Received: 1 February 2020 | Revised: 13 May 2020 | Accepted: 21 May 2020

DOI: 10.1111/jcpe.13324

CLINICAL PERIODONTOLOGY

Oral health-related quality of life impacts are low 27 years

after periodontal therapy

Christian Graetz1 | Maike Schwalbach1 | Miriam Seidel1 | Antje Geiken1 |

Falk Schwendicke2

1
Clinic of Conservative Dentistry and
Periodontology, University of Kiel, Kiel,
Germany
2
Department of Oral Diagnostics, Digital
Health and Health Services Research,
Charité University of Berlin, Berlin, Germany
Correspondence
Christian Graetz, Clinic for Conservative
Dentistry and Periodontology, University
Hospital Schleswig-Holstein, Campus Kiel,
Arnold-Heller-Str. 3, Haus B, 24105 Kiel,
Germany.
Email: graetz@konspar.uni-kiel.de
Abstract
Aim: This pilot study assessed the oral-health-related quality of life (OHRQoL) after
long-term periodontal therapy and explored OHRQoL differences along the 2018
Classification of Periodontal Diseases.
Methods: Sixty patients were examined before (T0) and after active periodon-
tal therapy (APT/T1) and 32.0 ± 2.9 [range: 27–38] years of supportive periodon-
tal therapy (SPT/T2). Periodontal diagnosis at T0 was assessed according to the
2018 Classification of Periodontal Diseases (stage 1/2/3/4: n = 1/3/44/13; grade
n = A/B/C: 0/8/53). OHRQoL at T2 was measured using the Oral Health Impact
Profile-G14 (OHIP-G14). Patients’ Eichner's classification, accumulated tooth loss
and treatment outcomes (SSO criteria) were assessed at T2. Generalized linear mod-
elling (GLM) assessed associations between different factors and OHrQoL.
Results: Mean OHIP-G14 sum score was 3.7 (SD 5.6). There was no statistically sig-
nificant association between OHIP-G14 and gender, stage, SSO criteria and tooth
loss. OHIP-G14 was significantly lower in older patients (−0.2[−0.3;0] per year,
p = .008), non-smokers (−5.9[−9.9;-1.9] p = .003) and former smokers (−7.4[−11.6;-
3.2]; p < .001) versus current smokers, patients with Eichner class A1–B2 versus C2
(p < .05), sufficient adherence during SPT (−2.3[−4.6;-0.1], p = .044) versus insuf-
ficient ones. Patients with grade B (4.4[1.3;7.4]; p < .005) showed higher OHIP-G14
than those with grade C.
Conclusion: A number of aspects, grounded in the initial diagnosis, the adherence
to SPT, the resulting dentition, socio-demographic and behavioural covariates, were
associated with good OHrQoL.

KEYWORDS

oral health-related quality of life, periodontitis, supportive periodontal therapy, tooth loss

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction
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© 2020 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd

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wileyonlinelibrary.com/journal/jcpe J Clin Periodontol. 2020;47:952–961.

GRAETZ et al.
1 | I NTRO D U C TI O N
Periodontitis is one of the most prevalent chronic diseases worldwide
and affects more than 65% of the population (Dye, 2012). Untreated,
a progressive periodontal destruction (Needleman et al., 2018) will
lead to functional and aesthetic constraints as well as discomfort,
the consequences being a reduced oral health-related quality of life
(OHRQoL) (Borges Tde et al., 2013; Levin et al., 2018) and tooth loss
(Kocher, König, Dzierzon, Sawaf, & Plagmann, 2000). While success-
ful management of periodontitis by active periodontal treatment
(APT) and individualized supportive periodontal therapy (SPT) has
been shown to reduce tooth loss and to allow retention of most teeth
long term (Manresa, Sanz-Miralles, Twigg, & Bravo, 2018), it may not
fully mitigate the impact of the disease on OHRQoL (Bajwa, Watts, &
Newton, 2007; Bäumer et al., 2018; El Sayed et al., 2018; Mendez,
Melchiors Angst, Stadler, Oppermann, & Gomes, 2017; Ohrn &
Jonsson, 2012; Shanbhag, Dahiya, & Croucher, 2012; Sonnenschein,
Betzler, Kohnen, Krisam, & Kim, 2018).
A number of studies further showed that the severity of the dis-
ease is associated with OHRQ oL (Buset et al., 2016) and that specific
subdomains of OHrQoL (e.g. pain or psychological limitations) can
be improved when the disease is managed appropriately (Botelho
et al., 2020; Mendez et al., 2017), mainly as clinical symptoms (e.g.
and periodontal pocket depth, bleeding on probing) and disability
(e.g. tooth mobility) are reduced (Graziani, Karapetsa, Alonso, &
Herrera, 2017). A positive psychological (i.e. non-physical) impact of
periodontal therapy has also been reported (Jonsson & Ohrn, 2014)
and is controversially discussed (Locker & Gibson, 2006). Overall,
especially short-term investigations, following patients for months
or 1–2 years after therapy, indicate that successful periodontal
therapy has a positive impact on OHrQoL (Jonsson & Ohrn, 2014;
Makino-Oi et al., 2016), without a strong association to the specific
type of therapy provided, that is non-surgical or surgical (Makino-Oi
et al., 2016; Shanbhag et al., 2012). Most of these studies did not
assess the long-term impact of periodontitis on OHRQoL; there
are only sparse data on how periodontitis patients’ OHrQoL is af-
fected by the disease for decades (Bäumer et al., 2018; El Sayed
et al., 2018).
The new 2018 Classification of Periodontal Diseases character-
izes periodontitis multidimensionally, capturing disease severity, ex-
tent and progression using a staging and grading approach (Tonetti,
Greenwell, & Kornman, 2018). Patients are classified into four stages
(I-IV), considering attachment level or bone loss (severity staging)
as well as probing-pocket depths (PPD), type of bone loss (vertical
and/or horizontal) and furcation involvement (complexity staging).
Moreover, the past disease extent and complexity is considered.
Patients are further classified into three grades (A, B, C), determined
by the past disease progression (measured via the bone loss/age
index) and further factors (Tonetti et al., 2018). Such classification
has been shown to be able to reflect the disease characteristics, but
also tooth loss (Graetz et al., 2019; Ravida et al., 2019). It remains
unclear how the severity and extent of the initial diagnoses accord-
ing to this classification can be associated with long-term OHRQoL.
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953
Clinical Relevance
Scientific rationale for the study: Data on the long-term im-
pact of periodontitis on oral health-related quality of life
(OHrQoL) are scarce. Moreover, it remains unclear if diag-
noses according to the 2018 Classification of Periodontal
Diseases are associated with OHrQoL. Periodontitis pa-
tients receiving active and supportive periodontal treatment
(APT/SPT) for ≥27 years were assessed for their OHrQoL.
Principal findings: Patients who were systematically man-
aged showed good OHrQoL. Certain factors (like the
number of masticatory zones and adherence to SPT) were
positively associated with OHrQoL. There was no statis-
tically significant association with periodontitis stage, but
with its grade.
Practical implication: The OHrQoL impact of periodontitis
may be limited if the disease and its sequels are managed
appropriately.
The aim of the present longitudinal pilot study was to investigate
OHRQ oL of patients, who received periodontitis therapy for ≥27 years,
and to assess possible associations with the new 2018 Classification of
Periodontal Diseases (Papapanou et al., 2018). We hypothesized that
the initial diagnosis according to this classification was statistically
significantly associated with long-term OHRQoL. Note that it is also
conceivable that successful therapy may be able to mitigate such dif-
ferences in initial diagnoses. Therefore, our null hypothesis was that
there was no such association between the diagnosis and OHrQoL.
2 | M ATE R I A L A N D M E TH O DS
2.1 | Sample
We included patients with periodontitis who had been treated at the
Department of Periodontology, Christian-Albrechts-University of
Kiel, Germany, and who (a) received APT (from the first systematic as-
sessment [T0] to the last active treatment appointment [T1]) between
1982 and 1992, (b) received SPT for ≥27 years with at least one annual
documentation (±1 year) of probing-pocket depths (PPD), as well as a
radiographic documentation at T0 and at the last documented visit of
SPT (T2), (c) had sufficient parameters documented at T0 to come to
a diagnosis according to the 2018 classification (as described) and (d)
were willing to attend a visit for measuring OHrQoL in 2018–2019.
No sample calculation had been performed, as we assumed only a
minority of patients in our pool to fulfil these criteria and we aimed
for a maximal statistical power. Out of 1,643 patients available in the
database of the department, 61 patients fulfilled all inclusion criteria;
all of them had also been assessed in previous publications (Graetz
et al., 2011; Graetz, Plaumann, et al., 2017; Graetz, Salzer, et al., 2017)
and had been followed since then (Figure 1).
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2.2 | Active and supportive periodontal therapy
Active periodontal therapy included non-surgical, mechanical root
debridement (scaling and root planing, SRP) with, if indicated, addi-
tional access flap surgery. Debridement of furcation involvement (FI)
was performed in the 1980s with hand instruments and later on with
diamond-coated sonic scaler inserts (Kocher & Plagmann, 1999).
Further treatments, for example endodontic treatments, splinting
of mobile teeth, tunnelling procedures and molar root resections
were carried out in individual cases. No pocket elimination surgery
or osseous resection as well as no regenerative therapies were un-
dertaken. Patients presenting with high severity of periodontal de-
struction and persistent inflammation despite sufficient mechanical
treatment received adjunctive 3 × 375 mg amoxicillin and 3 × 250 mg
metronidazole antibiotics for seven days (van Winkelhoff, Rams, &
Slots, 1996), with re-evaluation after six months.
Supportive periodontal therapy followed individualized intervals
of three to twelve months and included re-instruction/re-motivation
of patients, individual oral hygiene, professional tooth cleaning with
SRP of residual pockets and polishing by a dental auxiliary. If neces-
sary, further treatments like open flap debridement with or without
subsequent systemic antibiotic therapy were performed. Details of
the treatment concept are described elsewhere (Graetz et al., 2011;
Graetz, Plaumann, et al., 2017).
2.3 | Oral health impact profile questionnaire
The OHRQoL was measured using the German short version of the
Oral Health Impact Profile (OHIP-G14) (John et al., 2006), which
is the abbreviated, translated and validated version of the original
OHIP with 49 questions (Slade & Spencer, 1994). The OHIP-G14
consists of 14 questions on the frequency of impairments caused
by oral conditions during the last month. It reflects seven domains:
functional limitation, physical pain, psychological discomfort, physi-
cal disability, psychological disability, social disability and handicap.
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GRAETZ et al.
A Likert-type scale ranging from 0 to 4 (0 = never; 1 = hardly ever;
2 = occasionally; 3 = fairly often; 4 = very often) is applied (John
et al., 2006). Responses can be summed up in each domain and over-
all. The total OHIP-G14 sum score can range from 0 to 56; higher
scores indicate a poorer OHRQoL. The questionnaire was self-com-
pleted by the participants to prevent the introduction of bias by an
interviewer. Missing values did not occur in our sample.
2.4 | Independent variables
Annual records of the medical history, the self-reported smoking
status and the clinical charting were available. For the latter, third
molars were included. For classifying patients according to Tonetti
et al. (2018), with some modifications as described in detail else-
where (Graetz et al., 2019), the following variables were available:
• Gender and age at T0 and T2.
• Number of missing teeth (at T0, T1 and T2). Note that it was not
possible to ascertain the reasons for previous tooth loss (peri-
odontitis or other) in many cases before T0. Given that all patients
were periodontitis patients, though, we assume the majority of
teeth having been lost due to periodontitis prior to T0.
• Number of teeth lost during APT (T0–T1) and SPT (T1–T2) were
recorded by the treating dentist. In many cases, the reasons for
tooth removal were multiple or could not be ascertained (some
teeth, for example, were removed alieno loco).
• Diabetes mellitus (T0). As no patient of our sample had diabetes
mellitus, this factor was not relevant for the classification (Tonetti
et al., 2018). Note that other systemic diseases known to influ-
ence periodontitis, for example coronary heart disease, were not
recorded at any time point (Genco & Borgnakke, 2013).
• Smoking status (T0) was assessed categorically (never/ former
[i.e. quit > 5 years ago]/ current smoker) (Lang & Tonetti, 2003).
All current smokers smoked more than ten cigarettes per day.
Note that smoking (also diabetes status) may have changed after
FIGURE 1 Flow chart of the
recruitment

GRAETZ et al.
T0 but given that our focus was to assess the association between
initial diagnosis and OHrQoL, we accepted that.
• PPDs and CAL (T0, T1 and T2) were evaluated at six sites per
tooth. The CAL was calculated as the sum of PPD plus the dis-
tance between the cementum–enamel junction up to the gingival
margin. To classify patients, we only considered the interdental
CAL on two non-adjacent teeth, or if buccal or oral CAL was
≥3 mm, with pocketing >3 mm (Tonetti et al., 2018).
• Relative radiographic bone loss (BL, in %, T0 and T2) was assessed
on peri-apical radiograph films after digitization, as described
previously by Graetz et al. (2011). Bone loss type had not been
classified, while the vast majority of patients and teeth showed
horizontal, not vertical bone loss (Tonetti et al., 2018).
• The furcation involvement of molars (T0) was assessed according
to Hamp, Nyman, and Lindhe (1975). Only the highest degree of
furcation involvement for each molar was used.
• The extent of periodontitis was classified as localized if ≤ 30% of
the teeth were affected (n = 1) or as generalized if it was >30%
(n = 60). No patient with a molar/incisor pattern was available
(Tonetti et al., 2018).
Further data which may be required for fully applying the
new classification, like the presence of plaque, masticatory dys-
function, bite collapse, drifting or flaring, were not consistently
available and not used (Tonetti et al., 2018). Also, mobility was
not considered in this study, as in some cases, splinting had been
performed during APT (often initially) and no data were available
for baseline.
At T2, a range of further variables was recorded:
• Treatment outcomes were assessed according to the SSO
(Swiss Dental Society) criteria (Mombelli, Schmid, Walter, &
Wetzel, 2014), as laid out in Table S1. Overall, four classes (from
A + to C) can be established, with worse treatment outcomes in
higher classes.
• Adherence during SPT was classified as sufficient (max. ±6 months
of deviation between set SPT intervals) or insufficient (SPT in-
terval extended more than half of the recommended interval or
≥12 months of deviation).
• To analyse occlusion and masticatory function, the classification
system outlined by Eichner (1955) was used, which assesses both
dental arches combined and enumerates the number of posterior
occlusal zones without implants (Table S2). A total of four zones
are available, and three different classes (from A to C, each with
3–4 sub-classes, e.g. A1, A2 etc.) can be established. Higher
classes indicate decreased occlusion and masticatory function.
2.5 | Data management and statistical analysis
Data were managed using a database (ParoDat, Department of
Periodontology), which had been installed in 1982 via a database
platform (FileMaker). All patients gave their informed consent for
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955
the analysis of their data documented during periodontal therapy.
The Ethical Committee of the Christian-Albrechts-University of Kiel
approved the protocol of the study (AZ: D489/13). Statistical evalu-
ation was performed using SPSS 20 (SPSS). Descriptive analyses
were conducted. To assess the joint association between the fac-
tors and OHRQoL, generalized linear modelling (GLM) with a linear
link was performed. Factors were entered simultaneously, and only
a full model was assessed (i.e. no stepwise selection etc.). Regression
coefficients, standard errors (SE), p-values and 95% confidence in-
tervals (CI) were used as effect estimates. To determine the power
of the conducted analysis, a post hoc power analysis was performed
(G*Power, University of Düsseldorf).
3 | R E S U LT S
3.1 | Sample and tooth loss
At baseline, the included 61 patients (male/female: 29/32) had a
mean ± SD age of 41.6 ± 7.9 (range: 23–67) years, and a permanent
dentition with a mean of 25.6 ± 3.7 teeth (n = 1,559 teeth). Thirty-
four patients were non-smokers, 22 former smokers and five active
smokers. Forty-four patients were classified with stage 3 and 13
with stage 4, only three showed stage 2 and one patient stage 1. The
respective numbers of patients with grade A/B/C were 0/8/53. Only
two of the 61 patients had implants. Further details on periodontal
parameters (PPD, CAL and BL) are shown in Table 1.
The duration of APT (T0–T1) was 0.6 ± 0.5 (range: 1–2.4) years.
During APT, four patients were treated only non-surgically, while 57
patients also received surgical treatment (open flap debridement,
root resection) after non-surgical treatment had been completed.
Fifty-three patients were exclusively treated by using mechanical de-
bridement with or without surgical therapy; eight patients received
adjunctive systemic antibiotic therapy. A total of 37 teeth (0.6 ± 4.7 per
patient) were extracted during APT, resulting in a mean of 25.0 ± 4.0
teeth per patient at T1. However, extractions were provided in a small
minority of patients only (n = 8); 53 patients lost no tooth at all.
The duration of SPT was 32.0 ± 2.9 [range: 27–38] years (T1–
T2). Twenty-one patients showed insufficient adherence. Fifty-five
patients lost a total of 288 teeth during SPT (2.1 ± 4.2 teeth per
patient; 0.15 ± 0.14 teeth per patient and year). At T2, nine patients
showed a total of 35 implants. According to the classification out-
lined by Eichner (1955), we found 35 patients in class A, 20 patients
in class B and six patients in class C (Table 1). At T0 54/6/1, patients
had been assigned to classes A/B/C, respectively. The periodontal
status at T2 was evaluated according to the SSO criteria; 17 patients
were classified as A+, 15 patients as A and 29 patients as B.
3.2 | OHRQoL
The OHIP-G14 mean sum score of all 61 patients (age: 71.2 ± 9.0
with a range of 52–96 years) at T2 was 3.7 ± 5.6 (median 1, range
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956 GRAETZ et al.

TA B L E 1 Characteristics of the sample at different time points

≥27 years of SPT

Number of patients (male/female) 29/32

Age at T0 (mean ± SD) in years 41.6 ± 7.9
Age at T2 (mean ± SD in years 71.2 ± 9.0
APT (T0–T1) in years (mean ± SD) 0.6 ± 0.5
SPT (T1–T2) in years (mean ± SD) 32.0 ± 2.9
Number of smoker/ former smoker/ never smoker (T0) 5/22/34
Number of patients with stage 1/2/3/4 (T0) 1/3/44/13
Number of patients with grade A/B/C (T0) 0/8/53
Number of patients with Eichner Class A1/A2/A3/B1/B2/B3/B4/C1/C2/C3 (T0) 19/21/14//3/2/1/0//0/1/0
Number of patients with Eichner Class A1/A2/A3//B1/B2/B3/B4//C1/C2/C3 (T2) 4/12/19/5/7/7/1//3/3/0
Number of patients with SSO criteria A+/A/B/C (T2) 17/15/29/0
Number of patients with removable dentures (T0) 8
Number of patients with removable dentures (T2) 16
Number of patients with renewed removable dentures (T1–T2) 8
Number of patients treated exclusively mechanical during non-surgical/ surgical procedure 53
Number of patients treated with adjunctive antibiotics 8
Number of patients treated with regenerative therapy 3
Number of patients treated non-surgically 4
Number of patients treated surgically 57
Mean survival time of extracted teeth in APT (T0–T1) 1.1 ± 0.9
Mean survival time of extracted teeth in SPT (T1–T2) 17.9 ± 10.0

T0 T1a T2

Number of teeth 1,559 1,522 1,234

Number of teeth/patient 25.6 ± 3.7 25.0 ± 4.0 20.2 ± 6.3
Number of tooth loss/patient – 0.6 ± 4.7 2.1 ± 4.2
Mean PPD in mm 5.1 ± 2.0 3.9 ± 1.8 3.4 ± 1.0
Mean CAL in mm 6.8 ± 2.7 5.7 ± 2.5 5.6 ± 1.9
Mean BL in % of the root length 31.1 ± 21.8 – 25.0 ± 17.7
Number of patients with implants 2 2 9
Number of implants 8 8 35

Note: Active periodontal treatment phase (APT) T0–T1, Bone loss (BL), Pocket probing depths (PPD), Clinical attachment Loss (CAL), Supportive
periodontal treatment phase (SPT) T1–T2
a
Bone loss was not assessed at T1.

0–23), indicating a very low level of impairment (Table 2). Twenty-
five patients indicated no impairment at all (score 0), and further 25
patients reported a score of ≤ 9, indicating low impairment. Only 11
patients showed an overall sum score >9. Details on the scores in dif-
ferent domains are shown in Table 2, with highest scores in the do-
mains psychological disability (0.7 ± 1.3) and physical pain (0.7 ± 1.2).
There was no statistically significant association between
OHIP-G14 and gender, stage, SSO criteria and tooth loss in GLM
(Table 3). Notably, the statistical power to detect differences in stage
or SSO criteria with statistical significance was < 30%. OHIP-G14
was significantly lower in older patients (−0.2[−0.3;0] per year,
p = .008), non-smokers (−5.9[−9.9;-1.9], p = .003) and former smok-
ers (−7.4[−11.6;-3.2]; p < .001) versus current smokers, patients with
Eichner class A1–B2 versus C2 (p < .05), sufficient adherence during
SPT (−2.3[−4.6;-0.1], p = .044) versus insufficient ones. Patients with
grade B (4.4[1.3;7.4]; p = .005) showed higher OHIP-G14 than those
with grade C.
4 | D I S CU S S I O N
The aim of the present pilot study was to investigate long-term
OHrQol in patients who received successful APT and SPT for 27 years
or more and to assess the association between OHrQol and initial diag-
nosis (according to the 2018 Classification), treatment outcomes (SSO
criteria, Eichner classification) and further socio-demographic covari-
ates. In the resulting small sample of patients, who showed rather se-
vere periodontitis at T0 and were largely compliant (otherwise, such
 TA B L E 2 OHIP–G14 summary and subdomain scores

OHIP scores of sub-domains mean ± SD [range]

GRAETZ et al.

N of Total OHIP–G14 Functional Handicap Psychological Psychological Physical Physical pain Social
patients mean ± SD limitation (questions 3, disability (questions discomfort disability (questions 7, disability
Category (%) [range] (questions 1, 2) 10) 4, 11) (questions 5, 14) (questions 6, 12) 13) [range] (questions 8, 9)

Total 61 (100) 3.7 ± 5.6 [0–23] 0.5 ± 1.1 [0–4] 0.5 ± 1.1 [0–4] 0.7 ± 1.3 [0–6] 0.6 ± 1.1 [0–6] 0.2 ± 0.6 [0–3] 0.7 ± 1.2 [0–6] 0.6 ± 1.1 [0–5]
Gender
Male 29 (47.5) 3.7 ± 5.6 [0–17] 0.7 ± 1.2 [0–4] 0.6 ± 1.2 [0–4] 0.7 ± 1.1 [0–4] 0.5 ± 0.8 [0–3] 0.1 ± 0.4 [0–2] 0.4 ± 0.8 [0–3] 0.7 ± 1.1 [0–5]
Female 32 (52.5) 3.8 ± 5.7 [0–23] 0.4 ± 0.9 [0–4] 0.3 ± 0.9 [0–4] 0.7 ± 1.4 [0–6] 0.7 ± 1.4 [0–6] 0.3 ± 0.7 [0–3] 1.0 ± 1.5 [0–6] 0.5 ± 1.1 [0–5]
Smoking (T0)
Non-smoker 34 (55.7) 4.0 ± 5.1 [0–18] 0.5 ± 1.1 [0–4] 0.5 ± 1.2 [0–4] 0.7 ± 1.2 [0–4] 0.6 ± 1.0 [0–4] 0.2 ± 0.7 [0–3] 0.8 ± 1.2 [0–4] 0.6 ± 1.1 [0–5]
Former 22 (36.1) 1.3 ± 3.6 [0–17] 0.2 ± 0.5 [0–2] 0.2 ± 0.8 [0–3] 0.1 ± 0.3 [0–1] 0.1 ± 0.4 [0–1] 0.1 ± 0.4 [0–2] 0.2 ± 0.7 [0–3] 0.4 ± 1.1 [0–5]
smoker
Active smoker 5 (8.2) 12.4 ± 8.0 [4–23] 2.0 ± 1.6 [0–4] 1.2 ± 1.3 [0–3] 3.0 ± 2.0 [1–6] 2.4 ± 2.3 [0–6] 0.4 ± 0.5 [0–1] 2.0 ± 2.4 [0–6] 1.4 ± 0.9 [0–2]
Stage (T0)
Stage 1 1 (1.6) 18 0 4 4 3 2 0 5
Stage 2 3 (4.9) 4.0 ± 6.1 [0–11] 1.3 ± 1.5 [0–3] 0.3 ± 0.6 [0–1] 0.7 ± 1.2 [0–2] 0.7 ± 1.2 [0–2] 0 0.3 ± 0.6 [0–1] 0.7 ± 1.2 [0–2]
Stage 3 44 (72.1) 3.5 ± 5.3 [0–23] 0.5 ± 1.1 [0–4] 0.4 ± 0.9 [0–4] 0.6 ± 1.3 [0–6] 0.6 ± 1.2 [0–6] 0.2 ± 0.6 [0–3] 0.8 ± 1.4 [0–6] 0.4 ± 0.8 [0–3]
Stage 4 13 (21.3) 3.4 ± 5.7 [0–17] 0.5 ± 0.9 [0–2] 0.5 ± 1.3 [0–4] 0.7 ± 1.2 [0–4] 0.3 ± 0.6 [0–2] 0.2 ± 0.6 [0–2] 0.5 ± 0.9 [0–3] 0.7 ± 1.4 [0–5]
Grade (T0)
Grade A 0 – – – – – – –
Grade B 8 (13.1) 7.1 ± 7.2 [0–8] 1.0 ± 1.2 [0–3] 1.6 ± 2.0 [0–4] 1.4 ± 1.8 [0–4] 1.0 ± 1.2 [0–3] 0.4 ± 0.7 [0–2] 0.5 ± 0.8 [0–2] 1.3 ± 1.8 [0–5]
Grade C 53 (86.9) 3.2 ± 5.2 [0–23] 0.5 ± 1.0 [0–4] 0.3 ± 0.7 [0–3] 0.6 ± 1.2 [0–6] 0.5 ± 1.1 [0–6] 0.2 ± 0.6 [0–3] 0.7 ± 1.3 [0–6] 0.5 ± 1.0 [0–5]
SSO criteria (T2)
A+ 17 (27.9) 5.3 ± 7.6 [0–23] 0.6 ± 1.2 [0–4] 0.7 ± 1.4 [0–4] 1.2 ± 2.0 [0–6] 0.9 ± 1.7 [0–6] 0.2 ± 0.5 [0–2] 0.8 ± 1.7 [0–6] 0.8 ± 1.5 [0–5]
A 15 (24.6) 3.0 ± 3.7 [0–11] 0.5 ± 1.0 [0–3] 0.5 ± 1.1 [0–4] 0.3 ± 0.6 [0–2] 0.5 ± 0.7 [0–2] 0.1 ± 0.3 [0–1] 0.8 ± 0.9 [0–3] 0.4 ± 0.6 [0–2]
B 29 (47.5) 3.2 ± 5.1 [0–17] 0.5 ± 1.0 [0–4] 0.3 ± 0.7 [0–3] 0.6 ± 1.0 [0–4] 0.4 ± 0.9 [0–4] 0.3 ± 0.8 [0–3] 0.6 ± 1.1 [0–4] 0.5 ± 1.1 [0–5]
C 0 – – – – – – –
Adherence during SPT
Sufficient 40 (65.6) 2.9 ± 5.1 [0–23] 0.4 ± 0.9 [0–3] 0.3 ± 0.7 [0–3] 0.6 ± 1.2 [0–6] 0.5 ± 1.2 [0–6] 0.2 ± 0.6 [0–3] 0.5 ± 1.2 [0–6] 0.5 ± 0.8 [0–3]
Insufficient 21 (34.4) 5.4 ± 6.5 [0–23] 0.8 ± 1.3 [0.4] 0.8 ± 1.5 [0–4] 1.0 ± 1.4 [0–4] 0.8 ± 1.0 [0–3] 0.2 ± 0.6 [0–2] 1.0 ± 1.3 [0–4] 0.8 ± 1.6 [0–5]
Eichner class (T2)
Eichner A1 4 (6.6) 2.0 ± 2.3 [0–4] 0 0 0.5 ± 0.6 [0–1] 0.5 ± 0.6 [0–1] 0 0.5 ± 1.0 [0–2] 0.5 ± 1.0 [0–2]
Eichner A2 12 (19.7) 5.1 ± 6.6 [0–3] 0.7 ± 1.1 [0–3] 1.0 ± 1.7 [0–4] 0.6 ± 1.2 [0–4] 0.5 ± 0.9 [0–3] 0.4 ± 0.8 [0–2] 0.7 ± 1.0 [0–3] 1.3 ± 2.0 [0–5]
|

Eichner A3 19 (31.1) 1.5 ± 2.5 [0–10] 0.4 ± 1.0 [0–4] 0.1 ± 0.2 [0–1] 0.4 ± 0.7 [0–2] 0.2 ± 0.5 [0–2] 0 0.3 ± 0.6 [0–2] 0.2 ± 0.4 [0–1]
957

(Continues)

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958 GRAETZ et al.

TA B L E 3 Association between factors and OHrQoL in

(questions 8, 9)

0.3 ± 0.8 [0–2]

1.3 ± 1.0 [0–2]

0.7 ± 1.2 [0–2]

0.3 ± 0.6 [0–1]
multivariable analysis

disability
Factors Coefficient SE LCL UCL p-value
Social
Constant term 25.7 4.2 17.3 34.0 <.001

0
Age (T0, per −0.2 0.1 −0.3 0 .008
year)
0.6 ± 1.3 [0–3]

1.9 ± 1.7 [0–4]

3.3 ± 2.3 [2–6]

0.3 ± 0.6 [0–1]
Physical pain
(questions 7,

Gender
13) [range]

Male 0.8 1.1 −1.3 3.0 .439

Female Reference
0

0
Smoking (T0)
(questions 6, 12)

Non-smoker −5.9 2.0 −9.9 −1.9 .004

0.7 ± 1.3 [0–3]

0.7 ± 0.6 [0–1]

Former −7.4 2.2 −11.6 −3.2 .001
disability
Physical

smoker
Smoker Reference
0
0

0
0

Stage (T0)a
Stage 2 −4.2 2.8 −9.7 1.2 .126
(questions 5, 14)

Stage 3 −1.3 1.4 −4.0 1.4 .338

1.4 ± 1.6 [0–4]
0.4 ± 0.8 [0–2]

3.3 ± 2.3 [2–6]

0.3 ± 0.6 [0–1]
Psychological

Stage 4 reference
discomfort

Grade (T0)b
Grade 2 4.4 1.6 1.3 7.4 .005
0

Grade 3 Reference
SSO criteria (T2)b
disability (questions

A+ −1.1 1.2 −3.5 1.3 .373

0.6 ± 1.5 [0–4]
1.7 ± 1.8 [0–4]

2.7 ± 3.1 [0–6]

0.3 ± 0.6 [0–1]
Psychological

A −1.8 1.2 −4.0 0.5 .128

B Reference
OHIP scores of sub-domains mean ± SD [range]

4, 11)

Adherence during SPT

0

Sufficient −2.3 1.1 −4.6 −0.1 .044

Insufficient Reference
0.6 ± 1.5 [0–4]

1.7 ± 1.5 [0–3]

0.7 ± 0.8 [0–2]

0.3 ± 0.6 [0–1]

(questions 3,

Eichner class (T2)b

Handicap

Eichner A1 −9.8 3.1 −16.0 −3.6 .002

10)

Eichner A2 −5.5 2.8 −10.9 0 .048

0

Eichner A3 −8.2 2.5 −13.2 −3.2 .001

(questions 1, 2)

Eichner B1 −8.9 3.1 −15.0 −3.0 .004

1.3 ± 1.5 [0–3]
1.0 ± 1.7 [0–4]
0.4 ± 0.8 [0–2]

1.0 ± 1.0 [0–2]

Eichner B2 −6.7 2.9 −12.4 −1.0 .021

Functional
limitation

Eichner B3 0 2.6 −5.1 5.2 .987

Eichner B4 −8.3 4.3 −16.8 0.2 .056
0

Eichner C1 −4.0 3.6 −11.1 3.1 .268

13.7 ± 9.5 [4–23]
Total OHIP–G14

2.3 ± 5.2 [0–14]

8.7 ± 6.3 [0–16]

Eichner C2 Reference
0.6 ± 1.3 [0–3]

2.7 ± 3.1 [0–6]

No. of teeth lost 0 0.1 −0.3 0.3 .915

mean ± SD

(T0–T2, per
[range]

tooth)
Abbreviation: SD, standard deviation.
1

Note: Factors were entered jointly (full model). Coefficients, standard

errors (SE), 95% CI (lower and upper confidence limits, LCL and UCL)
patients

and p-values are shown.

7 (11.5)
7 (11.5)
5 (8.2)

1 (1.6)
3 (4.9)
3 (4.9)
(Continued)

a
Coefficients for Stage 1 were not provided given that only one patient
N of

(%)

suffered from this stage.

b
Factor classes where no data were available are not shown.
Eichner C3
Eichner C2
Eichner B4
Eichner B3

Eichner C1
Eichner B2
Eichner B1
TA B L E 2

Category

long follow-up is not possible), we found periodontitis grade, but not

stage to be statistically significantly associated with OHrQol. Notably,
the statistical power to detect any association between OHrQol and

GRAETZ et al.
periodontitis was low, which should be born in mind when interpret-
ing our results. We further found non-adherent subjects, smokers and
younger patients to show statistically significantly worse OHrQol.
Overall, and the key finding of our study, OHrQol was generally good
for periodontitis patients after long-term SPT, as indicated by a mean
OHIP sum score of 3.7, when compared to the general public as de-
scribed by John et al. (2004), with sum scores of ≤11 for patients with-
out removable dental prostheses, ≤17 for patients with removable
partial dental prostheses and ≤25 for those with full dental prostheses.
It is conceivable, though, that this low impairment is not only a result
of successful treatment, but that patients fulfilling our inclusion cri-
teria may not be fully representative for the overall population (given
that they could be followed up long term); this should be born in mind.
Moreover, our cohort is older (71 years) than the general German
population (44 years; BIB, 2019), which may impact on OHIP-G14, as
discussed below. Impairment in our population largely occurred in the
subdomains “psychological disability” and “physical pain,” affirming the
outcomes of previous studies which found that periodontitis can cause
pain (El Sayed et al., 2018) and impacts on patients’ psychological per-
ception (Bäumer et al., 2018; Sonnenschein et al., 2018).
A range of aspects needs to be discussed. First, the initial stage
of periodontal disease (min. 27 years ago) was not statistically sig-
nificantly associated with today's OHRQoL. However, patients
with grade B showed higher OHIP-G14 values (7.1 ± 7.2) than those
with grade C (3.2 ± 5.2), something we ascribe to patients with a
more progressing periodontitis (grade C) at baseline being already
“primed” on having poorer oral health than those with lower grade,
while eventually, long-term tooth retention was possible in most pa-
tients regardless of their grade, hence positively contradicting the
expectations of grade C, but not grade B patients. Overall, we only
partially accept our hypothesis. The latter was grounded in the as-
sumption that disease severity, extent and progression, all reflected
in the 2018 Classification via multi-dimensional staging and grading,
are related with OHRQoL. Moreover, as staging and, more so, grad-
ing have been found to associate with long-term tooth loss, this im-
pact on OHRQoL may even aggravate long term given the different
course of the disease sequels long term. This was evidently not fully
the case. A number of reasons may explain our findings. First, our
sample generally showed more severe diagnoses; sample heteroge-
neity may have been too low to demonstrate any differences in long-
term OHRQoL between lower versus higher stages, especially as
OHRQoL was generally good. This was to some degree also true for
grade, while the differences in OHRQoL were larger between the 8
grade B and the 52 grade C patients (see above). For extent, it is fur-
ther noteworthy that only one patient showed localized periodonti-
tis, which is why no analysis at all was carried out in this direction.
Second, the limited sample size may further reduce the statistical
power to show any such differences with statistical certainty, as
demonstrated by our post hoc power calculation. Third, and possi-
bly associated with the other explanations, the cohort received sys-
tematic and successful APT and SPT, possibly mitigating the factors
underlying OHRQoL reductions, like pain or tooth loss, as discussed
initially. The ratings of treatment outcomes according to SSO criteria
|
1600051x, 2020, 8, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13324 by Cochrane Colombia, Wiley Online Library on [01/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
959
point into this direction. Bäumer et al. (2018) reported that, in a sam-
ple of 71 patients with aggressive periodontitis followed for a mean
of 10.5 years of SPT, only the psychological disability subscale of the
OHIP-G-14 was associated with treatment outcomes. Fourth, other
covariates like smoking status or adherence may be more relevant
for treatment outcomes than the initial diagnosis and may hence be
associated with OHRQoL instead of stage, for example. Compliance
and smoking status have been found to be positively associated with
patients’ oral health perception according to El Sayed et al. (2018).
Similarly, age was found to be associated with OHRQoL, with older
individuals showing a better OHRQoL (indicating some kind of cop-
ing mechanism found in the elderly). This is noteworthy, as given the
long follow-up of our study, the vast majority of our participants was
rather old at T2. Last, OHRQoL measured via OHIP does not reflect
further aspects like aesthetics, which may be affected by periodon-
titis, and OHRQoL might have been determined by a large range of
aspects beyond the initial diagnosis during the three-decade fol-
low-up. Larger and more diverse samples should be assessed to con-
firm our findings or refute them.
We also assessed the association of occlusion and masticatory
function (measured via the number of occlusal zones) and OHrQoL.
We used the classification according to Eichner (1955) that classifies
both dental arches combined. A previous study of our group found
that reconstructing at least three contact zones is highly relevant
for function; strategic tooth retention may hence be recommend-
able for this purpose (Graetz et al., 2013). Our study confirmed this,
with patients who had two or more occlusal zones showing a mean
OHIP-G14 score of ≤2.3, and patients with less than two contact
areas scores up to 13.7 (Eichner class C2). Our findings are in line
with previous studies showing that, for example, the presence of a
removable denture affects masticatory function and hence OHrQoL
(John et al., 2004); the Eichner class is a proxy for such aspects.
This study has a number of limitations, some of which have been
described above. First, it is a retrospective longitudinal study, with
treatment outcomes (tooth loss or retention) being not only the result
of the disease, but also of individual and not necessarily calibrated
decision-making. Second, we assessed OHrQoL only after long-term
SPT but not before APT; longitudinal comparisons and the detection
of trends are not possible (Ng & Leung, 2006). Third, we did not con-
sider tooth mobility in this study, as splinting had been performed
before and within APT, but also afterwards (during SPT), which may
affect mobility. Mobility is known to affect patient´s OHrQoL (Goel
& Baral, 2017). Last, our rigid inclusion criteria resulted in a small and
possibly bias sample, as discussed. Generally, generalizability of our
findings may not be given, as a very specific sample of well-compli-
ant older patients with initially severe periodontitis was treated in a
specialized university-based setting.
5 | CO N C LU S I O N
In conclusion and within the outlined limitations of this pilot
study, patients with severe periodontitis at baseline who were
 |
960
systematically treated during APT and long-term SPT showed good
OHrQoL. Dentists should keep in mind that pain and physical dis-
comfort are relevant drivers of long-term OHrQoL of periodontitis
patients. A number of aspects, grounded in the initial diagnosis, the
adherence to therapy, the resulting dentition and socio-demographic
and behavioural covariates, were associated with OHrQoL. Further
studies are needed to clarify the relationship between periodontal
status according to the 2018 Classification of Periodontal Diseases
and OHRQoL.
AC K N OW L E D G E M E N T S
The authors are grateful to Prof. Dr. H.C. Plagmann, who established
the Department of Periodontology in Kiel in 1980 and laid the foun-
dations for the databank “Parodat” in 1982 as well as to all colleges S.
Engel, U. Engelsmann, E. Haase, R. Nicolaisen, M. Kahl, B. Kuhrau, T.
Kocher, J. König, A. Rühling, J. Rabe, A. Roever, F.P. Lemke, P. Adam,
N. Gansohr, C. Springer, P. Stöckel, J. Eberhard and E. Volk who have
treated the investigated patients during the last 40 years. This study
was self-funded by the authors and their institutions.
C O N FL I C T O F I N T E R E S T
The authors have stated explicitly that there are no conflicts of inter-
est in connection with this article.
ORCID
Christian Graetz https://orcid.org/0000-0002-8316-0565
Falk Schwendicke https://orcid.org/0000-0003-1223-1669
REFERENCES
Bajwa, A., Watts, T. L., & Newton, J. T. (2007). Health control beliefs and
quality of life considerations before and during periodontal treat-
ment. Oral Health & Preventive Dentistry, 5, 101–104.
Bäumer, A., Kappesz, D., Ozga, A. K., Mertens, C., Eickholz, P., & Pretzl,
B. (2018). Oral health-related quality of life and standard of treat-
ment in aggressive periodontitis patients more than 5 years after
therapy. Journal of Clinical Periodontology, 45, 1347–1355. https://doi.
org/10.1111/jcpe.13011
BIB (2019) Durchschnittsalter der Bevölkerung (1871–2018*).
Bundesinstitut für Bevölkerungsforschung. Retrieved from: https://
www.bib.bund.de/DE/Fakte​n /Fakt/pdf/B19-Durch​s chni​t tsal​t er-
Bevoe​l keru​n g-ab-1871.pdf;jsess​i onid​=1875F​1874E​1870D​F1878​
DFADF​1816B​1704B​C A926​3 4EC9​2639.92632_cid92​3 89?__blob=-
publi​c atio​nFile​&v=92637
Borges Tde, F., Regalo, S. C., Taba, M. Jr, Siessere, S., Mestriner, W. Jr, &
Semprini, M. (2013). Changes in masticatory performance and quality
of life in individuals with chronic periodontitis. Journal of Periodontology,
84, 325–331. https://doi.org/10.1902/jop.2012.120069
Botelho, J., Machado, V., Proenca, L., Bellini, D. H., Chambrone, L.,
Alcoforado, G., & Mendes, J. J. (2020). The impact of nonsurgical
periodontal treatment on oral health-related quality of life: A sys-
tematic review and meta-analysis. Clinical Oral Investigations, 24(2),
585–596. https://doi.org/10.1007/s0078​4-019-03188​-1
Buset, S. L., Walter, C., Friedmann, A., Weiger, R., Borgnakke, W. S., &
Zitzmann, N. U. (2016). Are periodontal diseases really silent? A
systematic review of their effect on quality of life. Journal of Clinical
Periodontology, 43, 333–344. https://doi.org/10.1111/jcpe.12517
Dye, B. A. (2012). Global periodontal disease epidemiology. Periodontology
2000, 58(1), 10–25. https://doi.org/10.1111/j.1600-0757.2011.00413.x
1600051x, 2020, 8, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13324 by Cochrane Colombia, Wiley Online Library on [01/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
GRAETZ et al.
Eichner, K. (1955). Über eine Gruppeneinteilung des Lückengebisses für
die Prothetik. Deutsche Zahnarztliche Zeitschriff, 10, 1831–1834.
El Sayed, N., Baeumer, A., El Sayed, S., Wieland, L., Weber, D., Eickholz, P.,
& Pretzl, B. (2018). Twenty years later: Oral health-related quality of
life and standard of treatment in patients with chronic periodontitis.
Journal of Periodontology, 90(4), 323–330. https://doi.org/10.1002/
JPER.18-0417
Genco, R. J., & Borgnakke, W. S. (2013). Risk factors for peri-
odontal disease. Periodontology 2000, 62, 59–94. https://doi.
org/10.1111/j.1600-0757.2012.00457.x
Goel, K., & Baral, D. (2017). A comparison of impact of chronic periodon-
tal diseases and nonsurgical periodontal therapy on oral health-re-
lated quality of life. International Journal of Dentistry, 2017, 9352562.
https://doi.org/10.1155/2017/9352562
Graetz, C., Dörfer, C. E., Kahl, M., Kocher, T., Fawzy El-Sayed, K., Wiebe,
J. F., … Rühling, A. (2011). Retention of questionable and hope-
less teeth in compliant patients treated for aggressive periodon-
titis. Journal of Clinical Periodontology, 38, 707–714. https://doi.
org/10.1111/j.1600-051X.2011.01743.x
Graetz, C., Mann, L., Krois, J., Salzer, S., Kahl, M., Springer, C., &
Schwendicke, F. (2019). Comparison of periodontitis patients' clas-
sification in the 2018 versus 1999 classification. Journal of Clinical
Periodontology, 46(9), 908–917. https://doi.org/10.1111/jcpe.13157
Graetz, C., Plaumann, A., Schlattmann, P., Kahl, M., Springer, C., Salzer, S.,
… Schwendicke, F. (2017). Long-term tooth retention in chronic peri-
odontitis - results after 18 years of a conservative periodontal treat-
ment regimen in a university setting. Journal of Clinical Periodontology,
44, 169–177. https://doi.org/10.1111/jcpe.12680
Graetz, C., Salzer, S., Plaumann, A., Schlattmann, P., Kahl, M., Springer, C.,
… Schwendicke, F. (2017). Tooth loss in generalized aggressive peri-
odontitis: Prognostic factors after 17 years of supportive periodontal
treatment. Journal of Clinical Periodontology, 44, 612–619. https://doi.
org/10.1111/jcpe.12725
Graetz, C., Schwendicke, F., Kahl, M., Dörfer, C. E., Sälzer, S., Springer,
C., … Rühling, A. (2013). Prosthetic rehabilitation of patients with
history of moderate to severe periodontitis: A long-term evalua-
tion. Journal of Clinical Periodontology, 40, 799–806. https://doi.
org/10.1111/jcpe.12124
Graziani, F., Karapetsa, D., Alonso, B., & Herrera, D. (2017). Nonsurgical
and surgical treatment of periodontitis: How many options for
one disease? Periodontology 2000, 75(1), 152–188. https://doi.
org/10.1111/prd.12201
Hamp, S. E., Nyman, S., & Lindhe, J. (1975). Periodontal treatment of mul-
tirooted teeth. Results after 5 years. Journal of Clinical Periodontology,
2, 126–135. https://doi.org/10.1111/j.1600-051X.1975.tb017​3 4.x
John, M. T., Koepsell, T. D., Hujoel, P., Miglioretti, D. L., LeResche,
L., & Micheelis, W. (2004). Demographic factors, den-
ture status and oral health-related quality of life. Community
Dentistry and Oral Epidemiology, 32, 125–132. https://doi.
org/10.1111/j.0301-5661.2004.00144.x
John, M. T., Miglioretti, D. L., LeResche, L., Koepsell, T. D., Hujoel, P., &
Micheelis, W. (2006). German short forms of the oral health impact
profile. Community Dentistry and Oral Epidemiology, 34, 277–288.
https://doi.org/10.1111/j.1600-0528.2006.00279.x
Jonsson, B., & Ohrn, K. (2014). Evaluation of the effect of non-sur-
gical periodontal treatment on oral health-related quality of life:
Estimation of minimal important differences 1 year after treat-
ment. Journal of Clinical Periodontology, 41, 275–282. https://doi.
org/10.1111/jcpe.12202
Kocher, T., König, J., Dzierzon, U., Sawaf, H., & Plagmann, H. C. (2000).
Disease progression in periodontally treated and untreated pa-
tients–a retrospective study. Journal of Clinical Periodontology, 27,
866–872. https://doi.org/10.1034/j.1600-051x.2000.02701​1866.x
Kocher, T., & Plagmann, H. C. (1999). Root debridement of molars with
furcation involvement using diamond-coated sonic scaler inserts

GRAETZ et al.
during flap surgery – a pilot study. Journal of Clinical Periodontology,
26, 525–530. https://doi.org/10.1034/j.1600-051X.1999.260806.x
Lang, N. P., & Tonetti, M. S. (2003). Periodontal risk assessment (PRA)
for patients in supportive periodontal therapy (SPT). Oral Health and
Preventive Dentistry, 1, 7–16.
Levin, L., Zini, A., Levine, J., Weiss, M., Lev, R., Chebath Taub, D., …
Almoznino, G. (2018). Demographic profile, Oral Health Impact
Profile and Dental Anxiety Scale in patients with chronic periodon-
titis: A case-control study. International Dental Journal, 68, 269–278.
https://doi.org/10.1111/idj.12381
Locker, D., & Gibson, B. (2006). The concept of positive health: A re-
view and commentary on its application in oral health research.
Community Dentistry and Oral Epidemiology, 34, 161–173. https://doi.
org/10.1111/j.1600-0528.2006.00263.x
Makino-Oi, A., Ishii, Y., Hoshino, T., Okubo, N., Sugito, H., Hosaka, Y.,
… Saito, A. (2016). Effect of periodontal surgery on oral health-re-
lated quality of life in patients who have completed initial periodon-
tal therapy. Journal of Periodontal Research, 51, 212–220. https://doi.
org/10.1111/jre.12300
Manresa, C., Sanz-Miralles, E. C., Twigg, J., & Bravo, M. (2018). Supportive
periodontal therapy (SPT) for maintaining the dentition in adults
treated for periodontitis. Cochrane Database Systematic Review, 1,
CD009376. https://doi.org/10.1002/14651​858.CD009​376.pub2
Mendez, M., Melchiors Angst, P. D., Stadler, A. F., Oppermann, R. V.,
& Gomes, S. (2017). Impacts of supragingival and subgingival peri-
odontal treatments on oral health-related quality of life. International
Journal of Dental Hygiene, 15, 135–141. https://doi.org/10.1111/
idh.12193
Mombelli, A., Schmid, J., Walter, C., & Wetzel, A. (2014). Qualitätsleitlinien
in der Zahnmedizin. Parodontologie. Swiss Dental Journal, 124, 261–267.
Needleman, I., Garcia, R., Gkranias, N., Kirkwood, K. L., Kocher, T., Iorio,
A. D., … Petrie, A. (2018). Mean annual attachment, bone level, and
tooth loss: A systematic review. Journal of Clinical Periodontology,
45(Suppl 20), S112–S129. https://doi.org/10.1111/jcpe.12943
Ng, S. K., & Leung, W. K. (2006). Oral health-related quality of life and
periodontal status. Community Dentistry and Oral Epidemiology, 34,
114–122. https://doi.org/10.1111/j.1600-0528.2006.00267.x
Ohrn, K., & Jonsson, B. (2012). A comparison of two question-
naires measuring oral health-related quality of life before and
after dental hygiene treatment in patients with periodontal dis-
ease. International Journal of Dental Hygiene, 10, 9–14. https://doi.
org/10.1111/j.1601-5037.2011.00511.x
|
1600051x, 2020, 8, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13324 by Cochrane Colombia, Wiley Online Library on [01/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
961
Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H.,
… Tonetti, M. S. (2018). Periodontitis: consensus report of workgroup
2 of the 2017 World Workshop on the classification of periodontal and
peri-implant diseases and conditions. Journal of Clinical Periodontology,
45(Suppl 20), S162–S170. https://doi.org/10.1111/jcpe.12946
Ravida, A., Qazi, M., Troiano, G., Saleh, M. H. A., Greenwell, H., Kornman,
K., & Wang, H. L. (2019). Using periodontal staging and grading sys-
tem as a prognostic factor for future tooth loss: A long-term retro-
spective study. Journal of Periodontology, 91(4), 454–461. https://doi.
org/10.1002/JPER.19-0390
Shanbhag, S., Dahiya, M., & Croucher, R. (2012). The impact of periodon-
tal therapy on oral health-related quality of life in adults: A system-
atic review. Journal of Clinical Periodontology, 39, 725–735. https://
doi.org/10.1111/j.1600-051X.2012.01910.x
Slade, G. D., & Spencer, A. J. (1994). Development and evaluation of the
oral health impact profile. Community Dental Health, 11, 3–11.
Sonnenschein, S. K., Betzler, C., Kohnen, R., Krisam, J., & Kim, T. S.
(2018). Oral health-related quality of life in patients under support-
ive periodontal therapy. Acta Odontologica Scandinavica, 76, 572–
579. https://doi.org/10.1080/00016​357.2018.1483528
Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grad-
ing of periodontitis: Framework and proposal of a new classification
and case definition. Journal of Clinical Periodontology, 45(Suppl 20),
S149–S161. https://doi.org/10.1111/jcpe.12945
van Winkelhoff, A. J., Rams, T. E., & Slots, J. (1996). Systemic antibiotic
therapy in periodontics. Periodontology 2000, 10(1), 45–78. https://
doi.org/10.1111/j.1600-0757.1996.tb000​68.x
S U P P O R T I N G I N FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section.
How to cite this article: Graetz C, Schwalbach M, Seidel M,
Geiken A, Schwendicke F. Oral health-related quality of life
impacts are low 27 years after periodontal therapy. J Clin
Periodontol. 2020;47:952–961. https://doi.org/10.1111/
jcpe.13324