Abstract

JUAREZ, Rolando Pablo; MAZZAFERO, Vicente Enrique  and  GORODNER, Jorge Osvaldo. Impacto económico de la hiperglucemia en la salud oral de pacientes diabéticos tipo 2. Acta odontol. venez [online]. 2009, vol.47, n.1, pp.182-195. ISSN 0001-6365.

Objective: The aim of the present study was to determine dentistry necessity treatments and analyse the direct dentistry sanitary costs in type 2 diabetes patients treated (June 2004 - July 2006) at the Central Dentistry Hospital, Resistencia, Chaco, Argentina. Material and methods: A total of 300 type 2 diabetic patients were included in this study and divided into two groups of 150: Group I, diabetic with metabolic control (glycosylated haemoglobin [HbA1c] < 8.0%, mean 6.7%; mean age ± 56.1 3.1 años) and Group II, diabetic without metabolic control (HbA1c > 8.0%, mean 13,7%; mean age ± 55.4 3.2 años). Clinical examination included Community Periodontal Index of Treatment Needs (CPITN), Caries Index Treatments Needs (CITN), and the number of missing teeth. Health service costs were assessed by means of descriptive study and application of a simulation model to compare costs of reparative dental treatment versus prevention (cost-minimization, cost-benefit and cost-effectiveness analysis). The percentage frequency, mean values and standard deviations, the test of difference of proportions, and Chi Square test with significance levels of p < 0.05 were used for the statistical analysis. Results: Periodontal pockets exceeding 5 mm, elevated CITN values and a higher number of missing teeth were associated with a high level of HbA1c. Total direct dental costs clearly or probably attributable to diabetes were estimated at 173.627,66 Argentine Pesos (531.300,63 American Dollars). If this cost is divided into categories, endodontics represents approximately 27.38% of the global cost, oral radiology 19.37%, removable prosthodontics 19.00%, restorative dentistry 10.95%, surgery 7.85%, periodontology 7.63%, preventive dentistry 6.66% and checkups 1.12%. Costs were particularly high in patients with elevated level of blood glucose. Compared with reparative dentistry, preventive strategies were found to be highly cost-effective. Cost-benefit analysis estimated the cost of reparative treatment for prevalent oral diseases to be 15 times greater than that of preventive therapy. Conclusions: Hyperglycemia has a substantial economical impact on the costs of managing oral diseases in Type II diabetic patients. Implementation of a community-based program to prevent oral diseases and promoting oral health for people with diabetes can lead to clinical outcomes in the short-term and substantial improvements in costs.

Keywords : Diabetes Mellitus; Periodontal Disease; Caries; Missing teeth; Costs-analysis.