Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 754

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 6-9
Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: A clinico-biochemical study


Department of Periodontics and Oral Implantology, A.M.E's Dental College and Hospital and Research Centre, Karnataka, India

Click here for correspondence address and email

Date of Submission28-Mar-2009
Date of Decision16-Apr-2010
Date of Acceptance13-Nov-2010
Date of Web Publication25-Apr-2011
 

   Abstract 

Aims and Objectives: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress that influences the periodontium with the use of a questionnaire data and serum cortisol level.
Materials and Methods: In this study 47 subjects, both male and female, were taken and divided into two groups. Group I comprised of 16 chronic periodontitis subjects. Their stress level was evaluated using a standard questionnaire method (social readjustment rating scale). Plaque index (PI), gingival index (GI), periodontal disease index (PDI) and serum cortisol level were also measured. Group II comprised of 31 stressed subjects and their clinical parameters PI, GI, PDI and cortisol level were recorded.
Statistical Analysis Used: Spearman's rank correlation coefficient and unpaired 't' test.
Results: In group I statistically significant correlation (P<0.05) was found between cortisol and PDI; and cortisol and PI. In group II positive correlation was found between stress, cortisol, PI, GI and PDI. A statistically significant correlation was found between cortisol and smoking.
Conclusion: Stress may be a contributing factor in periodontal disease.

Keywords: Cortisol, periodontal disease, smoking and stress

How to cite this article:
Goyal S, Jajoo S, Nagappa G, Rao G. Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: A clinico-biochemical study. Indian J Dent Res 2011;22:6-9

How to cite this URL:
Goyal S, Jajoo S, Nagappa G, Rao G. Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: A clinico-biochemical study. Indian J Dent Res [serial online] 2011 [cited 2020 Jul 6];22:6-9. Available from: http://www.ijdr.in/text.asp?2011/22/1/6/79966
Periodontitis is an inflammatory response of the periodontium which involves the destruction of the investing tissues around the teeth, resulting in loss of tooth support, ultimately leading to the tooth loss. The etiology and pathogenesis of periodontal disease are multifactorial. Numerous risk factors are involved like uncontrolled diabetes, smoking, specific infections,age, psychosocial stress and certain psychosomatic conditions like anxiety and depression. [1],[2],[3]

Stress is a state of physiological or psychological strain caused by adverse stimuli, physical, mental, or emotional, internal or external, that tend to disturb the functioning of an organism and which the organism naturally desires to avoid. [4] Socioeconomic factor, type of occupation, daily schedule, competitive work load, emotional disturbances, etc. have led to increased stress levels in the modern lifestyle. [5]

Stress has a direct effect on the hypothalamus-pituitary-adrenal cortex axis. [6],[7] It is hypothesized that prolonged activation of this axis can be detrimental to health and may provide a link between mental stress and physical illness. [8],[9],[10] Release of stress hormones impairs host defense which helps in the growth of opportunistic organisms in the gingival sulcus. [7]

Stress is also associated with certain masochistic habits like lip biting or cheek biting and habitual grinding of teeth. Traumatic ulcers, apthous ulcers, [11] lichen planus [12],[13] have known stress as the etiology.

Systemic disorders like gastritis, ulcerative colitis and overeating are also linked to stress. [14] The impact of stress on periodontal health is not merely by its presence or absence but the type, duration and how an individual copes with it. Individuals under stress tend to adopt behavioural changes like poor oral hygiene maintenance, smoking, clenching or grinding of teeth.

Need for the study

Studies have shown a positive correlation between stress and periodontal disease. [15],[16],[17],[18] On the contrary studies have also shown no correlation between the two. [19],[20],[21]

The objective of this study was to evaluate the role of stress in the periodontal disease by measuring the periodontal clinical parameters, the serum cortisol levels and recording the psychosocial stress scale values.


   Materials and Methods Top


Study population

The present study was conducted in Raichur district, Karnataka. Forty-seven subjects, both male and female, were included in the study.

Inclusion criteria

  • Subjects in the age range of 30-55 years.
  • Minimum 20 teeth excluding the third molars should be present in the dentition.
Exclusion criteria

  • Systemically ill subjects.
  • Subject on any antibiotic, steroidal, chemotherapeutic or antipsychotic drug therapy.
  • History of professional oral prophylaxis within the last 6 months.
  • Use of chemical methods of plaque control.
  • Pregnancy.
Methodology

The 47 subjects were divided into two groups.

  • Group I: 16 subjects with chronic periodontitis.
  • Group II: 31 subjects having the social readjustment rating scale value (By Thomas Holmes and Richard Rahe 1967) of ≥149. [22] The 31 subjects consisted of 17 prisoners and 14 truck drivers.


Clinical parameters and investigations

The clinical parameters measured were

  • Plaque index (PI). [23]
  • Gingival index (GI). [24]
  • Probing depth (PD; using Williams graduated probe)
  • Periodontal disease index (PDI). [25]
The clinical parameters were measured by a single examiner and the stress scale ratings by the other. 1.5 ml of venous blood sample was drawn in the morning between 9:00 and 11:00 am after 20 min of rest for the subject. [22] The serum cortisol levels were measured using enzyme-linked fluorescent assays (VIDAS® Cortisol, Biomerieux, Marcy I'Etoile, France).

Spearman's rank correlation coefficient was used for statistical analysis of relationship between stress, cortisol and periodontal parameters. Unpaired 't' test was used to assess correlation between smokers and non-smokers for stress, cortisol and periodontal parameters.


   Results Top


  • Group I

    The mean stress scale value was 139.7± 98.6. [Table 1] shows a statistically significant correlation (P<0.05) between cortisol and PDI; and cortisol and PI. A positive correlation was found between stress and cortisol and stress and PDI.
  • Table 1: Correlation of stress, cortisol and clinical parameters in chronic periodontitis subjects in group I

    Click here to view


  • Group II

    The mean stress scale value was 218± 51.2. [Table 2] shows a positive correlation between stress and cortisol, stress and clinical parameters, and cortisol levels and clinical parameters. When smoking was considered as an individual risk factor for stress it was statistically significant [Figure 1]. A statistically significant correlation was found between cortisol and smoking [Figure 2]. Smoking was assessed by the number of pack per years.
Figure 1: Relation between PI, GI and PDI with smoking status in group II

Click here to view
Figure 2: Relation between stress and cortisol with smoking status in group II

Click here to view
Table 2: Correlation of stress, cortisol and clinical parameters in stressed subjects in group II

Click here to view



   Discussion Top


Despite a general understanding of predisposing factors for chronic periodontitis, the complete variability on periodontal disease severity remains unclear. Owing to the variability in periodontal disease severity the group II was designed to contain 31 stressed individuals and which were then evaluated for periodontal status.

The results of this cross-sectional study suggest that elevated levels of cortisol were associated with PDI and PI in the group I (P<0.05) and cortisol and smoking in group II (P<0.05). Also, positive correlations were found between stress and cortisol, and stress and PDI in group I. Similarly, positive correlations were found between stress and cortisol, stress and clinical parameters and, cortisol and clinical parameters.

It must be emphasized that for group II a baseline score of 149 was the threshold of stress factor, which was assessed through a standard questionnaire [social readjustment rating scale (SRRS)] contemplated for the study. Further statistical analysis was done to compare the variables like PI, GI and PDI, stress factor and cortisol levels between smokers and non-smokers in group II by using unpaired 't' test. However, the values were not significant in three parameters except when cortisol levels were compared between smokers and non-smokers with P-value 0.01(90% of limit of confidence). The SRRS scale may promote the subjects to give biased answers depending on their subjective and behavioural aspects.

From the present study, it was noted that the stress factor has an important bearing upon plaque and periodontal disease, wherein the more stress factor more is the periodontal disease. Further it can also be evaluated that high-stress strung patients had higher cortisol levels among the smokers in the group II.

These results are in correlation with the study done by Ishisaka et al.[26] They examined 467 subjects for serum cortisol levels, psychological stress and periodontal clinical parameters. A significant correlation was found between serum cortisol and severity of periodontitis.

Deinzer et al. conducted a study to assess the effect of academic stress on oral hygiene. [27] The medical students participating in exam were studied against the control students. It was concluded that psychosocial stress may induce neglect from oral hygiene.

However, Monteiro da Silva 1998 found no correlation between psychosocial stress and periodontal disease. [19] He studied the psychological status in 40 patients with aggressive periodontitis and 40 with chronic periodontitis. No association was found between psychological factor and periodontal disease.

The present study had the following limitations.

  • Sample size was small. Larger sample size will provide more conceptual evidence.
  • The present study had very few female participants hence the effect of stress among the woman population was not sufficiently determined.
  • The role of stress along with other manifestations like bruxism, lichen planus, oral submucous fibrosis and recurrent apthous ulcers could also be associated along with periodontal disease. It was coincidental finding that three patients were having submucous fibrosis.
  • The study was also restricted to lower-middle class or lower-class families who by virtue of their economic strata were subjected to high stress and strain.



   Conclusion Top


The results of the present study showed psychosocial stress to be contributing factor in the pathogenesis of periodontal disease and increased serum cortisol level. Also smoking was found as contributing factor for increased cortisol level which was statistically significant. Further representative research is needed to determine the impact of stress/psychological factors as risk factors for periodontal disease.

 
   References Top

1.Genco RJ. Current view of risk factors for periodontal diseases. J Periodontol 1996;67:1041-9.   Back to cited text no. 1
[PUBMED]    
2.Moss ME, Beck JD, Kaplan BH, Offenbacher S, Weintraub JA, Koch GG, et al. Exploratory case-control analysis of psychosocial factors and adult periodontitis. J Periodontol 1996;67:1060-9.   Back to cited text no. 2
[PUBMED]    
3.Monteiro da Silva AM, Oakley DA, Newman HN, Nohl FS, Lloyd HM. Psychosocial factors and adult onset rapidly progressing periodontitis. J Clin Periodontol 1996;23:789-94.  Back to cited text no. 3
[PUBMED]    
4.Dorland. Dorland's Illustrated Medical Dictionary. Oxford, UK: WB Saunders; 2000.  Back to cited text no. 4
    
5.Croucher R, Marcenes WS, Torres MC, Hughes F, Sheiham A. The relationship between life events and periodontitits: a case control study. J Clin Periodontol 1997;24:39.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Breivik T, Opstad PK, Gjermo P, Thrane PS. Effects of hypothalamic-pituitary-adrenal axis reactivity on periodontal tissue destruction in rats. Eur J Oral Sci 2000;108:115-22.   Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Miller DB, O'Callaghan JP. Neuroendocrine aspects of the response to stress. Metabolism 2002;51:5-10.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Ballieux RE. Impact of mental stress on the immune response. J Clin Periodontol 1991;18:427-30.   Back to cited text no. 8
[PUBMED]    
9.Chatterton RT Jr, Vogelsong KM, Lu YC, Hudgens GA. Hormonal responses to psychological stress in men preparing for skydiving. J Clin Endocrinol Metab 1997;82:2503-9.   Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: implications for health. Nat Rev Immunol 2005;5:243-51.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Rennie JS, Reade PC, Hay KD, Scully C. Recurrent aphthous stomatitis. Br Dent J 1985;159:361-7.  Back to cited text no. 11
    
12.Conklin RJ, Blasberg B. Oral lichen planus. Dermatol Clin 1987;5:663-73.  Back to cited text no. 12
[PUBMED]    
13.Allen CM, Beck FM, Rossie KM, Kaul TJ. Relation of stress and anxiety to oral lichen planus. Oral Surg Oral Med Oral Pathol 1986;61:44-6.   Back to cited text no. 13
[PUBMED]    
14.Johnson BD, Engel D. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. J Periodontol 1986;57:141-50.   Back to cited text no. 14
[PUBMED]    
15.Breivik T, Thrane PS, Murison R, Gjermo P. Emotional stress effects on immunity, gingivitis and periodontitis. Eur J Oral Sci 1996;104:327-34.   Back to cited text no. 15
[PUBMED]    
16.Clarke NG, Hirsch RS. Personal risk factors for generalized periodontitis. J Clin Periodontol 1995;22:136-45.   Back to cited text no. 16
[PUBMED]    
17.Da Silva AM, Newman HN, Oakley DA. Psychosocial factors in inflammatory periodontal diseases. J Clin Periodontol 1995;22:516-26.   Back to cited text no. 17
[PUBMED]    
18.Deinzer R, Forster P, Fuck L, Herforth A, Stiller-Winkler R, Idel H. Increase of crevicular interleukin-1b under academic stress at experimental gingivitis sites and at sites of perfect oral hygiene. J Clin Periodonto1999;26:1-8.  Back to cited text no. 18
    
19.Monteiro da silva AM, Newman HN, Oakley DA, O'Leary R. Psychosocial factors, dental plaque levels and smoking in periodontitis patients. J Clin Periodontol 1998;25:517-23.   Back to cited text no. 19
[PUBMED]  [FULLTEXT]  
20.Mengel R, Bacher M, Flores-De-Jacoby L. Interactions between stress, Il-1b, Il-6 and cortisol in periodontally diseased patients. J Clin Periodontol 2002;29:1012-22.   Back to cited text no. 20
[PUBMED]  [FULLTEXT]  
21.Vedhara K, Miles J, Bennett P, Plummer S, Tallon D, Brooks E, et al. An investigation into the relationship between salivary cortisol, stress, anxiety and depression. Biol Psychol 2003;62:89-96.   Back to cited text no. 21
[PUBMED]  [FULLTEXT]  
22.Vettore MV, Leão AT, Monteiro Da Silva AM, Quintanilha RS, Lamarca GA. The relationship of stress and anxiety with chronic periodontitis. J Clin Periodontol 2003;30:394- 402.  Back to cited text no. 22
    
23.Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontologica Scandinevica 1964;22:121-35.  Back to cited text no. 23
    
24.Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontologica Scand 1963;21:533-51.   Back to cited text no. 24
    
25.Ramfjord SP. Indices for prevalence and incidence of periodontal disease. J Periodontol 1959; 30:51.  Back to cited text no. 25
    
26.Ishisaka A, Ansai T, Soh I, Inenaga K, Awano S, Yoshida A, et al. Association of cortisol and dehydroepiandrosterone sulphate levels in serum with periodontal status in older Japanese adults. J Clin Periodontol 2008;35:853-61.  Back to cited text no. 26
[PUBMED]  [FULLTEXT]  
27.Deinzer R, Hilpert D, Bach K, Schawacht M, Herforth A, et al. Effects of academic stress on oral hygiene - a potential link between stress and plaque-associated disease? J Clin Periodontol 2001;28:459-64.  Back to cited text no. 27
[PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Sunil Goyal
Department of Periodontics and Oral Implantology, A.M.E's Dental College and Hospital and Research Centre, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.79966

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]

This article has been cited by
1 DISETI ILTIHAPLI VE PERIODONTAL SAGLIKLI BIREYLERDE TÜKÜRÜK KORTIZOL VE ALGILANAN STRES DÜZEYLERININ DEGERLENDIRILMESI
Özge GÖKTÜRK,Fatma UÇAN YARKAÇ,Ferhat ÖZELÇI
Atatürk Üniversitesi Dis Hekimligi Fakültesi Dergisi. 2020; : 1
[Pubmed] | [DOI]
2 DISETI ILTIHAPLI VE PERIODONTAL SAGLIKLI BIREYLERDE TÜKÜRÜK KORTIZOL VE ALGILANAN STRES DÜZEYLERININ DEGERLENDIRILMESI
Özge GÖKTÜRK,Fatma UÇAN YARKAÇ,Ferhat ÖZELÇI
Atatürk Üniversitesi Dis Hekimligi Fakültesi Dergisi. 2020; : 1
[Pubmed] | [DOI]
3 Comparative evaluation of the cortisol level of unstimulated saliva in patients with and without chronic periodontitis
Narges Naghsh,Ahmad Mogharehabed,Elahe Karami,Jaber Yaghini
Dental Research Journal. 2019; 16(6): 421
[Pubmed] | [DOI]
4 Comparative evaluation of the cortisol level of unstimulated saliva in patients with and without chronic periodontitis
Narges Naghsh,Ahmad Mogharehabed,Elahe Karami,Jaber Yaghini
Dental Research Journal. 2019; 16(6): 421
[Pubmed] | [DOI]
5 The effect of nonsurgical periodontal treatment on gingival crevicular fluid stress hormone levels: A prospective study
Omer Cakmak,Banu Arzu Alkan,Ebru Saatci,Zekeriya Tasdemir
Oral Diseases. 2019; 25(1): 250
[Pubmed] | [DOI]
6 The effect of nonsurgical periodontal treatment on gingival crevicular fluid stress hormone levels: A prospective study
Omer Cakmak,Banu Arzu Alkan,Ebru Saatci,Zekeriya Tasdemir
Oral Diseases. 2019; 25(1): 250
[Pubmed] | [DOI]
7 DISETI ILTIHAPLI VE PERIODONTAL SAGLIKLI BIREYLERDE TÜKÜRÜK KORTIZOL VE ALGILANAN STRES DÜZEYLERININ DEGERLENDIRILMESI
Özge GÖKTÜRK,Fatma UÇAN YARKAÇ,Ferhat ÖZELÇI
Atatürk Üniversitesi Dis Hekimligi Fakültesi Dergisi. 2019; : 206
[Pubmed] | [DOI]
8 Impact of chronic stress on periodontal health
Mathieu Gunepin,Florence Derache,Marion Trousselard,Bruno Salsou,Jean-Jacques Risso
Journal of Oral Medicine and Oral Surgery. 2018; 24(1): 44
[Pubmed] | [DOI]
9 Impact of chronic stress on periodontal health
Mathieu Gunepin,Florence Derache,Marion Trousselard,Bruno Salsou,Jean-Jacques Risso
Journal of Oral Medicine and Oral Surgery. 2018; 24(1): 44
[Pubmed] | [DOI]
10 Relevance of Periodontal Disease According to Presence of Cognitive Stress, Sleeping Hours, and Subjective Oral-Health Status of Adults
Ye-Hwang Kim,Jung-Hwa Lee
The Korean Journal of Health Service Management. 2017; 11(4): 169
[Pubmed] | [DOI]
11 Relevance of Periodontal Disease According to Presence of Cognitive Stress, Sleeping Hours, and Subjective Oral-Health Status of Adults
Ye-Hwang Kim,Jung-Hwa Lee
The Korean Journal of Health Service Management. 2017; 11(4): 169
[Pubmed] | [DOI]
12 Influence of the number of remaining teeth of on sleep time and stress of adults older than 40 years
Min-Jeong Cho,Hae-Kyoung Kim,Na-Rae Oh
Journal of Digital Convergence. 2016; 14(7): 225
[Pubmed] | [DOI]
13 Influence of the number of remaining teeth of on sleep time and stress of adults older than 40 years
Min-Jeong Cho,Hae-Kyoung Kim,Na-Rae Oh
Journal of Digital Convergence. 2016; 14(7): 225
[Pubmed] | [DOI]
14 Association of Periodontitis and Subsequent Depression
Chih-Chao Hsu,Yi-Chao Hsu,Hsuan-Ju Chen,Che-Chen Lin,Kuang-Hsi Chang,Chang-Yin Lee,Lee-Won Chong,Chia-Hung Kao
Medicine. 2015; 94(51): e2347
[Pubmed] | [DOI]
15 Association of Periodontitis and Subsequent Depression
Chih-Chao Hsu,Yi-Chao Hsu,Hsuan-Ju Chen,Che-Chen Lin,Kuang-Hsi Chang,Chang-Yin Lee,Lee-Won Chong,Chia-Hung Kao
Medicine. 2015; 94(51): e2347
[Pubmed] | [DOI]
16 The Relationship Between Psychological Health and Self-rated Oral Health on Convergence Study
Young-Soon Won,Ji-Hyun Kim
Journal of Digital Convergence. 2015; 13(7): 239
[Pubmed] | [DOI]
17 The Relationship Between Psychological Health and Self-rated Oral Health on Convergence Study
Young-Soon Won,Ji-Hyun Kim
Journal of Digital Convergence. 2015; 13(7): 239
[Pubmed] | [DOI]
18 Expression and distribution of TNF-a and PGE2 of periodontal tissues in rat periodontitis model
Chu-Hang Liao,Wei Fei,Zhi-Hao Shen,Ming-Ping Yin,Chen Lu
Asian Pacific Journal of Tropical Medicine. 2014; 7(5): 412
[Pubmed] | [DOI]
19 Expression and distribution of TNF-a and PGE2 of periodontal tissues in rat periodontitis model
Chu-Hang Liao,Wei Fei,Zhi-Hao Shen,Ming-Ping Yin,Chen Lu
Asian Pacific Journal of Tropical Medicine. 2014; 7(5): 412
[Pubmed] | [DOI]
20 role of chronic stress and depression in periodontal diseases
warren, k.r. and postolache, t.t. and groer, m.e. and pinjari, o. and kelly, d.l. and reynolds, m.a.
periodontology 2000. 2014; 64(1): 127-138
[Pubmed]
21 Role of chronic stress and depression in periodontal diseases
Kimberly R. Warren,Teodor T. Postolache,Maureen E. Groer,Omar Pinjari,Deanna L. Kelly,Mark A. Reynolds
Periodontology 2000. 2014; 64(1): 127
[Pubmed] | [DOI]
22 Periodontal Emotional Stress Syndrome: Review of Basic Concepts, Mechanism and Management
Jyoti Bansal,Abhishek Bansal,Mohit Shahi,Suresh Kedige,Rachita Narula
Open Journal of Medical Psychology. 2014; 03(03): 250
[Pubmed] | [DOI]
23 L’alcool : une drogue licite aux conséquences bucco-dentaires non négligeables
Catherine Pesci-Bardon,Isabelle Prêcheur
Actualités Odonto-Stomatologiques. 2013; (262): 24
[Pubmed] | [DOI]
24 Parodontitis
H. Schulze,H. Dommisch
wissen kompakt. 2013; 7(1): 3
[Pubmed] | [DOI]
25 Detrimental effects of cement mortar and fly ash mortar on asthma progression
Ara Cho,Hong-Seok Jang,Yoon Seok Roh,Hee Jin Park,A.F.S.M. Talha,Seung-Young So,Chae Woong Lim,Bumseok Kim
Environmental Toxicology and Pharmacology. 2013; 36(3): 1087
[Pubmed] | [DOI]
26 Association among stress, salivary cortisol levels, and chronic periodontitis
Zoila Refulio,Marco Rocafuerte,Manuel de la Rosa,Gerardo Mendoza,Leandro Chambrone
Journal of Periodontal & Implant Science. 2013; 43(2): 96
[Pubmed] | [DOI]
27 The effects of stress on periodontal treatment: a longitudinal investigation using clinical and biological markers
Issam Bakri,Charles W. Ian Douglas,Andrew Rawlinson
Journal of Clinical Periodontology. 2013; 40(10): 955
[Pubmed] | [DOI]
28 Periodontal diseases and stress: a brief review
A. Akcali,O. Huck,H. Tenenbaum,J. L. Davideau,N. Buduneli
Journal of Oral Rehabilitation. 2013; 40(1): 60
[Pubmed] | [DOI]
29 Periodontal diseases and stress: a brief review
A. Akcali,O. Huck,H. Tenenbaum,J. L. Davideau,N. Buduneli
Journal of Oral Rehabilitation. 2013; 40(1): 60
[Pubmed] | [DOI]
30 influence of stress and depression in the outcome of periodontal therapy - a case report
kripal, k. and senthil rajan, r.s. and nalini, m.s. and jayanti, i.
biomedicine (india). 2013; 33(3): 451-454
[Pubmed]
31 Is depression associated with periodontal status in elderly?
Viana, L.R.F. and Castro, C.P. and Pereira, H.W. and Pereira, A.D.F.V. and Lopes, F.F.
Brazilian Journal of Oral Sciences. 2013; 12(1): 20-22
[Pubmed]
32 Periodontal diseases and stress: A brief review
Akcali, A. and Huck, O. and Tenenbaum, H. and Davideau, J.L. and Buduneli, N.
Journal of Oral Rehabilitation. 2013; 40(1): 60-68
[Pubmed]
33 The effect of stress on periodontitis: A clinicobiochemical study
Chava, V.K. and Mannem, S.
Journal of Indian Society of Periodontology. 2012; 16(3): 365-369
[Pubmed]



 

Top
 
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Materials and Me...
    Results
    Discussion
    Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed8787    
    Printed334    
    Emailed17    
    PDF Downloaded753    
    Comments [Add]    
    Cited by others 33    

Recommend this journal