Avaliação de aspectos orais, socioeconômicos e craniofaciais em pacientes com síndrome de sheehan

Abstract

The stomatognathic system is admittedly the site for manifestation of various diseases of the endocrine system. In this context, Sheehan syndrome (SSH) is a more predominant endocrinopathy in underdeveloped countries, characterized by partial or total necrosis of the pituitary gland due to hypovolemic shock ischemia during or after delivery. By the fact SSH is a condition of chronic hypopituitarism related to osteometabolic alterations, it is justified to carry out studies related to odontological aspects in such individuals. Thus, the present dissertation is composed of two chapters that have as objective, respectively: 1) to conduct a cross-sectional observational study on oral aspects in patients with SSH; 2) to carry out a casecontrol study on craniofacial morphological aspects in patients with SSH. In Chapter 1, a crosssectional observational study was performed with 23 women diagnosed with SSH in which data on sociodemographic, dental and salivary flow aspects were collected through a clinical approach and panoramic radiographs evaluation. The mean age was 64 ± 11.5 years, with the sample consisting mainly of married women (56.5%), socioeconomic class C2 or D / E (78.2%) and years of education up to 8 years (69,5%). Presence of horizontal bone loss (p <0.001) and bilateral pneumatization of the maxillary sinus (p = 0.015) were significant. The mean number of teeth absent considering all subjects was 23.17 ± 9.7, being statistically significant (p <0.0001). In relation to age, the mean number of missing teeth was higher in individuals over 65 (p = 0.048). Reduced salivary flow was observed in 78.3% of the patients. In a bivariate analysis, considering the "missing teeth" and "reduced salivary flow" outcome variables, it was observed that economic class (p <0.001), family income (0.037) and maxillary sinus pneumatization (0.032) were statistically signifiers. In Chapter 2, a case-control study was performed in which lateral cephalometric radiographs of 19 adult women diagnosed with SSH and 19 non-SSH controls matched by sex and age were analyzed. The skeletal cephalometric profile included angular and linear measurements obtained through the Radiocef Studio 2 program. Mean values and standard deviations (SD) were obtained. The level of significance was set at 5%. The mean age of the patients was 65.47 ± 10.19. The data showed: position of the maxilla in relation to the protusive cranial base in 52.63% (S.N.A > 820); protusive mandible in 52.63% (S.N.B > 800); mandibular prognathism in 73.68% (A.N.B <20); deep growth pattern at 42.1% (SN.GoGn <320); mandibular plane increase in 36.84%; and reduced anterior facial height (N-Me <114mm). The SSH group compared to controls had a statistically significant difference in relation to S.N.B (p = 0.026), N-Me (p = 0.006), soft palate (p = 0.011) and ANSMe (p <0.001). Abnormal EDP was obtained in relation to total maxillary length (Co-A, EDP = 3.5 ± 10.84) and total mandibular length (Co-Gn, EDP = 5.2 ± 15.38). As conclusions of both studies it is highlighted that: 1) patients with SSH evidenced low educational and socioeconomic levels, reduced salivary flow and severe dental losses; 2) individuals with SSH presented a craniofacial pattern characterized by maxillary / mandibular prognathism, short face, increased mandibular plane and reduced soft palate length.