The assessment of stress, depression, and inflammation as a collective risk factor for periodontal diseases: a systematic review
Open accessAbstract
Objectives The purpose of this review was to provide a novel perspective utilizing an assessment of biomarkers to evaluate the impact of stress-related disorders on the progression of periodontal disease and evaluate the growing body of evidence of stress as a risk indicator for periodontal disease progression.Methods Cross-sectional, case-control, and biomarker studies associating psychological disorders and periodontal disease were included in the literature search. Computational studies, animal studies, reviews, and studies lacking healthy controls were excluded. Electronic and manual literature searches were conducted by two independent reviewers in several databases as well as a manual search for relevant articles published up to January 2018.Results Twenty-six articles fulfilled the inclusion criteria and were included in the qualitative synthesis. Relationships between stress-related disorders and serum and salivary biomarkers such as cortisol, dehydroepiandrosterone (DHEA), chromogranin A (CgA), and pro-inflammatory cytokines were identified.Conclusions The use of salivary pro-inflammatory cytokines alone is not sufficient for the identification of periodontal disease severity/progression with or without the presence of stress-associated diseases. Keeping in mind the limitations of this review, a positive qualitative correlation was observed in the literature among stress-related biomarkers and the severity of periodontal disease. This correlation may serve as an important reporter of patient susceptibility for periodontal breakdown in the future.Clinical relevance Stress-related disorders should be included in the list of globally screened diseases because it can change the biochemistry of both the local periodontal microenvironment as well as the global systemic inflammatory burden.
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Emerging evidence suggests that chronic stress and related diseases, such as depression and anxiety, may be significant factors contributing to the development of oral dysbiosis, progression of periodontal/peri-implant disease, and inconsistent wound healing following periodontal therapy.
“Emerging evidence suggests that chronic stress and related diseases, such as depression and anxiety, may be significant factors contributing to the development of oral dysbiosis, progression of periodontal/peri‐implant disease, and inconsistent wound healing following periodontal therapy.125, 224, 225, 226”
From The oral microbiome: Role of key organisms and complex networks in oral health and disease (2021) · cites this paper as [224]
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References 59 · Cited by 98
Research works printed but not linked: 2
- [29]Lipp MEN, Guevara AJH. Validação empírica do Inventário de Sintomas de Stress (ISS). Estudos de Psicologia 1994; 11: 43– 49.
- [56]Hernandez M, Wenk E, Southren A, Rappaport S, Vittek J. LOCALIZATION OF ANDROGENS-H-3 IN HUMAN GINGIVA BY AUTORADIOGRAPHY. Paper presented at: Journal of Dental Research, 1981.
- Authors
- Decker, A., Askar, H., Tattan, M., Taichman, R., & Wang, H.-L.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Wang, Hom-Lay
- Venue
- Clinical Oral Investigations
- Published
- 2019-11-01
- Volume
- 24
- Issue
- 1
- Pages
- 1-12
- ISSN
- 1432-6981 (ISSN-L)
- 1436-3771
- PMC
- PMC6980776
- OpenAlex
- W2986337301
- Cited by
- 98
- References
- 59
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 22 · 2023: 14 · 2022: 10 · 2021: 15 · 2020: 11
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Clinical Oral Investigations (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Dental and Craniofacial Research (5T32DE007057-42)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- periodontal disease, psychological stress, depression, stress-related disorders, inflammatory cytokines, salivary biomarkers, cortisol, dehydroepiandrosterone, chromogranin A, systemic inflammation, periodontal disease progression, risk factors
- MeSH terms
- Psychological Distress, Adult, Animals, Cross-Sectional Studies, Depression, Humans, Inflammation, Periodontal Diseases, Risk Factors
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