The Silent Assault: Stress and the Breakdown of Periodontal Health

ABSTRACT Psychological stress significantly influences the progression of periodontal disease and the efficacy of its treatment. Stress activates the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, leading to increased cortisol and catecholamine levels. These neuroendocrine responses can impair immune function, elevate inflammation, and disrupt tissue repair mechanisms, thereby hindering the healing process following periodontal interventions. Stress also adversely affects patient behaviour, including oral hygiene practices, dietary habits, and adherence to treatment regimens. Such behavioural changes further exacerbate periodontal conditions and impede recovery. Moreover, elevated salivary cortisol levels have been associated with increased periodontal inflammation and attachment loss, underscoring the biological impact of stress on periodontal health. A systematic review and meta-analysis have confirmed that psychological stress and stress related disorders negatively influence clinical outcomes, particularly clinical attachment level and probing pocket depth, following periodontal treatment. These findings highlight the necessity of integrating stress management strategies into periodontal care to enhance treatment efficacy and patient well-being.