Short-Term Impact of Non-Surgical and Surgical Periodontal Therapy on Oral Health-Related Quality of Life in a Greek Population-A Prospective Cohort Study

Impact of Periodontal Diseases on Oral Health-Related Quality of Life: A Study with a Condition-Specific Questionnaire in Croatian Population

OBJECTIVES

 The aim of this study was to translate and validate the condition-specific Oral Health Impact Profile (OHIP) in the Croatian cultural context and assess the impact of periodontal diseases and nonsurgical periodontal therapy on quality of life (QoL).

MATERIALS AND METHODS

 A cross-sectional study was carried out on 150 individuals: 50 periodontally healthy, 50 with gingivitis, and 50 with periodontitis who self-administrated the OHIP. The participants' age ranged between 18 and 71 years, with the median age of 45 (34-57) years. Forty-seven percent of the participants were females. The validity and reliability of the Croatian OHIP version were tested. The impact of gingivitis and periodontitis on QoL was assessed. Changes in QoL induced by nonsurgical periodontal therapy in 20 patients with periodontitis were analyzed.

STATISTICAL ANALYSIS

 Categorical data were presented by absolute and relative frequencies. The normality of the distribution of continuous variables was tested by the Shapiro-Wilk test. Continuous data were described by the median and the limits of the interquartile range (IQR). Differences in continuous variables between two independent groups were tested with the Mann-Whitney U test, and between three groups with the Kruskal-Wallis test (post hoc Conover). The Wilcoxon signed-rank test was used to examine the differences in the total score before and after therapy. All p values were two-sided. The level of significance was set at alpha of 0.05.

RESULTS

 The analysis detected a single-factor structure that explained for the 56.9% of the variance. Cronbach's alpha value was 0.937, which indicated an excellent internal consistency. Overall OHIP score reported a strong correlation with the subjective estimate of periodontal problems (Rho = 0.92; p < 0.001). Test-retest reliability was high (r = 0.984; p < 0.001). The periodontitis group had the highest OHIP score (28 [23-34]), followed by the gingivitis group (14 [12-20]) and the periodontally healthy group (9 [5-11]; p < 0.001). Nonsurgical periodontal therapy significantly improved the QoL in those with periodontitis (p < 0.001).

CONCLUSION

 The condition-specific Croatian version of the OHIP instrument can be considered adequate to measure the impact of periodontal diseases on oral health-related QoL. Periodontal diseases, especially periodontitis, have a negative effect on the patient's QoL. Nonsurgical periodontal treatment can improve patients' QoL.

The oral health impact of dental hygiene and dental therapy populations: a systematic review

OBJECTIVES

Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals.

METHODS

The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review.

RESULTS

After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60.

CONCLUSIONS

This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

Patient-reported outcome measures after periodontal surgery

OBJECTIVES

The present study aimed to explore the impact of different periodontal surgical treatments on the quality of life and postoperative morbidity.

MATERIALS AND METHODS

The present study is a single-center, prospective, observational cohort trial. One hundred fifty-five patients, referred to the Periodontal Department of Bologna University who needed periodontal surgical treatment, were recruited. The self-reported perception of the postoperative course was assessed using the following anonymous questionnaires: Italian oral health impact profile (I-OHIP-14), visual analog scale (VAS) to evaluate the intensity of the pain, and 5-point Likert scale.

RESULTS

Patients reported a mean OHIP-14 total score of 9.87±8.5 (range 0-42), significantly influenced by the female sex, flap extension, and periodontal dressing. A mean VAS score of 2.96±2.39 (range 0-9) was calculated, and was found to be influenced by the presence of vertical releasing incisions and palatal flap extension. Of the 155 subjects, 40 (25.8%) patients reported bleeding as a post-surgical complication, 96 (61.9%) swelling, 105 (67.7%) eating discomfort, and 44 (28.4%) reported speech discomfort.

CONCLUSIONS

Within the limitations of the nature of the present study, periodontal surgical procedures have a low impact on patients' quality of life evaluated through the OHIP-14 and VAS pain questionnaires.

CLINICAL RELEVANCE

Periodontal surgical procedures are safe procedures, with a limited duration of postoperative discomfort as well as the incidence of complications.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

Periodontal Disease and Nonsurgical Periodontal Therapy on the OHRQoL of the Patient: A Pilot Study of Case Series

The objective of this prospective study was to assess oral health-related quality of life (OHR-QoL) in patients with periodontitis and nonsurgical periodontal treatment. A prospective, longitudinal case series study was carried out at the University Dental Clinic of the Morales Meseguer Hospital in Murcia. Eighty periodontal patients with periodontitis, aged 22 to 72 years, were included in this study. The Spanish version of the Oral Health Impact Profile 14 (OHIP-14sp) questionnaire was used on two occasions: at the first visit and one month after completing the nonsurgical periodontal treatment. Clinical measurements of probing depth, plaque index and bleeding on probing were performed at baseline and after periodontal therapy. Data were analyzed using Student’s t-test and analysis of variance. We found statistically significant differences (p < 0.05) between the pre- and post-treatment in all the dimensions studied except disability. Similarly, statistically significant differences were also found according to the degree or stage of the disease. However, these differences were not observed with respect to the extent of periodontal disease. Periodontal disease has a negative impact on the OHRQoL of periodontal patients, especially in severe stages (III–IV). Basic periodontal treatment can improve the OHRQoL of periodontal patients one month after treatment.

Understanding the feelings and experiences of patients with periodontal disease: a qualitative meta-synthesis

Background

Patients’ experiences, feelings, and perceptions play key roles in quality of life and dental care quality, but they are poorly understood in periodontal disease. Therefore, this meta-synthesis aimed to gain deep insights into the feelings, experiences, and perceptions of people living with periodontal disease.

Methods

Electronic database searches in PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, PsycINFO, CINAHL, and Open AIRE were conducted up to December 2021 (updated in June 2022). The JBI Critical Appraisal Tool was used for quality assessment. Then reviewers integrated findings from qualitative studies with a thematic synthesis approach.

Results

A total of 567 studies were identified, of which eight involving 131 participants met the inclusion criteria. Studies were conducted between 2008 and 2021within Europe (Sweden and UK), Asia (Korea, Indonesia, and Singapore), and Oceania (New Zealand). Three analytical themes with nine descriptive themes emerged from the qualitative data. The themes were as follows: (1) “pressure (physical, psychosocial, and financial),” (2) “coping and adaptation (avoidance of the status quo, trying to understand it, and taking responsibility for their own),” (3) “reflection and evaluation (exploring the causes, personal control, and calling for better dental care).”

Conclusions

This review provides insights into how patients perceive and cope with periodontal disease. The findings highlighted patient-centered care in PD, and based on the findings, it is possible to provide more precise and efficient interventions for better patient compliance and treatment outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-02042-5.

The Influence of Periodontal Disease on Oral Health Quality of Life in Patients with Cardiovascular Disease: A Cross-Sectional Observational Single-Center Study

Background and Objectives: Cardiovascular disease is a leading cause of global death with a rising prevalence and a heavy economic burden. Periodontal disease has been associated with cardiovascular diseases—including incident coronary heart disease, peripheral artery disease and ischemic stroke. The study evaluates the quality of life of patients with cardiovascular and periodontal disease from the point of view of oral health by using the short version of the Oral Health Impact Profile (OHIP-14) questionnaire. Materials and Methods: This study included a total of 221 patients (61.86 ± 15.03 years old) selected from the Emergency Hospital of Sibiu, Romania. The participants self-completed the OHIP-14 questionnaire and they benefited from an oral health examination conducted to assess the presence and the severity of periodontal disease. Results: Out of the 147 patients with cardiovascular disease, 77.5% had periodontal disease (32.6% stage I, 29.2% stage II, and 15.6% stage III and IV). The presence of periodontal disease was associated with a lower oral-health-related quality of life (p < 0.001, ANOVA) and with a higher OHIP-14 score in patients with cardiovascular disease (18.67 ± 8.17, p < 0.001 ANOVA). No significant difference was observed concerning patient sex and background; however, age, body mass index and the lack of an appropriate oral hygiene routine had a strong association with the individual quality of life. The general OHIP-14 score was higher in patients with periodontal disease and associated cardiovascular disease, the presence of both cardiovascular and periodontal disease being associated with a lower quality of life. Conclusions: By increasing the patients’ awareness to oral healthcare measures, better outcomes and improved oral-health-related quality of life could be observed.

Effect of periodontal treatment on oral health-related quality of life - A randomised controlled trial

Objectives

Periodontal disease is a chronic, infectious gum disease, which eventually leads to tooth loss, adversely affecting quality of life (QoL). Most of the research in this area focuses on evaluating clinical parameters rather than patient-based outcomes. Currently, these parameters are gaining importance along with treatment outcomes of chronic diseases and QoL. This study evaluates the impact of periodontal disease and its treatment on oral health-related quality of life (OHRQoL).

Methods

We recruited 90 participants who were divided into two groups. One was the test group (n = 45) that underwent non-surgical periodontal therapy (NSPT) followed by periodontal flap surgery (SurgPT). Second was the control group (n = 45) that underwent only NSPT. Clinical parameters, plaque index, gingival index, periodontal/probing pocket depth (PPD), clinical attachment level (CAL), and mobility were recorded. An OHRQoL questionnaire was used to assess the functional, physical, social, and psychological domains at baseline, three, and six months.

Results

The mean PPD in the test group was 6.9 ± 0.38, 3.2 ± 0.36, 3.5 ± 0.5, and 5.8 ± 0.67, 3.13 ± 0.21, 3.73 ± 0.45 in the NSPT group at baseline, 3, and 6 months, respectively. The mean CAL in the SurgPT group was 7.07 ± 0.41, 3.56 ± 0.27, 3.74 ± 0.30, and 6.08 ± 0.16, 4.02 ± 0.17, 4.16 ± 0.19 in the NSPT group at baseline, 3, and 6 months, respectively. Both treatments resulted in reduction in all clinical parameters and were statistically significant in the SurgPT group (p < 0.001). Oral Health Impact Profile scores substantially decreased in the SurgPT group (mean difference-25.0) compared to the NSPT group (mean difference-5.0) (p-0.001).

Conclusions

In this study, NSPT and SurgPT had a positive impact on OHRQoL by improving clinical parameters, but SurgPT had substantially better outcomes in terms of improved QoL.

Socio-behavioral factors, oral hygiene level and periodontitis prevalence in a 35-44-year-old Greek adult population: A cross-sectional survey

Background

Sub-optimal oral hygiene is considered as a primary risk factor for periodontitis occurrence. Various socio-behavioral determinants may contribute either independently or by influencing adversely the oral hygiene (OH) level. The aim of the present study was to examine the periodontal status of 35-44-year-old Greek adults and determine the contribution of risk indicators, including the socio-behavioral aspects and the population’s oral hygiene level, on disease prevalence.

Material and Methods

In 1218 participants, Community Periodontal Index (CPI), Loss of Attachment (LoA) and simplified Oral Hygiene Index (OHI-S) were calculated. Multivariable regression models examined the effect of socio-behavioral factors with/without the inclusion of OHI-S level on pocket depth (PD)≥4mm and LoA≥4mm presence.

Results

11.8% of the participants had healthy periodontium, whereas 37.3% and 5.6% presented with shallow and deep pocketing, respectively. 60.4%, 28.8%, and 10.8.% of the adults demonstrated LoA≤3mm, 4-5mm, and ≥6mm, accordingly. Fair and poor oral hygiene significantly increased the likelihood for PD≥4mm (OR=4.8-20.3) and LoA≥4mm (OR=3.3-6.0) presence. ‘Emergency-oriented dental visiting pattern’ significantly elevated the chance for PD≥4mm presence (OR=1.7). ‘Lower education level’ ‘urban location’, and ‘using an interdental brush’ were significantly independently linked to LoA≥4mm occurrence (OR=1.7-2.1, 1.5, and 2.0, respectively). Lower educated individuals demonstrated inferior oral hygiene status, which in turn elevated significantly the chances of PD≥4mm presence. Smoking more than 10 cigarettes/day, emergency-oriented dental attendance pattern and not flossing were linked to worse oral hygiene levels, which consequently increased significantly the likelihood of LoA≥4mm occurrence.

Conclusions

Fair and poor oral hygiene contribute strongly to periodontitis occurrence. Various socio-behavioral factors may influence adversely oral hygiene maintenance, leading to periodontitis manifestations.

Key words:Community periodontal index, periodontal attachment loss, oral hygiene, adults 35-44, cross-sectional survey, socio-behavioral indicators.