Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020

Antecedentes: la asociación unidireccional entre la enfermedad cardiovascular (ECV) y la periodontitis se caracteriza por la presencia de microorganismos periodontotapátogenos que inducen una respuesta inmune inflamatoria descontrolada a nivel local, que transloca a la circulación sanguínea, e incre...

Full description

Autores:
Suárez Carvajal, María Angélica
Jaimes Gómez, Dayana Alejandra
Martínez Casallas, Daniela Katherinne
Marcucci Delgado, Ricardo
Chicaíza Becerra, Alejandro
Tipo de recurso:
Trabajo de grado de pregrado
Fecha de publicación:
2020
Institución:
Universidad Santo Tomás
Repositorio:
Repositorio Institucional USTA
Idioma:
spa
OAI Identifier:
oai:repository.usta.edu.co:11634/29365
Acceso en línea:
http://hdl.handle.net/11634/29365
Palabra clave:
Periodontal disease
Hypertension
Cardiovascular disease
Dental disease
Dental implants
Enfermedades periodontales
Enfermedades cardíacas
Enfermedad dental
Implantes dentales
Hipertensión
Enfermedad cardiovascular
Enfermedad dental
Implantes dentales
Enfermedad periodontal
Rights
openAccess
License
Atribución-NoComercial-SinDerivadas 2.5 Colombia
id SANTTOMAS2_131f81adc5d7ad148e5120c0532d0667
oai_identifier_str oai:repository.usta.edu.co:11634/29365
network_acronym_str SANTTOMAS2
network_name_str Repositorio Institucional USTA
repository_id_str
dc.title.spa.fl_str_mv Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
title Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
spellingShingle Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
Periodontal disease
Hypertension
Cardiovascular disease
Dental disease
Dental implants
Enfermedades periodontales
Enfermedades cardíacas
Enfermedad dental
Implantes dentales
Hipertensión
Enfermedad cardiovascular
Enfermedad dental
Implantes dentales
Enfermedad periodontal
title_short Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
title_full Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
title_fullStr Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
title_full_unstemmed Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
title_sort Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020
dc.creator.fl_str_mv Suárez Carvajal, María Angélica
Jaimes Gómez, Dayana Alejandra
Martínez Casallas, Daniela Katherinne
Marcucci Delgado, Ricardo
Chicaíza Becerra, Alejandro
dc.contributor.advisor.spa.fl_str_mv Otero Wandurraga, Johanna Alejandra
Cárdenas Gutiérrez, Angélica María
dc.contributor.author.spa.fl_str_mv Suárez Carvajal, María Angélica
Jaimes Gómez, Dayana Alejandra
Martínez Casallas, Daniela Katherinne
Marcucci Delgado, Ricardo
Chicaíza Becerra, Alejandro
dc.subject.keyword.spa.fl_str_mv Periodontal disease
Hypertension
Cardiovascular disease
Dental disease
Dental implants
topic Periodontal disease
Hypertension
Cardiovascular disease
Dental disease
Dental implants
Enfermedades periodontales
Enfermedades cardíacas
Enfermedad dental
Implantes dentales
Hipertensión
Enfermedad cardiovascular
Enfermedad dental
Implantes dentales
Enfermedad periodontal
dc.subject.lemb.spa.fl_str_mv Enfermedades periodontales
Enfermedades cardíacas
Enfermedad dental
Implantes dentales
dc.subject.proposal.spa.fl_str_mv Hipertensión
Enfermedad cardiovascular
Enfermedad dental
Implantes dentales
Enfermedad periodontal
description Antecedentes: la asociación unidireccional entre la enfermedad cardiovascular (ECV) y la periodontitis se caracteriza por la presencia de microorganismos periodontotapátogenos que inducen una respuesta inmune inflamatoria descontrolada a nivel local, que transloca a la circulación sanguínea, e incrementa la inflamación sistémica. Objetivo: Determinar la asociación entre las condiciones autoreportadas de riesgo para desarrollar enfermedad periodontal y los eventos crónicos en población residente en Santander. Metodología: Estudio de corte transversal analítico anidado al estudio Epidemiológico Prospectivo Urbano y Rural (PURE, por sus siglas en inglés). Santander cuenta con 511 participantes en la cohorte PURE, elegibles para el presente estudio de quienes fue tomada la información de seguimiento y eventos crónicos (ECV y diabetes tipo 2). Se aplicó vía telefónica una encuesta de autopercepción de salud oral y periodontal. El análisis se procesó con el software STATA 12.0 en términos descriptivos, tablas de contingencia para prueba de hipótesis y estimación de riesgo a través de modelos logísticos simples y múltiples. Resultados: La proporción de respuesta fue de 94,3%. Se evidenció una asociación significativa (p<0,05) entre hipertensión arterial (HTA) y el último motivo de consulta relacionado con acciones curativas (30,1%), pobre percepción de salud oral (64,7%) y alteraciones en las encías (38,8%). Ser hipertenso denota riesgo de desarrollar enfermedad periodontal (OR 2,02 IC 95% 1.21-3.37) y este es independiente de características demográficas, socioeconómicas y comportamentales. Conclusión: La HTA se asocia significativamente con condiciones autoreportadas de riesgo para enfermedad periodontal como tener pobre percepción de la salud oral o signos de enfermedad periodontal.
publishDate 2020
dc.date.accessioned.spa.fl_str_mv 2020-09-01T17:07:26Z
dc.date.available.spa.fl_str_mv 2020-09-01T17:07:26Z
dc.date.issued.spa.fl_str_mv 2020-08-31
dc.type.local.spa.fl_str_mv Trabajo de grado
dc.type.version.none.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.category.spa.fl_str_mv Formación de Recurso Humano para la Ctel: Trabajo de grado de Pregrado
dc.type.coar.none.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.drive.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
format http://purl.org/coar/resource_type/c_7a1f
status_str acceptedVersion
dc.identifier.citation.spa.fl_str_mv Suarez Carvajal, M. A., Jaimes Gómez, D. A., Martínez Casallas, D. K., Marcucci Delgado, R. y Chicaíza Becerra, A. (2020). Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020 [Tesis de especialización]. Universidad Santo Tomás, Bucaramanga, Colombia.
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/11634/29365
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad Santo Tomás
dc.identifier.instname.spa.fl_str_mv instname:Universidad Santo Tomás
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.usta.edu.co
identifier_str_mv Suarez Carvajal, M. A., Jaimes Gómez, D. A., Martínez Casallas, D. K., Marcucci Delgado, R. y Chicaíza Becerra, A. (2020). Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020 [Tesis de especialización]. Universidad Santo Tomás, Bucaramanga, Colombia.
reponame:Repositorio Institucional Universidad Santo Tomás
instname:Universidad Santo Tomás
repourl:https://repository.usta.edu.co
url http://hdl.handle.net/11634/29365
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv (1) Ministerio de Salud y Proteccion Social. IV Estudio Nacional de Salud Bucal - ENSAB IV. 2014.
(2) Najafipour H, Malek Mohammadi T, Rahim F, Haghdoost AA, Shadkam M, Afshari M. Association of Oral Health and Cardiovascular Disease Risk Factors “Results from a Community Based Study on 5900 Adult Subjects”. ISRN Cardiology 2013;782126:1-6.
(3) GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017 Sep 16,;390(10100):1211-1259.
(4) Tonetti MS, Jepsen S, Jin L, Otomo‐Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. Journal of Clinical Periodontology 2017 May;44(5):456-462.
(5) Corsi DJ, Subramanian SV, Chow CK, McKee M, Chifamba J, Dagenais G, et al. Prospective Urban Rural Epidemiology (PURE) study: Baseline characteristics of the household sample and comparative analyses with national data in 17 countries. American Heart Journal 2013;166(4):636-646.e4.
(6) Institute for Health Metrics and Evaluation, Universidad de Washington, Red de Desarrollo Humano, Banco Mundial. La carga mundial de morbilidad: generar evidencias, orientar políticas. 2013.
(7) Hwang S, Shim J, Kang D, Choi J. Poor Oral Health Predicts Higher 10-Year Cardiovascular Risk: A Propensity Score Matching Analysis. The Journal of Cardiovascular Nursing 2018 Jun 12,;33(5):429-436.
(8) Janket S, Baird AE, Chuang S, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 2003 May;95(5):559-569.
(9) Carrizales-Sepúlveda EF, Ordaz-Farías A, Vera-Pineda R, Flores-Ramírez R. Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart, Lung and Circulation 2018 Nov;27(11):1327-1334.
(10) Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation 2012 May 22,;125(20):2520-2544.
(11) Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. The Lancet 2019 Jul 20,;394(10194):249-260.
(12) Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dentistry and Oral Epidemiology 2012 Aug;40(4):289-296.
(13) Boillot A, El Halabi B, Batty GD, Rangé H, Czernichow S, Bouchard P. Education as a Predictor of Chronic Periodontitis: A Systematic Review with Meta-Analysis Population-Based Studies. PloS one 2011;6(7):e21508.
(14) Sheiham A, Watt RG. The Common Risk Factor Approach: a rational basis for promoting oral health. Community Dentistry and Oral Epidemiology 2000 Dec;28(6):399-406.
(15) Shweta Y, Santhosh-Kumar C. Common risk factor approach: Finding common ground for better health outcomes. International Journal of Contemporary Medical Research 2017;4(6):1367-1370.
(16) Jepsen S, Blanco J, Buchalla W, Carvalho JC, Dietrich T, Dorfer C, et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. Journal of Clinical Periodontology 2017;44(S18):S85-S93.
(17) World Health Organization. WHO | Global Hearts Initiative, working together to promote cardiovascular health. Available at: http://www.who.int/cardiovascular_diseases/global-hearts/en/. Accessed Nov 19, 2019
(18) Beaglehole RH, Beaglehole R. Promoting radical action for global oral health: integration or independence? The Lancet 2019;394(10194):196-198.
(19) Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Globalization and health 2017 Jun 15,;13(1):34.
(20) Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nature reviews. Immunology 2015 Jan;15(1):30-44.
(21) Armitage GC. Development of a Classification System for Periodontal Diseases and Conditions. Annals of Periodontology 1999;4(1):1-6.
(22) Chatzistavrianou D, Blair F. Diagnosis and management of chronic and aggressive periodontitis part 1: periodontal assessment and diagnosis. Dental Update 2017;44(4):306-315.
(23) Eke PI, Page RC, Wei L, Thornton‐Evans G, Genco RJ. Update of the Case Definitions for Population‐Based Surveillance of Periodontitis. Journal of Periodontology 2012;83(12):1449-1454.
(24) Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification. Journal of Clinical Periodontology 2018 Jun;45(S20):S1-S8.
(25) Chapple ILC, Mealey BL, Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Journal of Clinical Periodontology 2018;89:S74-S84.
(26) Lang NP, Bartold PM. Periodontal health. Journal of Periodontology 2018;89:S9-S16.
(27) Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque‐induced gingivitis: Case definition and diagnostic considerations. Journal of Clinical Periodontology 2018 Jun;45(S20):S44-S67.
(28) Lindhe J, Nyman S. Exploración de pacientes con enfermedad periodontal. Periodontologia clinica e implantologia odontológica. Madrid: Médica Panamericana; 2000.
(29) Barrios G. Periodoncia, su fundamento biológico. Bogotá D.C.; 1989.
(30) Fuster V, Badimon L, Badimon JJ, Chesebro JH. The Pathogenesis of Coronary Artery Disease and the Acute Coronary Syndromes. N Engl J Med 1992;326(4):242-250.
(31) Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Mäkelä PH, et al. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. The Lancet 1988;2(8618):983-6.
(32) Velosa-Porras J, Escobar-Arregoces F, Latorre-Uriza C, Ferro-Camargo MB, Ruiz ÁJ, Uriza-Carrasco LF. Association between periodontal disease and endothelial dysfunction in smoking patients. Acta Odontológica Latinoamericana 2016;29(1):29-35.
(33) Ruiz ÁJ, Latorre C, Escobar FM, Velosa J, Ferro MB, Uriza F, et al. Asociación entre enfermedad periodontal y disfunción endotelial valorada por vasodilatación mediada por flujo en la arteria braquial: Estudio piloto. Revista Colombiana de Cardiología 2013;20(1):12-20.
(34) Latorre C, Escobar F, Velosa J, Ferro MB, Ruiz A. Ultra-Sensitive C-Reactive Protein (US-CRP) in Patients With Periodontal Disease and Risk of Acute Myocardial Infarction. Cardiology research 2011;2(1):27-35.
(35) Escobar F, Latorre C, Velosa J, Ferro MB, Ruiz A. Relation between ultra-sensitive C-reactive protein, diabetes and periodontal disease in patients with and without myocardial infarction. Arquivos Brasileiros de Endocrinologia & Metabologia 2014;58(4):362-368.
(36) Aristizabal PA, Gomez MP, Escobar F, Velosa J. Asociacion entre enfermedad periodontal y disfuncion endotelial. Revision sistematica de la literatura. Universitas Odontologica 2013;32(69):147-160.
(37) Amano A, Nakagawa I, Okahashi N, Hamada N. Variations of Porphyromonas gingivalis fimbriae in relation to microbial pathogenesis. Journal of Periodontal Research 2004;39(2):136-142.
(38) Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio A, Willett WC. Poor Oral Health and Coronary Heart Disease. Journal of Dental Research 1996;75(9):1631-1636.
(39) Abreu MT, Arditi M. Innate immunity and toll-like receptors: clinical implications of basic science research. The Journal of Pediatrics 2004;144(4):421-429.
(40) Joshipura KJ, Wand HC, Merchant AT, Rimm EB. Periodontal Disease and Biomarkers Related to Cardiovascular Disease. Journal of Dental Research 2004;83(2):151-155.
(41) Humphrey L, Fu R, Buckley D, Freeman M, Helfand M. Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis. J GEN INTERN MED 2008;23(12):2079-2086.
(42) Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis. American Heart Journal 2007;154(5):830-837.
(43) Joshy G, Arora M, Korda RJ, Chalmers J, Banks E. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study. BMJ open 2016;6(8):e012386.
(44) Ando A, Tanno K, Ohsawa M, Onoda T, Sakata K, Tanaka F, et al. Associations of number of teeth with risks for all‐cause mortality and cause‐specific mortality in middle‐aged and elderly men in the northern part of Japan: the Iwate‐KENCO study. Community Dentistry and Oral Epidemiology 2014;42(4):358-365.
(45) Solar O, Irwin AA. A conceptual framework for action on the social determinants of health: social determinants of health discussion paper 2. 2010:243-257.
(46) Graham H, White PCL. Social determinants and lifestyles: integrating environmental and public health perspectives. Public Health 2016;141:270-278.
(47) Tejerina JM, Cuesta S, Menéndez M, Sicilia A. Existe relación entre enfermedad cardiovascular y periodontitis? Avances en Periodoncia e Implantología Oral 2003;15(3):113-9.
(48) Lowe GDO. Etiopathogenesis of Cardiovascular Disease: Hemostasis, Thrombosis, and Vascular Medicine. Annals of Periodontology 1998;3(1):121-126.
(49) Hernández YZ. Atherosclerosis and Atherometric System. 2016.
(50) Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and Economic Consequences of Overweight in Adolescence and Young Adulthood. The New England Journal of Medicine 1993;329(14):1008-1012.
(51) Pérez SC. Presión arterial. Conceptos . Available at: http://www.fbbva.es/TLFU/microsites/salud_cardio/mult/fbbva_libroCorazon_cap12.pdf.
(52) Marmot M. Social determinants of health inequalities. The Lancet 2005;365(9464):1099-1104.
(53) Hastings G. Why corporate power is a public health priority. BMJ : British Medical Journal 2012;345(7871):26-29.
(54) Kaski JC. Inflamación, infección y enfermedad coronaria: mitos y realidades. Conferencia Especial del XXXV Congreso Nacional de la Sociedad Española de Cardiología. Revista Española de Cardiología 2000;53(10):1311-1317.
(55) Ministry of Health and Welfare of Korea. Korea Centers for Disease Control and Prevention. 2011 Korea Health Statistics. Seoul, South Korea: . 2012; Available at: https://www.mohw.go.kr/eng/.
(56) Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontitis–systemic disease associations in the presence of smoking – causal or coincidental? Periodontology 2000 2002;30(1):51-60.
(57) Historia clínica de la Universidad Santo Tomás, Bucaramanga.
(58) Blizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association between self-reported and clinical oral health status in Belarusian adults. Journal of investigative and clinical dentistry 2017 May;8(2):1-6.
(59) Chen M. Misperception of Oral Health among Adults in Rural Areas: A Fundamental but Neglected Issue in Primary Healthcare. International journal of environmental research and public health 2018;15(10):5-8.
(60) Maia FBM, de Sousa ET, Sampaio FC, Freitas, C H S M, Forte FDS. Tooth loss in middle-aged adults with diabetes and hypertension: Social determinants, health perceptions, oral impact on daily performance (OIDP) and treatment need. Medicina oral, patología oral y cirugía bucal 2018;23(2):e203-e210.
(61) López-Ilisástigui A, Ilisástigui-Ortueta Z, Pérez-Borrego A. Asociación entre hipertensión arterial y periodontitis. Kiru 2017;14(2):109-114.
(62) Frick M, Alber HF, Hügel H, Schwarzacher SP, Pachinger O, Weidinger F. Short‐ and long‐term changes of flow‐mediated vasodilation in patients under statin therapy. Clinical Cardiology 2002 Jun;25(6):291-294.
(63) López-Casasnovas G, Soley-Bori M. The Socioeconomic Determinants of Health: Economic Growth and Health in the OECD Countries during the Last Three Decades. International journal of environmental research and public health 2014 Jan 8,;11(1):815-829.
(64) Goulart MdA, Vettore MV. Is the relative increase in income inequality related to tooth loss in middle-aged adults? Journal of public health dentistry 2016 Dec;76(1):65-75.
(65) Braveman P, Gottlieb L. The Social Determinants of Health: It's Time to Consider the Causes of the Causes. Public Health Reports 2014 Jan 1,;129(Suppl 2):19-31.
(66) Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet, The 2012;380(9841):601-610.
(67) Tsai S, Lin M, Chiu W, Jane S, Tu L, Chen M. Factors associated with having less than 20 natural teeth in rural adults: a cross-sectional study. BMC oral health 2015 Dec 11,;15(1):151-8.
(68) Eldarrat AH. Diabetic patients: their knowledge and perception of oral health. Libyan Journal of Medicine 2011 Jan 1,;6(1):5691-5.
(69) Pathy J. The muong: A North Vietnamese “Tribe” in transmutation. The Eastern Anthropologist 1985;38(4):279-94.
dc.rights.*.fl_str_mv Atribución-NoComercial-SinDerivadas 2.5 Colombia
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rights.local.spa.fl_str_mv Abierto (Texto Completo)
dc.rights.accessrights.none.fl_str_mv info:eu-repo/semantics/openAccess
dc.rights.coar.none.fl_str_mv http://purl.org/coar/access_right/c_abf2
rights_invalid_str_mv Atribución-NoComercial-SinDerivadas 2.5 Colombia
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
Abierto (Texto Completo)
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.coverage.campus.spa.fl_str_mv CRAI-USTA Bucaramanga
dc.publisher.spa.fl_str_mv Universidad Santo Tomás
dc.publisher.program.spa.fl_str_mv Especialización Periodoncia
dc.publisher.faculty.spa.fl_str_mv Facultad de Odontología
institution Universidad Santo Tomás
bitstream.url.fl_str_mv https://repository.usta.edu.co/bitstream/11634/29365/1/2020Mart%c3%adnezDaniela.pdf
https://repository.usta.edu.co/bitstream/11634/29365/2/2020Mart%c3%adnezDaniela1.pdf
https://repository.usta.edu.co/bitstream/11634/29365/3/2020Mart%c3%adnezDaniela2.pdf
https://repository.usta.edu.co/bitstream/11634/29365/6/2020Mart%c3%adnezDaniela.pdf.jpg
https://repository.usta.edu.co/bitstream/11634/29365/7/2020Mart%c3%adnezDaniela1.pdf.jpg
https://repository.usta.edu.co/bitstream/11634/29365/8/2020Mart%c3%adnezDaniela2.pdf.jpg
https://repository.usta.edu.co/bitstream/11634/29365/4/license_rdf
https://repository.usta.edu.co/bitstream/11634/29365/5/license.txt
bitstream.checksum.fl_str_mv ee2ec08a4115c104dc0242b93cf0e575
4bdbf0565a86880d5705a80e5565b3c5
b4432ff59fb33bc1ede97ac956c98572
6a4ccc25210d3373e27fca48edead5a2
e72e766bc9d24a721501c4e6166ab0e4
d3913d57c7c848e8a828ae5ca584aa48
217700a34da79ed616c2feb68d4c5e06
aedeaf396fcd827b537c73d23464fc27
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
repository.name.fl_str_mv Repositorio Universidad Santo Tomás
repository.mail.fl_str_mv repositorio@usantotomas.edu.co
_version_ 1782026181917278208
spelling Otero Wandurraga, Johanna AlejandraCárdenas Gutiérrez, Angélica MaríaSuárez Carvajal, María AngélicaJaimes Gómez, Dayana AlejandraMartínez Casallas, Daniela KatherinneMarcucci Delgado, RicardoChicaíza Becerra, Alejandro2020-09-01T17:07:26Z2020-09-01T17:07:26Z2020-08-31Suarez Carvajal, M. A., Jaimes Gómez, D. A., Martínez Casallas, D. K., Marcucci Delgado, R. y Chicaíza Becerra, A. (2020). Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020 [Tesis de especialización]. Universidad Santo Tomás, Bucaramanga, Colombia.http://hdl.handle.net/11634/29365reponame:Repositorio Institucional Universidad Santo Tomásinstname:Universidad Santo Tomásrepourl:https://repository.usta.edu.coAntecedentes: la asociación unidireccional entre la enfermedad cardiovascular (ECV) y la periodontitis se caracteriza por la presencia de microorganismos periodontotapátogenos que inducen una respuesta inmune inflamatoria descontrolada a nivel local, que transloca a la circulación sanguínea, e incrementa la inflamación sistémica. Objetivo: Determinar la asociación entre las condiciones autoreportadas de riesgo para desarrollar enfermedad periodontal y los eventos crónicos en población residente en Santander. Metodología: Estudio de corte transversal analítico anidado al estudio Epidemiológico Prospectivo Urbano y Rural (PURE, por sus siglas en inglés). Santander cuenta con 511 participantes en la cohorte PURE, elegibles para el presente estudio de quienes fue tomada la información de seguimiento y eventos crónicos (ECV y diabetes tipo 2). Se aplicó vía telefónica una encuesta de autopercepción de salud oral y periodontal. El análisis se procesó con el software STATA 12.0 en términos descriptivos, tablas de contingencia para prueba de hipótesis y estimación de riesgo a través de modelos logísticos simples y múltiples. Resultados: La proporción de respuesta fue de 94,3%. Se evidenció una asociación significativa (p<0,05) entre hipertensión arterial (HTA) y el último motivo de consulta relacionado con acciones curativas (30,1%), pobre percepción de salud oral (64,7%) y alteraciones en las encías (38,8%). Ser hipertenso denota riesgo de desarrollar enfermedad periodontal (OR 2,02 IC 95% 1.21-3.37) y este es independiente de características demográficas, socioeconómicas y comportamentales. Conclusión: La HTA se asocia significativamente con condiciones autoreportadas de riesgo para enfermedad periodontal como tener pobre percepción de la salud oral o signos de enfermedad periodontal.Background: The unidirectional association between cardiovascular disease (CVD) and periodontitis is characterized by the presence of periodontopathogenic microorganisms that induce an uncontrolled inflammatory immune response at the local level, which translocates the blood circulation, and increases systemic inflammation. Objective: To determine the association between self-reported risk conditions for developing periodontal disease and chronic events in the population resident in Santander. Methodology: Analytical cross-sectional study nested within the Prospective Urban and Rural Epidemiological Study (PURE). Santander has 511 participants in the PURE cohort, eligible for the present study from whom follow-up information and chronic events (CVD and type 2 diabetes) were taken. A self-perception survey of oral and periodontal health was applied by telephone. The analysis was processed with STATA 12.0 software in descriptive terms, contingency tables for hypothesis testing and risk estimation through simple and multiple logistic models. Results: The response rate was 94.3%. There was a significant association (p<0.05) between high blood pressure (BP) and the last reason for consultation related to curative actions (30.1%), poor perception of oral health (64.7%) and gum alterations (38.8%). Being hypertensive denoted a risk of developing periodontal disease (OR 2.02 95% CI 1.21-3.37) and this was independent of demographic, socioeconomic and behavioral characteristics. Conclusion: ETS is significantly associated with self-reported risk conditions for periodontal disease such as having poor perception of oral health or signs of periodontal disease.Especialización Periodonciahttp://www.ustabuca.edu.co/ustabmanga/presentacionEspecializaciónapplication/pdfspaUniversidad Santo TomásEspecialización PeriodonciaFacultad de OdontologíaAtribución-NoComercial-SinDerivadas 2.5 Colombiahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Asociación entre las condiciones autoreportadas de riesgo para enfermedad periodontal y eventos crónicos, cohorte PURE Santander 2020Periodontal diseaseHypertensionCardiovascular diseaseDental diseaseDental implantsEnfermedades periodontalesEnfermedades cardíacasEnfermedad dentalImplantes dentalesHipertensiónEnfermedad cardiovascularEnfermedad dentalImplantes dentalesEnfermedad periodontalTrabajo de gradoinfo:eu-repo/semantics/acceptedVersionFormación de Recurso Humano para la Ctel: Trabajo de grado de Pregradohttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesisCRAI-USTA Bucaramanga(1) Ministerio de Salud y Proteccion Social. IV Estudio Nacional de Salud Bucal - ENSAB IV. 2014.(2) Najafipour H, Malek Mohammadi T, Rahim F, Haghdoost AA, Shadkam M, Afshari M. Association of Oral Health and Cardiovascular Disease Risk Factors “Results from a Community Based Study on 5900 Adult Subjects”. ISRN Cardiology 2013;782126:1-6.(3) GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017 Sep 16,;390(10100):1211-1259.(4) Tonetti MS, Jepsen S, Jin L, Otomo‐Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. Journal of Clinical Periodontology 2017 May;44(5):456-462.(5) Corsi DJ, Subramanian SV, Chow CK, McKee M, Chifamba J, Dagenais G, et al. Prospective Urban Rural Epidemiology (PURE) study: Baseline characteristics of the household sample and comparative analyses with national data in 17 countries. American Heart Journal 2013;166(4):636-646.e4.(6) Institute for Health Metrics and Evaluation, Universidad de Washington, Red de Desarrollo Humano, Banco Mundial. La carga mundial de morbilidad: generar evidencias, orientar políticas. 2013.(7) Hwang S, Shim J, Kang D, Choi J. Poor Oral Health Predicts Higher 10-Year Cardiovascular Risk: A Propensity Score Matching Analysis. The Journal of Cardiovascular Nursing 2018 Jun 12,;33(5):429-436.(8) Janket S, Baird AE, Chuang S, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 2003 May;95(5):559-569.(9) Carrizales-Sepúlveda EF, Ordaz-Farías A, Vera-Pineda R, Flores-Ramírez R. Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart, Lung and Circulation 2018 Nov;27(11):1327-1334.(10) Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation 2012 May 22,;125(20):2520-2544.(11) Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. The Lancet 2019 Jul 20,;394(10194):249-260.(12) Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dentistry and Oral Epidemiology 2012 Aug;40(4):289-296.(13) Boillot A, El Halabi B, Batty GD, Rangé H, Czernichow S, Bouchard P. Education as a Predictor of Chronic Periodontitis: A Systematic Review with Meta-Analysis Population-Based Studies. PloS one 2011;6(7):e21508.(14) Sheiham A, Watt RG. The Common Risk Factor Approach: a rational basis for promoting oral health. Community Dentistry and Oral Epidemiology 2000 Dec;28(6):399-406.(15) Shweta Y, Santhosh-Kumar C. Common risk factor approach: Finding common ground for better health outcomes. International Journal of Contemporary Medical Research 2017;4(6):1367-1370.(16) Jepsen S, Blanco J, Buchalla W, Carvalho JC, Dietrich T, Dorfer C, et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. Journal of Clinical Periodontology 2017;44(S18):S85-S93.(17) World Health Organization. WHO | Global Hearts Initiative, working together to promote cardiovascular health. Available at: http://www.who.int/cardiovascular_diseases/global-hearts/en/. Accessed Nov 19, 2019(18) Beaglehole RH, Beaglehole R. Promoting radical action for global oral health: integration or independence? The Lancet 2019;394(10194):196-198.(19) Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Globalization and health 2017 Jun 15,;13(1):34.(20) Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nature reviews. Immunology 2015 Jan;15(1):30-44.(21) Armitage GC. Development of a Classification System for Periodontal Diseases and Conditions. Annals of Periodontology 1999;4(1):1-6.(22) Chatzistavrianou D, Blair F. Diagnosis and management of chronic and aggressive periodontitis part 1: periodontal assessment and diagnosis. Dental Update 2017;44(4):306-315.(23) Eke PI, Page RC, Wei L, Thornton‐Evans G, Genco RJ. Update of the Case Definitions for Population‐Based Surveillance of Periodontitis. Journal of Periodontology 2012;83(12):1449-1454.(24) Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification. Journal of Clinical Periodontology 2018 Jun;45(S20):S1-S8.(25) Chapple ILC, Mealey BL, Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Journal of Clinical Periodontology 2018;89:S74-S84.(26) Lang NP, Bartold PM. Periodontal health. Journal of Periodontology 2018;89:S9-S16.(27) Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque‐induced gingivitis: Case definition and diagnostic considerations. Journal of Clinical Periodontology 2018 Jun;45(S20):S44-S67.(28) Lindhe J, Nyman S. Exploración de pacientes con enfermedad periodontal. Periodontologia clinica e implantologia odontológica. Madrid: Médica Panamericana; 2000.(29) Barrios G. Periodoncia, su fundamento biológico. Bogotá D.C.; 1989.(30) Fuster V, Badimon L, Badimon JJ, Chesebro JH. The Pathogenesis of Coronary Artery Disease and the Acute Coronary Syndromes. N Engl J Med 1992;326(4):242-250.(31) Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Mäkelä PH, et al. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. The Lancet 1988;2(8618):983-6.(32) Velosa-Porras J, Escobar-Arregoces F, Latorre-Uriza C, Ferro-Camargo MB, Ruiz ÁJ, Uriza-Carrasco LF. Association between periodontal disease and endothelial dysfunction in smoking patients. Acta Odontológica Latinoamericana 2016;29(1):29-35.(33) Ruiz ÁJ, Latorre C, Escobar FM, Velosa J, Ferro MB, Uriza F, et al. Asociación entre enfermedad periodontal y disfunción endotelial valorada por vasodilatación mediada por flujo en la arteria braquial: Estudio piloto. Revista Colombiana de Cardiología 2013;20(1):12-20.(34) Latorre C, Escobar F, Velosa J, Ferro MB, Ruiz A. Ultra-Sensitive C-Reactive Protein (US-CRP) in Patients With Periodontal Disease and Risk of Acute Myocardial Infarction. Cardiology research 2011;2(1):27-35.(35) Escobar F, Latorre C, Velosa J, Ferro MB, Ruiz A. Relation between ultra-sensitive C-reactive protein, diabetes and periodontal disease in patients with and without myocardial infarction. Arquivos Brasileiros de Endocrinologia & Metabologia 2014;58(4):362-368.(36) Aristizabal PA, Gomez MP, Escobar F, Velosa J. Asociacion entre enfermedad periodontal y disfuncion endotelial. Revision sistematica de la literatura. Universitas Odontologica 2013;32(69):147-160.(37) Amano A, Nakagawa I, Okahashi N, Hamada N. Variations of Porphyromonas gingivalis fimbriae in relation to microbial pathogenesis. Journal of Periodontal Research 2004;39(2):136-142.(38) Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio A, Willett WC. Poor Oral Health and Coronary Heart Disease. Journal of Dental Research 1996;75(9):1631-1636.(39) Abreu MT, Arditi M. Innate immunity and toll-like receptors: clinical implications of basic science research. The Journal of Pediatrics 2004;144(4):421-429.(40) Joshipura KJ, Wand HC, Merchant AT, Rimm EB. Periodontal Disease and Biomarkers Related to Cardiovascular Disease. Journal of Dental Research 2004;83(2):151-155.(41) Humphrey L, Fu R, Buckley D, Freeman M, Helfand M. Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis. J GEN INTERN MED 2008;23(12):2079-2086.(42) Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis. American Heart Journal 2007;154(5):830-837.(43) Joshy G, Arora M, Korda RJ, Chalmers J, Banks E. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study. BMJ open 2016;6(8):e012386.(44) Ando A, Tanno K, Ohsawa M, Onoda T, Sakata K, Tanaka F, et al. Associations of number of teeth with risks for all‐cause mortality and cause‐specific mortality in middle‐aged and elderly men in the northern part of Japan: the Iwate‐KENCO study. Community Dentistry and Oral Epidemiology 2014;42(4):358-365.(45) Solar O, Irwin AA. A conceptual framework for action on the social determinants of health: social determinants of health discussion paper 2. 2010:243-257.(46) Graham H, White PCL. Social determinants and lifestyles: integrating environmental and public health perspectives. Public Health 2016;141:270-278.(47) Tejerina JM, Cuesta S, Menéndez M, Sicilia A. Existe relación entre enfermedad cardiovascular y periodontitis? Avances en Periodoncia e Implantología Oral 2003;15(3):113-9.(48) Lowe GDO. Etiopathogenesis of Cardiovascular Disease: Hemostasis, Thrombosis, and Vascular Medicine. Annals of Periodontology 1998;3(1):121-126.(49) Hernández YZ. Atherosclerosis and Atherometric System. 2016.(50) Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and Economic Consequences of Overweight in Adolescence and Young Adulthood. The New England Journal of Medicine 1993;329(14):1008-1012.(51) Pérez SC. Presión arterial. Conceptos . Available at: http://www.fbbva.es/TLFU/microsites/salud_cardio/mult/fbbva_libroCorazon_cap12.pdf.(52) Marmot M. Social determinants of health inequalities. The Lancet 2005;365(9464):1099-1104.(53) Hastings G. Why corporate power is a public health priority. BMJ : British Medical Journal 2012;345(7871):26-29.(54) Kaski JC. Inflamación, infección y enfermedad coronaria: mitos y realidades. Conferencia Especial del XXXV Congreso Nacional de la Sociedad Española de Cardiología. Revista Española de Cardiología 2000;53(10):1311-1317.(55) Ministry of Health and Welfare of Korea. Korea Centers for Disease Control and Prevention. 2011 Korea Health Statistics. Seoul, South Korea: . 2012; Available at: https://www.mohw.go.kr/eng/.(56) Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontitis–systemic disease associations in the presence of smoking – causal or coincidental? Periodontology 2000 2002;30(1):51-60.(57) Historia clínica de la Universidad Santo Tomás, Bucaramanga.(58) Blizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association between self-reported and clinical oral health status in Belarusian adults. Journal of investigative and clinical dentistry 2017 May;8(2):1-6.(59) Chen M. Misperception of Oral Health among Adults in Rural Areas: A Fundamental but Neglected Issue in Primary Healthcare. International journal of environmental research and public health 2018;15(10):5-8.(60) Maia FBM, de Sousa ET, Sampaio FC, Freitas, C H S M, Forte FDS. Tooth loss in middle-aged adults with diabetes and hypertension: Social determinants, health perceptions, oral impact on daily performance (OIDP) and treatment need. Medicina oral, patología oral y cirugía bucal 2018;23(2):e203-e210.(61) López-Ilisástigui A, Ilisástigui-Ortueta Z, Pérez-Borrego A. Asociación entre hipertensión arterial y periodontitis. Kiru 2017;14(2):109-114.(62) Frick M, Alber HF, Hügel H, Schwarzacher SP, Pachinger O, Weidinger F. Short‐ and long‐term changes of flow‐mediated vasodilation in patients under statin therapy. Clinical Cardiology 2002 Jun;25(6):291-294.(63) López-Casasnovas G, Soley-Bori M. The Socioeconomic Determinants of Health: Economic Growth and Health in the OECD Countries during the Last Three Decades. International journal of environmental research and public health 2014 Jan 8,;11(1):815-829.(64) Goulart MdA, Vettore MV. Is the relative increase in income inequality related to tooth loss in middle-aged adults? Journal of public health dentistry 2016 Dec;76(1):65-75.(65) Braveman P, Gottlieb L. The Social Determinants of Health: It's Time to Consider the Causes of the Causes. Public Health Reports 2014 Jan 1,;129(Suppl 2):19-31.(66) Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet, The 2012;380(9841):601-610.(67) Tsai S, Lin M, Chiu W, Jane S, Tu L, Chen M. Factors associated with having less than 20 natural teeth in rural adults: a cross-sectional study. BMC oral health 2015 Dec 11,;15(1):151-8.(68) Eldarrat AH. Diabetic patients: their knowledge and perception of oral health. Libyan Journal of Medicine 2011 Jan 1,;6(1):5691-5.(69) Pathy J. The muong: A North Vietnamese “Tribe” in transmutation. The Eastern Anthropologist 1985;38(4):279-94.ORIGINAL2020MartínezDaniela.pdf2020MartínezDaniela.pdfTrabajo de gradoapplication/pdf1823221https://repository.usta.edu.co/bitstream/11634/29365/1/2020Mart%c3%adnezDaniela.pdfee2ec08a4115c104dc0242b93cf0e575MD51open access2020MartínezDaniela1.pdf2020MartínezDaniela1.pdfAprobación facultadapplication/pdf171999https://repository.usta.edu.co/bitstream/11634/29365/2/2020Mart%c3%adnezDaniela1.pdf4bdbf0565a86880d5705a80e5565b3c5MD52metadata only access2020MartínezDaniela2.pdf2020MartínezDaniela2.pdfAutorización de publicaciónapplication/pdf591096https://repository.usta.edu.co/bitstream/11634/29365/3/2020Mart%c3%adnezDaniela2.pdfb4432ff59fb33bc1ede97ac956c98572MD53metadata only accessTHUMBNAIL2020MartínezDaniela.pdf.jpg2020MartínezDaniela.pdf.jpgGenerated Thumbnailimage/jpeg3921https://repository.usta.edu.co/bitstream/11634/29365/6/2020Mart%c3%adnezDaniela.pdf.jpg6a4ccc25210d3373e27fca48edead5a2MD56open access2020MartínezDaniela1.pdf.jpg2020MartínezDaniela1.pdf.jpgGenerated Thumbnailimage/jpeg4559https://repository.usta.edu.co/bitstream/11634/29365/7/2020Mart%c3%adnezDaniela1.pdf.jpge72e766bc9d24a721501c4e6166ab0e4MD57open access2020MartínezDaniela2.pdf.jpg2020MartínezDaniela2.pdf.jpgGenerated Thumbnailimage/jpeg5044https://repository.usta.edu.co/bitstream/11634/29365/8/2020Mart%c3%adnezDaniela2.pdf.jpgd3913d57c7c848e8a828ae5ca584aa48MD58open accessCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repository.usta.edu.co/bitstream/11634/29365/4/license_rdf217700a34da79ed616c2feb68d4c5e06MD54open accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8807https://repository.usta.edu.co/bitstream/11634/29365/5/license.txtaedeaf396fcd827b537c73d23464fc27MD55open access11634/29365oai:repository.usta.edu.co:11634/293652022-10-10 16:39:46.623open accessRepositorio Universidad Santo Tomásrepositorio@usantotomas.edu.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