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ORAL HEALTH STATUS OF PATIENTS WITH PULMONARY TUBERCULOSIS Murtazaev S.S.1, Utesheva I.Z.2, Parpieva N.N.3
1Murtazaev Saidmurodkhon Saidialoevich - Doctor of Medical Sciences, Associate Professor; 2Utesheva Iroda Zokirzhonovna - assistant DEPARTMENT OF PEDIATRIC THERAPEUTIC DENTISTRY TASHKENT STATE DENTAL INSTITUTE 3Parpiyeva Nargiza Nusratovna - Professor, Director, REPUBLICAN SPECIALIZED SCIENTIFIC AND PRACTICAL MEDICAL CENTER FOR PHTHISIOLOGY AND PULMONOLOGY
TASHKENT, REPUBLIC OF UZBEKISTAN
Abstract: today tuberculosis (TB) is a curable disease. Its prevalence decreased significantly after the introduction of streptomycin and polychemotherapy, but the problem has not been completely solved problem, and it has reappeared in a spectacular manner forcing doctors to keep it in mind not only when faced with lung diseases but also when diagnosing and treating symptoms located in various other organs. Keywords: tuberculosis, caries, stomatitis, congenital pathologies.
СОСТОЯНИЕ ЗДОРОВЬЯ ПОЛОСТИ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ
1 2 3
Муртазаев С.С. , Утешева И.З. , Парпиева Н.Н.
1Муртазаев Саидмуродхон Саидиалоевич - д.м.н., доцент;
2Утешева Ирода Зокиржоновна - ассистент, Кафедра Десткая терапевтическая стоматология, Ташкентский государственный стоматологический институт;
3Парпиева Наргиза Нусратовна - профессор, директор, Республиканский специализированный научно-практический медицинский центр фтизиатрии и пульмонологии,
г. Ташкент, Республика Узбекистан
Аннотация: сегодня туберкулез (ТБ) является излечимым заболеванием. Его распространенность значительно снизилась после внедрения стрептомицина и полихимиотерапии, но проблема не была полностью решена, а вновь проявилась эффектным образом, заставляя врачей помнить о ней не только при заболеваниях легких, но и при диагностике и лечении. симптомы, расположенные в различных других органах. Ключевые слова:туберкулез, кариес, стоматит, врожденные патологии.
УДК:616.31-002.5.078
Dental diseases are the most common diseases in the human body. A special place among them is occupied by diseases of the oral mucosa (OOM). There is no such organ or tissue where a greater number of diseases occur than on the OAS. But even though the causes of occurrence, the mechanisms of development and their clinical course are quite diverse, many of these diseases are characterized by some common signs, which makes it possible to combine them into separate related groups.
With tuberculosis, not only the general condition of the body suffers, but also the condition of the oral cavity. However, the structure of dental morbidity in patients with respiratory tuberculosis is not fully understood. The algorithms for the treatment of dental diseases against the background of chemotherapy for infectious pathology require clarification; there is no single methodological approach to the choice of methods and timing of its implementation. According to the WHO, the prevalence of inflammatory periodontal diseases reaches 80-100% in different age groups, while chronic generalized periodontitis is the most common. At the same time, the features of the course of inflammatory periodontal diseases, depending on the severity of tuberculosis infection, have not been finally established. The oral cavity is a kind of ecological system that closely interacts with both the internal environment of the body and external factors. The occurrence and intensity of pathological processes are directly related to the qualitative and quantitative composition of the microflora of dental plaque and plaque. In patients with active forms of tuberculosis, mycobacterium tuberculosis can be found in the microflora of the oral cavity, which, in turn, affects the microbiocenosis of the oral cavity. The role of local immunity of the oral cavity in the occurrence of dental caries, periodontal disease and oral mucosa is known. In chronic generalized periodontitis, there is an imbalance in the factors of local immunity of the oral cavity.
According to the WHO, the quality of life is characterized by how a person perceives himself in society, his attitude to culture and value systems, correlating them with his goals, concerns, expectations, and standards. When studying the quality of life of a patient, data are evaluated showing his physical, psychological, and social interaction, the effect of the disease on the general condition of the patient and his well-being. The problem of assessing the quality of life in patients with
tuberculosis in the modern world is relevant, due to the high prevalence and medical and social significance of pulmonary tuberculosis.
At the same time, the indicator "quality of life" reflects the patient's attitude to his health and does not in any way assess the severity of the disease. Today, the study of the quality of life can be considered an effective method for assessing the well-being of both one person and a group of individuals, dividing them by sex, age, professional activity, and many other criteria. In the studies conducted, a decrease in the quality of life in patients with pulmonary tuberculosis, including those with disabilities or those with complications, has been noted. Studies conducted to assess the quality of life in patients with a dental profile make it possible to determine the impact of dental health on the quality of human life. Diseases of the oral cavity organs affect the general health of a person, changing his usual behavior, often causing severe pain, changing his diet, speech, well-being, thus changing the quality of life. In the study of dental morbidity, the assessment of the quality of life is one of the necessary components. For this, specialized dental tests are used to determine the frequency and degree of the impact of oral diseases on physical, mental and social well-being.
The consistency of assessing the quality of life using a special questionnaire Oral Health Impact Profile (OHIP-14-RU) has been proven by many modern domestic scientists. When assessing the effectiveness of complex dental care, the patient's subjective perception is used to reflect the quantitative criteria of the quality of life. In modern 34 domestic dentistry, the use of such indicators is relevant due to the fact that the improvement of all aspects of the quality of life, including dental, is solved at the federal level with the help of national projects. In connection with the high incidence of pulmonary tuberculosis among various groups of the population, interest in assessing the psychological sphere in phthisiatric patients is increasing, while, based on knowledge of the characteristics of the psychology of such patients, it is possible to predict ways and methods of increasing the effectiveness of complex treatment of pulmonary tuberculosis. So, with infiltrative tuberculosis, not only physical, but also social and psychological indicators of the quality of life deteriorate.
The successful treatment of tuberculosis at the present time does not exclude it from the group of serious diseases. This pathology has a strong effect on the psychological state of the patient: a person begins to relate to himself in a different way (influence on self-awareness), in a different way evaluates his capabilities and his role in the lives of other people (changes self-esteem), changes his worldview, reduces self-confidence and tomorrow. Such experiences can lead the patient to an increase in psycho-emotional stress, self-isolation, indiscipline in the implementation of the doctor's recommendations and early incomplete termination of treatment.
In the special literature, there are conclusions about the personality traits that contribute to the development of a disease such as tuberculosis. These include some features of character, a person's relationship not only to himself, but also to other people. Stressful conditions often occur, in which psychoemotional overstrain and depletion of the adaptive and protective mechanisms of the body occur. Therefore, patients of this profile, in addition to psychoemotional optimization of the state, need to correct some personality traits. According to G.Ya. Kosheleva. (1990), in patients who first became infected with pulmonary tuberculosis, neurotic disorders are revealed, in the symptoms of which vegetative-somatic and emotionalpersonal disorders are expressed, and women are most susceptible to these disorders. Such patients are characterized by a decrease in the level of subjective control, which is reflected in a passive, and often inadequate, attitude to their disease and the necessary treatment. At the same time, family and social status plays an important role.
The studies carried out also prove that tuberculosis has an adverse effect not only on the physiological component of the patient's life, but also on his physical, emotional, psychological, and social functioning of the human body. These changes can be identified by assessing the indicators of the patient's quality of life. One of the pathogenetic methods of treatment in patients with tuberculosis infection is the use of psychotherapeutic corrective therapy. Analyzing the data of special domestic and foreign literature, the relationship of combined general somatic pathology and diseases of the oral cavity is an urgent problem of modern medicine. Pulmonary tuberculosis, being a socially significant disease, is widespread throughout the globe, affecting all segments of the population. This systemic infectious disease affects the physical, 36 psychological and social components of human health.
In Uzbekistan, at this time, there are no clear algorithms for the provision of dental care to patients with respiratory tuberculosis, no optimal pathogenetic treatment regimens for inflammatory periodontal diseases in this category of patients have been proposed. In this regard, the necessity and timeliness of this study is beyond doubt.
The pathological process affects the mucous membrane of the oral cavity, gums, cheeks, hard and soft palate, tongue, red border of the lips.
The symptoms of oral tuberculosis are different depending on the severity, nature, shape, and localization of the process. Clinically, they are characterized by several general functional disorders of the body, characteristic of tuberculous intoxication, and local symptoms, including manifestations of pulmonary lesions and the direct picture of tuberculosis of the oral mucosa.
Oral manifestations of TB are rare because saliva continuously acts on the bacilli and prevents it from depositing on oral tissue. When bacilli achieve penetration of the mucosa, they are phagocytized and incorporated into the circulation without causing oral lesions. The mucosa is not environmentally suitable for development of mycobacterium tuberculosis. The clinical characteristics of TB in the mouth can be primary (rare) or secondary (much more common) infections. The gums are most frequently affected by primary infections, followed by the oropharynx. Nevertheless, the parotid can also be affected. Secondary forms are mainly located on the tongue.
Children and young adults are most likely to be affected especially because of immunosuppression and the association shown by some studies with HIV/AIDS. A study in India of 212 children with HIV found that 132 of them (62.26%) presented oral lesions, and TB was reported as a systemic disease in 49.1%. Thirty- three patients (26%) did not show immunosuppression, 74 (58%) had moderate immunosuppression, and 20 (15%) had severe immunosuppression. In all cases it was shown that oral lesions correlated with lesions elsewhere in the body.
In contrast, the case reported here is a 69-year-old patient with no history of any primary or secondary immunosuppression.
In primary oral TB, lesions occur most commonly in the form of ulcers which appear pitted and are surrounded by edematous areas (20). The edges of these ulcers bleed but heal spontaneously after 10 to 20 days. Their sizes vary, but they average 2 to 3cm in diameter. They are whitish with a regular background and are usually located at the front and on the ventral surface of the tongue. When TB occurs in the nodular form, the clinical course is more persistent and painful. In these cases there is painless cervical lymphadenopathy which subsequently can form abscesses and open to the skin. They discharge a necrotic material. Lymphadenopathy may suggest malignancy.
Oral TB and lesions in other organs or other areas of the eye, nose and throat region are more common in secondary infections although they usually originate in the lungs. In these cases, the lesions occur by direct infection of the mycobacteria from the sputum when a previous mucosal lesion allows infection or by transmission through the blood or lymph. The most frequent site for tubercular ulcers and nodules is on the back of the tongue. Ulcers are resectable, non-adherent, soft, and usually painful. Pain is exacerbated during chewing and typically radiates to the ear. Lesions are rounded so that when cleaned they show yellowed corpuscles and bleeding points. These corpuscles are called yellow beans or Trelat signs. They are usually accompanied by cervical lymphadenopathy.
The patient reported on here had a form of secondary tuberculosis with lingual compromise without ulcers, but with quite a few painful nodules on the dorsal surface of the tongue. He also presented thrush on the ventral side. This is a truly unusual finding not found in the literature reviewed. Adenopathy was never evident in any of the explored node chains.
The patient's oral condition and clinical, radiological, and endoscopic signs are nonspecific. Usually the diagnosis is made by histopathology that differentiates among granulomatous and neoplastic diseases. A biopsy of the lingual region shows chronic granulomatous inflammatory reaction suggestive of TB, as was seen in the study of one of the lingual nodules of this patient. When there is lymphadenopathy of the cervix or elsewhere, it can provide support for a diagnosis. However, it should be considered that sometimes the histopathology of the initial biopsy reveals only nonspecific inflammation. Excised tissue biopsy is essential for differential diagnosis. Other possible diagnoses which must be discarded include squamous tongue cancer, smoking, histoplasmosis in endemic areas, syphilis, traumatic lesions, aphthous ulcers, lymphomas, and various bacterial infections. Polymerase chain reactions are also useful because of their high specificity in detecting genomic material of mycobacterium tuberculosis.
Although the diagnosis of lingual TB is a real clinical challenge, early identification is essential. Lesions can be completely healed with specific antimicrobial treatment for between two and eight months. Some authors indicate six months despite lingual TB's association with other locations in the oral cavity, larynx, and lung.
A literature review was carried out, and the work done on the state of the oral cavity in persons with tuberculosis was reviewed, which at the moment remains a very hot topic, since this problem is not considered in such detail and it is necessary to take into account the fact that the state of the oral cavity in patients with drug-susceptible and drug-resistant forms of tuberculosis, and it will probably be further clear also the difference in the state of the oral cavity in persons with pulmonary and extrapulmonary forms of tuberculosis.
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