Psychopathologies and socioeconomic status as risk indicators for periodontitis: a survey-based investigation in German dental practices.

OBJECTIVES: Periodontitis is a highly prevalent multifactorial disease associated with various mental disorders. However, study results about this association are still contradictory. One methodological reason could be the neglect of potential confounders, such as socioeconomic factors or mental comorbidity. Our study examined a wide range of potential psychosocial risk indicators to identify those with relevant associations to periodontitis. MATERIALS AND METHODS: In a cross-sectional study, 111 patients with periodontitis (PERIO) (> 30% teeth with approximal attachment loss ≥ 5 mm) and 110 patients without periodontitis (NON-PERIO) were recruited in four dental practices in Germany. Clinical attachment loss, pocket depth, plaque, bleeding on probing, and DMFT were measured. Psychopathologic symptoms and socioeconomic status were recorded using self-report questionnaires (DAS, PHQ-8, GAD-7, CTS, SCOFF, AUDIT, FTND, SSS-8, SES). RESULTS: The PERIO group reported significantly lower socioeconomic status (Cohen's d = 0.49) and higher psychopathological symptom burden than the NON-PERIO regarding dental anxiety (d = 0.86) and avoidance behavior, nicotine dependency (d = 0.84), depressiveness (d = 0.46), general anxiety (d = 0.45), somatic symptoms (d = 0.42), and childhood traumatization (d = 0.34). No significant group differences existed for alcohol abuse and eating disorders. Dental anxiety was the strongest predictor of periodontitis and showed significant correlations with other psychopathologies and social status. CONCLUSIONS: Out of all psychosocial factors, socioeconomic status and dental anxiety showed the greatest association with periodontitis. CLINICAL RELEVANCE: Dentists should encourage socially disadvantaged and dentally anxious patients in the utilization of prevention and dental care. Furthermore, physicians and psychotherapists can contribute to the early detection of dental anxiety, oral diseases, and avoidance behavior.

Gender-Specific Relation Between Olfactory Sensitivity and Disgust Perception.

The perception of disgust is a powerful but yet puzzling emotion, aiming at the prevention of potential microbial pathogens and being directly linked to olfactory processing in its neurophysiological pathways via the anterior insular cortex. In sample of healthy participants with a natural variation in olfactory function, we investigated the relation between olfactory sensitivity and disgust perception. A total of 123 healthy individuals were surveyed with a disgust sensitivity questionnaire. Olfactory threshold was assessed in all participants using the Sniffin' Sticks. Additionally, tactile 2-point discrimination threshold was tested in a subgroup of the participants as a controlling factor for the specificity of the relationship between olfactory sensitivity and disgust. Only in men, a significant relation between disgust ratings and olfactory threshold was observed. Men with high olfactory sensitivity reported as high levels of disgust as female participants, while men with low olfactory sensitivity reported significantly lower disgust than women. There was no such relation for tactile sensitivity. Investigating sensory subscales of the disgust questionnaire, olfactory sensitivity was related to olfactory and tactile, but not to visual disgust ratings. In conclusion, there is a specific relation between the level of disgust and olfactory sensitivity in men, who generally present lower values of disgust than women. When disgust ratings are low, there seems to be an additional merit in the ability to perceive subtle olfactory stimuli. Thus high olfactory sensitivity may facilitate the perception of potential pathogenic threats and contribute to the evolutionary function of disgust as disease avoidance mechanism.

[Domestic Violence and Intimate Partner Violence - a Challenge within the Health Care Sector - Result of a Survey Among Physicians]. / Häusliche Gewalt und Partnerschaftsgewalt ­ eine Herausforderung im Gesundheitssektor.

Domestic violence evidently endangers health. Since physicians are seen as primary contact persons by victims of violence it is necessary to understand their perception of their role. 1346 of all physicians and dentists registered in 2015 with the Saxony Board of Physicians filled in a questionnaire on contact with victims, knowledge on support structures and willingness to take part on specific medical education. Frequency of contact was estimated to be low, while readiness to approach patients in case of suspicion was high. There was uncertainty about where to refer, as well as a limited level of awareness of existing support structures. Most indicated a high request in further education. In conclusion, motivation and readiness contrast with uncertainty and lack of awareness. Education focusing on key players and major network interfaces should endorse physicians in their significant role within the care and prevention system of violence.

The association between socioeconomic status, psychopathological symptom burden in mothers, and early childhood caries of their children.

OBJECTIVES: Various maternal mental disorders and socioeconomic status [SES] are discussed as risk factors for early childhood caries [ECC]. In our study, we examined a wide range of symptoms of mental disorders with the aim to identify those maternal psychopathological symptom burdens [PSBs] which show relevant associations with ECC. Our second objective was to investigate how SES affects the associations between PSB and ECC. METHODS: In this study, sixty children with ECC (caries group [CG]) and sixty caries-free children [NON-CG] with their mothers were recruited at two sites in Germany. Children aged three or four years were included in the study. Children's dental status [dmf-t] and plaque index were recorded, and mothers answered a multidimensional SES index (including education, profession and income) as well as screening questionnaires capturing dental anxiety, depressive disorders, generalized anxiety, somatic symptom burden, eating disorders, traumatic childhood experiences, nicotine dependency and alcohol dependency. RESULTS: Mothers of the CG reported significantly higher dental anxiety (dCohen = 0.66), childhood trauma (dCohen = 0.53) and nicotine dependency (dCohen = 0.64) than the NON-CG. However, mediator analyses showed that these effects were partly mediated by the SES. Mothers of the CG had a significantly lower SES (dCohen = 0.93); with education as strongest predictor of dental status. The groups did not differ significantly in symptoms of depressiveness, subjective somatic symptom burden, alcohol dependency, eating disorders, and generalized anxiety. CONCLUSIONS: Several PSBs are associated with ECC, however the SES as the strongest influencing factor mediates this association. Difficult socioeconomic conditions might predispose for both, ECC and mental illness. Targeted strategies are needed to facilitate the use of preventive measures and dental health services especially in families of lower status. For this purpose, psychosocial risk constellations must be identified. More integrative, multifactorial oriented research is necessary to gain a bio-psycho-social understanding of ECC.

The source effect as a natural function of disgust in interpersonal context and its impairment in mental disorders.

Disgust affects interpersonal relationships and regulates hygienic, sexual and distance behaviour. Its intensity in the interpersonal context depends on the character of the relationship. Strangers normally evoke more disgust than intimates (known as the source effect). General disgust sensitivity is increased in various mental diseases. It is unclear how disgust in the interpersonal context is affected and whether the source effect is preserved. 460 inpatients with mental disorders and 463 healthy subjects answered a newly developed Questionnaire (DIRQ) that covers disgust in the interpersonal context on content categories (hygiene, physical proximity, sexuality) and on source categories (self, partner, parent, stranger). Mental disorders were diagnosed with structured interviews. Healthy controls exhibited a pronounced source effect, with strangers evoking more disgust than intimates. In patients, this source effect was reduced (Cohen's d = 0.3), especially for sexual disgust, while general disgust sensitivity was increased (d = 0.5). High disgust in patients was best predicted by a history of sexual abuse and by the presence of post-traumatic stress disorder. In conclusion, mentally impaired patients show increased and trauma-associated disgust sensitivity. Their downregulation of sexual disgust in intimate relationships is hindered, which may have a boundary protective function but might also fuel difficulties engaging in relationships or intimacy.

Fear of dental treatment--an underrecognized symptom in people with impaired mental health.

BACKGROUND: In industrialized countries, about 5% to 15% of all adults have a pathologically severe fear of dental treatment, and some 3% avoid going to the dentist altogether. The affected persons may, in turn, suffer from severe dental diseases and their psychosocial effects. Many people with dental phobia have other mental disorders as well. These facts motivated us to study the prevalence of fear of dental treatment in a group of patients being treated by our psychosomatic service. METHOD: 212 patients of our psychosomatic service and 95 healthy controls were studied with the Hierarchical Anxiety Questionnaire (HAQ) to determine the intensity of their fear of dental treatment. Mental disorders were diagnosed with structured clinical interviews according to DSM-IV. RESULTS: Nearly one patient in three (30.5%, n = 64) suffered from pathologically severe fear of dental treatment; 24 of them (38.5%) had avoided visiting a dentist for longer than one year. Only 4 (4.2%) of the healthy controls were greatly afraid of dental treatment. Certain types of mental disorder were especially highly associated with fear of dental treatment: in particular, anxiety disorders (relative risk [RR] 7.44, 95% confidence interval [CI] 2.68-20.70) and depressive disorders (RR 4.92, 95% CI 1.73-14.05). Patients with post-traumatic stress disorder were affected most commonly: 34 (42%) of these patients were greatly afraid of dental treatment (RR 9.97, 95% CI 3.69-26.90). 75 of the 134 study participants who were afraid of dental treatment (56%) had cancelled a dental appointment, or failed to appear for a scheduled appointment, because of their fears. CONCLUSION: Fear of dental treatment commonly accompanies certain types of mental disorder. Patients at high risk should be asked about such fears so that the problem can be recognized early and appropriately treated.