Combat and Operational Stress Reaction Clinical Trial
Official title:
Evaluating the Adjunctive Effect of Stress Reduction Protocol in the Non-Surgical Periodontal Therapy of Chronic Periodontitis Subjects Associated With Stress: A Randomized Control Pilot Study
Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. Minimal evidence in literature exists to assess the effect of stress reduction therapy (SRT) in the outcome of non-surgical periodontal therapy (NSPT). Hence, the present study was aimed at exploring the possibility of employing SRT in stressed subjects (assessed using questionnaire data and serum cortisol level) as an adjunctive intervention in the management of periodontal diseases.
Periodontitis is a multifactorial disease where microbial dental biofilms are considered to
be a key etiological agent for the initiation & progression of the inflammatory process.
Apart from the microbial biofilms, several other risk factors have been associated with
increased susceptibility, progression and severity of periodontal diseases such as systemic
diseases, genetic polymorphisms, socio-economic or educational status, tobacco smoking, oral
hygiene level and psychological stress.
With respect to other possible factors influencing chronic periodontitis, more direct
evidence has emerged that stress, depression and anxiety contribute to the development of
periodontitis in odds ratio of 1:2. Further, it has been shown that subjects with stress are
more prone to develop periodontal disease than subjects without stress. It is speculated that
chronic stress contribute to the development of periodontitis by having a net negative effect
on the immunological response of body or by health related risk behaviors such as smoking,
over eating and lessen compliance with the preventive behavior or even both. In addition, it
has been found that patients experiencing stress were slower in recovery from periodontal
treatment compared to subjects who are not experiencing stress.
Interestingly, the impact of stress on the pathogenesis and periodontal treatment outcomes
depends upon the individuals coping ability. Literature evidence shows that emotional-focused
coping individuals (defensive coping, resigned coping, distractive coping which are
advantageous in the short term) have more advanced disease and poor response to non-surgical
periodontal treatment when compared to problem focused coping (i.e. active coping). Hence,
assessment of a patient's stress level, their coping ability and stress management might be
of value in understanding psychological effects on periodontal health and its disease
process, which will be helpful in future preventive care. Considering these facts, we
hypothesize that if stress is causally related to the worsening of parameters in a chronic
periodontitis patient, its alleviation might result in an additive response to the
conventional periodontal therapy. However, till date, there are no intervention studies on
possibility of employing psychological intervention (stress reduction therapy) as adjunctive
measure in the treatment of periodontitis subjects with unfavorable psychological background.
Hence, considering this hypothesis, the present study is conducted which is first of its
kind, to explore and evaluate, if intervention focused on stress management enhancement
training may serve as adjunctive role in non-surgical treatment of periodontal diseases by
monitoring the improvements in periodontal condition through clinical parameters and
correlating with stress marker like salivary cortisol levels and Derogatis stress profile
(DSP) scores.
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