Correlated dependence between clinical indicators gained over the treatment of generalized chronic periodontitis in patients from bad environment regions

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Ivano-Frankivsk National Medical University

Correlated dependence between clinical indicators gained over the treatment of generalized chronic periodontitis in patients from bad environment regions

Kaminska M.V.

Ivano-Frankivsk, Ukraine

Abstract

Камінська М.В. Кореляційна залежність між клінічними показниками в процесі лікування хронічного генералізованого пародонтиту у пацієнтів екологічно несприятливих регіонів

Стаття присвячена дослідженню кореляційної залежності між основними клінічними показниками у процесі лікування генералізованого пародонтиту в пацієнтів різних екологічних регіонів Прикарпаття.

Метою дослідження є встановлення кореляційної залежності між клінічними показниками, що спостерігаються при захворюваннях тканин пародонта та порівняльний аналіз отриманих результатів у пацієнтів різних екологічних регіонів Прикарпаття у процесі лікування генералізованого пародонтиту.

Матеріали і методи. Обстежено 83 хворих на генералізований пародонтит, що проживають у різних екологічних умовах. Проведено кореляційний аналіз між основними клінічними показниками при генералізованому пародонтиті.

Результати. Встановлено достовірні (р<0,05) кореляційні зв'язки різної сили та характеру між індексом РМА та індексом кровоточивості, індексом Рассела та глибиною пародонтальних кишень, між індексом РМА та індексом Рассела, індексом Федорової-Володкіної та індексом кровоточивості, між індексом гігієни та індексом РМА, індексом Рассела та індексом кровоточивості, глибиною пародонтальних кишень та індексом кровоточивості, індексом РМА та глибиною пародонтальних кишень, між індексом Федорової-Володкіної та пародонтальним індексом Рассела, індексом гігієни та глибиною пародонтальних кишень.

Наукова новизна. Встановлена кореляційна залежність між основними клінічними показниками, що спостерігаються при захворюваннях тканин пародонта та проведено порівняльний аналіз отриманих результатів у пацієнтів різних екологічних регіонів Прикарпаття у процесі лікування генералізованого пародонтиту.

Висновки. Доведена кореляційна залежність між основними клінічними показниками у пацієнтів із генералізованим пародонтитом та можливість використання кореляційного методу статистичного аналізу при обробці даних клінічних показників у пацієнтів із захворюваннями тканин пародонта.

Ключові слова: генералізований пародонтит, кореляційні зв'язки, індекс Федорова-Володкіної, індекс PMA, пародонтальний індекс Рассела, індекс кровоточивості, глибина пародонтальних кишень.

Introduction

A number of authors indicate that the prevalence and intensity of periodontal diseases is on the growth in those who are exposed to the negative effects of the environmental factors, which confirms their harmful effect on the occurrence and severity of chronic generalized periodontitis [1, 2, 3, 4]. The long-term toxic effect of xenobiotics significantly worsens oral metabolism therefore activating local and general pathogenic factors which can cause damage to the periodontium [5]. In a number of studies is noted that some anthropogenic reasons, such as the air pollution index, the surface water pollution index and the content of heavy metals are of primary importance in establishment of periodontal disorders [3]. Moreover, studies suggest that there are social, genetic, somatic health components of susceptibility for development of chronic generalized periodontitis [6].

The negative impact of harmful factors affecting the severity and manifestation of chronic periodontitis requires special measures to correct their damaging effect on periodontal tissues [7]. Traditional treatment is not very efficient in polluted regions and does not lead to a complete arrest of the destructive process in periodontium [8, 9].

The aim of the study. It is the establishment of connection between the clinical indexes observed by periodontitis and a comparative analysis of the obtained results in patients from different Pry Carpathian regions over the course of the periodontal treatment.

Object and methods of research

There were examined 83 patients diagnosed with chronic generalized periodontitis (CGP), aged 20 to 59, from ecologically unfavorable Prycarpathian regions. According to the maps of the ecological state of soils and water, the village Horokholyna belongs to Conditionally Contaminated Zone. Ivano- Frankivsk, on another site, belongs to the Conditionally Clean Zone. The study enrolled 37 patients with chronic generalized periodontitis from Conditionally Contaminated Zone (7 people with the initial degree of CGP and 15 patients of both - I and II degrees of CGP) and 46 patients from Conditionally Clean Zone (12 people with the initial degree of CGP and 17 patients with I and II degrees of CGP) To establish the diagnosis, the classification of M.F. Danylevskyy (1994) was used. Dental status was determined by the standard method proposed by WHO. The intensity and destruction of the periodontal tissues were determined using a number of indices: the Fedorov-Volodkina hygiene index, inflammation in the periodontal tissues was determined by the PMA index (Parma, 1960), the assessment of the severity in periodontium - by the Russell index (Russel A., 1956), bleeding of the gingival papillae on probing by MQhlmann and measuring of the pocket's depths. The data from periodontal examination was recorded on a special chart introduced by WHO.

Depending on the treatment performed, patients from both regions were divided into two groups. The first group included 42 patients diagnosed with chronic generalized periodontitis, whose treatment was carried out by the generally accepted method (I a - 18 patients from Conditionally Contaminated Zone and I b - 24 patients from Conditionally Clean Zone). Group II included 41 patients with chronic generalized periodontitis who were treated with the proposed complex of therapeutic and preventive measures (II a - 19 patients from Conditionally Contaminated Zone, II b - 22 patients from Conditionally Clean Zone).

The generally traditional treatment (I group of patients) comprised administration of Metragil-Denta (to be applied twice a day for 14 days); Hepilor (oral rinses 3 times daily for 14 days); Vitrum Osteomag - 1 tablet 2 times a day for 3 weeks; general dental management.

The proposed therapeutic and preventive measures (applied in group II) included a complex of pharmacological agents to improve the condition of the bone tissue and to prevent their resorption. The patients were prescribed with "Calcemin-Advance" -1 tablet to be taken with a meal twice daily for 1-2 months and later "Calcemin"-1 tablet twice a day for 2-5 months.

Enterosorbent "Silix" as a suspension of 80 ml to be taken three times daily was also prescribed for 14 days (daily dose is 12g). Mouthwashes included 0.1% solution of 15 ml of Stomatidine (1 tablespoon) 2-3 times a day for 14 days. In addition, local gingival application with "Holosal-gel" twice a day for 14 days was also used.

The effectiveness of the treatment was evaluated by the dynamics of clinical indicators at different time points: immediately after the treatment, 6 and 12 months after the therapy was finished.

Statistical processing of the obtained data was carried out by "Statistica" program using generally accepted methods of variation statistics (parametric and non-parametric) in compliance with the Uniform requirements of the International Committee of Editors of Medical Journals. When processing the results, the average arithmetic value of the variation series (М), the average square deviation (a) and the average error (m) were calculated [10]. Reliability was determined by using Student's t-criteria.

The root mean square deviation (a) was determined using the formula:

Where у is the mean square deviation;

d - numerical value of the indicator;

n - is the number of observations.

The root mean square error of the mean value (m) was determined by the formula:

Where у - is the mean square deviation;

n - is the number of observations

Among the parametric methods, the Student's reliability criterion (t) was used, which was determined by the formula:

Where M1 is the average arithmetic value of the first indicator;

M2 - the average arithmetic value of the second indicator;

m1 - average error of the average value of the first indicator;

m2 - average error of the average value of the second indicator

Reliability was considered reliable at p<0.05.

Correlation analysis was performed for the investigated indicators. Correlation was determined between two values in case when their values were in relations to each other. At the same time, a change of one value leads to a change in another one. The formula for calculating the correlation: covfX Y)

where cov (X, Y) is the covariance of X and Y;

уx, уy -standard deviation of X and Y values.

Correlation takes on values from-1 to+1. The closer the calculated correlation is to the number -1 or +1, the more dependent the values are. If the correlation is zero, then there is no connection between the data.

The strength of the connection is concluded according to the following rule: if the correlation coefficient is equal to 1, then the connection is complete; if it is 0.66-0.99 - the connection is strong; if the coefficient is within 0.33-0.66 - average; if the correlation coefficient is less than 0.33, then the relationship is weak.

The direction of the relationship is indicated by the sign of the correlation coefficient. If the sign is "+", then the correlation is direct, and if the sign is "-", then the correlation is inverse.

A conclusion is made upon the reliability of the relationship according to the rule: if the criterion of the reliability of the correlation coefficient is actual greater than its theoretical values or equal to it, then the relationship is reliable.

The study was conducted in accordance with the principles of the Helsinki Declaration on the Protection of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine, and the provisions of the relevant laws of Ukraine. The study protocol was approved by the Local Ethics Committee for all participants. Written informed consent was obtained from all patients who participated in the study.

clinical indicator generalized periodontitis сarpathian region

The results of the research and their discussion

The results of researches regarding administered treatment at different term points given in studies [11, 12, 13] further showed a significant decrease in a number of indexes (Fyodorov-Volodkina oral hygiene index, PMA index, Russell index, bleeding index, pockets depths) at all observation periods, which indicates the suspension of the pathological process.

It was established that the use of the proposed complex of therapeutic and preventive measures introduced by us, contributed to a more pronounced normalization of the clinical manifestation in comparison with the generally accepted treatment.

Statistical analysis of the obtained data confirmed a correlated dependence between diverse clinical indicators in patients from different ecological regions of Prycarpatya over the treatment of periodontal disorders.

The conducted analysis between the bleeding index and the Fedorova-Volodkina index revealed a reliably strong direct correlation in patients from Conditionally Contaminated Zone affected with chronic generalized periodontitis of the 1st degree, who were administered with traditional treatment (r = 0.91) and a reliably strong inverse relationship in patients treated with the proposed method (r = -0.79).

Furthermore, constant correlations of medium strength were verified between the bleeding index and oral hygiene index in patients from Conditionally Contaminated Zone affected with generalized periodontitis of the 1st degree immediately after appointed traditional treatment (r = 0.42) and in patients managed with the proposed method (r = -0.42). By contrast, in patients from Conditionally Clean Zone diagnosed with generalized periodontits of the 1st degree immediately after the proposed treatment (r = 0.65), in those from Conditionally Contaminated Zone affected by general periodontitis of 1st degree 12 months after the generally accepted treatment (r = 0.49).

In patients with II degree of CGP, reliable correlations were found immediately after the proposed treatment in patients from Conditionally Contaminated Zone (r = -0.52), in patients from Conditionally Clean Zone (r = 0.52) - by the generally accepted method, (r = 0.57) - by the proposed method.

A study suggests that the reliable correlations were found immediately after the proposed treatment (r = -0.52) in patients from Conditionally Contaminated Zone with generalized periodontitis of II degree, in those from Conditionally Clean Zone treated by traditional method (r = 0.52) and (r = 0.57) - by the proposed method. When analyzing connection between the bleeding index and the PMA index in patients with 1st degree of chronic periodontitis, a reliably strong direct relationship was found in patients from Conditionally Contaminated Zone immediately after conventional treatment (r = 0.79), 6 months after (r = 0.89), 12 months after (r = 0.93) and in those from Conditionally Clean Zone 6 months after conventional treatment (r = 0.85), after 12 months (r = 0.77); correlations of the average strength with first degree of CGP in patients from Conditionally Contaminated Zone immediately after the proposed treatment (r = 0.42), in those from Conditionally Clean Zone 6 months after the proposed treatment (r = -0.51) and after 12 months (r = 0.44). In patients with II degree of CGP, a reliably strong inverse relationship was established between the bleeding index and the PMA index in patients from Conditionally Contaminated Zone immediately after the traditional treatment (r = -0.78), correlations of medium strength in patients from Conditionally Contaminated Zone administered with the recommended treatment (r = -0.61) and in patients from Conditionally Clean Zone 12 months after traditional treatment (r = 0.39).

Significant (р<0.05) correlations of medium strength were observed between the bleeding index and the Russell's index in case of chronic generalized periodontitis of the first-degree in patients from Conditionally Clean Zone detected 12 months after traditional treatment (r = 0.46), with the proposed treatment immediately after treatment in Conditionally Contaminated Zone (r = 0.54), in Conditionally Clean Zone (r = 0.69) and a feedback 6 months after the proposed treatment in Conditionally Clean Zone (r = -0.44).

A reliably strong inverse relationship between the bleeding index and the Russell index was detected in patients from Conditionally Clean Zone affected by II- degree of CGP that were administered with traditional therapy (r = -0.76), correlations of medium strength were established in Conditionally Contaminated Zone directly, 6 and 12 months after the conventional treatment (r = 0.48), (r = -0.40), (r = -0.39) respectively and 12 months after the recommended treatment (r = -0.50).

The analyzed correlation between the oral hygiene index and PMA index in case of first-degree CGP revealed a strong direct connections in those from Conditionally Contaminated Zone immediately (r = 0.79) and 6 months after (r = 0.84) traditional treatment, connections of medium strength in patients from Conditionally Contaminated Zone 12 months after the generally accepted treatment (r = 0.53), inverse correlations of average strength in the Conditionally Clean Zone directly (r = -0.4) and 6 months (r = -0.44) after the proposed treatment.

In the case of 2nd degree of CGP a reliably strong direct associations were established between oral hygiene index and the PMA index in patients from Conditionally Contaminated Zone 6 and 12 months after the recommended treatment (r = 0.70) and (r = 0.89), respectively, and inverse relationships of the average strength in individuals from Conditionally Contaminated Zone immediately, 6 and 12 months after the generally accepted treatment (r = -0.47), (r = -0.37), (r = -0.42), respectively.

A significant (p<0.05) strong direct correlation was observed between oral hygiene index and Russell's index in case of 1st degree of CGP in Conditionally Clean Zone 6 months after the proposed treatment (r = 0.71), the average strength of the relationship in patients from Conditionally Contaminated Zone directly (r = 0.66), 6 months after(r = -0.46), within 12 months (r = -0.53) after traditional therapy, in the Conditionally Clean Zone immediately after treatment (r = 0.65) and with the proposed management in Conditionally Clean Zone immediately after treatment (r = 0.59), in Conditionally Contaminated Zone 12 months after treatment (r = -0.40).

In patients with CGP of the II degree, correlations of medium strength were observed in the Conditionally Contaminated Zone 6 months after (r = -0.54) and 12 months (r = 0.47) after conventional treatment, in the Conditionally Clean Zone immediately (r = 0.43), after 6 (r = -0.44) and 12 months (r = -0.41) after traditional treatment, in Conditionally Contaminated Zone directly (r = -0.47) and after 6 months (r = -0.49) after the recommended treatment.

Analysis between oral hygiene index and pockets depths in case of CGP of II - degree further recorded reliable correlations of average strength in Conditionally Contaminated Zone directly (r = 0.45) and 6 months (r = 0.42) after traditional treatment; in Conditionally Clean Zone there were inverse relationships of average strength 6 months after (r = -0.43) and 12 months after (r = -0.52) conventional treatment.

Constant direct correlations of medium strength were found between the PMA index and the Russell index in case of I-degree of CGP in Conditionally Contaminated Zone immediately after conventional treatment (r = 0.45) and proximate (r = 0.49) in case of the proposed method 6 months after (r = 0,55), in the Conditionally Clean Zone 12 months after the generally accepted treatment (r = 0.65) and 12 months after the developed treatment (r = 0.45).

Patients with CGP of II degree also demonstrated a strong direct correlation between the PMA index and the Russell index in the Conditionally Clean Zone 12 months after the proposed treatment (r = 0.72) and there were inverse connections of medium-strength in the Conditionally Clean Zone 6 months after (r = -0.63) and 12 months (r = -0.59) after traditional treatment and direct relationships of the average strength in the Conditionally Clean Zone directly and 6 months after the introduced treatment (r = 0.69), (r = 0.49) respectively.

Correlations of medium strength were found between the PMA index and pockets depths in case of 1st degree of CGP in the Conditionally Clean Zone, direct relationships 12 months after the generally accepted treatment (r = 0.40) and inverse relationships immediately after the proposed treatment (r = -0,45).

In case of II-degree of CGP, direct correlations of medium strength were recorded between the PMA index and pockets depths in those from Conditionally Clean Zone immediately after the generally accepted treatment (r = 0.40) and 6 months after the proposed treatment (r = 0.43), in the Conditionally Contaminated Zone the feedback relationship of medium strength was detected 12 months after conventional treatment (r = -0.58).

Strong direct correlations between Russell's index and pockets depths were observed in patients from Conditionally Contaminated Zone affected by 1st degree of CGP detected 12 months after conventional treatment (r = 0.81), in Conditionally Clean Zone 6 months after (r = 0.90) and 12 months (r = 0.80) after conventional treatment.

Correlations of medium strength between Russell's index and pockets depths by first degree of CGP were found in Conditionally Contaminated Zone 6 months after traditional treatment (r = 0.60), directly (r = -0.55) and 6 months after the proposed treatment (r = -0.42), in the Conditionally Clean Zone immediately after the generally accepted treatment (r = 0.56).

In patients with CGP of the II degree, reliable strong direct correlations were established between the Russell index and pockets depths in the Conditionally Contaminated Zone immediately after the generally accepted treatment (r = -0.87) and 12 months after the proposed treatment (r = 0.90), direct correlations connections of medium strength in the UCH 12 months after the generally accepted treatment (r = 0.56), in the Conditionally Clean Zone immediately (r = 0.55) and 6 months (r = 0.67) after the recommended treatment.

Conclusions

A study established reliable correlations of different strength and origin between the main clinical indicators gained during the treatment of affected periodontal tissues, which are observed in patients from different ecological Prycarpathian regions. A comparative analysis of the obtained results was also carried out. It was proved that the correlation method of statistical analysis can be used in the processing of clinical indices in patients affected by periodontal disorders.

Prospect for further research. The results of the research will be used in the future to conduct the data of clinical indexes in patients affected by periodontitis.

Further investigations will be directed on improving of the treatment of chronic generalized periodontitis based on the results of previous studies.

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