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O papel do médico dentista na prevenção da diabetes mellitus
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Abstract(s)
A Diabetes Mellitus constitui um desafio emergente de saúde pública global, com projeções de crescimento exponencial nas próximas décadas. Esta dissertação investiga o papel do médico dentista na prevenção da Diabetes Mellitus, enfatizando a relação bidirecional entre saúde oral e controlo glicémico.
Esta revisão narrativa da literatura explora estratégias preventivas implementáveis em contexto de medicina dentária, organizadas segundo os níveis de prevenção primária, secundária e terciária. Na prevenção primária, destaca-se o papel educativo do médico dentista na promoção de estilos de vida saudáveis, incluindo modificações dietéticas, prática de atividade física regular, cessação tabágica e manutenção rigorosa da higiene oral, fundamentais para reduzir fatores de risco modificáveis da diabetes.
A componente mais inovadora desta investigação reside na prevenção secundária, demonstrando que o consultório dentário constitui um local estratégico e privilegiado para rastreio de diabetes não diagnosticada. Evidencia-se a viabilidade clínica de protocolos de rastreio através de questionários validados de avaliação de risco e determinação de hemoglobina glicada por métodos point-of-care. A utilização de sangue do fluido gengival crevicular é uma técnica minimamente invasiva e particularmente promissora que aproveita procedimentos de sondagem periodontal de rotina, demonstrando elevada correlação com valores plasmáticos convencionais e concordância diagnóstica com avaliação médica especializada subsequente.
Na prevenção terciária, confirma-se que o tratamento periodontal não cirúrgico em doentes diabéticos promove reduções clinicamente significativas da glicemia no sangue, traduzindo-se em menor risco de complicações micro e macrovasculares. Este constitui o único tratamento de manifestações orais da diabetes com impacto comprovado no controlo metabólico sistémico.
Conclui-se que a integração sistemática do médico dentista em estratégias multidisciplinares de prevenção da diabetes potencia a deteção precoce, melhora o controlo glicémico e reduz complicações sistémicas. A implementação de protocolos padronizados de rastreio representa uma oportunidade única para identificar populações vulneráveis, particularmente aquelas cujo contacto exclusivo com o sistema de saúde ocorre através da medicina dentária.
Diabetes Mellitus is an emerging global public health challenge, with projections of exponential growth in the coming decades. This dissertation investigates the role of the dentist in the prevention of Diabetes Mellitus, emphasizing the bidirectional relationship between oral health and glycemic control. This narrative review of the literature explores preventive strategies that can be implemented in the context of dentistry, organized according to primary, secondary and tertiary levels of prevention. In primary prevention, the educational role of the dentist in promoting healthy lifestyles is highlighted, including dietary modifications, regular physical activity, smoking cessation and strict maintenance of oral hygiene, which are fundamental to reduce modifiable risk factors for diabetes. The most innovative component of this research lies in secondary prevention, demonstrating that the dental office is a strategic and privileged place for screening for undiagnosed diabetes. The clinical feasibility of screening protocols is evidenced through validated risk assessment questionnaires and determination of glycated hemoglobin by point-of-care methods. The use of crevicular gingival fluid is a minimally invasive and particularly promising technique which takes advantage of routine periodontal probing procedures, demonstrating a high correlation with conventional plasma values and diagnostic agreement with subsequent specialized medical evaluation. In tertiary prevention, it is confirmed that non-surgical periodontal treatment in diabetic patients promotes clinically significant reductions in blood glucose, translating into a lower risk of micro and macrovascular complications. This is the only treatment of oral manifestations of diabetes with a proven impact on systemic metabolic control. It is concluded that the systematic integration of the dentist in multidisciplinary diabetes prevention strategies enhances early detection, improves glycemic control and reduces systemic complications. The implementation of standardized screening protocols represents a unique opportunity to identify vulnerable populations, particularly those whose exclusive contact with the health system occurs through dentistry.
Diabetes Mellitus is an emerging global public health challenge, with projections of exponential growth in the coming decades. This dissertation investigates the role of the dentist in the prevention of Diabetes Mellitus, emphasizing the bidirectional relationship between oral health and glycemic control. This narrative review of the literature explores preventive strategies that can be implemented in the context of dentistry, organized according to primary, secondary and tertiary levels of prevention. In primary prevention, the educational role of the dentist in promoting healthy lifestyles is highlighted, including dietary modifications, regular physical activity, smoking cessation and strict maintenance of oral hygiene, which are fundamental to reduce modifiable risk factors for diabetes. The most innovative component of this research lies in secondary prevention, demonstrating that the dental office is a strategic and privileged place for screening for undiagnosed diabetes. The clinical feasibility of screening protocols is evidenced through validated risk assessment questionnaires and determination of glycated hemoglobin by point-of-care methods. The use of crevicular gingival fluid is a minimally invasive and particularly promising technique which takes advantage of routine periodontal probing procedures, demonstrating a high correlation with conventional plasma values and diagnostic agreement with subsequent specialized medical evaluation. In tertiary prevention, it is confirmed that non-surgical periodontal treatment in diabetic patients promotes clinically significant reductions in blood glucose, translating into a lower risk of micro and macrovascular complications. This is the only treatment of oral manifestations of diabetes with a proven impact on systemic metabolic control. It is concluded that the systematic integration of the dentist in multidisciplinary diabetes prevention strategies enhances early detection, improves glycemic control and reduces systemic complications. The implementation of standardized screening protocols represents a unique opportunity to identify vulnerable populations, particularly those whose exclusive contact with the health system occurs through dentistry.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Diabetes Mellitus Saúde oral Prevenção Doença periodontal