Association of stress, salivary alpha-amylase and periodontal conditions in patients visiting a tertiary care institution
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Abstract
Objective: To assess the association between psychological stress, salivary alpha-amylase (sAA) levels, and periodontal diseases (gingivitis and periodontitis).
Methods: This unmatched case-control study was conducted at Baqai Medical University and its affiliated institutes, Karachi, Pakistan, in 2022. A total of 88 participants aged 18–45 years were enrolled, comprising 28 healthy controls, 30 patients with gingivitis, and 30 with periodontitis. Periodontal status was assessed using the Community Periodontal Index of Treatment Needs (CPITN), periodontal pocket depth, and clinical attachment level. Perceived stress was evaluated using the 10-item Perceived Stress Scale (PSS-10), while salivary alpha-amylase levels were quantified by enzyme-linked immunosorbent assay (ELISA). Statistical analyses included Chi-square test, one-way ANOVA, Tukey's HSD test, and Spearman rank correlation.
Results: The study groups were comparable in age and gender (p>0.05). Moderate-to-high perceived stress was significantly more common among patients with periodontitis (86.7%) and gingivitis (86.6%) than controls (35.7%) (p<0.01). Mean salivary alpha-amylase levels were significantly higher in the periodontitis (6.8±0.5 µ/ml) and gingivitis (5.2±1.2 µ/ml) groups than in controls (2.4±0.6 µ/ml) (p<0.01). Pairwise comparisons showed significant differences in sAA levels among all three groups (p<0.01). Salivary alpha-amylase demonstrated a moderate positive correlation with perceived stress (r=0.428, p<0.01), whereas no significant associations were observed with age or gender.
Conclusion: Patients with gingivitis and periodontitis exhibited significantly higher perceived stress and salivary alpha-amylase levels than healthy controls. Salivary alpha-amylase showed a positive association with psychological stress, supporting its potential role as a non-invasive biomarker of stress in periodontal disease.
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