ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE.

ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE.

Umid Golibovich Nusratov Assistant of the Department of Orthopedic and Orthodontics, Bukhara State Medical Institute,Uzbekistan. [email protected]

Umid Golibovich Nusratov, ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE.-Palarch’s Journal Of Archaeology Of Egypt/Egyptology 17(6),ISSN 1567-214x

Abstract: Recent advances in the study of the mechanisms of development of type 2 diabetes have contributed to the development of fundamentally new views on the genesis of the disease and its complications. Our goal is a comparative analysis of the assessment of quality of life in patients with type 2 diabetes mellitus complicated by chronic kidney disease after the use of orthopedic dental treatment. Analysis of questionnaires showed that the quality of life of patients with partial absence of teeth was reduced to a varying degree in all groups of patients. Summarizing the results of the study, we can conclude that the correct deontological approach using the developed recommendations for the collection of anamnesis will facilitate understanding by the of the algorithms and methods of treating the patient and help to improve the quality of prosthetics and further rehabilitation. Key words: diabetes, Dental diseases, kidney disease, orthopedic dentistry, Tongue plaque. Introduction In recent years, the role of chronic inflammation in the development and progression of atherosclerosis, obesity, metabolic syndrome, insulin resistance has been actively discussed.3 Diabetic neuropathy complicates the course of diabetes in 60-90% and is dangerous for the development of diabetic foot syndrome. A statement of diabetic nephropathy in 41% of patients with type 2 diabetes is associated with a risk of developing renal failure 10 years after the start of the process. Diabetic nephropathy in 5-10% of cases leads to terminal renal failure, which in the structure of mortality of patients with type 2 diabetes is 1.5-3%. Transformation of the microalbuminuric stage of diabetic nephropathy into proteinuric occurs in 20–40% of cases over a ten-year period. 2 A high frequency of lesions of the oral organs (up to 90%) in diabetes is due to damage to the microvascular system, bone resorption, and a decrease in local immune responses. Inflammatory periodontal diseases that occur against the background of somatic have a long chronic course, often resistant to treatment, and, despite the improvement of diagnostic methods, a wide arsenal of

14385 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. conservative and surgical methods of treatment and increased attention to prevention, remain a significant problem in modern dentistry.4-8 Dental diseases have a significant impact on the social and psychological adaptation of the nephrological patient in society. Patients suffering from kidney disease, mainly people of a young, able-bodied age, leading an active social life (work, travel, etc.), therefore the state of the oral cavity affects many components of their quality of life. 1, 2, 5 In this regard, the prevention and treatment of somatic disease of type 2 diabetes with chronic kidney disease occupy an important place in dentistry and are clearly interpreted as an epidemiologically significant direction in the development of a preventive strategy in patients.9 Significant changes in the analyzed parameters justify the importance of their control at the stages of orthopedic dental rehabilitation during orthopedic dental treatment, especially in patients with concomitant general pathology. Purpose Comparative analysis of assessing the quality of life of patients with type 2 diabetes mellitus complicated by chronic kidney disease after applying orthopedic dental treatment. Material and methods Scientific research was conducted at the departments and clinics of orthopedic dentistry of the Bukhara State Medical Institute and the Tashkent State Dental Institute. We examined 90 patients with partial secondary adentia, men - 39 (43%) women - 51 (57%). A comprehensive diagnosis of type 2 diabetes was established by endocrinologists in accordance with WHO clinical and laboratory criteria. (1999). Figure 1. Patient distribution by gender and age

25 20 15 Men 10 Women 5 0 40 45 50 55 60 years and more

As can be seen in figure 1. The average age of the examined group was 55.0 ± 9.5 years. men - 36 (40%) women - 54 (60%). All patients were divided into three groups. The first group consisted of 30 patients with type 2 diabetes mellitus without chronic kidney disease, the second - 30 patients with chronic kidney disease. The third group (30) is the control group. The clinical and hygienic examination included the study of the anamnesis of life, disease, general and local dental status of the patient. General clinical methods were used: interrogation, examination Questioning of patients with type 2 diabetes mellitus with chronic kidney 14386 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. disease and dentition defects and periodontal diseases was carried out using a specially designed (Questionnaire 1.) questionnaire, which was filled directly by the dentist when collecting an anamnesis. Questionnaire 1. Specially designed questionnaire, which was filled directly by the dentist when collecting an anamnesis Symptomatic indicators 1 Dry oral cavity (xerostomia) 2 Bad breath (halitosis) 3 Gum soreness 4 Soreness of the tongue and (stomalgia) 5 Burning in the mouth and tongue 6 Taste perversion 7 Metallic taste in the mouth 8 Gum bleeding 9 Tongue plaque 10 Soft deposits on the teeth

11 Hard deposits on the teeth

Pathology of periodontal and oral mucosa 12 Uremic plaque

13

14 Secondary Adentia

• full • partial 15 Angulite

16 Chronic generalized periodontitis

• moderate severity • severe 17

18 Сhronic recurrent aphthous

19 Lichen

20 Fungal stomatitis

14387 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. 21 Bacterial stomatitis

Tooth pathology 22 Hyperesthesia

23 Carious lesions

24 Pathological mobility

25 Pathological

An additional survey of patients with type 2 diabetes mellitus with chronic kidney disease and dentition defects and periodontal diseases was performed using the Oral Health Impact Profile-14 (OHIP-14) quality of life dental questionnaire. The main questions of the OHIP-14 questionnaire relate to the identification of difficulties in pronouncing words, pain in the mouth, a decrease in vital interests, a taste for food, difficulties in eating, constraints in communicating with people, and difficulties in working due to problems with teeth and the mucous membrane of the cavity mouth or . The index is an objective measurement tool that allows you to evaluate dental health in terms of its impact on quality of life. Defects of dentitions of the III, IV classes according to Kennedy and their combination were localized both on the lower and on the upper jaw. All patients had . Testing of patients was carried out: at the initial examination; after the pre-prosthetic sanitation of the oral cavity in the amount of extraction, dental treatment and periodontium; after applying orthopedic treatment with partial fixed dentures. To assess the effect on the mucous membrane of removable prostheses, a number of laboratory microbiological and immunological studies were undertaken. The antiseptic drug LOROBEN was tested in patients to normalize the function of the oral mucosa, prevent inflammatory processes, prevent dysbiotic changes and quickly adapt the applied prostheses in the oral cavity during prosthetics. Patients were divided into the following groups according to orthopedic treatment; - The first group included 13 patients with type 2 diabetes and CKD (control group) who received conventional treatment; - The second group included 17 patients with type 2 diabetes and CKD (the main group) using LOROBEN; Patients in the main group were recommended to rinse the oral cavity with the prepared LOROBEN solution diluted (according to the instructions) with boiled or distilled water, after meals and before bedtime, 3-4 times a day. Pre-prosthetic rehabilitation preparation took (with varying severity of pathology) from one week to 1 month. After rehabilitation measures, prosthetics were carried out for one to two weeks. Results At the stage of clinical and hygienic examination, studying the general and local dental status of patients, symptoms of various types of diseases, such as chronic mechanical trauma, recurrent , , candidiasis, desquamative , exfoliative, were revealed in patients suffering from type 2 diabetes, complicated by CKD severe cheilitis, gingivitis and periodontitis. The condition was exacerbated by foci of chronic diseases on the background of uremic

14388 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. intoxication and progressive renal dysfunction. The decrease in the functional state of the dentofacial system was reflected in the indicators of assessing the quality of life according to the OHIP-14 questionnaire. Analysis of questionnaires showed that the quality of life of patients with partial absence of teeth was reduced to a varying degree in all groups of patients. The study revealed that most patients with somatic disease - diabetes mellitus complained of dryness (xerostomia) in the oral cavity, while the percentage in the group with CKD complication was 96%, in the group of patients with type 2 diabetes without CKD - 76. Many of the subjects had no a pool at the bottom of the oral cavity, the consistency of saliva was viscous, dense (saliva strand was more than 3 cm). Groups of patients with type 2 diabetes had a significantly higher intensity of carious tooth injuries (93% in patients with type 2 diabetes with CKD and 86 in the group of patients without renal complications) compared with the control group, the percentage of carious disorders of which was 50%, all this is associated with high glycated hemoglobin. Taste perversion was observed in 30% of patients of the first group and in 26% of patients of the second group.

Figure 2.Hygienic condition of the oral cavity in patients with chronic kidney disease and type 2 diabetes. 6

5

4 tooth plaque 3 tooth stone 2

1

0 1 sq. 2 sq. 3 sq

1 Main group of patients without urological pathology, 2 group of patients with type 2 diabetes and CKD, 3 Control group.

Significantly, all patients showed varying degrees of hard and soft dental deposits (43% and 36%, respectively, in the group of patients with type 2 diabetes with CKD, 23% and 33%, respectively, in the group of patients with type 2 diabetes without CKD, and 20% and 23% accordingly, the comparison group (Figure 2.). Gum bleeding was observed in 86% of patients with type 2 diabetes with CKD and 63% in patients with type 2 diabetes without renal complications. Neuropathy in patients with type 2 diabetes showed spontaneous pain and paresis of the trigeminal or facial nerves, sensitivity disorders, gum soreness (46% in the group of patients with type 2 diabetes and CKD, 23% in the group of patients without complications from the renal system) and severe stomalgia (36% and 23% respectively). In patients of the comparison group, these symptoms were absent. 14389 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. Reliably noted the defeat of patients with type 2 diabetes with stomatitis in 13 people from the group with CKD and in 6 people without complications from the renal system. In patients from the control group, these lesions were practically not observed (6%). Inflammatory periodontal diseases accounted for 73.9%, of which chronic generalized gingivitis was detected in 73%, 53%, 30% of patients in the groups, respectively; moderate generalized periodontitis was moderate, severe in 90%, 56%, 36%, respectively. In 79.6% of patients, secondary adentia was noted, and only in 10.0% of patients with type 2 diabetes with CKD - an intact periodontium. Figure 3. Dental health indicators of patients in accordance with the OHIP-14 questionnaire.

50 Damage 40

30 Psychological disorders 20 Psychological discomfort 10 Function limitation 0 A group of A group of control group patients withpatients with The studytype of the2 resultstype 2 of determining the quality of life using the OHIP-14 index revealed the integral value of this index in the group of healthy individuals. A significant decrease in the quality of life was almost halved in the presence of type 2 diabetes complicated by CKD, and this dependence is directly related to the severity of the clinical picture of the disease. The quality of life, as assessed by the questionnaire, was worse in dental patients before treatment than in healthy people (Figure 3). So, in patients before treatment, physical functioning was 60% less than in healthy ones. In patients, respectively: physical discomfort and pain were 50% less, and psychological disorder was more by 42.3%. The total changes in physical health accounted for 35.6% of the physical health in healthy people. During microbiological studies, it was found that the quantitative index of bacteria found in the oral cavity of the group of patients with type 2 diabetes and CKD was convincingly high (P <0.001) compared with the control group and the first group of patients. Representatives of Candida sp. and Actinomyces sp. were found in 5 cases in the oral cavity of a healthy control group, accounting for 7.3% of the total number of optional isolated bacteria. In the first group of patients, this indicator increased by 17.2%, and in the main group - by 19.4%. In addition to reducing the natural constant microflora of the oral cavity, microbes that are not specific to this biotope began to appear: Prevotella sp., Fusobacterium.sp., S. aureus, Str. pyogens, Enterococcus sp., intestinal bacteria of the Enterobacteriacea group: Escherichia spp., Proteus spp., Klebsiella sp. and mushrooms: Candida sp. and Actinomyces sp. 14390 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. Quantitative indicators and frequency of occurrence of Prevotella sp. in patients with CKD, it was convincingly (P <0.001) 4.4 and 1.1 times higher, respectively, than in patients with type 2 diabetes, without renal complications. Differences between dysbiotic changes in the microflora of the oral cavity of patients with CKD, as well as patients without CKD, were also specific for the intestinal group of bacteria. These values were found in 22.3% of patients in the first control group and in 35% in the main group. The toxic substances in the blood resulting from impaired renal activity in this group of patients with CKD, as well as its changes in the oral microbiocenosis due to the disease, had an adverse effect on the local immune system of the oral cavity. When analyzing the results, it was found that in patients with type 2 diabetes, although there were no profound changes in the local immunity of the oral cavity, an increase in sIgA, lysozyme and spontaneous activation of neutrophils, phagocytic index was noted in comparison with the healthy control group. After studying the local immune system in the oral cavity in patients with type 2 diabetes and CKD, it was found that this group of patients has profound changes in the local immune system of the oral cavity, that is, the state of immunodeficiency, compared with the control and the first group of patients. The number of gram-positive pathogenic streptococci, staphylococci, candida fungi and actinomycetes in the oral cavity when treating patients with the LOROBEN antiseptic of patients with orthopedic fixed prostheses during the adaptation period (15 days) showed a significant significant decrease compared with the results of the initial examination. Such cases were specific for anaerobic bacteria (Bacteroidis sp., Prevotella sp.). A decrease in quantitative and detected values was also observed in the intestinal group. By the 30th day of the study, the dynamics of treatment with the LOROBEN drug showed positive changes in the oral biocenosis in the main group of patients. Lactobacillus sp. Was discovered from the local anaerobic flora of the oral cavity. in 8 of 17 patients (47%) by day 30. When we compared these figures with the results of the initial control (4.7 and 2.3), the 15-day study (2.3 and 2.7) and the results of the first control group (2.7; 1.2), we saw a significant increase (2.7; 1.2). In patients receiving the LOROBEN antiseptic drug, the process of adaptation to orthopedic prostheses proceeded differently than in the control group. In 17 patients taking treatment with LOROBEN, adaptation took an average of 13-15 days, in contrast to the group taking traditional treatment, which amounted to 20-25 days. The bactericidal effect of the antiseptic drug “LOROBEN” on pathogenic, conditionally pathogenic microorganisms and fungi and its use in patients with type 2 diabetes and CKD with the use of fixed dentures had a positive effect on the process of adaptation of patients to prostheses. By the 15th day of treatment, FAN was 51.2 for the middle group i.e. a significant increase (P <0.001) compared with the indicator before treatment. The level of the number of positive indicators was 37% after 30 days and showed a convincing advantage compared with traditional treatment. Therapy with the use of the antiseptic drug “LOROBEN” also had a positive effect on other parameters of phagocytes. By the 15th day of the study, the FC was 3.69 ± 0.22 units for the middle group. Compared with the first group, it was convincingly positive (P <0.05) (28.1%).

14391 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. The dynamics of the positive effect of the antiseptic drug “LOROBEN” on the process of adaptation of patients to orthopedic fixed prostheses was also evident in the study of lysozyme and sIgA in saliva. The bactericidal effect of the antiseptic drug “LOROBEN” on pathogenic, conditionally pathogenic microorganisms and fungi and its use in patients with chronic renal failure when using dentures had a positive effect on the process of adaptation of patients to prostheses. Significant changes in the positive side were observed when re-evaluating the quality of life of patients with type 2 diabetes and CKD after pre-prosthetic rehabilitation and orthopedic treatment with fixed prostheses. So, after orthopedic treatment of partial in dental patients with type 2 diabetes and CKD compared with the data before treatment, the indicators of function restriction decreased by 50.3%, physical discomfort and pain decreased 69%, the indicator Psychological discomfort decreased by 28.5 %, physical disorders decreased by 33.6%, psychological disorders decreased by 51.3%, social maladaptation decreased 56.0%, damage decreased by 59.4%. Thus, mental health improved by 50.7%, which resulted in an increase in the total results of physical health by 43.3% and psychological health by 51%. Conclusion In patients with type 2 diabetes, complicated CKD, a high prevalence of periodontal diseases of a generalized nature was determined. The severe course of the underlying disease significantly affects the prevalence and intensity of inflammatory periodontal diseases. Patients with type 2 diabetes needed active dental treatment, prophylactic and orthopedic care. After the pre-prosthetic rehabilitation of the oral cavity and direct orthopedic treatment, based on the results obtained, it can be concluded that the quality of life increases after the defects in the dentition have been filled with orthopedic structures in patients with type 2 diabetes and CKD. All treatments were carried out on account of patient funds. The parameters of physical functioning, vital activity, psychological health and social orientation have significantly increased compared to similar ones before treatment, which in turn confirms a significant improvement in the quality of life after dental prosthetics. The quality of life of patients after prosthetics can be quantified, which is an obvious tool for monitoring the therapy for both the doctor and the patient; the study of only the objective dental status of the patient is insufficient to develop individual tactics of orthopedic care, because, according to the patients themselves, in the presence of partial absence of teeth, the quality of different aspects of life sharply decreases. Summarizing the results of the study, we can conclude that the correct deontological approach using the developed recommendations for the collection of anamnesis will facilitate understanding by the dentist of the algorithms and methods of treating the patient and help to improve the quality of prosthetics and further rehabilitation. The use of dental quality of life questionnaires, such as OHIP-14, in the treatment of diseases of the oral cavity allows you to optimize the approach to choosing a method of therapy and more successfully predict the success of the treatment and patient satisfaction with it. REFERENCES 1. Ametov A.S., Demidova T.Yu., Doskina E.V., Chernikova N.A. Algoritm diagnostiki i upravleniya sakharny`m diabetom 2 tipa. Klinicheskie rekomendaczii dlya praktikuyushhikh vrachej. Moskva. -2007. [in Russ] 2. Dedov I.I., Shestakova M.V., Sunczov Yu.I. Sakharny`j diabet v Rossii: problemy` i resheniya. 2008; 3-6. [in Russ] 14392 ANALYSIS OF ORAL HEALTH AND QUALITY OF LIFE OF GROUPS OF PATIENTS WITH TYPE 2 PJAEE, 17 (6) (2020) DIABETES AND CHRONIC KIDNEY DISEASE. 3. Karimova M. M., Khalimova Z. Yu., Shamirzaev Kh. E`. Chastota i klinicheskaya kharakteristika bol`ny`kh s nesakharny`m diabetom pri ego sochetanii s sakharny`m diabetom po g. Tashkentu po danny`m registra. Mi`zhnarodnij endokrinologi`chnij zhurnal. 2011; 2: 31-34. [in Russ] 4. Gazhva, S. I., Zagajnov, V. E., Igolkina, N. A., Lipatov, K. S., Murtazalieva, M. S. Vliyanie khronicheskoj bolezni pochek na sostoyanie slizistoj obolochki polosti rta. Sovremenny`e problemy` nauki i obrazovaniya. 2013; 2: 5-9. [in Russ] 5. Agranovich N.V., Kny`shova S.A., Anopchenko A.S., Pustovej D.V., Pilipovich L.A. Arterial`naya gipertenziya kak modificziruemy`j prediktor porazheniya pochek u pozhily`kh paczientov. Materialy` V mezhregional`noj nauchno- prakticheskoj geriatricheskoj konferenczii na Severnom Kavkaze «Kachestvo zhizni licz pozhilogo i starcheskogo vozrasta – zerkalo zdorov`ya naseleniya». Stavropol`. 2014; 47-53. [in Russ] 6. Ar`ev A. L., Ar`eva G. T. Sindemicheskaya paradigma interpretaczii parodonto- renal`ny`kh vzaimootnoshenij v geriatricheskoj praktike. Nephrology. 2014; 18(4): 8-11. [in Russ] 7. Galimova A. Z. Optimizacziya kompleksnoj profilaktiki i lecheniya stomatologicheskikh zabolevanij u detej s khronicheskoj pochechnoj nedostatochnost`yu, nakhodyashhikhsya na gemodialize. Diss. na soiskanie uchenoj stepeni kand. med. nauk. 2012; 22. [in Russ] 8. Chujkin, S. V., Galimova, A. Z., Kudashkina, N. V., Shakirova, F. A. Oczenka sub`ektivny`kh oshhushhenij v polosti rta u detej s khronicheskoj pochechnoj nedostatochnost`yu, nakhodyashhikhsya na gemodialize. Ural`skij mediczinskij zhurnal. 2012; 8 (100): 79-83. [in Russ] 9. Manjunath N. Sahana, Nanaiah P. Prevalence of Periodontitis in Hemodialysis Patients. Journal of Dental and Medical Sciences. 2013; 6 (4): 01-05.

14393