Psychological Resilience, Perceived Stress and Periodontal Status Among Bruxers

Psychological Resilience as a Modifier of the Relationship Between Perceived Stress and Periodontal Status Among Bruxers: a Cross-sectional Study

The present study aims to evaluate psychological resilience as a modifier of the relationship between perceived stress and periodontal status among bruxers. Given that both stress and inflammation share common neuroendocrine and immunological pathways, resilience may play a crucial role in buffering stress-induced periodontal breakdown. Understanding this relationship could shift periodontal management toward a biopsychosocial model, integrating psychological assessment and resilience enhancement with conventional non-surgical therapy. Such insights could help design personalized periodontal care strategies addressing both biological and psychological determinants of disease progression.

Study Overview

• Status: Not yet recruiting
• Conditions: Periodontitis; Bruxism; Perceived Stress
• Intervention / Treatment: Other: Resilience assessment

Detailed Description

Periodontitis has been defined by the 2018 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions as "a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth supporting apparatus". The disease represents one of the most prevalent chronic conditions globally and is a leading cause of tooth loss in adults. The pathogenesis involves a complex interplay between microbial challenge, host immune-inflammatory responses, and modifying environmental, systemic and psychosocial factors. Although bacterial biofilm is a necessary etiological factor, it is the host response that determines disease progression or stability. Among several modifying influences, psychosocial stress has gained increasing attention in periodontal research. Chronic stress leads to sustained activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary system, resulted in elevated cortisol and cathecholamine. These neuroendocrine mediators exert profound effects on immune regulation, enhancing pro-inflammatory cytokine production, impairing neutrophil function, and delaying wound healing. In the periodontium, such dysregulation may potentiate tissue breakdown by amplifying inflammatory cascades and reducing reparative capacity.

Several studies have demonstrated a positive association between perceived psychosocial stress and periodontal disease severity, including increased probing depth, attachment loss, and bleeding on probing. Furthermore, stress can indirectly influence oral health through behavioral pathways such as poor oral hygiene, smoking, bruxism, and altered diet. Despite this, not all individuals exposed to similar stress levels exhibit equivalent periodontal destruction, indicating the presence of psychological moderators that buffer or modify stress effects.

One such factor is psychological resilience, defined as "a measure of stress-coping ability and a personal quality that enables one to thrive in the face of adversity".It reflects an individual's ability to maintain or regain mental health and functional stability despite adversity. Resilience is shaped by cognitive, emotional, and social components that promote adaptive coping and self-regulation. High resilience has been linked to better immune regulation, lower inflammatory markers such as C-Reactive protein and Interleukin-6, and faster recover from stress induced physiological changes.

Moreover, behavioural factors such as stress related parafunctional activity bruxism, characterized by repetitive jaw-muscle activity involving clenching or grinding of teeth and/or bracing or thrusting of the mandible. The excessive and repetitive forces associated with bruxism may exert traumatic effects on tooth supporting structures and are considered an important cofactor in the progression of periodontal breakdown.

Emerging evidence in behavioral medicine suggests that resilience can moderate the relationship between perceived stress and health outcomes, attenuating the physiological and behavioral impacts of chronic stress. In dentistry, however, this construct remains underexplored. No study have assessed how resilience interacts with stress to influence periodontal status among bruxers. Given that both stress and inflammation share common neuroendocrine and immunological pathways, resilience may play a crucial role in buffering stress-induced periodontal breakdown in bruxers.

Understanding this relationship could shift periodontal management toward a biopsychological model, integrating psychological assessment and resilience enhancement with conventional non-surgical therapy. Therefore, the present study aims to evaluate psychological resilience as a modifier of the relationship between perceived stress and periodontal status among bruxers. Such insights could help designed personalized periodontal care strategies addressing both biological and psychological determinants of disease progression.

• Study Type: Observational
• Enrollment (Estimated): 75

Contacts and Locations

• Study Contact: Name: Gaytri, BDS; Phone Number: +91 9991092061; Email: gaytrilalit901@gmail.com
• Study Contact Backup: Name: Dr. Rajinder Kumar Sharma, MDS; Phone Number: +91 9416358222; Email: rksharmamds@yahoo.in

Study Locations

• India
  • Haryana
    • Rohtak, Haryana, India
      • Post Graduate Institute of dental sciences
      • Contact: Dr. Rajinder Kumar Sharma, MDS; Phone Number: +91 9817574959; Email: rksharmamds@yahoo.in

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population will be drawn from patients reporting to the outpatient clinic of department of Periodontics at PGIDS, Rohtak on the basis of strict inclusion and exclusion criteria

Description

Inclusion Criteria:

• Patients with age group 30-50 years diagnosed with generalized periodontitis.
• Probable bruxers (as per BruxScreen questionnaire)
• Presence of minimum 20 teeth excluding third molars
• Able to read/understand Hindi or English (for questionnaires)

Exclusion Criteria:

• Systemic diseases that may affect periodontal disease progression or outcome of treatment (diabetes, autoimmune diseases)
• History of Periodontal treatment within last 6 months
• History of Antibiotic use within the previous 3 months
• History of Steroid, immunosuppressive and psychiatric drug use
• Pregnant and lactating women
• Smoking or substance abuse

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Probable Bruxers; Patients aged 30-50 years with probable bruxism based on self report and clinical examination using Bruxscreen questionnaire. Participants underwent assessment of perceived stress using the perceived stress scale, pyschological resilience using Connor-Davidson Resilience scale, and periodontal health status via pocket probing depth, clinical attachment level, bleeding on probing, gingival index and plaque index.

Other: Resilience assessment; Psychological resilience and perceived stress was assessed using questionaires

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychological Resilience	Participants will complete validated questionnaire using Connor-Davidson Resilience Scale (CD-RISC-10) to assess psychological resilience. 10 Items using 5-point Likert scale from 0 = not true at all to 4 = true nearly all the time. Minimum score:0, maximum score: 40. Higher score indicates greater psychological resilience.	Baseline
Perceives Stress Scale	Perceived stress scale will be assessed using perceived stress scale-10 item version questionnaire. 10 items using 5 point Likert scale 0= never to 4= very often. Minimum score: 0, maximum score: 40. Higher score indicate greater perceived stress.	baseline

Collaborators and Investigators

• Sponsor: Postgraduate Institute of Dental Sciences Rohtak
• Investigators: Study Director: Dr. Rajinder Kumar Sharma, MDS, Post Graduate Institute of dental sciences

Study record dates

Study Major Dates

• Study Start (Estimated): June 21, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: May 22, 2026
• First Submitted That Met QC Criteria: May 22, 2026
• First Posted (Actual): May 29, 2026

Study Record Updates

• Last Update Posted (Actual): June 2, 2026
• Last Update Submitted That Met QC Criteria: May 30, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: stress; periodontitis; resilience; bruxism
• Additional Relevant MeSH Terms: Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Tooth Diseases; Behavior; Habits; Periodontitis; Bruxism
• Other Study ID Numbers: Gaytri Perio2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No