Relationships among cortisol, perceived stress, and dental caries experience in adolescents and young adults.

INTRODUCTION Stress can impact mental and physical health, especially during adolescence and young adulthood. Previous studies have shown that salivary cortisol levels are elevated in both severe dental caries and periodontal disease. The role of stress in periodontal disease has been studied, but the extent of its contribution to dental caries is less well understood, especially in this age group. The present study aimed to assess the association between perceived stress, cortisol levels (in hair and saliva) and overall caries experience of adolescents and young adults aged between 15 and 25 years. METHODS Hair and saliva samples were obtained from 93 participants (age range=15-25 years) free of periodontal disease. Cortisol concentrations in hair and saliva were determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. In addition, sociodemographic variables were recorded. Univariate and multivariable binary logistic regressions were used to assess the relationships of interest. RESULTS There were significantly higher hair cortisol levels (p=0.042) and perceived stress scale (PSS) scores (p=0.026) in individuals with dental caries experience (DMFT≥1) than in those without (DMFT=0). However, there was no significant difference in salivary cortisol concentration (p=0.302). A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with an increased odds of having experienced dental caries (OR=4.08, 95% CI 1.04, 15.96; OR=1.65, 95% CI 1.04, 2.63; respectively). In contrast, no significant association was found between dental caries and salivary cortisol concentration (OR=0.31, 95% CI 0.02, 4.23). Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for confounding sociodemographic variables. CONCLUSION In the absence of periodontal disease, hair cortisol levels have a significant association with dental caries experience, whereas salivary cortisol concentrations do not. Hair cortisol levels may reflect the chronic physiological burden imposed by exposure to detrimental stressors.