Title: 0785 - Stressed-out Immunity: A Gateway From Socioeconomic Adversity to Periodontal Disease?


Noha Gomaa (Presenter)
University of Toronto

Michael Glogauer, University of Toronto
Howard Tenenbaum, University of Toronto
Belinda Nicolau, McGill University
Arjumand Siddiqi, University of Toronto
Carlos Quinonez, University of Toronto


Objectives: To assess the extent of association between socioeconomic position (SEP), periodontal disease (PD) and proinflammatory oral neutrophil function, and whether self-reported stress and stress biomarkers contribute to these relationships.

Methods: In this cross-sectional study, participants (n=103) completed financial and perceived stress questionnaires and underwent full-mouth periodontal examinations to record probing depths, attachment loss and bleeding on probing. SEP was characterized by annual household income and level of education. Stress biomarkers (cortisol and alpha-amylase) were assessed in hair and saliva samples using immunoassays. Oral inflammatory load and neutrophil functionality were obtained by counting neutrophils isolated from oral rinse samples and and analyzing their expression of a panel of eight Cluster of Differentiation (CD) markers, using mutlicolour flow cytometry. Hierarchical blockwise multiple linear regression models were constructed to assess the relationships of interest. Covariates included age, sex and the availability of dental insurance. A mediation analysis was also conducted to assess whether cortisol mediated the relationship between neutrophil function and PD.

Results: Socioeconomic differences were evident in PD and proinflammatory neutrophil characteristics, where compared to middle and higher income groups, individuals earning less than $20,000/year (low-income threshold in the study’s jurisdiction) exhibited higher oral inflammatory load and hyperactive neutrophil immunophenotypes, which are conducive to periodontal tissue breakdown. In fully adjusted models, financial stress and cortisol were shown to significantly contribute to this socioeconomic gradient, explaining differences between lower and middle income groups, but not middle and higher income ones. In addition, cortisol was shown to mediate the relationship between proinflammatory neutrophils and PD.

Conclusions: Psychosocial stress contributes to a proinflammatory immune system that is implicated in the PD process, particularly in individuals exposed to socioeconomic adversity. Integrated policy solutions that target the underlying structural and biopsychosocial factors in PD are needed.

Student Presenter

Disclosure Statement:
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: NONE