title: Professional dental prophylaxis increases salivary cortisol in children with dental behavioural management problems: a longitudinal study.
abstract: BACKGROUND
  Dental procedures may cause stress and increase the salivary cortisol levels. It is important to known if apparently simple procedures such as professional dental prophylaxis at low speed (DP) are stressful for children with dental behaviour management problems (DBMP) to help with behaviour guidance strategies. This longitudinal study aimed to evaluate if DP changes a physiological marker of stress (salivary cortisol) in children with DBMP who were referred to dental treatment under sedation.
  
  
  METHODS
  One paediatric dentist carried out a DP with rubber cup and pumice followed by dental examination in 39 children aged 2-5 years, prior to the dental sedation appointment. Children's saliva was collected at three different moments: upon waking (UW), on arrival at the dental office reception area (RA) and 25 min after the dental prophylaxis (DP). The saliva samples were analysed using an enzyme immunoassay kit. The Wilcoxon test was used in paired comparison (P < 0.05).
  
  
  RESULTS
  Salivary cortisol levels decreased from UW (0.34; 0.15-0.54) to RA (0.14; 0.08-0.56) (P = 0.019) and increased from RA to DP (0.25; 0.06-1.48) (P = 0.008). Higher salivary cortisol levels were observed at DP when compared to RA in children who did not have previous dental treatment (P = 0.007), had toothache (P = 0.006), presented some protest behaviour during DP (P = 0.008), or needed protective stabilisation by parents for the dental examination (P = 0.005).
  
  
  CONCLUSIONS
  Paediatric dentists should be aware that even simple procedures such as professional dental prophylaxis are related to stress in young children.
authors.affiliation: Programa de Pós-Graduação em Odontologia, Universidade Federal de Goiás (UFG), Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil.
authors.forename: Heloisa Sousa
authors.initials: HS
authors.lastname: Gomes
authors.affiliation: Departamento de Saúde Oral, Faculdade de Odontologia/UFG, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil.
authors.forename: Liliani Aires Candido
authors.initials: LA
authors.lastname: Vieira
authors.affiliation: Departamento de Pediatria, Faculdade de Medicina/UFG, Rua 235 c/ 1a. s/n - S. Universitário, CEP 74605-020, Goiânia, GO, Brazil.
authors.forename: Paulo Sucasas
authors.initials: PS
authors.lastname: Costa
authors.affiliation: Departamento de Ciências Estomatológicas, Faculdade de Odontologia/UFG, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil.
authors.forename: Aline Carvalho
authors.initials: AC
authors.lastname: Batista
authors.affiliation: Departamento de Saúde Oral, Faculdade de Odontologia/UFG, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil. lsucasas@ufg.br.|Faculdade de Odontologia, Universidade Federal de Goiás, Primeira Avenida, Setor Universitário, CEP: 74605-220, Goiânia, Goiás, Brazil. lsucasas@ufg.br.
authors.forename: Luciane Rezende
authors.initials: LR
authors.lastname: Costa
mesh_terms: D002648:Child; D016854:Dental Anxiety; D003777:Dental Prophylaxis; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008137:Longitudinal Studies; D012463:Saliva / Q000737:chemistry
chemical_list: D006854:Hydrocortisone
keywords: Child behaviour; Dental care for children; Dental prophylaxis; Saliva; Stress, psychological