Psychosocial aspects of periodontal disease diagnosis and treatment

Abstract

Patient-reported outcomes (PROs) have attracted interest in periodontal research as our focus shifts from clinician-centric endpoints. PROs generate meaningful insight into the impact of a condition on patients. This mixed-methods study aimed to develop an understanding of the psychosocial impact of periodontitis diagnosis and treatment.

Fourteen adults with chronic periodontitis—who had been referred to a university clinic— kept diaries about their experiences. The diary information was then used as a framework for semi-structured qualitative interviews conducted at the completion of their non-surgical therapy. Inductive thematic content analysis with NVivo was employed. Data on clinical periodontal status, self-reported oral health and the condition’s impact (the latter determined with the short-form Oral Health Impact Profile, or OHIP-14) were collected at baseline and follow-up to supplement the qualitative data. Finally, the findings were considered in the context of status passage, a sociological theory.

Three themes were identified which illustrated the detrimental impact of periodontal disease on the participants’ psychosocial wellbeing: ‘concealment’, ‘having a guilty conscience’ and ‘patient comfort as paramount’. These were related to a core underlying concept, ‘progression to a more positive outlook’, which described how the participants became more optimistic as they progressed through diagnosis and treatment. While most considered the treatment to be unpleasant, the participants not only perceived improvements in their symptoms, but described profound positive influences on their social wellbeing, self-esteem, mood, work, relationships and outlook. These findings were not reflected in the quantitative data, with a slight increase in the mean OHIP-14 score between baseline and follow-up (14.0 and 15.4 respectively). However, changes in self-reported periodontal status suggested greater periodontal awareness. Moreover, many of the findings were applicable to the notion of status passage, which indicated that this theory may be relevant to future studies investigating patients’ experiences of periodontitis.

This study illustrated the broad psychosocial impact of periodontitis. The findings suggest that the benefits of periodontal treatment extend beyond improvements in traditional biomedical indicators to those which are more relevant and desirable to patients. The findings may be reassuring for patients embarking upon periodontal treatment. In addition, this study gives clinicians valuable insights into the idiosyncratic experiences of our patients, to which we are not frequently exposed. This may improve our understanding of patients’ perspectives and facilitate the delivery of periodontal care which is sensitive and responsive to patients’ needs.