Periodontite e lesões bucais: aspectos clínicos, epidemiológicos e o impacto da saúde oral autorrelatada na qualidade de vida de indivíduos psoriáticos: estudo caso-controle

Abstract

Despite emerging data, the literature points to a risk association between psoriasis and periodontitis, supported by the fact that these two immune-mediated diseases have similar etiopathogenic pathways and common risk factors. On the other hand, studies on the presence of oral lesions in psoriatic individuals are limited and scarce. In addition, the impact of oral health (presence of periodontitis and oral lesions) on quality of life (QOL) in psoriatic individuals has not yet been reported. The aim of this study was to evaluate the periodontal condition, oral lesions and the impact of self-reported oral health on the quality of life (OHRQL) of psoriatic individuals in relation to non-psoriatic individuals. Thus, this case-control study comprised 295 individuals with psoriasis and 359 controls and was approved by the Ethics and Research Committee (CAAE 20156019.0.0000.5149). A full mouth examination was performed for all periodontal clinical parameters, and demographic and behavioral data of interest were collected. In addition, the presence / absence of the most frequent types of oral lesions in psoriatics was assessed [such as angular cheilitis (AC), geographic tongue (GT), fissured tongue (FT), white (WP), yellow (YP), red plaques (RP), gray / translucent plaques and annular forms or diffuse areas of erythema]. To evaluate OHRQL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. The data were analyzed using the Chi-square, Fischer, Kruskal-Wallis, Mann-Whitney tests when appropriate, and Bootstrap intervals to determine different profiles in relation to the OIDP. There was a high prevalence of periodontitis in psoriatics (41%) when compared to controls (33.1%). Psoriatic individuals had a 1.40 greater chance of having periodontitis than controls (95% CI 1.01-1.9; p = 0.019), higher BMI values and use of antidepressants (p <0.001), diabetes, alcohol (p = 0.001) and anxiolytics use (p = 0.006). Psoriatics with periodontitis (+ P) showed significantly greater impacts on OHRQL (13.76 ± 15.58), when compared to those without periodontitis (-P) (4.83 ± 8.25; p <0.001). Additionally, psoriatic individuals + P stage III / IV (13.94 ± 15.68) had worse indicators of OIDP than controls + P (9.49 ± 22.54; p = 0.001). Individuals with psoriasis had significantly more oral lesions than controls (OR 3.66, 95% CI: 2.33–5.85; p<0.001). Higher occurrence of (1) GT (OR = 8.20, 95% CI: 2.08–54.01; p <0.001) and (2) QA (OR = 4.38; 95% CI: 2.23–9.15; p <0.001) was observed in individuals with psoriasis. Psoriatic individuals with oral lesions had higher global OIDP when compared to controls (11.15 versus 7.63; p = 0.009). In the final multivariate model for the occurrence of higher OIDP scores, characterizing worse OHRQL, the following variables remained significant: use of alcohol and anxiolytics, diabetes. This study demonstrated an important risk association between psoriasis, periodontitis and the presence of oral lesions, and psoriatic individuals with these diseases had significantly worse OHRQL indicators. A multidisciplinary interaction (doctors and dentists) should be encouraged to improve the impact of these diseases on the QOL of individuals with psoriasis and periodontitis.