Dr. Anwar Merchant and colleagues’ December JADA article, "A Prospective Study of Social Support, Anger Expression and Risk of Periodontitis in Men," states that anger expression and social isolation, associated with stress, had not previously been evaluated as related to the risk of developing periodontitis.
This is not true. Their alleged new finding is actually old hat. Over half a century ago, I and Samuel Charles Miller (then professor of periodontia and chair of that department at New York University College of Dentistry) together researched and published such results in a study entitled, "Psychosomatic Factors in the Etiology of Periodontal Disease,"1 which also was incorporated as a chapter in Dr. Miller’s 1950 Textbook of Periodontia.2
We detailed and demonstrated (replete with photographs of patients’ dentitions, X-rays, case histories and laboratory data) how "emotional tension may create oral disease through a disturbance of the physiology," such as, for example, bruxism due to unrealized aggression, or a change in salivary composition and blood calcium levels caused by an emotional disturbance. Indeed, we had found so much evidence that our study was subtitled, "A Critical Review of the Literature." The majority of cases presented a reciprocal relationship with greater or lesser percentages of psychic and somatic phases in innumerable variations.
For example, as we did our study soon after [World War II], we observed many returning veterans in whom psychosomatic tension factors produced extreme alveoloclasia, where a few years previously only a mild situation had been present. We found that many people who could not cope with stress in an active and practical way had the greatest risk of developing severe periodontosis. The destructive psychosomatic mechanisms were many and varied, such as
- – reduction of local nutrition through vasospasm;
- – development of objective habits, such as pencil and fingernail biting, which are antagonistic to the health of periodontal tissues;
- – induced excessive clenching or grinding of teeth;
- – creating taste perversions for harmful foods, such as candy, cake, coffee and alcoholic beverages, as well as smoking to excess and insufficient intake of proper nutrition;
- – bodily conditions inimical to the health of periodontal tissues (as a decrease in blood calcium and phosphorus in tense, agitated, depressed stations);
- – neglect of oral hygiene and avoidance of professional care by those who are mentally preoccupied or depressed.
In 1947, we also provided an in-depth explanation of how and why unrelieved anger and stress are particularly destructive to the periodontal mechanism. For example, we stated that psychosomatic factors such as excessive chewing, clenching or grinding create excessive wear and excessive pressures. L. Rittenberg, a psychiatrist whom we consulted, explained therein: "Within the personality there exists an aggressive group of instincts. They strive to find expression in the outside world. They would destroy, they would engulf, they would annihilate the outside world if they could get there. We can occasionally see this happening in the insane. But under ordinary circumstances, the world of personal and social reality sets up barriers to the unchecked gratification of these instincts, in the form of conscience, morality, education and training. When the dynamic relationship of aggressive drives and repressing forces begin to show strain, the muscles of the mouth may begin to show irrational phenomena. They may contract unconsciously in response to aggressive instincts, and bruxism results ... ."1
We also quoted Frohman3 in our article. He related how one of his psychiatric patients responded favorably to surgical periodontal treatment, only to have a return to the old condition. The dentist then discovered that clamping of the jaws was the main etiologic factor. Frohman relieved the condition by psychotherapy, producing a recovery surprising to the analyst, patient and dentist.
While I applaud the publication of this recent article, which once again explains and proves that stress, anger expression and poor coping behaviors are risk factors for periodontosis, perhaps the authors might have first done further library research, and thus not declared their research tenets and methodology, conclusion and clinical implications to be recent and original.
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