Association of Porphyromonas gingivalis with high levels of stress-induced hormone cortisol in chronic periodontitis patients

Hormonal Environment Shapes the Oral Microbiome

Hormones are present in oral fluids and undergo dynamic changes throughout life. Hormonal changes can influence the interactions between the microbial community and the host. The oral microbiome is sensitive to changes in the oral environment, and hormonal fluctuations can create conditions that favour the growth of certain types of bacteria over others. Since the gingival niche harbours the resident microbial community in the biofilm form, while saliva has a transient microbiota in the planktonic form, both could modulate the host-microbial interaction under hormonal oscillations.The microbiome and hormones have a dynamic bidirectional interaction. Specific oral microorganisms can metabolize steroid hormones, disrupting their host regulation. Hormones can serve as host-microbial crosstalk related to health and disease. Hormonal imbalances are associated with systemic diseases such as polycystic ovary syndrome, endometriosis, cortisol-related conditions and oral cancer. Elucidating the complex relationship between steroid hormones and the oral microbiome offers valuable insights into the mechanisms of the disease and potential therapeutic avenues for maintaining oral and systemic health.

Exploring the Potential Clinical Applications of Salivary Cortisol in the Diagnosis and Management of Cushing’s Syndrome, Diabetes, Depression, and Periodontal Disease: A Systematic Review

Background

Current research primarily aims to investigate the potential of salivary cortisol for early diagnosis as well as clinical management and monitoring of disease progression. Its utility extends to a range of multidisciplinary settings, encompassing conditions, such as Cushing's syndrome, stress, and depression, pre-diabetes, type 2 diabetes, and periodontal disease, within dentistry. This systematic review aimed to analyze recent literature on the use of salivary cortisol as a biomarker for various clinical and pre-clinical conditions, including stress, depression, diabetes, Cushing's Syndrome (CS), and periodontal disease. Specifically, the review sought to evaluate its application in screening, diagnosis, clinical management, and monitoring disease progression.

Materials and Methods

Employing PubMed (MEDLINE) and Scopus databases, the search strategy utilized Medical Subject Heading (MeSH) terms, including “Cushing’s syndrome”, “diabetes mellitus type 2”, “hydrocortisone”, “saliva”, “biomarker”, “depression”, and “periodontal disease”, following the PICO model. The Cochrane Collaboration tool was used to assess bias risk for randomized clinical studies, while the ROBINS-I tool was used for observational studies.

Results

Adhering to PRISMA guidelines, 25 studies, comprising controlled interventions, pre-post studies, and observational/cohort or cross-sectional studies, were analyzed. We found a correlation between salivary cortisol levels and various health conditions. Elevated salivary cortisol was associated with increased disease severity in periodontitis, characterized by higher probing pocket depths and a greater plaque index. Patients with chronic periodontitis exhibited notably higher cortisol levels compared to healthy individuals, suggesting a link between stress and inflammatory responses in periodontal disease. Furthermore, salivary cortisol was identified as a valuable biomarker for detecting conditions, such as Cushing's syndrome and type 2 diabetes, with altered cortisol patterns indicative of disease progression. The findings highlighted the potential of salivary cortisol as a non-invasive diagnostic tool in assessing health status and managing related conditions.

Conclusion

Salivary cortisol serves as a crucial biomarker for the diagnosis and management of several health conditions, including Cushing's disease, diabetes, stress, depression, and periodontal disease. Its ease of measurement and reliability provide valuable insights into the Hypothalamic-pituitary-adrenal (HPA) axis, and the standardization of testing methods could enhance diagnostic accuracy. Continued research is essential to elucidate the interconnections among these conditions, which may inform future diagnostic and therapeutic strategies.

Site-specific autonomic vasomotor responses and their interactions in rat gingiva

Blood flow in the gingiva, comprising the interdental papilla as well as attached and marginal gingiva, is important for maintaining of gingival function and is modulated by risk factors such as stress that may lead to periodontal disease. Marked blood flow changes mediated by the autonomic (parasympathetic and sympathetic) nervous system may be essential for gingival hemodynamics. However, differences in autonomic vasomotor responses and their functional significance in different parts of the gingiva are unclear. We examined the differences in autonomic vasomotor responses and their interactions in the gingiva of anesthetized rats. Parasympathetic vasodilation evoked by the trigeminal (lingual nerve)-mediated reflex elicited frequency-dependent blood flow increases in gingivae, with the increases being greatest in the interdental papilla. Parasympathetic blood flow increases were significantly reduced by intravenous administration of the atropine and VIP antagonist. The blood flow increase evoked by acetylcholine administration was higher in the interdental papilla than in the attached gingiva, whereas that evoked by VIP agonist administration was greater in the attached gingiva than in the interdental papilla. Activation of the cervical sympathetic nerves decreased gingival blood flow and inhibited parasympathetically induced blood flow increases. Our results suggest that trigeminal-parasympathetic reflex vasodilation 1) is more involved in the regulation of blood flow in the interdental papilla than in the other parts of the gingiva, 2) is mediated by cholinergic (interdental papilla) and VIPergic systems (attached gingiva), and 3) is inhibited by excess sympathetic activity. These results suggest a role in the etiology of periodontal diseases during mental stress.

Evaluation of hydrocortisone as a strain-dependent growth-regulator of Porphyromonasgingivalis

OBJECTIVE

Porphyromonas gingivalis is an oral key pathogen and known to be very diverse in geno- and phenotypes. It is a fastidious bacterium with low O₂-tolerance and 3-7 days of incubation are necessary. With growing interest in the field of microbial endocrinology we explored the potential growth-stimulating effect of hydrocortisone (HC, synonym cortisol) on P. gingivalis cultures.

MATERIAL AND METHODS

Six different P. gingivalis strains were pre-incubated in supplemented Brain-Heart-Infusion broth under appropriate conditions for 24 h, diluted and transferred into microplates. A newly developed and semi-automated spectrophotometric measurement in triplicate, applying a SpectraMax i3x microplate reader at an optical density of 600 nm, was conducted to test growth differences between test group (exposed to a supplement of either 1.25, 2.5, 5, 10, or 20 μg/ml of hydrocortisone) and control group over 48 h of anaerobic incubation (O₂ ≤ 1%). Furthermore, strains were also incubated on HC-supplemented blood agar to test for a possible growth-stimulating effect on solid media.

RESULTS

HC significantly stimulated the lag-phase growth of four out of six P. gingivalis strains. Our data suggest a concentration-dependent growth stimulatory effect of HC between 2.5 and 5 μg/ml, while below 1.25 μg/ml and above 10 μg/ml HC either did not stimulate or inhibited growth.

CONCLUSIONS

HC could reduce the incubation time when isolating P. gingivalis from clinical samples and could boost low biomass cultivations especially during their lag-phase. The growth-modulating effect might be via modulation of virulence factors/quorum sensing gene expression or by reactive oxygen species(ROS)-capturing during early stages of bacterial growth. Further experiments are necessary to explain the mechanism behind our observations.

Prevalence of Chronic Periodontitis and Chronic Stress in the South Indian Population

Background Chronic stress is commonly thought to have a net negative effect on the efficacy of the immune response, leading to an imbalance between host and parasite and consequently resulting in a periodontal breakdown. Aim To identify the prevalence of chronic periodontitis and chronic stress as well as a comparative evaluation of clinical, demographic, and psychoanalytical parameters among the South Indian population. Materials and methods A total of 500 subjects between the ages of 30 and 60 were chosen from the Trivandrum district, Kerala, using multistage random sampling. Subjects were evaluated based on psychoanalytical parameters as well as periodontal examination. Psychoanalytical parameters were measured by the questionnaire method using the perceived stress scale. Periodontal parameters examined were the probing depth, clinical attachment loss, bleeding on probing, simplified oral hygiene index, and community periodontal index (loss of attachment). Statistical Analysis Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively. Logistic regression analysis was used to analyze the association between the periodontal variables and psychoanalytical variables. All the statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows (IBM Corp., USA). Results A total of 500 subjects, of whom 308 (61.6%) were female and 192 (38.1%) were male, participated in this study. The overall prevalence of periodontitis among all the subjects was found to be 42.4%, and the proportion of periodontitis among the stressed participants was found to be 46.2%, which is 10% higher compared to the non-stressed (36.1%) participants. Conclusion Our study showed an increased frequency of periodontitis among the stressed subjects as compared to the non-stressed subjects. These findings suggest that there is a positive association between chronic stress and chronic periodontitis, but further prospective studies are required to establish the extent of the effect chronic stress has on chronic periodontitis and vice versa.

Common Risk Factor Approach to Limit Noncommunicable Diseases and Periodontal Disease-The Molecular and Cellular Basis: A Narrative Review

Introduction

The link between periodontal disease and noncommunicable diseases (NCDs) has been the subject of major research over the past several years. The primary objective of this review is to understand the cellular and molecular components that link common risk factors (exposure) in adult patients (population) with periodontal disease and other NCDs (outcome). The secondary objective is to interpret from existing literature the possibility of identifying the molecular plausibility of the Common Risk Factor Approach (CRFA).

Materials and Methods

A literature search was performed in PubMed/MEDLINE, CINAHL, Web of Science, and Google Scholar for all published articles pertaining to the molecular and cellular basis of the risk factors between periodontal diseases and major NCDs. Data from all randomized and nonrandomized clinical trials, cross-sectional studies, case-control, cohort studies, literature, and systematic reviews were included.

Results

Periodontal pathogens, stress, obesity, smoking, and dietary factors are some of the common risk factors between periodontal disease and NCDs.

Conclusion

Understanding the molecular and cellular link of common risk factors between NCDs and periodontal disease would ensure the application of CRFA. The CRFA implies that controlling the risk factors associated with NCDs can have an incredible positive impact on regulating many chronic conditions, which would extend to periodontal health also.

Environmental factors and periodontal microbiome

Periodontal diseases are chronic inflammatory, multifactorial diseases where the major triggering factors for disease onset are bacteria and their toxins, but the major part of tissue destruction occurs as a result of host response towards the periodontal microbiome. Periodontal microbiome consists of a wide range of microorganisms including obligate and facultative anaerobes. In health, there is a dynamic balance between the host, environment, and the microbiome. Environmental factors, mainly tobacco smoking and psychological stress, disrupt the symbiotic relationship. Tobacco smoke and its components alter the bacterial surface and functions such as growth. Psychological stressors and stress hormones may affect the outcome of an infection by changing the virulence factors and/or host response. This review aims to provide currently available data on the effects of the major environmental factors on the periodontal microbiome.

Influence of psychological stress on non-surgical periodontal treatment outcomes in patients with severe chronic periodontitis

BACKGROUND

The aim of this study was to evaluate the influence of psychological stress on non-surgical periodontal treatment (SRP) outcomes in patients with severe chronic periodontitis (stage 3/4 generalized periodontitis) at 6 months in the French population.

METHODS

Patients diagnosed with severe generalized chronic periodontitis (periodontitis stage 3/4) were included in this study. At baseline, psychological status was evaluated by self-administered questionnaire (Depression Anxiety Stress Scale 42 [DASS-42] and Toulouse coping scale [TCS]). Plasma levels of cortisol and chromogranin-A were determined. Patients were then managed by oral hygiene instructions, scaling and root planing of sites with PD >3 mm and followed at 3 and 6 months. Quantitative and qualitative variables were described and interactions were determined by linear and logistic regressions.

RESULTS

Seventy-one patients were included in this study and 54 were followed up to 6 months. An average probing depth (PD) reduction of 0.73 ± 0.11 mm and decrease of diseased sites (PD >3 mm) were measured at 6 months illustrating SRP efficacy. Multivariable analysis showed that increased DASS-stress score was associated to worsened SRP outcomes in terms of bleeding on probing (BOP) (OR = 1.02, P <0.05) and mean PD (P <0.05) reduction. An increase of DASS-depression score negatively influenced PD >5 mm (OR = 1.06, P <0.05), PD >7 mm (OR = 1.17, P <0.01), CAL >5 mm (OR = 1.03, P <0.05), and CAL >7 mm (OR = 1.07, P <0.05) reduction. Negative coping strategies were also associated with worsened SRP outcomes.

CONCLUSIONS

Patients with increased stress, anxiety, and depression scores as well as those exhibiting negative coping strategies demonstrate worsened SRP outcomes. DASS-42 and TCS were useful to determine psychological status and their use could be incorporated to assess treatment prognosis.

Association between Psychological Stress and Periodontitis: A Systematic Review

This systematic review aims to investigate the association between psychological stress and periodontitis through analysis of cortisol levels and periodontal clinical parameters. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide and based on PECO (Participants, Exposure, Comparators, Outcomes) question and registered at PROSPERO under the code CRD42017076670. As eligibility criteria, observational studies performed in adult humans presenting periodontitis (P), which evaluated patients exposed (E) and nonexposed to psychological stress (C) and to verify the association between this type of stress and periodontitis (O) were included. The searches were performed until March 2018. The following databases were used: PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar. After searches, the duplicate results were removed. The remaining citations were selected according to eligibility criteria in two phases. In the first phase, the title/abstract was evaluated. In the second phase, the articles were chosen previously were assessed by full text. After selection, the studies were submitted to data extraction and risk of bias evaluation by Fowkes and Fulton. A total of 1,386 citations were retrieved. After duplicates removal and selection process, three articles were selected by full text. Among them, two articles reported a positive association between psychological stress and periodontitis. All articles were classified as low risk of bias. Even though two articles highlighted an association between psychological stress and the presence of a possible modulatory pattern of cortisol levels in clinical parameters of periodontitis, more studies are necessary to elucidate this question.

Is there association between stress and periodontitis?

OBJECTIVE

This study estimated the association between stress and periodontitis.

MATERIALS AND METHODS

A cross-sectional study was conducted with a sample of 621 individuals. Information about individuals was obtained through a questionnaire. Stress was evaluated using the Perceived Stress Scale. The diagnosis of periodontitis was based on a complete periodontal examination including clinical attachment level, probing depth, and bleeding on probing. Prevalence ratios (PR), crude and adjusted, and their respective 95% confidence intervals (95%CI) were estimated by Poisson regression analysis.

RESULTS

In the final sample, 48.47% (301) of the individuals were classified as having stress, of which, 23.92% (72) had the diagnosis of periodontitis. Association measurements between stress and probing depth ≥ 4 mm (PR_adjusted = 1.28, 95%CI [1.04 to 1.58]), stress and clinical attachment level ≥ 5 mm (PR_adjusted = 1.15, 95%CI [1.01 to 1.31]), and stress and periodontitis (PR_adjusted = 1.36, 95%CI [1.01 to 1.83]) showed that the frequency of these outcomes among those exposed to stress was 15-36% higher than those without the condition of stress, after adjustment for age, sex, schooling level, current smoking habit, pulmonary disease, and body mass index.

CONCLUSIONS

The findings showed positive association between exposure to stress and the presence of periodontitis, reaffirming the need to prevent and control stress.

CLINICAL RELEVANCE

Although there are limitations in this study, the results showed that an association exists between stress and periodontitis, signaling the necessity of a multidisciplinary attention when considering the psychological status in the management of oral and general health conditions of the individual.

Association of Stress, Salivary Cortisol, and Chronic Periodontitis: A Clinico-biochemical Study

Background

Periodontitis and stress are among the areas of increasing interest over the past two decades. Early detection of these diseases plays a crucial role in successful therapy. Cortisol is a protein which was found to be consistently associated with both.

Aim

The present study was aimed to evaluate saliva cortisol levels (SCLs) in chronic periodontitis (CP) patients with and without stress.

Materials and Methods

In this cross-sectional study, saliva samples were collected and cortisol levels were determined using ELISA method in 92 participants. The participants were divided into four groups based on periodontal condition (number of teeth present, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and clinical attachment level) and stress levels into Group 1 (no periodontitis and no stress), Group 2 (with periodontitis and no stress), Group 3 (without periodontitis and with stress), and Group 4 (with periodontitis and stress).

Results

Overall, 92 adult participants (41 males and 51 females) were included in the study. Participants with stress and periodontitis have high mean SCL when compared to other groups (Group 1: 15.01 ± 2.62, Group 2: 31.92 ± 6.80, Group 3: 34.47 ± 13.47, and Group 4: 60.13 ± 6.68). Group I shows a significant negative correlation of cortisol to BOP, stress to PI, and stress to cortisol level, whereas there is a positive correlation of SCL to PD in Group 4 which is not statistically significant.

Conclusion

SCL showed difference among the groups. SCL were associated with both CP and psychological stress. Increase in inflammation and stress levels enhances the SCL.