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OPTIMIZATION OF THE TREATMENT METHOD FOR PATIENTS WITH
PERIODONTITIS * Shertayeva A.Zh., Kurakbayev K.K.
LLP Kazakhstan's Medical University "KSPH" Almaty, Kazakhstan
Summary
According to the World Health Organization, partial tooth loss is one of the most common diseases of the dental system, affecting up to 75% of the world's population. The percentage of people suffering from this condition and the number of missing teeth increase with age.
Among the reasons for the deterioration of the environmental situation in the regions, which contribute to an increase in the incidence of periodontitis, the main role is played by high levels of pollution of the atmosphere, water, vegetation and soil with oxides of nitrogen, carbon, sulfur, as well as non-ferrous and other metals. Environmental degradation in industrial centers and increased anthropogenic impact on soil, water resources, plants and the human body, as well as associated aerosol pollution, provoke the development of inflammatory diseases, including periodontitis, and cause serious allergic reactions. Numerous epidemiological studies conducted in recent years have demonstrated the significant prevalence of periodontal diseases worldwide. These diseases occur in all age groups, manifest themselves in various forms of severity and often worsen with age. Generalized periodontitis of moderate to severe degree is common, especially in people over 45 years of age.
Key words: periodontitis, inflammation, treatment, diagnosis
Introduction. Inflammatory periodontal diseases represent one of the most significant problems in the field of dentistry. According to research by the World Health Organization (WHO), the highest percentage of gingivitis and periodontitis is observed in the age group from 34 to 45 years, affecting 97% of the adult population. The main task of modern dentistry is the development and implementation of new, more effective methods for the conservative treatment of chronic generalized periodontitis [1-4]. Despite the wide range of existing medicines and diagnostic and treatment methods, not all of them guarantee the elimination of all symptoms and the achievement of complete remission. The high prevalence, aggressive course and influence of chronic generalized periodontitis of mild and moderate severity on other body systems emphasize the need for research to create new algorithms and approaches in the conservative
treatment of this disease, which will minimize the negative consequences and limitations in treatment. In the treatment of various inflammatory periodontal diseases, patients may be prescribed medications that include components that stimulate immunity, promote regeneration, affect the microflora of periodontal pockets, improve tissue nutrition and reduce inflammation. In this context, special attention should be paid to drugs containing active substances such as netilmycin and propolis. In addition, additional treatment methods can be used, for example, various physiotherapy procedures that increase the ability of tissues to repair and have antiinflammatory and regenerating effects [5-7].
Periodontal diseases are among the most common and socially significant dental problems. The issues of diagnosis and treatment of periodontal pathology pose a serious challenge to dental science and practice due to the long-running debates on etiology and pathogenesis, as well as due to the diversity of existing classifications reflecting ambiguity in terminology [8].
Chronic diseases are known as the final stage of a long-term pathological process in the body initiated by the influence of harmful factors that can affect the progression of the disease both directly and indirectly [9].
According to statistics from the World Health Organization, the causes of human diseases are distributed as follows: genetic factors account for 20%, environmental influences - 25%, and lifestyle has the greatest impact, occupying 55% [10].
Many scientific papers indicate that the cause of periodontal diseases, along with the general level of immunity, the presence of systemic diseases, genetic predisposition and other factors, is insufficient oral hygiene. Yu. A. Fedorov and V. N. Koren emphasize that the incidence of periodontitis decreases to 30.4% with regular and proper oral care, while with unsystematic care, it is 37.5%, and increases to 48.5% in its complete absence. This state of affairs directly affects the local immune status of the oral cavity and causes the progression of pathological changes that accompany all forms of inflammatory periodontal diseases [11].
A low level of oral hygiene is the main factor in the formation of dental plaque and biofilms containing specific microflora with high periodontal pathogenic potential. These formations are considered a key factor in the etiology of inflammatory processes of periodontal tissues [12].
One of the main tasks of a doctor is to organize individual hygiene measures for each patient aimed at monitoring the state of oral hygiene. This serves as a foundation for sanitary and educational work. Inflammatory and destructive periodontal diseases are considered one of the most difficult and common problems in dentistry and are the main cause of tooth loss among the adult population. An epidemiological study conducted by the World Health Organization (WHO)
in 35 economically developed countries among people aged 31-44 years showed a high prevalence of periodontal diseases — over 75%. This is confirmed not only by the high incidence rate, but also by a noticeable decrease in the age of patients suffering from this disease. According to E.M. According to Kuzmina, intact periodontal disease is detected in only 12% of people, while the rest have lesions of varying severity — from initial inflammatory to severe destructive changes with loss of teeth. Severe periodontitis, leading to tooth loss, occurs in 5 -15% of cases in most of the studied populations [13, 14].
It should be noted that the patient's age plays a significant role in the development of periodontal diseases, as the number of systemic diseases and drugs used to treat them increases with age, which leads to a decrease in the effectiveness of protective mechanisms, especially in elderly patients. With increasing age, there is a decrease in bone density and a slowdown in healing abilities due to a decrease in metabolic activity [15]. In addition, taking medications, including corticosteroids, immunosuppressants, hydantoin, heavy metal salts, oral contraceptives and cyclosporine, can negatively affect the condition of periodontal tissues [16].
According to modern literature sources, disorders of metabolic processes in periodontal tissues caused by exo- and endogenous factors and dysfunction of enzymatic systems lead to a violation of the periodontal blood supply. Blood microcirculation plays an important role in tissue nutrition and compensation in the development of inflammatory and ischemic lesions of periodontal tissues. Blood circulation provides periodontal tissues with oxygen and nutrients, and also helps to remove metabolic products. However, a decrease in the stroke and minute volume of the heart, as well as arterial hypotension, can lead to a decrease in perfusion pressure in the vessels of the supporting and retaining apparatus of the tooth, which in turn causes the development of dystrophic changes. These changes reduce the resistance of periodontal tissues [17, 18].
Modern methods of treatment of inflammatory periodontal diseases. Periodontists have been striving for many decades to improve the results of comprehensive treatment of chronic generalized periodontitis. The importance of this problem is due to the high prevalence of this disease, which is associated with changes in the standard of living of the population, deterioration of the environmental situation, resistance of microflora to widely used antibacterial drugs and a decrease in the overall resistance of the body. In addition, many people still have an unsatisfactory hygienic condition of the oral cavity.
During the development of pathologies in the periodontium, the destruction of the ligamentous apparatus of the teeth, the formation of periodontal pockets and bone resorption occur. These changes set the main goal of periodontal surgery — the regeneration of lost periodontal structures and stabilization of the disease. Modern practice includes the use of
autogenic, allogeneic, xenogenic, alloplastic materials and membranes for directed tissue regeneration to repair intraosseous defects. Many researchers note the high osteogenic properties of autografts and the lack of an immune response to the transplantation of their own tissue. However, the use of autografts is not always possible due to additional trauma in the donor area. Systemic osteopathies are a contraindication to their use. Moreover, when autosteous tissue comes into contact with the surface of the roots of teeth, resorptive processes can accelerate due to the activity of osteoclasts.
Describing the high osteoinductive and osteoconductive properties of allografts, it is necessary to mention the risk of immune conflict and the possibility of transmission of viral diseases. The opinions of researchers on the use of brefomaterial are divided: some support the use of human embryo bone tissue, while others are critical of this, paying attention to the immaturity of the bone matrix in the third month of intrauterine development, rapid resorption and low biomechanical strength. Many researchers highlight the effectiveness of composites based on hydroxyapatite and collagen, which are structurally similar to the bone matrix, but have excellent physical and mechanical properties such as brittleness, porosity and rapid biodegradation. In this regard, the issue of the ability of alloplastic materials to stimulate the formation of new bone remains debatable.
Contraindications to the use of plasma therapy techniques include: systemic hematopoietic diseases, malignant neoplasms, allergic reactions to heparin, acute infectious diseases and decompensated form of diabetes mellitus [19, 1]. Platelet plasma used in plasmolifting contains growth factors (PDGF, PDAF, TGFb, IGF, EGF, PD-ECGF), which they stimulate capillary germination, normalize hemodynamics, tissue respiration and metabolic processes. About thirty years ago, Rita Levi-Montalcini and Stanley Cohen (1986) discovered that platelets secrete biologically active polypeptide molecules that emit specific signals perceived by receptors on damaged cells. These cells, in response to the signal, activate division, which promotes regeneration. Thus, an increase in the level of platelets in the blood leads to an increase in their effect on regenerative processes. The strengthening of bone tissue occurs through the formation of a collagen matrix and bone structure with the participation of collagen proteins, while local immunity is also activated [20].
The use of platelet autoplasm is an advanced method in the strategy of treating inflammatory and destructive processes in periodontal tissues and accelerated implant engraftment without complications. This method of treatment allows you to achieve the desired results in a shorter time and provides a long-lasting effect. Currently, there are no alternative operations that could be compared in efficiency, quality, aesthetic and other indicators with dental implants in dentistry.
Currently, considerable attention is being paid to the role of stomatogenic infection in the pathogenesis of diseases of the cardiovascular system. In particular, it was found that periodontitis is important for the occurrence and development of atherosclerosis. These studies emphasize the importance of studying the etiology and pathogenesis of periodontitis. New knowledge in this field can significantly improve the effectiveness of treatment and prevention of this pathology.
Conclusions. In conclusion, inflammatory periodontal diseases such as gingivitis and periodontitis remain one of the main problems in dentistry. They affect a significant part of the population and require a comprehensive approach to treatment and prevention. Modern treatment methods, including pharmacotherapy and physiotherapy procedures, as well as innovative approaches such as the use of platelet autoplasm, offer new opportunities to improve the periodontal condition and the quality of life of patients. However, despite advances in periodontics, it is important to emphasize the role of prevention, including proper oral hygiene and regular dental examinations, to prevent the development and progression of periodontal diseases. Taking into account the influence of lifestyle, ecology and genetic factors, an integrated approach to periodontal health should include both medical and social aspects.
ПАРОДОНТИТПЕН АУЫРАТЫН НАУЦАСТАРДЫ ЕМДЕУ ЭД1С1Н
ОЦТАЙЛАНДЫРУ * Шертаева А.Ж., Куракбаев К.К.
«^ДСЖМ» ^азакстан медициналык университет ЖШС Алматы, ^азакстан
Тушндеме
ДYниежYзiлiк денсаулык сактау уйымыныц мэлiметтерi бойынша, тютердщ шшар а жогалуы-бул жер шарыныц 75% -на дешн эсер ететш тю-жак жYЙесшщ ец кеп таралган ауруларыныц бiрi. Бул аурудан зардап шегетш адамдардыц пайызы жэне жетюпейтш тютердщ саны жасына карай артады.
Периодонтит ауруыныц есуiне ыкпал ететш аймактардагы экологиялык жагдайдыц нашарлау себептершщ арасында атмосфераныц, судыц, еамд^ердщ жэне топырактыц азот, кемiртек, кYкiрт оксидтерiмен, сондай-ак тYCтi жэне баска металдармен ластануыныц жогары децгей басты рел аткарады. Энеркэсiптiк орталыктардагы коршаган ортаныц нашарлауы жэне топыракка, су ресурстарына, есiмдiктерге жэне адам агзасына антропогендш эсердщ жогарылауы, сондай-ак онымен байланысты аэрозольдiк ластану кабыну ауруларыныц, соныц iшiнде периодонтиттщ дамуын тудырады жэне ауыр
аллергиялык реакцияларды тудырады. Соцгы жылдары жYргiзiлген кептеген эпидемиологиялык зерттеулер бYкiл элемде пародонт ауруларыныц айтарлыктай таралуын керсетп. Бул аурулар барлык жас топтарында кездеседi, ауырлыктыц эртYрлi формаларында керiнедi жэне кебiнесе жасына карай нашарлайды. Орташа жэне ауыр жалпыланган периодонтит, эаресе 45 жастан аскан адамдарда жш кездеседi.
ТYйiндi свздер: периодонтит, цабыну, емдеу, диагностика
ОПТИМИЗАЦИЯ МЕТОДА ЛЕЧЕНИЯ ПАЦИЕНТОВ С ПАРОДОНТИТОМ
* Шертаева А.Ж., Куракбаев К.К.
ТОО Казахстанский медицинский университет «ВШОЗ» г.Алматы, Казахстан
Аннотация
По данным Всемирной организации здравоохранения, частичная потеря зубов является одним из наиболее распространенных заболеваний зубочелюстной системы, от которого страдает до 75% населения земного шара. Процент людей, страдающих этим заболеванием, и количество отсутствующих зубов увеличиваются с возрастом.
Среди причин ухудшения экологической обстановки в регионах, которые способствуют росту заболеваемости пародонтитом, основную роль играют высокие уровни загрязнения атмосферы, воды, растительности и почвы оксидами азота, углерода, серы, а также цветными и другие металлы. Ухудшение состояния окружающей среды в промышленных центрах и усиление антропогенного воздействия на почву, водные ресурсы, растения и организм человека, а также связанное с этим аэрозольное загрязнение провоцируют развитие воспалительных заболеваний, в том числе пародонтита, и вызывают серьезные аллергические реакции. Многочисленные эпидемиологические исследования, проведенные в последние годы, продемонстрировали значительную распространенность заболеваний пародонта во всем мире. Эти заболевания встречаются во всех возрастных группах, проявляются в различных формах тяжести и часто усугубляются с возрастом. Распространен генерализованный пародонтит средней и тяжелой степени, особенно у людей старше 45 лет.
Ключевые слова: пародонтит, воспаление, лечение, диагностика
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Conflict of interest. The author declares that there is no potential conflict of interest requiring disclosure in this article.
The contribution of the authors. The author contributed to the development of the concept, the execution and processing of the results, and the writing of the article. We declare that this
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Corresponding author. Shertayeva Aigerim Zharkynbekkyzy— 2nd year master's student in the specialty «Medicine», LPP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan, E-mail: Drshertayeva@gmail. com
Kurakbayev Kuralbai Kurakbayevich- MD, Professor, LPP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan, E-mail: kiirakhavevamail. ru, ORCID https://orcid.org/0000-0002-8117-6846
Article submitted: 30.05.2024 Accepted for publication: 04.06.2024
