This is a significant study because it addresses two important and timely areas of interest about a periodontal-systemic relationship. Clinicians are becoming more interested in individualized medicine as an key consideration in effective patient care. We know that variations in periodontal disease severity and response to therapy are influenced by many individual factors, such as coexisting systemic conditions, genetics, smoking, oral hygiene, and age. But we also know that the variations cannot be fully explained by these factors alone, so research looks to psychological factors which have been shown to influence many other parameters of health and disease.

A systematic review published in 2007 by Peruzzo, et al.¹ identified a positive relationship between psychosocial factors/stress and periodontal disease, and concluded with the recommendation for further well-designed studies from a more comprehensive and representative perspective. This article attempts to expand the body of research to analyze behavioral, psychological, and immunologic correlates of periodontal disease through a pilot cross-sectional study with periodontal patients currently in maintenance therapy.

Because the complex network of these interrelated factors can influence the susceptibility, development, severity, and outcome of the disease, as well as modalities for its treatment, therapeutic approaches must account for and affect each particular component of this complex system in order for successful healing to occur. In this study, the authors evaluated the contribution of psychological factors such as depression and stress, physiologic markers such as salivary cortisol (CORT), and environmental/behavioral components such as oral hygiene (tooth brushing and flossing), as well as other confounding factors such as gender and cigarette smoking, on the severity of periodontal disease in a sample of 45 subjects. While each factor has been reported in the literature to be independently associated with periodontal disease, the novelty of this report is the inter-influence that each factor may have on the association.

The authors found a definite correlation between psychological factors such as stress and depression, and periodontal disease. However, due to the low number of subjects chosen from active patients in a periodontal maintenance program, caution must be exercised in interpreting and applying the results of this pilot cross-sectional study, particularly avoiding any extrapolation to suggest causal links exist between psychosocial factors and periodontal diseases.