Stress is a known precursor of periodontal disease (Boyapati & Wang 2000; Wimmer, Janda, Wieselmann-Penker, Jaske, Polansky & Pertl 2002; Davis & Jenkins 1962). Whether due to the effects of stress on intermediary factors like hormonal changes that, in turn, affect oral health or to the direct effects of stress on disorders of the mouth and gums, psychology plays a considerable role in the prevention and treatment of disease. As early as the 1960s, research showed that interim factors like hormonal imbalance, diabetes, nutritional deficiencies, and blood dyscrasias all play a role in periodontal disease and that stress is a precursor to each of these factors too (Davis & Jenkins 1962). Stress causes the release of adrenaline, increased heart rate, increased respiration, and other physiological signals. Boyapati & Wang (2000) point out that especially when stress is sustained over long periods of time it can lead to disease and periodontal disease in particular. Wimmer et al (2002) describe periodontal disease as "opportunistic infections" that take root well under the physiological conditions defined by stress. Therefore, the role of stress in periodontal illness has been confirmed and deserves further attention.
             Periodontal disease is caused by "periopathogenic microorganisms and their metabolic products," leading to "a characteristic inflammatory reaction of the gingiva," (Wimmer et al 2002). Gingivitis is a form of periodontal disease, which manifests mainly as inflamed gums. Bacteria is the immediate cause of periodontal disease, but stress can be a precursor to the condition developing. Stress has been shown to exacerbate the preexisting conditions that cause periodontal disease and is therefore considered an important risk factor when studying the disease's etiology. Moreover, stress likely prevents healing of periodontal wounds (Boyapati & Wang 2000).
             Stress itself is defined by both psychological and physiological factors....