Salivary cortisol response to dental treatment of varying stress

Craig S. Miller, Jeffrey B. Dembo, Donald A. Falace, Alan L. Kaplan

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87 Scopus citations


The physiologic stress of various dental procedures (dental examination, dental prophylaxis, restoration, root canal therapy, and tooth extraction) 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 salivary cortisol assay. Expectorated saliva was collected at four time points: 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 μg/dl with a recovery of 100%±8.4%. The mean cortisol value for the extraction group (1.09±0.42 μg/dl) was significantly different (p<0.05) from the mean values of the examination (0.46±0.10 μg/dl), prophylaxis (0.64±0.64 μg/dl), root canal (0.49±0.07 μg/dl), and restorative (0.60±0.04 μg/dl) groups as determined by the Duncan's multiple range test. Cortisol levels decreased from the initial reading to the end of the procedure by about 15% for patients undergoing an examination, root canal, and restorative procedure. Cortisol levels at the end of the procedure were elevated in the prophylaxis (55%) and extraction (148%) groups compared with the baseline cortisol recording. A minority of patients in the prophylaxis group had elevated cortisol levels throughout dental treatment, whereas cortisol levels were elevated during treatment in 80% of patients undergoing extraction. These data suggest that the adrenal stress response associated with tooth extraction(s) is greater than that associated with other routine dental procedures.

Original languageEnglish
Pages (from-to)436-441
Number of pages6
JournalOral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Issue number4
StatePublished - Apr 1995

Bibliographical note

Funding Information:
Cortisol is a 21-carbon glucocorticoid secreted by the adrenal cortex that regulates carbohydrate, protein, fat, and water metabolism, maintains vascular reactivity, affects the sensitivity of the nervous system, regulates blood cell numbers, and affects the human stress response.l Adrenocorticotrophic hormone produced in the anterior pituitary gland regulates the production of cortisol. Stress and the diurnal rhythm Supported by Biomedical Research Support Grant No. RR0534 from the Biomedical Research Support Branch, Division of Research Facilities and Resources, National Institutes of Health. aAssociate Professor, University of Kentucky College of Dentistry, Department of Oral Health Science. bAssociate Professor, University of Kentucky College of Dentistry, Department of Oral Health Practice. cProfessor, University of Kentucky College of Dentistry, Department of Oral Health Science. dAssociate Professor, University of Kentucky Collegeo f Dentistry, Department of Oral Health Science. Copyright | 1995 by Mosby-Year Book, Inc. 1079-2104/95/$3.00 + 0 7/13/62135 are modulating factors that can upregulate the production of cortisol, whereas decreased output of cortisol results from negative feedback and primary or secondary adrenal insufficiency. Secondary adrenal insufficiency, the more common form of adrenal insufficiency, results from the chronic administration of exogenous corticosteroids, which disrupts the hypothalamic-pituitary-adrenal axis.: Inhibition of adrenocorticotrophic hormone and the diminished output of cortisol can lead to serious changes in the body's homeostasis when stressful situations are encountered. Authorities suggest that the risk of having adrenal insufficiency is greatest when stress is encountered within the first 14 days after corticosteroid administration ceases. 2, 3 Dental treatment is often considered anxiety-producing and stressful, 4"6 yet the amount of stress generated by different kinds of dental procedures is not well known. A few studies have investigated the stress response to minor general and oral surgical procedures with plasma hydroxycorticosteroid as a mea-

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology
  • General Dentistry


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