CC BY
8213. Sulaymonovich D.S. Ways to Eliminate Postoperative Complications after Ventral Hernia Repair in Patients with Morbid Obesity // American Journal of Medicine and Medical Sciences, 2017. ^ 7. № 3. Q 147-150.
THE STRUCTURE OF PERIODONTAL AND ORAL MUCOSA DISEASES IN PREGNANT WOMEN AGAINST THE BACKGROUND OF IRON DEFICIENCY ANEMIA (LITERATURE REVIEW)
12 3
Zoyirov T.E. , Sodikova Sh.A. , Elnazarov A.T.
1Zoyirov Tulkin Elnazarovich - Doctor of Medical Sciences,
Professor;
Sodikova Shoira Amriddinovna - Assistant;
Elnazarov Azamat Tulkin ugli - Assistant, DEPARTMENT OF DENTISTRY № 2, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the analysis of domestic and foreign scientific publications on the issue of periodontal disease in pregnant women against the background of iron deficiency anemia. The prevalence of periodontal diseases in pregnant women, the polyetiology of their occurrence, the complex mechanism of development, the characteristics of treatment and prevention are considered. Pregnancy, being a physiological process, has increased requirements for all types of metabolism in the body, which leads to changes in various organs and systems, including the oral cavity. The only way to solve this problem is a detailed study of the somatic and dental anamnesis, changes in all body systems, on the basis of which it is possible to create a well-founded complex of individual preventive measures and improve the therapy of the revealed disorders in the periodontal tissues of pregnant women with iron deficiency anemia. Keywords: iron deficiency anemia, periodontium, pregnancy, pathology, pathogenesis, prevention.
Introduction. The analysis of professional literature and modern scientific trends regarding the peculiarities of etiology, pathogenesis, treatment and prevention of periodontal diseases in pregnant women against the background of iron deficiency anemia has been carried out. It is known that pregnancy is accompanied by an increase in metabolism, when assimilation processes are significantly enhanced and the delay of dissimilation products, which must be removed from the body, increases. Such changes during pregnancy are due to hormonal changes, since it is known that the activity of the endocrine glands changes during pregnancy. Already from 3-4 months of pregnancy, the amount of estrogen in the blood increases sharply, which leads to an increase in the content of progesterone. Numerous clinical, histological and histochemical studies show that sex hormones have a significant effect on the body as a whole, especially on the vascular and skeletal systems. Estrogens stimulate the proliferation of gingival fibroblasts, affect the differentiation and growth of cells, inducing protein synthesis. They increase the activity of the bone marrow, have a general anabolic effect, have anti-inflammatory activity, and affect the duration of the cell life cycle. Progesterone causes expansion of gum capillaries, swelling [6, 14, 18, 30].
As a result of experimental studies and clinical observations, it was established: in pregnant women, periodontal disease occurs due to estrogen deficiency. This is because most of the estrogens that enter the blood of pregnant women bind to plasma proteins, and free estrogens acquire special vasoactive proliferative epithelial properties and are contained in saliva in high concentrations. So, changes in hormonal status significantly affect the occurrence and pathogenesis of periodontal disease in pregnant women [2, 7, 13, 20, 26].
During pregnancy, changes occur in a woman's body, in which it is quite difficult to separate the physiological compensatory mechanisms themselves from pathological manifestations. Other scientists believe that mainly during pregnancy there is an exacerbation of the chronic inflammatory process in the periodontal tissues as a result of significant changes in the
homeostasis of the oral cavity. Even deeper changes in the homeostasis of the oral cavity occur during the pathological course of pregnancy [26, 31].
A known fact in the pathogenesis of periodontal tissue diseases is the connection with systemic pathology of the body, and inflammatory and dystrophic-inflammatory lesions of the periodontium are predominantly secondary to systemic processes in the body, which are the basis of a number of diseases of internal organs [4, 19, 29].
Despite numerous studies by domestic and foreign scientists devoted to the dental status of pregnant women, the issue of preventing and treating periodontal diseases in this category of the population remains relevant. It is optimal to implement measures aimed at preventing the occurrence of dental diseases in the period from 3 to 6 months of pregnancy planning. According to special literature, the greatest manifestation of inflammatory phenomena in the periodontal tissues is observed in the II trimester of pregnancy, critical - in the III trimester, which makes it possible to determine the optimal periods of dental examinations and to take a differentiated approach to treatment and prophylactic measures [6, 13, 20, 30].
A common complication of pregnancy is iron deficiency anemia (IDA), which ranks first among all complications of the gestational period [1, 8]. IDA is a clinical and hematological syndrome characterized by a decrease in the amount of iron in the body (blood, bone marrow and depot), when the synthesis of heme is disrupted, as well as proteins that contain iron (myoglobin, iron-containing tissue enzymes). Tofan N.I. (2013) considers iron deficiency anemia as a total organ pathology, which leads to functional and morphological changes in all organs and tissues. The tissues capable of regeneration are especially damaged: the epithelium of the skin, respiratory tract, gastrointestinal tract, as well as the immune system, the main brain [15, 18, 25].
Against the background of reduced resistance of periodontal capillaries and secondary physiological immunodeficiency, the role of local irritating factors significantly increases. Pathogenic
microflora is an essential and driving factor in the development of generalized periodontitis (GP). Oral bacteria can have a local and systemic effect on human health by disseminating locally formed inflammatory mediators, provoking allergic or autoimmune reactions, aspirating the contents of the oral cavity and getting it into the digestive and respiratory systems. A special threat to the focus of infection in the oral cavity is posed for people with weakened immunity, which are pregnant women with IDA, they have a decrease in the colonization resistance of the body to infectious factors. Normally, the bacterial spectrum of the oral cavity is predominantly made up of various types of coccal microflora: non-hemolytic streptococci and non-pathogenic staphylococci [10, 23, 28].
Lactobacilli, Neisseria, Corynebacteria are present in large numbers in the oral cavity of healthy people. Endogenous microflora ensures the restoration of the mucous membrane, plays a role in metabolic processes and enzymatic reactions, synthesizes vitamins, acids (lactic, acetic, folic), hydrogen peroxide, bacteriocins, etc. [20, 31].
During microbiological studies, various degrees of oral biocenosis were found in pregnant women. It has been established that a violation of the ratio between the indicators of contamination of the oral mucosa of pregnant women by representatives of normal and opportunistic microflora increases the risk of complications of pregnancy and childbirth, as well as the risk of infection of the fetus and newborn [22].
Among the mechanisms of the damaging effects of periodontal pathogenes, there are disorders in the oral biocenosis, the ability of microorganisms to invade tissues, active secretion of toxins and enzymes, the synthesis of proteases that destroy immunoglobulins, inhibition of body defense factors, induction of apoptosis of lymphocytes [4, 17]. During prolonged contact of microorganisms with periodontal tissues, the development of alteration processes is possible until the formation of a periodontal pocket. This creates favorable conditions for the development of microflora in the oral cavity, the constant focus of which determines the development of periodontal pockets, affects
the state of the periodontal tissues and the body as a whole. Absorbed with blood and lymph, microbial and tissue toxins can cause the formation of a focal infection in other organs of the expectant mother, complicate the course of pregnancy. But the microorganisms themselves are not the cause of the disease, but become it only when interacting with a macroorganism, in the case of a combination of certain unfavorable conditions (for example, a failure in the functioning of the body's defense mechanisms) [16, 21, 23].
According to statistical studies, the prevalence of periodontal tissue diseases in pregnant women ranges from 84.0-89.2%, and according to S. Gajendra (2004), periodontal lesions of varying intensity during pregnancy are found in 100% of those surveyed. Comparison of the clinical state of the periodontium in pregnant and non-pregnant women of the same age, as well as taking into account the influence of the socio-economic state and other factors, is informative. Thus, a significant severity of gingivitis with progression of inflammatory changes during pregnancy was found in pregnant women [7, 16].
Comparative studies S. Moore et al. show that during pregnancy, bleeding of the gums was observed in 50-53% of women, and the index indicators of dental plaque and inflammation of the gums after childbirth prevailed over the same indicators in the third trimester of pregnancy. The index of periodontal pocket and bleeding during pregnancy is higher than after childbirth, although the amount of dental plaque is the same. Considering clinical evaluation data index scores of dental plaque, inflammation of the gums and the level of epithelial attachment, argue that pregnancy affects only the condition of the gums, and found no difference in indicators of loss of attachment in pregnant and non-pregnant women [8, 15]. According to many authors, gingivitis of pregnant women is most often manifested by gingival hyperplasia. The appearance of hypertrophic formations is associated with changes in hormonal status [18, 24].
So, it was found that during pregnancy, these areas are histologically rich in inflammatory cells and neutrophils, as well as proliferating fibroblasts and a newly formed capillary system.
Hypertrophic changes in the interdental papillae that have arisen during pregnancy, by morphological characteristics, can be classified as vascular epulis, and in non-pregnant women, such growths most often manifest themselves as hypertrophic gingivitis with pronounced lymphoplasmacytic infiltration of the stroma. Improvement in the condition of the gingival margin after childbirth (even without treatment) allows many researchers to make an assumption about the neurohumoral nature of hypertrophic processes in the gums that have arisen during pregnancy [6, 16].
According to many scientists, the first signs of gingivitis appear in the first trimester (at 10-12 weeks of pregnancy) as gum flushing, burning and itching in the gums. Also, there is an increased sensitivity to the effects of chemical and temperature irritants (sweet, sour, cold, etc.) of various groups of teeth, more often the front group. This may be due to an imbalance in the macrocosm of microelements (macrocosm of microdisselementosis), which are involved in the formation of the mineral basis of the fetus [26].
During the clinical examination, the main complaints and signs of gingivitis during this period are bleeding of the gums, bad breath (halitosis), hyperesthesia of the hard tissues of the teeth. In the first trimester, a common clinical form of the inflammatory process is catarrhal gingivitis, in the second trimester, gingivitis of pregnant women develops as catarrhal or hypertrophic inflammation, less often ulcerative necrotic lesions of the gums. Catarrhal gingivitis of pregnant women is characterized by generalized symmetric lesions of the frontal region of the upper and lower jaws. Patients complain of discomfort in the gums, itching, halitosis, impaired taste, bleeding gums while eating and brushing teeth. The general condition of women is not disturbed. As a result of edema, clinical (gingival) pockets are formed, on the teeth - an increased layering of soft plaque. Women avoid brushing their teeth due to soreness and bleeding of the gums, oral hygiene deteriorates, and the pathological process spreads to the interalveolar membranes of the alveolar bone of the jaws [5, 26].
During an objective examination, edema, hyperemia, cyanosis of the gums, foci of desquamation of the epithelium, single erosion, mainly in the zone of the tops of the interdental papillae, are noted, mechanical damage of which is accompanied by bleeding [6, 18, 21, 29].
In the third trimester and prenatal period, the clinical picture of hypertrophic gingivitis of pregnant women acquires its maximum development. The gums can cover almost the entire surface of the teeth, reaching the incisal edge, which leads to additional trauma, increased pain and bleeding. Due to the significant growth of the gums, deep gingival pockets with serous-hemorrhagic exudate are formed. X-ray examination, performed in the postpartum period, showed osteoporosis, partial destruction of the cortical layer of interalveolar membranes, allowed us to speak about the primary signs of irreversible changes in the periodontium inherent in generalized periodontitis [22, 27].
Treatment of inflammatory-dystrophic periodontal diseases is directed against infections, intoxication, activation of immunity, normalization of metabolic disorders in the periodontium and stimulation of regeneration. The choice of drugs from a large number of drugs used for local and general treatment of HP, due to the need to act both on the focus of inflammation (primarily on the pathogenic microflora of the oral cavity) and on dystrophic processes. So, the doctor seeks to influence the sanogenetic and pathogenetic processes in the periodontium, involving the use of antimicrobial, anti-inflammatory, desensitizing drugs, the effect on local blood circulation, the enhancement of regeneration processes, as well as the use of general strengthening, immunomodulation and stimulating therapy, etc. [11, 16, 23].
Traditionally, the treatment of periodontal diseases begins with the elimination of local irritants, for example, professional hygiene, including the removal of all soft and hard dental plaque and subgingival dental plaque, polishing the surfaces of the teeth. They immediately conduct training in oral care, give recommendations on the choice of hygiene products. The next stage is the elimination of the primary traumatic occlusion, the
treatment of symptomatic gingivitis and the elimination or reduction of periodontal pockets [3, 18].
Drug therapy in the treatment of periodontal diseases plays an auxiliary role aimed at the pathogenetic link of the inflammatory process in the periodontium, weakening infection in periodontal pockets, eliminating hypoxia, stimulating regeneration and scarring of periodontal pockets, inhibiting the growth of granulations in periodontal pockets, as well as increasing the protective capabilities of the periodontal [15, 26].
Antimicrobial topical therapy for inflammatory periodontal disease is of paramount importance. Modern antibacterial drugs do not have a wide enough spectrum of action to destroy all bacterial strains present in the periodontal pocket; they can cause serious systemic side effects (allergic and toxic). The use of antibiotics can promote the development of resistant strains of bacteria. In addition, the use of antibacterial agents during pregnancy is rather limited, so antiseptic agents are attracting a lot of attention. Antiseptics have a number of advantages: minimal absorption, no allergic reactions, high bactericidal activity against microorganisms on the cell surface [3, 9, 16, 30].
Despite the fact that most women now have a real consumption of macro- and microelements and vitamins with food is much less than the level that ensures a favorable course of pregnancy and lactation, the obligatory use of vitamin-mineral complexes in pregnant women with periodontal tissue diseases on the background of IDA. At the initial stages of HP, vitamin therapy is most effective [16, 22]. Foreign authors have defined the so-called concept of micronutrient programming for the development of an unborn child during pregnancy, which consists in the advisability of using multivitamin complexes.
The replenishment of reserves of micro- and macroelements should be viewed through the prism of the necessary physiological needs of the body, and not as the effect of drugs. The main task of dentists, obstetricians and gynecologists is to form an understanding of the importance of timely dental care in pregnant women by creating a positive motivation for treatment [16, 19].
In modern professional literature, the concept of individual prevention of dental diseases during pregnancy does not fully show the essence of the necessary measures to support a woman's dental health at a high level. So, it is advisable to search for new modern diagnostic methods and an individual approach to primary and secondary prevention of changes in the periodontal tissues of pregnant women. A detailed study of the somatic and dental anamnesis, changes in all systems of the body, the possibility of a reasonable creation of a complex of individual preventive measures, as well as improvement of the therapy of the revealed disorders in the periodontal tissues is necessary [15, 23, 26].
Conclusion. Pregnancy, being a physiological process, has increased requirements for all types of metabolism in the body, which leads to changes in various organs and systems, including the oral cavity. Deeper changes in metabolic processes occurring in the pathological course of pregnancy. In modern professional literature, the concept of individual prevention of dental diseases during pregnancy does not fully show the essence of the necessary measures to support a woman's dental health at a high level. The search for new modern diagnostic methods and an individual approach to primary and secondary prevention of periodontal tissue changes in pregnant women is urgent.
The only way to solve this problem is a detailed study of the somatic and dental anamnesis, changes in all body systems, on the basis of which it is possible to create a well-founded complex of individual preventive measures and improve the therapy of the revealed disorders in the periodontal tissues of pregnant women with iron deficiency anemia.
References
1. Abduvakilov J., Rizaev J. Characteristic Features of Hemostasis System Indicators in Patients with Inflammatory Periodontal Diseases Associated with Metabolic Syndrome // Journal of Advanced Medical and Dental Sciences Research, 2019. ^ 7. № 4. Р. 13-15.
2. Akhmedova N.Sh., Sokhibova Z.R., Boltayev K.J. Some features of laboratory indicators of micro and macro-elementary status of the organism of femaleage women in normality and in iron deficiency // Biomedical and practice magazine, 2020. № I -2. P. 238-244.
3. Alimdjanovich R.J. et al. Pathomorphological changes in the oral mucosa in patients with colon cancer // European Journal of Molecular & Clinical Medicine, 2020. ^ 7. № 7. Р. 666672.
4. Amriddinovna S.S. Optimization of therapeutic and preventive measures for periodontal diseases of pregnant women with iron deficiency anemia // Euro-Asia Conferences, 2021. ^ 1. № 1. P. 66-68.
5. Bahodirovich N.B. et al. Assessment of behavior and biochemical parameters of blood in experimental animals under conditions of a technogenic rotating electric field // Science and Education Bulletin, 2020. №.23-2 (101).
6. Bazhanova O.E., Kamilov Kh. P., Zoyirov T.E. Optimization of complex treatment of generalized periodontitis // Materials for the IV International Conference on Clinical Pharmacology and Pharmacotherapy: Topical Issues, 2014. P. 29-30 [in Russian].
7. Davlatov S.S. et al. A New method of detoxification plasma by plasmapheresis in the treatment of endotoxemia with purulent cholangitis // Academic Journal of Western Siberia, 2013. ^ 9. № 2. Р. 19-20.
8. Davlatov S.S., Kasimov Sh.Z., Kurbaniyzov Z.B, Ismailov A.O. A modified method of plasmаferesis in the treatment of patients with purulent cholangitis // Materials of the IX international scientific-practical conference" New Scientific Achievements, 2013. ^ 17. Р. 30-33.
9. Davlatov S.S., Kurbaniyazov Z.B. New method plasmapheresis in the treatment of cholemic endotoxicosis // Problems of biology and medicine, 2015. № 4. Р. 85.
10. Gadaev A.G., Rizaev Zh.A., Norbutaev A.B., Olimzhonov K.Zh. Iron, its role in the functioning of body systems and associated damage to the oral mucosa // Problems of Biology and Medicine, 2020. № 1. Volu e. 116. P. 219-224. DOI: http://doi.org/10.38096/2181-5674.2020.L00058 [in Russian].
11. Hamdamova M.T. The problem of the development of iron deficiency by using a copper-bearing intrauterine contraceptive // Europaische Fachhochschule. European Applied Sciences, 2014. Vol. 3. P. 44-45.
12. Indiaminova G.N., Zoirov T.E. Improvement Of Methods Of Providing Dental Care For Children With Mental Delayed Development // The American Journal of Medical Sciences and Pharmaceutical Research, 2021. T. 3. № 01. P. 111-116.
13. Kamilov Kh.P., Zoyirov T.E., Kamilov E.Kh. Efficiency of the Vektor apparatus in the complex therapy of endodonto-periodontal lesions // Achievements of Science and Education, 2018. № 5 (27) [in Russian].
14. Khadjimetov A.A., Rizaev J.A., Akramova S.A. The role of the system of hemostasis of blood and saliva in the development of the inflammatory process in the periodontium in patients with cardiovascular pathology // European Journal of Molecular & Clinical Medicine, 2020. T. 7. № 3. P. 36363645.
15. Khamdamov B.Z. et al. The role and place laser photodynamic therapy in prevention postoperative complication at treatment of diabetic foot syndrome // Applied Sciences: challenges and solutions, 2015. P. 27-31.
16. Khamdamov B.Z., Nuraliev N.A. Pathogenetic approach in complex treatment of diabetic foot syndrome with critical lower limb ischemia // American Journal of Medicine and Medical Sciences, 2020. T. 10. № 1. P. 17-24.
17. Khamidova N.K., Davlatov S.S. Correction of hyperlipidemia in various clinical forms of chronic glomerulonephritis. Monograph. Bukhara, 2021. 88 p.
18. Kudratova D.S., Ikhtiyarova G.A., Davlatov S.S. Medical and social problems of the development of congenital malformations during a pandemic // International Journal of Pharmaceutical Research, 2021. T. 13. № 1. P. 756-760.
19. Malik A., Yoshida Y., Erkin T., Salim D. & Hamajima N. (2014). Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in Samarkand, Uzbekistan. Nagoya Journal of Medical Science, 76(3-4). P. 255-263. Retrieved from www.scopus.com.
20. Rakhimova D.A., Tilloeva Sh.Sh., Husenov O.N., Kozilova N.A. Estimation of the condition of the cardiorespiratory system of patients with the concilation of bronchial asthma and arterial hypertension, effects of complex therapy // New day in medicine, 2020.-№ 2.230. P. 227-231.
21. Rizaev J.A., Maeda H., Khramova N.V. Plastic surgery for the defects in maxillofacial region after surgical resection of benign tumors // Annals of Cancer Research and Therapy, 2019. T. 27. № 1. P. 22-23.
22. Rizaev J.A., Rizaev E.A., Akhmadaliev N.N. Current View of the Problem: A New Approach to Covid-19 Treatment //Indian Journal of Forensic Medicine & Toxicology, 2020. T. 14. № 4.
23. Rizayev J.A., Khaydarov A.M. Fluoride concentration in water and its influence on dental diseases in Uzbekistan // World Healthcare Provoders. USA, 2015. T. 6. № 3. P. 4-6.
24. Rizayev J.A., Khaydarov N.K. Medical rehabilitation of patients with acute disorders of cerebral circulation: Literature review // American journal of research, Vienna, Austria, 2018. P. 9-10.
25. Shukurov E.M. et al. Treatment of Open Fractures of The Long Bones of The Lower Extremities with External Fixation Devices //International Journal of Pharmaceutical Research, 2021. T. 13. P. 2517-2521.
26. Sodikova S. Periodontitis in pregnant women // 36ipHHK HayKOBHx npa^ A'OTOX, 2021. P. 47-48.
27. Solieva N.K., Tuksonova D.I., Bobokulova S.B. The role of determining the study of D- Dimer parameters in predicting dic syndrome in women withantenatel fetal death// Academicia an international multidisciplinary research journal, 2020. № 7. P. 582-584.
28. Teshayev S.J., Khudoyberdiyev D.K., Davlatov S.S. The impact of exogenous and endogenous factors on the stomach wall, macro-, microscopic anatomy of newborn white rats // International Journal of Pharmaceutical Research, 2021. T. 13. № 1. P. 679-682.
29. Tulkin Z., Nigora A., Azamat E. Improving the endodontic treatment of chronic apical periodontitis by delayed filling // European science, 2019. № 5 (47).
30. Zoyirov T.E., Sodikova Sh.A. Dental health of pregnant women (literature review) // Bulletin of Science and Education, 2020. № 22-3 (100). P. 44-52 [in Russian].
31. Zoyirov T.E., Sodikova Sh.A. Dental status and awareness in prevention of major dental diseases (literature review) // Bulletin of Science and Education, 2020. № 22-3 (100). P. 5356 [in Russian].
ОСОБЕННОСТИ МОРФОМЕТРИЧЕСКИХ
ПАРАМЕТРОВ ЛИЦА И УГЛОВ НИЖНЕЙ ЧЕЛЮСТИ
У 11-ЛЕТНИХ ДЕТЕЙ С РАСЩЕЛИНАМИ ГУБЫ И
НЁБА
1 2 Камбарова Ш.А. , Ядгарова Г.С.
1Камбарова Шахноза Алихусейновна - ассистент; Ядгарова Гульнара Садриддиновна - PhD, доцент, кафедра хирургической стоматологии, стоматологический
факультет,
Бухарский государственный медицинский институт, г. Бухара, Республика Узбекистан
Аннотация: целью нашего исследования было определить антропометрические параметры лица и угла нижней
