Evaluation of stress, serum, and salivary ghrelin and cortisol levels in smokers and non‐smokers with Stage III periodontitis: A cross‐sectional study

Abstract

Background The present study aimed to investigate the serum and salivary ghrelin and cortisol levels in smokers and non‐smokers with Stage III Periodontitis. Methods The present study comprised of a total of 90 systemically healthy patients categorized in three groups: Group I‐ Periodontally healthy patients; Group II‐Non‐smokers with Stage III Periodontitis and Group III‐Smokers with Stage III periodontitis. Clinical parameters of Probing pocket depth (PPD), Clinical attachment levels (CAL), Plaque Index (PI), Gingival Index (GI) and Papillary Bleeding Index (PBI) were recorded and biochemical parameters of serum and salivary ghrelin and cortisol levels were analyzed via Enzyme Linked Immunosorbent Assay (ELISA). Stress levels were assessed using Zung's self‐rating depression scale. Results Serum and salivary ghrelin values were found to be higher in Group II (620.25 ± 260.86 pg/mL, 892.40 ± 271.65 pg/mL respectively) as compared to Group III. Similarly, salivary as well as serum cortisol levels were higher in Group III (20.78 ± 9.23 pg/mL, 399.37 ±189.21 pg/mL respectively) as compared to Group II (16.36 ± 8.88 pg/mL, 320.68 ± 107.01 pg/mL respectively). In Group III, a direct correlation was observed between stress, serum and salivary cortisol levels while an inverse correlation was found between stress, serum and salivary ghrelin levels. Group III showed a greater number of depressed patients followed by Group II and I. Conclusion As per the results smokers with Stage III Periodontitis exhibit an elevated stress and cortisol levels, lower serum and salivary ghrelin levels as compared to the non‐smokers.

Biomarkers common for inflammatory periodontal disease and depression: A systematic review

“… Katuri et al. (2016) Cortisol Serum Serum cortisol levels and depression scores were higher in periodontitis patients with stress vs. with those without stress/yoga practitioners Rahate et al. (2021) Cortisol, Ghrelin Serum, saliva/ELISA There was a positive correlation between salivary cortisol and depression scores in IPD patients (coefficient r ​= ​0.45 (non-smokers) and 0.40 (smokers)).…”

“…In the study ( da Silva et al., 2015 ), there was a strong correlation between MD and biomarker (diurnal decline in salivary cortisol) in IPD group (r ​= ​−0.64; p ​< ​0.01), but not in control group (r ​= ​0.07, NS). Also Rahate et al. (2021) reported on increased levels of salivary cortisol in depressed IPD patients compared to IPD-only patients.…”

“…(2016) , India 70: 23 with depression; 24 no depression; 23 yoga-practitioners Dental outpatients, 46.83–47.13 ​yrs, 53% women All patients with chronic periodontitis divided in 3 groups: with/without depression and yoga-practicing Chronic periodontitis (based on PI, PPD 5–8 ​mm, CAL>5–8 ​mm) Depression (ZSDS-Zung's Self-rating Depression Scale) – No difference between the groups with regards to periodontal parameters. poor Rahate et al. (2021) , India 90: 30 healthy controls; 30 periodontitis; 30 periodon titis/smokers Dental outpatients, 49–52 ​yrs, 38% women Comparison between periodontally healthy patients and stage III periodontitis patients with or without a history of smoking.…”

“…Twenty of the included studies on human subjects reported on biomarkers related to periodontal disease, fiftteen of which found an association between the measured biomarkers and periodontitis. Most studies reported cortisol levels measured in saliva, GCF, serum or urine to be positively correlated with periodontal disease ( Bawankar et al., 2018 ; Cakmak et al., 2014 , 2016 ; Cohen-Cole et al., 1983 ; Fenol et al., 2017 ; Rahate et al., 2021 ; Refulio et al., 2013 ; Rosania et al., 2009 ). However, five studies found no associations between salivary cortisol and periodontal disease ( Cakmak et al., 2019 ; da Silva et al., 2015 ; Kurer et al., 1995 ; Petit et al., 2020 ; Zhang et al., 2021 ).…”

“…(1995) only included patients with good oral health and could not associate cortisol levels to depression or periodontal inflammation. Smoking is a major contributor to both immune and comorbid psychopathologies, requiring a close consideration in all biological assessments of IPD-MD links ( Moeintaghavi et al., 2017 ), which was also reflected in some of the included studies that performed separate analyses for smokers and non-smokers ( Bawankar et al., 2018 ; Rahate et al., 2021 ; Zhang et al., 2021 ).…”