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Relação entre a doença periodontal e as doenças oculares: revisão integrativa
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| Projeto de pós-graduação_42276 | 1.74 MB | Adobe PDF |
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Introdução: A inflamação periodontal crónica e o microbioma compartilham vários elementos significativos com muitas condições sistémicas, incluindo mediadores pró inflamatórios, metabólitos bacterianos e predisposição genética. A correlação entre doenças oculares e saúde oral está sendo reavaliada nos últimos anos por meio de evidências limitadas. Várias pesquisas têm pretendido esclarecer o envolvimento de agentes patogénicos orais no início e prognóstico de diversas doenças oculares.
Objetivo: Esta revisão integrativa teve como objetivo explorar e sintetizar as evidências científicas existentes sobre a relação entre a doença periodontal e diversas patologias oculares crónicas, como a retinopatia diabética, a degenerescência macular relacionada com a idade, o glaucoma, a catarata, a uveíte e a esclerite.
Metodologia: A análise baseou se em estudos observacionais, coortes e revisões experimentais, com foco em mecanismos fisiopatológicos comuns, manifestações clínicas e implicações terapêuticas. Os dados foram organizados segundo capítulos temáticos que abordam a associação entre a doença periodontal e várias doenças oculares inflamatórias.
Resultados: Verificou-se que a inflamação crónica decorrente da periodontite — mediada por citocinas como IL-6 e TNF-α, bem como lipopolissacarídeos bacterianos — pode atravessar a barreira vascular e afetar estruturas oculares distantes como a retina, o epitélio pigmentar e a câmara anterior. Estudos apontam que a presença de agentes patogénicos orais como Porphyromonas gingivalis nos tecidos oculares pode contribuir para alterações inflamatórias locais. Pacientes com doença periodontal apresentaram risco aumentado de desenvolver retinopatia diabética, degenerescência macular relacionada com a idade, glaucoma e catarata, independentemente de outros fatores de risco. Além disso, casos clínicos apontam uma melhora de quadros como esclerite e uveíte após tratamento periodontal, sugerindo um possível papel terapêutico da saúde oral na modulação de doenças oculares.
Discussão: Apesar da consistência das associações descritas, a maioria das evidências disponíveis ainda é de natureza observacional, o que limita a inferência de causalidade. Ainda assim, os dados convergentes indicam a importância de incluir a avaliação periodontal nos protocolos de rastreio oftalmológico, principalmente em populações de risco como idosos e diabéticos. O tratamento da doença periodontal poderia ter um impacto positivo na progressão de algumas condições oculares, embora ensaios clínicos prospetivos sejam necessários para confirmar essa hipótese.
Conclusão: A saúde periodontal deve ser encarada como um componente essencial da saúde sistémica e visual. A sua preservação representa uma via promissora para a prevenção de complicações oftalmológicas em saúde pública. Futuros estudos deverão investigar a interação entre o microbioma oral, a inflamação sistémica e a saúde ocular, promovendo uma abordagem médica mais integrada, preventiva e personalizada.
Introduction: Chronic periodontal inflammation and the microbiome share several significant elements with many systemic conditions, including pro-inflammatory mediators, bacterial metabolites, and genetic predisposition. The correlation between ocular diseases and oral health has been re-evaluated in recent years through limited evidence. Various studies have aimed to clarify the involvement of oral pathogens in the onset and prognosis of several ocular diseases. Objective: This integrative review aimed to explore and synthesize the existing scientific evidence on the relationship between periodontal disease and various chronic ocular conditions, such as diabetic retinopathy, age-related macular degeneration, glaucoma, cataract, uveitis, and scleritis. Methodology: The analysis was based on observational studies, cohort studies, and experimental reviews, with a focus on shared pathophysiological mechanisms, clinical manifestations, and therapeutic implications. The data were organized according to thematic chapters addressing the association between periodontal disease and various inflammatory ocular diseases. Results: It was found that chronic inflammation resulting from periodontitis—mediated by cytokines such as IL-6 and TNF-α, as well as bacterial lipopolysaccharides—can cross the vascular barrier and affect distant ocular structures such as the retina, retinal pigment epithelium, and anterior chamber. Studies indicate that the presence of oral pathogens such as Porphyromonas gingivalis in ocular tissues may contribute to local inflammatory changes. Patients with periodontal disease showed an increased risk of developing diabetic retinopathy, age-related macular degeneration, glaucoma, and cataracts, independently of other risk factors. Furthermore, clinical cases have reported improvement in conditions such as scleritis and uveitis following periodontal treatment, suggesting a possible therapeutic role of oral health in the modulation of ocular diseases. Discussion: Despite the consistency of the described associations, most of the available evidence remains observational in nature, which limits causal inference. Nevertheless, the converging data highlight the importance of including periodontal assessment in ophthalmological screening protocols, particularly in at-risk populations such as the elderly and diabetic individuals. Periodontal treatment could have a positive impact on the progression of certain ocular conditions, although prospective clinical trials are needed to confirm this hypothesis. Conclusion: Periodontal health should be regarded as an essential component of systemic and visual health. Its preservation represents a promising avenue for the prevention of ophthalmological complications in public health. Future studies should investigate the interaction between the oral microbiome, systemic inflammation, and ocular health, promoting a more integrated, preventive, and personalized medical approach.
Introduction: Chronic periodontal inflammation and the microbiome share several significant elements with many systemic conditions, including pro-inflammatory mediators, bacterial metabolites, and genetic predisposition. The correlation between ocular diseases and oral health has been re-evaluated in recent years through limited evidence. Various studies have aimed to clarify the involvement of oral pathogens in the onset and prognosis of several ocular diseases. Objective: This integrative review aimed to explore and synthesize the existing scientific evidence on the relationship between periodontal disease and various chronic ocular conditions, such as diabetic retinopathy, age-related macular degeneration, glaucoma, cataract, uveitis, and scleritis. Methodology: The analysis was based on observational studies, cohort studies, and experimental reviews, with a focus on shared pathophysiological mechanisms, clinical manifestations, and therapeutic implications. The data were organized according to thematic chapters addressing the association between periodontal disease and various inflammatory ocular diseases. Results: It was found that chronic inflammation resulting from periodontitis—mediated by cytokines such as IL-6 and TNF-α, as well as bacterial lipopolysaccharides—can cross the vascular barrier and affect distant ocular structures such as the retina, retinal pigment epithelium, and anterior chamber. Studies indicate that the presence of oral pathogens such as Porphyromonas gingivalis in ocular tissues may contribute to local inflammatory changes. Patients with periodontal disease showed an increased risk of developing diabetic retinopathy, age-related macular degeneration, glaucoma, and cataracts, independently of other risk factors. Furthermore, clinical cases have reported improvement in conditions such as scleritis and uveitis following periodontal treatment, suggesting a possible therapeutic role of oral health in the modulation of ocular diseases. Discussion: Despite the consistency of the described associations, most of the available evidence remains observational in nature, which limits causal inference. Nevertheless, the converging data highlight the importance of including periodontal assessment in ophthalmological screening protocols, particularly in at-risk populations such as the elderly and diabetic individuals. Periodontal treatment could have a positive impact on the progression of certain ocular conditions, although prospective clinical trials are needed to confirm this hypothesis. Conclusion: Periodontal health should be regarded as an essential component of systemic and visual health. Its preservation represents a promising avenue for the prevention of ophthalmological complications in public health. Future studies should investigate the interaction between the oral microbiome, systemic inflammation, and ocular health, promoting a more integrated, preventive, and personalized medical approach.
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Palavras-chave
Doença periodontal Retinopatia diabética Esclerite Uveíte Glaucoma Degenerescência macular relacionada com a idade Periodontal disease Diabetic retinopathy Scleritis Uveitis Macular degeneration