Metabolic Therapy in the Treatment of Concomitant Periodontal and Internal Diseases (pp. 21-36)
Authors: Irina A. Gorbacheva, Yuliya A. Sycheva, and Lyudmila Y. Orekhova
Abstract: Background: Nowadays, the relationship between periodontal disease and diseases of internal organs has been established. Universal molecular and cellular deviations, disorders of redox metabolism, pathological activation of apoptosis promote development and progression of many somatic diseases, forming polymorbidity in patients including patients with inflammatory periodontal disease.
Objective: The purpose is to evaluate the efficacy of metabolic therapy in treatment of patients with concomitant periodontal and internal organ diseases.
Methods: We examined 909 patients with internal diseases associated with generalized periodontitis Group I included 100 patients with chronic infection sites with various localization. Group II included 100 patients with cardiovascular diseases. After examination, patients in group I were prescribed metabolic drugs such as mexidol (ethylmethylhydroxypyridine succinate) or cycloferon (meglumine acridone acetate); patients in group II were prescribed mildronate (meldonium dihydrate) or cytoflavin (a preparation containing succinic acid).
Free radical oxidation was assessed by measuring the intensity of lipid, protein and low-molecular-weight thiol peroxidation; lymphocytes were used as a model for studying apoptosis by flow cytometry (Annexin V – FITC); the periodontal status was evaluated using the periodontal index (PI) and the community periodontal index of treatment needs (CPITN).
Results: Lipid peroxidation, thiol oxidation by free radicals (p < 0.01), and markers of pathological apoptosis (Annexin V-FITC) (p < 0.05) were increased in patients with concomitant periodontal and internal diseases. In the course of treatment with various antioxidant metabolic drugs we observed a decreased number of cells entering apoptosis (p < 0.01) associated with reduction of lipid peroxidation (p < 0.01) and restoration of thiol-disulfide ratio in all the examined patients.
Conclusions: Personalized approach to the treatment of patients with concomitant periodontal and internal diseases is based on the identification of the most significant alterations of metabolic homeostasis, followed by the choice of an appropriate metabolic therapy.