Evaluation of the effects of periodontal treatment and botulinum toxin treatment applied as support on quality of life scales, clinical periodontal and biochemical parameters in individuals with periodontal disease

Aim: Periodontal diseases are common inflammatory conditions that can affect individuals' quality of life and systemic biomarker levels. This study aimed to evaluate the effects of botulinum toxin administration as an adjunct to periodontal treatment on quality of life scores and salivary MMP-8 levels in individuals with treated periodontal disease. Materials and Methods: A total of 50 individuals were included in the study from among 69 systemically healthy participants aged between 18 and 45 years who had been diagnosed with periodontal disease and had completed their treatments. All participants received periodontal treatment and were divided into three groups: the group that received non-surgical periodontal therapy only (COPT), the group that underwent surgical periodontal therapy (CPT), and the group that received non surgical therapy in combination with botulinum toxin administration (COPT+BT). Clinical periodontal parameters including Plaque Index (PI), Gingival Index (GI), Clinical Attachment Loss (CAL), Probing Pocket Depth (PPD), and Bleeding on Probing (BOP) were recorded before and after treatment. Questionnaire assessments were administered to each participant, and unstimulated whole saliva samples were collected. Demographic data were recorded, and quality of life was evaluated using the OHIP-14TR, PAPS, and Rosenberg Self-Esteem Scale (RSES). Post-treatment evaluations were conducted 1 month after treatment in the COPT group, 3 months after treatment in the CPT group, and 6 months after treatment in the COPT+BT group. Salivary levels of matrix metalloproteinase-8 (MMP-8) were analyzed using the ELISA method. The obtained data were analyzed using the latest version of the SPSS 25.0 software. Statistical Analyses: For data that did not show normal distribution, the Kruskal-Wallis test was used for intergroup comparisons, while the Wilcoxon signed rank test was applied for pre- and post-treatment evaluations. Categorical variables were analyzed using the Chi-square test. Non-parametric methods were preferred for the comparison of biochemical markers (MMP-8) and questionnaire scores (OHIP 14, RSES, PAPS) among the treatment groups, as the data did not meet the assumptions of parametric tests. The relationships among questionnaire scores were assessed using Spearman's rank correlation coefficient. Results were presented as mean ± standard deviation (SD), median (min–max), and percentage (%). A p-value < 0.05 was considered statistically significant for all analyses. Findings: This study demonstrates that individuals who received periodontal treatment exhibited favorable outcomes in terms of quality of life, biochemical markers, and oral hygiene behaviors. Statistically significant improvements were observed in all study groups in OHIP-14TR, PAPS, and Rosenberg Self-Esteem Scale (RSES) scores, along with a notable post-treatment decrease in salivary MMP 8 levels. In the COPT+CPT group, Plaque Index (PI) and Clinical Attachment Loss (CAL) values significantly decreased compared to baseline. Additionally, participants reported positive changes in oral hygiene and lifestyle behaviors, such as increased tooth brushing frequency, greater use of dental floss, and smoking cessation. Among the treatment groups, only the OHIP-14 scores showed a statistically significant difference (p = 0.0039); the lowest median value was observed in the COPT+BT group, indicating the greatest improvement in oral health related quality of life. The lowest MMP-8 values were seen in the COPT+BT group. The lower MMP-8 levels and the more homogeneous distribution of PAPS scores suggest that aesthetic intervention may contribute positively at both biochemical and perceptual levels. Although no statistically significant differences were found between groups in terms of RSES scores, the higher aesthetic satisfaction and individual contentment reported in the COPT+BT group imply a potential benefit to psychological well-being. Conclusion and Recommendations: The more pronounced improvements observed in the COPT+BT group suggest that botulinum toxin may provide supportive effects to periodontal treatment in both biochemical and psychosocial aspects. The addition of botulinum toxin injections to non-surgical periodontal therapy may enhance periodontal healing, improve patient satisfaction, and increase quality of life. Salivary MMP-8 levels may serve as a useful objective marker for monitoring post treatment improvement. Surgical periodontal therapy (CPT) may be considered as an alternative treatment approach. This study may serve as a foundation for future, more comprehensive research in this field.