Patient’s Experience About the Impact Of Periodontitis

Submitted By, Arya.V.Devi CRRIRajas Dental College

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 biopsychological approach to disease and illness

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 implicati

ons

• 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

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)

MATERIAL

&

METHODS

Results

Impairment

Functional

Limitatio

n

Discomfort

Disabilit

y

Effects Of Periodontal Disease On Patients' Daily Lives

Relevant to the domains of locker's conceptual model of oral health

periodontal

disease

periodontal

disease

Locker's model

Locker's model

Death

Stigma And Retrospective Regret

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

DiscomfortSelf 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

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

Domain of oral health • Functional

limitation

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

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

Domain of oral health

Discomfort

Discomfort

I’m an person who likes hoootttt coffee… Yummieeee….

One morning it makes sensitivity…Argh…

SENSITIVITY

As its ma favourite… I have to wait till it cools down

And we know

how a cool

coffee

tastes….Awww..

Its no longer ma

favourite

Domain of oral health

Discomfort

HALITOSIS

Domain of oral health

Discomfort

It was easy to eat a full apple before

But later a small bite makes my gums bleed. Aargh….

TOOTH MOBILITY

I have to chop the apple…This makes me awkward…and so I wouldn’t eat with anybody at all

I know I cant eat an apple…it makes me feel my teeth are gonna fall…especially the lower….

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 DisabilityI 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 DisabilityI 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.

Domain of oral health

Periodontal disease

Representative quotation

Disability

Aww...people with rotten teeth and all..

PSYCHOLOGICAL DISABILITY

I wont say its Gum diseaseIts embarrassing….

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

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

Quoteit 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

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

Reference

• Journal of Clinical Periodontology 2010 Vol 37• Internet

Take Care Of your

Periodontium