CLINICAL AND DIAGNOSTIC CHARACTERISTICS OF ORAL MUCOSA LESIONS IN INTERNALLY DISPLACED PERSONS AGAINST THE BACKGROUND OF COMORBID GASTRODUODENAL PATHOLOGY

Abstract

Summary. Under conditions of prolonged psycho-emotional stress caused by the war and forced population migration from the combat zone, a significant increase in dental morbidity is observed among internally displaced persons (IDPs). Special attention is required to study the relationship between gastrointestinal tract pathology, in particular associated with Helicobacter pylori, and the condition of the oral mucosa in IDPs, which will allow improving diagnostic approaches and personalizing treatment tactics. The aim of the study – to evaluate the features of clinical manifestations of oral mucosa diseases, the condition of periodontal tissues, and oral hygiene in IDPs with gastrointestinal diseases to identify specific patterns of comorbid course. Materials and Methods. A comprehensive examination of 115 individuals with verified diseases of the gastroduodenal zone and associated lesions of the oral mucosa was conducted. According to the study design, two groups were formed: the main group (n = 82) – internally displaced persons, and the comparison group (n = 33) – permanent residents of the Ternopil region. Comprehensive diagnostics were based on clinical and anamnestic analysis, visual detection, and morphometry of oral mucosa lesion elements. The hygienic status and condition of periodontal tissues were assessed using the OHI-S index, PMA index, tongue coating index according to K. Kojima, and gingival bleeding intensity according to H. Kotzschke. Results and Discussion. The analysis of the obtained data demonstrated a significant decompensation of the dental status in patients from among IDPs. It was established that the frequency of subjective complaints of dryness, burning, and discomfort during eating in patients of the main group was 2.4 times higher than in the comparison group. Objectively, swelling of the tongue and oral mucosa in IDPs was diagnosed in 68.3 % of cases versus 12.1 % in residents of the Ternopil region, p < 0.05. The structure of oral mucosa lesions in the main group was characterized by the predominance of erosive-ulcerative forms of lichen planus and recurrent aphthous stomatitis of moderate severity, which correlated with the duration of stress exposure. The hygienic status of IDPs was assessed as “unsatisfactory” (OHI-S – 2.84 ± 0.14 points), which was accompanied by massive tongue coating (according to Kojima – 2.76 ± 0.16 points). The state of periodontal tissues in IDPs indicated a generalized inflammatory process: the PMA index was 51.13 ± 1.26 %, and bleeding according to Kotzschke reached 2.14 ± 0.12 points, which significantly exceeded the indicators of the comparison group (27.41 ± 1.44 % and 0.78 ± 0.08 points, respectively). Conclusions. The impact of chronic psycho-emotional stress caused by forced displacement is a powerful aggravating factor that significantly worsens the clinical course of comorbid gastroduodenal pathology and induces severe inflammatory-destructive lesions of the oral mucosa in internally displaced persons. Furthermore, a significant deterioration in hygienic status and rapid progression of generalized inflammation of periodontal tissues were found in this contingent of individuals, compared to residents of the Ternopil region. This scientifically justifies the need to develop specialized algorithms for the therapeutic and prophylactic management of this category of patients.