title: A prospective study of social support, anger expression and risk of periodontitis in men.
abstract: BACKGROUND
  Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance and potentially increased risk of periodontitis.
  
  
  METHODS
  The authors examined the association between social support, anger expression and periodontitis in 42,523 male, U.S.-based, health professionals. Subjects were aged 40 to 75 years in 1986, and more than half were dentists. The men were free of a diagnosis of periodontitis at the start of follow-up in 1996.
  
  
  RESULTS
  Subjects who reported having at least one close friend had a 30 percent lower risk of developing periodontitis compared with those who did not have a close friend (relative risk, or RR = 0.70; 95 percent confidence interval, or CI, 0.51-0.96). Men who participated in religious meetings or services had a 27 percent lower risk of developing periodontitis compared with men who did not participate in religious meetings (RR = 0.73; 95 percent CI, 0.64-0.83). After the authors adjusted for potential confounding variables, men whose anger scores were in the top quintile were 72 percent more likely to report having periodontitis compared with men whose scores were in the lowest quintile (RR = 1.72; 95 percent CI, 1.39-2.12). Men who reported being angry on a daily basis had a 43 percent higher risk of developing periodontitis compared with men who reported being angry seldom.
  
  
  CONCLUSIONS
  Reduced social isolation and anger expression may play an important role in maintaining oral health, as well as general health and well-being.
  
  
  CONCLUSIONS
  When treating patients with periodontitis, clinicians should be cognizant of the social and behavioral factors that may affect oral health.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Mass., USA. amerchan@hsph.harvard.edu
authors.forename: Anwar T
authors.initials: AT
authors.lastname: Merchant
authors.forename: Waranuch
authors.initials: W
authors.lastname: Pitiphat
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Kaumudi
authors.initials: K
authors.lastname: Joshipura
mesh_terms: D000328:Adult; D000368:Aged; D000786:Anger; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000209:etiology / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires