Comparative Assessment of Oral Health Related Quality of Life in Chronic Periodontitis Patients of Rural and Urban Populations in Punjab.

PURPOSE: To assess and compare the oral health related quality of life in patients suffering from chronic periodontitis using the short questionnaire of oral health impact profile (OHIP-14) in rural and urban populations of Punjab state, India. MATERIALS AND METHODS: One hundred patients suffering from chronic periodontitis were screened and divided into two groups, rural and urban (50 participants in each group). The clinical parameters plaque index (PI), gingival index (GI), pocket probing depth (PPD) and OHIP-14 were assessed in all patients. RESULTS: The mean PI (2.11 ± 0.635), GI (1.61 ± 0.45), PPD (3.12 ± 0.692) and OHIP-14 (11.49 ± 9.733) scores were significantly higher in the rural than in the urban population (1.69 ± 0.45, 1.56 ± 0.355, 3.30 ± 0.973, 5.88 ± 5.588, respectively) suffering from chronic periodontitis. The most affected domain in the rural population was functional limitation, whereas psychological disability was the most affected in the urban population. A statistically significant positive correlation was observed between the periodontal parameters and OHIP-14 (p < 0.001) in both groups. CONCLUSION: Within the limitations of the study, periodontal status and oral health related quality of life are significantly correlated with each other in both rural and urban populations.

Sense of coherence and incidence of periodontal disease in adults.

AIM: To assess whether sense of coherence (SOC) predicts the 4-year incidence of periodontal disease in adults. METHODS: Data from 848 adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education level, the SOC scale, pre-existing diabetes and dental behaviours. The outcome measure was the change in number of teeth with pocketing ≥ 4 mm over 4 years over 4 years. Two separate sets of longitudinal analyses were conducted. The first set was conducted with all the 848 subjects who participated in both surveys and the second set was conducted with the 305 subjects who had no pocketing ≥ 4 mm at baseline. RESULTS: In the full sample, baseline SOC was not associated with change in number of teeth with pocketing over 4 years (coefficient from linear regression: -0.28; 95% CI: -0.74 to 0.18). Similarly, baseline SOC was not associated with number of teeth with pocketing after 4 years (Rate Ratio: 0.94; 95%CI: 0.80 to 1.11) among those with no pocketing at baseline. CONCLUSION: This 4-year prospective study suggests that SOC measured in adulthood does not explain change in the number of teeth with periodontal pocketing ≥ 4 mm.

Association of gingival crevicular fluid cortisol/dehydroepiandrosterone levels with periodontal status.

BACKGROUND: The aim of the present study is to examine whether anxiety and depression scale scores change with regard to clinical periodontal status and to investigate the association between the levels of stress-related hormones in gingival crevicular fluid (GCF) and extent/severity of periodontal disease. METHODS: One hundred twenty participants who fulfilled the study inclusion criteria were chosen. Patients with chronic periodontitis (CP) and those with healthy periodontal tissues/mild gingivitis were included. The clinical examinations were performed on the day after the psychologic evaluations which included anxiety and depression measurements. GCF sampling was undertaken the following day. Commercially available enzyme-linked immunosorbent assay kits were used to determine GCF cortisol and dehydroepiandrosterone (DHEA) levels. Study groups were assigned as follows: group 1, non-periodontitis; group 2, localized CP; and group 3, generalized CP. RESULTS: There were no significant differences with respect to age, sex, education, income level, occupation, or smoking history among the groups (P >0.05). There were no significant differences between the non-periodontitis and CP groups for any of the psychosocial scales (P >0.05). Group 3 had significantly higher mean DHEA scores compared with group 1 (P <0.05); however, the median cortisol scores showed no statistically significant differences among the three groups (P >0.05). CONCLUSIONS: Anxiety/depression scores and GCF cortisol levels did not show any difference with regard to clinical periodontal status. However, a significant association was found between elevated levels of GCF DHEA and the severity of periodontitis.

Impact of periodontal disease experience on oral health-related quality of life.

BACKGROUND: Periodontal research has traditionally focused on the site level, regarding etiology, pathogenesis, and treatment outcome. Recently, some studies have indicated that the presence of periodontal disease is associated with reduced quality of life. The aim of this study is to investigate the impact of periodontal disease experience on the quality of life. METHODS: This cross-sectional study includes 443 individuals. Clinical and radiographic examinations were performed; in conjunction, the oral health-related quality of life of all participants was assessed using the Swedish short-form version of the Oral Health Impact Profile (OHIP-14). Based on marginal bone loss, measured on radiographs, three different groups were identified: participants with loss of supporting bone tissue of less than one third of the root length (BL-), loss of supporting bone tissue of one third or more of the root length in <30% of teeth (BL), or loss of supporting bone tissue of one third or more of the root length in ≥ 30% of teeth (BL+). RESULTS: The effect of periodontal disease experience on quality of life was considerable. For the BL- group, the mean OHIP-14 score was 3.91 (SD: 5.39). The corresponding mean values were 3.81 (SD: 5.29) for the BL group and 8.47 (SD: 10.38) for the BL+ group. The difference among all groups was statistically significant (P ≤ 0.001). A comparison among the mean OHIP-14 scores in the different groups (BL-, BL, and BL+) revealed significant differences in six of seven conceptual domains. CONCLUSIONS: The BL+ individuals experienced reduced quality of life, expressed as the OHIP-14 score, compared with the BL and BL- participants.

Psychosocial distress and periodontitis in adolescents.

PURPOSE: To assess whether adolescents with periodontitis presented with higher scores for non-psychotic psychosocial disorders than control subjects without periodontitis. MATERIALS AND METHODS: A case control study (n = 160) nested in a well-defined adolescent population (n = 9,163) was performed using the 28-item Spanish version of the General Health Questionnaire. The inclusion criterion for being a case was a clinical attachment level of >= 3 mm in at least two teeth. Multiple logistic regression analyses were used to assess the association between periodontitis and psychosocial distress. RESULTS: The response rate was high and 94% of the participants answered all the items of the questionnaire. Similarly, the internal consistency of the instrument was high (Cronbach's = 0.91). The results of multiple logistic regression analyses, adjusted for age and gender, suggested an association between case status and higher total scoring for psychosocial distress (OR = 1.69). Among the four subdomains of the General Health Questionnaire, the dimensions 'somatic symptoms' and 'severe depression' appeared positively associated with periodontal case status, albeit not significantly. CONCLUSION: The findings of this study suggest that the association between periodontitis and dimensions of psychosocial distress can be documented early in life. This calls for awareness on the part of healthcare providers attending adolescents.

Smile esthetics: the influence of posterior maxillary gingival margin position.

PURPOSE: Successful replacement of posterior teeth using contemporary prosthodontic techniques in esthetically demanding cases relies upon visual replication of the natural posterior dentition and surrounding gingival architecture. There is currently little in the way of guidance for creating ideal or acceptable gingival relationships for posterior teeth. MATERIALS AND METHODS: A cross-sectional study was conducted comparing perceptions of four groups of individuals to six digitally manipulated images with various posterior teeth gingival margin position configurations. A total of 120 volunteers aged 12 years to 80 years, comprising 30 patients diagnosed with hypodontia, 30 patients diagnosed with periodontal disease, 30 patients without either condition, and 30 qualified dentists were recruited from the Eastman Dental Institute & Hospital, London. A ranked order of preference for each set was obtained, and this was repeated after a minimum time interval of 10 minutes. RESULTS: Posterior gingival margin configurations from 0 mm to 2 mm (measured at the first premolar) were deemed most esthetic by the majority of the patient groups; dentists had a strong preference for the 1 mm configuration. Dentists appeared to be more perceptive to the alterations in gingival positions. CONCLUSIONS: Posterior gingival margin configurations where the first premolar margins were 1 mm lower than the canine margins were deemed the most esthetically pleasing; however, it is likely that a range of acceptability of 1 mm deviations from this ideal exists.

Association of self-perceived periodontal status with oral hygiene, probing depth and alveolar bone level among young adults.

The literature regarding self-reported dental/oral health data suggests that certain self-reported information is valid. The objective of this study was to show whether self-perceived periodontal conditions can predict actual periodontal status measured by probing depth and radiographic bone level. Participants completed a questionnaire regarding systemic health, education, smoking status, oral hygiene habits and self-perception of their own periodontal status using a visual analog scale (VAS); they were examined clinically and radiographically. More than two-thirds self-perceived their periodontal status as between 5 and 8 (out of 10). Smoking was related to radiographic bone loss, but not to the number of sites with PD > or = 5mm. Periodontal self-assessment correlated with the number of sites with PD > or = 5mm (p = 0.013), the number of sites with radiographic bone loss > or = 3 mm (p = 0.045), as well as with plaque index (p = 0.003) and daily flossing (p = 0.022). For a cutoff of 5 in the VAS score, sensitivity of 84% and specificity of 22% were found for high PD and sensitivity of 85% and specificity of 24% for bone loss.

Association of clinical oral health status with self-rated oral health and GOHAI in Japanese adults.

OBJECTIVE: The objective of this study was to investigate clinical oral health status relationships that affect quality of life (using the 12-item General Oral Health Assessment Index (GOHAI)) and self-rated oral health in a community of Japanese residents. METHODS: 459 residents of Yokote City, Japan aged 40-55 years had oral health examinations and completed self-administered questionnaires collecting data on age, gender, GOHAI items and self-rated oral health. Linear regression analysis was performed with GOHAI or self-rated oral health as a dependent variable and gender, age and indicators of oral health status as independent variables. RESULTS: The GOHAI indicated 42.7% of subjects were concerned about the appearance of their teeth, 30.1% were worried about teeth problems and 27.5% concerned about sensitive teeth. Analyses showed that gender, decayed teeth, oral dryness and missing teeth were significantly associated with variation in GOHAI scores, and that gender, decayed teeth, oral dryness and oral hygiene were significantly associated with variation in self-rated oral health. CONCLUSION: This study revealed that in this sample of Japanese adults aged 40-55 years, decayed teeth and oral dryness affected both GOHAI and self-rated oral health, whereas missing teeth affected GOHAI and oral hygiene affected self-rated oral health. Subjects did not recognise periodontal disease as a quality of life impacting condition or as a health problem.

Sense of coherence and oral health in dentate adults: findings from the Finnish Health 2000 survey.

AIM: To assess the relationship between sense of coherence (SOC) and oral health, and the role of oral health-related behaviours in this relationship. MATERIALS AND METHODS: This is a cross-sectional study of 5401 dentate adults who participated in the nationally representative Health 2000 Survey in Finland. The survey gathered information on SOC, demographic characteristics, education, income, pre-existing diabetes, daily smoking, dental attendance, toothbrushing frequency and sugar intake frequency. Oral health was assessed through clinical outcomes, such as number of teeth, number of decayed teeth and extent of periodontal pockets and perceived oral health. RESULTS: A strong SOC was related to having more teeth, fewer decayed teeth, lower extent of periodontal pockets and good perceived oral health after adjustment for confounders, such as demographic and socioeconomic factors (all p0.003). These associations were attenuated but remained significant after further adjustment for potential mediators (oral health-related behaviours), except for the association of SOC with the extent of periodontal pockets, which was fully accounted for by pre-existing diabetes, oral health-related behaviours and dental plaque (p=0.549). CONCLUSION: SOC is positively associated with various aspects of adult oral health, in part because of the better oral health-related behaviours among people with a strong SOC.

Effect of initial periodontal therapy on oral health-related quality of life in patients with periodontitis in Japan.

BACKGROUND: It is becoming increasingly important for periodontists and dental hygienists to take a biopsychosocial approach to care when considering periodontal interventions. However, information on how patients perceive periodontitis and its treatment is limited. The purpose of the present study is to gain insight into the patient perception of oral health and the impact that periodontitis and treatment have on self-assessed quality of life (QoL). METHODS: This was a prospective, two-center, clinical study in Japan. Patients with periodontitis were assessed for their perceptions of oral health by using an instrument for oral health-related QoL (OHRQL) before and after initial periodontal therapy. RESULTS: A total of 58 patients (mean age: 53.6 years; 23 male and 35 female) participated in the study and completed initial periodontal therapy. At baseline, 97% of the patients perceived that their oral health status impacted on their QoL in one or more ways. Pain, eating and chewing, and psychologic function were identified as compromised OHRQL domains. More than one-half of the patients rated their overall oral health as poor. Initial periodontal therapy, consisting mainly of oral hygiene instructions and scaling and root planing, significantly improved OHRQL scores (P = 0.0027). The effect size was calculated to be 0.51, indicating a moderate improvement. Compared with baseline, a significantly higher proportion of patients reported rarely or never having a problem regarding OHRQL domains such as pain (P = 0.0049) and eating and chewing (P = 0.0145) after treatment. No significant difference in the OHRQL improvement was found with respect to disease severity. CONCLUSIONS: Periodontitis negatively affected QoL in this population of Japanese patients with periodontitis. Conventional non-surgical periodontal therapy has a potential to ameliorate patient perceptions of oral health.

Psychosocial impact of periodontal disease and its treatment with 24-h root surface debridement.

AIM: To assess the impact of periodontal disease and treatment with 24-h root surface debridement on the oral health-related quality of life of patients (OHQoL). METHODS: Two cohorts were recruited: 20 patients with moderate to advanced periodontal disease and 16 dentally healthy patients. Patients with periodontal disease were treated with 24-h root surface debridement. OHQoL was assessed, using Oral Health Impact Profile-14, during the initial assessment and by a telephonic interview daily for 7 days for both groups. OHQoL was also assessed at review for the treated cohort. The number of impacts each patient experienced "occasionally" or more often was analysed by non-parametric tests. RESULTS: Patients with periodontal disease reported significantly more impacts on their quality of life than dentally healthy patients (p<0.05). After root surface debridement the impact was significantly reduced (p<0.05) and sustained at review (p<0.05); however, the impact on quality of life was still greater than that experienced by the dentally healthy cohort (p<0.05). CONCLUSIONS: Patients with periodontal disease have worse OHQoL than healthy patients, but this impact can be partly ameliorated by periodontal treatment. This implies that periodontal disease is not "silent" and that conventional non-surgical treatment provided in a secondary referral centre can be effective from patients' perspectives.

Cynical hostility as a determinant of poor oral health status in an adult population.

Our aim in this study was to determine whether there is an association between cynical hostility and clinically determined poor oral health, and whether this association is confounded by socioeconomic position and mediated by health behavior. The sample consisted of 4,207 dentate Finns, 30-64 yr of age. Oral health was measured in terms of numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets (> or = 4 mm). Cynical hostility was measured using the cynical distrust self-administered questionnaire. The subjects with the highest level of cynical hostility had fewer teeth, and a greater number of decayed teeth as well as teeth with deepened periodontal pockets compared to subjects with the lowest level of cynical hostility. The associations between cynical hostility and number of missing and decayed teeth were clearly confounded by level of education. Poor oral health behavior was shown to be a possible mediator between cynical hostility and number of decayed teeth, but not of missing teeth or teeth with deepened periodontal pockets. General health-related behavior did not serve as a possible mediator in any of the associations. In conclusion, cynical hostility can be considered as a risk marker for poor oral health. Interventions aimed to improve oral health should focus on psychosocial factors and on less-educated subjects.

Oral health-related quality of life of periodontal patients.

BACKGROUND AND OBJECTIVE: The purpose of this study was to assess the oral health-related quality of life of patients presenting to a periodontal specialist by means of six questions, and to assess the perceived oral health by means of one question. Self-assessments of oral health were associated with clinical characteristics. MATERIAL AND METHODS: Logistic regression models were used to associate self-assessments with clinical characteristics in a cross-sectional study. RESULTS: On the six-item questionnaire, close to 20% (295/1480) of the patients reported that teeth, gums or dentures had an impact fairly often or very often on one or more items (eating, relaxing, avoiding going out, feeling self-conscious, pain or discomfort). On the single question requesting a self-assessment of oral health, 42% (628/1468) rated their oral health as fair or poor. Both common oral health-related quality of life problems and worse perceived oral health were associated with having more than eight teeth with>5 mm periodontal pockets (odds ratio=1.45, 95% confidence interval=1.01-2.08; and odds ratio=2.83, 95% confidence interval=2.08-3.84, respectively), compared with patients who had fewer than three teeth with>5 mm periodontal pockets. CONCLUSION: Oral health-related problems in patients presenting to a periodontal specialist office negatively affect their quality of life. If some of the findings of this study can be confirmed in other studies, it could change the perception of chronic periodontitis as a silent disease.

Oral health-related quality of life and periodontal status.

BACKGROUND: As patient-centered approaches become more popular, increasing attention is being given to assess the effects of various human health situations on an individual's overall quality of life (QoL). Measures have been used in dentistry to study the effects of orthodontic treatment and oral surgery, but so far little has been reported about the effects of periodontal disease. OBJECTIVE: This study assessed the impact of periodontal health status on QoL. METHODS: A subsample of 767 subjects were selected from a community study (n=1000) which investigated the association between psychological factors and clinical periodontal attachment level (CAL). The sample included subjects with full-mouth mean CAL3 mm (high/severe periodontal attachment loss group). The subjects were requested to complete the Chinese short-form version of Oral Health Impact Profile (OHIP-14S) and a checklist of self-reported periodontal symptoms during the previous 12 months. RESULTS: A total of 727 subjects (95%) completed the questionnaire. The OHIP-14S and subscale scores were significantly associated with six of seven of the self-reported periodontal symptoms. A comparison of the mean OHIP-14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities. CONCLUSION: This study demonstrates a significant association between oral health-related QoL and periodontal disease.

Association between psychosocial factors and periodontitis: a case-control study.

OBJECTIVE: This case-control study investigated the association between life events, anxiety, and depression with periodontitis. METHODOLOGY: The study counted with 165 individuals, both sexes, 35-60 years of age. Case group included 96 individuals suffering from periodontal disease; and in control group 69 subjects with no history of periodontitis. Clinical examinations were performed by a single examiner. Psychological assessment included four inventories: Life Events Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory and Beck Depression Inventory. Bivariate and multivariate logistic regression analyses were performed to compare cases and controls. RESULTS: Mean probing depth and clinical attachment level were 3.44+/-0.80 and 4.01+/-1.61 in the case group and 1.96+/-0.19 and 0.95+/-0.50 in the control group, respectively (p<0.05). Positive association of periodontitis with age (odds ratio (OR)=1.15 95% confidence interval (CI): 1.06-1.24), male gender (OR=2.71, CI: 1.13-6.49), smoking (OR=6.05, CI: 1.67-21.94) and educational level (OR=6.49, CI: 1.14-36.95) was confirmed. Bivariate analysis did not demonstrate significant mean differences in life events, anxiety symptoms, trait or state of anxiety, or depression symptoms between cases and controls. Multivariate logistic regression, controlling for confounding factors, demonstrated no significant association between psychosocial factors and periodontal disease. CONCLUSIONS: Within the limits of this study it is possible to conclude that there was no significant association between periodontitis and the psychosocial factors analysed.

The influence of stress and anxiety on the response of non-surgical periodontal treatment.

AIM: The aim of this study was to evaluate the influence of stress and anxiety on the response to non-surgical periodontal treatment (NPT) in patients with chronic periodontitis. METHOD: Sixty-six patients (mean age 46.1 +/- 8 years) were assigned to three groups: control group, probing pocket depth (PPD) or=4 and 6 mm, n=20. Stress, state anxiety (SA) and trait anxiety (TA) and plaque index (PI), gingival index, PPD and clinical attachment level (CAL) were recorded at baseline and 3 months after NPT. RESULTS: TA scores were different among groups at baseline and after NPT. TA was related to periodontitis at baseline and after NPT. PI was associated with the SA at baseline. The reduction of frequency of CAL >6 mm was correlated with TA after adjusting for confounders. Stressed subjects did not show reduction of frequency of PPD >6 mm (T1), CAL 4-6 mm and CAL >6 mm (T2). CONCLUSIONS: The data suggest an influence of trait of anxiety and stress on the response to NPT.

Impact of oral health on the life quality of periodontal patients.

OBJECTIVES: To assess the impact of oral health on the life quality of a periodontal patient group. MATERIALS AND METHODS: Two hundred and five patients attending a private periodontal clinic completed a questionnaire incorporating the 16-item UK oral health-related quality-of-life measure (OHQoL-UK), a check list of questions about their periodontal health over the past year and a comprehensive periodontal examination. RESULTS: The effect of oral health on quality of life was considerable, with many individuals experiencing negative impacts across a broad range of physical, social and psychological aspects of life quality. OHQoL-UK(Copyright ) scores was associated with patient's self-reported periodontal health in the past year: experiences of "swollen gums" (p<0.01), "sore gums" (p<0.01), "receding gums" (p<0.01), "loose teeth" (p<0.01), "drifting teeth" (p<0.01), "bad breath" (p<0.01) and "toothache" (p<0.01). In addition, OHQoL-UK scores were correlated with the number of teeth with pocket depths of 5 mm or more (r(s)-0.42, p<0.01). New patients had poorer oral health-related quality of life compared with the treated maintenance group (p<0.01). CONCLUSIONS: Periodontal status impacts on life quality. This has implications in understanding the consequences of periodontal health and in the use of patient-centred outcomes in periodontal research.

Relationship of depressive symptoms to edentulousness, dental health, and dental health behavior.

We investigated the relationship of edentulousness, dental health, and dental health behavior to depressive symptoms in the 55-year-old population of Oulu (a medium-sized Finnish town), 780 of whom (78%) participated. The dental examination included an assessment of oral health status. Depressive symptoms were determined with the Zung Self-Rating Depression Scale (ZSDS). The participants were also asked about their dental health behavior, smoking habits, health, life satisfaction, and factors related to their work. Depressive symptoms were associated with edentulousness among non-smoker men. When further evaluated by logistic regression analysis, edentulousness was independently associated with depressive symptoms in this subpopulation (odds ratio = 6.4, confidence interval = 1.4-29.2) after adjusting for confounding factors. Depressive symptoms were not associated with dental caries, periodontal status, or number of teeth. The dentate women with high rates of depressive symptoms had a more negative attitude towards preserving their natural teeth, used sugary products more frequently, reported a longer time since their last dental visit, and tended to have a lower percentage of filled tooth surfaces than the non-depressed dentate women. The aspect of depression should be borne in mind by dentists when treating edentulous patients. On the other hand, certain subgroups of depressed patients might benefit from dental implant therapy. Thus, the importance of teamwork between clinicians, psychiatrists, and dentists is emphasized.

Therapy-resistant periodontitis. Psychosocial characteristics.

This study investigated the perspective of a stress system disorder in the pathogenesis of therapy-resistant periodontitis. The goal was to find indications that the stress-behaviour-immune system model holds as an explanatory model for the understanding of periodontal disease. 2 patient-groups were compared: one group classified as responding well to periodontal treatment (responsive-group, R-group, n=11); the other group was classified as responding less well to treatment (non-responsive-group, NR-group, n=11). Somatic and psychological factors were described as obtained by interviews and psychological testings. These findings were related to clinical data documented during the treatment of the patients. An exact logistic multivariate regression analysis was performed on a model based on variables selected by bivariate analysis (variable versus group). The results indicated that the NR-group patients displayed indications of more psychosocial strain and a more passive-dependent personality. The R-group patients displayed a more rigid personality and possibly a less stressful psychosocial situation in the past. The report highlights the possible contribution of stress factors in the context of therapy resistant periodontal disease, and the results seem to be understandable within the context of a stress system disorder perspective.

Therapy-resistant periodontitis (II). Compliance and general and dental health experiences.

In this exploratory case-control study, somatic and psychological factors are used for exploring whether the anamnestic information gives support to the hypothesis of a relationship between therapy-resistant periodontitis and stress factors. From retrospective comparisons of pocket probing depth charts, we classified 22 patients as either non-responding or responding to periodontal treatment. The non-responding patient group, in comparison with the responding patient group, showed a profile over time of less pocket probing depth (PPD) reduction in response to periodontal treatment. Information registered in each patient's file regarding periodontal registrations and dental status was gathered, and an interview was conducted aiming at collecting information on dental experiences and attitudes. Bivariate and logistic multivariate regression analyses were performed. The NR-group patients experienced significantly more unpleasant feelings towards dental procedures and a higher tendency to experience pain in connection with dental procedures. This group was found to start smoking at an older age than the R-group. One reason for this may be that smoking debut at an older age is more related to stress conditions than debut at a younger age. The report highlights the possible contribution of stress factors in periodontal disease.