Association of Stress, Salivary Cortisol, and Chronic Periodontitis: A Clinico-biochemical Study

BACKGROUND: Periodontitis and stress are among the areas of increasing interest over the past two decades. Early detection of these diseases plays a crucial role in successful therapy. Cortisol is a protein which was found to be consistently associated with both. AIM: The present study was aimed to evaluate saliva cortisol levels (SCLs) in chronic periodontitis (CP) patients with and without stress. MATERIALS AND METHODS: In this cross-sectional study, saliva samples were collected and cortisol levels were determined using ELISA method in 92 participants. The participants were divided into four groups based on periodontal condition (number of teeth present, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and clinical attachment level) and stress levels into Group 1 (no periodontitis and no stress), Group 2 (with periodontitis and no stress), Group 3 (without periodontitis and with stress), and Group 4 (with periodontitis and stress). RESULTS: Overall, 92 adult participants (41 males and 51 females) were included in the study. Participants with stress and periodontitis have high mean SCL when compared to other groups (Group 1: 15.01 ± 2.62, Group 2: 31.92 ± 6.80, Group 3: 34.47 ± 13.47, and Group 4: 60.13 ± 6.68). Group I shows a significant negative correlation of cortisol to BOP, stress to PI, and stress to cortisol level, whereas there is a positive correlation of SCL to PD in Group 4 which is not statistically significant. CONCLUSION: SCL showed difference among the groups. SCL were associated with both CP and psychological stress. Increase in inflammation and stress levels enhances the SCL.