Salivary Cortisol Levels and its Implication on Behavior In Children with Autism during Dental Treatment

The aim of the study was to estimate the diurnal variations of salivary cortisol in children with autism and healthy children and it’s implication on behavior during non-invasive dental procedures. Study design: 50 children with autism and 50 healthy children in the age group between 6 to 12 years of both genders with the need for dental treatment were included in the study. Whole unstimulated saliva was collected from them during early hours of the day and during evenings for 2 consecutive days . The collected saliva was then subjected to electrochemiluminescence assay . Minimum invasive dental procedures like hand scaling, pit and fissure sealants and glass ionomer cement restorations were performed for the participants each time after the saliva sample collection and their behavior during the procedures was rated using Frankl’s Behavior Rating Scale. Results:Significant correlation was seen between cortisol levels and behavior in children with autism. As cortisol levels increased in children with autism, behavior worsened and as the cortisol levels decreased they showed positive behaviour. Conclusion: Cortisol acts as a stress marker and studying the diurnal variations of salivary cortisol can help us in attaining better knowledge about the behavior pattern and thereby assist us in modifying the behavior modification procedures and treatment planning in this group of special children.

Autism, Cortisol, Stress, Diurnal Variation, children

1. World Health Organization. “F84. Pervasive developmental disorders”, International Statistical Classification of Diseases and Related Health Problems, 10th ed. (ICD-10),2006.

2. Medina A, Sogbe R; Factitial oral lesions in an autistic paediatric patient. IJPD,133: 130-137, 2003.

3. Corbett B A, Mendoza Sally, Wegelin Jacob A, Carmean Vanessa, Levine Seymour. Variable cortisol circadian rhythms in children with autism and anticipatory stress. J Psychiatry Neurosci,33(3): 227-234,2008.

4. Corbett B A, Schupp C W, Levine S, Mendoza S. Comparing cortisol, stress and sensory sensitivity in children with autism. Autism Res,2(1): 39-49,2009.

5. Vahdettin B, Nihat D, Funda T. Evaluation of Relationships among Cortisol, Stress, Autism and Exercise. Australian journal of basic and applied sciences,3(2):1013-1021,2009.

6. Aardal E, Holm A-C. Cortisol in Saliva — Reference Ranges and Relation to Cortisol in Serum. Eur J Clin Chem Clin Biochem,33:927-932,1995.

7. FDI Working group 10, CORE. Saliva: Its role in health and disease. IDJ,42:291-304,1992.

8. Rai K, Hegde AM, Shetty S, Shetty S. Estimation of Salivary Cortisol in Children with Rampant Caries. J Clin Pediatr Dent 34(3):249-252,2010.

9. Sreebny L M, Banoczy J, Baum B J, Edgar W M, Epstein J B, Fox P C et al. Saliva:Its role in health and disease.IDJ;42:291-304. 1992.

10. Van Aken M O,Romjin J A, Mittenburg J A, Lentjes G.W.M. Automated measurement of salivary cortisol.Clinical Chemistry,49(8);1408-09,2003.

11. Frankl S. N, Shiere F. R, Fogels H.R, Should the parent remain with the child in the dental operator? Journal of Dentistry for the children,29: 150-163,1962

12. Flinn M. W. Evolution and ontogeny of stress response to social challenges in the human child. Developmental Review,26:138–174,2006.

13. Seeman T. E, & Robbins R. J. Aging and hypothalamic pituitary-adrenal response to challenge in humans. Endocrine Reviews,15:223–261,2006.

14. Seltzer M. M, Almeida D. M, Greenberg, J. S, Savla J, Stawski R. S, Hong J et al. Psychological and biological markers of daily lives of midlife parents of children with disabilities. Journal of Health and Social Behavior,50:1–15,2006.

15. McEwen B. S. Protective and damaging effects of stress mediators. The New England Journal of Medicine,338:171–179,1998.

16. Segerstrom S. C, & Miller G. E. Psychological stress and the human immune system: A meta-analytic study of 30 years of inquire. Psychological Bulletin,130:601–630,2004.

17. Kirschbaum C, & Hellhammer D. H. Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology,19: 313–333,1994.

18. Tohara Y, Sakurai K, Ando T. Influence of chewing and clenching on salivary cortisol levels as an indicator of stress. J Prosthodont ,16:129-135,2007.