title: The effect of stress on periodontitis: A clinicobiochemical study.
abstract: BACKGROUND
  Clinical and epidemiological data suggest that negative life experience events, like depression, may contribute to an increased susceptibility to periodontal disease.
  
  
  OBJECTIVE
  To study the association between psychological stress and chronic periodontitis.
  
  
  METHODS
  One hundred and eleven dentate individuals, of age 40 years and above, were selected. The clinical examination included, the number of teeth present, plaque index, Probing Pocket Depth, and Clinical Attachment Level. Assessment of Psychological stress levels were done by a questionnaire and were correlated with salivary cortisol levels, which were estimated biochemically by using the Enzyme-Linked Immunosorbent Assay (ELISA) method.
  
  
  RESULTS
  Statistical analysis was done by using the student 't' test and Mann Whitney test. According to our observation, chronic periodontitis showed a significant correlation with hypercortisolemia (P<0.0001), work tension (P=0.04), economic problems (P<0.0001), clinical stress syndrome (P<0.0001), plaque index (P<0.0001), and unsecured job (P=0.003).
  
  
  CONCLUSIONS
  Stress may be considered as an important risk factor for periodontal disease. Routine salivary cortisol assessment may be an economical and useful diagnostic marker to rule out stress in periodontitis patients.
authors.affiliation: Department of Periodontics, Narayana Dental College, Nellore, Andhra Pradesh, India.
authors.forename: Satheesh
authors.initials: S
authors.lastname: Mannem
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Chava