Reports & Studies

Stress results in poorer treatment outcomes!

PD Dr. Kristina Bertl, PhD MSc MBA

In a previous article (‘Does periodontitis cause anxiety and depression?’) we explored the links between periodontal disease and mental illnesses and, based on a systematic review, it was shown that periodontitis increases the risk of both depression and anxiety disorder. This connection is thought to be bi-directional.

Stress results in poorer treatment outcomes! (Shutterstock)

But how does this manifest itself during periodontal treatment? Does this mean that patients with stress and/or depression might display a poorer response to our treatment?

A French research group recently investigated this very question. They observed 54 periodontitis patients for a period of six months (Petit et al. 2021). All patients in the study had been diagnosed with generalized stage III or IV periodontitis. All patients received non-surgical periodontal treatment, and the outcome of this treatment was assessed after three and six months. In addition, questionnaires were used at the start of the study to assess the patients’ stress, depression and anxiety levels and their stress coping mechanism.

Analysis of these data revealed some extremely interesting results. Increased stress, increased depression and negative coping strategies all resulted in a significantly worse outcome after non-surgical periodontal treatment. Of course, the rather small number of patients in this study must be taken into account; nonetheless, we should bear in mind that stress, depression and negative coping strategies are possible risk factors for a worse treatment outcome among periodontitis patients. Future studies should look at the extent to which these negative effects might be reversed by using stress questionnaires for a more detailed diagnosis and, accordingly, recommended treatment approaches. For example, approaches to giving up smoking and conscious diabetes control are already recommended in the recently published S3 guideline (Sanz 2020).


Petit C, Anadon-Rosinach V, Rettig L, et al. Influence of psychological stress on non-surgical periodontal treatment outcomes in patients with severe chronic periodontitis. J Periodontol. 2021;92:186–195.
Sanz M, Herrera D, Kebschull M, et al; On behalf of the EFP Workshop Participants and Methodological Consultants. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47:4–60.