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Outlin
e
1. Introduction
2. Definition
3. Classification
4. Etiology
5. Pathophysiology
 Hypothalamic-Pitutory- adrenal a...
6. ANUG
7. Effect of stress on wound healing
8. Self-inflicting injuries
9. Cohen’s perceived stress scale
10. Studies
 A...
INTRODUCTI
ON
Hippocrates (1945) Health as a harmonious balance of the
elements comprising the quality of life
Selye (1967...
Definitio
ns
Definitions Different authors have proposed different definitions
for stress
Stress is defined as a total tra...
“Stressor” is defined as forces that had the potential to
challenge the adaptive capacity of the organism
“Coping” is the ...
Classificatio
n
Classified based on reasons for the stress
Occupational Stress: E.g. Athletes, Boxers,
Diamond cutters.
In...
Etiology
Neglect of oral hygiene
Changes in dietary intake
Smoking and other harmful oral hiabits
Bruxism
Gingival circula...
Alteration in saliva flow and components
Endocrine changes
Lowered host resistance
Pathophysiology
Four main pathways
1. Hypothalamic-pitutory- adrenal axis.
2. Autonomous nervous system activation.
Sympat...
Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195–
210
Courtesy: EurJOralSci,1996:104:327-334
Neuropeptides
release
Neuropeptides released from peptidergic nerve Fibers also
modulate the activity of the immune system...
Alteration of Th1/Th2
ratio
Breivik and co-workers 1997
Hypothalamic–pituitary–adrenal axis and its effects on T-
lymphocy...
Effect of stress on wound healing
Health-impairing behaviors Pathophysiological effects
Poor oral hygiene Higher glucocort...
Animal
studies
Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195–
Concluded that stress causes
↓ Vascular permeability in gingivomucosal
tissue
↓IL1 mRNA expression
↓Response to vaccines
↓...
Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195–
Human
studies
Concluded that stress causes
• ↑ plasma cortisol levels
• Stressor is directly related to periodontal
disease
• No differe...
ANU
G
According to (Cohen- Cole et al )
Compared to controls the ANUG patients presented the following
significant differe...
Psychiatric influence of self-inflicted injuries
• Grinding and clenching of the teeth, nibbling of the foreign
objects,na...
Cohen’s perceived stress
scale
Drawbacks of current models
Two major models to study the effect of stress on
systemic health are,
 Role of major life ev...
There are several major problems with this relatively simplistic
classification
• It is obvious that not all factors induc...
• Lack of a uniform method of quantifying stress
• Lack of proper Questionnaires
• The effects of stress may be altered by...
Clinical implications and treatment plan
Periodontal
management
• Careful history
• Debridement of root surfaces,
• Optimi...
Stress management
There are four basic approaches to dealing with
stress:
• Removal or alteration of the source of stress
...
Stress reduction
protocol
Stress reduction for the oral health
patient
Pre treatment
protocol
Physical
classification
(ASA...
References
1. Clinical periodontology, Carranza, 10th ed
2. The role of stress in periodontal disease and wound healing, P...
Stress on periodontium
Stress on periodontium
Stress on periodontium
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Stress on periodontium

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Stress on periodontium

  1. 1. Outlin e 1. Introduction 2. Definition 3. Classification 4. Etiology 5. Pathophysiology  Hypothalamic-Pitutory- adrenal axis.  Autonomous nervous system activation.  Sympathetic  Parasympathetic  Release of neuropeptides  Alteration of Th1/Th2 ratio
  2. 2. 6. ANUG 7. Effect of stress on wound healing 8. Self-inflicting injuries 9. Cohen’s perceived stress scale 10. Studies  Animal studies  Human studies 11. Drawbacks of current models 12. Clinical implication, Treatment plan Stress reduction protocol  Dental treatment  Psychological treatment 13. Conclusion
  3. 3. INTRODUCTI ON Hippocrates (1945) Health as a harmonious balance of the elements comprising the quality of life Selye (1967) Terms “Stress”. “Stressor” “Coping “ Stress is compatible with good health being very necessary to cope with the challenges of everyday life . If it is sustained causes damage
  4. 4. Definitio ns Definitions Different authors have proposed different definitions for stress Stress is defined as a total transaction from demand to resolution in response to an environmental encounter that requires appraisal, coping and adaptation by the individual Stress is defined as a state of physiological or psychological strain caused by adverse stimuli, physical, mental, or emotional, internal or external, that tend to disturb the functioning of an organism and which the organism naturally desires to avoid. (GPT 4th ed) Selye (1967)
  5. 5. “Stressor” is defined as forces that had the potential to challenge the adaptive capacity of the organism “Coping” is the response of the individual to stress (emotionally and physically Eustress -------- positive stress Distress -------- negative stress
  6. 6. Classificatio n Classified based on reasons for the stress Occupational Stress: E.g. Athletes, Boxers, Diamond cutters. Involuntary Stress: E.g. Soldiers, Recovery from General anesthesia. Voluntary Stress : E.g. Dancers, Musicians. stress Psychological Physiologic al Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195– 210
  7. 7. Etiology Neglect of oral hygiene Changes in dietary intake Smoking and other harmful oral hiabits Bruxism Gingival circulation
  8. 8. Alteration in saliva flow and components Endocrine changes Lowered host resistance
  9. 9. Pathophysiology Four main pathways 1. Hypothalamic-pitutory- adrenal axis. 2. Autonomous nervous system activation. Sympathetic Parasympathetic 3. Through release of neuropeptides 4. Alteration of Th1/Th2 ratio
  10. 10. Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195– 210
  11. 11. Courtesy: EurJOralSci,1996:104:327-334
  12. 12. Neuropeptides release Neuropeptides released from peptidergic nerve Fibers also modulate the activity of the immune system and the release of cytokines. This includes  Substance P,  Somatostatin,  Endogenous opioid peptides (beta endorphin and enkephalins),  Nerve growth factor. Among these the Neuropeptide SP, calcitonin gene related peptide (CGRP) secreted from sensory C-type nerve fibers have different immuno-modulatory functions.
  13. 13. Alteration of Th1/Th2 ratio Breivik and co-workers 1997 Hypothalamic–pituitary–adrenal axis and its effects on T- lymphocyte numbers Th cells Th1 Th2 Protective (INF gamma,IL2) Destructive (IL4,5,6,10) ↑ Plasma glucocorticoid – provoke inappropriate Th2 response A cytokine profile, consistent with a T helper 2 cell response seen in medical students during stressful examination periods (Marshal and coworkers 1998)
  14. 14. Effect of stress on wound healing Health-impairing behaviors Pathophysiological effects Poor oral hygiene Higher glucocorticoid levels (cortisol) and higher catecholamine levels (epinephrine and norepinephrine), which may lead to any or all of the following Increased consumption of cigarettes Hyperglycemia, which may impair neutrophil function and impair the initial phase of wound healing Increased alcohol consumption Reduced levels of growth hormone, which may down-regulate the tissue repair response Forgetfulness and difficulty concentrating Altered cytokine profiles,(IL1B) which may affect recruitment of cells important to wound remodeling, such as macrophages and fibroblasts Disturbed sleeping patterns Reduced tissue matrix metalloproteinase levels, leading to impaired tissue turnover and reduced wound remodeling Poor nutritional intake Decreased natural killer cell levels, reducing the host ability to mount an appropriate immune response to periodontal pathogensCourtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195–
  15. 15. Animal studies Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195–
  16. 16. Concluded that stress causes ↓ Vascular permeability in gingivomucosal tissue ↓IL1 mRNA expression ↓Response to vaccines ↓Clot stabilization, wound strength
  17. 17. Courtesy : LAKSHMIBOYAPATI&HOM-LAYWANG, Periodontology 2000, Vol. 44, 2007, 195– Human studies
  18. 18. Concluded that stress causes • ↑ plasma cortisol levels • Stressor is directly related to periodontal disease • No difference in plaque scores between test and control groups
  19. 19. ANU G According to (Cohen- Cole et al ) Compared to controls the ANUG patients presented the following significant differences • More state anxiety before disease resolution • Th2 dominant immune response • Depressed lymphocyte proliferation • Elevated serum cortisol levels before ANUG resolution • Decreased neutrophill cheamotaxis and phagocytosis
  20. 20. Psychiatric influence of self-inflicted injuries • Grinding and clenching of the teeth, nibbling of the foreign objects,nail biting all are potentially injurious to the periodontium. • Self inflicted injuries like gingival recession have been described in both children and adults. • Some authors reported that these injuries are not common in psychiatric patients (sandhu et al)
  21. 21. Cohen’s perceived stress scale
  22. 22. Drawbacks of current models Two major models to study the effect of stress on systemic health are,  Role of major life events  Day-to-day, stresses
  23. 23. There are several major problems with this relatively simplistic classification • It is obvious that not all factors inducing stress fall neatly into one or another of these categories • It is difficult to determine whether it is the stressful events that caused the altered disease pattern, or whether the stress response is a consequence of having a disease. • This area of investigation, within the dental field, is the lack of a uniform definition of stress. • Stress studies differ regarding whether acute or chronic stress but these are somewhat arbitrary terms
  24. 24. • Lack of a uniform method of quantifying stress • Lack of proper Questionnaires • The effects of stress may be altered by gender, personality type, age, lifestyle, psychological disorders, and varying coping styles
  25. 25. Clinical implications and treatment plan Periodontal management • Careful history • Debridement of root surfaces, • Optimizing oral hygiene, • Utilization of antimicrobial substances, • Adjunct use of growth factors in various delivery vehicles.
  26. 26. Stress management There are four basic approaches to dealing with stress: • Removal or alteration of the source of stress • Learning to change how you see the stressful event • Reducing the effect on your body that stress has • Learning alternative ways of coping
  27. 27. Stress reduction protocol Stress reduction for the oral health patient Pre treatment protocol Physical classification (ASA) and acute anxiety recognition Proper rest and diet Initial consulting appointment and prescription for the pre operative medication Short morning appointment s, Early in the week, early in the morning Pain control Vocal sedation and relaxation techniques Music, aroma therapy, massage Hypnosis and acupuncture NO inhalation, local anesthetic use Post treatment protocol Referral if needed Written recommenda tions Medication:O TC, prescription Fallow up: telephone call Courtesy : Clinical feature july 2004
  28. 28. References 1. Clinical periodontology, Carranza, 10th ed 2. The role of stress in periodontal disease and wound healing, Periodontology 2000, Vol. 44, 2007, 195–210 3. Emotional stress effects on immunity, gingivitis and periodontitis, EurJOralSci1996:104:327-334 4. Stress, Depression, Cortisol, and Periodontal Disease, J Periodontol 2009;80:260-266 5. Effects of academic stress on oral hygiene – a potential link between stress and plaque associated disease? J Clin Periodontol 2001; 28: 459–464 6. Psychosocial stress, lifestyle and periodontal health, J Clin Periodontol 2002; 29: 326–335 7. Psychosocialfactors in inflammatory periodontal diseases, /ClinPeriodontol1995:22:516-526 8. Chromogranin A: Novel biomarker between periodontal disease and psychosocial stress, Journal of Indian Society of Periodontology- Vol 17, Issue 2, Mar-Apr 2013 9 Models to Evaluate the Role of Stress in Periodontal Disease, Ann Periodontol 1998;3: 288-302. 10.coping with stress, its influence on periodontal diseases,J Periodontal,2002,73,1343-1351

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