Akyuz S, Pince S, Hekin N
Department of Pediatric Dentistry, Marmara University, Faculty of Dentistry, Istanbul, Turkey.
J Clin Pediatr Dent. 1996 Spring;20(3):219-23.
Dental environment may be a source of stress for the young patient. Such stressful conditions may provoke fear in anxious children. It is well known that stress produces an activation adrenal steroid secretion. Among the methods for assessing child dental fear, measurement of salivary cortisol level is a simple method, because especially in children, sampling of saliva is easy, and cortisol levels in saliva closely mirror serum free cortisol levels, independent of salivary flow rate. For this study, the salivary cortisol levels of 8 children (mean age 5.6 yr) were measured receiving initial dental treatment. Saliva samples were collected via cotton rolls placed to the floor of the mouth at four stages; prior to treatment, during cavitation, placement of the liner and the restoration. Statistical comparison of the results were done by Student-t test. The increase in salivary cortisol levels during cavitation at the first and secondary appointments were significant (p<0.01 and p<0.05), but not at the second. The other comparisons were not statistically significant (p>0.05). The results of this study suggest that in restorative procedures, mostly it is the cavitation step that creates stress and anxiety in children. Knowledge of the most stressful condition may be helpful for the dentist to prepare the child to treatment steps.
牙科环境可能是年轻患者压力的来源。这种压力状况可能会引发焦虑儿童的恐惧。众所周知，压力会促使肾上腺类固醇分泌增加。在评估儿童牙科恐惧的方法中，测量唾液皮质醇水平是一种简单的方法，因为特别是对于儿童来说，唾液采样容易，而且唾液中的皮质醇水平能密切反映血清游离皮质醇水平，与唾液流速无关。在本研究中，对8名接受初次牙科治疗的儿童（平均年龄5.6岁）的唾液皮质醇水平进行了测量。在四个阶段通过放置于口腔底部的棉卷收集唾液样本，分别是治疗前、开髓时、放置垫底材料时和修复时。结果的统计比较采用学生t检验。在首次和第二次就诊开髓时唾液皮质醇水平的升高具有显著性（p<0.01和p<0.05），但第二次就诊时没有。其他比较无统计学意义（p>0.05）。本研究结果表明，在修复过程中，主要是开髓步骤给儿童带来压力和焦虑。了解最具压力的状况可能有助于牙医让儿童为治疗步骤做好准备。
