Models to evaluate the role of stress in periodontal disease.
Models to evaluate the role of stress in periodontal disease.
复制标题
DOI：
10.1902/annals.1998.3.1.288
复制
发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Tedesco, L A
中科院分区：
文献类型：
--
作者：
Genco, R J;Ho, A W;Tedesco, L A
我们评估了纽约州伊利县1,426名年龄在25 - 74岁的受试者的压力、痛苦和应对行为与牙周病的关系，包括人口统计学特征、病史和牙科史、吸烟和饮酒，以及对龈上菌斑、龈下植物群、牙龈出血、牙石、探诊深度、临床附着水平（CAL）、获得每个受试者的放射学牙槽骨丢失（ABL）。受试者还完成了一套5心理社会工具，测量生活事件，日常紧张，麻烦和振奋，痛苦和应对行为。仪器上的所有分量表的内部测试都很高，Cronbach的α范围从0.88到0.99。Logistic回归分析表明，调整年龄、性别和吸烟后，经济压力与更大的附着和牙槽骨丢失显著相关（OR分别为1.70; 95%CI，1.09-2.65;和1.68; 95%CI，1.20-2.37）。当那些有财务压力的人就应对行为进行分层时，发现那些表现出高情绪集中应对的人，（应对不足）有，甚至更高的风险有更严重的依恋丧失（OR 2.24; 95% CI，1.15-4.38）和牙槽骨丢失（OR 1.91; 95%CI，1.15-3.17）比那些低水平的财政紧张在同一应对组，调整后的年龄，性别和吸烟。在进一步调整了看牙医的次数后，那些经济紧张的高情绪集中的警察仍然有更高水平的牙周病（OR 2.12; 95%CI，1.07-4.18）。相比之下，高水平的经济压力谁报告高水平的问题为基础的应对（良好的应对）没有更多的牙周病比那些低水平的经济压力。与对照组相比，表现出严重牙周炎、高水平财务压力和高情绪集中应对的测试组唾液皮质醇水平更高，对照组包括很少或没有牙周疾病、低财务压力和低水平情绪集中应对（分别为11.04 +/-4.4 vs/ 8.6 +/-4.1 nmol/L唾液皮质醇）。这些研究结果表明，与经济压力相关的心理社会措施是成年人牙周病的重要风险指标。需要进一步的前瞻性研究，以帮助建立时间过程中的压力，痛苦，牙周病的发病和进展的应对不足，以及评估的机制，压力对牙周感染的影响。
We evaluated the association of stress,distress, and coping behaviors with periodontal disease in 1,426 subjects, aged 25 to 74, in Erie County, NY, Demographic characteristics, medical and dental history, and tobacco and alcohol consumption, as well as clinical assessments of supragingival plaque, subgingival flora, gingival bleeding, calculus, probing depth, clinical attachment level (CAL), and radiographic alveolar bone loss (ABL) were obtained for each subject. Subjects also completed a set of 5 psychosocial instruments that measured life events, daily strains, hassles and uplifts, distress, and coping behaviors. Internal consistencies of all subscales on the instruments were high, with Cronbach's alpha ranging from 0.88 to 0.99. Logistic regression indicated that financial strain was significantly associated with greater attachment and alveolar bone loss (OR 1.70; 95% CI, 1.09-2.65; and 1.68; 95% CI, 1.20-2.37, respectively) after adjusting for age, gender, and smoking. When those with financial strain were stratified with respect to coping behaviors, it was found that those who exhibited high emotion-focused coping (inadequate coping) had and even higher risk of having more severe attachment loss (OR 2.24; 95% CI, 1.15-4.38) and alveolar bone loss (OR 1.91; 95% CI, 1.15-3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. After further adjusting for number of visits to the dentist, those with financial strain who were high emotion-focused copers still had higher levels of periodontal disease based on CAL (OR 2.12; 95% CI, 1.07-4.18). In contrast, subjects with high levels of financial strain who reported high levels of problem-based coping (good coping) had no more periodontal disease than those with low levels of financial strain. Salivary cortisol levels were higher in a test group exhibiting severe periodontitis, a high level of financial strain, and high emotion-focused coping, as compared to a control group consisting of those with little or no periodontal disease, low financial strain, and low levels of emotion-focused coping (11.04 +/-4.4 vs/ 8.6 +/- 4.1 nmol/L salivary cortisol, respectively). These findings suggest that psychosocial measures of stress associated with financial strain are significant risk indicators for periodontal disease in adults. 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.