{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:27:43Z","timestamp":1792632463758,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bulgarian Ministry of Education and Science"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Psychological stress is increasingly recognized as a potential modifier of periodontal disease through both behavioral and biological mechanisms. Cortisol, a key stress hormone, exerts complex immunomodulatory effects and may influence periodontal inflammation and tissue breakdown. This study aimed to compare salivary levels of cortisol, interleukin-1\u03b2, and interleukin-6 in patients with varying periodontitis severity and examine their associations with clinical periodontal parameters. Methods: A total of 67 patients diagnosed with periodontitis were classified according to the 2017 World Workshop Classification into Stage I\/II vs. Stage III\/IV and Grade B vs. Grade C. Unstimulated saliva samples were collected and analyzed for cortisol using electrochemiluminescence immunoassay, and for IL-1\u03b2 and IL-6 using ELISA. Statistical analyses included Mann-Whitney U test, Spearman\u2019s correlations, and multivariate regression. Results: Median salivary cortisol levels were significantly higher in Stage III\/IV (11.90 nmol\/L) than in Stage I\/II (7.64 nmol\/L; p = 0.014) and in Grade C (10.60 nmol\/L) vs. Grade B (7.70 nmol\/L; p = 0.019). In multivariate analysis, cortisol independently predicted both Stage III\/IV (OR = 1.23, p = 0.007) and Grade C (OR = 1.24, p = 0.026) periodontitis. ROC analysis showed that salivary cortisol had moderate diagnostic performance for Stage III\/IV periodontitis (AUC = 0.68, cut-off 11.57 nmol\/L) and Grade C (AUC = 0.67, cut-off 9.76 nmol\/L). Cortisol showed significant positive correlations with clinical markers of disease severity and with IL-1\u03b2 (r = 0.399, p = 0.001) and IL-6 (r = 0.424, p &lt; 0.001). Conclusions: Salivary cortisol is a promising non-invasive biomarker reflecting both stress-related physiological burden and clinical severity in periodontitis. Cortisol measurement may represent a valuable addition to multifactorial assessments and risk stratification in periodontitis, pending further validation in longitudinal studies.<\/jats:p>","DOI":"10.3390\/medsci13030120","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T15:30:52Z","timestamp":1754667052000},"page":"120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Salivary Cortisol and Periodontitis Severity: A Cross-Sectional Biomarker-Based Assessment of Stress and Inflammation"],"prefix":"10.3390","volume":"13","author":[{"given":"Velitchka","family":"Dosseva-Panova","sequence":"first","affiliation":[{"name":"Department of Periodontology, Faculty of Dental Medicine, Medical University\u2014Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoaneta","family":"Mlachkova","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Faculty of Dental Medicine, Medical University\u2014Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3910-5147","authenticated-orcid":false,"given":"Marina","family":"Miteva","sequence":"additional","affiliation":[{"name":"Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University\u2014Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5903-8033","authenticated-orcid":false,"given":"Dimitar","family":"Dimitrov","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Faculty of Dental Medicine, Medical University\u2014Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1111\/jcpe.13506","article-title":"Global, Regional, and National Burden of Severe Periodontitis, 1990\u20132019: An Analysis of the Global Burden of Disease Study 2019","volume":"48","author":"Chen","year":"2021","journal-title":"J. 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