Relevance. Symptom of bleeding in elderly age has a number of features of its manifestation, not fully associated with the severity of gingivitis and periodontitis. It is associated withpolymorbidity, polypragmasy, age-dependent involutional processes, as well as with immune system aging.Purpose. To study the influence of confounders on the interpretation of the gingival bleeding index in elderly patients with periodontitis.Materials and methods. The clinical and laboratory examination of 64 elderly patients with chronic generalized periodontitis, divided into 2 clinical groups, was conducted. The conventional treatment was administered in both patient groups. The patients in the second cohort, along with other medications, received Polyoxidonium.Each clinical group was divided into two subgroups: “a” and “b” (depending on the NSIADintake). The comparison group was also formed.It consisted of 25 patients of middle age with a similar degree of periodontitis. To assess the bleeding symptom, the Mühlemann-Cowell (1975) bleeding index was determined, as well as its reduction (%). The study of local immunity included gingival fluid sampling andestimation of IL-1β and IL-10 concentration (pg / ml). Clinical and laboratory examination of patients was carried out within the time constraints: before the start of treatment, after 7, 14, 21, and 30 days.Results. During the initial examination and statistical analysis of the bleeding index mean values in elderly patients, higher values of the coefficient of variation were found (25.07%) than in the comparison group (16.24%).It confirmed the influence of confounders over this indicator.Moreover, before treatment, in both groups, significant differences between subgroups remained (which verified the effect of non-steroidal anti-inflammatory drugs), which disappeared in the subsequent stages of the examination. In further periods of observation, a decrease in the bleeding index was found, as well as the concentration of cytokines, and in the 2nd group, these indicators were statistically significantly lower than in the 1st (p < 0.05).Conclusion. The study showed a more significanthaemostatic effect of immunomodulation compared with conventional treatment. When analyzing bleeding index in elderly patients, confounders must be considered, otherwise, the findings, which do not fully correspond to the level of inflammation in the marginal periodontium, will be incorrectly interpreted.
« ГЛУБИНА ПАРОДОНТАЛЬНОГО КАРмАНА » ИЛИ « ВЕЛИЧИНА ПОТЕРИ ПРИКРЕПЛЕНИЯ » , КАКОЙ ПАРАмЕТР ВЫБРАТЬ В ГЕРОНТОСТОмАТОЛОГИИ? Крайнов С. В., Михальченко В. Ф., Яковлев А. Т., Попова А. Н., Алеханова И. Ф. ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России, г. Волгоград, Россия АннотацияПредмет. В статье показана актуальность геронтостоматологии, связанная с многочисленными особенностями эпидемиологии, клинического течения и лечения заболеваний полости рта и необходимостью иных подходов к диагно-стическим мероприятиям. Впервые поднимается вопрос состоятельности параметра глубины пародонтального кармана при оценке степени тяжести генерализованного пародонтита у лиц пожилого возраста, а также дается обоснование выбора показателя «величина потери прикрепления» (attachment loss -AL), как альтернатива вышеназванному критерию. Приводится обобщение литературных данных о гистоархитектонике пародонтального комплекса, и ее влиянии на объ-ективность инструментального осмотра, а также конфаундерах в геронтопародонтологической практике. Авторы дают рекомендации по методологии зондирования пакетов, а также правильной интерпретации полученных данных с целью корректной постановки диагноза и выбора обоснованной тактики лечения, в том числе при групповых обследованиях.Цель. Оптимизировать инструментальное обследование больных пожилого возраста, страдающих хроническим генерализованным пародонтитом.Методология. Было обследовано 113 человек пожилого возраста, страдающих хроническим генерализованным пародонтитом средней степени тяжести. Производилось инструментальное измерение степени деструкции поддерживаю-щего аппарата зуба: глубина пародонтального кармана и величина потери прикрепления -ВПП. Также рассчитывались: средние гПК и ВПП, средние max гПК и ВПП.Результаты. Наименьшим по значению критерием оказалась гПК, которая, в среднем, составила 3,52±0,13 мм; средняя max гПК составила 4,78±0,17 мм; средняя ВПП существенно превосходила среднюю гПК, но, в то же время была меньше, нежели средняя max гПК и средняя max ВПП (p<0,05). Наибольшим по значению критерием оказалась средняя max ВПП, которая составила 5,6±0,19 мм.Выводы. Наиболее информативным и корректным критерием является «средняя ВПП», определяющая истинный объем деструктивных изменений пародонтального комплекса, учитывающая имеющуюся рецессию, или гипертрофию десневого края.Ключевые слова: пародонтальные карманы, потеря прикрепления, зондирование, геронтостоматология, паро-донтит. 9-14Терапевтическая стоматология / Therapeutic dentistry Оригинальные исследования / Original research papers 9-14 Адрес для переписки:Correspondence address:Сергей Валерьевич КРАйНоВ 400117, Россия, г. Волгоград, ул. 8 Воздушной армии, д. 47, кв. 45 Тел.: 8-903-375-66-78 E-mail.: Проблемы стоматологии 2017, т. 13, № 4, стр. © 2017, Екатеринбург, УГМУ Терапевтическая стоматология / Therapeutic dentistry Оригинальные исследования / Original research papers 10Геронтостоматология является одним из наиболее актуальных разделов современной стоматологии. Во многом это дете...
Background. The article has explored the problem of the humoral immunity recovery of elderly patients with chronic generalized periodontitis. Such immunological indicators as the immunoglobulin concentrations were used as detectors of inflammatory-destructive disease. Polyoxidonium has been suggested as an immunomodulator, as it promotes faster immune and clinical recovery compared to the conventional treatment regimens. Goals To assess the dynamics of clinical indicators and indicators of humoral immunity (sIgA, IgA, IgG and IgM levels), depending on immunomodulation, is added to the combined treatment regimen of elderly patients with periodontitis. Methods. Two patient cohorts of 69 elderly persons with chronic generalized periodontitis were examined. The conventional treatment was administered in both patient groups. The patients in the second cohort, along with other medications, received Polyoxidonium. The examination included gingival fluid and venous blood sampling, estimation of sIgA, IgA, IgG and IgM concentration as well as evaluation of PMA and SBI indices reduction. Results. The study has revealed the rise of IgG and IgM in venous blood. The recovery trend was observed in both cohorts, with a more marked dynamics in the second one. The mean values of antibodies concentration in the 2-nd group (since the 14th day) were statistically significant compared to the similar measures in the 1st one. After 3 months follow-up the substantial growth of immunoglobulins concentration was registered in the 1st cohort, whereas the 2nd one still showed the recovery trend. Results. The study has revealed the rise of IgG and IgM in venous blood. The recovery trend was observed in both cohorts, with a more marked dynamics in the second one. The mean values of antibodies concentration in the 2-nd group (since the 14th day) were statistically significant compared to the similar measures in the 1st one. After 3 months follow-up the substantial growth of immunoglobulins concentration was registered in the 1st cohort, whereas the 2nd one still showed the recovery trend. Conclusions. The inclusion of immunomodulator Polyoxidonium into the conventional treatment protocol of periodontitis promotes the immunologic reactivity recovery of elderly patients and the improvement of the therapeutic intervention effectiveness over the longer term.
Background. The article has explored the problem of the diagnostics of parodontal tissue destruction and revealed the interrelation between the immunoreactivity level and the intensity of resorptive processes. Such biochemical indices as the concentrations of lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) were used as detectors of destructive disease. Polyoxidonium has been suggested as an immunomodulator, as it promotes faster immune and clinical recovery compared to the conventional treatment regimens. Objectives. To estimate the dynamics of destructive pathology indicators (level of LDH and ALP) in paradontium changes, depending on the immunomodulation, added to the combined treatment regimen of elderly patients with periodontitis. Methods. 2 patient cohorts of 67 elderly persons with chronic generalized periodontitis were examined. The conventional treatment was administered in all patient groups. The patients in the second cohort, along with other medications, received Polyoxidonium. The examination included gingival fluid and venous blood sampling, estimation of LDH and ALP concentration as well as evaluation of periodontium indices (papillary-marginal-alveolar index and gingival bleeding index). Results. The study has revealed the rise of LDH and ALP in gingival fluid and venous blood. The recovery trend was observed in both cohorts, with a more marked dynamics in the second one. The mean values of enzyme concentration in the 2-nd group (since the 14th day) were statistically significant compared to the similar measures in the 1st one. After 3 months follow-up the substantial growth of LDH and ALP concentration was registered in the 1st cohort, whereas the 2nd one still showed the recovery trend. Conclusions. The inclusion of immunomodulator Polyoxidonium into the conventional treatment protocol of periodontitis promotes the effectiveness of the therapeutic intervention, discontinues resorptive processes and stabilizes reparative processes in the paradontium.
Relevance. Immunomodulation is becoming increasingly relevant in geriatric dentistry. The administration of this therapy cannot be empirical and requires the study of the corresponding immunological parameters. The study of the gingival crevicular fluid composition allows evaluating not only the immune system ageing processes and their influence on the periodontitis course but the effectiveness of the treatment. The study aimed to evaluate the effectiveness of transcranial electrostimulation (TES) for the treatment of periodontitis in elderly patients and to prove the value of gingival crevicular fluid laboratory testing during immunomodulatory therapy. Materials and methods. We conducted a clinical, prospective, controlled, randomized, unblinded, comparative study. We examined two groups of periodontal patients (68 subjects), aged 60-74, and equally treated them. But the patients in the second group additionally received transcranial electrostimulation (TES). The research included the follow-up assessment of IL-1β, TNF-α, IL-10, sIgA and LDH in the crevicular fluid and periodontal index reduction: SBI and PMA (%), before the treatment and on the 7th, 14th, 21st and 30th day.Results. The study established that the periodontal treatment scheme, which includes TES (immunomodulation), is more clinically effective than conventional treatment. There were statistically significant differences in the clinical and laboratory parameters between the 1st and the 2nd patient groups after the 14th day (p < 0,05). On the 30th day of observation, the described trend persisted: the parameters of crevicular fluid in both groups continued to decrease. Moreover, their mean values were significantly lower in the 2nd group than in the 1st. The level of IL-1β (pg/ml) was 16.9 ± 0.33 and 18.8 ± 0.38;TNF-α (pg/ml): 11.9 ± 0.37 and 14.4 ± 0.4; IL-10 (pg/ml): 11.0 ± 0.35 and 12.9 ± 0.36, respectively (p < 0.05).Conclusion. In elderly patients, TES (as a part of a comprehensive treatment) is more effective clinically than the conventional periodontal treatment alone. In geriatric dentistry, it is of primary importance to test gingival crevicular fluid composition and properties in a laboratory and to select the most significant immunological and biochemical components: IL-1β, TNF-α, IL-10, sIgA, LDH. It allows a periodontist to confirm the changes in the manifestations of periodontitis in the elderly patients and to verify the clinical effectiveness of immunomodulation.
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