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Variantes moleculares de CYP2D6, OPRM1, COMT E CYP2C9: revisão integrativa das implicações farmacogenómicas na medicina dentária
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A farmacogenómica representa uma vertente fundamental da medicina personalizada, com crescente relevância na Medicina Dentária. Ao estudar como as variantes genéticas influenciam a resposta aos fármacos, esta abordagem permite adaptar tratamentos às características individuais de cada paciente. Em Medicina Dentária, analgésicos e anti inflamatórios são amplamente utilizados, mas a variabilidade na resposta clínica evidencia a necessidade de estratégias terapêuticas mais precisas. Genes como CYP2D6, CYP2C9, OPRM1 e COMT têm sido implicados na metabolização de opioides e AINEs, na perceção da dor e na eficácia terapêutica. Esta revisão integrativa teve como objetivo reunir e analisar criticamente a evidência científica existente sobre a associação entre polimorfismos nestes genes e a resposta a fármacos em contexto odontológico. Foi realizada uma pesquisa bibliográfica nas bases de dados PubMed/MEDLINE, Scopus e Web of Science, abrangendo os últimos 20 anos. Foram incluídos estudos clínicos em humanos (ensaios clínicos, observacionais e relatos de caso), publicados em português, inglês, espanhol ou italiano. Excluíram-se revisões sistemáticas, estudos in vitro e modelos animais. Além dos dados em contexto odontológico, integraram-se estudos contextuais relevantes que abordam os mesmos genes e fármacos noutras condições clínicas. Os resultados indicam que variantes genéticas nos genes analisados estão associadas a diferenças clinicamente relevantes na eficácia, segurança e metabolização de fármacos como tramadol, codeína, ibuprofeno e propranolol. A evidência mais robusta refere-se aos genes CYP2D6 e CYP2C9, com implicações diretas na prática clínica. Apesar do seu potencial, a implementação da farmacogenómica em Medicina Dentária permanece limitada, sendo essencial desenvolver diretrizes específicas e investir em formação dos profissionais.
Pharmacogenomics is a key component of personalized medicine and is gaining increasing relevance in Dental Medicine. By studying how genetic variants affect drug response, it allows treatments to be tailored to each patient's unique genetic profile. In dentistry, analgesics and anti-inflammatory drugs are widely prescribed, yet clinical response varies significantly among individuals. Genes such as CYP2D6, CYP2C9, OPRM1, and COMT have been implicated in opioid and NSAID metabolism, pain perception, and therapeutic outcomes. This integrative review aimed to compile and critically evaluate the scientific evidence regarding the association between polymorphisms in these genes and drug response in dental contexts. A bibliographic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science, covering the past 20 years. Human clinical studies (including clinical trials, observational studies, and case reports) published in Portuguese, English, Spanish, or Italian were included. Systematic reviews, in vitro and animal studies were excluded. In addition to dental specific data, contextual studies relevant to the genes and drugs of interest were integrated to support clinical interpretation. Results indicate that genetic variants in the target genes are associated with clinically meaningful differences in drug metabolism, efficacy, and safety—particularly regarding tramadol, codeine, ibuprofen, and propranolol. Strongest evidence was observed for CYP2D6 and CYP2C9, with direct clinical implications. Despite this potential, the integration of pharmacogenomics into dental practice remains limited, underscoring the need for clinical guidelines and professional training.
Pharmacogenomics is a key component of personalized medicine and is gaining increasing relevance in Dental Medicine. By studying how genetic variants affect drug response, it allows treatments to be tailored to each patient's unique genetic profile. In dentistry, analgesics and anti-inflammatory drugs are widely prescribed, yet clinical response varies significantly among individuals. Genes such as CYP2D6, CYP2C9, OPRM1, and COMT have been implicated in opioid and NSAID metabolism, pain perception, and therapeutic outcomes. This integrative review aimed to compile and critically evaluate the scientific evidence regarding the association between polymorphisms in these genes and drug response in dental contexts. A bibliographic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science, covering the past 20 years. Human clinical studies (including clinical trials, observational studies, and case reports) published in Portuguese, English, Spanish, or Italian were included. Systematic reviews, in vitro and animal studies were excluded. In addition to dental specific data, contextual studies relevant to the genes and drugs of interest were integrated to support clinical interpretation. Results indicate that genetic variants in the target genes are associated with clinically meaningful differences in drug metabolism, efficacy, and safety—particularly regarding tramadol, codeine, ibuprofen, and propranolol. Strongest evidence was observed for CYP2D6 and CYP2C9, with direct clinical implications. Despite this potential, the integration of pharmacogenomics into dental practice remains limited, underscoring the need for clinical guidelines and professional training.
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Farmacogenómica Medicina dentária Analgésicos Medicina personalizada Pharmacogenomics Dental medicine CYP2D6 OPRM1 COMT CYP2C9 Analgesics Personalized medicine