Stress Level Among Dentists in Performing Treatment
Condition: Stress, Job
MeSH terms: Occupational Stress
Study type: Interventional

Summary: 
      Purpose: To evaluate the stress levels of dentists working under clinical, deep sedation, or
      general anaesthesia. Methods: Blood pressure (Systolic, Diastolic blood pressure), Pulse
      value, O2 saturations were measured, and saliva samples were taken by the dentists 10 minutes
      before the dental treatment, at the 25th minute of the treatment, and 30 minutes after the
      treatment under clinic, deep sedation, and general anesthesia. Salivary cortisol was measured
      by electrochemiluminescence (ECLIA) method using the Cobas Cortisol ll kit. The data are
      analayse statistically
    

Detailed description: 
      Occupational stress, defined as when the resources of the individual are not sufficient to
      cope with the needs of a situation, is a leading modern health and safety challenge 2.

      Although stress is defined as a feeling of tension and pressure, small amounts of stress can
      be helpful for the individual to cope with difficult situations. The dentist who wants to
      provide the best treatment for the patient can feel stress and uneasiness when the current
      conditions are inappropriate. If this stress of dentist is very the desired amount, it can
      lead to harmful results for patient health.

      Especially in pediatric dentistry, behaviour management problems in children, parents'
      expectations, and behaviours can be more stressful and exhausting in practice. A dentist' s
      fear and anxiety in children can create various difficulties for the child, parents,
      dentists, and their team.

      Deep sedation is the method in which consciousness is suppressed in a controlled manner by
      the drug applied, partial loss of protective reflexes, and the response to verbal stimuli is
      removed. General anaesthesia, on the other hand, is a condition in which the level of patient
      unconsciousness can be controlled, the patient's protective reflexes are partially or wholly
      lost, he cannot protect the airway independently, and cannot respond to verbal commands or
      physical stimuli. Ensuring and maintaining airway patency is vital in sedation applications.
      In anaesthesia applications, deep sedation in dental procedures is challenging due to the
      anatomical proximity of the surgical area to the airway, the risk of microaspiration. Dental
      treatment with general anaesthesia is seen that it is a stressful situation for the
      practitioner since some complications such as neurological damage, cardiac and respiratory
      arrest, and even death may occur.

      In healthy individuals, stimulation of the sympathetic nervous system at the beginning of the
      stress response begins with the secretion of epinephrine and norepinephrine from the adrenal
      medulla. For this reason, sympathetic activity is measured by various evaluation methods such
      as heart rate, blood pressure, O2 saturation. Salivary cortisol has been accepted as a
      reliable biomarker of the Hypothalamus-Pituitary-Adrenal system as a delayed stress response.

      In the literature review, very few studies investigated occupational stress related to
      pediatric dentistry. Furthermore, no study was found in which the stress situation in three
      treatment protocols was evaluated and compared. It was aimed to evaluate the stress which was
      experienced by dentists working with children while treating children in all three treatment
      protocols by using objective tests. The H0 hypothesis of the study is that the stress levels
      of dentists change according to the different treatment protocols.

      METHODS This study was approval required for the study was obtained by the clinical research
      ethics committee from University (No: 82021/32) and conducted following the principles of the
      Declaration of Helsinki. Both the parents and their children and dentists who agreed to
      participate in the study provided informed consent.

      According to the power analysis, the estimated number of samples was determined as 9 patients
      in each groups (α error 0.05 and 1-β=0.80). Therefore, each dentist treated 27 patients in 3
      different treatment approaches, and the study resulted in a total of 108 patients.Blood
      pressure (Systolic, Diastolic blood pressure), Pulse value, O2 saturations were measured, and
      saliva samples were taken by the dentists 10 minutes before the dental treatment, at the 25th
      minute of the treatment, and 30 minutes after the treatment for all 3 treatment approaches
      The Saliva Swab Sample Collection kit was used to collect saliva samples. It was placed under
      the tongue for 2 minutes and was ensured that the swab absorbed the saliva. Afterwards, the
      swab was centrifuged and placed in saliva storage tubes with a perforated chamber for
      separating saliva and remaining dry swab. Samples were centrifuged at 3000 rpm for 15
      minutes, saliva was cleared of debris and poured to the bottom of the storage tube. Then,
      saliva in the plastic saliva storage tube was stored at -80 ºC in an upright position until
      measurements were made 30. After the saliva samples were thawed at room temperature on the
      day of the measurements, they were taken to the University Medical Faculty Central
      Biochemistry Laboratory for analysis.

      Salivary Cortisol Measurement Protocol:

      Salivary cortisol was measured by electrochemiluminescence (ECLIA) method using the Cobas
      Cortisol ll kit (Roche Diagnostics GmbH; Mannheim, Germany).

      10 µL of sample is incubated with cortisol-specific biotinylated antibody and cortisol
      derivative labelled with ruthenium complex. Depending on the analyte concentration in the
      sample and the formation of the respective immune complex, the labelled antibody binding site
      is filled partly with the sample analyte and partly with the ruthenium hapten.

      After streptavidin-coated microparticles have been added, biotin and streptavidin interact.
      The complex becomes bound to the solid phase.

      The reaction mixture is aspirated into the measuring cell on the surface of the electrode.
      The measuring cell is that the microparticles, magnetically, are captured. Unbound substances
      are then removed with ProCell/ProCell M. Applying voltage to the electrode induces
      chemiluminescence emission, which is measured with a photomultiplier.

      An instrument-specific calibration curve determines results with 2-point calibration and a
      master curve acquired via the reagent barcode 30.

      Statistical analysis In the study, the analyzes were made with the SPSS 25.0 program. On the
      analysis of data, descriptive statistics are presented with mean and standard deviation
      values. In the study, the Kruskal Wallis test was performed to examine the differences in
      measurements according to dentists and treatment approaches. Mann Whitney U test was used to
      reveal the evaluation that caused the difference. The Friedman test was used to examine the
      differences between the measurements in the treatment approaches before, during, and after
      the procedure.

      Results When the findings are evaluated according to the measurement times: systolic and
      diastolic blood pressure measurements for all dentists before the procedure are similar in
      clinical, general anaesthesia, and sedation (p>0.05). During the procedure, both systolic and
      diastolic blood pressure measurements were found to be higher under the deep sedation
      (p<0.05). It was determined that systolic blood pressure measurements did not differ
      according to under clinical, general anaesthesia, and deep sedation after the procedure
      (p>0.05), but diastolic blood pressure measurements differed according to treatment
      approaches. The measurements under the deep sedation were higher than the clinical and
      general anaesthesia (p<0.05). Pulse and oxygen saturation measurements before, during, and
      after the treatment did not differ under clinical, general anaesthesia, and deep sedation. It
      was observed that cortisol measurements before and during the treatment were not at different
      levels compared to clinical, general anaesthesia, and deep sedation (p>0.05). After the
      procedure, cortisol measurements under the deep sedation were higher than clinical and
      general anaesthesia (p<0.05).

      It was observed that the heart rate measurements were at similar levels before, during, and
      after the procedure under clinical and general anaesthesia. Under the deep sedation, it was
      determined that the heart rate measurements during the procedure were at higher levels than
      before and after the procedure (p<0.05).

      When authors evaluated the oxygen saturation measurements, the oxygen saturation during the
      procedure was lower than before and after the procedure.

      Cortisol measurements were found to be at different levels according to the processing times
      in Table 2.
    

Intervention name(s): Blood pressure (Systolic, Diastolic), Pulse value, O2 saturations were measured.
Intervention type(s): Diagnostic Test
Intervention description(s): Salivary cortisol was measured by electrochemiluminescence (ECLIA) method using the Cobas Cortisol ll kit.
Other intervention name(s): Salivary cortisol
Intervention MeSH terms: Hydrocortisone
Allocation: Non-Randomized
Intervention model: Factorial Assignment
Intervention model description: In the present study, it was aimed to evaluate the stress which was experienced by dentists working with children while treating children in all three treatment protocols by using objective (salivary cortisol, pulse, blood pressure, O2 saturation) and subjective (Dentists' Stress Questionnaire) findings 27. The H0 hypothesis of the study is that the stress levels of dentists change according to the different treatment protocols.
each dentist treated 27 patients in 3 different treatment approaches, and the study resulted in a total of 108 patients.
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: DEEP SEDATION; GENERAL ANESTHESIA; pediatric dentistry; STRESS LEVELS