Impact Of Periodontitis

1. Patient’s Experience About
the Impact Of Periodontitis
Submitted By,
Arya.V.Devi
CRRI
RajasDental College

2. Introduction
Traditionally,
research focus
on the clinico-
pathological
mechanisms of
the disease
rather than its
impact on the
patient.
This is in line
with the
historical
biomedical
approach to
disease and
illness.
Periodontal
disease can
exert more
than simply
biological
effects and
can affect
both the
sufferers’
psychology and
social
functioning.
It is more
appropriate to
take a
biopsychologic
al approach to
disease and
illness

3. Clinical relevance
Scientific
Rationale
for the study
• Investigation of the biopsychosocial effects of
periodontitis to improve our understanding of
patient perceptions of the impact of periodontal
disease
Principle
Findings
• Impairment, functional limitation,
discomfort(physical
&psychological)disability(psychological, social &
physical)
• Stigma (negative associations and impressions of
periodontal disease for the patient)
Practical
implications
• A central tenet of successful periodontal therapy
is behavior change and improved understanding of
patients experiences regarding their disease is
therefore relevant to help effect such change

4. Interviews of patients with
periodontal conditions were conducted
Data were organized in a framework
and recurrent themes identified
Interviews occurred until it was felt
that no new themes or ideas were being
expressed by respondents (N=14)
M
A
T
E
R
I
A
L
&
M
E
T
H
O
D
S

5. Results
Impairmen
t
Functional
Limitation
Discomfort Disability
Effects Of Periodontal Disease On
Patients' Daily Lives
Relevant to the domains of locker's conceptual model
of oral health

6. periodonta
l
disease
periodonta
l
disease
Locker's
model
Locker's
model
Death
Stigma And
Retrospective
Regret

7. Definitions Of Domains Of Locker's Model
Domain/ concept Subdivision Definition
Death
Mortality rates, life expectancy, potential years of
life lost
Impairment Extent of anatomical loss or structural abnormality
Functional limitation Extent of loss of function of body parts or systems
Discomfort
Self reported physical and psychological distress,
including pain and other feeling states not directly
observable
Disability
Physical 1.Activity restriction 2.Social limitation
Psychological 1.Affective states 2.Cognitive states
Social 1.Integrative 2.Social contacts 3.Intimacy
Handicap
Inequality Lack of access to social opportunities
Deprivation
Inequality of outcomes in terms of income, self
image, self esteem
Dissatisfaction With health and/or overall quality of life

8. Domain of oral
health
• Impairment
Periodontal
disease
• Tooth mobility
• Sensitivity of
teeth
Representative
quotation
• I cannot bite into an
apple and eat it that
way, I have got to
chop it up.
• On cold days, cold air
and things like that,
if you breathed in
you’d be like “Aargh”,
like you were eating
an ice cream
Impairment & functional
limitation

9. Domain of oral
health
• Functional
limitation
Periodontal
disease
• As a result
of tooth
mobility
• As a result of
sensitivity of
teeth
Representative
quotation
• I have to cut the apple
and eat it from the side
of my mouth. I cannot
eat a crust or french
bread because I felt
teeth would fall out
• If I am eating a lolly, I
wont bite it. I will bite it
at the back of my teeth

10. I have to bite hard foods at the back of my
teeth

11. Domain of
oral health
Discomfort
Periodontal
disease
Physical related to
the sensitivity of
the teeth
Representative
quotation
If I go to my mum’s
and she’s making a
cup of tea I have to
say put some cold
water in it for us.
Whereas in a café I
wouldn’t dream of
like saying oh… I’d
sit there for half an
hour till it cools
down
Discomfort

12. I’m an person who likes
hoootttt coffee…
Yummieeee….
    
One morning it makes
sensitivity…Argh…
 

14. Domain of oral
health
Discomfort
Periodontal
disease
Psychological
discomfort related
to halitosis
Psychological
discomfort related
to pathognomonic
appearance
Representative
quotation
Wife mentioned something
like “your breat smells” you
sort of think “Ah” and you
put your hands over your
mouth…. I feel a bit self-
conscious
I am pretty confident when
it comes to everything else.
It is just the way my teeth
look. I mean, I am thinking
about that, when I am
talking to people I am
thinking “Are they looking
at my teeth?”

16. Domain of
oral health
Discomfort
Periodontal
disease
Psychological
discomfort
related to the
worry of losing
mobile teeth
Representativ
e quotation
I had an apple
and I couldn’t
eat it, I think
my tooth’s going
to fall out. I
was very self
conscious, I
couldn’t eat it

17. It was easy to eat a full apple before
  
But later a small bite
makes my gums bleed.
Aargh….
 

18. I have to chopthe apple…
This makes me awkward…
and so I wouldn’t eat with
anybody at all
  
I knowI cant eat an apple…it
makes me feel my teethare
gonna fall…especially the
lower….
   

19. Representative
quotation
Periodontal
disease
Domain
of oral
health
Disability
Psychological
Disability
It’s embarrassing, I don’t say I’ve got gum
disease, I’ll say its because my bone is
crumbling…it sounds better to say gum disease.
gum disease..people with rotten teeth and all
and don’t look after them
Social
Disability
I wouldn’t eat with anybody at all. if there
was only me and husband, I didn’t bother. I
was just like “Oh no, we’ll just stop in because
its too much of a hassle and I don’t want
anything
Physical
Disability
I couldn’t go out and eat a sandwich in a
restaurant or anything like that you just hadn’t
got the capacity to bite. That was one of the
things, you had to go somewhere where you had
knife and fork and you could cut things.
Disability

20. Aww...peoplewith
rotten teethand all..
  
I wont say its Gumdisease
Its embarrassing….
  

21. I couldn’t go out and eat a sandwich in a restaurant or anything
like that you just hadn’t got the capacity to bite
PHYSICAL DISABILITY

22. Handicap was not widely reported by
interviewees.
Handicap is A result of very high level
impacts on patient's lives
Handicap were reported as the inability to
participate in hobbies, enjoy time with
family, socialize and enjoy holidays
Handicap

23. Quote
it is embarrassing because people naturally
assume that it is because you have forgot your
hygiene and you have not looked after your
teeth and it is not always the case
The least people know, the better
I was a pretty confident lad before but It has
just affected my self confidence in a big way
I think about it at least 25% of the day, if not
more because I was very, very conscious of it
and it depends on what day it is as to how many
people I have to talk to
Interpretation
Perception of being unclean, embarrassed
Doesn’t want people to know
Reduced self confidence
Impacting relationships
Stigma

24. Conclusion
Health care systems tend to be consumer driven and evidence
demands that the clinician take a patient centered approach to
management of disease and illness
Understand the biopsychosocial effects of the disease so that
attempts can be made to minimize them
Plan periodontal care which addresses patient needs and key
concerns and evaluate outcomes of periodontal treatment from the
patient’s perspective

25. Reference
• Journal of Clinical Periodontology
2010 Vol 37
• Internet

26. Take Care Of your
Periodontium