A.A.Gruzdeva

State Establishment "Dnepropetrovsk Medical Academy

Ministry of Health of Ukraine"

The state of periodontal tissues in the working of iron ore production

ABSTRACT

Relevance. Dental health of miners has specific differences of the average of epidemiological surveys, due to the distinct negative impact on the tissues and organs of the mouth of the atmosphere of the working area. This is the basis for the development of major dental diseases, including periodontal disease.

The aim of this study was evaluate the changes of periodontal tissues, developing under the influence of a complex of factors of production of iron ore production.

Materials and methods. A clinical examination of 368 workers producing iron age 21-60 years with different seniority in the company. Indexed rating: PMA (Parma, 1960), GI (Y.A. Fedorov, V.V.Volodkina, 1971), PI (AL Russel, 1956), CPITN.The material for the study of electron-microscopic 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.

Results. Conclusions. Results and analysis of the conduct of clinical and morphological studies indicate a gradual increase in the prevalence of signs of periodontal disease in miners with age and increasing underground service. Clinical observations have revealed weighting of the pathological process and the involvement of large amounts of tissue (it is mostly about the generalization of the process), as well as the growth of periodontal disease with increasing length of service in hazardous conditions of iron ore production. The results of morphological studies showed signs of sluggish inflammation of the sclera, atrophic and destructive changes in the gingival tissue.

Keywords: working iron production, periodontal disease, an index evaluation, morphological study.

Dental health of miners has specific differences from the average performances of epidemiological studies, due to the distinct negative impact on the tissues and organs of the mouth of the atmosphere of the working area. By number of factors affecting the organism the mining industry is one of the most unsafe industrial sector.

Working conditions in the iron ore mines are characterized by a high degree of gas content in air of the working area, presence of the corrosive dust and its sorption by integumentary tissues, extreme temperature conditions, noise, differences in barometric pressure during ascents and descents in/from a zone of iron ore development, stressful work conditions. To everything mentioned above, working conditions are burdened by vibrations. It was described an adverse effect of factors of production of iron ore industry in the tissues and organs of the mouth [1 – 5]. Thus, with increasing of depth of mines the air temperature and the barometric pressure are increasing, amounting to 995 m 814-834 mm Hg at 27-30 C [4, 5]. Moreover significantly increases the dust formation and the relative humidity reaches 98%. Accommodation of miners to extreme thermal load associates with reduction of efficiency and productivity of working, systematic stress of thermostatic systems of the body, suppression of general immunologic reactivity, and as a result, increased morbidity [3, 4]. It is any exception a pathology of the oral mucosa, hard tissue of teeth and periodontal [1, 6, 7].

As a result of the combined effects of industrial harmful factors by workers develop occupational diseases of the respiratory, cardiovascular and digestive systems, kidney diseases etc. Such deterioration of general condition is the basis for the development of major dental diseases, including periodontal disease.

Goal. To study changes of periodontal tissues, developed under the influence of a complex of factors of manufacturing of iron ore production.

Materials and methods. We conducted a survey of 368 workers (all males) of underground workshops of iron ore mines of Krivoj Rog City which made the main group for studying. Their distribution over the length of service and age is shown in table 1.

Tabl.1.

Distribution of the surveyed workers by age and length of employment

Length of service (years)	Age
	21-30 years	% (of total)	31-40 years	% (of total)	41-50 years	% (of total)	51-60 years	% (of total)	Total (abs. number)	% (of total)
0-5	21	5,78	7	1,79	5	1,31			33	8,88
6-10	12	3,17	43	11,64	18	4,89	6	1,72	79	21,42
11-15	3	0,76	50	13,57	60	16,39	12	3,24	125	33,95
16-20			39	10,67	63	17,22	29	7,85	131	35,74
In total:	36	9,71	139	37,67	146	39,81	47	12,81	368	100

Among the surveyed workers dominated people with age 41-50 years with experience of working of 16-20 years (17.22% of the surveyed workers). Less representative groups were 21-30 years with experience of 11-15 years (0.76%), 41-50 years of experience of max. 5 years (1.3%) and 51-60 years with experience of 6-10 years (1.65%) and 11-15 years (1.72%). A control group consisted of 79 employees of ground services (males) of the same industrial facility, comparable in age, who have no exposure to occupational hazards.

The study was conducted adhering to the primary care sequence using an objective assessment of oral hygiene and periodontal tissue examination. The degree of gingivitis index was determined using a modification of PMA Parma (1960). We determined periodontal index CPITN (Communіty Perіodontal Іndex of Treatment Needs) - Index of the need for treatment of periodontal disease, the recommended WHO epidemiological survey of periodontal diseases. The level of hygienic condition of oral hygiene was assessed using the index proposed by Y. A. Fedorov and V.V. Volodkina (1971). To evaluate the presence and severity of periodontal disease we used periodontal index (PI) A.L. Russel (1956).

We conducted electron microscopic examination of fragments of gingival papillae by 24 workers aged from 20 to 60 years old with experience of 5-20 years. he material for the electron microscopy papilla were taken in the course of surgical procedures carried out for medical reasons (gingivitis - 32.27%, extractions - 56.61%, excision of the hood when perikoronarit - 9.12%, and others). Fragments of the gingival tissues were fixed in 2.5% solution of glutaraldehyde on the phosphate buffer (pH 7.2-7.4). Fixing of 1.5% solution of osmium acid and poured into a mixture eponidnyh resins. Ultrathin sections were prepared on a microtome UMPT-7. The material was examined using an electron microscope TEM-100 (Ukraine).

All data were processed statistically. Statistical processing was performed PC IBM PC / AT using application package Statistica version 5.5 for Windows 98.

Results and their discussion.

Comprehensive clinical examination showed that the inflammatory and degenerative-inflammatory processes in periodontal tissues occur in the first years of working on the production of iron ore.

Patients who formed a core group gave minor complaints about violations of the periodontal complex. However, an objective examination detected changes of the oral mucosa, which apply to all periodontal tissues (destruction of ligaments, bone resorption, etc.). Important, in our view, is the fact that there was a tendency to the appearance of generalized periodontal disease. Developing chronic processes had a dim clinic picture and meager clinical symptoms.

Table 2 shows the results of research on the state of periodontal tissues in miners of different ages and people not working in the mining industry (the comparison group).

Table 2

Dynamics of periodontal indices in miners

Indices and samples	Age
	21-30 years		31-40 years		41-50 years		51-60 years
	basic	comp.	basic	comp.	basic	comp.	basic	comp.
GI	2,76±0,45**	2,27±0,41	2,81±0,52**	2,29±0,43	2,97±0,56**	2,03±0,39	2,98±0,31	2,14±0,19
РМА (%)	47,03±1,07	32,12±0,9	53,32±2,1	41,27±1,3	56,42±1,8	46,19±2,0	60,56±2,4	54,32±2,6
CPITN	2,52±0,44**	1,87±0,35	2,75±0,15*	1,69±0,8	2,82±0,53**	1,92±0,36	2,88±0,17	1,97±0,43
PI	2,19±0,31	1,36±0,23	2,22±0,41**	1,41±0,27	2,64±0,18	1,57±0,13	2,85±0,52**	1,27±0,22**

Note: * significant differences between the study and control groups (p <0,01);

** Comparison group differences were statistically significant (p <0,05).

Hygienic index (GI) of a core group of workers of all ages has more than 2.6 points, indicating the absence of regular oral care and talks about poor levels of hygiene.

By the workers, of the primary and control groups of all ages, we recorded gingivitis of varying severity - mainly mild to moderate. In the main group PMA index of 1.46 times the data of the control group aged 21-30 years old, 1.22 times in 41-50 years, and 1.11 times in 51-60 years.

Periodontal Index (PI) among workers who formed the main group at the age of 21-30 years points to the formation of irreversible changes in periodontal tissues and 1.6 times higher than the PI control group [8]. CPITN index had significant differences in workers and control group.

The analysis of the data is the evident that there is a gradual increase in the prevalence of signs of periodontal disease in miners with age, and corresponds with the increase of work experience in underground service. It should be noted, the weighting of the pathological process and involving large amounts of tissue (it is mostly about the generalization of the process) as well as the growth of periodontal disease (gingivitis of varying severity, periodontitis) with an increase in part-time work in hazardous conditions, iron ore production and the age of the surveyed workers.

The analysis obtained by electron microscopic examination of the data, testified about certain changes in the epithelial cells of the gums in miners.

First of all, attention was drawn to the status of cell-cell contacts. In many fields of vision they looked tight all over plasmolemma, however, almost universally observed sections loosening of intercellular contacts which takes the form of a more or less wide band of average electron density, which is sometimes accompanied by a loss of definition of contours cytoplasmic membranes.

In some cases, the nucleus of epithelial cells had the scalloped shape, sometimes with deep appendages, or, conversely, invaginations karyoplasm. Moreover, the chromatin in the nucleus, was usually in the form of uniformly distributed euformy, although in some cells nucleoli absent.

The cytoplasm of epithelial cells was most homogeneous, moderate electron density, containing a complex of a few well-developed organelles. Among them prevailed mitochondria with moderately dense electro-optical matrix and the more or less tightly packed orderly arrangement Christie. At the same time, almost everywhere there were areas in which in electron microscopic studies reveal signs of inter- and intratselyullyar edema. In such areas, intercellular contacts between epithelial cells whose nuclei tend to have an irregular shape, looked sharply expanded.

Significant changes have taken place in lie deep layers. First of all, we pay attention to changes in the microvasculature vessels, most of which looked paralytic expansion. It should also be noted that in almost all cases, we observed the presence of expressed to a different extent of inflammatory infiltration. There prevailed lymphohistiocytic elements with almost no white blood cells.

Very characteristic has appeared the presence of inflammatory infiltrate of mast cells and plasma.

Finally, it must be emphasized that in some cases in the material were areas with more or less massive growths of collagen fibers. In these areas in a plurality were observed fibroblasts with signs of high functional activity. Such areas indicate a chronic flowing of inflammation.

Thus, obtained by electron microscopic examination of the data indicate that the examined miners, despite maintaining the overall organization of the epithelial layer, and the underlying structures, there were certain changes in the ultrastructure of the individual components of the gums. Moreover, these changes were a mosaic pattern, and different portions were expressed to varying degrees. In some areas was ultrastructure changes indicated intercellular and intracellular edema mainly epithelial cells, other – had a dystrophic nature and even destructive changes, indicating that the depth of the lesion cell ultrastructure.

Conclusions. After analyzing the data, we came to the following conclusions:

1) an increase in part-time work in hazardous conditions, iron ore production is associated with the development of complex periodontal disorders;

2) hazards of iron ore production by increasing the length of service caused microcirculatory disorders, the development of dystrophic and destructive processes in the gums by working of underground halls of iron production.

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