The psychobiological links between chronic stress-related diseases, periodontal/peri-implant diseases, and wound healing

Chronic stress is a relevant disease to periodontal practice, encompassing 25%-28% of the US population (American Psychological Association 2015). While it is well established that chronic psychologic stress can have significant deleterious systemic effects, only in recent decades have we begun to explore the biochemical, microbial, and physiologic impacts of chronic stress diseases on oral tissues. Currently, chronic stress is classified as a "risk indicator" for periodontal disease. However, as the evidence in this field matures with additional clinically controlled trials, more homogeneous data collection methods, and a better grasp of the biologic underpinnings of stress-mediated dysbiosis, emerging evidence suggests that chronic stress and related diseases (depression, anxiety) may be significant contributing factors in periodontal/peri-implant disease progression and inconsistent wound healing following periodontal-related therapeutics. Ideal solutions for these patients include classification of the disease process and de-escalation of chronic stress conditions through coping strategies. This paper also summarizes periodontal/implant-related therapeutic approaches to ensure predictable results for this specific patient subpopulation.

Neurobiology of Female Homicide Perpetrators

Neurobiology of female homicide perpetrators is not well understood. Data from private interviews and examinations of females were re-analyzed comparing those who committed homicide (n = 9); other violent crimes, no known homicide (n = 51); nonviolent crimes, no known violent convictions (n = 49); and noncriminals (n = 12). Homicide perpetrators suffered the most childhood sexual abuse (CSA); most recent abuse; had the most neurological histories, mainly traumatic brain injuries (TBIs); most health care access for abuse-related injuries; lowest AM and PM salivary cortisol; and greatest proportion who committed crime under the influence of alcohol. Only CSA, years since last abuse, TBI, neurological histories, and health care access for abuse-related injuries were significant. Those who committed homicide under the influence of alcohol suffered the most recent abuse and had the lowest AM cortisol and flattest diurnal cortisol slope (DCS) compared with others; though the n precludes determining significance. Amount of time since last abuse, AM cortisol and DCS progressively decreased as crime severity increased; other variables progressively increased as crime severity increased. These preliminary findings suggest that low AM cortisol, flat DCS, greater CSA frequency and severity, recent abuse, TBIs, and health care access for abuse-related injuries could be risk factors for females committing homicide. Further study is needed due to the small n of homicide perpetrators. Abuse victims may be at greater risk for alcohol use and cortisol dysregulation associated with perpetrating violence, especially homicide. Frontal lobe damage from TBIs may decrease ability to control behaviors associated with emotions from the limbic system. Health care providers released these women when their abuse-related injuries were not life-threatening; yet, they were life-threatening for victims of their subsequent homicides. Females accessing health care for abuse-related injuries present a critical opportunity for violent crime prevention interventions.

Low-dose short synacthen test with salivary cortisol in patients with suspected central adrenal insufficiency

CONTEXT

The low-dose short synacthen test (LDSST) is recommended for patients with suspected central adrenal insufficiency (AI) if their basal serum cortisol (F) levels are not indicative of an intact hypothalamic-pituitary-adrenal (HPA) axis.

OBJECTIVE

To evaluate diagnostic threshold for salivary F before and 30 min after administering 1 μg of synacthen, performed before 09:30 h.

DESIGN

A cross-sectional study from 2014 to 2020.

SETTING

A tertiary referral university hospital.

PATIENTS

In this study, 174 patients with suspected AI, 37 with central AI and 137 adrenal sufficient (AS), were included.

MAIN OUTCOME MEASURE

The diagnostic accuracy (sensitivity (SE), specificity (SP)) of serum and salivary F levels measured, respectively, by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry.

RESULTS

Low basal serum or salivary F levels could predict AI. For the LDSST, the best ROC-calculated threshold for serum F to differentiate AI from AS was 427 nmol/L (SE 79%, SP 89%), serum F > 500 nmol/L reached SP 100%. A salivary F peak > 12.1 nmol/L after administering synacthen reached SE 95% and SP 84% for diagnosing central AI, indicating a conclusive reduction in the likelihood of AI. This ROC-calculated threshold for salivary F was similar to the 2.5th percentile of patients with a normal HPA axis, so it was considered sufficient to exclude AI. Considering AS those patients with salivary F > 12.1 nmol/L after LDSST, we could avoid unnecessary glucocorticoid treatment: 99/150 subjects (66%) had an inadequate serum F peak after synacthen, but salivary F was >12.1 nmol/L in 79 cases, who could, therefore, be considered AS.

CONCLUSIONS

Salivary F levels > 12.1 nmol/L after synacthen administration can indicate an intact HPA axis in patients with an incomplete serum F response, avoiding the need to start glucocorticoid replacement treatment.

Assessment of Salivary Cortisol Concentrations as a Level of Stress Indicator among Individuals Undergoing Dental Extraction Procedure

Background:

Anxious patients tend to exaggerate the aversive events before the actual dental therapy. The anxiety and fear are the major factors that regulate cortisol levels.

Aim:

Our study aims to estimate the salivary cortisol among patients subjected to dental extraction and correlate any existence between pre- and post-extraction cortisol levels and vital parameters compared to the control group.

Methodology:

The study sample included sixty individuals, thirty patients indicated for a dental extraction, and thirty healthy patients between the ages of 18 and 60 years. We collected saliva samples from the control group and pre- and post-extraction samples from the study group participants and vital parameters. We used quantitative ELISA Kit, Diagnostics Biochem Canada Inc. (DBC), to estimate the salivary cortisol level. We evaluated the values using the Chi-square test, Pearson correlation test, and paired t-test using the JMP 15; JMP Pro, Version 15 (SAS) Microsoft^® Windows^® for × 64.

Results:

The mean value of cortisol concentration of saliva was significantly greater in the preextraction group (6.13 ± 0.53 μg/dl) than after extraction group (3.17 ± 0.14 μg/dl) (P < 0.001). There were no significant associations between hemodynamic parameters and salivary cortisol concentration except for the postextraction systolic blood pressure (BP). A comparison of hemodynamic parameters between the study and control group revealed substantial differences in systolic BP.

Conclusion:

The patient's anticipation and anxiety toward dental therapy elevate the cortisol level. Dental surgeons should treat the patients more conveniently and effectively without any strains and provide a comfortable atmosphere to avoid stress-related consequences.

A Disposable Printed Liquid Gate Graphene Field Effect Transistor for a Salivary Cortisol Test

Circadian rhythm of salivary cortisol is of clinical significance, tracking salivary cortisol in domicile is welcomed by both doctor and patient, due to its merits of noninvasion, ease of sampling, and free-of-stress response. Here, we present a portable salivary cortisol test setup based on a liquid gate graphene field effect transistor (Lg-GFET) for the first time. In this work, the Lg-GFET was prepared by the printing technology and exploited as a sensitive material. In the procedures of device preparation, the modified liquid exfoliation method and direct-ink-write technology were utilized for synthesizing the graphene ink and printing Lg-GFETs; then, the as-prepared Lg-GFETs were decorated and functionalized by tetrakis(4-carboxyphenyl) porphyrin and the cortisol aptamer, successively. Their sensitivity, selectivity, and robustness are seriously examined. The test results indicate that the sensors have good linear sensitivities over a seven-log analyte concentration range (0.01 to 10⁴ nM) and the anti-interference ability to distinguish from the substancess with similar chemical structures. Moreover, the conceptual application for tracking circadian rhythm was carried out successfully. Conclusively, the proposed flexible Lg-GFET-based salivary cortisol detection platform can satisfy the requirements of the salivary cortisol's assay for instant detection. Additionally, it also provides an alternative solution for developing similar household medical appliances.

Modification of Diurnal Cortisol Secretion in Women's Professional Basketball. A Pilot Study

Elite basketball training causes high levels of physiological stress, which can lead to negative physiological disorders in female athletes. The aim of this study was to establish the impact of physical activity on the rhythm of salivary cortisol secretion in elite female basketball players over one week. The population sample included 9 women professional basketball players. The control group was made up of 9 women who did not do any exercise. Saliva samples were collected from all participants at 9:00 a.m. and 11:00 p.m. on training days. Samples from the basketball group showed a significantly higher cortisol secretion. Moreover, from the second night, the pattern of cortisol secretion of these players was reversed, showing higher levels of cortisol in saliva at night than in the morning. The results suggest that the secretion rhythm changed over the course of the week and according to competitive demands.

To evaluate the serum cortisol, salivary cortisol, and serum interleukin-1 B level in patients of chronic periodontitis with smoking and stress and without smoking and stress

The role of cognitive, social and biological factors in the etiology of chronic periodontitis has been reported.The aim of this study was to evaluate the salivary cortisol level and interleukin-1 B level in patients of Chronic periodontitis in smokers and stress and nonsmokers without stress.The design of study randomized, prospective, double-blinded, and prospective study.The total sample size was comprised of 600 subjects between the ages of 20 and 50 years. The sample size was divided into 300 males and 300 females. Out of 600 subjects, 200 subjects comprised of subjects with chronic periodontitis with positive depression level with a history of smoking (Group I), 200 subjects comprised of subjects with chronic periodontitis without depression and without smoking (Group II), and 200 subjects who were taken as the control group comprised of healthy subjects without chronic periodontitis, without depression level, and no smoking history (Group III). Salivary cortisol levels were determined by enzyme-linked immunosorbent assay (ELISA).The result showed that there was a positive correlation between morning and evening salivary cortisol level in all the groups with correlation coefficient. There was significant higher value of salivary cortisol in Group I patients when compared with Group II and Group III. However, when the comparison of salivary cortisol levels was done between the Group II and Control group, the result showed nonsignificant P value.It is suggested that stress is positively correlated with the salivary cortisol levels in smokers and nonsmokers.

Cardiorespiratory Fitness, Blood Pressure and Ethnicity Are Related to Salivary Cortisol Responses after an Exercise Test in Children: The ExAMIN Youth SA Study

BACKGROUND

Childhood elevated circulatory stress mediators such as cortisol seem to play an important role in the development of hypertension and metabolic disorders later in life. Little is known about the association of body composition, cardiorespiratory fitness (CRF), blood pressure (BP) and ethnicity with cortisol reactivity in young children.

METHODS

In this cross-sectional study, 324 black and 227 white school children (aged 7.4 ± 1.0 years) were screened for salivary cortisol reactivity, body mass index, BP and CRF (shuttle run) by standardised assessments for children.

RESULTS

Children in the lower cortisol reactivity percentile (<25th) had a higher heart rate (87.0 ± 12.9 bpm) and a lower CRF (3.1 ± 1.3 stages) compared to children in the upper (>25th) percentile (86.2 ± 11.5 bpm and 3.5 ± 1.7 stages, respectively). At baseline, children of black ethnicity had a higher cortisol level (p < 0.001). Immediately before the exercise test, no associations of obesity, BP, CRF and ethnicity with cortisol levels were found. In analysis of covariance (ANCOVA) we found that low CRF, high BP and black ethnicity were independently associated with lower cortisol reactivity by performing the shuttle run test (p < 0.01).

CONCLUSION

Low CRF and high BP were associated with lower cortisol reactivity after a cardiorespiratory exercise test. Black children showed a lower cortisol reactivity which may contribute to the earlier onset of hypertension reported in black compared to white populations. Primary prevention programs need to focus on improving physical fitness to reduce the growing prevalence of cardiometabolic disorders during childhood.

Connections between Different Sports and Ergogenic Aids-Focusing on Salivary Cortisol and Amylase

Athletes are exposed to a tremendous amount of stress, both physically and mentally, when performing high intensity sports with frequent practices, pushing numerous athletes into choose to use ergogenic aids such as caffeine or β-alanine to significantly improve their performance and ease the stress and pressure that is put onto the body. The beneficial or even detrimental effects of these so-called ergogenic aids can be appreciated through the use of numerous diagnostic tools that can analyze various body fluids. In the recent years, saliva samples are gaining more ground in the field of diagnostic as it is a non-invasive procedure, contains a tremendous amount of analytes that are subject to pathophysiological changes caused by diseases, exercises, fatigue as well as nutrition and hydration. Thus, we describe here the current progress regarding potential novel biomarkers for stress and physical activity, salivary α-amylase and salivary cortisol, as well as their use and measurement in combination with different already-known or new ergogenic aids.

A School Intervention Helps Decrease Daily Stress While Enhancing Social Integration in Children

Stress coping is highly relevant during childhood. This study analyses how the participation in a behavioral intervention involving mindfulness-based practices and empathic collaboration activities impact on diurnal cortisol rhythm and social integration in children. In both experimental and waitlist groups, we evaluated before and after the intervention: daily stress, by sampling salivary cortisol at three measurement time-points, and social integration, assessed by a social preference index. Daily average cortisol (DAC) and the area under the curve (AUC) differed when comparing pre-post intervention values in both groups: in the experimental group these measures decreased while in the waitlist group DAC and AUC increased. At the end of the intervention, the experimental group showed an enhancement in the social preference index whereas this parameter diminished in the waitlist group. This kind of behavioral intervention seems to be effective at reducing daily stress and improving social integration in Primary School children.

Everyday moral decision-making after acute stress exposure: do social closeness and timing matter?

There is increasing empirical evidence that social distance and timing affect prosocial behavior after acute stress exposure. The present study focused on everyday moral decision-making after acute psychosocial stress and how it is influenced by effects of social closeness and timing. We exposed 40 young healthy men to the Trier Social Stress Test (TSST, n = 20) or its non-stressful placebo version (PTSST, n = 20). Moral decision-making was assessed early (+10 until +30 min) and late (+75 until +95 min) after (P)TSST exposure by the Everyday Moral Conflict Situations (EMCS) Scale. The EMCS Scale requests altruistic versus egoistic responses to everyday moral conflict situations with varying closeness of target persons. Results revealed significantly higher total percentages of altruistic decisions in the stress than in the control condition and for scenarios involving socially close (e.g., mother) versus socially distant (e.g., stranger) protagonists, while the main effect of timing was nonsignificant. Only secondary analyses showed increased altruistic decision-making after acute stress exposure toward socially close but not toward distant protagonists at the early but not at the late point of measurement. Moreover, psychological stress responses and personality traits were significantly associated with EMCS scores. Positive correlations between cortisol levels and altruistic decision-making were descriptively observable, but did not reach statistical significance. In sum, our findings suggest increased altruistic decision-making toward socially close compared to socially distant protagonists and provide further evidence that acute stress influences decision-making in everyday moral conflict scenarios in a prosocial manner.Lay summaryIn order to investigate the effects of acute stress on everyday moral decision-making, 40 young healthy men were exposed to moderate psychosocial stress by the use of the Trier Social Stress Test (TSST) or its non-stressful placebo version and then completed a hypothetical everyday moral decision-making paradigm. Our findings provide evidence that acute stress exposure influences decision-making in everyday moral conflict situations in a prosocial manner. Furthermore, participants decided more altruistically in scenarios involving socially close (e.g., mother) versus socially distant (e.g., stranger) protagonists.

Smaller Cortisol Awakening Responses Are Associated with Greater Visual Dependence in Postural Control

There are known links between the hypothalamic–pituitary–adrenal (HPA) axis and systems responsible for regulating posture. Our aim was to explore directly, for the first time, whether an aspect of circadian HPA axis activity (the cortisol awakening response: CAR) was associated with greater visual dependency in postural control. For measurement of the CAR, electronically monitored saliva samples were collected by participants following morning awakening in their home environment. On the afternoons of the same days, postural sway was measured in the laboratory by exposing participants to static (control) and moving visual stimuli whilst standing still and upright on a force platform. Visual dependence was assessed as the increase in postural sway (path length) during exposure to the moving compared with the static condition. The 44 measurement days were derived from four days for each of eleven healthy participants (mean ± SD age: 51.18 ± 3.3 years). As expected, postural sway was greater when exposed to moving versus static cues. Mixed regression modelling showed that participants with smaller four day average CARs had greater deterioration in postural sway when presented with moving stimuli. These data are the first to document associations between the CAR and visual dependency in postural sway.

Salivary Markers of Stress in Grandparents Rearing Grandchildren in Rural Appalachia: The Role of Mental Health, Religiosity, and Social Support

This study examines changes in salivary cortisol and alpha-amylase among grandparents rearing grandchildren in rural Appalachia. Grandparent-caregivers experience greater stress than non-grandparent-caregivers. Participants included 20 grandparent-caregivers and a child for which they cared, who completed questionnaires assessing family functioning and mental health via interview. Grandparent-caregivers provided morning saliva samples once a year for two years. For grandparent-caregivers low in social support and religiosity, grandparent-caregiver depressive symptoms, child depressive symptoms, and child stress were associated with increased grandparent-caregiver salivary alpha-amylase. For grandparent-caregivers high in social support and religiosity, child depressive symptoms, child stress, and child aggression were associated with increased grandparent-caregiver cortisol.

Examining the same-day relationship between morning cortisol after awakening, perceived stress in the morning, and physical activity in youth

Most children in the United States currently do not meet physical activity (PA) guidelines, and perceived stress is a known barrier against PA. However, most studies have solely focused on the between-subject (BS) association of stress and PA, whereas the within-subject (WS) relationship remains under-studied in children. This limits our understanding of day-level psychosocial factors that influence children's PA engagement. This study assessed the same-day associations of the Morning Cortisol after Awakening (MCA) and morning perceived stress with moderate-to-vigorous physical activity (MVPA) in children using Ecological Momentary Assessment (EMA) methodologies. The analytic sample consisted of 143 children from Los Angeles in the Mothers and Their Children's Health (MATCH) study. Children collected four saliva samples and wore accelerometers to assess MVPA minutes across four days (two weekdays and two weekend days) during each data collection wave. On weekend days, they also answered a mobile phone EMA survey on perceived stress within 1 h of awakening. Data from four assessment waves, each approximately six months apart, were combined and analyzed cross-sectionally. Multilevel modeling, which adjusts for the nested data structure, was used to test the same-day associations of MCA and weekend morning perceived stress with MVPA. On weekend days when morning perceived stress was higher than usual, participants engaged in more MVPA on the same day (β = 0.79, SE = 0.32, p = 0.02), but no association was found between MCA and MVPA. These findings elucidate same-day factors that predict MVPA in children and inform future WS studies on stress and PA.HighlightIt is unknown how stress influences children's daily activity levels. We tested if two types of stress (self-reported and saliva-measured) are related to children's daily activity. We found that self-reported stress is associated with physical activity, but saliva-measured stress is not.

Reliability of salivary cortisol and testosterone to a high-intensity cycling protocol to highlight overtraining

Athletes physically overload to improve performance. Unbalanced stress/recovery may induce overtraining, which is difficult to diagnosis as no diagnostic marker exists. Hormonal responses to a 55/80 cycle (30-min of alternating blocks of 1-min at 55% and 4-min at 80% maximum work rate) may highlight early-stage overtraining (overreaching), as blunted cortisol and testosterone responses to 55/80 follows intensified training. However, the reliability of hormonal responses to 55/80 when not overreached is unknown. Therefore, reported blunted hormonal responses could be due to inconsistent cortisol and testosterone responses to 55/80. Participants (n = 23) completed three 55/80 bouts, >7 days apart, with no exercise 24 h pre-trials. Pre-exercise urine osmolality and stress questionnaire responses were measured. Pre, post, and 30-min post-exercise saliva samples were collected for cortisol and testosterone assessment. Salivary cortisol and testosterone responses, osmolality and well-being were not different between trials. Salivary cortisol and testosterone elevated from pre- to post-exercise [by 4.2 nmol^.L^-1 (cortisol) and 307 pmol^.L^-1 (testosterone)], and 30 min post-exercise [by 160 pmol^.L^-1 (testosterone) only]. Intraclass correlation coefficients for pre to peak post-exercise cortisol (0.89; good) and testosterone (0.53; moderate) were calculated. This demonstrates that 55/80 induces reliable elevations of salivary cortisol and testosterone when in a healthy state.

An experimental approach for exploring the impacts of work stress on unsafe behaviors

Previous studies have indicated that work stress has a significant impact on unsafe behaviors. This study explored the impacts of work stress on unsafe behaviors quantitatively using experimental methodology by developing a representative operation task to simulate the actual work in coal mines. The participants' work stress and unsafe behaviors were measured by the salivary cortisol concentrations and error rates, respectively. The results indicated that the experimental scenarios could effectively induce work stress, and there was a critical point from where unsafe behaviors were considerably minimized. When the stress level was below the critical point, there was a linear relationship between unsafe behaviors and the stress level. When the stress level was above the critical point, there was a quadratic relationship between them. The stress level below and above the critical point indicated challenge stress and hindrance stress, respectively. The results illustrated the feasibility of the experimental design, providing new ideas to eliminate unsafe behaviors induced by work stress among miners.

The Effect of Different Feeding Systems on Salivary Cortisol Levels during Gestation in Sows on Herd Level

Simple Summary

Physiological stress increases the activity of the hypothalamic-pituitary-adrenal (HPA) axis and the secretion of cortisol, which might cross the placenta and affect foetal development. Stress in sows can be affected by management factors such as enrichment, different feed systems of the housing accommodation, and is reflected in the salivary cortisol concentration. It is unclear how stressed the sow must be before there is an impact on foetal growth, but higher levels of cortisol might affect the maturity of piglets at birth as well as their birth weight. Therefore, it could be beneficial to accommodate gestating sows in the least stressful manner, not only for piglet performance but also for sow welfare. Cortisol concentration in sows seems to be influenced by a combination of parity and feed systems, but its connection to those factors, as well as to foetal development, warrants further investigation.

Abstract

The aim of this study was to investigate herd cortisol levels as an indicator of stress during gestation in three different feeding systems. Twelve commercial Danish herds with 800 to 3050 sows were included, with either free-access feeding stall (Stall), floor feeding (Floor), or electronic sow feeding (ESF; n = 4 herds per system). Saliva samples were collected from 30 sows/herd in the gestation unit for cortisol analysis with an average of 67.2 gestation days for ESF, 72.4 days for Floor, and 68.6 days for Stall. Data on piglet birth weight (PBW) and the percentage of intrauterine growth restricted (IUGR) piglets from 452 litters (9652 piglets, 8677 liveborn) from all 12 herds were obtained on the saliva collection days. The cortisol levels in saliva increased throughout gestation (p < 0.01), and lower concentrations were observed among sows belonging to Stall (4.80 nmol/L), compared to Floor (7.03 nmol/L) and ESF (7.87 nmol/L), and that difference was significant as an independent effect in the case of ESF (p < 0.01). There was no difference between Floor and ESF or Stall and Floor (p > 0.05). An interaction was observed between parity and feeding system, with parities 4–5 in ESF herds having lower levels than other parities within the ESF system (p = 0.02).

Physiological and Perceptual Recovery-Stress Responses to an Elite Netball Tournament

PURPOSE

To investigate and explore the relationships between physiological and perceptual recovery and stress responses to elite netball tournament workloads.

METHODS

Nine elite female netballers were observed across a 3-day (T1-3), 4-match tournament. Participants provided salivary samples for cortisol and alpha-amylase analysis, completed the Short Recovery Stress Scale (SRSS), and reported session ratings of perceived exertion. Inertial measurement units and heart-rate monitors determined player load, changes of direction (COD), summated heart-rate zones, and jumps.

RESULTS

Analysis revealed 6 significant SRSS time effects: (1) decreased recovery markers of physical performance (P = .042), emotional balance (P = .034), and overall recovery (P = .001) and (2) increased perceptual stress markers of muscular stress (P = .001), negative emotional state (P = .026), and overall stress (P = .010). Salivary cortisol decreased over the tournament (T1-3) before progressively increasing posttournament with greater salivary samples for cortisol on T+2 compared with T3 (P = .014, ES = -1.29; -2.24 to -0.22]) and T+1 (P = .031, ES = -1.54; -2.51 to -0.42). SRSS overall recovery moderately negatively correlated with COD (r = -.41, P = .028) and session ratings of perceived exertion (r = -.40, P = .034). Cumulative workload did not relate to posttournament perceptual or salivary responses. Percentage change in salivary variables related (P < .05) to total player load, total COD, and overall recovery across specific cumulative time periods.

CONCLUSIONS

During and after an elite netball tournament, athletes indicated increased perceptual stress and lack of recovery. The SRSS is a valuable tool for recovery-stress monitoring in elite tournament netball. It is recommended that practitioners monitor COD due to its negative influence on perceived overall recovery.

Social, Psychological, and Behavioral Predictors of Salivary Bacteria, Yeast in Caries-Free Children

INTRODUCTION

Early childhood caries (ECC) is a complex, multifactorial oral disease that is a major public health concern because it is prevalent, profoundly alters a child's quality of life, is difficult to treat effectively, and has a distressing tendency to recur following treatment.

OBJECTIVES

The purpose of the study was to examine social, psychological, and behavioral predictors of salivary bacteria and yeast in young children at risk for ECC.

METHODS

A sample of 189 initially caries-free preschool children was assessed for child stress physiology from salivary cortisol, child and family stress exposure, diet, oral health behaviors, and sociodemographic risks. Multiple logistic regression analysis was implemented to examine the associations between these risk factors and cariogenic microorganisms: mutans streptococci (MS), lactobacilli (LB), and Candida species.

RESULTS

Higher baseline salivary cortisol (odds ratio [OR] = 6.26; 95% confidence level [CL], 1.69-23.16) and a blunted response to an acute laboratory stressor (OR = .56; 95% CL, .37-.83) were associated with an increased likelihood of elevated salivary MS (≥10⁵ colony-forming units/mL) in caries-free children. Sociodemographic risk for cariogenic microorganisms was also found. Specifically, lower education attainment of the parent/primary caregiver was associated with children being more likely to carry salivary Candida species and elevated salivary MS; in addition, children from households with an unemployed parent/primary caregiver were more likely (OR = 3.13; 95% CL, 1.2-8.05) to carry salivary Candida species and more likely (OR = 3.03; 95% CL, 1.25-7.33) to carry elevated levels of MS and/or salivary Candida and/or LB.

CONCLUSIONS

The impact of sociodemographic risk and stress physiology on cariogenic disease processes are evident prior to ECC onset. The findings provide novel data on the early onset of cariogenic processes in children and the importance of considering sociodemographic, psychosocial, and behavioral factors when judging ECC risk.

KNOWLEDGE TRANSFER STATEMENT

The findings provide valuable and novel findings that, pre-ECC onset, the caries disease process is explicable from a detailed assessment of behavioral, sociodemographic, and psychosocial stress variables.

Bedtime Salivary Cortisol as a Screening Test for Cushing Syndrome in Children

Background

Diagnosing Cushing syndrome (CS) can be challenging. The 24-hour urine free cortisol (UFC) measurement is considered gold standard. This is a laborious test, dependent on correct urine collection. Late-night salivary cortisol is easier and is used as a screening test for CS in adults, but has not been validated for use in children.

Objective

To define liquid chromatography tandem mass spectrometry (LC-MS/MS)-based cutoff values for bedtime and morning salivary cortisol and cortisone in children, and validate the results in children with and without CS.

Methods

Bedtime and morning salivary samples were collected from 320 healthy children aged 4 to 16 years. Fifty-four patients from the children’s outpatient obesity clinic and 3 children with pituitary CS were used for validation. Steroid hormones were assayed by LC-MS/MS. Cutoff levels for bedtime salivary cortisol and cortisone were defined by the 97.5% percentile in healthy subjects.

Results

Bedtime cutoff levels for cortisol and cortisone were 2.4 and 12.0 nmol/L, respectively. Applying these cutoff levels on the verification cohort, 1 child from the obesity clinic had bedtime salivary cortisol exceeding the defined cutoff level, but normal salivary cortisone. All 3 children with pituitary CS had salivary cortisol and cortisone far above the defined bedtime cutoff levels. Healthy subjects showed a significant decrease in salivary cortisol from early morning to bedtime.

Conclusions

We propose that bedtime salivary cortisol measured by LC-MS/MS with a diagnostic threshold above 2.4 nmol/L can be applied as a screening test for CS in children. Age- and gender-specific cutoff levels are not needed.

Early Evaluation of Fearfulness in Future Guide Dogs for Blind People

Fear is the leading cause of guide dog failure. Detecting the nature and causes of these fears as early as possible is the first step in preventing their occurrence. The process of habituation is a fundamental part of fear prevention. In this study, 11 puppies, all five months of age, underwent an emotional reactivity test (ERT) composed of 12 scored items, classified into three categories: unknown person (UP), sound and visual stimuli (SVS), and body sensitivity (BS). Salivary cortisol was also measured. Foster families were asked to complete a questionnaire concerning puppies' habituation. The physiological data were correlated with UP (r = 0.71) and BS scores (r = 0.67), but not with SVS scores (r = 0.16), suggesting the ability of these dogs to control themselves when faced with the latter stimulus category. Additionally, the more time a puppy spent alone, the more likely it was to be afraid of SVS (p = 0.05). A correlation, albeit moderate, was detected between cortisol and habituation scores (r = 0.48). These results give us interesting avenues to explore, particularly regarding the importance of focusing on early puppy socialization and habituation to improve the numbers of guide dog candidates becoming successful guide dogs.

Does exposure to parasites modify relationships between diurnal cortisol and leukocytes among Honduran women?

BACKGROUND

Altered hypothalamic-pituitary-adrenal (HPA) function and related changes in circulating glucocorticoids have been implicated in the pathogenesis of numerous diseases that involve dysregulated immune function. Glucocorticoid hormones have both direct and indirect modulatory effects on both pro- and anti-inflammatory aspects of the immune system, including granulocytic and lymphocytic leukocyte subsets. However, past findings are complicated by inconsistencies across studies in how glucocorticoids and immune markers interact and relate to disease risk. Some incongruencies are likely due to an overreliance on single-unit (e.g., HPA or one immune marker) measures, and a failure to consider ecological exposures that may shape the base levels or correspondence between these systems. Here, we test single-unit and diurnal measures of HPA axis and immune system interactions in a less-industrial ecological setting with relatively high parasite loads.

METHODS

In a sample of 114 Honduran women (mean age = 36 years), morning and evening blood samples were analyzed to quantify granulocytes, lymphocytes, and immunoglobulin-E (IgE). Saliva was collected over 2 days (8 samples per woman) to measure peak cortisol, cumulative cortisol, and slope of decline. These repeated measures of saliva and venous blood were used to investigate associations between single-point and diurnal salivary cortisol and leukocytes, under variable levels of past parasite exposure (proxied by IgE).

RESULTS

Individuals with less of a decline in cortisol (i.e., "flatter" decline) show less of an increase in lymphocytes (2.27% increase in cells/μL/hr; 95% CI: 0.91-7.29; p = .01) across the day compared to those with steeper cortisol decline (7.5% increase in lymphocytes; 95% CI: 5.79-9.34; p < .001). IgE levels did not modify this association. Interestingly, IgE did moderate relationships between measures of cortisol and granulocytes: diurnal cortisol was positively associated with granulocytes, only in individuals with high previous exposure to parasites. There were no consistent relationships between single-unit measures of cortisol, lymphocytes or granulocytes, regardless of past parasite exposure.

DISCUSSION

Results demonstrate that the relationship between HPA function and immune modulation cannot be fully understood without an understanding of local disease ecology. These results highlight the importance of research that seeks to identify etiologies of disease across environmental contexts.

Salivary biomarkers associated with obstructive sleep apnea: a systematic review

Introduction: This study aimed to define and characterize current literature describing salivary biomarker changes with the goal of improving diagnosis and treatment outcomes for sleep apnea.Area Covered: A search of six databases yielded 401 peer-reviewed articles published through October 2019 corresponded to 221 unique references following deduplication. Twenty studies were selected. The sample size ranged from 17 to 99. The samples were mostly whole saliva and selected glandular areas.Expert Opinion: Most targeted studies focused on the level of salivary cortisol and ɑ-amylase. One study used RNA transcriptome analysis of 96 genes. Only two explored novel targets using mass spectrometry. ɑ-amylase, myeloperoxidase, and IL-6 were among those biomarkers found associated with OSA. Cytokeratin, CystatinB, calgranulin A, and alpha-2-HS-glycoprotein are upregulated in OSA patients based on non-targeting mass spectrometry. Salivary cortisol and ɑ-amylase and others appeared to be associated with severity of OSA and OSA treatment. There were inconsistencies in saliva collection and processing protocols. More studies are needed in exploring novel biomarkers to examine if these biomarkers are capable of diagnosing and monitoring OSA through proteomics or transcriptomics. Salivary biomarkers have a potential to be a noninvasive measure for the disease diagnosis and treatment outcome monitoring for sleep apnea.

Cortisol and socioeconomic status in early childhood: A multidimensional assessment

The hypothalamic-pituitary-adrenal (HPA) axis is sensitive to early life stress, with enduring consequences for biological stress vulnerability and health (Gunnar & Talge, 2008). Low socioeconomic status (SES) is associated with dysregulation of the stress hormone cortisol in early childhood. However, a mechanistic understanding of this association is lacking. Multidimensional assessment of both SES and cortisol is needed to characterize the intricate relations between SES and cortisol function in early childhood. We assessed parent-reported family income, parent education, occupational prestige, neighborhood risk, food insecurity, and household chaos for 12-month-old infants (N = 90) and 3.5-year-old children (N = 91). Hair cortisol concentration (HCC) was obtained from parent and child, indexing chronic biological stress, and diurnal salivary cortisol was measured in the children. Controlling for parent HCC, parent education uniquely predicted infant and child HCC and, in addition, neighborhood risk uniquely predicted infant HCC. Household chaos predicted bedtime salivary cortisol concentration (SCC) for both infants and children, and infant daily cortisol output. Food insecurity was associated with flattened cortisol slope in 3.5-year-old children. Parental sensitivity did not mediate relations between SES and cortisol. Results highlight the utility of SES measures that index unpredictable and unsafe contexts, such as neighborhood risk, food insecurity, and household chaos.

The Effect of Music Therapy in Reducing Dental Anxiety and Lowering Physiological Stressors

BACKGROUND AND AIM

The anxiolytic effects of music have been studied during the past twenty years in different medical therapies. The aim of this study is to evaluate the effect of music therapy on patients' dental anxiety, salivary cortisol, heart rate, blood pressure and body temperature during dental treatment.

METHODS

In this randomized control study, 46 patients were randomly selected from the Urgent Care dental clinic who needed urgent endodontic treatment (endodontic access and pulp extirpation). Participants were divided into two groups: intervention group (N=23) which was exposed to slow rhythm melody music and had no lyrics throughout the entire procedure and a control group (N=23) who undergoes the same dental procedure without being exposed to music. Participants' blood pressure, heart rate, body temperature and salivary cortisol were measured before and after the treatment for both groups.

RESULTS

Patients in the intervention group showed lower salivary cortisol, blood pressure, heart rate and body temperature compared to those in the control group, however, the differences did not reach to statistical significance.

CONCLUSION

-Despite the change in the dental anxiety and stress during treatment with music, the findings of this study could not establish evidence of the effect of music in reducing dental anxiety and lowering physiological stressors. Therefore, further studies with larger sample size may be needed. (www.actabiomedica.it).