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 Table of Contents  
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 73-76

Impact of lifestyle change plus dental care programme on stress levels and periodontal status in chronic periodontitis patients

1 Department of Periodontology, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
2 Department of Periodontology, Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujarat, India

Date of Submission16-Mar-2021
Date of Decision28-Apr-2021
Date of Acceptance05-May-2021
Date of Web Publication16-Oct-2021

Correspondence Address:
Shilpa Duseja
Department of Periodontology, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_38_21

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Introduction: Periodontitis is a polymicrobial chronic disease modified by numerous factors, with stress and unhealthy lifestyles being associated with the progression of the disease. It is believed that cognitive-behavioural approaches can improve stress and lifestyle patterns which may subsequently improve oral hygiene-related behaviours. Materials and Methods: Hundred systemically healthy patients participated in the study. Patients with chronic periodontitis, stress (Social Readjustment Rating scale) and with unhealthy lifestyles (Abel's criteria) were selected for the study. The selected patients in the test group (n = 50) were provided with Individual lifestyle counselling and oral education programme along with non-surgical periodontal therapy, while the patients in the control group (n = 50) were provided with non-surgical periodontal therapy. Plaque index (PI), modified gingival index (GI) and probing depth were recorded at baseline and 3 months. The self-efficacy scale for self-care (SESS) was also recorded at baseline and 3 months. Means of all parameters were collected and subjected to Student's t-test. Results: Statistically significant (P ≤ 0.05) reductions were observed in both test and control group for PI, modified GI and probing depth. The SESS showed statistically significant improvement (P ≤ 0.01) in the test group as compared to the control group. Conclusion: Self-efficacy is related to numerous health-related practices such as diet and health-promoting lifestyle, and smoking cessation. The approaches applying the social cognition model are useful for the improvement of periodontal status and should be made part of regular treatment and maintenance regimens.

Keywords: Health, lifestyle, periodontitis, self-efficacy

How to cite this article:
Duseja S, Parikh H. Impact of lifestyle change plus dental care programme on stress levels and periodontal status in chronic periodontitis patients. Adv Hum Biol 2021;11:73-6

How to cite this URL:
Duseja S, Parikh H. Impact of lifestyle change plus dental care programme on stress levels and periodontal status in chronic periodontitis patients. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4];11:73-6. Available from: https://www.aihbonline.com/text.asp?2021/11/4/73/328397

  Introduction Top

Periodontitis has been one of the most significant problems worldwide, and periodontal health has become one integral aspect of health-related quality of life. A healthy periodontium is the key component of oral health which affects general health at the individual as well as population levels. Periodontitis is one of the most ubiquitous and complex diseases and is associated with the destruction of connective tissue and underlying bone following an inflammatory host response secondary to infection by periodontal bacteria.[1] Evidently, all forms of the periodontal disease occur as a result of co-existing microbial infections with various modifiable and non-modifiable risk factors affecting the progression of this disease.[2] In recent years, the customary view of physical illness as a purely biological phenomenon has changed to a bio-psychosocial model of illness. According to this model, physical illness is the result of a complex interaction of biological, sociocultural and psychological factors.[3] Stress, whether physiological or psychosocial, anxiety and depression, have all been found to be associated with a significant amount of inflammatory disease progression and impaired wound healing. Prolonged negative events are found to disturb the optimal functions of the host defence. The bio-behavioural mechanism of stress affects the progression of periodontal disease by two basic pathways. The activation of neuroendocrinal systems like the hypothalamic-pituitary adrenal axis and sympathetic nervous system leads to altered host response and negative changes in lifestyle factors such as smoking, inappropriate diet intake, and poor oral hygiene maintenance have been found to be associated with poor periodontal health.[4]

As the entire concept of stress is highly dependent on an individual's response to different situations, the change in lifestyle factors play an important role as stressors and evidence strongly suggests that chronic, multifactorial diseases are largely affected by environmental and socio-psychological risk factors.[5] In various studies done by Locker et al.[6] and Sakki et al.[7] unhealthy lifestyles were found to be associated with a higher prevalence of periodontitis. Healthy lifestyles were related to better immunity with higher natural killer cells activity, whereas elevated or suppressed immunoglobulin levels were reported in people with unhealthy lifestyles. People with an unhealthy lifestyle have a poor periodontal status because of their aberrant brushing habits and the detrimental effects of smoking.[8] Improved lifestyle has gained tremendous importance with reference to the maintenance of periodontal health. More emphasis is now directed towards the elimination of the combined influence of socioeconomic factors along with standard risk factors. Behavioural interventions for promoting oral health are being proposed for both prevention and treatment of oral diseases.[9] Furthermore, additional strategies such as coping strategies and motivational interviewing are also being promoted to negate the effects of distress which has a strong correlation with unhealthy lifestyles.

Hence, this study was carried out to find out the integrated effect of lifestyle change plus dental care (LCDC) on periodontal health as it provides the dual benefit of professional and improved self-efficacy, which is considered as an antecedent factor for behaviour modification.

  Materials and Methods Top

The study was carried out at the Department of Periodontology, Narsinhbhai Patel Dental College and Hospital, Visnagar. Patients were selected by convenience sampling method, and only consenting subjects were selected for the study. Ethical approval was taken from the institutional ethical review committee (NDM/2019/234). The study population consisted of 100 systemically healthy adults in the age group of 35–60 years, irrespective of gender. Patients who were immuno-compromised, pregnant or lactating females, patients with a history of tobacco consumption in any form, patients with any history of psychiatric illness, patients on corticosteroid therapy and patients on antibiotics, tranquillisers, sedatives and anti-depressants were excluded from the study. No dental casts or radiographs were used in the study.

Before being clinically examined, demographic data of the patients were obtained. All the patients were then administered with the questionnaire based on Social Readjustment Rating scale according to The Holmes Rahe Stress scale Inventory,[10] and lifestyle evaluation of all these patients as suggested by Abel[11] was also done. Patients with stress levels >150 and subjects with lifestyle evaluation scores ranging from − 4 to 1 (unhealthy lifestyles) were included. A single examiner then checked the periodontal parameters like plaque index (PI),[12] modified gingival index (GI)[13] and full mouth probing pocket depth (PPD) of the selected patients. Patients with chronic periodontitis were finally recruited for the study. Periodontitis was defined as PI and GI >1 and at least >4 teeth in each quadrant having probing depth ≥5 mm for this study. All the selected patients were then divided randomly into two groups.

  • Group I (Test Group): Fifty patients subjected to Individual lifestyle counselling and oral education program along with non-surgical periodontal therapy (LCDC program)
  • Group II (Control Group): Fifty patients subjected to non-surgical periodontal therapy.

All the patients (both test and control group) were subjected to non-surgical periodontal treatment, but patients in the test group also received lifestyle counselling and oral hygiene education by Farquhar's six-step method[14] to improve self-efficacy and self-care in adults.

Patients from both the groups were recalled after 1–3 months for follow-up and evaluation of oral hygiene status. The self-efficacy scale for self-care (SESS)[15] was also recorded at baseline and 3 months.

Statistical analysis using SPSS Software (Version 22.0 for windows, IL, USA) was performed by calculating means and standard deviation of PI, modified GI and pocket probing depth reduction for both the groups at baseline, 1–3 months. Analysis for the self-efficacy scale for both the groups was done at baseline and 3 months. Paired t-test was used to test the significance for intragroup comparison, and an unpaired t-test was used for intergroup comparisons for both groups.

  Results Top

The data were obtained from all the participants at baseline, 1–3 months. On intragroup comparison, means of ancillary periodontal parameters, i.e. the PI and modified GI, showed statistically significant reduction (P ≤ 0.05) from baseline to 3 months [Table 1]. The intergroup comparison showed plaque scores and modified GI scores were less at 3 months in the test group as compared to the control group, although the difference was not statistically significant (P ≥ 0.05) [Table 2]. Clinical parameters, i.e., PPD, showed a decrease from baseline to 3 months which was statistically significant (P ≤ 0.05) in both the groups [Table 3]. PPD reduction in both the groups showed a statistically non-significant difference (P ≥ 0.05) on comparing both the groups [Table 4]. SESS scale showed a statistically significant difference when compared at baseline and 3 months in the test group. In the control group, there were no significant differences in the SESS scale at baseline and 3 months. When compared in both the group's SESS scale [Table 5] showed statistically significant improvement in the test group (P ≤ 0.01).
Table 1: Intragroup comparison in both the groups from baseline to 3 months

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Table 2: Intergroup comparison between the groups at baseline and 3 months

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Table 3: Intragroup comparison in both the groups from baseline to 3 months

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Table 4: Intergroup comparison between the groups at baseline and 3 months

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Table 5: Self-efficacy scale for self-care at baseline and 3 months

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  Discussion Top

The relationship between psychosocial stress, lifestyle and periodontal support maintenance has been hypothesised for a long. The term lifestyle generally indicates the way of living in a wide sense and individual patterns of behaviour as determined by sociocultural factors and personal characteristics. This way of living is believed to produce behavioural patterns that are either beneficial or detrimental to health. It is elucidated that the main effects of stress occur through behavioural pattern changes, which possibly led to changes in at-risk health behaviours such as smoking, poor oral hygiene and poor compliance with dental care.

Over the last decade, the field of impacting behaviour has encouraged the integration of different forms of treatments for the prevention of chronic diseases. This has been made possible by promoting patient's involvement in self-care. Bandura's social cognitive[16] theory includes self-efficacy as a determinant of health behaviour with an effect on health habits. It is believed that intervention methods that pay attention to self-efficacy promote behavioural changes and prepare subjects to change. The six-step method used in this study is a systematic and simple method with clinical applicability as with this method, patient's progress is not static but is cyclical.

In this study on analysis, it was found that after non-surgical therapy, PI and modified GI reduced significantly in both test and control groups after 3 months, but the reduction was more in the test group than the control group, which can be attributed to individual lifestyle counselling and oral education programme [Table 1] and [Table 2]. Similar results were observed in pocket probing depth reduction, which was more in the test group after 3 months owing to continuous improvement in self-care [Table 3] and [Table 4]. As observed on the SESS score evaluation [Table 5], it was quite evident that subjects in the test group who received professional counselling pertaining to oral hygiene maintenance, as well as lifestyle habits, showed more improvement in their compliance with increased brushing efficacy and consultations with the dentist. They also showed improved dietary habits after their professional counselling.

Numerous other studies have been done to find the relation between stress, the role of coping and periodontal health. Ng and Leung WK,[17] in their study, concluded that problem-focussed coping might reduce the stress associated odds. In a study by Kakudate et al.[18] et al., it was found that a systematic cognitive-behavioural approach for oral hygiene instruction is effective for enhancing self-efficacy and behavioural change of oral hygiene than oral hygiene instruction alone. A study was done by Saengtipbovorn and Taneepanichskul[19] et al. showed that a combination of LCDC program could improve glycaemic status as well as the periodontal status of Type 2 diabetes patients.

The results of the present study show that behavioural interventions seem to be beneficial for patients' motivation and may lead to improved initial periodontal treatment success. However still, there is a scope for further exploration with larger sample sizes. Longer follow-up times and evaluation of behavioural as well as clinical outcome measures will further help in assessing the effect of cognitive approaches which can be later integrated with regular treatment regime of periodontal patients.

  Conclusion Top

Maintenance of oral hygiene is the key to success in periodontal treatment. Effective intervention along with patient's adherence to oral hygiene instructions can have a significant effect on oral health-related quality of life. Systematic cognitive-behavioural approaches to improve oral hygiene-related behaviours can markedly improve lifestyle patterns and stress levels, which may ultimately lead to better periodontal health.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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