|Year : 2019 | Volume
| Issue : 4 | Page : 301-305
Association between dental caries, periodontal status, and personality traits of 35–44-year-old adults in Bareilly City, Uttar Pradesh, India
Anushka Gupta1, Nagesh Laxminarayan Shetty2
1 Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly International University, Bareilly, Uttar Pradesh, India
2 Department of Public Health Dentistry, Dayananda Sagar College of Dental Sciences, Bangalore, Karnataka, India
|Date of Submission||28-Jun-2018|
|Date of Decision||06-Nov-2019|
|Date of Acceptance||25-Oct-2019|
|Date of Web Publication||12-Dec-2019|
Dr. Anushka Gupta
Department of Public Health Dentistry, Institute of Dental Sciences, Pilibhit By-Pass Road, Bareilly, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: A majority of human diseases are said to have psychosomatic origin. Certain pathologic entities have already been accepted to have a psychological basis. Personality of an individual is one such psychological entity, but the research on relationship between personality traits and oral diseases is scarce. Aim: To find an association between the personality traits of the participants and their dental caries and periodontal status. Materials and Methods: A descriptive survey (questionnaire + clinical examination) using consecutive sampling technique was conducted. The study population consisted of 450 adults, aged 35–44 years. Sociodemographic details, oral hygiene practices, dental health seeking behavior, dietary practices, decayed–missing–filled teeth (DMFT) index, and community periodontal index were recorded. Eysenck Personality Questionnaire Revised-Short Form (Hindi version) was used to measure personality traits. The data were analyzed using SPSS version 19. Kruskal–Wallis ANOVA followed by Mann–Whitney U-test (post hoc), linear regression analysis using enter method, and logistic regression analysis were done. Results: As per the lie scale, 72 individuals were excluded, of which only 375 were further analyzed. There were 282 (62.7%) extroverts, 76 (16.9%) neurotics, 17 (3.8%) were a combination of extroversion and neuroticism, and 3 (0.7%) were a combination of extraversion and psychoticism. Dental caries (P = 0.002) and periodontal disease (P = 0.005) were significantly less in extroverts in comparison to other personality traits. Conclusions: Among different personality traits, extroverts were found to have lesser dental caries and better periodontal status. Thus, personality traits as one of the determinants of oral health may throw more light on the psychosomatic link of oral diseases, hence on the importance of behavior management.
Keywords: Extraversion, neuroticism, periodontal disease, personality traits, psychology, psychotics, questionnaire
|How to cite this article:|
Gupta A, Shetty NL. Association between dental caries, periodontal status, and personality traits of 35–44-year-old adults in Bareilly City, Uttar Pradesh, India. J Indian Assoc Public Health Dent 2019;17:301-5
|How to cite this URL:|
Gupta A, Shetty NL. Association between dental caries, periodontal status, and personality traits of 35–44-year-old adults in Bareilly City, Uttar Pradesh, India. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2021 Apr 11];17:301-5. Available from: https://www.jiaphd.org/text.asp?2019/17/4/301/272781
| Introduction|| |
Recently, instead of regular risk factors, combined influence of lifestyle, education, psychosocial factors, and socioeconomic factors is given more emphasis when dealing with chronic illnesses. The “causes of the causes” or the “root causes” have gained more attention, and therefore, the focus has shifted from one-to-one cause to multifactorial approach in disease causation. Various psychological factors have also been considered as implicated in disease etiology. The hypothesis of a relationship between psychological factors and bodily dysfunction has been in existence since long. There is substantial experimental research output leading to the acceptance of certain pathologic entities having a psychological basis. Moreover, certain scientific works have yielded inferences that oral pathological conditions could have psychosomatic bases. Manhold and Manhold were the ones who presented the first attempt of establishing a statistical correlation between dental disorders and psychological factors.
One such psychological as well as biological factor is personality. Personality is the blend of characteristics or qualities that form an individual's distinguishable characteristic. Personality characteristics appear to affect the oral health. Oral health status of people with particular personality behavior differs from others. Research into the association between personality and oral health has shown at least three processes which can explain the biological plausibility between the two:
- First, some particular personality traits may predispose to poor oral health, like predisposition to bruxism may lead to temporomandibular joint dysfunction, among individuals who score more highly on the trait of aggressiveness
- Second, some personality traits are associated with health-damaging behaviors and therefore may predispose to poor oral health. For example, individuals who have poor self-control might be more likely to smoke and consequently might suffer periodontitis and oral cancer
- Third, personality characteristics may also determine the way in which individuals react to or interpret their symptoms and thus construct their illness state. For example, those who score highly on stress reaction might interpret their oral symptoms as being more disastrous than would their low scoring counterparts.
There are various measures available to assess an individual's personality. The one used in this study is Eysenck Personality Questionnaire (EPQ) Revised-Short Form (EPQR-S). It measures three personality traits, namely extraversion, neuroticism, and psychoticism.
- Extraversion dimension represents sociality and impulsivity; thus, the individuals in this dimension have been defined as enjoying social interactions, energetic, and preferring social situations to loneliness
- Neuroticism dimension indicates emotional instability and reactiveness, and individuals who score high on this dimension tend to be anxious, depressive, overly emotional, shy, and have low self-esteem
- Psychoticism dimension highlights more bizarre personality characteristics, such as being distant, cold, insensitive, absurd, and unable to empathize with others.
Although there are few reports suggesting relationship between the personality traits and oral diseases, the research in this connection is scarce. Hence, the aim of the present study was to identify any association existing between the personality traits of the participants and their dental caries and periodontal status. The objectives of the study were to determine dental caries and periodontal status among 35–44-year-old attendants of patients visiting Rohilkhand Medical College and Hospital (RMCH) and patients and their attendants visiting Institute of Dental Sciences (IDS), Bareilly.
| Materials and Methods|| |
Consecutive sampling technique was used in this study. The study population consisted of 450 adults aged 35–44 years who were the patients and their attendants visiting IDS and attendants of patients visiting RMCH from August 19, 2015, to August 31, 2015. This age group was selected as it is the standard age group for surveillance of oral health conditions in adults. The sample size was calculated based on the prevalence obtained from 2004 survey of oral diseases in rural India. The prevalence recorded was 79.2% and 89.2% for dental caries and periodontal disease, respectively. Because periodontal disease prevalence was higher, it yielded lesser sample size. Therefore, dental caries' prevalence was used for calculation. The formula used for sample size calculation was n = 4pq/l 2. The allowable error was set at 6%. The minimum sample size required was 292. To allow for exclusion of participants based on the lie scale, the final sample size was chosen to be 450.,, The individuals were selected based on the eligibility criteria.
Adults who were either patients and their attendants visiting IDS or the attendants of patients visiting RMCH, aged 35–44 years with minimum of 20 permanent teeth, were included in the study. Those who gave voluntary, written informed consent and were mentally fit to answer the questions were included. Adults with any systemic illness or undergoing any medications such as antibiotics during the previous 4 weeks or those under professionally monitored plaque control program and pregnant females were excluded from the study.
Instruments used in the study were EPQR-S – Hindi edition (EPQRS-H), decayed–missing–filled teeth (DMFT) index (WHO modification 2013), and community periodontal index (CPI). EPQRS-H is a Hindi edition of EPQR-Short. It is a self-reported questionnaire. It consists of 48 items, of which 12 each represent traits of neuroticism, extraversion, and psychoticism and 12 items are for the lie scale. The lie subscale represents a control scale through which whole scale is tested for social desirability bias. Each question has a binary response, “yes” or “no” which is scored as 1 or 0, respectively, and each scale has a maximum possible score of 12 and minimum score of 0.
A self-administered pro forma was prepared for the purpose of data collection. The following data were collected pertaining to name, age, gender, education, occupation, details on socioeconomic status (SES), oral hygiene practices, dental health-seeking behavior, and dietary practices. The pro forma also included EPQRS-H to assess the personality characteristics. It also had provision to record DMFT and CPI values after clinical examination. The American Dental Association Type III clinical examination was conducted using a plane mouth mirror, CPI probe, and an artificial light source. All individuals were examined within the college premises by a single examiner who was trained and calibrated and showed intraexaminer consistency of 82% (κ = 0.82).
Ethical approval was obtained from the Institutional Review Board of IDS. Prior permissions were taken from IDS and RMCH. Voluntary written informed consent was obtained from every participant before conducting the survey. The participants were assured that the information would be kept completely confidential.
The data were entered into the Microsoft Office Excel 2007 sheet and were analyzed using IBM SPSS version 19. Kruskal–Wallis ANOVA followed by Mann–Whitney U-test (post hoc) was used to compare the dental caries experience (DMFT) and periodontal status (CPI) among different personality traits. Linear regression analysis using enter method and logistic regression analysis were done to control the confounders when analyzing differences in DMFT and CPI scores, respectively. For logistic regression, the individuals were categorized into two categories, one with CPI score <2 and the other with CPI score >3, on the basis of their highest recorded CPI scores. P < 0.05 was considered statistically significant.
| Results|| |
As per the lie scale, 72 individuals were excluded, of which only 378 (84.0%) were considered for further analysis. There were 282 (62.7%) extroverts, 76 (16.9%) neurotics, 17 (3.8%) were a combination of extraversion and neuroticism, and 3 (0.7%) were a combination of extraversion and psychoticism. As the number of individuals showing a combination of extraversion and psychoticism as their personality type was very less, they were also excluded and the final analysis was carried out on 375 individuals.
When the dental caries experience of individuals with different personality traits was analyzed, there was a statistically significant difference in the mean missing teeth between the three groups (E, N, and E + N) as found by Kruskal–Wallis ANOVA at P < 0.001 [Table 1]. The post hoc test revealed that only the mean missing teeth between Group E (0.88 + 2.20) and Group E + N (2.12 + 1.27) was found to be statistically significant at P = 0.001 [Table 2]. The combination of extroversion and neuroticism contributed for a higher missing score.
|Table 1: Dental caries experience of individuals with different personality traits|
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A statistically significant difference in the mean caries experience between the three groups (E, N, and E + N) was found by Kruskal–Wallis ANOVA at P = 0.002 [Table 1]. A statistically significant difference was found in caries experience as measured by mean DMFT score between Group E (1.90 + 2.86) and Group N (2.79 + 3.44) at P = 0.02, followed by a statistically significant difference between Group E (1.90 + 2.86) and Group E + N (2.82 + 1.29) at P = 0.003 [Table 2]. Neuroticism alone and in combination with extroversion has contributed for significantly higher caries experience when compared to extroversion alone.
When the periodontal health status of individuals with different personality traits was analyzed, a statistically significant difference in the mean sextant value for score 0 in CPI between E, N, and E + N groups was found by Kruskal–Wallis ANOVA at P = 0.005 [Table 3]. The mean sextant value for score 0 in CPI was found to be statistically significant between Group E (3.26 + 1.77) and Group N (2.53 + 1.60) at P = 0.001 [Table 4]. The mean sextant value for score 0 in CPI was statistically significant between Group N (2.53 + 1.60) and Group E + N (3.00 + 1.73) at P = 0.001. This suggests that only neuroticism and neuroticism in combination with extroversion show poorer periodontal health.
|Table 3: Periodontal health status of individuals with different personality traits|
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A statistically significant difference in the mean sextant value for score 1 in CPI between E, N, and E + N groups was found by Kruskal–Wallis ANOVA at P = 0.040 [Table 3]. Further post hoc showed that the difference in the mean sextant value for score 1 between Group E (0.32 + 0.69) and Group E + N (0.00 + 0.00) was statistically significant at P = 0.03 [Table 4]. The mean sextant value between Group N (0.37 + 0.63) and Group E + N (0.00 + 0.00) was also found to be statistically significant at P = 0.01. The Group E + N was relatively free of score 1 when compared to Group E and Group N.
A statistically significant difference in the mean sextant value for score 2 in CPI between E, N, and E + N groups was found by Kruskal–Wallis ANOVA at P = 0.011 [Table 3]. For score 3 on CPI, the differences between the groups were found to be statistically not significant at P = 0.126. Further post hoc analysis revealed that the difference in the mean sextant value for score 2 between Group E (2.32 + 1.57) and Group N (2.95 + 1.52) was found to be statistically significant at P = 0.003 [Table 4]. Neurotic individuals were found to have poorer periodontal health when compared to extroverts.
The selected output from linear regression analysis done in order to find out the effect of multiple predictor variables, namely age, gender, residence, education, SES, past dental visits, frequency of sweets consumption, and classification of personality into three classes (E, N, and E + N) on DMFT (caries experience) as the outcome variable is shown in [Table 5]. As many of these predictor variables were not controlled at the design stage, there aroused a need to control them during statistical analysis by applying regression. Age, gender, and frequency of sweets consumption were found to be confounders in the study with P < 0.05.
|Table 5: Linear regression analysis for decayed, missing, and filled teeth|
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To understand the influence of confounders, namely age, gender, SES, frequency of cleaning teeth, frequency of rinsing mouth, past dental visits, and classification of personality traits into E, N, and E + N as explanatory variables on the CPI scores as the outcome variable, logistic regression was done [Table 6]. Only frequency of cleaning teeth was found to be a strong confounder with P = 0.002. The rest of the explanatory variables were found to have not confounded the results.
| Discussion|| |
The present study is a cross-sectional survey conducted among 450 individuals visiting IDS and RMCH as patients or their attendants. The data on personality traits were collected using EPQRS-H, which is a self-reported questionnaire. In its preliminary version, according to the two psychologists Hans Jurgen Eysenck and Sybil B. G. Eysenck, the Eysenck personality theory involved neuroticism–stability and extraversion–introversion dimensions  and led to the development of Eysenck personality inventory which had 57 items. Later, the psychoticism dimension was added to the theory. This scale had some psychometric weaknesses due to which it was improved to produce EPQ-R  (revised form) which had 100 items. Inception of Eysenck personality theory led to the development of various measures to assess different personality traits. The upshot to this was the progressive increase in the length of questionnaires. Despite good reliability and validity of all these questionnaires, their length posed some practical disadvantages, particularly when applying them clinically. Therefore, the need for shorter length of personality questionnaires resulted in shorter versions of the instruments. One of these shorter personality scales is the EPQR-S. This questionnaire was chosen as it had lesser number of questions when compared to other personality scales, leading to lesser fatigue and better response. It has also been standardized and validated in the Indian population.
DMFT (WHO 2013 modification) and CPI were used as they are the most commonly and widely accepted indices used for measuring dental caries and periodontal disease, respectively. In this study, extroverts were found to have less dental caries and periodontal disease when compared to other personality traits. This finding was in discordance with the findings reported by some other studies.,,, This finding can be explained on the basis that extroverts are socially more active and have to be presentable at all points of time. Therefore, they might be consciously or unconsciously maintaining their oral hygiene well because of which they were found to have less dental caries and better periodontal status. Being extroverts they create more opportunities for knowledge interactions and in the process may have better awareness and oral health literacy.
Behavioral science offers scope for understanding the behavioral traits and their influence on health. Oral health status of individuals and populations are found to be influenced by the behavior as documented in some of the studies., Personality traits reflect the behavior of a person, thereby providing a clue to the psychosomatic origin of diseases. Dental caries and periodontal disease do have complex etiology which is multifactorial, including some modifiable risk factors and some nonmodifiable risk factors. Public health personnel are interested in understanding the modifiable risk factors associated with dental caries and periodontal disease because appropriate interventions can modify these risk factors, resulting in prevention and alleviation of disease. In the current study, extroversion in combination with neuroticism has been found to be a risk factor for dental caries and also periodontal disease. Alone extroversion was not significantly associated and alone neuroticism had some association with dental caries and periodontal status; hence, neuroticism may be considered as a risk factor for dental caries and as well periodontal disease. The high stung behavior of neurotics probably would lead to some pathological changes in the stomatognathic system impairing the protective mechanism, thus resulting in dental caries and periodontal disease.
Eysenck's questionnaire is a lengthy questionnaire having 48 questions. It can result in some amount of fatigue in the patient when answering. The educational status of the individuals can also influence the results because the questions need to be comprehended correctly. The current study may contain few biases of such kind and that constitutes the limitations of the study. Probably, more studies on different populations from multiple centers around the world are required to better ascertain the association of personality traits and oral health.
| Conclusions|| |
This study showed that extroverts had less dental caries and better periodontal status when compared to other personality traits. As determinants of oral health, personality traits may throw more light on the psychosomatic link of oral diseases. This furthers the importance of behavior management, which might eventually lead to better oral health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]