Khushi Yadav, Vrinda Saxena

ABSTRACT

Both periodontitis and common mental disorders are highly prevalent, chronic and mutually reinforcing. There is growing evidence that depression and anxiety are risk indicators for the onset, severity and treatment resistance of periodontal disease, independent of shared confounders such as smoking and socioeconomic status. This narrative review summarizes current mechanistic evidence linking depressive and anxiety disorders with periodontal breakdown through three interrelated pathways: (i) neuroendocrine dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and resultant hypercortisolaemia; (ii) systemic and local proinflammatory cytokine dysregulation, involving interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-?); and (iii) maladaptive health behaviours, including poor oral hygiene compliance, tobacco use, and reduced engagement with dental care. These pathways are not independent with chronic psychological stress leading to prolonged glucocorticoid exposure which paradoxically does not suppress, and may potentiate, local periodontal inflammation. Behavioural disengagement adds to biological susceptibility. Clinical evidence also supports that nonsurgical periodontal therapy is less effective under psychological stress. The recognition of depression and anxiety as modifiable, biologically active risk indicators has implications for periodontal risk assessment, interdisciplinary care between dentistry and mental health services, and the design of future intervention trials targeting the stress-inflammation-behavior axis.