Correlation Between Serum Cortisol Level And Psychological Stress With Chronic Periodontits
Chronic periodontitis is an infectious disease caused by gram negative bacteria which leads to inflammation of the tissues supporting the teeth leads to attachment loss and bone loss. Many factors that may alter the host response to plaque build-up such as diabetes, smoking, and stress.
Stress is actually a normal part of life. If we handle stress it will help us out, if we don’t it seriously interferes with job, family, and our own body, it may also increase propensity to periodontal diseases. Stress is nothing but is a state of physiological or psychological strain caused by adverse stimuli, physical, mental or emotional, internal or external that tend to disturb the functioning of an organism and which the organism naturally desires to avoid.
Stress governs the host immune defences through the pituitary-hypothalamic adrenal axis influence over the pathogenesis of periodontitis3. Stress activates the hypothalamus leads to the excessive secretion of ACTH which suppresses the immunity especially IgA results in infection progress into periodontal diseases. The psychosocial stress reaction involves the activation of the hypothalamus-pituitary-adrenal axis, followed by the secretion of corticotropin releasing hormone from hypothalamus, adrenocorticotropic hormone from pituitary gland and glucocorticoids from the adrenal cortex. The dysregulation of circulating cortisol that influence the function of the immune system leads to the chronic activation of hypothalamus-pituitary-adrenal axis which affects the periodontal status. A physiological response occurs towards psychosocial factors resulting in a change in the concentration of cortisol in the body’s fluids, like serum, saliva, and GCF.
Cortisol is the primary glucocorticoid which is produced in the adrenal cortex. Cortisol increases the blood glucose concentration and affects the fat metabolism and also it has the negative effects on inflammatory and immune components, inhibiting lymphocyte formation. Cortisol suppresses the secretion of certain pro inflammatory cytokines.
Psychosocial stress plays a key role in the etiology and progression of periodontal infection. The factors are psychologically induced modulation of immune system leading to increased level of adrenocorticotropic hormone and alteration of crevicular cytokine levels, depressed PMN Chemotaxis, reduced proliferation of lymphocytes, changes in blood circulation and healing time.
Many studies are there for the association between periodontal diseases and psychological stress but the correlation is still unclear. Genco et al found that stress with financial worries are the risk indicators for periodontal disease. Wimmer et al concluded that stress coping strategies of periodontitis patients were the risk for severe periodontal disease. Refulio et al concluded that there is a significant association between emotional depression, level of anxiety and periodontitis.
