“…Moreover, the administration of pro-inflammatory cytokines and lipopolysaccharide has been able to induce depressive-like behaviors in rodent studies (Manosso et al, 2013 ; Mello et al, 2013 ; Kurosawa et al, 2015 ; Zhu et al, 2015 ). Critically, periodontal disease is also associated with high levels of systemic inflammation, in particularly, interleukin-6 (IL-6), TNF-α, and C-reactive protein (CRP; Pussinen et al, 2007 ; Bansal et al, 2014 ) that may potentiate inflammatory and oxidative and nitrosative stress processes and thus may lead to a vulnerability to depression (Battino et al, 1999 ; Chapple and Matthews, 2007 ; Berk et al, 2013 ; Bullon et al, 2014 ). - Furthermore, periodontal disease may increase the risk for depression through the psychosocial effects (e.g., shame, isolation, embarrassment, loneliness) of poor oral hygiene and halitosis, frequent characteristics of patients with periodontal disease (Morita and Wang, 2001 ; Tsai et al, 2008 ; Pham et al, 2012 ; Silveira et al, 2012 ; Durham et al, 2013 ; Guentsch et al, 2014 ).
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