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2Central Asian Research Journal For Interdisciplinary Studies (CARJIS) ISSN (online): 2181-2454 Volume 1 | Issue 3 | December, 2024 | SIIF: 5,965 | UIF: 7,6 | ISRA: IIF 1.947 | Google Scholar |
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DIABETES AND PARODONTAL DISEASES
Usmonova Shoira Ravshanbekovna
Doctor of Medical Sciences, Professor Alfraganus University Avazova Shakhlo Nuridinovna
Assistant Alfraganus University Usmonov Asilbek Farxodovich 2nd year student Alfraganus University
Annotation.
Diabetes mellitus (DM) is an endocrine disease that develops due to a relative or absolute lack of the hormone insulin or a violation of its interaction with body cells, resulting in a persistent increase in blood sugar (glucose) (hyperglycemia). One of the earliest and most frequent manifestations of diabetes mellitus is a violation of the secretory function of the salivary glands, leading to xerostomia, which is accompanied by complaints of dry mouth. It is assumed that diabetic complications of salivary gland function may be associated with the autoimmune process of degeneration of salivary producing cells. Diabetes, one way or another, affects all the main components of the etiology and pathogenesis of generalized parodontal diseases: bacterial invasion, protective properties of the body and tissues of the parodontal complex, reparative properties of the latter, blood circulation and metabolism in them. The data presented in the review indicate the leading role of the presence of diabetes mellitus in the development of destructive changes in parodontitis.
Key words: Diabetes mellitus, parodontal disease, salivary glands.
Diabetes mellitus (DM) is an endocrine disease that develops due to a relative or absolute lack of the hormone insulin or a violation of its interaction with body cells, resulting in a persistent increase in blood sugar (glucose) (hyperglycemia).
One of the earliest and most frequent manifestations of diabetes mellitus is a violation of the secretory function of the salivary glands, leading to xerostomia, which is accompanied by complaints of dry mouth. It is assumed that diabetic
Central Asian Research Journal For Interdisciplinary Studies (CARJIS) ISSN (online): 2181-2454 Volume 1 | Issue 3 | December, 2024 | SIIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
www.afu.uz/j ournal
complications of salivary gland function may be associated with the autoimmune process of degeneration of salivary producing cells.
Diabetes, one way or another, affects all the main components of the etiology and pathogenesis of generalized parodontal diseases: bacterial invasion, protective properties of the body and tissues of the parodontal complex, reparative properties of the latter, blood circulation and metabolism in them.
The data presented in the review indicate the leading role of the presence of diabetes mellitus in the development of destructive changes
50 43,75 73 d_^pr d_^^ d_^^ man
0
5-9 years 10-14 years 15-18 years
man ■ woman
Figure 1. Prevalence of parodont disease in children with Type 1 diabetes mellitus by sex and age (%).
As is known, diabetes mellitus (DM) is an endocrine disease that develops due to a relative or absolute deficiency of the hormone insulin or a violation of its interaction with body cells, resulting in a persistent increase in blood sugar (glucose) (hyperglycemia).
According to WHO, there are currently 285 million DM patients in the world, and by 2025 their number will reach 380 million and 435 million in 2030. At the same time, the real rate of increase in morbidity is significantly ahead of even such depressing forecasts of statisticians. So, in 2000, the number of patients with diabetes turned out to be 11% more - 175 million against 154 million according to the calculated data of 1998.
Diabetes is characterized by a chronic course and a violation of all types of metabolism (carbohydrate, fat, protein, mineral and water-salt). Normally, the blood glucose content varies within fairly narrow limits: from 5.5 to 6.6 mmol/l. This is due
in parodontics.
woman
Central Asian Research Journal For Interdisciplinary Studies (CARJIS) ISSN (online): 2181-2454 Volume 1 | Issue 3 | December, 2024 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
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to the fact that the pancreas produces more insulin the higher the blood glucose level.
There is a distinction between type 1 diabetes and type 2 diabetes mellitus.
The key point in the development of type 1 diabetes is the massive destruction of endocrine cells of the pancreas (islets of Langerhans) and, as a result, a critical decrease in blood insulin levels. This may occur in the case of viral infections, oncological diseases, pancreatitis, toxic lesions of the pancreas, stress conditions, various autoimmune diseases in which cells of the immune system produce antibodies against pancreatic P-cells, destroying them. The basis of autoimmune cell damage is their damage by any cytotoxic agents. This lesion causes the release of autoantigens that stimulate the activity of macrophages and T-killers, which, in turn, leads to the formation and release of interleukins into the blood in concentrations that toxic effect on pancreatic cells, as well as cells are damaged by macrophages located in the tissues of the gland.
Usually, type 1 diabetes mellitus is associated with either autoimmune disorders or may be idiopathic in nature.
The causes of type 2 diabetes include hereditary predisposition and external factors. Hereditary predisposition plays an important role, but environmental factors are still of leading importance.
Thus, it was found that patients with relatives with diabetes mellitus have a higher risk of developing this disease. Studies have shown that the risk of developing diabetes if one of the parents is ill ranges from 3 to 9 %.
One of the earliest and most frequent manifestations of diabetes mellitus is a violation of the secretory function of the salivary glands, leading to xerostomia, which is accompanied by complaints of dry mouth. It is assumed that diabetic complications of salivary gland function may be associated with an autoimmune process of degeneration of salivary-producing cells.
Dry mouth in diabetic patients is accompanied by increased thirst and appetite. The mucous membrane is shiny, hyperemic, and catarrhal inflammation engulfs almost the entire mucous membrane of the oral cavity.
The composition and properties of oral fluid in patients with diabetes mellitus differ significantly from those in somatically healthy individuals in all indicators. This is especially true for enzymatic activity. There is almost always a violation of the acid-base equilibrium with a shift towards acidosis.
One of the most significant signs of changes in oral fluid is also an increase in glucose content, almost an order of magnitude compared to healthy individuals. There is a direct relationship between the glucose content in the oral fluid and in the
Central Asian Research Journal For Interdisciplinary Studies (CARJIS) ISSN (online): 2181-2454 Volume 1 | Issue 3 | December, 2024 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
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blood.
Changes in the oral fluid lead to a violation of its main functions - mineralizing, cleansing, protective and the predominance of demineralization processes over remineralization, which causes the development of dental caries. The problem of the relationship between diabetes and parodontal diseases is being developed most intensively in dentistry.
Diabetes mellitus, one way or another, affects all the main components of the etiology and pathogenesis of generalized parodontal diseases: bacterial invasion, protective properties of the body and tissues of the parodontal complex, reparative properties of the latter, blood circulation and metabolism in them. Inflammation of parodontal tissues in diabetic patients has a complex genesis.
Angiopathy is of the greatest importance in the development of parodontal tissue inflammation in patients with diabetes mellitus. The starting point of diabetic microangiopathies is a violation of carbohydrate metabolism, as well as a violation of the metabolism of glycoses, which determine the functional and structural integrity of the vascular basement membrane. Vascular changes in diabetes mellitus have a peculiar character: the lumen of the vessel, as a rule, does not completely close, but the vessel wall is always affected. The processes of plasmorrhagia are the basis of diabetic microangiopathy. They are reduced to primary plasma damage to the basement membrane of the microcirculatory bed, and then cause sclerosis and hyalinosis of the vascular walls. Consequently, microcirculatory disorders are primary in nature against the background of already existing transcapillary metabolism, increased permeability of connective tissue structures of the parodontium, hypoxia and decreased resistance of parodontal tissues to the action of nonunpleasant factors. The microflora of the dental sulcus (endotoxins and enzymes of microorganisms) initiates inflammatory and destructive changes, and the emerging overload of parodontal tissues further aggravates the situation.
Immunological disorders play an important role in the occurrence of inflammation of the parenteral tissues. In the oral cavity of diabetic patients, the activity of natural protective factors decreases: specific and non-specific. It has been established that phagocytosis is slowed down by monocytes-macrophages of microorganisms of the oral cavity. The content of lysozyme in saliva in patients with diabetes mellitus is reduced by 1.5 times compared with healthy ones. The content of immunoglobulins A and G increases along with a decrease in the content of immunoglobulin M in saliva. At the same time, a decrease in the content of lysozyme and an increase in the content of IgA and IgG in patients with diabetes mellitus indicate an imbalance of
Central Asian Research Journal For Interdisciplinary Studies (CARJIS) ISSN (online): 2181-2454 Volume 1 | Issue 3 | December, 2024 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
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non-specific (lysozyme) and specific (immunoglobulins) factors of local oral immunity, which generally affects the resistance of the oral cavity as a whole.
At the whole body level, a decrease in immunity is manifested by a decrease in the number of T and B lymphocytes, theophylline-sensitive and resistant T lymphocytes. The leading role of cytokines in the development of parodontitis in diabetic patients has also been proven.
The content of mucopolysaccharides and glycogen in the gums of diabetic patients increases. There is coarsening of collagen fibers, their disorderly arrangement, ruptures, foci of thickening and loosening, atrophy of muscle tissue, the mucous membrane has more pronounced vascular lesions of the type of angiopathies with atrophy, sclerosis and inflammation; there is an increase in the number of mast, plasma cells, eosinophils, macrophages. The presence of a nested and diffuse inflammatory infiltrate with an admixture of plasma and mast cells, according to a number of authors, indicates that in diabetes mellitus these processes are autoimmune in nature.
Rheoparodontography data indicate a significant change in the hemodynamics of the parodontal vessels. The most serious changes in the rheopathogram are observed in patients with prolonged and severe diabetes mellitus. They have a decrease in the patency of the pre-capillary bed, the speed of blood flow and oxygen transport to parodontal tissues. Capillary resistance decreases and vascular permeability increases.
According to literature data, 60.3% of patients with diabetes mellitus have destructive changes in the bone, 26.2% have dystrophic -sclerotic restructuring.
The leading radiological signs of parodontitis are the disappearance of the cortical plate and the appearance of osteoporosis, the presence of various destructive changes in the bone tissue of the alveolar process.
Conclusion. The data presented in the review indicate the leading role of the presence of diabetes mellitus in the development of destructive changes in parodontitis.
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