“…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.…”