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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie

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25-06-2021 | Anxiety | Original Article

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study

Authors: Associate Professor Nehir Canigur Bavbek, DDS, PhD, Erdal Bozkaya, DDS, PhD, Associate Professor Sila Cagri Isler, DDS, PhD, Sehri Elbeg, MD, PhD, Associate Professor Ahu Uraz, DDS, PhD, Professor Sema Yuksel, DDS, PhD

Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie | Issue 5/2022

Abstract

Purpose

The aim of this prospective study was to evaluate the relationship between pain intensity and concentrations of salivary pain and stress biomarkers during orthodontic tooth movement.

Methods

Eighteen patients (8 males, 10 females; mean age 14.57 ± 2.39 years) who needed orthodontic treatment with maxillary premolar extraction and segmental canine distalization participated in this study. Baseline samples were collected (T1), and orthodontic attachments were placed to maxillary first molars, second premolars, and canines. Then extractions were performed. After 1‑month follow-up, canine distalization started with a segmental wire (T2). Concentrations of salivary α‑amylase (sAA), cortisol, secretory immunoglobulin A (sIgA) and chromogranin A (CgA) were examined at T1, T2, and on days 4 (T3), 7 (T4), 14 (T5), and 30 (T6) after starting retraction. Participants also scored their pain on a visual analogue scale (VAS). Pain catastrophizing behavior and dental anxiety levels of the participants were evaluated by the Pain Catastrophizing Scale (PCS) and Corah’s Dental Anxiety Scale (C-DAS), respectively. Repeated measure ANOVA, Mann–Whitney U test and Spearman’s rank correlation coefficient analysis were used for statistical evaluations (p < 0.05).

Results

The maximum values for sAA were seen at T1. Males had higher sAA levels than females with statistical differences at T1, T3, and T4. No significant differences for cortisol, sIgA, and CgA concentrations were observed. The highest mean VAS score was recorded at T3. No correlations were detected between any salivary biomarkers, VAS, C‑DAS, and PCS scores.

Conclusions

The stress of starting orthodontic treatment increased sAA levels more than the pain that was experienced during orthodontic tooth movement. Being male was a predictor of higher sAA concentrations. Orthodontic tooth movement did not cause significant alterations in salivary pain and stress biomarkers.

Ahmadi-Motamayel F, Shahriari S, Goodarzi MT, Moghimbeigi A, Jazaeri M, Babaei P (2013) The relationship between the level of salivary alpha amylase activity and pain severity in patients with symptomatic irreversible pulpitis. Restor Dent Endod 38:141–145. https://doi.org/10.5395/rde.2013.38.3.141CrossRefPubMedPubMedCentral

Aksoy A, Cesur MG, Dagdeviren BH, Ozkaynak YA, Karacin G, Gultekin F (2019) Assessment of pain, anxiety, and cortisol levels during the initial aligning phase of fixed orthodontic treatment. Turk J Orthod 32:34–40. https://doi.org/10.5152/TurkJOrthod.2019.18043CrossRefPubMedPubMedCentral

Bavbek NC, Tuncer BB, Tortop T, Celik B (2016) Efficacy of different methods to reduce pain during debonding of orthodontic brackets. Angle Orthod 86:917–924. https://doi.org/10.2319/020116-88R.1CrossRefPubMedPubMedCentral

Bergius M, Kiliaridis S, Berggren U (2000) Pain in orthodontics. A review and discussion of the literature. J Orofac Orthop 61:125–137. https://doi.org/10.1007/BF01300354CrossRefPubMed

Boonstra AM, Stewart RE, Koke AJ, Oosterwijk RF, Swaan JL, Schreurs KM, Schiphorst Preuper HR (2016) Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and Catastrophizing. Front Psychol 7:1466. https://doi.org/10.3389/fpsyg.2016.01466CrossRefPubMedPubMedCentral

Campos MJ, Raposo NR, Ferreira AP, Vitral RW (2011) Salivary alpha-amylase activity: a possible indicator of pain-induced stress in orthodontic patients. Pain Med 12:1162–1166. https://doi.org/10.1111/j.1526-4637.2011.01185.xCrossRefPubMed

Cohen J (1988) Statistical power analysis for the bahavioral sciences, 2nd edn. Erlbaum, Hillsdale

Corah NL (1969) Development of a dental anxiety scale. J Dent Res 48:596. https://doi.org/10.1177/00220345690480041801CrossRefPubMed

Costa EOD, Blagitz MN, Normando D (2020) Impact of catastrophizing on pain during orthodontic treatment. Dental Press J Orthod 25:64–69. https://doi.org/10.1590/2177-6709.25.1.064-069.oarCrossRefPubMedPubMedCentral

10.

da Silva Campos MJ, Souza Alves CC, Barbosa Raposo NR, Ferreira AP, Farinazzo Vitral RW (2010) Influence of salivary secretory immunoglobulin A level on the pain experienced by orthodontic patients. Med Sci Monit 16:CR405–CR409PubMed

11.

Espin L, Villada C, Hidalgo V, Salvador A (2019) Effects of sex and menstrual cycle phase on cardiac response and alpha-amylase levels in psychosocial stress. Biol Psychol 140:141–148. https://doi.org/10.1016/j.biopsycho.2018.12.002CrossRefPubMed

12.

Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160. https://doi.org/10.3758/BRM.41.4.1149CrossRefPubMed

13.

Firestone AR, Scheurer PA, Burgin WB (1999) Patients’ anticipation of pain and pain-related side effects, and their perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 21:387–396. https://doi.org/10.1093/ejo/21.4.387CrossRefPubMed

14.

Gecgelen M, Aksoy A, Kirdemir P, Doguc DK, Cesur G, Koskan O, Ozorak O (2012) Evaluation of stress and pain during rapid maxillary expansion treatments. J Oral Rehabil 39:767–775. https://doi.org/10.1111/j.1365-2842.2012.02330.xCrossRefPubMed

15.

Haririan H, Bertl K, Laky M, Rausch WD, Bottcher M, Matejka M, Andrukhov O, Rausch-Fan X (2012) Salivary and serum chromogranin A and alpha-amylase in periodontal health and disease. J Periodontol 83:1314–1321. https://doi.org/10.1902/jop.2012.110604CrossRefPubMed

16.

Ilguy D, Ilguy M, Dincer S, Bayirli G (2005) Reliability and validity of the modified dental anxiety scale in Turkish patients. J Int Med Res 33:252–259. https://doi.org/10.1177/147323000503300214CrossRefPubMed

17.

Jasim H, Carlsson A, Hedenberg-Magnusson B, Ghafouri B, Ernberg M (2018) Saliva as a medium to detect and measure biomarkers related to pain. Sci Rep 8:3220. https://doi.org/10.1038/s41598-018-21131-4CrossRefPubMedPubMedCentral

18.

Jing D, Hao J, Shen Y, Tang G, Lei L, Zhao Z (2019) Effect of fixed orthodontic treatment on oral microbiota and salivary proteins. Exp Ther Med 17:4237–4243. https://doi.org/10.3892/etm.2019.7401CrossRefPubMedPubMedCentral

19.

Kanegane K, Penha SS, Munhoz CD, Rocha RG (2009) Dental anxiety and salivary cortisol levels before urgent dental care. J Oral Sci 51:515–520. https://doi.org/10.2334/josnusd.51.515CrossRefPubMed

20.

Krishnan V (2007) Orthodontic pain: from causes to management—a review. Eur J Orthod 29:170–179. https://doi.org/10.1093/ejo/cjl081CrossRefPubMed

21.

Kuroki H, Miyagawa Y, Shimomura-Kuroki J, Endo T, Shimomura H (2014) Identification of marker proteins by orthodontic treatment: relationship of RANKL in the gingival crevicular fluid and of amylase in whole saliva with orthodontic treatment. Odontology 102:303–309. https://doi.org/10.1007/s10266-013-0121-6CrossRefPubMed

22.

Kvam E, Bondevik O, Gjerdet NR (1989) Traumatic ulcers and pain in adults during orthodontic treatment. Community Dent Oral Epidemiol 17:154–157. https://doi.org/10.1111/j.1600-0528.1989.tb00012.xCrossRefPubMed

23.

Lee KC, Bassiur JP (2017) Salivary alpha amylase, dental anxiety, and extraction pain: a pilot study. Anesth Prog 64:22–28. https://doi.org/10.2344/anpr-63-03-02CrossRefPubMedPubMedCentral

24.

Lin CS (2013) Pain catastrophizing in dental patients: implications for treatment management. J Am Dent Assoc 144:1244–1251. https://doi.org/10.14219/jada.archive.2013.0052CrossRefPubMed

25.

Litt MD (1996) A model of pain and anxiety associated with acute stressors: distress in dental procedures. Behav Res Ther 34:459–476. https://doi.org/10.1016/0005-7967(96)00015-0CrossRefPubMed

26.

Loggia ML, Schweinhardt P, Villemure C, Bushnell MC (2008) Effects of psychological state on pain perception in the dental environment. J Can Dent Assoc 74:651–656PubMed

27.

Lopez-Jornet P, Cayuela CA, Tvarijonaviciute A, Parra-Perez F, Escribano D, Ceron J (2016) Oral lichen planus: salival biomarkers cortisol, immunoglobulin A, adiponectin. J Oral Pathol Med 45:211–217. https://doi.org/10.1111/jop.12345CrossRefPubMed

28.

Maan AS, Patil AK (2019) Assessment of salivary interleukin-1beta (IL-1beta), prostaglandin E2 (PGE2) levels and pain intensity in children and adults during initial orthodontic treatment. J Orthod Sci 8:16. https://doi.org/10.4103/jos.JOS_13_19CrossRefPubMedPubMedCentral

29.

Obayashi K (2013) Salivary mental stress proteins. Clin Chim Acta 425:196–201. https://doi.org/10.1016/j.cca.2013.07.028CrossRefPubMed

30.

Parkerson HA, Noel M, Page MG, Fuss S, Katz J, Asmundson GJ (2013) Factorial validity of the English-language version of the pain catastrophizing scale—child version. J Pain 14:1383–1389. https://doi.org/10.1016/j.jpain.2013.06.004CrossRefPubMed

31.

Rashkova MR, Ribagin LS, Toneva NG (2012) Correlation between salivary alpha-amylase and stress-related anxiety. Folia Med 54:46–51. https://doi.org/10.2478/v10153-011-0088-4CrossRef

32.

Sadi H, Finkelman M, Rosenberg M (2013) Salivary cortisol, salivary alpha amylase, and the dental anxiety scale. Anesth Prog 60:46–53. https://doi.org/10.2344/0003-3006-60.2.46CrossRefPubMedPubMedCentral

33.

Sari Z, Uysal T, Karaman AI, Sargin N, Ure O (2005) Does orthodontic treatment affect patients’ and parents’ anxiety levels? Eur J Orthod 27:155–159. https://doi.org/10.1093/ejo/cjh072CrossRefPubMed

34.

Silva Andrade A, Marcon Szymanski M, Hashizume LN, Santos Mundstock K, Ferraz Goularte J, Hauber Gameiro G (2018) Evaluation of stress biomarkers and electrolytes in saliva of patients undergoing fixed orthodontic treatment. Minerva Stomatol 67:172–178. https://doi.org/10.23736/S0026-4970.18.04025-6CrossRefPubMed

35.

Sobas EM, Reinoso R, Cuadrado-Asensio R, Fernandez I, Maldonado MJ, Pastor JC (2016) Reliability of potential pain biomarkers in the saliva of healthy subjects: inter-individual differences and intersession variability. PLoS ONE 11:e166976. https://doi.org/10.1371/journal.pone.0166976CrossRefPubMedPubMedCentral

36.

Sullivan MJL, Bishop SR, Pivik J (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7:524–532. https://doi.org/10.1037/1040-3590.7.4.524CrossRef

37.

Sullivan MJL, Neish NR (1998) Catastrophizing, anxiety and pain during dental hygiene treatment. Community Dent Oral 26:344–349. https://doi.org/10.1111/j.1600-0528.1998.tb01971.xCrossRef

38.

Sullivan MJL, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC (2001) Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 17:52–64. https://doi.org/10.1097/00002508-200103000-00008CrossRefPubMed

39.

Thilander B, Hatch N, Sun Z (2017) The biologic basis of orthodontics. In: Graber LW, Vanarsdall RL, Vig KWL, Huang GJ (eds) Orthodontics: current principles and techniques. Elsevier, St. Louis, pp 51–98

40.

Vahedi M, Mazdeh M, Hajilooi M, Farhadian M, Barakian Y, Sadr P (2018) The relationship between salivary alpha amylase activity and score of mcgill pain questionnaire in patients with tension type headache. Basic Clin Neurosci 9:59–64. https://doi.org/10.29252/nirp.bcn.9.1.59CrossRefPubMedPubMedCentral

41.

van Stegeren AH, Wolf OT, Kindt M (2008) Salivary alpha amylase and cortisol responses to different stress tasks: impact of sex. Int J Psychophysiol 69:33–40. https://doi.org/10.1016/j.ijpsycho.2008.02.008CrossRefPubMed

42.

Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804. https://doi.org/10.1111/j.1365-2702.2005.01121.xCrossRefPubMed

43.

Yildirim E, Karacay S (2012) Evaluation of anxiety level changes during the first three months of orthodontic treatment. Korean J Orthod 42:201–206. https://doi.org/10.4041/kjod.2012.42.4.201CrossRefPubMedPubMedCentral

Title: Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study
Authors: Associate Professor Nehir Canigur Bavbek, DDS, PhD
Erdal Bozkaya, DDS, PhD
Associate Professor Sila Cagri Isler, DDS, PhD
Sehri Elbeg, MD, PhD
Associate Professor Ahu Uraz, DDS, PhD
Professor Sema Yuksel, DDS, PhD
Publication date: 25-06-2021
Publisher: Springer Medizin
Keywords: Anxiety
Biomarkers
Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie / Issue 5/2022
Print ISSN: 1434-5293
Electronic ISSN: 1615-6714
DOI: https://doi.org/10.1007/s00056-021-00311-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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