Psychological Stress: A Predisposing and Exacerbating Factor in Periodontitis
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SYSTEMIC DISEASES (N BUDUNELI, SECTION EDITOR)
Psychological Stress: A Predisposing and Exacerbating Factor in Periodontitis Anna M. Spector 1 & Teodor T. Postolache 1,2,3,4 & Faisal Akram 1,5 & Alison J. Scott 6 & Abhishek Wadhawan 1,5 & Mark A. Reynolds 7 Published online: 11 August 2020 # The Author(s) 2020
Abstract Purpose of Review This review focuses on recent advances in our understanding of the interactions between psychological stress, the immune system, and periodontitis, including the dynamic role of host stress responses in altering immune function, altering the oral microbiome and biofilm formation, and promoting local and systemic disease progression. Recent Findings Within the context of periodontal health and disease, stress leads to an impairment of effective antimicrobial defense, shifts in oral microbiome profiles toward more pathogenic gene expression and taxa composition, increased translocation, and biofilm formation. The link between stress and periodontitis is multiform and includes hypothalamic–pituitary–adrenal (HPA) axis and catecholamine activation, production of immune mediators of inflammation and, clinically, syndromes of depression, bipolar disorder, anxiety disorders, and sleep-wake disorders. Summary Psychological stress appears to be an important modifiable risk factor for the development and progression of periodontitis and other periodontal diseases. Keywords Periodontal disease . Stress . Microbiome . Inflammation . Sleep . Biofilm
Introduction Inflammation is a prominent feature of common chronic diseases, including atherosclerosis, cancer, and periodontitis. This article is part of the Topical Collection on Systemic Diseases * Mark A. Reynolds [email protected] 1
Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
2
Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA
3
Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Denver, CO, USA
4
VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA
5
Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC, USA
6
Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, MD, USA
7
Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
Many modifiable risk factors, such as smoking, contribute to increases in systemic markers of inflammation, which can further modify gene regulation through a variety of biologic mechanisms [1]. Mounting evidence points to the ability of psychological stress to dysregulate the inflammatory response, promoting the development and progression of disease [2]. Moreover, evidence continues to expand our understanding of the reciprocal interaction between psychological well-being and overall physical health. The significance of this interplay is perhaps most evident when adaptive capacities are overloaded
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