Exploring the Indirect Role of Cortisol in the Association Between Trait Anxiety and Chronic Periodontitis in Vietnamese Adults: A Case–Control Study
Ai Diep-Minh Nguyen, Chi Kim Nguyen, Quynh Huong Nguyen, Huu Tien Cao
Abstract
Background:
Chronic periodontitis (CP) is a multifactorial inflammatory disease influenced by microbial and psychosocial factors. Trait anxiety may exacerbate periodontal disease through dysregulation of the hypothalamic–pituitary–adrenal axis and cortisol release; however, the mediating role of salivary cortisol remains unclear, particularly in Vietnamese populations.
Objective:
To examine the association between trait anxiety, salivary cortisol, and CP in Vietnamese adults and to assess whether salivary cortisol mediates this relationship.
Methods:
A case–control study was conducted in 2024 at the Odonto-Maxillo-Facial Hospital, Ho Chi Minh City. Ninety-six participants underwent full-mouth periodontal examination, completed the State-Trait Anxiety Inventory-Trait (STAI-T), and provided unstimulated saliva samples for cortisol analysis. Logistic regression adjusted for demographic and behavioral confounders. Mediation analysis was performed using PROCESS Model 4 with 5,000 bootstrap samples.
Results:
CP patients exhibited higher STAI-T scores (42.18 ± 10.26 vs. 34.51 ± 8.47,
Conclusions:
Elevated trait anxiety and salivary cortisol were associated with CP in Vietnamese adults, supporting further investigation of psychosocial and biological factors in periodontal disease.