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GENERALIZED LESIONS OF PERIODONTAL TISSUES: PARTICULAR QUALITIES OF DEVELOPMENT IN YOUNG
ADULTS
M.D. Professor Antonenko M., Revych V., Cand. Med. science Sayapina L.
Ukraine, Kyiv, Bogomolets National Medical University, Dentistry department
Abstract.As a result of comprehensive examination of 39 young person (23-24 years old) with the help of clinical, radiological and morphological methods of research (n = 39) it was founded that the main manifestations of the pathology of alveolar bone depend on the imbalance between the intensity of resorption and new formation processes. The prevalence is of the last one process.. Also it depends on the reduction of osteoplastic processes. A significant reduction ofalveolar bone mineralization for a light level and generalized periodontitis in young age develops on the background of reduction of energy supplying. It shows that there is an expediency of using antioxidants and antihypoxants together with osteotropic therapy in the treatment. The applying of them will help to improve the re-ossification process of a poor in minerals alveolar bone
Keywords: the periodontal disease, the energy metabolism of gums, periodontal tissues, alveolar bone.
A significant prevalence of periodontal disease in adult population in the world necessitates the further development of diagnostic criterias and treatment plans aimed on the pathogenetic influence. In literature all aspects of periodontal diseases (pathogenesis, diagnosis, clinical features, treatment and prevention) are highlighted mainly in individuals of 40-50 years or older, and features of their flow at a young age . Particularly, the initial changes in periodontal tissues remain poorly understood at the beginning of the pathogenetic chain [1,2].
It is established that it is important that an age of a patient has a value in a character of a metabolism and bone structure of the alveolar bone. At a young age processes of bone formation dominate. In middle ages - the formation and destruction of bone are balanced, in old - a resorption process prevails on others. The bone mineralization of the alveolar bone reaches a maximum in 25-30 years [3,4,5].
Alveolar bone, as it is known, consists of inorganic and organic substances, including collagen that prevails. The bone cells are osteoblasts, osteobclasts, osteocytes. These cells are involved in a permanent processes of resorption and bone tissue osteogenesis. Normally these processes are balanced and they are the basis of continuous reconstruction of alveolar bone that characterizes an expressed plasticity and adaptation. Bone component of alveolar bone of both jaws is in a constant state of renewal due to permanent restructuring processes. As a result of these processes the old bone is replaced by a new one.
In the conditions of the development of pathological processes in the bone tissue there is a development of changes in alveolar process. The great importance among this changes has the osteoporosis - a systemic disease of metabolic osteopathy, based on a reduction of the bone weight infraction of architectonics. [6]. Therefore, to specify the mechanisms of periodontal diseases, it is logical, to study bone structure of the alveolar process parallel with studying of energy metabolism of gums . As as a part of periodontal complex they reflect the state of redox processes that provide the functional activity of periodontal tissues in general.Till today specialists have no doubt that there is the fact about the correlation between morphological characteristics of inflammation in periodontal tissues and severity of clinical course of chronic catarrhal gingivitis (HKH) and generalized periodontitis (GP).
Based on these data, the aim of the study was clinical, radiological and morphological manifestations of periodontal tissue damage concerning generalized periodontal diseases in young people.
Material and methods
Clinical, radiological and histochemical investigations were conducted in 39 patients that were divided into 3 main groups.
Group I - 9 patients with chronic catarrhal gingivitis, lasting 3-5 years
Group II - 23 patients with early generalized periodontitis -- I stage;
Group III - 7 patients with no signs of pathology of periodontal tissues (control). Morphological studies of periodontal bone were conducted on archival material. Painting of histological sections of teeth blocks by hematoxylin and eosin (by van Ghisoni method) were made on the material of 9 dead persons that suffered from chronic catarrhal gingivitis and generalized periodontitis early lesion- I stage, when they were alive. Teeth blocks were decalcified in trichloroacetic acid and embedded in the paraffin..
Histochemical studies of energy metabolism were conducted on criostatic sections of incisional bioptates of gums. We studied the activity of complex of limiting enzymes of tissue respiration, glycolysis, pentose cycle and terminal oxidation, succinate dehydrogenase (SDG) - by Nahlas et al., Malate dehydrogenase (MDH), lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (Ch-6f-DG) -by Hess, Skarpelli and Pierce; NAD-P and NADPH dehydrogenase - by Farber. The histochemical methods were taken from the manual [7].
All patients were aged 19-30 years and didn't stand at the dispensary because of the presence of somatic pathology
Morphological studies were conducted in the laboratory of experimental studies (Head. - Dr. med., Professor Kolesov NA) Research Institute of Experimental and Clinical Medicine (Bogomolets National Medical University).
Results and discussion
The results of clinical and radiological studies of GP development - - I stage and in young people without somatic pathology showed that clinical symptoms of GP are associated with disorders of the bone tissue of the 1/3 height of alveolar bone. It appears on X-ray results as irregular cortical resorption on the tops of interalveolar membranes with a gradual spread to spongious substance (Figure 1).
The activity of bone destructive changes is radiologically determined by the nature of resorption and their definition. Unclear contours of the focuses of osteoporosis on X-ray pictures indicate on exacerbation of GP and clinically it is combined with an increase of bleeding gums, purulent exudate character. There are the stablished clinical and radiological signs of GP that have a clear morphological basis:a presence of chronic inflammation in remission or aggravation stages in the gums and periodontal
bone. ((Lympho-plazmocelMar, macrophagous, tissue-basophilic infiltration of neutrophils in the presence of exacerbations, edema vessels of the walls of hematocritic channel and perivascular connective tissue (Figure 2)). The osteoblastic bone resorption and inflammatory destruction develop. The flow of pathological process is associated with bone resorption and alveolar bone that appears as increase the number of preosteoclasts and osteoclasts with high functional activity, which make a further alteration of the bone. Microscopically the progression of the signs of destruction of bone tissue with the enlargement of diameter of the medullar bone space are detected, what becomes the basis of radiographic signs of osteoporosis. Cells of the inflammatory infiltrates are moving from the gums and encourage the production of proinflammatory cytokines and osteoporotic cytokines, enzymes, biologically ctive substances, which makes on the one hand, an activation of functional activity of osteoclasts, and on the other - a reducing of the pH with the development of acidosis. The regeneration of bone is slower, due to the decrease in the number of osteoblasts per unit area of histological sections, their degenerative and atrophic changes.
Fig. 1. Orthopantomogram The diagnosis: generalized periodontitis,early lesion -1 stage, chronic flow course. (Explanation is in the text)
Fig. 2. Histological section of dento-alveolar unit The diagnosis: generalized periodontitis,early lesion -1 stage, chronic flow course. (Explanation is in the text) Painted with hematoxylin and eosin. Coll. Ab. 10 Ok.10.
As for the intimate mechanisms of inflammatory alteration of the near-dental tissues, we support modern scientific views about the importance of complex of immunological, biochemical, structural and other pathological changes, including the importance of vitamin D in this process. The metabolites of vitamin D have the influence on every stage of appearance a GP. Mainly they have the influence on the the
periodontopatohens by inducing the formation of antibacterial peptides, inflammation reaction of organism and periodontal tissues by reducing the formation of pro-inflammatory cytokines and an increase in the formation of anti-inflammatory cytokines reducing bone resorption of alveolar bone [8,9].
In parallel, we analyzed the state of metabolic pathways that provide the character of energy metabolism in periodontium. It was esteblished that the percentage of normal processes of respiration and glycolysis in gums structures are 54,3 ± 2,21% and 45,7 ± 2,11% (r<0,005) respectively. This state of energy processes provides the normal physiological and clinical gums parameters (color, turgor, no bleeding and no periodontal pockets).
In patients with GP of early stage there are changes of metabolic profile of gum epithelium. At this steps of GP development the corelation of processes of tissue respiration and glycolysis in the gums is changing in favor of the likely prevalence of the last one: 42,2 ± 2,01% and 57,8 ± 2,29% (r<0,005) respectively . These data together with other indicators indicates on the development of periodontal tissue hypoxia. Tissue hypoxia is one of the triggers in a cascade of reactions of lipid peroxidation, which leads to the development of periodontal alterative processes and clinical manifestations of GP. During this, the histochemical studies revealed a likely decrease of the enzyme activity of tissue respiration (SDG, MDH), pentose cycle (Ch-6-F DG) and terminal oxidation (NAD-H and NADPH DG) in the epithelium and connective tissue cells while increasing the glycolysis enzymes activity (LDH).
Regarding chronic catarrhal gingivitis (CCG), on the X-ray pictures the main feature is the "occultness" of the figure of spongious bone of interalveolar membrane due to swelling and cell infiltration of gum tissues, especially during the exacerbation period of chronic inflammation (Figure 3).
Fig. 3. Orthopantomogram. The diagnosis: chronic catarrhal gingivitis. (Explanation is in the text).
Morphologically CCG manifests by the presence of cell infiltration in gum tissue, where small and medium lymphocytes, plasma cells are dominated ; less common are tissue macrophages and basophils. The walls of the blood vessels of hemo-microcirculatory channel are swollen, gaps are unevenly widened, especially in capacitive (venous) part. Perivascular connective tissue is swelling, especially during the exacerbation of CCG. In this period, the number of neutrophilic granulocytes are increasing in infiltrates. Energetic supply of functional activity of periodontal tissues have a tends to decrease due to the decrease of enzyme activity of breathing (SDG) up to 51,2 ± 2,02% while increasing the activity of enzymes of glycolysis (LDH) to 48,8 ± 1,86% (r< 0.005).
Inflammatory processes in the CCG are distributed mainly to the papillary layer of connective tissue and epithelium of gums and epithelium that do not lead to the direct contact of cell infiltrates and oedematous fluid with alveolar bone tissue , the structure of which has no unidirectional pathological changes (Figure 4). And only in some time (usually several years) swelling and infiltration spread on a reticular layer of connective tissue of gums and then on bone basis of alveolar bone and periodontium.
Thus, these data allow us to conclude that the pathogenesis of CCG and GP in young adults is associated with the development of inflammation in the gum tissues at first, and then in alveolar bone tissue and peridontium. It matches with the literature where there is the information about using the method of densitometry [10]. Thus, according to photodensytometric investigations of the X-ray photoes about CCH there is no reliable data about the decreases of the optical density of the alveolar bone tissue (HC ranges
from 0,96 ± 0,002 to 0,99 ± 0,021 units). According to GP, this figure was significantly reduced to 0,84 ± 0,023 - 0,92 ± 0,032, which is an early diagnostic criteria of the development of GP.
Fig. 4. Histological section of dento-alveolar unit The diagnosis: chronic catarrhal gingivitis. (Explanation is in the text).
Painted with hematoxylin and eosin. Coll. Ab. 10 Ok.10.
The clinical, radiological and structural changes in periodontal tissues are established in CCG and especially during the GP they develop on the background of reducing the energy sufficiency of their functional activity. It is manifested by signs of tissue hypoxia with decreased activity of enzymes of tissue respiration and increased glycolysis.
Conclusions. The development of periodontal tissue diseases in young persons who have no somatic pathology is associated, mainly, with slowly progressive chronic inflammatory process with periodic slowly progressive exacerbations and transitions of pathological process from gums (while CCG) to alveolar bone, tooth circular ligament and periodontium (while GP).
It is established that " occultness " of alveolar bone tissue on X-ray photos in patients with CCG is mainly due to edema and cellular infiltration of gums, especially during exacerbations of inflammation, and it depends not a lot on the development of bone resorption during this pathology processes , which coincides with the facts from the literature about detection of alveolar bone mineral density by photodensytometric method of X-ray photos.
The basis of the development of the I stage of GP in young people is a contact switch of gum chronic inflammation to the alveolar bone tissue with a distribution of cell infiltration on it (lymphocytes, plasma cells, macrophages, tissue basophils, neutrophil granulocytes) and edema that causes an accumulation of biologically active substances (inflammatory cytokines, osteoporotic cytokines, enzymes, etc.), which activate the functional activity of osteoclasts and lead to the decrease in pH and the development of acidosis. Together in complex they determine the prevalence of alveolar bone resorption over the bone tumor and also they determine the clinical symptoms development of generalized periodontitis. It is detected by radiological symptoms of GP of early I stage and it is reflected by a significant decrease of the optical density of the alveolar bone tissue to 0,84 - 0,92 units.
A significant reduction of mineralization of alveolar bone tissue of the I stage of GP in people of young age develops in the reduction of the energy sufficiency and shows the expediency of using antioxidants and antihypoxants together with osteotropic therapy in complex treatment.The use of them will conduce the re-ossification of impoverished on the mineral components alveolar bone of both jaws.
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«ШКОЛА ДИАБЕТА» - ПРОФИЛАКТИКА РАЗВИТИЯ ДИАБЕТИЧЕСКОЙ РЕТИНОПАТИИ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ
проф. Степанова И. С., д. м. н. Утельбаева З. Т., асс. Бердишева А. А., асс. Исмаилова С. К., студент 4-курса ОМ Насирова А., студент 4-курса ОМШомансуров Ш., студент 4-курса ОМ Лобанов Р., студент 4-курса ОМКалдарбеков С.
г. Алматы, КазНМУ им С. Д. Асфендиярова
Аннотация. Для профилактики развития диабетической ретинопатии у больных сахарным диабетом необходимо проводить комплексные занятия в «Школе диабета» с привлечением эндокринолога, офтальмолога и психотерапевта.
Ключевые слова: диабетическая ретинопатия, сахарный диабет, профилактика.
Актуальность. Важную роль в профилактике прогрессирования диабетической ретинопатии играет выполнение пациентом рекомендаций врача по медикаментозному лечению или «комплаенс». В результате исследования, проведенного А.М. Газизовым с соавт. (2008) среди больных со II типом СД, установлено, что большинство пациентов имели недостаточный комплаенс, заключающийся в отсутствии соответствующего лечения, как общего заболевания, так и его осложнений со стороны органа зрения [1].
В последние годы появились работы, посвященные оценке качества жизни у больных с офтальмопатологией [2,3]. Е.В. Козина (2004), изучая качество жизни больных глаукомой, установила, что помимо различных жалоб, касающихся снижения зрения, больные предъявляют жалобы, согласующиеся с понятием «качества жизни», которое подразумевает
