Avaliação das condições de saúde bucal e expressão de mediadores inflamatórios na gengivite em pessoas com doença falciforme

Abstract

Sickle Cell Disease (SCD) is a genetically hereditary hemolytic disease characterized by vascular occlusion, infarction, hemolysis and chronic inflammation that can affect the whole organism, including the oral cavity. Cytokines contribute to its pathophysiology but the mechanisms involved still not well understood. The objectives of this study were to identify the oral health conditions and to evaluate the expression of the inflammatory mediators (IL-10; IL-12; IL-1β; IL-6, TNF-α e IL-8) in the saliva and gingival crevicular fluid (GCF) associated to gingivitis and to the use of Hydroxyurea in patients with SCD, before and after the periodontal treatment. A clinical oral examination and questionnaire were performed for 35 subjects with SCD (SG) and 28 healthy controls (CG). Cytokines/chemokine were dosed by the Cytometric Bead Array (CBA) technique, according to the producer’s instructions. The statistical analysis was realized by the program Statview (Abaccus), with significant results for p<0.05. The results showed a mean age significantly lower of the SG (23.41 years); prevalence of the feminine gender (62.85%), non-white ethnicity (77.14%) and 57.14% presented HbSS. From this group, 60% had pallor of the oral mucosa; 51.43% presented depapillated tongue, 51.43% had malocclusion, 42.86% had pigmentation in teeth or gingiva; 31.43% presented ankyloglossia; 8.5% with enamel hypoplasia and 15 patients with SCD (42.86%) reported using Hydroxyurea. The mean decay-missing-filled teeth index (DMFT) of patients with sickle cell disease was 10.80 and the mean deciduous decay teeth index with indicated extraction and filled (dmft) was 2.2. For the control group, the mean DMFT was 11.04. Gingivitis was observed in 80% of the SG and 96.42% of CG. IL-1β levels were significantly lower in SG in saliva before treatment compared to CG (p=0.02) but showed no significant difference after the treatment. In CG, IL-1β levels showed significant reduction in saliva after treatment (p=0.008). IL-8, in GCF, had significantly lower levels in SG after treatment (p=0.0002). In subjects with gingivitis, of both groups, levels of IL-1β were significantly higher before and after periodontal treatment in saliva (p=0.009 and p=0.02), as well as in the GCF (p=0.01 and p=0.003), respectively and IL-8 levels were significantly higher in GCF in individuals with gingivitis before and after periodontal treatment (p=0.01 and p=0.001) respectively. IL-10 and IL-12 were not detected in any of the samples. There was no significant difference on cytokines levels (1β; IL-6 e IL-8) associated with the use of hydroxyurea. It is concluded that the conditions of oral health of the SG were similar to CG, and patients with SCD developed less intense levels of inflammatory response, presenting lower IL-1β and IL-8 expression in saliva and GCF which does not aggravate the inflammatory process in this local.