Objective: The objective of this study was to determine whether stress influenced the outcome of NPT using measurements of loss and integrity of alveolar bone.
Methods: Local Ethics Committee approval was obtained for the study. 40 subjects were categorised as stressed or unstressed using a perceived stress scale questionnaire (PSS) and ELISA measurement of salivary cortisol level. Patients were assessed clinically by pocket probing depth (PPD) and clinical attachment level (CAL) and radiographically using interdental space, tooth crest angle, residual bone, bone loss level and bone density values. Also, C-terminal telopeptide of type I collagen (ICTP) in gingival crevicular fluid was measured by ELISA from a deep bleeding (DB), a deep non-bleeding (DNB) and a healthy site in each patient at baseline and at 6 months post treatment. Treatment involved root surface debridement but not the use of antibiotics.
Results: 14 stressed and 26 unstressed patients took part in the study with equal numbers of smokers in each group. Comparing the goups, ICTP levels did not differ at baseline but at 6 months was lower in the unstressed group (p = 0.03). Radiographically the stressed group showed lower bone density and greater interdental area at DB sites at both baseline and at 6 months post treatment. There was no significant difference between the groups in the other bone measurements.
Conclusion: These data indicate that stressed patients exhibit a poorer response to NPT than unstressed patients as judged by bone loss and integrity. Questionnaire-based assessment of stress may help in patient management.