Psychological Resilience, Perceived Stress and Periodontal Status Among Bruxers

Periodontitis has been defined by the 2018 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions as "a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth supporting apparatus". The disease represents one of the most prevalent chronic conditions globally and is a leading cause of tooth loss in adults. The pathogenesis involves a complex interplay between microbial challenge, host immune-inflammatory responses, and modifying environmental, systemic and psychosocial factors. Although bacterial biofilm is a necessary etiological factor, it is the host response that determines disease progression or stability. Among several modifying influences, psychosocial stress has gained increasing attention in periodontal research. Chronic stress leads to sustained activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary system, resulted in elevated cortisol and cathecholamine. These neuroendocrine mediators exert profound effects on immune regulation, enhancing pro-inflammatory cytokine production, impairing neutrophil function, and delaying wound healing. In the periodontium, such dysregulation may potentiate tissue breakdown by amplifying inflammatory cascades and reducing reparative capacity.

Several studies have demonstrated a positive association between perceived psychosocial stress and periodontal disease severity, including increased probing depth, attachment loss, and bleeding on probing. Furthermore, stress can indirectly influence oral health through behavioral pathways such as poor oral hygiene, smoking, bruxism, and altered diet. Despite this, not all individuals exposed to similar stress levels exhibit equivalent periodontal destruction, indicating the presence of psychological moderators that buffer or modify stress effects.

One such factor is psychological resilience, defined as "a measure of stress-coping ability and a personal quality that enables one to thrive in the face of adversity".It reflects an individual's ability to maintain or regain mental health and functional stability despite adversity. Resilience is shaped by cognitive, emotional, and social components that promote adaptive coping and self-regulation. High resilience has been linked to better immune regulation, lower inflammatory markers such as C-Reactive protein and Interleukin-6, and faster recover from stress induced physiological changes.

Moreover, behavioural factors such as stress related parafunctional activity bruxism, characterized by repetitive jaw-muscle activity involving clenching or grinding of teeth and/or bracing or thrusting of the mandible. The excessive and repetitive forces associated with bruxism may exert traumatic effects on tooth supporting structures and are considered an important cofactor in the progression of periodontal breakdown.

Emerging evidence in behavioral medicine suggests that resilience can moderate the relationship between perceived stress and health outcomes, attenuating the physiological and behavioral impacts of chronic stress. In dentistry, however, this construct remains underexplored. No study have assessed how resilience interacts with stress to influence periodontal status among bruxers. Given that both stress and inflammation share common neuroendocrine and immunological pathways, resilience may play a crucial role in buffering stress-induced periodontal breakdown in bruxers.

Understanding this relationship could shift periodontal management toward a biopsychological model, integrating psychological assessment and resilience enhancement with conventional non-surgical therapy. Therefore, the present study aims to evaluate psychological resilience as a modifier of the relationship between perceived stress and periodontal status among bruxers. Such insights could help designed personalized periodontal care strategies addressing both biological and psychological determinants of disease progression.

Inclusion criteria

• Patients with age group 30-50 years diagnosed with generalized periodontitis.
• Probable bruxers (as per BruxScreen questionnaire)
• Presence of minimum 20 teeth excluding third molars
• Able to read/understand Hindi or English (for questionnaires)

Exclusion criteria

• Systemic diseases that may affect periodontal disease progression or outcome of treatment (diabetes, autoimmune diseases)
• History of Periodontal treatment within last 6 months
• History of Antibiotic use within the previous 3 months
• History of Steroid, immunosuppressive and psychiatric drug use
• Pregnant and lactating women
• Smoking or substance abuse