Relationship of clinical depression to periodontal treatment outcome

Depression has been associated with periodontal disease; however, its relationship to periodontal treatment outcome (PTO) has not been investigated.

Data were obtained by chart abstraction and computer databases on 1,299 health maintenance organization (HMO) patients aged 30 to 64 who had concurrent medical, dental, and pharmacy benefits, and who had an initial periodontal examination during 1996, 1997, or 1998. Depression (yes/no) was the main independent variable and was determined by presence of any diagnosis code for depression on the patient record. PTO was determined by the difference in percent of sites with probing depth (PD) > or = 5 mm between the initial and 1-year post-treatment periodontal exams. Sub-median periodontal treatment outcome (SMPTO) was defined as a reduction in fewer than the median percent of sites (7.33%) with PD > or = 5 mm. Information on sociodemographics, periodontal therapy, calculus and plaque, number of remaining teeth, smoking, antidepressant medications, and diabetes were collected.

A total of 697 patients had a periodontal exam at both baseline and follow-up. Of these, 12.2% had depression. In a multivariable logistic model, depression (odds ratio [OR] 2.16, 95% confidence interval [Cl] 1.12 to 4.16) and 4-month recall treatment (OR 2.34, Cl 1.46 to 3.75) were associated with SMPTO, while percent of sites at baseline with PD > or = 5 mm (OR 0.93, Cl 0.91 to 0.94), number of remaining teeth at baseline (OR 0.94, Cl 0.89 to 0.99), and number of teeth lost during the study period (OR 0.75, Cl 0.58 to 0.96) were negatively associated. Periodontal surgery, age, gender, smoking, plaque, calculus, diabetes, and antidepressant medication were not significant in the model.

Clinical depression may have a negative effect on periodontal treatment outcome in this group model HMO population.