Psychological perspectives on the pathogenesis of periodontal disease

When defining the relationship between psychosocial factors and periodontitis several issues should be considered: most published studies support a positive association periodontitis, and several psycho-social factors: social isolation, socio-economic status, personality factors, anxiety, depression and life stress; many studies are cross-sectional in nature, include relatively small sample sizes and have inadequate control of potential confounding factors; varying methods to assess both psychosocial factors and periodontitis were used; psychological variables are usually measured by self-report scales and the informers may supply incorrect information and the situation bias may also take place that is the condition of instability of the clinical phenomenon being evaluated; the demographic makeup of the population under study (age, gender, education level, race) and control of potential confounding variables (smoking, oral hygiene status) differs markedly across studies. The findings indicate that the main mechanisms by which psychosocial factors promote gingivitis and periodontitis development included: 1) behavioural mechanisms, whereby the given factor exacerbates lifestyles known to potentiate periodontal disease (e.g., neglect of oral hygiene, changes in diet, increase in smoking), and 2) direct pathophysiological effects on host resistance. As a result, interferences on the association between psychosocial factors and periodontal disease require careful considerations.