Pathogenetic Justification of Pharmacological Correction of Microcirculatory Disorders and Peroxide Status in Chronic Gingivitis

The study is dedicated to the pathogenic justification of pharmacological correction of microcirculatory disorders and peroxide status in chronic catarrhal gingivitis. The work identified patterns of microcirculation and lipid peroxidation disorders in periodontal tissues in patients with chronic gingivitis residing in the selenium-deficient region of Zabaykalsky Krai, as well as established the role of selenium deficiency in the intensification of free radical processes and lipid peroxidation. Based on the obtained data, the use of the drug «Neoselen» with an oak bark decoction in complex therapy of chronic catarrhal gingivitis is justified and evaluated.

Relevance of the Problem. At present, one of the main problems of dentistry remains the questions of studying the etiopathogenesis and improving the efficiency of prevention and treatment of inflammatory periodontal diseases. The relevance of the question is conditioned by the high prevalence of the pathology, reaching 80-85% among the population aged 30 to 50 years [13, 27, 41].

The most frequently encountered nosological form of the specified pathology is inflammation of the gums - gingivitis, leading to the appearance of foci of chronic intoxication in the dentition, reduced reactivity of the organism, development of sensitization, and ultimately - to decreased work capacity, impairment of the psycho-emotional sphere, and reduction of quality of life [46, 124, 132].

The reason for the low efficiency of the methods employed, whose prescription often does not yield a stable remission in gingivitis, is, undoubtedly, the insufficient knowledge of the mechanisms of disease development. Despite numerous attempts to study the problem of chronic gingivitis, many aspects of the pathogenesis remain unresolved. Some authors assign the role of the primary cause of periodontal diseases to the microbial factor and violation of occlusal relationships [3, 8, 44, 159].

However, in 57-80% of cases, the prescription of antibacterial therapy to patients with intact dentition, orthognathic occlusion, and satisfactory hygiene index does not lead to complete cure of gingivitis, but only to a reduction in the intensity of the inflammatory reaction. This testifies to the fact that poor oral hygiene, defects of the dentition, and malocclusion are not the only causes triggering the development of gingivitis [59, 85, 123, 168].

Numerous studies point to the important role in the pathogenesis of periodontal diseases of disorders of microcirculation, leading to changes in metabolism and micromorphology in periodontal tissues, as well as pronounced hypoxia. Under conditions of hypoxia, free-radical processes are activated, causing damage to cellular and subcellular membranes [63, 78, 103, 133, 119].

In connection with this, the use of antioxidants as therapeutic agents in individuals with inflammatory periodontal diseases is warranted. The antioxidant defense system is an important link not only in the neutralization of free radicals but also participates in the reactions of many metabolic processes. An important element of radical protection is selenium as a component of selenium-dependent glutathione peroxidase. In addition, the regulation of lipid peroxidation of membranes may be realized by selenium without engaging the glutathione peroxidase mechanism of peroxide utilization [15, 144, 190].

The literature contains indications of the use of selenium-containing preparations in the treatment of various diseases: anemia, tuberculosis of the lungs, infectious diseases [18, 93, 113, 155, 200].

The use of these preparations in selenium-deficient regions, including Zabaykalsky Krai, is warranted. However, works on investigating the influence of selenium-containing preparations on free-radical processes and microcirculation in periodontal tissues are absent. The question of the application of selenium preparations in complex treatment of chronic catarrhal gingivitis remains open to this day.

On the basis of the above, we formulated the following goal and objectives of the study.

Goal of the study:

To provide a pathogenic justification for the use of the drug «Neoselen» in complex therapy of chronic catarrhal gingivitis based on the identified patterns of microcirculatory disorders and lipid peroxidation processes.

Tasks of the study:

1. To study the clinical-functional features of periodontal tissues in patients with chronic catarrhal gingivitis.

2. To investigate the peroxide status and selenium content in various biological objects in chronic catarrhal gingivitis.

3. To evaluate the correlational relationships between indicators of microcirculation of periodontal tissues and selenium content in the blood of the examined individuals.

4. To justify the expediency and evaluate the efficacy of using the drug «Neoselen» in complex therapy of chronic catarrhal gingivitis for the correction of microcirculatory disorders and peroxide status in chronic catarrhal gingivitis.

Scientific Novelty

For the first time in Zabaykalsky Krai, a study of microcirculation indicators by laser Doppler flowmetry in patients with chronic catarrhal gingivitis in the alveolar and marginal parts of the gingiva was conducted, and a decrease in the efficiency of microcirculation in the studied areas of the periodontium was identified. It was established that in young individuals with gingival inflammation in the absence of occlusal pathology, microcirculation and hemodynamics parameters are characterized by increased vascular tone, increased peripheral resistance index, and decreased elasticity index.

For the first time, it was discovered that in patients with chronic catarrhal gingivitis residing in the Zabaykalsky Krai region, a selenium deficiency in the blood was registered against the background of enhanced elimination of the microelement with urine. These shifts are accompanied by an increase in the levels of primary and secondary lipid peroxidation products, along with the accumulation of intermediate intermediates of lipid peroxidation both in blood components and in mixed saliva, with a decrease in overall antioxidant activity.

It was established that in mixed saliva, changes in the parameters of the «lipid peroxidation - antioxidants» system are expressed more significantly than in blood components, which testifies to a predominant violation of peroxide homeostasis in the oral cavity.

For the first time, the character of correlational relationships between selenium content in the blood and parameters of the «lipid peroxidation - antioxidants» system, as well as indicators of microcirculation, was determined. It was established that in chronic catarrhal gingivitis, direct correlational relationships exist between the level of selenium in the blood and the content of total antioxidants in mixed saliva, the efficiency of microcirculation, as well as inverse relationships between selenium content in the blood and the level of intermediate peroxidation products.

The use of the complex drug «Neoselen» with an oak bark decoction in complex treatment of patients with chronic catarrhal gingivitis, compared with traditional methods, is more effective and influences the parameters of the microcirculatory bed (the efficiency of microcirculation and elasticity index increase, the peripheral resistance index and vascular tone indicator decrease). Along with this, the peroxide imbalance is normalized, the content of initial and intermediate lipid peroxidation products in mixed saliva and blood components decreases, and overall antioxidant activity increases. These changes are accompanied by a significant improvement in the clinical symptomatology of the disease and a stable remission lasting 12 months.

Theoretical and Practical Significance:

The identified patterns expanded theoretical representations about the pathogenic role of microcirculatory disorders, selenium deficiency, changes in the activity of lipid peroxidation processes and their regulatory systems in blood components and mixed saliva in individuals with chronic catarrhal gingivitis in the Zabaykalsky Krai region. Based on the data of correlation analysis, additions were made to the scheme of pathogenesis of chronic gingivitis.

It was established that in individuals with chronic catarrhal gingivitis after traditional therapy, disturbances in the processes of microcirculation and lipid peroxidation recur 3 months after treatment.

It was proven that in complex treatment of chronic catarrhal gingivitis, the use of the drug «Neoselen» with an oak bark decoction is warranted, the prescription of which leads to a sustained improvement in the microcirculation of periodontium vessels and a significant increase in the antioxidant reserve of tissues.

A scheme for the use of the drug «Neoselen» with an oak bark decoction in complex therapy of chronic catarrhal gingivitis was developed and implemented. The results of the work were introduced into the educational process of the Department of Dentistry of the Advanced Training and Professional Retraining Faculty, as well as are used in the practice of the polyclinic department of the dental clinic of Chita State Medical Academy.

Validation of the Work

The materials of the dissertation were presented and discussed at the All-Russian Scientific and Practical Conference dedicated to the 50th anniversary of Chita State Medical Academy «Actual Problems of Clinical and Experimental Medicine» (Chita, 2003); the X Russia-Japan International Medical Symposium «Yakutia - 2003» (Yakutsk, 2003); the conference «Methods of Investigation of Regional Blood Circulation and Microcirculation in Clinical Practice» (Saint Petersburg, 2004); the international conference «Problems of Education, Science, and Student Training in Agricultural Educational Institutions» (Chita, 2004); the joint session of the Departments of Dentistry of the Advanced Training and Professional Retraining Faculty, orthopedic, surgical, therapeutic dentistry and pediatric dentistry, and the Departments of Biochemistry and Pathological Physiology of Chita State Medical Academy (Chita, 2005).

Publications

Six scientific works were published on the topic of the dissertation.

Volume and Structure of the Dissertation

The dissertation consists of an introduction, three chapters, a conclusion, conclusions, and a list of references. The work is presented on 146 pages of typed text, illustrated with 15 tables and 18 figures. The list of references consists of 202 sources, of which 127 are domestic and 75 are foreign authors.