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| Year : 2011 | Volume
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| Issue : 1 | Page : 6-9 |
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| Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: A clinico-biochemical study |
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Sunil Goyal, Siddhant Jajoo, G Nagappa, Gururaja Rao
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 Submission | 28-Mar-2009 |
| Date of Decision | 16-Apr-2010 |
| Date of Acceptance | 13-Nov-2010 |
| Date of Web Publication | 25-Apr-2011 |
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 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 2023 Oct 4];22:6-9. Available from: https://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 | |  |
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 | | |
- 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 | | |
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 | | |
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.
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Correspondence Address:
Sunil Goyal
Department of Periodontics and Oral Implantology, A.M.E's Dental College and Hospital and Research Centre, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.79966
[Figure 1], [Figure 2]
[Table 1], [Table 2] |
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