Dental anxiety and oral health-related quality of life in aggressive periodontitis patients.

OBJECTIVES: To measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with aggressive periodontitis (AgP) compared to controls and analyze their association with various demographic and clinical parameters. METHODS: Sixty consecutive patients with AgP were compared to 80 age- and sex-matched controls with no known history of periodontal disease. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah's Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss. RESULTS: AgP patients exhibited statistically significant higher scores in the DAS total as well as sub-scores, except from DAS 1st question. Compared to the control group, AgP patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores. Among both AgP and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain. CONCLUSIONS: AgP patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases. STATEMENT OF CLINICAL RELEVANCE: Aggressive periodontitis (AgP) patients exhibited higher dental anxiety levels and worse oral health-related quality of life (OHRQoL) compared to controls. Professionals should design strategies that will cope with the dental anxiety associated with the treatment and prevent decreases in OHRQoL.

Compliance with supportive periodontal therapy among patients with aggressive and chronic periodontitis.

Compliance with supportive periodontal therapy (SPT) depends on many factors but is generally poor. We compared SPT compliance among patients with aggressive and chronic periodontitis. This single-center longitudinal observational study enrolled 101 patients with generalized aggressive periodontitis (GAP; n = 52) or generalized chronic periodontitis (GCP; n = 49) to compare SPT compliance. All participants were studied for 1 year before the close of data collection. Compliance was classified as complete (100% of programmed visits), erratic (≥50% of programmed visits), or noncompliant (<50% of programmed visits). The proportion of compliant participants was greater among patients with GAP (57.7%) than among those with GCP (30.6%) (P < 0.003); 44.9% of patients with GCP and 15.4% of those with GAP were noncompliant. Compliance was significantly associated with age and sex among patients with GAP. In conclusion, SPT compliance was better in patients with GAP than in those with GCP. Patient attitude and self-belief appear to be important factors in SPT compliance.

Prosthodontic rehabilitation of a patient with aggressive periodontitis.

Aggressive periodontitis previously termed as juvenile periodontitis is characterised by rapid destruction of the periodontium at a relatively young age. Rehabilitation of these patients is often challenging and difficult. Controlling the disease and restoring periodontal health is essential for successful prosthodontic rehabilitation. This clinical report describes an interdisciplinary approach in the rehabilitation of a young adult patient with generalised aggressive periodontitis. Treatment objectives included plaque control, prevention of further attachment loss, reduction/elimination of pockets, and prosthetic rehabilitation to enhance aesthetics and restore masticatory function. One year recall evaluation revealed stable periodontal support with no further loss of attachment and no other complications.

Role of psychotherapy in managing a case of generalised aggressive periodontitis.

Generalised aggressive periodontitis is characterised by "generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors." The management of generalised aggressive periodontitis is challenging as it involves an interdisciplinary approach. When the patient presents himself late to the clinician, the tooth and bone loss can be up to 60%. Natural teeth and alveolar bone contribute to the contour and aesthetics of the face. Loss of teeth in younger age may lead to attitude, behaviour changes and may cause psychological depression and withdrawal from society. The main distinguishing feature of this case report is the psychological counselling provided along with periodontal and prosthetic treatment.

Influence of psychological attachment patterns on periodontal disease - a pilot study with 310 compliant patients.

OBJECTIVES: Psychosocial variables have received increased attention in periodontology. Attachment theory adds to known risk factors by linking early interactional experiences with adult tendencies of stress-regulation, health behaviour, symptom reporting, and healthcare utilization. The study investigates associations between attachment patterns and periodontal parameters. METHODS: Within the context of a longitudinal study on periodontal diseases, 310 patients with aggressive (AgP) and chronic periodontitis (CP) filled out questionnaires on psychological attachment patterns. The influence of attachment style on health behaviour, treatment attendance and utilization, and periodontal variables was tested. RESULTS: We found associations between psychological attachment anxiety on smoking and higher number of session use, independent of disease severity, which was more pronounced for women. Patients with higher attachment avoidance attended periodontal treatment later when diagnosed with CP and earlier with AgP. For men, we found differential associations for attachment avoidance and anxiety and number of teeth at beginning of treatment. CONCLUSION: Psychological attachment patterns are a promising target for understanding periodontal disease in addition to known psychosocial risk factors.

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.

The association of aggressive and chronic periodontitis with systemic manifestations and dental anomalies in a jordanian population: a case control study.

BACKGROUND: The relationship between dental anomalies and periodontitis has not been documented by earlier studies. Although psychological factors have been implicated in the etiopathogenesis of periodontitis, very little information has so far been published about the association of anxiety and depression with aggressive periodontitis. The aim of this study was to investigate the association of chronic periodontitis and aggressive periodontitis with certain systemic manifestations and dental anomalies. METHODS: A total of 262 patients (100 chronic periodontitis, 81 aggressive periodontitis and 81 controls), attending the Periodontology clinics at Jordan University of Science and Technology, Dental Teaching Centre) were included. All subjects had a full periodontal and radiographic examination to assess the periodontal condition and to check for the presence of any of the following dental anomalies: dens invaginatus, dens evaginatus, congenitally missing lateral incisors or peg-shaped lateral incisors. Participants were interrogated regarding the following: depressive mood, fatigue, weight loss, or loss of appetite; and their anxiety and depression status was assessed using the Hospital Anxiety and Depression (HAD) scale. RESULTS: Patients with aggressive periodontitis reported more systemic symptoms (51%) than the chronic periodontitis (36%) and control (30%) patients (p < 0.05). Aggressive periodontitis patients had a higher tendency for both anxiety and depression than chronic periodontitis and control patients. Dental anomalies were significantly (p < 0.05) more frequent among both of chronic and aggressive periodontitis patients (15% and 16%, respectively), compared to controls. CONCLUSION: In this group of Jordanians, systemic symptoms were strongly associated with aggressive periodontitis, and dental anomalies were positively associated with both aggressive and chronic periodontitis.

Impact of periodontal disease on quality of life.

OBJECTIVE: To determine the impact of periodontal disease on quality of life using the Oral Health Impact Profile (OHIP) 14, simplified version. METHOD AND MATERIALS: A cross-sectional study was conducted involving a convenience sample of 401 patients of both sexes aged 19 to 71 years. After diagnoses of periodontal condition, the patients voluntarily completed a form to collect the OHIP-14, as well as socioeconomic and demographic data. RESULTS: Chronic periodontitis was the most prevalent, affecting 227 patients (56.7%). With regard to the impact of periodontal disease on quality of life, functional limitation was the predominant item, affecting 91.5% of the sample. The patients with aggressive periodontitis achieved the highest impact scores. The highest scores on the OHIP-14 index were those of patients with a diagnosis of chronic or aggressive periodontitis. OHIP-14 scores were associated with sex, age, and income (P < .001). CONCLUSION: Functional limitation was the most affected dimension, and impact was significantly associated with age, income, and a diagnosis of periodontal disease.

The impact of early-in-life periodontal infection on the smiles of children: a worldwide view.

Little attention has been directed toward evidence that an early-in-life oral infection with the potential to reach epidemic proportions is threatening the health of youths throughout world. Health professionals and the public seem unaware that the silent disease process of early-in-life periodontal infection is targeting thousands of children and young adults, their smiles, and, consequently, their emotional and psychologic lives. Yet, the literature is replete with reports that many periodontopathic microorganisms are multiplying at an alarming rate with a serious impact on youths in many cities, towns, and villages throughout the globe. However, clinical measurement of reported periodontal disease has been fraught with problems that have confused and clouded messages to policymakers in government and health professionals in treatment settings. The aim of this article is to help raise the level of awareness so that those who have the power and knowledge can appropriately address the suffering of the youngest members of societies.

The impact of periodontal disease on the quality of life of individuals with Down syndrome.

OBJECTIVE: This study aimed to determine the prevalence of periodontal disease among children and adolescents with Down syndrome and the possible repercussions of such pathology in the quality of life of the group in question. METHOD: The sample consists of 93 individuals with Down syndrome 6 - 20 years old, living in Brazil (Minas Gerais). Periodontal probing was carried out on every site of each tooth. The Plaque Index and periodontal clinical parameters were recorded. A broad interview was carried out with the mothers, consisted of an adaptation of the Oral Health Impact File OHIP-14 that was used to measure the negative repercussions of periodontal disease in the daily lives of these individuals. RESULTS: The prevalence of gingivitis was 91%, whereas periodontitis was found in 33% of the individuals. When the impact of periodontal disease on the quality of life was correlated with the clinical periodontal parameters, it was observed that there are significant statistical differences among them: bleeding on probing, probing depth and attachment loss. These same results, correlated with all the different groups that are categorised according to the diagnosis of periodontal disease, also show significant differences. CONCLUSIONS: Periodontal disease can be considered as a condition with high prevalence within the group in question, which has negative effects on the quality of life of the subjects. These effects are aggravated by the seriousness of the disease.

Rehabilitative management offered Nigerian localized and generalized aggressive periodontitis patients.

This paper highlights the typical clinical features of aggressive periodontitis (formerly known as juvenile periodontitis in the South Western region of Nigeria), the attending psychological effect following tooth loss, and the rehabilitative management offered which included periodontal therapy, psychotherapy, and prosthetic replacement of the missing teeth. The psychotherapy is the main distinguishing treatment in this study from previously reported modes of management of this disease entity. Subjects were from a part of the South Western region of Nigeria, and ages ranged from 15 to 22 years. They all presented very late with subsequent gross periodontal breakdown and subsequent psychological depression. The mean values of the probing depth (mm), degree of mobility, and the amount of bone fill (mm) from the periapical radiographs were recorded pre and post-operatively. The missing teeth were replaced with acrylic dentures, and psychotherapy was offered at three levels (individual, group, and conjoint-family psychotherapy). There was significant improvement of these clinical parameters six months after treatment, and the partial denture replacement of the missing teeth improved their appearance as expected but did not totally improve the initial depressive state. The psychotherapy offered gave the patients positive psychological effects that further restored their ability to socialize in their environment, which added to their positive experience of life. In conclusion the typical clinical features of localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP) patients in our environment are late presentation with gross periodontal tissue breakdown. Psychotherapy is an important aspect in the management of this group of patients in conjunction with the periodontal and prosthetic management, which gives total rehabilitation.

Interactions between stress, interleukin-1beta, interleukin-6 and cortisol in periodontally diseased patients.

BACKGROUND/AIMS: The aim of the present study was to measure interleukin-1beta, interleukin-6 and cortisol levels in the peripheral blood of periodontally diseased patients in order to record any interactions with psychosocial stress. MATERIAL AND METHODS: The test group comprised 16 patients with untreated and 14 with treated aggressive generalized periodontitis (AGP), five patients with untreated aggressive localized periodontitis (ALP) and five with chronic generalized periodontitis (CGP). The control group comprised 40 periodontally healthy probands. Blood was taken from the cephalic vein of all patients and controls at the same time (8 a.m.) each day. IL-1beta, IL-6 and cortisol levels were then measured with a sensitive ELISA, the 'Quantikine HS Immunoassay Kit' (Biermann Diagnostica, Bad Nauheim, FRG). The clinical examination covered probing depth, gingival recession, gingival index, plaque index and clinical attachment level. A questionnaire was used to ask the patients and controls about their attitude to life and the stress induced by their jobs and their families. Previous and current levels of tobacco consumption were also recorded. Statistical evaluation was based on the Mann-Whitney U-Wilcoxon test for comparison of blood serum values and clinical parameters between patients and controls, and the Kruskal-Wallis test for intergroup comparison. All data were correlated by means of Spearman's rank correlation coefficient, and significance levels relating to stress and smoking were determined with the chi-square test. RESULTS: With respect to cortisol, the results showed no significant differences either between the patient groups or in comparison with the controls. IL-1beta was detected only in the AGP patients and their controls, but with no significant differences. IL-6 was detected in virtually all patients and controls, but with no significant differences. Only in the untreated AGP patients was IL-6 significantly elevated (P < 0.05) and a slight correlation with attachment loss recorded. In all AGP patients a slight correlation between IL-1beta and IL-6 was recorded. Evaluation of the questionnaire revealed a higher proportion of untreated AGP patients than of controls with a pessimistic attitude to life. In all AGP patients, family-induced stress and smoking were found to correlate with attachment loss. In the untreated AGP patients, smoking correlated with IL-1beta protein content, and in the controls there was a moderate correlation between smoking and IL-6 levels. CONCLUSIONS: The present study found no correlation between the immunological mediators (IL-1beta, IL-6), glucocorticoids (cortisol) and the registered stress values. However, the patients with untreated AGP showed signs of a pessimistic attitude to life, and an elevated IL-6 level was recorded in the peripheral blood. As a restrictive factor it should be borne in mind that the number of patients investigated was too small for adequate conclusions to be drawn.