Role of Psychological Stress as a Risk Indicator in Periodontal Diseases

Objective: The purpose of this study was to analyze if simple self reported methods for assessing stress can be used in dental offices to identify patients with an increased risk to periodontal disease resulting in different needs for periodontal maintenance care. Methods: A group of 289 patients with chronic periodontitis answered a questionnaire including four self reported stress screening questions regarding sadness, lethargy, stress coping, and duration of stress as well as self-reported gingivitis signs (bleeding and swelling). The patients were considered to have generalized chronic periodontitis when radiographicaly more than 30% of the teeth had bone resorption to at least one third of the root length. Frequency data of questionnaire answers were compared between different stress groups by chi square test. Spearman's correlation coefficient was calculated to analyze a potential correlation between both stress and gingivitis or stress and periodontitis. Results: Gingivitis signs were reported significantly more frequently in patients suffering from sadness and lethargy (chi square test, p 0.001). The answers from questions regarding stress coping and long duration of stress showed no significant correlation with self reported gingival inflammation (p > 0.05). A correlation calculated by the Spearman's correlation coefficients showed an association between stress and gingival inflammation while no association between stress and periodontitis severity was found. Conclusion: These results suggest that the use of simple screening methods can reflect the association between stress and gingival inflammation in periodontitis patients. However, this method is not sufficient enough to identify patients with high stress related risk to generalized periodontitis. Keywords: Psychological Stress, Risk factors, Gingivitis, Periodontitis, Immunity