Positive relationship between stress and periodontal disease?
METHODS
Medline and the Cochrane Oral Health Group Specialist Trials Register were utilised to find relevant studies.


METHODS
Articles were examined independently by two reviewers, and all review articles and animal studies were excluded. Studies published in the English language were included if they controlled for the potential effect of confounding factors, had adequate criteria to define periodontal disease, and it was possible to establish evaluate stress levels and the methodological quality of the study.


METHODS
Data were extracted by two reviewers independently and verified by a third. A qualitative summary of the findings was presented.


RESULTS
One prospective clinical trial, seven case-control studies and six cross-sectional studies were included. Eight studies found a positive outcome between psychosocial factors or stress and periodontal disease; four studies observed a positive outcome for some characteristics and a negative outcome for others; whereas two studies found a negative outcome between psychosocial factors or stress and periodontal disease.


CONCLUSIONS
Within the limitations of this systematic review, the majority of studies showed a positive relationship between stress or psychological factors and periodontal disease. In the future, however, well-designed and more representative studies should be considered to confirm these factors as a risk for periodontal disease.
McCracken
Giles
G
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.