Open Journal Systems

Cover Image

Association of periodontal diseases to anxiety and stress

Maryam Abrishami, Zeynab Abdi Zamharir, Sajedeh Ghorbanzadeh


The effect of periodontal diseases is not equal for the people of a same community. There are risk factors in some people making them more sensitive to the disease spread. Getting infected to certain pathogens, cigarette, and uncontrolled diabetes increases the risk of periodontitis. Other factors such as stress, depression, and anxiety are not considered as absolute risk factors, yet. The biological justification for this relationship is that the psychological status and facing with stressors could change the immune response and made the individual more sensitive to the disease spread. The aim of the present article was to review the periodontal relationship with psychological factors of anxiety and stress. The research is conducted using review article method and by searching through keywords such as anxiety, periodontal disease, and stress in PubMed. Most of the published studies are backing up of a positive relationship between periodontitis and socio psychological factors. Diff erent lifestyles, stressful situation, hormonal changes, dental negligence, bad habits like smoking are considered as predisposing factors of periodontal diseases.


Anxiety; depression; periodontal disease; stress

Full Text:



Peruzzo DC, Benatti BB, Ambrosano GM, Nogueira-Filho GR, Sallum EA, Casati MZ, et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol 2007;78:1491-504.

LeResche L, Dworkin SF. The role of stress in inflammatory disease, including periodontal disease: Review of concepts and current findings. Periodontol 2000 2002;30:91-103.

Karadottir H, Lenoir L, Barbierato B, Bogle M, Riggs M, Sigurdsson T, et al. Pain experienced by patients during periodontal maintenance treatment. J Periodontol 2002;73:536-42.

Moss ME, Beck JD, Kaplan BH, Off enbacher S, Weintraub JA, Koch GG, et al. Exploratory case-control analysis of psychosocial factors and adult periodontitis. J Periodontol 1996;67:1060-9.

Vettore M, Quintanilha RS, Monteiro da Silva AM, Lamarca GA, Leão AT. The influence of stress and anxiety on the response of non-surgical periodontal treatment. J Clin Periodontol 2005;32:1226-35.

Genco RJ, Ho AW, Grossi SG, Dunford RG, Tedesco LA. Relationship of stress, distress and inadequate coping behaviors to periodontal disease. J Periodontol 1999;70:711-23.

Taubman MA, Valverde P, Han X, Kawai T. Immune response: The key to bone resorption in periodontal disease. J Periodontol 2005;76:2033-41.

Kinane DF, Lappin DF. Immune processes in periodontal disease: A review. Ann Periodontol 2002;7:62-71.

Breivik T, Thrane P. Psychoneuroimmune interactions in periodontal disease. Psychoneuroimmunology 2001;2:627-44.

Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Psychoneuroimmunology: Psychological influences on immune

function and health. J Consult Clin Psychol 2002;70:537-47.

Vettore MV, Leão AT, Monteiro Da Silva AM, Quintanilha RS, Lamarca GA. The relationship of stress and anxiety with chronic periodontitis. J Clin Periodontol 2003;30:394-402.

Kamma JJ, Giannopoulou C, Vasdekis VG, Mombelli A. Cytokine profile in gingival crevicular fluid of aggressive periodontitis: Influence of smoking and stress. J Clin Periodontol 2004;31:894-902.

Hilgert JB, Hugo FN, Bandeira DR, Bozzetti MC. Stress, cortisol, and periodontitis in a population aged 50 years and over. J Dent Res 2006;85:324-8.

Takada T, Yoshinari N, Sugiishi S, Kawase H, Yamane T, Noguchi T. Effect of restraint stress on the progression of experimental periodontitis in rats. J Periodontol 2004;75:306-15.

Genco RJ, Ho AW, Kopman J, Grossi SG, Dunford RG, Tedesco LA. Models to evaluate the role of stress in periodontal disease. Ann Periodontol 1998;3:288-302.

Chrousos GP, Gold PW. Th e concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 1992;267:1244-52.

da Silva AM, Newman HN, Oakley DA. Psychosocial factors in inflammatory periodontal diseases. A review. J Clin Periodontol 1995;22:516-26.

Solis AC, Lotufo RF, Pannuti CM, Brunheiro EC, Marques AH, Lotufo-Neto F. Association of periodontal disease to anxiety and depression symptoms, and psychosocial stress factors. J Clin Periodontol 2004;31:633-8.

Roberts A, Matthews JB, Socransky SS, Freestone PP, Williams PH, Chapple IL. Stress and the periodontal diseases: Effects of catecholamines on the growth of periodontal bacteria in vitro. Oral Microbiol Immunol 2002;17:296-303.

Marques-Vidal P, Milagre V. Are oral health status and care associated with anxiety and depression? A study of Portuguese health science students. J Public Health Dent 2006;66:64-6.

Saletu A, Pirker-Frühauf H, Saletu F, Linzmayer L, Anderer P, Matejka M. Controlled clinical and psychometric studies on the relation between periodontitis and depressive mood. J Clin Periodontol 2005;32:1219-25.

Klages U, Weber AG, Wehrbein H. Approximal plaque and gingival sulcus bleeding in routine dental care patients: Relations to life stress, somatization and depression. J Clin Periodontol 2005;32:575-82.

Dumitrescu AL, Kawamura M. Involvement of psychosocial factors in the association of obesity with periodontitis. J Oral Sci 2010;52:115-24.

Dumitrescu AL, Dogaru BC, Dogaru CD. Self-control and self-confidence: Their relationship to self-rated oral health status and behaviours. Oral Health Prev Dent 2009;7:155-62.

Persson GR, Persson RE, MacEntee CI, Wyatt CC, Hollender LG, Kiyak HA. Periodontitis and perceived risk for periodontitis in elders with evidence of depression. J Clin Periodontol 2003;30:691-6.

Eitner S, Wichmann M, Paulsen A, Holst S. Dental anxiety – An epidemiological study on its clinical correlation and effects on oral health. J Oral Rehabil 2006;33:588-93.

Ng SK, Leung WK. A community study on the relationship of dental anxiety with oral health status and oral health-related quality of life. Community Dent Oral Epidemiol 2008;36:347-56.

McGrath C, Bedi R. The association between dental anxiety and oral health-related quality of life in Britain. Community Dent Oral Epidemiol 2004;32:67-72.

Deinzer R, Förster P, Fuck L, Herforth A, Stiller-Winkler R, Idel H. Increase of crevicular interleukin 1beta under academic stress at experimental gingivitis sites and at sites of perfect oral hygiene. J Clin Periodontol 1999;26:1-8.

Deinzer R, Rüttermann S, Möbes O, Herforth A. Increase in gingival inflammation under academic stress. J Clin Periodontol 1998;25:431-3.

Deinzer R, Hilpert D, Bach K, Schawacht M, Herforth A. Effects of academic stress on oral hygiene – A potential link between stress and plaque-associated disease? J Clin Periodontol 2001;28:459-64.

Nicolau B, Marcenes W, Hardy R, Sheiham A. A life-course approach to assess the relationship between social and psychological circumstances and gingival status in adolescents. J Clin Periodontol 2003;30:1038-45.

Vanderas AP, Kavvadia K, Papagiannoulis L. Urinary catecholamine levels and gingivitis in children. J Periodontol 1998;69:554-60.

Monteiro da Silva AM, Newman HN, Oakley DA, O’Leary R. Psychosocial factors, dental plaque levels and smoking in periodontitis patients. J Clin Periodontol 1998;25:517-23.

Ng SK, Keung Leung W. A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss. Community Dent Oral Epidemiol 2006;34:252-66.

Castro GD, Oppermann RV, Haas AN, Winter R, Alchieri JC. Association between psychosocial factors and periodontitis: A case-control study. J Clin Periodontol 2006;33:109-14.

Aleksejuniené J, Holst D, Eriksen HM, Gjermo P. Psychosocial stress, lifestyle and periodontal health. J Clin Periodontol 2002;29:326-35.

Hugoson A, Ljungquist B, Breivik T. The relationship of some negative events and psychological factors to periodontal disease in an adult Swedish population 50 to 80 years of age. J Clin Periodontol 2002;29:247-53.

Wimmer G, Janda M, Wieselmann-Penkner K, Jakse N, Polansky R, Pertl C. Coping with stress: Its influence on

periodontal disease. J Periodontol 2002;73:1343-51.

Dumitrescu AL. Psychological perspectives on the pathogenesis of periodontal disease. Rom J Intern Med 2006;44:241-60.


  • There are currently no refbacks.