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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2007.tde-11032008-154135
Document
Author
Full name
Gisele Maria Campos Fabri
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2007
Supervisor
Committee
Siqueira, José Tadeu Tesseroli de (President)
Bizeto, Luciana
Camparis, Cinara Maria
Sannomiya, Paulina
Valle, Luiz Biella de Souza
Title in Portuguese
Doença periodontal grave em pacientes com e sem queixa de dor crônica crânio-facial: correlação dos aspectos clínicos com a análise quantitativa da substância P e do óxido nítrico do tecido gengival inflamado
Keywords in Portuguese
Doenças periodontais
Dor facial
Neurotransmissores
Óxido nítrico
Periodontite
Qualidade de vida
Substância P 7
Abstract in Portuguese
Objetivos: Avaliar a implicação da doença periodontal (DP) avançada, e da expressão da NOS e sP dos tecidos gengivais inflamados, na intensidade de dor e na qualidade de vida de pacientes com dor crônica crânio-facial. Casuística e Métodos: foram avaliados e tratados 20 pacientes com queixas de dores crônicas crânio-faciais e DP (Grupo de Estudo), comparativamente com 20 pacientes que tinham somente DP (Grupo Controle). Todos os pacientes receberam tratamento cirúrgico periodontal. A avaliação foi realizada pré e pós-tratamento periodontal (7, 30 e 180 dias). Instrumentos de avaliação: ficha clínica EDOF-HC, Escala Visual Analógica (EVA), questionário de dor McGill, Índices de Placa (IP), Sangramento (IS), Profundidade Clínica de Sondagem (PCS) e de Inserção (PCI); questionário de qualidade de vida WHOQOL-bref e análise imunohistoquímica para a expressão da óxido nítrico sintase (NOS) e da substância P do tecido gengival inflamado. A avaliação da dor foi realizada por investigador independente. Resultados: Os grupos apresentaram evolução clínica semelhante pelos parâmetros da DP: IP (p=0,0934), IS (p=0,8657), PCS (p=0,1728) e PCI (p=0,7406) nos três momentos avaliados. Houve redução da EVA no Grupo de Estudo aos 30 dias (p<0,05) e 180 dias (p<0,05), comparativamente ao pré-operatório. Aos 180 dias houve melhora significativa das queixas iniciais (p=0,005 para o Grupo de Estudo e p = 0,027 para o Grupo Controle), comparativamente ao pré-operatório, entretanto, houve diferença significativa entre os dois grupos nos três momentos da avaliação, seja para o percentual de melhora (p<0,001), seja para os descritores de melhora Edof-HC (p=0,004 aos 30 dias e p=0,001 aos 180 dias). No Grupo de Estudo, houve redução significativa dos descritores afetivos de dor (questionário de dor McGill) aos 180 dias (p = 0,014). Os escores de qualidade de vida do Grupo de Estudo foram inferiores aos do Grupo Controle nos domínios psicológico e físico (p<0,001 e p=0,007, respectivamente). As expressões da nNOS e da iNOS foram maiores nas gengivas inflamadas do Grupo de Estudo (p<0,001 e p= 0,003, respectivamente) e a expressão da sP foi semelhante nos dois grupos (p=0,363). Conclusões: Houve redução da intensidade da dor crônica crânio-facial dos pacientes que receberam tratamento para doença periodontal avançada. A expressão da substância P foi semelhante nos tecidos gengivais inflamados dos dois grupos, mas a expressão da nNOS e iNOS foi superior na gengiva inflamada dos pacientes com dor crônica crânio-facial. Pelos dados deste estudo a Doença Periodontal avançada pode ter implicação nas queixas de dor dos pacientes com dor crônica crânio-facial.
Title in English
Severe Periodontal Disease in patients with and without chronic complaint of craniofacial pain: correlation with clinical aspects with the quantitative analysis of substance P and nitric oxide of inflamed gingival tissue
Keywords in English
Facial pain
Neurotransmitter agents
Nitric oxide
Periodontal diseases
Periodontitis
Quality of life
Substance P 7
Abstract in English
Aims: To assess the implications of advanced periodontal disease (PD), and the expression of NOS and sP of inflamed gingival tissue, in the intensity of pain and the quality of life in patients with chronic craniofacial pain. Casuistic and Methods: Were evaluated and treated 20 patients with complaints of chronic craniofacial pain and DP (Study Group), compared with 20 patients who had only DP (Control Group). All patients received surgical periodontal treatment. The evaluation was performed at pre-operative and post-operative periodontal treatment (7, 30 and 180 days). Tools for evaluation: clinical record EDOF-HC, Visual Analogic Scale (VAS), McGill Pain Questionnaire, Scores of Plaque (IP), Bleeding (IS), Clinical Probing Depth (CPD) and Insertion (CPI), the quality of life questionnaire WHOQOL-Bref and immunohistochemical analysis for the expression of nitric oxide synthase (NOS) and substance P from inflamed gingival tissue. The assessment of pain was conducted by independent researcher Results: The groups had similar clinical evolution by parameters of the PD: IP (p=0.0934), IS (p=0.8657), PCS (p=0.1728) and PCI (p=0.7406) in the three moments evaluated. There was reduction in the VAS of Study Group at 30 days (p<0.05) and 180 days (p<0.05), compared to preoperative. At 180 days there was significant improvement of the initial complaints (p=0.005 for the Study Group and p=0.027 for the Control Group), compared to preoperative, but there was significant difference between the two groups in the three moments of assessment, for the percentage of improvement (p<0.001), and either for the improvement descriptors Edof-HC (p=0.004 at 30 days and p=0.001 for 180 days). In Study Group, there was significant reduction of pain affective descriptors (McGill Pain Questionnaire) to 180 days (p=0.014). The scores of quality of life of the Study Group were lower than the Control Group in the psychological and physical (p<0.001 and p=0.007, respectively). The nNOS and iNOS expressions were higher in inflamed gingival Study Group (p<0.001 and p=0.003, respectively) and the expression of sP was similar in the two groups (p=0.363). Conclusions: There was reduction in the intensity of chronic craniofacial pain of patients receiving treatment for advanced periodontal disease. The expression of substance P was similar in inflamed gingival tissue of the two groups, but the expression of iNOS and nNOS was higher in inflamed gingival of patients with chronic craniofacial pain. The data of this study show that advanced periodontal disease can have involvement in complaints of pain in patients with chronic craniofacial pain.
 
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Publishing Date
2008-03-19
 
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