Ph.D. Gruzdeva A. A.
State Establishment "
Ministry of
Health of
PATHOLOGICAL CHANGES OF THE ORAL MUCOSA AND
PERIODONTAL TISSUES BY THE WORKERS OF MINING INDUSTRY
Production conditions of iron ore industry promote occurrence of
pathological changes of the oral mucosa and periodontal diseases.
The prevalence of lesions of oral tissues in workers related to exposure
to hazardous occupational factors is significantly higher than those without
contact with a professional harm.
On the
enterprises of the mining industry in Dnepropetrovsk region under unfavorable
and hazardous working conditions employs about 65, 9% of all industry workers
[7, 8].
The use of personal protection against harmful factors of production,
introduction of new technological processes have reduced professional diseases
among miners. However, it’s level remains high.
With 7 - 8
years of working experience defeats of the oral mucosa and periodontium are 80 – 90 %. Bots M. I.
in a survey of underground miners has revealed periodontal disease in 86 % of
workers [9]. Depth of periodontal lesions increases with the length of working
time. At the same depth and activity of the pathological process the parameters
of microcirculation among the workers were significantly lower than in the
control group: Vacuum test (named after Kulazhenko W. I.) 9,5 ± 0,1 vs. 26,4 ± 0,3.
Leukoplakia
is the mouth's reaction to chronic irritation
of the mucous membranes of the mouth.
Violation of maturation of the epithelium of the oral mucosa is the leading element of
pathogenesis of
leukoplakia. Exfoliative cytology is a noninvasive procedure,
which helped in identifying the cellular changes. The study revealed a
subclinical phase of OHL, where the cellular changes were seen even before the
appearance of the clinical lesion [2]
The degree of maturity of the epithelium
(maturation index) is determined by the balance of epithelial cells. In the
epithelium of the mucous membranes of the mouth are allocated: basal,
parabasal, intermediate and superficial cells, and in the stratum areas - horny
scales.
The basal cells can be in the smear with
deep inflammation of the epithelium by its injury. The presence of parabasal
cells shows sharply expressed atrophy. A sign of maturation of the epithelium
is the predominance of intermediate cells in the smear. In not cornified sites
of the oral mucosa to the maximum level of maturation of the epithelium
corresponds the appearance of the surface cells, and in the cornified - horny
scales.
Maturation index (the ratio of parabasal / intermediate /
surface / horny scales)
assess the degree of differentiation of
epithelial maturation completeness. As a normal for the not cornified epithelium is
considered to be ratio 0 / 96 / 2,5 / 1,5; for cornified epithelium – 0 / 60 /
8 / 32 [6]. Oral exfoliative cytology has 100% specificity [3].
Although it is considered a potentially
malignant disorder the overall malignant progression of oral leukoplakia is of
the order of 5% and even more. Nowadays there are no currently accepted markers
to distinguish those that may progress to cancer from those that may not [5].
Routine exfoliative cytology may be a
reliable, noninvasive, and inexpensive technique for the diagnosis of hairy
leukoplakia [1]. Oral exfoliative cytology has 100% specificity [3].
The aim of our study was to determine the degree of maturity of the
epithelium of the oral mucosa in different forms of leukoplakia and examine the state of gums among workers of iron ore industry with a
help of electron-microscopic method and structure of the bone tissue with a
help of densitometry method.
Materials and methods. We conducted a clinical and laboratory study of 58
patients with leukoplakia of the oral mucosa. In our study we used the
classification of the oral mucosa by Danilevsky N. F., Urbanowich L. I., 1979.
The flat form of leukoplakia was
diagnosed in 34 patients (58.62%), rising leukoplakia - in 16 (27.58%),
verrucous leukoplakia - in 5 (8.26%) and erosive form - in 3 (5.17%) .
For the manufacture of the cytological
preparations the fence of the lesion was performed in several ways: direct
imprint, impression smears or scraping. Preparations
were fixed in a mixture of Nikiforov. Coloring was performed by Papanikolau. In
smears we had examined the ratio of epithelial cells.
The material for the study
were the fragments of gingival papillae of 24 workers in the age of 30 – 60
years, with working experience of 5 – 20 years, which have been taken in the
course of surgery for medical reasons. Ultrathin sections were obtained on a ultramicrotome UMPT-7 and contrasted by
Reynolds, also they were stained with uranyl acetate
and lead citrate. They were viewed
in the electron microscope TEM-100.
Results and its discussion. In patients with flat form of leukoplakia among the epithelial cells in the
smear prevailed horny scales (51,5%) and superficial cells (31%). The content
of intermediate cells was reduced to 17.5%. All this can be interpreted as a
violation of the maturation of the epithelium, as hyperkeratosis and chronic
inflammation.
In patients with rising leukoplakia the breach of epithelial differentiation was
aggravated: the ratio of parabasal / intermediate /
surface / horny scales was
0/25/29/46.
The analysis of the results of cytological research of
patients with warty leukoplakia revealed a severely impaired maturation of the
epithelium – so named “left shift”. In this case, in a smear appeared basal
(3%) and parabasal (10,5%) cells, were observed phenomena of dyskaryosis, that
is reflecting the increasing damaging effect on the oral mucosa.
The results of cytological research in
patients with erosive form of leukoplakia are typical for a significant injury
of the epithelium and for the defeat of it with a deep inflammation. In compare
with warty form of leukoplakia in smears were found the increasing of basal
(4%) and parabasal cells (15,5%).
Significant changes in the gingival epithelium of examined patients were identified. Almost everywhere were the
loosening areas of intercellular contacts defined, sometimes it was accompanied
by a loss of edge definition
of intercellular membranes. In other
places, while maintaining the sharpness of the cytoplasmic membrane, intercellular
contacts took the form of channels field with an amorphous content of different
density, what indicates loosening of the epithelial layer. Almost everywhere,
there were areas in which signs of inter- and intracellular edema were
detectable. The nuclei of the epithelial cells, in some cases, had a
scalloped shape with protrusions or invaginations of karyoplasm. In the nuclei of the cells, there
was a sharp decrease in the chromatin, which condensed on the periphery of karyoplasm.
Significant
changes have taken place in the interior lying tissues. Most microvasculars
were paralytic expanded. Endothelial cells appeared swelled with sharp
increased cores. In the nuclei of myocytes rapidly reduces the content of
chromatin which condensed at the nuclear membrane. In the
cytoplasm, there were signs of
destruction of organelles (mitochondria). There was swelling of the myofibrils.
It should be noted, that all
the examined had the lack of oral hygiene and parodontal tissue destruction
intensity was increased with age.
Conclusions.
Analysis of
data, obtained in electron-microscopic study shows that, while retaining the
overall organization of the epithelial layer and underlying structures, there
were some changes in the ultrastructure of the individual components of the
gum. Changes had mosaic nature and in different areas were expressed in varying
degrees. In some zones changes in the ultrastructure showed intercellular and intracellular edema of mainly epithelial
cells, in other areas they had the nature of dystrophic and even
destructive changes, what indicates the depth of the destruction of the cells
ultrastructure.
So, the degree of maturity of the epithelium decreases with worsening of
the forms of leukoplakia. Determining of the degree of differentiation of
epithelium of the oral mucosa with the use of exfoliative cytology method is
the auxiliary diagnostic test for the diagnosis of "leukoplakia" and
can be used in combination with other methods of research. The method of
exfoliative cytology is characterized by simplicity, security, rapidity of
obtaining of results and plays an important role in the diagnosis of different
forms of leukoplakia.
REFERENCES
1. Migliorati CA,
Jones AC, Baughman PA.
Use of exfoliative cytology in the
diagnosis of oral hairy leukoplakia . J
Oral Surg Oral Med Oral Pathol.1993
Dec;76(6):704-10
5. Parlatescu I, Gheorghe C, Coculescu E, et al. Oral leukoplakia - an update. [Journal Article]. Maedica (Buchar) 2014 Mar; 9(1):88-93.
6.
Быков В.Л. Гистология и эмбриология
органов полости рта человека. – С.Петербург, “Специальная литература”, 1996. –
247 с.
7. Состояние профессиональной заболеваемости трудящихся
Днепропетровской области /Карнаух Н.Г., Выщипан В.Ф., Бернарик О.Н. и др.//
Матеріали наук.-практ.конференції. – Дн-ськ, “Поліграфіст”, 1998.– 102 с.
8.
Сааркопель Л.М.
Сравнительная оценка здоровья рабочих горнорудной промышленности //Медицина
труда и промышленная. – 2007. - №12. - С.17-22.
9. Боць М.І. Стоматологічний статус у гірничних
працівників з професійними захворюваннями // Мат.наук.-практ.конф., присвяч.
20-p. фак..удоск.лікарів Дн-ського мед.ін-ту. – Кривий Ріг, 1991. – С.221.