SALIVARY CORTISOL RESPONSE TO DENTAL TREATMENT OF VARYING STRESS

The physiologic stress of various dental procedures (dental examinatio n, dental prophylaxis, restoration, root canal therapy, and tooth extr action) was measured in 50 nonsmoking healthy men between the ages of 18 and 55 years (mean 34.6 years, range 21 to 53 years) with a salivar y cortisol assay. Expectorated saliva was collected at four time point s: 10 minutes before the start of the procedure, 15 minutes after the patient was seated, at the end of the procedure, and 1 hour after the completion of the procedure. Of the 196 samples included for analysis, mean cortisol values ranged from 0.1 to 3.8 mu g/dl with a recovery o f 100% +/- 8.4%. The mean cortisol Value for the extraction group (1.0 9 +/- 0.42 mu g/dl) was significantly different (p < 0.05) from the me an values of the examination (0.46 +/- 0.10 mu g/dl), prophylaxis (0.6 4 +/- 0.64 mu g/dl), root canal (0.49 +/- 0.07 mu g/dl), and restorati ve (0.60 +/- 0.04 mu g/dl) groups as determined by the Duncan's multip le range test. Cortisol levels decreased from the initial reading to t he end of the procedure by about 15% for patients undergoing an examin ation, root canal, and restorative procedure. Cortisol levels at the e nd of the procedure were elevated in the prophylaxis (55%) and extract ion (148%) groups compared with the baseline cortisol recording. A min ority of patients in the prophylaxis group had elevated cortisol level s throughout dental treatment, whereas cortisol levels were elevated d uring treatment in 80% of patients undergoing extraction. These data s uggest that the adrenal stress response associated with tooth extracti on(s) is greater than that associated with other routine dental proced ures.