POSSIBILITIES OF LOCAL ANTIBACTERIAL THERAPY OF CHRONIC GENERALIZED PARODONTITIS IN THE BACKGROUND OF GASTRIC ULCER DISEASE

Аннотация

Numerous clinical observations show that peptic ulcer disease (PUD) is accompanied by pathological changes in periodontal tissues. In 92% of patients with gastrointestinal diseases, oral pathology is diagnosed, which is mainly manifested by periodontitis. Chronic disseminated periodontitis (CDP) is one of the most common periodontal diseases. This condition is characterized by inflammation of the gums and damage to the supporting tissues surrounding the teeth, and if the disease is not treated in a timely manner, it can lead to tooth loss. In recent years, local antibacterial therapy has attracted the attention of specialists as a safe and effective method of treating CDP in patients with chronic systemic diseases. This article discusses modern approaches to local therapy of chronic periodontitis associated with gastrointestinal ulcer disease. Key words: periodontology, microbiota, periodontitis, peptic ulcer, periodontal pocket, microorganisms, periodontal pathogens, Helicobacter pylori, metronidazole, pomegranate seed oil. Systemic diseases, including peptic ulcer disease, have a significant impact on the course of periodontitis. Studies confirm that inflammatory processes in the gastrointestinal tract increase the overall inflammatory load on the body, which can contribute to the progression of periodontitis. In addition, Helicobacter pylori infections, often associated with peptic ulcer disease, can play a role in the pathogenesis of periodontitis, creating additional complications in treatment. Periodontal diseases against the background of peptic ulcer disease of the gastrointestinal tract are characterized by an earlier development of the generalized pathological process compared to patients without background pathology. In the early stages of the disease, the periodontium of all teeth is affected, inflammatory processes are more intense and are often accompanied by the release of pus from periodontal pockets. In patients with concomitant gastroduodenal diseases, periodontitis often has a continuously recurring nature, is resistant to standard therapy, and periods of https://scientific-jl.com/wsrj 1 3 Volume-38_Issue-1_April-2025 World scientific research journal remission are unstable. According to modern concepts, inflammatory periodontal diseases are infectious chronic inflammatory processes, so normalization of microflora is an important condition for their effective treatment. It is known that with chronic periodontitis, there is a significant shift towards an increase in the proportion of anaerobic bacteria: according to Slots J., under conditions of inflammation in periodontal pockets, their number reaches 70-80%, while normally the level of anaerobic flora is only 20-30%. The main cause of gastric ulcer and duodenal ulcer is the bacterium Helicobacter pylori. In recent years, the infectious factor associated with the bacterium Helicobacter pylori (HP) has become of great importance in the development of peptic ulcer disease. Studies show that these bacteria can be found in the microenvironment of dental plaque and saliva. Periodontal pockets are a natural reservoir for Helicobacter pylori, providing favorable microaerobic conditions. It has been established that Helicobacter pylori infection occurs through the oral cavity by the oral-oral or fecal- oral route, where the bacteria can persist as a permanent reservoir. Helicobacter pylori, although mainly associated with gastrointestinal diseases, can also be involved in the development of inflammatory processes in the oral cavity, including gingivitis. Some researchers believe that the presence of Helicobacter pylori in the oral cavity can serve as a source of re-infection of the gastric mucosa in patients with duodenal ulcer disease (DU). There is a hypothesis that Helicobacter pylori in the oral cavity can act as a commensal, that is, a microorganism that lives on the mucous membranes of a person without obvious harm or benefit to the body. When infected with Helicobacter pylori, the development of diseases such as periodontitis or gastrointestinal ulcers (GIT) depends on many factors, including the route of infection, the state of the body, genetic predisposition and immune status. Thus, the most powerful factor contributing to the development and maintenance of periodontal diseases is the development of dysbiosis in the oral cavity, which develops either against the background of reduced immunity or itself leads to a change in it. This explains the feasibility of using antibacterial drugs, but requires an integrated approach and an assessment of potential risks and benefits. Antibacterial therapy can reduce the microbial load, eliminating the key etiological factor of the disease. Chronic inflammation in the oral cavity can increase systemic inflammation, which is especially dangerous for patients with gastrointestinal ulcers. Antibacterial therapy helps reduce the level of proinflammatory cytokines, which can alleviate the course of peptic