Clinical laboratory assessment and predictability of the periodontal inflammation development in children with undifferentiated connective tissue disease
Authors: Ippolitov Yu. A. , Chubarov T. V. , Sharshova O. G. , Buzulukina I. N. , Folomeeva D. M. , Chan Ch. Ch. 
Published: December 2021

Relevance. The development of multiple organ lesions in undifferentiated connective tissue disease leads to secondary immunodeficiency, which triggers oral homeostasis disruption and activates periodontal pathogens, which produce anti-inflammatory cytokines, which trigger the mechanisms of periodontal destruction. Purpose – to establish the relationship between undifferentiated connective tissue disease in children and their predisposition to periodontal inflammation and destruction.

Materials and methods. The study examined the patients, aged 15 to 17 years old, of the endocrinological department of the Children's Clinical Hospital of N. N. Burdenko Voronezh State Medical University. All examined children had the same diagnosis of undifferentiated connective tissue disease. The control group consisted of 15 children with healthy periodontium. Silness-Loe plaque index (Loe H., Silness J., 1962) at the gingival margin assessed the children periodontal status. Mühlemann bleeding index (Mühlemann H.R., Son S., 1971) [19] evaluated the bleeding. The study measured the intensity and extension of the inflammatory reaction by the cytological changes in the periodontium according to the Page and Schroeder model (Page R.C. and Schroeder M. E., 1976). The enzyme immunoassay kits from eBioscince determined the level of pro-inflammatory cytokines: interleukin (IL-1β), interferon-gamma (IFN-γ) and transforming growth factor (TGF-β1) in the oral fluid; and the anti-inflammatory cytokine, receptor antagonist interleukin IL-1 (IL-1ra), was measured using Invitrogen kit in strict accordance with Multiskan FC microplate photometer instructions (Thermo Scientific).

Results. Children periodontal status evaluation did not reveal any pronounced clinical manifestations of the inflammation that could cause concern and complaints of bleeding gums. Thus, the Silness-Loe plaque index at the gingival margin was 1.70 ± 0.07 (control group 1.10 ± 0.03), the Mühlemann gingival sulcus bleeding index in children with undifferentiated connective tissue disease was 2.10 ± 0.05 (control group 0). The results of the oral fluid cytokine count in patients with undifferentiated connective tissue disease demonstrated a tendency for pro-inflammatory cytokine increase and anti-inflammatory cytokine decrease, in contrast to the control group.

Conclusions. Thus, the qualitative composition of pro-inflammatory cytokines – interleukin (IL-1β), interferongamma (IFN-γ) and transforming growth factor (TGF-β1), interleukin IL-1 receptor antagonist (IL-1ra) in the oral fluid, in combination with clinical diagnostic methods in periodontal practice, can reliably predict the predisposition of people with undifferentiated connective tissue disease to periodontal inflammation and destruction. Medical checkup in children with undifferentiated connective tissue disease mainly aims to carry out comprehensive treatment and preventive measures to preserve the functions of the dental system. As children periodontal service is not allocated in the register of medical specialties in the Russian Federation, pediatric periodontal patients are followed-up in the periodontally healthy groups. However, it is evident today that periodontal passports are necessary, which indicate a genetic predisposition to inflammatory periodontal diseases.