Interaction between stress, cytokines, and salivary cortisol in pregnant and non-pregnant women with gingivitis

Oral Health, Anxiety, Depression, and Stress in Pregnancy: A Rapid Review of Associations and Implications for Perinatal Care

Research demonstrates associations between oral health and specific mental health conditions in the general population, yet these relationships remain understudied during pregnancy, despite pregnancy's profound effects on both oral and psychological well-being. Our rapid review examines current evidence on associations between oral health conditions and psychological states (anxiety, depression, and stress) during pregnancy, aiming to inform and strengthen integrated prenatal care strategies. Following PRISMA-RR guidelines, we conducted a systematic search on OVID Medline, CINAHL, and PsycINFO (January 2000-November 2024) for studies examining relationships between oral health conditions (periodontal disease, dental caries) and psychological status during pregnancy and up to one year postpartum. Systematic screening of 1201 records yielded 22 eligible studies (13 cross-sectional studies, 3 longitudinal cohort studies, 3 comparative studies, 2 prospective studies, and 1 case-control study). Analysis confirmed significant associations between oral health and psychological well-being during pregnancy through three pathways: psychological (dental anxiety directly limits oral healthcare utilization), behavioral (maternal depression reduces oral health self-efficacy), and physiological (elevated stress biomarkers correlate with periodontal disease, and periodontal therapy is associated with reduced salivary cortisol). These interactions extend intergenerationally, with maternal psychological distress showing significant associations with children's caries risk. Evidence suggests interactions between oral health conditions and psychological states during pregnancy, warranting integrated care approaches. We recommend: (1) implementing combined oral-mental health screening in prenatal care, (2) developing interventions targeting both domains, and (3) establishing care pathways that address these interconnections. This integrated approach could improve both maternal and child health outcomes.

Salivary inflammatory burden in pre- and postmenopausal women: Associations with body mass index, patient-reported health, serum cytokines, and periodontal parameters

BACKGROUND

The decline of estrogen levels during menopause impacts weight, mood, and overall health, both orally and systemically. This study assessed salivary levels of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), IL-10, and IL-7 in postmenopausal (PMW) and regularly menstruating premenopausal (RMPW) women, while considering serum cytokine levels, body mass index (BMI), periodontal health, and self-reported physical and emotional well-being.

METHODS

In this study, 75 PMW and 71 RMPW were included. Clinical and periodontal parameters were evaluated, and perceived health was assessed with the Women's Health Questionnaire (WHQ). Cytokine levels in both saliva and serum were quantified by enzyme-linked immunosorbent assay (ELISA). Covariate evaluations of salivary cytokines were conducted using hierarchical linear regression modeling.

RESULTS

Cytokines were detectable in saliva from 71 PMW and 67 RMPW. In the initial unadjusted model, IL-7, IL-10, and TNF-α exibited significant differences between RMPW and PMW. However, these differences became non-significant (p > 0.05) in the final model after adjusting for age, which implies a negligible effect of the investigated covariates on salivary cytokine levels when age was considered. Lower levels of IL-6 in PMW, which initially showed no significant difference, became borderline (p = 0.054) in the final model after adjusting for age.

CONCLUSIONS

After adjusting for multiple factors, no significant difference was found in the salivary levels of the investigated cytokines between RMPW and PMW. Factors such as BMI, perceived health, serum cytokine levels, and periodontal parameters seem to minimally influence these levels in PMW. However, age may be a stronger confounding factor.

Impact of Stress on Periodontal Health: Literature Revision

Stress is a physiological response of the body to stressful life events but may not be when the individual is persistently exposed to the stress trigger, and it negatively affects certain physiological functions, thus triggering psychosomatic diseases. In literature, chronic stress and inadequate coping strategies are found to mediate the risk and development of periodontitis; mechanisms have therefore been proposed to explain the effects of stress on the periodontium. Since stress is a prevalent problem in modern life and given the importance of maintaining oral health, the present literature review aimed to estimate the association between stress and periodontal disease. The research question adopted is the following: "Are psychological stress and periodontal disease related?" The search was conducted in August 2022 and limited to articles in electronic databases from 2017 to 2022 in English, excluding reviews and literature reviews. From the electronic databases, a total of 532 articles were identified and became 306 after reviews and duplicates were removed. An additional bibliographic search was conducted through the same electronic databases, controlled terms and keywords including only systematic reviews, which were previously excluded. Through the bibliography cited in the systematic reviews, an additional 18 articles were identified, with a new total of 324. As a result of reading the title and abstract of these 324 articles, an additional 295 were excluded. Reading the full text of the remaining 29 studies, 2 articles were excluded due to non-adherence to the eligibility criteria. The remaining 27 results were included in our literature review. It has been suggested in the literature that adverse socioeconomic conditions elicit a stress response, which can trigger periodontal inflammation. Most of the 27 articles included in the study confirm and demonstrate a positive association between psychological stress and periodontal disease. Numerous studies have shown the mechanisms through which chronic stress negatively affects periodontal tissues. Therefore, in the light of the results obtained from this review, it is important that oral health professionals, also for general health purposes, consider stress factors among the risk factors of periodontal disease, its severity and decreased efficacy of treatments. It is therefore advisable to act preventively through the interception of chronic stress.

Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review

Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.

Exogenous progesterone short-termly affects the periodontal environment in perimenopausal women

OBJECTIVE

This study aimed to evaluate the effects of exogenous progesterone in the periodontal environment of perimenopausal women.

METHODS

Either with or without periodontitis, 100 perimenopausal women received 3 months of progesterone treatment, as well as age-matched 100 perimenopausal and 100 postmenopausal women without treatments were enrolled (N = 50). The gingival index (GI), probing depth (PD), clinical attachment level (CAL), and tooth mobility (TM), as well the gingival crevicular fluid (GCF) levels of IL-6 and TNF-α were analyzed.

RESULTS

Periodontitis showed higher GI, PD, and CAL than non-periodontitis at perimenopausal and postmenopausal periods. In women without periodontitis, the GI and PD, and the GCF levels of IL-6 and TNF-α were increased by 3 months of progesterone treatment, but recovered from the 6^th month in the absence of progesterone. In women with periodontitis, only the PD was short-termly increased by progesterone treatment. For those without progesterone treatment, the GI, PD, and TM were not significantly different between perimenopausal and postmenopausal women either with periodontitis or not.

CONCLUSIONS

Exogenous progesterone short-termly exacerbated the inflammation and PD in perimenopausal women without periodontitis, and the PD in those with periodontitis.