Sir,Periodontitis is defined as an inflammatory disease of supporting tissues of teeth, caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession or both.[1] The oral cavity has the potential to harbor at least 600 different bacterial species, and in any given patient, more than 150 species may be present, and the surface on tooth can have as a billion bacteria in its attached bacterial plaque.[2] Modifying factors for various forms of periodontal and gingival diseases include local factors (tooth shape, plaque accumulation, and oral hygiene habits), systemic diseases (like diabetes), and environmental and behavioral factors (like smoking and emotional stress). There are several studies that have demonstrated a relationship between psychological stress and inflammatory diseases such as rheumatoid arthritis and periodontitis.[3] Even though investigators have studied the impact of the immune response and of psychosocial components on the extent and severity of periodontitis, few studies have evaluated the impact of relationships among psychosocial well-being, status of the immune system, and the health of the periodontium, and the hypothesis was that stress elicits hypothalamus–pituitary–adrenal axis hyperactivation and leads to periodontitis.[3] Several correlation questionnaire studies have observed a positive relationship between psychological stress and periodontal diseases. Deinzer et al. analyzed the effects of academic stress on periodontal health[4] and Linden et al. correlated occupational stress and periodontitis.[5] In addition to bacterial infections, adverse effects of immunological changes, in particular, stress factors, may represent precipitating parameters of inflammatory periodontal diseases.[6] The impact of stress on the immune system has been well established, and a possible influence on a chronic inflammatory disease like periodontitis appears probable. Yet, a direct association between periodontal disease and stress remains to be proven, which is partly due to lack of an adequate animal model and the difficulty in quantifying amount and duration of stress and the detrimental effects of inadequate coping with stress. Multiple variables affecting the severity of periodontal disease and the uncertainty about the individual onset of periodontal disease complicate the issue further. Nevertheless, more recent studies indicate that psychosocial stress represents a risk indicator for periodontal disease and should be addressed before and during treatment.[7] It has recently been shown that emotional or psychological load (stress) may influence immune activities directly via neuroendocrine (hormone) messenger substances (neurotransmitters and neuropeptides) and/or indirectly via neuroendocrine (hormone) substances.[8] Further prospective studies are needed to help establish the time course of stress, distress, and inadequate coping on the onset and progression of periodontal disease, as well as to evaluate the mechanisms by which stress exerts its effects on periodontal infections.[9] The oral cavity works as a continuous source of infectious agents, and its state often reflects succession of systemic pathologies and various aspects affecting the disease progression must be considered before planning a true treatment plan.