Impact of Subgingival Instrumentation on Masticatory Performance and Psychological Distress

Inclusion Criteria: * Adult patients with age group 30-50 years diagnosed with stage III/IV generalized periodontitis. * Presence of minimum 20 teeth (Eichner group A1, A2, A3) excluding third molars. Exclusion Criteria: * Systemic diseases that may affect periodontal disease progression or outcome of treatment (diabetes, autoimmune diseases) * Systemic diseases that may affect masticatory ability of the patient (sarcopenia, TMJ disorders, Xerostomia, Acute Pulpitis) * Periodontal treatment within the 6 months * Patients wearing orthodontic appliances * Any diagnosed psychiatric disorder * Antibiotic use within the previous 3 months * Steroid, immunosuppressive and psychiatric drug use * Pregnant and lactating women * History of menopause * Smoking or substance abuse