Comparative Evaluation of Deoxyribonucleic Acid Methylation Patterns of Neuropeptides in Chronic Periodontitis Cases with and without Chronic Stress: A Case–Control Study

IntroductIonPeriodontitis is a chronic, multifactorial inflammatory disorder of the tooth-supporting structures that poses significant risks to both oral and systemic health.The World Health Organization (WHO) estimates that severe periodontal disease affects nearly 19% of adults globally, representing over 1 billion people. 1 The disease originates from bacterial biofilm accumulation on tooth surfaces; however, microorganisms alone do not explain the extensive tissue destruction observed in advanced cases.Instead, an aberrant and amplified host immune-inflammatory response is recognized as the key driver of disease progression. 2eyond being a leading cause of tooth loss, periodontitis has been associated with several systemic conditions, particularly in aging populations across both developed and developing countries. 3,4Despite its high prevalence, public awareness remains remarkably low-a French cohort reported that only 19% of individuals at high risk recognized their gum disease, underscoring the silent, often undiagnosed nature of this chronic condition. 5mong the numerous behavioral and systemic factors influencing periodontal health, chronic psychological stress has emerged as a major modifier of disease severity.Persistent stress