Periodontal disease is characterized by chronic inflammation of the gingiva (gum tissues) caused by infection with anaerobic bacteria. In older adults, progression of disease can lead to tooth loss, inadequate nutritional intake, and a higher risk of other chronic conditions such as cardiovascular disease and diabetes mellitus. As the proportion of older adults continues to grow over time and rates of tooth loss decline, prevalence and severity of periodontal disease will increase. While much is known about risk factors for disease onset, gaps remain in our understanding of factors that could influence disease progression. Over the past few decades, stress has been implicated as a contributory factor. This review critically examines the epidemiological and laboratory evidence and describes a conceptual framework that could help move the research forward.