The dissertation presents theoretical generalization and novel solution of the topical scientific and practical problem of contemporary dentistry, namely, the improvement of the efficacy of the combined therapy of women of childbearing age with inflammatory and inflammatory-dystrophic periodontal diseases, associated with bacterial vaginosis, by enhancing the screening examination and creating a protocol of management of patients by a dentist and gynecologist.
The relevance of the selected scientific problem is determined by insufficient level of simultaneous research of the initial areas of the genital and digestive tracts along with “congenial” pathological states, caused by microbial pathogenic factors, including bacterial vaginosis (BV) and inflammatory, inflammatory and dystrophic periodontal diseases that a common in the female population. Study of the common features of its pathogenesis is crucial due to the common features of the clinical course of catarrhal gingivitis, generalized periodontitis and BV, the сhronicity and recurrent nature of the above pathological states, since the cross- infection of the open cavities of the human body is an urgent and understudied problem. There are absolutely no protocols developed on the management of dental patients with dysbioses of genital tract, including women with bacterial vaginosis.
Based on the polymerase chain reaction method of diagnostics of pathogens of bacterial vaginosis in the oral cavity (Gardnerella vaginalis and Atopobium vaginae), which are non-specific representatives of the oral microbiota, the plan of management of patients with bacterial vaginosis by a dentist and gynecologist has been developed with substantiation of treatment and prevention of pathological lesions of periodontium in women with bacterial vaginosis.
Findings of the research showed the presence of inflammatory and inflammatory-dystrophic diseases in all patients with bacterial vaginosis. Thus, chronic catarrhal gingivitis was found in 11.11% of women with vaginal dysbiosis; chronic generalized periodontitis was found in 61.11%; chronic generalized I degree periodontitis was found in 27.78%; clinically intact periodontium was not registered in any patient with bacterial vaginosis; however, clinically intact periodontium was found in 20% of women with vaginal normocenosis and carriers of Gardnerella vaginalis. The comparative analysis of the index evaluation of the periodontium of women of all groups confirmed the worse state of periodontium in women with bacterial vaginosis. The PMA index of patients of Group III was 2.1 and 2.6 times higher the values in women of Group I and II, respectively; Leus comprehensive parodontal index (CPI) was 2,5 and 3,3 times, respectively, higher; Svrakov’s value was 2,3 and 3,4 times, respectively, higher. The Gardnerella vaginalis and Atopobium vaginae tests in the oral cavity confirmed absence of above microorganisms in no patient without bacterial vaginosis, in contrast to individuals with bacterial vaginosis, where was recorded in 75,9 % of women and Atopobium vaginae in 81.5%, confirming the cross-infection of the oral cavity and vagina, and demonstrates the indirect correlation between bacterial vaginosis and periodontal diseases.
The suggested and patented amino-test of the oral fluid was positive in 80,3% of patients with vaginal dysbiosis and in 100% was associated with PCR- positive Gardnerella vaginalis, Atopobium vaginaе in the oral cavity and is the method of express diagnosis of the pathogens of bacterial vaginosis in the oral microbiota.
The study of cytological markers of bacterial vaginosis, the amount of lactobacilla and leukocytes in the smears from mucous membrane of the alveolar ridge and vagina showed the 100% presence of the “key cells” both in vagina and oral cavity of women with bacterial vaginosis. Increased number of leukocytes (34,9±1,59), as a criterion of inflammatory reaction, was detected in the oral smears; however, the number of leukocytes in the vaginal smears (12,3±0,72) is not a diagnostic determinant, indicating about the absence of inflammatory reaction in vagina in BV.
The suggested tactics of combined pathogenetic treatment of women with bacterial vaginosis by a dentist and gynecologist facilitated the positive clinical dyamics of the state of periodontal tissues on day 14 in 75%, and on day 28 in 96.4% of patients, whereas the conventional treatment showed 46.2% and 81.6% of patients, respectively, that was accompanied by normalization of their clinical-laboratory indices. In the remote terms of the dynamic observation of women with bacterial vaginosis, treated simultaneously by a dentist and gynecologist according to conventional regimen, relapses of the inflammatory process in the periodontal tissues occurred in 38,5%, 46,2% and 76,9% of patients within 3, 6 and 12 months, respectively, that is 10.8, 1.4 and 3.6 times more frequently (on the average by 5.3 times) in a similar timefra
