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Section 4. Medical science
Yusupalikhodjaeva Saodat Hamidullaevna, PhD, Tashkent State Dental Institute, Uzbekistan, Faculty Dental Therapeutics department E-mail: syx76.76@mail.ru Bekjanova Olga Esenovna, PhD, MD, DDS, ashkent State Dental Institute, Faculty Dental Therapeutics department E-mail: bekjanovaolga@mail.ru
Pathogenetic aspects of treatment of periodontitis associated with candida infection in patients with diabetes mellitus
Abstract: It is currently known a large number of substances with properties of free radicals play a role in metabolic processes. In the presence of fungal flora in the oral cavity. The expressed shifts lipid peroxidation, which actively interacts with the phospholipids of cell membranes, they change conformation of biomolecules and reduce membrane fluidity and, hence, the pressure of a cell resistance damaging factors including to the effects of Candida fungi. When included in the treatment regimen provides an antifungal drug FLUNOL synthesis and activity of antioxidants.
Keywords: free radicals, lipid peroxidation, of Candida, pathogenetic treatment, chronic periodontitis, diabetes.
Catalysts are currently known a large number of substances of free radicals (FR) with the properties, plays a role in metabolic processes [5, 85-88].
Free radicals — a variety of substances in nature, characterized by one common feature — the presence of water from the atoms of the unpaired electron. This state of matter is unstable, and free radicals tend to become stable in products by a free electron pairing [5, 88-95; 3, 100].
The most famous and important is the active oxygen species (AOS): superoxide anion radical (O2-); hydroxyl radical (HO-); hydrogen peroxide (H2O2), singlet oxygen (1O2) [5].
Adjustable intensity of the AOS is the physiological metabolic process. Under their influence, there are processes of renovation phospholipids regulated permeability of cell membranes. They activate the membrane proteins, immunoglobulins, enzymes. Activities FR affects the process of cell division and oxidative phosphorylation. The products of free radical reactions and lipid peroxidation are involved in the biosynthesis of progesterone, a steroid and thyroid hormones, leukotriene's and prothrombin. In addition, oxygen metabolites are important components of cellular responses and humoral immunity [5, 85-95].
Excessive activation of lipid peroxidation (LPO) triggers the formation of excess free radicals. The stability and sustainability of the epithelial cell membrane depends on the balance between the processes of free radical oxidation (FRO) [5, 87-90]. The peroxide destruction leads to an explosion of the membrane of epithelial cells, thereby optimizing the adhesion of organisms per cell.
At the same time, the presence of fungal flora in the oral cavity pronounced shifts observed lipid peroxidation. Actively interact with the phospholipids of cell membranes, they change conformation of biomolecules and reduce membrane fluidity, therefore, the cells resistant to the onslaught of disturbing factors, including exposure to Candida fungi. Furthermore, it should be noted that the failure of the system can be balanced LPO start a chain reaction of reactive oxygen species, which greatly exacerbates the disease occurred.
However, it is advantageous that in the body there are mechanisms that control the formation of free radicals and lipid peroxidation regulatory processes in the complex they form its antioxidant protection (AOP). Antioxidants act as protectors and inhibitors of pathological reactions, contribute to the inhibition of destructive
processes, slow down aging and cell death. The physiological antioxidant system is a total hierarchy of protective mechanisms of cells [1, 40-43; 3, 220].
Antioxidants break the chains of molecules in the reactions of free radical oxidation and destroy peroxide molecule. Among enzymatic antioxidants include superoxide dismutase, glutathione peroxidase and catalase, are in the cellular structures. Non-enzymatic antioxidants - Vitamin E, K, C, ubiquinone, tryptophan, phenylalanine, ceruloplasmin, transferrin, haptoglobin, glucose, carot-enoids, flavonoids, blocking the activity of free radicals in blood. Changes in the structure and function of the substrates, which act on free radicals depend ultimately on the ratio of activity of free radicals and antioxidants. Increasing the ratio of FRO/AOP specific to oxidative stress — an important factor in the pathogenesis of many diseases [1, 42-43; 8, 430-431].
In modern pharmacology antioxidants are subdivided into water-soluble and fat-soluble [2, 8-12]. Fat soluble antioxidants include one of the most powerful antioxidant — alpha-tocopherol, which plays a major role in protecting the basic structural components of biological membranes — phospholipids. The structure of the molecule enables it to effectively destroy the majority of reactive oxygen metabolites and provide antioxidant protection lipoprotein serum. Tocopherol — only lipid soluble antioxidant, a chain terminator plasma oxidation and human erythrocyte membranes.
Is invaluable in the water-soluble antioxidant - ascorbic acid, which reduces the level of superoxide anion-radical, singlet oxygen, hydroxyl radical, peroxide radical, regenerates vitamin E and glutathione oxidized form, thus restoring their antioxidant properties [1, 39-41; 10, 264-266]. In addition, there are substances necessary for the synthesis and activity of antioxidants.
The role of certain etiological factors in the development ofperi-odontal disease is almost set, but in relation to the pathogenesis so far no consensus [3, 45-150; 7, 34-35; 9, 129-131]. The development of periodontal disease is often associated with the proliferation of Candida. The frequency of detection of Candida in parasitocenoses periodontal pockets was 26.9 % [4, 61-62; 6, 42-43; 8, 428-430]. Among patients with chronic generalized periodontitis (GP) associated with Candida spp., Often recorded moderately (51.1) or severe (29.8) of the disease [1, 39-41; 2, 18-20]. The urgency of the optimization of complex treatment of generalized periodontitis associated with Candida infection is evident.
Pathogenetic aspects of treatment of periodontitis associated with Candida infection in patients with diabetes mellitus
Objective: To evaluate the clinical efficacy in treatment Flu-nol in Candido — associated periodontal disease in patients with diabetes mellitus.
Materials and methods: Patients with generalized periodontitis associated with Candida spp. They were divided into 2 groups: group 1 (control), 14 patients received conventional treatment; Group 2 (basic) 15 patients received standard therapy in addition to a new antifungal drug FLUNOL (firm NOBEL, Turkey) at a dose of 50 mg. 1 time in 14 days.
Objective condition of periodontal tissues was assessed complex periodontal indices. Carried out X-ray examination. Were performed conventional periodontal treatment. Antibiotic and antiinflammatory therapy consisted of rinsing the mouth 0.05 % chlorhexidinebi-gluconate 2 times a day after brushing, application of metronidazole ("Metrogil-denta gel") to the periodontal pocket, absorption in the mouth 6-8 tablets Anzibel 7 days. Delivery to the lab material for bacteriological examination in order to identify the genus Candida fungi was carried out in a liquid medium Saburo, crop produced on dense medium Saburo. We use a standard environment, HiMedia production (India). Statistical processing of the research data was performed using the program «Stat Soft Statistica» v. 6.0.
Results and discussion: In the clinical examination of the oral cavity in patients with established presencewhite plaque on gingival mucosa and tongue — palatine arches and cheeks. For some patients with Candida-associated periodontitis showed infiltration of individual sections of the gingival margin in the form of a dense to the touch roller. Patients diagnosed advantageously higher microbial concentration Candida spp. Thus, to treat Candida
spp. recorded in titers less than 6.0 CFU/ml in 46.67-50.0 % of patients, and more than 6.0 CFU/ml — from 50.0-53.33 % (in-tergroup differences to treatment is not revealed). As a result of therapeutic interventions in patients with periodontitis associated with Candida spp., Were observed normalization of oral hygiene, reduction or complete disappearance of bleeding, sealing of the gingival margin, reduction of tooth mobility. All the defined tests (health index, PMA, gum recession, periodontal index, the degree of bleeding gums) in patients with GP associated with Candida spp., in the II main group II after treatment values were significantly (P < 0.05) closer to normal values. I than in patients of the control group. Therefore, the clinical efficacy of treatment of chronic periodontitis associated candida was higher in patients receiving treatment along with the basic antifungal drug FLUNOL.
Clinical improvement of the periodontal tissues, apparently mediated by both the eradication of fungal microflora and complex therapy ofperiodontitis. Eradication of Candida spp. achieved in all patients of the main group II, patients control group 1 Candida spp eradication was not so expressed: After treating 4 (12.07 %) of titer remained at more than 6.0 CFU/ml. Clinical and microbiological observations suggest a more effective eradication of Candida spp fungi. when included in the treatment regimen FLUNOL antifungal drug. The use of antimycotic agents FLUNOL a dose of 50 mg once every 14 days, increases the effectiveness of treatment of generalized periodontitis associated with Candida spp., Significantlyimproves the clinical-functional and structural periodontal condition, promotes the eradication of Candida spp. of periodontal pockets with achieving and maintaining disease remission for 6 months.
References:
1. Bekjanova O. Ye. Clinical efficacy flunol in the complex treatment ofperiodontitis associated with Candida infection//Stomatology. -2015. - № 1-2(59-60). - P. 39-43.
2. Beybulatov G. D. Improving the diagnosis and treatment of chronic generalized periodontitis associated with Candida infection: Avtoref. dis. ... K. m. n. - Saratov, 2014. - 22 p.
3. Grudyanov A. I. Periodontal disease/A. I. Grudyanov. - M.: MIA, 2009. - 336 p.
4. Nedoseko V. B. Prevalence of fungal flora and microbiocenosis especially in individuals with intact periodontium and chronic inflammatory periodontal diseases/V. B. Nedoseko, M. G. Chesnokova, O. A. Chepurkova, A. S. Komlev//Periodontology. - 2009. - №1. - S. 60-65.
5. Okovity S. V. Clinical pharmacology of antioxidants//Farmindeks practices. - 2003. - P. 85-111.
6. Tsarev V. N. The role of yeast fungi of the genus Candida in the development of periodontitis/V. N. Tsarev, R. V. Ushakov, T. V. Usha-kova, A. C. Spout//Dentistry. - 2005. - № 4. - S. 42-45.
7. Chepurkova O. A. Rationale for the use of antiseptic agents in treatment of patients with CGP and insemination habitat Candida/O. A. periodontal pocket Chepurkova, M. G. Chesnokov, V. B. Nedoseko//Periodontology. - 2009. - № 2(51). - P. 34-38.
8. Canabarro A. Association ofsubgingival colonization of Candida albicans and otheryeasts with severity ofchronic periodontitis/A. Cana-barro, C. Valle, M. R. Farias et al.//Periodontal Res. - 2013. - Vol. 48, № 4. - P. 428-432.
9. Thornton-Evans G. Periodontitis among adults aged >30 years - United States, 2009-2010/G. Thornton-Evans, P. Eke, L. Wei et al.//MMWR SurvrillSumm. V - 2013. - Vol. 62, Suppl. 3. - P. 129-135.
10. Lalla R. V., Patton L. L., Dongarri-Bagtzoglou A. Oral candidiasis: pathogenesis, clinical presentation, diagnosis and treatment strategies//J. Calif.Dent. Assoc. - 2013. - Vol. 41, 34. - P. 263.
