Analysis of Salivary Cortisol and Amylase Levels in Patients with Oral Ulcers: A Case-Control Study

Background: Oral ulcers are common inflammatory lesions of the oral mucosa caused by factors including local trauma, systemic disease, and psychosocial stress. The changes in the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary (SAM) system under stress can be measured non-invasively by salivary cortisol and α-amylase levels. The purpose of this study was to determine the salivary cortisol and α-amylase in patients with oral ulcers compared to healthy controls, and to assess their associated clinical factors. Methods: A case-control study was conducted among 18-60-year-olds, 126 participants (63 patients and 63 controls). The unstimulated whole saliva samples were collected between 8:00-10:00 a.m. under standardized pre-sampling conditions. Cortisol levels were measured via Enzyme-linked Immunosorbent Assay (ELISA), and α-amylase activity was quantified through a kinetic colorimetric technique. SPSS v26 was used for data analysis. Independent t-test and the chi-square test were used for variables measurement. p < 0.05 was considered significant. Results: Salivary cortisol levels were significantly higher in cases (8.42 ±1.25) ng/ml compared to controls (6.23 ± 1.12; p < 0.001). Mean salivary α-amylase was also increased in cases (162.5 ± 28.7 U/mL) than in controls (129.8 ± 25.4 U/mL; p < 0.001). Recurrent lesions (45 (71.4%)), insufficient sleep (38 (60.3%)), and recent psychological stress (42 (66.7%)) were more commonly reported in ulcer patients. Conclusion: High levels of salivary cortisol and α-amylase in oral ulcer patients indicate neuroendocrine involvement in ulcer development as a stress reaction. These biomarkers can be valuable tools in diagnosis, prognosis, and stress-focused management.