PSYCHOLOGICAL STRESS AND PERIODONTAL DISEASE1

JALALEDDIN HAMISSI, DDS, DipPerio, MDS (Periodontics) 2 SHAHRIYAR KAKAEI, DDS 3 HESAMMEDDIN HAMISSI

ABSTRACT The aim of the study was to investigate the relationship between psychological stress and periodontal disease. The study was carried out on 496 patients aged 17-64 years from January 2007 to December 2008 at the Department of Pcriodontics, College of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran. 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 examinations were carried out using standard protocol. It was followed by Clinical Attachment Loss (CAL) determination as a basis for evaluation of periodontal status. Later psychoso-cial factors were evaluated using internationally recommended questionnaires. The data were analysed using chi square test with p < 0.05 defined as level of significance. 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. The patients having severe Clinical Attachment Loss (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. The results of this study showed that the continuous financial strains, depression, inadequate coping ability and maladaptive trait dispositions were significant risk factors for periodontal attachment loss. Key words: Psychosocial factors, stress, anxiety, periodontal disease, clinical attach-ment loss

INTRODUCTION

behavioral and emotional life events.2 Studies have demonstrated that Periodontal disease is defined as an inflammatory process of the gingival individuals under psychological tissues, resulting in deep gingi-val sulci, and possibly producing periodontalstress are more4-18 likely to develop pockets and supporting alveolar bone loss.1 Several risk factors broadly knownclinical attachment include, but not limited to, oral hy-giene, smoking, advancing age and loss and loss of alveolar bone. systemic diseases involved.2 The relationship between psychosocial stress and During recent years, various periodontal disease has also been emphasized.3 Psychosocial stress is epidemiological stud-ies carried out in described as particularly tense various countries revealed that periodontal diseases in different societies have a differ-ent prevalence.5,6,7 For many years dental research scholars were searching the factors responsible for severe periodontal attachment loss which occurs even1

Correspondence: Dr Jalaleddin Hamissi, Associate Professor, Department of Periodontics, College of Dentistry,

Qazvin University of Medical Sciences, Qazvin, Iran. Email: jhamissi@qums.ac.ir, jalal_hammissi@yahoo.com 2 3 Dentist Dental student, College of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran

Pakistan Oral & Dental Journal Vol 30, No. 2 (December 2010)

464

Psychological stress and periodontal disease

Psyciatric University in some very cleanHospital Zurish was used. mouths, whereIt is called Symptom check infection possiblylist SCL 90). These could not have beenwere used to assess chronic the initiating factors.stress. Questionnaires were This study was andistributed among patients effort to investigatewho were asked to fill whether stress andthese and they were anxiety of moderncollected 3 days later. The life could be theresponses were scored and analyzed together with the causative factor. data received from METHODOLOGY periodontal charts. Standard protocol was This was an inter used for periodontal disciplinary, crossexamination and for sectional pro-spective calculating clinical study, which was attachment loss (CAL) carried out in the Depart-ment of Periodontics at Qazvin CAL was classified in the College/Hospital offollowing groups; Dentistry, Qazvin 14 patients (8.9%) male 32 (10.6%) fema (Located at a distance 1.5m Slight 42 (23.9%) M of 140 km from 3.4m Moderate 72 (40.9%) M Teheran Iran).5 mm Severe 48 (27.3%) M 176 patients

There were 496RESULTS patients in age range Out of 496 patients of 15-65 years. 176 were males and 320referred to department of females. Most ofperiodontics, 320 were them were referredfemales and 176 males. illustrate the from medicalTable-1 frequency specialists. All therelative distribution of demopatients had periodontal as well asgraphic characteristics of under study. psychological stresssubjects the patients prob-lems. ThoseWhen psychological data were patients who were suffering from severecollected and classified pain or other medicalbased on degree of clinical loss, the ailments wereattachment correlation of excluded from the study. For recordingpsychological factors with of clinical psychological stress aseverity attachment loss was question-naire evaluated (Fig 1). Amongst comprising 90 psychological questions used byevaluated

factors, anxiety, depression, emotional focused coping behavior and chronic stress

TABLE 1: THE RELATIVE FREQUENCY DISTRIBU-TION OF DEMOGRAPHIC CHARACTERISTICS OF PEOPLE UNDER STUDY Sample characteristics Sex Male Female Age in decades Lower than 20 21-30 31-40 41-50 51-60 Higher than 61 Marital status Single Married Education Illiterate Elementary Junior high school Secondary studies Academic studies Occupation Retiree unemployed Worker Housewife Self-employed Student (at school or university) Employees Number 176 320 36 118 134 130 66 12 104 390 28 118 108 62 44 32 266 80 18 56

were revealed to have a significant relationship with attachment loss (p