Page 16 - MDJ Volume 47 Number 2 ( Jul-Dec 2024)

Erdemir, et al.: The effect of local anaesthesia on dental anxiety and salivary cortisol levels
prevalence of dental anxiety in pediatric and adult Faculty of Dentistry, Department of Restorative Dentistry
patients demonstrate that it varies between 5.7% and for treatment. A total of 95 patients with an average age
20.2% worldwide, while the prevalence in the Turkish of 30 years (range = 16–45 years) who had at least one
population is between 21.3% and 23.5%. [6-8] According to carious lesion with an ICDAS-II score of 5, verified by
studies conducted in Turkey and other countries, dental two independent examiners, were selected to participate in
anxiety is significantly higher in women than in men. [4,6] this cross-sectional study conducted at a single centre. The
Dental anxiety causes severe pain in patients, and the study complied with Good Clinical Practice guidelines,
dentist may also suffer during the treatment of such and the research protocol was ethically approved by the
patients. The main cause of delaying dental treatment Istanbul University Faculty of Medicine (No. 2015/54).
[8]
or missing a dental appointment is dental anxiety, which All patients were informed verbally and in writing about
is a major obstacle to maintaining oral health. Missed the study, and signed informed consent was obtained.
dental treatment, in turn, can lead to tooth decay and
social stigmatisation and in severe cases can even cause Sample size determination and patient selection
social isolation. [1]
The sample size was determined by a power analysis at
Dental anxiety is generally measured using questionnaires a power of 80% with a confidence level of 95% and a
and scales. The Dental Anxiety Scale is widely used significance level of P < 0.05 (NCSS PASS 2000, Kaysville,
[9]
in epidemiology and clinical research. The Modified UT, USA). The power analysis was performed based on a
Dental Anxiety Scale (MDAS) was developed to improve previous study in which the sample size was estimated.
[17]
the DAS and overcome its limitations. In particular, a The results of the power analysis indicated that at least
question on injections was included in the MDAS. The 88 patients were required for the study, but to increase the
MDAS uses five questions to assess patients’ anxiety power and account for the possible loss of patients, 111
about dental treatment. The response to each question patients were included in the study. Due to insufficient
[10]
is scored from 1 to 5 (1 = not anxious and 5 = extremely saliva number of samples (n = 10 patients) and the detection
anxious). [10,11] A Likert scale is used in the MDAS, which of contaminated blood in saliva (n = 6 patients), a total
gives a minimum score of 5 and a maximum score of 25. [10] of 16 patients were not included in the study [Figure 1].
Of the 95 patients, 53 were female and 42 male. The study
Cortisol is a glucocorticoid steroid hormone derived from was conducted from January 2015 to May 2015.
cholesterol and is a biomarker used to assess stress-
[12]
related disorders. It is produced in the zona fascicula of Patients were included if they (1) were in good general
the adrenal cortex. Dental anxiety causes activation of health, (2) had no systemic health problems and (3) had
[13]
the autonomic nervous system and the hypothalamic– at least one decayed tooth that had an ICDAS-II score
pituitary–adrenal (HPA) axis. This activation causes the of 5. Patients were excluded from the study if they (1)
[14]
secretion of cortisol from the adrenal cortex into all body had a systemic disease that altered salivary flow, (2) were
fluids, such as urine, serum and saliva. Therefore, salivary taking medications that caused hyposalivation, (3) were
[15]
cortisol levels may increase during stress and anxiety. pregnant or breastfeeding, (4) had a known allergy to
Measuring salivary cortisol levels is a simple, reliable, a local anaesthetic, (5) were addicted to alcohol and/or
accurate and noninvasive way to determine increased drugs or (6) were smokers.
stress levels. In dentistry, salivary cortisol levels can be
[16]
measured to determine the level of dental anxiety. [17]
The aim of this study was to investigate the association Clinical procedure
between dental anxiety and salivary cortisol levels in a The same experienced, specially trained investigator
group of patients prior to operative dental treatment carried out all the data collection, data recording and
under local anaesthesia due to the presence of carious saliva sampling procedures. To reduce the effects of the
lesion with an ICDAS-II score of 5. circadian rhythm on cortisol secretion, saliva samples
were collected between 10:00 and 11:00 am. Before
The null hypotheses tested were as follows: (1) no significant saliva sample collection, each patient was asked not
difference between male and female patients in terms of to eat or drink anything at least 1 h before the session.
dental anxiety, (2) no significant correlation between salivary Prior to saliva sample collection, each patient waited in
cortisol levels and dental anxiety and (3) no significant a separate room for 15 min before being asked to enter
correlation between age and salivary cortisol levels. the treatment room. Each patient was informed about
the dental injection while sitting in the dental chair.
Immediately after this information, saliva samples were
MaterIals and Methods taken, and the MDAS questionnaire was completed.
Study protocol Saliva was taken from the patients once shortly before
The study was conducted among dental patients who administering anaesthesia, and the cortisol level was
regularly attended the clinics of Istanbul University, measured accordingly. To measure patients’ anxiety about

42 Malaysian Dental Journal ¦ Volume 47 ¦ Issue 2 ¦ July-December 2024
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