Self-Reported Stress, Hair Cortisol and Untreated Caries in Low-Income Adolescents in the United States.

Purpose: To evaluate pairwise associations between 4 self-reported and 1 biological stress measure (hair cortisol) and assess the associations between stress and untreated dental caries in adolescents enrolled in public insurance (Medicaid) in the United States.

Methods

This pilot cross-sectional study used survey, hair and dental screening data collected from Oregon Medicaid-enrolled adolescents ages 12 to 18 years (n=268). Self-reported stress measures included the Perceived Stress Scale-10 (PSS) and adapted versions of the Stressful Life Events Screening Questionnaire, the Psychosocial Index and Things I Have Seen and Heard (TISH) questionnaire. The biological stress measure was hair cortisol concentration (HCC). Untreated caries was defined as the number of decayed primary and permanent tooth surfaces. Spearman's rank-order correlation test was used to report correlations (r) and 95 percent confidence intervals (α=0.05).

Results

The four self-reported stress measures were significantly and positively correlated. PSS was the only self-reported stress measure that was significantly associated with HCC (r=-0.16; P=0.008). Most stress measures showed very weak, statistically insignificant associations with untreated caries, except for a significant but negative correlation between untreated caries and the TISH questionnaire (r=-0.13; P=0.04).

Conclusions

Self-reported and biological stress measures may not be interchangeable. Most of the evaluated stress measures demonstrated an insignificant association with untreated caries. Additional work is needed to elucidate the relationship between different types of stress and oral health outcomes in low-income adolescents.