Nikolaeva A. A differentiated approach to the prevention and treatment of chronic generalized periodontitis in women of reproductive and pre-menopausal age against hypo-and hyperestrogenism (experimental and clinical study).

A concept is developed to substantiate the advisability of a differentiated approach to the treatment and prevention of chronic generalized periodontitis initial-I degree in women if there is increasing evidence of failure in estrogen production, taking into account the clinical course and the obligatory consultative participation of a gynecologist, as the incidence of female hormonal imbalances reaches 39.5%. The features of the generalized periodontitis in women with dysfunction of estrogen production were studied and it was shown that the destructive processes of the alveolar bone prevail in women with hypoestrogenimia, and the periodontal inflammatory reactions in women with hyperestrogenimia. The inflammatory markers, the parameters of the system "lipid peroxidation -antioxidant system", antimicrobial protection and oral dysbiosis were studied in a comparative aspect, and the state of the immunological reactivity of women with generalized periodontitis of the initial-I degree, which occurs against the background of hypo- or hyperestrogenimia, was assessed. The mechanisms of destructive action on periodontal tissues of existing and proposed own experimental models that are reproduced by oral reproduction of lidase, warfarin, collagenase and kuprenil are determined. In conditions of experimental models of periodontitis, protective properties of polyphenols of Hypericum perforatum (a decrease in the degree of atrophy by 20-26%), Equisetum arvensis (11%), and Polygonum aviculareby (19%) are expressed. Different efficacy of plant polyphenols of Hypericum perforatum L., Equisetum arvensis L., Polygonum aviculare L. in women of reproductive and pre-menopausal age with hypo-and hyperestrogenimia has been established, which causes a differentiated approach to treatment and prevention of generalized periodontitis. It's proved the high protective efficiency against chronic periodontitis of differentiated complexes of therapeutic and prophylactic measures in women with generalized periodontitis of the initial-I degree with dysfunction of estrogen production, the mechanism of which is based on anti-inflammatory, immunomodulating and osteoprotective action, and also due to reduction of the degradation processes of the components of the connective-tissue matrix of periodontium, which is confirmed by a sustained remission of generalized periodontitis during the year in 95% of women with hypoestrogenimia and in 92% of women with hyperestrogenimia.