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Article
Influence of dental extraction on patient’s stress and anxiety levels by assessing the salivary cortisol concentration at different time points during the extraction procedure

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Abstract

The aim of our study was to analyze the stress and anxiety in patients undergoingroutine dental extraction, by the assessment of cortisol in saliva, which can beconsidered as one of the major hormones that is released during stressful events.After obtaining the ethical approval and the patients were consented for their rolein this study, we examined 26 patients (13 males, and 13 females).The age rangedfrom 29-42 with mean age of 36.2. We collected three salivary samples from eachpatient after asking him to chew on a cotton roll to stimulate salivary secretion. Thefirst sample was obtained 10 minutes prior to local anesthetic injection, the secondsample collected 6-8 minutes after the local anesthetic injection, and third sampleacquired 10-15 minutes post-extraction. The samples were assessed and analyzedusing ELISA immunoassay (competitive inhibition enzyme immunoassay technique).Statistical analysis was performed using SPSS statistical software (version19).ANOVA and t-test were applied to obtain the significance and correlationbetween the examined samples.Significant difference was shown among the three samples (P-Value =0.002).The mean value in the third sample (post-extraction salivary sample) wasconsiderably high when compared to the other samples (Mean ± SD = 0.184± 0.184,0.307 ± 0.121 and 0.357 ± 0.141) respectively, which positively correlates with thepatient’s level of stress. Cortisol concentration in μg/dl in percentages between eachsample and the percentages, 50%, were0.105 μg/dl, 0.295 μg/dl and 0.410 μg/dl, (75%) were0.348 μg/dl, 0.410 μg/dl and 0.443 μg/dl and (90%), 0.443 μg/dl, 0.468 μg/dland 0.518 μg/dl.Our study revealed that salivary cortisol is within its highest levels after extractionin 15 minutes.


Article
Acute stress, salivary cortisol and calcium ions, in patients undergoing dental extraction procedure

Author: Dr. Hani Radhi B.D.S. M.Sc. * د. هاني راضي
Journal: MUSTANSIRIA DENTAL JOURNAL مجلة المستنصرية لطب الاسنان ISSN: 18138500 Year: 2014 Volume: 11 Issue: 1 Pages: 111-121
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Stress is well approved to be co-related to the dental extraction procedure, andlinked to the increase in cortisol levels in patients undergoing dental treatments. Boneaffected vastly by exposure to cortisol and that is mainly due to scavenging ofminerals (calcium and phosphorus) from the bone by cortisol to be consumed as a fueland energy source in the process of gluconeogenesis; hence, alter the density of boneand can cause substantial deterioration in bone quality and quantity. Cortisol can beinfluential on the function of both the osteoblasts and the osteoclasts and that willdemonstrate significant changes on bone as well. This research investigated therelation between the levels of cortisol and calcium ions with the degree of stressbefore and after routine dental extraction.Fifty two participants were included in this study, all met the inclusion andexclusion criteria designated for the research; they were subdivided into 2 groups, firstgroup was admitted to salivary cortisol evaluation, and salivary calcium ions wereachieved for the second group.The collected data represent a significant increase in both salivary cortisol andsalivary calcium ions in the post – dental extraction group when compared to the preextractiongroup. The evaluated salivary cortisol with mean of 4.589± 0.819 mmol/Lfor pre- extraction while, in the post-extraction the mean was 5.364 ± 1.017 mmol/Lwith a significant changes. The salivary calcium ions mean were 5.66 ±0.985mmol/L, while for the post-extraction mean was 6.380± 1.161 mmol/L with asignificant changes .The findings of this research gave an insight that stress plays an essential role inaltering both salivary calcium ions and cortisol levels in the post-extraction period, asboth increased significantly.


Article
Evaluation of salivary cortisol level in patient's pre and post insertion of removable partial and complete dentures

Author: Dr. Aula K. Rafeeq (Assistant Lecturer), B.D.S., M.Sc. د. علا كمال رفيق
Journal: MUSTANSIRIA DENTAL JOURNAL مجلة المستنصرية لطب الاسنان ISSN: 18138500 Year: 2015 Volume: 12 Issue: 1 Pages: 76-87
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

The aim of our study was to analyze the stress and anxiety in patients undergoingroutine denture insertion, by the assessment of cortisol in saliva, which can beconsidered as one of the major hormones that is released during stressful events.Stress is defined as an organism's total response to an environmental condition orstimulus, also known as a stressor. Cortisol is a stress hormone produced by theadrenal glands. It is one of the stress hormones, and is produced at higher levels inindividuals who are prone to stress. Aside from contributing factors such as work andemotions, it is also produced at greater levels by people who work early morningshifts. After obtaining the ethical approval and the patients were consented for theirrole in this study, we examined 22 patients (8 males, and 14 females).The age rangedfrom 22-74 with mean age of 59.6 & 42.6. I collected two salivary samples from eachpatient using spitting methods; one hour pre and one hour post insertion of removablepartial and complete dentures (R.P.D. & R.C.D.). The samples were assessed andanalyzed using ELISA test. Statistical analysis was performed using SPSS statisticalsoftware (version 19).ANOVA and t-test was applied to obtain the significance andcorrelation between the examined samples. Statically significant association regardingthe difference of mean (post and pre using of denture) of cortisol level regarding thegender of the patients, where the difference of mean of female was higher than that ofmale patients (0.2, 0.14) respectively, p =0.001.My study revealed that salivarycortisol is within its highest levels after insertion of R.P.D. & R.C.D. in one hour.Significant association regarding the age was reported and the R.C.D group has hadhigher mean than that of R.P.D group.


Article
Assessment of dental anxiety by physiological measurement (salivary cortisol) and psychological measurement (dental anxiety scale) in children

Authors: Abeer M.H.Zwain --- Ban A.Salih
Journal: Journal of University of Babylon مجلة جامعة بابل ISSN: 19920652 23128135 Year: 2014 Volume: 22 Issue: 9 Pages: 2578-2568
Publisher: Babylon University جامعة بابل

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Abstract

Dental anxiety is considered one of the most common sources of fear and anxiety that cause activation of adrenal gland to increase secretion of cortisol hormone. The aims of the present study are: measurement of the level of dental anxiety by physiological measurement (cortisol level in saliva) and psychological measurement (dental anxiety scale (DAS); evaluation of the stress response during several stages of dental treatment; assessment of the effects of dental anxiety on the oral health status of the child; and evaluation of factors that could affect dental anxiety in the children. The studied group included 85 children, aged between 9-13 years, 39 female, 46 male, selected from patients attended to the Dental Preventive Health Center in Al-Kadhimiya City, accompanied by the mother. Interviewing with each child's mother were conducted including a questionnaire about different variables affect dental anxiety, then another interviewing with each child including (DAS). Then saliva samples were collected from the children at the waiting room. All children received dental treatment according to their chief complaint, except 15 children, they received amalgam restoration under local anesthesia and saliva samples were collected from them during different stages of the treatment:1. After anesthetic injection, 2. After cavity drilling, 3. At the end of the treatment.The control group included 30 children, from them saliva samples had been collected in their school away from dental fear. A highly significant difference in the level of salivary cortisol was found between control and studied group and a significant correlation was observed between DAS scores and salivary cortisol level at the waiting room which indicates that both of these two methods are valid and can be used as a tool for the assessment of dental anxiety. Anesthetic injection was associated with a higher increase in the level of salivary cortisol. Patients reported high scores in DAS, have less filled, more decayed surfaces and more plaque accumulation than those who reported low scores in the scale. It is found that anesthetic injection, and pain associated with dental treatment is the most common sources and reasons for dental anxiety, so the dentist must decrease or eliminate any procedure that provoke anxiety and fear because of its effect on later perception of the child to the dentistry in general.

الخوف من طب الاسنان يعتبر واحد من مصادر الخوف والتوتر الشائعة والتي تسبب تنشيط الغدة الكظرية لفرز هرمون الكورتيزول . الهدف من هذه الدراسة هو : قياس مستوى الخوف من طب الاسنان بواسطة المقياس الفسلجي( مستوى الكورتيزول اللعابي) و المقياس النفسي( المقياس المدرج للخوف من طب الاسنان((DAS),تقييم الاستجابة للتوتر خلال عدة مراحل من العلاج في عيادة طب الاسنان , تقدير تاثيرات الخوف من طب الاسنان على حالة صحة الفم للطفل ,تقييم العوامل التي قد تؤثر على الخوف من طب الاسنان عند الاطفال.العينة المدروسة تشمل 85 طفل تتراوح اعمارهم بين 9-13 سنة,39 انثى,46 ذكر, مختارة من مراجعين حاضرين عيادة طب الاسنان مصاحبين والداتهم. مقابلة مع والدة كل طفل جرت لجمع اجابات عن اسئلة حول مختلف المتغيرات المؤثرة في الخوف من طب الاسنان, مقابلة اخرى جرت مع كل طفل متضمنة اسئلة تشمل(المقياس المدرج للخوف من طب الاسنان للاطفال((DAS), عينات من اللعاب جمعت من الاطفال في غرفة الانتظار. كل طفل تلقى العلاج حسب الشكوى الاساسية له, 15 طفل اجريت لهم حشوة بمادة الاملغم تحت التخدير الموضعي ومنهم عينات اللعاب اخذت في مراحل مختلفة من العلاج:1- بعد اعطاء البنج الموضعي 2- بعد حفر السن 3- عند نهاية العلاج. العينة المسيطر عليها تشمل 30 طفل منهم عينات اللعاب اخذت وهم في المدرسة بعيداعن عيادة طب الاسنان. اختلاف ذو مغزى عالي وجد في مستوى الكورتيزول اللعابي بين العينة المدروسة و العينة المسيطر عليها, وايضا اختلاف ذو مغزى لوحظ بين المقياسالمدرج للخوف من طب الاسنان ((DAS و الكورتيزول اللعابي في غرفة الانتظار مما يدل على ان كلتا الطريقتين مضبوطتين و يمكن ان تستخدم لتقييم الخوف من طب الاسنان. اعطاء ابرة البنج ارتبط مع اعلى ارتفاع في مستوى الكورتيزول اللعابي خلال العلاج. الاطفال الذين سجلوا علامات عالية في المقياس المدرج للخوف من طب الاسنان ((DAS لديهم حشوات اقل وتسوس اكثر وتجمعات من الصفيحة الجرثومية اكثر في اسطح اسنانهم من الاطفال الذين اوردوا علامات قليلة.لقد وجد ان ابرة البنج و الالم المرتبط مع علاج الاسنان هو المصدر الشائع لسبب الخوف من طب الاسنان لذلك يجب على طبيب الاسنان ان يقلل او يزيل اي اجراء يحث التوتر و الخوف من طب الاسنان لتاثيره اللاحق على فهم الطفل لطب الاسنان بصورة عامة.


Article
Salivary cortisol among low birth weight 5 years old kindergarten children in relation to dental caries (comparative study)

Authors: Rihab A. Ali --- Ban S. Diab
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2013 Volume: 25 Issue: 4 Pages: 126-133
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Birth weight is a powerful predictor of infant growth and survival. Evidence now shows that children bornwith low birth weight face an increased risk of chronic diseases and have many health problems including oral health.The aims of this study were to assess the salivary flow rate, viscosity, and salivary cortisol among low birth weightkindergarten children aged 5 years old in Hilla centre, in relation to dental caries and compares them with thenormal birth weight children of the same age and gender.Materials and methods: The total sample involved 80 children (40 low birth weights and 40 normal birth weights)aged 5 years old. The diagnosis and recording of severity of dental caries was recorded through the application ofd1-4mfs index according to the criteria described by Mühlemann (1976). The stimulated saliva was collected from thetotal sample under standardized conditions and then analyzed for measuring salivary flow rate and viscosity, inaddition to estimation of salivary cortisol by special cortizol kit using VIDAS® Cortisol S.Results: The mean rank of dmfs, ds, ms and fs were found to be higher among low birth weight than normal birthweight groups, with a statistically significant difference for dmfs, ds (P<0.05), highly significant difference for ms(P<0.01) and non significant difference for fs (P>0.05). Concerning the ds grade, data analysis showed a significantdifference only for d1 grade (P<0.05). Salivary analysis demonstrated that the mean rank of salivary flow rate wasfound to be lower among the low birth weight than the normal birth weight groups with non significant difference(P>0.05). The viscosity of saliva was found to be highly significantly higher among low birth weight than normal birthweight groups (P<0.01). Concerning salivary cortisol, data analysis showed that the mean rank was higher amonglow birth weight than normal birth weight groups. However, the difference was not significant (P>0.05).Conclusion: The results of the current research revealed that low birth weight status affect oral health conditions

خلفیة : وزن الولادة یشكل مؤشرا قویا لنمو الرضع و البقاء على قید الحیاة . الدلائل تشیر الآن أن الأطفال الذین یولدون مع انخفاض الوزن عند الولادة یواجھون خطرا متزایدا منالأمراض المزمنة ولھا العدید من المشاكل الصحیة بما في ذلك صحة الفم . وكانت أھداف ھذه الدراسة تقییم معدل تدفق اللعاب ، واللزوجة ، والكورتیزول اللعابي بین انخفاض الوزنعند الولادة لریاض الأطفال الذین تتراوح أعمارھم بین 5 سنوات من العمر في مركز الحلة ، وعلاقتھ بتسوس الأسنان ومقارنتھا مع الوزن الطبیعي عند الولادة للأطفال من نفس العمروالجنس.المواد و الطرق : تضمنت العینة الكلیة 80 طفلا ( 40 انخفاض الوزن عند الولادة و 40 الوزن الطبیعي عند الولادة) الذین تتراوح أعمارھم بین 5 سنوات . وتم تسجیل شدة تسوسخلال تطبیق مؤشر وقد تم جمع اللعاب المحفز من العینة الكلیة في ظل ظروف موحدة ومن ثم تحلیلھا لقیاس d1- 4mfs وفقا للمعاییر التي وصفھا . Mühlemann ( الأسنان من ( 1976معدل تدفق اللعاب واللزوجة ، بالإضافة إلى تحلیل الكورتیزول اللعابي باستخدام كت خاص بالكورتیزولfs و ms ،ds ، dmfs الطبیعي عند الولادة ، وجدت لتكون أعلى عند اطفال انخفاض الوزن عند الولادة عنھ لأطفال الوزن .VIDAS® Cortisol Sوفرق معنوي كبیر للغایة ms وفرق غیر معنوي فیما یخص fs وفیما یتعلق ds النتائج: رتبة متوسط تسوس السطوح للأسنان اللبنیة ، أظھر تحلیل البیانات فرقا معنویا فقط للرتبةأظھر تحلیل اللعاب أن رتبة متوسط معدل تدفق اللعاب وجدت لتكون أقل بین مجموعة انخفاض الوزن عند الولادة من . d مع وجود فرق دال إحصائیا , 1 dmfs, ds , فیما یخصمجموعة الوزن الطبیعي عند الولادة مع وجود فارق غیر معنوي . لزوجة اللعاب وجدت لتكون أعلى بكثیر مع فارق معنوي كبیر للغایة بین مجموعة انخفاض الوزن عند الولادة منمجموعة الوزن الطبیعي عند الولادة. وفیما یتعلق بالكورتیزول اللعابي ، أظھر تحلیل البیانات أن رتبة متوسط الكورتیزول أعلى بین مجموعة انخفاض الوزن عند الولادة من مجموعةالوزن الطبیعي عند الولادة . ومع ذلك ، كان الفارق غیر معنوي .الاستنتاج: كشفت نتائج البحث الحالي أن حالة انخفاض الوزن عند الولادة تؤثر على الأوضاع الصحیة للفم.


Article
An Anxiety and Salivary Cortisol Correlation in Dental Managements between Different Dental Departments
العلاقة بين التوتر ومستوى الكورتزول في اللعاب خلال عمليات العلاج بين مختلف اقسام طب الاسنان

Author: Ahmad Fliah Hassan احمد فليح حسن
Journal: Al-Rafidain University College For Sciences مجلة كلية الرافدين الجامعة للعلوم ISSN: 16816870 Year: 2015 Issue: 35 Pages: 343-356
Publisher: Rafidain University College كلية الرافدين الجامعة

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Abstract

Stress is a normal psychological and physical reaction to the ever-increasing demands of life. Studies show that many challenges with stress at some point during the year. Seventy five Iraqi dental patients interning collage of dentistry divided in three groups, twenty five patients were admitted to oral medicine and diagnosis department, twenty five patients to periodontal department and the last twenty five patients were to oral surgical department. Each selected group was compared to the each other groups. The parameters of comparison were dental anxiety scale and salivary cortisol. The research was based on evaluation of salivary cortisol and modified dental anxiety scale (MDAS). The cortisol evaluation was achieved using ELISA technique while, MDAS were based on scoring questionnaire.The salivary cortisol levels and MDAS were ranges from 0.243±0.190 ng/L to 7.760±2.488 with a significant changes 0.0001 (p<0.05) in the oral surgery department. The collected cortisol level and MDAS were 0.274±0.273ng/L to 9.000±3.617 in periodontal department with a significant changes 0.0001 (p<0.05), while the diagnosis department showed a cortisol changes between 0.178±0.132 ng/L to 7.240±2.385 with significant changes 0.0001 (p<0.05).We concluded that the relations between the anxiety-fear of the patients were significantly changed and strongly related to the type of treatments ; we confirmed that by using MDAS according to the dental treatment in a different departments (oral medicine and diagnosis, periodontal and oral surgery) in compared with salivary cortisol level.The diagnosis department showed the lower values in salivary cortisol and MDAS with high correlation, while the higher values were recorded in periodontal department. MDAS was an effective tool in monitoring an anxiety for the patients. Types and applying of dental instruments were associated with anxiety.

ان الهدف من هذه الدراسة هو بيان درجة الخوف لمرضى الاسنان وعلاقتة بنسبة الكورتزون المقاس من اللعاب لثلاث عينات من المرضى تمت معالجتهم في ثلاثة فروع علاجية في كلية طب الاسنان- الجامعة المستنصرية.شارك في هذه الدراسة خمسة وسبعون مريضا. خمسة وعشرون مريضا تمث معالجتهم في كل قسم (جراحة الفم و امراض وجراحة ماحول الاسنان والتشخيص الفمي). وزع على المرضى استبيان معدل لقياس الخوف من علاج الاسنان مع اخذ عينة من اللعاب من اجل قياس نسبة الكورتزون لغرض معرفة العلاقة الاحصائية بينهما.اظهرت النتائج الاحصائية ان المرضى الذين يعالجون في قسم امراض وجراحة ماحول الاسنان هم الاكثر خوفا، يليهم المرضى المعالجين في قسم جراحة الفم وقد كان المرضى المعالجين في قسم التشخيص الفمي هم الاقل تخوفا حسب النتائج الاحصائية بين مجموعة واخرى حسب نتائج الاستبيان والكورتزون المقاس من اللعاب وارتباطها بالقسم الذي تم العلاج به وذلك يعود لعدة اسباب منها طول فترت انتظار المرض ومعرفته او عدم معرفته بنوع العلاج المقدم له وطبيعة المواد المستخدمة في العلاج.

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