Comparative evaluation of the cortisol level of unstimulated saliva in patients with and without chronic periodontitis

Narges Naghsh, Ahmad Mogharehabed, Elahe Karami, Jaber Yaghini


Background: Chronic periodontitis (CP) is one of the most prevalent diseases of the oral cavity
with various biological and behavioral risk factors. We aimed to evaluate the association between
the salivary cortisol level (SCL) of unstimulated saliva and CP in patients referred to Isfahan Dental
Materials and Methods: In this analytic cross‑sectional study, 90 patients were selected based
on the presence of periodontitis and were divided into two groups: with periodontitis and without
periodontitis (n = 45). First, by evaluating the level of anxiety with Spielberger State‑Trait Anxiety
Inventory questionnaire, each group was divided into three subgroups, each containing 15 persons.
To measure the SCL in all subgroups by the enzyme‑linked immunosorbent assay method, saliva
samples were collected with unstimulated spitting method between 9 and 11 AM. Periodontal
evaluation was done using the mean probing depth (PD), plaque index, and bleeding on probing. The
obtained data were analyzed using SPSS software (version 20, IBM Corp., Armonk, N.Y., USA) and
analysis of variance, independent t‑test, Chi‑square, Mann–Whitney, Spearman correlation, and
Pearson correlation coefficient tests (α = 0.05).
Results: The mean level of salivary cortisol (P = 0.048) and PD (P = 0.009) in patients with
periodontitis was significantly higher than those without periodontitis. There was a direct and
meaningful correlation between PD and SCL (P < 0.001, r = 0.363). In both groups of participants
with (P < 0.001) and without periodontitis (P < 0.001), the mean SCL in patients with high anxiety
was significantly more than patients with medium and low anxiety.
Conclusion: Our results showed that there is an increased level of salivary cortisol (as anxiety index)
in patients with CP. Therefore, it seems that the probability of the occurrence of periodontitis is
higher in those with increased cortisol level.
Key Words: Anxiety, chronic periodontitis, glucocorticoid, periodontal index, saliva

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