Vivcharenko and Rozhko: Evaluation of Oral Hygiene in Patients with Generalized Periodontitis of II Degree and Stage II Hypertension



Problem statement and analysis of the recent research

Nowadays, the problem of periodontal disease is relevant due to its high prevalence among the working-age population [1, 2, 4, 8, 13]. Generalized periodontitis is a chronic disease being characterized by progressive destruction and loss of periodontal tissue [1, 2, 13]. This disease affects anatomical structures such as the alveolar bone, periodontal ligament, and tooth cement, which, according to modern research [1, 2, 5] require a long time to recover. The disease is multifactorial as the development and progression of the disease depend on both local and general factors.

Infectious factors as well as poor oral hygiene are important etiological factors. Dental plaque has a special composition and different set of microorganisms. The formation of dental plaque (or biofilm) is one of the most important mechanisms of persistence of microorganisms in the oral cavity. Biofilm is an accumulation of microorganisms attached to tooth surface or to each other and embedded into a matrix of extracellular polymeric substances [3, 6, 7, 9, 11, 14, 15, 16].

The supragingival biofilm consists of Gram-positive microorganisms: Streptococcus sanguinis, Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Lactobacilli, while the subgingival biofilm consists of Gram-negative microorganisms: Aggregatibacter (Actinobacillus) actinomycetemcomitans, Tannerella forsythia, Campylobacter spp., Fusobacterium nucleatum, Porphyromonas gingivalis, Treponema denticola. These microorganisms can create high concentrations of metabolites (acids, ammonia, hydrogen peroxide, oxidants etc.) affecting the composition of microoranisms inside the microcolony as well as the whole body. Waste products of pathogenic microorganisms activate the secretion of cytokines, prostaglandines, hydrolytic enzymes that cause periodontal tissue destruction [3].

Nowadays, there is no means of ensuring the complete and final removal of the biofilm from the oral cavity. However, its pathogenicity can be significantly reduced by restoring the microflora by means of professional hygiene of oral cavity [14].

Personal oral hygiene contributes to mechanical removal of dental plaque that can prevent many inflammatory diseases. Although, mechanical toothbrush eliminates only 43% of plaque and for the elimination of dental plaque on the approximate surfaces dental floss or interdental brushes should be used. The combination of personal oral hygiene and professional oral hygiene can efficiently control the formation of biofilms thereby preventing the diseases caused by them.

The initial signs of periodontal disease, being often asymptomatic, are characterized by a chronic course (clinical forms of gingivitis according to the WHO classification). Such chronic forms of periodontal disease can be detected during clinical examination of the oral cavity, when the patient complains of dental caries and its complications. However, depending on the severity of periodontal disease and the severity of clinical symptoms, patients have specific complaints, such as bleeding gums, teeth mobility, bad taste in the mouth, itchy gums, bad breath etc. The patient’s age, the level of dental hygiene education and the presence of somatic diseases should be considered as well.

General factors include systemic diseases, namely diabetes mellitus, diffuse toxic goiter, cardiovascular pathology, gastrointestinal pathology. According to statistics, in 2013, there were more than 12 million (32% of the adult population) people with high blood pressure in Ukraine [12]. Cardiovascular pathology and the reduction in bone mineral density are interrelated processes; osteopenia and osteoporosis are progressing in parallel with atherosclerotic changes complicating treatment of generalized periodontitis.

The objective of the research was to determine the status of oral cavity hygiene in patients with generalized periodontitis of II degree and stage II hypertension.

Materials and methods

The study included 30 patients with generalized periodontitis of II degree and stage II hypertension being treated in the Ivano-Frankivsk Regional Clinical Cardiology Dispensary; the average age ranged from 35 to 54 years (the main group). The control group included 10 patients of the same age without generalized periodontitis and somatic pathology. The diagnosis of periodontal disease was made based on the data of the anamnesis, dental examination and traditional additional diagnostic examinations. Patients of the main group were examined on the 1st-5th days after discharge from the hospital.

The status of oral cavity hygiene was determined using the Green Vermillion index. The diagnosis of periodontal disease was made based on the classification proposed by M.F. Danilevskyi. The obtained results were subjected to variation-statistical analysis using statistical package “Stat Soft 6.0”; classical methods of variational statistics were applied; mean values and their reliability were evaluated.

Results and discussion

The results of examination showed poor oral hygiene in almost all patients. All patients used personal devices for oral care, however, in the majority of patients toothpaste and brush were incorrectly selected or the period of using the brush exceeded the recommended one. Only a few of them used dental floss and mouthwash. The analysis of hygienic indices showed the following results: in patients of the main group, the Green Vermillion index was 1.99 ± 0.13 points (p<0.001) which corresponds to unsatisfactory level of oral hygiene. In patients of the control group, this index was 1.10 ± 0.17 points which corresponds to satisfactory level of oral hygiene.

According to the index in the main group, 9 (30.0%) patients had satisfactory oral hygiene, 12 (40.0%) patients had poor oral hygiene, and in 9 (30.0%) patients, poor oral hygiene was observed.

In the control group, 2 (20.0%) patients had good oral hygiene, 6 (60.0%) patients had satisfactory oral hygiene and in 2 (20.0%) patients, unsatisfactory oral hygiene was observed. There were no patients with poor oral hygiene. The analysis of the indicators of the Green Vermillion index showed that in case of the pathological process exacerbation the oral hygiene status in patients deteriorated (Table 1).

Table 1

Status of oral cavity hygiene in the main and control groups (M ± m)

Groups of patients n Green Vermillion Index Hygiene level
The main group (А) 30 1.99 ± 0.13 Poor hygiene
The control group (В) 10 1.10 ± 0.17 Satisfactory hygiene
р* (А:В) р<0.001

Note.

p – the confidence index of differences between the data of the main and control groups

Conclusions

  1. The level of oral hygiene in patients of both groups was low due to incorrect selection of personal hygiene products or their untimely replacement.

  2. In patients with generalized periodontitis of II degree and stage II hypertension, the level of oral hygiene was lower than in somatically healthy persons: the worse status of oral cavity hygiene – the more pronounced changes in the periodontal tissues.

  3. We can suppose that high blood pressure affects the status of the oral cavity, creates a higher risk and exacerbates the periodontal diseases.

Prospects for further research

Further study of etiological factors and pathogenetic mechanisms of the development of periodontal diseases on the background of hypertension as well as the optimization of existing methods of treatment is promising.

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