Response to article: Stress and periodontal disease: The link and logic!!

Sir,

We read with great interest the review article “stress and periodontal disease: The link and logic!!” by Goyal et al.[1] that appeared in industrial psychiatry journal.

The authors highlight the various links between psychological stress and the periodontal status and these being endocrinal changes, changes in dietary intake, smoking and harmful habits, alteration in salivary flow and components, oral habits, and lower host resistance. Though stress can affect the incidence and severity of periodontal diseases, but the association is indirect in most of the cases as rightly acknowledged by the authors.

Since the relationship of stress and periodontal diseases has comprehensively been reviewed here, we would like to make a sincere mention of some suggestions, which can have a lasting impact on patient's care:

The treating dental clinicians should carefully assess the presence of any stressors in their patients, especially those who do not respond, respond poorly or relapse after the medical treatment. Use of validated instruments (for example, Perceived Stress Scale[23]) after basic training for this purpose might prove helpful for the clinicians

A collaborative-care approach, that is, seeking advice from an expert in stress management should be adopted for those who screen positive for different stressors

Even at their level, the treating dental clinicians can intervene to educate their patients regarding modifiable stress-linked factors like changes in dietary habits, smoking, and other harmful habits. It would be of added advantage if the dental clinician himself can help the patient to identify warning signs and triggers that raise the stress levels in a particular individual.

Though it is clearly apparent from the review that psychological stress can affect the genesis of periodontal diseases, it would be of interest to review and analyze how the periodontal status is affected by various types (acute stress, acute episodic stress, or chronic stress)[4] and severity of stress, especially in special populations like children and adolescents and elderly, since these people can have differences in nature of stressors (for example, academic stress in a child when compared to stress of comorbid diabetes or hypertension in an elderly).