FEATURES OF THE CLINICAL COURSE OF PERIODONTITIS DEPENDING ON THE LEVEL OF PSYCHO-EMOTIONAL STRESS IN INDIVIDUALS LIVING IN KYIV ON A PERMANENT OR TEMPORARY BASIS

Abstract

The issue of determining the characteristics of the clinical course of periodontal diseases in the civilian population of Kyiv depending on the level of psycho-emotional stress remains highly relevant. In this context, a comparative study of individuals who have been permanently resident in Kyiv since the start of the full-scale war and internally displaced persons from the temporarily occupied territories of Ukraine is of particular interest. Both population groups are exposed to military stressors, but differ in the nature of the events they have experienced, the extent to which their usual social environment has been disrupted, and the need to adapt to new living conditions. Purpose of the study. To investigate the features of the clinical course of periodontitis in persons permanently residing in Kiev and internally displaced persons from the temporarily occupied territories of Ukraine, depending on the severity of the level of psychoemotional stress, estimated by the total PHQ-9 indicator. Materials and methods. A total of 189 patients were examined and divided into two groups: Group I (136 individuals) – residents of Kyiv who had not left the city from February 2022 to the present; Group II (53 individuals) – internally displaced persons (IDPs) from the temporarily occupied territories of Ukraine. Both groups were comparable in terms of age (19–57 years). In patients from both groups, the level of psychological distress (PHQ- 9) was assessed in accordance with the recommendations of K. Kroenke, R. L. Spitzer and J. B. W. Williams (2001). The objective periodontal examination included a clinical examination of the oral cavity and an objective assessment of the condition of the periodontal tissues using the following periodontal indices: PMA, pocket depth, VEP, bleeding and pus discharge from the pockets, gingival recession, and pathological tooth mobility. The diagnosis of periodontal diseases was carried out according to the EFP classification (2017). Statistical analysis of the results was performed using methods of variational statistics. Results. Among patients in Group I, minimal (0–4 points on the PHQ-9) and mild (5–9 points on the PHQ-9) levels of psychological distress predominated, with a diagnosis of gingivitis and, predominantly, stage I and II periodontitis. In some patients with a level of psychological stress of 5–9 points on the PHQ-9, gingival recession with exposure of the tooth necks and roots was diagnosed, accompanied by complaints of hyperaesthesia of the hard dental tissues, predominantly of grades I and II. Among patients in Group II, signs of a more severe course of stage II and III periodontitis were identified against a background of increased levels of psychological stress (10–14 and 15–19 points on the PHQ-9). Thus, a comparison of the two groups revealed that patients in Group II predominantly exhibited higher levels of psychological stress (10–14 and 15–19 points on the PHQ-9) and, in the majority of cases, were diagnosed with periodontitis at advanced stages: stages II and III, with more pronounced signs of exacerbation of the inflammatory-dystrophic process in the periodontium. Conclusions. In some patients with periodontitis, signs of recession may be observed alongside a relatively moderate level of psychological stress, accompanied by hyperaesthesia of the hard tissues of the teeth, whereas when the total PHQ-9 score rises to 10–14 points or higher‒15-19 points‒signs of inflammatory-dystrophic damage to periodontal tissues begin to predominate in the clinical presentation. In patients in Group I (permanent residents of Kyiv), against a background of minimal (0–4 points on the PHQ-9) and mild (5–9 points on the PHQ-9) levels of psycho-emotional stress, gingivitis and periodontitis were diagnosed, predominantly at stages I and II. In patients in Group II (internally displaced persons), against a background of higher levels of psychoemotional stress (up to 10–14 and 15–19 points on the PHQ-9), signs of a more severe course of advanced periodontitis at stages II and III were identified.