Assessment of Salivary Cortisol Levels as a Biomarker of Anxiety in Patients Undergoing Minor Oral Surgery
Keywords:
Anxiety, Biomarker, Minor oral surgery, Salivary cortisol, Stress physiologyAbstract
Background: Anxiety is a common psychological response among patients undergoing minor oral surgical procedures, often influencing pain perception, treatment outcomes, and overall patient experience. Conventional assessment methods rely on subjective scales, which may not accurately reflect physiological stress. Cortisol, a key hormone released in response to stress, can be measured non-invasively in saliva, offering an objective biomarker for anxiety assessment.
Objective: This study aimed to evaluate salivary cortisol levels as a biomarker of anxiety in patients undergoing minor oral surgery and to explore its correlation with subjective measures of anxiety.
Methods: A cross-sectional study was conducted on patients scheduled for minor oral surgical interventions. Preoperative anxiety levels were assessed using standardized anxiety scales, followed by collection of unstimulated saliva samples at defined time intervals. Cortisol concentrations were analyzed using enzyme-linked immunosorbent assay (ELISA). Statistical analyses were performed to determine associations between salivary cortisol levels, self-reported anxiety scores, and demographic or clinical variables.
Results: Salivary cortisol levels demonstrated a significant rise in patients with higher preoperative anxiety scores. A positive correlation was observed between subjective anxiety ratings and cortisol concentrations (p < 0.05), supporting the utility of salivary biomarkers in objectively identifying stress responses. Age, gender, and type of surgical procedure also influenced anxiety-cortisol dynamics.
Conclusion: Salivary cortisol serves as a reliable, non-invasive biomarker for assessing perioperative anxiety in patients undergoing minor oral surgery. Integrating salivary cortisol monitoring with conventional psychological assessments may enhance clinical understanding of patient stress, guide preoperative counseling, and improve overall surgical care
Downloads
References
Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clinical, cosmetic and investigational dentistry. 2016 Mar 10:35-50. http://doi:10.2147/CCIDE.S63626. PMID: 27022303; PMCID: PMC4790493.
Moore R. Trusting the Dentist—Expecting a Leap of Faith vs. a Well-Defined Strategy for Anxious Patients. Dentistry Journal. 2022 Apr 7;10(4):66. http://doi:10.3390/dj10040066. PMID: 35448060; PMCID: PMC9032626.
Saviola F, Pappaianni E, Monti A, Grecucci A, Jovicich J, De Pisapia N. Trait and state anxiety are mapped differently in the human brain. Scientific reports. 2020 Jul 6;10(1):11112. http://doi:10.1038/s41598-020-68008-z. PMID: 32632158; PMCID: PMC7338355.
Rogowska AM, Kuśnierz C, Bokszczanin A. Examining anxiety, life satisfaction, general health, stress and coping styles during COVID-19 pandemic in Polish sample of university students. Psychology Research and Behavior Management. 2020 Sep 28:797-811. http://doi:10.2147/PRBM.S266511. PMID: 33061695; PMCID: PMC7532061.
Acharya S, Joshi S, Pradhan A. Anxiety level of patients undergoing oral surgical procedures. PMID: 29717285.
Vicković S, Zdravković R, Maričić-Prijić S, Nikolić D, Pap D, Čolak E, Jovičić S. Salivary cortisol as a biomarker of stress in surgical patients. Journal of Medical Biochemistry. 2023 Aug 25;42(3):469. http://doi:10.5937/jomb0-42011. PMID: 37790204; PMCID: PMC10543123.
Hu CC, Wang SG, Gao Z, Qing MF, Pan S, Liu YY, Li F. Emerging salivary biomarkers for early detection of oral squamous cell carcinoma. World Journal of Clinical Oncology. 2025 Apr 24;16(4):103803. http://doi:10.5306/wjco.v16.i4.103803. PMID: 40290680; PMCID: PMC12019256.
Kassahun WT, Mehdorn M, Wagner TC, Babel J, Danker H, Gockel I. The effect of preoperative patient-reported anxiety on morbidity and mortality outcomes in patients undergoing major general surgery. Scientific Reports. 2022 Apr 15;12(1):6312. http://doi:10.1038/s41598-022-10302-z. PMID: 35428818; PMCID: PMC9012824.
Scribante A, Pellegrini M, Ghizzoni M, Pulicari F, Giannì AB, Spadari F. Exploring the Potential Clinical Applications of Salivary Cortisol in the Diagnosis and Management of Cushing’s Syndrome, Diabetes, Depression, and Periodontal Disease: A Systematic Review. The Open Dentistry Journal. 2024 Dec 27;18(1).
Balasamy S, Atchudan R, Arya S, Sundramoorthy AK. Emerging Trends in Wearable and Non-Invasive Cortisol Sensing Technologies-A review. Journal of Materials Chemistry B. 2025. http://doi:10.1039/d5tb01519g. Epub ahead of print. PMID: 41025239.
Contac LR, Pop SI, Dobreanu M, Oprica M, Voidazan S, Bica CI. Salivary Cortisol as a Biomarker for Assessing Fear and Anxiety in Patients with Molar–Incisor Hypomineralization. Diagnostics. 2025 Feb 17;15(4):489. http://doi:10.3390/diagnostics15040489. PMID: 40002640; PMCID: PMC11854619.
AlSahman L, AlBagieh H, AlSahman R, Mehta NR, Correa LP. Does salivary cortisol serve as a potential biomarker for temporomandibular disorders in adults?. BMC Oral Health. 2024 Nov 10;24(1):1364. http://doi:10.1186/s12903-024-05131-7. PMID: 39523299; PMCID: PMC11550516.
Lin CS, Wu SY, Yi CA. Association between anxiety and pain in dental treatment: a systematic review and meta-analysis. Journal of dental research. 2017 Feb;96(2):153-62. http://doi:10.1177/0022034516678168. Epub 2016 Nov 16. PMID: 28106507.
Balsamo M, Cataldi F, Carlucci L, Fairfield B. Assessment of anxiety in older adults: a review of self-report measures. Clinical interventions in aging. 2018 Apr 6:573-93. http://doi:10.2147/CIA.S114100. PMID: 29670342; PMCID: PMC5896683.
Herman JP, McKlveen JM, Ghosal S, Kopp B, Wulsin A, Makinson R, Scheimann J, Myers B. Regulation of the hypothalamic‐pituitary‐adrenocortical stress response. Comprehensive physiology. 2016 Apr 17;6(2):603-21. http://doi:10.1002/cphy.c150015. PMID: 27065163; PMCID: PMC4867107.
Boucher P, Plusquellec P. Acute stress assessment from excess cortisol secretion: Fundamentals and perspectives. Frontiers in endocrinology. 2019 Nov 5;10:749. http://doi:10.3389/fendo.2019.00749. PMID: 31749763; PMCID: PMC6848065.
Ahmed T. Optical Sensing of Salivary Cortisol for Stress Monitoring (Doctoral dissertation, City, University of London).
Barrientos-Moral L, Gimeno-Longas MJ, Obispo-Díaz C, Martín-Vacas A, Paz-Cortés MM, Aragoneses JM. Analysis of the impact of clinical practices on salivary biomarkers of inflammation and stress in oral surgery postgraduate students: a pilot study. Frontiers in Medicine. 2025 Jun 13;12:1568047. http://doi:10.3389/fmed.2025. 1568047. PMID: 40584710; PMCID: PMC12202477.
Grosser L, Yates C, Dorrian J, Centofanti S, Heilbronn L, Wittert G, Kennaway D, Coates AM, Gupta CC, Stepien JM, Matthews RW. Exploring circadian and meal timing impacts on cortisol during simulated night shifts. SLEEPJ. 2025 Aug 21:zsaf249. http://doi:10.1093/sleep/zsaf249. Epub ahead of print. PMID: 40838738.
Prete A, Yan Q, Al‐Tarrah K, Akturk HK, Prokop LJ, Alahdab F, Foster MA, Lord JM, Karavitaki N, Wass JA, Murad MH. The cortisol stress response induced by surgery: A systematic review and meta‐analysis. Clinical endocrinology. 2018 Nov;89(5):554-67. http://doi:10.1111/cen.13820. Epub 2018 Aug 23. PMID: 30047158
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
