Method: Full mouth probing depths (PD), gingival recession, mobility, bleeding on probing (BOP) and plaque were recorded from 80 pregnant (second trimester) women (mean age=24). Women requiring antibiotic prophylaxis, having <20 teeth or health conditions impacting immune/endocrine function or periodontium were excluded. Subjects completed questionnaires [Center for Epidemiologic Studies-Depression Scale (CES-D), Everyday Discrimination Scale, Experiences of Discrimination Scale (EDS), Perceived Stress Scale (PSS), Pittsburg Sleep Quality Index (PSQI), Pregnancy Distress Questionnaire, Prenatal Health Behaviors Scale (PHBS), State Anxiety Inventory (STAI)]. Peripheral blood and crevicular fluid samples were obtained and analyzed with bioplex assays. Correlation coefficients were calculated between clinical parameters/psychosocial measures and local and systemic cytokine levels. Expected false positives for this hypothesis-generating analysis = 13 (α=0.05).
Result: Periodontal diagnoses: gingivitis(31%), slight(29%), moderate(29%) and severe(11%) chronic periodontitis. 24% of women had >50% of tooth sites BOP+, while 22% of these subjects had >30 sites with ≥ 4mm PD. 43% of women had clinically significant depression (CES-D > 16). Mean STAI was 11±4 and mean PSS was 17±7. BOP, plaque and sites with PD>4mm were all significantly correlated (all r>0.58, p<0.001). Three local cytokines were significantly correlated with clinical parameters: IL-1b with BOP, PD, and plaque (r>0.29, p<.001); IL-6 with BOP (r=0.3, p=0.01); and Eotaxin with plaque (r=0.22, p=0.047). PHBS was correlated with BOP and plaque (rs<-0.23, ps<0.01). Correlations between psychosocial measures and cytokine levels were significant for EDS with local IL-8, PSS with systemic TNF-a, and PSQI with local IL-8, IFN-g, and IP-10 (all r>0.2, p<0.04).
Conclusion: Psychosocial stress in young expectant women may be affecting local factors that relate to periodontal health. Further studies are needed to elucidate the interrelationships between psychosocial stress and periodontally-related systemic or local inflammation.