Este estudo descritivo, transversal e quantitativo avaliou os aspectos sociais e saúde bucal dos pacientes com neoplasias malignas na região de cabeça e pescoço (NMRCP) tratados com radioterapia (RTx) no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP/USP) de 2010 a 2014, o impacto desta terapêutica na qualidade de vida (QV), o grau de xerostomia e o fluxo salivar. 184 prontuários médicos referentes a esse período foram analisados para observação das condições sociais e de saúde dos pacientes. 40 pacientes desse grupo foram avaliados em relação ao índice de dentes cariados perdidos e obturados (CPOD), qualidade de vida (questionários OHIP-14), xerostomia (Xerostomia Inventory (XI)) e fluxo salivar. De acordo com os dados obtidos, o perfil social e de saúde dos pacientes foi: 78,8% do gênero masculino, idade média de 57,7 anos, 79,3% de cor branca, 38,0% casados, 41,8% residentes em cidade com população acima de 100 mil habitantes, 58,7% e 34,2% eram respectivamente tabagistas e etilistas há mais de 30 anos. Os sítios mais acometidos por tumores primários foram a faringe (31,0%) e a língua (25,5%); 57,6% das NMRCP evoluíram até o diagnóstico por um período de até 6 meses; 40,2% fizeram tratamento quimioterápico associado à RTx. A comorbidade mais prevalente foi a hipertensão arterial (30,4%). Avaliação odontológica prévia à RTx ocorreu em 83,2% dos casos; 48,4% não realizaram tratamento odontológico previamente à RTx e 27,7% o fizeram. As alterações decorrentes da RTx mais presentes foram a mucosite (62,0%), a xerostomia (46,2%) e a candidíase (38,0%). O índice CPOD observado classifica-se como muito alto, com média de 28,55. O OHIP-14 mostrou que a qualidade de vida foi afetada principalmente no aspecto alimentar. O XI indicou elevado grau de xerostomia percebido pelo paciente. A média do fluxo salivar dos pacientes foi de 0,20 ml/min. / This descriptive, cross-sectional and quantitative study evaluated the social aspects and oral health of patients with malignant neoplasms in the head and neck (NMRCP) treated with radiotherapy (RTX) at the Ribeirão Preto Clinical Hospital (HCFMRP/USP) among 2010 to 2014, the impact on quality of life (QOL), the degree of xerostomia and salivary flow. It was analyzed medical and dental developments to verify the social and health conditions; dental examination was performed to assess the decayed, missing and filled teeth (DMFT) index, the OHIP-14 and Xerostomia Inventory questionnaire (XI) were applied for evaluating quality of life and the degree of xerostomia, and saliva stimulated was measured to quantify the salivary flow. It was analyzed 184 medical reports, 78.8% were male, mean age 57.7 years, 79.3% white, 38.0% were married, 41.8% live in town with population over 100 thousand habitants, 58.7% and 34.2% were smokers and drinkers respectively more than 30 years. The most affected sites with the primary tumor was the pharynx (31.0%) and the tongue (255%), 57.6 % of NMRCP evolved to diagnosis for a period of up to six months, 34.8% were diagnosed in 2013, 40.2% received chemotherapy treatment associated with RTX. 30.4% had hypertension, 83.2% had dental evaluation prior RTX, 48.4% did not receive dental treatment prior to RTX and 27.7% received; the alterations caused by RTX were mucositis (62.0%), dry mouth (46.2%) and candidiasis (38.0%). The survival rate varies according to the analyzed year. 40 patients participated in the dental examinations, it was found high DMFT index, on average 28.55; the quality of life was affected mainly in the food aspect and the high degree of xerostomia was associated with low salivary flow (mean 0.20 ml/min).

Disfunções em glândulas salivares são frequentes no diabetes e na hipertensão arterial. Glândulas salivares foram removidas para analisar o conteúdo das proteinas SGLT1 e PKA em ratos Wistar Kyoto (WKY), WKY diabéticos (WKY-D), espontaneamente hipertensos (SHR) e SHR diabéticos (SHR-D). A atividade simpática para as glândulas salivares também foi avaliada. A atividade simpática foi aumentada em SHR (P<0,001) comparado com WKY; e diminuída após a induçao do diabetes em WKY and SHR (P<0,05). A regulação da subunidade catalítica da PKA e da proteína SGLT1 em membrana plasmática foram paralelas com a atividade simpática. Em ratos diabéticos e/ou hipertensos, a análise da imunohistoquímica mostrou aumento da proteína SGLT1 na membrana luminal de células ductais, onde isto pode promover captação de água, reduzindo o fluxo salivar. Confirmando isso, a secreção salivar não-estimulada foi reduzida (P<0,001) em WKY-D, SHR e SHR-D. Os resultados mostram que o aumento da SGLT1 luminal foi inversamente proporcional com o fluxo salivar em ratos diabéticos e hipertensos. Isto indica o papel do transporte de água da SGLT1 e, pelo aumento da reabsorção de água, pode explicar a hiposalivação em indivíduos diabéticos e hipertensos. / Salivary gland dysfunction is a feature in diabetes and hypertension. In Wistar Kyoto rats (WKY), diabetic WKY (WKY-D), spontaneously hypertensive rats (SHR) and diabetic SHR (SHR-D), salivary glands were harvested for SGLT1 and PKA protein expression analysis. Moreover, sympathetic nerve activity to the salivary glands was measured. Diabetes decreased the nerve activity in WKY and SHR (P<0.05), pointing out that it was higher in SHR, as compared to WKY (P<0.001). The regulation of catalytic subunit of PKA and plasma membrane SGLT1 protein were parallel to the sympathetic nerve activity. In diabetic and/or hypertensive rats, imunohistochemical analysis showed increased SGLT1 protein in luminal membrane of ductal cells, where it may promote water uptake, reducing the salivary flow. Confirming that, nonstimulated salivary secretion was reduced (P<0.001) in WKY-D, SHR and SHR-D rats. The results show in luminal membrane of ductal cells SGLT1 protein increased inversely proportional to the nonstimulated salivary flux in diabetic and hypertensive rats. This indicates the water transporter role of SGLT1 and, by increasing salivary water reabsorption, may explain the hyposalivation complained by diabetic subjects.

Abstract With the growing proportion of older people and increasing use of drugs in this population, it is important to study how drugs affect oral health among older people. The aim of this thesis was to study whether sedative load, which represents cumulative exposure to drugs with sedative properties, is associated with oral health among community-dwelling older people. The focus was on a dry mouth, oral health behavior, dental caries, and infection in the periodontium. In addition, sedative load and anticholinergic burden were compared. The present study population was a subpopulation from an intervention study “Geriatric Multidisciplinary Strategy for Good Care of the Elderly”. The study population consisted of 159 community-dwelling, dentate, and non-smoking people aged 75 or older from the city of Kuopio, Finland. Data were collected with interviews, geriatric assessments, and clinical oral examinations. Sedative load was determined by using a previously published method. The study showed that participants with a sedative load were more likely to have dental caries, but not periodontitis, when compared with participants without a sedative load. Sedative load was associated with decreased stimulated salivary secretion and less strongly with unstimulated salivary secretion but not with xerostomia. The results also showed that sedative load was associated with poor or insufficient oral health behavior. Anticholinergic burden was associated with low unstimulated salivary secretion and xerostomia, but not with low stimulated salivary secretion. In conclusion, cumulative exposure to drugs with sedative properties was associated with insufficient oral self-care and poor oral health. The results from this study emphasize the fact that older people using drugs with sedative properties require thorough prophylaxis measures and regular dental check-ups because of their high risk of having poor oral health. / Tiivistelmä Väestön iäkkäiden henkilöiden osuuden kasvaessa ja heidän lääkkeiden käytön lisääntyessä on tärkeää tutkia, miten lääkkeet vaikuttavat ikääntyneiden suun terveyteen. Tutkimuksen tarkoituksena oli selvittää lääkityksestä aiheutuvan sedatiivikuorman (sedative load) vaikutuksia suun terveyteen kotona asuvilla iäkkäillä henkilöillä. Eritoten tutkimuskohteena oli sedatiivikuorman yhteys kuivaan suuhun, suun terveyskäyttäytymiseen, kariekseen sekä hampaiden tukikudosten sairauteen. Lisäksi tutkittiin antikolinergisen kuorman yhteyttä kuivaan suuhun ja tuloksia verrattiin sedatiivikuormaan. Tutkimuspopulaatio oli osa geriatrista Hyvän Hoidon Strategia -interventiotutkimusta (HHS). Populaatio koostui 159 kotona asuvasta 75-vuotiaasta tai sitä vanhemmasta hampaallisesta, ei-tupakoivasta kuopiolaisesta. Tutkimusmateriaali kerättiin haastattelulla, geriatrisella tutkimuksella sekä kliinisellä suun tutkimuksella. Sedatiivikuorma laskettiin käyttäen aiemmin kehitettyä mallia, jossa määritetään kokonaislääkityksestä aiheutuva sedatiivikuorma. Tutkimus osoitti, että osallistujilla, joilla oli sedatiivikuormaa, oli keskimäärin enemmän kariesta muttei hampaiden tukikudoksen sairautta verrattuna henkilöihin, joilla ei ollut sedatiivikuormaa. Tulokset osoittivat myös, että sedatiivikuorma oli yhteydessä alentuneeseen stimuloidun syljeneritykseen ja vähemmässä määrin alentuneeseen leposyljeneritykseen, mutta ei kuivan suun tunteeseen. Antikolinerginen kuorma oli yhteydessä alentuneeseen leposyljeneritykseen ja kuivan suun tunteeseen, mutta ei alentuneeseen stimuloidun syljeneritykseen. Sedatiivikuorma oli yhteydessä puutteelliseen suun terveyskäyttäytymiseen, kuten vähäiseen hammastahnan käyttöön ja suureen plakkimäärään. Johtopäätöksenä voidaan todeta, että altistuminen väsyttäville lääkkeille on yhteydessä puutteelliseen omahoitoon ja huonoon suun terveyteen. Tämän tutkimuksen tulokset korostavat väsyttäviä lääkkeitä käyttävien ikääntyneiden tarvitsevan perusteellisia ennaltaehkäiseviä toimia sekä säännöllisiä suun tutkimuksia, koska heillä on suurentunut riski huonoon suun terveyteen.