Odds ratio (OR)
27,8
Logit (OR)
3,32
95 % CI
9.5056 - 81.4415
Tabella 8: Risultati dello studio.
Grafico 1: Rappresentazione grafica dei risultati dello studio
55 17 5 43 0 10 20 30 40 50 60
Cardiopatici (test) Non Cardiopatici (controllo) Bruxisti Non bruxisti
55
Discussione
Ad oggi le malattie cardiovascolari rappresentano la prima causa di morte globale. Nel 2014, 17.5 milioni di persone sono morte (3 in ogni 10 decessi) a causa di patologie cardiovascolari, che hanno rappresentato il 31% delle morti globali. Di questi, 7.4 milioni di persone sono morte di cardiopatia ischemica e 6.7 milioni da ictus (WHO 2015).
La prevalenza del bruxismo diurno è di circa il 20% nella popolazione adulta americana, mentre quella del bruxismo notturno si aggira intorno all’8% (Manfredini 2013).
Dai risultati ottenuti si evince che non è possibile parlare di rischio finchè non verrà effettuato uno studio prospettico. A tale proposito è stata misurata la potenziale associazione tra bruxismo e malattie cardiovascolari tramite l’odds ratio.
L’odds ratio definisce quanto devi moltiplicare la probabilità di essere bruxista di un non cardiopatico per ottenere la probabilità di essere bruxista di un cardiopatico.
Se l’OR è maggiore di 1, allora l’essere bruxista è associato all’essere cardiopatico.
Essendo le malattie cardiovascolari al primo posto tra le cause di morte; al momento l’obiettivo è quello di ridurre le morti da malattie cardiovascolari e infarto del 20% (American Heart Association) e, contestualmente, incrementare la salute cardiovascolare del 20% entro il 2020.
La salute cardiovascolare è un nuovo concetto introdotto dall’American Heart Association per promuovere la prevenzione cardiovascolare. Essa include 7 parametri:
Non aver mai fumato o aver smesso da più di un anno, Indice di massa corporea < 25 Kg/m²,
Attività fisica pari ad almeno 150 min (se corrispondente a sforzo moderato) o 75 min (sforzo intenso) alla settimana,
Coprire dai 4 ai 5 aspetti di dieta salutare come proposti dalle linee guida dell’American Health Association,
56 Livelli di colesterolo < 200 mg/dl,
Pressione sanguigna inferiore ai 120/80 mmHg, Glucosio nel sangue < 100 mg/dl.
I paramentri precedentemente elencati rappresentano variabili modificabili, che risultano necessarie per raggiungere gli obiettivi sopra menzionati.
In questo studio è stata osservata una stretta correlazione tra bruxismo e malattie cardiovascolari, dato che la maggior parte dei pazienti cardiopatici mostravano la presenza di faccette di usura; per questo motivo e per il fatto che l’usura determinata dal bruxismo rappresenta un epifenomeno dello stress, crediamo che pazienti a rischio di sviluppo di malattie cardiovascolari dovrebbero essere sottoposti anche ad uno stretto follow- up odontoiatrico.
Anche se nel 91% dei pazienti cardiopatici (gruppo test) è stato diagnosticato il bruxismo, i dati di questo studio non forniscono molte informazioni riguardo il rapporto di causa-effetto tra i due disordini, ma ci permettono comunque di avere un punto di partenza per future indagini. La rilevanza clinica di questa associazione è stata considerata uno strumento utile per monitorare i livelli di stress, i quali rappresentano un rischio per lo sviluppo di malattie cardiovascolari o eventuali ricadute.
Conclusioni
Il presente studio pilota comparativo a doppia coorte, evidenzia una stretta correlazione tra bruxismo e malattie cardiovascolari.
I pazienti cardiopatici hanno una probabilità di 3,32 volte superiore di essere bruxisti rispetto ai non cardiopatici.
L’obiettivo futuro è quello di trasformare questo studio pilota in uno studio prospettico, basato su un campione costituito da pazienti non cardiopatici divisi in bruxisti e non, in modo da valutare chi svilupperà una malattia
57 cardiovascolare nel lungo termine e poter stabilire così un’eventuale reale correlazione tra bruxismo e malattie cardiovascolari.
58
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