Psychosocial aspects of periodontal disease diagnosis and treatment: A qualitative study

Scoring algorithm for predicting periodontitis in dentate adults using self-report measures - National Health and Nutrition Examination Survey 2009-2012

AIM

Our goal was to develop and externally validate oral health self-report measures for predicting periodontitis in a representative U.S. adult population (30-79 years old) and to evaluate a predictive scoring tool for periodontitis constructed from the best performing model parameter estimates.

METHODS

The predictive models for periodontitis using demographic characteristics and self-reported oral health measures were developed and tested with the National Health and Nutrition Examination Survey (NHANES) 2009-2012 data (development 2009-2010, validation 2011-2012). The best performing model was externally validated against clinical periodontitis cases defined by measurements from a full-mouth periodontal examination at six sites around all teeth excluding third molars. A predictive scoring tool derived from the transformed sum of the model coefficient estimates was also externally validated. Model performances were evaluated by their sensitivity, specificity, predictive accuracy, and area under the receiver-operating characteristic curve (AUROC).

RESULTS

Our best model used self-reported oral health, smoking, and demographics. Predictive Risk Scores (PRS) of ≥65 captured about 98% of the true periodontitis cases. Three forms of the model (1-individual risk factor variables, 2-continuous PRS, and 3-PRS categories) were applied to the development and validation data sets. Overall, all three forms had high sensitivity (>84%) in both the development and validation data sets and had similar AUROC (around 80%). Specificity was low to moderate. When externally validated, the model incorporating PRS as a continuous measure had high sensitivity (84.0%) and low specificity (57.5%), with AUROC of 79.5% and predictive accuracy of 71.6%. Similarly, when PRS as a categorical variable was externally validated, the model had a high sensitivity (82.8%) and low specificity (59.9%), with an AUROC of 79.3% and predictive accuracy of 72.0%.

CONCLUSION

Overall, modeling of four self-report oral health measures, combined with smoking and demographic characteristics, performs well in predicting clinical periodontitis in a nationally representative sample of the adult dentate US adult population. Compared with clinical periodontal examination, this approach is promising as a viable, non-clinical, and much less resource-intensive alternative method for estimating the burden of periodontitis.

Necessity of Collaborative Health Care for Patients with Stage III and IV Periodontitis: Qualitative Study

AIM

To understand the barriers and facilitators faced by clinicians in the treatment of periodontitis and to explore the barriers and facilitators to periodontal care encountered by patients when navigating the health care system.

MATERIALS AND METHODS

Semistructured in-depth interviews were conducted with clinicians (n = 22) and patients (n = 18) selected through purposive sampling. Audio recordings were transcribed, coded, and analyzed thematically to identify key issues.

RESULTS

Four main themes were identified by clinicians: 1) psychological barriers and dissatisfaction caused by uncertain treatment outcomes when managing periodontitis; 2) professional barriers caused by referral processes and decisions about shared care; 3) barriers caused by patients' undervaluing specialist care; and 4) participatory care, standardized referral processes, and aligning treatment expectations in primary and tertiary care-facilitated management. Three main themes were identified for patients: 1) first contact with general dentists facilitated patients' perceptions about good dental care; 2) recognizing the emotional and social impact of periodontitis promoted health seeking and engagement in dental care; and 3) problems with navigating and understanding the health care system negatively affected patients' journeys. Both groups highlighted the importance of primary care services in playing a key role in managing periodontitis and raising public awareness of periodontitis.

CONCLUSION

Close collaboration between primary and tertiary levels of health care is required to ensure an efficient referral process and continuity of care. Prioritizing empathetic approaches and raising awareness of periodontitis at clinical and policy levels is needed to address the structural and interpersonal barriers in care delivery.Knowledge Transfer Statement:Primary care services play a key role in treating patients with periodontitis. Closer collaboration is required to ensure a seamless transition of care between specialists and general dental practitioners. Patients need to be engaged and play a participatory role when planning for care integration at a health care system level. Greater public health education is needed to improve awareness of the etiology and treatment of periodontitis.

Perceptions, Attitudes and Needs of Periodontitis Patients: A Qualitative Systematic Review

AIM

Patient-reported outcomes (PROs) hold significant potential in guiding clinical decision making, yet their utilization in periodontal trials has been limited. This systematic review aimed to critically synthesize and analyse qualitative studies that evaluated the knowledge and impact of periodontitis and its treatment on patients' lives, as well as their motivations, expectations and experiences in seeking treatment.

MATERIALS AND METHODS

Six databases were searched up to March 2024 for qualitative studies on periodontitis patients. Studies were quality-assessed using the JBI Critical Appraisal and ConQual tools. Two authors independently extracted the findings, with discrepancies resolved by a third reviewer.

RESULTS

Thirteen studies from 2006 to 2023 across four continents, involving 215 participants, identified five themes related to periodontitis: (i) knowledge about periodontitis and its treatment; (ii) impact of periodontitis on patients' lives; (iii) motivation and treatment expectations; (iv) obstacles to treatment; and (v) treatment impact on patients' lives.

CONCLUSION

Significant physical and psychosocial impacts of periodontitis on patients' lives were identified, along with critical gaps in knowledge and awareness, emphasizing the important role of dentists in patient education. Specific PROs for use in validated instruments tailored to periodontitis were identified. These results can enhance patient-centred care by guiding future studies in accurately assessing patient perspectives on their condition and treatment.

Exploring experiences of living with removable dentures-A scoping review of qualitative literature

OBJECTIVE

Examine the literature on the experiences of living with removable dentures (complete or partial) to identify any gaps and provide a map for future research.

BACKGROUND

Increasing proportions of society are living partially dentate with some form of restoration, including removable dentures. Previous studies have reported on the location, materials and usage of these prostheses, along with effects on oral-health-related quality of life (OHRQoL). However, less is known about experiences with removable dentures from a patient-centred perspective.

METHODS

A scoping review of the qualitative literature was undertaken using the framework of Arksey and O'Malley, updated by Levac et al. Literature searches were carried out using Medline and Web of Science. Papers were screened by title and abstract using inclusion and exclusion criteria. Remaining papers were read in full and excluded if they did not meet the required criteria. Nine papers were included in the final review.

FINDINGS

Key themes from these papers were: impact of tooth loss and living without teeth, and its impacts in relation to social position, appearance, confidence and function (chewing and speaking); social norms and tooth loss, including attitudes to tooth retention and treatment costs, and changes in intergenerational norms towards dentures; expectations of treatment, including patients being more involved in decision making, viewing the denture as a "gift" and dentures helping to achieve "an ideal"; living with a removable denture (complete or partial), including patient preparedness for a denture, adaptation and impacts on activities and participation; and the dentist-patient relationship, including issues with information and communication, and differing priorities between patients and dentists.

CONCLUSION

Little qualitative research exists on experiences of living with a removable denture. Existing literature demonstrates the importance of dispersed activities in differing social, spatial and temporal contexts when wearing removable dentures. Focusing on processes of positive adaptation to dentures and OHRQoL, rather than deficits, is also required to fully understand patients' experiences. Additionally, more complex technological advances may not always be in the best interest of every patient.

Gum health and quality of life—subjective experiences from across the gum health-disease continuum in adults

Background

There has been a lack of qualitative work investigating the effects of the wide range of gum-related symptoms, and the perceived everyday impacts associated with these including on quality of life. While periodontal disease has been shown to have significant effects on quality of life, fewer studies have researched the perceived impacts of gingivitis and symptoms from across the entire gum health-disease continuum, despite evidence that these can also negatively affect quality of life. The aim of this study was to investigate perceived everyday impacts and explore the subjective experiences of adults with a variety of symptoms from across the self-reported gum health-disease continuum, and how these may affect quality of life.

Methods

Participants were recruited at a large UK University using purposive sampling, for self-reported symptoms ranging from mild gingivitis to severe periodontal disease. Semi-structured interviews gathered details on symptom history, changes occurring over time and associated beliefs, as well as perceived impacts on everyday life, and links between these experiences and identity. Interviews were analysed using framework analysis based on the Wilson and Cleary health-related quality of life model.

Results

Twenty-seven participants were recruited − 15 with symptoms of gingivitis, 12 with more severe periodontal symptoms. Prominent themes included description of symptoms, changes in daily life, social impacts, psychological impacts, identity, and overall impacts and quality of life. Differences were noted in severity, extent and frequency of symptoms and participant experiences, with greater perceived impacts often felt by those with periodontal disease. However, participants from across the gum health-disease continuum often expressed similar experiences and concerns.

Conclusion

Findings demonstrate the range of experiences from participants with a variety of gum-related symptoms; notably, gingivitis was reported to have a range of perceived impacts on quality of life alongside those reported by periodontal disease sufferers. Future work should look to include symptoms from across the entire gum health-disease continuum when considering quality of life, as well as considering a more patient-centred approach which could be valuable in both clinical and research settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02507-5.

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.

[Dental disorders with a psychosocial background]

While the mouth and teeth play a lifelong central role in a person's development and wellbeing, psychosocial aspects of disease and health are still only reluctantly included in dental explanatory models. Only dental anxiety with its disease quality of a specific phobia is generally recognized as a mental disorder requiring intervention. It is interpreted as an emotional reaction to aspects of dental treatment, which results in distress for the affected person and appears to be unreasonably intense given the actual dangers involved. Apart from that, the tendency to provide a somatic explanation for symptoms in the dental context persists. This bears implications for the expectations of those affected as well as for interdisciplinary cooperation. In order to improve interdisciplinary support and mutual understanding, the following article introduces the clinical pictures of craniomandibular dysfunction, bruxism, occlusal dysaesthesia, and somatoform prosthesis intolerance alongside dental anxiety. Psychosocial factors can profoundly influence the development, course, and management of these conditions.

Dental Anxiety and Higher Sensory Processing Sensitivity in a Sample of German Soldiers with Inflammatory Periodontal Disease

(1) Background: Dental anxiety with disease value usually leads to avoidance of dental treatment. For the initial diagnosis of the level of anxiety, questionnaires such as the Hierarchical Anxiety Questionnaire (HAQ) are suitable. The construct of sensory processing sensitivity (SPS) describes a general trait in which people with a higher degree of SPS perceive information more strongly and process it more thoroughly. (2) Methods: This cross-sectional study evaluated the relationship between dental anxiety and higher levels of SPS in 116 soldiers referred with different stages of periodontitis for mandatory dental fitness before military deployment. (3) Results: The proportion of patients with periodontitis in stage III + IV was 39% and in stage I + II was 27%. The mean cumulative values of the questionnaires were 20.9 ± 10.6 for HAQ and 27.7 ± 16.0 for SPS. Eleven moderately anxious patients had a SPS value of 37.4 ± 13.5 and 10 highly anxious patients had a value of 36.3 ± 14.1. Patients diagnosed with stage III + IV periodontitis showed significantly higher values on the SPS subscale Low Sensory Threshold (LST), which describes overstimulation by external sensory stimuli, compared to patients with stage I + II periodontitis. Dental anxiety showed moderately significant correlations with the SPS subscale Ease of Excitation (EOE), which measures emotional reactivity to physiological stimuli. (4) Conclusions: Due to the frequency of dental anxiety and higher sensitivity in patients with severe periodontitis, it is useful to record said frequency.