Odontologia e o Diabetes
Autor: Olá | Publicado: 2013-05-17T07:46:00-07:00

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O Diabetes Mellitus constitui uma síndrome
caracterizada por ausência relativa ou absoluta de insulina, pela alteração do
metabolismo de carboidratos, proteínas e gorduras. Pode ser conceituado como
uma alteração metabólica caracterizada por aumento da glicose circulante no
sangue (hiperglicemia) e o aumento da glicose eliminada pela urina
(glicosúria).

O diabetes causa uma distorção no equilíbrio entre
a glicose que é utilizada pelos tecidos e a glicose que é liberada pelo fígado
e causa também uma distorsão na produção e liberação dos hormônios
pancreáticos, da hipófise anterior e da supra renal.&nbsp;



A insulina é um hormônio proteico cujas principais
funções são:

&nbsp;impedir que a taxa de açúcar no sangue venha a ultrapassar,
     após a alimentação, os valores de 160-180 mg/dl;&nbsp;
armazenar glicose no fígado e nos músculos na forma de
     glicogênio;&nbsp;
participar do crescimento ósseo, muscular e de vários órgãos.&nbsp;


A produção de insulina é regulada de acordo com os
tipos e a quantidade de alimentos ingeridos. A insulina exerce a sua função de
manter os níveis de açúcar na corrente sanguínea, em valores normais, pelo
mecanismo de feedback, ou seja, conforme os níveis de açúcar no sangue caem, a
insulina através da utilização de receptores na superfície celular permite a
passagem da glicose para o interior da célula.

A insulina participa da produção de colágeno,
como catalisador da biossíntese de ácido hialurônico, que é uma glicoproteína
sintetizada pelos fibroblastos e osteoblastos.

&nbsp;Quando a quantidade de insulina é pequena,
como ocorre nos pacientes diabéticos não-compensados, a reparação dos tecidos
lesados é mais lenta.&nbsp; Os tecidos bucais são bastantes resistentes à
tração mecânica, sendo que essa resistência&nbsp; é proporcional à quantidade
de colágeno que estiver sendo produzido. No paciente diabético não compensado,
como a&nbsp; síntese de colágeno é mais lenta, há&nbsp; maior facilidade para
deiscência e contaminação de feridas cirúrgicas, causando retardo da reparação
tecidual e aumento do risco de mobilidade dental.



Nos pacientes diabéticos o fator determinante da
doença periodontal é a placa bacteriana. Graus variáveis de inflamação
podem ser encontrados relacionados a um controle insatisfatório de placa.
Alterações no ambiente subgengival, tais como aumento dos níveis da glicose
e da uréia no fluido gengival, favorecem o crescimento de algumas
espécies bacterianas.&nbsp; Os diabéticos apresentam alterações vasculares
pela&nbsp; prolongada exposição à hiperglicemia que impedem a difusão do
oxigênio, a eliminação de metabólitos. O espessamento dos vasos do
periodonto dificulta o transporte de elementos nutritivos à intimidade dos
tecidos, fazendo-os mais vulneráveis aos produtos de agressão microbiana e a
maior severidade da enfermidade periodontal

Nos diabéticos mal controlados há uma diminuição
da resposta imune à infecção, devido a&nbsp; alteração da fagocitose
dos macrófagos e a quimiotaxia dos polimorfonucleares.&nbsp; O diabetes
compromete a produção da matriz óssea pelos osteoblastos, diminui a
síntese de colágeno pelos fibroblastos gengivais, além de aumentar a
atividade da colagenase gengival. O difícil controle da cicatrização
tecidual no diabético decorre da presença de hiperglicemia, microangiopatias,
acidez metabólica e ineficácia&nbsp; da fagocitose pelos polimorfonucleares
e&nbsp; pelos macrófagos.



&nbsp;Os pacientes diabéticos insulinodependentes
apresentaram gengivite com maior freqüência do que os pacientes saudáveis.
Embora a gengivite raramente evolua para periodontite, a inflamação gengival é
mais frequente nos pacientes diabéticos, quando comparado com não-diabéticos.
Entretanto, crianças com um bom controle metabólico não diferem das crianças
saudáveis. Se os parâmetros clínicos do diabetes juvenil estiveram sob
controle, a doença não exacerbará a inflamação gengival em crianças e
adolescentes.

Uma associação positiva foi encontrada entre
diabetes e a gravidade da doença periodontal.


O diabético controlado, aglicosúrio e normoglicêmico, poderá se comportar
clinicamente como um indivíduo saudável, enquanto que o descompensado necessita
de várias medidas profiláticas para submeter-se ao tratamento bucal
especializado.


Texto baseado no artigo:&nbsp; A estreita relação entre diabetes e doença
periodontal inflamatória.

(Anagélica Tolentino Madeiro, Fabiana Guedes
Bandeira, Cláudia Roberta Leite Vieira de Figueiredo)

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   UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
  
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   UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
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   UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
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  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 1"/>
  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
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  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
   UnhideWhenUsed="false" Name="Light List Accent 2"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
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  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
   UnhideWhenUsed="false" Name="Light List Accent 3"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
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  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
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   UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
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   UnhideWhenUsed="false" Name="Light List Accent 4"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
   UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
   UnhideWhenUsed="false" Name="Light List Accent 5"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 5"/>
  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
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   UnhideWhenUsed="false" Name="Light List Accent 6"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 6"/>
  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
  <w:LsdException Locked="false" Priority="19" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
  <w:LsdException Locked="false" Priority="21" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
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   UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
  <w:LsdException Locked="false" Priority="32" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
  <w:LsdException Locked="false" Priority="33" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
  
  
 
<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-qformat:yes;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin:0cm;
 mso-para-margin-bottom:.0001pt;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri","sans-serif";
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-bidi-font-family:"Times New Roman";
 mso-bidi-theme-font:minor-bidi;
 mso-fareast-language:EN-US;}

<![endif]-->


<!--[if gte mso 9]>
 
  Normal
  0
  
  
  21
  
  
  false
  false
  false
  
  PT-BR
  X-NONE
  X-NONE
  
   
   
   
   
   
   
   
   
   
   
   
  
  MicrosoftInternetExplorer4
  
   
   
   
   
   
   
   
   
   
   
   
  
<![endif]-->


<!--[if gte mso 9]>
 
  Normal
  0
  
  
  21
  
  
  false
  false
  false
  
  PT-BR
  X-NONE
  X-NONE
  
   
   
   
   
   
   
   
   
   
   
   
  
  MicrosoftInternetExplorer4
  
   
   
   
   
   
   
   
   
   
   
   
  
<![endif]-->

<!--[if gte mso 9]>
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  LatentStyleCount="267">
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   UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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   UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
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   UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
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   UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
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   UnhideWhenUsed="false" Name="Table Grid"/>
  
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   UnhideWhenUsed="false" Name="Light Shading"/>
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   UnhideWhenUsed="false" Name="Light Grid"/>
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   UnhideWhenUsed="false" Name="Medium List 1"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1"/>
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   UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 1"/>
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   UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
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   UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
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   UnhideWhenUsed="false" Name="Light List Accent 3"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 3"/>
  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
   UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
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   UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
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   UnhideWhenUsed="false" Name="Light List Accent 4"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
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   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
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   UnhideWhenUsed="false" Name="Dark List Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
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   UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
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   UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
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   UnhideWhenUsed="false" Name="Light List Accent 5"/>
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   UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
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   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
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  <w:LsdException Locked="false" Priority="33" SemiHidden="false"
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<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-qformat:yes;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin:0cm;
 mso-para-margin-bottom:.0001pt;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri","sans-serif";
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-bidi-font-family:"Times New Roman";
 mso-bidi-theme-font:minor-bidi;
 mso-fareast-language:EN-US;}

<![endif]--><!--[if gte mso 9]>
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<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-qformat:yes;
 mso-style-parent:"";
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 mso-para-margin:0cm;
 mso-para-margin-bottom:.0001pt;
 mso-pagination:widow-orphan;
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 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-bidi-font-family:"Times New Roman";
 mso-bidi-theme-font:minor-bidi;
 mso-fareast-language:EN-US;}

<![endif]-->