It is recognized that psychosocial stress may lead to different somatic reactions. In dental practice the focus has been placed on the contribution of stress in the development of periodontal disease. Epidemiologic studies combining psychological evaluation of stress with clinical data on periodontitis indicate that the degree of periodontal disease is enhanced by stress factors such as negative life events, depression, strong work-related demands, financial distress, etc. Despite epidemiological statistics designed to separate the effect of stress from other health and behavioural risk factors such as diabetes and smoking, the causal role of stress factors in periodontal etiology may be difficult decide. However, majority of available epidemiological data indicates that stress is important, although the exact part of the contribution is unknown. Several investigations show that satisfactory coping mechanisms are of preventive value in stress situations. The physiologic mechanisms are common to many other somatic reactions associated with psychosocial stress, such as cardiovascular disease. The impact of stress takes place by biochemical signals originating in the brain, which eventually lead to the release of adrenocortical stress hormones, such as cortisol. A parallel pathway is the sympathetic nerve system, leading to the release of stress related cathecholamines from the adrenal medulla. Both pathways are communicating with the immune system. In the development of periodontitis the role of cortisol as an immunological inhibitory agent is central.

Stress og periodontal sykdom
Jacobsen N
Nor Tannlegeforen Tid 2012; 122: 580-7