Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study

Figures & data

Figure 1. Schematic depiction of the study protocol and saliva sampling. Cort: salivary cortisol and sAA: salivary alpha-amylase.

Table 1. Sample characteristics.

Gender	Variable	N	Median	iqr	Minimum	Maximum
Male	Dental anxiety	58	31	15	15	63
	State anxiety	58	51	14	30	78
	Trait anxiety	58	42	13	22	67
	Cort_prtx	58	4.7	4.6	1.2	16.4
	Cort_post	58	5.2	3.7	0.9	25.5
	Cort_recall	52	5.3	2.3	1.8	22.8
	Cort_evening	56	3.4	2.3	0.7	5.8
	Cort_morning	56	12.2	5.6	3.4	27.9
	Cort_mor/eve	56	3.6	4.2	1.2	14.1
	sAA_prtx	58	232.8	370	9	1042
	sAA_post	57	273	353	20	1183
	sAA_recall	52	539.5	676	12	1609
	Caries score	58	5.5	6	0	17
	Age	58	85.5	23	62	118
Female	Dental anxiety	39	30	14	17	54
	State anxiety	39	52	13	24	73
	Trait anxiety	39	44	15	26	63
	Cort_prtx	39	5	4.4	1.2	21.1
	Cort_post	39	6.1	5.8	1	28.4
	Cort_recall	35	5.8	3.7	1	13.9
	Cort_evening	36	3.4	2.3	1	4.9
	Cort_morning	37	12	6	3.8	24.4
	Cort_mor/eve	36	4.1	4.4	1.2	18
	sAA_prtx	39	285.7	488.6	12	1450
	sAA_post	39	267.4	555.5	50.6	1092
	sAA_recall	36	472.5	630.5	29	1441
	Caries score	39	5	6	0	14
	Age	39	91	24	64	124
Total	Dental anxiety	97	30	14	15	63
	State anxiety	97	51	14	24	78
	Trait anxiety	97	44	13	22	67
	Cort_prtx	97	4.9	4.4	1.2	21.1
	Cort_post	97	5.5	4.3	0.9	28.4
	Cort_recall	87	5.3	3	1	22.8
	Cort_evening	92	3.4	2.2	7	5.8
	Cort_morning	93	12.1	6	3.4	27.9
	Cort_mor/eve	92	3.6	4.2	1.2	18
	sAA_prtx	97	237	385	9	1450
	sAA_post	96	270.2	530.5	20	1183
	sAA_recall	88	522	624	12	1609
	Caries score	97	5	5	0	17
	Age	97	87	24	62	124

Non-transformed values: N, number of subjects; iqr, interquartile range; cort_prtx, cortisol prior to treatment; cort_post, cortisol post treatment; cort_mor/eve, morning to evening cortisol ratio; sAA, salivary alpha-amylase; and caries score refers to primary teeth.

Concentration for sAA is given in U/ml and for salivary cortisol in nmol/L. Age is given in months.

Figure 2. Box plots of salivary cortisol (a) and α-amylase (sAA) levels (b) in response to initial dental visit (pre- and post-treatment) and to the recall visit. *Denotes significance (p < 0.05) and **denotes significance (p < 0.001).

Table 2. Correlations between salivary cortisol and alpha-amylase levels.

		Cort_prtx	Cort_post	Cort_recall	sAA_prtx	sAA_post	sAA_recall
Cort_prtx	r	1.00
	p
Cort_post	r	0.65*	1.00
	p	0.000
Cort_recall	r	0.67*	0.51*	1.00
	p	0.000	0.000
sAA_prtx	r	0.30*	0.18	0.23*	1.00
	p	0.005	0.105	0.030
sAA_post	r	0.32*	0.31*	0.30*	0.65*	1.00
	p	0.003	0.004	0.004	0.000
sAA_recall	r	−0.14	0.03	−0.06	0.26*	0.30*	1.00
	p	0.210	0.790	0.580	0.014	0.005

Log₁₀-transformed values: cort_prtx, cortisol prior to treatment; cort_post, cortisol post treatment; cort_recall, cortisol at the recall visit; sAA_prtx, salivary alpha-amylase prior to treatment; sAA_post, salivary alpha-amylase post treatment; sAA_recall, salivary alpha-amylase at the recall visit. Spearman’s two-tailed: r, correlation coefficient values; p, level of significance; and number of observations = 86 for all comparisons.

*Significance (significance was accepted for p ≤ 0.05).

Table 3. Correlations between biological responses and self-reported anxiety.

		AOC_prtx	AOC_post	AOC_recall	Dental anxiety	State anxiety	Trait anxiety
AOC_prtx	r	1.000
	p
AOC_post	r	0.60*	1.000
	p	0.000
AOC_recall	r	0.61*	0.42*	1.000
	p	0.000	0.0001
Dental anxiety	r	−0.15	−0.24*	0.02	1.000
	p	0.181	0.029	0.842
State anxiety	r	−0.26*	−0.19	−0.19	0.33*	1.000
	p	0.015	0.077	0.084	0.002
Trait anxiety	r	−0.15	−0.16	−0.07	0.37*	0.42*	1.000
	p	0.167	0.145	0.519	0.0004	0.0001

AOC, salivary alpha-amylase over cortisol ratio; AOC_prtx, AOC prior to treatment; AOC_post, AOC post treatment; AOC_recall, AOC at the recall visit; Spearman’s two-tailed: r, correlation coefficient values; p, level of significance; number of observations = 86 for all comparisons.

*Significance (significance was accepted for p ≤ 0.05).

Table 4. Univariable and multivariable linear regression analysis for the association of cortisol levels to study variables.

	Univariable analysis			Multivariable analysis
Variable	β	95% CI	p	β	95% CI	p
Cortisol_pre-treatment
Dental anxiety (per unit)	0.01	0.002, 0.03	0.03	0.00	−0.003, 0.02	0.13
State anxiety (per unit)	0.01	−0.001, 0.02	0.07	0.00	−0.00, 0.01	0.64
Trait anxiety (per unit)	0.00	−0.01, 0.01	0.96
Caries score (per unit)	−0.00	−0.30, 0.29	0.98
Prv dental exp (no:ref/yes)	−0.08	−0.40, 0.25	0.64
Sampling time (per hour)	−0.16	−0.24, −0.08	<0.001	−0.14	−0.22, −0.06	0.001
Age (per unit)	0.00	−0.01, 0.01	0.51
Fender (male:ref/female)	0.05	−0.21, 0.31	0.69
Cortisol_post-treatment
Dental anxiety (per unit)	0.02	0.004, 0.03	0.01	0.01	0.001, 0.03	0.03
State anxiety (per unit)	0.01	−0.01, 0.02	0.23
Trait anxiety (per unit)	0.00	−0.01, 0.02	0.58
Caries score (per unit)	0.02	−0.32, 0.36	0.91
Prv dental exp (no:ref/yes)	0.09	−0.27, 0.46	0.61
Sampling time (per hour)	−0.11	−0.20, −0.01	0.028	−0.09	−0.18, 0.002	0.06
Age (per unit)	−0.00	−0.01, 0.01	0.99
Gender (male:ref/female)	0.09	−0.20, 0.39	0.54
Anesthesia (no:ref/yes)	−0.17	−0.47, 0.12	0.24
Cortisol_recall
Dental anxiety (per unit)	0.00	−0.01, 0.01	0.480
State anxiety (per unit)	0.01	0.0004, 0.02	0.04	0.00	−0.001, 0.01	0.10
Trait anxiety (per unit)	0.00	−0.01, 0.01	0.489
Caries score (per unit)	−0.06	−0.31, 0.20	0.66
Prv dental exp (no:ref/yes)	−0.09	−0.36, 0.19	0.53
Sampling time (per hour)	−0.10	−0.16, −0.05	<0.001	−0.09	−0.15, −0.04	0.001
Age (per unit)	−0.00	−0.01, 0.00	0.53
Gender (male:ref/female)	−0.05	−0.27, 0.17	0.67

Log₁₀-transformed data: caries score refers to primary teeth; prv dental exp, existing previous dental treatment experience; β, coefficient; and CI, confidence interval.

Table 5. Univariable linear regression analysis for the association of salivary alpha-amylase levels to study variables.

	sAA_pre-treatment			sAA_post-treatment			sAA_recall
Variables	β	95% CI	p	β	95% CI	p	β	95% CI	p
Dental anxiety (per unit)	0.01	−0.01, 0.03	0.25	0.00	−0.02, 0.02	0.79	0.01	−0.01, 0.03	0.33
State anxiety (per unit)	−0.00	−0.02, 0.02	0.96	0.01	−0.01, 0.03	0.46	−0.01	−0.03, 0.01	0.29
Trait anxiety (per unit)	−0.01	−0.23, 0.10	0.36	0.00	−0.02, 0.02	0.94	−0.01	−0.03, 0.01	0.43
Caries score (per unit)	−0.02	0.51, 0.47	0.94	−0.19	−0.64, 0.27	0.41	0.06	−0.47, 0.60	0.81
Prv dental exp (no:ref/yes)	−0.14	−0.67, 0.40	0.61	−0.00	−0.50, 0.49	0.99	0.14	−0.43, 0.70	0.63
Sampling time (per hour)	−0.01	−0.15, 0.12	0.83	−0.03	−0.16, 0.10	0.63	0.08	−0.04, 0.20	0.20
Age (per unit)	−0.00	−0.02, 0.01	0.77	−0.01	−0.02, 0.01	0.42	−0.00	−0.01, 0.01	0.99
Gender (male:ref/female)	−0.03	−0.46, 0.40	0.88	0.01	−0.39, 0.41	0.96	−0.05	−0.51, 0.40	0.82
Anesthesia (no:ref/yes)				−0.21	−0.60, 0.19	0.30

Log₁₀-transformed data: sAA, salivary alpha-amylase; caries score refers to primary teeth; prv dental exp, existing previous dental treatment experience; β, coefficient; and CI, confidence interval.