Effect of anxiety and psychologic stress on periodontal health: a systematic review and meta-analysis

Objective: The primary objective of this meta-analysis (PROSPERO No: CRD42019124695) was to assess the association between psychologic stress, anxiety, and periodontitis. Data sources:The electronic search was conducted using PubMed, Embase, and Scopus, by three independent reviewers till December 2019. The search was limited to human studies published only in English language. The fixed-effect model and random-effects model were used to obtain the overall mean difference, odds ratio (OR), and its 95% CI for all studies. The heterogeneity was calculated by I2 statistics. The Newcastle Ottawa scale was used to assess the risk of bias in the included studies. Out of 775 potentially relevant articles, 25 studies were selected for systematic review and only 14 studies could be used for meta-analysis in three subsets. The pooled OR for stress and periodontitis was ;1.78, which was statistically highly significant (I-2 = 98.6%, P = .00). Mean salivary cortisol levels as measure of stress in patients with periodontitis was 4.81 nmol/L (I-2 = 98.0%, P = .08). State-Trait Anxiety Inventory value was seen as -1.28 (I-2 = 0.0%, P = .06) for state anxiety and -0.11 (I-2 = 0.0%, P = .85) for trait anxiety in patients with periodontitis. Conclusion: The findings indicate a role of psychologic stress and anxiety in the progression of periodontitis.