Associations of Social Psychological Factors and OHRQoL in Periodontitis Patients: A Structural Equation Modeling Study

Abstract

Background and purpose: Periodontitis is the leading cause of tooth loss in adults worldwide. The functional loss, nutritional deficiencies, and psychological barriers it causes, as well as its impact on overall health and quality of life, are all significant. The prevalence of periodontal disease is high in China. Our study aimed to determine the intricate relationship between periodontal disease status, dental anxiety, self-rated oral health (SROH), self-efficacy for oral care, perceived social support, socioeconomic status (SES), and the oral health-related quality of life (OHRQoL) among periodontitis patients.

Methods: This cross-sectional study used purposive sampling to identify 247 patients with periodontitis who entered the First Affiliated Hospital of Bengbu Medical University between October 2022 and October 2023. 247 participants underwent a periodontal clinical examination combined with imaging, adhering to the "2018 world new classification of periodontal and peri⁃implant diseases and conditions". Participants also completed a detailed questionnaire in paper format, which included OHRQoL, sociodemographic details, dental anxiety, SROH, self-efficacy in oral care, perceived social support, and subjective SES.

Results: Dental anxiety, self-efficacy for oral care, and SROH all had a direct and significant effect on OHRQoL. OHRQoL was indirectly related to SROH mediated by dental anxiety and subjective SES, perceived social support and self-efficacy for oral care, respectively. SROH was directly related to subjective SES, and at the same time, they had a direct effect on dental anxiety. Furthermore, patient's age, gender, annual household income, and education level were significantly associated with the degree of periodontal disease.

Conclusion: OHRQoL and periodontal status was influenced by socio-demographics characteristics, dental anxiety, SROH, self-efficacy for oral care, perceived social support, subjective SES in periodontitis patients. These insights underscore the importance of adopting a holistic approach in the management and treatment of periodontal diseases.

Keywords: oral health-related quality of life; periodontitis; self-rated oral health; structural equation modeling.

Figure 1

The ideal SEM. Ellipses represent latent variables, rectangles represent observed variables. Yellow represents oral-related psychological factors, blue represents social-related psychological factors.

Figure 2

Disparities in periodontitis stagings among different ages (a), educational levels (b), genders (c) and annual household income (d).

Figure 3

The correlation between SROH and OHIP-14 scores at various education (a) and income levels (b).

Figure 4

Direct effects in the final model (bootstrapped standardized estimates). Solid lines represent direct effects. Ellipses represent latent variables, rectangles represent observed variables. Yellow represents oral-related psychological factors, blue represents social-related psychological factors. *p<0.05; **p < 0.01; ***p < 0.001.

Figure 5

Indirect effects in the final model (bootstrapped standardized estimates). Dashed lines represent indirect impacts. The red and blue solid lines represent two different indirect paths respectively. Ellipses represent latent variables, rectangles represent observed variables. *p<0.05; **p < 0.01; ***p < 0.001.