Relationship among Periodontal Disease, Insulin Resistance, Salivary Cortisol, and Stress Levels during Pregnancy

Abstract

Pregnancy is a period involving important metabolic changes that enable the maintenance of the mother's health and development of the fetus. This study aimed to assess the relationship among periodontal disease, insulin resistance, salivary cortisol concentration and level of perceived stress in pregnant women. This was a cross-sectional study. The sample comprised 96 pregnant women between the fifth and seventh month of pregnancy registered at the Basic Health Units of the Unified Health System (SUS). The periodontal condition was assessed after obtainment free and informed consent from the participants. Participants were divided into three groups: control subjects with a healthy periodontal condition (CN; n=46), patients with gingivitis (GI; n=26), and patients with periodontitis (PI; n=24). Saliva and blood samples were collected for evaluation of salivary cortisol concentration, glycemia, insulinemia and Homeostasis Model Assessment-Insulin Resistance index. A validated survey for the assessment of perceived stress levels was also performed. PI group showed significantly higher (p<0.05) blood glucose levels (CN: 4.43±0.05; GI: 4.46±0.04; PI: 4.68±0.08), insulinemy (CN: 6.93±0.45; GI: 8.87±0.79; PI: 12.77±1.30), insulin resistance (CN: 1.40±0.10; GI: 1.81±0.18; PI: 2.66±0.29) compared with the CN and GI groups. The levels of perceived stress were higher (p<0.05) in PI and GI groups when compared to CN group (CN: 20.5±1.26; GI: 25.8±1.95; PI: 26.6±1.36). There was no significant difference in the concentration of salivary cortisol between the groups (CN: 11.13±0.58; GI: 11.96±0.74; PI: 11.47±0.74). It was concluded that there is a relationship between higher levels of perceived stress, insulin resistance and the occurrence of periodontal disease during pregnancy. This study emphasizes the importance of preventing periodontitis in order to avoid insulin resistance and stress during pregnancy since these can cause systemic complications for the mother and the fetus.

Factors determining the negative perception of the health of Brazilian elderly people

“…A similar condition was also observed in relation to oral health, where the data showed that a negative classification of disease results in a greater possibility of elderly persons also considering their general health to be poor (OR =1.92). This is unsurprising, as the oral cavity is part of the individual and is today considered to have a direct influence on overall health, contributing to high levels of quality of life and health perception [24][25][26] .…”

Periodontal profile and oral hygiene status in pregnants at maternity hospital in the state of Goias, Brazil

“…It was seen that most of the pregnant women (48%) were between 21 and 30 years old, while the minority (19%) were between 31 and 40 years. A study by Moimaz et al (13) presented a mean age of 24.7 years while that of Seraphim et al (8) presented a mean age of 26.18 years for the 96 pregnant women they evaluated. The mean ages in these studies were very close to those of this present study.…”

“…Gingivitis can be considered the main oral disease affecting women in the gestational period, due to an increase in the concentration of female sex hormones, and leads to exacerbated gingival inflammation (2,5,8,12) .…”

“…Research has shown that Fusobacterium nucleatum, a common oral bacterium in periodontal diseases, can invade not only periodontal cells, but also other types of cell in the human body even leading to a probable association between periodontal disease and intercurrences during pregnancy (premature birth and low birth weight) (5,7) . An experimental study in rats has shown that maternal periodontal disease can increase the plasma concentration of the Tumor Necrosis factor-alpha and Interleukin-6, thereby allowing periodontal pathogens to reach the amniotic cavity and cause pregnancy complications (8) .…”

Gengivite Ulcerativa Necrosante: um relato de caso

“…Assim, o estresse parece alterar o processo inflamatório dificultando a cicatrização devido ao fato de deprimir as funções dos neutrófilos e linfócitos, o que facilita a invasão e bacteriana. [21][22][23][24] Além disso, o segundo fator está relacionado à diminuição da microcirculação gengival e do fluxo salivar. 17,20 A resistência do tecido hospedeiro pode ser alterada por mecanismos que atuam por meio do sistema nervoso autônomo e de glândulas endócrinas, resultando em elevação dos níveis de cortisol e catecolaminas.…”