title: Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older.
abstract: BACKGROUND
  The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years.
  
  
  METHODS
  In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes.
  
  
  RESULTS
  The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%).
  
  
  CONCLUSIONS
  Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.
authors.affiliation: Faculty of Dentistry of Piracicaba, State University of Campinas, Piracicaba, São Paulo, Brazil. fnhugo@yahoo.com.br
authors.forename: Fernando N
authors.initials: FN
authors.lastname: Hugo
authors.forename: Juliana B
authors.initials: JB
authors.lastname: Hilgert
authors.forename: Mary C
authors.initials: MC
authors.lastname: Bozzetti
authors.forename: Denise R
authors.initials: DR
authors.lastname: Bandeira
authors.forename: Tonantzin R
authors.initials: TR
authors.lastname: Gonçalves
authors.forename: Josiane
authors.initials: J
authors.lastname: Pawlowski
authors.forename: Maria da Luz R
authors.initials: Mda L
authors.lastname: de Sousa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000032:analysis; D002908:Chronic Disease; D003773:Dental Plaque / Q000209:etiology*; D003863:Depression / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D005891:Gingivitis / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry*; D013312:Stress, Physiological / Q000150:complications*
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone