Psychopathologic Symptoms as Risk Factors for Periodontitis

Objectives: Several local, systemic, and environmental risk factors were identified for chronic periodontitis. Among these, psychological factors are discussed. However, study data are heterogeneous. The aim of this study was to investigate whether psychopathological symptoms like depression, dental anxiety, and somatic symptom severity are more pronounced in chronic periodontitis patients than in periodontally healthy controls.
Methods: In a cross-sectional study 140 periodontitis patients and 141 patients without periodontitis were recruited in 5 urban dental practices in Germany. The periodontitis group comprised patients who had more than 30% teeth with approximal attachment loss (AV) ≥5mm. The control group included only patients who had not more than 1 tooth with AV ≥4mm or probing depths (PD) ≥5mm. Clinical examinations included AV, PD, plaque, and bleeding. Furthermore, validated questionnaires were answered concerning dental anxiety (DAS), depression (PHQ-8), and somatic symptom burden (SSS-8). Data were analyzed using t-tests and regression analysis with α<0.05.
Results: Periodontitis patients were older than patients in the control group (56.6±11.2 vs. 50.4±9.7; p<0.001). They had higher depression scores (4.55±4.09 vs. 2.99±2.86; p<0.05; effect size 0.44), higher dental anxiety scores (10.04±3.83 vs. 7.37±3.08; p<0.05; effect size 0.77), and higher somatic symptom scores (6.49±5.55 vs. 4.96±4.08; p<0.05; effect size 0.32). Periodontitis patients reported a higher intensity of dental anxiety and omitted dental visits more often and longer than healthy controls. Regression analysis confirmed that among all co-morbidities tested dental anxiety had the highest impact.
Conclusions: Dental anxiety causes severe dental problems resulting in profound caries, endodontic complications, and tooth loss. The study showed a considerable influence on periodontitis, too. Therefore, dental anxiety as risk factor for periodontitis should be given more attention in future research and treatment strategies.