Salivary Cortisol Response to Acute Stress in Children with Early Childhood Caries

Background: Cortisol level is the best known marker of acute stress.

Methods: The study was carried out in Volgograd Pediatric Dental Clinic with approval from the regional Ethics Committee. The parents´ informed consents were obtained. 36 children aged 18-83 month with Early Childhood Caries (ECC) with positive or definitely positive behavior (according to Frankl scale) were included into the study. The children were randomly assigned to 2 treatment groups: CT (n=17) - conventional (drilling and filling) and NIT (n=18) - non-invasive cavitated lesion sealing. The children were subsequently stratified into subgroups according to the children´s age: CT1 (n=9) and NT1 (n=8) included 18-48-month-old children (mean age 28.8±10.9), CT2 (n=8) and NT2 (n=10) included 49-83-month-old children (mean age 64.8±11.2). Unstimulated saliva was collected before and after dental treatment. The CL level in saliva was analyzed using ‘Hema’ immunoassay (Russia). Wilcoxon test was used to compare the results, with p-value being significant <0.05.

Results: In the CT group the post-treatment CL level was significantly higher than the pre-treatment level in both age-related groups (CT: 1.6 ng/ml and 2.3ng/ml, respectively, p=0.01. In the NT1 group the post-treatment CL level was slightly higher than the pre-treatment one (1.2ng/ml and 1.6ng/ml, respectively, p=0.01). Nevertheless, in the NT2 group the post-treatment CL level was significantly lower than the pre-treatment one (1.5 ng/ml and 0.9 ng/ml, respectively, p=0.007).

Conclusion: Conventional methods of dental treatment show elevated cortisol levels both in small children and in pre-school children. Non-invasive methods show decreased cortisol levels in pre-schoolers as compared to elevated ones in very small children. Our findings suggest that the invasive methods of treatment contribute to significant cortisol response to stress during the treatment. Non-invasive methods show decreases in cortisol responses to stress only in 4-6-year-olds.