{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:15:14Z","timestamp":1793218514350,"version":"4.5.0"},"reference-count":65,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Clinic Periodontology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>In humans 16\u2009years and above with periodontitis (Population), how do psychological stress and stress\u2010related disorders (PSRD; Exposure) compared to those without PSRD (Comparison) affect clinical attachment level (CAL) upon periodontitis treatment (Outcome), as observed in experimental studies or descriptive pre\u2013post studies (Study design)?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five major databases were searched for pre\u2013post studies, descriptive cohort and quasi\u2010experimental or randomised controlled trials (RCTs). For meta\u2010analysis, mean differences in CAL and bleeding on probing (BOP) were pooled with random\u2010effects models. Risk of bias, study quality and certainty of evidence were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirteen studies (eight prospective, two retrospective, two quasi\u2010experimental and one pilot RCT) with 1610 participants were identified. PSRD (measured as stress in nine studies, depression in three studies and anxiety in one study) showed a negative influence on periodontitis treatment (steps 1\u2009+\u20092: eight studies, steps 1\u2009+\u20092\u2009+\u20093 or 4: four studies, step 4: one study) outcomes. Meta\u2010analysis of steps 1\u2009+\u20092 treatment results revealed that patients with PSRD (exposure: stress)\u2014compared to those without\u2014had smaller reductions in CAL (three studies;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009170; weighted mean difference (WMD)\u2009=\u20090.78\u2009mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and probing pocket depth (PPD; three studies;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009170; WMD\u2009=\u20091.02\u2009mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) following periodontitis treatment in studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PSRD adversely affected periodontitis treatment outcomes, particularly concerning CAL and PPD, even though our confidence in the effect estimate is limited in the case of CAL and very low in the case of PPD. This conclusion, based on small treatment cohorts and quasi\u2010experimental studies following steps 1 + 2 of periodontitis treatment over a 3\u20136\u2010month period, warrants validation through rigorously designed studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpe.70022","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T08:25:48Z","timestamp":1756196748000},"page":"1760-1778","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The Influence of Psychological Stress and Stress\u2010Related Disorders in the Treatment Outcome of Periodontitis: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5386-0176","authenticated-orcid":false,"given":"Erik Klepsland","family":"Mauland","sequence":"first","affiliation":[{"name":"Oral Health Centre of Expertise in Rogaland  Stavanger Norway"},{"name":"Department of Periodontology University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudan Prasad","family":"Neupane","sequence":"additional","affiliation":[{"name":"Oral Health Centre of Expertise in Rogaland  Stavanger Norway"},{"name":"National Centre for Suicide Research and Prevention, Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3290\/j.qi.b2091191"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2004.00563.x"},{"issue":"3","key":"e_1_2_9_5_1","first-page":"1330","article-title":"Assessment of Psychological Stress as a Risk Factor for Periodontal Disease: Systematic Review and Meta\u2010Analysis","volume":"15","author":"Badia I. 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