The impact of psychological stress on salivary cortisol levels in periodontitis patients: a case-control study

Background Psychological stress is linked to elevated salivary cortisol levels, potentially worsening periodontitis by exacerbating inflammation. This study examines the impact of stress on cortisol levels in periodontitis patients, aiming to explore salivary cortisol as a biomarker for disease severity and its role in improving management strategies. Methods This case-control study, conducted at Dow University of Health Sciences in Karachi from January to December 2022, involved 120 dental clinic patients aged 30-60. Participants were selected based on the presence (cases) or absence (controls) of periodontitis, excluding those with systemic diseases, taking hydrocortisone, immunosuppressives, antidepressants, systemic antibiotics, having oral ulcers and pregnancy or lactation. Periodontal parameters, stress levels (using the Perceived Stress Scale), and morning salivary cortisol (measured via ELISA) were assessed. Statistical analyses were performed using SPSS version 23, including descriptive statistics, independent t-tests, ANOVA, and odds ratio calculations with a 95% confidence interval at 0.05. Results The study cohort comprised 120 subjects, equally divided between periodontitis patients and healthy controls. Predominantly male (63%) with a mean age of 41.75 years, participants were subjected to comprehensive evaluations. Oral health indices (Gingival index, Plaque index, Clinical attachment loss, Periodontal probing depth, Tooth mobility) and stress markers (Perceived Stress Score, Salivary cortisol levels [SCLs]) were significantly higher in cases compared to controls (p < 0.001). Majority of cases (58.3%) had stage II periodontitis. Notably, cases exhibited significantly higher stress levels (2.05 +/- 0.59 vs. 1.38 +/- 0.52; p < 0.001) and elevated salivary cortisol levels (6.67 +/- 1.64 vs. 2.54 +/- 0.88; p < 0.001) compared to controls. The odds ratio (OR) of 3.73 (95% CI [1.75, 7.93], p = 0.0006) indicated that periodontitis patients were over 3.5 times more likely to have elevated SCLs. Stress prevalence was 42.5% in periodontitis patients compared to 18.33% in controls. Conclusions This study highlights a potential link between stress, cortisol levels, and periodontitis, suggesting that salivary cortisol could be a valuable biomarker. Incorporating cortisol measurements into routine dental evaluations may enable personalized treatment plans, addressing both biological and psychological contributors to periodontitis. Further research is needed to explore the long-term effects of stress on cortisol levels and periodontal disease progression, as well as the role of stress management in managing periodontitis.