Resolution of Periodontal Inflamed Surface Area (Pisa) and Perceived Stress Following Non-surgical Mechanical Therapy in Chronic Periodontitis: A Comparative Clinical Study
DOI:
https://doi.org/10.48165/ajm.2026.9.02.29Keywords:
Periodontal Inflamed Surface Area, Chronic Periodontitis, Perceived Stress Scale, Scaling and Root Planing, Host Modulation, PsychoneuroimmunologyAbstract
Background
While the association between psychological stress and periodontal tissue breakdown is established, the therapeutic capacity of non-surgical mechanical debridement to modulate the biological wound surface area and patient-reported perceived stress remains under-investigated in large cohorts. This study evaluated the resolution of the Periodontal Inflamed Surface Area (PISA) and perceived psychological stress following non-surgical mechanical periodontal therapy in patients with chronic periodontitis.
Materials and Methods
A comparative clinical study was conducted involving 1,000 adult participants divided into two equal cohorts: Group B (Untreated Chronic Periodontitis, n=500) and Group C (Post-treatment Chronic Periodontitis evaluated at least six months following comprehensive scaling, root planing, and supportive care, n=500). An age- and sex-matched cohort of periodontally healthy individuals (Group A, n=250) served as a reference baseline. Full-mouth periodontal examinations were conducted across six sites per tooth to record the Simplified Oral Hygiene Index (OHI-S), Gingival Index (GI), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), and Bleeding on Probing (BOP). These metrics were converted into PISA values (cm2) using standardized root surface area algorithms. Perceived stress over the preceding month was quantified using the 10-item Perceived Stress Scale (PSS-10). Data were analyzed using independent Student’s t-tests, one-way ANOVA with post-hoc Tukey’s HSD, Chi-square tests, and Pearson’s correlation coefficients (p<0.05).
Results
Patients in the post-treatment cohort (Group C) demonstrated significantly lower mean PISA values (4.6±2.1 cm2) compared to the untreated periodontitis cohort (Group B, 12.5±4.3 cm2, p<0.001), reflecting a 63.2% reduction in vascularized ulcerated epithelial surface area. Concurrently, mean PSS-10 scores were significantly lower in Group C (17.2±4.5) than in Group B (22.7±5.1, p<0.001). The proportion of patients categorized with high stress shifted from 24.0% (n=120) in the pre-treatment group to 7.4% (n=37) in the post-treatment group. While perceived stress exhibited a moderate-to strong positive correlation with PISA during active untreated disease (r=0.62, p<0.001), this association was absent following therapy (r=0.11, p=0.142).
Conclusion
Non-surgical mechanical periodontal debridement resolves the biologically active inflammatory surface area (PISA) and is accompanied by a significant reduction in perceived psychological stress. Mechanical elimination of subgingival biofilms and pocket ulceration decouples the relationship between psychological stress appraisal and active periodontal tissue breakdown
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