title: Gingival inflammation, increased periodontal pocket depth and elevated interleukin-6 in gingival crevicular fluid of depressed women on long-term sick leave.
abstract: OBJECTIVE
  The aim of this work was to investigate periodontal status, in relation to inflammatory markers and cortisol, in the gingival crevicular fluid and saliva of a homogenous group of women on long-term sick leave for job-stress related depression in comparison to nondepressed women.
  
  
  METHODS
  The participants comprised 20 women with depression (DSM-IV) (mean age 48.5 +/- 6.9 years) and 29 healthy controls (mean age 54.5 +/- 2.9 years). Clinical examination was performed. Gingival crevicular fluid was collected by an intracrevicular washing technique. Interleukin-1 beta, interleukin-6, matrix metalloproteinase (MMP)-8 and MMP-9 were determined with enzyme-linked immunosorbent assay and cortisol was determined by using a radioimmunoassay. One-way analysis of covariance was used as the statistical method.
  
  
  RESULTS
  The depressed patients had significantly higher gingival inflammation (p < 0.001), and deeper pockets (p < 0.003), than the healthy controls, after adjusting for age and smoking. The levels of interleukin-6 in the gingival crevicular fluid were significantly higher in the patients than in the controls: 3.84 +/- 1.58 pg per site and 0.79 +/- 1.83 pg per site, respectively, p < 0.003. There were no significant differences in the levels of interleukin-1 beta, MMP-8 and MMP-9. The patients had lower cortisol values in gingival crevicular fluid than the controls, whereas the levels of cortisol in saliva were similar in both groups.
  
  
  CONCLUSIONS
  Women on long-term sick-leave for depression had more severe periodontitis and higher concentrations of interleukin-6 in gingival crevicular fluid than healthy controls. An alteration of the immune system in these patients might be interpreted as reflecting the consequences of long-term stress exposure and might contribute to worse periodontal conditions in these particular patients.
authors.affiliation: Department of Periodontology, Institute of Odontology, Karolinska Institutet, Stockholm, Sweden. Annsofi.johannsen@ki.se
authors.forename: A
authors.initials: A
authors.lastname: Johannsen
authors.forename: I
authors.initials: I
authors.lastname: Rydmark
authors.forename: B
authors.initials: B
authors.lastname: Söder
authors.forename: M
authors.initials: M
authors.lastname: Asberg
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003863:Depression / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D005260:Female; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D005891:Gingivitis / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D008875:Middle Aged; D010514:Periodontal Pocket / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D012463:Saliva / Q000737:chemistry; D018582:Sick Leave; D013315:Stress, Psychological / Q000150:complications / Q000276:immunology / Q000378:metabolism
chemical_list: D015850:Interleukin-6; D006854:Hydrocortisone