The Psychosomatic Nexus in Periodontology: A Deeper Look into Patient Psychology and Supportive Periodontal Therapy

The outcome of the supportive periodontal therapy (SPT) relies on the existence of psychosomatic and behavioral variables outside the original period of the mechanical treatment. The present paper is a discussion of the effect of psychological state, and particularly stress, on periodontal health because of the neuroendocrine and immune interactions. Long-term psychosocial stress has been associated with changes in inflammatory and immune biomarkers that may contribute to the acceleration of the periodontal disease process. A review of literature has pointed out that the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system play a critical role in the mediation of these effects, leading to an increase in the levels of pro-inflammatory cytokines. The self-care and adherence patterns are attributed to the subtle interpretation of the patient behavior on the basis of the developed behavioral models, such as the Health Belief Model. Interventions based on behavioral theory, such as motivational interviewing and mindfulness-based approaches, have been explored in clinical periodontal settings and may enhance patient adherence and anxiety management, although evidence for superior effects over standard educational interventions is still emerging. The emphasis on the psychosomatic processes and application of the evidence-based behavioral interventions, therefore, becomes instrumental to the most advantageous and long-term treatment in SPT. The system of clinical improvement of outcomes is more comprehensive and effective by the patient-centered, biopsychosocial model of care adoption.