The relationship between periodontitis and stress-related hormones is poorly understood. In this cross-sectional study we investigated the associations between the stress-related hormone, chromogranin A (CgA) and periodontitis in healthy community-dwelling elderly subjects aged 60 years old and older. A total of 171 subjects (85 males, 86 females; mean age of 68.4 ± 4.46 (SD) years old) participated, all of whom were living independently. Stimulated whole saliva samples were collected and CgA levels were determined, while a medical questionnaire regarding medical conditions and lifestyle was also administered. Clinical examinations included probing depth (PD), bleeding on probing (BOP), and clinical attachment loss (CAL). When the subjects were divided into two groups based on periodontitis severity, the salivary CgA levels were significantly higher in subjects with severe PD or CAL. Multiple regression analysis showed that higher CgA level was significantly associated with greater numbers of teeth with severe PD or CAL, after adjusting for confounding variables. In this first known report of the association between CgA level and periodontitis, our results suggest a close relationship between the extent and severity of periodontitis and salivary level of CgA in healthy elderly subjects.A number of investigators have proposed an association between periodontitis, a chronic inflammatory disease, and psychosocial stress, as described in a systematic review recently reported (11), and the majority of studies found a positive relationship between stress/psychological factors and periodontal disease. However, the relationship between periodontitis and stress-related hormones is poorly understood, as to the best of our knowledge, only two studies have been presented, both of which investigated salivary cortisol levels. The level of salivary cortisol level reliably reflects hypothalamic-pituitary-adrenal (HPA) activity and has long been used in human psychobiological studies as a biological marker of stress (5). In general, the stress system consists of brain elements, of which the main components are corticotropin-releasing hormone (CRH) and the locus ceruleus-norepinephrine/autonomic systems, as well as their peripheral effectors, the HPA axis and sympatho-adrenomedullary (SAM) system (3). Chromogranin A (CgA) is an acidic glycoprotein that is stored and co-released by exocytosis with catecholamines from the adrenal medulla and sympathetic nerve endings (9, 10), thus it is considered to be a sensitive and reliable index of the SAM system. Recently, salivary CgA was shown to be produced by the human submandibular gland and secreted into saliva (12). To our knowledge, little has been reported the association between salivary CgA levels and periodontal status. In the present cross-sectional study, we analyzed the association between periodontitis and the SAM system using saliva CgA as a marker. Furthermore, we in-