Associação entre condição periodontal de gestantes e variáveis maternas e de assistência à saúde / Association between the periodontal condition of pregnant women and maternal variables and health assistance

RESUMO

Objetivo: Avaliar a condicao periodontal de gestantes e analisar a influencia de variaveis maternas socio-economico-demograficas, de saude, habitos deleterios e acesso ao servico odontologico e a existencia do Programa Saude da Familia (PSF) nos servicos publicos de atendimento a gestante. Metodo: Esta avaliacao faz parte de um estudo de coorte com gestantes e criancas desenvolvido em dois municipios do Estado de Sao Paulo, sendo um deles com PSF implantado. Foram realizados exames bucais utilizando os Indices Periodontal Comunitario e Perda de Insercao Periodontal e entrevistas semi-estruturadas com as gestantes em seus domicilios. As analises incluiram o Teste do Qui-quadrado e Teste Exato de Fisher, ao nivel de significancia de 5% (?=0.05). Resultados: Foram examinadas todas as gestantes (n=119) cadastradas no servico de saude de ambos municipios. A idade media foi 24,7 anos; 61,4% pertenciam a raca negra/parda, a maioria (65,5%) recebia entre 2-3 salarios minimos e somente 6,7% iniciaram o ensino superior. Apenas 8% das pacientes mostraram periodonto saudavel. Sangramento e calculo foram observados em 66% do total e bolsas periodontais rasas e profundas em 20%. Perda de insercao periodontal superior a 4mm foi verificada em 24% das gestantes. O grupo mostrou-se homogeneo quanto as caracteristicas maternas, sendo que a idade (p=0,0384) e habito de fumar (p=0,0102) foram os unicos fatores associados com a doenca periodontal. A existencia do PSF nao foi associada com uma menor prevalencia da doenca. Conclusao: Os achados deste estudo mostram uma alta prevalencia de alteracoes periodontais durante a gestacao, nao havendo influencia do PSF na condicao encontrada. Dentre as variaveis de risco, a idade e o fumo foram os fatores associados com a presenca da doenca periodontal. Ha necessidade de melhor planejamento e execucao das acoes em saude bucal durante o pre-natal.

ABSTRACT

Objective: To evaluate the periodontal condition of pregnant women and to analyze the influence of maternal variables - socioeconomic-demographic data, health, deleterious habits and access to dental service- and the existence of the Family Health Program (FHP) at the public assistance services to pregnant women. Method: This evaluation was part of a cohort study with pregnant women and children conducted in two cities of the Sao Paulo State, one of which with an implemented FHP. Oral examinations were done using the Community Periodontal and Periodontal Attachment Loss Indexes, and semi-structured interviews with the pregnant women at their homes. Data were analyzed statistically by the chi-square test and Fisher?s exact test at 5% significance level (?=0.05). Results: All pregnant women (n=119) registered at the public health service of each city were examined. The mean age was 24.7 years; 61.4% were black or black/white mixed-race women; most (65.5%) earned 2-3 minimum wages, and only 6.7% initiated higher education. Only 8% of the patients presented periodontal health. Bleeding and calculus were observed in 66% of them, and shallow and deep periodontal pockets in 20%. Periodontal attachment loss > 4 mm was observed in 24% of the pregnant women. The group was homogeneous as to the maternal characteristics, age (p=0.0384) and smoking (p=0.0102) being the only factors associated with periodontal disease. The existence of a FHP at the public assistance service was not associated with a lower prevalence of the disease. Conclusion: The findings of this study show a high prevalence of periodontal alterations during pregnancy, with no influence from the existence of a FHP on the observed conditions. Among the risk variables, age and smoking were the factors associated with the presence of periodontal disease. There is a need for a better planing and accomplishment of oral health actions during the prenatal period.