Risk Factors - Stress and Genetics

Question 1

What is the psychoneurological model of stress?

Answer 1

Poor coping behaviour to chronic stress results in activation of hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system
- leads to complex interactions between hormones, neurotransmitters and cytokines
- reduces the efficiency of the immune system resulting/exacerbating in chronic disease

Question 2

What is the behaviour orientated model of stress?

Answer 2

Poor coping behaviour to chronic stress results in changed behaviour
- results in at risk behaviour that potentially promotes chronic disease
- increased smoking/alcohol
- poor diet
- decreased OH
- disturbed sleeping pattern
- poor compliance with health/dental care, decreased attendance

Question 3

How does stress impact the periodontium?

Answer 3

Evidence that emotional stress is a risk factor for necrotising gingivitis
- evidence for stress as a risk factor for periodontitis is less clear

Question 4

What are the oral effects of stress?

Answer 4

• decreased salivary flow
• increased glycoprotein content - increased salivary viscosity
• increased salivary acidity
• this favours plaque formation
  Some evidence stress could influence the nature and composition of the subgingival biofilm and promote periodontal disease

Question 5

Which patients are likely to have a high genetic susceptibility to periodontal disease?

Answer 5

Stage 3/4 Grade C patients
- more rapid periodontal destruction more than expected for their age
- often a strong family history of periodontal disease/early tooth loss due to periodontal disease