles

Porphyromonas gingivalis-Lipopolysaccharide Induced Gingival Fibroblasts Trained Immunity Sustains Inflammation in Periodontitis.

To investigate whether trained immunity occurs in gingival fibroblasts (GFs) and its relationship to the persistence of inflammation in periodontitis. Periodontally healthy and inflammatory gingival fibroblasts (HGFs and IGFs) were cultured through continuous adherence subculture of tissue blocks. Trained immunity in HGFs was evaluated via a classic invitro model, with relevant markers assessed via enzyme-linked immunosorbent assay, lactate content assay, glycolytic rate assay, and chromatin immunoprecipitation. A histone methyltransferase blocker and a PI3K inhibitor were added to investigate the mechanisms underlying trained immunity. The relationship between trained immunity and periodontitis was further examined via immunofluorescence staining and chromatin immunoprecipitation on IGFs. Compared with untrained cells, GFs trained with Porphyromonas gingivalis-lipopolysaccharide (P. gingivalis-LPS) exhibited a significant increase in IL-6 and TNF-α secretion, enhanced glycolytic metabolism, and enriched mono-methylation of lysine 4 on histone H3 (H3K4me1) at the enhancer regions of TNF-α and IL-6. The addition of a histone methyltransferase blocker and a PI3K inhibitor greatly reduced trained immunity. Additionally, the response of IGFs to P. gingivalis-LPS stimulation and their epigenetic modifications were similar to those observed in trained HGFs. This study novelly discovered that both P. gingivalis-LPS-stimulated HGFs and IGFs in periodontitis acquired trained immunity. Following P. gingivalis-LPS stimulation, HGFs underwent metabolic and epigenetic changes via the PI3K/AKT pathway, with these epigenetic changes also observed in IGFs. This finding suggests that trained immunity in GFs may be a key mechanism underlying the recurrence and persistence of periodontitis.

Backpack-carrying macrophage immunotherapy for periodontitis.

Cell immunotherapy is a promising therapeutic modality to combat unmet medical needs. Macrophages offer a prominent cell therapy modality since their phenotypic plasticity allows them to perform a variety of roles including defending against pathogens, inducing/suppressing adaptive immunity, and aiding in wound healing. At the same time, this plasticity is a major hurdle in implementation of macrophage therapy. This hurdle can be overcome by cellular backpacks (BPs), discoidal particles that adhere on the macrophage surface and regulate M1/M2 phenotypic shift in an environment-independent manner. In this study, we engineered IL-4 BPs for maintaining macrophages in the M2 phenotype to regulate excess inflammation in periodontitis, a major oral infectious disease. IL-4 BPs induced and maintained M2 phenotype in macrophages in vitro for several days. After injection of macrophages carrying IL-4 BPs into the gingiva, the cells stayed in the tissue for over 5 days and maintained the M2 phenotype in the disease sites. Furthermore, treatment with IL-4 BP-macrophages significantly suppressed the disease progression. Altogether, a treatment with BP-carrying macrophages offers a promising local therapy against periodontitis.

Gender differences in periodontal pocket microflora in patients with chronic generalized periodontitis

Background: Periodontal disease, the primary cause of tooth loss, is a critical public health concern with a considerable impact on quality of life. It is of interest to explore gender differences in the course of inflammatory periodontal diseases, as well as the prospects of their personalized treatment and prevention in males and females. Aim: To assess the dental health and quantitative composition of periodontal pocket microflora in periodontitis patients, taking into account gender differences. Materials and Methods: The study included 39 patients with moderate chronic generalized periodontitis aged 40–60 years. The diagnosis was made using both primary and secondary dental diagnostic tools. The study had two groups: males (41%, n=16) and females (59%, n=23). The following parameters were assessed: oral hygiene index (OHI-S), severity of gingival inflammation (PMA), and quantitative composition of periodontal pocket microflora (DENTOSCREEN, “Lytech” Co. Ltd., Russia), taking into account gender differences. The study findings were statistically processed using Microsoft Office Excel 2016 with Data Analysis and AtteStat 12.0.5 add-ins. The Shapiro–Wilk test was used. The data are presented as median and interquartile range: Me [Q1; Q3]. The frequency of microorganisms is presented as percentage of the mean and standard error of the mean. The confidence interval was calculated using the Wald method, according to the formula for proportions and frequencies. For small values, the Wald method with Agresti–Coull correction was used. Samples were compared using the following tests: the Mann–Whitney U test was used for quantitative data and Fisher’s angular transformation (φ*emp) for frequency (nominal) attributes. Significant differences were defined as a probability 95% (p 0.05). Results: The quantitative composition of periodontal pocket microflora in patients with moderate periodontitis revealed significant gender differences, as demonstrated by an increase in the count of Fusobacterium nucleatum and Prevotella intermedia, as well as the frequency of Porphyromonas gingivalis, in males compared to females (φ*emp=1.736; p 0.05). Dental health indices confirmed the hypothesis of significant differences between males and females in terms of plaque index (OHI-S) and РМА. In males, poor oral hygiene was reported in 93.7% cases, which was significantly higher (φ*emp=2.04; p 0.05) than in females (69.6%). Moderate gingival inflammation was more prevalent in males, while mild gingival inflammation was more prevalent in females (p 0.05). Conclusion: The study findings emphasize the importance of oral hygiene in the prevention of chronic periodontitis and can be used to improve complex treatment algorithms for patients with periodontal diseases. This includes more frequent dental check-ups and professional oral care sessions, as well as oral hygiene training and monitoring, in males compared to females. Diagnosis by polymerase chain reaction allows for the identification and quantitative determination of DNA from periodontopathogenic bacteria at low concentrations, as well as the justification of treatment algorithms and prediction of treatment outcomes.

Hemodynamic periodontal changes in the treatment of chronic generalized periodontitis using polarized polychromatic light

Background: Ineffective treatment of inflammatory periodontal diseases is a significant medical and social issue. Previous research have shown that improved vascular response and local immunity activation are crucial for the treatment of periodontal diseases. This can be accomplished using polarized polychromatic light. However, the effect of polarized polychromatic light on microhemocirculation in periodontal tissues is poorly understood. Aim: To assess microhemodynamic changes in periodontal tissues in the treatment of mild chronic generalized periodontitis using polarized polychromatic light. Materials and Methods: A complex dental examination and treatment were performed in 70 patients (32 males and 38 females) with active chronic generalized periodontitis aged 20 to 59 years. The study had two groups (35 subjects each) based on treatment approaches. Group 1 received professional oral care and a course of antimicrobial therapy using Dentamet dental gel. Group 2 received antimicrobial therapy in combination with polarized polychromatic light therapy (wavelength 480–3,400 nm, power 40 mW/cm2, flux density 2.4 J/cm2 per minute, polarization 95%). Laser Doppler flowmetry was used to assess hemodynamics before treatment, as well as 3, 6, and 12 months after treatment. Results: Group 1 demonstrated an improvement in microcirculation parameters for up to 3 months (p=0.0027). In group 2, an improvement was observed for up to one year (p=0.0455). Conclusion: Polarized polychromatic light therapy in mild chronic generalized periodontitis improves microhemocirculation in periodontal tissues, increasing the efficacy of drug therapy.

The effectiveness of non-drug correction of chronic periodontitis in patients who have undergone a new coronavirus infection on the severity of oxidative stress

Purpose of the study. To evaluate the effect of the use of non-drug correction of chronic periodontitis in patients who have undergone a new coronavirus infection on the severity of oxidative stress. Material and methods. A total of 156 patients with CP aged 26 to 63 years participated in the study (the average age was 44.7±6.15 years). When dividing patients by gender, the majority were men — 86 patients (55.1 %). 126 patients out of 156 examined had a history of COVID-19 with a prescription of 1 to 6 months. At the first stage, by stratified randomization, all patients (156 patients), depending on the presence of a history of NCI, were divided into two unequal groups: 126 patients with CP who underwent COVID-19, and 30 patients with CP who did not have NCI. At the second stage, 126 patients with CP who underwent COVID-19 were divided into 4 groups using simple fixed randomization: a control group, two comparison groups and a main one. The control group received standard periodontal therapy (SPT), regulated by clinical guidelines. In comparison groups 1 and 2, SPT was supplemented, respectively, with applications of liposomal gel with DHA and NILI. In the main group, a complex of liposomal gel and NILI was used as an adjunct to SPT. Results. The SPT included professional oral hygiene with ultrasonic scalers and curettes of the Piezon Master 700 device (EMS, Switzerland). The removal of dental deposits was carried out using air-abrasive technology Aig-Flow (EMS, Switzerland). Individual oral hygiene was trained and monitored. Conclusion. The factors contributing to the development of inflammatory periodontal diseases, namely carious cavities, wedge-shaped defects, overhanging edges of fillings, were also eliminated.

Photodynamic therapy in the treatment of periodontal diseases. Literature review

Periodontal diseases affect about 90% of the adult population, but the treatment regimens for this pathology are different, with varying degrees of effectiveness. One of the causes of inflammatory phenomena is the microbial factor. In some cases, there is a need for antimicrobial prescriptions, which, against the background of growing antibiotic resistance, becomes a problem. This article describes the possibilities of using such a method of influencing periodontal pathogens as photodynamic therapy. The main conclusions of studies on the effectiveness of PDT in inflammatory periodontal diseases are presented.

Взаимосвязь между бактериями-эпибионтами Nanosynbacter lyticus и воспалительными заболеваниями пародонта

The inflammatory periodontal disease pathogenesis is determined by microorganisms of the oral cavity. Along with the well-studied periodontopathogens, microbial agents of unproven clinical significance, including epibiotic bacteria, are found in individuals with gingivitis and periodontitis. The study aimed to determine the association between the Nanosynbacter lyticus epibiont and inflammatory periodontal diseases. Conservative DNA sequences specific for the genera Nanosynbacter, Schaalia and the Bacteria domain were identified using PCR in 47 study participants (31 females and 16 males) aged 18–45 years. The results were expressed as indices determining the quantitative relationships between N. lyticus and Schaalia spp. (NS index), as well as between N. lyticus and representatives of the Bacteria domain (NB index). Schaalia spp. were not found in a large share (11/27, 40.7%) of patients with no periodontitis. All patients with moderate-to-severe periodontitis, as well as 75% of patients with mild periodontitis were carriers of Schaalia spp. All the Schaalia-positive samples from patients with periodontitis showed higher NS indices (p < 0.05) compared to Schaalia-positive samples from patients with no periodontitis: the median NS values were Ме = 0.89 (0.79; 0.93) and Ме = 0.63 (0.00; 0.73), respectively. The patients suffering from chronic generalized periodontitis had significantly higher NB indices (Ме = 0.83 (0.79; 0.85)) (p < 0.05) compared to patients with no periodontitis, Ме = 0.67 (0.00; 0.81).

Connecting the dots: NETosis and the periodontitis-rheumatoid arthritis nexus.

Periodontitis (PD) is characterized by the host's inflammatory responses to microbial dental biofilm dysbiosis, potentially resulting in tooth loss if left untreated. Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease leading to synovial inflammation and destruction of joint cartilage and bone. The suggested association between PD and RA is based on the potential of chronic inflammation present in periodontitis, which could induce alterations in proteins through post-translational modifications, leading to the formation of citrullinated and carbamylated protein antigens. Antibodies directed against these antigens can serve as biomarkers for the underlying immunological processes in RA. Recent studies have also focused on bacterial proteolytic enzymes released from PD-associated bacteria, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, which are also sources of these antibodies. Chronic inflammation in PD causes increased levels of inflammatory cytokines (interferon-α, interleukins-6 and 8, tumor necrosis factor-α) and neutrophil extracellular traps (NETs). The oral microbiota in PD is also associated with the release of NETs (a process known as NETosis). Elevated NET levels are a source of citrullinated and carbamylated proteins which highlights their role in an individual's risk of developing RA (pre-RA individuals) and the progression of chronic RA. This narrative review describes periodontitis and the dysbiotic subgingival microbiota and its role in NETosis as risk factors for inducing early RA and the prospects of identifying pre-RA individuals and seronegative RA patients with these risk factors.

CLINICAL JUSTIFICATION OF THE USE OF METROGIL DENTA AND LISTERINE IN THE COMPLEX TREATMENT OF PERIODONTAL DISEASES

The wide prevalence of periodontal diseases among the active able-bodied part of the population of our country determines the special relevance of this problem. The emergence and progression of periodontal diseases is largely facilitated by the pathogenic microflora of the oral cavity, which encourages the search and development of new antibacterial drugs. As is known, the most important component of the therapy of inflammatory periodontal diseases, along with traditional periodontal treatment, is the use of antibacterial agents. ‎

The green formulation of silver nanoparticles for the anticancer and lupus nephritis treatment applications and reducing the inflammatory cytokines in the rat periodontal model

In this study, a novel bio-inspired synthesis for the preparation of Ag NPs by Calendula persica flower extract has been researched. Also, the effects of the recent composite on lupus nephritis by following the TGF-β1 signaling pathway in mice and gingival amounts of IL1-β and TNF-α in the animal periodontal model were determined. To assess the crystal nature, morphology and size of the prepared nanoparticles, X-ray diffraction (XRD), transmission electron microscopy (TEM), ultraviolet–visible (UV–Vis) and field emission-scanning electron microscopy (FE-SEM) analyses were applied in this study. The prepared Ag NPs was employed for its effectiveness against colon cancer cell line (C26). The bio-synthesized Ag NPs had also cytotoxic property versus colon cancer based on MTT protocol. Collectively, the Ag NPs fabricated by biological way has potential applications in inflammatory treatment. In lupus nephritis section, indexes in animal tissues and serum were identified using specific kits, while pathological alterations in the mice kidney were examined through H&E staining. Additionally, qPCR was employed to determine the expression related to TGF-β 1 in kidney, thereby providing further insight into the silver nanoparticles mechanism. The findings indicated that silver nanoparticles reduced the mRNA expression levels of TGF-β 1 and NF-κB in the kidneys, while simultaneously increasing the Mn-SOD and IκB-α expression. Histological examination of H&E-stained sections revealed that silver nanoparticles mitigated the morphological abnormalities of the glomeruli and the inflammatory infiltration associated with nephritis. Silver nanoparticles demonstrated an inhibitory effect on the dsDNA positive rate in animal suffering from nephritis. Silver nanoparticles were found to reduce the increase in urinary protein and the pro-inflammatory cytokines concentrations in both the kidney and serum. In the periodontal model study, 0-3 ligatures were applied to induce the inflammatory periodontitis in right mandibular first molar neck in rats. The levels of inflammatory cytokines (IL1-β, CINC-1, IL-10 and TNF-α) were determined by common immunological test, ELISA. The findings revealed that Ag NPs administration could decease the IL1-β and TNF-α production in the rat periodontal model gum tissue. In addition, the outcome of this research indicated that IL1-β and TNF-α levels raised in the rat periodontal model gum tissue compared to control group. Ag NPs increased the levels of superoxide dismutase, catalase, and plasma bone alkaline phosphatase and reduced the IL1-β, TNF-α, inducible nitric oxide synthase and RANK genes mRNA expression. The results indicate that pre/post-treatment with Ag NPs because of its direct activity on pro-inflammatory cytokines inhibition improved the inflammatory symptoms in the periodontitis and lupus nephritis animals.

Results of the study on the baseline status of flight-associated periodontal pathology in civil aviation flight personnel

Aim. To assess the baseline condition of periodontal structures in civil aviation flight personnel in order to improve the algorithm for treatment and preventive dental care.Materials and Methods. A periodontal examination of the oral cavity was conducted for 120 flight personnel at the physician-sanitary unit of Dushanbe International Airport. The participants were divided into five groups: flight personnel with mild chronic gingivitis, moderate chronic gingivitis, mild chronic periodontitis, moderate chronic periodontitis, and a control group of flight personnel with healthy periodontium. The clinical course of chronic gingivitis and periodontitis was evaluated using oral hygiene and periodontal indices.Results and Discussion. Inflammatory periodontal diseases, such as chronic gingivitis and periodontitis of moderate severity (Groups II and IV), presented with more pronounced symptoms, including severe inflammatory reactions of the periodontal tissues and poor oral hygiene, compared to those in Groups I and III.Conclusion. The study demonstrated that papillary-marginal-alveolar (PMA) index, bleeding index, and oral hygiene scores were significantly elevated in flight personnel with mild to moderate chronic periodontitis, highlighting the need for targeted treatment and preventive care.

Clinical study of the effectiveness of the use of metronidazole-based gels in the occurrence of inflammatory periodontal diseases without violations of periodontal attachment (literature review)

At this moment inflammatory diseases of the oral cavity are widespread in the world among people of different ages. Metronidazole is widely used as an effective drug for their treatment. This review is aimed at analyzing modern literature sources that tell about the role of metronidazole in the treatment of inflammatory disorder of oral cavity.

ГЕТЕРОГЕННОСТЬ ФАКТОРОВ ВИРУЛЕНТНОСТИ СРЕДИ КЛИНИЧЕСКИХ ИЗОЛЯТОВ PORPHYROMONAS GINGIVALIS, ВЫДЕЛЕННЫХ ОТ ПАЦИЕНТОВ C ХРОНИЧЕСКИМ ГЕНЕРАЛИЗОВАННЫМ ПАРОДОНТИТОМ

The development of chronic generalized periodontitis occurs due to a combination of a several causes, among which the leading role is assigned to periodontal pathogens, which include P. gingivalis. Among P. gingivalis virulence factors, the polysaccharide capsule, fimbria proteins, cysteine proteases, and hemagglutinins are of special importance. The study was aimed to investigate the prevalence of specific virulence genes and identify a virulent genotype among P. gingivalis isolates found in patients with severe chronic generalized periodontitis (CGP). 41 patients (27 women and 14 men, average age 43.9±1.5 years) were examined, of which main and control group consisted of 22 patients with severe CGP and 19 patients without inflammatory periodontal diseases, respectively. The PCR data allow to consider type II fimbria (FimA II), arginine-dependent type A protease (RghA) and lysine-dependent protease (Kgh) as specific markers for the detection of more virulent P. gingivalis strains. It was found that in St. Petersburg, the following P. gingivalis genotypes predominate among patients with severe CGP: fimA II:kg:rghA, fimA II:kgh and fimA II:rghA. In addition, it has been demonstrated that virulent genotypes are detected to a small extent in P. gingivalis isolates from healthy control group patients. The identification of P. gingivalis strains with a more prominent pathogenic potential and the detection of their virulent genotypes is of great practical importance, in the future allowing to develop advanced effective methods for disease prevention to be used in a personalized medicine strategy. The results obtained are also of high importance due to the recorded variability in the circulation of P. gingivalis strain genotypes in various worldwide regions.

The Bidirectional Effects of Periodontal Disease and Oral Dysbiosis on Gut Inflammation in Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) flares can lead to excessive morbidity and mortality. This study aimed to determine whether oral dysbiosis/periodontal disease (PD) is common in IBD and is associated with disease activity in IBD. This single-center, prospective, cross-sectional, proof-of-concept, observational study assessed the frequency of periodontal inflammatory disease and interrogated oral and stool microbiota using 16S rRNA gene amplicon sequencing of active-IBD (aIBD), inactive-IBD (iIBD), and healthy controls (HC). Questionnaires assessed diet, alcohol usage, oral hygiene behavior, and disease activity. A subset of participants underwent comprehensive dental examinations to evaluate PD. PD was severer in aIBD subjects than in HC, as aIBD had poorer quality diets (lower Mediterranean diet scores) than iIBD and HC. Significant differences in microbial community structure were observed in unstimulated saliva, stimulated saliva, gingiva, and stool samples, primarily between aIBD and HC. Saliva from aIBD had higher relative abundances of putative oral pathobionts from the genera Streptococcus, Granulicatella, Rothia, and Actinomyces relative to HC, despite similar oral hygiene behaviors between groups. Our study suggests that patients with aIBD have severer periodontal disorders and higher relative abundances of putative "pro-inflammatory" microbiota in their oral cavity, despite normal oral hygiene behaviors. Our data are consistent with the potential presence of an oral-gut inflammatory-axis that could trigger IBD flare-ups in at-risk patients. Routine dental health assessments in all IBD patients should be encouraged as part of the health maintenance of IBD and as a potential strategy to decrease the risk of IBD flares.

Comorbidity of inflammatory bowel diseases and periodontal pathology

Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, are a global disease of the 21st century. Periodontitis is the sixth most common disease in the world (second among dental pathologies after caries) and the leading cause of tooth loss in adults. At the beginning of the 21st century, the concept of “periodontal medicine” was formed, within the framework of which the bidirectional connection of periodontal pathology with systemic diseases of the body is considered. Extraintestinal manifestations of inflammatory bowel disease are associated with the generalized nature of the inflammatory response. In clinical guidelines, only aphthous stomatitis is described as a systemic manifestation of Crohn’s disease and ulcerative colitis from the oral cavity. Periodontitis is considered a less representative non-specific oral manifestation of inflammatory bowel disease. We searched the Pubmed and Scopus information databases for articles published before 02/15/2024 that examined the relationship between inflammatory bowel disease and periodontal pathology. The results of clinical studies, their synthesis in systematic reviews and meta-analyses, indicate a bidirectional relationship between Crohn’s disease and ulcerative colitis with periodontal pathology. The most likely mechanism is associated with a change in the microbiocenosis of the oral cavity and a further change in the intestinal microbiome due to oral intake of periodontal organisms, which leads to impaired intestinal permeability and the development of immune reactions that play a key role in the development of periodontal diseases and inflammatory bowel diseases.

Treatment of inflammatory periodontal diseases in children

Treatment of inflammatory periodontal diseases in children

Oral Microbiocenosis in Cases of Inflammatory Periodontal Diseases in Children with Tuberculosis

Objective — to examine the microbial spectrum of the oral cavity in cases of inflammatory periodontal diseases of children with tuberculosis. Materials and methods. A study of the microbial habitat of oral biotopes and gingival surfaces was conducted in 97 children aged 6 to 17 years with inflammatory periodontal diseases and tuberculosis (treatment group). The control group consisted of 20 practically healthy children of the same age. The periodontal diseases were diagnosed according to M.F. Danilevsky’s classification (2000). The study of oral microbiocenosis and gingival surfaces in the examined groups of children was performed in accordance with Order No. 234 of the Ministry of Health of Ukraine as of 2006. Results and discussion. Aerobic, facultative anaerobic, and anaerobic bacteria persisted in the oral fluid and on the gingival surfaces of children with tuberculosis and inflammatory periodontal diseases. The most frequent colonies of bacteria were Streptococcus, in particular S. mutans, S. salivarius, S. β-haemolyticus, Staphylococcus (S. aureus, S. epidermidis).The significant evidence of Neisseria (N. catarrhalis) and Corynebacterium (C. xerosis) was revealed in the oral cavity and gingival surfaces of the examined children. The microflora of children from the treatment group revealed mostly Lactobacillus genus. The microbial associations of the examined children consisted of Candida, E. coli fungi. Smear microscopy revealed viruses. S. aureus was higher in the children from the treatment group as compared to the healthy children. In addition, the concentration of microorganisms was higher on the gingival surface versus the oral fluid and was more evident in the children from the treatment group. Conclusions. The obtained spectrum of the oral microbial contamination in the children with tuberculosis and inflammatory periodontal diseases revealed the persisting associations of aerobic, facultative anaerobic, and anaerobic bacteria. The inflammatory periodontal diseases in tuberculosis-infected children were accompanied by the evident increase in the frequency and concentration of microorganisms increasing with the higher severity of the specific process.

THE IMMUNOMODULATORY ROLE OF CYTOKINES IN THE PATHOGENESIS OF PERIODONTAL DISEASE

Background:Inflammatory periodontal diseases are one of the most acute problems of modern dentistry, which is associated with their widespread prevalence in the world. In the structure of periodontal diseases, periodontitis a leading place in the age group of 40-50 years. Many factors play a role in the etiology of periodontitis, the most important of which are the local microbiota and the host immune response. Cytokines play an extremely important role. Cytokines are key modulators of both homeostasis and inflammatory processes, acting in the first wave of responses against pathogens, stimuli at barrier sites and linking tissue cells to lymphocytes and additional cell populations. Objective:The aim of the study was to analyze modern literature on the role of cytokines in the etiology and pathogenesis of inflammatory periodontal diseases. Materials and methods:Data Extraction: A comprehensive electronic literature search was performed in the following databases:PubMed, Scopus,Web of Scienc, Google Scholar, EBSCO host from 2000 to 2024 terms: periodontitis, infection, inflammation, immunity, cytokines, interleukin. 124 articles were found and 50 full-text articles of high methodological quality were selected according to the review method used, the PRISMA. Inclusion criteria:included clinical trials, considered randomized controlled trials, cross-sectional studies, casecontrol studies, and cohort studies in human subjects that evaluated the current literature on the periodontitis, infection, inflammation, immunity, cytokines, interleukin written in English articles.There was no limitation on minimal quality, minimal sample size, or the number of patients. Exclusion criteria were:original primary studies, due to language limitations , abstracts, letters to the editor, book chapters, case reports, conference abstracts, duplicate publications, and in vitro and in vivo animal experimental studies. Result:Many factors of general and local origin are involved in the development and progression of inflammatory periodontal diseases. Microorganisms and their products cause activation of the host immune system, which results in the release of cytokines and other proinflammatory biomarkers that cause tissue damage. The inflammatory process in periodontal tissues progresses through various stages, beginning with the infiltration of immune cells into the gingival tissue. Immune cells secrete proinflammatory cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α),which further promote inflammation and tissue destruction. The interaction between bacterial biofilm and the immune response, which is mainly controlled by cytokines, determines the course of periodontal disease. Conclusion:The etiology and pathogenesis of periodontal disease is quite complex, diverse and not yet fully disclosed. Cytokines are control and modulate the immune response in periodontitis

DIABETES MELLITUS AND ITS IMPACT ON THE STATE OF THE ORAL CAVITY IN CHILDREN

Today, the number of people with diabetes is growing in all age groups both in our country and around the world. Diabetes is one of the most serious diseases in terms of its course and complications. It is known that diabetes destroys all types of metabolism, changes cellular and humoral immunity, is characterized by persistent hemorrhagic and neuromodulatory disorders, and slows down regenerative and reparative processes. The development of diabetic complications is associated with hyperglycemia and pathological changes in the vascular and peripheral nervous system. Studies by Ukrainian and foreign scientists have repeatedly shown that the child's body is an integral system and that endocrine disorders are accompanied by changes in various organs and systems, including the dentition. Although periodontal tissues are the main affected organ, other dental lesions, such as caries, inflammatory and infectious diseases of the oral mucosa and salivary glands. They are more common in diabetic patients than in children without somatic lesions. The first and most common symptoms in diabetic patients are dry mouth (xerostomia) and dry lips due to dehydration with polyuria, which is especially noticeable in children with worsening diabetes. Inflammatory periodontal diseases and inflammatory-dystrophic periodontal diseases occupy a special place among the symptoms of diabetes in the oral cavity in diabetic children. Vascular damage is of prime importance in the development of periodontal tissue inflammation in diabetic patients. Microangiopathy in diabetes mellitus enhances the process of bone resorption. The analysis of scientific material shows that there are significant pathological changes in the oral cavity of children with diabetes mellitus, which increase the dynamics of the disease and worsen its course. Therefore, the planning of dental treatment of patients with diabetes at each clinical stage should be based on a clear understanding of all etiological relationships, manifestations of various forms of diabetes in the oral cavity and their relationship with the corrected state of carbohydrate metabolism. A literature search was conducted using the databases Web of Science, Scopus, The Cochrane Library, MedLine, EMBASE and Global Health.

Efficacy of Pomegranate Peel Extract Mouthwash on Gingivitis and C-reactive protein

Background and objective: Gingivitis is characterized as the world’s most predominant inflammatory periodontal disease. Healthy mouth and teeth are obtained by brushing and uses mouthwash. And because of the side effects of chlorhexidine, pomegranate peel extract mouthwash used alternative which are thought to have anti-inflammatory effect. The aim of this study is to prepare a herbal mouthwash and to evaluate the efficacy of pomegranate peel extract mouthwash on plaque index, gingival index, and C-reactive protein on moderate gingivitis patients. Method: this study is a clinical crossover design study, which consists of 25 volunteers with moderate gingivitis, who visited Duhok Dental Training Center. This study started from December 2022 to March 2023. Plaque and gingival index with a sample of saliva for C-reactive protein measuring were taken as a baseline before each mouth wash and after that, the pomegranate peel extract mouthwash was used for two weeks, then three weeks wash out between them, then chlorhexidine mouth wash was used for two weeks (crossover method). All saliva samples were analyzed using (CRP ELISA Test). Results: Twenty-five patients who used pomegranate peel extract mouthwash showed a significant reduction after two weeks used (CRP=162.28, GI=0.54, PI=0.82) and p value (<0.0001) in mean C-reactive protein, gingival index, and plaque index from baseline which was (CRP=669.78, GI=1.88, PI=2.11). Conclusion: Pomegranate peel extract mouthwash had been shown effective against moderate gingivitis in adult patients with no systemic diseases through lowering in mean salivary C-reactive protein, gingival index, and plaque index.