Slobodianyk M. Clinical features and pathogenesis of periodontal disease in patients with acquired valvular heart disease

M. V. Slobodianyk. Clinical features and pathogenesis of periodontal disease in patients with acquired valvular heart disease – published as a manuscript. Dissertation for the Degree of Candidate of Medical Sciences in the specialty 14.01.22 – Dentistry. – Shupyk National Medical Academy of Postgraduate Education, Kyiv, 2020. The dissertation is devoted to the study of clinical features and pathogenesis of generalized periodontitis in patients with acquired valvular heart disease, as well as identification of the species composition and interactions of the oral and valvular microbiome. The findings indicated the extremely high prevalence of generalized periodontitis (100 %) in patients with acquired valvular heart disease. Taking systemic antibacterial drugs in order to prevent infective endocarditis has led to an increase in the number of patients with generalized chronic periodontitis (70 %). It was found that molecular diagnostics and genetic testing, or simply real-time PCR, is more appropriate to use for determining the qualitative and quantitative composition of periodontal pathogens and the spread of periodontal uncultured anaerobes. The findings of molecular diagnostics and genetic testing were indicative of the coexistence of major periodontal pathogens in periodontal pockets and the surface of heart valves in patients with acquired valvular heart disease: Pg – in 51.7 % patients (45), Tf – in 35.6 % (31), Td – in 26.4 % patients (23), Aa was identified in 34.5 % of cases in periodontal pockets, though it was not detected on heart valves; Pi – in 4.6 % of cases, indicating a high risk of hematogenous spread of major periodontal pathogens with the following colonization of the valvular surface. The significant contamination of the periodontal pocket by the periodontal pathogen Porphyromonas gingivalis predetermines a high risk of contaminating heart valves in patients with acquired valvular heart disease (p ≤ 0.001). The strong correlation between the extent of contamination of the periodontal pocket and valves after surgery in patients with acquired valvular heart disease was registered for the periodontal pathogen Porphyromonas gingivalis (ρ = 0.72; р = 0.01), which is indicative of a higher virulence among other species comprising the oral microbiome. Exacerbations of generalized periodontitis in patients with acquired valvular heart disease increase the risk of bacterial load (U = 59.0; p = 0.05) and provoke an increase of total microbial contamination (TMC) on heart valves. The effectiveness of systemic antibiotic therapy combined with long-acting topical antimicrobial agents was proved to effectively control microbial biofilms of periodontal pockets in patients with acquired valvular heart disease (p <0,001). Keywords: generalized periodontitis, acquired valvular heart disease, mitral stenosis, aortic stenosis, real-time PCR, Porphyromonas gingivalis, periodontopathogenic microflora.