The Effect of Conscious Sedation on Salivary Alpha-Amylase Levels During Third Molar Surgery

Abdullah Tolga Şitilci 1, Selin Gaş 2 * , Şule Batu 3, Hümeyra Kocaelli Arıkan 4, Büşra Bozbay 5
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1 Department of Anesthesiology and Reanimation, School of Dentistry, Istanbul University, Istanbul, Turkey
2 Department of Oral and Maxillofacial Surgery, School of Dentistry, Beykent University, Istanbul, Turkey
3 Biochemistry Department, School of Dentistry, Istanbul University, Istanbul, Turkey
4 Oral and Maxillofacial Surgery Department, School of Dentistry, Istanbul University, Istanbul, Turkey
5 Orthodontics Department, School of Dentistry, La Sapienze University, Rome, Italy
* Corresponding Author
J CLIN MED KAZ, Volume 2, Issue 56, pp. 11-16. https://doi.org/10.23950/1812-2892-JCMK-00738
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ABSTRACT

Aim: The aim of the present study was to investigate whether salivary alpha-amylase levels could be decreased by conscious sedation in the patients undergoing impacted third molar extraction.
Material and methods: A total of 18 male patients were recruited. All patients were administered the Modified Dental Anxiety Scale test. Patients were divided into a test group (procedures under sedation) and a control group (procedures under local anesthesia). Systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate were monitored at different study time-points. Five samples of saliva were taken from each patient: the first time the patient came to the clinic, the patient sat in the chair for extraction, before local anesthesia, immediately after extraction, at 4 h after extraction.
Results: Although no statistically important difference was found for systolic blood pressure (p>0.05) between groups, postoperative diastolic blood pressure level of control group was statistically higher than the test group (p=0.030). Also, a statistically significant decrease was found in the oxygen saturation level in postoperative time compared to preoperative time (p<0.05). 
Conclusion: Even though conscious sedation may be a solution for dental anxiety and phobia, our results indicated that sedation did not affect acute stress levels during oral surgery.
Keywords: conscious sedation, dental anxiety, stress biomarkers, salivary alpha-amylase, tooth extraction

CITATION

Şitilci AT, Gaş S, Batu Ş, Kocaelli Arıkan H, Bozbay B. The Effect of Conscious Sedation on Salivary Alpha-Amylase Levels During Third Molar Surgery. Journal of Clinical Medicine of Kazakhstan. 2020;2(56):11-6. https://doi.org/10.23950/1812-2892-JCMK-00738

REFERENCES

  • Krueger TH, Heller HW, Hauffa BP, Haake P, Exton MS, Schedlowski M. The dental anxiety scale and effects of dental fear on salivary cortisol. Percept Mot Skills. 2005; 100(1):109-117. https://doi.org/10.2466/pms.100.1.109-117
  • Miller CS, Dembo JB, Falace DA, Kaplan AL. Salivary cortisol response to dental treatment of varying stress. Oral Surg Oral Med Oral Pathol. 1995; 79(4):436-441. https://doi.org/10.1016/S1079-2104(05)80123-4
  • Rayen R, Muthu MS, Chandrasekhar Rao R, Sivakumar N. Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res. 2006; 17(1):27-34. https://doi.org/10.4103/0970-9290.29895
  • Locker D, Poulton R, Thomson WM. Psychological disorders and dental anxiety in a young adult population. Commun Dent Oral Epidemiol. 2001; 29(6):456-463. https://doi.org/10.1034/j.1600-0528.2001.290607.x
  • de Kloet ER, Sibug RM, Helmerhorst FM, Schmidt MV. Stress, genes and the mechanism of programming the brain for later life. Neurosci Biobehav Rev. 2005; 29(2):271-281. https://doi.org/10.1016/j.neubiorev.2004.10.008
  • Bale TL, Epperson CN. Sex differences and stress across the lifespan. Nat Neurosci. 2015; 18(10):1413-1420. https://doi.org/10.1038/nn.4112
  • Viau V, Meaney MJ. The inhibitory effect of testosterone on hypothalamic-pituitary-adrenal responses to stress is mediated by the medial preoptic area. J Neurosci. 1996; 16(5):1866-1876. https://doi.org/10.1523/JNEUROSCI.16-05-01866.1996
  • Torres-Lagares D, Recio-Lora C, Castillo-Dalí G, Ruiz-de-León-Hernández G, Hita-Iglesias P, Serrera-Figallo MA,et al. Influence of state anxiety and trate anxiety in postoperative in oral surgery. Med Oral Patol Oral Cir Bucal. 2014; 19(4):e403-e408. https://doi.org/10.4317/medoral.19604
  • Hu S, Loo JA, Wong DT. Human body fluid proteome analysis. Proteomics. 2006; 23:6326-6353. https://doi.org/10.1002/pmic.200600284
  • Agha-Hosseini F, Shirzad N, Moosavi MS. Evaluation of xerostomia and salivary flow rate in Hashimoto's thyroiditis. Med Oral Patol Oral Cir Bucal. 2016; 21(1):e1-5. https://doi.org/10.4317/medoral.20559
  • Skrinjar I, Brailo V, Vidovic-Juras D, Vucicevic-Boras V, Milenovic A. Evaluation of pretreatment serum interleukin-6 and tu-mour necrosis factor alpha as a potential biomarker for recurrence in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal. 2015; 20(4):e402-e407. https://doi.org/10.4317/medoral.20373
  • Wei P, Li C, Qiang L, Li Z, Hua H. Role of salivary anti-SSA/B antibodies for diagnos-ing primary Sjögren's syndrome. Med Oral Patol Oral Cir Bucal. 2015; 20(2):e156-160. https://doi.org/10.4317/medoral.20199
  • Pereira DL, Vilela VS, Dos Santos TC, Pires FR. Clinical and laboratorial profile and histological features on minor salivary glands from patients under investigation for Sjögren's syndrome. Med Oral Patol Oral Cir Bucal. 2014; 19(3):e237-241. https://doi.org/10.4317/medoral.19486
  • Bachmeier E, Mazzeo MA, López MM, Linares JA, Jarchum G, Wietz FM, et al. Mucositis and salivary antioxidants in patients undergoing bone marrow transplantation (BMT). Med Oral Patol Oral Cir Bucal. 2014; 19(5):e444-e450. https://doi.org/10.4317/medoral.19062
  • Rahim MA, Rahim ZH, Ahmad WA, Hashim OH. Can saliva proteins be used to predict the onset of acute myocardial infarction among high-risk patients. Int J Med Sci. 2015; 12(4):329-335. https://doi.org/10.7150/ijms.11280
  • Powell J, DiLeo T, Roberge R, Coca A, Kim JH. Salivary and serum cortisol levels during recovery from intense exercise and pro-longed, moderate exercise. Biol Sport. 2015; 32(2):91-95.https://doi.org/10.5604/20831862.1134314
  • Delacroix DL, Dive C, Rambaud JC, Vaerman JP. IgA subclasses in various se-cretions and in serum. Immunology. 1982; 47(2):383-385.
  • Stephen KW, McCrossan J, Mackenzie D, Macfarlane CB, Speirs CF. Factors deter- mining the passage of drugs from blood into saliva. Br J Clin Pharmacol. 1980; 9(1):51-55. https://doi.org/10.1111/j.1365-2125.1980.tb04796.x 
  • Krishnan R, Thayalan DK, Padmanaban R, Ramadas R, Annasamy RK, Anandan N. Association of serum and salivary tumor necrosis factor-a with histological grading in oral cancer and its role in differentiating premalignant and malignant oral disease. Asian Pac J Cancer Prev. 2014; 15(17):7141-7148. https://doi.org/10.7314/APJCP.2014.15.17.7141
  • Kuehl MN, Rodriguez H, Burkhardt BR, Alman AC. Tumor necrosis factor-a, matrix-metalloproteinases 8 and 9 levels in the saliva are associated with increased hemo-globin A1c in type 1 diabetes subjects. PLOS ONE. 2015; 10(4):e0125320. https://doi.org/10.1371/journal.pone.0125320
  • Pfaffe T, Cooper-White J, Beyerlein P, Kost- ner K, Punyadeera C. Diagnostic potential of saliva: current state and future applications. Clin Chem. 2011; 57(5):675-687. https://doi.org/10.1373/clinchem.2010.153767
  • Yoon AJ, Cheng B, Philipone E, Turner R, Lamster IB. Inflammatory biomarkers in saliva: assessing the strength of association of diabetes mellitus and periodontal status with the oral inflammatory burden. J Clin Periodontol. 2012; 39(5):434-440. https://doi.org/10.1111/j.1600-051X.2012.01866.x
  • Prasad S, Tyagi AK, Aggarwal BB. Detection of inflammatory biomarkers in saliva and urine: potential in diagnosis, prevention, and treatment for chronic diseases. Exp Biol Med (Maywood). 2016; 241(8):783-799. https://doi.org/10.1177/1535370216638770
  • Nater U, Rohleder N. Salivary alpha-amylase as a noninvasive biomarker for the sympathetic nervous system: current state of research. Psychoneuroendocrinology. 2009; 34(4):486-496. https://doi.org/10.1016/j.psyneuen.2009.01.014
  • Lee KC, Bassiur JP. Salivary Alpha Amylase, Dental Anxiety, and Extraction Pain: A Pilot Study. Anesth Prog. 2017; 64(1):22-28. https://doi.org/10.2344/anpr-63-03-02
  • Chaturvedi Y, Chaturvedy S, Marwah N, Chaturvedi S, Agarwal S, Agarwal N. Salivary Cortisol and Alpha-amylase-Biomarkers of Stress in Children undergoing Extraction: An in vivo Study. Int J Clin Pediatr Dent. 2018; 11(3):214-218. https://doi.org/10.5005/jp-journals-10005-1514
  • Gutiérrez-Corrales A, Campano-Cuevas E, Castillo-Dalí G, Serrera-Figallo MÁ, Torres-Lagares D, Gutiérrez-Pérez JL. Relationship between salivary biomarkers and postoperative swelling after the extraction of impacted lower third molars. Int J Oral Maxillofac Surg. 2017; 46(2):243-249. https://doi.org/10.1016/j.ijom.2016.10.005
  • Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health. 1995; 12(3):143-150.
  • Leitch J, Macpherson A. Current state of sedation/analgesia care in dentistry. Curr Opin Anaesthesiol. 2007; 20(4):384-387. https://doi.org/10.1097/ACO.0b013e32825ea2a4
  • Robles TF, Sharma R, Park KS, Harrell L, Yamaguchi M, Shetty V. Utility of a salivary biosensor for objective assessment of surgery-related stress. J Oral Maxillofac Surg. 2012; 70(10):2256-2263. https://doi.org/10.1016/j.joms.2012.03.005
  • Furlan NF, Gavião MB, Barbosa TS, Nicolau J, Castelo PM. Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children. J Clin Pediatr Dent. 2012; 37(1):83-87. https://doi.org/10.17796/jcpd.37.1.n32m21n08417v363
  • Strahler J, Skoluda N, Kappert MB, Nater UM. Simultaneous measurement of salivary cortisol and alpha-amylase: Application and recommendations. Neurosci Biobehav Rev. 2017; 83:657-677. https://doi.org/10.1016/j.neubiorev.2017.08.015
  • Chatterton RT, Vogelsong KM, Lu YC, Ellman AB, Hudgens GA. Salivary α-amylase as a measure of endogenous adrenergic activity. Clin Physiol. 1996; 16(4):433-448. https://doi.org/10.1111/j.1475-097X.1996.tb00731.x
  • Gordis EB, Granger DA, Susman EJ, Trickett PK. Salivary alpha amylase- cortisol asymmetry in maltreated youth. Horm Behav. 2008; 53(1):96-103. https://doi.org/10.1016/j.yhbeh.2007.09.002
  • Allwood M, Handwerger K, Kivlighanc K, Granger D, Stroude L. Direct and moderating links of salivary alphaamylase and cortisol stress-reactivity to youth behavioral and emotional adjustment. Biol Psychol. 2011; 88(1):57-64. https://doi.org/10.1016/j.biopsycho.2011.06.008
  • Kang Y. Psychological stress-induced changes in salivary alpha-amylase and adrenergic activity. Nurs Health Sci. 2010; 12(4):477-484. https://doi.org/10.1111/j.1442-2018.2010.00562.x
  • Ogunlewe MO, James O, Ajuluchukwu JN, Ladeinde AL, Adeyemo WL, Gbotolorun OM. Evaluation of haemodynamic changes in hypertensive patients during tooth extraction under local anaesthesia. West Indian Med J. 2011; 60(1):91-95.
  • Fukayama H, Yagiela JA. Monitoring of vital signs during dental care. Int Dent J. 2006; 56(2):102-108. https://doi.org/10.1111/j.1875-595X.2006.tb00081.x
  • Zivotic-Vanovic M, Marjanovic M. Examination of cardiovascular function variables in tooth extraction under local anesthesia. Vojnosanit Pregl. 2006; 63(1):43-47. https://doi.org/10.2298/VSP0601043Z
  • Alemany-Martínez A, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Hemodynamic changes during the surgical removal of lower third molars. J Oral Maxillofac Surg. 2008; 66(3):453-61.https://doi.org/10.1016/j.joms.2007.06.634