A software-based observational coding approach for evaluating paediatric dental pain, anxiety, and fear

Salivary Cortisol as a Biomarker for Assessing Fear and Anxiety in Patients with Molar-Incisor Hypomineralization

Background/Objectives: Molar-incisor hypomineralization (MIH) is a prevalent dental condition characterized by hypomineralized enamel affecting the first permanent molars and incisors. It leads to visible enamel opacities, with varying severity. Children with MIH often experience dental hypersensitivity, which can result in increased dental fear and anxiety, complicating dental treatment. Salivary cortisol, a well-established biomarker of stress, has been used to assess stress levels in various pediatric conditions but has not been extensively studied in MIH. This study aimed to assess salivary cortisol levels as a stress biomarker in children with MIH and compare them to those in children without MIH. Methods: Sixty children aged 5-9 years were divided into two groups: 31 with MIH and 29 healthy controls. Salivary cortisol levels were measured using ELISA, and statistical analysis was performed using IBM SPSS software, version 23 The Mann-Whitney test was used for group comparison, and the Kruskal-Wallis test evaluated the correlation between MIH severity and cortisol levels. Results: Children with MIH showed significantly higher mean cortisol levels (2.63 ng/mL) compared to controls (0.96 ng/mL), with a p-value of 0.0001. A progressive increase in cortisol levels was observed with the severity of MIH, with the highest levels recorded in grade 3 (4.38 ng/mL), in contrast to grade 0 (0.95 ng/mL), with a p-value of 0.001. Conclusions: Salivary cortisol levels are significantly higher in children with MIH, suggesting that MIH-related stress may contribute to dental anxiety and hypersensitivity. These findings highlight the importance of stress management in pediatric dental care.

Epidemiological and Oral Public Health Aspects of Dental Pain: A Narrative Review

The aim of this narrative review is to synthesize and discuss existing evidence on the epidemiological aspects of dental pain, addressing its prevalence, risk factors, population distribution, impact on the quality of life, and implications for public health. Dental pain is a common condition that involves complex mechanisms of pain transmission and perception. Dental pain can be due to various causes, such as caries, pulpitis, periodontitis, dental trauma, and soft tissue conditions (e.g., stomatitis). In addition, psychological and social factors influence pain perception and severity, such as anxiety and previous negative experiences. The global burden of dental pain is considerable, generating a significant impact on the quality of life of people at individual and collective levels. This impact manifests itself in a reduction in productivity, due to absenteeism from work and school, as well as difficulties in performing daily tasks. In addition, dental pain entails high costs for health systems, including expenses associated with diagnosis, treatment, and the care of complications arising from the lack of timely care. These costs also include indirect expenses associated with the loss of productivity and impacts on the general well-being of the population. The magnitude of these effects, both at individual and population levels, underlines the importance of prevention and access to timely and effective treatment of dental pain. The prevalence of dental pain varies by region and factors such as age, socioeconomic status, and access to services. Risk factors include sociodemographic (age, gender, and ethnicity), socioeconomic (income, education, and occupation), psychological (anxiety and depression), and behavioral (oral hygiene and diet) dimensions. People with lower socioeconomic and educational status are more likely to suffer from dental pain due to a lack of access to services and inadequate preventive practices. Dental pain negatively affects the quality of life, disrupting daily functions and causing emotional distress. Public health proposes improving access to preventive dental care, oral health education, and equitable policies to reduce disparities. Strategies aimed at reducing the burden of dental pain at the population level include expanding access to dental care, promoting healthy habits, and ameliorating the significance of care costs as a barrier. Future research should focus on innovative assessment methods, expanding the accessibility to various levels of care, and understanding the biopsychosocial determinants of dental pain to develop effective interventions.