Salivary stress biomarkers and anxiety symptoms in children with and without temporomandibular disorders

Abstract The etiology of temporomandibular disorders (TMD), which are considered as a heterogeneous group of psychophysiological disturbances, remains a controversial issue in clinical dentistry. This study aimed to evaluate whether the salivary alpha-amylase (sAA), cortisol levels, and anxiety symptoms differ between children with and without TMD. Initially, 316 young subjects were screened in public schools (nonreferred sample); 76 subjects aged 7-14 years were selected and comprised the TMD and control groups with 38 subjects each matched by sex, age, and the presence/absence of sleep bruxism. Four saliva samples were collected: upon waking, 30 min and 1 h after awakening (fasting), and at night (at 8 PM) on 2 alternate days to examine the diurnal profiles of cortisol and sAA. Anxiety symptoms were screened using the Multidimensional Anxiety Scale for Children (MASC-Brazilian version). Shapiro-Wilk test, Student's t-test/Mann-Whitney U test, and correlation tests were used for data analysis. No significant differences were observed in the salivary cortisol area under the curve (AUCG mean ± SD = 90.22 ± 63.36 × 94.21 ± 63.13 µg/dL/min) and sAA AUCG (mean ± SD = 2544.52 ± 2142.00 × 2054.03 ± 1046.89 U/mL/min) between the TMD and control groups, respectively (p > 0.05); however, the clinical groups differed in social anxiety domain (t = 3.759; CI = 2.609, 8.496), separation/panic (t = 2.243; CI = 0.309, 5.217), physical symptoms (U = 433.500), and MASC total score (t = −3.527; CI = −23.062, −6.412), with a power of the test >80% and large effect size (d = 0.80), with no significant correlation between the MASC total score, cortisol, and sAA levels. Although children with TMD scored higher in anxiety symptoms, no difference was observed in the salivary stress biomarkers between children with and without TMD.

Evaluation of masticatory and salivary parameters in preschool children with different morphological occlusion / Avaliação dos parâmetros mastigatórios e salivares em crianças pré-escolares com diferente oclusão morfológica

Objetivos: Para compreender melhor a relação entre má oclusão e as funções mastigatória e salivar na dentição decídua, objetivou-se avaliar as diferenças na performance mastigatória (PM), morfologia facial (MF), força de mordida (FM) e parâmetros salivares em 65 pré-escolares com oclusão normal (n = 22), mordida cruzada funcional posterior (n = 20) e mordida aberta anterior (n = 23) e explorar a relação entre essas variáveis. Materiais e Métodos: PM, MF e FM foram avaliados pelo método de peneiragem, antropometria e gnatodinamômetro, respectivamente. O fluxo salivar estimulado (SE) e não estimulado (SNE) e composição salivar foram mensurados por técnica colorimétrica automatizada. Os dados foram analisados utilizandose ANOVA/Kruskal-Wallis, teste-t/Wilcoxon e teste de correlação de Pearson/Spearman. A relação entre fluxo salivar e as demais variáveis independentes foi avaliada por regressão linear múltipla. Resultados: A dimensão facial inferior foi menor no grupo com mordida cruzada e observou-se menor FM no lado cruzado do arco dentário. A FM correlacionou-se positivamente com a largura intergoníaca no grupo com mordida aberta. Nos grupos com má oclusão, uma melhor PM relacionou-se com as larguras bizigomática e intergoniana. O fluxo de SNE foi menor no grupo com mordida cruzada e a concentração de proteína total diferiu entre SE e SNE apenas no grupo com mordida cruzada, sendo menor na SNE. A atividade da amilase foi maior na SE em relação à SNE em todos os grupos. O fluxo de SE mostrou relação positiva com a idade e negativa com a presença de maloclusão. Conclusão: Em crianças de pouca idade foram encontradas correlações significativas entre os parâmetros mastigatórios e as dimensões faciais; além disso, parâmetros mastigatórios e salivares importantes diferiram entre crianças com diferentes tipos de oclusão, mostrando a importância da avaliação precoce destes parâmetros.(AU)

Objective: To better understand the relationship between malocclusion and masticatory and salivary functions in the primary dentition, the aim was to evaluate the differences in masticatory performance (MP), facial morphology (FM), maximal bite force (BF) and salivary parameters in 65 preschool children with normal occlusion (n = 22), functional posterior crossbite (n = 20) and anterior open bite (n = 23), and to explore the relationship between these variables. Material and Methods: MP, FM and BF were assessed by sieving method, anthropometry and gnatodynamometer, respectively. Stimulated (SS) and unstimulated (US) saliva flow and composition were measured by automated colorimetric technique. Data were analyzed using ANOVA/Kruskal-Wallis, t-test/Wilcoxon and Pearson/Spearman correlation test. The relationship between SS flow rate and the independent variables were assessed using multiple linear regression. Results: The lower face dimension was smaller in crossbite-group, and a decreased BF in the crossbite-side of the dental arch was observed. BF correlated positively with intergonial width in open bite group. In malocclusion groups, better MP correlated with byzigomatic and intergonial widths. US flow rate was lower in crossbite-group and total protein concentration differed between SS and US saliva only in the crossbite-group, being lower in US. Amylase activity was higher in SS than US in all groups. SS flow rate related positively with age and negatively with the presence of malocclusion. Conclusion: In young subjects, significant correlations were found between masticatory parameters and facial dimensions; in addition, some important masticatory and salivary parameters differed between children with diferent morphological occlusions, hence the importance of the early assessment of these parameters.(AU)