Smoking and stress: common denominators for periodontal disease, heart disease, and diabetes mellitus.

The scientific evidence supporting the relationship between periodontal disease and two major health problems of the US population, i.e., cardiovascular disease and diabetes mellitus, is discussed. Evidence supporting the behavioral and psychosocial factors mediating the relationship between periodontal infection and these systemic conditions, namely smoking and stress, is presented, as well as models explaining these relationships. Treatment protocols are suggested for the clinical management of patients who smoke, are diabetic, or are at risk for cardiovascular disease.