Controle de higiene oral e efeitos da progressão de periodontite em diabéticos do tipo 2

Abstract

Diabetes mellitus is a metabolic disorder that is configured as a public health problem and its relation to periodontal disease rather currently studied. This work aims to: 1- evaluate the influence of HbA1c levels in the gingival status of type 2 diabetic patients under oral hygiene control dentifrice with triclosan-based (Chapter 1), 2 evaluate the effect of progression of periodontitis on HbA1c levels of type 2 diabetics through a retrospective cohort study (Chapter 2). In one study a cohort study was carried out with forty-two patients that were divided into two groups according to the glycated hemoglobin (HbA1c) presented. The test group was composed of twenty non-controlled patients with HbA1c> 9.0%, and a control group consisting of 22 patients moderately controlled, with HbA1c <9.0%. In both groups it was initially performed anamnesis and clinical examination with analysis of gingival bleeding index (GBI), followed by supragingival scaling, oral hygiene instruction, and recommended the use of soft toothbrush with toothpaste uniform tufts and the triclosan base. After four weeks the patients returned for reassessment. In study 2 eighty diabetic patients type 2 toothed who participated in a previous study were selected. With a minimum interval of 24 months between the initial and final exams, clinicians and laboratory data were collected from medical records. It was obtained data about age of individuals, sex and diagnosis of diabetes time. The evaluated parameters were periodontal probing depth (PD) and clinical attachment loss (PIC). The data analyzed considered as final outcome the change in glycated hemoglobin (HbA1c). There was no difference in ISG values at the initial examination between the test groups (65.9 ± 21.1%) and control (57.6 ± 21.5%) (p> 0.05). After four weeks, there was a significant reduction in the ISG only in the control group (p = 0.0057) and the two groups were compared, there was difference in the ISG values, being the lowest rate in the control group: Test (55 17 ± 21.5%) and control (36.5 ± 19.1%) (p = 0.005). The second study has resulted in 66.2% of female patients with an average age of 56 ± 8.9 years and 37.5% had severe periodontitis. The interval between clinical examination was 36.5 ± 5 months. Statistically significant changes were observed HbA1c for the presence of severe periodontitis at the initial examination (2.32%), insertion loss progression ≥ 2 mm (2.24%), male (2.75%), HbA1c levels in the initial period, having controlled at increased initial period 3.08%. Significant changes to age and time of diagnosis of diabetes were observed. Even after adjusting for initial HbA1c levels, there was an increase in HbA1c of 0.95% and 1.23%, respectively, remained significant for the presence of severe periodontitis and insertion loss progression. Thus, it is concluded that: diabetic type 2 patients with moderate glycemic control showed significant improvement in gingival inflammation following the imposition of standardized measures of oral hygiene and the use of toothpaste triclosan base, not observable in those with uncontrolled high glycemic (study 1); the progression of periodontal disease was associated with increased uncontrolled glycemic control in type 2 diabetics (study2).