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Authors : Dr. Oreshaka oleg, m.d, Dr. Sherbakov Ivan, Dr. Shvetz Marina.

Status and functioning of various systems in the body of woman are largely determined by her hormonal status 3,9.
It is known that estrogen deficiency contributes to the damaging of periodontal tissues 7,11. Proved that the degree of severity of chronic generalized periodontitis is strongly depends on the level of estradiol in the blood 5,8.
However, the question about the deterioration of dental health in patients with pronounced menopause have not been studied, which was the object of our research.

Materials and methods.
23 women at the age of 45-56 years with surgical menopause were studied. The comparison group included 20 healthy women, of premenopausal age (45-53 years). All the patients were examined before and after 3, 6 and 12 months after surgery. Also because of different reasons all of them haven't been treated by hormones.
The prevalence of inflammation of gums was evaluated by PMA index (modification of Parm), its intensity by probe of Schiller - Pisarev, bleeding of gums by index Myulleman - Cowell (1975) and as a result the comprehensive periodontal index MMSI was calculated (1987). Hygienic condition of the oral cavity was estimated by the index of Green-Vermillion (1964).
We studied some of the salivation indicators such as: the speed of salivation and oral fluid viscosity. The functional state of microcirculation in the periodont was evaluated by LDF. Plasma level of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) and progesterone (P) were determined by IFA.
The significance of differences of the studied parameters was evaluated by U-Mann - Whitney test, the differences were considered significant at p≤0,05. Correlation between the studied parameters was assessed using Spearman rank correlation test. Statistical analysis of the material was carried out using the software Statistica 6.0 (StatSoft Inc., USA).

Results and discussion.

The analysis showed that the hormonal status in patients of both groups was rather similar before treatment (the concentrations of estradiol in blood plasma as well as in mixed saliva were the same). But three months later the serious reduction of the estrogen's concentrations  was determined: the level of estradiol was lower up to 2 times in blood plasma, and 5 times in mixed saliva compared to the initial state (Fig. 1).

Fig. 1. Dynamic of estradiol concentration in blood plasma and mixed saliva in menopausal women 

As a result of this process we found the increasing of gums bleeding, which was estimated by the index of Myulleman-Cowell that might be associated with increased vascular permeability because of estrogen deficiency. And also the inflammation of gums (index PMA) was increased (table 1).

Dynamic of the periodontal tissues condition in menopausal women after surgery.


Notes: * -  the values are significantly different from the comparison group (Mann-Whitney U-test, p <0.05) ** - values are significantly different from the baseline (Mann-Whitney U-test, p <0.05)
Possibly these changes in periodontal tissue can be explained as a particular manifestation of systemic changes in a condition of connective tissues due to violation of secretion of sex steroids 1,6.
At the same time, the lack of estrogen resulted to the deterioration of indicators characterizing the hygienic condition of the oral cavity and the state of dental hard tissues, in particular the index of Green-Vermillion. Deterioration of hygienic condition of the oral cavity, can be explained by a decrease of the washing ability of saliva and weakening of its cleaning capabilities 4,12.
When analyzing the LDF-grams we identified the deteriorating of microcirculation in periodontal tissues. Thus, if the initial values ​​of the index of perfusion in the interdental papillae in the anterior dentition in patients of the observation group were 28,87 ± 1,46 M, pf. u., then three months later there was a significant decline of 29.33%, 8.87% after six and 11.63% in twelve months. This could be due to the defect of the protective effect of estrogen and the formation of pathological types of microcirculation 10.
Interesting, in our opinion, were the results obtained in the study of the state of the salivary glands. In the first stage of observations in patients there was a significant decrease in the rate of secretion of saliva (0,44 ± 0,12 ml / min in the outcome, 0,24 ± 0,11 ml / min in three months, 0,17 ± 0,07 ml / min, and after six months 0,14 ± 0,08 ml / min through a year). And increasing of its viscosity (1,63 ± 0,26 cps before surgery, 2,4 ± 0,21 cps three months, 2,6 ± 0,17 cps six months and 2,89 ± 0,17 cps in a year ). These disorders were associated with the metabolic processes in the oral mucosa and salivary glands 2.
The results of the correlation analysis between the significant changes in periodontal tissues and a decrease of estrogen levels in mixed saliva, testified about the relationship of these indicators.

Thus, in women with surgical menopause in the early stages (one year after surgery) because of sharp estrogen deficiency, the significant deterioration of some clinical and functional indicators of periodontal tissues and salivary glands, the level of hygienic condition of the oral cavity were identified. Can be added that in these patients additional preventive and therapeutic measures are required.


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