Association between Psychological Stress and Periodontitis: A Systematic Review

Micaele M. L. Castro; Railson de O. Ferreira; Nathalia C. F. Fagundes; Anna P. C. P. S. C. Almeida; Lucianne C. Maia; Rafael R. Lima

doi:10.1055/s-0039-1693507

European Journal of Dentistry, Table of Contents

CC BY 4.0 · Eur J Dent 2020; 14(01): 171-179
DOI: 10.1055/s-0039-1693507

Review Article

Association between Psychological Stress and Periodontitis: A Systematic Review

Micaele M. L. Castro

¹Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil

,

Railson de O. Ferreira

¹Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil

,

Nathalia C. F. Fagundes

²School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta. 5528 Edmonton Clinic Health Academy, Edmonton, Canada

,

Anna P. C. P. S. C. Almeida

¹Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil

,

Lucianne C. Maia

³Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

,

Rafael R. Lima

¹Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil

› Author Affiliations

Abstract

This systematic review aims to investigate the association between psychological stress and periodontitis through analysis of cortisol levels and periodontal clinical parameters. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide and based on PECO (Participants, Exposure, Comparators, Outcomes) question and registered at PROSPERO under the code CRD42017076670. As eligibility criteria, observational studies performed in adult humans presenting periodontitis (P), which evaluated patients exposed (E) and nonexposed to psychological stress (C) and to verify the association between this type of stress and periodontitis (O) were included. The searches were performed until March 2018. The following databases were used: PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar. After searches, the duplicate results were removed. The remaining citations were selected according to eligibility criteria in two phases. In the first phase, the title/abstract was evaluated. In the second phase, the articles were chosen previously were assessed by full text. After selection, the studies were submitted to data extraction and risk of bias evaluation by Fowkes and Fulton. A total of 1,386 citations were retrieved. After duplicates removal and selection process, three articles were selected by full text. Among them, two articles reported a positive association between psychological stress and periodontitis. All articles were classified as low risk of bias. Even though two articles highlighted an association between psychological stress and the presence of a possible modulatory pattern of cortisol levels in clinical parameters of periodontitis, more studies are necessary to elucidate this question.

Keywords

stress - psychological - periodontitis - periodontal disease - systematic review

Full Text

References

References
1 Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent Jr. RL. Microbial complexes in subgingival plaque. J Clin Periodontol 1998; 25 (02) 134-144
2 Ebersole JL, Dawson III D, Emecen-Huja P. et al. The periodontal war: microbes and immunity. Periodontol 2000 2017; 75 (01) 52-115
3 Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol 2015; 15 (01) 30-44
4 Bosshardt DD. The periodontal pocket: pathogenesis, histopathology and consequences. Periodontol 2000 2018; 76 (01) 43-50
5 Takei N, Carranza K. Carranza. Periodontia Clínica. 12th ed.. Brazil: Elsevier; 2016
6 Genco RJ, Ho AW, Kopman J, Grossi SG, Dunford RG, Tedesco LA. Models to evaluate the role of stress in periodontal disease. Ann Periodontol 1998; 3 (01) 288-302
7 Koo HS, Hong SM. Prevalence and risk factors for periodontitis among patients with metabolic syndrome. Metab Syndr Relat Disord 2018; 16 (07) 375-381
8 P. Kolte A, A. Kolte R, N. Lathiya V. Association between anxiety, obesity and periodontal disease in smokers and non-smokers: a cross-sectional study. J Dent Res Dent Clin Dent Prospect 2016; 10 (04) 234-240
9 Monteiro da Silva AM, Oakley DA, Newman HN, Nohl FS, Lloyd HM. Psychosocial factors and adult onset rapidly progressive periodontitis. J Clin Periodontol 1996; 23 (08) 789-794
10 Ng SK, Keung Leung W. A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss. Community Dent Oral Epidemiol 2006; 34 (04) 252-266
11 Araújo MM, Martins CC, Costa LC. et al. Association between depression and periodontitis: a systematic review and meta-analysis. J Clin Periodontol 2016; 43 (03) 216-228
12 Ballieux RE. Impact of mental stress on the immune response. J Clin Periodontol 1991; 18 (06) 427-430
13 Boyapati L, Wang HL. The role of stress in periodontal disease and wound healing. Periodontol 2000 2007; 44: 195-210
14 Fishta A, Backé EM. Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews. Int Arch Occup Environ Health 2015; 88 (08) 997-1014
15 Ayub LG, Júnior AB, Grisi MF. et al. Stress as possible risk factor for periodontal disease - literature review. R Periodontia 2010; 20 (03) 28-36
16 Breivik T, Thrane PS, Murison R, Gjermo P. Emotional stress effects on immunity, gingivitis and periodontitis. Eur J Oral Sci 1996; 1044(Pt 1): 327-334
17 Oppermann RV, Alchien JC, de Castro GD. Stress effects on immunity and periodontal disease. Rev Fac Odontol P Alegre 2002; 43 (02) 52-59
18 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
19 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 ed. Available from http://handbook.cochrane.org The Cochrane Collaboration; 2011
20 Fowkes FG, Fulton PM. Critical appraisal of published research: introductory guidelines. BMJ 1991; 302 (6785): 1136-1140
21 Almeida A, Fagundes NCF, Maia LC, Lima RR. Is there an association between periodontitis and atherosclerosis in adults?. A systematic review. Curr Vasc Pharmacol 2017; 16 (06) 569-582
22 Bakri I, Douglas CW, Rawlinson A. The effects of stress on periodontal treatment: a longitudinal investigation using clinical and biological markers. J Clin Periodontol 2013; 40 (10) 955-961
23 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 (01) 6-9
24 Hilgert JB, Hugo FN, Bandeira DR, Bozzetti MC. Stress, cortisol, and periodontitis in a population aged 50 years and over. J Dent Res 2006; 85 (04) 324-328
25 Ishisaka A, Ansai T, Soh I. et al. Association of cortisol and dehydroepiandrosterone sulphate levels in serum with periodontal status in older Japanese adults. J Clin Periodontol 2008; 35 (10) 853-861
26 Weik U, Herforth A, Kolb-Bachofen V, Deinzer R. Acute stress induces proinflammatory signaling at chronic inflammation sites. Psychosom Med 2008; 70 (08) 906-912
27 Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999; 4 (01) 1-6
28 Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 1997; 126 (05) 376-380
29 Brunton LL, Hilal-Dandan R. Goodman & Gilman's Manual of Pharmacology and Therapeutics. 2nd ed. New York, NY: McGraw-Hill Education; 2008
30 Warren KR, Postolache TT, Groer ME, Pinjari O, Kelly DL, Reynolds MA. Role of chronic stress and depression in periodontal diseases. Periodontol 2000 2014; 64 (01) 127-138
31 Irwin M, Patterson T, Smith TL. et al. Reduction of immune function in life stress and depression. Biol Psychiatry 1990; 27 (01) 22-30
32 Mesa F, Magán-Fernández A, Muñoz R. et al. Catecholamine metabolites in urine, as chronic stress biomarkers, are associated with higher risk of chronic periodontitis in adults. J Periodontol 2014; 85 (12) 1755-1762
33 Parwani R, Parwani SR. Does stress predispose to periodontal disease?. Dent Update 2014; 41 (03) 260-264, 267–268, 271–272
34 Azuma K, Adachi Y, Hayashi H, Kubo KY. Chronic psychological stress as a risk factor of osteoporosis. J UOEH 2015; 37 (04) 245-253
35 Deinzer R, Kottmann W, Förster P, Herforth A, Stiller-Winkler R, Idel H. After-effects of stress on crevicular interleukin-1beta. J Clin Periodontol 2000; 27 (01) 74-77
36 Giannopoulou C, Kamma JJ, Mombelli A. Effect of inflammation, smoking and stress on gingival crevicular fluid cytokine level. J Clin Periodontol 2003; 30 (02) 145-153
37 Lopez-Castejon G, Brough D. Understanding the mechanism of IL-1β. secretion. Cytokine Growth Factor Rev 2011; 22 (04) 189-195
38 Mousavijazi M, Naderan A, Ebrahimpoor M, Sadeghipoor M. Association between psychological stress and stimulation of inflammatory responses in periodontal disease. J Dent (Tehran) 2013; 10 (01) 103-111
39 Peruzzo DC, Benatti BB, Antunes IB. et al. Chronic stress may modulate periodontal disease: a study in rats. J Periodontol 2008; 79 (04) 697-704
40 Huang S, Lu F, Zhang Z, Yang X, Chen Y. The role of psychologic stress-induced hypoxia-inducible factor-1α in rat experimental periodontitis. J Periodontol 2011; 82 (06) 934-941
41 Ardila CM, Guzmán IC. Association of Porphyromonas gingivalis with high levels of stress-induced hormone cortisol in chronic periodontitis patients. J Investig Clin Dent 2016; 7 (04) 361-367
42 El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva - are our assays good enough?. Ann Clin Biochem 2017; 54 (03) 308-322
43 Cakmak O, Alkan BA, Ozsoy S, Sen A, Abdulrezzak U. Association of gingival crevicular fluid cortisol/dehydroepiandrosterone levels with periodontal status. J Periodontol 2014; 85 (08) e287-e294
44 Cakmak O, Tasdemir Z, Aral CA, Dundar S, Koca HB. Gingival crevicular fluid and saliva stress hormone levels in patients with chronic and aggressive periodontitis. J Clin Periodontol 2016; 43 (12) 1024-1031
45 Axtelius B, Edwardsson S, Theodorsson E, Svensäter G, Attström R. Presence of cortisol in gingival crevicular fluid. A pilot study. J Clin Periodontol 1998; 25 (11) Pt 1): 929-932
46 Dantas FT, Martins SHL, Dantas ATM, Gnoatto M. Stress and periodontal disease - A literature review. Braz J Periodontol 2016; 26 (03) 19-28
47 Lindhe J, Socransky SS, Nyman S, Haffajee A, Westfelt E. “Critical probing depths” in periodontal therapy. J Clin Periodontol 1982; 9 (04) 323-336
48 Heitz-Mayfield LJ, Trombelli L, Heitz F, Needleman I, Moles D. A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol 2002; 29 (Suppl. 03) 92-102 discussion 160–162
49 Guyatt G, Oxman AD, Akl EA. et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64 (04) 383-394
50 Rettori E, De Laurentiis A, Dees WL, Endruhn A, Rettori V. Host neuro-immuno-endocrine responses in periodontal disease. Curr Pharm Des 2014; 20 (29) 4749-4759
51 Wimmer G, Köhldorfer G, Mischak I, Lorenzoni M, Kallus KW. Coping with stress: its influence on periodontal therapy. J Periodontol 2005; 76 (01) 90-98

Supplementary Material