Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion

Background: The aim of the present study was to investigate the importance of stress for the development of periodontitis by comparing oral health status, proinflammatory markers, and cortisol in gingival crevicular fluid (GCF) and saliva in patients with stress-related mental depression and controls. Methods: The participants consisted of 43 women with stress-related depression and exhaustion (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]), with a mean age of 42.0 (+/- 9.3 SD) years, and 29 controls, with a mean age of 54.5 (+/- 2.9 SD) years. Clinical examination included the assessment of dental plaque, gingival inflammation (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and number of teeth. GCF was collected with an intracrevicular washing technique from four sites in each subject. Interleukin (IL)- 1 beta, IL-6, and matrix metalloproteinase-9 were determined with enzyme-linked immunosorbent assay and cortisol with radioimmunoassay (I-125 RIA). Analysis of covariance (one-way covariance analyses) was used to remove the influence of age and smoking. Results: The amount of plaque was significantly higher in patients compared to controls (P < 0.003). The patients had an average GI of 1.53 (+/- 0.13 SD) compared to 0.89 (+/- 0.10 SD) for the controls (P < 0.001). The levels of cortisol in GCF was significantly higher in patients than in controls, 3.46 nmol/l (3.25 SD) and 0.30 nmol/l (+/- 0.25 SD), respectively (P < 0.001), whereas cortisol in saliva did not differ between groups. The levels of IL-6 in GCF were significantly higher in the patients than in controls (P < 0.05). Conclusion: Women with stress-related depression and exhaustion had more plaque accumulation, GI, and increased levels of IL-6 and cortisol in GCF compared to normal controls, suggesting that depression might affect immune function, which could lead to impaired periodontal health.