Fesenko V.I. , Fesenko I.V. PARTICULAR CLINICAL AND LABORATORY INDICES OF THE PROGRESS OF GENERALIZED PERIODONTITIS IN PATIENTS WITH CHRONIC VIRUS HEPATITIS B

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V.I. Fesenko, I.V. Fesenko*

State institution "Dnipropetrovsk Medical Academy" of the Ministry of Healthcare of Ukraine

Kharkiv National Medical University *

PARTICULAR CLINICAL AND LABORATORY INDICES OF THE PROGRESS OF GENERALIZED PERIODONTITIS IN PATIENTS WITH CHRONIC VIRUS HEPATITIS B

A lot of issues remain the subject of discussion, despite the significant achievements in the study of the problem of periodontal diseases. These include the study of factors causing the onset and progression of generalized periodontitis, as well as aggravating its course [1, 4].

It has been established that the progression of generalized periodontitis is caused by a number of factors playing a leading role: the structure of bacterial periodontal pathogens, the reduction of immune and non-specific mechanisms of protection, the presence of concomitant diseases. Particularly close connection of generalized periodontitis has been established with viral hepatitis B [2]. This may be due to both the degree of inflammatory activity of hepatitis and the severity of immunopathological disorders induced by the hepatitis B virus.

All this determines the relevance of the study that would determine the role of chronic viral hepatitis B (HBV) on the course of the generalized periodontitis with a view to further prevention and treatment development.

Materials and methods of research.

The basis of this Papers is the analysis of clinical, immunological and biochemical studies of 98 patients with generalized periodontitis (GP) in combination with chronic viral hepatitis at the age from 16 to 58 years. Separate examinations of 34 patients with periodontitis, identical in age with no history of chronic comorbidities were conducted.

Patients were divided into three groups, depending on the course of CHBV: the first clinical group consisted of patients with Generalized Periodontitis in combination with CHBV, the replication phase (positive HBsAg, HBeAg, anti-HBc IgM, HBV DNA; active progress of minimal and moderate activity) - 64 people 65.3%). The second group consisted of patients with Generalized Periodontitis in the setting of CHBV in the integration phase (remission - positive HBsAg, negative HBeAg, anti-HBc IgM, HBV DNA, indices of transaminases are normal or close to the normal) - 20 people (20.4%). The third group consisted of patients with Generalized Periodontitis in combination with hepatocirrhosis of virus (B) genesis with a minimum activity level - 14 people (14.3%).

The examination of patients was carried out according to the generally accepted pattern: complaints, anamnesis of the disease, objective information about the clinical laboratory examination. Evaluation of the condition of periodontal tissues was carried out by means of periodontal tests and indices. The state of oral hygiene was calculated using the index (Fedorov-Volodkina, 1970), the periodontal index (Russel, 1956), the PMA index (Parma, 1960), the Muhlemann Bleeding Index, the Schiller-Pisaryev test; the functional stability of capillaries was calculated according to V.I. Kulazhenko technique (1960). [1]. Evaluation of the jaws bone tissue condition, in particular a compact plate of interdental alveolar septa, was performed by the method of dental X-ray radiography.

The classification of periodontal diseases was used as amended by M.F. Danylevskyi (1994) [1] in order to establish the diagnosis of generalized periodontitis.

All patients underwent virological blood testing using enzyme-linked immunosorbent assay (ELISA) for the presence of HBsAg, HBeAg, anti-HBcIgM, and Polymerase chain reaction (PCR) being the qualitative determination of HBV DNA to determine the diagnosis of chronic viral hepatitis B. [5]. The quantitative composition of immunoglobulins was determined by the method of radial immunodiffusion (RID) [6]. The level of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was determined by means of Dinitrophenylhydrazine Colorimetric Method by the Reitman-Frenzel [7]. The level of bilirubin was determined by means of Jendrassik-Grof method. Statical processing of materials was performed on a computer using the Excel program. The difference in the parameters compared was considered as definitive for p˂ 0.05.

The results of the research and their discussion. The clinical course of generalized periodontitis in patients with CHBV in different clinical groups was significantly different according to the obtained results of examination. So, for example the first clinical group was characterized by the presence of an active inflammatory process in the periodontium, i.e. a high level of indices and periodontal tests (Table 1).

Table No. 1.

Indices of periodontal indexes and tests for patients with Generalized Periodontitis in the setting of CHBV

Groups examined	Periodontal indexes and tests
	РМА %	Г І in points	Kulazhenko test	Bleeding index in points	П І in points	Schiller-Pisaryev test
Patients with GP without concomitant pathology (control group)	45,7±3,0	2,1±0,1	39,7±1,7	1,6±0,2	2,43±0,2	1,82±0,1
І clinical group	87,2±2,6*	2,6±0,1*	16,9±2,0*	3,4±0,1*	3,2±0,2*	3,4±0,2*
ІІ clinical group	58,2±3,8*	2,43±0,2	24,2±2,4*	2,9±0,2*	2,9±0,2	2,6±0,2*
ІІІ clinical group	66,4±2,8*	2,29±0,2	28,8±2,4*	2,6±0,2*	2,7±0,2	2,1±0,1*

* - The indices are significantly different (p˂ 0,05) in relation to the control group

Patients of this group showed the presence of deep periodontal pockets with a purulent discharge, numerous dental deposits over and under the concretions, the presence of foci of active osteoporosis of interdental alveolar septa, as well as mobility of teeth (grade II and III).

An initial and 1 degree of severity of periodontitis was found in 26 patients (40.6%). These patients complained of the spontaneous nature of gum bleeding and their soreness. 2 degree of severity of periodontitis was found in 33 patients (51%). Patients complained of significant soreness of the gums, bleeding, bad breath. In addition, they suffered edema and the presence of diffuse gum. It should be noted that in this group of patients the presence of periodontal pockets up to 5-6 mm with significant serous-purulent exudate and mobility of the second degree was established. Radiographically - the phenomenon of diffuse osteoporosis of interdental septa, a decrease in alveolar bone levels from 1/3 to ½. The clinical picture of the disease corresponded to the described symptoms in all patients.

It should be emphasized that the clinical severity of a pathological process in the periodontium had a direct relationship with the length of the underlying disease. The maximum expression of the inflammatory reaction and destructive progress was recorded in patients with hepatitis, for a period of 5 years or more. Thus, approximately 82% of patients have noted that after six months or a year there was a sharp deterioration of the state of the gums expressed by bleeding, halitosis, dental mobility, not noted previously. Identified patterns of development of generalized periodontitis is good reason to assert that there are patients with CHBV common pathological changes that contribute to the onset and progression of periodontal disease. This assertion is documented by the fact, that positive tests for the presence of replication markers HBV (HBsAg, HBeAg, anti-HBcIgM, HBV DNA) in serum coincides with a significant decrease in the mixed oral liquid secretory immunoglobulin A, immunoglobulin M and increase in immunoglobulin content G (Table. 2).

Table No. 2.

Composition of immunoglobulins of mixed saliva of patients with GP in the setting of CHBV

Groups examined	Saliva immunoglobulins (in g / l)
	S Ig A	Ig M	IgG
Healthy	1,4±0,01	1,23±0,04	10,7±0,2
Control group	0,56±0,02	0,87±0,02	11,8±0,2
І clinical group	0,31±0,05	0,42±0,06	13,8±0,4
ІІ clinical group	0,63±0,03	0,66±0,05	12,1±0,4
ІІІ clinical group	0,60±0,03	0,72±0,04	12,3±0,5

The development of periodontal disease was not very significant in patients of the second clinical group: insignificant hyperemia of the gingival tissues, bleeding, exposure of the roots of the teeth, periodontal pockets up to 2-3 mm with insignificant purulent discharge and slow progression of bone resorption of the jaws. 65% of patients had periodontitis of primary and 1 degree of severity. Lesions are noted for grade 2 periodontitis in 25% of patients. Objectively, the exposure of the necks of the teeth and insignificant hyperemia were revealed. For this group, the humoral response in the ELISA test differed from previous patients in that only Hbs Ag was found and even covered not in all cases (12%). The majority (87%) of patients in this group found to have no viral antibodies. The indices of the main immunoglobulins varied only slightly (Table 2). This also can serve as indices of the remission phase of the underlying disease.

The third group: patients often complained only of mobility and loss of teeth, numerous deposits of dental tartar, and less often bleeding from the gums. Moreover, in this group of patients, grade II and grade III of GP were more frequent (24% and 76%, respectively).

Comparing the clinical indices with the biochemical blood test data characterizing the functional state of the liver, it was revealed that in patients with HP with CHBV that their average levels of both clinical and laboratory indices characterizing the severity of these diseases are significantly higher (Table 3).

Table No. 3.

Biochemical indices of patients with GP in the setting of CHBV.

Groups examined	Biochemical indices
	Bilirubin Mmol / l	Alat Mmol / hr l	AsAT Mmol / hr l
Control group	12,5±0,8	0,42±0,03	0,39±0,04
І clinical group	53,4,6±9,5	3,1±0,3	1,3±0,07
ІІ clinical group	20,8±2,4	0,6±0,04	0,58±0,01
ІІІ clinical group	29,7±6,8	1,4±0,4	0,42±0,02

Comparison of the systemic immunological parameters of patients of different groups, found that patients suffering from GP with no CHBV had only a tendency to growth of M, G immunoglobulins. with HBV in combination with HBV, the available significant elevated levels of immunoglobulins, high values, they reach in patients with active viral And inflammatory process (Table 4)

Table No. 4

Composition of immunoglobulins in patients with GP in the setting of CHBV.

Groups examined	Імуноглобуліни (в г/л)
	S Ig A	Ig M	IgG
Control group	1,43±0,05	1,23±0,04	11,7±0,2
І clinical group	2,2±0,09*	1,87±0,08*	17,68±0,4*
ІІ clinical group	1,63±0,05	1,2±0,04	14,8±0,4*
ІІІ clinical group	1,6±0,03	1,18±0,04	13,5±0,3*

* - the indices differ significantly (р˂ 0,05) in relation to the patients from the control group

Patients with GP combined with CHBV in the replicative phase were found to have severe violations of the immune status and their indices were significantly different in comparison with the control group. It should be noted that a significant increase in blood IgG in patients of all major groups is present. Thus, the level of IgG increased to 17.68-0.4 g / l, which on the average was 1.3 times higher than in the control group.

An in-depth analysis of the results obtained made it possible to determine the influence of a number of unfavourable factors on the expressiveness of pathological changes on the part of clinical implications of GP: the duration of the disease for more than 5 years, the active phase of the viral process and more expressive immunological shifts. The pair correlation analysis revealed a positive associative relationship between the level of IgG saliva and the duration of the disease (r = 0,372, р˂0,05), the level of the bleeding index and the duration of the disease (r = 0.224, р˂0.05), serum IgG level and the duration of the disease (R = 0.41, р˂ 0.05), the level of the bleeding index and the activity of ALAT (r = 032.4, р˂ 0.05).

Thus, the information presented above confirm once again the dependence of the clinical manifestation of generalized periodontitis on the characteristics of the course and duration of chronic viral hepatitis B.

Conclusions.

1. Clinical manifestations of generalized periodontitis have a clear dependence on the phase of activity of chronic viral hepatitis B and the duration of the disease.

2. The evaluation of the clinical condition of periodontal tissues in patients with chronic viral hepatitis B has to include the basic biochemical, immunological, and virological parameters reflecting the course of the progress and the activity of the underlying disease.

3. The clinical findings of generalized periodontitis have a clear connection with laboratory parameters characterizing the functional state of the liver.

List of references

1. Practical periodontology / Scientific and methodical publication // A.V. Borysenko, M.Yu. Antonenko, L.F. Sidelnikova – К.: “Doctor –Media” LLC, 2011.- p.472

2. O.V. Sierova, Diagnosis and complex treatment of periodontitis in patients with acute and chronic viral hepatitis. Author's abstract. Dis ... Candidate of Medical Sciences- Poltava. 1999.-p. 19

4. I.S. Mashchenko, Periodontal diseases / I.S. Mashchenko, Dnipropetrovsk: KOLO, p. 2003-273

5. M.Ya. Orel, HbsAg-finding by means of competitive immune enzyme assay / M. Ya. Orel, A.L. Hural, V.R. Shahynyan, V.F. Mariyevskyi / Clinical and laboratory diagnostics.- 1994.- No. 6.-P.40-41.

6. Manchini G, Garbonara A.O., Hermans I.E., Immunochemical quantitation of antigens by single radial immunodiffusion // Immunochemistry.- 1965.- Vol.2, № 6.- Р.234-235.

7. V.V. Menshykov, Laboratory research methods in the clinic. М.: Medicine, 1987.- p. 365

Resume. The following examinations have been conducted: complex clinical, X-ray, biochemical, immunological and virological of 98 patients with generalized periodontitis in the setting of chronic viral hepatitis B, and of 34 patients with generalized periodontitis with NPH of chronic background pathology. The dependence of the clinical course of Generalized Periodontitis on the activity of the course and duration of the liver disease has been established.

Key words: clinical course, generalized periodontitis, chronic viral hepatitis B.