Abstract
Background. The effect of depressive symptomatology on periodontitis is not clear in its path of action. Objective. To test a model to predict clinical attachment loss by direct effect of the dental plaque accumulation, which is a direct effect of worse oral hygiene habits and an indirect effect of greater depressive symptomatology. Methods. Three incidental samples were collected: 35 dental patients with periodontitis, 26 mental health patients with depressive symptomatology, and 29 people from the general population. The Beck Depression Inventory-II and the Oral Hygiene Habits Scale were applied. Plaque index and clinical attachment loss were assessed. Path analysis was used to test the model. The parameters were estimated by the maximum-likelihood method. Results. Depressive symptomatology had no direct effect on oral hygiene habits nor an indirect effect (mediated by oral hygiene habits) on the plaque index in any of the 3 samples. Oral hygiene habits had a large-size direct effect on plaque index and a medium-size indirect effect on clinical attachment loss in the general population sample. The plaque index had a direct effect on clinical attachment loss with a large effect size in general population sample and with a medium effect size in dental patients and depressive symptomatology patients. Conclusion. The model shows that dental plaque accumulation has a direct effect on clinical attachment loss in the 3 samples, and oral hygiene habits have an indirect effect on attachment loss mediated by dental plaque accumulation only in the general population sample. However, depressive symptomatology is not a relevant variable.
Highlights
Periodontitis is an infectious disease that results in inflammation of the supporting tissues of the teeth, clinical attachment loss (CAL), and bone loss
It is associated with the presence of dental plaque and calculus [1]. e clinical characteristics that identify periodontitis are as follows: interproximal CAL ≥2 or 3 mm, interdental CAL detectable at 2 or more nonadjacent teeth, and presence of interproximal tissue loss confirmed through radiographic assessments [2], as well as bleeding at probing, periodontal pockets ≥4 to 6 mm, and CAL ≥3 to 5 mm [3]
As the effect and mechanism of action of depression on periodontitis are not clear, the objective of this study is to test a predictive model for CAL including depressive symptomatology, oral hygiene habits, and dental plaque accumulation. is hypothetical model proposes that CAL is a direct effect of a greater dental plaque accumulation and an indirect effect of greater depressive symptomatology and worse oral hygiene habits. e first hypothesis to specify the model is that depressive symptomatology has a direct effect on oral hygiene habits [8], as well as an indirect effect on dental plaque and on CAL [7, 11]
Summary
Periodontitis is an infectious disease that results in inflammation of the supporting tissues of the teeth, clinical attachment loss (CAL), and bone loss. It is associated with the presence of dental plaque and calculus [1]. Poor oral hygiene generates accumulation of dental plaque, which first leads to gingivitis. The chronification of gingivitis causes a destruction of the tissues that support the teeth and periodontitis appears [6]. Oral hygiene instructions for self-care are important to preserve periodontal health as well as mechanical or chemotherapeutic removal of dental plaque to International Journal of Dentistry minimize disease activity. It has been pointed out that the difficulty in modifying oral hygiene habits may be due to lack of motivation or problems with the implementation of prescribed oral hygiene procedures [7]
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