Stress reduction intervention and the initial periodontal therapy outcome in chronic periodontitis patients. a randomized controlled pilot study

Karthikeyan Bangalore Varadhan,Sai Jyothsna N,Prabhuji Munivenkatappa Lakshmaiah Venkatesh,Smiti Bhardwaj,Munaga Shanmukha Venkata Nagarjuna,Rekha Murahari

doi:10.14419/ijdr.v7i2.29595

Abstract

Background: Psychosocial stress, have been implicated as risk indicators for periodontal disease. Minimal evidence in literature exists to assess the effect of stress reduction therapy (SRT) in the outcome of non-surgical periodontal therapy (NSPT).Objective: Hence, we aimed to explore the possibility of employing SRT in stressed patients as an adjunctive intervention in the management NSPT.Materials and Methods: Sixty male patients divided into Group 1 comprised of 20 unstressed chronic periodontitis patients receiving non-surgical periodontal therapy alone, Group 2a (20 stressed chronic periodontitis patients) received intervention focused on SPT with NSPT and Group 2b (20 stressed chronic periodontitis patients) received only NSPT without SPT. Their stress level was evaluated using a standard questionnaire method and salivary cortisol levels, at baseline and 3 months along with periodontal parameters.Results: There was significant reduction in stress parameters for Group 2a patients. The reduction of total periodontitis affected sites was highest in Group I patients (55.4%), followed by Group 2a patients (53.2%) and Group 2b patients (38%).Conclusion: SRT may result in comparable treatment outcome to unstressed chronic periodontitis patients. This study opens new avenues to investigate the effects of stress management as an adjunctive to conventional NSPT, which should be explored further.Â

Highlights

Periodontitis is a multifactorial disease where microbial dental biofilms are considered to be a key etiological agent for the initiation & progression of the inflammatory process (Genco, 1996; Page and Beck, 1997; Page. 1998; Elter et al, 1999)
Till date, there are no intervention studies on possibility of employing psychological intervention (stress reduction therapy (SRT)) as adjunctive measure in the treatment of periodontitis patients with unfavorable psychological background. Considering this hypothesis, the present study is conducted which is first of its kind, to explore and evaluate, if intervention focused on stress management enhancement training may serve as adjunctive role in non-surgical treatment of periodontal diseases by monitoring the improvements in periodontal condition through clinical parameters and correlating with stress marker like salivary cortisol levels and Derogatis stress profile (DSP) scores
A weak positive correlation between DSP scores and clinical attachment level (CAL) found in the Group 2a of 3 - 4 mm, Group 1 and Group 2a of ≥ 5 mm the at the base line and end of the third month and between the salivary cortisol levels and pocket depths at the base line and end of the third month, a weak positive correlation found in the Group 2b of 4 - 6 mm, Group 1 and Group 2b of > 8 mm

Summary

Introduction

Periodontitis is a multifactorial disease where microbial dental biofilms are considered to be a key etiological agent for the initiation & progression of the inflammatory process (Genco, 1996; Page and Beck, 1997; Page. 1998; Elter et al, 1999). Assessment of a patient‘s stress level, their coping ability and stress management might be of value in understanding psychological effects on periodontal health and its disease process, which will be helpful in future preventive care. Considering these facts, we hypothesize that if stress is causally related to the worsening of parameters in a chronic periodontitis patient, its alleviation might result in an additive response to the conventional periodontal therapy. This study opens new avenues to investigate the effects of stress management as an adjunctive to conventional NSPT, which should be explored further

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Methods

Results

Discussion

Conclusion