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Cited by 25Oral microbiology and periodontitis researchDental Health and Care UtilizationHealth disparities and outcomes

Stressed-Out Oral Immunity: A Gateway From Socioeconomic Adversity to Periodontal Disease

Gomaa, Noha, Glogauer, Michael, Nicolau, Belinda, Tenenbaum, Howard, Siddiqi, Arjumand, Fine, Noah, Quiñonez, Carlos·2020·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000774
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Abstract

Objective: It has been suggested that adverse socioeconomic conditions “get under the skin” by eliciting a stress response that can trigger periodontal inflammation. We aimed to a) estimate the extent to which socioeconomic position (SEP) is associated with periodontal disease (PD) and proinflammatory oral immunity, and b) determine the contribution of psychosocial stress and stress hormones to these relationships. Methods: In this cross-sectional study (n = 102), participants (20–59 years old) completed financial and perceived stress questionnaires and underwent full-mouth periodontal examinations. SEP was characterized by annual household income and educational attainment. Cortisol, a biological correlate of chronic stress, was assessed in hair samples. Oral immunity was characterized by assessing oral inflammatory load and proinflammatory oral neutrophil function. Blockwise Poisson and logistic regression models were applied. Results: Compared with lower SEP, individuals in the middle- and higher-income categories had a significantly lower probability of PD (incidence rate ratio [IRR] = 0.5 [confidence interval {CI} = 0.3–0.7] and IRR = 0.4 [95% CI = 0.2–0.7]) and oral inflammatory load (IRR = 0.6 [95% CI = 0.3–0.8] and IRR = 0.5 [95% CI = 0.3–0.7]) and were less likely to have a proinflammatory oral immune function (odds ratio [OR] = 0.1 [95% CI = 0.0–0.7] and OR = 0.1 [95% CI = 0.0–0.9]). PD and oral immune parameters were significantly associated with financial stress and cortisol. Adjusting for financial stress and cortisol partially attenuated the socioeconomic differences in PD to IRR = 0.7 (95% CI = 0.5–0.8) and IRR = 0.6 (95% CI = 0.5–0.7) for the middle- and higher-income categories, respectively. Similar results were observed for proinflammatory immunity (OR = 0.2 [95% CI = 0.0–1.8] and OR = 0.3 [95% CI = 0.0–2.3]). Conclusion: These findings suggest that psychosocial stress may contribute to a proinflammatory immunity that is implicated in PD pathobiology and provide insight into social-to-biological processes in oral health.

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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 [225]

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Authors
Gomaa, N., Glogauer, M., Nicolau, B., Tenenbaum, H., Siddiqi, A., Fine, N., & Quiñonez, C.
Affiliations
University of North Carolina at Chapel Hill (US)
Corresponding author
Gomaa, Noha
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-12-20
Volume
82
Issue
2
Pages
126-137
ISSN
  • 0033-3174 (ISSN-L)
  • 1534-7796
DOI
10.1097/psy.0000000000000774
OpenAlex
W2996350986
Cited by
25
References
84
Citations by year
2026: 1 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 1
FWCI
2.88
Type
journal article
Language
en
Open access
closed
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Social Sciences › Health › Health disparities and outcomes
Keywords
periodontal disease, socioeconomic position, psychosocial stress, financial stress, cortisol, oral immunity, stress hormones, household income, educational attainment, periodontal inflammation, socioeconomic inequalities in oral health, periodontal treatment outcomes, oral microbiota, oral cancer risk
MeSH terms
Adult, Cross-Sectional Studies, Female, Hair, Humans, Hydrocortisone, Inflammation, Male, Middle Aged, Mouth, Neutrophils, Periodontal Diseases, Social Class, Stress, Psychological, Young Adult

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