A Cross-Sectional Study of Salivary Cortisol, Alpha Amylase, and Measures of Psychological Distress in Children Undergoing Dental Procedures

Background/Objectives: Dental fear and anxiety are areas of concern in clinical pediatric dentistry, often leading to treatment avoidance and negative oral-health consequences. Cortisol and alpha amylase, measurable in saliva, have been proposed as biomarkers of stress and may provide an objective means of assessing and monitoring distress over time. This study examined measures of psychological and physiological distress in pediatric patients undergoing dental procedures and their correlation. Methods: 7-to-17-year-old new patients scheduled for a dental procedure or orthodontic bonding completed a psychological battery assessing dental fear (using Children’s Fear Survey Schedule—Dental Subscale), stress (Perceived Stress Scale), and dental anxiety (Modified Children Dental Anxiety Scale). Before the dental appointment, we assessed anticipated pain intensity, heart rate (HR), and collected two saliva samples to quantify cortisol and alpha amylase. Correlations between psychological and physiological measures were assessed with Pearson’s correlation and treatment groups were compared with independent t-tests. Results: Out 34 participants (12.8 ± 2.7 y/o, 52.9% females, 73.5% pediatric patients and 26.5% orthodontic patients), 38.2% endorsed moderate anxiety; 85.3% reported moderate to high stress; and 29.6% indicated dental fear. Psychological distress was not influenced by procedure type. Dental fear positively correlated with dental anxiety (p < 0.001) and HR (p < 0.001); dental anxiety positively correlated with anticipated pain (p = 0.010) and HR (p = 0.003); stress positively correlated with HR (p = 0.006). Even if 72.2% of participants had cortisol value outside normal range and those with greater stress exhibited elevated cortisol, cortisol and alpha amylase levels (measured on n = 18) were not correlated with psychological variables. Conclusions: Cortisol and alpha amylase levels were not correlated with psychological measures in a cross-sectional study on pediatric patients undergoing dental procedures.