title: The influence of academic stress on gingival inflammation.
abstract: OBJECTIVE
  The aim of the present study was to investigate the effects of academic stress on periodontal health, in relation to inflammatory markers in gingival crevicular fluid (GCF) and cortisol in saliva.
  
  
  METHODS
  The study included 20 healthy dental hygienists (females: mean age 29.3 +/- 8.5 SD) and was conducted during a major exam period and 4 weeks later after the exams. A clinical examination was performed and GCF was collected from four sites in each subject on these two occasions. Interleukin (IL)-1beta, IL-4, IL-6, IL-10 levels were determined using Luminex 100 and cortisol amounts by radioimmunoassay (RIA (125)I). Students registered their perceived stress on a visual analogue scale (VAS). Significance of the findings was determined using paired t-test, Wilcoxon-matched pair and Spearman's rank correlations.
  
  
  RESULTS
  Students had higher amounts of dental plaque (P < 0.007) and gingival inflammation (P < 0.001) during the exam period compared with after the exams. The amounts of IL-6 and IL-10 in GCF were significantly increased during the time of examinations. The median level of cortisol in saliva was also significantly raised during the exam period compared with after the exams, 20.52 nmol/l (range: 11.91-27.34) and 16.41 nmol/l (range: 10.91-24.17) respectively, P < 001. The results from the VAS registration revealed a significant difference (P < 001) between the two occasions.
  
  
  CONCLUSIONS
  Academic stress appears to affect periodontal health, shown by more plaque accumulation, gingival inflammation and increased amounts of IL-6, IL-10 in GCF and cortisol in saliva.
authors.affiliation: Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. annsofi.johannsen@ki.se
authors.forename: A
authors.initials: A
authors.lastname: Johannsen
authors.forename: N
authors.initials: N
authors.lastname: Bjurshammar
authors.forename: A
authors.initials: A
authors.lastname: Gustafsson
mesh_terms: D000328:Adult; D003756:Dental Hygienists / Q000193:education*; D003773:Dental Plaque / Q000145:classification / Q000209:etiology; D005260:Female; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D005884:Gingival Hemorrhage / Q000145:classification; D005891:Gingivitis / Q000145:classification / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D018836:Inflammation Mediators / Q000032:analysis; D016753:Interleukin-10 / Q000032:analysis; D053583:Interleukin-1beta / Q000032:analysis; D015847:Interleukin-4 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D017622:Periodontal Attachment Loss / Q000145:classification; D010514:Periodontal Pocket / Q000145:classification; D012463:Saliva / Q000737:chemistry; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D016753:Interleukin-10; D015847:Interleukin-4; D006854:Hydrocortisone