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Relação entre a doença periodontal e as patologias cardiovasculares
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Resumo(s)
A doença periodontal e as patologias cardiovasculares apresentam uma etiologia complexa e multifatorial, sendo parte desta causada por fatores de risco. A relação entre estas duas patologias tem sido especulada há aproximadamente três décadas, contudo, esta eventual relação permanece controversa entre os diversos estudos epidemiológicos realizados até à data. Com o objetivo de procurar esclarecer uma eventual relação, entre as duas patologias, foram propostas e descritas três teorias: teoria infeciosa ou bacteriana, teoria inflamatória e a teoria imunológica. No entanto, a associação causal entre a doença periodontal e os eventos cardiovasculares continua a ser posta em causa visto alguns fatores de risco tradicionais para as patologias cardiovasculares serem comuns aos da doença periodontal, bem como, devido à presença de modificadores do efeito, dos próprios fatores de risco, e de uma eventual relação bidirecional. A influência do tratamento da doença periodontal na melhoria, ou agravamento, do estado inflamatório sistémico e na prevenção de futuros eventos cardiovasculares é igualmente controversa. Os estudos realizados nesta temática apresentam diversas limitações e grande heterogeneidade, nomeadamente, quanto à sua metodologia e amostras analisadas carecendo de evidência científica. Deste modo, são necessários mais estudos futuros, a longo prazo, nomeadamente estudos longitudinais, que permitam esclarecer o mecanismo concreto responsável por esta relação, bem como, a postura mais correta para o médico dentista adotar aquando do tratamento de pacientes com patologia cardiovascular ou com risco de vir a desenvolvê-la futuramente.
Periodontal disease and cardiovascular diseases have a complex and multifactorial etiology, being part of this, caused by risk factors. The relationship between these two diseases has been postulated for nearly three decades, however, this possible relationship remains controversial among several epidemiological studies conducted to date. In order to seek to clarify a possible relationship between the two diseases it has been proposed and described three theories: the bacterial or infectious theory, the inflammatory theory and the immunological theory. However, a causal association between periodontal disease and cardiovascular events continues to be challenged because some traditional risk factors for cardiovascular diseases are common to periodontal disease, as well as due to the presence of effect modification of their own risk factors, and a possible bidirectional relationship. The influence of the treatment of periodontal disease in improving or worsening, the systemic inflammatory state and in the prevention of the future cardiovascular events is also controversial. Studies on this topic have several limitations and heterogeneity, in particular, regarding its methodology and samples lacking scientific evidence. Thus, further long term studies are needed, namely longitudinal studies, to clarify the mechanism responsible for this particular relationship, as well as the correct posture for the dentist to adopt when treating patients with cardiovascular disease or risk of developing it in the future.
Periodontal disease and cardiovascular diseases have a complex and multifactorial etiology, being part of this, caused by risk factors. The relationship between these two diseases has been postulated for nearly three decades, however, this possible relationship remains controversial among several epidemiological studies conducted to date. In order to seek to clarify a possible relationship between the two diseases it has been proposed and described three theories: the bacterial or infectious theory, the inflammatory theory and the immunological theory. However, a causal association between periodontal disease and cardiovascular events continues to be challenged because some traditional risk factors for cardiovascular diseases are common to periodontal disease, as well as due to the presence of effect modification of their own risk factors, and a possible bidirectional relationship. The influence of the treatment of periodontal disease in improving or worsening, the systemic inflammatory state and in the prevention of the future cardiovascular events is also controversial. Studies on this topic have several limitations and heterogeneity, in particular, regarding its methodology and samples lacking scientific evidence. Thus, further long term studies are needed, namely longitudinal studies, to clarify the mechanism responsible for this particular relationship, as well as the correct posture for the dentist to adopt when treating patients with cardiovascular disease or risk of developing it in the future.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2012
Palavras-chave
Periodontologia Teses de mestrado - 2012