Methods: 40 patients (15 male, 25 female; mean age 42.2 years; 11 smokers) with chronic periodontitis consented to participate in this study, which was approved by South Sheffield Research Ethics Committee. All patients received a perceived stress questionnaire and assessment of salivary cortisol level, as well as a comprehensive periodontal examination. Three teeth in each patient were selected for the study (a shallow non-bleeding site ≤ 3mm (SNB); a deep non-bleeding site ≥ 6mm (DNB); and a deep-bleeding site ≥ 6mm (DB)). At baseline and at 3 months post treatment, plaque index (dichotomous score); probing pocket depth (PPD); clinical attachment level (CAL); bleeding on probing (BOP); and Miller Mobility Index (MI) were measured. Cortisol was measured in resting saliva by ELISA. Gingival crevicular fluid (GCF) was investigated for elastase activity as a marker of inflammation, and C-terminal telopeptide of type I collagen (ICTP) as marker of bone resorption (UniQ ICTP ELISA kit; Quidel diagnostics, Oxford, UK).
Results: 14 patients were identified as chronically stressed, 4 were smokers. At baseline, stressed patients had higher GCF elastase levels in DNB and DB sites (26.1 and 28.2ng/µl respectively) than in unstressed patients (20.2 and 23.5ng/µl respectively. p<0.05), but other parameters did not differ. At 3 months post treatment, elastase levels remained higher in DNB (21.4ng/µl) and DB sites (24.6ng/µl) in stressed than in unstressed patients (15.7 and 19.5ng/µl respectively), CAL was higher in DNB sites (p<0.05) and PPD was higher in both DNB (5.57+0.5mm) and DB (5.86+0.6mm) sites in stressed than in unstressed patients, (PPD 5.0+0.7; 5.3+0.8mm respectively. p<0.05). ICTP levels and other parameters were not significantly different.
Conclusion: Stress appeared to influence patients' initial response to non-surgical periodontal treatment.