Evaluation of the effectiveness of an optimized treatment protocol for periodontal diseases in patients with hypothyroidism

Relevance. Systemic diseases – particularly endocrine disorders that modulate host immune responses – play a significant role in the pathogenesis of periodontal diseases (gingivitis and periodontitis). Hypothyroidism is associated with poorer oral hygiene, a higher prevalence of periodontitis and dental caries, and heightened inflammatory activity in periodontal tissues. This underscores the need for a comprehensive, interdisciplinary approach to diagnosing and managing patients with hypothyroidism, taking into account the bidirectional links between endocrine and oral conditions.

Objective. To evaluate the effectiveness of an improved treatment protocol for periodontal diseases – specifically gingivitis and periodontitis – in patients with hypothyroidism.

Materials and methods. This two-stage study first assessed periodontal status in patients with hypothyroidism by disease form. Participants were assigned to three groups: patients with periodontal diseases and subclinical hypothyroidism (n = 49), patients with periodontal diseases and overt hypothyroidism (n = 95), and a control group of patients with periodontal diseases and no thyroid pathology (n = 30). In the second stage, 136 patients with primary hypothyroidism and mild-to-moderate periodontal diseases were enrolled and allocated by therapy type: the comparison group (n = 52) received conventional periodontal treatment, whereas the main group (n = 84) received the improved protocol, which added a gel containing bacteriophages and Stellaria media extract and adjunctive physiotherapy using the ALST-01 Optodan laser unit. Treatment effectiveness was evaluated by periodontal charting before and after therapy.

Results. The findings of the first stage revealed marked differences in periodontal status between patients with subclinical and overt hypothyroidism. At the second stage, all groups showed a significant decrease in OHI-S, PDI, PMA, and PBI indices after treatment, with the most pronounced improvements observed in the main group.

Conclusion. Patients with periodontal diseases and overt hypothyroidism are at increased risk of accelerated periodontitis progression. The optimized treatment protocol showed strong clinical effectiveness, reducing inflammation, improving periodontal indices, and achieving periodontal stability.

1. Romanova RO, Zyulkina LA, Ivanov PV, Kuryaev II, Kashlevskaya ME. Modern aspects of etiopathogenesis inflammatory periodontal diseases (review). Vyatskij medicinskij vestnik. 2022;1(73):96-102 (In Russ.). DOI: 10.24412/2220-7880-2022-1-96-102

2. Shirmohammadi N, Kavianpour S, Namazi M, & others. Risk factors of periodontitis: A systematic review and meta-analysis. International Journal of Dentistry, 2021, Article ID 6666244. https://doi.org/10.1155/2021/6666244

3. Yelizova LA, Atrushkevich VG, Orekhova LY. New classification of periodontal diseases. Periodontitis. Parodontologiya. 2021;26(1):80-82 (In Russ.). Available from: https://www.parodont.ru/jour/article/view/433

4. Gavrilova ES, Komelyagina NA, Shishkina MP, Nesterova YuV, Ulyanov IN. Endocrine disorders as a risk factor for dental diseases. International Journal of Humanities and Natural Sciences. 2024;11-4(98):10-14 (In Russ.). https://doi.org/10.24412/2500-1000-2024-11-4-10-14

5. Slazhneva ES, Atrushkevitch VG, Orekhova LY, Loboda ES. Prevalence of periodontal diseases in patients with different body mass index. Parodontologiya. 2022;27(3):202-208 (In Russ.). https://doi.org/10.33925/1683-3759-2022-27-3-202-208

6. Fadeev VV, Morgunova TB, Melnichenko GA, Dedov II. Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism. Clinical and experimental thyroidology. 2021;17(1):4-13 (In Russ.). https://doi.org/10.14341/ket12702

7. Romanenko I, Kekosh E. The clinical course of chronic generalized periodontitis in patients with autoimmune hypothyroidism and hyperthyroidism. Parodontologiya. 2017;22(4):68-72 (In Russ.). Available from: https://www.parodont.ru/jour/article/view/115

8. Nazarova N, Ruzimurodova Z. Clinical and functional treatment of periodontal disease and tooth trauma in patients with hypothyroidism. Preventive Medicine and Health. 2022;1:83-91 (In Russ.). https://doi.org/10.47689/2181-3663-vol1-iss1-pp83-91

9. Bolsunovsky SM, Kazarina LN. Comparative assessment of the state of periodontal tissues in patients with subclinical hypothyroidism and euthyroidism. The Scientific Heritage. 2021;63-2:13-15 (In Russ.). https://doi.org/10.24412/9215-0365-2021-63-2-13-15

10. Dzetсyuh TI, Klishch IN, Marushchak MI. The peculiarities of humoral immune system in rats during acute periodontitis in case of mercazolyl-induced hypothyroidism. Modern problems of science and education. 2014;(1):105-105 (In Russ.). Available from: https://s.science-medicine.ru/pdf/2014/1/143.pdf