Auswirkungen von psychosozialen Belastungen und Ressourcen sowie psychischer Befindlichkeit auf den Verlauf einer behandelten Parodontitis

Many risk factors that correlate with periodontitis were identified in a number of studies. The studies seem to suggest that also stress-parameters and psychosocial resources have considerable impact on the progression of a periodontitis. The aim of this retrospective study was to detect risk groups through combinations of psychosocial strain and resources as well as the verification of correlations between those groups and the mental state and the progression of treated chronic periodontitis. The benefit of an evaluation of stress-parameters prior to treatment was to be investigated. Furthermore, an effect of smoking and mental state on the progression of periodontitis was to be analyzed. A total of 32 male and 62 female patients with treated chronic periodontitis and an average age of 54 years participated in the study. All patients were part of the recall system of the Department of Periodontitis of the Medical Centre for Oral Health of Philipps University Marburg for at least 2 years. The periodontally healthy control group (16 women, 19 men, average age 42 years) was used to classify the patients concerning age, gender, mental state and smoking habits. The recorded clinical parameters were probing depth (PD) with bleeding on probing (BOP), gingival recession (GR), clinical attachment level (AL) and approximal space plaque index (API). Using questionnaires anxiety, depression and current stress symptoms (as indicators for the stress-correlated mental state), life events, neuroticism and inadequate coping-mechanisms (as psychosocial strain) as well as social support, sense of coherence, psychological health and adequate coping-mechanisms (as potential psychosocial resources) were investigated. In addition, smoking was recorded. Using a cluster analysis the patients were divided in three risk groups (Cluster) concerning their psychosocial strains and resources. Cluster 1, with little strain through life events and a high potential of resources, portrayed the low-risk group. Cluster 2 was classified as the high-risk group as it stands out with very high strain through life events, low potential of resources and additionally with a comparably worse mental state. Patients of Cluster 3 showed both for their psychosocial strain and resources below average scores. At the time of the investigation the patients were hypothetically no high-risk patients, but they had the potential to develop to those with upcoming strains. The development of the clinical parameters in general and the improvement of BOP in particular (14.2 % to 7.6 % throughout the whole sample) suggest a general reduction of inflammation and a stabilization of the periodontal health of all patients. Despite the division of the patients in risk groups it was not possible to detect a correlation between group membership and the progress of the clinical parameters. However, patients of the low-risk group seemed to profit from a slightly more positive development of the clinical parameters by their high degree of psychosocial resources through adequate coping-mechanisms and high scores concerning social support. Notwithstanding that other studies found considerable impacts of stress factors on the progression of mostly untreated periodontitis, this study showed, that with a systemically performed periodontal treatment with subsequent regular three-monthly recall treatments promising results can by all means be expected. Therefore the evaluation of stress-parameters preceding the treatment does not seem necessary. In this study a general impact of smoking on the progress of periodontitis could not be verified. Detected tendencies of negative impacts from smoking and bad mental state are of no clinical relevance and influence at the most long-term results.