by Kristine A. Hodson, RDH, BS
Humor enables us to experience joy even when we're faced with adversity. Finding humor in a situation and laughing freely can be a powerful antidote to disease and an effective self-care tool. There is evidence-based research showing that humor and positive emotions can stimulate the immune system; hence, the possibility it may be a self-care tool for supporting the host response in the treatment and management of periodontal disease.
In Anatomy of an Illness, published in 1979 by the late Norman Cousins, the author used the positive emotions of faith, hope, laughter, and joy to counteract the effects of the stressful lifestyle that he believed led to his illness. He watched funny Marx Brothers movies several times a day, and subsequently recovered from ankylosing spondylitis (often a crippling disease that destroys the connective tissue).
Lee Berk, DrPH, MPH, and Stanley Tan, MD, PhD, researched the biochemical changes that occur in people when they are in a state of “mirthful laughter.” The pair's carefully controlled studies, which used statistical multivariate analysis of variance (MANOVA) to interpret the results, was first published in 1989. The stimulus for the “mirthful laughter” was a video titled “Over Our Head,” featuring the comedian Gallagher. Blood samples for both the experimental group and control group were taken before, during, and immediately after the video was shown, and the following day.
The results showed that the experimental group (that watched the funny video) had lower serum cortisol levels (stress hormones), increases in the amount of activated T and B lymphocytes, increases in the number and activity of natural killer cells (NK cells are important as inflammatory mediators), and IFN, a cytokine that supports activating T lymphocytes and NK cells. They also noted an increase in the antibody immunoglobulins IgA, IgM, and IgG. Lastly, they recorded an increase in Component 3, not only during the study, but through the next day. Component 3 helps antibodies pierce dysfunctional or infected cells.
Dillon et al. (1985) and Stone et al. (1987) concluded the salivary IgA response level was lower on days of negative moods and higher on days of positive moods. Later, Lefcourt et al. (1990) showed that subjects had an even stronger elevation of salivary IgA after viewing a humorous video.
What we know
Pathogenic bacteria from microbial biofilm can begin tissue destruction and permeability of gingival tissue that can lead to gingivitis and periodontitis. They ignite the host immune-inflammatory response. Proinflammatory molecules and cytokine networks are part of the process. Inflammatory markers and cortisol are found in gingival crevicular fluid and saliva. Inflammatory mediators such as interleukin-1, matrix metalloproteinase, IL-1b, B and T cells, enzymes, lipids, and proteins are part of these cascading events. Using the analogy of a three-legged stool — nonsurgical and surgical approaches to treat periodontal diseases, and pharmaceuticals (systemic and locally applied) represent two of the foundational periodontal legs. The third leg is self-care.
The humor and positive emotions we experience when we laugh directly benefit the mind/body connection by supporting our immune systems. Clinically speaking, if you bring levity to your hygiene appointments, it may replace the negative feelings (feeling overwhelmed or judged, or lacking self-efficacy) surrounding patients' diseases. To create positive emotions, stay in touch with your “inner clown.” Look each day for ways to bring laughter into your clinical practice. Consider showing TV comedy channels in the reception room. Perhaps combine traditional self-care tools such as a power brush or mouth rinse with a “cinematically elevated” DVD, a comedic link to a YouTube broadcast, or suggest that your patients' brush and floss while listening to or watching a funny show.
References available upon request.