Impact of periodontitis on systemic anxiety and oral health quality of life

Simona Santonocito, Alessandro Polizzi, Vincenzo Ronsivalle, Giuseppe Palazzo, Federica Sicari, Gaetano Isola


Aim: The aim of the present study was to measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with periodontitis compared to healthy controls and to analyze their association with various demographic, clinical and periodontal parameters.

Methods: Fifty-five patients with periodontitis and 56 healthy controls were enrolled. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah’s Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss.

Results: Periodontitis patients exhibited statistically significant higher scores in the total DAS and in almost of single DAS domains. Compared to the control group, periodontitis patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores. Among both periodontitis and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain.

Conclusion: Periodontitis patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases. This study showed that for a nationally representative sample of the southern Italian population population, periodontal disease was significantly associated with the domains of OHRQoL.


Quality of life, periodontitis, dental anxiety, oral health, clinical trial

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Al‐Harthi, L. S., Cullinan, M. P., Leichter, J. W., & Thomson, W. M. (2013). The impact of periodontitis on oral health‐related quality of life: A review of the evidence from observational studies. Australian dental journal, 58(3), 274-277.

Baer, P. N. (1971). The case for periodontosis as a clinical entity. J Periodontol, 42(8), 516-520.

Berggren, U., & Meynert, G. (1984). Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc, 109(2), 247-251. 1984.0328

Borges Tde, F., Regalo, S. C., Taba, M., Jr., Siessere, S., Mestriner, W., Jr., & Semprini, M. (2013). Changes in masticatory performance and quality of life in individuals with chronic periodontitis. J Periodontol, 84(3), 325-331.

Breivik, E. K., Bjornsson, G. A., & Skovlund, E. (2000). A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain, 16(1), 22-28.

Breivik, H., Borchgrevink, P. C., Allen, S. M., Rosseland, L. A., Romundstad, L., Breivik Hals, E. K., ... & Stubhaug, A. (2008). Assessment of pain. BJA: British Journal of Anaesthesia, 101(1), 17-24.

Carra, M. C., Detzen, L., Kitzmann, J., Woelber, J. P., Ramseier, C. A., & Bouchard, P. (2020). Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review. Journal of clinical periodontology, 47, 72-89.

Castro, M. M., Ferreira, R. D. O., Fagundes, N. C., Almeida, A. P., Maia, L. C., & Lima, R. R. (2020). Association between psychological stress and periodontitis: a systematic review. European journal of dentistry, 14(01), 171-179.

Catalano, A., Chilà, D., Bellone, F., Nicocia, G., Martino, G., Loddo, I., ... & Loddo, S. (2018). Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing?. Journal of clinical & translational endocrinology, 13, 9-13.

Choi, S. H., Cha, J. Y., Lee, K. J., Yu, H. S., & Hwang, C. J. (2017). Changes in psychological health, subjective food intake ability and oral health-related quality of life during orthodontic treatment. Journal of Oral Rehabilitation, 44(11), 860-869.

Conversano, C., & Di Giuseppe, M. (2021). Psychological factors as determinants of chronic conditions: clinical and psychodynamic advance. Frontiers in Psychology, 12, 86.

Conversano, C., Di Giuseppe, M., Miccoli, M., Ciacchini, R., Di Silvestre, A., Lo Sterzo, R., ... & Orrù, G. (2020). Retrospective Analyses of Psychological Distress and Defense Style Among Cancer Patients. Clinical Neuropsychiatry, 17(4). 10.36131/cnfioritieditore20200403

Corah, N. L., Gale, E. N., & Illig, S. J. (1978). Assessment of a dental anxiety scale. J Am Dent Assoc, 97(5), 816-819.

Corridore, D., Campus, G., Guerra, F., Ripari, F., Sale, S., & Ottolenghi, L. (2013). Validation of the Italian version of the oral health impact profile-14 (IOHIP-14). Annali di stomatologia, 4(3-4), 239.

Dahlström, L., & Carlsson, G. E. (2010). Temporomandibular disorders and oral health-related quality of life. A systematic review. Acta Odontologica Scandinavica, 68(2), 80-85.

Di Giuseppe, M., Nepa, G., Prout, T. A., Albertini, F., Marcelli, S., Orrù, G., & Conversano, C. (2021). Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms. International journal of environmental research and public health, 18(10), 5258.

Durham, J., Fraser, H. M., McCracken, G. I., Stone, K. M., John, M. T., & Preshaw, P. M. (2013). Impact of periodontitis on oral health-related quality of life. Journal of dentistry, 41(4), 370-376.

Ehrenthal, J. C., Graetz, C., Plaumann, A., Dorfer, C. E., & Herzog, W. (2016). Number of teeth predict depressive symptoms in a longitudinal study on patients with periodontal disease. J Psychosom Res, 89, 16-19.

El Sayed, N., Baeumer, A., El Sayed, S., Wieland, L., Weber, D., Eickholz, P., & Pretzl, B. (2019). Twenty years later: Oral health-related quality of life and standard of treatment in patients with chronic periodontitis. J Periodontol, 90(4), 323-330. 18-0417

Facco, E., Zanette, G., & Manani, G. (2008). Italian version of Corah's Dental Anxiety Scale: normative data in patients undergoing oral surgery and relationship with the ASA physical status classification. Anesthesia progress, 55(4), 109-115.

Ferreira, M. C., Dias-Pereira, A. C., Branco-de-Almeida, L. S., Martins, C. C., & Paiva, S. M. (2017). Impact of periodontal disease on quality of life: a systematic review. J Periodontal Res, 52(4), 651-665.

Frisone, F., Sicari, F., Settineri, S., & Merlo, E. M. (2021). Clinical Psychological Assessment of Stress: a Narrative Review of the Last 5 Years. Clinical Neuropsychiatry, 18(2).

Graetz, C., Ehrenthal, J. C., Senf, D., Semar, K., Herzog, W., & Dorfer, C. E. (2013). Influence of psychological attachment patterns on periodontal disease - a pilot study with 310 compliant patients. J Clin Periodontol, 40(12), 1087-1094.

Iqbal, P. S., Khan, S. N., Haris, M., Narayanan, M., Laju, S., & Kumar, S. S. (2015). Assessment of Systemic Inflammatory Markers in Patients with Aggressive Periodontitis. J Int Oral Health, 7(Suppl 2), 48-51.

Isiekwe, G. I., Sofola, O. O., Onigbogi, O. O., Utomi, I. L., Sanu, O. O., & daCosta, O. O. (2016). Dental esthetics and oral health-related quality of life in young adults. Am J Orthod Dentofacial Orthop, 150(4), 627-636.

Jerolimov, V. (2009). Temporomandibular disorders and orofacial pain. Rad Hrvatske akademije znanosti i umjetnosti. Medicinske znanosti, (504= 33), 53-77.

Johannsen, A., Asberg, M., Soder, P. O., & Soder, B. (2005). Anxiety, gingival inflammation and periodontal disease in non-smokers and smokers - an epidemiological study. J Clin Periodontol, 32(5), 488-491.

Kim, O. S., Shin, M. H., Kweon, S. S., Lee, Y. H., Kim, O. J., Kim, Y. J., & Chung, H. J. (2018).

The severity of periodontitis and metabolic syndrome in Korean population: The Dong-gu study. J Periodontal Res, 53(3), 362-368.

Kiyak, H. A. (2008). Does orthodontic treatment affect patients’ quality of life?. Journal of dental education, 72(8), 886-894.

Komaroff, A. L. (2017). The Gut-Brain Connection. Harvard Health Letter, Retrieved from:

Li, Q., Zhang, M., Chen, Y. J., Zhou, Q., Wang, Y. J., & Liu, J. (2013). Psychological stress alters microstructure of the mandibular condyle in rats. Physiology & behavior, 110, 129-139

Loe, H., Schiott, C. R., Karring, G., & Karring, T. (1976). Two years oral use of chlorhexidine in man. I. General design and clinical effects. J Periodontal Res, 11(3), 135-144.

Mahmood, T. M. A., & Kareem, F. A. (2013). Psychological impact of dental aesthetics for Kurdish young adults seeking orthodontic treatment. Scientific Journal Published by the College of Dentistry–University of Baghdad, 146.

Marchini, F., Langher, V., Napoli, A., Balonan, J. T., Fedele, F., Martino, G., ... & Caputo, A. (2021). Unconscious loss processing in diabetes: associations with medication adherence and quality of care. Psychoanalytic Psychotherapy, 1-19.

Martino, G., Caputo, A., Vicario, C. M., Feldt-Rasmussen, U., Watt, T., Quattropani, M. C., ... & Vita, R. (2021). Alexithymia, Emotional Distress, and Perceived Quality of Life in Patients With Hashimoto’s Thyroiditis. Frontiers in Psychology, 12, 1295.

Meusel, D. R., Ramacciato, J. C., Motta, R. H., Júnior, R. B. B., & Flório, F. M. (2015). Impact of the severity of chronic periodontal disease on quality of life. Journal of oral science, 57(2), 87-94.

Merlo, E. M. (2019a). Adolescent phobia as a "mask object". Mediterranean Journal of Clinical Psychology, 7(1).

Merlo, E. M. (2019b). Opinion Article: The role of psychological features in chronic diseases, advancements and perspectives. Mediterranean Journal of Clinical Psychology, 7(3).

Merlo, E. M., Sicari, F., Frisone, F., Alibrandi, A., & Settineri, S. (2020). Personality types and dreaming in future health professionals: Effect of age and gender. International Journal of Dream Research, 160-172.

Merlo, E. M., Stoian, A. P., Motofei, I. G., & Settineri, S. (2021). The Role of Suppression and the Maintenance of Euthymia in Clinical Settings. Frontiers in Psychology, 12, 1534.

Offenbacher, S., Divaris, K., Barros, S. P., Moss, K. L., Marchesan, J. T., Morelli, T., Zhang, S., Kim, S., Sun, L., Beck, J. D., Laudes, M., Munz, M., Schaefer, A. S., & North, K. E. (2016). Genome-wide association study of biologically informed periodontal complex traits offers novel insights into the genetic basis of periodontal disease. Hum Mol Genet, 25(10), 2113-2129.

Ozhayat, E. B. (2013). Influence of self-esteem and negative affectivity on oral health-related quality of life in patients with partial tooth loss. Community Dent Oral Epidemiol, 41(5), 466-472.

Păunică, I. (2016). Diagnostic and treatment difficulties in Crohn's disease. Journal of Clinical and Investigative Surgery, 1(2), 47-53. 10.25083/2559.5555.12.4753

Rahbar, F. (2001). Changes in self-esteem and self-concept as a result of orthodontic treatment. University of Southern California.

Rawlinson, A., Vettore, M. V., Baker, S. R., & Robinson, P. G. (2021). Periodontal treatment, psychological factors and oral health‐related quality of life. Journal of Clinical Periodontology, 48(2), 226-236.

Righolt, A. J., Jevdjevic, M., Marcenes, W., & Listl, S. (2018). Global-, Regional-, and Country- Level Economic Impacts of Dental Diseases in 2015. J Dent Res, 97(5), 501-507.

Shah, H., Shah, R., Sanghani, H., & Lakhani, N. (2020). Health related quality of life (HRQoL) and its associated surgical factors in diabetes foot ulcer patients. Journal of Clinical and investigative Surgery, 5(2).

Settineri, S., Frisone, F., Alibrandi, A., Pino, G., Lupo, N. J., & Merlo, E. M. (2018). Psychological Types and Learning Styles in Medical Education. Mediterranean Journal of Clinical Psychology, 6(3).

Settineri, S., Frisone, F., Alibrandi, A., & Merlo, E. M. (2019). Emotional Suppression and Oneiric Expression in Psychosomatic Disorders: Early Manifestations in Emerging Adulthood and Young Patients. Frontiers in Psychology, 10. 189710.3389/fpsyg. 2019.01897

Shimizu, S., Momozawa, Y., Takahashi, A., Nagasawa, T., Ashikawa, K., Terada, Y., Izumi, Y., Kobayashi, H., Tsuji, M., Kubo, M., & Furuichi, Y. (2015). A genome-wide association study of periodontitis in a Japanese population. J Dent Res, 94(4), 555-561.

Shinjo, T., Ishikado, A., Hasturk, H., Pober, D. M., Paniagua, S. M., Shah, H., Wu, I. H., Tinsley, L. J., Matsumoto, M., Keenan, H. A., Van Dyke, T. E., Genco, R. J., & King, G. L. (2019). Characterization of periodontitis in people with type 1 diabetes of 50 years or longer duration. J Periodontol, 90(6), 565-575.

Vicario, C. M., Nitsche, M. A., Salehinejad, M. A., Avanzino, L., & Martino, G. (2020). Time processing, interoception, and insula activation: a mini-review on clinical disorders. Frontiers in Psychology, 11, 1893.

Vita, R., Caputo, A., Quattropani, M. C., Watt, T., Feldt-Rasmussen, U., Puleio, P., ... & Martino, G. (2020). Quality of life in patients with hyperthyroidism: where do we stand?. Mediterranean Journal of Clinical Psychology, 8(2).



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