The personality traits, anxiety and depression, produce different periodontal outcomes: a 18-month follow-up study

Aim: Psychological attitude, depression, anxiety and oral hygiene on oral health have been recorded and correlated in subjects with untreated periodontal conditions. Methods: Periodontal data of forty systemically healthy-patients, affected by moderate periodontitis, were collected at baseline and 18 months later. The dental belief (DBQ) was self-administered to patients: a health-value scale (HV); two adherence-intent scales (AI1, AI2), were scored separately. The psychological variables were assessed by questionnaires administered by one expert operator. Personality traits were grouped into cluster including all the personality traits (cluster-A: paranoid, schizoid, schizotypal; cluster-B: borderline, antisocial, narcissistic, histrionic; cluster-C: avoidant, dependent, obsessive-compulsive) anxiety and depression were also assessed. Patients were instructed to oral hygiene measures, treated with cause-related therapy and with adjunctive surgical therapy, when needed. Data were expressed as mean ± standard deviation (m±SD). The comparisons were performed by nonparametric tests, Spearman correlation coefficients between variables were calculated and the relationships between the dependent variables and the independent ones were examined through the standard multiple regression models. The alpha Cronbach reliability coefficient for each HV, AI1 and AI2 scales was calculated by the item analysis procedure of Stata. The level of significance of the applied tests was the standard value P=0.05. Statistical analysis was performed by Stata, version 14.00. Results: Cluster-A and B showed a consistent tendency for reduced levels of oral hygiene (increased full-mouth-plaque-score -FMPS), independently by therapy and supportive periodontal therapy scheme applied. This effect appeared particularly enhanced in correlation with poorly compliant attitude and unfavorable baseline dental indices. On the contrary, cluster-C seemed to be linked to clinically better indices, particularly in terms of full-mouth-bleeding-score (FMBS) and pocket depth. Anxiety resulted directly correlated with depression, cluster-B and C, but inversely with FMPS and the patient’s requirement for professional oral-care. Additionally, depression was directly correlated with FMBS. Conclusions: Anxiety and depression, both affective disturbances, have a reciprocal link, and opposite effect on plaque and bleeding score. Personality traits (stable throughout life) play a significant role in periodontal condition and therapy outcomes that are not entirely ascribable to the lack of observance of oral hygiene rules, since study design and statistical analysis take in account also hygienic and behavior parameters. The knowledge of psychological traits of patients but also of anxiety and depression score, could greatly improve periodontal treatment outcomes.