keywords such as anxiety, periodontal disease, and stress in Some chronic recurrent .. The relationship of stress and anxiety with chronic. J Clin Periodontol. May;30(5) The relationship of stress and anxiety with chronic periodontitis. Vettore MV(1), Leão AT, Monteiro Da Silva AM, . Chronic inflammatory periodontal diseases have several etiological .. () The relationship of stress and anxiety with chronic periodontitis.
The relationship of stress and anxiety with chronic periodontitis.
All of the studies had criteria to define periodontal disease bleeding on probing BOPprobing depth PDattachment loss ALalveolar bone loss ABLrecession level RECremaining periodontal support and missing teeth and to establish stress stress evaluation questionnaires, psychometric scales to measure stress such as the salivary cortisol level.
The exclusion criteria were languages other than English, animal studies, review articles, studies presented in the form of abstracts of scientific conferences and other unpublished reports.
Studies involving participants with psychiatric diagnosis or psychological disorders were excluded. Appraisal of the quality of the studies The quality assessment was derived from the National Health Service Centre for Reviews and Dissemination [ 27 ]. The quality of the studies was evaluated on the criteria used to define periodontal disease and stress.
These characteristics were classified as present or absent, which is in agreement with Peruzzo et al. The specificity of the data indicating the randomization technique and the calibration value was required to be designated as present.
Data extraction The titles and abstracts identified by the electronic keywords search were printed and reviewed independently by two teams of independent reviewers to determine the relevance and whether the inclusion criteria were met.
In case of disagreement or uncertainty regarding the relevance of the article, the full text was retrieved and analyzed. Prior to commencement of the study, the full text of the relevant articles selected for this review was obtained. We separated the articles related to salivary cortisol as a measure of stress and studies focused on affective response. The studies that used a questionnaire to perceive stress were regarded as studies regarding affective response.
In phase I of the electronic search, animal studies and studies related to oxidative and mechanical stress were excluded, and 43 suitable articles were selected. In phase II, the articles that had the potential to fulfill the inclusion criteria were evaluated in their full-text format to determine their quality and eligibility for inclusion.
The reference lists were checked independently by the reviewers to identify other articles relevant to the research question that might have provided additional information. Any divergence regarding inclusion was discussed between the reviewers and resolved by the scientific advisor AS. The selection of the study group, the quality of adjustment for confounding factors, adequate criteria to define periodontal disease and stress and the ascertainment of the outcome of interest were considered in inclusion of the articles.
Results The initial search identified articles because the terms periodontal disease and stress are relatively common terms in dental studies. Phase I identified 43 studies, which included 12 reviews and 6 articles related to biomarkers of stress and periodontal disease.
These 18 articles were excluded in the second phase, which included 7 studies, predominantly because they did not have the exposure or outcomes required for this review; two of the studies were based on mental disorders and posttraumatic syndrome patients, respectively. A total of 18 potential articles were included in this systematic review. Description of the studies Twelve studies were cross-sectional[ 161728 - 37 ], three were case-control [ 38 - 40 ] studies, one was a cohort study [ 41 ] and two were prospective clinical trial [ 442 ] studies, comprising individuals.
Is Psychological Stress a Possible Risk Factor for Periodontal Disease? A Systematic Review1
Two of the studies were conducted only with women [ 1634 ], and two studies did not mention the gender distribution [ 2931 ]. In most of the studies [ 41728 - 30373840 - 42 ], the participants were patients at a university periodontal clinic or private dental practice.
Five studies [ 3133353641 ] were epidemiological surveys involving the residents in a particular area or a randomly selected general population. The study by Lopez et al. Two studies [ 1632 ] involved patients from an academic institution, and one study involved women in the post-partum period [ 34 ]. Criteria used to define periodontal disease All of the studies evaluated the periodontal pocket depth PPDand all, except for two studies, recorded bleeding on probing BOP [ 1729 ].
Changes in the clinical attachment level CAL were evaluated by most of the studies; however, the study by Graetz et al. The plaque index and gingival index were recorded as additional clinical parameters in nine and four studies, respectively. Other criteria were the mobility of teeth as well as the recession level in five studies and the presence of calculus in two studies.
The relationship of stress and anxiety with chronic periodontitis.
Two of the 18 studies evaluated patients prospectively during periodontal therapy. In general, the majority of the studies used the Williams periodontal probe for periodontitis screening during oral health examinations.
Two studies [ 2840 ] used the University of North Carolina 15 periodontal probe, and one study each used the Michigan probe [ 17 ] and the Broke probe periodontal probe [ 37 ]. Psychological measurements or affective response The affective response to psychological stress was demonstrated in all but one study [ 36 ] by using a psychometric measurement questionnaire.
The Lipp Stress Symptoms Inventory questionnaire was used in two studies [ 2932 ]. The other psychological parameters that were evaluated with the help of a questionnaire in the studies were as follows: The Visual Analog Scale was used as a measure of stress in a study by Johannsen et al.
Two studies [ 3741 ] validated and adapted the questionnaire for the study sample. Six studies, in addition to using questionnaires, used salivary cortisol levels as markers to evaluate stress, and two studies evaluated serum cortisol levels.
The other stress markers used were salivary peptides, salivary enzymes, cytokine levels in gingival crevicular fluid and stress hormones.
Control of confounding variables Adjustment of confounding variables is an important parameter in demonstrating the methodological quality of studies. The study designs minimize measurement biases affecting the dental and psychological assessment variables. The following investigations were conducted to determine whether the studies controlled various confounding variables. Randomization was followed at the design stage in one study [ 33 ]. All of the studies used exclusion criteria and achieved restriction.
Nine studies performed stratification of the study sample as follows: Five studies performed matching between the study groups as follows: The clinical parameters assessed for the full-mouth periodontal examination were as follows: The subjects were provided with a questionnaire for the assessment of stress based on the Zung's self-rating depression and anxiety scale, the scores of which were correlated with the periodontal findings.
The number of subjects showing depression and anxiety were significantly less and the severity of depression and anxiety was mild in them. There was no statistical significance for stress to be contributing toward the periodontal disease. The present study showed no association between stress and periodontal disease, and future longitudinal studies directed at larger population, might yield conclusive results.
Anxiety, depression, periodontal disease, stress How to cite this article: Determining the association between stress and periodontal disease: Environmental risk factors, such as smoking and diabetes mellitus, may modify the host response and hence, modify disease progression, severity, and outcome. Problems start when the stress response is inappropriate to the size of the challenge, producing neuroendocrine and biochemical changes that result in significant adverse effects on the proper functioning of the immune system.
The latest research by workspace provider Regus shows that Indian workers are getting more stressed. In a large cross-sectional study, Genco et al. However, the mechanisms leading to such interactions are still not clear. Furthermore, some studies have considered it to be an important risk factor for periodontal disease. Need for the study Studies have shown a positive correlation between stress and periodontal disease.
On the contrary, studies have also shown no correlation between the two. The objective of this study was to evaluate the role of stress in the periodontal disease by measuring the periodontal clinical parameters and recording the psychosocial stress scale values.
The study was carried out from August to Septemberafter the approval from the Ethical Committee of A. Medical College, Dhule, with the following reference number: