Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;51(6):1250-1257.
doi: 10.1111/cdoe.12889. Epub 2023 Jul 10.

Gastrointestinal distress as a potential mediator between stress and periodontal inflammation

Casey D Wright  1 , Brenda Heaton  2   3 , Raul I Garcia  2 , Maureen M Leonard  4 , Alessio Fasano  4 , Daniel W McNeil  5
Affiliations

Gastrointestinal distress as a potential mediator between stress and periodontal inflammation

Casey D Wright et al. Community Dent Oral Epidemiol. 2023 Dec.

Abstract

Objectives: Periodontal disease is multifactorial in its aetiology, which encompasses biopsychosocial contributors, including psychological stress. Gastrointestinal distress and dysbiosis have been associated with several chronic inflammatory diseases yet have rarely been investigated with respect to oral inflammation. Given the implications of gastrointestinal distress on extraintestinal inflammation, this study aimed to evaluate the potential role of such distress as a mediator between psychological stress and periodontal disease.

Methods: Utilizing a cross-sectional, nationwide sample of 828 adults in the USA generated via Amazon Mechanical Turk, we evaluated data collected from a series of validated self-report psychosocial questionnaires on stress, gut-specific anxiety around current gastrointestinal distress and periodontal disease, including periodontal disease subscales targeted at physiological and functional factors. Structural equation modelling was used to determine total, direct and indirect effects, while controlling for covariates.

Results: Psychological stress was associated with gastrointestinal distress (ß = .34) and self-reported periodontal disease (ß = .43). Gastrointestinal distress also was associated with self-reported periodontal disease (ß = .10). Gastrointestinal distress likewise mediated the relation between psychological stress and periodontal disease (ß = .03, p = .015). Given the multifactorial nature of periodontal disease(s), similar results were demonstrated using the subscales of the periodontal self-report measure.

Conclusions: Associations exist between psychological stress and overall reports of periodontal disease as well as more specific physiological and functional components. Additionally, this study provided preliminary data supporting the potential mechanistic role that gastrointestinal distress plays in connecting the gut-brain and the gut-gum pathways.

Keywords: digestive system disorders; gastrointestinal tract; health psychology; periodontal diseases; psychological stress; structural equation modelling.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

The Authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Structural equation model displaying relations between psychological stress (St), gastrointestinal distress (GI), and self-reported periodontal disease (Pd) total score while accounting for subscales of Physiological factors (Ph) and Functional Factors (Fc). Numbers depict individual items making up latent variables (circles). Covariates of gender (G), age (A), education (E), and household income (I) were manifest variables depicted with rectangles. Solid lines depict significant associations whereas dashed lines were non-significant associations. ** = p < 0.001 * = p < 0.05
Figure 2.
Figure 2.
Structural equation model displaying relations between psychological stress (St), gastrointestinal distress (GI), and self-reported periodontal disease subscales of Physiological factors (Ph) and Functional Factors (Fc). Numbers depict individual items making up latent variables (circles). Covariates of gender (G), age (A), education (E), and household income (I) were manifest variables depicted with rectangles. Solid lines depict significant associations whereas dashed lines were non-significant associations. ** = p < 0.001 * = p < 0.05
See this image and copyright information in PMC

References

    1. Albuquerque-Souza E, Sahingur SE. 2022. Periodontitis, chronic liver diseases, and the emerging oral-gut-liver axis. Periodontol 2000. 89:125–141. - PMC - PubMed
    1. Aleksejuniené J, Holst D, Eriksen HM, Gjermo P. 2002. Psychosocial stress, lifestyle and periodontal health. J Clin Periodontol.29(4):326–335. - PubMed
    1. Bajaj JS, Matin P, White MB, Fagan A, Deeb JG, Acharya C, Dalmet SS, Sikaroodi M, Gillevet PM, Sahingur SE. 2018. Periodontal therapy favorably modulates the oral-gut-hepatic axis in cirrhosis. Am J Physiol Gastrointest Liver Physiol. 315(5):G824–G837. - PMC - PubMed
    1. Blicher B, Joshipura K, Eke P. 2005. Validation of self-reported periodontal disease: A systematic review. J Dent Res. 84(10):881–890. - PubMed
    1. Byrd KM, Gulati AS. 2021. The “gum–gut” axis in inflammatory bowel diseases: A hypothesis-driven review of associations and advances. Front Immunol. 19(12):620124. - PMC - PubMed

Publication types

MeSH terms