Communilv Dcnl Ond Epidemiol 1993: 21: 176 7Prinied in Dennuirk . Al! riii:hls reserved

iC Altniksi^aard 1993

Communify Dentistryand Oral Epidemiologj

ISSlV 0301-5661

Stress measures as predictors ofperiodontal disease - a preliminarycommunication

Ruth Freeman^ and Sally'Department of Paediatric and PreventiveDentistry, Queen's tjniversity of Belfast,Belfast, ^Harrow Helath Care Centre, Harrow.UK

Freetnan R, Goss S: Stress tneasures as predictors of periodontal disease - aprelitninaty cotntnunication. Cotntnunity Dent Oral Epidetniol 1993; 21: 176-7.{(•) Munksgaard, 1993

Key words: periodontal disease; stress,psychological

R. Freemann, Department of Paediatric andPreventive Dentistry, Queen's tjniversity ofBelfast, Belfast BT12 6BP LIK

Accepted for publication 31 January 1993

The multiple burst hypothesis of perio-dontal disease postulated by Soct<ANSKYcl al. (1) has stitnulated re.search to exatn-ine factors within the host which increasethe probability of periodontal break-down. One factor which is ktiown to affectindividual's susceptibility to disease isstress. Sti essful life events have been dem-onstrated to be pathogenic with respect toperiodontal disease (2-4). More recentlystressful life events have been associatedwith increa.sed experience of both acuteand chronic oral symptotns (5).

Since stress-related illtiesses associatedwith the work place arc cotntnotily expe-rienced (6) and occupational stress isquantifiable (7), it seetned appropriateto investigate the effect of occupationalsttess upon periodontal health.

iVIateriais and methods

A total of 10 wotnen and 8 tnen from thehead office of a large cotnpany and witha tnean age of 39 yr cotnpleted the study.

The first tnolars (if absent, then the se-cond tnolar was substituted) and all inci-sors were exatnined over a 12-tnonthperiod for plaque, bleeding, calculus andpocket depth. The subjects were exam-ined by two exatniners and an inter-exatnincr reproducibility of Kappa = 0.80was achieved. Detnographic, health de-tails and stress assesstnent were obtainedat the first visit and at each subsequentvisit occupational stress was assessedusing the Occupational Stress Indicatorquestionnaire (7) (OSl). The OSl assessesoccupational stress retrospectively. It ex-atnines various aspects of stress in theworkplace and has been shown have highvalidity atid reliability (6). Statisticalanalysis used /-test to cotnpare tnean dif-ferences in periodontal status with titneand normative scores for occupationalstress with tbose obtained for the satnple.Regression tnodelling was used to predicttneati increase in pocket depth with allpsycho-social and general health dataacting as independent variables.

Table I

Week

052tP

. Differences in the

Plaqueseore

(.v±.sd)

0.31 (0.24)0.48 (0.23)

3.590.002

mean periodontal

Subgingivalcalculus(.v±sd)

0.18 (0.17)0.10 (0.1.3)

-2.650.01

index scores for

Suptagingivalcalculus(.v + sd)

0,13 (0.08)0.17 (0.10)

1.460.16

weeks 0 and 52

Bleedingseore

(.v + sd)

0.31 (0.16)0.23 (0.16)

-2.230.04

Pocketdepth

(.Y±sd)

1.37 (0.26)1.59 (0.37)

2.490,02

Resuits and Discussion

Of the sample 88% attended the dentistevery 6 tnonths. 88% brushed their teethat least twice a day with 83'!̂ i of thetnbelieving they took good care of theirteeth. Significant increases in tneanplaque score, subgingival calculus, bleed-ing on probing and pocket depth betweenweeks 0 and 52 were detnonstrated (Table1).

Thirteen of the 18 subjects cotnplainedof physical sytnptotns of stress dizzi-ness, sleeplessness, tiredness, anxiety andnausea (8), All of the wotnen complainedof pre-tnenstrual tension - feelitig bloat-ed, breast tenderness and irritability.Nevertheless, the subjects perceived theirgeneral health to be good with no differ-etices existing between scores for percep-

Tablc 2, Prediction of mean inerease in poeketdepth

Explanatory Coeffi-variable cient / P

0.41Type A behaviourWork environment

(organisation/climate)

Pereeption ofphysieal ill health -0 .23

Smok'ing behaviour -0.29Toothbrushing

frequeney —0.27

3.71 0.003

-0 .34 -3.25 0.007

-2.47 0.03-2.16 0.05

- 2 .24 0.04

F = 6 .93 , ? = 0 .002 , R- = 0 .745: / i = l 8 .

Stress uttd periodontal disease 177

tion of tnental ( / = - 0 . 5 0 , P>0.05) orphysical ill health ( / = - 0 . 5 0 . /^>0.05)compared with nortnative values (9).

Nearly all of thetn cotiformed to therecotnmended health care practices asso-ciated with dental health, stnoking andalcohol consutnption. 83'^ had smokedat sotne titne with only I7%> having neversmoked tobacco. All of tbe subjectsdrank alcohol. 7.4 units being theaverage weekly intake. This tendeticy totake control of their health vvas rellcctedin their low scores lor locus of control(/ = 2.02, P<0.05) and their mean scorefor the persotiality trait Type A bebavi-our (/ = 0.74, P>Q.()5) as compared withnortnative valtics (9). The need to controltheir health was rellccted in the incon-sisteticies of their replies concerning theirperception of ill health with their experi-ence of stress-related sytnptoms. The dis-crepancy between experience and percep-tion of ill health, suggested that the sub-jects denied and repressed stress in theirlives (10). Could the denial of stress to-gether with the wish to tnaintain controlalso affect periodontal health?

Regression tnodelling indicated thatan increase in pocket depth was sigtii-ficantly predicted by occupational stress

factors Type A persotiality. perceivedphysical ill health, lack of infortnationconcerning changes in the working envi-rontnent as well as positive health behav-iours, to tnaintain a high health status.These variables explained 74.5'/.. of thevariance of the relationship (Table 2).

The authors recognise the Iitnitationsof this study with regard to satnple sizeand the aspects of occupational stressexamined. Nevertheless, the results sug-gest that susceptibility to periodontaldisease tnay be related to psychologicalfactors, specifically Ihc personality of theindividual, which affects reactions tostressful life events (II , 12) iticlttdingthose experienced at work. There is aneed to exatnine the validity of sttch re-search findings and the authors proposethis as an area for ftirther investigation.

References

1. SOCRANSKY SS. HAiiAJiii: AD,.1, LiNtJiii: .1. New eoneepts of destructivepeiiodoiual di.sease. ,/ Cliit Periodoittol1984; //,• 21 32.

2. CotiiN-Cot.E S, CooKN R, Sii:vt:NS A etal. Psycho-social, endocrine, and itnmunefaetors in acule ulcerative cinaivilis

(treneh mouth). Psvcliosotii Med 19S1; 42:91 5.

3. GRr:i:N LW. MARKS WW. TKYON W et al

Periodontal disease as a funetion of lifeevents stress. ,/ Htitiiatt Siress 1986; 12:32 6.

4. Uix KER R, KARP CL, Bt:cKi:R W, BI;RGL. Personality dilTerenees and stresstullife events. Difterences between treatedperiodontal pattents with and withoutmaintenance. ,/ Cliti Periodontot 198S;/.\' 49 52.

5. MAR(I:NI:S W. CRot'ciiiiR R, MARMOTMG. Ihe relation between sell-reportedoral symptoms and life events. ,/ Dent Res1992; 72: 702.

6. COOPER CL, Coopi R RD, EAKHR LH. Liv-

ing with stress. London: Pengtiin Books.1988.

7. Coopii! CL. SroAN S.I. WILLIAMS S. Ovat-pittiottal stress iiiilictttor Wuidsor: Nelner-Nelson, 1988.

8. BAlt.i:"!' RD. Copitig with stress itt caritig.Oxford: Blaekwell Scientific Publieatious,1985.

9. Coopr.R CL. Written cotiitnunicatioti oftiormittive values. 1992.

10. HAY D, OKEN D. The psychological stress-es of intensive care nursins; imit. Psvclto-soni Med 1972; 34: 109 18".

11. DtiNliAR HF". Psychosomatic diagnosis.New York: Hoetx-r, 1950.

12. RO.SI:NMAN RH. Cn);sNi;v MA, Stress, typeA behaviour and eoronary heart disease,ln: Got.t:)tit:RC.L:R L. ed. Handbook ofsircss: theoretical itttit clinical aspects. NewYork: FYee Pre.ss. 1982.