Page 18 - MDJ Volume 47 Number 2 ( Jul-Dec 2024)

Erdemir, et al.: The effect of local anaesthesia on dental anxiety and salivary cortisol levels
of MDAS and salivary cortisol values between male and check-ups or cooperation with dentists, resulting in poor
female patients. The mean MDAS values for the male and oral and dental health. It may be caused by the reactions
[18]
female patients showed statistically significant differences, of the family and social environment, general fear, pain or
recorded as 9.07 ± 3.07 and 12.42 ± 4.33, respectively (P traumatic experiences. The most common demographic
[19]
< 0.001). The mean salivary cortisol levels (ng/mL) for factors associated with differences in anxiety levels are
male and female patients were 4.49 ± 2.31 and 3.95 ± 2.39, gender and age. [2,4] Caries-related chronic pain in patients
respectively, and there were no significant differences in and dental procedures may lead to increased levels of
the salivary cortisol levels (P > 0.05). Table 3 summarises chronic stress. In this study, we aimed to investigate
[20]
Spearman’s rho correlations of MDAS, age and salivary the effect of local anaesthesia administered immediately
cortisol levels between male and female patients. There prior to dental treatment on the correlation between
were significant correlations between age and salivary dental anxiety and salivary cortisol levels in patients with
cortisol levels for the female patients (r = −0.432, P < distinct cavities with visible dentin walls (ICDAS score
0.001), but there were no significant differences between of 5).
age and MDAS scores (r = 0.145, P > 0.05). There were
no significant correlations in any of the parameters of the It was found that the mean MDAS score was significantly
male patients. higher in female patients. According to MDAS, values
<11 are considered normal, 11–18 are moderately anxious
and those >19 are considered excessively anxious.
[21]
dIscussIon According to these values reported in our study, normal
dental anxiety levels were observed in male patients and
Dental anxiety affects most people of all ages and social
classes. They completely avoid dental treatment, dental moderate dental anxiety levels in female patients. Although
we observed that some patients have high MDAS scores,
we believe that not seeing high anxiety levels in terms
Table 1: Demographics of the included patients of mean values is why patients routinely undergo dental
faculty clinics for dental treatment. These findings are in
Gender n Age (Mean ± SD) Minimum Maximum line with those of the subsequent studies in which gender
Female 53 30.68 ± 8.06 16 45 significantly influences dental anxiety. [11,22] The reason
Male 42 29.62 ± 7.31 16 43 for this may be that females explain their psychological
SD: standard deviation
states more comfortably than males and that they are
more sensitive about this, causing this difference between
Table 2: Mean dental anxiety (MDAS) and salivary cortisol genders. This sensitivity was investigated, and the volume
levels according to gender of grey matter activated during emotional regulation was
Gender Mean ± SD Minimum Maximum P higher in females. However, Kanegane et al. stated
[23]
[17]
MDAS Female 12.42 ± 4.33 5.00 22.00 0.001 that there is no association between gender and dental
Male 9.07 ± 3.47 5.00 17.00 anxiety, and they linked this difference to the small sample
Cortisol Female 3.95 ± 2.39 1.41 12.35 0.065 size of their study.
Male 4.49 ± 2.31 2.03 12.17
Mann–Whitney U test (P < 0.05). SD: standard deviation, MDAS: Saliva cortisol level measurement is a reliable indicator
[24]
Modified Dental Anxiety Scale in evaluating HPA activity because HPA activity
Bold value indicates p < 0.001 induces the release of adrenocortical hormones during

Table 3: Spearman’s rho correlation analysis result (cross-comparison)
Gender Age MDAS Cortisol
Female Age r 0.145 r −0.432
P = 0.301 P < 0.001
MDAS r 0.145 r 0.005
P = 0.301 P = 0.971
Cortisol r −0.432 r 0.005
P < 0.001 P = 0.971
Male Age r −0.113 r −0.008
P = 0.476 P = 0.962
MDAS r −0.113 r 0.173
P = 0.476 P = 0.274
Cortisol r −0.008 r 0.173
P = 0.962 P = 0.274
MDAS: Modified Dental Anxiety Scale

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