Effects of academic stress on oral hygiene - a potential link between stress and plaque-associated disease?

Background: While there stems to be a common belief that psychosocial stress affects oral hygiene behavior, this assumption has rarely been proved. The present study thus aims to analyse stress effects on oral hygiene. Material and Methods: 16 matched pairs of medical students each consisting of 1 student participating in a major academic exam and 1 control without current academic stress, were formed on the basis of baseline plaque levels. At baseline, a professional tooth cleaning was performed. On the last day of exams, students answered questionnaires about oral hygiene during the exams and were afterwards asked to attend for a 2nd dental examination, of which they had no prior knowledge. Results: On the last day of exams, approximately 6 weeks after professional tooth cleaning, 20.9+/-18.3%;a of control students' sites but only 10.5+/-9.3% of exam students' sites were found to be free of any plaque (p=0.022). Differences were most obvious at oral, as compared to vestibular, sites, Exam students reported a reduction in thoroughness (p=0.019) but not of frequency of oral hygiene behavior. Conclusion: The study strongly supports the assumption that psychosocial stress may induce neglect of oral hygiene and increase of plaque accumulation.