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J Periodontol. 2011 Feb;82(2):287-92. doi: 10.1902/jop.2010.100319. Epub 2010 Aug 19.

Salivary stress markers, stress, and periodontitis: a pilot study.

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Oral Imaging Center, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Catholic University Leuven, Leuven, Belgium.



Some cross-sectional and longitudinal studies attempted to link periodontitis with stress. To our knowledge, only one small study was published on the mechanism by which stress may influence periodontal diseases, suggesting behavioral and physiologic mechanisms and investigating the role of inflammation as a potential mediator. The present study is planned to explore the associations among periodontal disease, psychologic factors, and salivary markers of stress, psychoneuroimmunologic variables, and health behaviors.


One hundred periodontitis patients were selected, and participants provided information on general health, chronic stress, and demographics. Stress markers (choromogranin A, cortisol, α-amylase, and β-endorphin) were measured from saliva. A dentist assessed the presence of dental plaque on lingual and buccal surfaces, the gingival index, and the number of remaining teeth with periodontal disease.


Stress and salivary stress markers were significantly correlated with clinical parameters of periodontal disease (ranging from 0.19 to 0.59; P <0.001). Neglecting to brush teeth during stress was associated with missing teeth. After adjusting for stress variables, salivary cortisol and β-endorphin were significantly associated with tooth loss and periodontal clinical parameters (P <0.001; R(2) = 0.59).


This study suggests that stress might be associated with periodontal disease through physiologic and behavioral mechanisms. In making diagnoses of psychiatric patients, the association between salivary stress markers and periodontal disease needs to be included. Further exploration of relationships between periodontitis and stress is warranted.

[Indexed for MEDLINE]

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