/pdf/relacao-entre-ansiedade-odontologica-e-cortisol-salivar-em-54n5fgbhh8.pdf

Relação entre ansiedade odontológica e cortisol salivar em pacientes submetidos à exodontia de terceiros molares inferiores

Summary Objective The aim of this study was to determine whether salivary cortisol measured by a simple enzyme immunoassay (EIA) could be used as a surrogate for serum total cortisol in response to rapid changes and across a wide range of concentrations. Design Comparisons of matched salivary and serum samples in response to dynamic hypothalamic‐pituitary‐adrenal (HPA) axis testing. Subjects Healthy women ( n = 10; three taking oral oestrogens) and men ( n = 2), aged 23‐ 65 years, were recruited from the community. Measurements Paired saliva and serum samples were obtained during three protocols: 10 min of exercise at 90% of maximal heart rate ( n = 8), intravenous administration of corticotrophin-releasing hormone (CRH; n = 4), and dexamethasone suppression ( n = 7). Cortisol was measured in saliva using a commercial high-sensitivity EIA and total cortisol was measured in serum with a commercial radioimmunoassay (RIA). Results The time course of the salivary cortisol response to both the exercise and CRH tests paralleled that of total serum cortisol. Salivary cortisol demonstrated a significantly greater relative increase in response to the exercise and CRH stimuli (697 ± 826% vs. 209 ± 150%, P = 0·04 saliva vs. serum). A disproportionately larger increase in free cortisol, compared with total, would be expected when the binding capacity of cortisol-binding globulin (CBG) is exceeded. In response to dexamethasone suppression, relative decreases in cortisol were not significantly different between the two media ( − 47 ± 56% vs. − 84 ± 8%, P = 0·13 saliva vs. serum). Although a significant linear correlation was found for all paired salivary and serum total cortisol samples ( n = 183 pairs, r = 0·60, P < 0·001), an exponential model provided a better fit ( r = 0·81, P < 0·001). The linear correlations were strengthened when data from subjects on oral oestrogens ( n = 52 pairs, r = 0·75, P < 0·001) were separated from those not taking oestrogens ( n = 131 pairs, r = 0·67, P < 0·001). Conclusions Salivary cortisol measured with a simple EIA can be used in place of serum total cortisol in physiological research protocols. Evidence that salivary measures represent the biologically active, free fraction of cortisol includes: (1) the greater relative increase in salivary cortisol in response to tests that raise the absolute cortisol concentration above the saturation point of CBG; (2) the strong exponential relationship between cortisol assessed in the two media; and (3) the improved linear correlations when subjects known to have increased CBG were analysed separately. Thus, an advantage of measuring salivary cortisol rather than total serum cortisol is that it eliminates the need to account for within-subject changes or between-subject differences in CBG.

https://www.hormonebalance.org/images/documents/Salivary%20not%20serum%20cortisol%20CE%2005.pdf

Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic–pituitary–adrenal axis activity

Background The authors review measures of anxiety and pain used in recent dental studies. In particular, the study identifies the reliability, validity and usefulness of the measures. Type of Studies Reviewed Three computerized databases of published scientific literature were searched over a 10-year period. Only studies that included measures of anxiety or pain were included. Results Information on the reliability and validity of 15 measures of dental care anxiety and three measures of pain and pain-related behaviors is provided. Reliability and validity data for most measures are good. Corah's Dental Anxiety Scale is the most widely used measure of anxiety, although it may not be as sensitive as other measures. The McGill Pain Questionnaire is the measure of choice for the assessment of pain. Clinical Implications The authors have summarized properties of the scales for clinicians and researchers planning to use measures of anxiety, measures of pain, or both.

Anxiety and pain measures in dentistry: a guide to their quality and application

This study attempted to predict postoperative pain from preoperative level of anxiety and the amount of information patients possessed regarding their surgery. Pain was assessed via the McGill Pain Questionnaire (MPQ) and a measure of pain complaints--number of analgesics taken. High levels of state anxiety and a high degree of information predicted the Present Pain Intensity measured of the MPQ, but did not predict the Pain Rating Index portion of the MPQ. The number of analgesics taken was predicted from the amount of information but not the level of presurgical anxiety. Biographical variables were unrelated to postoperative pain. The results were discussed in terms of State-Trait Anxiety theory, Janis' curvilinear prediction model and a contextual perspective of information imparting.

Preoperative predictors of postoperative pain

–Objectives: To document the incidence of dental anxiety among individuals aged 18 years at baseline and 26 years at follow-up, and to determine if dental treatment experience continues to play a significant etiological role with respect to the onset of dental anxiety in young adults. Methods: Dental anxiety scale (DAS; Corah, 1969) scores at ages 15, 18 and 26 were obtained for Study members in the Dunedin Multidisciplinary Health and Development Study. Dental examinations were conducted, and sociodemographic and dental service-use data were collected using a self-report questionnaire. Using a case definition of a DAS score of 13 or more, age 18–26 incident cases were identified and their dental treatment experience and service-use characteristics compared with the remainder. Results: DAS scores at 18 and 26 were available for 792 (80.8%) of the 980 26-year-old Study members. An increase in dental anxiety prevalence was observed over the eight-year period, with an annualized incidence of 2.1%. Fewer incident cases had visited a dentist in the previous eight years, and there were no differences between incident cases and others in their eight-year DFS, FS or tooth-loss increments. A subgroup of “recurrent” cases was identified who were dentally anxious at 15 and 26 but not at 18, and their eight-year incidence of tooth loss due to caries was substantially higher than non-cases. Conclusions: Aversive conditioning experiences appear to be unrelated to the adult onset of dental anxiety, and it may be that particular temperamental or psychological traits are associated with the condition.

Incidence of dental anxiety in young adults in relation to dental treatment experience.

Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.

Relação entre ansiedade odontológica e cortisol salivar em pacientes submetidos à exodontia de terceiros molares inferiores

References

Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic–pituitary–adrenal axis activity

Anxiety and pain measures in dentistry: a guide to their quality and application

Preoperative predictors of postoperative pain

Incidence of dental anxiety in young adults in relation to dental treatment experience.

What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting