Effects of different dental local anesthesia techniques on salivary cortisol and secretory immunoglobulin a in pediatric patients: a randomized controlled clinical study.

objectivesDental local anesthesia may elicit acute stress-related responses in children. This study compared salivary cortisol and secretory immunoglobulin A (s-IgA) responses to conventional anesthesia, conventional anesthesia following topical anesthesia, jet anesthesia, and computer-controlled local anesthesia delivery system (CCLAD), and examined associations between the biomarkers. MATERIALS AND

methods80 healthy children aged 6-9 years were randomly assigned to four anesthesia groups (n = 20/group). Behavioural, physiological, and biochemical responses were assessed using MCDAS, Frankl, SEM, heart rate, salivary cortisol, and s-IgA. Saliva was collected before and after anesthesia and analysed using standardized procedures.

resultsSEM scores increased during anesthesia in all groups (p < 0.05) and were lower with CCLAD than conventional anesthesia (p = 0.004). Cortisol increased after conventional (4.59 ± 2.45 to 6.07 ± 2.78 nmol/L; p < 0.001) and jet anesthesia (6.49 ± 4.42 to 8.07 ± 5.51 nmol/L; p = 0.007), but not after conventional anesthesia following topical anesthesia or CCLAD (p > 0.05). s-IgA decreased after conventional and jet anesthesia (p < 0.001), with no significant changes in the other groups. Baseline s-IgA concentrations differed among groups (p < 0.001). Changes in cortisol and s-IgA were negatively correlated in the conventional anesthesia following topical anesthesia and CCLAD groups (p < 0.001).

conclusionTaken together, the findings indicate that local anesthesia protocols are associated with different behavioural and biochemical response patterns in pediatric patients. CCLAD was associated with lower procedural SEM scores, while salivary cortisol and s-IgA responses varied across protocols. These patterns should not be interpreted as evidence that any technique definitively reduces psychological stress. Salivary s-IgA may have potential as a complementary stress-related biomarker, although further studies are needed to establish its clinical applicability. CLINICAL RELEVANCE: CCLAD was associated with lower SEM scores during anesthesia compared with conventional anesthesia, while no significant pre-to-post changes in salivary cortisol or s-IgA were observed in the CCLAD or conventional anesthesia following topical anesthesia groups. These findings may inform the clinical selection of anesthesia protocols; however, changes in cortisol and s-IgA should be interpreted as stress-related biomarker responses rather than direct evidence of reduced psychological stress.