Association of chronic stress, depression symptoms and cortisol with low saliva flow in a sample of south-Brazilians aged 50 years and older

Salivary levels of catalase, total antioxidant capacity and interleukin-1β and oral health-related quality of life after matcha and green tea consumption for patients with gingivitis: A randomized clinical trial

OBJECTIVES

To evaluate the changes in salivary levels of catalase (CAT), total antioxidant capacity (TAC) and IL-1β (primary outcomes) as well as gingival health and oral health-related quality of life (OHRQOL) 1 month after the consumption of matcha and green tea in adult patients with gingivitis.

METHODS

This study was a parallel randomized clinical trial. Forty gingivitis adult patients were randomly assigned to drink either matcha or green tea cup twice daily for a duration of 1 month. They were asked to keep their habitual oral hygiene measures. Plaque index (PI) and bleeding on probing (BOP) were recorded. In addition, saliva was collected at baseline and 1 month after tea consumption. Salivary levels of CAT, TAC and IL-1β were determined by ELISA. Each participant was asked to fill OHIP-14 questionnaire before and after tea consumption.

RESULTS

Following tea intake, 40.6% of the study sample had healthy gingiva. Both groups similarly showed reductions in PI (0.32 ± 0.11-0.22 ± 0.08) and BOP (0.24 ± 0.08-0.13 ± 0.07) scores after tea consumption. There was a significant difference between mean TAC before and after matcha tea consumption only. Non-significant reductions in salivary levels of CAT and IL-1β were detected after tea consumption. OHRQOL of participants was improved after tea, both types, consumption.

CONCLUSION

Despite study limitations, daily consumption of matcha and green tea might be beneficial as they potentially enhance OHRQOL of individuals with gingivitis and reduce the extent of gingivitis despite non-significant changes in salivary antioxidants and IL-1β levels.

Comparison of stress related physiological parameters with biological parameters of saliva among college students - An observational study

Background

Stress can also be defined as a physical, mental, or emotional response to events that causes bodily or mental tension. Starting with a lack of concentration, it creates a lot of inconveniences and problems with a snowball effect. Saliva, a prime component of the oral cavity, plays an important role in oral health. Under any stressful situation, this unstimulated salivary flow rate decreases, leading to an increase in salivary acidity, which in turn leads to a reduction in the salivary pH, leading to a lot of other complications.

Aim and Objectives

This study was conducted to understand the difference in the levels of salivary pH and the sleep pattern of dental students during their exams. The objective is to prove that there is a marked decrease in the salivary pH and a reduction in the number of hours of sleep when the students are subjected to a stressor.

Settings and Design

180 male and female college-going students were selected for a cross-sectional questionnaire study based on a random sampling method.

Materials and Methods

A questionnaire was circulated among the subjects as Google forms, and their responses were retrieved in excel sheets. Unstimulated salivary sample were collected in a sterile manner, and pH was estimated using a pH meter. An understanding of the sleep pattern was gained using a questionnaire.

Statistical Analysis Used

This study is a descriptive analysis of varied information on stress and salivary parameters. The responses recorded were made into graphical representation; the pH analysis and flow rate were estimated, and it showed variations in subjects during the examination.

Results and Conclusion

This study is the first-of-its-kind in comparing parameters of saliva, sleep quality and quantity in association with stress. We concluded that psychological variables-anxiety and stress-have a significant effect on reducing salivary flow rate which ultimately leads to a reduction in salivary pH.

Whole unstimulated salivary flow rate decreases during acute stressful condition

OBJECTIVE

To examine the influence of acute stress on salivary flow using a validated stressor paradigm.

STUDY DESIGN

This uniform crossover study consisted of 40 healthy adults who underwent the Trier Social Stress Test, consisting of a 5-minute mental arithmetic task (MAT), and a nonstressful task (NST), consisting of a 5-minute free speech task. The order of the tasks was counterbalanced and unstimulated whole saliva (UWS) was measured in 2 groups of 20 participants during each 5-minute task condition, with a 10-minute washout period between tasks. At baseline, mathematical ability was self-reported and psychological distress was measured using the Symptom Checklist-90-Revised. Heart rate (HR) and breathing rate (BR) were recorded during each task.

RESULTS

Age, sex, HR, BR, and psychological distress were similar between groups at baseline (P > .05). During the MAT, HR increased significantly and mean UWS flow rate decreased significantly compared with the NST (P < .001).

CONCLUSIONS

An acute psychobiological stressor task was associated with a rapid decrease in salivary flow in adults. Thus, stress can contribute to reduced salivary flow and should be considered as a factor during the diagnostic workup of patients who complain of a dry mouth.

Depression and dental caries in US adults, NHANES 2015-2018

PURPOSE

This study aimed to investigate the link between depression and untreated dental caries among adults in the United States.

METHODS

Data were collected from the National Health and Nutrition Survey (2015-2018); respondents aged 20 years or older who completed a patient health questionnaire and underwent a comprehensive oral examination were included. Participants were categorized into three groups according to depressive symptoms as follows: those with no, mild, or moderate to severe depression. Data were weighted, and multiple potential covariates were included in the analysis to provide national estimates and account for the complex sample design. A multivariable weighted logistic regression model was performed to test the hypothesis that varying degrees of depression in American adults are associated with untreated dental caries. Subgroup analyses were performed based on age and gender after adjusting for potential covariates. A P value of <.05 was considered significant.

RESULTS

Among 8740 participants, the prevalence of untreated coronal and root caries was 20.50% and 12.92%, respectively. Moderate to severe depression was a significant risk factor (odds ratio, 1.25; 95% confidence interval, 1.09-1.66) for untreated root caries. The risk of untreated root caries increased by 87% in young adults (aged 20-44 years) and by 46% in women with moderate to severe depression. The suest analysis revealed that the impact of moderate to severe depressive disorder on untreated root caries was non-significantly different between the age subgroup (p=0.09) and sex subgroup (p=0.51). However, depression was non-significantly associated with untreated coronal caries (mild depression: OR, 1.07; 95% CI, 0.85-1.34; moderate to severe depression 1.06; 95% CI, 0.83-1.36; respectively).

CONCLUSION

The results of this study suggested a significant association between moderate and severe depression and untreated root caries; however, the association with untreated coronal caries was non-significant. In the United States, moderate and severe depression in adults is associated with root caries.

Relationships among Cortisol, Perceived Stress, and Dental Caries Experience in Adolescents and Young Adults

INTRODUCTION

Stress can impact mental and physical health, especially during adolescence and young adulthood, but the extent of its contribution to dental caries is poorly understood. The present study assessed the association between perceived stress, cortisol levels (in hair and saliva), and overall caries experience of adolescents and young adults aged 15-25 years.

METHODS

Hair and saliva samples were obtained from 93 participants free of periodontal disease. Cortisol in hair and saliva was determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. Sociodemographic variables were also recorded.

RESULTS

There were significantly higher hair cortisol levels and perceived stress scale (PSS) scores in individuals with dental caries experience (DMFT≥1) than in those without (DMFT = 0). However, there was no significant difference in salivary cortisol concentration. A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with increased odds of having experienced dental caries. In contrast, no significant association was found between salivary cortisol concentration and dental caries. Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for sociodemographic variables.

CONCLUSION

Hair cortisol levels and perceived stress have a significant association with dental caries experience, whereas salivary cortisol concentrations do not.

The relationship between tooth decay with stress and BMI among elementary students in Iran

Background

Tooth decay is one of the most common chronic diseases among children worldwide. Stress and body mass index are also amongst the arguable risk factors which will affect people considerably. They include biological (hormones and blood sugar), socio-economic, and environmental factors and also lifestyle. In the present study, the relationship between tooth decay with stress and BMI in children was therefore investigated.

Materials and methods

This was a cross-sectional study of a descriptive-analytical type. A total of 350 students who were referred to the clinic of the faculty of dentistry at Qazvin University of Medical Sciences during 2021-2022 were selected through convenience sampling method to participate in the study. First, the students underwent a dental examination after being measured on their height and weight. Then, two questionnaires; namely, demographic information and Children's Stress Symptom Scale (CSSS) of Scherer and Ryan-Wenger were completed by the children's parents through self-reporting. The collected data were analyzed using SPSS software version 23 and then descriptive statistics and logistic regression were applied.

Results

The mean BMI of the participating students was in the normal range. The prevalence of tooth decay among participants was 76.9% (269 people). The mean and standard deviation of stress scores was 6.85 ± 4.01 out of 26, which was at a low level. Also, the mean and standard deviation of the BMI were 22.78 ± 5.28, which was within the normal range. The results of the logistic regression showed that the variables of "father's level of education," "family's economic status," "the experience of the toothache during the past year," "the oral health status," "the frequency of tooth brushing," "flossing," "stress," and "BMI" were influential factors in tooth decay (P <0.05).

Conclusion

Students who had improper BMI, more stress, less educated fathers, families with poor economic status, the experience of toothache within the past year, poor oral health status, and those who used toothbrushes and floss to a minimal degree suffered more tooth decay. Therefore, it is necessary that we pay more attention to these students in designing and implementing educational programs to prevent tooth decay.

Association of Hyper-Low-Density Lipoprotein and Hypo-High-Density Lipoprotein Cholesterolemia with Low Saliva Flow Rates in Japanese Community-Dwelling Elders

Introduction  The associations of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein (HDL-C) with reduced saliva flow rates have not been previously reported. Objective  The present study aimed to assess the association of cholesterolemia with reduced saliva flow rates in community-dwelling elderly subjects. Methods  The present study analyzed 342 participants (170 males and 172 females aged between 78 and 79 years old). Unstimulated salivary flow rate (USFR) was assessed using a cotton roll method. Low-USFR was defined as 0.10 g/30 seconds. Stimulated salivary flow rate (SSFR) was assessed by having the participants chew tasteless gum for 3 minutes. Low-SSFR was defined as 1.0 mL/minute. Blood samples were collected for the measurement of LDL-C, HDL-C, rheumatoid factor, hemoglobin A1c, and creatinine. To assess depression, the General Health Questionnaire 30 was used. A standardized questionnaire was completed, covering the current and previous medications of the participants and smoking status. We stratified the serum LDL-C levels of the participants as normal, moderate or severe hyper-LDL cholesterolemia and serum HDL-C levels as normal or hypo-HDL cholesterolemia. Multivariate logistic regression models were established and low-USFR or low-SSFR were set as dependent variables in the aforementioned models. Results  After controlling for the effects of the other variables, the odds ratios (ORs) (95% confidence intervals [CIs]) for low-USFR were 2.25 (1.10-4.61) for moderate and 5.69 (1.55-20.8) for severe hyper-LDL cholesterolemia, while that of hypo-HDL cholesterolemia was 3.40 (1.33-8.69). Severe hyper-LDL cholesterolemia was also associated with low-SSFR with an OR of 3.89 (1.39-10.88). Conclusion  Elderly patients with cholesterolemia have a risk of reduced salivary flow rate.

Caregiving of children with Down syndrome: impact on quality of life, stress, mental and oral health

AIM

Parental caregivers of children with Down Syndrome (DS) have a greater burden of daily activities that may affect their health. The aim of this exploratory study was to evaluate the impact of caregiving of children with Down syndrome on parenting quality of life, stress, mental and oral health.

METHODS

Fifty-four parental caregivers of children with DS and 51 parents of children without physical or mental disabilities participated of this study. All participants were clinically examined to evaluate the presence of dental caries, gingival conditions and answered a sociodemographic questionnaire. Depression, anxiety, quality of life and coping strategies were assessed using specific instruments. Hair cortisol level was assessed as biological marker of chronic stress.

RESULTS

Psychological and quality of life parameters were similar between the groups of caregivers (p > .05). Caregivers of children with DS were older (48.6 vs. 41.5, p < .001), had longer caregiving period (> 10 vs < 10 years, p = .003), presented higher gingival bleeding index (6.1 vs. 4.7, p = .014) and higher cortisol levels (55.9 vs. 38.4, p = .07) as compared with parents of children without disabilities. Sociodemographic data has no influence on cortisol levels (p > .05).

CONCLUSIONS

These findings suggest that the caregiving of children with DS has an impact on parenting oral health and stress.

The association between the salivary cortisol level of mothers, children's temperament, and early childhood caries

BACKGROUND

Multiple factors can affect early childhood caries (ECC). Maternal stress and child's temperament, as predictors of child behavior, are among factors that may be associated with ECC.

OBJECTIVES

The aim of this study was to evaluate the association between the salivary cortisol level of mothers as an indicator of maternal stress, child's temperament, and ECC.

METHODS

Ninety preschool children, who were divided into three groups of ECC, severe ECC (S-ECC), and caries-free (CF), were included in this study, as well as their mothers with no history of anxiety disorders. The salivary cortisol levels of mothers were analyzed using ELISA assay. Children were examined for the evidence of caries, using the decayed-missing-filled teeth index, based on the World Health Organization standard criteria. Child temperament was also assessed, using Cloninger's Preschool Temperament and Character Inventory, consisting of seven significant factors (cooperativeness, harm avoidance, novelty seeking, reward dependence, persistence, self-directing, and self-transcendence).

RESULTS

The association between the salivary cortisol level of mothers and temperament of children with S-ECC was positive although it was not statistically significant (P > 0.05). Of seven temperament factors, only harm avoidance was significantly different between the CF and S-ECC groups (P = 0.016).

CONCLUSION

Maternal stress and child's temperament were not associated with ECC. Based on the present findings, children with less harm avoidance may be more prone to S-ECC.

A Pilot Study on the Efficacy of Stress Relief Programs for Family Caregivers of Older People with Dementia

The aim of this study was to evaluate the effects of stress-relief programs on positive aspects of caregiving and depression among caregivers of older people with dementia. A quasi-experimental design was employed. Participants in the experimental group received a 8-week period and 120 minutes each session cognitive-behavioral therapy. Participants in the control group received standard health education. Stress relief programs may alleviate depression and increase positive aspects of caregiving among family caregivers of older people with dementia. These findings will help health professionals to implement stress-relief strategies for family caregivers of older people with dementia, or to use those strategies to increase positive aspects of caregiving, or to alleviate depression in caregivers.

Factors associated with hyposalivation and xerostomia in older persons in South Brazil

OBJECTIVE

This study aimed to investigate characteristics associated with xerostomia and hyposalivation in older persons.

BACKGROUND

Saliva is one of the most important body fluids and plays an important role in food bolus formation, lubricating the oral mucosa and protecting teeth against demineralisation.

MATERIALS AND METHODS

This is a cross-sectional study nested within a cohort and includes a sample of 872 older persons living independently in the community, both in rural and urban areas in Carlos Barbosa, Brazil. Data collection included standardised interviews to identify sociodemographic, behavioural and health-related variables, as well as oral clinical examination performed by two trained/calibrated dentists. Poisson regressions with robust variance were used to calculate the crude and adjusted prevalence ratios (PR) and their respective 95% confidence intervals.

RESULTS

The mean age was 68.5 ± 6.7 years, and the majority of the sample consisted of women (65.3%). The prevalence of xerostomia, of low stimulated salivary flow rate and low at rest salivary flow rate were 338 (38.8%), 494 (56.6%), 320 (36.7%), respectively. In the final adjusted model, women had a significantly increased prevalence of xerostomia (PR = 1.34; 95% CI: 1.12-1.61), as well as participants taking medication continuously (PR = 1.45; 95% CI: 1.16-1.82) and those with depressive symptoms (PR = 1.49; 95% CI: 1.27-1.76). Lower at rest (PR = 1.45, 95% CI: 1.22-1.72) and lower stimulated salivary flow were more prevalent in women (PR = 1.27, 95% CI: 1.11-1.44), while lower stimulated salivary flow was more prevalent in older persons taking medication continuously (PR = 1.24, 95% CI: 1.07-1.43).

CONCLUSION

Salivary hypofunction and xerostomia were more prevalent in women and in those with continuous medication use; however, depressive symptoms were associated only with xerostomia. Measures are required to promote oral comfort in cases of xerostomia, thereby reducing the unpleasant sensation of dry mouth and hyposalivation consequences in clinical practice.

Stress, salivary cortisol and periodontitis: A systematic review and meta-analysis of observational studies

OBJECTIVE

This meta-analysis aims to systematically assess whether periodontitis has a meaningful effect on salivary cortisol, reflecting changes on free blood cortisol levels.

DESIGN

The Cochrane Handbook and the PRISMA statement were used as reporting guidelines. The MEDLINE-PubMed, Google Scholar, EMBASE, and CENTRAL databases were searched until September 2017 to identify eligible studies, screened by seven independent authors and verified by an eighth. Studies comparing salivary cortisol level of periodontitis cases to controls were included. Data were extracted using a predefined table and since all papers were non-randomized clinical trials they were appraised using Downs and Black tool. DerSimonian random effects meta-analysis was performed using OpenMetaAnalyst.

RESULTS

Six cross-sectional studies were included, with 258 participants with chronic periodontitis and 72 with aggressive periodontitis, in a total of 573 participants. Overall results showed that aggressive periodontitis patients have, on average, 53% higher salivary cortisol levels than healthy controls 1.53 (1.11-2.12). Meta-regression exploring the relationship among salivary cortisol levels and periodontal measures, i.e., periodontitis severity, showed a global neutral effect, although this result requires future confirmation due to the low power of the model.

CONCLUSION

Observational studies results suggest that subjects with aggressive periodontitis have higher salivary cortisol levels than healthy ones or patients with chronic periodontitis. Such salivary cortisol response difference may have a negative impact on the periodontium, contributing to worse the burden of aggressive periodontitis disease. In the future, wide and well-designed longitudinal studies should be carried out in order to extensively confirm this possible effect, considering the complex nature of periodontitis and its many confounders factors that may contribute to this outcome.

Association between Root Caries and Depressive Symptoms among Elders in Carlos Barbosa, RS, Brazil

The aim of this study was to evaluate the association between depressive symptoms and root caries among independent-living older persons. All community-dwelling older adults (not hospitalized and not bedridden) living in Carlos Barbosa, RS, Brazil, were invited to participate, and 785 completed the study protocol (standardized questionnaire assessing socio-demographic information and health behavior, Geriatric Depression Scale [GDS] - brief version, and oral examination [DMFT-Root index, Visible Plaque Index and stimulated salivary flow]). Out of them, 390 participants with at least one natural tooth were included in the present analysis. The outcome of interest was the ratio between the number of decayed roots and the number of roots at risk. The association between independent variables (depression and socioeconomic aspects) and the outcome was assessed using negative binomial regression models.

RESULTS

The final, fully adjusted model revealed that age (β=0.03, p=0.001), female sex (β=-0.23, p=0.08), living in a rural area (β=0.25, p=0.008), tooth brushing frequency (β=0.43, p=0.025) and stimulated salivary flow (β=-0.012, p<0.0001) were significantly associated with the presence of root caries. In addition, the interaction between male sex and the presence of depression symptoms (β=-0.99, p=0.012) was also independently and significantly associated with root caries. The interaction between male sex and depression symptoms was associated with root caries, suggesting that psychological mechanisms may be involved indirectly in the development of root caries in older adults.

Investigating the association between stress, saliva and dental caries: a scoping review

BACKGROUND

This scoping review addressed the question 'what do we know about stress-related changes in saliva and dental caries in general population?'

METHODS

The review was conducted using electronic searches via Embase, MEDLINE, PsycINFO, CINAHL and WoS. All published human studies with both observational and experimental designs were included. Two reviewers independently reviewed eligible articles and extracted the data. The studies' quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

Our search identified 232 reports, of which six were included in this review. All six studies were conducted in children and used salivary cortisol as stress marker. The studies varied by design, types of stressors, children's caries experience, methods of saliva collection. Four studies reported a positive association between saliva cortisol levels and caries (p < 0.05) while the other two reported no association (p > 0.05). The quality of the included studies was weak to moderate.

CONCLUSIONS

There is lack of evidence about an association between stress-related changes in saliva and caries. Well-designed longitudinal studies with rigorous measurement technics for stress, saliva and dental caries are necessary. This will help to generate new insights into the multifactorial etiology of caries and provide evidence for a rational method for its control.

Relationship among perceived stress, xerostomia, and salivary flow rate in patients visiting a saliva clinic

OBJECTIVE

This aimed to assess the potential role of chronic stress in saliva secretion, xerostomia, and oral health in a population attending a saliva clinic.

MATERIALS AND METHODS

Data of 114 patients who met the inclusion criteria and completed all questionnaires were analyzed in this study. Participants completed several validated questionnaires, including the Perceived Stress Scale, the Oral Health Impact Profile (OHIP-14), Xerostomia Inventory (XI), and Bother xerostomia Index (BI). Subsequently, the unstimulated, chewing-stimulated, and citric acid-stimulated saliva secretion rates were determined gravimetrically. Data were evaluated using Spearman's correlation analysis and the Mann-Whitney U test.

RESULTS

A significant correlation was observed between perceived stress and XI score (r = 0.312, p = 0.001), as well as between perceived stress and BI score (r = 0.334, p = 0.001). Stress levels also were significantly associated with OHIP-14 scores (r = 0.420, p < 0.001), but an association between experienced stress and salivary flow rate could not be established.

CONCLUSION

In this population, perceived chronic stress seems to be related to several aspects of dry mouth, including the perception of dry mouth, suffering from dry mouth, and the impact on quality of life. These effects were independent of the use of psychotropic medication. No actual reduction in salivary flow was found. Further studies to explore the causal linkage of stress with xerostomia seem warranted.

CLINICAL RELEVANCE

Perceived chronic stress seems to be related with several aspects of dry mouth. This finding might be relevant in future prevention and treatment of xerostomia.

Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia

Background. Unstimulated salivary flow rate can be influenced by different factors. This study was undertaken to evaluate the effect of stress, anxiety and depression on unstimulated salivary flow rate in adults.

Methods. A total of 247 adult subjects, randomly selected from patients referring to Zanjan Dental School, were included in this investigation. The study procedures consisted of collecting salivary samples (in 5 minutes), completing a form for feeling of xerostomia and completing Depression Anxiety Stress Scale (DASS) Questionnaire to assess the severity of stress, anxiety and depression. Based on the results, the patients were categorized in four groups: Low salivary flow rate plus xerostomia (group 1, n=60), normal salivary flow rate plus xerostomia (group 2, n=59), low salivary flow rate without xerostomia (group 3, n=60) and normal salivary flow rate without xerostomia (control group, n=68).

Results. The frequencies of subjects with severe and major depression in groups 1, 2 and 3 were 31.4%, 11.7% and 8.5%, respectively, with 4.4% in the control group. The frequencies of subjects with severe stress in groups 1, 2 and 3 were 21.7%, 3.3% and 11.9%, respectively, with 1.5% in the control group. The frequencies of patients with severe anxiety in groups 1, 2 and 3 were 50%, 30% and 61.1%, respectively, with 4.4% in the control group. Stress, anxiety and depression exhibited a statistically significant relationship with unstimulated salivary flow rate and xerostomia (P<0.05).

Conclusion. Stress, anxiety and depression can influence unstimulated salivary flow rate and lead to xerostomia.

Association between salivary flow rate and depressive symptoms with adjustment for genetic and family environmental factors in Japanese twin study

OBJECTIVES

The association between salivary flow rate (SFR) and depressive symptoms have been inconclusive. The present study aimed to investigate the association between SFR and depressive symptoms with and without adjustment for genetic and family environmental factors.

MATERIALS AND METHODS

We conducted a cross-sectional study using twins and measured SFR and depressive symptoms as the outcome and explanatory variables, respectively. We also performed three-step regression analyses by first analysing the association between SFR and depressive symptoms without adjustment for genetic and family environmental factors (individual-level analyses). We then performed between-within analyses using monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs, and finally using only MZ twin pairs. These between-within analyses estimated the coefficients adjusted for genetic and family environmental factors. Furthermore, differences in the associations between individual-level and between-within suggest confounding by genetic and family environmental factors.

RESULTS

We conducted 448 twins aged ≥20 years. In individual-level analyses in males and between-within analyses using MZ and same-sex DZ male twin pairs, SFR associated with depressive symptoms. In between-within analyses using only MZ male twin pairs, SFR did not associate with depressive symptoms. In females, SFR did not associate with depressive symptoms in both individual-level and between-within analyses.

CONCLUSIONS

The present study revealed that the association between SFR and depressive symptoms was affected by common genetic factors in males.

CLINICAL RELEVANCE

Understanding this association between SFR and depressive symptoms with adjustment for genetic and family environmental factors could lead to an important consideration for the prevention and treatment of hyposalivation.

Relationship of Perceived Stress and Dental Caries among Pre University Students in Bangalore City

INTRODUCTION

Stress can increase the susceptibility to dental caries by four possible mechanisms. Studies show that adolescents tend to more likely develop negative body image, disturbed eating behaviours and high levels of stress. Students report stress, taking and studying for exams being the greatest source of academic stress due to competition and the large amount of content in less time.

AIMS AND OBJECTIVES

The objectives were to analyze the caries experience in relation to perceived stress during preuniversity examination period, to estimate the prevalence of dental caries and to calculate SiC (significant caries index) among preuniversity students in Marathahalli, Bangalore city, India.

MATERIALS AND METHODS

This cross-sectional, correlational study involved 210 students (Response rate = 65.37%). The questionnaire consisted of demographic details and Perceived Stress Scale (PSS). Dental caries status was evaluated using the WHO (1997) caries diagnostic criteria for decayed, missing, and filled teeth (DMFT: Dynamical mean field theory).

RESULTS

Prevalence of dental caries was 50.48%. Mean DMFT was 1.74 and Sic index was 4.56. The correlation between PSS and caries experience was found to be weak (r=0.389) (p<0.001).

CONCLUSION

Academic stress appears to affect oral health, shown by higher caries experience in high perceived stress score individuals.

The effect of cognitive appraisal for stressors on the oral health-related QOL of dry mouth patients

Background

Dry mouth is very common symptom, and psychological factors have an influence on this symptom. Although the influence of emotional factor related to patients with oral dryness has been examined in previous studies, the cognitive factors have not been examined thus far.

Objective

The purpose of this study was to examine the influence of cognitive factors on patients with oral dryness.

Methods

The participants were 106 patients complaining of oral dryness. They were required to complete a questionnaire measuring subjective oral dryness, oral-related QOL, cognition for stressors, and mood state.

Results

Correlational analyses revealed that OHIP-14 is significantly related to oral dryness, appraisal for effect, appraisal for threat, and commitment. These correlations were maintained even after controlling for the influence of depression and anxiety. Using oral dryness, appraisal for effect, appraisal for threat, and commitment, cluster analysis was done and three clusters (cluster-1, severe oral dryness; cluster-2, positive cognitive style: cluster-3, negative cognitive style) were extracted. The results of ANOVA showed that the group with severe oral dryness (cluster-1) had a significantly higher score on OHIP-14 than the other two groups. There was no significant difference between the groups with positive (cluster-2) and negative (cluster-3) cognitive style.

Conclusion

Although the group of patients with positive cognitive style complained of more severe oral dryness than the group with negative cognitive style, no significant difference was observed between these two groups in OHIP-14. These results indicate that cognitive factors would be a useful therapeutic target for the improvement of the oral-related QOL of patients with oral dryness.

Nursing home care: exploring the role of religiousness in the mental health, quality of life and stress of formal caregivers

Despite the high number of studies on family caregivers, there is little research on the impact of religiosity on formal caregiving (paid providers). We examine the role of religiousness in the mental health, quality of life and stress of nurse aides (NA) who provide care for patients in a nursing home. NA in a Brazilian nursing home were invited to participate. Because of its coping function, we hypothesized that religiousness was related to better mental health and quality of life. Linear regression was used to test this hypothesis and control for confounders. Compared with the Brazilian general population, NA scored higher on measures of religious involvement. Intrinsic religiosity was associated with better mental health and quality of life. Organizational religiosity was associated with better social functioning, better general mental health and fewer anxiety symptoms. Non-organizational religiosity (prayer), however, was associated with negative outcomes, such as higher stress, poorer general health perceptions and more anxiety symptoms. Most NA indicated that they had prayed for and with their patients. In conclusion, paid caregivers (NA) have a strong sense of religiousness, which plays an important role in many ways, including the type of care they provide, their mental health and their quality of life.

Prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people in Japan

OBJECTIVE

This study investigated the prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people.

BACKGROUND

Xerostomia and hyposalivation are common symptoms in the older population.

MATERIALS AND METHODS

This study included with 894 community-dwelling, Japanese older people (355 men, 539 women; age 65-84 years) who participated in a comprehensive geriatric health examination, which included questionnaires and interviews regarding medical history, medications, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), depressive condition. The Zung Self-Rating Depression Scale (SDS) was used to evaluate depression. Resting salivary flow rate was evaluated by the modified cotton roll method.

RESULTS

In this study, 34.8% of the participants (mean age, 73.5 ± 5.0 years) complained about xerostomia, while the prevalence of hyposalivation was 11.5%. Multiple regression analysis revealed hypnotics use [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.13-2.61], SDS (OR = 1.05, CI = 1.04-1.07) and TMIG-IC total points (OR = 0.87, CI = 0.76-0.99) to be significantly associated with xerostomia. In contrast, female gender (OR = 2.59, CI = 1.55-4.31) and the use of agents affecting digestive organs (OR = 1.78, CI = 1.11-2.86) were associated with hyposalivation.

CONCLUSION

Our findings showed that the prevalence of xerostomia and hyposalivation were approximately 1 in 3 and 1 in 10 respectively. The factors associated with psychological factors and high-level functional competence, while hyposalivation was associated with medications and gender, as well as systemic and/or metabolic differences. It is important to consider these multidimensional factors associated with xerostomia and hyposalivation.

Analysis of the normative conditions of oral health, depression and serotonin-transporter-linked promoter region polymorphisms in an elderly population

AIM

To investigate the association between depression, the normative conditions of oral health and serotonin-transporter-linked promoter region (5-HTTLPR) polymorphisms in a community-dwelling elderly sample.

METHODS

Elderly adults living in a community (n=200) were submitted to an oral clinical examination. Depression was assessed using the 15-item Geriatric Depression Scale. The 5-HTTLPR was analyzed by polymerase chain reaction-restriction fragment length polymorphism. Associations between the biomarkers and clinical covariates were assessed by bivariate and multivariate statistical tests. Statistical significance was set at P<0.05.

RESULTS

The prevalence of dental caries, periodontal disease, edentulism and oral mucosal lesions was 51.2%, 20.8%, 58.0% and 21.5%, respectively. The prevalence of depression was 21.5%. A higher frequency of the S allele was recorded in older individuals with depression (P=0.017). The present findings showed no significant association between depression and the normative conditions of oral health. The observed allelic polymorphisms were 44% S and 56% L, respectively. Genotypic variants were 33.5% LL, 45.0% SL and 21.5% SS. Individuals carrying the SS genotype showed a significantly high prevalence of periodontal disease (prevalence ratio=3.077, CI 95%=1.008-9.393, P=0.048).

CONCLUSION

The present findings suggest that depressive community-dwelling older individuals did not show any association with alterations of oral health normative conditions. However, the SS genotypic polymorphic variant of 5-HTTLPR seems to contribute to the occurrence of periodontal disease in the elderly.

Exploring the effects of pain and stress on wound healing

Wound-related pain is complex, involving a multitude of physiological and psychological factors, such as emotional state, culture, personality, meanings, and expectations. The impact of pain on the individual can contribute to stress and compromise quality of life. The purpose of this article is to review the relationships among pain, stress, and wound healing.

Associations between oral health-related quality of life and emotional statuses in children and preadolescents

OBJECTIVES

To evaluate the associations between oral health-related quality of life (OHRQoL) and emotional statuses in children and preadolescents.

METHODS

One hundred and forty-five Brazilian students (8-14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well-being (OWB). The Revised Children's Manifest Anxiety Scale (R-CMAS) and Children's Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non-paired t test/one-way ANOVA, Pearson's correlation test, and multiple linear regression analyses.

RESULTS

11-14-year-old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Children's Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (β =0.312; P < 0.001) and the OWB model retained TMD (β = 0.271; P < 0.001) and CDI scores (β=0.175; P < 0.05).

CONCLUSIONS

Children and preadolescents with poor emotional well-being are more sensitive to the impacts of OH and its effects on OWB.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

OBJECTIVES

To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel.

METHODS

Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed.

RESULTS

Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence.

CONCLUSIONS

This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Psychological stress has no association with salivary levels of β-defensin 2 and β-defensin 3

BACKGROUND

Recent studies suggest that stress can predispose an individual to the development of periodontal disease, but the exact biological mechanism is unknown. Considering that psychological stress can down-regulate the production of β-defensins (antimicrobial peptides produced in the oral cavity), the aim of the present study was to evaluate the association between stress and salivary levels of β-defensin 2 (HBD-2) and β-defensin 3 (HBD-3).

METHODS

For this purpose, seventy five volunteers, classified as periodontally healthy, were submitted to a psychological evaluation using a validated questionnaire (Questionnaire of Lipp-ISS). Following analysis of the questionnaires, the subjects were divided in two groups (Group A: Absence of stress and Group B: Presence of stress). Unstimulated saliva samples were collected and the concentration of total protein was determined using the BCA method, and the concentrations of HBD-2 and HBD-3 were determined by ELISA.

RESULTS

The levels of total protein did not show a statistically significant difference between the groups. Analyses of HBD-2 and HBD-3 concentrations indicate that the stress condition was not associated with the levels of either peptide in saliva (P=0.3664 for HBD-2 and P=0.3608 for HBD-3).

CONCLUSION

In periodontally healthy subjects, HBD-2 and HBD-3 levels are not influenced by stress.

Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence

The high comorbidity of posttraumatic stress disorder (PTSD) and alcohol dependence (AD) has been firmly established. Although laboratory studies have examined self-reported craving in response to trauma and alcohol cues, no studies have reported on alcohol-related physiological responding in response to trauma cues in PTSD-AD individuals. Using a cue reactivity paradigm, this study examined the impact of personalized trauma-image cues and in vivo alcohol cues on alcohol-related responding (e.g., salivation, craving) in individuals with PTSD and AD (n = 40). Participants displayed reactivity to both trauma and alcohol cues when compared to neutral cues, including increased self-reported craving and distress, as well as greater salivation. These findings suggest that through repeated pairings of trauma memories and alcohol consumption, salivation may become classically conditioned to trauma cues. Moreover, the fact that the trauma-alcohol cue combination elicited greater alcohol craving, salivary responding, distress, and arousal than either the trauma-neutral or neutral-alcohol cue combinations suggests that effects of the trauma and alcohol cues were additive in nature. Evidence that AD individuals with PTSD report increased alcohol craving and display greater salivation in response to trauma memories, supplements prior research indicating that PTSD-related negative emotion and trauma-related alcohol craving may play an important role in the maintenance of AD.

Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women

OBJECTIVES

To evaluate the relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth (DM) in menopausal women.

BACKGROUND

A feel of DM is a major complaint for many elderly individuals and strongly associated with the menopause. The exact mechanisms that mediate sensation of DM in menopausal women have not been firmly established.

METHODS

A case-control study was carried out on 104 selected menopausal women with/without a feeling of DM, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. Xerostomia Inventory (XI) score was used as an index of DM severity. Stimulated whole saliva cortisol concentration (stimulated by chewing standard-sized paraffin for 60 s) was measured by ELISA. Statistical analysis by Student's t-test and Spearman correlation was used.

RESULTS

The mean cortisol concentration of saliva, but not saliva cortisol output, was significantly higher in the cases than in the controls. There was significant positive correlation between XI score and concentration (r = 0.357, p = 0.000) or output (r = 0.223, p = 0.017) of stimulated whole saliva cortisol.

CONCLUSIONS

It appears that stimulated whole saliva cortisol is high in menopausal women with a feeling of DM.

The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

We evaluate the association between income inequality (Gini index) and oral health and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oral health survey in Brazil in 2002-2003. Our analysis included 23,568 15-19 and 22,839 35-44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individual income in the point beyond which it showed roughly no association with oral health. Adjusted rate ratio of mean untreated dental caries, respectively for the 15-19 and 35-44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15-19 year-old having at least one missing tooth or a 35-44 year-old being edentulous was, respectively, 1.19 and 1.01. High income inequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of income inequality at the municipal level were associated with worse oral health and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level income inequality had a similar, detrimental effect, among individuals with lower or higher income.