A multivariable hospital-based retrospective analysis of factors affecting non-surgical periodontal treatment response in the East London population
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Periodontitis is a chronic inflammatory disease, initiated by dental plaque bacteria and characterised by destruction of the tooth supporting tissues including alveolar bone. Historically, disease progression in periodontitis was thought to be correlated with the amount of plaque biofilm (Frunker and Gardner, 1956, Grant D et al., 1968, Russell, 1964, Waerhaug, 1956). However, our current understanding of the disease suggests that a loss in equilibrium between the commensal and pathogenic microorganisms (dysbiosis) and the reduction of the protective host response drives the disease. Since periodontitis is initiated by bacterial subgingival biofilms, mechanical removal of subgingival products and plaque retentive factors (e.g., calculus) is required. Although, complete removal of deposits is frequently not achieved (Waerhaug, 1978, Eaton et al., 1985, Caffesse et al., 1986, Sherman et al., 1990, Wylam et al., 1993, Breininger et al., 1987, Rateitschak-Pluss et al., 1992), mechanical non-surgical periodontal treatment (NSPT) continues to be an integral part of periodontal therapy. NSPT comprising of root surface debridement (RSD) alongside adequate oral hygiene to reduce bacterial load, not only improves gingival health and arrests disease progression (Heitz-Mayfield, 2005, Suvan, 2005, Cobb, 1996, Van der Weijden and Timmerman, 2002), but also reduces the risk of tooth loss (Badersten et al., 1985b, Badersten et al., 1985a, Badersten et al., 1984). The efficacy and effectiveness of NSPT is proven by many studies demonstrating reductions in periodontal probing depths (PPD), clinical attachment level (CAL) gain and bleeding on probing (BOP) (Van der Weijden and Timmerman, 2002, Trombelli et al., 2015, Suvan, 2005, Badersten et al., 1984, Suvan et al., 2020). Clinical outcomes of NSPT can be influenced by several factors including age (Trombelli et al., 2010), gender (Mascarenhas et al., 2003), cigarette smoking (Papantonopoulos, 1999, Pahkla et al., 2006, Wan et al., 2009), diabetes (Christgau et al., 1998, Tervonen and Karjalainen, 1997), operator experience (Fleischer et al., 1989) and patient compliance (Leininger et al., 2010). The Royal London Dental Hospital (RLH) in Tower Hamlets is one of the most socio-economically deprived and ethnically diverse boroughs in the UK. Recent data from a large sample of our local East London population has suggested that periodontitis is more severe in minority ethnic groups (Delgado-Angulo et al., 2016). Although, in general these groups are frequently under-represented in clinical outcome studies compared to Caucasian populations (Jiao et al., 2017). Therefore, there is a need to better understand the factors influencing non-surgical success in our local East London population. The aim of this hospital-based retrospective study was therefore to evaluate factors influencing the effectiveness of NSPT in patients referred for periodontal treatment at Royal London Dental Hospital using data extracted from their clinical records. We also wanted to specifically assess if individuals from a South East Asian (SEA) ethnic background had poorer outcomes after NSPT. Univariate, bivariate, and multivariate analysis to measure the relative contributions of the different factors in the local population of East London. Mean PPD change was the primary outcome variable. In this study, from a sample size of 108 patients, no differences were found between ethnicities or between the SEA group and ‘others’ group in relation to NSPT outcome measured by mean PPD change. There were however differences between the SEA and other groups in terms of age of referral, levels of self-reported attendance, and levels of stress. Plaque scores at reassessment did not impact NSPT outcome but compliant patient had poorer outcomes. However univariate analysis showed that patients achieving at least a 10% improvement in plaque between baseline and reassessment showed better non-surgical treatment outcomes. There were also significant differences in NSPT response when comparing patients reassessed at <120 days (n=80) compared to those reassessed at >120 days (n=28). Baseline Disease severity was the only significant predictor of good treatment response in the binary logistic regression model which explained 26.6% of the variability in the dependent outcome variable. The multilevel analysis also showed that patients presenting with higher levels of disease (Highest 50% percentile) at baseline (Mean PPD) are 3.9 times more likely to have a good non-surgical treatment response (more pocket depth reduction) compared to those with lower levels of disease (Lowest 50% percentile). However all other variables were non-significant in this model, whilst many factors significant in the univariate analysis became non-significant when combined into the same binary logistic regression model. There are several limitations to this study especially in terms of the number of patients we were able to recruit which may explain some of the outcomes which contradict previous studies.
Authors
Kalsi, MCollections
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