Inflammatory periodontal diseases (IPD) are among the mass dental diseases, prevention and treatment of which, unfortunately, still are not effective enough. Without treatment this group of diseases leads to the tooth loss, so treatment of inflammatory periodontal diseases remains very relevant in today's world.Fig.1 Examples of periodontal tissue diseases Today, the state of this problem in the world is as follows (Table 1)
Scientists have proven that there are a number of common diseases and predisposing factors that lead to the development of various inflammatory diseases of the oral cavity, which, in their turn, have a negative effect on the body. It is a vicious circle, which can be broken only with close cooperation of dentists with doctors of other specialties.
It is well known that among the internal pathology, which accompanies the inflammatory periodontal diseases (IPD), a special place is occupied by cardiovascular diseases, in particular hypertension. So, against the background of microcirculation disorders, severe hypoxia and suppression of antioxidant protection, the dysfunction of the vascular endothelium develops, which leads to ischemia of periodontal tissues and entails serious consequences, unfortunately, not always reversible.
This kind of disease, like diabetes, is characterized by severe metabolic disorders, which gradually lead to the defeat of all organs, forming the polymorbid status of patients. IPD are a characteristic early manifestation of diabetes mellitus. Almost 100% of patients with diabetes mellitus have problems with periodontal tissues of various severity, which are distinguished by a bright clinical picture, aggressive course, resistance to traditional methods of treatment and prevention.
The role of Helicobacter pylori (HP) in the pathogenesis of various diseases is widely discussed in the world. Today a number of authors say that chronic generalized periodontitis (HP) in a certain percentage of cases is a disease associated with this pathogen. According to D.M. Neyzberg, I.Yu. Styuf (Department of Ter. St. St. Petersburg State Medical University, 2011), infection of the oral cavity by HP of the patients with HP-associated gastric ulcer is close to the value of 40%. Considering the fact that the diagnostics of Helicobacter pylori is multicomponent and high-tech, it is clear that this can be done only in a well-equipped high-level laboratory.
Today, the numerous researches of the relationship between metabolic syndrome (MS) and IPD are held in the world. MS includes several components: insulin resistance and hyperinsulinemia, abdominal-visceral obesity, primary (essential hypertension), diabetes mellitus (WHO, 1999). The steady increasing of the obesity prevalence and type 2 diabetes among the world's population has enabled the World Health Organization to call these diseases non-communicable epidemics of our time (WHO, 1997). According to WHO data published in 2003, 1.7 billion people on the planet are overweight. The development of generalized periodontitis (GP) is considered as a complication of MS and is characterized by fast destruction of bone tissue and is detected more often among young people. We subscribe to the opinion of the authors who believe that the prevention of the development of generalized periodontitis should be included in measures to prevent MS.
Undoubtedly, perodontopathogenic bacteria play a leading role in the development of IPD. According Socransky data for the development of periodontitis, a combination of four factors is necessary:
The task of the dentist is to control the conditions in the oral cavity that affect the development of IPD. Decisive measures in this direction are scaling and polishing of the root, which can be performed by a doctor-periodontist who has the appropriate qualifications and necessary equipment in the clinic. It is the manipulations aimed at controlling infection in periodontal tissues. Thanks to modern methods, now it is quite possible to treat various IPD' s, including Generalized periodontitis or, at least, to achieve stabilization and long-term remission of the course of disease.
From the above-mentioned follows that very often the pathology of periodontal tissues is related to the overall somatic status and it is impossible to treat IPD without the basic therapy of the underlying disease. In addition, it is very important to correctly examine the overall clinical status of the patient and make a diagnosis, against which the pathology of periodontal tissue develops. It is possible only with the cooperation of dentists with clinicians of various specializations. That is why our clinic conducts IPD treatment, taking into account the generally accepted European protocols, conservative and surgical methods and works in close cooperation with doctors of various specialties, which allows to conduct dental treatment taking into account somatic pathology. This significantly improves the quality of our patients' treatment. Even with severe forms of generalized periodontitis a stable remission is possible.Clinical case 1. (Doctor: Volinskaya T.B.) Patient K., diagnosis: generalized periodontitis GP of I-II degree, aggravated course, diabetes mellitus type II. Fig. 2 Condition of periodontal tissues before and 21 days after treatment. Clinical case 2. (Doctor: Volinskaya T.B.) Patient B., diagnosis: GP II-III degree, aggravated course. Disorders in the endocrine system.
Fig. 3. Condition of periodontal tissues before and after treatment after 6 months and one year. Reducing the depth of the periodontal pocket from 12 to 8 mm and 3 mm in dynamics.General view of the oral cavity before treatment and after a year. Inflammation in periodontal tissues is completely absent as a result of joint treatment with doctors of related specialties.