Diagnostic and prognostic value of nitric oxide measurement in clinical dental practice

Background. The present study analyzes the diagnostic and prognostic validity of determining nitric oxide (NO) metabolites in the pathogenesis of odontogenic inflammatory diseases of the maxillofacial region. Odontogenic inflammatory diseases of the maxillofacial region in the adult population are the main etiologic cause of adentia in people over 30 years of age. The etiopathogenesis of secondary immunodeficiency in these nosological forms is associated with hyperproduction of nitric oxide; however, the role of NO-associated pathogenetic mechanisms in odontogenic inflammatory diseases of the maxillofacial region remains insufficiently verified. Purpose – to investigate the possibility of using the determination of NO metabolites in clinical dental practice for the diagnosis, prevention, and prognosis of the course of inflammatory diseases of the maxillofacial region. Materials and Methods. A prospective observational study was conducted involving 207 patients aged 26–80 years (121 women, 86 men) with verified odontogenic inflammatory diseases of the jaw: apical chronic periodontitis (n=144), acute purulent periodontitis (n=40), marginal periodontitis (n=23). The reference group consisted of 20 healthy volunteers of appropriate age and gender. Biochemical detection of the concentration of total NO metabolites was performed by the method of L.C. Green, nitrite anion (NO3–) – by the method of T.V. Zvyagina, and the content of nitrate (NO2–) was calculated by the difference in the indicators of total metabolites and nitrite. Longitudinal monitoring of NO metabolites before surgery, after surgery, as well as on days 3–5, 6–9 and 12–14 of the postoperative period. Results. In patients of all nosological groups in the preoperative period, a statistically significant (p<0.05) increase in the concentration of NO metabolites was found. Surgical intervention induced a significant potentiation of the imbalance in the NO system, especially pronounced in patients with acute purulent periostitis. With a favorable clinical course, a gradual normalization of the concentration of NO metabolites in the oral fluid was observed in the dynamics, which correlated (r=0.78; p<0.001) witha positive clinical course of inflammatory and destructive processes of the alveolar bone. Conclusions. Determination of NO metabolites in the oral fluid is essential in the study of pathogenetic mechanisms of inflammatory dental diseases and can be used as a highly sensitive and rapidly responding diagnostic and prognostic marker. A correlation between the clinical course of inflammatory and destructive diseases of the alveolar bone and impaired NO metabolism has been established. The proposed method for the study of NO metabolites in oral fluid optimizes the assessment of the immunological status of dental patients and can serve as a valid method of rapid diagnosis, prediction of the course of the postoperative period and a predictor of the need to correct the therapeutic algorithm to prevent complications.