Stress, Genetics and Systemic Disease

Question 1

What are some effects of stress?

Answer 1

Positive:

• exciting/pleasurable
• fight or flight response

Negative:

• pain, discomfort
• loss of function

Question 2

What is the psychoneurogenic model of stress?

Answer 2

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

Question 3

Describe the behaviour orientated model:

What is stress a risk factor for?

Answer 3

• poor coping behaviour to chronic stress results in changed behaviour
• results in at risk health behaviour which potentially promotes chronic disease:
• increased smoking, alcohol, poor diet, decreased OH, disturbed sleep patterns, poor compliance with health professionals

Stress is a risk factor for necrotising gingivitis, less clear cut as a risk factor for periodontitis

Question 4

What are the oral effects of stress?

What is the key study which links periodotnal disease to stress?

Answer 4

• decreased saliva
• increased glycoprotein content
• increased salivary acidity
• favouring plaque formation
• could influence the nature and composition of subgingival biofilm and promote periodontal disease progression

Genco study - 1999 - financial stress study

Question 5

What is a quick and simple way to assess a patients genetic susceptibility to periodontal disease?

Answer 5

• extent of previous PD (bone loss/LOA/BOP)
• age
• level of OH
• all easily measureable

Question 6

What are some possible mechanisms linking CVD and PD?

Answer 6

• the common susceptibility model
• direct bacterial effects on platelets
• autoimmune responses
• invasion/uptake of bacteria into endothelial cells and macrophages
• inflammation

Question 7

What accounts for the possible link between periodontal disease and systemic chronic disease?

Answer 7

Leaking of pro-inflammatory mediators and/or periodontal bacteria into the systemic bloodstream accounts for the possible links between PD and chronic systemic diseases either by:

• raising systemic inflammation
• direct effects of periodontal bacteria (bacteraemia)
• or both