Therapy‐resistant periodontitis. Psychosocial characteristics

Abstract

This study investigated the perspective of a stress system disorder in the pathogenesis of therapy-resistant periodontitis. The goal was to find indications that the stress-behaviour-immune system model holds as an explanatory model for the understanding of periodontal disease. 2 patient-groups were compared: one group classified as responding well to periodontal treatment (responsive-group, R-group, n=11); the other group was classified as responding less well to treatment (non-responsive-group, NR-group, n=11). Somatic and psychological factors were described as obtained by interviews and psychological testings. These findings were related to clinical data documented during the treatment of the patients. An exact logistic multivariate regression analysis was performed on a model based on variables selected by bivariate analysis (variable versus group). The results indicated that the NR-group patients displayed indications of more psychosocial strain and a more passive-dependent personality. The R-group patients displayed a more rigid personality and possibly a less stressful psychosocial situation in the past. The report highlights the possible contribution of stress factors in the context of therapy resistant periodontal disease, and the results seem to be understandable within the context of a stress system disorder perspective.

Oral diseases and socio-economic status (SES)

“…36,37 The model outlined by Clarke and Hirsch 38 for example, has received considerable support from a number of more recent studies. [39][40][41][42] Thus the evidence supporting psychosocial stress as an aetiological factor in periodontitis is growing. The identification of possible biological pathways through which psychosocial stress may result in periodontal destruction provide circumstantial biological underpinning for the role of psychosocial stress.…”

Stress and Periodontal Disease

“…The HPA leads to a production of glucocorticoids (cortisol) that depresses the immune system by diminishing the IgA and IgG secretions, thereby enhancing the periodontal disease progression and poor treatment response. 11 Subsequently, this process could increase vulnerability of periodontal tissues to pathogenic microorganisms by activation of cellular responses leading to local tissue destruction (Flow Chart 3). 21 Patients suffering from periodontitis, who are under stressful conditions, have increased levels of IL-6 22 and IL-1b 23 in GCF, and similarly, patients with aggressive forms of periodontitis have elevated levels of IL-6 and IL-1b in serum.…”

Epidemiology: It’s Application in Periodontics

“…Significantly elevated cortisol level was observed in urine with NUG patients and that returned to normal after recovery (Cohen-Cole et al, 1983). Those individuals with more psychological stress were less responsive to periodontal therapy (Axtelius et al, 1998). The exact pathological link between stress and periodontal destruction, however, has not yet been established but are probably related to impaired immune function and altered oral health behaviors.…”