Article PDF first page preview

Article PDF first page preview

Introduction: Stress can impact mental and physical health, especially during adolescence and young adulthood, but the extent of its contribution to dental caries is poorly understood. The present study assessed the association between perceived stress, cortisol levels (in hair and saliva), and overall caries experience of adolescents and young adults aged 15–25 years. Methods: Hair and saliva samples were obtained from 93 participants free of periodontal disease. Cortisol in hair and saliva was determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. Sociodemographic variables were also recorded. Results: There were significantly higher hair cortisol levels and perceived stress scale (PSS) scores in individuals with dental caries experience (DMFT≥1) than in those without (DMFT = 0). However, there was no significant difference in salivary cortisol concentration. A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with increased odds of having experienced dental caries. In contrast, no significant association was found between salivary cortisol concentration and dental caries. Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for sociodemographic variables. Conclusion: Hair cortisol levels and perceived stress have a significant association with dental caries experience, whereas salivary cortisol concentrations do not.

1.
Caruso
S
,
Gatto
R
,
Cinque
B
,
Cifone
MG
,
Mattei
A
.
Association between salivary cortisol level and caries in early childhood
.
Eur J Paediatr Dent
.
2018
;
19
(
1
):
10
5
.
2.
Boyce
WT
,
Den Besten
PK
,
Stamperdahl
J
,
Zhan
L
,
Jiang
Y
,
Adler
NE
, et al
.
Social inequalities in childhood dental caries: the convergent roles of stress, bacteria and disadvantage
.
Soc Sci Med
.
2010
;
71
(
9
):
1644
52
.
3.
Lynch
R
,
Flores-Torres
MH
,
Hinojosa
G
,
Aspelund
T
,
Hauksdóttir
A
,
Kirschbaum
C
, et al
.
Perceived stress and hair cortisol concentration in a study of Mexican and Icelandic women
.
PLOS Glob Public Health
.
2022
;
2
(
8
):
e0000571
.
4.
Sabbah
W
,
Gomaa
N
,
Gireesh
A
.
Stress, allostatic load, and periodontal diseases
.
Periodontology
.
2018
;
78
(
1
):
154
61
.
5.
Jain
M
,
Singh
A
,
Sharma
A
.
Relationship of perceived stress and dental caries among pre university students in Bangalore City
.
J Clin Diagn Res
.
2014
;
8
(
11
):
ZC131
4
.
6.
Masterson
EE
,
Sabbah
W
.
Maternal allostatic load, caretaking behaviors, and child dental caries experience: a cross-sectional evaluation of linked mother: child data from the third National Health and nutrition examination survey
.
Am J Public Health
.
2015
;
105
(
11
):
2306
11
.
7.
Bosch
JA
,
Turkenburg
M
,
Nazmi
K
,
Veerman
ECI
,
de Geus
EJC
,
Nieuw Amerongen
AV
.
Stress as a determinant of saliva-mediated adherence and coadherence of oral and nonoral microorganisms
.
Psychosom Med
.
2003
;
65
(
4
):
604
12
.
8.
Sedghi
L
,
DiMassa
V
,
Harrington
A
,
Lynch
SV
,
Kapila
YL
.
The oral microbiome: role of key organisms and complex networks in oral health and disease
.
Periodontology
.
2021
;
87
(
1
):
107
31
.
9.
Nakano
R
,
Ohshima
T
,
Mukai
Y
,
Tsurumoto
A
,
Maeda
N
.
Association between dental caries prevalence and stress levels in Japanese children
.
Cureus
.
2022
;
14
(
11
):
e31074
.
10.
Hugo
FN
,
Hilgert
JB
,
Corso
S
,
Padilha
DMP
,
Bozzetti
MC
,
Bandeira
DR
, et al
.
Association of chronic stress, depression symptoms and cortisol with low saliva flow in a sample of south-Brazilians aged 50 years and older
.
Gerodontology
.
2008
;
25
(
1
):
18
25
.
11.
Peres
MA
,
Barros
AJ
,
Peres
KG
,
Araújo
CL
,
Menezes
AM
.
Life course dental caries determinants and predictors in children aged 12 years: a population-based birth cohort
.
Community Dent Oral Epidemiol
.
2009
;
37
(
2
):
123
33
.
12.
Tikhonova
S
,
Booij
L
,
D'Souza
V
,
Crosara
KTB
,
Siqueira
WL
,
Emami
E
.
Investigating the association between stress, saliva and dental caries: a scoping review
.
BMC oral health
.
2018
;
18
(
1
):
41
.
13.
Sheiham
A
,
Nicolau
B
.
Evaluation of social and psychological factors in periodontal disease
.
Periodontology
.
2000. 2005
;
39
(
1
):
118
31
.
14.
Gomaa
N
,
Glogauer
M
,
Nicolau
B
,
Tenenbaum
H
,
Siddiqi
A
,
Fine
N
, et al
.
Stressed-out oral immunity: a gateway from socioeconomic adversity to periodontal disease
.
Psychosom Med
.
2020
;
82
(
2
):
126
37
.
15.
Jesenak
M
,
Zelieskova
M
,
Babusikova
E
.
Oxidative stress and bronchial asthma in children: causes or consequences
.
Front Pediatr
.
2017
;
5
:
162
.
16.
Selwitz
RH
,
Ismail
AI
,
Pitts
NB
.
Dental caries
.
Lancet
.
2007
;
369
(
9555
):
51
9
.
17.
Yang
B
,
Tao
B
,
Yin
Q
,
Chai
Z
,
Xu
L
,
Zhao
Q
, et al
.
Associations between oral health status, perceived stress, and neuropsychiatric symptoms among community individuals with Alzheimer’s disease: a mediation analysis
.
Front Aging Neurosci
.
2021
;
13
:
801209
.
18.
Park
L
,
Gomaa
N
,
Quinonez
C
.
Racial/ethnic inequality in the association of allostatic load and dental caries in children
.
J Public Health Dent
.
2022
;
82
(
2
):
239
46
.
19.
Gomaa
N
,
Glogauer
M
,
Tenenbaum
H
,
Siddiqi
A
,
Quiñonez
C
.
Social-biological interactions in oral disease: a “cells to society” view
.
PLoS One
.
2016
;
11
(
1
):
e0146218
.
20.
Sheng
JA
,
Bales
NJ
,
Myers
SA
,
Bautista
AI
,
Roueinfar
M
,
Hale
TM
, et al
.
The hypothalamic-pituitary-adrenal axis: development, programming actions of hormones, and maternal-fetal interactions
.
Front Behav Neurosci
.
2020
;
14
:
601939
.
21.
Sugaya
N
,
Izawa
S
,
Ogawa
N
,
Shirotsuki
K
,
Nomura
S
.
Association between hair cortisol and diurnal basal cortisol levels: a 30-day validation study
.
Psychoneuroendocrinology
.
2020
;
116
:
104650
.
22.
Russell
E
,
Koren
G
,
Rieder
M
,
Van Uum
S
.
Hair cortisol as a biological marker of chronic stress: current status, future directions and unanswered questions
.
Psychoneuroendocrinology
.
2012
;
37
(
5
):
589
601
.
23.
Stalder
T
,
Kirschbaum
C
.
Analysis of cortisol in hair–state of the art and future directions
.
Brain Behav Immun
.
2012
;
26
(
7
):
1019
29
.
24.
Harris
MA
,
Cox
SR
,
Brett
CE
,
Deary
IJ
,
MacLullich
AMJ
.
Stress in childhood, adolescence and early adulthood, and cortisol levels in older age
.
Stress
.
2017
;
20
(
2
):
140
8
.
25.
Pani
SC
,
Abuthuraya
D
,
Alshammery
HM
,
Alshammery
D
,
Alshehri
H
.
Salivary cortisol as a biomarker to explore the role of maternal stress in early childhood caries
.
Int J Dent
.
2013
;
2013
:
565102
.
26.
Lenz
B
.
The transition from adolescence to young adulthood: a theoretical perspective
.
J Sch Nurs
.
2001
;
17
(
6
):
300
6
.
27.
Siqueira
L
,
Diab
M
,
Bodian
C
,
Rolnitzky
L
.
Adolescents becoming smokers: the roles of stress and coping methods
.
J Adolesc Health
.
2000
;
27
(
6
):
399
408
.
28.
Findlay
L
.
Depression and suicidal ideation among Canadians aged 15 to 24
.
Health Rep
.
2017
;
28
(
1
):
3
11
.
29.
Yu
SM
,
Bellamy
HA
,
Schwalberg
RH
,
Drum
MA
.
Factors associated with use of preventive dental and health services among U.S. adolescents
.
J Adolesc Health
.
2001
;
29
(
6
):
395
405
.
30.
Percy
MS
.
Oral health of adolescents--it's more than dental caries
.
MCN Am J Matern Child Nurs
.
2008
;
33
(
1
):
26
31
.
31.
Gazzaz
AZ
,
Carpiano
RM
,
Aleksejuniene
J
.
Socioeconomic status, social support, and oral health-risk behaviors in Canadian adolescents
.
J Public Health Dent
.
2021
;
81
(
4
):
316
26
.
32.
Abouseta
N
,
Gomaa
N
,
Dixon
SJ
,
Pani
SC
.
Neighborhood-level inequalities in dental care of adolescents and young adults in southwestern Ontario
.
Children
.
2022
;
9
(
2
):
183
.
33.
Statistics Canada
. Canadian health measures survey: cycle 1. 2007-2009. Household questionnaire.
34.
Cohen
S
,
Kamarck
T
,
Mermelstein
R
.
A global measure of perceived stress
.
J Health Soc Behav
.
1983
;
24
(
4
):
385
96
.
35.
Greff
MJ
,
Levine
JM
,
Abuzgaia
AM
,
Elzagallaai
AA
,
Rieder
MJ
,
van Uum
SH
.
Hair cortisol analysis: an update on methodological considerations and clinical applications
.
Clin Biochem
.
2019
;
63
:
1
9
.
36.
Granger
DA
,
Kivlighan
KT
,
Fortunato
C
,
Harmon
AG
,
Hibel
LC
,
Schwartz
EB
, et al
.
Integration of salivary biomarkers into developmental and behaviorally-oriented research: problems and solutions for collecting specimens
.
Physiol Behav
.
2007
;
92
(
4
):
583
90
.
37.
Petersen
PE
.
World Health Organization global policy for improvement of oral health-World Health Assembly 2007
.
Int Dent J
.
2008
;
58
(
3
):
115
21
.
38.
da Silva
AN
,
Alvares de Lima
ST
,
Vettore
MV
.
Protective psychosocial factors and dental caries in children and adolescents: a systematic review and meta‐analysis
.
Int J Paediatr Dent
.
2018
;
28
(
5
):
443
58
.
39.
Baker
SR
,
Mat
A
,
Robinson
PG
.
What psychosocial factors influence adolescents’ oral health
.
J Dent Res
.
2010
;
89
(
11
):
1230
5
.
40.
Koga
R
,
Herkrath
APCQ
,
Vettore
MV
,
Herkrath
FJ
,
Rebelo Vieira
JM
,
Pereira
JV
, et al
.
The role of socioeconomic status and psychosocial factors on gingivitis in socially disadvantaged adolescents
.
J Periodontol
.
2020
;
91
(
2
):
223
31
.
41.
Condon
EM
.
Chronic stress in children and adolescents: a review of biomarkers for use in pediatric research
.
Biol Res Nurs
.
2018
;
20
(
5
):
473
96
.
42.
Cruickshank
T
,
Porter
T
,
Laws
SM
,
Ziman
M
,
Bartlett
DM
.
Hair and salivary cortisol and their relationship with lifestyle, mood and cognitive outcomes in premanifest Huntington’s disease
.
Sci Rep
.
2021
;
11
(
1
):
5464
8
.
43.
Kambalimath
HV
,
Dixit
UB
,
Thyagi
PS
.
Salivary cortisol response to psychological stress in children with early childhood caries
.
Indian J Dent Res
.
2010
;
21
(
2
):
231
7
.
44.
Yfanti
K
,
Kitraki
E
,
Emmanouil
D
,
Pandis
N
,
Papagiannoulis
L
.
Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study
.
Stress
.
2014
;
17
(
4
):
296
304
.
45.
Angelhoff
C
,
Faresjö
T
,
Sundell
AL
.
Measuring hair cortisol concentration, insomnia symptoms and quality of life in preschool children with severe early childhood caries–a case-control pilot study
.
Acta Odontol Scand
.
2023
;
81
(
7
):
508
16
.
46.
Lazarus
RS
,
Folkman
S
.
Stress, appraisal, and coping
.
Springer publishing company
;
1984
.
47.
Wieckiewicz
M
,
Paradowska-Stolarz
A
,
Wieckiewicz
W
.
Psychosocial aspects of bruxism: the most paramount factor influencing teeth grinding
.
BioMed Res Int
.
2014
;
2014
:
469187
.
48.
Topaloglu-Ak
A
,
Kurtulmus
H
,
Basa
S
,
Sabuncuoglu
O
.
Can sleeping habits be associated with sleep bruxism, temporomandibular disorders and dental caries among children? Dental and Medical Problems
.
Dent Med Probl
.
2022
;
59
(
4
):
517
22
.
49.
Lawrence
HP
,
Fillery
ED
,
Matear
DW
,
Paterson
L
,
Hawkins
RJ
,
Locker
D
.
Salivary sIgA and cortisol: markers for functional dependence in older adults
.
Spec Care Dentist
.
2005
;
25
(
5
):
242
52
.
50.
Zhang
Q
,
Chen
Z
,
Chen
S
,
Yu
T
,
Wang
J
,
Wang
W
, et al
.
Correlations of hair level with salivary level in cortisol and cortisone
.
Life Sci
.
2018
;
193
:
57
63
.
51.
Sääksjärvi
K
,
Lehto
E
,
Lehto
R
,
Suhonen
E
,
Leppänen
M
,
Michels
N
, et al
.
Associations between hair and salivary cortisol, salivary alpha-amylase, and temperament dimensions among 3–6-year-olds
.
Horm Behav
.
2021
;
135
:
105042
.
52.
Singh
A
,
Peres
MA
,
Watt
RG
.
The relationship between income and oral health: a critical review
.
J Dent Res
.
2019
;
98
(
8
):
853
60
.
53.
Fang
C
,
Aldossri
M
,
Farmer
J
,
Gomaa
N
,
Quiñonez
C
,
Ravaghi
V
.
Changes in income-related inequalities in oral health status in Ontario, Canada
.
Community Dent Oral Epidemiol
.
2021
;
49
(
2
):
110
8
.
You do not currently have access to this content.