Mental Health and Periodontitis in Probable Bruxers

Stress is related to emotional and physiological reactions when there is a lifetime event conflict that exceeds the individual's ability to deal effectively with the situation.

Psychological stress is generally recognized as a potential cofactor in the pathogenesis of infectious disease. It can trigger immune responses that favor the occurrence or exacerbation of changes in the oral cavity, such as periodontitis. It can directly impair the periodontal status through various biological mechanisms: variation in the gingival fluid, production of interleukin IL1, IL-6, reduction of polymorphonuclear leukocytes and phagocytosis, and decreased lymphocyte production and antibody production, as well as through changes in behavior related to health, such as oral hygiene, smoking habit and diet.

Stress evokes emotional and physiologic reactions and is an important modifiable risk factor for both mental and physical illnesses.

Periodontitis is characterized by progressive destruction of the tooth-supporting apparatus causing loss of support which manifests through clinical attachment loss (CAL), radiographically assessed alveolar bone loss, presence of periodontal pocket and gingival bleeding.

Based on the ecologic plaque hypothesis, periodontal diseases result from environmental changes to the oral habitat. Marsh considers that the selection of ''pathogenic'' bacteria is directly coupled to changes in the environment.

A sound understanding of the psychosocial pathways of the behaviors strongly linked to periodontal diseases, and how psychological factors affect the response of the periodontal tissues to pathogens, is essential for diagnosis and improving interventions.

One of the stress manifestations is bruxism, or gnashing and grinding of the teeth. Theories about the origin of bruxism have hypothesized different types of factors: peripheral, connected to teeth occlusion interferences, central, connected to neurotransmission from brain to chewing muscles and psychosocial, associated to stress.

"Although extensive research has investigated the associations between stress and bruxism, as well as stress and periodontitis, there remains a notable gap in the literature examining the combined relationship among stress, bruxism, and periodontitis."

Inclusion criteria

• Adult periodontitis patients with age group 30-50 years diagnosed with probable bruxism.
• Presence of minimum 20 teeth excluding third molars.

Exclusion criteria

• History of systemic disease such as diabetes or autoimmune disease
• History of drugs having the potential impact on periodontal status like phenytoin, cyclosporin, calcium-channel blockers or antidepressant drugs.
• Pregnant or lactating females.
• Post-menopausal women.
• Patients diagnosed with temporomandibular disorders- pain and tenderness in the masticatory muscles