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DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ

Year 2019, Volume: 29 Issue: 2, 206 - 212, 22.03.2019
https://doi.org/10.17567/ataunidfd.519376

Abstract



Amaç: Psikososyal faktörler periodontal hastalık için önemli bir risk faktörü
olarak tanımlanır, konak direncini değiştirerek ve endokrin dengesizliklere
neden olarak periodontal dokuları etkileyebilir. Bu çalışmada algılanan stresin
ve strese bağlı hormon düzeyiyle periodontal durum arasındaki ilişkisinin
değerlendirilmesi amaçlanmıştır.



Gereç ve Yöntem: Bu çalışmaya 42 gingivitisli ve 30 periodontal olarak sağlıklı, toplam 72
birey dahil edildi. Hastaların klinik ve radyolojik periodontal değerlendirmesi
yapıldı. Stres düzeyleri tükürük kortizol seviyesi ve Cohen Algılanan Stres
Ölçeği (ASÖ-10) değerleri kullanılarak incelendi. Bireylerin tükürükteki
kortizol seviyesi ELİSA yöntemi kullanılarak ölçüldü. Elde edilen veriler
p<0.05 anlamlılık düzeylerine göre istatistiksel olarak analiz edildi.



Bulgular: Sosyodemografik veriler değerlendirildiğinde fırçalama
sıklığının kontrol grubunda daha yüksek olduğu görüldü (p<0.05). Periodontal
olarak sağlıklı gruptaki tükürük kortizol seviyesi ve ASÖ-10 skorları,
gingivitis grubuna kıyasla daha düşüktü (p<0.05). Tükürük kortizol seviyesi
ve algılanan stres ölçeği skorları ile periodontal klinik parametreler arasında
pozitif korelasyon gözlendi.



Sonuç: Gingivitisli bireylerde daha yüksek stres seviyesi görülmektedir.
Çalışmamızın sonuçları dahilinde stres ile periodontal hastalık arasında
pozitif bir ilişki olduğu söylenebilir. Bununla birlikte, stres ve periodontal
hastalık arasındaki ilişkiyi açıklamak için daha ileri araştırmalara ihtiyaç
vardır.



 Anahtar Kelimeler: stres, periodontal hastalık,
kortizol



Evaluation
of salivary cortisol levels and perceived stress levels in gingivitis and
periodontal healthy individuals



 Abstract



Aim:
Psychosocial factors are identified as an important risk factor for periodontal
disease, affecting periodontal tissues by altering host resistance and
endocrine imbalances. At present study, there was aimed to appraise the
relationship between perceived stress scale and stress hormone level and
periodontal status.



Material
and Methods:
There was included the total of 72 individuals, 42
subjects with gingivitis and 30 periodontal healthy subjects in this study.
Clinical and radiological periodontal evaluation of all participants were
performed. Stress levels were assessed using salivary cortisol level and
Cohen's Perceived Stress Scale (PSS-10) scores. Salivary cortisol level was
measured using by ELISA method. The data were analyzed statistically according
to p <0.05 significant levels.



Results: When
the sociodemographic data were compared, no statistical difference was found
between the groups (p >0.05). Salivary cortisol level and PSS-10 scores in
periodontal healthy subjects were lower than subjects with gingivitis (p
<0.05). There was a positive correlation between salivary cortisol level and
perceived stress scale scores and periodontal clinical parameters.



Conclusion:
There
were higher levels of stress in individuals with gingivitis. According to the
present study might mention that there is a positive relationship between
stress and periodontal disease. However, the further investigations are needed
to explain the relationship between stress and periodontal disease.



Keywords:
stress, periodontal disease, cortisol



References

  • 1. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. The Lancet 2005;366:1809-1820.
  • 2. Leininger M, Tenenbaum H, Davideau JL. Modified periodontal risk assessment score: long‐term predictive value of treatment outcomes. A retrospective study. J Clin Periodontol. 2010;37:427-435.
  • 3. Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque–induced gingival conditions. . J Clin Periodontol. 2018;45:S17-S27.
  • 4. Peruzzo DC, Benatti BB, Ambrosano GM, Nogueira-Filho GR, Sallum EA, Casati MZ, et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007;78:1491-1504.
  • 5. Johannsen A, Åsberg M, Söder PÖ, Söder B. Anxiety, gingival inflammation and periodontal disease in non‐smokers and smokers–an epidemiological study. J Periodontol. 2005;32:488-491.
  • 6. Johannsen A, Rydmark I, Soder B, Asberg M. Gingival inflammation, increased periodontal pocket depth and elevated interleukin-6 in gingival crevicular fluid of depressed women on long-term sick leave. J Periodontal Res. 2007;42:546-552.
  • 7. LeResche L, Dworkin SF. The role of stress in inflammatory disease, including periodontal disease: review of concepts and current findings. Periodontol 2000. 2002;30:91-103.
  • 8. Peruzzo DC, Benatti BB, Ambrosano GM, , Nogueira-Filho GR, Sallum EA, Casati MZ, et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007;78:1491-1504.
  • 9. Genco RJ, Ho AW, Kopman J, Grossi SG, Dunford RG, Tedesco LA. Models to evaluate the role of stress in periodontal disease. Ann Periodontol. 1998;3:288-302.
  • 10. Sheiham A, Nicolau B. Evaluation of social and psychological factors in periodontal disease. Periodontol 2000. 2005;39:118-131.
  • 11. Axtelius B, Söderfeldt B, Nilsson A, Edwardsson S, Attström R. Therapy‐resistant periodontitis. Psychosocial characteristics. J Clin Periodontol. 1998;25:482-491.
  • 12. Moss ME, Beck JD, Kaplan BH, Offenbacher S, Weintraub JA, Koch GG, et al. Exploratory case-control analysis of psychosocial factors and adult periodontitis J Periodontol. 1996;67:1060-1069.
  • 13. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB, Glaser R. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A. 2003;100:9090-9095.
  • 14. Groer M, Murphy R, Bunnell W, Salomon K, Van Eepoel J, Rankin B, et al. Salivary measures of stress and immunity in police officers engaged in simulated critical incident scenarios. J Occup Environ Med. 2010;52:595-602.
  • 15. Jentsch H, März D, Krüger M. The effects of stress hormones on growth of selected periodontitis related bacteria. Anaerobe 2013;24:49-54.
  • 16. Rosania AE, Low KG, McCormick CM, Rosania DA. Stress, depression, cortisol, and periodontal disease. J Periodontol. 2009;80:260-266.
  • 17. Hilgert J, Hugo F, Bandeira D, Bozzetti M. Stress, cortisol, and periodontitis in a population aged 50 years and over. J Dent Res. 2006;85:324-328.
  • 18. Mengel R, Bacher M, Flores‐de‐Jacoby L. Interactions between stress, interleukin‐1β, interleukin‐6 and cortisol in periodontally diseased patients. J Clin Periodontol. 2002;29:1012-1022.
  • 19. Lazarus RS. Psychological stress and the coping process. New York, NY, US: McGraw-Hill. 1966.
  • 20. Lazarus RS. Psychological stress and coping in adaptation and illness. Int J Psychiatr Med. 1974;5:321-333.
  • 21. Yarkac FU, Gokturk O, Demir O. Effect of non-surgical periodontal therapy on the degree of gingival inflammation and stress markers related to pregnancy. J Appl Oral Sci. 2018;26.
  • 22. Chapple IL, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. J Clin Periodontol. 2018;45:S68-S77.
  • 23. Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-135.
  • 24. Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967;38:610-616.
  • 25. Eskin M, Harlak H, Demirkıran F, Dereboy Ç. Algılanan Stres Ölçeğinin Türkçeye Uyarlanması: Güvenirlik ve Geçerlik Analizi. In: New Symposium Journal. 2013;51:132-140.
  • 26. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385-396.
  • 27. Redmond N, Richman J, Gamboa CM, Albert MA, Sims M, Durant RW, et al. Perceived stress is associated with incident coronary heart disease and all-cause mortality in low-but not high-income participants in the Reasons for Geographic And Racial Differences in Stroke study. J Am Heart Assoc. 2013;2:e000447.
  • 28. Haririan H, Bertl K, Laky M, Rausch WD, Böttcher M, Matejka M, et al. Salivary and serum chromogranin A and α-amylase in periodontal health and disease. J Periodontol. 2012;83:1314-1321.
  • 29. Cakmak O, Alkan BA, Ozsoy S, Sen A, Abdulrezzak U. Association of gingival crevicular fluid cortisol/dehydroepiandrosterone levels with periodontal status. J Periodontol. 2014;85:e287-294.
  • 30. Sheiham A, Nicolau B. Evaluation of social and psychological factors in periodontal disease. Periodontol 2000. 2005;39:118-131.
  • 31. Goyal S, Jajoo S, Nagappa G, Rao G. Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: a clinico-biochemical study. . Indian J Dent Res .2011;22:6-9.
  • 32. Ishisaka A, Ansai T, Soh I, Inenaga K, Awano S, Yoshida A, et al. Association of cortisol and dehydroepiandrosterone sulphate levels in serum with periodontal status in older Japanese adults. J Clin Periodontol. 2008;35:853-861.
  • 33. Johannsen A, Rylander G, Soder B, Asberg M. Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion. J Periodontol. 2006;77:1403-1409.
  • 34. Refulio Z, Rocafuerte M, de la Rosa M, Mendoza G, Chambrone L. Association among stress, salivary cortisol levels, and chronic periodontitis. J Periodontal Implant Sci. 2013;43:96-100.
  • 35. Hilgert JB, Hugo FN, Bandeira DR, Bozzetti MC. Stress, cortisol, and periodontitis in a population aged 50 years and over. J Dent Res .2006;85:324-328.
  • 36. Deinzer R, Schüller N. Dynamics of stress-related decrease of salivary immunoglobulin A (sIgA): relationship to symptoms of the common cold and studying behavior. Behavioral Medicine 1998;23:161-169.
  • 37. Deinzer R, Hilpert D, Bach K, Schawacht M, Herforth A. Effects of academic stress on oral hygiene–a potential link between stress and plaque‐associated disease? J Clin Periodontol. 2001;28:459-464.
  • 38. Johannsen A, Rylander G, Söder B, Marie Å. Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion. J Periodontol. 2006;77:1403-1409.
  • 39. Saxby MS. Destructive forms of periodontal disease in adolescents and young adults. Br Dent J. 1985;159:206.
  • 40. Cohen S. Perceived stress in a probability sample of the United States. in: S. Spacapan, S. Oskamp (Eds.), The Social Psychology of Health, Sage, Newbury Park, CA, 1988.
  • 41. Sudhanshu A, Sharma U, Vadiraja H, Rana RK, Singhal R. Impact of yoga on periodontal disease and stress management. Int J Yoga. 2017;10:121.
  • 42. Fenol A, Jebi S, Krishnan S, Perayil J, Vyloppillil R, Bhaskar A, et al. Association of stress, salivary cortisol level, and periodontitis among the inmates of a central prison in Kerala. Dent Res J. 2017;14:288.
  • 43. Johannsen A, Bjurshammar N, Gustafsson A. The influence of academic stress on gingival inflammation. Int J Dent Hyg. 2010;8:22-27.
Year 2019, Volume: 29 Issue: 2, 206 - 212, 22.03.2019
https://doi.org/10.17567/ataunidfd.519376

Abstract

References

  • 1. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. The Lancet 2005;366:1809-1820.
  • 2. Leininger M, Tenenbaum H, Davideau JL. Modified periodontal risk assessment score: long‐term predictive value of treatment outcomes. A retrospective study. J Clin Periodontol. 2010;37:427-435.
  • 3. Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque–induced gingival conditions. . J Clin Periodontol. 2018;45:S17-S27.
  • 4. Peruzzo DC, Benatti BB, Ambrosano GM, Nogueira-Filho GR, Sallum EA, Casati MZ, et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007;78:1491-1504.
  • 5. Johannsen A, Åsberg M, Söder PÖ, Söder B. Anxiety, gingival inflammation and periodontal disease in non‐smokers and smokers–an epidemiological study. J Periodontol. 2005;32:488-491.
  • 6. Johannsen A, Rydmark I, Soder B, Asberg M. Gingival inflammation, increased periodontal pocket depth and elevated interleukin-6 in gingival crevicular fluid of depressed women on long-term sick leave. J Periodontal Res. 2007;42:546-552.
  • 7. LeResche L, Dworkin SF. The role of stress in inflammatory disease, including periodontal disease: review of concepts and current findings. Periodontol 2000. 2002;30:91-103.
  • 8. Peruzzo DC, Benatti BB, Ambrosano GM, , Nogueira-Filho GR, Sallum EA, Casati MZ, et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007;78:1491-1504.
  • 9. Genco RJ, Ho AW, Kopman J, Grossi SG, Dunford RG, Tedesco LA. Models to evaluate the role of stress in periodontal disease. Ann Periodontol. 1998;3:288-302.
  • 10. Sheiham A, Nicolau B. Evaluation of social and psychological factors in periodontal disease. Periodontol 2000. 2005;39:118-131.
  • 11. Axtelius B, Söderfeldt B, Nilsson A, Edwardsson S, Attström R. Therapy‐resistant periodontitis. Psychosocial characteristics. J Clin Periodontol. 1998;25:482-491.
  • 12. Moss ME, Beck JD, Kaplan BH, Offenbacher S, Weintraub JA, Koch GG, et al. Exploratory case-control analysis of psychosocial factors and adult periodontitis J Periodontol. 1996;67:1060-1069.
  • 13. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB, Glaser R. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A. 2003;100:9090-9095.
  • 14. Groer M, Murphy R, Bunnell W, Salomon K, Van Eepoel J, Rankin B, et al. Salivary measures of stress and immunity in police officers engaged in simulated critical incident scenarios. J Occup Environ Med. 2010;52:595-602.
  • 15. Jentsch H, März D, Krüger M. The effects of stress hormones on growth of selected periodontitis related bacteria. Anaerobe 2013;24:49-54.
  • 16. Rosania AE, Low KG, McCormick CM, Rosania DA. Stress, depression, cortisol, and periodontal disease. J Periodontol. 2009;80:260-266.
  • 17. Hilgert J, Hugo F, Bandeira D, Bozzetti M. Stress, cortisol, and periodontitis in a population aged 50 years and over. J Dent Res. 2006;85:324-328.
  • 18. Mengel R, Bacher M, Flores‐de‐Jacoby L. Interactions between stress, interleukin‐1β, interleukin‐6 and cortisol in periodontally diseased patients. J Clin Periodontol. 2002;29:1012-1022.
  • 19. Lazarus RS. Psychological stress and the coping process. New York, NY, US: McGraw-Hill. 1966.
  • 20. Lazarus RS. Psychological stress and coping in adaptation and illness. Int J Psychiatr Med. 1974;5:321-333.
  • 21. Yarkac FU, Gokturk O, Demir O. Effect of non-surgical periodontal therapy on the degree of gingival inflammation and stress markers related to pregnancy. J Appl Oral Sci. 2018;26.
  • 22. Chapple IL, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. J Clin Periodontol. 2018;45:S68-S77.
  • 23. Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-135.
  • 24. Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967;38:610-616.
  • 25. Eskin M, Harlak H, Demirkıran F, Dereboy Ç. Algılanan Stres Ölçeğinin Türkçeye Uyarlanması: Güvenirlik ve Geçerlik Analizi. In: New Symposium Journal. 2013;51:132-140.
  • 26. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385-396.
  • 27. Redmond N, Richman J, Gamboa CM, Albert MA, Sims M, Durant RW, et al. Perceived stress is associated with incident coronary heart disease and all-cause mortality in low-but not high-income participants in the Reasons for Geographic And Racial Differences in Stroke study. J Am Heart Assoc. 2013;2:e000447.
  • 28. Haririan H, Bertl K, Laky M, Rausch WD, Böttcher M, Matejka M, et al. Salivary and serum chromogranin A and α-amylase in periodontal health and disease. J Periodontol. 2012;83:1314-1321.
  • 29. Cakmak O, Alkan BA, Ozsoy S, Sen A, Abdulrezzak U. Association of gingival crevicular fluid cortisol/dehydroepiandrosterone levels with periodontal status. J Periodontol. 2014;85:e287-294.
  • 30. Sheiham A, Nicolau B. Evaluation of social and psychological factors in periodontal disease. Periodontol 2000. 2005;39:118-131.
  • 31. Goyal S, Jajoo S, Nagappa G, Rao G. Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: a clinico-biochemical study. . Indian J Dent Res .2011;22:6-9.
  • 32. Ishisaka A, Ansai T, Soh I, Inenaga K, Awano S, Yoshida A, et al. Association of cortisol and dehydroepiandrosterone sulphate levels in serum with periodontal status in older Japanese adults. J Clin Periodontol. 2008;35:853-861.
  • 33. Johannsen A, Rylander G, Soder B, Asberg M. Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion. J Periodontol. 2006;77:1403-1409.
  • 34. Refulio Z, Rocafuerte M, de la Rosa M, Mendoza G, Chambrone L. Association among stress, salivary cortisol levels, and chronic periodontitis. J Periodontal Implant Sci. 2013;43:96-100.
  • 35. Hilgert JB, Hugo FN, Bandeira DR, Bozzetti MC. Stress, cortisol, and periodontitis in a population aged 50 years and over. J Dent Res .2006;85:324-328.
  • 36. Deinzer R, Schüller N. Dynamics of stress-related decrease of salivary immunoglobulin A (sIgA): relationship to symptoms of the common cold and studying behavior. Behavioral Medicine 1998;23:161-169.
  • 37. Deinzer R, Hilpert D, Bach K, Schawacht M, Herforth A. Effects of academic stress on oral hygiene–a potential link between stress and plaque‐associated disease? J Clin Periodontol. 2001;28:459-464.
  • 38. Johannsen A, Rylander G, Söder B, Marie Å. Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion. J Periodontol. 2006;77:1403-1409.
  • 39. Saxby MS. Destructive forms of periodontal disease in adolescents and young adults. Br Dent J. 1985;159:206.
  • 40. Cohen S. Perceived stress in a probability sample of the United States. in: S. Spacapan, S. Oskamp (Eds.), The Social Psychology of Health, Sage, Newbury Park, CA, 1988.
  • 41. Sudhanshu A, Sharma U, Vadiraja H, Rana RK, Singhal R. Impact of yoga on periodontal disease and stress management. Int J Yoga. 2017;10:121.
  • 42. Fenol A, Jebi S, Krishnan S, Perayil J, Vyloppillil R, Bhaskar A, et al. Association of stress, salivary cortisol level, and periodontitis among the inmates of a central prison in Kerala. Dent Res J. 2017;14:288.
  • 43. Johannsen A, Bjurshammar N, Gustafsson A. The influence of academic stress on gingival inflammation. Int J Dent Hyg. 2010;8:22-27.
There are 43 citations in total.

Details

Primary Language Turkish
Subjects Dentistry
Journal Section Araştırma Makalesi
Authors

Özge Göktürk This is me 0000-0002-3147-735X

Fatma Uçan Yarkaç 0000-0001-8126-585X

Ferhat Özelçi This is me 0000-0001-8485-0288

Publication Date March 22, 2019
Published in Issue Year 2019 Volume: 29 Issue: 2

Cite

APA Göktürk, Ö., Uçan Yarkaç, F., & Özelçi, F. (2019). DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi, 29(2), 206-212. https://doi.org/10.17567/ataunidfd.519376
AMA Göktürk Ö, Uçan Yarkaç F, Özelçi F. DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ. Ata Diş Hek Fak Derg. March 2019;29(2):206-212. doi:10.17567/ataunidfd.519376
Chicago Göktürk, Özge, Fatma Uçan Yarkaç, and Ferhat Özelçi. “DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ”. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi 29, no. 2 (March 2019): 206-12. https://doi.org/10.17567/ataunidfd.519376.
EndNote Göktürk Ö, Uçan Yarkaç F, Özelçi F (March 1, 2019) DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi 29 2 206–212.
IEEE Ö. Göktürk, F. Uçan Yarkaç, and F. Özelçi, “DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ”, Ata Diş Hek Fak Derg, vol. 29, no. 2, pp. 206–212, 2019, doi: 10.17567/ataunidfd.519376.
ISNAD Göktürk, Özge et al. “DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ”. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi 29/2 (March 2019), 206-212. https://doi.org/10.17567/ataunidfd.519376.
JAMA Göktürk Ö, Uçan Yarkaç F, Özelçi F. DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ. Ata Diş Hek Fak Derg. 2019;29:206–212.
MLA Göktürk, Özge et al. “DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ”. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi, vol. 29, no. 2, 2019, pp. 206-12, doi:10.17567/ataunidfd.519376.
Vancouver Göktürk Ö, Uçan Yarkaç F, Özelçi F. DİŞETİ İLTİHAPLI VE PERİODONTAL SAĞLIKLI BİREYLERDE TÜKÜRÜK KORTİZOL VE ALGILANAN STRES DÜZEYLERİNİN DEĞERLENDİRİLMESİ. Ata Diş Hek Fak Derg. 2019;29(2):206-12.

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