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

The Relationship Between Dental Anxiety and Oral Health-Related Quality of Life in Patients with Periodontitis

OBJECTIVES

This study aimed to (1) investigate whether dental anxiety (DA) and oral health-related quality of life (OHRQoL) differed between patients diagnosed with periodontitis and individuals with periodontal health, (2) examine associations and correlations between these patient-reported measures, and (3) analyze demographic and clinical parameters.

METHODS

Ninety-six patients diagnosed with periodontitis and age- and sex-matched periodontally healthy controls were included. Participants' demographic characteristics, smoking status, current dental pain, dental pain during the last month, the Modified Corah's Scale (MDAS), and the Oral Health Impact Profile (OHIP-14) were determined.

RESULTS

The mean age of participants was 48.51 years ± 11.41. Patients with periodontitis experienced higher pain in the last month compared to controls (p = 0.003). Patients with periodontitis exhibited significantly higher MDAS total and sub-scores (p < 0.001). Compared to controls, the periodontitis group indicated extreme DA (1.04% vs. 7.79%, p = 0.034). Patients with periodontitis feared having a foreign object in the mouth compared to controls (p = 0.004). The periodontitis group exhibited worse OHIP-14 global and sub-scores (all Ps < 0.001). Positive associations and correlations of MDAS total and sub-scores with OHIP-14 global and domain scores were found for the periodontitis group, but not for controls. Patients with periodontitis who reported "moderate and extreme anxiety" had poorer OHRQoL compared to controls (p = 0.001). The minimal importance difference for this finding indicates a large effect size and a moderate standardized response mean between groups.

CONCLUSIONS

Patients with periodontitis had higher levels of DA and worse OHRQoL compared to controls. Our study highlights the importance of providing a comprehensive approach, including psychosocial well-being, when diagnosing and treating periodontal disease.

Associations of Social Psychological Factors and OHRQoL in Periodontitis Patients: A Structural Equation Modeling Study

Background and Purpose

Periodontitis is the leading cause of tooth loss in adults worldwide. The functional loss, nutritional deficiencies, and psychological barriers it causes, as well as its impact on overall health and quality of life, are all significant. The prevalence of periodontal disease is high in China. Our study aimed to determine the intricate relationship between periodontal disease status, dental anxiety, self-rated oral health (SROH), self-efficacy for oral care, perceived social support, socioeconomic status (SES), and the oral health-related quality of life (OHRQoL) among periodontitis patients.

Methods

This cross-sectional study used purposive sampling to identify 247 patients with periodontitis who entered the First Affiliated Hospital of Bengbu Medical University between October 2022 and October 2023. 247 participants underwent a periodontal clinical examination combined with imaging, adhering to the "2018 world new classification of periodontal and peri⁃implant diseases and conditions". Participants also completed a detailed questionnaire in paper format, which included OHRQoL, sociodemographic details, dental anxiety, SROH, self-efficacy in oral care, perceived social support, and subjective SES.

Results

Dental anxiety, self-efficacy for oral care, and SROH all had a direct and significant effect on OHRQoL. OHRQoL was indirectly related to SROH mediated by dental anxiety and subjective SES, perceived social support and self-efficacy for oral care, respectively. SROH was directly related to subjective SES, and at the same time, they had a direct effect on dental anxiety. Furthermore, patient's age, gender, annual household income, and education level were significantly associated with the degree of periodontal disease.

Conclusion

OHRQoL and periodontal status was influenced by socio-demographics characteristics, dental anxiety, SROH, self-efficacy for oral care, perceived social support, subjective SES in periodontitis patients. These insights underscore the importance of adopting a holistic approach in the management and treatment of periodontal diseases.

Excessive Gag Reflex, Dental Anxiety, and Phobia of Vomiting in Dental Care

BACKGROUND

The most known and commonly studied behavioral obstacle to dental care is dental anxiety. An obstacle that is less studied though no less problematic is excessive gag reflex, which can severely impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting).

OBJECTIVE

The aim of this study was to examine possible comorbidity amongst self-reported emetophobia, dental anxiety, and excessive gagging in the dental office.

METHODS

A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Gagging Problem Assessment, Gagging Assessment Scale (GAS), and Specific Phobia of Vomiting Inventory (SPOVI).

RESULTS

In all, 164 participants fully completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found amongst all variables (P < .001). High gagging (GAS > 6) was associated with a 7.29 times (P < .000) greater risk of positive emetophobia (SPOVI ≥ 10). Linear regression analyses revealed that the intensity of the reflex and the experience of gagging upon encountering odours in the dental office as well as dental anxiety and vomiting phobia significantly predicted participants' gagging scores as evaluated by GAS (R2 = 0.59; F = 21.16; P < .001).

CONCLUSIONS

The study shows that excessive gagging reflex in the dental office is closely related both to dental anxiety and to emetophobia.

Evaluation of the effects of periodontal status according to 2017 classifications on oral health-related quality of life and quality of life-related to general health: A cross-sectional study

BACKGROUND

In patients with periodontal disease, various symptoms are observed along with inflammation. The impact of local and systemic inflammation on periodontal tissue is well-known; however, the impact of periodontal disease on the individual's quality of life is unclear. This study aimed to assess oral health-related and general health-related quality of life in patients undergoing maintenance treatment following treatment for periodontitis (RP-CPH), patients with gingivitis (G) and patients with Stage I periodontitis (SI-P) and to compare this with individuals with clinical periodontal health (IP-CPH).

METHOD

This study was comprised of cross-sectional periodontal assessment along with questionnaires. Oral health-related quality of life and general health-related quality of life were assessed using, respectively, the Oral Health Impact Profile-14 (OHIP-14) and Short-Form-36 (SF-36) questionnaires. Study participants were classified according to the classification of periodontal and peri-implant diseases and conditions established by the 2017 World Workshop.

RESULTS

The OHIP-14 total scores for the 166 study participants (age range: 22-57) of the G (11.61 ± 3.21) and SI-P (13.03 ± 3.47) groups were significantly higher than the OHIP-14 total scores of the IP-CPH (1.09 ± 1.58) and RP-CPH (2.95 ± 2.58) groups. SF-36 scores were found to be significantly lower in the SI-P group in all subgroups compared to the G and IP-CPH groups.

CONCLUSIONS

A correlation was found between early-stage periodontal disease and low levels of OHRQoL and GHRQoL. The health of periodontal tissues may have a positive effect on the quality of life.

Investigation of the effect of virtual reality distraction in patients undergoing mandibular periodontal surgery: A randomized controlled study

OBJECTIVE

This clinical study aimed to evaluate the effect of virtual reality (VR) technology on anxiety and pain levels in patients undergoing gingivectomy and gingivoplasty procedures.

MATERIALS AND METHODS

The patients were randomized into test (surgery with VR glasses) and control (surgery without VR glasses) groups. Before the surgery, the anxiety level was measured using the modified dental anxiety scale (MDAS), and anticipated pain (AP) was measured by a visual analog scale (VAS). Immediately after the surgery, the pain and discomfort associated with the surgery (VASP), procedure time (T), and time perception (TP) were evaluated. The patients in the test group were requested to assess the immersion (VASI), satisfaction (VASS), perception of reduced anxiety (VASA), and perceived control (VASC). One week after surgery, MDAS was applied to all patients.

RESULTS

This trial was conducted with 41 female and 17 male subjects with a mean age of 29.69 ± 12.32. There were no significant differences between the groups in terms of age, sex, preoperative MDAS, or AP. After surgery, MDAS, VASP, T, and TP failed to differ significantly between the groups. The subject age was positively correlated with VASI, VASS, VASA, and VASC (r = 0.60, p = 0.00; r = 0.44, p = 0.02; r = 0.46, p = 0.02; r = 0.50, p = 0.01, respectively) and negatively correlated with VASP (r = 0.47, p = 0.04).

CONCLUSIONS

VR application did not affect anxiety and pain levels in patients undergoing periodontal surgery. More studies are needed to evaluate VR distraction in periodontal surgeries with diverse age samples and video options.

CLINICAL SIGNIFICANCE

VR does not affect anxiety and pain levels during gingivectomy and gingivoplasty surgeries in the young adult population. It should be evaluated in older age groups. Trial registration ClinicalTrials.gov Identifier: NCT06092177.

Periodontal conditions and association of periodontitis with oral-health-related quality of life in patients experiencing different episodes of bipolar disorder compared with healthy controls

AIM

The aim of the present cross-sectional study was to evaluate periodontal conditions and the association of periodontitis with oral-health-related quality of life (OHRQoL) in patients with a history of bipolar disorder.

MATERIALS AND METHODS

A total of 160 participants were recruited in four groups for the study: 40 patients with euthymic episodes, 40 patients with depression, 40 patients with manic episodes and 40 systemically healthy individuals. Clinical periodontal parameters were recorded. Oral Health Impact Profile (OHIP-14) was used to measure the impact of oral health on the quality of life.

RESULTS

Bipolar disorder groups exhibited generally higher clinical parameters compared with the control group (p < .05). OHIP-14 total score (β = 3.32, 95% confidence interval [CI]: 0.08-6.56, p = .044), functional limitation (β = .89, 95% CI: 0.27-1.49, p = .005) and physical pain (β = .64, 95% CI: 0.01-1.27, p = .046) were associated with bipolar depression episodes. Psychological discomfort was associated with the presence of generalized periodontitis (β = .76, 95% CI: 0.01-1.51, p = .047) and psychological disability was associated with the presence of stage III-IV (β = .83, 95% CI: 0.07-1.59, p = .033) and generalized (β = .75, 95% CI: 0.07-1.42, p = .029) periodontitis.

CONCLUSIONS

According to this study, a history of bipolar disorder episodes (exposure) may be associated with increased prevalence and severity of periodontitis and related reported OHRQoL impacts (outcomes). Bipolar depression episodes had a higher impact on OHRQoL than other bipolar episodes.

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.

Evaluation of the Effect of Non-Surgical Periodontal Treatment on Oral Health-Related Quality of Life in Patients with Periodontitis at Different Stages

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Self-perception of periodontal health and pain experience during periodontal examination in 14- to 15-year-old Danish adolescents

OBJECTIVE

To evaluate different aspects of periodontal examination among Danish adolescents.

MATERIALS AND METHODS

In all, 521 Danish adolescents underwent a periodontal examination and answered a questionnaire concerning their self-perception of periodontal health (PH). Furthermore, 107 participants reported their pain experience during periodontal examination using a visual analog scale. The self-perception of PH and the pain experience were correlated with plaque score (PS), bleeding on probing (BOP), probing pocket depth (PPD), and interdental clinical attachment loss (CAL).

RESULTS

Good PH was reported by 424 (81%) of the participants. However, the association between PH and PS, BOP, PPD, and CAL was small (sensitivity: 7.7, 7.8, 12.0, and 0.0%, respectively). Only 57 (11%) of the participants reported bleeding gums (BG) during tooth brushing, but the correlation with BOP showed a sensitivity of 11.7%. The specificity of both self-perception of PH and BG was high. Sixty-seven (66.6%) of the participants experienced 'mild pain' during periodontal examination. There were no differences in periodontal outcomes between the pain groups (p > .05).

CONCLUSIONS

The adolescents showed a poor ability to identify themselves as having poor PH and BG, and 67 (66.6%) of the adolescents experienced mild pain during periodontal examination. The findings emphasize the need for dental staff to monitor the PH of Danish adolescents and advise them as necessary.

Periodontal damage after thermal inhalation injury - The impact of high temperature inhalation injury on long term periodontal health

PURPOSE

Thermal inhalation injury is a common, life-threatening problem in burned patients. Whether or not this single event of damage to the oral integrity causes long term health problems is yet to be examined.

MATERIAL AND METHODS

All consecutive burn patients between 2014 and 2017 of Marienhospital Stuttgart (MHS), Germany, with at least 10% of burned skin surface were included and compared. The Periodontal Screening Index as well as Vitamin D levels were examined. Vitamin D has been suspected to contribute to the genesis of periodontitis. Risk factors and subjective oral life quality were prompted.

RESULTS

We included a total of 32 patients, 15 of which had an inhalation injury in their medical history. Risk factors were examined via Renatus' questionnaire. While risk factors were equally distributed in both groups we saw a remarkable difference in periodontal integrity, with the Periodontal Screening Index (PSI) per sextant differing drastically (with inhalation injury: 2.40, without inhalation injury: 1.10, p < 0.001). Patients with an inhalation injury had a mean of 5.2 out of 6 possible sextants with a pathologic PSI (with the median being 6/6), while patients without an inhalation injury had a mean of 1.83 out of 6 (median: 1/6), p < 0.001. The oral health impact profile showed a difference as well, albeit without statistical significance (with inhalation injury: median = 11, without: median = 3.5, p = 0.414). A correlation between Serum Vitamin D levels and periodontal integrity could not be seen in this group.

CONCLUSION

Inhalation injury is a possible cause for periodontitis and hence impacts the quality of life of burned patients.

Evaluation of the relationship among dental fear, scaling and root planing and periodontal status using periodontitis stages: A retrospective study

Background/purpose

Patients with periodontal disease have higher dental fear levels, which may have negative effects on their clinical outcome during scaling and root planing (SRP). The present study used the new classification of periodontitis and validated questionnaires to assess the relationship among dental fear, SRP pain and periodontal status.

Materials and methods

A total of 120 periodontitis patients were enrolled and staging according to the new classification of periodontitis. SRP was performed, and the visual analog scale (VAS) to assess pain was used with every patient after treatment. Questionnaires, including Corah's Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and short-form Dental Anxiety Inventory (S-DAI) were implemented from the first attendance and subsequent visits after 6 months. The patients were grouped by DAS scores. The statistical analysis was performed using T-test, chi-square, Pearson and Spearman correlative analysis.

Results

Compared to pre-SRP treatment, the dental fear level on DFS was decreased in the posttreatment period for all periodontitis stages. There were no statistically significant differences in S-DAI and DAS between pretreatment and posttreatment periods in stage I and II; meanwhile, there were statistically differences in stage III and IV. The correlation among periodontitis stages, VAS and dental fear level was significant. The proportion of high periodontitis stages was increased in high dental fear group.

Conclusion

SRP can reduce dental fear levels in all periodontitis stages, especially in stage III and IV. Correlations exist among periodontal status, dental fear and SRP pain. High dental fear is associated with poor periodontal status.

The Influence of Hepatitis C Virus Infection on ORAL Health-Related Quality of Life in Patients with Oral Lichen Planus

Background: oral lichen planus (OLP) is a mucocutaneous disease that affects about 4% of the global population. Hepatitis C virus (HCV) was linked to lichen planus. The current study aimed to assess the impact of OLP associated or not with HCV infection on the oral health-related quality of life (OHRQoL). Methods: The study included patients diagnosed with OLP who filled in the Romanian version of OHIP-14 questionnaire at their first appointment and 6 months later, after the OLP treatment. A control group of OLP-free subjects similar as age and sex was also included in the study. Results: 68 patients with OLP and 46 controls were included in the study. The OHIP scores are significantly higher on OLP group than controls (p-value < 0.0001) and significantly reduced at 6-month follow-up (p-values: < 0.0001 pre- vs. post-treatment in OLP group). Patients with and without HCV associated with OLP demonstrated a similar oral quality of life (p-values > 0.05). Conclusions: the OHRQoL for patients suffering from OLP is compromised but is improved after treatment. The HCV associated with OLP did not influence the overall OHRQoL, but the patients who associate HCV reported more frequently aching in the mouth and discomfort eating food at six-month follow-up.

Psychosocial oral health-related quality of life impact: A systematic review

BACKGROUND

Psychosocial wellbeing is an important determinant for patients' oral health-related quality of life (OHRQoL). Psychosocial impact (PI), together with the dimensions Oral Function, Orofacial Pain and Orofacial Appearance, has been proposed to cover the different areas of OHRQoL.

OBJECTIVE

The objective of the study was to collect further scientific support for the new four-dimensional structure of OHRQoL. This study is one out of a series of four and focuses on the PI in patients with dental anxiety, oral cancer and periodontitis (PROSPERO registration number: CRD42017064033).

METHODS

Five databases (Pubmed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO) were electronically searched on 8 June 2017 and updated on 14 January 2019, to identify the studies that measure OHRQoL using the Oral Health Impact Profile (OHIP) for oral health conditions. In this review, studies were included if the mean/median domain scores from OHIP-14 or OHIP-49 were available for patients with dental anxiety, oral cancer or periodontitis. The score of the handicap domain from the OHIP was used to assess patients` PI. The handicap domain includes 6 items for OHIP-49 with a domain score ranging from 0 to 24 and 2 items for OHIP-14 with a domain score ranging from 0 to 8. For comparison between the 2 versions of the OHIP, the domain score of OHIP-49 was conversed into a 0 to 8 metric. The domain scores of the included studies were then pooled, separately for each of the included dental disorders.

RESULTS

A total of 2104 records were identified based on the search strategy. After screening of titles and abstracts, 1607 articles were reviewed in full text. Twenty-three articles met the inclusion criteria for this review and were included in the study. The 23 articles contained 3884 patients, grouped in 30 patient populations and 42 patient samples. The pooled mean scores of PI for dental anxiety, oral cancer and periodontitis were 3.2, 1.9 and 0.8, respectively, on the 0 to 8 metric.

CONCLUSION

This review provides standardised information about the OHRQoL impact for three dental disorders as a model for the PI dimension. Dental anxiety tends to show the strongest effect on the PI dimension, while periodontitis tends to show the weakest effect on the PI dimension. Future studies need to confirm whether the reported differences in PI scores between the three dental disorders are statistically significant.

Pre-Operative Oral Health-Related Quality of Life in Patients Attending Surgical Removal of Mandibular Third Molar Teeth

The study aimed to measure the pre-operative oral health-related quality of life (OHRQoL) and to identify patient and teeth pathologies associated with worse OHRQoL among patients attending mandibular third molar tooth extraction. Data were collected preoperatively from 199 patients attending surgical removal of their mandibular third molar. To that end, we measured the Oral Health Impact Profile-14 (OHIP-14) and analyzed its association with: (1) demographics; (2) health-related behaviors such as smoking, alcohol consumption, physical activity, and dietary habits; (3) Plaque Index (PI); (4) Decay, Missing, and Filled Teeth (DMFT); and (5) clinical characteristics related to third molar extraction, such as the indication for extraction, tooth angulations, and radiographic pathology. The mean age of the study population was 21.5 ± 3.2 years and the mean OHIP-14 global score was 22.5 ± 8.3. The present study identified patient and teeth profiles that are associated with worse pre-operative OHRQoL in patients attending mandibular third molar extraction. The “vulnerable patient” profile includes poor health-related behaviors, particularly the performance of physical activity less than once a week (p = 0.028). The “disturbing teeth” profile includes higher plaque scores (p = 0.023) and specific characteristics of the third molar teeth, such as pericoronitis (p = 0.027) and radiolucency around third molars in panoramic radiography (p < 0.001). These findings support the hypothesis that OHRQoL is a complex phenomenon which is associated with the patient’s health-related behaviors as well as with specific tooth pathologies.

Increased Anxiety-Like Behavior in the Acute Phase of a Preclinical Model of Periodontal Disease

Periodontal disease (PD) is an infectious-inflammatory oral disease that is highly prevalent among adolescence and adulthood and can lead to chronic orofacial pain and be associated with anxiety, stress and depression. This study aimed to identify anxiety-like behaviors in the ligature-induced murine preclinical model of PD in different phases of the disease (i.e., acute vs. chronic). Also, we investigated orofacial mechanical allodynia thresholds and superficial cortical plasticity along the orofacial motor cortex in both disease phases. To this aim, 25 male Wistar rats were randomly allocated in acute (14 days) or chronic (28 days) ligature-induced-PD groups and further divided into active-PD or sham-PD. Anxiety-like behavior was evaluated using the elevated plus maze, mechanical allodynia assessed using the von Frey filaments test and superficial motor cortex mapping was performed with electrical transdural stimulation. We observed increased anxiety-like behavior in active-PD animals in the acute phase, characterized by decreased number of entries into the open arm extremities [t (1,7) = 2.42, p = 0.04], and reduced time spent in the open arms [t (1,7) = 3.56, p = 0.01] and in the open arm extremities [t (1,7) = 2.75, p = 0.03]. There was also a reduction in the mechanical allodynia threshold in all active-PD animals [Acute: t (1,7) = 8.81, p < 0.001; Chronic: t (1,6) = 60.0, p < 0.001], that was positively correlated with anxiety-like behaviors in the acute group. No differences were observed in motor cortex mapping. Thus, our findings show the presence of anxiety-like behaviors in the acute phase of PD making this a suitable model to study the impact of anxiety in treatment response and treatment efficacy.

Patient's pre-operative dental anxiety is related to diastolic blood pressure and the need for post-surgical analgesia

In order to study the relationship of the patient’s anxiety level from Corah’s Dental Anxiety Scale (DAS) vs different physiological parameters: pre and post-operative blood pressure, and pre and post-operative heart rates, and subsequently, relate the results to the patient’s post-operative anti-inflammatory analgesic need, 185 patients requiring a simple dental extraction were recruited. They filled out the DAS in the waiting room prior to their procedure and once in the examination room, their preoperative blood pressure and heart rate was measured. Once the dental extraction had been completed, their blood pressure and heart rate were measured again. Before leaving the clinic, the patient was given an analgesic form in which they had to indicate whether or not they had required analgesia after the procedure. Diastolic blood pressure (DBP) showed statistically significant differences between pre-operative and post-operative (P = 0.001). DAS was related with pre-operative diastolic blood pressure (pre-DBP) (P = 0.001) and post-operative diastolic blood pressure (post-DBP) as well as pre-operative heart rate (pre-HR) (P = 0.027) and post-operative heart rate (post-HR) (P = 0.013). Patients with high levels of DAS tend to take more Ibuprofen 400 mg (P = 0.038). The different levels of anxiety will determine what type of anti-inflammatory analgesia the patient will take, if necessary.

The association of socio-economic status, dental anxiety, and behavioral and clinical variables with adolescents' oral health-related quality of life

PURPOSE

It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents' OHRQoL.

METHODS

Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents' educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents' OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ_11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis.

RESULTS

1207 adolescents (46.6% females) participated in this study. The mean total CPQ_11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p < 0.05). In addition, gingival bleeding was a predictor of the oral symptom domain (β = 0.7, p = 0.027); the emotional well-being of adolescents whose father went to college had a better OHRQoL (β =  - 0.9, p = 0.014) and adolescents from the higher-income family had a statistically better social well-being (p = 0.015).

CONCLUSION

Our study indicates that adolescents with poorer oral health knowledge, higher dental anxiety levels, brushing their teeth less than once a day, or having a daily consumption of chocolate or biscuits had statistically worse OHRQoL. These findings can provide guidance for future oral health promotion in improving OHRQoL among adolescents.

Association of oral health-related quality of life measures with aggressive and chronic periodontitis

BACKGROUND AND OBJECTIVE

Evidence suggests that periodontitis has a negative effect on the quality of life of an individual, with increased impacts by greater disease severity. The aim of this study was to assess the association between quality of life and the presence of different severity and forms of periodontitis (aggressive and chronic), compared to a disease-free control group.

MATERIALS AND METHODS

Four hundred and seventy one study participants were classified according to periodontal diagnosis using the 1999 Consensus Classification into chronic periodontitis (CP), aggressive periodontitis (AgP) and periodontally healthy. Oral health-related quality of life was assessed using the OHIP-14 questionnaire. Outcomes consisted of the prevalence of oral impacts reported occasionally, fairly often or very often (OFOVO) as well as fairly often or very often (FOVO), OHIP-14 total and domain scores. Logistic and linear regression analyses were carried out to test associations between periodontal diagnosis and quality of life outcomes, adjusted for smoking, age, ethnicity and body mass index.

RESULTS

Over 90% of periodontitis patients reported at least one oral impact experienced occasionally, fairly often or very often (OFOVO) compared with 53.8% of periodontally healthy controls (P < .001). After adjustment for covariates, significant differences were found between the periodontitis groups and healthy controls for OHIP-14 outcome scores (P < .001) and across all of the OHIP-14 domains (P < .005). These differences were clinically meaningful as they were higher than the measurement errors. No significant differences were identified between AgP and CP in adjusted analysis when comparing OHIP-14 scores.

CONCLUSION

Patients with periodontitis have worse quality of life than periodontally healthy individuals, with differences being clinically meaningful. AgP patients reported worse OHRQoL overall compared to CP patients, but these moderate and meaningful differences were explained through the adjustment process.

Diet Practices, Body Mass Index, and Oral Health-Related Quality of Life in Adults with Periodontitis- A Case-Control Study

Objectives: To assess and compare diet practices, body mass index (BMI), and oral health-related quality of life (OHRQoL) in adults with and without periodontitis. Methods: Demographics, health-related behaviors, BMI, dental and periodontal parameters, diet practices, and Oral Health Impact Profile-14 (OHIP-14) were collected from 62 periodontitis patients and 100 controls without periodontitis. Results: Having periodontitis was positively associated with male sex (p = 0.004), older age (p < 0.001), smoking pack-years (p = 0.006), weight (p = 0.008), BMI (p = 0.003), number of meals per day (p < 0.001) and had a negative association with decayed teeth (p = 0.013), alcohol (p = 0.006), and sweets (p = 0.007) consumption. Periodontitis patients were more likely to avoid carbonated beverages (p = 0.028), hot (p = 0.003), and cold drinks (p = 0.013), cold (p = 0.028), hard textured (p = 0.002), and fibrous foods (p = 0.02) than the controls, and exhibited higher global OHIP-14 (p < 0.001) and most domain scores. Age (p < 0.001), BMI (p =0.045), number of meals per day (p = 0.024), and global OHIP-14 score (p < 0.001) remained positively associated with periodontitis in the multivariate analysis. Conclusions: Periodontitis patients exhibited higher BMI and altered diet practices and OHRQoL as compared to controls. Assessment of diet practices, BMI, and OHRQoL should be part of periodontal work-up. Dentists and dietitians should collaborate to design strategies to address these challenges.

Quality of Life and Anxiety in Military Personnel

The quality of life of military personnel represents their self-evaluation of the quality of their own mental and physical health, social relations, and the environment in which they live and work. The aim of our study was to evaluate the relationship between quality of life and anxiety levels in military personnel of the Serbian Armed Forces.

The cross-sectional study included a total of 311 randomly selected professional military personnel (officers, non-commissioned officers and professional soldiers) between 23 and 53 years of age (mean, 35.3±7 years) without current mental health problems. For the purpose of this study, we used the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF) and the Beck Anxiety Inventory (BAI). The statistical analysis included parametric and non-parametric descriptive statistics.

Professional military personnel showed high satisfaction with their quality of life in the categories of social relations (82.52), psychological health (82.10) and physical health (81.68), while the satisfaction scores in the category environment category were the lowest (62.77). The average value for the total BAI score was 4.83±5.66. Quality of life decreased, while anxiety increased, with increasing age of the military personnel. Higher BREF score values were associated with lower scores on the BAI questionnaires in all subscales (p<0.001).

Military personnel of the Serbian Armed Forces showed a high degree of satisfaction with their own quality of life. Learning techniques to easily overcome everyday stress would reducedreduce anxiety and improve the quality of life in military personnel of the Serbian Armed Forces.

Oral health-related quality of life in different clinical forms of oral lichen planus

OBJECTIVES

The aim of the study was to determine the prevalence of clinical forms in a group of oral lichen planus (OLP) patients and to investigate whether the oral health-related quality of life (OHRQoL) of patients with common clinical OLP forms differs significantly from that of other clinical forms of OLP and healthy patients, respectively.

METHODS

OHRQoL was assessed using the Romanian version of the short form of the Oral Health Impact Profile (OHIP-14). OLP patients rated the pain they were currently experiencing on a visual analog scale (VAS). Statistics was performed using parametric and non-parametric tests and multiple linear regression.

RESULTS

Eighty OLP patients and 80 healthy controls were enrolled. The most prevalent OLP clinical form was keratotic form (n = 39, 48.75%, group 1), followed by atrophic (31.25%), erosive-ulcerative (17.5%), and bullous (2.5%) forms, which were included in group 2 (n = 41). The OHRQoL did not differ significantly between group 1 and the other two groups. A negative social impact was reported on psychological discomfort domain for both OLP groups, as compared with healthy controls. VAS scores were significantly associated with OHIP total scores in group 1 (rho = 0.41, n = 39, p = 0.009, Spearman's correlation coefficient). Within the same group, significantly higher OHIP total scores were recorded in patients lacking academic education (p = 0.0086, Mann-Whitney U test).

CONCLUSIONS

Overall, the most common clinical OLP form did not impact significantly the OHRQoL of OLP patients.

CLINICAL RELEVANCE

Psychological therapy and meeting the educational needs might improve the OHRQoL of patients with common clinical forms of OLP.

Where periodontitis meets metabolic syndrome-The role of common health-related risk factors

OBJECTIVES

To analyse and compare associations between metabolic syndrome (MetS) and its components in periodontitis compared to control patients.

METHODS

This 7-year cross-sectional study retrospectively analysed medical records of 504 individuals aged 18-90 who attended the student dental clinic between 2008 and 2014. Demographics, smoking habits, blood pressure, waist circumference, as well as presence of: periodontitis, MetS, diabetes, hypertension, hyperlipidaemia, stroke, heart disease, cancer and psychiatric disorders were recorded.

RESULTS

The study population composed of 231 (45.8%) males and 273 (54.2%) females, with an average age of 55.79 ± 16.91 years. A patient profile associated with periodontitis was identified and included male sex, older age, smoking, higher smoking pack-years, abdominal obesity, higher systolic and diastolic blood pressures, the presence of MetS or its components, hypertension, hyperlipidaemia, diabetes or diseases associated with its consequences such as ischaemic heart disease and stroke. Following multivariate logistic regression analysis, age and smoking retained a significant association with periodontitis, whereas the systemic disorders did not.

CONCLUSIONS

The association between periodontitis and MetS may be explained by shared common profile and risk factors. An appropriate risk factors management approach should be adopted by both dental and general health clinicians and health authorities, to control common high-risk behaviours.

When the fear of dentist is relevant for more than one's oral health. A structural equation model of dental fear, self-esteem, oral-health-related well-being, and general well-being

PURPOSE

To develop and test a complex model that captures the individuals' general well-being and the specific oral-health-related well-being. We were specifically interested, as a specific research question, if self-esteem, dental fear, and the oral health-related well-being are credible predictors for the general well-being.

PATIENTS AND METHODS

A one-time associative research design measured dental-specific anxiety, self-esteem, oral-health-related specific well-being, and general well-being in 281 participants, 3rd and 6th year dental students (M _Age =22.59 years, SD _Age =3.13; 55% females), which completed a battery of relevant questionnaires: the Dental Fear Survey, the Rosenberg Self-Image Scale, the short form of Oral Health Impact Profile, and the Flourishing Scale. The data were subject to structural equation modeling in order to validate potential pathways of influence hypothesized based on previous evidence from the literature.

RESULTS

We developed and tested a complex structural equations model, in which dental fear influences both the specific oral-health-related well-being and the persons' self-esteem. In turn, self-esteem mediates the influence pathways between dental fear and oral-health-specific well-being, on the one hand, and the overall well-being, on the other hand.

CONCLUSION

Our research contributes directly to strengthening the theoretical basis for future interdisciplinary research, by providing, first, a tested and replicable model that surpasses the simple correlation or prediction, and second, empirical evidence for the significant mutual interdependence between psychological experiences, eg, self-esteem, and the two main aspects of well-being, ie, specific and general. From a practical, clinical viewpoint, our research provides further insights and justification for the importance of educating the patient, on all levels, from the individual clinical practice to community programs and public oral health policies, with respect to the importance of oral health.