title: Association among stress, salivary cortisol levels, and chronic periodontitis.
abstract: OBJECTIVE
  Chronic periodontitis (CP) seems to be associated with stress and depression, but little information on this possible association is available in the literature. Thus, the objective of this study was to evaluate the association among stress, the salivary cortisol level (SCL), and CP.
  
  
  METHODS
  Seventy systemically healthy subjects were included in the study from January to September 2011. Full medical and dental histories were obtained, and the following measurements were recorded: 1) probing depth; 2) clinical attachment level; 3) bleeding on probing; and 4) tooth mobility. Saliva samples were collected for the evaluation of SCL (via a highly sensitive electrochemiluminescence immunoassay), and all subjects also answered a questionnaire (i.e., the Zung Self-rating Depression Scale). The odds ratio (OR) with a 95% confidence interval (CI) was calculated, and one way analysis of variance and the Tukey-Kramer method were performed.
  
  
  RESULTS
  A total of 36 subjects with CP (51.4%) and 34 without CP were evaluated. Of them, all of the subjects with CP and one periodontally healthy subject were diagnosed with depression. Subjects with moderate CP had statistically significantly higher levels of SCL than subjects with a diagnosis of slight CP (P=0.006). Also, subjects with severe CP showed the same outcome when compared to those with slight CP (P=0.012). In addition, 46 subjects presented high SCL whereas 24 had a normal level. CP was found to be correlated with the SCL, with an OR of 4.14 (95% CI, 1.43 to 12.01).
  
  
  CONCLUSIONS
  Subjects with a high SCL and depression may show an increased risk for CP.
authors.affiliation: Department of Periodontology, Universidad San Martin de Porres, Lima, Peru.
authors.forename: Zoila
authors.initials: Z
authors.lastname: Refulio
authors.forename: Marco
authors.initials: M
authors.lastname: Rocafuerte
authors.forename: Manuel
authors.initials: M
authors.lastname: de la Rosa
authors.forename: Gerardo
authors.initials: G
authors.lastname: Mendoza
authors.forename: Leandro
authors.initials: L
authors.lastname: Chambrone
keywords: Chronic periodontitis; Depressive disorder; Physiological stress; Saliva