Journal of Clinical and Diagnostic Research. 2011 August, Vol-5(4): 889-893 889 889 Stress as an Aggravating Factor for Periodontal Diseases Key Words: Serum cortisol & periodontal diseases, Stress & periodontitis, Cccupational stress & chronic periodontal diseases ABSTRACT Background and Objective: The aim of the research was to evaluate the association between stress, serum cortisol levels and chronic periodontitis in the police personnel of the Cuddalore District of the State of Tamil Nadu, India. Study design: In this case-control study, 110 police personnel were grouped into the test (group 1 and group 2) and the con- trol groups, depending on their probing pocket depth. The various groups were the control group (PPD ≤ 3 mm, n = 30), the test group 1 (at least four sites with PPD > 4mm and ≤6 mm, n = 40) and the test group 2 (at least four sites with PPD > 6 mm, n = 40). Methodology: The clinical parameters such as the Silness Löe plaque index (PI), the sulcus bleeding index (SBI) and the clinical attachment levels were recorded. Stress was measured by using the occupational stress index (OSI). Blood samples were collected and the serum cortisol levels were determined by using ELISA. Results: The mean plaque score and the sulcus bleeding index score were found to be significantly higher in the test groups as compared to those in the control group (< 0.001). The mean clinical attachment level, the occupational stress index score and the serum cortisol levels were found to be significantly higher in the test groups as compared to those in the control group (< 0.001). Pearson’s Correlation showed a positive correlation between the clinical attachment level, the occupational stress index score and the serum cortisol levels only in the test groups. Conclusion: These results suggest that stress can be an oc- cupational risk factor for periodontal diseases because stress accompanied by altered oral hygiene habits causes the accumulation of plaque and obstructs the immunity of the person through the endocrinal connections. LITTLE MAHENDRA, JAIDEEP MAHENDRA, RAVI DAVID AUSTIN, S. RAJASEKHAR, R. MYTHILI Dentistry Section INTRODUCTION Periodontitis is a multi-factorial disease in which the host factors and the environmental factors play an important role [1]. Though bacterial plaque is a chief aetiological factor for periodontitis, it is widely accepted that periodontitis results from the interaction of the host’s defense mechanisms with bacteria which accumulate on the tooth surface [2]. Stress being an important factor which governs the host defenses through the hypothalamic-pituitary- adrenal (HPA) axis [3], it has a command over the pathogenesis of periodontitis. Lazarus [4] defines stress as, “An inharmonious fit between the person and the environment, one in which the person’s resources are taxed or exceeded, forcing the person to struggle, usually in complex ways to cope.” A reasonable amount of researches indicate the association of psychosocial stress, financial stress, occupational stress, distress, the negative impact of life-events and depression with periodontitis [5]. Stress can be viewed as a process with both psychological and physiological components [6] affecting the periodontium directly or indirectly. The direct route involves the alteration of the resistance of the periodontium to infection. The indirect route involves the psychological aspect of a person with health impairing behaviour like poor oral hygiene, smoking, alcohol consumption and poor nutritional intake [7]. Almost any type of stress, whether physical or neurogenic causes an immediate and marked increase in the adrenocorticotropin hormone (ACTH) secretion from the anterior pituitary gland followed within minutes by a greatly increased secretion of cortisol from the adrenal cortex. Cortisol stabilizes the lysosomal membranes, decreases the permeability of the capillaries, decreases both the migration of the white blood cells into the inflamed area and the phagocytosis of the damaged cells as well as it suppresses the immune system causing the lymphocyte reproduction to decrease markedly [8]. Various studies have shown substantial evidence of the correlation between stress and decreased immune functions like decreased NK-cell [9] and T-cell activity [10]. For years, the police profession has been ranked among the top five of the most stressful occupations. [11] The constant risk, uncertainty and tension which are inherent in law enforcement and the exposure to vast amounts of human suffering and violence can lead susceptible individuals to stress, anxiety, depression and alcoholism. Several studies which have been done all around the globe have demonstrated a positive relationship between stress and the police profession. [12], [13], [14] Although many studies have shown the relationship of the stress factors to periodontal diseases and the incidence of stress in the police personnel; a search in PubMed for studies relating to stress, police and periodontal disease, resulted in no articles with only one article providing information on the incidence of periodontitis in the police personnel. [15] Hence, in this study it was hypothesized that stress activates the hypothalamus-pituitary-adrenal axis with the hypersecretion of cortisol and leads to periodontitis in the police personnel. Thus, the aim of this study was to evaluate the association of stress, serum Original Article