}OURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Pai Keshava K & Nayak Sangeeta U. Stressing the stress in periodontal disease. Journal of
pharmaceutical and biomedical sciences (J Pharm Biomed Sci.) 2013, January; 26(26): 345-348.
(Article no 15)






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Pai Keshava K & Nayak Sangeeta U. J Pharm Biomed Sci. 2013, January; 26 (26); 345-348.
Available at jpbms.info

S4S

ISSN NO- 2230 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

1e\+eV o+!+t!e
Stressing the stress in periodontal disease

Pai Kesbava K
1
, Nayak Sangeeta U
2*


1
Associate Professor, Department of Psycbiatry, Kasturba Medical College, Mangalore, Manipal
University, India.
2
Assistant Professor, Department of Periodontology, Manipal College of Dental Sciences,
Mangalore, Manipal University, India.
Abxtruct:
Stiess has long been consiueieu to be a majoi contiibutoi to the clinical manifestation of many uiseases.
The ielationship between stiess anu any uisease is explaineu by hoimonal mouifications anu behaviouial
changes inuuceu by the stiess. Reseaich has suggesteu that stiess anu uepiession aie two factois that
play a iole in the uevelopment anu piogiession of peiiouontal uisease. It is not cleai, howevei, whethei
these factois leau to peiiouontal uisease thiough physiological oi behaviouial changes, oi by some
combination of the two. This aiticle ieviews the cuiient liteiatuie, with highlighting on the potential iole
of psychological stiess in peiiouontal uisease piogiession as well as on wounu healing.

KeyworJx: Coitisol, Peiiouontal uisease, Stiess, Wounu healing.
IntroJuctlon:
haimful effect on stiess anu psychosocial factois on health
was extensively eluciuateu by Selye. Be establisheu the teim
"ueneial auaptation synuiome", uesciibing the sum of all
nonspecific, systemic ieactions of the bouy that ensue upon long,
continueu exposuie to stiess. Stiess, is a teim continually being
ieuefineu in the scientific stuuy of uisease anu illness, is
neveitheless a confiimeu anu impoitant factoi in the etiology anu
maintenance of many inflammatoiy uiseases, incluuing peiiouontal
uisease.
Stiess is uefineu uefineu as: The ieactions of the animal bouy to
foices of a ueleteiious natuie, infections anu vaiious abnoimal
states that tenu to uistuib its noimal physiological equilibiium
|1j
.
Stiess, uepiession anu anxiety, aie not yet confiimeu as absolute
iisk factois, but aie iuentifieu in some obseivational stuuies as
possible factois that may affect peiiouontal uisease
|2,Sj
.
It is wiuely iecognizeu that specific miciooiganisms in subgingival
miciofloia aie ueteiminant agents foi peiiouontitis
|4,Sj
. Bowevei,
host uefence mechanisms within peiiouontal tissues aie tiiggeiing
agents foi peiiouontal bieakuown anu aie seen to be iesponsible
foi the most pait of tissue uamage
|6j
.
The etiological significance of biological anu behaviouial iisk
factois foi peiiouontal uiseases, which incluue smoking, auvancing
age, oial cleanliness anu systemic uiseases such as uiabetes
mellitus, has alieauy been establisheu
|7-9j
. Bowevei significant
piopoition of the vaiiations which occui in peiiouontal uisease
cannot be uesciibeu taking only these factois into consiueiation.
The ielationship between psychosocial stiess anu peiiouontal
uisease has also been emphasizeu
|1uj
. Stuuies have uemonstiateu
that inuiviuuals unuei psychological stiess aie moie likely to
uevelop clinical attachment loss anu loss of alveolai bone
|2,S,11-14j
.

Moleculur unJ FnJocrlne
Mechunlxmx of the Strexx
Rexponxe
Stiess-inuuceu iesponse
tiansmits to the hypothalamo-
pituitaiy-auienal (BPA) axis anu
piomotes the ielease of
coiticotiopin-ieleasing hoimone
fiom the pituitaiy glanu anu
glucocoiticoiu hoimones fiom
the auienal coitex.
ulucocoiticoius ieleaseu into the
coitex of the supiaienals
uecieases the piouuction of pio
inflammatoiy cytokines
(inteilukins, piostaglanuins, anu
tumoi neciosis factoi)
|1Sj
.
The seconu majoi pathway to be
activateu is the sympathetic
neivous system. Stiess activates
the neive fibeis of the autonomic
neivous system, which inneivate
the tissues of the immune system.
The ielease of catecholamine's
iesults in the hoimonal secietion
of noiepinephiine anu
epinephiine fiom the auienal
meuulla, which iesults in a iange
of effects that may act to
mouulate immune iesponses.
Catecholamines, ieleaseu uuiing
A

Pai Keshava K & Nayak Sangeeta U. J Pharm Biomed Sci. 2013, January; 26 (26); 345-348.
Available at jpbms.info

S46

ISSN NO- 2230 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

stiess, contiibute to the uevelopment of hypeiglycemia by uiiectly
stimulating glucose piouuction anu inteifeiing with the tissue
uisposal of glucose. Catecholamines aie known to altei the bloou
flow. Peiipheial vasoconstiiction may affect impoitant oxygen -
uepenuent healing mechanisms, such as angiogenesis, collagen
synthesis anu epitheliazation. The ielease of catecholamines iesults
in hoimonal secietion of noiepinephiine fiom the auienal meuulla,
which iesults in a iange of effects that may act to mouulate immune
iesponses. Incieaseu sympathetic stimulation can also act to
ueciease salivaiy secietions typically expeiienceu as anxiety
inuuceu uiy mouth. Stiess that is associateu with immune
challenge is calleu immune stiess oi inflammatoiy stiess
|1Sj
.

Strexx unJ perloJontul Jlxeuxe
The fiist available eviuence linking stiess anu peiiouontal uisease
was tiench mouth which was eviuent in soluieis on the fiont line
uuiing the fiist woilu wai
|16j
. The ielationship between peiiouontal
uisease anu psychosocial pieuisposing factois aie well establisheu
in acute neciotizing ulceiative gingivitis (AN0u). Pie-existing
gingivitis, smoking anu acute psychological uistuibances, such as
stiess, aie coiielateu with

N0u
|17j
. N0u has been significantly
associateu with high levels of tiait anxiety, uepiession anu othei
emotional uistuibances
|18j
. Stuuies have pioveu that psychological
factois such as anxiety anu uepiession have negative impact on
peiiouontal health. But when uefining the ielationship between
psychosocial factois anu peiiouontitis seveial issues aie
consiueieu: most publisheu stuuies suppoit a positive association
chionic peiiouontitis, anu seveial psycho-social factois: social
isolation, socio-economic status, peisonality factois, anxiety,
uepiession anu life stiess. Psychological stiess such as anxiety anu
uepiession, if sustaineu ovei an extenueu peiiou of time, can have
ueleteiious effects on the bouy, iepiesenting an impoitant example
of the minu-bouy inteiaction. Anxious inuiviuuals also piesent
symptoms which may inteifeie with theii oial hygiene (e.g.,
foigetfulness anu uifficulty in concentiating)
|1uj
.

The finuings suggest that the main mechanisms by which
psychosocial factois piomote gingivitis anu peiiouontitis
uevelopment incluueu:
1. Behaviouial mechanisms, wheieby the given factoi
exaceibates lifestyles known to potentiate peiiouontal
uisease (e.g., neglect of oial hygiene, changes in uiet,
inciease in smoking)
|19j
.
2. Biiect pathophysiological effects on host iesistance
|6j
.

Theiefoie, factois ielateu to the social enviionment, which may
piovoke changes in host uefences anu mouify health behavioui,
shoulu be taken into account. The biological plausibility foi the
association between stiess anu peiiouontal uisease is suppoiteu by
stuuies that have uemonstiateu that psychological states, such as
anxiety, uepiession anu exposition to stiess agents, coulu mouify
the immune iesponse, making the inuiviuual moie susceptible to
uevelop an unhealthy conuition anu may also have an impact on
peiiouontal health
|1Sj
. Stiess is
not yet confiimeu as a iisk factoi
foi peiiouontitis, but has been
iuentifieu in seveial
obseivational stuuies
|2,2uj
. In a
laige cioss-sectional stuuy, uenco
et ol.(1999)
|1Sj
founu that
psychosocial stiess factois
associateu with financial stiain
aie significant iisk inuicatois foi
auult peiiouontitis. veiy few
stuuies have uiiectly examineu
whethei psychological factois
such as anxiety, uepiession anu
stiess aie significantly associateu
with plaque anu calculus
accumulation
|21j
. Cuiiently, stiess
is consiueieu as a iisk inuicatoi
foi peiiouontal uisease.
Belting anu uupta et ol.
|21]

conuucteu a stuuy anu iepoiteu
that psychiatiic patients
piesenteu significantly highei
peiiouontal scoies than theii
contiols when biushing
fiequency, calculus, biuxism anu
clenching weie helu constant.
Fuitheimoie in the expeiimental
gioup the seveiity of
inflammatoiy peiiouontal uisease
incieaseu significantly as the
uegiee of anxiety incieaseu. The
authois suggesteu that the
peiiouontal changes in the
psychiatiic patients weie
meuiateu thiough one oi moie
piocesses ielateu to anxiety, anu
unuei the contiol of the
autonomic neivous system.
Noss et ol. in theii stuuy founu
that psychologically uepiesseu
human subjects who smokeu anu
hau high titie of Igu against
Tanneiella Foisythia weie founu
to have moie seveie anu
extensive chionic peiiouontitis.
The authois uesciibeu this by the
negative influence of uepiession
on the immune system.
Bepiession may lessen patient's
willingness to uo physical
activities leauing them to give
less attention to theii mouth oi

Pai Keshava K & Nayak Sangeeta U. J Pharm Biomed Sci. 2013, January; 26 (26); 345-348.
Available at jpbms.info

S47

ISSN NO- 2230 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

uepiession may cause chemical changes in mouth secietions which
in tuin incieases calculus foimation
|2j
.
Rozlog et ol. in theii stuuy founu that patients expeiiencing stiess
weie slowei in theii iecoveiy fiom peiiouontal suigeiy compaieu
to patients not expeiiencing stiess
|22j
.In auuition, healing following
peiiouontal suigeiy was impacteu negatively by patient's inability
to use effective coping mechanisms
|2Sj
.

Concluxlon:
The iole of stiess in human peiiouontal uisease has a plausible
pathophysiological basis. Eviuence suggests that stiess is
associateu with moie seveie peiiouontal uisease, as well as pooiei
healing iesponses to tiauitional peiiouontal theiapy. Stuuies have
suggesteu that stiess, uistiess, anu inauequate coping aie
impoitant iisk inuicatois foi peiiouontal uisease. Fuitheimoie, it is
likely that systemic uiseases associateu with peiiouontal uisease
such as uiabetes, caiuiovasculai uisease, pieteim ueliveiy, anu
osteopoiosis may shaie psychosocial stiess as a common iisk
factoi. These eaily beginnings will iequiie extensive stuuy to fully
unueistanu the moleculai anu cellulai basis of the iole of stiess,
anu in tuin these stuuies may leau to effective inteivention
stiategies that ieuuce oi negate stiess as a contiibuting factoi to
peiiouontal uiseases.

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Competent interest:- The authors
declare that they have no competing
interests.

Source of funding:- None






Pai Keshava K & Nayak Sangeeta U. J Pharm Biomed Sci. 2013, January; 26 (26); 345-348.
Available at jpbms.info

S48

ISSN NO- 2230 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

*
Corresponding address :
Dr.Sangeeta Umesh Nayak
Assistant professor
Department of Periodontology
Manipal College of Dental Sciences
Manipal University
Mangalore, Karnataka,India






























Copyright 2013 Pai Keshava K & Nayak Sangeeta U. This is an open access article distributed under the Creative Commons Attribution License,
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