Opaleye Taofiq, Okoturo Eyituoyo, Adesina Oluwafemi Adewale, Oyapero Afolabi, Salami Yussuf, Wemambu John Chukwudumebi
Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, Ikeja, Lagos Nigeria.
Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos State Nigeria.
J Maxillofac Oral Surg. 2022 Dec;21(4):1112-1118. doi: 10.1007/s12663-020-01480-2. Epub 2020 Nov 22.
Procedures in oral surgery, especially surgical extraction of the impacted mandibular third molar is often considered anxiety-producing and stressful. This study evaluated the effect of oral sedation (5 mg diazepam) on the physiological stress level in subjects that underwent surgical extraction of the mandibular third molar by measuring the change in salivary cortisol concentration.
204 salivary samples were collected from 102 subjects between 9.00 am and 12.00 pm to standardise the diurnal variations of cortisol secretion. Saliva samples were collected 45 min before and 15 min after surgical extraction from each subject in either group. The samples were stored in the freezer (- 20 °C) until analysis was done in the laboratory using salivary cortisol ELISA kits (DiaMetra S.r.l., Eagle Biosciences, Italy), and the cortisol concentration was measured with a microplate reader.
There was a statistically significant change ( = <0.001 between the pre-surgical extraction salivary cortisol concentration of all subjects with a median of 7 ng/ml and post-surgical extraction salivary cortisol concentration of both the study and the control groups with a median of 17 ng/ml and 15 ng/ml, respectively. Only 11.8% of subjects in the study group had a reduction in post-surgical salivary cortisol concentration, while in the control group, 3.9% of subjects had a reduction in post-surgical salivary cortisol concentration. There was no statistically significant difference between the two groups ( = 0.135).
Hence, oral sedation has no significant impact on physiological stress during the surgical extraction of the mandibular third molar. However, salivary cortisol concentration can adequately reflect the stress induced by surgical extraction in subjects and its usefulness as a biomarker in stress research. Furthermore, the type of disimpaction of mandibular third molar affects salivary cortisol concentration, with distoangular disimpaction having the highest cortisol concentration and more stressful to subjects when compared to other types of disimpaction.
口腔外科手术，尤其是下颌阻生第三磨牙的外科拔除术，通常被认为会引起焦虑和压力。本研究通过测量唾液皮质醇浓度的变化，评估了口服镇静剂（5毫克地西泮）对接受下颌第三磨牙外科拔除术患者生理应激水平的影响。
从102名受试者中在上午9点至12点之间采集了204份唾液样本，以标准化皮质醇分泌的昼夜变化。从每组的每个受试者在手术拔除前45分钟和后15分钟采集唾液样本。样本保存在冰箱（-20°C）中，直到在实验室使用唾液皮质醇ELISA试剂盒（DiaMetra S.r.l.，Eagle Biosciences，意大利）进行分析，并用酶标仪测量皮质醇浓度。
所有受试者术前唾液皮质醇浓度中位数为7纳克/毫升，研究组和对照组术后唾液皮质醇浓度中位数分别为17纳克/毫升和15纳克/毫升，两者之间存在统计学显著变化（P = <0.001）。研究组中只有11.8%的受试者术后唾液皮质醇浓度降低，而对照组中3.9%的受试者术后唾液皮质醇浓度降低。两组之间无统计学显著差异（P = 0.135）。
因此，口服镇静剂对下颌第三磨牙外科拔除术中的生理应激没有显著影响。然而，唾液皮质醇浓度可以充分反映受试者手术拔除引起的应激及其作为应激研究中生物标志物的效用。此外，下颌第三磨牙的阻生类型会影响唾液皮质醇浓度，与其他类型的阻生相比，远中倾斜阻生的皮质醇浓度最高，对受试者的压力也更大。
