Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Dentistry
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 889 - 893 Full Version

Stress as an Aggravating Factor for Periodontal Diseases


Published: August 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1465
LITTLE MAHENDRA, JAIDEEP MAHENDRA, RAVI DAVID AUSTIN, S. RAJASEKHAR, R. MYTHILI

Senior Lecturer, Department of Periodontics, Rajah Muthaiah Dental College and Hospital, Annamalai University, Annamalai Nagar 608002, India. Professor, Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai 600095, India. Principal, Rajah Muthaiah Dental College and Hospital, Annamalai University, Annamalai Nagar 608002, India.. Professor, Department of Periodontics, Rajah Muthaiah Dental College and Hospital, Annamalai University, Annamalai Nagar 608002, India. Professor and Head, Department of Periodontics, Rajah Muthaiah Dental College and Hospital, Annamalai University, Annamalai Nagar 608002, India.

Correspondence Address :
Dr. Jaideep Mahendra, MDS., Ph.D., PGDHM.,
X-1/1-2 SAF Games Village,
Koyambedu, Chennai-600 107,
Tamil Nadu, India.
Mobile No. +91- 9444963973
Fax No. +91-44-24343205
email: jaideep_m_23@yahoo.co.in

Abstract

Background and Objective: The aim of the research was to evaluate the association between stress, serum cortisol levels and chronic periodontitis in the police personnel of the Cuddalore District of the State of Tamil Nadu, India.

Study design: In this case-control study, 110 police personnel were grouped into the test (group 1 and group 2) and the control groups, depending on their probing pocket depth. The various groups were the control group (PPD ≤ 3 mm, n = 30), the test group 1 (at least four sites with PPD > 4mm and ≤6 mm, n = 40) and the test group 2 (at least four sites with PPD > 6 mm, n = 40).

Methodology: The clinical parameters such as the Silness Löe plaque index (PI), the sulcus bleeding index (SBI) and the clinical attachment levels were recorded. Stress was measured by using the occupational stress index (OSI). Blood sampleswere collected and the serum cortisol levels were determined by using ELISA.

Results: The mean plaque score and the sulcus bleeding index score were found to be significantly higher in the test groups as compared to those in the control group (< 0.001). The mean clinical attachment level, the occupational stress index score and the serum cortisol levels were found to be significantly higher in the test groups as compared to those in the control group (< 0.001). Pearson’s Correlation showed a positive correlation between the clinical attachment level, the occupational stress index score and the serum cortisol levels only in the test groups.

Conclusion: These results suggest that stress can be an occupational risk factor for periodontal diseases because stress accompanied by altered oral hygiene habits causes the accumulation of plaque and obstructs the immunity of the person through the endocrinal connections.

Keywords

Serum cortisol & periodontal diseases, Stress & periodontitis, Cccupational stress & chronic periodontal diseases

Periodontitis is a multi-factorial disease in which the host factors and the environmental factors play an important role (1). Though bacterial plaque is a chief aetiological factor for periodontitis, it is widely accepted that periodontitis results from the interaction of the host’s defense mechanisms with bacteria which accumulate on the tooth surface (2). Stress being an important factor which governs the host defenses through the hypothalamic-pituitaryadrenal (HPA) axis (3), it has a command over the pathogenesis of periodontitis.

Lazarus (4) defines stress as, “An inharmonious fit between the person and the environment, one in which the person’s resources are taxed or exceeded, forcing the person to struggle, usually in complex ways to cope.” A reasonable amount of researches indicate the association of psychosocial stress, financial stress, occupational stress, distress, the negative impact of life-events and depression with periodontitis (5).

Stress can be viewed as a process with both psychological and physiological components (6) affecting the periodontium directly or indirectly. The direct route involves the alteration of the resistance of the periodontium to infection. The indirect route involves the psychological aspect of a person with health impairing behaviour like poor oral hygiene, smoking, alcohol consumption and poor nutritional intake. (7)

Almost any type of stress, whether physical or neurogenic causes an immediate and marked increase in the adrenocorticotropinhormone (ACTH) secretion from the anterior pituitary gland followed within minutes by a greatly increased secretion of cortisol from the adrenal cortex. Cortisol stabilizes the lysosomal membranes, decreases the permeability of the capillaries, decreases both the migration of the white blood cells into the inflamed area and the phagocytosis of the damaged cells as well as it suppresses the immune system causing the lymphocyte reproduction to decrease markedly (8). Various studies have shown substantial evidence of the correlation between stress and decreased immune functions like decreased NK-cell (9) and T-cell activity (10).

For years, the police profession has been ranked among the top five of the most stressful occupations. (11) The constant risk, uncertainty and tension which are inherent in law enforcement and the exposure to vast amounts of human suffering and violence can lead susceptible individuals to stress, anxiety, depression and alcoholism. Several studies which have been done all around the globe have demonstrated a positive relationship between stress and the police profession. (12), (13), (14) Although many studies have shown the relationship of the stress factors to periodontal diseases and the incidence of stress in the police personnel; a search in PubMed for studies relating to stress, police and periodontal disease, resulted in no articles with only one article providing information on the incidence of periodontitis in the police personnel. (15) Hence, in this study it was hypothesized that stress activates the hypothalamus-pituitary-adrenal axis with the hypersecretion of cortisol and leads to periodontitis in the police personnel. Thus, the aim of this study was to evaluate the association of stress, serumcortisol levels and chronic periodontitis in the police personnel of Cuddalore district, India.

Material and Methods

Study Population and Sampling
All the police personnel who were aged 35-48 years, of Cuddalore district, India in the rank of head constable or in lower ranks formed the population for this case-control study. The 432 police personnel who volunteered for the study were provided with a socio-demographic sheet which consisted of questions about their social, demographic and general health status as well as their medication history. By analyzing the socio-demographic sheet, out of the 432 police personnel, 314 were selected by excluding the participants whose health status could interfere with the study eg., those who were taking corticosteroids or immunosuppressant drugs, those having Addison’s disease or Cushing’s syndrome, smokers, female participants who were pregnant or who were taking contraceptive pills at the time of the study.

Written consent for participation in the study was obtained from 314 eligible candidates for the study and 110 subjects were selected after the clinical periodontal examination. The ethical clearance committee of Annamalai University gave the approval for the conduct of the study. They were grouped into the test (group 1 and group 2) and the control groups by using the same criteria as was used in the study by Vettore et al. (16) The control group consisted of 30 participants with probing pocket depth (PPD) ≤ 3 mm, the test group 1 consisted of 40 participants with at least four sites with probing pocket depth (PPD) > 4mm and ≤ 6 mm, and the test group 2 consisted of 30 participants with at least four sites with probing pocket depth (PPD) > 6mm. All the groups had a Silness-Löe plaque index score of more than 1. All the subjects of the test (group 1 and group 2) and the control groups were subjected to cortisol analysis and psychological evaluation.

Clinical Examinations The clinical examinations included the assessment of the oral hygiene status, gingival bleeding, probing pocket depth and the clinical attachment level. The Silness-Löe plaque index (PI) (modified) was used to assess the oral hygiene status in this study, which was similar to the method which was used in the study by Monteiro da Silva et al. (7) After using a disclosing solution, 4 surfaces of 3 teeth in each of the maxillary and the mandibular quadrants were examined for plaque and the mean plaque score was calculated. (17) The sulcus bleeding index was used to grade the gingival bleeding in this study, which was similar to that which was used in the study by Klages et al (18).

The clinical examinations which were performed for the evaluation of periodontitis were probing pocket depth (PPD) and clinical attachment level (CAL) by using William’s periodontal probe (0.6 mm in diameter). The pocket depth of all the existing teeth was assessed except that of the root stumps; the periodontal probe was inserted into the periodontal pocket which was parallel to the long axis of the tooth. The calculation of CAL was done by using two measurements: (a) the distance from the free gingival margin (FGM) to the cemento-enamel junction (CEJ) and (b) the distance from the FMG to the bottom of the sulcus (probing pocket depth; PPD). The clinical attachment level (CAL) was calculated by subtracting the distance, FGM-CEJ from the probing pocket depth (PPD).

The Evaluation of Stress All the 110 subjects of the case-control study were evaluated for stress by using the occupational stress index which was put forth by Srivastava A.K. and Singh, A.P., a psychological evaluation tool which was developed and validated for use in the Indian population(19).

The questionnaire was originally designed in English and it was modified to a bilingual one with questions in both the English and Tamil languages (Tamil- the official language of the State of Tamil Nadu, India), for a better understanding of the questions by the participants.

The questionnaire consisted of 46 questions which had to be answered by both the test and the control groups. Each question was rated on a 5-point scale. Out of the 46 questions, 28 were “Truekeyed” and the rest of the 18, were “False-keyed.” The questions in the questionnaire were related to almost all relevant components of the job life which could cause stress in some way or other, such as role over-load, role ambiguity, role conflict, group and political pressures, the responsibility for persons, under-participation, powerlessness, poor peer relationship, intrinsic impoverishment, low status, strenuous working conditions and unprofitability. The summation of the individual scores of all the 46 questions gave the occupational stress index score of each participant.

Cortisol Analysis About 1 ml of blood was collected by venipuncture by using a sterile disposable syringe and a needle from the median cubital vein between 8:00-9:00 a.m., in accordance with the diurnal rhythm of cortisol secretion. (20) The blood was centrifuged and the serum was capped and stored for up to 5 days at 2-8°C, prior to its assaying. About 20 μl of serum was used to estimate the serum cortisol levels by using the Cortisol ELISA-kit. After the ELISA reaction, the quantitative in vitro value of the serum cortisol levels was determined by using an ELISA reader (microtiter plate reader) with its optical density being set at 450±10 nm. The value of cortisol was expressed in ng/ml.

Statistical Analysis The data which was obtained from the study of the control group, the test group 1 and the test group 2 were analyzed by using the F- test (ANOVA), the Scheffe’s multiple comparison test and Pearson’s Correlation. ANOVA was used to compare the means of the variables between the three groups. The Scheffe’s multiple comparison test was used to adjust the significance levels in ANOVA. Pearson’s correlation was used to study the correlation between the variables in the different groups.

Results

Age The mean age in all the three groups was found to be around 40 years for the control group, it was 40.23 years, for the test group 1, it was 40.42 years and for the test group 2, it was 41.18 years, with standard deviations of 3.46 years, 3.54 years and 3.78 years respectively. This showed that all the groups were homogeneous in their ages and that there was no significant age difference between the groups.

Plaque The mean plaque score ranged from 1.2 to 1.7 in the three groups which indicated that the oral hygiene status among the three groupswas fair. The mean plaque score of the control group, the test group 1 and the test group 2 were 1.19, 1.52 and 1.70 respectively. The ANOVA test revealed that the mean plaque score was different in all the three groups, which was statistically significant (p <0.001). The Scheffe’s multiple comparison test indicated that the mean plaque score increased with an increase in the pocket depth. The control group had a lower mean plaque score as compared to the test group 1 and the test group 2. Further, the test group 1 had a lower mean plaque scores as compared to the test group 2.

The Sulcus Bleeding Index The mean sulcus bleeding index score ranged from 0.9 to 2 in the three groups. The mean sulcus bleeding index score of the control group, the test group 1 and the test group 2 were 0.96, 1.62 and 2.00 respectively. The ANOVA test revealed that the mean sulcus bleeding index score was different in all the three groups, which was statistically significant (p<0.001). The Scheffe’s multiple comparison test indicated that the mean sulcus bleeding index score increased with an increase in the pocket depth. The control group had a lower mean sulcus bleeding index score as compared to the test group 1 and test group 2. Further, the test group 1 had a lower mean sulcus bleeding index score as compared to the test group 2.

The Clinical Attachment Level The mean clinical attachment level ranged from 2.7 to 5.9 mm in the three groups. The clinical attachment levels of the control group, the test group 1 and the test group 2 were 2.63, 4.68 and 5.92 respectively. The ANOVA test results revealed that the mean clinical attachment level was different in all the three groups which was statistically significant (p <0.001). The Scheffe’s multiple comparison test indicated that the mean clinical attachment level increased with an increase in the pocket depth. The control group had a lower mean clinical attachment level as compared to the testgroup 1 and the test group 2. Further, the test group 1 had a lower mean clinical attachment level as compared to the test group 2 (Table/Fig 1).

The Occupational Stress Index The mean occupational stress index score ranged from 79.5 to 158.2 in the three groups. The mean occupational stress index score of the control group, the test group 1 and the test group 2 were 79.53, 133.68 and 158.13 respectively. The ANOVA test results revealed that the mean occupational stress index score was different in all the three groups, which was statistically significant (p <0.001). The Scheffe’s multiple comparison test indicated that the mean occupational stress index score increased with an increase in pocket depth. The control group had a lower mean occupational stress index score as compared to the test group 1 and the test group 2. Further, the test group 1 had a lower mean occupational stress index score as compared to the test group 2 (Table/Fig 2).

Serum Cortisol Levels The mean serum cortisol level ranged from 125.6 to 212.4 in the three groups. The mean serum cortisol level of the control group, the test group 1 and the test group 2 were 125.67, 187.75 and 212.40 respectively. The ANOVA test results revealed that the mean serum cortisol level was different in all the three groups, which was statistically significant (p <0.001). The Scheffe’s multiple comparison test indicated that the mean serum cortisol level increased with an increase in the pocket depth. The control group had a lower mean serum cortisol level as compared to the test group 1 and the test group 2. Further, the test group 1 had a lower mean serum cortisol level as compared to the test group 2 (Table/Fig 3).

The Relationship between the Occupational stress index score and the Clinical attachment level in the different groups: Pearson’s correlation was used to study the correlation between the occupational stress index score and the clinical attachmentlevel in the different groups, a significant positive relationship existed between the occupational stress index score and the serum cortisol levels in the test group 1 and the test group 2 i.e., whenever there was an increase in the occupational stress, the serum cortisol levels also increased simultaneously. However, there was no significant relationship between occupational stress and clinical attachment in the control group (Table/Fig 4).

The Relationship between the Occupational stress index score and the Serum cortisol levels in the different groups: correlation revealed a significant positive relationship between the occupational stress index score and the serum cortisol levels in the control group, the test group 1 and the test group 2 i.e., whenever there was an increase in the occupational stress, the serum cortisol levels also increased simultaneously (Table/Fig 4).

The Relationship between the Clinical attachment level and the Serum cortisol levels in the different groups: correlation revealed a significant positive relationship between the clinical attachment level and the serum cortisol levels in the test group 1 and the test group 2 i.e., whenever there was an increase in the clinical attachment level, the serum cortisol levels increased accordingly. However, there was no significant relationship between the clinical attachment level and the serum cortisol levels in the control group (Table/Fig 4).

Discussion

The present case-control study was attempted to investigate the effects of the stress factors on the periodontal health of the police personnel in which potential confounding factors such as age, gender, smoking and systemic disease could be controlled.

The age group which was chosen for evaluation in this study was the adult group which was ranged from 35-48 years, as epidemiological studies have indicated that both the severity and the prevalence of chronic periodontitis were found to increase with an increase in age. (21) The mean age in the three groups was around 40 years, all the groups were homogeneous in their ages and there was no significant age difference between the groups. In this study, the subjects were grouped into two test groups and one control group. This method of grouping the sample into 2 study groups and 1 control group, which is also called as the 2:1 casecontrol match was similar to that in a study which was done by Vettore et al. (16) A 2:1 case-control ratio was chosen to increase the power and efficiency of the study. The occupational stress index was used to assess the occupational stress in the police personnel, as the same had been used previously to assess the police personnel in India by Mishra and Minum Shyam (19) and it was the questionnaire which was used extensively in India to measure occupational stress.

In the present study, the control group had a lower mean plaque score as compared to the test group 1 and the test group 2. Further, the test group 1 had a lower mean plaque score as compared to the test group 2. These findings were in accordance with thefindings of the studies which were done by Deinzer et al, (22) who reported increased dental plaque accumulation and gingival inflammation in medical students who were under academic stress and with the findings of a study which was done by Kurer et al, (23) which showed an association between the mean depression scores and plaque. In contrast, a study by Monteiro da Silva et al (7) on perceived life events and stress did not correlate with the mean dental plaque.

In this study, the control group had a lower mean sulcus bleeding index score as compared to the test group 1 and the test group 2. Further, the test group 1 had a lower mean sulcus bleeding index core as compared to the test group 2. This was in harmony with the results of the study which was done by Klages et al, (18) which correlated SBI and stress.

Psychosocial stress activates the hypothalamus to release the corticotrophin releasing hormone, which in turn stimulates the release of ACTH from the pituitary which results in the production of cortisol by the adrenal cortex, which in turn depresses immunity (6). Cortisol is closely associated with stress, as was suggested by Clemens Kirschbaum et al (24) and Francesco Tomei et al(25).

The present study showed a positive relationship between the serum cortisol levels and the occupational stress index score and the clinical attachment level in the test group 1 and the test group 2, the serum cortisol levels increased with an increase in the probing pocket depth. This finding was similar to the findings of Genco RJ et al. (6) In the present study, it was found that the test group 1 and test group 2 had higher mean clinical attachment levels as compared to the control group. Further, the test group 2 had a higher mean clinical attachment level as compared to the test group 1. These results were comparable with the findings of Linden et al (5) and Genco RJ et al (6).

The main strengths of this study were- first, an appropriate questionnaire was selected for the population which was under study. The occupational stress index which was put forth by Srivastava and Singh, being a tried and tested questionnaire to evaluate the occupational stress in India, was more appropriate for the mindset and the geographical region from where the sample was selected. Secondly, an appropriate population was selected to study the correlation between stress and periodontitis i.e. Police personnel, whose work has been ranked among the top five most stressful occupations(11).

The major limitation of present study was that though the effect of stress on the periodontium was measured, how the body responded to the stress - was not measured. The results of this case-control study suggested that stress was related to chronic periodontitis and the serum cortisol levels in the police personnel of Cuddalore district, Tamil Nadu, India. This study provides one more explanation for the prevalence of periodontitis in the police personnel(15).

It has to be borne in mind that the primary aetiology of the periodontal disease is the pathogenic bacterial plaque in a susceptible patient.

Stress can be a risk factor because with stress, the person’s behavioural changes lead to altered oral hygiene habits, thus causing the accumulation of plaque on one hand and on the other hand it obstructs the immunity of the person through its endocrinal connections. Hence, if good oral hygiene is combined with regular periodontal check-ups, it can drastically reduce the effects of stress on the periodontium.

Acknowledgement

The authors are grateful to Mr. John William Felix, Lecturer-cum- Statistician, Department of Community Medicine, Annamalai University, for his help in the statistical analysis of the study data and Mr. Pradeep Kumar, IPS, Superintendent of Police, Cuddalore district, Tamil Nadu, India for granting permission to perform the study on the police personnel of Cuddalore district, Tamil Nadu, India.

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