Non-surgical periodontal therapy improves oral health-related quality of life.

AIM: The influence of non-surgical periodontal therapy on oral health-related quality of life (OHQoL) was investigated. MATERIALS AND METHODS: Sixty-five Chinese adults (25 men, mean 47.4 years) with moderate-to-advanced chronic periodontitis were recruited. All received oral hygiene instructions (OHI) and non-surgical periodontal treatment in a quadrant-wise approach, followed by recalls at 1, 3, 6, 9 and 12 months post treatment, when OHI and prophylaxis were repeated. Clinical parameters were recorded, and oral health impact profile short-form (OHIP-14S) was administered at all time points. RESULTS: Moderate-to-deep sites (≥4 mm) decreased from 31.0% to 3.0% at 12 months post treatment (p < 0.005) which corresponded well with reductions in plaque, 72.8% to 25.4% (p < 0.005) and bleeding on probing, 86.3% to 32.0% (p < 0.005). Median OHIP-14S scores gradually reduced from 17 at baseline to 14 over the first 6 months and remained plateaued at 12-month post treatment (p < 0.005). Improvements in subdomains of physical pain, psychological discomfort and psychological disability accounted for the changes. CONCLUSION: This study demonstrates that OHQoL, in particular, pain and psychological subdomains, improvement was associated with non-surgical periodontal therapy responses. Clinicians could capitalize upon the positive psychological OHQoL impacts of mechanical periodontal treatment for subsequent patient-centred motivation during maintenance therapy.

Intracranial electroencephalogram to evaluate refractory temporal and frontal lobe epilepsy.

OBJECTIVE: We undertook a collaborative study in a multidisciplinary team to channel refractory epilepsy patients to test a hypothesis about placement of intracranial electroencephalography arrays. DESIGN: This was a descriptive case series. Prospective non-invasive presurgical evaluations were based on clinical semiology, magnetic resonance imaging, video-electroencephalography findings and neuropsychological assessments. If the results were discordant, a hypothesis was generated using individualised combinations of positron emission tomography, single-photon emission computed tomography, functional magnetic resonance imaging and Wada tests. The indications for intracranial electroencephalography were: (a) focal magnetic resonance imaging, ictal/interictal scalp electroencephalography with variable results (group A); (b) multi-focal magnetic resonance imaging, focal/multi-focal ictal scalp electroencephalography (group B); (c) non-lesional magnetic resonance imaging, focal/multi-focal ictal scalp electroencephalography (group C). We evaluated whether the seizure-onset zones and eloquent areas were delineated, surgical outcomes (if operated on), and pathology results. SETTING: A tertiary referral centre for neurology in Hong Kong. PATIENTS: A total of 105 refractory epilepsy patients completed non-invasive presurgical evaluations over the period 2007 to 2009. Thirty-two patients were eligible for direct resective surgery, and another 25 patients had a testing hypothesis formulated. Of these 25 patients, 10 were eligible for intracranial electroencephalography based on technical/financial considerations. RESULTS: All 10 patients (group A=2, group B=4, group C=4) had their epileptogenic zones defined. Six patients underwent functional mapping, all of whom had their eloquent areas defined. Seven of the 10 patients underwent resective surgery; four of them achieved Engel class I/II outcomes. The dichotomised outcomes were 100% (group A), 50% (group B), and 33% (group C) achieving Engel class I/II. Two patients had asymptomatic subdural haematoma. There was no intracranial infection or operative mortality. In five (71%) of seven of the patients, a histological diagnosis was established. CONCLUSION: Proper deployment of intracranial electroencephalography is useful in the presurgical evaluation of patients with refractory epilepsy. This modality of management is potentially of benefit for patients with refractory epilepsy, but is underutilised locally.

Periodontal status of adults with systemic sclerosis: case-control study.

BACKGROUND: Systemic sclerosis (SSc) is a systemic autoimmune disease that affects connective tissue in the skin, blood vessels, and major organs of the body. This project aims to compare the periodontal status of dentate Hong Kong Chinese with and without SSc. METHODS: Thirty-six non-smoking adults with SSc (one male and 35 females: aged 50.6 ± 11.7 years; free from Sjögren syndrome) attending a teaching hospital were age- and sex-matched to systemically healthy controls attending a dental hospital. Both groups had similar demographic characteristics but a lower proportion of patients with SSc were working or studying (P <0.05). Twenty-three (32%) of all participants were regular dental attendees. Orthopantomogram radiographs were taken. Participants were surveyed and periodontally examined. RESULTS: Both groups had a similar number of erupted teeth, proportion of sites with detectable plaque, and mean full-mouth clinical attachment level, whereas controls had less bleeding on probing (49.3% ± 22.6% versus 78.4% ± 19.6%; P <0.001) and a shallower mean full-mouth probing depth (1.92 ± 0.44 mm versus 2.52 ± 0.58 mm; P <0.001). Radiographically, patients with SSc had wider periodontal ligament spaces (0.36 ± 0.06 mm versus 0.33 ± 0.03 mm; P <0.01). CONCLUSIONS: Hong Kong Chinese adults with SSc seem to exhibit higher levels of periodontal inflammation and wider radiographic periodontal ligament spaces than age- and sex-matched controls. Future studies are warranted to further investigate any associations between these periodontal features and SSc.

Periodontal Status of Adults With Systemic Sclerosis: Case-Control Study.

Background: Systemic sclerosis (SSc) is a systemic autoimmune disease that affects connective tissue in the skin, blood vessels and major organs of the body. This project aimed to compare the periodontal status of dentate Hong Kong Chinese with and without SSc. Methods: Thirty-six non-smoking adults with SSc (35 women; 50.6 ? 11.7 years, free from Sjogren's syndrome) attending a teaching hospital were age- and sex-matched to systemically healthy controls attending a dental hospital. Both groups had similar demographic characteristics but a lower proportion of SSc patients were working or studying (p < 0.05). Twenty-three (32.0%) of all participants were regular dental attendees. Orthopantomogram rediograph were taken. Participants were surveyed and periodontally examined. Results: Both groups had a similar number of erupted teeth, proportion of sites with detectable plaque, and mean full-mouth probing attachment level, whereas controls had less bleeding on probing (BOP(%), 49.3 ? 22.6 vs. 78.4 ? 19.6; p < 0.001) and a shallower mean full-mouth probing pocket depth (PPD(mm), 1.92 ? 0.44 vs. 2.52 ? 0.58; p < 0.001). Radiographically, SSc patients had wider periodontal ligament spaces. (PDL (mm), 0.36 ? 0.06 vs. 0.33 ? 0.03, p < 0.01) Conclusion: Hong Kong Chinese SSc adults seem to exhibit higher levels of periodontal inflammation and wider radiographic PDL spaces than age- and sex- matched controls. Future studies are warranted to further investigate any associations between these periodontal features and SSc.

A community study of periodontal attachment loss in smokers.

OBJECTIVE: This study compared per-sextant periodontal attachment levels of smokers and non-smokers attending private dental practices. METHOD: One thousand adults (51.5% female) aged 25 to 64 years underwent an oral clinical examination and questionnaire survey covering demographic characteristics, personal traits, coping and history of tobacco consumption. Medical history was also recorded. RESULTS: Of the subjects, 9.0% had a healthy periodontal status, whereas 52.5%, 23.3%, 10.1% and 5.1% showed low, moderate, high and severe attachment loss, respectively. Most participants (86.0%) were never-smokers, and 1.1%, 3.9%, 3.5% and 5.5% were very light, light, moderate and heavy smokers, respectively. Corresponding full-mouth mean clinical attachment levels (CALs) were 2.0mm, 1.5mm, 1.4mm, 1.8mm and 2.9mm (p < 0.001, ANOVA). After adjustment for factors known to be associated with an increase in CAL, the mean per-sextant CAL in never-smokers was 2.0-2.1mm (p = 0.11); in heavy smokers, the mean CAL for the anterior sextants was significantly higher than that for the posterior sextants (3.2mm vs. 2.8mm; p = 0.04). CONCLUSION: In Hong Kong, heavy smokers are more likely to experience attachment loss than are other smokers and never-smokers, and their anterior sextants are affected more than their posterior sextants.

A community study on the relationship of dental anxiety with oral health status and oral health-related quality of life.

OBJECTIVE: To investigate the relationship of dental anxiety with oral health status and oral health-related quality of life (OHQoL) among dentate subjects living in Hong Kong. METHODS: One thousand Hong Kong residents who were aged 25-64 years and predominantly Chinese were asked to complete the Chinese short-forms of the Dental Anxiety Inventory (SDAxI) and Oral Health Impact Profile (OHIP-14S). Dental (DMFT index) and periodontal statuses [full-mouth clinical attachment level (CAL)] were also assessed. RESULTS: Ninety-six (9.6%; mean SDAxI, 9.6), 799 (79.9%; mean SDAxI, 15.0), and 105 (10.5%; mean SDAxI, 27.4) participants had low, average, and high dental anxiety, respectively. The mean DMFT/CAL scores of each SDAxI subgroup were 8.5/1.4, 9.3/1.9, and 9.8/3.6, respectively. The corresponding mean OHIP-14S scores for each SDAxI subgroup were 4.0, 8.1, and 13.2, respectively. Post hoc analysis, adjusted for possible confounding factors, revealed statistically significant differences in DMFT and CAL scores in subjects with low versus high level of SDAxI, and significant differences in OHIP-14S scores between all 3 SDAxI categories. CONCLUSION: The trait disposition of dental anxiety may be a significant risk indicator of poor dental and periodontal status and is associated with a worse OHQoL.

A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss.

BACKGROUND: Psychological factors may increase the risk for periodontal diseases. Contemporary conceptualization of the stress process supports the evaluation of stress at three levels: stressors, moderating and mediating factors, and stress reactions. OBJECTIVE: This study was undertaken to investigate the relationship of periodontal disease in terms of clinical attachment level (CAL) to psychosocial stress, making reference to the major components of stress process. METHODS: A cross-sectional study of 1000 subjects aged 25-64 years in Hong Kong was conducted. Subjects were asked to complete a set of questionnaires measuring stressors including changes, significant life event and daily strains, stress reactions including physiological and affective responses, and coping and affective dispositions. CAL was assessed. RESULTS: Individuals with high mean CAL values had higher scores on the job and financial strain scales than periodontally healthy individuals (P < 0.05), after adjusting for age, gender, cigarette smoking and systemic disease. Depression, anxiety trait, depression trait, problem-focused coping, and emotion-focused coping were also related to CAL. Logistic regression analysis indicated that all these factors were significant risk indicators for periodontal attachment loss, except problem-focused coping, which reduced the odds of CAL. Individuals who were high emotion-focused copers, low problem-focused copers, trait anxious, or trait depressive had a higher odds of more severe CAL. CONCLUSION: Chronic job and financial strains, depression, inadequate coping, and maladaptive trait dispositions are significant risk indicators for periodontal attachment loss. Adequate coping and adaptive trait dispositions, evidenced as high problem-focused coping and low anxiety/depression trait, may reduce the stress-associated odds.

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.

Validation of a Chinese version of the dental anxiety inventory.

OBJECTIVES: To translate the English version of Dental Anxiety Inventory (DAxI) and its short-form (SDAxI) and to validate their use in Hong Kong Chinese. METHODS: The DAxI and SDAxI were translated into Chinese. A total of 500 adults (18-64 years) were interviewed, the Chinese DAxI, Symptom Checklist 90 (SCL-90), Depression Anxiety Stress Scales (DASS) and State-Trait Anxiety Inventory (STAI) were completed. Based on their initial DAxI scores, 135 interviewees were invited to attend a dental examination 1 month later. Then, the subjects completed the DAxI again, together with Beck Anxiety Inventory (BAI) which measured the state anxiety level of the participants. Two months after the initial interview, all 500 subjects were asked to complete the DAxI again. Another 300 adults were recruited and interviewed for the SDAxI validation. RESULTS: Cronbach's alpha of the Chinese DAxI and SDAxI were 0.77 and 0.80 and the test-retest correlation coefficients were 0.90 and 0.84, respectively. High correlation between BAI and DAxI scores and its stability over time supported construct validity of the Chinese DAxI. Small positive correlations between the DAxI and other subscales of the SCL-90, DASS and STAI supported discriminant validity of the instrument. The SDAxI demonstrated comparable validity and reliability with DAxI. CONCLUSION: The translated Chinese DAxI demonstrated good validity and reliability. It is available for use in dental anxiety research in adult Chinese. In situations where a short-form is desirable, the Chinese SDAxI is a simple, valid, reliable and interpretable scale for measuring dental anxiety in both research and dental practice.

The effect of pre-operative information in relieving anxiety in oral surgery patients.

UNLABELLED: Appropriate stress management of patients is essential for smooth running of invasive or surgical dental procedures conducted under local anaesthesia. OBJECTIVE: The current study analysed the effectiveness of pre-operative information provision for anxiety reduction during dentoalveolar surgery in patients with high- or low-trait anxiety. METHODS: Patients scheduled for oral surgical procedures performed by six private dental practitioners were invited to participate in the study. They were randomly assigned to four groups and received the following pre-operative information: (i) basic information only, (ii) basic information with details of the operative procedures, (iii) basic information with details of the expected recovery, and (iv) basic information with details of both the operative procedures and recovery. The participants' trait anxiety level was measured with the Depression Anxiety Stress Scales (DASS), then they were divided into high- or low-trait anxiety groups with the method of median-split on the basis of the DASS score. Self-rated anxiety was recorded immediately before, during and 10 min after the surgical procedures. RESULTS: High-trait anxiety subjects gave higher self-reported anxiety levels (repeated-measures ANOVA, P < 0.05). Pre-operative provision of details about the expected recovery only or details concerning both the operative procedures and recovery led to significant reduction in self-reported anxiety among the participants throughout the procedure (P < 0.01). However, information on operative procedures led to anxiety reduction in low (P < 0.05) but not high-trait anxiety participants. CONCLUSION: Provision of pre-operative information of the recovery process leads to significant anxiety reduction in all patients who undergo surgical/invasive procedures with local anaesthesia.