Internalized Stigma and Tooth Loss Due to Periodontitis

Tooth loss due to periodontitis refers to the extraction or spontaneous exfoliation of a tooth as a direct consequence of the progressive destruction of the tooth-supporting structures, including the periodontal ligament, alveolar bone, and connective tissue attachment. This destruction results from chronic inflammation and tissue breakdown caused by periodontal pathogens. Teeth are considered lost due to periodontitis when mobility, severe attachment loss, and bone resorption render them non-functional, painful, or unsalvageable despite periodontal therapy.

Internalized Stigma of Mental Illness Scale assessment was performed in patients with tooth loss due to periodontitis.Internalized Stigma of Mental Illness Scale is a Likert-type scale calculated as 'strongly disagree' (1 point), 'disagree' (2 points), 'agree' (3 points), 'strongly agree' (4 points).High scores on this scale indicate how aggressive the person's internalized stigma is negatively.

Sociodemographic data such as age, gender, marital status, education level, income level, smoking status, presence of systemic diseases, reason for referral, and frequency of tooth brushing were recorded.Internalized Stigma of Mental Illness Scale is a Likert-type scale calculated as 'strongly disagree' (1 point), 'disagree' (2 points), 'agree' (3 points), 'strongly agree' (4 points).High scores on this scale indicate how aggressive the person's internalized stigma is negatively.

These measurements were taken at specific sites around each tooth via a Williams periodontal probe.

The Plaque Index (PI), as described by Silness and Löe, is used to assess the thickness of plaque at the gingival area.Without using disclosing agents, the presence of plaque is assessed visually and by gently passing the probe along the gingival margin. Each surface is scored on a scale from 0 to 3:

Score 0: No plaque.

Score 1: A film of plaque adhering to the free gingival margin and adjacent area of the tooth, detectable only by running a probe across the tooth surface.

Score 2: Moderate accumulation of soft deposits within the gingival pocket or on the tooth and gingival margin, visible to the naked eye.

Score 3: Abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin.

The GI was measured at six sites per tooth, according to Löe & Silness: 0- Normal gingiva; 1- Mild inflammation with slight color change, mild alteration of gingival surface structure and no bleeding on probing; 2- Moderate inflammation with edema, redness, swelling and bleeding on probing; 3- Severe inflammation with marked edema and redness, ulceration and tendency to bleed spontaneously.These measurements were taken at specific sites around each tooth via a graduated periodontal probe.

Probing pocket depth were taken at six sites/tooth and recorded using a Williams periodontal probe. PPD is measured as the distance from the gingival margin to the base of the gingival sulcus or periodontal pocket. A calibrated periodontal probe is gently inserted parallel to the long axis of the tooth into the sulcus or pocket until slight resistance is felt at the base. The depth is recorded in millimeters at six sites per tooth: mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual. This measurement reflects the current inflammatory status and pocket formation around the tooth.

The CAL is measured by determining the distance from the cementoenamel junction (CEJ) to the base of the periodontal pocket or sulcus. A calibrated periodontal probe is gently inserted into the gingival sulcus or pocket, and the probing depth (PD) is recorded. If the gingival margin is located coronal to the CEJ, the distance from the gingival margin to the CEJ is subtracted from the probing depth. If the gingival margin is apical to the CEJ (in cases of recession), this distance is added to the probing depth. The resulting value represents the CAL, which reflects the extent of periodontal support loss.