Salivary Cortisol as a Stress Monitor During Third Molar Surgery

Taofiq Opaleye; Eyituoyo Okoturo; Oluwafemi Adewale Adesina; Afolabi Oyapero; Yussuf Salami; John Chukwudumebi Wemambu

doi:10.1007/s12663-020-01480-2

Salivary Cortisol as a Stress Monitor During Third Molar Surgery

J Maxillofac Oral Surg. 2022 Dec;21(4):1112-1118. doi: 10.1007/s12663-020-01480-2. Epub 2020 Nov 22.

Authors

Taofiq Opaleye¹, Eyituoyo Okoturo^{1

2}, Oluwafemi Adewale Adesina^{1

2}, Afolabi Oyapero³, Yussuf Salami¹, John Chukwudumebi Wemambu¹

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, Ikeja, Lagos Nigeria.
² Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos State Nigeria.
³ Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, Ikeja, Lagos State Nigeria.

Abstract

Background: Procedures in oral surgery, especially surgical extraction of the impacted mandibular third molar is often considered anxiety-producing and stressful. This study evaluated the effect of oral sedation (5 mg diazepam) on the physiological stress level in subjects that underwent surgical extraction of the mandibular third molar by measuring the change in salivary cortisol concentration.

Subjects and methods: 204 salivary samples were collected from 102 subjects between 9.00 am and 12.00 pm to standardise the diurnal variations of cortisol secretion. Saliva samples were collected 45 min before and 15 min after surgical extraction from each subject in either group. The samples were stored in the freezer (- 20 °C) until analysis was done in the laboratory using salivary cortisol ELISA kits (DiaMetra S.r.l., Eagle Biosciences, Italy), and the cortisol concentration was measured with a microplate reader.

Results: There was a statistically significant change (p = <0.001 between the pre-surgical extraction salivary cortisol concentration of all subjects with a median of 7 ng/ml and post-surgical extraction salivary cortisol concentration of both the study and the control groups with a median of 17 ng/ml and 15 ng/ml, respectively. Only 11.8% of subjects in the study group had a reduction in post-surgical salivary cortisol concentration, while in the control group, 3.9% of subjects had a reduction in post-surgical salivary cortisol concentration. There was no statistically significant difference between the two groups (p = 0.135).

Conclusions: Hence, oral sedation has no significant impact on physiological stress during the surgical extraction of the mandibular third molar. However, salivary cortisol concentration can adequately reflect the stress induced by surgical extraction in subjects and its usefulness as a biomarker in stress research. Furthermore, the type of disimpaction of mandibular third molar affects salivary cortisol concentration, with distoangular disimpaction having the highest cortisol concentration and more stressful to subjects when compared to other types of disimpaction.

Keywords: Cortisol; ELISA; Saliva; Sedatives; Stress.