Depression and Somatization in Patients with Temporomandibular Disorders

Istraživanja upozoravaju na povišenu somatizaciju, stres, anksioznost i depresiju u pacijenata s temporomandibularnim poremećajima (TMP-om) te je pokazana čvrsta povezanost između anksioznosti, općih somatskih tegoba i bolova vezanih uz TMP. Svrha istraživanja bila je odrediti razlike u rezultatima depresije i somatizacije u pacijenata različitih dijagnostičkih skupina osi I DKI/TMP i istražiti ulogu psiholoških čimbenika (depresije i somatizacije) u TMP-u. Izabrana su 154 pacijenta (37 muškaraca i 117 žena; srednja dob 39.0 ± 14.5 godina) iz DKI/TMP kategorije s klinički ustanovljenim TMP-om. Pacijenti su na temelju različitih dijagnostičkih skupina pomoću DKI/TMP osi I klasificirani u 7 skupina. Razlike prosječnih SCL-90 rezultata depresije i somatizacije između dijagnostičkih skupina uspoređene su jednosmjernom analizom varijance i Scheffeovim post hoc testovima na razini značajnosti od 0,05. Učestalost različitih dijagnostičkih skupina bila je sljedeća: skupina 1 (mišićni poremećaj, MP) - 35,7%; skupina 2 (pomak diska, PD) - 18,2%; skupina 3 (artralgija, artritis, artroza, AAA) - 7,8%; skupina 4 (MP+PD) - 9,1%; skupina 5 (MP+AAA) - 13,0%; skupina 6 (PD+AAA) - 9,1% i skupina 7 (MP+PD+AAA) - 7,1%. Većina pacijenata imala je jednu dijagnozu (61,7%), a ostali dvije ili više njih (38,3%). Oko 19,5% kliničkih pacijenata s TMP-om imalo je povišene rezultate depresije, a 27,3% ih je iskusilo izražene razine nespecifičnih fizičkih simptoma. Samo 6 pacijenata (21,4%) imalo je visok stupanj nefunkcioniranja s umjerenom do teškom ograničenošću (pacijenti s psihosocijalnom disfunkcijom). Pacijenti kod kojih su dijagnosticirani miofacijalna bol i artralgija (skupina 5 i 7) imali su znatno više razine depresije i somatizacije u odnosu prema pacijentima kod kojih je dijagnosticiran pomak diska (skupina 2). Ti podaci pokazuju da screening i liječenje depresije i somatizacije trebaju biti sastavni dio ispitivanja i obrade pacijenata s TMP-om.Studies have indicated that patients with TMD demonstrate increased somatization, stress, anxiety, depression.A consistent relationship has been demonstrated among anxiety, general somatic complaints, and TMD-related pain. The aims of this study were to determine the differences in depression and somatization scores in patients in different RDC/TMD axis I diagnostic groups and to investigate the role of psychological factors (depression and somatization) in TMD. One hundred fifty-four patients (37 male and 117 female; mean age, 39.0 ± 14.5 years) with RDC/TMD-defined clinical TMD were selected. Patients were subsequently classified into 7 groups based on the presence of the various RDC/TMD axis I diagnostic groups. Differences in mean SCL-90 depression and somatization scores between the diagnostic groups were compared by one-way analysis of variance and Scheffé post hoc tests at a significance level of 0.05. The frequencies of the different diagnostic groups were as follows: group 1 (muscle disorders, MD), 35.7%; group 2 (disc displacement, DD), 18.2%; group 3 (arthralgia, arthritis, arthrosis, AAA), 7.8%; group 4 (MD+DD), 9.1%; group 5 (MD+AAA), 13.0%; group 6 (DD+AAA), 9.1%; group 7 (MD+DD+AAA), 7.1%. The majority of patients had one diagnosis (61.7%) while the remaining patients experienced two or more diagnoses (38.3%). About 19.5% of TMD clinical patients yielded severe depression scores, and 27.3% experienced severe levels of non-specific physical symptoms scores. Only 6 patients (21.4%) had high disability with moderate and severe limitations (psychosocially dysfunctional patients). Patients diagnosed with myofascial pain and arthralgia (group 5 and 7) had significantly higher levels of depression and somatization than patients diagnosed with only disc displacements (group 2). These data mandate that screening and treatment for depression and somatization should be an integral part of the evaluation and management of patients with TMD

Influence of Tabacco Use on Periodontal Health in PTSD Patients

Brojne epidemiološke i kliničke studije utvrdile su pušenje duhana čimbenikom rizika za progresiju parodontne bolesti. Također je pronađena pozitivna korelacija izme đu nižega socioekonomskog statusa i težine parodontne bolesti.Željeli smo istražiti utjecaj pušenja na klinički parodontni status i subgingivni mikrobni profil u pacijenata s PTSP-om i pacijenata s progresivnom parodontnom bolesti. Istraživanje je uključilo 130 ispitanika podijeljenih u 3 skupine. Prva je skupina bila 50 osoba kojima je postavljena dijagnoza PTSP-a, i aktivno su sudjelovali u Domovinskom ratu. Druga se skupina sastojala od 50 pacijenata s uznapredovalim parodontitisom, a kontrolnu skupinu tvorilo je 30 parodontno zdravih osoba. Osobe iz tih skupina nisu bile izravno izložene ratnom stresu. Klinički pregled parodonta uključivao je mjerenje indeksa plaka (PI), indeksa krvarećeg sulkusa (SBI) dubine sondiranja (PD) i klinički gubitak pričvrstka (CAL). Parodontni patogeni Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) i Eikenella corrodens (Ec) identificirani su s pomoću metode lančane reakcije polimeraze (PCR). Pušački i društvenoekonomski status, mjeren stupnjem naobrazbe takođe su određeni. Ispitanici s PTSP-om su u usporedbi s drugim dvjema skupinama imali najveći postotak pušača. U skupini s PTSP-om 78% ispitanika bili su pušači, a samo je 33% kontrolnih ispitanika pušilo. U skupini s PTSP-om 34% je pušilo manje od 20 cigareta na dan, a 30% je pušilo više od 40 cigareta na dan. Ovo razlikuje PTSP skupinu od druge dvije. Rezultati pokazuju da su, gledajući sve skupine zajedno, pušači imali više parodontnih upala i destrukcija nego nepušači, premda su samo PI i SBI vrijednosti bile statistički znatne. Odnos jakosti parodontne upale i destrukcije u pušača i nepušača je isti, i kada se promatra svaka skupina zasebno. Nisu pronađene statistički znatne razlike između prevalencije bakterija Aa, Pg i Ec imeđu pušača i nepušača. Skupina s PTSP-om imala je najniži stupanj školovanja. Navika pušenja i niži društvenoekonomski status čimbenici su koji utječu na zdravlje parodonta i pridonose parodontnoj upali u oboljelih od PTSP-a.Numerous epidemiological and clinical studies have identified tobacco smoking as a risk factor for periodontal disease progression. Positive correlation between lower socioeconimic status and periodontal disease severity has also been found. We wanted to study the influence of smoking on clinical periodontal status and the subgingival microbial profile in post-traumatic stress disorder (PTSD) patients and patients with progressive periodontal disease. The investigation included 130 subjects divided in to three groups. The first group comprised 50 persons diagnosed with PTSD, who has actively participated in the Croatian liberation war. The second group were 50 patients treated for advanced periodontitis, and the control group were 30 periodontally healthy subjects. Subjects from the latter two groups were not directly subjected to war-related stress. Clinical periodontal examination included recording of plaque index (PI), sulcus bleeding index (SBI), probing depth (PD) and clinical attachment loss (CAL). Periodontal pathogens Actinobacillus actinomycetemcomitans (Aa),Porphyromonas gingivalis (Pg) and Eikenella corrodens (Ec) were identified using poymerase chain reaction (PCR) method. Smoking and socioeconomic status, evaluated by the level od education, were also assessed. The group of subjects with PTSD, compared to the other groups, had most cigarette smokers. In the PTSD group, 78% were smokers, wile only 33% of control subjects smoked. In the PTSD group, 34% smoked less than 20 cigarettes per day, and 30% smoked more than 40 cigarettes per day. In this respect PTSD group differs greatly from the other group. The results show that, of all participiants, smokers had more periodontal inflammation and destruction than non-smokers, although only PI and SBI values were significantly higher. This relationship is similar for each of the studied groups. No statistically significant difference was observed between bacterial prevalence of Aa, Pg and Ec between smokers and nonsmokers. PTSD group had the lowest education level. Smoking habits and lower socioeconimic status are contributing factors influencing the periodontal status of PTSD patients

Influence of Tabacco Use on Periodontal Health in PTSD Patients

Brojne epidemiološke i kliničke studije utvrdile su pušenje duhana čimbenikom rizika za progresiju parodontne bolesti. Također je pronađena pozitivna korelacija izme đu nižega socioekonomskog statusa i težine parodontne bolesti.Željeli smo istražiti utjecaj pušenja na klinički parodontni status i subgingivni mikrobni profil u pacijenata s PTSP-om i pacijenata s progresivnom parodontnom bolesti. Istraživanje je uključilo 130 ispitanika podijeljenih u 3 skupine. Prva je skupina bila 50 osoba kojima je postavljena dijagnoza PTSP-a, i aktivno su sudjelovali u Domovinskom ratu. Druga se skupina sastojala od 50 pacijenata s uznapredovalim parodontitisom, a kontrolnu skupinu tvorilo je 30 parodontno zdravih osoba. Osobe iz tih skupina nisu bile izravno izložene ratnom stresu. Klinički pregled parodonta uključivao je mjerenje indeksa plaka (PI), indeksa krvarećeg sulkusa (SBI) dubine sondiranja (PD) i klinički gubitak pričvrstka (CAL). Parodontni patogeni Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) i Eikenella corrodens (Ec) identificirani su s pomoću metode lančane reakcije polimeraze (PCR). Pušački i društvenoekonomski status, mjeren stupnjem naobrazbe takođe su određeni. Ispitanici s PTSP-om su u usporedbi s drugim dvjema skupinama imali najveći postotak pušača. U skupini s PTSP-om 78% ispitanika bili su pušači, a samo je 33% kontrolnih ispitanika pušilo. U skupini s PTSP-om 34% je pušilo manje od 20 cigareta na dan, a 30% je pušilo više od 40 cigareta na dan. Ovo razlikuje PTSP skupinu od druge dvije. Rezultati pokazuju da su, gledajući sve skupine zajedno, pušači imali više parodontnih upala i destrukcija nego nepušači, premda su samo PI i SBI vrijednosti bile statistički znatne. Odnos jakosti parodontne upale i destrukcije u pušača i nepušača je isti, i kada se promatra svaka skupina zasebno. Nisu pronađene statistički znatne razlike između prevalencije bakterija Aa, Pg i Ec imeđu pušača i nepušača. Skupina s PTSP-om imala je najniži stupanj školovanja. Navika pušenja i niži društvenoekonomski status čimbenici su koji utječu na zdravlje parodonta i pridonose parodontnoj upali u oboljelih od PTSP-a.Numerous epidemiological and clinical studies have identified tobacco smoking as a risk factor for periodontal disease progression. Positive correlation between lower socioeconimic status and periodontal disease severity has also been found. We wanted to study the influence of smoking on clinical periodontal status and the subgingival microbial profile in post-traumatic stress disorder (PTSD) patients and patients with progressive periodontal disease. The investigation included 130 subjects divided in to three groups. The first group comprised 50 persons diagnosed with PTSD, who has actively participated in the Croatian liberation war. The second group were 50 patients treated for advanced periodontitis, and the control group were 30 periodontally healthy subjects. Subjects from the latter two groups were not directly subjected to war-related stress. Clinical periodontal examination included recording of plaque index (PI), sulcus bleeding index (SBI), probing depth (PD) and clinical attachment loss (CAL). Periodontal pathogens Actinobacillus actinomycetemcomitans (Aa),Porphyromonas gingivalis (Pg) and Eikenella corrodens (Ec) were identified using poymerase chain reaction (PCR) method. Smoking and socioeconomic status, evaluated by the level od education, were also assessed. The group of subjects with PTSD, compared to the other groups, had most cigarette smokers. In the PTSD group, 78% were smokers, wile only 33% of control subjects smoked. In the PTSD group, 34% smoked less than 20 cigarettes per day, and 30% smoked more than 40 cigarettes per day. In this respect PTSD group differs greatly from the other group. The results show that, of all participiants, smokers had more periodontal inflammation and destruction than non-smokers, although only PI and SBI values were significantly higher. This relationship is similar for each of the studied groups. No statistically significant difference was observed between bacterial prevalence of Aa, Pg and Ec between smokers and nonsmokers. PTSD group had the lowest education level. Smoking habits and lower socioeconimic status are contributing factors influencing the periodontal status of PTSD patients

Molecular Epidemiology of Oral Treponemes in Patients with Periodontitis and in Periodontitis-Resistant Subjects

The etiologic role of oral treponemes in human periodontitis is still under debate. Although seen by dark-field microscopy in large numbers, their possible role is still unclear since they comprise some 60 different phylotypes, most of which are still uncultured. To determine their status as mere commensals or opportunistic pathogens, molecular epidemiological studies are required that include both cultured and as-yet-uncultured organisms. Here we present such data, comparing treponemal populations from chronic periodontitis (CP) or generalized aggressive periodontitis (GAP) patients. As a periodontitis-resistant (PR) control group, we included elderly volunteers with more than 20 natural teeth and no history of periodontal treatment and no or minimal clinical signs of periodontitis. Almost every treponemal phylotype was present in all three groups. For most treponemes, the proportion of subjects positive for a certain species or phylotype was higher in both periodontitis groups than in the PR group. This difference was pronounced for treponemes of the phylogenetic groups II and IV and for Treponema socranskii and Treponema lecithinolyticum. Between the periodontitis groups the only significant differences were seen for T. socranskii and T. lecithinolyticum, which were found more often in periodontal pockets of GAP patients than of CP patients. In contrast, no difference was found for Treponema denticola. Our findings, however, strengthen the hypothesis of treponemes being opportunistic pathogens. It appears that T. socranskii, T. lecithinolyticum and group II and IV treponemes may represent good indicators for periodontitis and suggest the value of the respective probes for microbiological diagnosis in periodontitis subjects