Organization and implementation of the timely treatment and prevention measures among military personnel is one of the main objectives of the medical service of the Armed Forces, resolution of which allows to have a significant impact on maintaining them at the appropriate level in constant combat readiness (Isaeva, 2009; Kuzmin, 2009). The scientific studies analyzing the characteristics of the organization of dental care in the army and the improvement of the organization of provision of the highly qualified dental care to military personnel in the conditions of reforming the military medical service in the current conditions revealed that the determining directions in improving its construction and efficient operation are accessibility and mobility (Alimova, 2004; Dovbnev, 2009; Skec, Macan, Susac, Jokic, Brajdic & Macan, 2006). At the same time, expert assessment of the functioning of the dental service in the armed forces in all directions will allow to find out the disadvantages, which include the high incidence of dental diseases, occupational hazards, social and hygienic factors, ecological situation in the region of the military service, often with insufficient level of dental care, weak adaptive capacity of the military dental care to modern requirements in the provision of dental care to military personnel. According to the results of the epidemiological studies conducted in recent years, an increase was seen in the incidence of tooth decay among different categories of military personnel. Tooth decay and its complications, as well as inflammatory periodontal diseases, hold the leading place in the structure of morbidity (Alimsky, Nikonenko, 2007; Zadik, Zusman, Galor, Dinte, 2009). Development of the science-based measures on the clinical examination of military personnel and the received updated data on the prevalence and intensity of major dental diseases will allow to timely determine the neediness of military personnel in medical, surgical and orthopedic dental care.

Purpose of the study

Scientific substantiation and development of proposals for improving the complex therapy for military personnel with inflammatory periodontal diseases.

Materials and methods of examination

To achieve the goals, the internal military troops were examined at the Central Dental Clinics of the Interior Ministry of the Azerbaijan Republic, taking into account the recommendations of the World Health Organization (1995) and with techniques used in epidemiological surveys. Health of teeth, paradontium and oral mucosa of 312 military personnel were studied. Age of the surveyed ranged from 25 to 52 years. The diagnosis among employees of the Interior Ministry was made in accordance with WHO recommendations, according to the ICD-10, the study of the clinical manifestations of the disease identified with both basic and additional methods of examination. Physical illnesses of employees of the Interior Ministry, who participated in this survey, were not diagnosed. At the first stage, all patients had a clinical examination. Health of teeth and periodontal tissues was studied using dental indexes. The intensity of tooth decay and inflammatory periodontal diseases was measured by the DSR index (the number of decayed, sealed and removed permanent teeth) and the community periodontal index of treatment needs (CPITN) (WHO index, Ainamo J., Barmes D., Beagrie G., Cutress T., Martin J., 1982). At the second stage of the survey, patients with inflammation in the periodontal tissues were divided into two groups. In the process of treatment, the patients of the first main group, in addition to conventional treatment and preventive measures, were prescribed the medicine on the basis of black cumin (Oleum Nigella Sativa), while the second group of patients – the control group – received standard treatment. Comparative evaluation of the effectiveness of the therapy was carried out by clinical, immunological and microbiological parameters. Standard traditional treatment of mild periodontitis included professional oral hygiene, curettage, treatment of tooth decay and its complications; 0.02% chlorhexidine was used as a local anti-inflammatory therapy. The course of treatment was 10 days. All employees fulfilled the prescribed hygienic oral care. The effectiveness of the measure was determined using clinical and laboratory research methods. SBI – the intensity of the gingival sulcus bleeding at the probe trial or at a pressure in the dental papilla, Muhlemann H.R. index in Cowell I. modification, 1975; OHI-S – a simple hygiene index by Green – Vermillion (1964). Unstimulated mixed saliva served as the material for the study of the state of local immunity of the mouth. At all stages of the study, the level of sIg A was determined in patients’ mixed saliva. Quantitative determination of the secretory immunoglobulin SIgA in mixed saliva was made by radial diffusion in the gel according to the method of Mancini G.C. (Mancini, 1965).

To study the qualitative and quantitative composition of the mouth microflora, the following culture media were used: 5% blood agar to determine the general level of microbial contamination of the oral cavity; vitelline agar for staphylococcus; sugar broth and “Mitis Salivarius Agar” for streptococcus; chromogen of CandiSelect agar (Boi-Rad, France) was used for Candida yeast cultivation. The samples were immediately placed in Stuart transport media and forwarded to the scientific research laboratory of the Department of Microbiology and Immunology of the Azerbaijan Medical University for further research.

The results were subjected to statistical analysis using parametric and nonparametric methods. Statistical research methods included methods of variation statistics (determination of the mean arithmetic value – M, standard error – m, Student’s significance test – t). Statistical analysis of the results of clinical trials was performed using standard software packages of the applied statistical analysis (Microsoft Excel and Statistica 7.0 for Windows).

Outcomes of own Research

The results of examination of the internal military troops indicate a high prevalence and intensity of tooth decay, which is confirmed by statistical analysis of the results of clinical and epidemiological studies in different age groups (Table 1).

The prevalence of tooth decay among personnel of various forces, according to foreign authors, may vary from 60.20% to 97.40% with its intensity from 1.25±0.41 to 8.40±0.23, which may depend on various factors (living in environmentally unfriendly areas, inadequate hygiene education, lack of adequate dental care) (Sorokin, 2006; Marker, Vigild, Praetorius, 1997). D component prevailed in the structure of DSR index, indicating a rather low level of dental health. Surveyed groups were considered comparable, as there were no statistically significant differences between the compared groups by age, sex and somatic state.

Table 1: Prevalence and intensity of tooth decay in the military personnel

It should be noted that the S component in the structure of DSR index was significantly high in the surveyed against the relatively high levels of infestation of tooth decay.

The average number of removed teeth due to tooth decay was low: 0.11±0.01 and 0.12±0.01 in the younger age groups per cadet; 0.11±0.01 in the third group.

The outcomes of the research and analysis of the elements of CPITN index show a high prevalence (96.8%) of signs of periodontal disease in the military personnel. At the same time, 42.31% of the patients revealed the presence of hard and soft dental plaque, while a considerable number of people, even in the relatively young age, – 30.0% – were diagnosed periodontal pockets with a depth of 4-5 mm (Table 2). Assessment of the structural components of CPITN index showed a high level of incidence of inflammatory periodontal diseases of inflammatory and destructive nature in all age groups of the surveyed military personnel.

Table 2: Prevalence of periodontal disease in different age groups of military personnel (CPITN index)

It should be noted that the study of this factor allows to determine the neediness for specialized periodontal care, taking into account the severity of the disease, which is very important. The reason for the frequent detection of clinical signs of periodontal disease among military personnel is inadequate care of the oral health and irregular visits to a dentist, which may indicate a certain degree of the level of hygiene education (Mombiedro-Sandoval, Llena-Puy, 2008). Evaluation of neediness of local population for periodontal care by CPITN index showed that hygiene education, followed by repeated control, needed for a total of 6.73±1.42% military personnel (Table 3).

Professional oral hygiene was required by 75.64% of patients with gingivitis and periodontitis. Comprehensive periodontal treatment, including, in addition to occupational health and sanitation, a conservative therapy and surgical treatment, was required for 13.46% military personnel with moderate and severe chronic generalized periodontitis in average.

Table 3: Community periodontal index of treatment needs for military personnel (CPITN index)

Frequent structural and functional abnormalities in the organs and tissues of the mouth, which lead to frequent exacerbations and development of more severe forms of inflammatory periodontal disease, causes a high level of neediness of surveyed military personnel in combined treatment, most often including professional hygiene and supporting conservative therapy. Among the range of measures, the development of which achieves preserving and strengthening the dental health of military personnel, the most important are effective treatment and preventive measures.

As you know, with the development of pathological inflammatory processes in periodontal tissues, concentration of the factors of specific and non-specific immune defense change in the oral fluid. Therefore, in order to assess the nature of these changes, we studied the dynamics of quantitative indices of s IgA before and after completion of treatment and prevention measures. According to information received, the content of secretory immunoglobulin A, which is an important indicator of immune status, was not statistically significantly different in patients of the first and second groups before the start of the course of the basic therapy, which indicates the lack of activity of specific immune protection in surveyed military personnel.

A number of researchers identified the effectiveness of black cumin and its active ingredient, thymoquinone, as an anti-inflammatory agent. It was found that the anti-inflammatory effect of this oil plant is also due to the presence of p-cymene and limonene; mixture of eicosadienoic, eicosatrienoic and eicosenic acids; and triterpenoid saponins. The presence of the antioxidant properties of Nigella oil, used as a highly effective diuretic, mild laxative, immunostimulatory agent, due to the presence of p-cymene and limonene, was confirmed (Mashirova, Orlovskaya, 2012; Nurmagomedova, Omarieva 2014; Patudin et al, 2011; Kapoor, Singh, Singh et al, 2010; Mazaki, Kataoka, Kinouchi, 2006). Given the advantageous performance of this herbal medicine, phagocytic changes in the pathogenesis of inflammatory periodontal diseases and lack of efficacy of the known therapeutic methods, medicine on the basis of black cumin oil was used as maintenance therapy in the main group of surveyed patients in addition to generally accepted standard treatment. The trend should not go unnoticed to a more significant positive dynamics in the group of patients where the application of black cumin oil was used and where concentration of the test component in the mixed saliva has increased from 171.3±0.98 mg/ml to 221.9±2.46 mg/ml (p<0.001) two months after completion of the therapeutic course. At the same time, in the second group of patients, this indicator increased slightly and amounted to only 178.3±0.34 mg/ml (Table 4).

Table 4: Concentration of sIg A (mg/ml) in mixed saliva of patients of the first and second groups

The initial level of sIg A before the treatment and preventive measures had no statistically significant differences in the observation groups (p>0.05).

Thus, there has been a significant increase in the concentration of secretory immunoglobulin A in saliva of the main group of patients after the treatment. In the control group, the relatively low values ​​indicate the absence of positive dynamics. In our opinion, the surveyed factor of the local immunity status allows to judge about the normalization of mucosal immunity by using herbal medicine in treatment of inflammatory periodontal diseases. Moreover, the better pronounced normalizing immunoglobulin concentration of sIg A identified in the first group in comparison with the second group agrees with the dynamics of microflora of the oral cavity. A further purpose of our study was to determine the effectiveness of the proposed plant medicine in the correction of the microbial composition of the oral cavity in internal military personnel. These microbiological studies show the effectiveness of using black cumin oil in treatment of inflammatory periodontal diseases. Analysis of the microbial content showed reduction in the number of colonies of pathogenic organisms in samples taken 2 months after the treatment in the first group of patients (Table 5).

Table 5: Change in the number of CFU microbial associations before and after treatment

During observation, certain types of micro-organisms and Streptococcus haemolyticus, Streptocoscus aureus, Candida albicans were plated on the above date in the samples obtained in all groups of the surveyed persons, but they were less common in the main group than those in the control group. It should be noted that at the final stage of studies after a standard treatment plan, there was a significant (p<0.001) increase in the frequency of the isolation rate of microbial associations that contribute to the development of tooth decay and inflammatory periodontal disease. After treatment with the use of black cumin oil, normalization of the microbiocenosis of oral cavity contributed to significant change in the index values ​​of health and ulaemorrhagia in the favorable direction.

At the second stage of the study, the basic indicators of the clinical health of periodontal tissue were compared in patients treated with the new plant medicine from the first main group and their opponents, who received only standard treatment and were joined into a control group. The dynamics of changes in the values ​​of hygienic and periodontal indices in patient outcomes were compared. The average values ​​of hygienic OHI-S index in the first and second sub-groups of the surveyed military personnel are reflected in Table 6.

Table 6: Value of OHI-S index in patients depending on the chosen treatment

There were significant changes in the main indicators of the hygiene health of periodontal soft tissues on the background of a significant reduction in the amount of dental plaque after using black cumin oil in combined treatment. Thus, a statistically significant decline in the studied index was observed in the main group at the initial phase of clinical observation – from 1.59±0.032 to 0.95±0.027 (p<0.001).

A comparative evaluation of values of ​​OHI-S index found significant differences between the indicators of the first and second groups of surveyed patients, registered 2 months after completion of treatment: the group of patients who underwent applications of the herbal medicine had lower value of the indicator (p<0.001). No statistically significant differences were determined between the initial values of the surveyed hygienic index (p>0.05). In assessing the dynamics of OHI-S index, the first group achieved positive results and maintained them in a long-term period of observation. At the same time, the values changed in patients of the control group towards increasing the intensity of plaque deposits. In order to determine the effectiveness of the proposed biologically neutral medicine in treatment and prevention of inflammatory periodontal diseases in military personnel, we studied changes in Muhlemann’s sulcus bleeding index (SBI), depending on the means of the conservative treatment used (Table 7).

 Table 7: Dynamics in SBI index in patients depending on the chosen treatment

During clinical observation, as soon as 10 days after completion of the basic and supporting treatment, a significant reduction in bleeding gums when brushing teeth was seen in the main group of patients. Similar pattern was observed for the dynamics of the surveyed dental index in this group at the final stage of research: the bleeding index reaches zero 2 months after treatment in military personnel who use the prescribed herbal medicine. Thus, sustained remission was observed in all patients by the end of the clinical observations, confirmed by the data of the surveyed index. At the same time, over a similar period, a trend was observed in patients in the control group towards increasing the index values and increase in inflammation in periodontal tissues (p>0.001).

Conclusion

An effective treatment and preventive agent with anti-inflammatory, antimicrobial and immunomodulatory properties was suggested for prevention and treatment of inflammatory periodontal diseases in internal military personnel. After applying the herbal medicine, according to clinical and laboratory studies, the hygienic health of the oral cavity greatly improves, inflammation in the periodontal tissues significantly reduces, pronounced microbial “recover” effect is achieved, which proves the validity of the choice of the medicine on the basis of black cumin oil in the combined treatment of periodontal disease and with no doubt will have a beneficial impact on a significant improvement in the quality of life of the surveyed patients.

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