慢性应激、抑郁和皮质醇水平作为50岁及以上个体斑块和牙龈炎水平升高的风险指标。

Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older.

作者信息

Hugo Fernando N, Hilgert Juliana B, Bozzetti Mary C, Bandeira Denise R, Gonçalves Tonantzin R, Pawlowski Josiane, de Sousa Maria da Luz R

机构信息

Faculty of Dentistry of Piracicaba, State University of Campinas, Piracicaba, São Paulo, Brazil.

出版信息

J Periodontol. 2006 Jun;77(6):1008-14. doi: 10.1902/jop.2006.050037.

DOI:10.1902/jop.2006.050037

PMID:16734576

Abstract

BACKGROUND

The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years.

METHODS

In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes.

RESULTS

The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%).

CONCLUSION

Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.

摘要

背景

口腔卫生领域中精神神经免疫学因素的作用在牙科文献中一直被忽视。我们的目标是评估压力、抑郁和皮质醇水平对年龄≥50岁人群牙菌斑积聚和牙龈炎的影响。

方法

在这项横断面研究中，对从巴西阿雷格里港痴呆患者组的照料者以及社交活动组中选取的230名受试者进行了评估。使用利普压力量表评估压力，采用贝克抑郁量表评估抑郁症状。收集三份唾液样本（分别在8小时、12小时和20小时），通过放射免疫分析法进行皮质醇分析。皮质醇水平以每位患者三份样本的曲线下面积表示。以可见菌斑指数和牙龈出血指数为结果进行多变量逻辑回归分析。

结果

受试者的平均年龄为61.6±8.2岁，平均月收入为668±590美元，平均皮质醇水平为22.1±33.7nmol/l。共有51.5%的个体为照料者；9.4%为吸烟者，25.5%使用牙间刷/牙间清洁器。作为照料者（比值比[OR]=3.97；95%置信区间[95%CI]=2.08至7.54）、使用牙间刷（OR=0.23；95%CI=0.11至0.47）、皮质醇（OR=2.03；95%CI=1.09至3.81）和压力（OR=1.45；95%CI=1.03至2.02）均与可见菌斑指数>平均值（43%）显著相关。作为照料者（OR=2.35；95%CI=1.13至4.86）、使用牙间刷（OR=0.32；95%CI=0.13至0.77）、吸烟（OR=0.26；95%CI=0.08至0.89）、压力（OR=1.78；95%CI=1.31至2.38）和可见菌斑指数（平均值）（OR=12.87；95%CI=6.29至26.31）均与牙龈出血指数>平均值（37%）显著相关。