Effects of academic stress on oral hygiene - a potential link between stress and plaque-associated disease?

The association between oral health and risk behaviours of university students

BACKGROUND

Young adults are exposed to a variety of risk-related behaviours such as alcohol, smoking, and changes in dietary habits, which may result in unknown outcomes in their oral health. There is limited evidence on whether different risk behaviours are associated with oral health behaviours in the university student population. This study gathers data on the behaviours of students in their first year of university, which will inform the future development of oral health behaviour change interventions for this population.

METHOD

This longitudinal quantitative survey involved 205 first-year students aged 18-24 at the University of Manchester. Students completed online questionnaires at baseline and again at a 6-month follow-up interval, providing information regarding self-reported oral health status, hygiene routines, and risk behaviours (e.g., diet, smoking, alcohol).

RESULTS

The findings showed associations between oral health behaviours with risk behaviours, including links with oral care routines, bleeding gums, brushing frequency, with exercise, vaping, and unhealthy food and drink intake. Significant changes over the two-time points were also observed, including the worsening of the self-reported condition of the teeth (p < 0.001), a reduction in the self-reported condition of the gums (p = 0.004), a decrease in brushing frequency (p = 0.003), fewer regular dental visits (p = 0.013), more students intending to visit their previous dentist rather than finding a new dentist at university (p = 0.026), and greater consumption of unhealthy non-alcoholic drinks (p = 0.003). Positive changes over time included reduced frequency and units of alcohol consumption (p = 0.030 and p = 0.001), fewer instances of binge drinking (p = 0.014), and less frequent consumption of unhealthy foods (p = 0.034).

CONCLUSION

The findings highlighted the complex relationship between oral health and risk behaviours in this demographic. Poorer oral health behaviours were linked to engagement in risk behaviours. Thus, oral health behaviours should be targeted alongside other risk behaviours, and tailored interventions should be developed to improve behaviours among university students.

Gender-Based Differences in Psychological, Nutritional, Physical Activity, and Oral Health Factors Associated with Stress in Teachers

The aim of this study was to analyze gender differences in stress-related factors among active teachers. A cross-sectional study was conducted to examine gender disparities in psychological, nutritional, physical activity, and oral health factors and how these habits correlate with stress and burnout in their work environment. The sample comprised 1037 teachers from Spain, Colombia, and Chile, consisting of 40.1% men and 59.9% women, with an average age of 41 years and teaching experience of 11.8 ± 9.2 and 12.2 ± 8.7 years, respectively. They were evaluated using a compilation of questionnaires with the objective of analyzing gender differences in habits that are associated with stress levels in teachers. The findings revealed that men had significantly higher levels of depersonalization and personal accomplishment, whereas women exhibited higher levels of perceived stress and conscientiousness. Regarding nutritional habits, results were more positive for women, and men exhibited healthier functional habits by engaging in more weekly sports. Regarding oral health habits, women had better oral hygiene practices, brushing their teeth more frequently. However, women showed a higher tendency to smoke than their male counterparts. We conclude that there are notable gender differences that can provide insights for developing strategies to enhance the overall well-being of teachers.

Evaluation of hydrocortisone as a strain-dependent growth-regulator of Porphyromonasgingivalis

OBJECTIVE

Porphyromonas gingivalis is an oral key pathogen and known to be very diverse in geno- and phenotypes. It is a fastidious bacterium with low O₂-tolerance and 3-7 days of incubation are necessary. With growing interest in the field of microbial endocrinology we explored the potential growth-stimulating effect of hydrocortisone (HC, synonym cortisol) on P. gingivalis cultures.

MATERIAL AND METHODS

Six different P. gingivalis strains were pre-incubated in supplemented Brain-Heart-Infusion broth under appropriate conditions for 24 h, diluted and transferred into microplates. A newly developed and semi-automated spectrophotometric measurement in triplicate, applying a SpectraMax i3x microplate reader at an optical density of 600 nm, was conducted to test growth differences between test group (exposed to a supplement of either 1.25, 2.5, 5, 10, or 20 μg/ml of hydrocortisone) and control group over 48 h of anaerobic incubation (O₂ ≤ 1%). Furthermore, strains were also incubated on HC-supplemented blood agar to test for a possible growth-stimulating effect on solid media.

RESULTS

HC significantly stimulated the lag-phase growth of four out of six P. gingivalis strains. Our data suggest a concentration-dependent growth stimulatory effect of HC between 2.5 and 5 μg/ml, while below 1.25 μg/ml and above 10 μg/ml HC either did not stimulate or inhibited growth.

CONCLUSIONS

HC could reduce the incubation time when isolating P. gingivalis from clinical samples and could boost low biomass cultivations especially during their lag-phase. The growth-modulating effect might be via modulation of virulence factors/quorum sensing gene expression or by reactive oxygen species(ROS)-capturing during early stages of bacterial growth. Further experiments are necessary to explain the mechanism behind our observations.

Saliva microbiome, dietary, and genetic markers are associated with suicidal ideation in university students

Here, salivary microbiota and major histocompatibility complex (MHC) human leukocyte antigen (HLA) alleles were compared between 47 (12.6%) young adults with recent suicidal ideation (SI) and 325 (87.4%) controls without recent SI. Several bacterial taxa were correlated with SI after controlling for sleep issues, diet, and genetics. Four MHC class II alleles were protective for SI including DRB1*04, which was absent in every subject with SI while present in 21.7% of controls. Increased incidence of SI was observed with four other MHC class II alleles and two MHC class I alleles. Associations between these HLA alleles and salivary bacteria were also identified. Furthermore, rs10437629, previously associated with attempted suicide, was correlated here with SI and the absence of Alloprevotella rava, a producer of an organic acid known to promote brain energy homeostasis. Hence, microbial-genetic associations may be important players in the diathesis-stress model for suicidal behaviors.

Evaluation of relationship between stress and periodontal disease in different professional college students

BACKGROUND

To evaluate the association between stress and periodontitis in different professional college students.

SUBJECTS AND METHODS

The study was conducted in 360 professional college students which includes Medical, Dental, Pharmacy, Nursing, Engineering, and Chartered Accountancy. From each group, 60 students were included in the study. Self-reported Depression, Anxiety, and Stress Scale questionnaire was given to all the students and clinical examination was conducted in all the participants to assess the Oral hygiene index - simplified (OHI-S), clinical attachment level (CAL), and Gingival Index Simplified (GI-S).

STATISTICAL ANALYSIS

Statistics was performed using the ANOVA test, post hoc test, and Pearson correlation test to compare the psychological parameter of stress with periodontal parameters among six groups of students. P <0.05 was considered to be statistically significant.

RESULTS

Group I showed higher mean stress scores (10.78 ± 0.76) compared to other groups. The mean OHI-S (1.61 ± 0.15), mean CAL (3.68 ± 0.79), and mean GI-S (1.43 ± 0.15) scores also increased with elevated stress levels among medical students. Followed by Group VI and Group II showed almost similar results.

CONCLUSION

The present study showed strong association between stress and periodontal disease and have an adverse effect over oral hygiene factors among the students.

Uptake of oxidative stress-mediated extracellular vesicles by vascular endothelial cells under low magnitude shear stress

Extracellular vesicles (EVs) are increasingly used as delivery vehicles for drugs and bioactive molecules, which usually require intravascular administration. The endothelial cells covering the inner surface of blood vessels are susceptible to the shear stress of blood flow. Few studies demonstrate the interplay of red blood cell-derived EVs (RBCEVs) and endothelial cells. Thus, the phagocytosis of EVs by vascular endothelial cells during blood flow needs to be elucidated. In this study, red blood cell-derived extracellular vesicles (RBCEVs) were constructed to investigate endothelial cell phagocytosis in vitro and animal models. Results showed that low magnitude shear stress including low shear stress (LSS) and oscillatory shear stress (OSS) could promote the uptake of RBCEVs by endothelial cells in vitro. In addition, in zebrafish and mouse models, RBCEVs tend to be internalized by endothelial cells under LSS or OSS. Moreover, RBCEVs are easily engulfed by endothelial cells in atherosclerotic plaques exposed to LSS or OSS. In terms of mechanism, oxidative stress induced by LSS is part of the reason for the increased uptake of endothelial cells. Overall, this study shows that vascular endothelial cells can easily engulf EVs in areas of low magnitude shear stress, which will provide a theoretical basis for the development and utilization of EVs-based nano-drug delivery systems in vivo.

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We recently reported that endothelial cells were amateur phagocytic cells for RBCEVs engulfment.

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Low magnitude shear stress (LSS and OSS) can increase the uptake of RBCEVs by endothelial cells in vitro and in vivo.

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ROS induced by low magnitude shear stress acts as an accelerator to enhance endothelial cells uptake of RBCEVs.

Psychological distress, oral health behaviour and related factors among adolescents: Finnish School Health Promotion Study

BACKGROUND

Psychological distress may affect health behaviour. We examined how psychological distress, social phobia (SP) and anxiety associated with tooth brushing among Finnish adolescents with respect to gender, school grade, parents' education, family structure, smoking and perceived general health.

METHODS

This study is part of the Finnish national School Health Promotion Study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). Mini-Social Phobia Inventory (Mini-SPIN) and generalized anxiety disorder (GAD) served to assess SP and anxiety. A questionnaire enquired about the respondents' oral health habits (tooth brushing, smoking), background factors (age, gender, family structure and parents' education) and perceived general health. Chi-squared tests and logistic regression analyses served in the statistical analyses.

RESULTS

About two-thirds of the girls (66.7%) and less than half of the boys (40.1%) followed the international recommendation of tooth brushing twice daily. Girls reported possible problems with SP and GAD more often than boys did. Those reporting possible problems with SP or moderate or severe anxiety brushed their teeth at least twice daily less often than did those reporting no possible problems with SP and those with no, slight or mild anxiety. Logistic regression analyses showed that male gender (OR = 3.2; 95% CI 3.1-3.4), parents' basic education (OR = 1.5; 95% CI 1.4-1.5), and adolescents' perception of their current state of health as moderate, fairly or very poor (OR = 1.8; 95% CI 1.5-2.0) associated with not brushing teeth twice daily. Gender-specific logistic regression analyses showed that boys who smoked (OR = 1.7; 95% CI 1.6-1.8) were less likely than non-smokers to brush their teeth twice daily.

CONCLUSION

Adolescents with psychological distress, such as possible SP or possible general anxiety, had less favourable oral health behaviour. Psychological distress indicates a greater risk for oral health problems already in adolescence.

Gender Differences in Stress- and Burnout-Related Factors of University Professors

The aim of the present study was to analyse the gender differences in stress-related factors of university professors. A cross-sectional study was carried out, where gender differences in psychological, nutrition, physical activity, and oral health stress-related factors were analysed in 470 Spanish university professors (58.7% male and 41.3% female, 42.1 ± 9.2 years) through a compendium of questionnaires. The results showed how females presented significantly (p ≤ 0.05) higher scores than males in perceived stress (females: 22.15 ± 4.40 vs. males: 19.69 ± 3.61), emotional exhaustion (females: 20.86 ± 9.51 vs. males: 16.44 ± 9.12), and neuroticism (females: 5.53 ± 1.97 vs. males: 4.77 ± 1.96). These results may be related to higher probabilities to suffer the burnout syndrome, showing possible physical symptoms of this psychological disorder such as dry mouth and gastritis or heartburn. We concluded that female professors presented higher burnout perceived stress, emotional exhaustion, and neuroticism levels than males. Females also presented higher dry mouth, gastritis, and heartburn than males. Female professors showed healthier nutritional habits than males, presenting higher consumption of milk products and fruit per day, a higher number of meals, and less eating between hours and fried food consumption. Nevertheless, females consumed fewer water glasses and practised less weekly sport than male professors.

Cultural Differences in Stress-Related Psychological, Nutrition, Physical Activity and Oral Health Factors of Professors

With the aim to explore cultural differences in stress-related psychological, nutrition, physical activity, and oral health factors between Spanish and Latin American professors, we analysed stress-related factors in 598 professors (39.9% male, 60.1% female, 41.3 ± 9.8 years) by a collection of questionnaires, which involved psychological, nutritional, physical activity and oral health items. Results showed how Spanish professors presented significantly (p ≤ 0.05) higher scores than Latin American professors in perceived stress (Spanish: 21.40 ± 4.32 vs. Latin American: 20.36 ± 4.31), teaching stress (Spanish: 6.59 ± 2.28 vs. Latin American: 6.00 ± 2.99) and neuroticism (Spanish: 5.40 ± 2.10 vs. Latin American: 4.58 ± 1.72). Spanish professors also showed healthier nutritional and physical activity habits than their Latin American counterparts, presenting higher consumption of milk products and a higher numbers of meals per day, greater weekly meat and fish consumption and higher weekly resistance training, as well as less eating between hours and snacking consumption. Nevertheless, Spanish professors brushed their teeth less and showed a higher smoking habit than Latin American professors. We concluded that there were cultural differences between Spanish and Latin American professors. In the present research, Spanish professors showed significantly higher burnout levels, teaching stress, perceived stress, and neuroticism than Latin American professors, and several differences were also found around health behaviours. These differences in perceived stress, teaching stress and burnout syndrome may be due to the habituation process of Latin American professors, and probably are associated with a higher stressful and demanding socio-cultural context.

Self-reported stress, coping ability, mental status, and periodontal diseases among police recruits

OBJECTIVE

This cross-sectional study aimed to investigate self-reported stress level and coping ability as well as mental status (anxiety and depression) via the 12-item General Health Questionnaire (GHQ-12) questionnaire and periodontal status among police academy recruits during their 8 months of training.

METHODS

Eighty-five consenting police recruits were examined at baseline during the first month of training and again during the last month of training. Full mouth plaque score (FMPS), full mouth bleeding score, basic periodontal examination, self-reported stress level (scale of 1-10) and GHQ-12 questionnaire (mental status) were recorded at both visits. Ability to cope (yes/no) with stress was recorded at the final visit. Periodontal diagnosis was derived based on clinical examination. t test and regression analyses (p < .05) were performed.

RESULTS

High stress (odds ratio: 1.25) and inability to cope with stress (odds ratio: 1.31) were statistically significant (p < .05) predictors of high FMPS. Inability to cope with stress (odds ratio: 1.45) was also a statistically significant (p < .05) predictor for periodontitis compared to gingivitis. Mental status (anxiety and depression) may play a greater role in gingivitis (mean 1.75) as opposed to periodontitis (mean 1.00) as reflected by the higher mean GHQ-12 (t test, p = .04).

CONCLUSIONS

In this study, both self-reporting of stress level and ability to cope with stress were statistically significant predictors of higher plaque score (FMPS). Ability to cope with stress was also a statistically significant predictor of periodontitis compared to gingivitis. Recording of both self-reported stress level and ability to cope may be valuable variables to note in the management of plaque and periodontal diseases.

Exposure to occupational noise and periodontitis in Korean workers

BACKGROUND

Chronic exposure to occupational noise is reported to cause a wide range of health problems. But, there are no reports on studies investigating the association between noise exposure and periodontitis. The purpose of this study was to examine the relationship between occupational noise exposure and periodontitis in a nationally representative sample of Korean workers.

METHODS

This cross-sectional study used data from the 4^th Korean National Health and Nutrition Examination Survey. The study sample included 8,927 workers aged 19 to 54 years. Noise exposure assessment was performed by using self-report questionnaires. The dependent variable was periodontitis. Age, sex, perceived stress level, place of residence, income, education, health behaviors (frequency of daily toothbrushing, binge drinking, smoking status, regular dental checkup), diabetes, obesity, and white blood cell count were included as covariates. Logistic regression analyses estimated the association between noise exposure and periodontitis after sequential adjustment.

RESULTS

Compared with never-exposed individuals, participants exposed to occupational noise had an increased prevalence of periodontitis. The association remained significant after full adjustment of covariates (odds ratio [OR] 1.34; 95% confidence interval [CI] 1.06 to 1.70). Association of noise exposure with periodontitis was particularly strong for individuals aged < 45 years (OR 1.65; 95% CI 1.22 to 2.23).

CONCLUSIONS

Our study shows that there is an association between occupational noise exposure and periodontitis in a representative sample of Korean workers. Policy efforts to improve workplace noise environments might have an effect on improving periodontal health status among Korean workers.

Is the intake of selective serotonin reuptake inhibitors associated with an increased risk of dental implant failure?

The aim of this retrospective study was to investigate the association between the intake of selective serotonin reuptake inhibitors (SSRIs) and the risk of dental implant failure. Patients were included if they were taking SSRIs only and no other medication, did not present any other systemic condition or compromising habits (bruxism, smoking, snuff), and complied with the use of prophylactic antibiotics for implant surgery. The multivariate generalized estimating equation (GEE) method and multilevel mixed-effects parametric survival analysis were used to test the association between SSRI exposure (predictor variable) and the risk of implant failure (outcome variable), adjusting for several potential confounders (other variables). The total number of implants with information available and meeting the necessary eligibility criteria was 931 (35 failures). These were placed in 300 patients. The implant failure rate was 12.5% for SSRI users and 3.3% for non-users (P=0.007). Kaplan-Meier analysis showed a statistically significant difference in the cumulative survival rate (P<0.001). The multivariate GEE model did not show a statistically significant association between SSRI intake and implant failure (P=0.530), nor did the multilevel model (P=0.125). It is suggested that the intake of SSRIs may not be associated with an increased risk of dental implant failure.

Relationship among Periodontal Disease, Insulin Resistance, Salivary Cortisol, and Stress Levels during Pregnancy

Pregnancy is a period involving important metabolic changes that enable the maintenance of the mother's health and development of the fetus. This study aimed to assess the relationship among periodontal disease, insulin resistance, salivary cortisol concentration and level of perceived stress in pregnant women. This was a cross-sectional study. The sample comprised 96 pregnant women between the fifth and seventh month of pregnancy registered at the Basic Health Units of the Unified Health System (SUS). The periodontal condition was assessed after obtainment free and informed consent from the participants. Participants were divided into three groups: control subjects with a healthy periodontal condition (CN; n=46), patients with gingivitis (GI; n=26), and patients with periodontitis (PI; n=24). Saliva and blood samples were collected for evaluation of salivary cortisol concentration, glycemia, insulinemia and Homeostasis Model Assessment-Insulin Resistance index. A validated survey for the assessment of perceived stress levels was also performed. PI group showed significantly higher (p<0.05) blood glucose levels (CN: 4.43±0.05; GI: 4.46±0.04; PI: 4.68±0.08), insulinemia (CN: 6.93±0.45; GI: 8.87±0.79; PI: 12.77±1.30), insulin resistance (CN: 1.40±0.10; GI: 1.81±0.18; PI: 2.66±0.29) compared with the CN and GI groups. The levels of perceived stress were higher (p<0.05) in PI and GI groups when compared to CN group (CN: 20.5±1.26; GI: 25.8±1.95; PI: 26.6±1.36). There was no significant difference in the concentration of salivary cortisol between the groups (CN: 11.13±0.58; GI: 11.96±0.74; PI: 11.47±0.74). It was concluded that there is a relationship between higher levels of perceived stress, insulin resistance and the occurrence of periodontal disease during pregnancy. This study emphasizes the importance of preventing periodontitis in order to avoid insulin resistance and stress during pregnancy since these can cause systemic complications for the mother and the fetus.

Association of Porphyromonas gingivalis with high levels of stress-induced hormone cortisol in chronic periodontitis patients

AIM

The aim of the present study was to evaluate the association between the occurrence of periodontopathogens with cortisol levels in chronic periodontitis patients.

METHODS

Seventy-five chronic periodontitis patients were invited to participate in the present study. Cortisol levels in serum were measured using an immunoassay method. Porphyromonas gingivalis (P. gingivalis) Tannerella forsythia, Treponema denticola, and Aggregatibacter actinomycetemcomitans were detected by polymerase chain reaction using primers designed to target the respective 16S rRNA gene sequences.

RESULTS

Severe chronic periodontitis patients showed higher mean levels of cortisol (P < 0.05). Twenty-six patients had hypercortisolemia. High cortisol levels showed a positive significant correlation with P. gingivalis (r = 0.237, P < 0.01). Of the 26 patients with hypercortisolemia, 81% had P. gingivalis, of which 86% had severe chronic periodontitis (P < 0.001). There were higher levels of cortisol with the presence of P. gingivalis (478.65 ± 122.57 vs 402.58 ± 139.60, P = 0.01). The adjusted logistic regression model showed a significant association between high cortisol levels and P. gingivalis (odds ratio = 1.7, 95% confidence interval = 1.6-1.8).

CONCLUSIONS

This research offers support for the association between P. gingivalis and higher levels of cortisol in chronic periodontitis patients. These results suggest that high levels of cortisol could increase the occurrence of P. gingivalis in the biofilm.

Association of yoga practice and serum cortisol levels in chronic periodontitis patients with stress-related anxiety and depression

AIM

Reducing the psychosocial stress by various methods can improve overall health, and yoga is now considered as an easily available alternative method. The present cross-sectional pilot study was conducted mainly to find the association of yoga practice with periodontal disease by measuring serum cortisol levels.

MATERIALS AND METHODS

A total of 70 subjects with age range of 35-60 years suffering with chronic periodontitis were divided into group I (with stress), group II (without stress), and group III (practicing yoga). Psychological evaluation was carried out using Hamilton Anxiety Rating Scale (HAM-A) and Zung Self-rating Depression Scale (ZSDS). Periodontal parameters like plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) at 5-8 mm and >8 mm were recorded. Blood samples were collected and serum cortisol levels were measured.

RESULTS

Mean age, plaque scores, and number of teeth with PPD and CAL at 5-8 mm and >8 mm were similar in all the groups, except between group I and group III where a multiple comparison with Tukey's post-hoc test showed significant difference in plaque index (P < 0.038) and the number of teeth with CAL 5-8 mm (P < 0.016). Serum cortisol levels and HAM-A scale and ZSDS scores showed highly significant value (P < 0.001) in group I subjects when compared with group II and group III subjects.

CONCLUSION

Cross-sectional observation done among three groups showed that individuals practicing yoga regularly had low serum cortisol levels, HAM-A scale and ZSDS scores, and better periodontal health.

Periodontal treatment needs and systemic diseases in an older population in Greece

Background

To evaluate the relationship between systemic diseases, body mass index and periodontal treatment needs in an older population in Greece.

Material and Methods

A total of 262 older people were clinically examined about their periodontal status and medical histories were recorded using a health history questionnaire. Additionally, weight and height measurements as well as demographic data were obtained from the participants in the study.

Results

Older people exhibited mean age of 63.98 years, weight of 78.76 kg and height of 1.64 m. The mean CPITN score was 2.84. 31.7% of the study population were smokers and 53.8% females. No statistically significant difference was observed in seniors between periodontal treatment needs and systemic diseases. Females exhibited statistically significant more often osteoporosis, thyroid disorders (p<0.001) and hypercholesterolemia (p=0.014) than males. High CPTIN scores were not associated with higher levels of BMI.

Conclusions

Within the limitation of this study, older adults’ periodontal treatment needs are not associated significantly with a great number of systemic diseases and body mass index.

Key words:Seniors, periodontitis, systemic diseases, body mass index (BMI), smoking, Greece.

Evaluation of association between psychological stress and serum cortisol levels in patients with chronic periodontitis - Estimation of relationship between psychological stress and periodontal status

Background:

Stress classically describes a destructive notion that can have a bearing on one's physical and mental health. It may also add to an increased propensity to periodontal disease.

Aim:

To investigate the association between psychological stress and serum cortisol levels in patients with chronic periodontitis.

Materials and Methods:

Forty subjects were recruited from the outpatient department at the Department of Periodontics, from a college in Mangalore, divided into two groups, i.e., twenty as healthy controls and twenty were stressed subjects with chronic periodontitis. The clinical examination included the assessment of probing pocket depth, clinical attachment level and oral hygiene index-simplified. Serum cortisol levels were estimated biochemically using the enzyme-linked immunosorbent assay method and the estimation of psychological stress was done by a questionnaire.

Results:

Descriptive statistics such as mean and standard deviation was used to review the collected data. Independent sample t-test was used for comparison and correlation was evaluation using Pearson's correlation test. As per our observation, high serum cortisol levels and psychological stress are positively linked with chronic periodontitis establishing a risk profile showing a significant correlation (P < 0.05).

Conclusion:

Routine serum cortisol assessment may be a reasonable and a valuable investigative indicator to rule out stress in periodontitis patients as it should be considered as an imperative risk factor for periodontal disease.

The effects of stress hormones on growth of selected periodontitis related bacteria

The focus of this study was to examine in vitro the effects of stress hormones (catecholamines: epinephrine, norepinephrine, dopamine and hydrocortisone: cortisol) on the growth of four anaerobic species of periodontitis-related bacteria (Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia and Tannerella forsythia) and one facultative anaerobic species (Eikenella corrodens). Bacterial growth was determined by two different methods: fluorescence in situ hybridization (FISH), and the viable count by culture method. To simulate stress, each single strain was grown in a special growth medium with three different concentrations of each hormone, using an anaerobic chamber at 37 °C. Growth of F. nucleatum increased in the presence of all stress hormones. Growth of P. gingivalis was not significantly influenced by any hormone. Growth of P. intermedia and E. corrodens was inhibited by almost all stress hormones tested. Both methods of analysis revealed that the highest concentrations of norepinephrine and cortisol increased the growth of T. forsythia. Different hormones have a different effect on the growth of periodontitis-related bacteria in vitro. It appears that bacterial viability is more strongly influenced than is bacterial metabolic activity. The growth of F. nucleatum particularly and partially of T. forsythia is increased by several stress hormones and may have an additional negative impact on periodontal disease.

Stress and periodontal disease: The link and logic!!

Stress is an equated response to constant adverse stimuli. At one point or another everybody suffers from stress. Stress is compatible with good health, being necessary to cope with the challenges of everyday life. Problems start when the stress response is inappropriate to the intensity of the challenge. Psychological stress can down regulate the cellular immune response. Communication between the central nervous system and the immune system occurs via a complex network of bidirectional signals linking the nervous, endocrine, and immune systems. Stress disrupts the homeostasis of this network, which in turn, alters immune function. Direct association between periodontal disease and stress remains to be proven, which is partly due to lack of an adequate animal models and difficulty to quantifying the amount and duration of stress and also there are many factors influencing the incidence and severity of periodontal disease. Nevertheless, more recent studies indicate that psychosocial stress represents a risk indicator for periodontal disease and should be addressed before and during treatment. This paper discusses how stress may modulate host response to bacteria and influence the course and progression of periodontal disease.

Major differences in oral health knowledge and behavior in a group of Iranian pre-university students: a cross-sectional study

To establish efficient methods for self-prevention of oral diseases, assessment of dental health behavior and knowledge in various social classes is necessary. The main purpose of this study was to determine the major differences in oral health knowledge and behavior in a group of Iranian pre-university students. In this cross-sectional study, 591 pre-university students from different regions of Mashhad, Iran were randomly selected to complete a questionnaire consisting of two parts including dental health behavior and knowledge. Scores were recorded and statistical analyses performed to determine the correlation between dental health behavior and knowledge. Data was analyzed with Student's t-test, one-way analysis of variance and Pearson correlation. The mean score of dental health knowledge was significantly lower than the dental health behavior (2.95 ± 0.02 vs. 3.31 ± 0.05, P < 0.001). This difference was observed with gender, birth location and major subject of study. The dental health behavior of Iranian pre-university students was inadequate and their dental health knowledge was at a lower level compared to their behavior. Experimental science students had better oral health behavior compared to other students.

Are Oral Health Status and Care Associated with Anxiety and Depression? A Study of Portuguese Health Science Students

The relationship between oral health and anxiety/depression were assessed in a cross-sectional study conducted in 388 Portuguese students from the Health Sciences (age: 21 +/- 3 years, 75% women). Oral health included prevalence of reported tooth pain/gum bleeding, dentist attendance, and dentifrice and dental floss use. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Subjects with anxiety or depression had a higher frequency of perceived gum bleeding and reported a higher dentist attendance than normal subjects. On multivariate analysis, anxiety was significantly and independently related to perceived toothache (OR = 2.90, 95% CI: 1.25-6.72) and dentist attendance (OR = 2.15, 95% CI: 1.18 - 3.91) whereas depression was associated with perceived gum bleeding (OR = 4.96, 95% CI: 1.68 - 14.59), and no differences were found regarding teeth brushing or dental flossing. The author concludes that anxiety and depression are related to perceived toothache and gum bleeding, but this association cannot be explained by decreased dental care.

Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older

BACKGROUND

The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years.

METHODS

In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes.

RESULTS

The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%).

CONCLUSION

Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.

Attitudes of dental and medical students in their first and final years of undergraduate study to oral health behaviour

OBJECTIVE

To compare differences in attitude to oral health behaviour amongst medical and dental students when they were in years 1 and 5 of University study respectively.

METHODS

Medical and dental students of Peking University in Beijing, China were invited to take part in this study. The original version of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was written in Japanese. After testing the validity of both English and Chinese versions, the revised Chinese version of the HU-DBI was administered to new medical and dental students. In their final year of University study, the same questionnaire was again administered.

RESULTS

Significant differences were found for 13 of 21 items, reflecting an improvement in oral health attitudes and behaviour in final year dental students when compared with the time they were entrants. This difference was not found to be significant in the sample of medical students.

CONCLUSIONS

There were significant differences in oral health attitudes and behaviours in dental students between entrance to University and the final year of their study. The same was not found to be true for medical students.

Cynical hostility as a determinant of toothbrushing frequency and oral hygiene

AIM

Our aim was to investigate whether cynical hostility, self-reported toothbrushing frequency and objectively assessed levels of oral hygiene were associated.

MATERIAL AND METHODS

The present study sample consisted of 4156 30-64-year-old dentate Finns. The questionnaire and the home interview included information about socioeconomic and sociodemographic factors and behavioural variables, such as toothbrushing frequency, dental attendance, smoking and cynical hostility. The level of oral hygiene was assessed during a clinical oral examination. The chi(2) test and ordinal logistic regression analyses were used.

RESULTS

After controlling for sociodemographic and socioeconomic factors, smoking habits and reported dental attendance, the subjects belonging to the lowest cynical hostility level were found to brush their teeth significantly more often and to have better oral hygiene compared with those belonging the highest cynical hostility level. Toothbrushing frequency was adjusted when oral hygiene was used as the outcome variable. The association of cynical hostility with toothbrushing frequency and the oral hygiene seems to be partly dependent on the level of education.

CONCLUSIONS

Cynical hostility is a psychosocial risk marker for the frequency and quality of toothbrushing and it could be a connecting trait between general health behaviour and oral health behaviour.

Psychosocial factors as risk indicators of periodontitis

OBJECTIVE

Cross-sectional investigation of associations between psychosocial and periodontal parameters.

METHODS

One hundred and ten patients 18-76 years of age were examined clinically and 57 radiographically at the Department of Conservative Dentistry of the University Hospital of Heidelberg: probing depths (PDs) and attachment level (PAL-V) were obtained at six sites per tooth. Inter-proximal bone loss was assessed in 57 patients on panoramic radiographs. Further chemical and general environmental sensitivity, somatization, and smoking status were assessed by several questionnaires.

RESULTS

Significant correlations between severe bone loss and age (r=0.38, p=0.004) were observed. PAL-V and PD also correlated with age (r=0.45, p<0.001; r=0.37, p<0.001) and pack years (r=0.21, p=0.031; r=0.3, p=0.002). After adjustment for age, smoking, and sex a negative correlation between chemical odour sensitivity and bone loss, PD=4 mm as well as PAL-V=4 mm was observed. Further, a negative correlation was observed between gastrointestinal sensitivity and PAL-V=4 mm. Psychological stress correlated positively with bone loss.

CONCLUSION

The results give evidence for associations of psychosocial factors and periodontal disease. Some environmental traits seem to be related to more favourable periodontal status.

Modulation of clinical expression of plaque-induced gingivitis: effects of personality traits, social support and stress

BACKGROUND

Studies have shown an association between an acute stressful event and gingivitis. However, the possible effects of personality traits associated with stress resistance/susceptibility and current level of stress on the clinical expression of plaque-induced inflammation remain to be examined. The aim of this study was to characterize the subject-based clinical behaviour of the gingiva during experimental gingivitis in relation to personality profile, psychological stress and coping behaviour.

METHODS

Ninety-six systemically and periodontally healthy subjects (mean age: 23.6+/-1.7 years), 46 males and 50 females, non-smokers, participated in a randomized, split-mouth, localized experimental gingivitis trial. Prior to the trial, subjects were asked to complete self-administered questionnaires evaluating personality traits (Hardiness scale and Courtauld Emotional Control Scale), subjective stress (Visual Analogue Scale-Total Distress), social support (Multidimensional Scale of Perceived Social Support, MSPSS) and life events (Life Experiences Survey (LES)). The influence of psychosocial factors was investigated in the overall population as well as in two sub-populations with different inflammatory response to plaque accumulation.

RESULTS

No significant relationships were found between gingival inflammation variables and psychological measures. No significant differences were detected between subjects with different susceptibilties to plaque-associated gingivitis for any considered psychological variable. A significant association between plaque variables and LES (negative) or MSPSS (positive) was found; however, the variance explained by the model was low.

CONCLUSIONS

Differences in the current level of stress and psychosocial variables indicative of stress susceptibility do not account for variability in plaque accumulation and gingival inflammation during experimental gingivitis in young adults.

[Correlation between psychosocial factors and periodontal disease--a systematic review of the literature]

OBJECTIVES

This is a systematic review of the available empirical studies up to 2004 which deal with the question of the correlation between psychosocial factors/stress and gingival and periodontal disease.

METHOD

The three medical and psychological databases Medline, PsycInfo und Psyndex were searched systematically for relevant literature between 1946 and 2004.

RESULTS

34 empirical studies on humans (16 with and 18 without a control group) and ten empirical studies on animals are presented.

DISCUSSION

Despite serious methodological flaws in many studies, most (particularly the methodologically solid ones) indicated associations between a variety of psychosocial factors and periodontitis incidence and severity. The pathomechanisms between stress and periodontitis should therefore be the subject of further research.

Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults

INTRODUCTION

The aim of this study was to investigate whether young adults with varying dental esthetics and histories of orthodontic treatment also differ in oral-health attitudes, preventive behaviors, and self-perceived oral health.

METHODS

The sample comprised 298 young adults, 18 to 30 years old, with at least 13 years of primary and secondary school education. The subjects were asked to complete questionnaires dealing with various measures related to oral-health attitudes, preventive behaviors, and perceptions of oral health. Dental esthetics were assessed by means of the aesthetic component of the index of orthodontic treatment need. Dental plaque accumulation was assessed in a subsample of respondents.

RESULTS

Subjects with high dental-esthetics scores reported more favorable oral-health attitudes, such as internal control, dental awareness, value of occlusion, and preventive behavior expectations than subjects with lower scores. Subjects with previous orthodontic treatment showed greater internal control and dental awareness than those who had not previously been treated. Subjects ranking high in dental esthetics and those with previous orthodontic treatment reported stricter oral-hygiene adherence than others. Self-perceived oral health was better in high scorers on dental esthetics. Less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment.

CONCLUSIONS

These findings suggest that favorable dental esthetics and previous orthodontic treatment might be important variables in explaining individual differences in oral-health attitudes and behaviors.

Stress, oral health behaviour and clinical outcome

OBJECTIVE

Several studies indicate that stress adversely affects various health behaviours. Oral hygiene behaviour, however, has been rarely studied in this context. The present study thus aims to assess the effects of stress on oral hygiene behaviour and clinical outcome.

DESIGN

In a prospective matched controlled design 12 pairs of medical students, each consisting of 1 student participating in a major academic exam and 1 student not participating in any exams (control) were studied.

METHODS

A professional tooth cleaning was performed 4 weeks prior to exams to obtain plaque levels of 0 at all sites. Immediately prior to professional tooth cleaning and 4 weeks after exams plaque levels (as indicator of oral hygiene behaviour) and bleeding on probing (an indicator of gingivitis) were assessed.

RESULTS

No group differences were observed at the beginning of the exam period; after exams significant higher rates of plaque (p=.0005, d=1.74) and gingivitis (p=.016, d=1.01) were observed in exam students as compared with controls.

CONCLUSIONS

The study illustrates the clinical significance of stress effects on health behaviour. Stress should be included as a factor in models of patient compliance and health behaviour.

Approximal plaque and gingival sulcus bleeding in routine dental care patients: relations to life stress, somatization and depression

OBJECTIVES

Previous research on relations between life stress and periodontal conditions was often based on indicators of periodontal destruction history and stimulus-specific measures of life stress. The present study was undertaken to compare patients showing different degrees of gingival sulcus bleeding with patients without signs of bleeding, using an instrument measuring cognitive impacts of events and assessing reported symptoms of depression and somatization. Additionally the patient groups were compared with regard to dental status and dental visiting behaviour. Analog comparisons were conducted in patients with different degrees of approximal plaque.

MATERIALS AND METHODS

140 routine dental care patients attending a private dental practice were examined. Measurement devices were the sulcus bleeding index (SBI), the approximal plaque index (API), the Dental Avoidance Scale, the Life Experience Survey (LES), the Impact of Event Scale with the subtests cognitive intrusion and cognitive avoidance, and the SCL-90-R subscales somatization and depression.

RESULTS

Patients with high API scores differed from their zero-score counterparts in dental avoidance and time since last visit only. By contrast, subjects scoring high in the SBI not only had more missing teeth and reported more dental avoidance than their zero-score counterparts but also had elevated scores in intrusive and avoidant thoughts related to a stressful event as well as in symptoms of somatization and depression. No difference was found for the measure of stimulus specific recent life events (LES).

CONCLUSIONS

The results suggest that cognitive preoccupation with adverse events and the presence of somatization and depression symptoms might play a role in gingival inflammation.

Sense of Coherence as a Determinant of Toothbrushing Frequency and Level of Oral Hygiene

BACKGROUND

Antonovsky's salutogenic theory seeks to find general health-promoting factors in individuals as distinct from characteristics that function as risks for specific diseases. A central construct of the theory is sense of coherence (SOC). Individuals with a strong SOC have the ability to define events as less stressful (because of comprehensibility); to mobilize resources to deal with encountered stressors (manageability); and to possess the motivation, desire, and commitment to cope (meaningfulness). Our aim is to investigate whether SOC, self-reported toothbrushing frequency, and objectively assessed levels of oral hygiene are related.

METHODS

The sample of the present study consisted of 4,131 30- to 64-year-old dentate Finns belonging to a large nationally representative sample. The questionnaire and home interview included information about socioeconomic and demographic factors, behavioral variables, such as oral health behaviors (toothbrushing frequency), and a 12-item SOC scale, used here as a unidimensional measure categorized into quintiles. The level of oral hygiene was measured during clinical oral examination. Chi-square test, ordinal, and ordinary logistic regression analyses were used.

RESULTS

Subjects belonging to the strongest SOC quintile were found to be significantly more often two, or more, times a day brushers compared to those with less strong SOC. After controlling for toothbrushing frequency, sociodemographic and socioeconomic factors, smoking habits, and number of teeth, both strong and moderate levels of SOCs were also found to be related to a good level of oral hygiene compared with moderate and poor levels of oral hygiene. Furthermore, subjects within the weakest SOC quintile were found to have significantly more often than others poor levels of oral hygiene.

CONCLUSIONS

Our results suggest that a weak sense of coherence increases both the probability of having a poor level of oral hygiene and a frequency of toothbrushing of less than once a day. This and the theory concerning the development of SOC suggest that sense of coherence may be taken as a determinant of both the frequency and the quality of toothbrushing.

Relationships between lifestyle and dental health behaviors in a rural population in Japan

OBJECTIVES

The aim of this study was to determine associations of lifestyle with dental health behaviors such as tooth brushing frequency, use of extra cleaning devices, and regular dental visits to a dentist.

METHODS

Data were collected from 1182 dentate residents 18 years of age or older who resided in a typical farming district. The data included data on the demographic factors, dental health behavior, and various aspects of lifestyle, i.e. mental condition, alcohol consumption, smoking habit, physical activity, social activity, dietary habits, and presence of systemic diseases.

RESULTS

Multiple logistic regression analysis revealed that subjects in a younger group (18-39 years of age) and subjects who had never smoked brushed their teeth more frequently. Experience of social volunteer work and presence of systemic disease were correlated with use of extra cleaning devices. Associations of female gender with frequency of tooth brushing and use of extra cleaning devices were weakly positive. The subjects who considered dietary combination carefully and those who lived alone were predisposed to visit a dentist regularly.

CONCLUSIONS

The results indicate that dental health behavior is associated with lifestyle as well as demographic factors.

Association of periodontal disease to anxiety and depression symptoms, and psychosocial stress factors

OBJECTIVE

A cross-sectional study was conducted to investigate if anxiety, depression and hopelessness symptoms are associated with periodontal disease.

METHOD

A total of 160 subjects took part in this study. Probing depth and clinical attachment level were recorded at six sites per tooth and the gingival and plaque indices were also recorded. The instruments used to assess the psychological variables (anxiety, depression, stress, psychiatric symptoms and hopelessness) were: the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Life Events Scale modified by Savoia, the Self-Report Screening Questionnaire-20 and the Beck Hopelessness Scale.

RESULTS

There was no difference in scale score means between patients with and without established periodontitis. Results of the Ordinal Logistic Regression Analysis model that included age, plaque index, smoking and psychological factors showed that patients with psychiatric symptoms (odds ratio (OR) 1.24, 95% confidence interval (CI) 0.33-4.78), depression symptoms (OR 0.57, 95% CI 0.15-2.21) and with hopelessness (OR 0.70, 95% CI 0.13-3.84) were not at a greater risk of developing established periodontitis.

CONCLUSION

In this sample, no evidence was found for an association between depression, hopelessness, psychiatric symptoms and established periodontitis. The association of periodontal disease to depression, anxiety and stress should be investigated in psychiatric populations, especially in those with depression and anxiety disorders.

Acute stress effects on local Il-1beta responses to pathogens in a human in vivo model

The combined effects of stress and antigen on interleukin-1beta (Il-1beta) have rarely been studied locally at the site of microbial challenges in vivo, so far. We here propose a model for the analysis of such effects in humans and examine its utility for acute stress trials. Twelve students (6 male, 6 female) refrained from oral hygiene in two antagonistic quadrants for 28 days to allow for increasing bacterial stimulation of the respective gingival sites due to accumulation of microbial plaque. Good oral hygiene was maintained in the remaining quadrants. At day 27 and 28 students were subjected to either stress ('public speech') or a control condition, in a cross-over design. Samples of gingival crevicular fluid (GCF) which emerges between the tooth surface and the gingival epithelium as transudate of healthy and exudate of inflamed gingival tissue, were taken immediately after stress and 60 min later for Il-1beta analysis. Salivary cortisol was assessed to prove the validity of the stress protocol. Stress induced a profound increase of salivary cortisol (p=.001). Repeated measures (stress x time x hygiene) ANOVA with gender as between factor revealed significant stress (p=.014) and hygiene (p=.038) effects on GCF-Il-1beta concentrations and tentatively significant hygiene x time (p = .097) and stress x time x hygiene x gender (p=.107) interactions. Stress induced an increase of Il-1beta as did plaque accumulation. The merits of the proposed model are discussed. It is concluded that it is well suited for the assessment of the effects of stress on inflammatory responses in vivo in humans.

The Impact of Ethnicity, Gender, and Marital Status on Periodontal and Systemic Health of Older Subjects in the Trials to Enhance Elders' Teeth and Oral Health (TEETH)

BACKGROUND

Few studies have examined the association between periodontitis risk, gender, and marital status in older adults. The purpose of this study was to assess if the oral health status of older subjects could be explained by differences in: 1) marital status; 2) gender; and 3) ethnicity.

METHODS

Clinical and radiographic periodontal oral conditions were studied in 701 older subjects from the TEETH clinical trial. Medical conditions as well as ethnic and marital status and smoking habits were considered.

RESULTS

A total of 89 married couples were identified; 40.7% of these were of European descent and 48.1% of Chinese descent. The mean age was 67.7 years (SD +/- 4.7). The men were older than the women (mean difference: 1.5 years, SD +/- 4.6, 95% confidence interval [CI]: 0.5 to 2.5, P<0.01). No significant differences in periodontal conditions were found between spouses or by marital status. Chinese descent was associated with a higher risk for periodontitis, regardless of marital status (odds ratio: 1.5, 95% CI: 1.05 to 2.04, P<0.03).

CONCLUSIONS

1) Married couples have similar social habits, similar oral health perceptions, and similar patterns of periodontal disease. 2) Dental studies including married couples do not bias data for married subjects as such. 3) Marital status has a limited impact on periodontal health but may have a greater impact on several systemic conditions, especially in widowed, divorced, or never married women. 4) Older Chinese subjects perceive themselves as being at lower risk for periodontitis but have more objective signs of periodontitis than older subjects of European descent.