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188 rev port estomatol med dent cir maxilofac. 2018;59(4):181-190

other studies, 39,40 the DM2 group had significantly more par- mandibular or both), and these showed a more negative im-
ticipants in the heavier classes of BMI than the nDM2 group. pact on GH and OH.
However, no relation was found between MT and obesity, as The MLR showed that the factors with greater relevance
41
described by Nascimento. Regarding SRH, the nDM2 partici- for a worse perceived GH were the presence of calculus and
pants with a pre-obese condition presented better health per- oral hygiene at night for the nDM2 group. As for the DM2 group,
ception than DM2 participants. Similarly to other studies, 8,42 those factors were HTA, dyslipidaemia, total edentulism and
the DM2 group had significantly fewer smokers, and tobacco at least one missing tooth, although this was a protective fac-
use was significantly different among the DM2 participants, tor (OR=0.45, IC95%: 0.20-0.99) when DM2 was controlled.
probably due to a perception of its negative impacts on OH. Regarding SROH in the nDM2 group, the MLR showed that
There were no significant differences in daily oral hygiene having at least 20 teeth represented a protective factor
habits between groups. As reported by other authors, the peri- (OR=0.22, IC95%:0.089-0.556) and the presence of calculus or a
odontal condition was significantly better in the nDM2 than periodontal pocket >3.5mm had a negative impact. Daily oral
in the DM2 group. 13,14,38 The most severe forms of periodonti- hygiene “in the morning” or “at night”, MT>0 and total eden-
tis in DM2 participants, with more gingival recession and peri- tulism, when included in the model, were found to be predic-
odontal pockets >3mm, had a more negative impact on SRH tor factors for a negative impact on OH in nDM2 participants.
and SROH. Finally, the MLR showed that the predictors of a negative
Regarding associations between SRH and SROH, a better SROH in DM2 patients were: the duration of DM2, smoking
concordance was found in the nDM2 group, whereas DM2 par- habits, MT>0, FT>0, DMFT> 0, total teeth <20 and total eden-
ticipants reported significantly more negative impacts by rat- tulism. This estimated model has a correct prediction of 80.1%.
ing GH and OH as “very bad” and “bad” more often. As theo- The fact that the pairing was performed only from an an-
33
rized by Petersen and reported in other studies, 1,30-32,44 DM2 alytical perspective and not by pairing each participant could
patients showed a poorer perception of health than nDM2 be a limitation of the study. However, as Pierce pointed out
44
individuals, which explains why the “median” OH classifica- in his methodological review article, when there are no prob-
tion was significantly more reported in controls than in DM2 lems with data dispersion, a standardized statistical analysis
patients. The same goes for the opposite extreme of percep- for a case-control study can be performed.
tion, as nDM2 participants rated OH and GH as “good” or “very Because this study is based on a clinical sample obtained
good” more often. Regarding the socio-demographic variables, in a primary public health centre that follows the most diabet-
there were no significant differences in SRH and SROH. ic patients for disease monitoring in Portugal, the results
Individuals with an HbA1c value indicating a lack of con- should be generalized to the overall population with care.
trol of DM2 showed better SRH, probably because they did not
value their health status adequately as they did not feel the
complications of DM2 significantly affecting them. The other Conclusions
DM2 complications probably justified a worse self-perception
of GH and OH by those who had an older diagnosis comparing The present study confirms the hypothesis that DM2 pa-
to those with up to 10 years of disease. tients had a worse SRH and SROH than individuals without
DM2 patients with HTA or dyslipidaemia showed worse DM2. Both groups perceived GH and OH differently, and OH
SRH, while those who had normotension showed a significant- was generally self-rated worse than GH regardless of having
ly better perception of GH. None of these systemic character- DM2.
istics revealed a significantly different impact on SROH be- The prevalence of oral pathologies in both groups was
tween groups. high. However, DM2 patients presented fewer caries lesions,
Regarding OH variables, including daily oral hygiene, DT>0, more extracted teeth, more FT, and few were rehabilitated.
MT>0, FT, DMFT>0, <20 teeth in the mouth, total edentulism The presence of more advanced forms of periodontal disease
and need of prosthesis rehabilitation, the latter was associat- (pockets) affected the SRH and SROH negatively. Simultane-
ed with a higher perception of GH as “bad” or “very bad” in DM2 ously, an older diagnosis of DM2 and tobacco use induced the
patients. Within the DM2 group, a severe CPI classification, <20 greater perception of negative impacts on OH among DM2
teeth or total edentulism and no prosthesis rehabilitation were patients.
associated with a worse perception of GH. These data support The most developed primary health centres should include
the concept of OH influencing GH and the quality of life of access to oral care in order to monitor OH regularly, as well as
individuals. 1,3,12,22,24 other macro and microvascular complications in DM2 pa-
The absence of daily oral hygiene habits and calculus tients. Better attention centred in the OH patient by healthcare
showed more negative impacts only among nDM2 partici- units is needed, and the access to OH professionals could be a
pants. However, the presence of caries lesions was not signif- way of improving diabetic patient’s GH and OH.
icant. Calculus (had lower medians than the “normal” state),
MT>0 and DMFT>0 showed significantly negative impacts in
both groups, and FT>0 only in the DM2 group. Total edentu- Ethical disclosures
lism, the absence of fewer than 20 teeth and the need of pros-
thetic rehabilitation had negative impacts with a significantly Protection of human and animal subjects. The authors
worse perception of OH. Oral rehabilitation is always related declare that the procedures followed were in accordance with
to removable prostheses (independently of being maxillary, the regulations of the relevant clinical research ethics com-