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Table 1 Selected studies for the systematic review

From: Investigating the association between stress, saliva and dental caries: a scoping review

Publication 1. Rai K et al., 2010 India [44]
Study design Quasi-experimental study (experimental group with 5 or more active caries lesions, history of pain; controls without caries history)
Study Sample n = 60, children aged 5–10 years
Stressor/Stress measure Dental treatment (e.g., oral prophylaxis, fluoride application, sealants, pulp therapy); done only for the experimental group Stress measure: saliva cortisol
Salivary parameters Unstimulated whole saliva; Saliva cortisol collected before treatment and in 1, 2, 3 months after treatment; the time of the day was not indicated Measurement method: ELECSYS Immunoassay
Follow-up No follow-up measurement for the control group
Caries measurement DMFT and dmft index, WHO, 1997
Statistical test Willcoxon signed rank test
Main results Children with rampant caries had higher saliva cortisol level at the baseline then control group (p < 0.05). The baseline salivary cortisol level in children with rampant caries decreased gradually when observed for a period of three months following dental treatment.
Publication 2. Kambalimath et al., 2010 India [43]
Study design Quasi-experimental study (experimental group with at least one carious lesion; controls without obvious caries)
Study Sample n = 30, children aged 4–5 years
Stressor/Stress measure Oral prophylaxis and topical fluoride treatment done for experimental and control groups Stress measure: saliva cortisol
Salivary parameters Unstimulated whole saliva; Saliva cortisol collected before/after treatment (between 1 pm to 4 pm) at first and second appointments; Measurement method: Radioimmunoassay
Follow-up Yes (first appointment post- treatment; recall appointment in one week)
Caries measurement Not reported
Statistical test T-test
Main results No significant differences were found between the salivary cortisol levels prior to treatment, post oral prophylaxis, or post fluoride treatment at the first and second appointments of both groups (p > 0.05).
Publication 3. Yfanti et al., 2014 Greece [40]
Study design Quasi-experimental study dmft≥3 – high degree of dental caries; dmft≤2 – low degree of dental caries
Study Sample n = 97, children aged 6–10 years
Stressor/Stress measure Dental treatment: a cleaning with rotary instruments or a small restorative procedure with the use of local anesthesia Stress measures: saliva cortisol; dental anxiety questionnaires
Salivary parameters Stimulated whole saliva; Saliva cortisol collected before, after treatment (in 30 min) same day, same night, next morning, at recall Measurement method: Electrochemiluminescence Saliva alpha amylase collected before and after treatment, at recall. Measurement method: Enzymatic chromatometry
Follow-up Yes (post-treatment, same night, next morning, recall visit in 7–14 days)
Caries measurement DMFT (S), dmft (s), Koch criteria, 1970
Statistical test Univariable linear regression
Main results No significant associations were detected between cortisol and sAA levels and caries (p > 0.05).
Publication 4. Boyce et al., 2010 USA [30]
Study design Cross-sectional study
Study Sample n = 94, children ages 5–6 years from low SES families participating in a longitudinal study
Stressor/Stress measure SES, family financial stress; Stress measure: saliva cortisol
Salivary parameters Stimulated whole saliva; Salivary cortisol collected at first and last 20 min of the morning /evening school class, at the same time on each of three consecutive days. Measurement method: Immunoassay
Follow-up No
Caries measurement DMFS, WHO, 1997
Statistical test Multivariate Poisson regression
Main results Low SES, higher basal salivary cortisol secretion, and larger numbers of cariogenic bacteria associated with higher number of caries lesions (p < 0.001). The strongest risk factor for development of dental caries was the joint presence of heightened expression of salivary cortisol and high levels of cariogenic bacteria.
Publication 5. Barbosa et al., 2012 Brazil [31]
Study design Cross-sectional study
Study Sample n = 145, school children aged 8–14 years, low socio-economic status
Stressor/Stress measure Stress measures: saliva cortisol; RCMAS (revised children’s manifest anxiety scale); CDI (children’s depression inventory)
Salivary parameters Stimulated whole saliva; Diurnal decline (morning-night) in salivary cortisol Measurement method: Immunoassay
Follow-up No
Caries measurement dmft, DMFT, WHO, 1997
Statistical test T test
Main results Participants who experienced more dental caries had lower diurnal declines of salivary cortisol concentrations than participants with low caries experience (p < 0.05). No differences in anxiety and depression scores between individual with and without caries.
Publication 6. Pani et al., 2013 Saudi Arabia [45]
Study design Cross-sectional study
Study Sample n = 64, college-educated, working mothers aged 24–31 years n = 64 first born children aged 49–70 months
Stressor/Stress measure Stress measure: salivary cortisol
Salivary parameters Unstimulated whole saliva; Saliva cortisol collected two hours after waking up. Measurement method: Immunoassay
Follow-up No
Caries measurement DMFT (mothers) or dmft (children), WHO, 1997; bitewing radio-graphs
Statistical test Mann-Whitney U test; Logistic regression
Main results The mean salivary cortisol levels of children with ECC were significantly higher than caries free children (p < 0.001). The mean salivary cortisol levels of mothers of children with ECC were significantly higher than those of mothers of caries free children (p < 0.05). A significant correlation was determined between the salivary cortisol level of the mother and that of the child (p < 0.001).
  1. DMFT(S) – decayed, missed and filed permanent teeth/surfaces because of caries; dmft (s) - decayed, missed and filed primary teeth/surfaces because of caries