Shkrebnyuk R. Endothelial dysfunction in the development of generalized periodontitis and its treatment in patients with type I diabetes mellitus complicated by diabetic cardiomyopathy

The total of 163 examined patients with type I diabetes mellitus with cardiomyopathy have been examined during the research. The generalized periodontitis was identified in 80,37±3,11 of examined patients. Compared with the individuals with generalized periodontal diseases without accompanying somatic injuries (47,31±5,18 %, р<0,01) the received result exceeded in 1.7 times. The research showed that in patients with type I diabetes mellitus with cardiomyopathy the spread and intensity of periodontitis followed by distinct inflammatory and destructive processes in the periodontal tissue was increasing with age and the duration. This tendency has been proved by: the increase in PMA indexes; gingival bleeding; depth of periodontal pockets and looseness of teeth in 1.2 times and PI index; Rtg-index of gingival recession; absence of epithelial attachment in 1.5 in comparison with the indexes of patients with generalized periodontal diseases without general somatic diseases. The study of the gingival bioptate ultrastructure in patients with periodontitis affected by I diabetes mellitus with cardiomyopathy determined heterogenic changes in all gingival mucous layers with distinct haemocapillary damages. Epithelial dysfunction in patients with periodontitis affected by I diabetes mellitus with cardiomyopathy was caused by the increase concentration of endothelin-1 molecules, molecules of vascular adhesion, soluble sE-selectine in the blood plasma and the activity of angiotensine-convertive enzyme in comparison with the same data in healthy individuals and patients with generalized periodontitis without accompanying somatic conditions. The treatment and prevention scheme for generalized periodontitis based on the pathogen-directed action has been designed. The efficacy of the suggested complex treatment has been proved by the improvement of the results of clinical and laboratory tests, the shortage in the number of visits and the prolonged stabilization of the pathological process (up to 1.5 year) in the periodontal tissue.