Cells-Aren’t They Stressed Too?

Introduction

Stress is any type of change that causes physical and physiological strain on the body. It is the body’s response to changes occuring to higher physiological demands.

Stress has always generated a negative impact on a person’s mind, although, it can be beneficial too. Hans Selye (1976) introduced the concept of eustress and distress.¹ Eustress is beneficial stress. It facilitates the performance of an individual by creating positive stimulating factors. Distress, on the other hand, is a response to stimuli that prompt anxiety and behavioral changes. Heart diseases, obesity, and diabetes are the common adverse reactions noted due to distress. Distress may also affect the oral cavity in the form of recurrent ulcers, bruxism, impaired salivary flow, and increased risk of periodontal disease.

With this background, we were prompted to review the mechanism by which stress influences the periodontium at the host level and the cellular level. We have also attempted to shed light on nature’s contribution to help us combat this cellular level stress.

Role of Stress in Periodontal Disease

Periodontitis is a multifactorial disease caused by several local and systemic factors. Stress is identified as one of the risk factors for periodontal diseases. It aggravates the progression of the disease by the immunosuppressive effect on the host.²

Several studies have shown that cellular immune responses are down-regulated by psychological stress. Evidence suggests that stress can also influence the genetic makeup of an individual. Epigenetic alteration is one of the processes by which stress can accentuate disease progression.³

Stress alters the behavioral changes in an individual by initiating complex interactions of the nervous, endocrine, and immune system that impact the periodontal health of an individual. (Figure 1). The disruption of the immune-regulatory balance leads to tissue degradation. Cellular level stress also negatively influences the outcome of periodontal treatment.  

Depending on the nature and strength of the stimuli, the cells activate a number of pathways to respond to the noxious stressor. These pathways facilitate cell survival through coping mechanisms.

The cellular protective responses include:⁴

1. Heat shock responses where the heat shock proteins inhibit apoptosis.

2. Unfolded protein responses enhance the equilibrium between protein load and protein folding capability of the endoplasmic reticulum, thereby facilitating cell survival.

3. DNA damage responses ensure cell viability. DNA restores the continuity of its double-stranded structure.

4. Cells respond to oxidative stress by generating inherent antioxidants that maintain a sustainable environment.

The cell death occurs (via activation of death signallig pathways) when the built-in mechanisms are overpowered or when the toxic stimuli are too potent to be resolved.. (Figure 2). The cellular death responses in turn lead to the development of disease by altering the immune homeostasis and initiating an inflammatory response. Periodontitis is one such chronic inflammatory disease that is provoked by varied stress responses.⁵

Management

The basic structural and functional unit of an organism is “the cells”. These make up the tissues, organs, and organ systems of the body. Thus, the body’s function is ultimately its cell’s function. Stress at the psychological level transcends to the physical level, culminating at the cellular level.

It is known that air, water, light, food, and flowers are some priceless gifts of nature. However, the utilization of these resocurces in an apt mannaris questnnable. The role of these resources given by mother nature in the management of cellular level stress needs to be addressed. The subsequent section focuses on the bounties of nature.

Exposure to nature, such as walking in a forest, breathing fresh air, or even simply listening to the natural sounds of water has been found to alleviate stress.⁶

Light therapy, also known as phototherapy is a treatment involving exposure to a natural or artificial light source. Light therapy dates back more than 3000 years when sunlight was used for therapeutic purposes. The beneficial effects of light therapy are well established such as a rise in serotonin levels and a reduction in NO levels.⁷ Low-level light therapy/photo biomodulation is a form of non-invasive light treatment that has shown benefits as an anti-anxiety treatment modality.⁷ As a result, when stress levels are lowered with phototherapy, the consequences of periodontal disease are minimized, and we can get a better outcome from the provided periodontal treatment.

The age-old concept of “DNA does not change” has evolved. Not everything about how our genes operate is programmed at birth. As indicated by the concept of nutrigenomics, environmental factors such as diet/ nutrition can trigger epigenetic alterations, resulting in changes in gene activity. Bioactive food components can alter the gene expression⁸ at the transcription level, thereby playing a role in alleviating cellular stress. Consumption of a balanced diet brings about a reduction in stress by biosynthesis of neurotransmitters, which in turn help in preventing periodontal disease.

Flowers can also be used as a form of alternative medicine. Bach’s flower remedy and aroma therapy9 can be used to alleviate stress. Various researches have concluded that these therapies are safe in treating psychological stress and promoting well-being.

With this discussion, we highlighted the use of natural therapeutic modalities to address stress at both the host level and cellular level. We have endeavored to project the role of natural resources in the treatment of periodontal disease in distressed individuals.

Conclusion

The above-presented literature proves that cellular level stress exists and can have a detrimental effect on health. Presently, we have sufficient evidence that stress acts as a risk factor in the development of periodontal disease. Evaluation of a patient’s stress level during diagnosis and managing the same may help us in improving the overall prognosis of the patient.

The present study intended to touch on some aspects of cellular level stress and shed light on how the above mentioned natural resources can prove therapeutic and help combat cellular stress. The food a person consumes, natural resources like flowers, light energy, air, water, and even meditation/prayer can be utilized to overcome the adverse effects of stress. These approaches help in keeping the entire body and mind healthy.

Conflict of interest

None