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Mohammadreza Karimi et al.
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS RELATIONSHIP BETWEEN STRESS, ANXIETY, DEPRESSION AND SALIVARY IGA WITH PERIODONTAL DISEASE 91
micro bacterium. The major speci c defense factors of
saliva are the IgA, IgG, and IgM (Sindhu and Jagan-
nathan, 2014).
The adherence of bacteria and bacterial metabolism
interfered in presence of the immunoglobulins, particu-
larly with the IgA type. Many biomarkers have been
found in saliva and some of these were shown to be
involved in periodontal disease (Giannobile et al. 2009).
The salivary concentrations of these immunoglobulins
increase in periodontitis which decreases following peri-
odontal therapies (Sindhu and Jagannathan, 2014). As
seen in this study, salivary IgA decreased in periodontal
patients compared to the normal people (without peri-
odontal disease). These results suggested a correlation
exists between incidence of the periodontal disease and
immunity. In condition pain, anxiety and stress, many
metabolic and endocrine changes occur in the body,
the most common effect of which is increased cortisol
level in the blood. It plays a role in the regulation of the
immune system and vascular reactions. Also known as
the stress hormone, cortisol is a decisive index in stress-
ful situations (Ismail et al. 2007). One of the likely mech-
anisms of such relationship is activation of the HPA axis
following stressful life events, which leads to elevation
of cortisol concentrations in gingival crevicular uid,
serum, and other body uids. Leukocytic, chemotactic,
polymorphonuclear leukocytes, IgG production and sali-
vary IgA secretion are considerably declined by contin-
ued elevation in cortisol concentrations, placing the host
in an immunosuppressive status, hence more vulnerable
to periodontal infection and breakdown (Wong, 2008).
The IgA level measurement is a reliable method to
determine the immune system function (Shah et al. 2009).
Chronic stress decreases the immune system performance
and suppresses the immunoglobulin production. So, the
IgA levels play a role in the pathogenesis of oral mucosa
and its associated clinical changes (Rabiei et al. 2012).
The IgA and IgG levels Increased in patients with lichen
planus (Sistig et al. 2002) and lichenoid reaction Lesions
(Ghalayani et al. 2009). Also, Sato et al. (1991) studies
compared the salivary IgA level in patients with differ-
ent oral diseases using the ELISA method. An increase
in the salivary IgA level was observed in patients with
oral leukoplakia, oral lichen planus and carcinoma of
the oral cavity. Higher IgA levels facilitate the antigen
supply by Langerhans cells, make changes in the basal
layer destruction and dispatch immune cells to the area
(Nosratzehi et al. 2014). Furthermore, Salivary IgA lev-
els in uenced by mental stress and several studies have
suggested a negative correlation between the levels of
salivary IgA and stress (Fukui et al. 2010). Despite the
mechanism for how Salivary IgA affects by mental stress
is not fully elicited, it is reported Chromogranin A is
an acidic glycoprotein which is released along with cat-
echolamines from the adrenal medulla and the sympa-
thetic nerve endings, and has been receiving attention
as a novel stress marker in the saliva (Fukui et al. 2010).
In conclusion these results suggested a correlation
exists between incidence of the periodontal disease and
immunity. We think obtained results can use as informa-
tion for clinical applications in human therapies. Also,
we think further researches is needed to determine the
direct molecular and cellular mechanism for observed
data.
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