Skip to main content

Advertisement

Log in

Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

Dental anxiety level has been previously associated with oral health status. Since general anesthesia (GA) allows dental treatments to be performed in anxious children with a high number of caries, we aimed to evaluate the dental anxiety levels of these children before and after dental treatments performed under GA.

Materials and methods

Thirty-eight children with high anxiety aged between 35 and 72 months who required multiple dental treatments to be performed under GA were included in the study. Frankl’s Behavior Rating Scale, sitting patterns, Facial Image Scale, and Children’s Fear Survey Schedule-Dental Subscale (completed by the children’s parents) were recorded before and after the dental treatments performed under GA. Pre-treatment and post-treatment biochemical parameters, including cortisol, alpha-amylase, and chromogranin A levels, in saliva and serum samples were also evaluated.

Results

The psychometric scales showed a statistically significant reduction in the post-treatment dental anxiety levels of the children compared with the pre-treatment anxiety levels. Additionally, the biochemical parameters measured in the serum and whole saliva samples showed a decrease after treatments performed under GA.

Conclusions

Our study results suggest that performing dental treatments under GA can reduce the dental anxiety levels of children with a high number of caries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lee CY, Chang YY, Huang ST (2007) Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children. J Public Health Dent 67(1):36–41. https://doi.org/10.1111/j.1752-7325.2007.00006.x

    Article  PubMed  Google Scholar 

  2. Holmes RD, Girdler NM (2005) A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management. Int J Paediatr Dent 15(3):169–176. https://doi.org/10.1111/j.1365-263X.2005.00633.x

    Article  PubMed  Google Scholar 

  3. Chapman HR, Kirby-Turner N (2002) Visual/verbal analogue scales: examples of brief assessment methods to aid management of child and adult patients in clinical practice. Br Dent J 193(8):447–450. https://doi.org/10.1038/sj.bdj.4801593

    Article  PubMed  Google Scholar 

  4. Noorani H, Joshi HV, Shivaprakash P (2014) Salivary alpha amylase as a noninvasive biomarker for dental fear and its correlation with behavior of children during dental treatment. Int J Clin Pediatr Dent 7(1):19–23. https://doi.org/10.5005/jp-journals-10005-1227

    PubMed  PubMed Central  Google Scholar 

  5. Benjamins C, Asscheman H, Schuurs AH (1992) Increased salivary cortisol in severe dental anxiety. Psychophysiology 29(3):302–305. https://doi.org/10.1111/j.1469-8986.1992.tb01703.x

    Article  PubMed  Google Scholar 

  6. Noto Y, Sato T, Kudo M, Kurata K, Hirota K (2005) The relationship between salivary biomarkers and state-trait anxiety inventory score under mental arithmetic stress: a pilot study. Anesth Analg 101(6):1873–1876. https://doi.org/10.1213/01.ANE.0000184196.60838.8D

    Article  PubMed  Google Scholar 

  7. Takai N, Yamaguchi M, Aragaki T, Eto K, Uchihashi K, Nishikawa Y (2004) Effect of psychological stress on the salivary cortisol and amylase levels in healthy young adults. Arch Oral Biol 49(12):963–968. https://doi.org/10.1016/j.archoralbio.2004.06.007

    Article  PubMed  Google Scholar 

  8. Krueger TH et al (2005) The dental anxiety scale and effects of dental fear on salivary cortisol. Percept Mot Skills 100(1):109–117. https://doi.org/10.2466/pms.100.1.109-117

    Article  PubMed  Google Scholar 

  9. Kanegane K, Penha SS, Munhoz CD, Rocha RG (2009) Dental anxiety and salivary cortisol levels before urgent dental care. J Oral Sci 51(4):515–520. https://doi.org/10.2334/josnusd.51.515

    Article  PubMed  Google Scholar 

  10. Nakane H, Asami O, Yamada Y, Ohira H (2002) Effect of negative air ions on computer operation, anxiety and salivary chromogranin A-like immunoreactivity. Int J Psychophysiol 46(1):85–89. https://doi.org/10.1016/S0167-8760(02)00067-3

    Article  PubMed  Google Scholar 

  11. Nicolas E et al (2010) Factors affecting dental fear in French children aged 5-12 years. Int J Paediatr Dent 20(5):366–373. https://doi.org/10.1111/j.1365-263X.2010.01054.x

    Article  PubMed  Google Scholar 

  12. Rantavuori K, Lahti S, Hausen H, Seppä L, Kärkkäinen S (2004) Dental fear and oral health and family characteristics of Finnish children. Acta Odontol Scand 62(4):207–213. https://doi.org/10.1080/00016350410001586

    Article  PubMed  Google Scholar 

  13. Skaret E et al (2007) Psychological characteristics of Norwegian adolescents reporting no likelihood of visiting a dentist in a situation with toothache. Int J Paediatr Dent 17(6):430–438. https://doi.org/10.1111/j.1365-263X.2007.00869.x

    Article  PubMed  Google Scholar 

  14. Venham L, Quatrocelli S (1977) The young child's response to repeated dental procedures. J Dent Res 56(7):734–738. https://doi.org/10.1177/00220345770560070501

    Article  PubMed  Google Scholar 

  15. Frankl SN, Shiere FR, Fogels HR (1962) Should the parent remain with the child in the dental operatory? ASDC J Dent Child 29:150–163

    Google Scholar 

  16. Yamada MK et al (2002) Cooperation during dental treatment: the Children’s Fear Survey Schedule in Japanese children. Int J Paediatr Dent 12(6):404–409. https://doi.org/10.1046/j.1365-263X.2002.00399.x

    Article  PubMed  Google Scholar 

  17. Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V (2013) Evaluation of dental fear in children during dental visit using children’s fear survey schedule-dental subscale. Int J Clin Pediatr Dent 6(1):12–15. https://doi.org/10.5005/jp-journals-10005-1178

    Article  PubMed  PubMed Central  Google Scholar 

  18. Buchanan H, Niven N (2002) Validation of a facial image scale to assess child dental anxiety. Int J Paediatr Dent 12(1):47–52

    PubMed  Google Scholar 

  19. Thomson WM, Broadbent JM, Locker D, Poulton R (2009) Trajectories of dental anxiety in a birth cohort. Community Dent Oral Epidemiol 37(3):209–219. https://doi.org/10.1111/j.1600-0528.2009.00473.x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mittal N et al (2015) Effects of deep sedation on future anxiety and behavior in a pediatric dental setting: a prospective report. J Dent Oral Health 1(2):1–4

    Google Scholar 

  21. Peretz B, Faibis S, Ever-Hadani P, Eidelman E (2000) Children with baby bottle tooth decay treated under general anesthesia or sedation: behavior in a follow-up visit. J Clin Pediatr Dent 24(2):97–101

    PubMed  Google Scholar 

  22. Camilleri A, Roberts G, Ashley P, Scheer B (2004) Analysis of paediatric dental care provided under general anaesthesia and levels of dental disease in two hospitals. Br Dent J 196(4):219–223; discussion 213. https://doi.org/10.1038/sj.bdj.4810988

    Article  PubMed  Google Scholar 

  23. Milsom KM, Tickle M, Humphris GM, Blinkhorn AS (2003) The relationship between anxiety and dental treatment experience in 5-year-old children. Br Dent J 194(9):503–506; discussion 495. https://doi.org/10.1038/sj.bdj.4810070

    Article  PubMed  Google Scholar 

  24. Kuscu OO, Akyuz S (2006) Children’s preferences concerning the physical appearance of dental injectors. J Dent Child (Chic) 73(2):116–121

    Google Scholar 

  25. Cantekin K, Yildirim MD, Delikan E, Cetin S (2014) Postoperative discomfort of dental rehabilitation under general anesthesia. Pak J Med Sci 30(4):784–788

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cantekin K, Yildirim MD, Cantekin I (2014) Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia. Pediatr Dent 36(1):12E–17E

    PubMed  Google Scholar 

  27. Klein U, Manangkil R, DeWitt P (2015) Parents’ ability to assess dental fear in their six- to 10-year-old children. Pediatr Dent 37(5):436–441

    PubMed  Google Scholar 

  28. Sreebny LM (2000) Saliva in health and disease: an appraisal and update. Int Dent J 50(3):140–161. https://doi.org/10.1111/j.1875-595X.2000.tb00554.x

    Article  PubMed  Google Scholar 

  29. Rodrigues Gomes SS, Barretobezerra AC, Maia Prado AC (2013) Salivary biomarkers, vital signs and behaviour of pre-school children during their first dental visit. Eur J Paediatr Dent 14(4):279–283

    PubMed  Google Scholar 

  30. Furlan NF, Gaviäo MBD, Barbosa TS, Nicolau J, Castelo PM (2012) Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children. J Clin Pediatr Dent 37(1):83–87. https://doi.org/10.17796/jcpd.37.1.n32m21n08417v363

    Article  PubMed  Google Scholar 

  31. Scannapieco FA, Bergey EJ, Reddy MS, Levine MJ (1989) Characterization of salivary alpha-amylase binding to Streptococcus sanguis. Infect Immun 57(9):2853–2863

    PubMed  PubMed Central  Google Scholar 

  32. Martins C, Buczynski AK, Maia LC, Siqueira WL, Castro GFBA (2013) Salivary proteins as a biomarker for dental caries—a systematic review. J Dent 41(1):2–8. https://doi.org/10.1016/j.jdent.2012.10.015

    Article  PubMed  Google Scholar 

  33. Nater UM, la Marca R, Erni K, Ehlert U (2015) Alpha-amylase activity in blood increases after pharmacological, but not psychological, activation of the adrenergic system. PLoS One 10(6):e0130449. https://doi.org/10.1371/journal.pone.0130449

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fukui M, Hinode D, Yokoyama M, Yoshioka M, Kataoka K, Ito HO (2010) Levels of salivary stress markers in patients with anxiety about halitosis. Arch Oral Biol 55(11):842–847. https://doi.org/10.1016/j.archoralbio.2010.07.014

    Article  PubMed  Google Scholar 

  35. Abrao AL, Leal SC, Falcao DP (2014) Salivary and serum cortisol levels, salivary alpha-amylase and unstimulated whole saliva flow rate in pregnant and non-pregnant. Rev Bras Ginecol Obstet 36(2):72–78. https://doi.org/10.1590/S0100-72032014000100005

    Article  PubMed  Google Scholar 

  36. Zhang D, Lavaux T, Sapin R, Lavigne T, Castelain V, Aunis D, Metz-Boutigue MH, Schneider F (2009) Serum concentration of chromogranin A at admission: an early biomarker of severity in critically ill patients. Ann Med 41(1):38–44. https://doi.org/10.1080/07853890802199791

    Article  PubMed  Google Scholar 

  37. Porritt J, Marshman Z, Rodd HD (2012) Understanding children’s dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 22(6):397–405. https://doi.org/10.1111/j.1365-263X.2011.01208.x

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by the Bezmialem Vakif University Scientific Research Committee with a protocol number 3.2016/5.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Meltem Bakkal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article reports a study that involved human participants. All the procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Clinical relevance

1. Salivary biomarkers appear to be reliable in stress research.

2. Salivary stress biomarkers provide an objective method for measuring anxiety in children.

3. Children seem to have a reduced anxiety level after they become caries free.

4. General anesthesia helps children become caries free in a single-session procedure.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yıldırım, S., Bakkal, M., Bulut, H. et al. Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia. Clin Oral Invest 22, 2373–2380 (2018). https://doi.org/10.1007/s00784-018-2340-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-018-2340-2

Keywords

Navigation