Self-reported stress, coping ability, mental status, and periodontal diseases among police recruits

Association between cognitive rumination and periodontal disease, tooth loss and oral health-related quality of life in a rural Southern Brazil population

OBJECTIVES

Rumination is a maladaptive emotion regulation strategy. It has been associated with several psychological disorders and physical problems. This cross-sectional study aimed to evaluate whether cognitive rumination is associated with periodontal disease (PD), tooth loss (TL), and oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

A population-based sample from a rural area in southern Brazil was evaluated. Calibrated examiners carried out a complete periodontal examination at six sites-per-tooth. Rumination and Reflection (RRQ) and Oral Health Impact Profile (OHIP-14) questionnaires were administered. Regression modeling was used to assess the prevalence ratio (PR) between rumination and PD and to estimate the rate ratio (RR) between rumination and TL and rumination and OHIP.

RESULTS

Severe periodontitis prevalence of 33% was observed in the sample. In the Poisson-adjusted model (n = 587), individuals who ruminate more have 27% more periodontal disease (PR: 1.27, 95%CI:1.02 - 1.60). Regarding TL and OHIP, negative binomial regression (n = 672) showed an association with rumination, but it was not significant (RR 1.14, 95%CI 0.99 - 1.31) and (RR 1.20, 95%CI 0.98 - 1.48), respectively.

CONCLUSIONS

Cognitive rumination was independently associated with periodontal disease in individuals living in a rural area. Borderline non-significant estimates were observed regarding TL and OHRQoL. More research using different populations and focusing on individual's responses to psychological stress may confirm these results.

CLINICAL RELEVANCE

Emotional regulation is crucial to deal with stress, anxiety, and depression. Since psychopathologies are among the most prevalent diseases in the world, it is critical to understand the role of these issues in dental outcomes.

Dental anxiety and oral health-related quality of life before and after non-surgical periodontal treatment

OBJECTIVES

To (1) investigate dental anxiety (DA) and oral health-related quality of life (OHRQOL) before and after non-surgical periodontal treatment (NSPT) and (2) determine correlations between these patient-reported measures.

MATERIALS AND METHODS

Demographics, smoking habits, dental pain, Modified Corah's Dental Anxiety Scale (MDAS), and Oral Health Impact Profile (OHIP-14) were assessed in eighty-two participants.

RESULTS

Mean age was 48.3 years ± 11.5. At baseline, 8.5% reported being active smokers. Of non-smokers, 11% reported being an ex-smoker. After NSPT, 11.0% reported smoking. Patients' maximal pain in the last month decreased after therapy. Before treatment, participants reported higher DA. Extreme DA was observed in 8.5% of participants before therapy. Afterwards, 2.4% of participants reported extreme DA. Fear of having a foreign object in the mouth decreased after NSPT. All OHIP-14 scores, except functional limitation, improved post-treatment. Higher DA was associated with worse OHRQoL before treatment. After treatment, total MDAS score was associated with OHIP-14 global score, physical pain, psychological disability, and social disability. Worse MDAS sub-scores were associated with a higher OHIP-14 global score. Individuals with "normal/slight anxiety" had a significant improvement in OHRQoL, whereas people in the "moderate and extreme anxiety" group did not report a significant improvement. Patients diagnosed with generalized periodontitis (GP) stage III grade B and GP stage IV grade B reported less anxiety after NSPT.

CONCLUSIONS

Associations of MDAS subcategories with OHIP-14 domain scores were found before and after therapy. DA decreases and OHRQoL enhances after NSPT in patients with "normal/slight" anxiety to dental treatment. Dental practitioners should plan strategies to cope with anxiety to dental treatment and prevent decreases in OHRQoL.

CLINICAL RELEVANCE

Within the limitations of this study, DA and OHRQoL were positively correlated in patients with periodontitis, before and after NSPT, using the MDAS and OHIP-14 questionnaires. The results of our study suggest that treatment is effective in terms of alleviating DA and improving oral health, along with quality of life, in patients that report "normal/slight" anxiety to dental treatment. Nonetheless, results must be interpreted with caution since patients are generally anxious before any type of dental treatment. DA may not just be confined to NSPT per se. According to our results, evaluation of both outcomes should be an integral part of routine periodontal clinical evaluation and periodontal reevaluation of initial therapy. It is important that clinicians learn to identify patients that suffer from anxiety and take time to explain the treatment procedures to the patient, to strive for patient's emotional well-being before, during, and after dental care services. The use of specific questionnaires for both DA and OHRQoL may be more appropriate to demonstrate the psychological and quality of life differences due to periodontal disease and NSPT.

Stress and coping among police personnel in South India

Background

Police personnel experience the highest levels of stress due to the nature and demands of work. Though many researchers have studied these variables quantitatively, there is a lack of qualitative study, particularly in India.

Methods

A qualitative study has been carried out to explore the stress and coping strategies of police personnel. This study conducted in-depth interviews with ten police personnel and three focus group discussions with 22 police personnel.

Results

Thematic analysis revealed five themes: family stressor, personal stressor, work stressor, and adaptive and maladaptive coping. Inability to take leave, multi-tasking, unscheduled excessive working hours, inability to spend time with the family members, and lack of basic amenities to meet personal hygiene were significant factors for their high level of stress.

Conclusion

The results reinforce the need for mitigating the impact of stress by using positive coping strategies and social support resources, which could be achieved through capacity building and mental health programs.

A Cross-Sectional Survey on the Association between Dental Health Conditions and University Personality Inventory Scores among University Students: A Single-Center Study in Japan

This study examined the association between dental health conditions and scores on the University Personality Inventory (UPI) among university students in Japan. Participants were freshmen at Yamagata University between 2010 and 2019. Dental check-ups, including dental caries, periodontal disease, malocclusion, and temporomandibular disorders (TMD), and mental health screening using the UPI were performed; 12,433 students were included in the final analysis. A logistic regression analysis was performed to confirm the association between dental health conditions and >30 UPI scores, which indicate the need to consult mental health professionals. Overall, students who required treatment for TMD had a 3.165-fold higher risk of >30 UPI scores (OR = 3.165, 95% CI = 1.710−5.857). Periodontal disease and TMD in male participants (periodontal disease: OR = 1.329, 95% CI = 1.108−1.595; TMD: OR = 3.014, 95% CI = 1.107−8.204) and TMD in female participants (OR = 2.938, 95% CI = 1.340−6.445) were significant risk factors for >30 UPI scores. Students requiring treatment for TMD were at risk of obtaining >30 UPI scores. Although our study has several limitations, students with subjective symptoms (e.g., disturbance in opening the mouth) should take the UPI test or in some cases consult mental health professionals.

Aggravating Effects of Psychological Stress on Ligature-Induced Periodontitis via the Involvement of Local Oxidative Damage and NF-κB Activation

Periodontitis is the leading cause of tooth loss in adults, and psychological factors play an important role in the development of periodontitis. To elucidate the adverse effects of psychological stress on the inflammatory process and redox status of periodontitis tissue, fifty male Sprague-Dawley rats were divided into the control, experimental periodontitis, psychological stress, experimental periodontitis plus psychological stress, and experimental periodontitis plus psychological stress plus fluoxetine groups. Chronic unpredictable mild stress (CUMS) was used to establish psychological stress, and silk ligature was used to induce experimental periodontitis. Four weeks later, stressed rats showed altered behaviour, serum hormone levels, and sucrose preference. More obvious alveolar bone loss and attachment loss and higher protein expressions of inflammatory cytokines were observed in the experimental periodontitis plus psychological stress group. The combination of CUMS and periodontitis had synergistic effects on increasing hypoxia-inducible factor-1α (HIF-1α) protein expression and reactive oxygen species (ROS) and malondialdehyde (MDA) contents and decreasing antioxidant enzyme activities compared with those in the stress or periodontitis groups. Moreover, psychological stress further increased p-IκBα and p-NF-κB p65 protein levels and decreased IκBα protein levels in periodontitis rats. Fluoxetine administration alleviated the adverse effects of psychological stress on the progression of periodontitis in rats. These results hint us that psychological stress could aggravate inflammation in periodontitis tissues, which may be partly due to local worsening of oxidative damage and further activation of the nuclear factor kappa-B (NF-κB) signalling pathway.

Trajectories of Mental Health Status Among Police Recruits in Sweden

BACKGROUND

The stressful and complex nature of police work and its adverse effects on mental health are well-documented in police research. The mental health of police students however, has not been given the same attention. To the best of our knowledge, studies on the mental health of Swedish police recruits have not been undertaken since 2010.

OBJECTIVES

The present study aims to examine whether there are differences in the mental health between two cohorts (2009 and 2020) of Swedish police recruits, as well as to compare the mental health of both cohorts with the general population data collected in 2002.

METHODS

Data was collected using the SCL-90-R survey. Data was analyzed using multivariate analysis of variance (MANOVA) and independent sample T-tests. Bi-variate analyses including t-test and chi-square were used to examine differences in sociodemographic variables between the two cohorts.

RESULTS

A total of 376 police recruits participated in the study. Results indicated no significant differences between the cohorts with regards to the three global indices of the SCL-90-R: Global Severity Index (GSI), Positive Symptom Total (PST), and Positive Symptom Distress Index (PSDI). Recruits with a college degree had lower scores on GSI and PSDI, similar to respondents that where in a relationship vs. singles. A total of 15 (four female) recruits had GSI scores above the Swedish patient mean. Compared with the general population, males and females from the 2009, as well as females from the 2020 cohorts had lower or insignificantly different mean scores on all global indices, with males from the 2020 cohort having a significantly lower PST score.

CONCLUSIONS

While the vast majority of recruits had results that where indicative of a low prevalence and intensity with regards to mental health disorders, some recruits did score above the Swedish patient mean. While mental preparedness is part of the curriculum for Swedish police recruits, interventions targeting the stigmas of poor mental health could be of value. The fact that educational attainment appears to have a positive impact on the mental health of police recruits, could be taken in to consideration when recruiting future police officers.

Influence of Depression and Anxiety on Non-Surgical Periodontal Treatment Outcomes: A 6-Month Prospective Study

Periodontal treatment could be worsened by risk factors. Depression and anxiety have been suggested as potentially influencing periodontal treatment outcomes. The aim of this study was to determine their association with non-surgical periodontal treatment outcomes in patients with generalized severe periodontitis (stage III/IV generalized periodontitis) at 6 months. A total of 68 patients diagnosed with generalized severe periodontitis were treated with scaling and root planing (SRP) and were followed at 3 and 6 months. The data of the 54 patients that followed the entire protocol were considered for analysis. Depression and anxiety levels were determined at baseline by the Beck Depression Inventory (BDI) and State-Trait Inventory (STAI) questionnaires. The association between psychological scores and periodontal parameters was evaluated by multivariate analysis. At 3 and 6 months, SRP induced an improvement for all periodontal parameters (plaque index (PI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment loss (CAL)). BDI and STAI scores were associated with the evolution of PI, BOP, mean PPD and number of sites with PPD > 3 mm and with CAL > 3 mm. Depression and anxiety should be considered as risk factors for SRP and the identification of at-risk patients should be performed using well-established tools.