title: Effects of academic stress on oral hygiene--a potential link between stress and plaque-associated disease?
abstract: BACKGROUND
  While there seems to be a common belief that psychosocial stress affects oral hygiene behavior, this assumption has rarely been proved. The present study thus aims to analyse stress effects on oral hygiene.
  
  
  METHODS
  16 matched pairs of medical students each consisting of 1 student participating in a major academic exam and 1 control without current academic stress, were formed on the basis of baseline plaque levels. At baseline, a professional tooth cleaning was performed. On the last day of exams, students answered questionnaires about oral hygiene during the exams and were afterwards asked to attend for a 2nd dental examination, of which they had no prior knowledge.
  
  
  RESULTS
  On the last day of exams, approximately 6 weeks after professional tooth cleaning, 20.9+/-18.3% of control students' sites but only 10.5+/-9.3% of exam students' sites were found to be free of any plaque (p=0.022). Differences were most obvious at oral, as compared to vestibular, sites. Exam students reported a reduction in thoroughness (p=0.019) but not of frequency of oral hygiene behavior.
  
  
  CONCLUSIONS
  The study strongly supports the assumption that psychosocial stress may induce neglect of oral hygiene and increase of plaque accumulation.
authors.affiliation: Institute for Medical Psychology, University of Duesseldorf, Germany. renate.deinzer@uni-duesseldorf.de
authors.forename: R
authors.initials: R
authors.lastname: Deinzer
authors.forename: D
authors.initials: D
authors.lastname: Hilpert
authors.forename: K
authors.initials: K
authors.lastname: Bach
authors.forename: M
authors.initials: M
authors.lastname: Schawacht
authors.forename: A
authors.initials: A
authors.lastname: Herforth
mesh_terms: D001294:Attitude to Health; D016022:Case-Control Studies; D003773:Dental Plaque / Q000209:etiology*; D003774:Dental Plaque Index; D003777:Dental Prophylaxis; D004521:Educational Measurement; D005260:Female; D005884:Gingival Hemorrhage / Q000145:classification; D015438:Health Behavior; D006801:Humans; D007071:Immunoglobulin A, Secretory / Q000032:analysis; D008297:Male; D009910:Oral Hygiene; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D016037:Single-Blind Method; D012907:Smoking; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000523:psychology*; D013337:Students, Medical; D011795:Surveys and Questionnaires; D014099:Toothbrushing
chemical_list: D007071:Immunoglobulin A, Secretory