title: Catecholamine metabolites in urine, as chronic stress biomarkers, are associated with higher risk of chronic periodontitis in adults.
abstract: BACKGROUND
  The purpose of this case-control study is to investigate the association between stress and periodontitis by determining stress biomarkers in saliva and urine and to determine whether oral hygiene, gingival inflammation, and tooth loss are correlated with stress biomarkers in patients with periodontitis.
  
  
  METHODS
  A total of 77 patients (41 cases [with periodontitis] and 36 controls) participated in this study. Periodontal examination findings included probing depth, clinical attachment loss, bleeding on probing (BOP), plaque index (PI), and tooth loss. Secretory immunoglobulin (sIg)A and cortisol were determined in saliva. Cortisol, creatinine-adjusted cortisol, metanephrine, normetanephrine, and total metanephrines were measured in urine.
  
  
  RESULTS
  Urinary metanephrine (P = 0.013) and total metanephrine (P = 0.023) levels were higher in the case group. In cases, salivary cortisol was correlated with PI (r = 0.464, P <0.01), BOP (r = 0.401, P <0.05), and tooth loss (r = 0.245, P <0.05). Urinary metanephrine levels above the median were associated with a 3.4-fold higher risk of periodontitis (95% confidence interval [CI] = 1.1 to 10.2; P = 0.029), with an 82% increase in risk for each increment of 0.05 µg/24 hours. Urinary total metanephrine levels above the median were associated with a five-fold higher risk of periodontitis (95% CI = 1.6 to 15.7; P = 0.006).
  
  
  CONCLUSIONS
  The present results offer new evidence of the association between urinary concentrations of catecholamine metabolites (metanephrine and total metanephrines) and chronic periodontitis. Salivary IgA level showed no statistical difference between the cases and controls. Salivary cortisol levels in the patients with periodontitis were correlated with worse PI, higher gingival inflammation, and greater tooth loss.
authors: Department of Periodontology, School of Dentistry, University of Granada, Granada, Spain.
authors: Francisco
authors: F
authors: Mesa
authors: Antonio
authors: A
authors: Magán-Fernández
authors: Ricardo
authors: R
authors: Muñoz
authors: Lara
authors: L
authors: Papay-Ramírez
authors: Rafael
authors: R
authors: Poyatos
authors: Elena
authors: E
authors: Sánchez-Fernández
authors: Pablo
authors: P
authors: Galindo-Moreno
authors: Miguel
authors: M
authors: Rodríguez-Barranco
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D055113:Chronic Periodontitis / Q000150:complications* / Q000652:urine; D003404:Creatinine / Q000032:analysis / Q000652:urine; D003774:Dental Plaque Index; D005260:Female; D005891:Gingivitis / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000652:urine; D007071:Immunoglobulin A, Secretory / Q000032:analysis; D008297:Male; D017533:Marital Status; D008676:Metanephrine / Q000652:urine*; D008875:Middle Aged; D009647:Normetanephrine / Q000652:urine*; D009910:Oral Hygiene; D010512:Periodontal Index; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D012923:Social Class; D013312:Stress, Physiological / Q000502:physiology*; D064424:Tobacco Use / Q000652:urine; D016388:Tooth Loss / Q000652:urine; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007071:Immunoglobulin A, Secretory; D009647:Normetanephrine; D008676:Metanephrine; D003404:Creatinine; D006854:Hydrocortisone
keywords: Anxiety disorders; catecholamines; chronic periodontitis; hydrocortisone; immunoglobulin A; secretory