Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2015, vol. 52, nr 4, October-December, p. 408–414

doi: 10.17219/dmp/59574

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Salivary Cortisol Measurement as a Test for Dental Anxiety Before Tooth Extraction

Ocena stężenia kortyzolu w ślinie dla oceny stresu pacjenta przed zabiegiem ekstrakcji zęba

Joanna Jakiel1,B,C,D, Anna Szyszkowska1,A,E,F, Joanna M. Szczerba-Gwóźdź1,B,C, Michał Mełges1,A,B,C,D, Mansur Rahnama2,E

1 Department of Oral Surgery, Medical University of Lublin, Lublin, Poland

2 Department of Oral Surgery Medical University of Lublin, Lublin, Poland


Background. Dental procedures are a source of anxiety, which is why most patients consider dental treatment unpleasant. Cortisol is a steroid hormone with wide effects on metabolism. Increased cortisol concentration is observed in stressful situations.
Objectives. The aim of the study was to evaluate the level of anxiety before tooth extraction, both in patients’ subjective opinion as well as in cortisol concentration in patients’ saliva before the procedure.
Material and Methods. Saliva for the examination of cortisol concentration was gathered from 44 patients (21 males and 23 females) before tooth extraction. The control group consisted of 31 persons between the ages of 18 and 64 (11 males and 20 females). The Corah’s Dental Anxiety Scale (CDAS) was used to estimate dental fear. Cortisol concentration was determined by means of electrochemiluminescence (ECLIA).
Results. The average cortisol concentration in patients’ saliva before tooth extraction was 0.50 ± 0.23 μg/dL which is within the 0.04 μg/dL – 1.23 μg/dL range. The average cortisol level in saliva in the control group was 0.18 ± 0.10 μg/dL. The difference in cortisol concentration between both groups was statistically significant. Statistical analysis of cortisol concentration in different age groups showed no significant correlation between the concentration of cortisol and age. No statistically significant difference in cortisol concentration before tooth extraction in women and men was noticed. The concentration of cortisol in men had more often extreme values, which is different from the results obtained in women. The highest concentration of salivary cortisol was found in the group declaring low level of anxiety by CDAS. However, there was no statistically significant correlation between salivary cortisol and level of anxiety measured by CDAS.
Conclusion. Increased salivary cortisol concentration showed patients’ anxiety before tooth extraction. The level of anxiety declared by patients before tooth extraction did not show any significant correlation with salivary cortisol concentration.

Key words

cortisol, saliva, dental anxiety

Słowa kluczowe

kortyzol, ślina, lęk dentystyczny

References (24)

  1. Corah N.: Dental anxiety assessment, reduction and increasing patient satisfaction. Dent. Clin. North Am. 1988, 32, 779–790.
  2. Krueger T.H., Heller H.W., Hauffa B.P., Haake P., Exton M.S., Schedlowski M.: The dental anxiety scale and effects of dental fear on salivary cortisol. Percept Mot. Skills, 2005, 100, 109–117.
  3. Carter A.E., Carter G., Boschen M., AlShwaimi E., George R.: Pathways of fear and anxiety in dentistry: A review. World J. Clin. Cases, 2014, 2, 642–653.
  4. Jöhren P., Jackowski J., Gängler P., Sartory G.: Fear reduction in patients with dental treatment phobia. Br. J. Oral Maxillofac. Surg. 2000, 38, 612–616.
  5. Humpris G., King K.: The prevalence of dental anxiety across previous distressing experiences. J. Anxiety Dis. 2011, 25, 232–236.
  6. Oosterink F.M., de Jongh A., Aartman I.H.: Negative events and their potential risk of precipitating pathological forms of dental anxiety. J. Anxiety Dis. 2009, 23, 451–457.
  7. Rodríguez V., Rubiños L., Varela C., Blanco O., Varela O., Varela C.: Stress amongst primary dental care patients. Med. Oral Patol. Oral Cir. Bucal. 2008, 13, 253–256.
  8. Greabu M., Purice M., Totan A., Spinu T., Totan C.: Salivary cortisol-marker of stress response to different dental treatment. Rom. J. Intern. Med. 2006, 44, 49–59.
  9. Gröschl M., Wagner R., Rauh M., Dörr H.: Stability of salivary steroids: the influences of storage, food and dental care. Steroids, 2001, 66, 737–741.
  10. Bradley P.J.: Saliva secretion. Surgery (Oxford), 2006, 24, 304–311.
  11. Soo-Quee Koh D., Choon-Huat Koh G.: The use of salivary biomarkers in occupational and environmental medicine. Occup. Environ. Med. 2007, 64, 202–210.
  12. Patil S.J., Shah P.P., Patil J.A., Shigli A., Patil A.T., Tamagond S.B.: Assessment of the changes in the stressrelated salivary cortisol levels to the various dental procedures in children. J. Indian Soc. Pedod. Prev. Dent. 2015, 33, 94–99.
  13. Dantzer R., Kalin N.: Salivary biomarkers of stress: cortisol and alpha-amylase. Psychoneuroendocrinol. 2009, 34, 1–2.
  14. Dodds M., Johnson D., Yeh C.: Health benefits of saliva: a review. J. Dent. 2005, 33, 223–233.
  15. Wong D.T.: Saliva diagnostics. Am. Sci. 2008, 96, 37–43
  16. Kaufman E., Lamster I.: The diagnostic applications of saliva — a review. Crit. Rev. Oral Biol. Med. 2002, 13, 197–212.
  17. Albanidou-Farmaki E., Poulopoulos A., Epivatianos A., Farmakis K., Karamouzis M., Antoniades D.: Increased anxiety level and high salivary and serum cortisol concentrations in patients with recurrent aphthous stomatitis. Tohoku J. Exp. Med. 2008, 214, 291–296.
  18. Brand H.: Anxiety and cortisol excretion correlate prior to dental treatment. Int. Dent. J. 1999, 49, 330–336.
  19. Kanegane K., Penha S., Munhoz C., Rocha R.: Dental anxiety and salivary cortisol levels before urgent dental care. J. Oral Sci. 2009, 51, 515–520.
  20. Refulio Z., Rocafuerte M., de la Rosa M., Mendoza G., Chambrone L.: Association among stress, salivary cortisol levels, and chronic periodontitis. J. Periodontal. Implant. Sci. 2013, 43, 96–100.
  21. Blomqvist M., Holmberg K., Lindblad F., Fernell E., Ek U., Dahllof G.: Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder. Eur. J. Oral Sci. 2007, 115, 1–6.
  22. Miller W., Dembo J., Falace D., Kaplan A.: Salivary cortisol response to dental treatment of varying stress. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 1995, 79, 436–441.
  23. Hill C., Walker R.: Salivary cortisol determinations and self-rating scales in the assessment of stress in patients undergoing the extraction of wisdom teeth. Br. Dent. J. 2001, 191, 513–515.
  24. Coulthard P.: A study of stress levels amongst patients undergoing third molar extraction by local and general anaesthesia. Br. Dent. J. 2001, 191, 508–509.