The Effect of Surgical and Non-surgical Periodontal Treatment on the Quality of Life in Patients With Periodontitis

doi:10.21203/rs.3.rs-4973626/v1

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Research Article

The Effect of Surgical and Non-surgical Periodontal Treatment on the Quality of Life in Patients With Periodontitis

https://doi.org/10.21203/rs.3.rs-4973626/v1

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Background: The purpose of the present research is evaluating the status of periodontitis patients and changes in their quality of life after non-surgical and surgical periodontal treatment using OHIP-14 (Oral Health Impact Profile), OHRQoL-UK (Oral Health Related Quality of Life United Kingdom) questionnaires, and VAS (Visual Analogue Scale).

Methods: A total of 50 people, classified as periodontitis patients, participated in this study, 27 of whom received non-surgical treatment and 23 of whom received surgical treatment in addition to non-surgical treatment. OHIP-14, OHRQoL-UK questionnaires and VAS were administered to these patients before and after their periodontal treatments.

Results: OHRQoL-UK results found that there was a statistically significant increase in the 3rd month control values after the flap operation compared to the initial session (p<0.05). Compared to non-surgical periodontal treatment, there was no statistically significant difference in quality of life in all categories except the pain/discomfort category (p>0.05). Although OHIP-14 results showed a statistically significant difference in all categories (p<0.05) compared to the initial (T1) values of non-surgical treatment (T2) and surgical periodontal treatment (T3), no significant difference was found between T2 and T3 treatment. (p>0.05). After surgical and non-surgical periodontal treatment, an increase in some values was observed in VAS results compared to the initial session, but no significant difference was found. (p>0.05).

Conclusions: Compared to T1 values, a significant difference was observed in T2 and T3, but when the values after T2 and T3 were compared; there was no significant difference in the quality of life of patients with periodontitis.

OHIP-14

OHRQoL-UK

VAS

periodontitis

periodontal treatment

The World Health Organization (WHO) describes health status as a condition of well-being that includes mental, physical, and social characteristics in addition to the absence of sickness or impairment.[1] The terms "health status," "functional status," and "quality of life" are all used to refer to the same area of "health." This approach acknowledges the importance of evaluating an individual's overall quality of life, psychosocial well-being, and physical health. Moreover, these terms - functional status, health status, and quality of life - are often used interchangeably to assess different perspectives on an individual's daily functioning, general health, and overall life experience.[2]

Oral and dental diseases adversely impact individuals' general well-being and quality of life, as they negatively affect daily activities such as nutrition, speech, and socialization.[3]

Despite the lack of universal consensus on defining the quality of life-related to oral health, there is agreement that it is a subjective construct best reported from the patient's perspective. Various quality of life scales have been developed in recent years to capture aspects of oral diseases beyond clinical dimensions.[4] These surveys play a crucial role in identifying patient needs, guiding treatment choices, and understanding the impact of treatment outcomes. The most commonly used and globally accepted surveys are OHIP-14 (Oral Health Impact Profile) and OHRQoL-UK (Oral Health Related Quality of Life United Kingdom).[5]

While OHIP-14 evaluates only the negative aspects of diseases related to the oral-dental region, the OHRQoL-UK scale allows for evaluating both the negative and positive impacts of health. In the OHRQoL-UK questionnaire, which incorporates both negative and positive assessments, a low score defines a lower quality of life. In contrast, in OHIP-14, a low score signifies a higher quality of life.[6]

Due to periodontal diseases characterized by hyperemic bleeding gums, halitosis, and the presence of abundant dental calculus and plaque, self-esteem diminishes. Advanced periodontal disease leads to tooth loss, negatively affecting chewing function, disrupting nutrition, and adversely impacting general health, ultimately resulting in a low quality of life.[7] In this respect, since periodontitis is also associated with other common systemic conditions and diseases, treatment success, prevention and intervention programs, and activities are of great importance.[8]

Periodontal surgery involves the elimination of the underlying cause of periodontal disease, initiating initial treatment, and establishing a conducive environment for long-term care and health.[9]

The significance of evaluating changes in patient perceptions during surgical operations has been reported in other fields of dentistry.[10–12] Additionally, it has been noted that insufficient attention has been given to patients' perception of periodontal surgery and its impact on oral health-related quality of life. Pain and functional loss may occur in many patients after surgical periodontal treatment.[13] However, no clear information exists on how much the treatment affects and makes a difference. Therefore, a study has been planned comparing and evaluating the potential impact of surgical and non-surgical periodontal treatment on patients' quality of life. Using the OHIP-14, OHRQoLUK, and VAS (Visual Analogue Scale) questionnaires, this study attempts to evaluate the baseline status of patients with periodontitis as well as improvements in their quality of life following non-surgical and surgical periodontal treatment. According to our research, non-surgical periodontal therapy will improve quality of life more than surgical periodontal therapy.

After radiological, clinical and periodontal examinations of adult patients who applied to Izmir Kâtip Çelebi University Department of Periodontology for control and treatment between 2019–2020, 50 patients who were diagnosed with stage III, grade C periodontitis and met the research criteria voluntarily participated in our study. The Izmir Katip Celebi University Faculty of Medicine Ethics Committee (2019/302) granted ethical permission for the study, and each participant signed an informed consent form. The Helsinki Declaration of 1975, which was updated in 2013, served as the guide for this investigation. This study was registered with ClinicalTrials.gov (registration number: NCT06539364).

After the patients were informed about the study, the personal evaluation questionnaire and survey forms for socio-demographic data were administered face-to-face by a single researcher. After the survey application, the patient's initial non-surgical periodontal treatment was started. A single clinician performed periodontal treatments of the patients.

Criteria for Inclusion of Individuals in the Research: being literate, being over 18 years of age, volunteering to participate in the study, not having mental retardation or any disorder that would prevent communication.

Criteria for Exclusion in the Research: Having any systemic disease affecting periodontal tissues or having a disease affecting periodontal health, being on medication, being lactating or pregnant, patients who have received periodontal treatment in the last six months.

Clinical Periodontal Evaluation

In order to specify the periodontal status of the patients participating in the study, whole mouth clinical evaluations, Silness and Löe's Plaque Index (PI), Löe and Silness' Gingival Index (GI), probing depth,[14] bleeding on probing (BOP) and clinical attachment level (CAL) measurements were performed and recorded. All clinical periodontal parameters were documented at the first session before periodontal treatment (T1), 1 month after non-surgical periodontal treatment (T2) and 3 months after surgical periodontal treatment (T3). For each individual, the whole mouth averages of the periodontal parameter measurements recorded from the teeth in the whole mouth were taken and the individual averages were used in statistical evaluation. OHIP-14 Turkish questionnaire created by Balcı[15] and the Oral Health-Related Quality of Life-United Kingdom (OHRQoL-UK) scale were used to evaluate the quality of life related to oral dental health. All questions were scored between 1 and 5 and statistical analyses were performed.

A questionnaire form was applied to the patients to question the general condition of the patients, oral care and the relationship with gingival diseases with questions such as the reasons for applying to the faculty, the complaints of those who applied with gingival problems, daily oral hygiene habits, daily cigarette consumption amount of smokers, age, gender, educational status and socio-economic level.

Evaluation with VAS

VAS is a suitable scale, especially for the observation of change. VAS assessment was performed using a 10 cm long scale with starting and ending points numbered 0 and 10 on a horizontal axis. The patient was asked to evaluate the symptoms of periodontitis by giving a score between 0 and 10. The symptoms of periodontitis that patients were asked to assess on the scale were as follows: Bleeding gums, bad breath, smile aesthetics, loose teeth, redness and swelling of the gums, bad taste, sensitivity, chewing function. [16]

Periodontal Treatment Procedures

After medical and dental anamnesis and periodontal examination of 50 volunteer patients diagnosed with periodontitis who participated in our study, the OHIP-14 questionnaire, OHRQoL-UK scale, and VAS were administered by the researcher at the initial session. (T1) After these evaluations, another clinician performed non-surgical periodontal treatment (supragingival and subgingival debritman). After a suitable waiting period (at least 3 weeks) for tissue healing after non-surgical periodontal treatment, periodontal parameters were re-evaluated. In this session, OHIP-14, OHRQoL-UK scale and VAS were applied to the patients again. (T2) According to the reassessment results, a new treatment plan was planned and presented to the patient.

Open flap debridement was performed in patients with radiographic bone loss, teeth with PD deeper than 5 mm, teeth needing periodontal surgery and patients who could provide adequate plaque control. Patients were divided into two groups as follows: flap operation group, surgical group, and non-surgical group, which were evaluated after non-surgical periodontal treatment. As a result of the measurement of periodontal parameters after non-surgical periodontal treatment, 27 of 50 patients showed improvement in periodontal parameters and no need for surgical periodontal treatment. Since 23 of 50 patients needed surgical treatment, these patients were included in the surgical group.

Non-Surgical Group: The group in which periodontal treatment was performed without surgery (27 patients). Surgical Group: Surgical periodontal treatment group (23 patients). Surgical intervention was completed in a single session or several sessions according to the treatment needs. Postoperatively, patients were given non-steroidal anti-inflammatory drugs and 0.12% chlorhexidine mouthwash. Approximately 12–14 weeks after the last surgical intervention, periodontal parameters were measured again and OHIP-14, OHRQoL-UK questionnaires and VAS were applied for the third time (T3).

Statistical Analysis of Data

The calculation and analysis of the data obtained from the study and the values obtained from the scales were performed using SPSS Windows version 20 (SPSS Inc. Chicago, USA) statistical analysis program. The Shapiro-Wilk test was used to examine whether all data were normally distributed. The Chi-square test was used to analyze the differences in demographic characteristics of the participants at baseline. The comparison of the subcategories of OHIP-14 TR, OHRQoL-UK questionnaire and VAS data before and after periodontal treatment in three groups was tested using repeated measures analysis of variance (ANOVA test). Tukey post hoc significant difference test was used in case of a significant difference. A comparison of demographic and questionnaire data was performed using Pearson correlation analysis. All analyses accepted the Statistical significance level as 'p < 0.05'.

Reasons for Patients' Application to the Faculty

When the reasons for the patients' application to the faculty were examined, it was seen that 11 of 50 patients (22%) applied to our faculty for prosthesis due to missing teeth, 29 patients (58%) for gingival problems, 5 patients (10%) for pain, 4 patients (7%) for caries and 1 patient (3%) for control. Of the 29 patients who presented to our faculty with gingival problems, 12 (43%) presented with loose teeth, 16 (56%) with bleeding, 15 (52%) with gingival recession, 6 (21%) with bad breath and 8 (30%) with tartar.

Demographic Findings Related to the Questionnaire

The results regarding the question formula used in our research are as follows: Our study was completed with a total of 50 volunteer periodontitis (Stage III, Grade C) patients, 23 of whom were women (46%) and 27 of whom were men (54%). It was determined that the participants were 47.6 ± 5.64 years old. Gender, educational level, income level and patients' responses to the questionnaire on smoking and oral hygiene habits (tooth brushing, mouthwash use and interface cleaning/dental hygiene) is shown in Table 1.

Table 1

Gender, educational level, income level, smoking, tooth brushing, mouthwash use and interface cleaning/dental hygiene habits of patients' responses to the questionnaire
		N	%
Gender	Female	23	46
Gender	Male	27	54
Educational Level	Elementary school	18	35
	High school	19	38
	College	13	27
Income Level	Very low income	6	13
	Low income	26	51
	Moderate income	9	18
	High income	9	18
Tooth Brushing	No Brushing	4	7,6
	Disorganised	12	23
	1 Time A Day	16	33,3
	2 Times A Day	18	35,8
Use Of Mouthwash	None	24	61,5
	Several Times A Month	8	15,3
	1 Time A Day	8	15,3
	3 Times A Week	4	7,6
İnterdental Cleaning/ Flossing	Yes	17	66,6
İnterdental Cleaning/ Flossing	None	33	33,3
Cigarette Consumption	None	28	56,4
	Less Than 10 Times A Day	10	12,8
	More Than 10 Times A Day	15	30,7

Gender, Education, Income, and Education Status of OHIP-14 and OHRQoL-UK Surveys The Relationship Between Level and Cigarette Consumption

OHIP-14 TR has a weak positive correlation with gender and income and a weak negative correlation with education level. As the level of education increased, the OHIP-14 value decreased and therefore the quality of life improved. The OHRQoL-UK questionnaire had a weak negative correlation with gender and a weak positive correlation with education and income. In both questionnaires, there was no statistically significant difference between gender, education, income, and quality of life (p > 0.05). It is shown in Table 2.

Table 2

OHIP-14 and OHRQoL-UK correlation between gender, education, income, and quality of life
	Gender	Educational Level	Income Level	Cigarette Consumption	P
OHIP-14 TR	0,057	-0,025	0,069	0,118	p > 0,05
OHRQoL-UK	-0,31	0,008	0,017	-0,069	p > 0,05

The Effect of Periodontal Therapy on Clinical Periodontal Parameters

When the distribution of patients according to treatment phases was analysed, T1 and T2 treatment included both non-surgical and surgical groups, whereas T3 treatment group included only surgical group. After non-surgical periodontal treatment, a statistically significant decrease was observed in all periodontal parameters except BOP compared to baseline values (p < 0.05). After surgical treatment, a greater decrease was observed in all parameters compared to the T1 phase. Successful results were obtained in all parameters in the surgical group. Although there was a decrease in all parameters in T3 phase compared to T2 phase, no statistically significant difference was observed (p > 0.05). The results are presented in Table 3.

Table 3 Clinical periodontal parameters according to time phases

	T1	T2	T3	P
PI	1,98 ± 0,55	0,89 ± 0,63^a	0,66 ± 0,43^a	p < 0,05
GI	1,78 ± 0,86	0,74 ± 0,55^a	0,51 ± 0,35^a	p < 0,05
PD	4,55 ± 1,57	3,58 ± 0,86^a	3,11 ± 0,43^a	p < 0,05
CAL	4,76 ± 1,44	4,02 ± 0,79^a	3,59 ± 0,54^a	p < 0,05
BOP	0,48 ± 0,17	0,31 ± 0,28	0,19 ± 0,18^a	p < 0,05
a is statistically significantly different from the T1 group.

Pre- and Post-Treatment Results of the Quality of Life Scale OHIP-14 TR

The OHIP-14 questionnaire was evaluated in 7 subcategories, including functional limitation, physical pain, physical inadequacy, psychological discomfort, psychological inadequacy, social inadequacy, and handicap, and it was observed that the values after non-surgical periodontal treatment decreased in all categories compared to the initial session (T1) before treatment. This decrease was statistically significant between the groups (p < 0.05). The decrease in the OHIP-14 TR questionnaire values indicates an increase in quality of life. In question 1 of the functional limitation category 'Did you have any problems pronouncing any words due to problems with your mouth, teeth or dentures', no significant difference was found before and after treatment (p > 0.05). The results are presented in Table 4.

Table 4

Clinical periodontal parameters according to time phases
OHIP-14 TR	T1	T2	T3	P
Functıonal Limitation	0,83 ± 1,08	0,34 ± 0,65	0,27 ± 2,42	p > 0,05
Physical Pain	3,32 ± 1,19	0,51 ± 0,71^a	0,21 ± 2,45^a	p < 0,05
Psychological Discomfort	2,33 ± 1,21	0,67 ± 0,92^a	0,42 ± 2,42^a	p < 0,05
Physical İnadequacy	1,35 ± 1,10	0,35 ± 0,59^a	0,15 ± 2,46^a	p < 0,05
Physical Disability	1,68 ± 1,22	0,62 ± 0,72^a	0,12 ± 2,48^a	p < 0,05
Social İncapacity	0,88 ± 1,11	0,26 ± 0,49^a	0,15 ± 2,46^a	p < 0,05
Handicap	3,51 ± 1,20	0,51 ± 0,56^a	0,12 ± 2,47^a	p < 0,05
a is statistically significantly different from the T1 group.

Although non-surgical treatment (T2) and surgical periodontal treatment (T3) showed a statistically significant difference in all categories compared to baseline (T1) values (p < 0.05), no significant difference was found between T2 and T3 treatment (p > 0.05).

Pre- and Post-Treatment Results of the Quality of Life Scale OHRQoL-UK

According to the OHRQoL-UK scale, quality of life was evaluated in four categories according to pain/discomfort, physical condition, psychological and social status, and it was observed that the values after non-surgical periodontal treatment and surgical periodontal treatment increased statistically significantly compared to the initial session (p < 0.05). The increase in the values in the OHRQoL-UK questionnaire indicates an increase in quality of life. It was found that there was a statistically significant increase in the 3rd month control values after the flap operation compared to the initial session (p < 0.05). However, compared to periodontal treatment without surgery, there was no statistically significant difference in quality of life except for the pain/discomfort category (p > 0.05). The results are shown in Table 5.

Table 5

OHRQoL-UK evaluations according to time phases
OHRQoL-UK Categories	T1	T2	T3	p
Pain/Discomfort	1,74 ± 0,63	4,02 ± 0,61^a	4,67 ± 0,47^a − b	P < 0,05
Physical Condition	2,21 ± 0,66	3,46 ± 0,66^a	3,87 ± 0,8^a	P < 0,05
Psychological Condition	2,36 ± 0,61	3,61 ± 0,62^a	4,04 ± 0,77^a	P < 0,05
Social Situation	2,39 ± 0,68	3,51 ± 0,62^a	3,75 ± 0,60^a	P < 0,05
a is statistically significantly different from the T1 group.
b is statistically significantly different from the T2 group.

There was no statistically significant difference in the question 'How do your teeth, gums, mouth, or dentures affect your personality/economic status?' of the OHRQoL-UK questionnaire in all phases before and after treatment (p > 0.05).

Patient Evaluation of Periodontitis Symptoms with Visual Analogue Score (VAS) Before and After Treatment

Patients were asked to score periodontitis symptoms out of 10. When we evaluated the VAS results; a statistically significant decrease was observed in gingival bleeding, bad breath, loose teeth, redness/swelling of the gums and bad taste symptoms after non-surgical and surgical periodontal treatment (p < 0.05). However, there was no statistically significant difference between non-surgical periodontal treatment and surgical periodontal treatment in other symptoms except gingival bleeding and bad breath (p > 0.05). Smile aesthetics, sensitivity and masticatory function values increased after non-surgical and surgical periodontal treatment compared to the initial session, but no significant difference was found (p > 0.05). The change in VAS scores after the treatments is shown in Table 6.

Table 6

Periodontitis Symptoms according to time phases
Periodontitis Symptoms	T1	T2	T3	p
Gingival Bleeding	7,69 ± 1,79	2,58 ± 1,56^a	1,20 ± 0,41^a − b	P < 0,05
Halitosis	6,28 ± 1,71	2,35 ± 1,13^a	1,20 ± 0,66^a − b	P < 0,05
Smile Aesthetics	5,30 ± 2,30	5,94 ± 2,09	6,10 ± 3,45	P > 0,05
Mobility Of Teeth	5,28 ± 2,63	2,28 ± 1,23^a	1,65 ± 0,19^a	P < 0,05
Redness And Swelling Of The Gingiva	7,02 ± 1,73	2,25 ± 1,11^a	1,30 ± 0,47^a	P < 0,05
Bad Taste	5,12 ± 2,40	2,00 ± 1,05^a	1,30 ± 0,92^a	P < 0,05
Sensitivity	5,92 ± 2,21	5,97 ± 1,76	6,08 ± 2,85	p > 0,05
Chewing Function	6,00 ± 1,90	7,12 ± 1,65	7,50 ± 3,05	p > 0,05
a is statistically significantly different from the T1 group.
b is statistically significantly different from the T2 group.

Although there has been a recent increase in studies on quality of life, there are few studies on the effect of periodontal treatment on the patient's quality of life. Patient-centered quality-of-life studies are helpful in better understanding how patients' oral health affects their daily lives, in planning and evaluating periodontal treatment, and in ensuring that patients' needs and concerns are met.[6] [17] To increase these studies in dentistry, a questionnaire with psychometric properties A number of scales have been developed.[17, 18]

In most clinical studies, the severity of periodontitis is evaluated by objective measures such as PD, CAL, and BOP. However, subjective evaluations determined from the patient's point of view, such as bad breath, loose teeth, difficulty in chewing function and appearance, play a complementary role to clinical measurements.[4, 14]

Clinical parameters alone are insufficient to assess treatment success, so the patient outcome statement plays a complementary role to clinical measurements to specify from the patient's perspective. The patient outcome statement measures health-related quality of life and treatment satisfaction with symptoms, functioning, and psychosociological factors. Dental structure-related quality of life questionnaires are one option to measure this.[19]

Since there is no definite information about which method to choose to measure quality of life in patients with periodontitis or which questionnaire is more useful and since quality of life is a multifactorial concept and it may be necessary to use more than one measurement method, OHIP-14, OHQoL-UK scales and VAS analysis, which are the two most commonly used and approved questionnaires in the evaluation of quality of life in patients with periodontitis, were preferred in this study.[20–22]

Oral hygiene habits and demographic factors also affect oral health-related quality of life. These factors include gender, age, socioeconomic status, smoking and oral hygiene habits.[23] Therefore, questionnaires that included these factors were also included in our study.

At the baseline session, the questionnaire, followed by the OHIP-14 TR and OHRQoL-UK questionnaire, was administered face-to-face by a single investigator. The patient was asked to score periodontitis symptoms with VAS. In the study by Robinson et al., there was no psychometric difference between face-to-face and patient administration, but in terms of comprehensibility, the face-to-face questionnaire application was found to be better.[24]

In the literature, no studies compare OHIP-14 and OHRQoL-UK questionnaires. Our study is the only study that used both questionnaires together and made a comparison after periodontal treatment. A statistically significant difference was found when OHIP-14 scoring was compared with OHRQoL-UK scoring. This was found to be due to the fact that OHRQoL-UK questionnaire questions were shorter, clearer and more We think that it is because it is easy to understand.

In this study, the number of male patients diagnosed with periodontitis was higher than female patients, but this difference was not significant. Women had higher total OHIP-14 scores and lower OHRQoL scores than men. As a result, women had a lower quality of life. Many previous studies evaluating periodontal health found that men had a lower quality of life than women.[25–27] However, in another study, which periodontal health was evaluated, it was noticed that there was no significant difference between gender and quality of life by the results of this study.[28]

No significant difference was found when we looked at the relationship between education and income level and quality of life. Consistent with the results of this study, Bernabe et al. in 2010 reported that there was no significant relationship between income and educational status in the relationship between periodontal disease and quality of life.[29] In the study conducted in Turkey by Mumcu et al., similar to our study, no relationship was found between sociodemographic data and quality of life.[30]

Regarding smoking, there was a negative correlation between quality of life and smoking, but this difference was not significant. The small number of participants and the lack of an equal classification according to cigarette consumption may have caused the lack of a significant relationship between quality of life and smoking.

It is known that objective findings such as PD, CAL and BOP increase as the severity of periodontitis increases and quality of life decreases statistically significantly in these individuals.[29] In addition, it was observed that the scores increased as the severity of periodontitis increased in the VAS scale showing periodontitis symptoms scored subjectively by the patient. Especially in many studies, it has been reported that patients with high PD and CAL values have significantly lower quality of life.[14, 29] These results found a significant difference in both VAS and clinical periodontal values in the time periods examined (p < 0.05).

While there was a significant change in BOP values between T1 and T2 treatments, no significant difference was found between T2 and T3 treatments. A significant difference was found in both non-surgical and surgical treatments in VAS evaluation. (p < 0.05) Gingival bleeding and bad breath decreased significantly after the T2 and T3 phases. While there was a significant decrease in the symptoms of loose teeth, redness/swelling of the gums and bad taste after T1 and T2; No significant difference was seen between T2 and T3. After surgical and non-surgical periodontal treatment, an increase in sensitivity, smile aesthetics and chewing function was observed, but no statistically significant difference was found. Studies have reported that the root surface may be exposed and sensitivity may occur after periodontal treatment.[31, 32] In our research, there may not have been a significant difference since VAS evaluation was performed 3 months after surgery.

Even though there was no significant difference between surgical and non-surgical periodontal treatment, it was found that both treatments increased the quality of life. Feedback from the patient through scales such as quality of life surveys and VAS to evaluate the patient's perceptions of periodontal treatment may help understand the patient's complaints and expectations and allow the physician to take precautions in this regard.

In a 2-year follow-up study by Linde et al., they compared the group in which only supra and subgingival debridement was performed with the group in which supra and subgingival debridement was combined with flap surgery. They observed that both groups were equally effective in obtaining clinically healthy gums and preventing CAL.[33] It appears that the initial periodontal treatment applied in this study was effective in improving most of the measured periodontal parameters. There is no significant difference between the T2 and T3 phases because the effect achieved after surgical periodontal treatment may be less than that obtained after initial periodontal treatment. In quality-of-life studies, it is generally more difficult to reduce low than high scores, which is called the 'floor effect'.[5] Therefore, since the healing scores decreased significantly after non-surgical periodontal treatment, this decrease may not have been reflected significantly after surgical treatment.

Saito et al. stated that surgical periodontal treatment did not have a significant effect on quality of life. [34]In another study, surgical periodontal treatment was reported to be more effective in healing and significantly affects quality of life compared to initial periodontal treatment. It has been suggested that this is due to the difference in the average number of teeth lost during the transition from T1 to T2 and the average number of teeth lost during the transition from T2 to T3.[35]

As clinical periodontal parameters decrease, the scores given to symptoms of gingival bleeding and gingival redness/swelling decrease; however, it has been shown in several studies that clinical parameters are not always related to quality of life.[36, 37] A study showed that the quality of life of chronic periodontitis patients with deep pockets was not affected.[38] This situation varies from person to person depending on the patient's way of looking at life, their values, their perception of events, and their character.

There are various limitations to our research that should be considered. The main limitation of this study is that the sample size did not reach high numbers. The psychological and sociodemographic distribution of the volunteer individuals participating in our study was not homogeneous and the sample size was insufficient to make generalizations. The criteria we utilized to select patients may not be enough for detecting moderate to severe periodontitis cases. Patients were placed into groups as without surgery and with surgery, but treatment comparison within the group was not made in this study. The lack of additional analysis to evaluate the effects of patients' other dental complaints or other sociodemographic factors that may affect their quality of life can also be considered a limitation of our study. Despite these limitations, this study contributes significant data to the restricted literature on the impact of periodontal therapy on oral health. Although the treatments applied by physicians seem successful both clinically and from the physician's perspective, we cannot talk about complete success if the results do not improve the patient's quality of life.

Within the limits of this research, compared to baseline values, a significant difference was observed in surgical and non-surgical periodontal treatment, but this difference was less in non-surgical treatment. A significant difference was found between the OHRQoL-UK and the OHIP-14 survey. Knowing how the effects of periodontal disease are perceived by patients will play an important role in determining the periodontal treatment needs of patients, planning health services, and giving the necessary importance and attention to oral health.

CONFLICTS OF INTEREST

The authors confirm that there are no potential conflicts of interest associated with the research, writing, or publication of this work.

ETHİCAL APPROVAL

The Izmir Katip Celebi University Faculty of Medicine Ethics Committee (2019/302) granted ethical permission for the study, and each participant signed an informed consent form.

FUNDING

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author Contribution

AG participated in the clinical documentation, survey conducting, data interpretation, and manuscript writing. YN and EÖ was involved in manuscript writing and editing. ASE made contributions to the study's conception and design, carried out the statistical analysis, interpreted the data. The submitted manuscript's final version was approved by all authors.

ACKNOWLEDGMENTS

We want to thank all subjects for participating in the study and the authors thank all people who contributed to the work but do not meet the criteria for authors are acknowledged.

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No competing interests reported.

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The Effect of Surgical and Non-surgical Periodontal Treatment on the Quality of Life in Patients With Periodontitis

Status:

Version 1

Abstract

INTRODUCTION

MATERIAL-METHOD

Clinical Periodontal Evaluation

Evaluation with VAS

Periodontal Treatment Procedures

Statistical Analysis of Data

RESULTS

Reasons for Patients' Application to the Faculty

Demographic Findings Related to the Questionnaire

The Effect of Periodontal Therapy on Clinical Periodontal Parameters

Pre- and Post-Treatment Results of the Quality of Life Scale OHIP-14 TR

Pre- and Post-Treatment Results of the Quality of Life Scale OHRQoL-UK

Patient Evaluation of Periodontitis Symptoms with Visual Analogue Score (VAS) Before and After Treatment

DISCUSSION

CONCLUSİONS

Declarations

CONFLICTS OF INTEREST

FUNDING

Author Contribution

ACKNOWLEDGMENTS

References

Additional Declarations

Status:

Version 1