Associação entre periodontite e síndrome metabólica: um estudo caso-controle

Abstract

In recent years, the association between metabolic disorders and periodontitis has been widely studied and recognized. However, the relationship between metabolic syndrome (MetS) and periodontitis remains controversial. The present case-control study (1:3) aimed to evaluate the association between MetS and periodontitis, as well as the influence of potentialt risk factors in this association. Study sample comprised 488 individuals, of which 122 were cases and 366 were controls, both genders and aged between 35-55 years, that were examined from June/2009 and April/2017. Sociodemographic and medical data of interest were collected. Diagnosis of MetS (cases) was defined as the combination of the following parameters: high plasma glucose levels, hypertension, dyslipidemia and/or increased abdominal circumference. Complete periodontal examination was performed by three experienced examiners (kappa = 0.89 and intraclass correlation index = 0.87). The study included individuals with moderate, severe or advanced periodontitis, that is, stage II, III and IV, respectively, being a) stage II – clinical attachment level (CAL) 3 to 4mm, maximum probing depth (PD) ≤ 5mm, radiographic bone loss at the coronal third between 15% to 33%, and no tooth loss due to periodontitis); b) stage III – at least interdental CAL ≥ 5mm, radiographic bone loss extending to mild-third of the root; and tooth loss due to periodontitis; c) stage IV – interdental CAL ≥ 5mm and presence of deep periodontal lesions that extend to the apical portion of the root, and/or history of multiple tooth loss. In relation to the extension of periodontitis, localized forms were classified as < 30% and generalized forms as ≥ 30% of affected teeth The association between MetS and variables of interest was evaluated by univariate analysis and logistic and linear regression. The occurrence of total periodontitis (stage II, III, IV) was 54.6% and 35.2% in the case and control groups, respectively. In the case group, the occurrence of periodontitis was of 83.2% for the stage II and 16.8% for the stage III and IV. In the control group, the occurrence of periodontitis was of 88.5% for the stage II and of 12.5% for the stage III and IV. Individuals with MetS showed worse clinical periodontal condition, expressed by higher means of plaque index, bleeding on probing, PD and CAL, as well as% of sites with PD 4-6 mm, CAL 3-5 mm and >5 mm. In the final logistic model, after adjusting for gender, alcohol use, age and smoking, the following variables were associated with periodontitis: MetS (OR = 1.98 95% CI 1.31-32.86), presence of up to 14 teeth (OR = 1 , 61 95% CI 1.02-2.04), body mass index >25kg / m² (OR = 1.81 95% CI 1.26-2.21) and smoking (OR = 2.13 95% CI 1.16-3.62). Presence of teeth up to 14 (p = 0.027) and smoking (p = 0.001) were associated with CAL, when considering elevated abdominal circumference, hypertension and dyslipidemia as components of MetS diagnosis. When diabetes was also taken as MetS component, age (p = 0.015) was also associated with CAL. These findings demonstrated that there is an important association between MetS and periodontitis. However, future studies with prospective and interventional designs in different populations are needed to confirm these results.