Periodontal Parameter Changes of Patients after Non-Surgical Periodontal Therapy
Nurul Huda Mohd Shukor1, Mohd Zulkarnain Sinor2, Akram Hassan3*
1, 2, 3 School of Dental Sciences, Universiti Sains Malaysia 16150 Kubang Kerian, Kelantan, Malaysia
ABSTRACT
The aim of this study was to determine the changes in periodontal parameters of patients attending Hospital UniversitiSains Malaysia (HUSM) Dental Clinic after non-surgical periodontal therapy. This was a cross sectional study of dental records from 36 patients who visited HUSM Dental Clinic for scaling and root planing treatment from 1st January 2016 until 31st December 2016. Periodontal parameters recorded were plaque score, bleeding on probing and probing pocket depth of the patients during their first and second dental visits.
Patient’s personal details were also retrieved to find out whether there were other factors affecting the changes in periodontal parameters. Mean and standard deviation (SD) at first and second visit for plaque score were 63.6(26.71) and 36.4(20.20), for bleeding on probing were 50.4(30.64) and 22.5(19.09) while for probing pocket depth were 18.6(17.80) and 13.1(19.48) respectively. Statistically significant reduction were observed in all periodontal parameters after scaling and root planing. Moreover, the changes in periodontal parameters were not influenced by other confounders (p>0.05). This study concluded that non-surgical periodontal therapy were shown to be effective in reducing periodontal parameters and no other factors were associated with this reduction.
Keywords
Periodontal disease, periodontal parameters, non-surgical
Introduction
Periodontal disease is one of the two major dental diseases which have high prevalence rates worldwide, the other being caries [1, 2]. According to the Global Burden of disease Study, severe periodontal disease was the 11th most prevalent condition in the world. The prevalence of periodontal disease was reported to range from 20% to 50% around the world [3].
Chronic periodontitis is defined as inflammation of the gingiva and the adjacent attachment apparatus. The disease is characterized by loss of clinical attachment due to destruction of the periodontal ligament and loss of the adjacent supporting bone.
The goals of periodontal therapy are to alter or eliminate the microbial aetiology and contributing risk factors for periodontitis, thereby arresting the progression of disease and preserving the dentition in a state of health, comfort and function with appropriate aesthetics; and to prevent the recurrence of periodontitis [4].
Clinical judgment is an integral part of the decision making process. Many factors affect the decisions for appropriate therapy (ies) and the expected therapeutic results. Factors associated with periodontal disease formation include age, sex, behavioural factors, socioeconomic status
clinician’s ability to remove subgingival deposits, prosthetic demands, and the presence and treatment of teeth with more advanced chronic periodontitis.
Methodology
In this cross sectional study, we used past dental record of the patients who visited Hospital UniversitiSains Malaysia (HUSM) Dental Clinic for dental treatment. The reference population were adult patient age range from 30 to 60 years old who attended HUSM Dental Clinic. The source population were dental records of adults patients aged 30 to 60 years old who attended HUSM Dental Clinic from 1st January 2016 until 31st December 2016. Sample size was calculated using single proportion formula with prevalence of periodontal diseases as a parameter which give total number (n) of 36.
We used systematic random sampling in this study. All dental records of adult patient age range from 30 to 60 years old who attended HUSM Dental Clinic from 1st January 2016 until 31st December 2016 were selected and screened using inclusion and exclusion criteria. Selected records were numbered from 1 to 180. Sampling interval of 5 was determined. A number between 1 and 5 was selected randomly as a random start. Then, every 5th dental record was selected until reaching 180.
The inclusion criteria for this study were Malaysian citizens and have at least two times plaque score, bleeding on probing and probing pocket depth recorded. In this study, we excluded patients who could not understand Malay or English, who declared of having physical disabilities such as hearing problem and hand dexterity and also those who had systemic diseases and under long term medication. Those who had undergone orthodontic treatment and dental prosthesis wearer were also excluded.
This study involved the retrieval information from the patient’s dental record. The plaque score, bleeding on probing and probing pocket depth of the patients during their first and second dental visits were recorded. The plaque score was recorded using the O’Leary’s Plaque Index. Universal socio-demographic characteristic of patients were also penned down in Performa. All data were entered and analysed using SPSS by IBM Inc.
Ethical clearance was obtained from the Research Ethics and Committee (Human), UniversitiSains Malaysia with the reference number was USM/JEPeM/17040217. All information was kept confidential and only accessible to researchers and only group information was reported and published.
Results
Table 1 showed descriptive characteristic of 36 sample obtained from selected dental records.
The distribution of subjects according to their age, sex, race, education level, working status, daily tooth brushing habit, daily dental flossing habit, frequency of visit to the dentist and period between pre and post treatment by weeks were recorded.
Table 1: Descriptive Statistics of the Patients Attending HUSM Dental Clinic (n=36) Mean (SD) Frequency (%)
Age 52.9 (12.27)
Sex Male Female
20 (55.6) 16 (44.4) Race
Malay Chinese Indian Others
32 (88.9) 4 (11.1) 0 (0) 0 (0) Education Level
No formal education Primary
Secondary Tertiary
0 (0) 0 (0) 19 (52.8) 17 (47.2) Working Status
Yes No
25 (69.4) 11 (30.6) Daily Tooth Brushing Habit
Once a day
More than once a day When Necessary Never
3 (8.3) 33 (91.7) 0 (0) 0 (0) Daily Dental Flossing Habit
Yes No
10 (27.8) 26 (72.2) Frequency of Visit to Dentist
Regularly Occasionally When Necessary
17 (47.2) 3 (8.3) 16 (44.4) Period between pre and post
treatment by weeks 10.2 (6.35)
Paired t-test was performed to assess the differences in periodontal parameters (plaque scores, bleeding and probing and probing pocket depth) during first and second dental visit. There were statistical significant difference between first and second visit of periodontal parameters (p<0.05).
The mean (SD) plaque score for the first and second visit were 63.6 (26.71) and 36.4 (20.20)
significant (p<0.001) was also noted on periodontal pocket depth where mean (SD) of pocket depth was reduced to 5.4 (9.39) on second visit (table 4).
Table 2: Changes in Plaque Score
Mean (SD) Mean difference
(SD)
t (df) P-value First Visit Second Visit
63.6 (26.71) 36.4 (20.20) 27.2 (22.86) 7.150 (35) < 0.001
Table 3: Changes in BOP
Mean (SD) Mean difference
(SD)
t (df) P-value
First Visit Second Visit
50.4 (30.64) 22.5 (19.09) 28.0 (28.38) 5.913 (35) < 0.001
Table 4: Changes in PPD
Mean (SD) Mean difference
(SD)
t (df) P-value
First Visit Second Visit
18.6 (17.80) 13.1 (19.48) 5.4 (9.39) 3.477 (35) < 0.001
Result table 5,6, and 7 showed no association between all possible confounders such as age, sex, race, education level, working status, medical history, daily flossing habit and frequency of visit to the dental clinic on all periodontal parameters (p>0.05).
Table 5: Factors Associated with Second Plaque Score Using Linear Regression
Independent Variable Beta
Coefficient
95%Confident Interval for Beta
t-stat P-Value
Age -0.262 (-0.829, 0.304) -0.941 0.353
Sex 1.066 (-22.0, -1.9) 0.155 0.878
Race -15.593 (-37.001, 5.814) -1.480 0.148
Education Level -8.026 (-24.830, 8.778) -0.980 0.336
Working Status -1.703 (-20.6, -0.5) -0.221 0.827
Daily Tooth Brushing Habit 4.864 (-20.193, 29.921) 0.394 0.696
Daily Flossing Habit -0.718 (-16.213, 14.777) -0.094 0.926
Frequency of Visit to the Dentist -3.980 (-11.099, 3.139) -1.136 0.264
Table 6: Factors Associated with Second BOP Using Linear Regression
Independent Variable Beta
Coefficient
95%Confident Interval for Beta
t-stat P-Value
Age -0.42 (-0.584, 0.501) -0.156 0.877
Sex 5.856 (-7.186, 18.898) 0.913 0.368
Race 3.096 (-17.748, 23.940) 0.302 0.765
Education Level -2.134 (-18.897, 14.628) -0.261 0.796
Working Status -1.660 (-17.001, 13.681) -0.221 0.827
Daily Tooth Brushing Habit 5.752 (-17.896, 29.400) 0.494 0.624
Daily Flossing Habit 10.118 (-4.096, 24.332) 1.447 0.157
Frequency of Visit to the Dentist 0.814 (-6.035, 7.662) 0.241 0.811
Table 7: Factors Associated with Second PPD Using Linear Regression
Independent Variable Beta
Coefficient
95%Confident Interval for Beta
t-stat P-Value
Age -0.157 (-0.708, 0.394) -0.578 0.567
Sex 6.375 (-6.894, 19.685) 0.978 0.335
Race -12.013 (-32.903, 8.877) -1.169 0.251
Education Level 1.669 (-14.368, 17.705) 0.213 0.833
Working Status 2.643 (-11.972, 17.258) 0.369 0.715
Medical History 13.189 (-10.597, 36.975) 1.127 0.268
Daily Flossing Habit 9.199 (-5.403, 23.800) 1.280 0.209 Frequency of Visit to the Dentist 0.319 (-6.677, 7.314) 0.093 0.927
Discussion
This study was conducted among the patients attending the HUSM dental clinic. As a prerequisite for dental treatment, scaling and root planing were delivered to the patients with periodontal problem. In this study, it was found that the mean plaque score, mean bleeding on probing and mean probing pocket depth were significantly reduced after scaling and root planing given to the patients.
Nonsurgical periodontal therapy (NSPT) is the keystone of periodontal therapy and the first recommended approach to control periodontal infections and is defined as plaque removal, plaque control, supragingival and subgingival scaling root planing (SRP). The primary objective is to restore the gingival health by completely eliminating the factors responsible for the inflammation (such as endotoxins, plaque, and calculus) in the oral environment [8].
During the last five decades, measures to combat dental caries and periodontitis have been developed, tested and implemented in many populations around the world and are thought to have benefitted millions of people. Despite the huge effort made, a large part of the world’s
Scaling and root planing (SRP) is one of the most commonly utilized procedures for the treatment of periodontal diseases and has been used as the ‘gold’ standard therapy against other therapies which have been compared [10]. A single session of sub-gingival root planing can yield a significant reduction in the bacterial population, even without effective removal of all sub- gingival calculus [11]. Our study has proven that non-surgical treatment done by dental students which were supervised by periodontistsimprove the periodontal parameters of the patient which is similar findings as reported by Kaldahl et al. (1993) [12].
Numerous risk factors, including plaque or oral hygiene modifications, systemic health including diabetes and HIV, socio-economics, stress, obesity, and smoking are all relevant and may interact to render subjects at increased risk of periodontal disease. Systemic modifiers such as smoking and diabetes may adversely affect the disease process, the ability to diagnose disease andthe healing following tissue destruction [7]. But in our study by using linear regression, it is revealed that sociodemographic and medical factor of the patient do not influence the treatment in improving periodontal parameters. This study is limited by the small sample due to time and cost constraint which resulted in the wide confidence interval of the estimates. Larger sample size study would offer a better precision but the main conclusion is not expected to differ too much from the present study.
Conclusion
Scaling and root planing done by dental students are proven to be effective in improving the periodontal parameters such as plaque score, bleeding on probing and probing pocket depth of the patient. It is also found that sociodemographic and medical factor of the patient do not influence the treatment in improving periodontal parameters in this study.
Acknowledgements
This work was supported by a UniversitiSains Malaysia Short Term Grant (Grant Number:
304/PPSG/61313100) and School of Dental Sciences, UniversitiSains Malaysia.
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