# Evaluation and Comparison of Cortisol Levels in Saliva and Hair among Dental Students
## 4 Discussion
\begin{table}
\begin{tabular}{c c c c c c c} \hline \hline
**Cortisol Level** & **Specimens** & **\({}^{\star}\) Mean** & \begin{tabular}{c} **Std.** \\ **Deviation** \\ \end{tabular} & \begin{tabular}{c} **Std. Error** \\ **Mean** \\ \end{tabular} & \begin{tabular}{c} **Paired** \\ **Differences** \\ \end{tabular} & \({}^{\star\ast}\)_p_-Value** \\ \hline \multirow{2}{*}{\
\begin{tabular}{c} First Visit \\ (N = 151) \\ \end{tabular} } & Saliva & 1.543 & 0.574 & 0.046 & \multirow{2}{*}{0.327} & \multirow{2}{*}{0.000} \\ \cline{2-3} \cline{5-5}  & Hair & 1.215 & 0.788 & 0.064 & & \\ \hline \multirow{2}{*}{
\begin{tabular}{c} Second Visit \\ (N = 151) \\ \end{tabular} } & Saliva & 1.302 & 0.699 & 0.056 & & \\ \cline{2-3} \cline{5-5}  & Hair & 0.789 & 0.610 & 0.049 & & \\ \hline \hline \end{tabular}  
* Mean value was recorded in microliters; **\(p\)-value was significant at \(p\) < 0.05.  
\end{table} 
Table 3: Comparison of cortisol levels in saliva and hair specimens of the participating students (N-151). The findings of our analysis are in line with numerous studies that examined the levels of cortisol in samples of saliva and hair from male and female subjects [6; 7; 23; 24; 25; 26; 27]. Despite advancements in laboratory diagnostics, such as cortisol assays, in our opinion, it is still difficult to translate intricate the in vivo regulation of cortisol production into relatively straightforward statistical models based on laboratory tests [28]. Positive and negative feedback may depend on exogenous variables and multiple genetic polymorphisms affecting the sensitivity of the cortisol receptor, which in turn may modify its level and impact on clinical symptoms [28]. Due to the pulsing nature of its production and responsiveness to circadian cycles, cortisol levels may be affected. This could lead to misdiagnosis and a misinterpretation of laboratory findings [29]. The insufficient validation of research evaluating the connection of cortisol concentrations with other biological samples is another issue brought up by numerous other authors [27; 28; 29; 30; 31]. It is also critical to take into account the possibility of pre-analytical errors, especially when cortisol level assessments are more challenging. For instance, the cortisol levels in hair measurements may be impacted by poorly understood effects of chemicals used in hair care products. Chemicals like hair dye and bleach are probably used more frequently by women [32]. This might be one of the causes of the different cortisol levels seen in the hair of the male and female subjects in the current study. It is widely established in the literature that cortisol levels vary from day to day [21; 22; 28; 29]. The findings of the current investigation also point to the existence of these daily variations in cortisol levels. Even if there were changes in the cortisol levels for the female participants, they were not statistically significant. It is interesting to note that, for females, the variations in cortisol levels for both saliva and hair samples displayed a similar non-significant trend. In contrast, there were noticeable changes in the male participant's saliva and hair cortisol levels. These variations may be attributed to the normal variations in stress that the male participants experienced on various days of the week. In earlier investigations, it was discovered that men had higher cortisol levels than women [33]. This pattern was also shown in the results of the current investigation, wherein the levels of cortisol in the saliva and hair samples of the male participants were higher than those of the female participants. The non-significant variations in cortisol levels between the two time points for the female individuals, however, are an intriguing discovery and might make for an interesting research topic. One of the interesting findings was the decrease in the salivary and hair cortisol levels recorded in the second visit as compared to their levels in the first visit.