Merchant Anwar T, Pitiphat Waranuch, Ahmed Bilal, Kawachi Ichiro, Joshipura Kaumudi
Department of Nutrition, Harvard School of Public Health, Boston, Mass., USA.
J Am Dent Assoc. 2003 Dec;134(12):1591-6. doi: 10.14219/jada.archive.2003.0104.
Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance and potentially increased risk of periodontitis.
The authors examined the association between social support, anger expression and periodontitis in 42,523 male, U.S.-based, health professionals. Subjects were aged 40 to 75 years in 1986, and more than half were dentists. The men were free of a diagnosis of periodontitis at the start of follow-up in 1996.
Subjects who reported having at least one close friend had a 30 percent lower risk of developing periodontitis compared with those who did not have a close friend (relative risk, or RR = 0.70; 95 percent confidence interval, or CI, 0.51-0.96). Men who participated in religious meetings or services had a 27 percent lower risk of developing periodontitis compared with men who did not participate in religious meetings (RR = 0.73; 95 percent CI, 0.64-0.83). After the authors adjusted for potential confounding variables, men whose anger scores were in the top quintile were 72 percent more likely to report having periodontitis compared with men whose scores were in the lowest quintile (RR = 1.72; 95 percent CI, 1.39-2.12). Men who reported being angry on a daily basis had a 43 percent higher risk of developing periodontitis compared with men who reported being angry seldom.
Reduced social isolation and anger expression may play an important role in maintaining oral health, as well as general health and well-being.
When treating patients with periodontitis, clinicians should be cognizant of the social and behavioral factors that may affect oral health.
压力与口腔卫生差、糖皮质激素分泌增加（可抑制免疫功能）、胰岛素抵抗增加以及牙周炎风险潜在增加有关。
作者研究了42523名美国男性健康专业人员的社会支持、愤怒表达与牙周炎之间的关联。1986年，受试者年龄在40至75岁之间，半数以上为牙医。这些男性在1996年随访开始时未被诊断出患有牙周炎。
报告至少有一个密友的受试者患牙周炎的风险比没有密友的受试者低30%（相对风险，或RR = 0.70；95%置信区间，或CI，0.51 - 0.96）。参加宗教会议或仪式的男性患牙周炎的风险比未参加宗教会议的男性低27%（RR = 0.73；95%CI，0.64 - 0.83）。在作者对潜在混杂变量进行调整后，愤怒得分处于最高五分位数的男性报告患牙周炎的可能性比得分处于最低五分位数的男性高72%（RR = 1.72；95%CI，1.39 - 2.12）。报告每天都生气的男性患牙周炎的风险比很少生气的男性高43%。
减少社会孤立和愤怒表达可能在维持口腔健康以及总体健康和幸福感方面发挥重要作用。
在治疗牙周炎患者时，临床医生应认识到可能影响口腔健康的社会和行为因素。
