Contribuição da saúde bucal na integralidade da atenção ao paciente diabético

Abstract

This dissertation aimed at analyzing the integrality of health actions in the basic health units of the city of Belo Horizonte when receiving diabetic patients. A descriptive cross-sectional epidemiological study was undertaken using a representative random sample of 300 diabetic patients of both genders, heterogeneous social classes and racial groups to determine the prevalence of periodontal disease among that population. As data collection instruments, interviews with the technical references for oral health, hypertension and diabetes of the health authority of the city of Belo Horizonte, interviews with the managers of basic health units, interviews with patients and clinical examinations were undertaken. Clinical parameters used were depth of probing, level of clinical insertion and bleeding. Data were processed using SPSS package 12.0 and Chi square and Fishers exact tests applied. Results showed that bleeding under probing was the most prevalent variable, with 88.7% of patients showing at least one bleeding site. Periodontitis, the presence of at least one site with probing depth = 4mm, was observed in 74% of diabetic patients. The presence of a light or moderate clinical insertion level (between 1 and 4 mm) was 23.3%, and severe (5mm or more) 76.7%. The Average number of missing teeth was13.49, with 51% losing up to 12 teeth and 49% 13 or more teeth. There was a significant correlation between bleeding and education level, alcohol use, pain, self-perception of bleeding and tooth loss. As for probing depth, a positive correlation was observed between that and gender, smoking, alcohol use, cardiovascular disease, lack of physical activity, self-perception of purple or swollen gingiva, self-perception of bleeding, pain, seeking the dentist, time gingiva got better or worse and number of missing teeth. Another significant correlation was observed between clinical insertion level and gender, age, smoking and obesity. As for the treatment of the diabetic patient in the municipal health units, it was observed that most of them (72.7%) were not under dental treatment , although considered a priority by the oral health authority of the city. As for dental visits in the last year, 61.7% had not been to the dentist. Among the studied population, 96.6% had no professional help other than that of the physician. When managers were asked if diabetic patients were sent to dental treatment, in 26.0% of health units they were, in 19.2% they were not, and in 53.9% they were in case of need. In 38.5% of health units diabetic patients were considered an oral health priority group, in 15.3% they were not, and in 46.2% they were prioritized in case of need. It is concluded that despite the lack of statistical significance in the relation between bleeding, probing depth, clinical level insertion and the fact that the patient received or not dental treatment, periodontal health is of great relevance for glucose level control among diabetic patients, making them an oral health priority group. Integral attention to the patient with diabetes should be granted - giving them treatment in all levels - and the integration of professionals within the health unit are essential aspects for the achievement on integrality of health actions for such patients.