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Dibello V, Custodero C, Cavalcanti R, Lafornara D, Dibello A, Lozupone M, Daniele A, Pilotto A, Panza F, Solfrizzi V. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis. GeroScience 2024:10.1007/s11357-024-01243-8. [PMID: 38943006 DOI: 10.1007/s11357-024-01243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
A growing body of research suggested that there was a link between poor periodontal health and systemic diseases, particularly with the early development of cognitive disorders, dementia, and depression. This is especially true in cases of changes in diet, malnutrition, loss of muscular endurance, and abnormal systemic inflammatory response. Our study aimed to determine the extent of these associations to better target the multi-level healthy aging challenge investigating the impact of periodontal disease on cognitive disorders (cognitive impairment and cognitive decline), dementia, and depression. We conducted a comprehensive literature search up to November 2023 using six different electronic databases. Two independent researchers assessed the eligibility of 7363 records against the inclusion criteria and found only 46 records that met the requirements. The study is registered on PROSPERO (CRD42023485688). We generated random effects pooled estimates and 95% confidence intervals (CI) to evaluate whether periodontal disease increased the risk of the investigated outcomes. The quality assessment revealed moderate quality of evidence and risk of bias. Periodontal disease was found to be associated with both cognitive disorders (relative risk (RR) 1.25, 95% CI 1.11-1.40, in the analysis of cross-sectional studies); cognitive impairment (RR 3.01, 95% CI 1.52-5.95 for longitudinal studies, cognitive decline); and dementia (RR 1.22, 95% CI 1.10-1.36). However, no significant increased risk of depression among subjects with periodontal disease was found (RR 1.07, 95% CI 0.95-1.21). Despite the association with two of the three explored outcomes, the available evidence on periodontal diseases and dementia, cognitive disorders, and depression is controversial due to several limitations. Therefore, further investigations involving validated and standardized tools are required.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Custodero
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Raffaele Cavalcanti
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Domenico Lafornara
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Dibello
- Stella Maris Nursing Home and Day Care Center, Monopoli, Bari, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine & Neuroscience 'DiBraiN', University of Bari Aldo Moro, Bari, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Pilotto
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Francesco Panza
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy.
| | - Vincenzo Solfrizzi
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Chen L, Nini W, Jinmei Z, Jingmei Y. Implications of sleep disorders for periodontitis. Sleep Breath 2023; 27:1655-1666. [PMID: 36547852 DOI: 10.1007/s11325-022-02769-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/14/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Periodontitis is a chronic inflammatory disease caused by multi-factors. Sleep is a natural physiologic process, and the sleep duration, quality, and patterns might be associated with periodontitis. Meanwhile, periodontitis might in turn induce systemic inflammation and thus impact sleep in different ways as well. METHODS To investigate the bidirectional relationship between sleep disorder and periodontitis, a literature search was conducted to reveal the interaction and possible mechanism between these two diseases. RESULTS The results show that sleep disorders can affect the progression of periodontitis via some pathomechanisms, and periodontitis also has a reverse impact on sleep. CONCLUSION Although the epidemiologic and clinical trials found the possible associations between sleep disorder and periodontitis, their relationship is still not that explicit. Further studies are warranted to shed light on them, to improve preventive health care.
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Affiliation(s)
- Li Chen
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Disease, Department of Periodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Chengdu, 610041, China
| | - Wang Nini
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Disease, Department of Periodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Chengdu, 610041, China
| | - Zhang Jinmei
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Disease, Department of Periodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Chengdu, 610041, China
| | - Yang Jingmei
- State Key Laboratory of Oral Disease & National Clinical Research Center for Oral Disease, Department of Periodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Chengdu, 610041, China.
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Wu Y, Lan Y, Mao J, Shen J, Kang T, Xie Z. The interaction between the nervous system and the stomatognathic system: from development to diseases. Int J Oral Sci 2023; 15:34. [PMID: 37580325 PMCID: PMC10425412 DOI: 10.1038/s41368-023-00241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
The crosstalk between the nerve and stomatognathic systems plays a more important role in organismal health than previously appreciated with the presence of emerging concept of the "brain-oral axis". A deeper understanding of the intricate interaction between the nervous system and the stomatognathic system is warranted, considering their significant developmental homology and anatomical proximity, and the more complex innervation of the jawbone compared to other skeletons. In this review, we provide an in-depth look at studies concerning neurodevelopment, craniofacial development, and congenital anomalies that occur when the two systems develop abnormally. It summarizes the cross-regulation between nerves and jawbones and the effects of various states of the jawbone on intrabony nerve distribution. Diseases closely related to both the nervous system and the stomatognathic system are divided into craniofacial diseases caused by neurological illnesses, and neurological diseases caused by an aberrant stomatognathic system. The two-way relationships between common diseases, such as periodontitis and neurodegenerative disorders, and depression and oral diseases were also discussed. This review provides valuable insights into novel strategies for neuro-skeletal tissue engineering and early prevention and treatment of orofacial and neurological diseases.
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Affiliation(s)
- Yuzhu Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yanhua Lan
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiajie Mao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiahui Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Ting Kang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
| | - Zhijian Xie
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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Wu C, Li W, Cen D, Zhou Q. Is insufficient sleep duration a risk indicator for periodontal disease? A systematic review. Int J Dent Hyg 2023; 21:18-27. [PMID: 36385732 DOI: 10.1111/idh.12633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/15/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In this study, we conducted a systematic review and meta-analysis to assess whether people who achieved <7 h of sleep were more likely to develop periodontal disease (PD). SOURCES We executed electronic searches in the PubMed, EMBASE and Cochrane Library, as well as a manual search of articles published by leading journals in related fields, for observational studies, published in English from 1 January 1966 to 31 March 2021.which evaluated the relationship between sleep duration and PD. The Agency for Healthcare Research and Quality (AHRQ) quality evaluation scale was used for the cross-sectional studies, and the random effects model was used to summarize the effect sizes in the included studies with a 95% confidence interval (CI). RESULTS A total of six cross-sectional studies met the inclusion criteria, totaling 107,777 participants, of which 69,773 had PD. The results of the present indicated that shorter sleep duration (<7 h) is significantly associated with PD (Odd ratio [OR], 1.19; 95% CI, 1.16-1.23; p < 0.001; I2 , 0.0%, I2 interval, 0%-75%). The strength of the sensitivity analysis and cumulative meta-analysis confirmed the reliability of the results. CONCLUSION Although the inclusion of only six studies makes it difficult to explore whether there is a publication bias, we found that insufficient sleep duration was closely related to PD, and we therefore speculated that getting enough sleep may help prevent PD.
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Affiliation(s)
- Chuanbin Wu
- School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Weiqi Li
- School and Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Province Key Laboratory of Oral Diseases, Shenyang, China
| | - Dongdong Cen
- School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Qing Zhou
- School and Hospital of Stomatology, China Medical University, Shenyang, China
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Kim YR, Son M, Nam SH. Association between depressive mood and chronic periodontitis among senior residents using the National Health Insurance Service-Senior Cohort Database. J Periodontol 2022. [PMID: 36566362 DOI: 10.1002/jper.22-0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bacteria involved in chronic periodontal disease induce inflammatory cytokines. These cytokines can enter the brain through systemic circulation and cause depression. In this study, we investigated the association between depressed mood and chronic periodontitis in older adults in Korea. METHODS This study used data from the Life-changing Period Health Checkup (2007-2008), performed only at 66 years of age, which is available from the National Health Insurance Service-Senior Cohort Database. The depressed mood status was evaluated by three questions in the mental health examination. The definition of chronic periodontitis was determined based on the diagnosis and treatment codes for chronic periodontitis. Based on the three questions, we investigated the association between depressive mood and chronic periodontal disease by dividing the study population into 9622 depressed mood subjects (DMS) and 9091 non-depressed mood subjects (NDMS). Multivariable-adjusted logistic regression analysis was performed, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were presented. RESULTS Among the NDMS, 5390 patients with chronic periodontitis were identified, and among the DMS, 5964 patients with chronic periodontitis were identified. The crude OR (95% CI) for chronic periodontitis in DMS compared to NDMS was 1.12 (1.06-1.19). The adjusted OR (95% CI) for chronic periodontitis was 1.12 (1.06-1.19). As a result of confirming the effect of sex and comorbidity on the association between depressed mood and chronic periodontitis, a significant association was observed for women at 1.15 (1.07-1.25). In addition, the adjusted OR (95% CI) for depressive mood and chronic periodontitis was 1.15 (1.07-1.25) for patients with hypertension, 1.13 (1.03-1.25) for patients with diabetes, 1.12 (1.02-1.22) for patients with dyslipidemia, and 1.18 (1.04-1.34) for patients with heart disease. CONCLUSIONS This study confirmed the relationship between depressed mood and chronic periodontitis in older adults. Therefore, education to strengthen the emotional management of older adults, especially with respect to depression, would play an auxiliary role in preventing and treating periodontitis.
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Affiliation(s)
- Yu-Rin Kim
- Department of Dental Hygiene, Silla University, Busan, Republic of Korea
| | - Minkook Son
- Department of Physiology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Seoul-Hee Nam
- Department of Dental Hygiene, College of Health Sciences, Kangwon National University, Samcheok-si, Gangwon-do, Republic of Korea
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Hakam AE, Duarte PM, Mbadu MP, Aukhil I, da Silva HDP, Chang J. Association of different antidepressant classes with clinical attachment level and alveolar bone loss in patients with periodontitis: A retrospective study. J Periodontal Res 2021; 57:75-84. [PMID: 34622954 DOI: 10.1111/jre.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/25/2021] [Accepted: 09/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Our study aimed to determine the relationship of antidepressant medicine use with periodontal diseases, exploring the association of different pharmacological classes of antidepressant with observations of clinical attachment loss (CAL) and alveolar bone level (BL) in patients with periodontitis. BACKGROUND Existing evidence on the impact of antidepressant medication on periodontal tissues has focused on some classes only and is still unclear. Therefore, this retrospective study evaluated the association of different antidepressant classes with clinical attachment loss (CAL) and alveolar bone level (BL). METHODS This study was carried out in a population of patients aged ≥ 30 years old with periodontitis who sought treatment at the University of Florida from 2014 to 2018. The following variables were obtained from patients' records; usage of antidepressant medications and their pharmacological classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic, atypical, and monoamine oxidase inhibitors [MAO]), age, gender, smoking habit, mild systemic diseases, CAL, and cement-enamel junction (CEJ) and alveolar bone crest (BC) distance, defined as BL, in the Ramfjord index teeth. RESULTS Five hundred and eighty-two periodontitis patients were evaluated, of which 113 (19.4%) were antidepressant users. Antidepressant users exhibited significantly lower BL and fewer sites with severe CAL (≥5 mm), than non-users (p < .05). Among all single-class antidepressant users, the SSRI users showed significantly less CAL and lower BL than non-users (p < .05). Patients taking combinations of the different classes of antidepressants also showed better CAL and BL than non-users. Generalized linear models, including variables such as gender, age, systemic diseases, and smoking, demonstrated that antidepressant users were more likely to have lower mean BL and fewer sites with severe bone loss (i.e. BL > 3 and >5 mm) than non-users (p < .05). CONCLUSIONS Antidepressant medications were associated with higher alveolar bone level and less clinical attachment loss in patients with periodontitis. When the different classes of antidepressants were analyzed individually, only the SSRI class users and the multiple-class users showed significantly less periodontal breakdown than non-users.
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Affiliation(s)
- Abeer Essam Hakam
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Poliana Mendes Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Marcia Phemba Mbadu
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Ikramuddin Aukhil
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | | | - Jia Chang
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Are periodontal diseases associated with sleep duration or sleep quality? A systematic review. Arch Oral Biol 2021; 129:105184. [PMID: 34118748 DOI: 10.1016/j.archoralbio.2021.105184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study aimed to systematically review the associations between periodontal diseases/tooth loss and sleep duration/quality. MATERIAL AND METHODS PubMed, Scopus, and Embase databases were searched (up to May 2021) to identify studies that assessed the association between periodontal diseases or number of teeth with sleep quality and sleep duration. Two researchers independently selected the studies and extracted the data. Considering the high heterogeneity among the included studies, meta-analysis was deemed unviable. Results are presented descriptively for sleep quality (studies that have used PSQI), self-reported sleep hours, and other tools that assessed sleep patterns. RESULTS Twenty studies (16 cross-sectional, two case-control, and two cohort) were included. Eight studies used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep. Six of these studies demonstrated that individuals with worse periodontal conditions demonstrated poorer sleep quality. However, most of the included studies that performed adjusted analysis showed no statistically significant association between self-reported hours of sleep and periodontitis. The mean number of present teeth was assessed in four studies; three of them demonstrated lower numbers of present teeth in individuals with inadequate sleep. CONCLUSION The literature shows conflicting results for the association between sleep hours and periodontitis. However, inadequate sleep may be associated with lower number of present teeth and periodontal diseases. Further studies are necessary in order to confirm these results.
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Kim SR, Nam SH. Comparison of Diagnosed Depression and Self-Reported Depression Symptom as a Risk Factor of Periodontitis: Analysis of 2016-2018 Korean National Health and Nutrition Examination Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:871. [PMID: 33498411 PMCID: PMC7908234 DOI: 10.3390/ijerph18030871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
Depression causes damage to the immune defense mechanism, and it can worsen periodontitis due to the accumulation of periodontitis pathogens. This study was conducted in order to explore the association of diagnosed depression and self-reported depression symptom with periodontitis by using the Korean National Health and Nutrition Examination Survey 7th (KNHANES VII) data. A total of 12,689 participants aged over 19 received a periodontal examination among the 24,269 participants of KNHANES VII. Diagnosed depression and self-reported depression symptom were the two terms used for depression. Periodontitis was defined as the presence of teeth with periodontal pockets of 4 mm or deeper. The age, sex, marital status, education, region, basic livelihood protection, private health insurance, type of housing, health insurance coverage, household income, sleeping hours, subjective health condition, stress perception, drinking status, obesity, and current smoking status of the participants were examined. Chi-square tests and two-tailed analyses were used. The association of depression and periodontitis was tested by using logistic regression models adjusted for socio-demographic and behavioral variables. Diagnosed depression was associated with periodontitis, as the odds ratio of diagnosed depression for periodontitis was 1.772 (95% confidence interval = 1.328-2.364). However, the association between self-reported depression symptom and periodontitis was not statistically significant. This study revealed that diagnosed depression, not self-reported depression symptom, could be a risk factor for periodontitis. Therefore, it is necessary to take a closer look into diagnosed depression in order to manage and prevent periodontitis.
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Affiliation(s)
- Seon-Rye Kim
- Department of Pharmacy, College of Pharmacy, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do 24341, Korea;
| | - Seoul-Hee Nam
- Department of Dental Hygiene, College of Health Science, Kangwon National University, 346 Hwangjo-gil, Dogye-up, Samcheok-si, Gangwon-do 25945, Korea
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Aragão WAB, Souza-Monteiro DD, Frazão DR, Né YGDS, Ferreira RDO, Rivera LFS, Saito MT, Rösing CK, Fagundes NCF, Maia LC, Lima RR. Is There Any Association Between Chronic Periodontitis and Anxiety in Adults? A Systematic Review. Front Psychiatry 2021; 12:710606. [PMID: 34413802 PMCID: PMC8368723 DOI: 10.3389/fpsyt.2021.710606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Periodontitis is a multifactorial disease triggered by dysbiotic biofilms, involving the host's immune response, systemic and behavioral factors, including psychosocial conditions. This systematic review aimed to investigate the possible association between periodontitis and anxiety in adults. Searches were performed in PubMed, Scopus, Web of Science, Lilacs, Cochrane, and OpenGrey databases, without language restrictions, considering studies in adults (P-Participants), with (E-Exposure) and without periodontitis (C- Comparison) in an outcome of association with anxiety (O-outcome). Methodological quality assessment was carried out using the Newcastle-Ottawa protocol for case-control and cross-sectional studies, followed by an analysis of the level of evidence using the GRADE tool. Metanalysis was not performed due to several differences in methods applied by authors in primary studies. Eleven observational studies were selected according to the inclusion criteria from the total of 6,380 studies retrieved from databases. Eight studies demonstrated higher anxiety levels in subjects with periodontitis, among which only one study presented a high risk of bias. The GRADE tool revealed a low level of evidence for the anxiety outcome measured by the State-Trait Anxiety Inventory (STAI), both for case-control and cross-sectional studies. However, since anxiety may affect the quality of life of many subjects, it reinforces the need for further studies that evaluate this association for more extended periods. Clinical Trial Registration:PROSPERO-CRD42020190445.
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Affiliation(s)
- Walessa Alana Bragança Aragão
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - de Deiweson Souza-Monteiro
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Deborah Ribeiro Frazão
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Yago Gecy de Sousa Né
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Railson de Oliveira Ferreira
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | | | - Miki Taketomi Saito
- School of Dentistry, Institute of Health Sciences, Federal University of Pará, Belém, Brazil
| | - Cassiano Kuchenbecker Rösing
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
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Zheng DX, Kang XN, Wang YX, Huang YN, Pang CF, Chen YX, Kuang ZL, Peng Y. Periodontal disease and emotional disorders: A meta-analysis. J Clin Periodontol 2020; 48:180-204. [PMID: 33103263 DOI: 10.1111/jcpe.13395] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/08/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the relationship of periodontal disease with depression and anxiety via a systematic review and meta-analysis. METHOD We systematically searched the EMBASE, PubMed, Web of Science, PsycINFO, and SinoMed databases (until August 4, 2019) with language restricted to English and Chinese. Case-control, cross-sectional, and cohort studies that calculated the risk ratio (RR), odds ratio (OR)/prevalence OR (POR), and hazard ratio (HR) of depression/anxiety with periodontal disease or the OR/POR/RR/HR of periodontal disease caused by depression/anxiety were included. Observational studies that reported the depression/anxiety scale score of patients with periodontal disease and healthy periodontal subjects aged ≥14 years were also included. We used the standard format to extract the following information from each included study: author/s, survey year, study design, age of participants, periodontal disease definition, depression/anxiety measurement, and summary of results. The Newcastle-Ottawa scale was used to ascertain the quality of the included citations. RESULTS After screening, 40 studies were included. A meta-analysis of the case-control studies showed that periodontal disease was positively associated with depression (OR = 1.70, 95% confidence interval [CI] = 1.01-2.83). A meta-analysis of 12 studies showed that periodontal disease was significantly correlated with anxiety (OR = 1.36, 95% CI = 1.11-1.66). A meta-analysis of 18 studies showed that subjects with periodontal disease had higher depression scale score (standardized mean difference [SMD] = 1.05, 95% CI = 0.68-1.41) and anxiety scale score (SMD = 0.70, 95% CI = 0.44-0.96). CONCLUSION Periodontal disease is associated with emotional disorders. However, the high degree of heterogeneity among studies should be considered. More high-quality prospective studies are required to confirm the relationship.
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Affiliation(s)
- De-Xiu Zheng
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Ning Kang
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Yi-Xi Wang
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Yi-Na Huang
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Chun-Feng Pang
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Xuan Chen
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhi-Li Kuang
- The Department of Stomatology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yun Peng
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
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12
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Wong LB, Yap AU, Allen PF. Periodontal disease and quality of life: Umbrella review of systematic reviews. J Periodontal Res 2020; 56:1-17. [PMID: 32965050 DOI: 10.1111/jre.12805] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/29/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
This umbrella review appraised existing systematic reviews and meta-analysis to establish the impact of periodontal disease and therapy on general and oral health-related quality of life. A systematic electronic literature search was carried out in accordance with the PRISMA guideline up to January 2020 using PubMed, LIVIVO, EMBASE and OpenGrey (PROSPERO CRD 42020163831). Hand searching was performed through the reference lists of periodontal textbooks and related journals. All English language-based systematic reviews and meta-analysis that assessed the impact of periodontal disease and treatment interventions on general and oral health-related quality of life were included. Overall, eight articles met the inclusion criteria and their methodological quality was assessed using the AMSTAR2 criteria. Two systematic reviews showed a significant impact of oral conditions on general health-related quality of life, although the specific impact of periodontal disease remains inconclusive. Three systematic reviews established a negative impact of periodontal disease on oral health-related quality of life. Another three systematic reviews concluded that periodontal treatment can improve oral health-related quality of life. Oral conditions, like periodontal disease, can impact the general health-related quality of life. Periodontal disease is negatively correlated with oral health-related quality of life, although treatment interventions can improve self-reported quality of life. In view of the heterogeneity of generic instruments currently utilized to assess the self-reported quality of life of periodontal patients, the development of a general and oral health-related quality of life instrument specific for periodontal disease is strongly recommended.
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Affiliation(s)
- Li Beng Wong
- Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.,Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.,Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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13
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Schmidlin PR, Khademi A, Fakheran O. Association between periodontal disease and non-apnea sleep disorder: a systematic review. Clin Oral Investig 2020; 24:3335-3345. [DOI: 10.1007/s00784-020-03475-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022]
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14
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Abstract
Patient-based outcomes complement clinical data with patients' self-evaluation of their physical, psychological, and social well-being, and as such facilitate clinical decision-making, assessing the quality of care provided, and evaluating practices and policies. Some validated generic oral health-related quality of life measures used in recent research indicated a high performance. There is a proportional relationship between the quality of life and periodontitis, ie, the higher the level of periodontitis, the poorer the oral health-related quality of life. This relationship is heightened by the presence of symptoms such as bleeding, halitosis, and mobility. On the other hand, periodontal treatment has demonstrated the capability to improve quality of life substantially. Future research should focus on questionnaires that are able to explain the interlinked pathways between periodontal conditions, approaches to treatment approaches, and patients' well-being. The acquisition of new knowledge in the field is essential for the whole community, as we treat people not millimeters.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, UCL, London, UK
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15
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Abstract
While clinical indicators, or so-called surrogate outcomes in periodontology, allow us to assess periodontal health and evaluate outcomes of periodontal therapy from a clinician's perspective, they cannot be used to evaluate patients' subjective perceptions of their health status or satisfaction with the received treatment. These can be assessed through patient-based outcomes, such as quality of life. The aim of this paper is to give an overview of the multidimensional concept of oral health-related quality of life (OHRQoL), its measures and association with plaque-induced, inflammatory periodontal diseases. Periodontitis and its clinical consequences, such as tooth loss, have a considerable negative effect on OHRQoL, while periodontal treatment and alleviation of the symptoms can lead to improvement in OHRQoL. Implant rehabilitation of missing teeth also seems to positively influence OHRQoL.
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16
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Lin W, Xiong L, Yang Z, Deng X, Zhu J, Chen C, Huang S, Ma Y, Zhu F. Severe Periodontitis Is Associated with Early-Onset Poststroke Depression Status. J Stroke Cerebrovasc Dis 2019; 28:104413. [PMID: 31582272 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Poststroke depression (PSD) is one of the most common complications after ischemic stroke, and periodontitis is associated with depression. However, whether severe periodontitis is associated with early-onset PSD status remains unknown. In this study, we aimed to investigate whether there is an association between severe periodontitis and PSD status in acute ischemic stroke patients. MATERIAL AND METHODS We recruited 202 acute ischemic stroke patients within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. On the basis of diagnosis of PSD status according to DSM-5 criteria and a 24-item Hamilton Depression Rating Scale score greater than or equal to 8 within 2 weeks after stroke onset, we stratified patients into PSD status or non-PSD status groups and identified the independent predictors for the development of PSD status in multivariate logistic analysis. RESULTS 77 (38.1%) patients were diagnosed as early-onset PSD status. PSD status group showed more severe periodontitis, lower income, lower Barthel Index (BI) score and Montreal Cognitive Assessment score, higher National Institutes of Health Stroke Scale score and modified Rankin scale (mRS) score compared with non-PSD status group. Multivariate logistic regression showed that severe periodontitis (odds ratio 2.401) and NIHSS score (>4, odds ratio 2.130) were independent predictors for early-onset PSD status. CONCLUSIONS Severe periodontitis is found to be an important independent predictor of early-onset PSD status in patients with acute ischemic stroke, in addition to the well-known prognostic factors such as nonminor stroke assessed by NIHSS greater than 4.
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Affiliation(s)
- Weifeng Lin
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Li Xiong
- BrainNow Research Institute, Shenzhen, Guangdong Province, China
| | - Zhi Yang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Xuhui Deng
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Jinhua Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Chunchun Chen
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Shuxuan Huang
- Department of Neurology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ying Ma
- Department of Cardiology, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Feiqi Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China.
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17
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Cunha FA, Cota LOM, Cortelli SC, Miranda TB, Neves FS, Cortelli JR, Costa FO. Periodontal condition and levels of bacteria associated with periodontitis in individuals with bipolar affective disorders: A case-control study. J Periodontal Res 2018; 54:63-72. [DOI: 10.1111/jre.12605] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/28/2018] [Accepted: 08/04/2018] [Indexed: 12/12/2022]
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18
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Bawankar PV, Kolte AP, Kolte RA. Evaluation of stress, serum and salivary cortisol, and interleukin‐1β levels in smokers and non‐smokers with chronic periodontitis. J Periodontol 2018; 89:1061-1068. [DOI: 10.1002/jper.18-0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/27/2018] [Accepted: 03/04/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Pranjali V. Bawankar
- Department of Periodontics & ImplantologyVSPM Dental College and Research Centre Nagpur India
| | - Abhay P. Kolte
- Department of Periodontics & ImplantologyVSPM Dental College and Research Centre Nagpur India
| | - Rajashri A. Kolte
- Department of Periodontics & ImplantologyVSPM Dental College and Research Centre Nagpur India
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Levin L, Zini A, Levine J, Weiss M, Lev R, Chebath Taub D, Hai A, Almoznino G. Demographic profile, Oral Health Impact Profile and Dental Anxiety Scale in patients with chronic periodontitis: a case-control study. Int Dent J 2018; 68:269-278. [PMID: 29383701 DOI: 10.1111/idj.12381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To examine whether dental anxiety (DA) and oral health-related quality of life (OHRQoL) differ between persons with and those without chronic periodontitis. METHODS One-hundred patients with chronic periodontitis and 50 age- and- sex-matched controls were included. Data were collected on the following: demographics; smoking habits; Numerical Rating Scale (NRS) for dental pain assessment; Corah's Dental Anxiety Scale (DAS); Oral Health Impact Profile 14 (OHIP-14); Decayed, Missing and Filled Teeth (DMFT) index; Plaque Index (PI); probing depth (PD); bleeding on probing (BOP); and radiographic bone loss. RESULTS Patients with chronic periodontitis exhibited a significantly higher percentage of high anxiety and phobia compared with subjects in the control group. Furthermore, patients with chronic periodontitis were statistically significantly more likely to consider themselves as suffering from dental anxiety (68.7% vs. 14.3%, P < 0.001) as well as more likely to have fear of receiving dental injections, hearing the dental drill noise and feeling a foreign object in the mouth. Patients with chronic periodontitis exhibited worse OHIP-14 global scores as well as worse scores in the following individual domains: functional limitation (P = 0.005); physical disability (P = 0.003); psychological disability (P = 0.010); social disability (P = 0.011); and handicap (P = 0.012). CONCLUSIONS Compared with controls, patients with chronic periodontitis had higher levels of dental anxiety and worse OHRQoL. It is important to consider dental anxiety and OHRQoL assessment as an integral component of the evaluation of patients with chronic periodontitis. Communication between dental and behavioral health professionals is needed to implement a multidisciplinary team approach involving behavioural and psychological interventions.
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Affiliation(s)
- Liran Levin
- Department of Periodontology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Avraham Zini
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Jonathan Levine
- Department of Prosthodontics, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Maor Weiss
- Department of Prosthodontics, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Ron Lev
- Department of Periodontology, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Daniella Chebath Taub
- Department of Periodontology, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Avihai Hai
- Department of Periodontology, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Galit Almoznino
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.,Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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20
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Pal M, Kumar S, Varma M, Gopalkrishna P, Bhat S. Assessment of Pyrexia and Associated Sickness Behavior in Patients with Chronic Periodontitis. Neuroimmunomodulation 2018; 25:138-145. [PMID: 30199858 DOI: 10.1159/000492471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to assess pyrexia and sickness behavior such as anxiety, depression, lethargy, and weight loss in subjects with chronic periodontitis, and evaluate inflammatory mediators such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the patients with fever. METHODS This was a cross-sectional study that consisted of 150 chronic periodontitis and 150 healthy subjects. Sublingual and subgingival temperatures were assessed using a digital temperature probe. Associated sickness behavior was assessed for all the subjects. Pathological tests, i.e., ESR and CRP were done for subjects with fever. RESULTS Evaluating the presence of fever with the severity of periodontal disease, 66.7% of the subjects with fever were in the group diagnosed with severe periodontitis, 20.4% had with moderate periodontitis, and 5.3% were in the healthy group. Subjects diagnosed with periodontitis comprised 66.2% of the subjects with higher (i.e., > 36.3°C) subgingival temperatures and healthy subjects made up the remaining 33.8% (p < 0.001). A correlation between the sublingual and subgingival temperature with the Pearson ρ correlation coefficient of 0.227 (p < 0.001) was observed. A statistically significant mean value of 37.05 ± 11.24 of ESR and 1.59 ± 1.11 mg/L of CRP was reported amongst the subjects with fever (p < 0.001). The association of sickness behavior with the severity of periodontitis was found to be significant: depression 40.006, anxiety 50.857, reported weight loss 76.463, and lethargy 141.581 (p < 0.001). DISCUSSION AND CONCLUSION The study demonstrated that there is a significant increase in the sublingual temperature amongst patients with severe chronic periodontitis. The subgingival temperature has a positive correlation with the sublingual temperature. There was a linear trend of an association of sickness behavior with the severity of chronic periodontitis. A significant increase in the circulating inflammatory mediators, CRP and ESR, were noticed in subjects with elevated body temperature.
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Affiliation(s)
- Monika Pal
- Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal,
| | - Santhosh Kumar
- Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Muralidhar Varma
- Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Pratibha Gopalkrishna
- Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Subraya Bhat
- Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
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21
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Bertoldi C, Venuta M, Guaraldi G, Lalla M, Guaitolini S, Generali L, Monzani D, Cortellini P, Zaffe D. Are periodontal outcomes affected by personality patterns? A 18-month follow-up study. Acta Odontol Scand 2018; 76:48-57. [PMID: 28950739 DOI: 10.1080/00016357.2017.1382714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This research aims to study the relationship between personality traits and periodontal clinical outcomes by taking into account the level of anxiety and depression, periodontal health and oral hygiene behaviour of patients affected with gingivitis or moderate periodontitis requiring periodontal therapy. MATERIAL AND METHODS The periodontal data of 40 systemically healthy patients affected by gingivitis or moderate periodontitis were collected at baseline and 18 months later. The psychological variables, dental awareness and adherence intent of the patients were assessed through questionnaires, and only those patients that exhibited a higher degree of compliance were included in the study. The personality traits (cluster A: paranoid, schizoid, schizotypal; cluster B: borderline, antisocial, narcissistic, and histrionic; cluster C: avoidant, dependent, and obsessive-compulsive) and the level of anxiety and depression of the patients were assessed. Patients were instructed with oral hygiene measures and were treated with periodontal therapy. RESULTS Clusters A and B showed a consistent tendency for reduced levels of oral hygiene (increased full-mouth plaque score - FMPS). The results from cluster B were found to be significantly related to deep periodontal pockets at baseline. On the contrary, cluster C seemed to be linked to clinically better indices, particularly in terms of full-mouth-bleeding-score and pocket depth, both at baseline and 18 months later. The results collected from clusters B and C were directly correlated with anxiety, depression and FMPS. Moreover, anxiety was directly correlated with the patient's need for professional oral-care. CONCLUSIONS Personality traits appear to play a significant role in determining the therapeutic outcomes of periodontal therapy in themselves. Thus, it is ideal for several important psychological, affective or behavioural factors to be associated with various personality traits so as to orient the outcome of periodontal therapy.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Venuta
- Department of Diagnostics, Clinical and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianpaolo Guaraldi
- Department of Diagnostics, Clinical and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Lalla
- Department of Economy ‘Marco Biagi’, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Monzani
- Department of Diagnostics, Clinical and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Graziani F, Karapetsa D, Mardas N, Leow N, Donos N. Surgical treatment of the residual periodontal pocket. Periodontol 2000 2017; 76:150-163. [PMID: 29193404 DOI: 10.1111/prd.12156] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 01/28/2023]
Abstract
The ultimate goal of periodontal therapy is to prevent further disease progression in order to reduce the risk of tooth loss. This objective can be achieved through a number of therapeutic modalities comprising both the nonsurgical and surgical phases of periodontal therapy. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. However, despite completion of nonsurgical treatment, a number of periodontal pockets, defined as 'residual', often remain. The presence of residual pockets may jeopardize tooth survival and be a risk factor of further disease progression, and ultimately tooth loss. Therefore, the aim of this review is to analyze the knowledge available on the indications for and the performance of periodontal surgical treatment of residual pockets in terms of 'traditional' (clinical, microbiological), patient-based and systemic health outcomes.
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Haag D, Peres K, Balasubramanian M, Brennan D. Oral Conditions and Health-Related Quality of Life: A Systematic Review. J Dent Res 2017; 96:864-874. [DOI: 10.1177/0022034517709737] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to verify whether oral conditions (tooth loss, periodontal disease, dental caries) are negatively associated with health-related quality of life (HRQoL) in adults. A search was carried out on PubMed, EMBASE, Web of Science, Scopus, SciELO, and LILACS databases until the end of July 2016 with no date restrictions. Quantitative observational studies written in English were included and data extraction was performed independently by 2 reviewers. HRQoL was investigated as the outcome, and tooth loss, periodontal diseases, and dental caries were exposures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used and the quality of the selected studies was assessed by using the Joanna Briggs Institute Meta-Analysis of Statistics assessment and review instrument (JBI-MAStARI). Twenty-one studies were included. The sample sizes ranged from 88 to 15,501 subjects; 20 studies were cross-sectional designs, while 1 was a case-control study. Case definitions of the exposures were different across the studies, mainly for tooth loss, which was defined according to 11 different criteria. Fifteen studies were of “high” and 6 of “medium” quality. Eight HRQoL instruments were identified, and the most frequent was the EuroQol ( n = 8). Ten of 16 studies reported a negative impact of tooth loss on HRQoL. Four of 7 studies reported that periodontal disease impairs HRQoL, and 1 study showed that periodontal disease is positively associated with HRQoL. All studies that assessed dental caries reported a negative association between this condition and HRQoL. Despite the different definitions and measures of tooth loss and dental caries, the majority of the available evidence reported a negative impact of these conditions on HRQoL. Mixed and inconclusive findings were observed for the association between periodontal disease and HRQoL. Longitudinal prospective studies are suggested to improve the strength of the findings.
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Affiliation(s)
- D.G. Haag
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia, Australia
| | - K.G. Peres
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia, Australia
| | - M. Balasubramanian
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia, Australia
| | - D.S. Brennan
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia, Australia
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Park HJ, Lee H, Cho S. Periodontal Disease and Health Related Quality of Life (HRQoL) in Pregnant Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2016; 22:191-201. [PMID: 37684868 DOI: 10.4069/kjwhn.2016.22.4.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/28/2016] [Accepted: 11/02/2016] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to identify relationships of periodontal disease and health related quality of life (HRQoL) in pregnant women. METHODS The participants in this study were 129 pregnant women. Data were collected using questionnaires of characteristics of the participants and subjective perception of periodontal disease and a dentist's assessment of periodontal disease. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression. RESULTS The physical QoL showed significant negative correlation with subjective perception of periodontal disease (r=-.21, p=.013). Mental QoL had significant negative correlations with subjective perception of periodontal disease (r=-.32, p<.001) and objective periodontal disease (r=-.34, p<.001). Hierarchical multiple regression analyses revealed that pregnant women who had a history of abortion and had higher subjective perception of periodontal disease tended to report lower levels of physical QoL. Pregnant women whose age are between 30-34 years and higher subjective perception and objective periodontal disease tended to report lower mental QoL. CONCLUSION To improve HRQoL of pregnant women, nurses should pay attention on the status of periodontal disease. Careful assessment of oral healthy behaviors and proper intervention for oral health of pregnant women are needed to enhance HRQoL of pregnant women.
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Affiliation(s)
- Hae Jin Park
- College of Nursing, Pusan National University, Yangsan · Ilsin Christian Hospital, Busan, Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan · Ilsin Christian Hospital, Busan, Korea
| | - Soohyun Cho
- College of Nursing, Pusan National University, Yangsan · Ilsin Christian Hospital, Busan, Korea
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25
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Schulze A, Busse M. Gender Differences in Periodontal Status and Oral Hygiene of Non-Diabetic and Type 2 Diabetic Patients. Open Dent J 2016; 10:287-97. [PMID: 27347232 PMCID: PMC4901196 DOI: 10.2174/1874210601610010287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects. METHODS 517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were "periodontitis" and "oral hygiene behaviour", each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The "low performance index" (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0). RESULTS Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6). CONCLUSIONS The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women.
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Affiliation(s)
- Antina Schulze
- General Outpatient Ambulance and Sports Dentistry of the Institute of Sports Medicine, University of Leipzig, Leipzig, Germany
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26
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Buset SL, Walter C, Friedmann A, Weiger R, Borgnakke WS, Zitzmann NU. Are periodontal diseases really silent? A systematic review of their effect on quality of life. J Clin Periodontol 2016; 43:333-44. [DOI: 10.1111/jcpe.12517] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Sabrina Lill Buset
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Anton Friedmann
- Clinic for Periodontology; University of Witten; Witten Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Wenche S. Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI USA
| | - Nicola U. Zitzmann
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
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Dumitrescu AL. Depression and Inflammatory Periodontal Disease Considerations-An Interdisciplinary Approach. Front Psychol 2016; 7:347. [PMID: 27047405 PMCID: PMC4804721 DOI: 10.3389/fpsyg.2016.00347] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/25/2016] [Indexed: 12/18/2022] Open
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Araújo MM, Martins CC, Costa LCM, Cota LOM, Faria RLAM, Cunha FA, Costa FO. Association between depression and periodontitis: a systematic review and meta-analysis. J Clin Periodontol 2016; 43:216-28. [DOI: 10.1111/jcpe.12510] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Milena Moreira Araújo
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Lidiane Cristina Machado Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Luís Otávio Miranda Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | | | - Fabiano Araújo Cunha
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Fernando Oliveira Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
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Hybels CF, Bennett JM, Landerman LR, Liang J, Plassman BL, Wu B. Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults. Int J Geriatr Psychiatry 2016; 31:83-91. [PMID: 25962827 PMCID: PMC4641817 DOI: 10.1002/gps.4292] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes. METHODS The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008. RESULTS Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism. CONCLUSIONS Chronic moderate depressive symptoms are associated with poorer oral health in older adults.
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Affiliation(s)
- Celia F. Hybels
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Joan M. Bennett
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Lawrence R. Landerman
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jersey Liang
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Bei Wu
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,School of Nursing, Duke University Medical Center, Durham, North Carolina,Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina
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Park HJ, Lee HJ, Cho SH. Influences of Oral Health Behaviors, Depression and Stress on Periodontal Disease in Pregnant Women. J Korean Acad Nurs 2016; 46:653-662. [DOI: 10.4040/jkan.2016.46.5.653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/05/2016] [Accepted: 06/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Hae-Jin Park
- Division of Nursing, Ilsin Christian Hospital, Busan·College of Nursing, Pusan National University, Yangsan, Korea
| | - Hae Jung Lee
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Soo Hyun Cho
- Dental Department, Ilsin Christian Hospital, Busan, Korea
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31
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Kumar A, Kardkal A, Debnath S, Lakshminarayan J. Association of periodontal health indicators and major depressive disorder in hospital outpatients. J Indian Soc Periodontol 2015; 19:507-11. [PMID: 26644715 PMCID: PMC4645535 DOI: 10.4103/0972-124x.167161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Major depressive disorder (MDD) has been associated with changes in behavioral, neurophysiological, and neuroendocrinological factors and thought to be one of the leading causes of disability worldwide. There are various evidences that depression and periodontitis may also be related. Aim: The aim was to evaluate the association between MDD and periodontitis in a convenience sample of hospital outpatients. Materials and Methods: Sixty individuals (30 subjects with MDD and 30 subjects without MDD) of age 26–67 years were included in the study. Depression was assessed by means of structured clinical interview for diagnostic and statistical manual of mental disorders. The periodontal clinical examination included the number of missing teeth, plaque index, gingival index (GI), probing pocket depth, and clinical attachment level (CAL). Results: Mean number of missing teeth per patient was 1.14 (±1.2 standard deviation [SD]) in the control group and 2.58 (±1.64 SD) in case group (P < 0.001). The amount of plaque was significantly higher in cases compared with control (P = 0.001). The patients had an average GI of 1.82 (±0.65 SD) compared to 1.14 (±0.81 SD) for the controls (P < 0.001). Mean probing depth and CAL were 4.67 (±0.8 SD) mm and 4.96 (±0.2 SD) mm in the case group and 2.6 (±2.2 SD) mm and 2.7 (±0.43 SD) mm in the control group, respectively (P < 0.05). Conclusion: Our study confirms the significant association between depression and periodontitis and depression can be considered one of the important risk factors for periodontal diseases.
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Affiliation(s)
- Amit Kumar
- Department of Periodontology, Navodaya Dental College, Raichur, Karnataka India
| | - Asif Kardkal
- Department of Periodontology, Navodaya Dental College, Raichur, Karnataka India
| | - Surangama Debnath
- Department of Periodontology, Navodaya Dental College, Raichur, Karnataka India
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Warren KR, Postolache TT, Groer ME, Pinjari O, Kelly DL, Reynolds MA. Role of chronic stress and depression in periodontal diseases. Periodontol 2000 2015; 64:127-38. [PMID: 24320960 PMCID: PMC7167640 DOI: 10.1111/prd.12036] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
An extensive body of experimental and clinical evidence documents the negative impact of chronic psychological stress and depression on the immune system and health. Chronic stress and depression can result in general dysregulation of the immune system, of both cellular and humoral pathways, which may contribute to pathogenic infection and concomitant periodontal tissue destruction. In general, the evidence is consistent with the hypothesis that stress can modify the host defense and progression of periodontal infections in patients susceptible to periodontitis. However, substantial evidence also indicates that these conditions can mediate risk for disease, including periodontitis, through changes in health-related behaviors, such as oral hygiene, smoking and diet. The unequivocal interpretation of studies has also been hampered, in part, by issues related to conceptualization of stress and depression, as well as commonly associated comorbidities, such as diabetes, that can modify the onset and progression of periodontal disease. In addition, stress and depression appear to fall into a spectrum, ranging from mild to severe, involving a complex interaction of genetic background, coping strategies and environment. Differences in the conceptualization of stress and depression are probably important in assessing associations with other biologic and clinical measures. Future studies are necessary to clarify the complex interactions of chronic stress and depression in periodontal diseases.
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Sundararajan S, Muthukumar S, Rao SR. Relationship between depression and chronic periodontitis. J Indian Soc Periodontol 2015; 19:294-6. [PMID: 26229270 PMCID: PMC4520114 DOI: 10.4103/0972-124x.153479] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 02/05/2015] [Indexed: 11/17/2022] Open
Abstract
Background: Periodontitis is a chronic, multifactorial, polymicrobial disease causing inflammation in the supporting structures of the teeth. There is a plethora of nonoral risk factors which can be quoted to aid in the development of chronic periodontitis. According to WHO, depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt, disturbed sleep or appetite, low energy and poor concentration. Depression is associated with negligent oral health care and another mechanism proposed disturbance in the hypothalamic-pituitary axis system and hypothalamic-pituitary-thyroid system, which can affect the periodontal status by affecting the immune system. Aim: The aim of this study was to assess the association between periodontal clinical parameters and depression rating. Materials and Methods: The study design is a case–control study with 35 patients each in case and control group. The periodontal parameters taken for measurement were probing depth and clinical attachment loss. Depression was calculated using Beck's depression scale. Statistical Analysis: The statistical analysis was performed by means of SPSS software (SPSS Inc., Chicago, IL, USA; version 17.0 under windows 2000). Student's t-test was used to determine the relationship between the clinical periodontal parameters and depression. Results: Self-reported scoring of depression by using Beck's depression inventory has shown that periodontal patients had a significantly higher total depression score than normal controls. Conclusion: This study reveals that there is a direct correlation between the severity of periodontal disease and the severity of depression in patients.
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Affiliation(s)
- Shiyamali Sundararajan
- Department of Periodontics, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | | | - Suresh Ranga Rao
- Department of Periodontics, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Delgado-Angulo EK, Sabbah W, Suominen AL, Vehkalahti MM, Knuuttila M, Partonen T, Nordblad A, Sheiham A, Watt RG, Tsakos G. The association of depression and anxiety with dental caries and periodontal disease among Finnish adults. Community Dent Oral Epidemiol 2015; 43:540-9. [PMID: 26130047 DOI: 10.1111/cdoe.12179] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the association of depression and anxiety with two oral health outcomes, dental caries and periodontal disease and assess possible mediators for any of the associations. METHODS Secondary analysis of the Finnish Health 2000 Survey. Depression was assessed with Beck's Depression Inventory and anxiety with Composite International Diagnostic Interview. Number of decayed teeth included carious lesions reaching dentine; periodontal disease was number of teeth with periodontal pockets of 4 mm or deeper. Third molars were excluded. The association of mental disorders and oral health was tested in regression models adjusted for confounders and potential mediators. RESULTS Depression was associated with number of decayed teeth only among 35- to 54-year-olds. The association between anxiety and the number of decayed teeth was not statistically significant. Depression and periodontal pocketing were not significantly associated. CONCLUSION Depression was significantly associated with number of decayed teeth only among participants aged 35-54 old and not with other age groups. Neither depression nor anxiety was significantly related to periodontal disease.
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Affiliation(s)
- Elsa K Delgado-Angulo
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Wael Sabbah
- Division of Population and Patient Health, King's College London, London, United Kingdom
| | - Anna L Suominen
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, (THL), Helsinki, Finland.,Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland.,Department of Oral Public Health, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Miira M Vehkalahti
- Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland.,Oulu University Hospital, Oulu, Finland
| | | | - Timo Partonen
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Nordblad
- Department for Social and Health Services, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Liu Y, Huang X, Yan Y, Lin H, Zhang J, Xuan D. Dental fear and its possible relationship with periodontal status in Chinese adults: a preliminary study. BMC Oral Health 2015; 15:18. [PMID: 25630232 PMCID: PMC4417219 DOI: 10.1186/1472-6831-15-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 01/15/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of the present study was to describe the characteristics of dental fear of Chinese adult patients with periodontal disease and provide information for clinical assessment. METHODS A total of 1203 dental patients completed questionnaires that included Corach's Dental Anxiety Scales (DAS), Dental Fear Survey (DFS) and the short-form Dental Anxiety Inventory (S-DAI). Among all the patients, 366 cases were self-reported periodontal disease. The general characteristics were described, such as socio-demographics, dental attendances and oral health behaviors. The statistical analysis was performed by t-test, Mann-Whitney U test and linear regression respectively to evaluate correlations between dental fear and general characteristics according to the three scales. RESULTS The prevalence of dental fear was 74% among 1203 patients, 23.4% of total with high dental fear, while 27.3% in the patients with periodontal disease. The average score of DAS and DFS for patients with periodontal disease was significantly higher than those without periodontal disease. The regression analysis indicated that gender, age, periodontal status, dental attendances and oral health behaviors were correlated with dental fear. Among 366 patients with periodontal disease, gender, dental attendances and oral health behaviors had correlation with dental fear. The analysis of DFS scale exhibited that 'drilling with handpiece' and 'injecting the anesthetic' were the most important factors to contribute to dental fear. CONCLUSIONS There was high prevalence of dental fear in Chinese adult patients, particularly in patients with periodontal disease, and high level of dental fear may lead to poor periodontal status.
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Affiliation(s)
- Yeungyeung Liu
- Department of Periodontology, Guangdong Provincial Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulevard, 510280, Guangzhou, China.
| | - Xin Huang
- Department of Periodontology, Guangdong Provincial Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulevard, 510280, Guangzhou, China.
| | - Yuxia Yan
- Department of Statistics, Southern Medical University, Guangzhou, China.
| | - Hanxiao Lin
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
| | - Jincai Zhang
- Department of Periodontology, Guangdong Provincial Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulevard, 510280, Guangzhou, China.
| | - Dongying Xuan
- Department of Periodontology, Guangdong Provincial Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulevard, 510280, Guangzhou, China.
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Associations of depressive and anxiety disorders with periodontal disease prevalence in young adults: analysis of 1999-2004 National Health and Nutrition Examination Survey (NHANES) data. Ann Behav Med 2013; 45:393-7. [PMID: 23389686 DOI: 10.1007/s12160-013-9471-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Depression and anxiety have been linked to periodontal disease, an emerging risk factor for chronic diseases. However, this literature is mixed, and few studies have concurrently evaluated depression and anxiety. PURPOSE We simultaneously examined the associations of depressive and anxiety disorders with periodontal disease prevalence and explored tobacco use as a mediator. METHODS Participants were 1,979 young adults from the National Health and Nutrition Examination Survey 1999-2004 who underwent a diagnostic interview and a dental examination. RESULTS Adults with panic disorder had a threefold higher odds of having periodontal disease than those without this disorder (OR = 3.07, 95 % CI 1.17-8.02). This relationship was partially mediated by tobacco use and remained after adjustment for major depressive disorder and generalized anxiety disorder, which were not related to periodontal disease. CONCLUSIONS Young adults with panic disorder may have greater odds of having periodontal disease, in part, due to increased tobacco use.
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37
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Solis ACO, Marques AH, Pannuti CM, Lotufo RFM, Lotufo-Neto F. Evaluation of periodontitis in hospital outpatients with major depressive disorder. J Periodontal Res 2013; 49:77-84. [PMID: 23586804 DOI: 10.1111/jre.12082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Major depressive disorder (MDD) has been associated with alterations in the neuroendocrine system and immune function and may be associated with an increased susceptibility to cardiovascular disease, cancer and autoimmune/inflammatory disease. This study was conducted to investigate the relationship between periodontitis and MDD in a convenience sample of hospital outpatients. MATERIAL AND METHODS The sample consisted of 72 physically healthy subjects (36 outpatients with MDD and 36 age-matched controls [± 3 years]). Patients with bipolar disorder, eating disorders and psychotic disorders were excluded. Probing pocket depth and clinical attachment level were recorded at six sites per tooth. Depression was assessed by means of Structured Clinical Interview for DSM-IV. RESULTS Extent of clinical attachment level and probing pocket depth were not different between controls and subjects with depression for the following thresholds: ≥ 3 mm (Mann-Whitney, p = 0.927 and 0.756); ≥ 4 mm (Mann-Whitney, p = 0.656 and 0.373); ≥ 5 mm (Mann-Whitney, p = 0.518 and 0.870);, and ≥ 6 mm (Mann-Whitney, p = 0.994 and 0.879). Depression parameters were not associated with clinical attachment level ≥ 5 mm in this sample. Smoking was associated with loss of attachment ≥ 5 mm in the multivariable logistic regression model (odds ratio = 6.99, 95% confidence interval = 2.00-24.43). CONCLUSIONS In this sample, periodontal clinical parameters were not different between patients with MDD and control subjects. There was no association between depression and periodontitis.
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Affiliation(s)
- A C O Solis
- Department of Stomatology, Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Shanbhag S, Dahiya M, Croucher R. The impact of periodontal therapy on oral health-related quality of life in adults: a systematic review. J Clin Periodontol 2012; 39:725-35. [DOI: 10.1111/j.1600-051x.2012.01910.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Siddharth Shanbhag
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London; UK
| | - Manu Dahiya
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London; UK
| | - Ray Croucher
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London; UK
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Mendes DC, Silva TF, Barros LDO, de Oliveira MVM, Vieira LT, Haikal DS, Guimarães ALS, De Paula AMB. Analysis of the normative conditions of oral health, depression and serotonin-transporter-linked promoter region polymorphisms in an elderly population. Geriatr Gerontol Int 2012; 13:98-106. [PMID: 22672136 DOI: 10.1111/j.1447-0594.2012.00867.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To investigate the association between depression, the normative conditions of oral health and serotonin-transporter-linked promoter region (5-HTTLPR) polymorphisms in a community-dwelling elderly sample. METHODS Elderly adults living in a community (n=200) were submitted to an oral clinical examination. Depression was assessed using the 15-item Geriatric Depression Scale. The 5-HTTLPR was analyzed by polymerase chain reaction-restriction fragment length polymorphism. Associations between the biomarkers and clinical covariates were assessed by bivariate and multivariate statistical tests. Statistical significance was set at P<0.05. RESULTS The prevalence of dental caries, periodontal disease, edentulism and oral mucosal lesions was 51.2%, 20.8%, 58.0% and 21.5%, respectively. The prevalence of depression was 21.5%. A higher frequency of the S allele was recorded in older individuals with depression (P=0.017). The present findings showed no significant association between depression and the normative conditions of oral health. The observed allelic polymorphisms were 44% S and 56% L, respectively. Genotypic variants were 33.5% LL, 45.0% SL and 21.5% SS. Individuals carrying the SS genotype showed a significantly high prevalence of periodontal disease (prevalence ratio=3.077, CI 95%=1.008-9.393, P=0.048). CONCLUSION The present findings suggest that depressive community-dwelling older individuals did not show any association with alterations of oral health normative conditions. However, the SS genotypic polymorphic variant of 5-HTTLPR seems to contribute to the occurrence of periodontal disease in the elderly.
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Affiliation(s)
- Danilo Cangussu Mendes
- Health Science Programme, Health Research Laboratory, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
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Saito A, Ota K, Hosaka Y, Akamatsu M, Hayakawa H, Fukaya C, Ida A, Fujinami K, Sugito H, Nakagawa T. Potential impact of surgical periodontal therapy on oral health-related quality of life in patients with periodontitis: a pilot study. J Clin Periodontol 2011; 38:1115-21. [DOI: 10.1111/j.1600-051x.2011.01796.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/17/2011] [Accepted: 08/22/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Atsushi Saito
- Department of Periodontology; Tokyo Dental College; Chiba; Japan
| | - Kei Ota
- Department of Clinical Oral Health Science; Tokyo Dental College; Tokyo; Japan
| | - Yasuo Hosaka
- Department of Dentistry and Oral Surgery; School of Medicine; Keio University; Tokyo; Japan
| | - Mayako Akamatsu
- Department of Dentistry and Oral Surgery; School of Medicine; Keio University; Tokyo; Japan
| | - Hiroki Hayakawa
- Department of Clinical Oral Health Science; Tokyo Dental College; Tokyo; Japan
| | - Chie Fukaya
- Department of Dentistry and Oral Surgery; School of Medicine; Keio University; Tokyo; Japan
| | - Atsushi Ida
- Department of Clinical Oral Health Science; Tokyo Dental College; Tokyo; Japan
| | - Koushu Fujinami
- Department of Clinical Oral Health Science; Tokyo Dental College; Tokyo; Japan
| | - Hiroki Sugito
- Division of General Dentistry; Tokyo Dental College Chiba Hospital; Chiba; Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery; School of Medicine; Keio University; Tokyo; Japan
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Ohrn K, Jönsson B. A comparison of two questionnaires measuring oral health-related quality of life before and after dental hygiene treatment in patients with periodontal disease. Int J Dent Hyg 2011; 10:9-14. [PMID: 21564538 DOI: 10.1111/j.1601-5037.2011.00511.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to compare the usefulness of two different questionnaires assessing oral health-related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx). METHODS A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment. RESULTS No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP-14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP-14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found. CONCLUSION No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP-14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.
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Affiliation(s)
- K Ohrn
- Dalarna University, School of Health and Social Sciences, Falun, Sweden.
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42
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Rosa EF, Corraini P, de Carvalho VF, Inoue G, Gomes EF, Lotufo JPB, De Micheli G, Pannuti CM. A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters. J Clin Periodontol 2011; 38:562-71. [DOI: 10.1111/j.1600-051x.2011.01723.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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O'Dowd LK, Durham J, McCracken GI, Preshaw PM. Patients' experiences of the impact of periodontal disease. J Clin Periodontol 2010; 37:334-9. [PMID: 20447256 DOI: 10.1111/j.1600-051x.2010.01545.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM To examine critically patients' experiences of the impact of periodontal disease on their daily lives. MATERIAL AND METHODS Semi-structured interviews of a purposive sample of patients with periodontal conditions were conducted using a flexible evolving topic guide. Data collection and analysis were an inductive, iterative process that occurred concurrently. The data were organized in a framework and recurrent themes identified. Interviews occurred until it was felt that no new themes or ideas were being expressed by respondents (n=14). RESULTS Effects of periodontal disease on patients' daily lives included impairment, functional limitation, discomfort and disability (including physical, psychosocial and social disability). A large number of the emergent themes from the analysis were relevant to the domains of Locker's conceptual model of oral health. The domain within Locker's model that had no data relevant to it in the context of periodontal disease was death. Two additional themes emerged that appeared unrelated to Locker's model, these were stigma and retrospective regret. CONCLUSION Periodontal disease reportedly affects patients' lives in a negative manner in a variety of ways. This is of relevance in the management of patients with periodontitis.
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Affiliation(s)
- Louise K O'Dowd
- Restorative Department, Newcastle Dental Hospital, Newcastle Upon Tyne, UK.
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Dumitrescu AL, Kawamura M. Involvement of psychosocial factors in the association of obesity with periodontitis. J Oral Sci 2010; 52:115-24. [PMID: 20339242 DOI: 10.2334/josnusd.52.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The present case-control study of 79 subjects (19-69 yr) was designed to assess the relationship of several psychological determinants to periodontal disease and obesity. Periodontal clinical examinations were performed, and the subjects were asked to complete a set of questionnaires measuring Type A personality, anxiety, depression, dental anxiety, hopelessness, emotional intelligence, stress, self-esteem, optimism and satisfaction with life. In a bivariate analysis, overweight individuals presented higher levels of smoking exposure, anxiety and depression and lower levels of optimism and satisfaction with life. They were mainly females, with a higher number of sites and teeth with probing depth (PD) >6 mm and clinical attachment level (CAL) >5 mm. Patients with a mean PD exceeding 3 mm and a bleeding on probing index of >25% presented higher values of dental anxiety and lower levels of self-esteem. Multiple linear regression analyses revealed that dental anxiety was positively associated with the number of teeth with a PD of >6 mm and with reasons for visiting a dentist, while satisfaction with life was associated with flossing frequency. We conclude that there is an association between several psychological determinants, periodontitis, and body mass index.
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Ababneh KT, Al Shaar MBA, Taani DQ. Depressive symptoms in relation to periodontal health in a Jordanian sample. Int J Dent Hyg 2010; 8:16-21. [DOI: 10.1111/j.1601-5037.2009.00373.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Payne FJ. Summary of: An intriguing association between dental and mental pathology in addicted and control subjects: a cross-sectional survey. Br Dent J 2008. [DOI: 10.1038/sj.bdj.2008.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Russell SL, Ickovics JR, Yaffee RA. Exploring potential pathways between parity and tooth loss among American women. Am J Public Health 2008; 98:1263-70. [PMID: 18511717 PMCID: PMC2424105 DOI: 10.2105/ajph.2007.124735] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the impact of parity on tooth loss among American women and examined mediators of this relationship. METHODS The study sample comprised 2635 White and Black non-Hispanic women who had taken part in the third National Health and Nutrition Examination Survey. We examined the relationship between parity and tooth loss, by age and by socioeconomic position, and tested a theoretical model focusing on direct and indirect influences of parity on dental disease. Robust regression techniques were used to generate path coefficients. RESULTS Although parity was associated with tooth loss, the relationship was not moderated through dental care, psychosocial factors, or dental health-damaging behaviors. CONCLUSIONS Parity is related to tooth loss among American women, but the mechanisms of the association remain undefined. Further investigation is warranted to determine whether disparities in dental health among women who have been pregnant are caused by differences in parity or to physiological and societal changes (e.g., factors related to pregnant women's access to care) paralleling reproductive choices.
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Affiliation(s)
- Stefanie L Russell
- Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA.
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Lechner HE, Kakebeeke TH, Hegemann D, Baumberger M. The Effect of Hippotherapy on Spasticity and on Mental Well-Being of Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2007; 88:1241-8. [PMID: 17908564 DOI: 10.1016/j.apmr.2007.07.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury (SCI), and to compare it with the effects of other interventions. DESIGN Crossover trial with 4 conditions. SETTING Swiss paraplegic center. PARTICIPANTS A volunteer sample of 12 people with spastic SCI (American Spinal Injury Association grade A or B). INTERVENTIONS Hippotherapy, sitting astride a Bobath roll, and sitting on a stool with rocking seat. Each session lasted 25 minutes and was conducted twice weekly for 4 weeks; the control condition was spasticity measurement without intervention. MAIN OUTCOME MEASURES Clinical rating by a blinded examiner of movement-provoked muscle resistance, using the Ashworth Scale; self-rating of spasticity by subjects on a visual analog scale (VAS); and mental well-being evaluated with the self-rated well-being scale Befindlichkeits-Skala of von Zerssen. Assessments were performed immediately after intervention sessions (short-term effect); data from the assessments were analyzed 3 to 4 days after the sessions to calculate the long-term effect. RESULTS By analyzing the clinically rated spasticity, only the effect of hippotherapy reached significance compared with the control condition (without intervention); median differences in the Ashworth scores' sum before and after hippotherapy sessions ranged between -8.0 and +0.5. There was a significant difference between the spasticity-reducing effect of hippotherapy and the other 2 interventions in self-rated spasticity by VAS; median differences of the VAS before and after hippotherapy sessions ranged between -4.6 and +0.05cm. There were no long-term effects on spasticity. Immediate improvements in the subjects' mental well-being were detected only after hippotherapy (P=.048). CONCLUSIONS Hippotherapy is more efficient than sitting astride a Bobath roll or on a rocking seat in reducing spasticity temporarily. Hippotherapy had a positive short-term effect on subjects' mental well-being.
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