The impact of dental treatment and age on salivary cortisol and alpha-amylase levels of patients with varying degrees of dental anxiety.

BACKGROUND: The purpose of this study was to assess the salivary cortisol and salivary alpha-amylase levels in children aged between 6 and 9 years, 3 months and 1 year after the successful completion of dental treatment through either pharmacological or non-pharmacological behavior management techniques. METHODS: A total of 1567 patients aged between 6 and 9 years who had completed dental treatment were screened. A total of 703 patients who were caries free at the end of 3 months were classified based on Frankl behavior score and administered the Arabic version of the Children's Fear Survey Schedule- Dental Subscale (CFSS-DS) and accordingly allocated to one of three groups; (Phobic Patients, Anxious Patients, Control Group). A total of 183 patients met the inclusion criteria and were followed up for 1 year. A total of 151 patients completed the study. Patients' heart rate on recall, salivary cortisol and salivary amylase were compared between the groups. RESULTS: The results of the study showed that amylase and cortisol levels had a significant association with the level of dental fear. The phobic patients had the highest levels of salivary amylase and salivary cortisol levels with no significant associations observed with either heart rate or extent of dental treatment. Control and anxious patients had significantly lower amylase levels when compared to phobic patients. There was no significant difference between the salivary cortisol levels of anxious and phobic patients. These findings were replicated on 1-year recall. CONCLUSIONS: Within the limitations of this study we can conclude that salivary amylase is an indicator of of acute stress that can differentiate between anxiety and dental fear; while salivary cortisol appears to be a marker of long-term stress that lacks the sensitivity to differentiate between the two.

Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia.

OBJECTIVES: Dental anxiety level has been previously associated with oral health status. Since general anesthesia (GA) allows dental treatments to be performed in anxious children with a high number of caries, we aimed to evaluate the dental anxiety levels of these children before and after dental treatments performed under GA. MATERIALS AND METHODS: Thirty-eight children with high anxiety aged between 35 and 72 months who required multiple dental treatments to be performed under GA were included in the study. Frankl's Behavior Rating Scale, sitting patterns, Facial Image Scale, and Children's Fear Survey Schedule-Dental Subscale (completed by the children's parents) were recorded before and after the dental treatments performed under GA. Pre-treatment and post-treatment biochemical parameters, including cortisol, alpha-amylase, and chromogranin A levels, in saliva and serum samples were also evaluated. RESULTS: The psychometric scales showed a statistically significant reduction in the post-treatment dental anxiety levels of the children compared with the pre-treatment anxiety levels. Additionally, the biochemical parameters measured in the serum and whole saliva samples showed a decrease after treatments performed under GA. CONCLUSIONS: Our study results suggest that performing dental treatments under GA can reduce the dental anxiety levels of children with a high number of caries.

Evaluation of cortisol concentrations in saliva as a measure of stress in patients having routine dental extractions.

We measured changes in the salivary concentrations of cortisol as an index of stress, and to find out if patients were stressed during routine intra-alveolar dental extractions. A total of 126 patients (63 experimental and 63 controls) matched for age and sex with a mean (SD) age of 26 (5) years (range 18-40) were recruited. Samples of saliva from patients whose glands had not been stimulated were collected twice from the study group (30minutes before, and 10minutes after, the procedure) and once from the control subjects. All samples were collected between 10.00 and 14.00hours to standardise the method and control for the diurnal variation of cortisol. There was a slight but not significant increase in the mean salivary concentration of cortisol between the preoperative samples (mean (SD) 12.3 (1.5)ng/ml and the postoperative samples 12.8 (2.3)ng/ml in the study group) and the control 8.7 (1.0)ng/ml. However, there was no difference between the sexes. The study highlights a simple but effective way of evaluating stress in patients having intra-alveolar dental extraction, and emphasises the invaluable role of salivary cortisol in the evaluation of stress (particularly in our environment).

Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study.

The stress of dental treatment often elicits negative emotions in children, expressed as dental fear or anxiety. Highly anxious children obstruct treatment and avoid therapy, further amplifying oral health problems. The aim of this study was to examine the neuroendocrine and autonomic nervous system responses to dental treatment and their possible interactions and associations with psychometric indices of anxiety, caries, previous dental experience, anesthesia, age and gender in school children. Upon informed consent, saliva was obtained from 97 children (59% males, mean age ± SD: 89.73 ± 15 months) in the Clinic of pediatric dentistry before treatment, immediately post-treatment and at the recall visit to determine cortisol and salivary alpha-amylase (sAA) levels. Dental and general anxiety was assessed through specific questionnaires completed by the children. Compared to pre-treatment, cortisol levels were increased following treatment, while sAA levels were higher at the recall. Pre- and post-treatment cortisol and sAA responses were positively correlated. Dental and general anxiety questionnaire scores were also significantly correlated with each other. The integrated autonomic and neuroendocrine responses prior to treatment were correlated with state anxiety and those following treatment with dental anxiety. However, univariable and multivariable linear regression analysis associated post-treatment cortisol, but not sAA, levels with dental anxiety. No associations of cortisol or sAA responses with caries, age, gender, previous dental experience or anesthesia were detected. These data provide some evidence that both sAA and cortisol levels are altered in children in anticipation or during dental treatment, but only cortisol levels are associated to dental anxiety.

Salivary cortisol, salivary alpha amylase, and the dental anxiety scale.

The aim of this study was to investigate the correlation between dental anxiety, salivary cortisol, and salivary alpha amylase (sAA) levels. Furthermore, the aim was to look into individual differences such as age, race, gender, any existing pain, or traumatic dental experience and their effect on dental anxiety. This study followed a cross-sectional design and included a convenience sample of 46. Every patient was asked to complete the Dental Anxiety Scale (DAS) and a basic demographic/dental history questionnaire. A saliva sample, utilizing the method of passive drooling, was then collected in 2-mL cryovials. Samples were analyzed for salivary cortisol and sAA levels by Salimetrics. Significant associations were observed between DAS scores and presence of pain and history of traumatic dental experience. However, no significant correlations were observed between DAS, cortisol, and sAA levels. Our study reconfirms that dental anxiety is associated with presence of pain and a history of traumatic dental experience. On the other hand, our study was the first to our knowledge to test the correlation between the DAS and sAA; nevertheless, our results failed to show any significant correlation between dental anxiety, cortisol, and sAA levels.

Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children.

OBJECTIVE: Anxiety and stress are usually related to the dental treatment situation. The objective was to investigate salivary cortisol and alpha-amylase levels (salivary biomarkers) and heart rate in children undergoing a minor dental procedure (dental prophylaxis). STUDY DESIGN: In total, 31 children (range 84-95 months) of both genders without caries or history of dental treatment/pain/trauma were selected. Three saliva samples were gathered: one prior to dental prophylaxis, one immediately after and one ten minutes later. Weight and height were assessed, and heart rate was evaluated prior to and during the procedure. Data were analyzed by correlation tests and t-test/Wilcoxon (alpha = 0.05). RESULTS: Higher cortisol and amylase levels were observed before prophylaxis compared to afterward. Cortisol and amylase levels did not show a significant correlation, nor did salivary biomarkers and body mass index. However, heart rate and amylase levels showed a significant positive correlation. CONCLUSIONS: In the studied sample, certain anticipation of the dental treatment was observed because higher cortisol and amylase levels were observed before, rather than after the event; moreover a significant correlation between amylase levels and heart rate was observed Thus, salivary biomarkers may be a valuable tool for evaluating anxiety-producing events, such as dental treatment, in children.

Salivary alpha amylase and cortisol levels in children with global developmental delay and their relation with the expectation of dental care and behavior during the intervention.

The purpose of this study was to analyze the alpha-amylase (sAA) and cortisol levels in children with Global developmental delay (GDD) before and after dental treatment and its association with the children's behavior during treatment. The morning salivary cortisol levels and activity of sAA of 33 children with GDD were evaluated before and after dental treatment and were compared to 19 healthy children. The behavior of children with GDD during dental care was assessed by the Frankl scale. Children with GDD showed lower levels of sAA activity than healthy children, but this result was not significant. The salivary cortisol levels were similar between GDD and healthy children. GDD children showed increased levels of sAA (but not cortisol) prior to the dental treatment as compared to the post-treatment phase. GDD children who showed less favorable behavior during dental care had higher levels of sAA and salivary cortisol than GDD children with more favorable behavior, but only the sAA results were significant. In conclusion, GDD children show hyperactivity of the SNS-axis in anticipation of dental treatment which indicates the need for strategies to reduce their anxiety levels before and during dental care.

Auditory symptom provocation in dental phobia: a near-infrared spectroscopy study.

The act of drilling a tooth belongs to the most feared situations of patients suffering from dental phobia. We presented 25 female patients and 24 nonphobic women with the sound of a dental drill, pleasant and neutral sounds. Brain activation was recorded via near infrared spectroscopy in fronto-parietal and premotor areas. The groups differed in supplementary motor area (SMA) recruitment. Relative to controls, the phobics displayed increased oxy hemoglobin while presented with the phobia-relevant sound, but showed comparable activation in the other conditions. As the SMA is engaged in the preparation of motor actions, the increased response in patients might mirror the priming of flight behavior during exposure. We found no indication of an emotional modulation of parietal and dorsomedial prefrontal cortex activation.

Glucose levels and hemodynamic changes in patients submitted to routine dental treatment with and without local anesthesia.

OBJECTIVE: The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2% mepivacaine with adrenaline 1100,000) and (2) correlate those parameters with the patients' anxiety levels. METHOD: This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. RESULTS: Thirty-seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. CONCLUSION: The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used.

Glucose levels and hemodynamic changes in patients submitted to routine dental treatment with and without local anesthesia

OBJECTIVE: The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2 percent mepivacaine with adrenaline 1100,000) and (2) correlate those parameters with the patients' anxiety levels. METHOD: This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. RESULTS: Thirty-seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. CONCLUSION: The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used.

Dental anxiety and salivary cortisol levels before urgent dental care.

Dental anxiety is still prevalent, despite advances in treatment, and affects the utilization of health care services. The purpose of this cross-sectional study was to determine if patients with different degrees of dental anxiety and pain undergoing emergency dental care have different stress reactions as measured by salivary cortisol. Seventy three patients completed the modified dental anxiety scale (MDAS), and described any previous dental traumatic experience. Their socio-demographic characteristics were also recorded. They also rated pain intensity on a 100 mm visual analogue scale (VAS). A saliva sample was collected before the procedure, and analyzed by enzyme immunoassay. Thirty patients were dentally anxious and forty one complained of pain. In this sample, dental anxiety was not related to gender, age, educational level and family income; however, a previous traumatic event was related to dental anxiety. There was no association between salivary cortisol concentrations and gender or dental anxiety. Patients with pain showed higher cortisol levels. When gathering patient information, the dentist should note patients' negative dental experiences in order to provide more effective, less traumatic treatment.

Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The present study tested the hypotheses that children with ADHD, particularly those exhibiting severe hyperactivity and impulsivity, have a different stress reaction (measured by salivary cortisol) during a dental recall visit and are more dentally anxious than children in a control group. Eighteen children with ADHD and a control group of 71 children, all 13 yr of age, underwent a clinical dental examination and completed the Corah Dental Anxiety Scale (CDAS). Four saliva samples were gathered for analysis of cortisol: one prior to dental examination, one after, and two the following morning. The subgroup ADHD with hyperactivity/impulsivity had statistically significantly lower cortisol levels than the control group 30 min after awakening. When cortisol values were plotted on a timeline, this subgroup always had lower cortisol concentrations than children in the control group. There was a significant correlation between CDAS scores and cortisol concentrations prior to the dental examination in both the ADHD and the control group. Behavioral expressions of anxiety in children with ADHD may be different from those in other children, not only due to the characteristics of their disorder, but also because of lower stress reactivity.

Salivary catecholamine assay for assessing anxiety in pediatric dental patients.

For the behavioral management of pediatric dental patients, it is important to estimate the degree of anxiety during dental treatment. The purpose of this study was to investigate salivary catecholamine levels in children undergoing dental treatment and to assess the degree of anxiety at each dental procedure. The salivary norepinephrine (NE) level was not influenced by a subcutaneous injection of 50 micrograms of NE in 6 adult volunteers, suggesting a poor diffusive effect of plasma NE into the salivary gland. The salivary NE and epinephrine (E) were measured in 8 children between the ages of 3 and 7 years who underwent restorative dental procedures. Salivary NE significantly increased when the children lay on a dental chair and subsequently received infiltration anesthesia. The salivary E level did not show a significant change throughout the study. After the treatment, salivary NE returned to the pretreatment level. These findings suggest that the increase in salivary NE before infiltration anesthesia reflects enhanced peripheral NE release as a result of stress-induced sympathetic responses and that salivary NE assay is useful for the assessment of dental anxiety in children.

Salivary cortisol levels in children during dental treatment.

Cortisol which is also called as stress hormone, is used as an indicator in the stress evaluation studies. 60 children who never visited a dentist before, participated in the present study. Saliva samples were collected from 30 children without any dental treatment (control group). Experimental group comprised 30 children with caries. Saliva samples were obtained at various stages during dental treatment. Totally 180 samples were collected and the cortisol levels were measured. Paired-t test has shown that the salivary cortisol levels at various stages of dental treatment in the experiment group were significantly higher in comparison with the control group. It is concluded that dental treatment may cause extreme stress in children who never had dental treatment experience before.

Children's stress during a restorative dental treatment: assessment using salivary cortisol measurements.

Dental environment may be a source of stress for the young patient. Such stressful conditions may provoke fear in anxious children. It is well known that stress produces an activation adrenal steroid secretion. Among the methods for assessing child dental fear, measurement of salivary cortisol level is a simple method, because especially in children, sampling of saliva is easy, and cortisol levels in saliva closely mirror serum free cortisol levels, independent of salivary flow rate. For this study, the salivary cortisol levels of 8 children (mean age 5.6 yr) were measured receiving initial dental treatment. Saliva samples were collected via cotton rolls placed to the floor of the mouth at four stages; prior to treatment, during cavitation, placement of the liner and the restoration. Statistical comparison of the results were done by Student-t test. The increase in salivary cortisol levels during cavitation at the first and secondary appointments were significant (p<0.01 and p<0.05), but not at the second. The other comparisons were not statistically significant (p>0.05). The results of this study suggest that in restorative procedures, mostly it is the cavitation step that creates stress and anxiety in children. Knowledge of the most stressful condition may be helpful for the dentist to prepare the child to treatment steps.

[Distribution of metanephrines in methanol-treated human whole saliva analyzed by HPLC].

Organic solvent extraction of three metanephrines (MNs) in supernatant and sediment fractions obtained by the addition of methanol to the whole saliva and liquid chromatographic analysis with voltammetric detection are described. Two milliliters of unstimulated whole saliva obtained from 13 healthy males was treated with chilled methanol to separate mucin clots. The mucin clots, supernatant, and whole saliva were then hydrolyzed at 98 degrees C for 40 minutes at pH 0.5-0.8. These hydrolyzed samples were subsequently brought up to pH 10.0 with a 6 N NaOH solution in 0.1 M borate buffer (pH 10.0), and then 5-HT and MNs were extracted into toluene: isoamylalcohol (3:2) from the basic phase. MNs in their organic phase were extracted back into 0.1 M acetic acid and used for the high-performance liquid chromatographic (HPLC) analysis. The supernatant fraction showed a higher distribution for MNs than the sediment and whole saliva fractions. The chromatographic profile obtained from the supernatant and the whole saliva fractions contained some serotonin in a pattern similar to that reported from urinary analysis. The use of methanol for the fractionation of saliva resulted in good differential determination of MNs and revealed their distribution in the three salivary fractions. It is attractive to speculate that patients undergoing restorative treatment possibly manifest their anxiety by salivary excretion containing serotonin and MNs. These compounds in saliva may be useful markers of emotional responses.