EC Dental Science

Introduction and Purpose: Psychological stress affects the host immune inflammatory response negatively through release of glucocorticoids, predominantly cortisol via the Hypothalamic Pituitary Adrenal (HPA) axis. Thus, it may play an important role in the pathogenesis and progression of chronic periodontitis, which is the result of host-microbial interaction. This study was conducted to evaluate the correlation of stress with generalized chronic periodontitis, if any, by estimating the level of serum cortisol.

Materials and Methods: The subjects (n = 60) were divided into two groups: control (n = 20) and case (n = 40). Control group comprises of the subjects with healthy periodontium, while the case group comprises of subjects with generalized chronic periodontitis. The periodontal parameters considered were plaque index, gingival index, probing pocket depth and clinical attachment level. Serum cortisol level was estimated in venous blood using electrochemiluminescence method. Correlation between the periodontal health and Serum cortisol level was evaluated applying Pearson’s Correlation Co-efficient, using Independent sample ‘t’ test considering 0.05 as significance level.

Results: Serum cortisol level was found to be higher in the subjects with chronic periodontitis compared to that of the subjects with healthy periodontium. A statistically significant correlation was observed between Serum cortisol level and probing pocket depth, whereas a positive though weak correlation was observed with the other periodontal parameters.

Conclusion: A positive correlation between chronic periodontitis and stress hormone is suggested.

Keywords: Chronic Periodontitis; Hypothalamic Pituitary Adrenal (HPA) Axis; Probing Pocket Depth; Serum Cortisol; Clinical Attachment Level

1. GP Chrousos. “Regulation and dysregulatïon of the hypothalamic-pïtuitary-adrenal axis. The corticotropin-releasing hormone perspective”. Endocrinology and Metabolism Clinics of North America 4 (1992): 833-858.
2. KE Habib., et al. “Neuroendocrinology of stress”.Endocrinology and Metabolism Clinics of North America3 (2001): 695-728.
3. W Vale., et al. “Characterization of a 41-residue ovine hypothalamic peptide that stimulates secretion of corticotropin and betaendorphin”. Science18 (1981): 1394-1397.
4. C Rivier and W Vale. “Modulation of stress-induced ACTH release by corticotropin-releasing factor, catecholamines and vasopressin”. Nature5932 (1983): 325-327.
5. A Munck., et al. “Physiological functions of glucocorticoids in stress and their relation to pharmacological actions”. Endocrine Reviews 1 (1984): 25-44.
6. BS McEwen and E Stellar. “Stress and the individual. Mechanisms leading to disease”. Archives of Internal Medicine 18 (1993): 2093-2101.
7. L Boyapati and HL Wang. “The role of stress in periodontal disease and wound healing”. Journal of Periodontology 20001 (2007): 195-210.
8. B Rai., et al. “Salivary stress markers, stress, and periodontitis: A pilot study”. Journal of Periodontology 2 (2011): 287-292.
9. RJ Genco RJ. “Current view of risk factors for periodontal diseases”. Journal of Periodontology 105(1996): 1041-1049.
10. S Goyal., et al. “Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: a clinico-biochemical study”. Indian Journal of Dental Research 1 (2011): 6-9.
11. L Mahendra., et al. “Stress as an Aggravating Factor for Periodontal Diseases”. Journal of Clinical and Diagnostic Research 4 (2011): 889-893.
12. AM Monteiro Da Silva., et al. “Psychosocial factors and adult onset rapidly progressive periodontitis”. Journal of Clinical Periodontology 8 (1996): 789-794.
13. R Mengel., et al. “Interactions between stress, interleukin-1beta, interleukin-6 and cortisol in periodontally diseased patients”. Journal of Clinical Periodontology11 (2002): 10-12.
14. GDC Castro., et al. “Association between psychosocial factors and periodontitis: a case–control study”. Journal of Clinical Periodontology 2 (2006): 109-114.
15. R Moulton., et al. “Emotional factors in periodontal disease”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 8 (1952): 833-860.
16. LW Green., et al. “Periodontal disease as a function of life events stress”. Journal of Human Stress 1 (1986): 32-36.
17. DB Miller and JP O’Callaghan. “Neuroendocrine aspects of the response to stress”. Metabolism6 (2002): 5-10.
18. T Takada., et al. “Effect of restraint stress on the progression of experimental periodontitis in rats”. Journal of Periodontology 2 (2004): 306-315.
19. J Breivik., et al. “Emotional stress effects on immunity, gingivitis and periodontitis”. European Journal of Oral Sciences 4 (1996): 327-334.
20. RA Daynes and BA Araneo. “Contrasting effects of glucocorticoids on the capacity of T cells to produce the growth factors interleukin 2 and interleukin 4”. European Journal of Immunology 12 (1989): 2319-2325.
21. K Iwakabe., et al. “The restraint stress drives a shift in Th1/Th2 balance towards Th2 dominant immunity in mice”. Immunology Letters 1 (1998): 39-43.
22. GD Marshall Jr., et al. “Cytokine dysregulation associated with exam stress in healthy medical students”. Brain, Behavior, and Immunity 4 (1998): 297-307.
23. RJ Genco., et al. “Models to evaluate the role of stress in periodontal disease”. Annals of Periodontology 1 (1998): 288-202.
24. RC Kessler. “The effects of stressful life events on depression”. Annual Review of Psychology 1 (1997): 191-114.
25. PR Cury., et al. “Hydrocortisone affects the expression of matrix metalloproteinases (MMP-1, -2, -3, -7, and -11) and tissue inhibitor of matrix metalloproteinases (TIMP-1) in human gingival fibroblasts”. Journal of Periodontology 7 (2007): 1309-1315.
26. JR Kurer., et al. “Psychological mood of regular dental attenders in relation to oral hygiene behaviour and gingival health”. Journal of Clinical Periodontology 1 (1995): 52-55.
27. AE Rosania., et al. “Stress, depression, cortisol and periodontal disease”. Journal of Periodontology 2 (2009): 260-266.
28. U Klages., et al. “Approximal plaque and gingival sulcus bleeding in routine dental care patients: relations to life stress, somatization and depression”. Journal of Clinical Periodontology 6 (2005): 575-582.
29. A Johanssen., et al. “Dental plaque, gingival inflammation and elevated levels of interleukin-6 and cortisol in Gingival Crevicular Fluid from women with stress related depression and exhaustion”. Journal of Periodontology 8 (2006): 1403-1409.
30. GJ Linden., et al. “Stress and the progression of periodontal disease”. Journal of Clinical Periodontology 7 (1996): 675-680.
31. R Jaiswal., et al. “Evaluation of association between psychological stress and serum cortisol levels in patients with chronic periodontitis- Estimation of relationship between psychological stress and periodontal status”. Journal of Indian Society of Periodontology 4 (2016): 381-385.
32. S Mannem and VK Chava. “The effect of stress on periodontitis: A clinicobiochemical study”. Journal of Indian Society of Periodontology 3 (2012): 365-369.
33. S Mudrika., et al. “Relationship between salivary levels of cortisol and dehydroepiandrosterone levels in saliva and chronic periodontitis”. Journal of International Clinical Dental Research Organization 2 (2014): 92-97.
34. IJ Elenkov., et al. “Modulatory effects of glucocorticoids and catecholamines on human interleukin-12 and interleukin-10 production: Clinical implications”. Proceedings of the Association of American Physicians 5 (1996): 374-381.
35. JC Buckingham., et al. “Activation of the HPA axis by immune insults: Roles and interactions of cytokines, eicosanoids, glucocorticoids”. Pharmacology Biochemistry and Behavior 1 (1996): 285-298.