Morphological Evaluation of the Effectiveness of Im- mune-Stimulating Drugs in Patients with Diabetes and Removable Denture based on the Analysis of Bi- opsic Material Obtained from the Oral Mucosa

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 1, Pages: 231-236

J. Environ. Treat. Tech.

ISSN: 2309-1185

Journal weblink: ttp://www.jett.dormaj.com

Morphological Evaluation of the Effectiveness of Im-

mune-Stimulating Drugs in Patients with Diabetes

and Removable Denture based on the Analysis of Bi-

opsic Material Obtained from the Oral Mucosa

Sergey V. Ignatiev *, Galina V. Reva , Yury Y. Pervov , Evgeny A. Kotsyurbii , Anna K.

Yatsenko¹

Pacific State Medical University of the Ministry of the Russian Federation. 690002, 2 Prospect Ostryakova, Vladivostok, Russia

Far-East Federal University of the Ministry of Education and Science. 690091, 8 Sukhanova Street, Vladivostok, Russia

Received: 01/08/2019

Accepted: 23/10/2019

Published: 20/02/2020

Abstract

The aim of the study was to evaluate morphological alterations in the parameters of the local cellular immunity of the oral mucosa

LCI OM) in patients with diabetes mellitus (DM) and removable denture based on the analysis of the biopsic material. The study

(

included 130 patients aged 40 to 85 years old that were split into control (n=32) and test groups. The patients were installed partial

laminar denture and complete removable denture: Test group I – patients with DM (n=70); Test group II – patients with DM (n=28) that

received immune-stimulating drug. The oral cavities were examined with clinical methods. The bioptates obtained from the oral mucosa

were studied with morphological immunohistochemical methods using antibodies to

CD68, CD204, CD163, CD4, CD8, CD11/303,

and Ki-67. The obtained data were statistically processed. The examination was performed in 6 and 12 months after the installation of

the denture. The parameters of LCI OM in patients with DM significantly differed from the parameters in healthy patients. It was

established that the installation of removable acrylic denture led to significant changes in the parameters of LCI OM. Clinical manifes-

tations of the periodontal tissues inflammation directly depended on the duration of the application of denture and the composition of

the inflammatory cells. The application of immune-stimulating drugs in patients with DM with removable denture led to qualitative and

quantitative changes in the local cellular immunity that differed from similar changes in patients that did not receive immune stimulators

and correlated with the intensity of clinical manifestations of periodontium tissues diseases.

Keywords: local immune homeostasis of the oral mucosa, patients with diabetes mellitus, removable denture, immune-stimulating drug

loss of teeth [18]. Some studies showed that patients with dia-

Introduction

betes mellitus have a 5-time higher chance of the development

of partial secondary adentia than patients that do not have this

pathology [28]. Patients with uncontrolled DM have increased

circulation of systemic inflammation markers in the blood (C-

reactive protein, fibrinogen, cytokines, etc.), disturbances of

the immune response formation and tissues reparation capacity.

The developing inflammatory periodontal diseases quickly pro-

gress and lead to the loss of teeth. In their turn, severe perio-

dontal diseases complicate glycemic control and aggravate the

severity of DM [15]. Around 33-58% of such patients require or-

thopedic treatment with removable denture. After the prostheticre-

pair, the recrudescence of inflammatory periodontal diseases is ob-

served, which aserious medical and social problemis [12]. A close

correlation was established between periodontal tissues dis-

eases and somatic pathology that are significantly associated

with each other [14]. The changes observed in patients with DM

affect numerous organ systems, in particular, lead to the eubio-

sis disturbances in the oral cavity [13]. The microflora of the

oral cavity is quite polymorphic. It activates when periodon-

tium gets inflamed and more mobile forms of microorganisms

appear, which indicates its virulence. The species composition

In Russia, there were 2.5 million people with diabetes

mellitus registered by the end of 2010. 90% of the registered

patients have DM type 2 and 10% - DM type 1 (according to

the register of diabetes mellitus www.diaregistry.ru for 2000-

016). The morbidity rate increase exceeds 15% per year [33].

According to the data of the State Register, in 2014, in Russia,

there were 3.96 million patients with diabetes mellitus and

more than 70% of the population aged 20-60 years old had the

integrity of dentition [34]. In its turn, due to its prevalence, diabe-

tes mellitus (DM) is considered to be a non-infectious pandemia

[

7]. A number of studies demonstrated a higher morbidity rate

of periodontal diseases among patients with DM than among

healthy people [22]. In Russia, the morbidity rate of periodontal

diseases of different forms among the adult population is

around 96% [11]. According to the reports, inflammatory peri-

odontal diseases occupy the 6 place among the DM complica-

tions along with neuropathy, nephropathy, retinopathy, and mi-

cro and macrovascular diseases [27].

It was established that diabetes affects the tissues of perio-

dontium by all the parameters, including the degree of bleeding,

depth of periodontal pockets, the loss of teeth attachment and

Corresponding author: Sergey V. Ignatiev, Pacific State Medical University of the Ministry of the Russian Federation. 690002, 2

Prospect Ostryakova, Vladivostok, Russia. E-mail: ignatiev_sergei@inbox.ru.

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 1, Pages: 231-236

of the oral cavity microflora gets established with aging. It is

very unstable in the initial period of human life and stabilizes

in adults becoming a self-regulated system. The changes in the

oral microflora complete the vicious circle: periodontopatho-

genic microflora increases the resistance of tissues to insulin

and, as a result, contributes to the worsening of metabolic con-

trol of glycemia. And on the contrary, high concentration of

glucose in gingival fluid and disturbances of neutrophil adhe-

sion, chemotaxis, and phagocytosis, observed in patients with

DM, promote the reproduction and persistence of subgingival

microflora [22]. A high rate of oral cavity organs diseases (up

to 90%) in patients with DM is associated with the changes in

the microvasculature, resorption of bone tissue, and a reduction

of local immune reactions. As a rule, inflamed tissues of perio-

dontium have an increased level of inflammatory mediators as-

sociated with the process of tissue destruction, such as tumor

necrosis factor α (TNFα), interleukin-6, interleukin-1β, prosta-

glandin E2, and matrix metalloproteinase (MMP) [32]. In addi-

tion to local destruction, the inflammation is characterized by

the increase in the permeability of capillaries, which can lead

to inflammatory mediators and bacterial products penetration

into the systemic circulation. These mediators play an im-

portant role in the pathogenesis of the development of insulin

resistance, ischemic heart disease, and according to the recent

data, diabetes mellitus [31]. Based on this theory, it was sug-

gested that successful control of bacterial infection of periodon-

tium leads to the improvement of the clinical picture of both

periodontitis and metabolic control of DM [24].

A weakening of specific and non-specific mechanisms of

local and systemic protection is always associated with an in-

creased activity of bacterial aggregates that leads to the devel-

opment of clinically expressed inflammatory reaction. A spe-

cial role in the development and maintenance of chronic in-

flammation is played by matrix endopeptidases – catabolic en-

zymes of the majority of proteins of extracellular matrix at dif-

ferent stages of the inflammatory process. They are secreted by

different cells: neutrophilic leukocytes, fibroblasts, epithelio-

cytes, macrophages, etc. [20]. Oral mucosa exerts borderline

immune protection of the organism, so the study of intercellular

contacts between immune-competent cells and the peculiarities

of local immunity associated with mucous membranes, as well

as their influence on the processes of proliferation and apopto-

sis of the epithelial cells becomes especially relevant [10].

Dendritic cells are heterogeneous population of antigen-

presenting cells of bone marrow origin. The main function of

dendrite cells is the presentation of antigens to T-cells [25].

Dendritic cells also perform important immune regulating func-

tions, such as a control for the differentiation of T-lymphocytes,

regulation of the activation and suppression of the immune re-

sponse [21]. An important peculiarity of dendritic cells is their

possibility to uptake different antigens from the medium due to

phagocytosis, pinocytosis, and receptor-mediated endocytosis

that they have heteroplastic origin from leukocytes, macro-

phages, etc. Histamine is released from the mast cells as a result

of a complicated chain of enzymatic processes because it can

be prevented by the effect of enzymatic inhibitors [32]. Since

macrophages are one of the tools of inborn immunity and are

involved in the acquired immune response along with B and T-

lymphocytes being an “additional” type of the immune re-

sponse cells, they are considered to be phagocytizing cells with

the function to “swallow” immunogens and process them for

the presentation of T-lymphocytes in a suitable form [19]. All

in all, these cellular populations form local cellular immunity

in the oral mucosa (LCI OM) [8]. Thus, immunopathological

mechanisms play an important role in the development of the

process of destruction of periodontal tissues [6]. The study of

pathomorphological and pathophysiological mechanisms of

this association is necessary for the development of new ap-

proaches to the diagnostics and treatment of periodontal dis-

eases [14]. All the above-mentioned facts suggest that the study

of local morphological substrate and character of changes in

LCI OM based on the biopsic and operational material can give

the basis for the improvement of pathogenetically grounded

methods of prevention of complications in dental treatment, in

particular, in patients with DM [8].

The aim of the study was to increase the quality and effec-

tiveness of removable denture in patients with diabetes mellitus

based on the morphological and immunohistochemical analysis

of the local cellular immunity of the oral mucosa. The follow-

ing objectives were set: (a) Identification of the group of prior-

ity with patients ranged by the age and duration of the disease.

(b) Study of morphological picture of the oral mucosa in pa-

tients with removable denture and diabetes mellitus. (c) Identi-

fication of the cellular pool in the denture-bearing area in pa-

tients with diabetes mellitus with removable denture using im-

munohistochemical and histochemical methods. (e) Perfor-

mance of comparative and correlation analysis of the obtained

data in the control group and observation group with a degree

of clinical manifestations of periodontal diseases.

Materials and Methods

The study included 130 patients aged 40 to 85 years old that

were divided into control and test groups. The patients received

partial laminar and complete removable denture:

Test group I – patients with diabetes mellitus with removable

acrylic denture (n=70);

Test group II – patients with diabetes mellitus with removable

denture that receive immune-stimulating drug (Imudon)

(

n=28). Drug intake schedule: 6 tables per day with a 2-hour

interval to dissolve in the mouth (no crunching). The duration

of the course was 20 days. The course was repeated in 2 months

until the end of the study. The examination was performed in 6

and 12 months of using orthopedic denture. Control group in-

cluded patients with DM that did not use removable denture but

those that required dental treatment (n=32). Since the changes

in the tissues in general and in oral mucosa, in particular, in

patients with DM type 1 or type 2 have stereotypic character,

the authors examined patients with DM type 2 as the most

widespread form [2]. All the examined patients had a compen-

sated form of this disease. The age groups were formed by the

classification of Craigie: medium adulthood (40-59 years old),

late adulthood (60 years old and more). Study exclusion criteria

were the following: (a) Patients younger than 20 and older than

[17]. According to the published data, the main concentration

of dendritic cells is in the tissues that are in contact with the

external environment, for example, in the epithelial layer of the

intestinal mucosa, in the submucous layer of the respiratory,

gastrointestinal, and urogenital tracts [2]. Dendritic cells uptake

antigens, process them and present them on their surface in

complex with МНС I or МНС II classes. This is the only way

for T-cells to identify an antigen and activate and promote an

immune response. Depending on the type of a pathogen, den-

dritic cells can direct the differentiation of naïve T-helpers

85, (b) mental disorders, (c) oncological diseases, and (d) de-

(

ThO) to T-helpers type 1, T-helpers type II, regulatory T-cells

compensated systemic diseases.

or T-helpers [16].

Clinical examination of the oral mucosa included the iden-

tification of hyperemic foci and evaluation of the degree of

edema in the denture-bearing area, evaluation of periodontal

tissues (including Shiller-Pisarev’s test). X-ray imaging of

Mast cells are not immune-competent cells. It is known that

they are not directly involved in the development of allergic

reactions. Mast cells appear homoplastically. It is suggested

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 1, Pages: 231-236

bony structures of the dentofacial system was performed with

the method of zonal tomography (OPTG). The morphological

study was performed on 1 x 1 mm samples of oral mucosa that

was dissected after tooth or tooth root removal, during implan-

tation and microsurgical periodontal operations under infiltra-

tion anesthesia. Since bioptate sampling indications are limited,

the sampling was performed only after a preliminary talk to a

patient and obtaining the informed consent. To obtain an objec-

tive characteristic of the processes in the gingiva, the authors

took samples only in the denture-bearing area using local anes-

thesia. The sampling was performed approximately at the same

time – 10 o’clock. The sizes of bioptates did not exceed 1mm³.

Sampling was performed using a mucotome or a scalpel (№5)

depending on the clinical situation.

Morphological study of the gingival bioptates obtained

from dental patients that contact with orthopedic materials and

constructions plays an important role in the diagnostics and

prognosis of the disease, and development of new approaches

to the treatment. The evaluation of pathologically altered biop-

tates affected by inflammatory processes has a scientific and

practical value because the pathology of the oral mucosa is a

condition that activates reparative regeneration of epithelial and

connective tissue in the oral cavity and the immune system ex-

erts its functions in the conditions of increased requirements.

Literature review showed that the characteristics of normal

condition and physiological regeneration in the elements of

mucous membranes are primarily based on the data obtained

from experiments on animals. The obtained material was fixed

in a 10% solution of formalin and hematoxylin and eosin

stained for the microscopic study at the magnification of 100

and 400. For the identification of the phenotype of immune-

competent cells, an immunohistochemical study was per-

formed using the following antibodies: CD68 (Langerhans

cells), CD204 (mast cells), CD163 (macrophages), CD4, CD8

(lymphocytes), CD11/303 (progenitors of dendritic cells). The

intensity of proliferative processes in the epithelial plate was

evaluated by the antibodies to Ki-67 protein. For immunohisto-

chemical reactions, serial paraffin sections were prepared ac-

cording to a standard method using monoclonal antibodies

(«Dako Inc» Denmark). The study of histological sections and

smear prints was performed with a microscope Olympus BX52

with original software for morphometry. The system of visual-

ization had the same manufacturer. Immunomorphological

study was performed at the Department of pathological anat-

omy and forensic medicine at the Pacific State Medical Univer-

sity and at the laboratory of University of Niigata (Japan).

Antigen positive cells count was performed in 10 fields of

vision at a constant magnification of 100 taking into account

the localization of the marker (cytoplasm, nucleus or mem-

brane) and the intensity of the staining that, in its turn, was eval-

uated by the semiquantitative method (low, moderate, high).

Statistical processing of the obtained data was performed with

the methods of statistical and correlation analysis (Pierson’s

test) using Windows XP (MS Word and Microsoft Excel XP

version 7.0).

Results and Discussion

In patients from the control group, clinical examination re-

vealed inflammatory periodontal diseases in 100% of cases.

Chronical periodontitis of different degree of severity was di-

agnosed (Table 1). The examination of patients with DM

showed that labial and buccal mucous membranes were hyper-

emic and edematous.

Table 1: Distribution of patients by the severity of the process

Period

months)

Degree of periodontium damage severity

Age (Years)

(

Light

Moderate

Severe

Control (number of patients)

0-59

0 and more

Total

43.75%

34.4%

21.9%

Dental prosthesis

40-59

60 и более

всего

months

1.42%

41.43%

48.57%

27.14%

38.57%

40-59

60 and more

Total

months

2.85%

Dental prosthesis in combination with Imudon

40-59

months

0 and more

Total

2.3%

39.3%

17.9%

40-59

months

60 and more

Total

35.71%

39.3%

25%

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 1, Pages: 231-236

Hygienic condition of the oral cavity was evaluated as un-

satisfactory in 27 patients (84.4%). Clinical signs of candidiasis

of the oral mucosa were revealed. Tongue plaque and atrophy,

especially in the area of the back of the tongue, was observed.

Hyperplasia of lingual filiform papilla was registered in 11 pa-

tients (35.0%). Based on the data obtained during immuno-

histochemical studies of patients from the control group, the

parameters of LCI OM were defined in patients with DM be-

fore the prosthetic repair (Table 2). The obtained data are pre-

sented and published in the article “The influence of removable

denture on the parameters of cellular immunity of the oral mu-

cosa in patients with diabetes mellitus” [3]. It should be men-

tioned that morphological study of the oral mucosa revealed at-

rophy and sclerosis, chronic productive inflammation, round

cell infiltration, an increase in the concentration of mast cells,

plasmatic cells, eosinophils, macrophages, and the develop-

ment of microangiopathy [9].

The condition of the oral cavity mucosa and its tissue ho-

meostasis is determined by a balance between the appearing

and existing cells. The determining factor in the process of cells

reproduction is the phase of DNA synthesis. It was proved that

the most adequate and precise concept of the process of DNA

synthesis is given by the method of immune histochemistry for

the identification of the gene Кi-67 that indicates an irreversible

stage of mitosis. This parameter is characterized by a mitotic

index (MI) that is defined by the ratio of non-mitotic cells and

cells that entered the stage of mitosis. The study of the bioptates

obtained from patients aged 40-59 years old 6 months after the

prosthetic treatment revealed an increased level of the cell clone

of CD163 by 24.1%, CD204 – by 30.7%, CD4/8 – by 33.3%. A

sharp increase in the level of Langerhans cells by 91.2% was ob-

served in comparison with the control group. The content of the

progenitors of dendritic cells also increased. The changes in the

parameters of cellular immunity were associated with a simulta-

neous increase in the expression of gingival mucosa epithelio-

cytes to Ki67 by 11.9%. In the group of patients aged 60 and

more, an increase in all the parameters of cellular immunity with

a proportional increase in the expression of the receptor Ki67 by

denture, all the patients had hyperemia and edema of the mucosa,

positive Shiller-Pisarev’s probe. Periodontitis of mild severity

was observed in 17 patients of the 1 age group and in 5 patients

of the 2 group. Moderate periodontitis was registered in 12 pa-

tients aged 40-59 years old and in 17 patients aged 60 and more

years old. 19 patients were diagnosed with severe periodontitis

that was characterized by the depth of gingival pockets more than

5 mm and the loss of bone tissue of the alveolar ridge by more

than ½ of the root length. III-IV degree of tooth mobility was

registered. In 12 months of wearing acrylic denture, a positive

dynamics was not registered in the oral mucosa. The studies re-

vealed a decrease in the number of patients with clinical mani-

festations of light periodontitis during the first 6 months of wear-

ing acrylic denture by 12.3% and during the second 6 months –

by 18.6%. It can be explained by an increase in the number of

patients with moderate periodontitis (by 7% and 14.2%) and se-

vere periodontitis (by 5.2% and 16.7%) in 6 and 12 months of

wearingacrylicdenture in comparison with the control group. An

increase in the number of visits to the dentist and a period of ad-

aptation to removable dentures was observed (Table 1).

Cellular composition in the oral mucosa of patients who

received Imudon is presented in Table 2. The level of cell

clones of CD11 /303 increased during the first 6 months of

wearing acrylic denture and remained higher than in patients

with DM in 12 months and those that did not use prosthetic

denture in all the age groups. The level of the clone of differ-

entiation 68 increased during the first 6 months of wearing

acrylic denture and remained higher than in patients with DM

in 12 months and those that did not use prosthetic denture in all

the age groups. An increase in the level of antibodies to CD204

in all the age groups was observed but, in 12 months, the pa-

rameters become lower than in the control group. Patients with

DM who used removable denture and received Imudon had a de-

creased level of CD163, CD204 and CD4/8 cells in the bioptates

obtained from the denture-bearing area in 6 months of using re-

movable denture in the group of observation aged 40-59 years

old. An increase in the level of Langerhans cells and progenitors

of dendritic cells was as compared to the group of comparison.

The changes in the parameters of cellular immunity were associ-

ated with an insignificant increase in the concentration of the fac-

tor of proliferation of epitheliocytes of surface epithelium by

8.1%. In the group of patients aged 60 and more years old, a de-

crease in all the parameters of cellular immunity and increase in

the level of Langerhans cells and progenitors of dendritic cells

were observed. The expression to Ki67 increased by 12.9%.

9.4% was observed.

The comparison of the parameters of cellular immunity in

and 12 months after the prosthetic treatment in groups of pa-

tients aged 40-59 and 60 and more years old revealed a decrease

in all the studied parameters. The intensity of proliferative pro-

cesses in the epithelium also decreased in the group of patients

aged 40-59 years old by 6.2% and in the group of patients aged

0 and more years old – by 4.1%. In 6 months of wearing acrylic

Table 2: Parameters of local cellular immunity of the periodontium tissues

Number of cells in the field of vision (M±m)

Period

months)

CD163⁺

CD11 /303

CD68

CD204

Control

CD4 /8

Age

(

0-59

2.90±0.15*

1.90±0.10

1.10±0.04

0.50±0.16*

3.40±0.07*

1.40±0.15

2.60±0.04*

1.60±0.06

2.40±0.15

1.60±0.07*

8.90±0.10

6.20±0.06*

Removable denture in patients with diabetes mellitus

0-59

3.60±0.25

3.25±0.04*

3.32±0.15

2.40±0.09

1.93±0.01*

1.42±0.06*

1.20±0.02*

0.55±0.01

6.50±0.17

2.90±0.07

3.86±0.08*

2.01±0.02

3.40±0.08

2.92±0.15

2.90±0.09*

1.60±0.01

3.20±0.02

2.60±0.03*

3.31±0.15

2.14±0.06

9.96±0.08

7.40±0.02*

9.34±0.20

7.10±0.02

0-59

Removable denture in patients who receive immune stimulators

0-59

3.31±0.12*

2.86±0.06*

3.02±0.12

2.22±0.08

2.62±0.03

1.83±0.04*

1.40±0.01

0.74±0.14

7.80±0.14*

4.26±0.02*

4.06±0.06

2.82±0.02

3.14±0.06

2.02±0.10

2.74±0.04*

1.40±0.02

2.82±0.03*

2.10±0.01

3.12±0.12*

1.86±0.02

9.62±0.06*

7.0±0.06*

9.0±0.20

0-59

6.80±0.04

The difference with the control group is statistically significant at p<0.05.

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 1, Pages: 231-236

A comparison of the parameter values of local cellular im-

munity in patients from Test group II in 12 months of using

acrylic denture with the analog parameters in patients from Test

group I revealed a decrease in the number of interstitial macro-

phages, mast cells, and T-lymphocytes in the mucosa of the den-

ture-bearing area. An increase in the level of CD11/303 and

Langerhans cells was registered. The intensity of proliferative

processes in the epithelium decreased by 3.6% in the group of

patients aged 40-59 years old and by 4.2% in the group of patients

aged 60 and more years old. Light periodontitis was registered in

of periodontitis with the drugs that optimize immune mecha-

nisms” 10. Literature review on the treatment of periodontitis

in patients with DM showed that the majority of authors prefer

rational therapy indicated by an endocrinologist and do not get

involved in the complex specific treatment of this pathology. A

correction of immunological and biochemical parameters of

blood and oral fluid plays an important role. It provides clini-

coradilogical effectiveness and favorably influences the results

of local treatment [1].

Rational evaluation of the problem shows that despite a

100% morbidity rate of periodontitis and gingivitis in patients

with DM, neither dentists nor diabetes specialists treat this

problem in a consistent manner. Statistical data obtained from

epidemiological studies on the status of the oral cavity in the

Russian population show that the degree of severity of perio-

dontitis decreased and its morbidity rate at early stages, on the

contrary, increased and was diagnosed at younger patients.

Thus, the treatment of periodontitis (including in patients with

DM) acquires more preventive character [4]. Numerous studies

showed that scaling (removing of tartar) and planification of

the root surface along with antibiotic therapy or without it led

to clinical improvement in patients with DM. The depth of

periodontal pocket and bleeding reduced, and the level of clin-

ical attachment of the gingiva increased [29,30]. On the other

hand, some authors suggest that successful control of bacterial

infection of periodontium leads to an improvement of clinical

picture of periodontitis and metabolic control of DM [24]. Suc-

cessful control of bacterial infection involves the indication of

drugs from the following pharmacological groups: antibacterial

drugs (antibiotics, antiseptics, antimycotics), anti-inflamma-

tory drugs (NSAI, steroids), anabolics (vitamins, etc.) [5]. The

described manipulations and indication of drugs exert primarily

etiotropic and symptomatic effect in cases when there is no

pathogenetic component. It can be suggested that the admin-

istration of local and systemic drugs in order to change the pa-

rameters of local cellular immunity will be pathogenetically

grounded for a reduction of the intensity of inflammatory pro-

cess in periodontal tissues in patients with DM that use remov-

able denture. In other words, successful control of bacterial in-

fection can result from the administration of drugs that affect

the local cellular immunity of the oral mucosa. Thus, the au-

thors can recommend the proposed treatment plan for patients

with DM who wear removable denture for the reduction of the

intensity of inflammatory processes in periodontal tissues.

0% of patients that used removable denture and received Imu-

don (Table 1). In 12 months of using removable denture, perio-

dontitis of different degree of severity was diagnosed in 60.7%

of patients that received Imudon. Clinical manifestations in-

cluded hyperemia, gingival edema, and rupture of the dentogingi-

val junction. Shiller-Pisarev probe was positive in 100% of pa-

tients. Thus, in the group of patients that received immune stim-

ulating drug, the authors registered a reduction of the dynamics

in the number of patients with periodontitis of moderate and se-

vere degrees by 2.1% and 9.2% in 6 months of wearing remova-

ble denture, and by 9.3% and 13.6%, respectively, in 12 months

of wearing removable denture in comparison with Test group I.

Conclusion

The parameters of cellular immunity in patients with DM

significantly differ from the parameters in healthy patients. The

analysis of the obtained data showed that all the patients with

DM had periodontal diseases of different degree of severity.

The presence of endocrine pathology in dental patients affects

the status of local cellular immunity of the oral mucosa in the

denture-bearing area after an insignificant decrease or un-

changed content of progenitors of dendritic cells. The regis-

tered significant increase in the mitotic activity of cells of basal

and parabasal epithelial layer associated with these changes can

be considered as a compensatory-adaptive mechanism of the

superficial epithelium of the oral cavity in response to the in-

flammation. Considering the character of regenerative pro-

cesses, it can be suggested that the changes in the cellular com-

position of the oral mucosa, that characterize its local cellular

immunity, are caused by the endocrine pathology, which, in its

turn, determines the clinical picture of the oral cavity condition,

in general. The use of removable acrylic denture leads to sig-

nificant changes in the parameters of cellular immunity of the

oral cavity with a simultaneous increase of the mitotic activity

of epitheliocytes of the gingival mucosa during the first 6

months. In their turn, clinical manifestations of the inflamma-

tion of periodontal tissues are associated with the changes in

the parameter values and character of cellular immunity of the

gingival mucosa. A significant direct correlation (r=0.8) be-

tween morphological characteristics of cellular immunity

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(

number of activated macrophages, mast cells, Langerhans

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Indication of immune-stimulating drug to patients with DM

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