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Alterações periodontais em pacientes com insuficiência renal crónica
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Abstract(s)
A influência da doença periodontal (DP) e do seu tratamento na progressão de determinadas doenças sistémicas, nomeadamente a insuficiência renal crónica (IRC) tem sido objeto de estudo na área da periodontologia. Verifica-se uma relação bidirecional entre a IRC e a DP. Os mecanismos através dos quais essa associação ocorre ainda não foram totalmente definidos. No entanto, sabe-se que a IRC, por si só ou pelo seu tratamento, aumenta a suscetibilidade dos doentes para infeções e eleva os níveis de proteína C-reativa (PCR) no sangue. Esta, uma proteína da fase aguda e um marcador inflamatório sistémico, é um fator de risco major para prever complicações ateroscleróticas e cardiovasculares. No que diz respeito à DP, pode aumentar a carga inflamatória sistémica através da produção local de citocinas inflamatórias ou pela entrada dos lipopolissacarídeos (LPS) das bactérias patogénicas em circulação. O tratamento da IRC deve ser instituído segundo o grau de progressão da doença, podendo ser conservador ou de substituição renal. A doença em si e o seu tratamento podem ter múltiplas manifestações sistémicas e locais. Ao nível da cavidade oral destacam-se xerostomia, hipoplasia do esmalte e hiperplasia gengival induzida por imunossupressores. Evidências científicas sugerem que o tratamento da DP pode regular ou diminuir os níveis de inflamação sistémica, melhorando o prognóstico destes doentes. Desta forma, é de extrema importância que estes doentes tenham um bom controle da saúde oral, principalmente nos períodos de tratamento de diálise, pré-transplante e pós-transplante, dado que estão imunodeprimidos e lesões orais não tratadas são potencias focos de infeção.
The influence of the periodontal disease (PD) and its treatment on the progression of some systemic diseases, namely chronic kidney disease (CKD) has been studied in the periodontology area. A bidirectional model between PD and CKD has been observed. The mechanisms though which this association occurs have not yet been fully defined. However, it is known that CKD, on its own or through its treatment, increases the susceptibility of patients to infections and raises levels of C-reactive protein (CRP) in the blood. This, an acute phase protein and a systemic inflammatory marker, is a major risk factor for predicting atherosclerotic and cardiovascular complications. With regard to PD, it may increase the systemic inflammatory burden through local production of inflammatory cytokines or through the entry of lipopolysaccharides (LPS) from pathogenic bacteria in circulation. CKD treatment should be instituted according to the degree of progression of the disease, and may be conservative or renal replacement. The disease itself and its treatment may have multiple systemic and local manifestations. On the oral cavity xerostomia, enamel hypoplasia and immunosuppressive-induced gingival hyperplasia are highlighted. Scientific evidence suggests that periodontal treatment can regulate or decrease levels of systemic inflammation, improving the prognosis of these patients. Therefore, it is extremely important that these patients have good oral health control, especially in the dialysis, pre-transplant and post-transplant periods, since they are immunocompromised and untreated oral lesions are potential foci of infection.
The influence of the periodontal disease (PD) and its treatment on the progression of some systemic diseases, namely chronic kidney disease (CKD) has been studied in the periodontology area. A bidirectional model between PD and CKD has been observed. The mechanisms though which this association occurs have not yet been fully defined. However, it is known that CKD, on its own or through its treatment, increases the susceptibility of patients to infections and raises levels of C-reactive protein (CRP) in the blood. This, an acute phase protein and a systemic inflammatory marker, is a major risk factor for predicting atherosclerotic and cardiovascular complications. With regard to PD, it may increase the systemic inflammatory burden through local production of inflammatory cytokines or through the entry of lipopolysaccharides (LPS) from pathogenic bacteria in circulation. CKD treatment should be instituted according to the degree of progression of the disease, and may be conservative or renal replacement. The disease itself and its treatment may have multiple systemic and local manifestations. On the oral cavity xerostomia, enamel hypoplasia and immunosuppressive-induced gingival hyperplasia are highlighted. Scientific evidence suggests that periodontal treatment can regulate or decrease levels of systemic inflammation, improving the prognosis of these patients. Therefore, it is extremely important that these patients have good oral health control, especially in the dialysis, pre-transplant and post-transplant periods, since they are immunocompromised and untreated oral lesions are potential foci of infection.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Insuficiência renal crónica Doença periodontal Proteína C-reativa Saúde oral