MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM DISTINCT SOCIOECONOMIC CLASSES
Identifieur interne : 002844 ( Pmc/Corpus ); précédent : 002843; suivant : 002845MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM DISTINCT SOCIOECONOMIC CLASSES
Auteurs : Celso Roberto Passeri ; Jacira Alves Caracik De Camargo Andrade ; Karla Thaíza Tomal ; Eduardo Marcucci Pracucho ; Livia Paschoalino De Campos ; Silvia Helena De Carvalho Sales-PeresSource :
- Arquivos Brasileiros de Cirurgia Digestiva : ABCD [ 0102-6720 ] ; 2016.
Abstract
Obesity and metabolic syndrome can be labeled as worldwide outbreak; thus, both have led to serious public health problem. Oral health can be worsened by both, obesity and metabolic syndrome. Tooth loss harms masticatory function, essential status to whom will be submitted to bariatric surgery.
Assess masticatory function of obese candidates to bariatric surgery, who belong to distinct socioeconomic class range, in order to recognize hazard factors and the bias of socioeconomic factor in this context.
Observational cross-section study, with samples comprised by two groups of patients, with distinct socioeconomic class range, one of them belonging to public health system (SUSG) and the other to private clinic (CPG), candidates to bariatric surgery. Were assessed anthropometric data, comorbidities and medicines usage, blood tests, habits and the number of dental functional units.
The groups SUSG and CPG were homogeneous taking into account gender (p=0,890) and age range (p=0,170). The number of dental functional units was higher in the private group (p<0.001). The impaired masticatory function was rather present among public group (p<0.001) and female gender (p<0,001). Regarded as blood tests, fasting glucose was higher in female in SUSG (p<0,001). The following hazard factors have corroborated to have patients rated as impaired masticatory function: belong to public service (OR: 8.420, p=0.003), higher age (OR: 1.186, p<0.001), female gender (OR: 0.153, p=0.029), diabetes mellitus (OR: 2.545, p=0.045) and smokers (OR: 2.951, p=0.043).
The general health and masticatory function of female SUSG were worse, highlighting the socioeconomic condition as hazard factor.
Url:
DOI: 10.1590/0102-6720201600S10014
PubMed: 27683777
PubMed Central: 5064279
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PMC:5064279Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM
DISTINCT SOCIOECONOMIC CLASSES</title><author><name sortKey="Passeri, Celso Roberto" sort="Passeri, Celso Roberto" uniqKey="Passeri C" first="Celso Roberto" last="Passeri">Celso Roberto Passeri</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Bauru School of Dentistry, University of São Paulo, Bauru, SP;</nlm:aff></affiliation></author><author><name sortKey="Andrade, Jacira Alves Caracik De Camargo" sort="Andrade, Jacira Alves Caracik De Camargo" uniqKey="Andrade J" first="Jacira Alves Caracik De Camargo" last="Andrade">Jacira Alves Caracik De Camargo Andrade</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Bauru School of Dentistry, University of São Paulo, Bauru, SP;</nlm:aff></affiliation></author><author><name sortKey="Tomal, Karla Thaiza" sort="Tomal, Karla Thaiza" uniqKey="Tomal K" first="Karla Thaíza" last="Tomal">Karla Thaíza Tomal</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation></author><author><name sortKey="Pracucho, Eduardo Marcucci" sort="Pracucho, Eduardo Marcucci" uniqKey="Pracucho E" first="Eduardo Marcucci" last="Pracucho">Eduardo Marcucci Pracucho</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation></author><author><name sortKey="De Campos, Livia Paschoalino" sort="De Campos, Livia Paschoalino" uniqKey="De Campos L" first="Livia Paschoalino" last="De Campos">Livia Paschoalino De Campos</name><affiliation><nlm:aff id="aff3">Botucatu Faculty of Medicine, Universidade Paulista, Botucatu, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Sales Peres, Silvia Helena De Carvalho" sort="Sales Peres, Silvia Helena De Carvalho" uniqKey="Sales Peres S" first="Silvia Helena De Carvalho" last="Sales-Peres">Silvia Helena De Carvalho Sales-Peres</name><affiliation><nlm:aff id="aff2">Bauru School of Dentistry, University of São Paulo, Bauru, SP;</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27683777</idno><idno type="pmc">5064279</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064279</idno><idno type="RBID">PMC:5064279</idno><idno type="doi">10.1590/0102-6720201600S10014</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002844</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002844</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM
DISTINCT SOCIOECONOMIC CLASSES</title><author><name sortKey="Passeri, Celso Roberto" sort="Passeri, Celso Roberto" uniqKey="Passeri C" first="Celso Roberto" last="Passeri">Celso Roberto Passeri</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Bauru School of Dentistry, University of São Paulo, Bauru, SP;</nlm:aff></affiliation></author><author><name sortKey="Andrade, Jacira Alves Caracik De Camargo" sort="Andrade, Jacira Alves Caracik De Camargo" uniqKey="Andrade J" first="Jacira Alves Caracik De Camargo" last="Andrade">Jacira Alves Caracik De Camargo Andrade</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Bauru School of Dentistry, University of São Paulo, Bauru, SP;</nlm:aff></affiliation></author><author><name sortKey="Tomal, Karla Thaiza" sort="Tomal, Karla Thaiza" uniqKey="Tomal K" first="Karla Thaíza" last="Tomal">Karla Thaíza Tomal</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation></author><author><name sortKey="Pracucho, Eduardo Marcucci" sort="Pracucho, Eduardo Marcucci" uniqKey="Pracucho E" first="Eduardo Marcucci" last="Pracucho">Eduardo Marcucci Pracucho</name><affiliation><nlm:aff id="aff1">Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</nlm:aff></affiliation></author><author><name sortKey="De Campos, Livia Paschoalino" sort="De Campos, Livia Paschoalino" uniqKey="De Campos L" first="Livia Paschoalino" last="De Campos">Livia Paschoalino De Campos</name><affiliation><nlm:aff id="aff3">Botucatu Faculty of Medicine, Universidade Paulista, Botucatu, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Sales Peres, Silvia Helena De Carvalho" sort="Sales Peres, Silvia Helena De Carvalho" uniqKey="Sales Peres S" first="Silvia Helena De Carvalho" last="Sales-Peres">Silvia Helena De Carvalho Sales-Peres</name><affiliation><nlm:aff id="aff2">Bauru School of Dentistry, University of São Paulo, Bauru, SP;</nlm:aff></affiliation></author></analytic><series><title level="j">Arquivos Brasileiros de Cirurgia Digestiva : ABCD</title><idno type="ISSN">0102-6720</idno><idno type="eISSN">2317-6326</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><sec><title>Background:</title><p> Obesity and metabolic syndrome can be labeled as worldwide outbreak; thus, both
have led to serious public health problem. Oral health can be worsened by both,
obesity and metabolic syndrome. Tooth loss harms masticatory function, essential
status to whom will be submitted to bariatric surgery. </p></sec><sec><title>Aim:</title><p> Assess masticatory function of obese candidates to bariatric surgery, who belong
to distinct socioeconomic class range, in order to recognize hazard factors and
the bias of socioeconomic factor in this context. </p></sec><sec><title>Methods:</title><p> Observational cross-section study, with samples comprised by two groups of
patients, with distinct socioeconomic class range, one of them belonging to public
health system (SUSG) and the other to private clinic (CPG), candidates to
bariatric surgery. Were assessed anthropometric data, comorbidities and medicines
usage, blood tests, habits and the number of dental functional units. </p></sec><sec><title>Results:</title><p> The groups SUSG and CPG were homogeneous taking into account gender (p=0,890) and
age range (p=0,170). The number of dental functional units was higher in the
private group (p<0.001). The impaired masticatory function was rather present
among public group (p<0.001) and female gender (p<0,001). Regarded as blood
tests, fasting glucose was higher in female in SUSG (p<0,001). The following
hazard factors have corroborated to have patients rated as impaired masticatory
function: belong to public service (OR: 8.420, p=0.003), higher age (OR: 1.186,
p<0.001), female gender (OR: 0.153, p=0.029), diabetes mellitus (OR: 2.545,
p=0.045) and smokers (OR: 2.951, p=0.043). </p></sec><sec><title>Conclusion:</title><p> The general health and masticatory function of female SUSG were worse,
highlighting the socioeconomic condition as hazard factor. </p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Anderson, La" uniqKey="Anderson L">LA Anderson</name></author><author><name sortKey="Eyler, Aa" uniqKey="Eyler A">AA Eyler</name></author><author><name sortKey="Galuska, Da" uniqKey="Galuska D">DA Galuska</name></author><author><name sortKey="Brown, Dr" uniqKey="Brown D">DR Brown</name></author><author><name sortKey="Brownson, Rc" uniqKey="Brownson R">RC Brownson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Babor, Tf" uniqKey="Babor T">TF Babor</name></author><author><name sortKey="Higgins Biddle, Jc" uniqKey="Higgins Biddle J">JC Higgins-Biddle</name></author><author><name sortKey="Saunders, Jb" uniqKey="Saunders J">JB Saunders</name></author><author><name sortKey="Monteiro, Mg" uniqKey="Monteiro M">MG Monteiro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Belle, Sh" uniqKey="Belle S">SH Belle</name></author><author><name sortKey="Chapman, W" uniqKey="Chapman W">W Chapman</name></author><author><name sortKey="Courcoulas, Ap" uniqKey="Courcoulas A">AP Courcoulas</name></author><author><name sortKey="Flum, Dr" uniqKey="Flum D">DR Flum</name></author><author><name sortKey="Gagner, M" uniqKey="Gagner M">M Gagner</name></author><author><name sortKey="Inabnet, Wb" uniqKey="Inabnet W">WB Inabnet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Benguigui, C" uniqKey="Benguigui C">C Benguigui</name></author><author><name sortKey="Bongard, V" uniqKey="Bongard V">V Bongard</name></author><author><name sortKey="Ruidavets, Jb" uniqKey="Ruidavets J">JB Ruidavets</name></author><author><name sortKey="Chamontin, B" uniqKey="Chamontin B">B Chamontin</name></author><author><name sortKey="Sixou, M" uniqKey="Sixou M">M Sixou</name></author><author><name sortKey="Ferrieres, J" uniqKey="Ferrieres J">J Ferrieres</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chalub, L" uniqKey="Chalub L">L Chalub</name></author><author><name sortKey="Borges, Cm" uniqKey="Borges C">CM Borges</name></author><author><name sortKey="Ferreira, Rc" uniqKey="Ferreira R">RC Ferreira</name></author><author><name sortKey="Haddad, Jpa" uniqKey="Haddad J">JPA Haddad</name></author><author><name sortKey="Ferreira, Efe" uniqKey="Ferreira E">EFE Ferreira</name></author><author><name sortKey="Vargas, Amd" uniqKey="Vargas A">AMD Vargas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Moura Grec, Pg" uniqKey="De Moura Grec P">PG De Moura-Grec</name></author><author><name sortKey="Yamashita, Jm" uniqKey="Yamashita J">JM Yamashita</name></author><author><name sortKey="Marsicano, Ja" uniqKey="Marsicano J">JA Marsicano</name></author><author><name sortKey="Ceneviva, R" uniqKey="Ceneviva R">R Ceneviva</name></author><author><name sortKey="De Souza Leite, Cv" uniqKey="De Souza Leite C">CV de Souza Leite</name></author><author><name sortKey="De Brito, Gb" uniqKey="De Brito G">GB de Brito</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Di Vetta, V" uniqKey="Di Vetta V">V Di Vetta</name></author><author><name sortKey="Kraytem, A" uniqKey="Kraytem A">A Kraytem</name></author><author><name sortKey="Giusti, V" uniqKey="Giusti V">V. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Arq Bras Cir Dig</journal-id><journal-id journal-id-type="iso-abbrev">Arq Bras Cir Dig</journal-id><journal-id journal-id-type="publisher-id">abcd</journal-id><journal-title-group><journal-title>Arquivos Brasileiros de Cirurgia Digestiva : ABCD</journal-title></journal-title-group><issn pub-type="ppub">0102-6720</issn><issn pub-type="epub">2317-6326</issn><publisher><publisher-name>Colégio Brasileiro de Cirurgia Digestiva</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27683777</article-id><article-id pub-id-type="pmc">5064279</article-id><article-id pub-id-type="doi">10.1590/0102-6720201600S10014</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM
DISTINCT SOCIOECONOMIC CLASSES</article-title><trans-title-group xml:lang="pt"><trans-title>FUNÇÃO MASTIGATÓRIA DE OBESOS CANDIDATOS À CIRURGIA BARIÁTRICA ORIUNDOS
DE CLASSES SOCIOECONÔMICAS DISTINTAS</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><name><surname>PASSERI</surname><given-names>Celso Roberto</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>ANDRADE</surname><given-names>Jacira Alves Caracik de Camargo</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>TOMAL</surname><given-names>Karla Thaíza</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>PRACUCHO</surname><given-names>Eduardo Marcucci</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>de CAMPOS</surname><given-names>Livia Paschoalino</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>SALES-PERES</surname><given-names>Silvia Helena de Carvalho</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label>Bariatric Surgery Service, Amaral Carvalho Hospital, Jau, SP;</aff><aff id="aff2"><label>2</label>Bauru School of Dentistry, University of São Paulo, Bauru, SP;</aff><aff id="aff3"><label>3</label>Botucatu Faculty of Medicine, Universidade Paulista, Botucatu, SP, Brazil.</aff><author-notes><corresp id="c1">Correspondence: Celso Roberto Passeri E-mail:
<email>celsopasseri@uol.com.br</email></corresp><fn fn-type="COI-statement" id="fn2"><p>Conflicts of interest: none</p></fn></author-notes><pub-date pub-type="epub-ppub"><year>2016</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><year>2016</year></pub-date><volume>29</volume><issue>Suppl 1</issue><fpage>53</fpage><lpage>58</lpage><history><date date-type="received"><day>01</day><month>3</month><year>2016</year></date><date date-type="accepted"><day>02</day><month>6</month><year>2016</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution License</license-p></license></permissions><abstract><title>ABSTRACT</title><sec><title>Background:</title><p> Obesity and metabolic syndrome can be labeled as worldwide outbreak; thus, both
have led to serious public health problem. Oral health can be worsened by both,
obesity and metabolic syndrome. Tooth loss harms masticatory function, essential
status to whom will be submitted to bariatric surgery. </p></sec><sec><title>Aim:</title><p> Assess masticatory function of obese candidates to bariatric surgery, who belong
to distinct socioeconomic class range, in order to recognize hazard factors and
the bias of socioeconomic factor in this context. </p></sec><sec><title>Methods:</title><p> Observational cross-section study, with samples comprised by two groups of
patients, with distinct socioeconomic class range, one of them belonging to public
health system (SUSG) and the other to private clinic (CPG), candidates to
bariatric surgery. Were assessed anthropometric data, comorbidities and medicines
usage, blood tests, habits and the number of dental functional units. </p></sec><sec><title>Results:</title><p> The groups SUSG and CPG were homogeneous taking into account gender (p=0,890) and
age range (p=0,170). The number of dental functional units was higher in the
private group (p<0.001). The impaired masticatory function was rather present
among public group (p<0.001) and female gender (p<0,001). Regarded as blood
tests, fasting glucose was higher in female in SUSG (p<0,001). The following
hazard factors have corroborated to have patients rated as impaired masticatory
function: belong to public service (OR: 8.420, p=0.003), higher age (OR: 1.186,
p<0.001), female gender (OR: 0.153, p=0.029), diabetes mellitus (OR: 2.545,
p=0.045) and smokers (OR: 2.951, p=0.043). </p></sec><sec><title>Conclusion:</title><p> The general health and masticatory function of female SUSG were worse,
highlighting the socioeconomic condition as hazard factor. </p></sec></abstract><trans-abstract xml:lang="pt"><title>RESUMO</title><sec><title>Racional:</title><p> Obesidade e síndrome metabólica são graves problemas de saúde pública, com
características de epidemia mundial. A saúde bucal é agravada por ambas as
condições. Perda dentária prejudica função mastigatória, condição essencial para o
paciente que será submetido à cirurgia bariátrica. </p></sec><sec><title>Objetivo:</title><p> Avaliar a função mastigatória de pacientes obesos candidatos à cirurgia
bariátrica pertencentes a dois serviços de saúde com padrões socioeconômicos
distintos, afim de identificar fatores de risco e a influência do fator
socioeconômico nesta condição. </p></sec><sec><title>Métodos:</title><p> Estudo observacional transversal, com amostra constituída por dois grupos de
pacientes obesos, com condições socioeconômicas distintas, um pertencente ao
sistema público de saúde (GSUS) e outro à clínica privada (GCP), candidatos à
cirurgia bariátrica. Foram analisados dados antropométricos, comorbidades e uso de
medicamentos para seu controle, exames laboratoriais, hábitos e o número de
unidades funcionais dentárias presentes. </p></sec><sec><title>Resultados:</title><p> Os grupos GSUS e GCP foram homogêneos quanto ao gênero (p=0,890) e faixa etária
(p=0,170). A média de unidades funcionais dentárias foi maior no grupo privado
(p<0,001). A função mastigatória prejudicada foi mais presente no grupo GSUS e
no gênero feminino (p<0,001). Quanto aos exames laboratoriais: glicemia de
jejum esteve mais alterada em mulheres do GSUS (p<0,001). Foram fatores de
risco independentes para ter função mastigatória prejudicada: ter origem no
serviço público de saúde (OR: 8,420 - p=0,003), maior idade (OR: 1,186 -
p<0,001), ser do gênero feminino (OR: 0,153 - p=0,029), portador de diabete
melito (OR: 2,545 - p=0,045) e tabagista (OR: 2,951 - p=0,043). </p></sec><sec><title>Conclusão:</title><p> A saúde geral e função mastigatória de mulheres do GSUS foram piores, ressaltando
a condição socioeconômica como fator de risco.</p></sec></trans-abstract><kwd-group><title>HEADINGS</title><kwd>Bariatric surgery</kwd><kwd>Epidemiologic Factors</kwd><kwd>Hematologic tests</kwd><kwd>Obesity</kwd><kwd>Oral health</kwd></kwd-group><counts><fig-count count="0"></fig-count><table-count count="6"></table-count><equation-count count="0"></equation-count><ref-count count="31"></ref-count><page-count count="6"></page-count></counts></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Obesity and metabolic syndrome are considered serious public health problems worldwide
and 2.8% of the world Gross Domestic Product is spent due to excessive fat<xref rid="B8" ref-type="bibr"><sup>8</sup></xref>. In Brazil, 52.5% of the population is overweight, indicating the urge for a
more intense investment inside the health system in the decades to come<xref rid="B22" ref-type="bibr"><sup>22</sup></xref>. This condition can trigger a myriad of related diseases, being responsible for
patient's autonomy loss and one of the most important death causes around the world<xref rid="B3" ref-type="bibr"><sup>3</sup></xref>.</p><p>Due to the lack of efficient long-term clinic treatments against overweight and
comorbidity control, bariatric surgery has become a safe and effective alternative<xref rid="B23" ref-type="bibr"><sup>23</sup></xref>.</p><p>Series of changes in oral health of obese patients have been released in literature,
such as: caries, periodontal disease, xerostomy, dental loss and dental abrasion,
showing that there is a strict relation between obesity, metabolic syndrome and oral
health, as well as the bariatric surgeries effects on it<xref rid="B4" ref-type="bibr"><sup>4</sup></xref><sup>,</sup><xref rid="B6" ref-type="bibr"><sup>6</sup></xref><sup>,</sup><xref rid="B27" ref-type="bibr"><sup>27</sup></xref><sup>,</sup><xref rid="B29" ref-type="bibr"><sup>29</sup></xref><sup>,</sup><xref rid="B30" ref-type="bibr"><sup>30</sup></xref>. The main reasons for dental loss in non-obese population are periodontal
disease and caries<xref rid="B10" ref-type="bibr"><sup>10</sup></xref><sup>,</sup><xref rid="B20" ref-type="bibr"><sup>20</sup></xref>. Obesity and metabolic syndrome raised the incidence and speed up the evolution
of these oral diseases<sup>4,27,29,30.</sup></p><p>Masticatory function has great importance to obese who are candidates for bariatric
surgery. Pre-operative protocols evince the need for changes on alimentary habits,
including an effective chewing that allows better adaptation to the future new anatomic
condition of the alimentary canal. These actions can avoid food deviation, which can
lead to a decrease in the patients' wellness<xref rid="B7" ref-type="bibr"><sup>7</sup></xref><sup>,</sup><xref rid="B9" ref-type="bibr"><sup>9</sup></xref><sup>,</sup><xref rid="B15" ref-type="bibr"><sup>15</sup></xref><sup>,</sup><xref rid="B26" ref-type="bibr"><sup>26</sup></xref>.</p><p>Efficient masticatory function is strictly related to both quantity of existing
functional dental unities and masticatory cycle<xref rid="B28" ref-type="bibr"><sup>28</sup></xref>. Functional unity means the tooth that has an antagonist, allowing mastication.
It has been shown that the minimum number of eight masticatory functional unities is
important for keeping of the efficient masticatory function, allowing the patient's
adaptation to the increase of masticatory dynamics<xref rid="B13" ref-type="bibr"><sup>13</sup></xref>. These concepts show the requirement for identification of people who suffer
from impaired masticatory function in bariatric surgical programs.</p><p>Socioeconomic condition influences both oral health and obesity<xref rid="B5" ref-type="bibr"><sup>5</sup></xref><sup>,</sup><xref rid="B21" ref-type="bibr"><sup>21</sup></xref><sup>,34</sup>. In order to assess this variable's effect on obese patients who are
bariatric surgery candidates, different groups were investigated: on one side, people
with better socioeconomic conditions and higher access to health care, belonging to the
private system; on the other side, people with a bad socioeconomic condition and lower
access to health care, belonging to the public health system.</p><p>This study's goal was to verify if there is a difference between both groups regarding
the amount of dental unities and consequent impairment of the masticatory function. It
also aimed to identify which epidemiological, anthropometric and laboratory parameters
correlate to this possible difference. </p></sec><sec sec-type="methods"><title>METHODS</title><p>The Hospital Amaral Carvalho's Ethics Committee in Research, sentence number 1,005,103,
has approved this study.</p><p>A cross-sectional observational study was accomplished on applicant patients to
bariatric surgery, attended in a row, between June/2010 and December/2014. These
patients have completed the pre-operative preparation, attended by the same
multi-professional team, however being from different health services and with distinct
socioeconomic standards. One group belonged to private practice (PCG) with average
monthly income over six minimum salaries. The other group belonged to the public system
(SUSG) with average monthly income of less than two minimum salaries.</p><p>Electronic charts were assessed and data regarding socio-demographic, anthropometric,
laboratory, comorbidities, medicine use, habits and number of functional units were
collected.</p><p>The anthropometric data assessed were: age rated in three ranges (17 to 29, 30 to 45 and
over 45); gender and marital status, also rated in three categories (single, married/in
a stable union, widower/divorced); weight, height and body mass index (BMI) categorized
in three ranges (35 to 39.9, 40 to 49.9 and over 50 kg/m<sup>2</sup>).</p><p>Regarding laboratory exams data, only values outside the normal range were taken into
account, according to the standard settled by the laboratory responsible for the
examination in both groups. Were assessed hemoglobin, hematocrit, ferritin, total
proteins, albumin, total cholesterol, triglycerides and fasting glucose.</p><p>The presence of obesity related comorbidities was studied, such as arterial
hypertension, diabetes mellitus, obstructive sleep apnea, arthropathy and metabolic
syndrome. It was also studied the number of daily prescribed medicine according to its
pharmacological class, in order to comorbidity control (antihypertensive, oral
hypoglycemic, insulin, statins, diuretics, vasodilators and antiplatelet).</p><p> Patients who either made use of tobacco in the treatment meantime or who has smoked 10
cigarettes per day throughout 10 years were labeled as smokers. Alcoholism was evaluated
on the AUDIT<xref rid="B2" ref-type="bibr"><sup>2</sup></xref> scale (The Alcohol Use Disorders Identification Test), being considered present
if the score is 16 or over, and absent if the score is 15 or under.</p><p>The number of functional dental units was assessed in a clinic exam accomplished by the
bariatric surgeon. Godlewski's criteria<xref rid="B13" ref-type="bibr"><sup>13</sup></xref> were used, which considers as efficient masticatory function carrier patients
with eight or more functional dental units. Patients with seven or less units were
considered inefficient masticatory function carriers.</p><p>Ultimately, it was assessed the period (in days) between the first medical appointment
and the bariatric surgery's accomplishment date, being rated in three ranges: between 0
and 180; between 181 and 365; and over 365 days.</p><sec><title>Statistical analysis</title><p>Was accomplished using IBM SPSS 19 program (Chicago - USA). Regarding continuous
variables, the data's descriptive analysis was done through the average's calculation
and its respective pattern deviations. The analysis regarding categorical variable
was done through presentation of absolute and relative frequencies. In order to
verify the distributions' normality, Kolmogorov-Smirnov's test was applied.
Comparisons between the averages were accomplished using analysis of variance test
(ANOVA) for continuous variables. Chi-square test was used for the assessment of
categorical variables. The meaningfulness level applied was of 5% (p<0.05). The
study regarding the relation between anthropometric, clinics, habits, origins service
variables and the number of functional dental units was accomplished by the multiple
logistic regression. In order to assess which of these variables independently
interfered with the masticatory function, the multiple logistic regression was
supplemented with gaps ranging until 95% trust for the risk ratios (OR)<xref rid="B14" ref-type="bibr"><sup>14</sup></xref>. The sample was subdivided into four groups according to the origin service
(SUSG or PCG) and the masticatory condition (impaired or efficient) in order to
correlate them with gender, age range, marital status and waiting time for the
surgery. Goodman's correlation test was applied<xref rid="B12" ref-type="bibr"><sup>12</sup></xref> with a meaningfulness level of 5%. The association between altered
laboratorial tests, origin services and number of functional dental units was
accomplished using Goodman's association test. It was also complemented with multiple
comparisons between and within multinomial populations, considering 5% of
meaningfulness level<xref rid="B12" ref-type="bibr"><sup>12</sup></xref>.</p></sec></sec><sec sec-type="results"><title>RESULTS</title><p>The private system (PCG) was composed by 141 patients [male: 25 (17.7%) and female: 116
(82.3%)], while the public system (SUSG) was composed by 267 patients [male: 45 (16.9%)
and female: 222 (83.1%)]. Both systems were homogenous regarding gender (p=0.890) and
average age (p=0.174), with predominance of female gender in both of 4.8:1 (p<0.001).
The age range between 17 and 29 years old was predominant in female PPG (p=0.037); the
rest had similar distribution between services.</p><p>Regarding marital status, the category "single" was predominant in female SUSG
(p=0.009). The rest was distributed evenly.</p><p>The average weight, overweight and BMI were higher in SUSG in both genders (male and
female: p<0.001). Inside PCG and SUSG, male gender has shown higher indexes than
female (p<0.001).</p><p>The average number of dental functional units in PCG, in both genders, showed the
highest average compared to SUSG (p<0.001). In SUSG, male gender showed higher
average compared to female gender (p=0.008). When comparing both groups regarding
impaired masticatory function (≤7 functional units) and efficient masticatory function
(≥8 functional units), the impaired function was more present in female SUSG
(p<0.001) and the efficient one in female PCG (p<0.001). Inside SUSG, the male
gender showed predominance of efficient masticatory function when compared to female
gender (p=0.036).</p><p>Smoking didn't show different incidence between both services, while alcoholism showed
predominance in SUSG when compared to PCG (0.014). Male gender showed higher alcoholism
rate in both services [PCG (p=0.031) and SUSG (p<0.001)].</p><p>The average number of patients who made use of medicine showed homogenous distribution
in both services and genders. However, the average of medicine used by pharmacological
class was higher in female SUSG (p<0.001).</p><p>Laboratorial tests didn't show difference between both services regarding hemoglobin,
hematocrit, ferritin, total cholesterol and triglycerides. Total proteins and albumin
were more frequently outside standard values in PCG (p=0.045 and p=0.040 respectively).
Fasting glucose was more altered in female SUSG (p<0.001), while in PCG it was more
altered in male gender than female (p=0.012).</p><p>Comorbidities presence was higher in female SUSG: arterial hypertension (p=0.005),
diabetes mellitus (p=0.006), sleep apnea (p=0.004) and metabolic syndrome (p<0.001).
Inside the private system (PCG), the male gender showed higher frequency of arterial
hypertension (p=0.022), sleep apnea (p=0.003) and metabolic syndrome (p=0.003).
Arthropathy was more frequent in PCG when compared to SUSG in both genders (male:
p=0.042 and female: p=0.007).</p><p> The average period between the first medical appointment and the surgery's
accomplishment date was higher in female SUSG (p<0.001). Regarding the period range,
the one between 0 and 180 days was predominant in female PCG (p<0.001) and the one
over 365 days was predominant in female SUSG (<0.001).</p><p>This sample features that: being from public service (p=0.003), advanced age
(p<0.001), being female (p=0.029), suffer from diabetes (p=0.045) and being smoker
(p=0.043) were independent risk factors that can trigger impaired masticatory
function.</p><p>It is able to assert that the female gender was predominant in all four groups. Patients
with efficient masticatory function were more frequent in PCG in both genders. Impaired
masticatory function, both in PCG and in SUSG, was predominant in over 45 years old
range. Within the range between 30 and 45, public system patients' percentage was higher
when compared to private system patients also regarding impaired masticatory function.
In the age range between 17 and 29 years old, no patients with impaired masticatory
function were found. When compared public and private systems, no statistic significance
between the groups regarding marital status was found. Single people with efficient
masticatory function are predominant in both private and public systems. Married/in a
stable union people with efficient masticatory function were predominant in PCG, while
in SUSG were predominant with impaired masticatory function. When comparing the waiting
time between the first medical appointment and the surgery's date in SUSG, over 365 days
range was predominant between patients with impaired masticatory function. In PCG,
patients with efficient masticatory function were more frequent in the range between 0
and 180 days.</p><p><table-wrap id="t1" orientation="portrait" position="float"><label>TABLE 1</label><caption><title>Distribution of sociodemographic, anthropometric, number of functional
dental unities, laboratorial tests, habits, medicines in usage, comorbidities,
period between first appointment and surgery date variable distribution
according to origin services and gender</title></caption><graphic xlink:href="0102-6720-abcd-29-s1-00053-gt1"></graphic><table-wrap-foot><fn id="TFN1"><p>χ2 = Chi-Square ; p<0,05</p></fn></table-wrap-foot></table-wrap></p><p><table-wrap id="t2" orientation="portrait" position="float"><label>TABLE 2</label><caption><title>Multiple logistic regression of the functional dental units quantity taking
into account sociodemographic, anthropometric, habits and clinical data</title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col></colgroup><tbody><tr><td align="center" rowspan="1" colspan="1">Variable</td><td align="center" rowspan="1" colspan="1">Logistic regression coefficient
(EP)</td><td align="center" rowspan="1" colspan="1">Odds Ratio (OR)</td><td align="center" rowspan="1" colspan="1">p</td><td align="center" rowspan="1" colspan="1">CI (OR)</td></tr><tr><td align="left" rowspan="1" colspan="1">Regression constant</td><td align="center" rowspan="1" colspan="1">- 9.939 (2.477)</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Origen service
(Public/Private)</td><td align="center" rowspan="1" colspan="1">2.131 (0.718)</td><td align="center" rowspan="1" colspan="1">8.420</td><td align="center" rowspan="1" colspan="1">0.003</td><td align="center" rowspan="1" colspan="1">(2.062; 34.385)</td></tr><tr><td align="left" rowspan="1" colspan="1">Age (years)</td><td align="center" rowspan="1" colspan="1">0.170 (0.0295)</td><td align="center" rowspan="1" colspan="1">1.186</td><td align="center" rowspan="1" colspan="1"><0.001</td><td align="center" rowspan="1" colspan="1">(1.119; 1.256)</td></tr><tr><td align="left" rowspan="1" colspan="1">Gender (male/female)</td><td align="center" rowspan="1" colspan="1">- 1.878 (0.859)</td><td align="center" rowspan="1" colspan="1">0.153</td><td align="center" rowspan="1" colspan="1">0.029</td><td align="center" rowspan="1" colspan="1">(0.0284; 0.823)</td></tr><tr><td align="left" rowspan="1" colspan="1">Waiting time for surgery
(days)</td><td align="center" rowspan="1" colspan="1">0.00143 (0.000666)</td><td align="center" rowspan="1" colspan="1">1.001</td><td align="center" rowspan="1" colspan="1">0.032</td><td align="center" rowspan="1" colspan="1">(1.00; 1.003)</td></tr><tr><td align="left" rowspan="1" colspan="1">BMI (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">- 0.0967 (0.0987)</td><td align="center" rowspan="1" colspan="1">0.908</td><td align="center" rowspan="1" colspan="1">0.327</td><td align="center" rowspan="1" colspan="1">(0.748; 1.102)</td></tr><tr><td align="left" rowspan="1" colspan="1">Overweight (kg)</td><td align="center" rowspan="1" colspan="1">0.0421 (0.0384)</td><td align="center" rowspan="1" colspan="1">1.043</td><td align="center" rowspan="1" colspan="1">0.272</td><td align="center" rowspan="1" colspan="1">(0.967; 1.124)</td></tr><tr><td align="left" rowspan="1" colspan="1">Hypertension (Absent /
Present)</td><td align="center" rowspan="1" colspan="1">- 0.303 (0.551)</td><td align="center" rowspan="1" colspan="1">0.739</td><td align="center" rowspan="1" colspan="1">0.583</td><td align="center" rowspan="1" colspan="1">(0.251; 2.177)</td></tr><tr><td align="left" rowspan="1" colspan="1">Obstructive sleep apnea ((Absent /
Present)</td><td align="center" rowspan="1" colspan="1">- 0.276 (0.478)</td><td align="center" rowspan="1" colspan="1">0.759</td><td align="center" rowspan="1" colspan="1">0.564</td><td align="center" rowspan="1" colspan="1">(0.297; 1.938)</td></tr><tr><td align="left" rowspan="1" colspan="1">Diabetes Mellitus (Absent /
Present)</td><td align="center" rowspan="1" colspan="1">0.934 (0,466)</td><td align="center" rowspan="1" colspan="1">2.545</td><td align="center" rowspan="1" colspan="1">0.045</td><td align="center" rowspan="1" colspan="1">(1.021; 6.342)</td></tr><tr><td align="left" rowspan="1" colspan="1">Arthropaties (Absent /
Present)</td><td align="center" rowspan="1" colspan="1">- 0.253 (0.828)</td><td align="center" rowspan="1" colspan="1">0.777</td><td align="center" rowspan="1" colspan="1">0.760</td><td align="center" rowspan="1" colspan="1">(0.153; 3.933)</td></tr><tr><td align="left" rowspan="1" colspan="1">Smoking (Absent / Present)</td><td align="center" rowspan="1" colspan="1">1.082 (0,535)</td><td align="center" rowspan="1" colspan="1">2.951</td><td align="center" rowspan="1" colspan="1">0.043</td><td align="center" rowspan="1" colspan="1">(1.035; 8.414)</td></tr><tr><td align="left" rowspan="1" colspan="1">Alcoholism (Absent / Present)</td><td align="center" rowspan="1" colspan="1">0.758 (1.067)</td><td align="center" rowspan="1" colspan="1">2.134</td><td align="center" rowspan="1" colspan="1">0.477</td><td align="center" rowspan="1" colspan="1">(0.264; 17.280)</td></tr><tr><td align="left" rowspan="1" colspan="1">Number of medicines usage</td><td align="center" rowspan="1" colspan="1">0.0187 (0.0992)</td><td align="center" rowspan="1" colspan="1">1.019</td><td align="center" rowspan="1" colspan="1">0.851</td><td align="center" rowspan="1" colspan="1">(0.839; 1.238)</td></tr></tbody></table><table-wrap-foot><fn id="TFN2"><p>Hosner & Lemeshow; confidence interval 95% for OR</p></fn></table-wrap-foot></table-wrap></p><p><table-wrap id="t3" orientation="portrait" position="float"><label>TABLE 3</label><caption><title>Impaired and efficient masticatory function percentage regarding the
variables: gender, age range, marital status and waiting time for the surgery,
separating both SUSG and PCG.</title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="1"></col><col span="4"></col></colgroup><tbody><tr><td align="center" rowspan="2" colspan="1">Variable</td><td align="center" colspan="4" rowspan="1">Origen service x masticatory
function </td></tr><tr><td align="center" rowspan="1" colspan="1">Private impaired (3 cases)</td><td align="center" rowspan="1" colspan="1">Private efficient (138
cases)</td><td align="center" rowspan="1" colspan="1">Public impaired (42 cases)</td><td align="center" rowspan="1" colspan="1">Public efficient (225 cases)</td></tr><tr><td align="center" rowspan="1" colspan="1">Gender Male Female</td><td align="center" rowspan="1" colspan="1"> 0 100 ¶</td><td align="center" rowspan="1" colspan="1"> 18,1 # 81,9¶ # </td><td align="center" rowspan="1" colspan="1"> 7,1 92,9 ¶</td><td align="center" rowspan="1" colspan="1"> 18,7 81,3 ¶</td></tr><tr><td align="center" rowspan="1" colspan="1">Age ranges (years) (1) 17 a 29
(2) 30 a 45 (3) > 45 </td><td align="center" rowspan="1" colspan="1"> 0 0 100 ¤</td><td align="center" rowspan="1" colspan="1"> 27,9 # 50 ∆ 22,1 #</td><td align="center" rowspan="1" colspan="1"> 0 26,2 v ∆ 73,8 v ∆</td><td align="center" rowspan="1" colspan="1"> 22,2 # 56,9 # ∆ 20,9 #</td></tr><tr><td align="center" rowspan="1" colspan="1">Marital Status Single Marriage
/Cohabiting Split / Div / Widow</td><td align="center" rowspan="1" colspan="1"> 0 66,7 33,3</td><td align="center" rowspan="1" colspan="1"> 27 # ∂ 65,7 ∞ 7,3 x</td><td align="center" rowspan="1" colspan="1"> 14,3 64,3 ∞ 21,4</td><td align="center" rowspan="1" colspan="1"> 31,1 ∂ 60,4 8,4 x</td></tr><tr><td align="center" rowspan="1" colspan="1">Waiting time (days) ≤ 180 181 a
365 > 365 </td><td align="center" rowspan="1" colspan="1"> 0 66,7 33,3 </td><td align="center" rowspan="1" colspan="1"> 34,8 # 41,3 23,9</td><td align="center" rowspan="1" colspan="1"> 4,8 26,2 69 ∏</td><td align="center" rowspan="1" colspan="1"> 18,7 #v¢ 41,8 39,6 #v</td></tr></tbody></table><table-wrap-foot><fn id="TFN3"><p>Goodman association test p< 0.05;¶ male x female; # impaired x efficient;
v private x public; ¤ age range 3 x the others; ∆ age range 1 x age range 2;
∂ singles x marriages and cohabiting, divorced and widows; ∶ marriages and
cohabiting x splits, divorced and widows; ∞ marriages and cohabiting x
splits, divorced and widows; ∴ > 365 x the others; ∏ ≤ 180 x the
others</p></fn></table-wrap-foot></table-wrap></p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>The results achieved concluded that the obese applicants for bariatric surgery with
rather graver cases of dental loss in the first appointment and consequently worst
masticatory function showed the following features: from SUSG, female gender, advanced
age, diabetes mellitus carrier and smoker. This condition led to a more lingering period
from the first medical appointment until the surgery's accomplishment date. These facts
evince that socioeconomic condition is strictly associated with the patient's systemic
and oral health.</p><p>The female gender was predominant in both private and public systems. The research
showed difference in the results of several weight loss treatments between the male and
female genders, the first one being more efficient both in weight loss and maintenance
after the loss<xref rid="B25" ref-type="bibr"><sup>25</sup></xref>. Another prospective longitudinal study showed the difference between male and
female genders regarding the evolutionary pattern of weight gain throughout the
following decades after the surgery was undergone, with progression of overweight and
obesity. BMI increase and abdominal circumference enlargement were higher in young
adults when compared to elders in both genders, being even more intense on women. After
the sixth decade, this gain ceased in men and maintained progressive in women. Besides
that, central obesity was more prevalent in female gender, what increases the risk of
comorbidities<xref rid="B16" ref-type="bibr"><sup>16</sup></xref>. In Brazil, the differences in the association of dental loss with obesity among
old adults were shown, where the incidence of central obesity is higher than general
obesity<xref rid="B24" ref-type="bibr"><sup>24</sup></xref>. There is a relation between central obesity and edentulousness, while this
relation doesn't occur in general obesity. Moreover, it has been proven that edentulous
women have a higher chance of suffering from obesity when compared to men. These data
indicate the importance of searching for bariatric surgery and the reasons for the low
conditions of general and oral health in female patients.</p><p>It was established in the study that the average age in both SUSG and PCG were similar,
being predominant in the fourth decade. This fact can be explained using some clinic
observations done during the medical appointments: unsuccessful attempts to clinic
treatments, obesity gained throughout pregnancies, concluded reproductive cycle in women
and onset of comorbidities clinical manifestations. All these features can lead the
patient to try the bariatric surgery. A study released showed that the main reason for
pursuing weight loss by American women over 40 was corporal image (nine times more than
clinical health). Many of these patients had, in their previous history, frustrated
attempts to clinical treatment against obesity, triggering the search for surgical
treatment within intermediate age range. The main factor that unleashed obesity was
consecutive pregnancies<xref rid="B1" ref-type="bibr"><sup>1</sup></xref>.</p><p>The categorization by age range showed that the youngest group (17 to 29 years old) was
prevalent in female PCG (p=0.037). The psychosocial inclusion and the willingness to
have a better corporal image in this age range are factors that can explain the young
women's interest in bariatric surgery<xref rid="B11" ref-type="bibr"><sup>11</sup></xref>.</p><p>Age was an independent risk factor regarding impaired masticatory function. Every year
the patient ages, the possibility of carrying impaired masticatory function grows 1.186
times (p<0.001). No patients carrying impaired masticatory function were found in
both SUSG and PCG within the age range between 17 and 29 years old.</p><p>Regarding marital status, the group married/in a stable union was prevalent in the
sample, with 64% of total. The correlation between marital status and masticatory
condition showed that single patients have a higher frequency of efficient masticatory
function. Age range could have biased this data, since the single group is concomitant
with the youngest population of the sample.</p><p>The initial weight, BMI and overweight averages were higher in SUSG than PCG
(p<0.05). Many studies show the paradox between bad socioeconomic condition and the
higher obesity incidence. The phenomenon poverty/obesity has been sorely studied and
some data have been released in order to attempt to explain it. Both the easy access to
industrialized food, with high calorific values and low prices, and expensive cost of
doing physical exercises (gym and sport goods) could be implicated in this
phenomenon<xref rid="B31" ref-type="bibr"><sup>31</sup></xref>.</p><p>Level II obesity carriers were prevalent in female PCG, evincing a more premature search
for the surgery. The psychosocial pressure and the easy access to healthcare can maybe
explain this fact. Meanwhile, super-obesity was predominant in SUSG in both genders.
This data confirms previous studies that relate bad socioeconomic conditions to obesity
and harder access to health system<xref rid="B31" ref-type="bibr"><sup>31</sup></xref>.</p><p>The correlation between BMI, overweight and masticatory function condition hasn't
reached any statistic meaning in this sample. The relation between obesity and general
and oral health condition has already been showed in previous studies<xref rid="B27" ref-type="bibr"><sup>27</sup></xref><sup>,</sup><xref rid="B29" ref-type="bibr"><sup>29</sup></xref>. This fact can be explained by the inexistence of patients in the standard
weight range, it means the unanimous presence of obesity patients in the sample who are
exposed to the same risk condition.</p><p>Efficient masticatory condition is primordial to a patient who will be undergone to
bariatric surgery<xref rid="B7" ref-type="bibr"><sup>7</sup></xref><sup>,</sup><xref rid="B9" ref-type="bibr"><sup>9</sup></xref>. When all the patients' dentition was assessed, the average number of function
dental unities was higher in PCG than SUSG in both genders (p<0.001). When assessed
the number of patients who carries impaired masticatory function, this group was higher
in female SUSG, showing a worse oral health condition. When assessed the number of
patients with efficient masticatory function, this group was higher in PCG, without
gender distinction. Studies released showed the existence of a strict interaction
between oral health (mainly periodontal disease) and obesity, getting even worse when
associated with metabolic syndrome<xref rid="B4" ref-type="bibr"><sup>4</sup></xref><sup>,</sup><xref rid="B29" ref-type="bibr"><sup>29</sup></xref><sup>,</sup><xref rid="B30" ref-type="bibr"><sup>30</sup></xref>. The main etiologies that favor dental loss in adults are periodontal disease
and dental caries<xref rid="B20" ref-type="bibr"><sup>20</sup></xref>. The female SUSG showed higher obesity level when compared to female PCG,
besides higher number of patients who suffer from associated comorbidities, such as
diabetes mellitus and metabolic syndrome. The number of functional dental unities loss
was also higher, evincing worse systemic and oral health. This data was corroborated to
similar findings in other studies, highlighting the strict relation between systemic and
oral health conditions<xref rid="B19" ref-type="bibr"><sup>19</sup></xref>.</p><p>Since female SUSG has fewer number of functional dental units e and more patients who
carry diabetes mellitus (p=0.006) and metabolic syndrome (p<0.001), it is wondered if
obesity and metabolic syndrome are triggered by oral health condition or vice-versa.
Longitudinal studies must be conducted in order to enlighten this relation.</p><p>The habit of smoking showed a homogenous distribution between the services (SUSG and
PCG) and genders. The harmful aspect of this habit in periodontal disease is already
known. Periodontal disease receives multifactorial influence in its evolution, including
access to the treatment, nourishing habits and systemic health conditions. In this
sample, for instance, diabetes mellitus and metabolic syndrome were more present in
female PSG, being the habit of smoking only an adding factor in periodontal disease's
evolutionary process<xref rid="B18" ref-type="bibr"><sup>18</sup></xref>.</p><p>Furthermore, the habit of smoking was an independent risk factor in the sample, when
smokers had a 2.9 times higher probability of carrying impaired masticatory function.
This variable has been established in literature as negative influence factor in the
evolution of oral pathologies, therefore acting as contributor to functional dental
unities loss<xref rid="B18" ref-type="bibr"><sup>18</sup></xref>.</p><p>Alcoholism was higher in SUSG when assessed in the total sample (p=0.014). It was also
higher in male gender both in PCG (p=0.031) and SUSG (p<0.001). Alcoholism didn't
reach statistic meaning regarding the risk of impaired masticatory function. Maybe this
fact is explained due to the higher incidence of alcoholism in male gender, which is
less represented in the total sample, what hinders statistic analysis.</p><p> The laboratory tests assessment showed that unusual fasting glucose dosages were more
frequent in female SUSG (p<0.001). The data also showed that the number of patients
with unusual fasting glucose dosages was higher in SUSG with impaired mastication
(p<0.05). It's known that diabetes mellitus has a strict relation with periodontal
disease, which is one of the main causes of dental loss in adults. So it's possible to
conclude that the data collected are in consonance with dental and medical
literatures<xref rid="B4" ref-type="bibr"><sup>4</sup></xref>. </p><p>The presence of comorbidities wasn't homogenous neither in the origin services nor in
the genders. Arterial hypertension (p=0.005), diabetes mellitus (p=0.006), obstructive
sleep apnea (p=0.004) and metabolic syndrome (p=0.001) were prevalent in female SUSG.
All these diseases are strictly related to the obesity level and the evolution time of
the patient's obese condition<xref rid="B30" ref-type="bibr"><sup>30</sup></xref>. Diabetes mellitus was the only comorbidity that had statistic meaningfulness as
independent risk factor to impaired masticatory function (p=0.045). As it was mentioned
before, this comorbidity has an intimate relation with periodontal disease, what
triggers dental loss in adults<xref rid="B4" ref-type="bibr"><sup>4</sup></xref>.</p><p>The carriage of arterial hypertension (p=0.583), obstructive sleep apnea (p=0.564) and
arthropathy (p=0,760) wasn't an independent risk factor with statistic meaning to
impaired masticatory function.</p><p>The average waiting time from the first medical appointment until the surgery
accomplishment date was higher in SUSG (p<0.001), which also had higher number of
patients who lingered more than 365 days until the surgery (p<0.001). The surgeries
accomplished until 180 days were higher in female PCG (p<0.001). All analysis had
done so far show consistency in the information. Both bariatric surgery services (SUSG
and PCG) are conducted by the same multi-professional team and follow the same
pre-operative norms, where no scheduling restriction according to the origin service is
done. It's important to highlight that, in both services, no surgery is accomplished
before all clinic alterations detected are treated. Adding to that, the patients who
carry impaired masticatory function are advised to amend its condition.</p><p>The waiting time in the range above 365 days was prevalent in patients from SUSG with
impaired masticatory function, according to the association test. Patients from PCG with
efficient masticatory function have prevalence of the time range until 180 days.</p><p>The patients from SUSG showed the risk 8.4 times higher of carrying impaired masticatory
function when compared to PCG patients. The results reached in this study corroborates
to literature data, which show the influence of socioeconomic condition in systemic and
oral health.</p><p>Some limitations of methodological genus must be mentioned. The first one is guided in
the study's type, which was observational transversal, what limits the facts triggering
analysis. The second one relates to laboratorial tests of cholesterol fraction in
patients from SUSG, which in sake of this test's high cost, only was compared total
values. That factor limited one of the parameters analysis (HDL cholesterol dosage) used
in the metabolic syndrome's diagnosis.</p><p>Prospective studies should be accomplished in order to measure the impact of masticatory
function rehabilitation in bariatric surgery results, regarding weight loss,
comorbidities control and wellness.</p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>The variables which showed relation to impaired masticatory function were: origin
service, age, gender, diabetes mellitus and smoking, all of them triggering off a
lingering waiting time for the surgery. This finding indicates that women from public
service (with worse socioeconomic condition), with advanced age, smokers and diabetes
mellitus carriers demand more attention coming from multi-professional teams, regarding
systemic and oral health. If this measure is taken in the beginning of the surgery
preparation, it could avoid lingering waiting time for its accomplishment. </p></sec></body><back><fn-group><fn fn-type="supported-by" id="fn1"><p>Financial source: none</p></fn></fn-group><ref-list><title>REFERENCES </title><ref id="B1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Anderson</surname><given-names>LA</given-names></name><name><surname>Eyler</surname><given-names>AA</given-names></name><name><surname>Galuska</surname><given-names>DA</given-names></name><name><surname>Brown</surname><given-names>DR</given-names></name><name><surname>Brownson</surname><given-names>RC</given-names></name></person-group><article-title>Relationship of satisfaction with body size and trying to lose weight
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