Stress and Periodontal Disease: Reflections on the Integration of Stress and Lifestyle Management into Routine Periodontal Disease Prevention

This narrative review examines the role of psychological stress in periodontal disease and evaluates the evidence supporting stress-informed lifestyle and behavioural interventions within a proposed theoretical framework for stress reduction/regulation. The framework includes slow diaphragmatic breathing, positive psychological approaches, mindfulness and meditation, physical activity and stretching, appropriate daylight or sun exposure, and nutrition. For each domain, evidence is considered in relation to stress regulation, mechanistic relevance to periodontal health, and, where available, direct periodontal outcomes. The available evidence varies considerably across domains and is frequently indirect. The proposed framework represents a structured approach to stress management in periodontal care and requires prospective clinical testing to determine its feasibility, effectiveness, and potential impact on periodontal treatment outcomes.