EFFECT OF THE THERAPEUTIC-PREVENTIVE COMPLEX ON THE PARAMETERS OF GLUTATHIONE SYSTEM AND GLUTATHIONE-DEPENDENT ENZYMES OF THE ORAL FLUID IN CHILDREN WITH CHRONIC CATARRHAL GINGIVITIS AND DIABETES MELLITUS
Authors: Kaskova L.F. , Honcharenko V.A. 
Published: March 2021

Chronic catarrhal gingivitis (CCG) is a common stomatological disease among children suffering from diabetes mellitus. The prooxidant-antioxidant system state plays an important role in occurrence and course of chronic catarrhal gingivitis. Antioxidant protective system (AOPS) is presented by enzymatic and non-enzymatic components. Though, distribution between them is rather conditional, since the action of enzymes-antioxidants is closely connected and balanced inside and with non-enzymatic components.Glutathione system including glutathione proper and three enzymes (glutathione peroxidase – GP, glutathione reductase – GR, glutathione transferase – GT) binds free radicals, reduce oxides, lipid peroxide oxidation products, the products of membrane phospholipids, proteins, nucleic acids, and removes them from the body in the form of non-toxic conjugates.

A number of methods to treat chronic catarrhal gingivitis in children including the treatment of the background of diabetes mellitus was proposed the scientists. Meanwhile, the search of new methods which able to produce a positive effect on the periodontal tissue state and regulate the body antioxidant system remains an urgent issue today.

The aim of the study is to investigate the effect of our suggested therapeutic-preventive complex on the state of glutathione system and glutathione-dependent enzymes of the oral fluid in children with chronic catarrhal gingivitis accompanied by diabetes mellitus.

Fifty children suffering from CCG aged from 12 to 16 years were examined and treated for stomatological issues. They were admitted to a hospital at the Children Endocrinological Department of the Municipal Institution “Regional Pediatric Clinical Hospital” in Chernivtsi due to diabetes. Eighteen children of the same age suffering from CCG without somatic pathology available were examined as well. Children with diabetes mellitus were divided into two equal groups. Thus, the first group (1st group is control one) included 18 somatically healthy children with CCG. The second group (the 2nd – the group of comparison) included 25 children with accomponied diabetes mellitus. Children from the 1st and the 2nd groups were treated according to the protocols of the Ministry of Health of Ukraine concerning giving medical aid on specialty «Pediatric Therapeutic Dentistry». The third group (the 3d – the main one) included 25 children with CCG and diabetes mellitus, who received oral complex medicine "Quertulin" in the dose of 1 tablet 3 times a day, drops «Imupret» in the dose of 25 drops 3 times a day and poly-vitamin drug "Pikovit" in the dose of 1 tablet once a day after meals till complete resorption in the oral cavity during 20 days. Topical irrigation of the oral cavity with the solution containing tooth wash "Exodent" (1 teaspoon per ¼ glass of water after every meals and cleaning teeth during 1-2 minutes). Such kind of therapy makes the foundation to prevent the formation of free radicals and decreases the concentration of LPO products.

In all the groups the treatment was proceeded by professional oral hygiene, sanitization (if necessary), teaching children the method of cleaning the teeth, the floss use, choosing the means of individual oral hygiene.

Effect of CCG treatment was assessed by means of comparison of the initial parameters (І examination) with the parameters immediately after its completion (ІІ examination), in 1 (ІІІ examination), 3 (IV examination) and 6 (V examination) months.

The content of SH-groups was determined by means of Ellman’s reagent; activity of glutathione-S-transferase – by the amount of accumulated conjugate by means of W.H. Habig et al. method; activity of glutathione reductase – by a reduced amount of NADFH2 in the reaction medium by R.E. Pinto, V. Bartley method; activity of glutathione peroxidase – by V.M. Mogen method; activity of glucose-6-phosphate dehydrogenase – by Kornberg and Khoreker method modified by Zakharyin; level of ceruloplasmin – by the modified Revin’s method. 

During the first examination the parameter of reduced glutathione in the examined groups of children with diabetes mellitus did not differ reliably, but it was considerably lower than that of healthy children (р<0,05) and in children with chronic catarrhal gingivitis without somatic pathology (р<0,05).

Patients who underwent our suggested treatment presented increase of the parameter of reduced glutathione activity 1.97 times as much after completion of treatment in comparison with the results before the beginning of treatment. Inconsiderable increase of the parameter was found in the 1st and the 2nd groups. During 6 months of observation the activity of reduced glutathione decreases in all the groups, but the best results remained in the 3d group.

A similar tendency concerning changes of parameters among children from the groups of observation was found during examination of glutathione peroxidase activity. A reliable difference in the activity of the enzyme in the 1st and the 2nd groups was not found in different terms of observation in comparison with the data before the treatment conducted. Glutathione peroxidase activity of the oral fluid increased in all the examined groups 6 months later, and only in the 3d group it differed reliably from the parameters of I examination, which is indicative of a positive effect of the suggested complex of treatment.

The dynamics of glutathione transferase activity in the oral fluid of children with chronic catarrhal gingivitis and diabetes mellitus who in addition to the common treatment received the antioxidant-containing complex should be taken notice of.

The parameter 1.7 times increased after completion of treatment in comparison with I examination. Six months later, it remained on a rather high level and differed reliably from I examination, which is indicative of a long action of the suggested complex. Considerable changes of glutathione transferase activity in the oral fluid in the 1st and 2nd groups were not found during the whole period of observation.

Our suggested treatment of chronic catarrhal gingivitis enabled to improve the parameter of glutathione reductase activity in the oral fluid of children from all the groups of observation. The most considerable difference between the parameters of II examination in comparison with I examination was found in the 3d group.

Even 6 months later, after completion of treatment the numerical values of glutathione, reductase activity in the oral fluid were 1.7 times higher than before treatment.

In addition to the traditional treatment introduction of our suggested therapeutic-preventive complex containing the use of antioxidants, enabled to improve the parameters of glutathione and glutathione-dependent enzymes and maintain their values on a rather high level during 6 months after the treatment completed.