Association among stress and depression in patients with advanced periodontitis: a cross-sectional study

Gaetano Isola, Alessandro Polizzi, Francesco Indelicato, Akhilanand Chaurasia


Background: The relationship between psychological factors and the onset and progression of periodontal disease has recently attracted more academic attention. The purpose of the study was to evaluate the association between psychological stress and periodontitis The study was conducted out on patients with periodontitis.

Methods: All the patients included in the study were suffering from psychological stress and were referred to us by medical specialists, and they also showed clinical features of periodontal disease. Patients suffering from acute severe pain or system diseases were excluded. Periodontal exams were done out utilizing standard procedures. It was followed by Clinical Attachment Loss (CAL) diagnosis as a basis for evaluation of periodontal condition. Later psychosocial aspects were examined using globally approved questionnaires. The data were examined using chi square test and the Spearman correlation test with p < 0.05 considered as level of significance.

Results: Among the psychosocial factors identified in this study were anxiety, depression and chronic stress and methods to adapt stress were shown to have a significant relationship with CAL. Specifically, probing depth (PD) was significantly correlated with anxiety (p<0.001), depression (p= 0.026), stress (p<0.001); CAL was significantly correlated with elderly age (p= 0.006), anxiety (p<0.001), depression (p= 0.026) and stress (p= 0.017); bleeding on probing (BOP) was significantly correlated with depression (p= 0.027); plaque index (PI) was significantly correlated with anxiety (p= 0.014); gingival recession (REC) was significantly correlated with depression (p= 0.016) and stress (p= 0.035). The patients having severe periodontitis measured through CAL were found suffering from severe anxiety and they used more emotional focused coping methods frequently. Those with lower CAL used problem focussed coping methods frequently.

Conclusions: The results of this study demonstrated that the persistent financial stresses, depression, insufficient coping capacity and maladaptive personality dispositions were important risk factors for periodontal attachment loss.


Clinical Psychology; Periodontitis; Non-surgical treatment; Quality of life; Systemic diseases; Self-esteem.

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