Abstract
OBJECTIVE: Periodontitis is a prevalent chronic inflammatory disease, with growing evidence suggesting a link to psychological factors such as stress and anxiety. University students, who frequently experience elevated psychological stress, may be particularly susceptible to periodontal issues. This study aimed to examine the relationship between stress levels, anxiety status, and periodontitis in university students, and to assess the potential influence of psychological factors on periodontal health. METHODS: The study sample comprised 240 university students. Participants were categorized post hoc according to their periodontal status and psychological assessment scores. Periodontal health was evaluated using the Community Periodontal Index (CPI), while stress and anxiety levels were measured with the Perceived Stress Scale-14 (PSS-14) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Statistical analyses included chi-square tests and multivariable logistic regression models to examine associations between psychological factors and periodontitis, adjusting for potential confounding variables. RESULTS: Among the participants (mean age: 21.70 ± 3.16 years), 43.3% were diagnosed with periodontitis. The mean age was 21.78 ± 3.32 years in the non-periodontitis group and 21.24 ± 2.06 years in the periodontitis group. Anxiety was prevalent: 33.8% had no anxiety, 30.8% had mild, 22.1% had moderate, and 13.3% had severe anxiety. Reported stress levels were 35.0% normal, 48.8% high, and 16.3% very high. Anxiety levels were significantly associated with an increased risk of periodontitis (P < 0.001). After adjusting for a range of potential confounders, including but not limited to gender, age, education level, smoking, and oral hygiene practices, individuals with mild, moderate, and severe anxiety had 8.391 (95% CI: 2.776-25.362), 11.423 (95% CI: 3.116-41.872), and 46.196 (95% CI: 10.414-204.921) times higher odds of developing periodontitis, respectively, compared to those without anxiety. In contrast, stress levels were not significantly associated with periodontitis after adjustment (P > 0.05). CONCLUSION: Anxiety was significantly associated with periodontitis in university students, highlighting the importance of addressing anxiety as part of periodontal disease prevention and management strategies in this population.