КОНЦЕНТРАЦІЯ СТРЕС-АСОЦІЙОВАНИХ НЕЙРОТРАНСМІТЕРІВ У РОТОВІЙ РІДИНІ ДІТЕЙ З РІЗНИМ СТАНОМ ТВЕРДИХ ТКАНИН ЗУБІВ ЗАЛЕЖНО ВІД РІВНЯ РЕАКТИВНОЇ ТРИВОЖНОСТІ ТА ФАКТОРА ВИМУШЕНОГО ПЕРЕМІЩЕННЯ

The pathogenesis of dental caries in children is closely associated with localized neuroendocrine imbalance exacerbated by chronic stress, a critical issue today for the vulnerable cohort of internally displaced persons. Insufficient data regarding the synergistic impact of persistent migration distress and the carious process on salivary stress markers necessitate the present study. The aim of this study is to determine the concentration patterns of stress-associated neurotransmitters (cortisol and noradrenaline) in the oral fluid of children aged 6-13 years with varying clinical status of dental hard tissues, in relation to reactive anxiety levels and the impact of forced displacement. Materials and methods. This cross-sectional clinical and laboratory study was conducted at the Department of Pediatric Dentistry and Orthodontics of I. Horbachevsky Ternopil National Medical University, and at the «OrthoXperts» and «Dental Cosmetics» dental clinics (Ternopil, Ukraine). The study included 375 children aged 6-13 years, stratified into a cohort of internally displaced persons (n=149) and local residents (n=226). Dental status was diagnosed according to WHO criteria and the ICDAS-II system, while the reactive anxiety level was verified using the adapted State-Trait Anxiety Inventory (STAI). The concentrations of cortisol and noradrenaline in unstimulated oral fluid were determined by enzyme-linked immunosorbent assay (ELISA). Statistical processing of the obtained results (mean ± standard error) was performed using parametric statistical methods with Student's t-test at a significance level of p < 0.05. The research protocol was reviewed and officially approved by the Bioethics Committee of I. Horbachevsky Ternopil National Medical University, Ministry of Health of Ukraine (excerpt from Protocol No. 85, April 1, 2026). This study was performed as part of the scheduled research program of the Department of Pediatric Dentistry and Orthodontics at I. Horbachevsky Ternopil National Medical University, Ministry of Health of Ukraine, entitled «An interdisciplinary approach to the diagnosis, treatment, and rehabilitation of patients with dental pathologies, considering age, gender, and systemic health status» (state registration: No. 0126U000026, implementation period: 2026-2028). Results. Data analysis demonstrated that the presence of caries is accompanied by localized neurohumoral imbalance: the concentrations of cortisol and noradrenaline in the oral fluid significantly exceeded those in subjects with intact teeth (p < 0.01), reaching maximum values in patients with high levels of reactive anxiety. A pronounced aggravating effect of migration stress was established: in internally displaced children aged 6-13 years (main group), the mean salivary cortisol level was 65.30 % higher compared to local residents (40.10±2.10 nmol/mL vs. 24.26 ± 0.97 nmol/mL, p1 < 0.01), while noradrenaline concentration increased by 40.0 %, p1<0.05. The synergistic impact of carious disease and the forced displacement factor resulted in the most critical alterations: in displaced children with caries, cortisol levels exceeded the corresponding data of caries-affected local peers in the Ternopil region by 44.31 %, p1 < 0.01, and noradrenaline levels by 38.10 %, p1<0.05, irrespective of the odontogenesis stage. Conclusions. The study findings indicate that the development of dental caries in children is associated with a significant increase in the concentration of cortisol and noradrenaline in the oral fluid, which correlate directly with the degree of reactive anxiety. The synergistic aggravating effect of the forced displacement factor was identified, which triggers pronounced localized hypercortisolemia and elevated catecholamine levels (by an average of 39.5 – 40.0 %) compared to the baseline values in children residing in the Ternopil region since birth.