Fatores associados à periodontite em pacientes com Diabetes Mellitus tipo II

Abstract

The relationship between Diabetes Mellitus and periodontal disease is well established, it’s considered a "two-way relationship", with diabetes increasing the risk of periodontal disease and periodontal disease adversely affecting glycemic control and increasing the severity of diabetes complications. The chronic-inflammatory characteristic in both diseases causes them to share many risk factors in common like socioeconomic level, age, gender, obesity, smoking, excessive alcohol consumption, sedentary lifestyle etc. Although there are studies that have demonstrated the influence of these risk factors on periodontitis and diabetes, there are few that have evaluated these associations and its direct and indirect relationships simultaneously. The aim of this project is to evaluate the role of obesity, socioeconomic status and age in the relationship between glycemic control and periodontal parameters through a theoretical-conceptual model, in patients with type 2 diabetes. It is an observational, cross-sectional and analytical study. The data from 195 patients followed up in basic health units in the city of Manaus / AM, already collected, were analyzed. The variables Age and level of education and income for socioeconomic characterization were collected through a questionnaire. For the obesity variable, the body mass index (BMI) was used. To assess glycemic parameters and determine diabetes control, serum levels of glycated hemoglobin (HbA1c) were considered. The measurement of periodontal parameters was performed by means of a clinical periodontal examination, in which probing depth (PS), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were recorded. The theoretical model was developed from the established theoretical framework and was tested through path analysis, estimating the direct and indirect effects between the variables. Participants had a mean age of 54.8 years, with a mean family income of 1 to 3 times the minimum wage (68.7%) and had completed high school education (66%); 87.7% were overweight with a mean glycated hemoglobin level of 7.9%; while 91.79% of the participants were diagnosed with periodontitis. The complete and parsimonious model demonstrated a good fit. After analysis, it was possible to observe that higher levels of glycated hemoglobin and low levels of education were directly associated with worse periodontal parameters (number of teeth with CIN > 4 mm and SS); there was no effect of obesity and age on the worsening of periodontal parameters. The results show the complex relationships between periodontitis and diabetes and the importance of controlling common risk factors to improve oral health in diabetic patients.