Influence of psychological stress exposure on orthodontic therapy: A comprehensive review

Abstract

Psychological stress exposure (PSE) is a major risk factor for neurological disorders, such as bipolar disorder, depression, and schizophrenia; 1 however, it is also associated with the etiopathogenesis of oral inflammatory conditions, including gingivitis, periodontitis, and aphthous stomatitis. 2 One explanation for this is that PSE increases blood cortisol levels, thereby compromising immune system activity and reducing monocyte and T-lymphocyte counts. 3,4 Moreover, PSE compromises wound healing by reducing the levels of cytokines, such as interleukin (IL)-1α, IL-6, and IL-8, and impairing inflammatory response. 5,6 Furthermore, elevated cortisol levels inhibit the proliferation, differentiation, and apoptosis of osteoblasts, 7 which might influence orthodontic therapy (OT) by either increasing or decreasing the amount of orthodontic tooth movement (OTM).Tooth movement has an inflammation-resembling nature that involves neural and immune processes. 8 A number of studies have assessed the impact of PSE on OT. [9][10][11][12][13][14] Results from a prospective clinical study showed that a reduction in PSE is associated with an improvement in the outcome of OT. 10 Moreover, in an experimental study, PSE in rats significantly increased OTM compared with unrestrained rats. 11 Conversely, Mirzakouchaki et al 13 showed that PSE AbstractThe aim of the present study was to comprehensively review the influence of psychological stress exposure (PSE) on orthodontic therapy (OT). Original clinical and experimental studies were assessed. Quality assessment of experimental studies was performed using the Animal Research Reporting In Vivo Experiment (ARRIVE) guidelines. Six studies (2 clinical and 4 experimental) were included. One clinical study showed that PSE during OT significantly increases nickel release from orthodontic appliances into the saliva. In another study, maternal support was found to be an important predictor of the outcome of OT. In one experimental study, chronic PSE increased orthodontic tooth movement (OTM), and in two experimental studies, PSE decreased OTM. One study on rats reported that PSE is not a risk factor for orthodonticallyinduced root resorption during OTM. One experimental study showed a significantly higher number of osteoclasts in the bone on the side of OTM in restrained rats compared with unrestrained rats. One study showed decreased osteoclast counts in the bone during OTM under PSE. The lowest, highest, and mean ARRIVE scores (out of 20)for the experimental studies were 16, 18, and 16.75 ± 0.96, respectively. The role of PSE in clinical orthodontics remains unclear, most likely due to a lack of studies in humans. Further power-adjusted, well-designed, and randomized studies are needed. K E Y W O R D Semotional stress, orthodontic therapy, psychological stress exposure, review, tooth movement

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies

“…Moreover, an underprivileged SES is a well-known risk factor of obesity (Keaver et al, 2019). Studies (Harrist et al, 2016; Janssen et al, 2004) have shown that overweight children are at higher risk for bullying and teasing, and have more psychological problems than normal-weight peers (Rankin et al, 2016), which may negatively influence treatment compliance and outcome of OT (Al-Shammery et al, 2019). It has also been reported that nicotine (Michelogiannakis et al, 2018b) and alcohol consumption (Schroder et al, 2018) alter bone remodelling and may jeopardise the outcome of OT.…”

“…Local factors that have been reported to influence OTM encompass age, gender, root morphology and nicotine intake (Chisari et al, 2014; Giannopoulou et al, 2016; Michelogiannakis et al, 2018b; Naveh and Weiner, 2015). Moreover, use of medications such as corticosteroids and systemic conditions including psychological stress and diabetes mellitus may also affect OTM (Al-Shammery et al, 2019; Michelogiannakis et al, 2018a).…”

An evidence‐based review of the scope and potential ethical concerns of teleorthodontics

“…28,29 Moreover, habits, such as tobacco smoking, and systemic diseases, including obesity, chronic hyperglycemia, and psychologic disorders, negatively influence orthodontically induced tooth movement in vulnerable populations. [30][31][32][33] Furthermore, use of medications, such as corticosteroids, non-steroidal anti-inflammatory drugs, and bisphosphonates, have been shown to compromise orthodontic tooth movement. [34][35][36] Under such circumstances, in-person patient evaluation prior to and during orthodontic therapy may facilitate identification and management of the potential risk factors, and may also help modify the traditional orthodontic treatment plan accordingly.…”

Edge-Wise Tekni̇k Ve Chi̇n-Cap Tedavi̇si̇ne Bağli Stres Hormonlarindaki̇ Deği̇şi̇mi̇n Peryodi̇k Araliklarla İncelenmesi̇

“…66,70 Ancak konvansiyonel sabit tedavi gören hastaların, psikolojik karakterini belirlemeye yönelik yapılan araştırmaların az olduğu görülmüştür. 11,65,71 Kiyak ve arkadaşları, 67 konvansiyonel ortodontik tedavi gören hastalar üzerinde yapmış oldukları çalışmada, ortodontik tedavinin zamanla moral skorlarında önemli değişiklikler meydana getirdiğini ve stresli bir olay haline dönüştüğünü bildirmişlerdir. Ancak tedavinin tamamlanması ile tüm emosyonel değerlerin normal seviyeye döndüğü rapor edilmiştir.…”