Periodontal Assessment in Depression Patients
Condition: Periodontitis; Depression
MeSH terms: Periodontitis; Depression; Depressive Disorder
Study type: Observational

Summary: 
      To assess the periodontal status in the patients with depression. Evaluation of periodontal
      status in patients with mild depression. Evaluation of periodontal status in patients with
      moderate depression. Evaluation of periodontal parameters in patients without depression.
    

Detailed description: 
      Periodontitis, a periodontal disease, results from interaction between the immune system and
      oral bacteria that may promote oxidative stress and initiate an inflammatory cascade inducing
      the destruction of the oral structure.

      The immune-microbial pathogenesis of periodontitis involves chronic inflammation, which
      alters the balance among multiple systems, including the neural, immune, and endocrine
      systems. Multiple systemic conditions, such as diabetes, cardiovascular diseases, and
      respiratory diseases, have been shown to have an inflammatory association with periodontitis,
      and pro-inflammatory cytokines such as tumor necrosis factor (TNF)-a, interleukin (IL)-1, and
      IL-6 are involved. In addition, distress experienced by the patients with periodontitis
      showed correlation with the progression of periodontitis. Studies have demonstrated that
      chronic stress and depression fall into a spectrum and could induce dysregulation of the
      immune system, impairing the course of periodontitis.

      Depression, a disabling psychiatric disorder, manifests with depressed mood, vegetative
      symptoms, and cognitive impairment, and could impair the personal life quality and physical
      function. In 2015, this mental disorder was classified as the third main cause of global
      disability . It is a well established and important risk factor for many systemic conditions,
      including obesity, sleep disturbance, and chronic diseases . In addition to the general
      health conditions, oral diseases have also been associated with depression . Although some
      biomarkers were reported to be associated with depression, such as inflammatory cytokines,
      the serum level of neurotropic factors, and the hypothalamic-pituitary-adrenal (HPA) axis
      hormone, the clinical use are still unclear.

      In the last years, most studies have drawn attention to a contribution of depression to poor
      oral health status . Conversely, there are researchers investigating a possible influence of
      oral health conditions on depression suggesting a bi-directional relationship between oral
      health and mental disorders. Therefore, it can be hypothesized that treatment of
      periodontitis may lead to improvement in the depression score in patients.

      Only few cross-sectional studies have been conducted evaluating association of depression and
      periodontitis that too in high income countries (Finland, USA and Korea) and the results are
      inconclusive. So the present study will be conducted in our country to evaluate association
      of periodontitis and depression to provide high level of evidence.

      STUDY DESIGN AND SETTINGS The present cross sectional study will be conducted in the
      department of Periodontology , PGIDS, Rohtak in collaboration with the department of
      Psychiatry, PGIMS, Rohtak. This will be an observational cross sectional study.

      STUDY PERIOD February 2020 to April 2021

      METHOD OF RECRUITMENT Patients in test groups will be recruited from the Outpatient
      Department of Psychiatry, Post Graduate Institute of Medical Sciences, Rohtak. Patients in
      control group will be recruited from Department of Oral Medicine and Radiology, Post Graduate
      Institute of Dental Sciences, Rohtak.

      BLINDING/MASKING Single blinding will be adopted where the operator assessing the periodontal
      parameters will be unaware regarding which group the patient belongs.

      PERIODONTAL PARAMETERS :- Indices will be taken at baseline. These will be:- Plaque index
      Gingival index Probing pocket depth Clinical attachment loss Bleeding on probing
    

Intervention name(s): periodontal status in mild depression patients; periodontal status in moderate depression patients; periodontal status in systemically healthy patients
Intervention type(s): Other; Other; Other
Intervention description(s): Assessment of periodontal status in mild depression patients; Assessment of periodontal status in moderate depression patients; Assessment of periodontal status in systemically healthy patients
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        the study patients having mild and moderate depression as well as systemically healthy will
        be included .