Utility of salivary biomarker for stress induced by dental treatment

A study protocol for a single-centred randomized trial to investigate the effect of pre-treatment communication methods on dental anxiety among adult dental patients

Objective

Optimal oral health is an essential component of good quality of life. However, this may be hindered by dental anxiety (DA), thereby, affecting the utilization of dental services. DA could be alleviated by pre-treatment information; however, the method of delivering this information is yet to be explored. It is, therefore, necessary to assess the modes of presenting pre-treatment information to ascertain the one with significant effect on DA. This will improve treatment outcomes and quality of life for individuals. Hence, the primary objective is to assess the effect of audiovisual and written forms of pre-treatment information on DA, while the secondary objective will compare the subjective and objective methods of assessing DA with psychometric anxiety scale (Index of Dental Anxiety and Fear (IDAF)-4C+) and salivary alpha-amylase respectively.

Study design

Single-centred, single-blind, parallel-group, four-arm randomized clinical trial.

Methods

The study will compare the effects of audiovisual and written forms of pre-treatment information on DA among adults. Patients 18 years and above scheduled for dental treatment will be screened for eligibility. Written informed consent will be sought before participation. Participants will be allocated randomly using block randomization, to the groups; G1: audiovisual and G2: a written form of pre-treatment information. At the visit, participants will complete the DA questionnaires (IDAF-4C+, Modified Dental Anxiety Scale and Visual Analogue Scale). Physiological anxiety-related changes of salivary alpha-amylase will be measured using a point-of-care kit (iPro oral fluid collector) at baseline, and 10 min after intervention. Furthermore, blood pressure will be taken at baseline and 20 min into the treatment. The mean changes of physiologic anxiety levels and 95% confidence intervals will be compared between the methods of pre-treatment information.

Discussion

This study hopes to establish pre-treatment information as a method for reducing DA among the populace. Also, to assess the relationship between questionnaire-based and physiologic methods of assessing DA.

Evaluating the activity of salivary enzymes as stress biomarkers under psychological stress and their relationship with rumination and personality traits

BACKGROUND

Salivary enzymes are used as non-invasive biomarkers to assess the activity of the sympathetic-adrenal-medullary system. The aim of this study was to evaluated levels of acid phosphatase, beta-glucuronidase and cathepsin salivary enzymes under psychological tension and their connection with rumination and personality traits.

METHODS

A total of 60 medical students, who wanted to participate in the final exam, two months before the exam, the inventory emotional control questionnaire and the neo-short form were completed. Saliva samples were taken in both the basal conditions and under exam stress.

RESULTS

A significant difference was found between the mean of level salivary enzymes in rest and under exam stress. Also, we found a positive and significant correlation between the activity of salivary enzymes and personality traits such as neuroticism, extraversion, agreeableness and rumination (p < .01, p < .05) level. Neuroticism, agreeableness and rumination predicted 45% of the variance of salivary acid phosphatase, neuroticism and rumination predicted 49% of the variance of salivary beta-glucuronidase and neuroticism, extraversion and rumination predicted 38% of the variance of salivary cathepsin under stress exam.

CONCLUSION

The results of this study show, levels of salivary enzymes may increase in individuals with traits of neuroticism, extraversion, agreeableness and rumination through response to psychological stressors.

Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students

OBJECTIVE

The purpose of this study was to evaluate the salivary testosterone levels under psychological stress and its relationship with rumination and five personality traits in medical students.

METHODS

A total of 58 medical students, who wanted to participate in the final exam, were selected by simple random sampling. Two months before the exam, in the basal conditions, the NEO Inventory short form, and the Emotional Control Questionnaire (ECQ) were completed. Saliva samples were taken from students in both the basal conditions and under exam stress. Salivary testosterone was measured by ELISA. Data was analyzed using multivariate analysis of variance with repeated measures, paired samples t-test, Pearson correlation and stepwise regression analysis.

RESULTS

Salivary testosterone level of men showed a significant increase under exam stress (p<0.05). However, a non-significant although substantial reduction observed in women. A significant correlation was found between extroversion (r=-0.33) and openness to experience (r=0.30) with salivary testosterone (p<0.05). Extraversion, aggression control and emotional inhibition predicted 28% of variance of salivary testosterone under stress.

CONCLUSION

Salivary testosterone reactivity to stress can be determined by sexual differences, personality traits, and emotional control variables which may decrease or increase stress effects on biological responses, especially the salivary testosterone.