Stress and periodontal disease: Is the relationship bidirectional? If yes, is MMP- 8 one of the connecting links?

Abstract

There is sufficient evidence to indicate that a unidirectional link exists between chronic stress and periodontal disease, with stress leading to a greater degree of periodontal tissue destruction in patients susceptible to it. Modification in behaviour related to life style such as oral hygiene, smoking and diet in patients under stress eventually adds on to the risk for periodontal disease onset and progression. Recently, a link between the alteration in social behaviour, stress and increased levels of matrix metalloproteinase-8 (MMP-8) has been established. As periodontal diseases are also characterized with disruption of cytokine response, resulting increase in the levels of MMP-8 could hence be considered as directly or indirectly augmenting this relationship even further. Hence the relationship between stress and periodontal disease might be bidirectional with each worsening the other, with MMP-8 acting as one of the connecting links. Correlation nowhere suggests causation, however the proposed hypothesis could definitely be considered a matter of future research.