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Study finds people with external locus of control at elevated risk of severe periodontal disease

A French study has suggested that people who believe that the events in their lives are determined by external forces rather than their own actions may be at greater risk of severe periodontal disease. (Image: Roman Samborskyi/Shutterstock)
Dental Tribune International

Dental Tribune International

Thu. 23. June 2022


COPENHAGEN, Denmark: A study conducted by researchers in France has suggested that people who believe that external factors—such as luck or chance—determine the course of their lives may be more likely to experience severe periodontal disease than those who think their own actions are mainly responsible. The findings were presented last week at the tenth EuroPerio, the leading congress in periodontics and implant dentistry, organised by the European Federation of Periodontology.

The study examined the relationships between people’s beliefs, oral health, and socio-economic and psychological factors. Regarding their belief system, patients were categorised as having an external or internal locus of control. Lead author Dr Sébastien Jungo of Université Paris Cité in France explained in a press release: “Locus of control is the extent to which people believe that the outcomes of life events are due to their own actions (internal locus of control) or factors over which they have little influence (external locus of control). For example, students who fail an exam more readily attribute the result to an outside cause (e.g. difficult exam, bad luck) if they have an external locus of control but to their own mistakes or lack of work if they have an internal locus of control.”

For the study, data on the lifestyle and socio-economic factors of 79 consecutive patients who attended a periodontal consultation at the Bretonneau university hospital in Paris was collected. They completed questionnaires to determine their locus of control, stress level and mood. In addition, the participants’ degree of plaque control and number of teeth were recorded, and they were taught how to perform good oral hygiene.

It was determined that 20 patients (25%) had an external locus control and 59 (75%) an internal one. The median depressed mood score was twice as high in the first group, compared with the second. With regard to education levels, the researchers found that approximately 75% of the external locus group had a low education level, compared with around 50% of the internal locus group.

In a follow-up approximately two weeks later, severity of periodontal disease was assessed by measuring bleeding on probing, pocket depth and maximum attachment loss. The research team found the average number of lost teeth was three for the external locus group and one for the internal locus group. The maximum attachment loss was significantly higher in the external locus group than in the control group.

“The finding that this belief system is linked with oral health should encourage dental professionals to assess the emotional state of their patients and, if necessary, refer them to appropriate psychological care,” commented Dr Jungo. “A few simple questions should be asked, such as: ‘According to you, what causes your disease?’ and ‘How can it be treated?’. Answers to these questions could be important for optimising adherence to treatment.”

The research team conducted statistical analyses to examine the association between locus of control, oral health status, and socio-economic and psychological factors, adjusted for factors that might influence the relationships. External locus of control belief was significantly associated with depression score, education level, number of teeth and maximum attachment loss.

“Having an external locus of control was independently associated with more tooth loss and attachment loss, indicating greater severity of periodontitis,” said Dr Jungo.

He continued: “In addition, these patients were more likely to be depressed and have a lower education level. The findings suggest that this group may need encouragement to consider periodontitis a manageable disease, particularly if they are feeling low.”


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