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Background

Oral health-related quality of life (OHRQoL) has become an important outcome measure in dentistry, reflecting not only physical functioning but also psychological and social well-being. Periodontitis, a common chronic disease, profoundly affects these aspects of life. Symptoms such as tooth mobility, migration, bad breath, and eventual tooth loss may cause both functional impairment and aesthetic concerns, leading to reduced life satisfaction and social withdrawal.

Although patient-reported outcomes are increasingly emphasized, current periodontal therapy endpoints still rely heavily on clinical measures. For example, the EFP's clinical-practice guidelines propose strict thresholds to define treatment success in stages I–III periodontitis.

More recently, a more flexible treat-to-target (T2T) concept has been put forward, which allows limited residual pocketing—although still based solely on clinical measures.

These differing approaches highlight the challenge of aligning clinical definitions of periodontal stability with patient-centred outcomes such as OHRQoL.

Aim

To investigate if clinical outcomes and endpoints of periodontal treatment show any association with OHRQoL in long-term supportive periodontal therapy (SPT) patients.

Materials & methods

Study design:

Longitudinal follow-up study of patients treated in the undergraduate programme of the Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.

Study population:

• Periodontitis patients treated between 2011–2016.
• Attending supportive periodontal therapy (SPT).
• Presented for re-examination in 2024.

Time points:

• T0: baseline: before step 1 and 2 of periodontal therapy.
• T1: periodontal re-evaluation, 6.33 ± 3.79 months after T0.
• T2: long-term re-examination, 126 ± 30 months (≈10 years) of SPT.

Study variables:

• T0, T1, T2: periodontal charting:
  • Probing pocket depth (PPD).
  • Bleeding on probing (BoP).
  • Tooth mobility.
  • Plaque.
• T2: additional examinations:
  • OHRQoL measured with the German short version of Oral Health Impact Profile-14 (OHIP-14).
  • Prosthetic status.
  • Self-reported tooth migration.
  • Compliance with SPT.
  • Patient variables: age, gender, current smoking status, and diabetes mellitus.

Composite outcomes:

• EFP endpoint: no PPD >4mm with BOP, no deep pockets (≥6mm).
• T2T endpoint: ≤4 sites with PPD ≥5mm.

Statistical analysis:

• Linear regression to model the association between OHRQoL and endpoints adjusted for confounders (sex, smoking, diabetes, and SPT compliance).
• To increase the robustness of the assessment, the two investigated endpoints (EFP/T2T) were merged for regression analyses.

Results

Patient characteristics:

• Total patients: 47 (out of the 122 of the initial cohort of 759 who agreed to extended data processing).
• Mean age: 71.7 ± 10.5 years.
• Stages:
  • Stage III: 40.4%.
  • Stage IV: 59.6%.
• Smokers: 8.5%.
• Diabetes: 12.8%.
• SPT compliance:
  • Regular attendance = 48.9%.
  • Irregular attendance = 51.1%.
• Tooth migration: 25.5% reported.
• Tooth loss was minimal (median 1 over 10 years).
• Prosthetic status (28 Stage IV patients):
  • Fixed: 46.4%.
  • Removable: 39.3%.
  • None: 14.3%.

Composite outcomes

• EFP endpoint achieved: 1 patient.
• T2T endpoint achieved: 16 patients.
• No endpoint achieved: 30 patients.

Patients failing endpointsshowed significantly more pockets and deep pockets at T2 (p < 0.001).

OHIP-14 scores – OHRQoL

• Mean total OHIP-14 score: 4.87 ± 6.38. This indicates a low OHRQoL impact.
• Eighty-three percent of the patients did not find life less satisfying because of their oral health, although12.8% reported occasional dissatisfaction.
• Stage IV patients reported higher overall OHIP-14 scores (5.79 ± 7.17) than those with Stage III (3.53 ± 4.86), especially concerning psychological discomfort and physical pain.
• Regarding the prosthetic status of Stage IV patients, the analysis revealed that those who had not received a prosthetic rehabilitation reported higher OHIP-14 scores (11.75 ± 9.14) than those with fixed (6.08 ± 7.97) or removable (3.27 ± 4.03) prostheses.
• Neither the achievement of clinical endpoints following steps 1 and 2 of therapy nor periodontal stability over the observation period was significantly associated with OHIP-14.

Regression analysis
Self-reported tooth migration was identified as a significant factor influencing OHIP-14 scores at T2 in all regression models.

Limitations

• OHRQoL was assessed only at the final follow-up (10 years), which prevents evaluation of temporal changes during therapy.
• The study had a small sample size (n = 47).
• Because of the patients’ characteristics, conclusions can be drawn only about stage III and IV periodontitis.
• The high mean age of the patients limits the generalisability of the findings.
• The monocentric, non-controlled design reduces external validity.
• Active periodontal therapy was performed by undergraduate students, potentially introducing operator-related variability despite specialist supervision.
• Only one patient achieved the EFP endpoint, limiting the statistical power for this criterion.
• Tooth migration was self-reported, without objective clinical verification, which may have introduced perception bias.

Rapporteurs: Francesca Pacifico, Haitam Yousfi, and Zacharenia Zoi Zafeiriadou, supervised by Isabelle Laleman

Affiliation: Postgraduate programme in periodontoogy, University of Liège, Liège, Belgium

 

 

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