Effect Of Pre-Treatment Educational Counseling on Psychological and Physiological Stress Responses During Orthodontic Bracket Bonding: A Randomized Controlled Trial

Abstract

Introduction: Orthodontic bracket bonding may induce psychological and physiological stress responses that influence patient comfort and treatment acceptance. This study evaluated anxiety levels, salivary alpha-amylase activity, pulse rate, blood pressure, and oxygen saturation during initial orthodontic bracket bonding.
Methods: In this prospective observational study, 80 patients undergoing first-time fixed orthodontic treatment were recruited. Anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). Salivary alpha-amylase activity, pulse rate, blood pressure, and oxygen saturation were recorded before, during, and after bracket bonding. Data were analyzed using repeated-measures analysis and correlation tests.
Results: The mean (SD) age of participants was 18.9 (3.4) years. Anxiety scores increased significantly following bracket bonding [11.8 (2.9) vs. 14.6 (3.4), P<0.001]. Salivary alpha-amylase activity increased from 54.7 (18.6) U/mL to 83.2 (24.9) U/mL (P<0.001). Significant increases were also observed in pulse rate and blood pressure during the procedure (P<0.05). Oxygen saturation remained stable (P=0.417). Anxiety scores showed a moderate positive correlation with salivary alpha-amylase activity (r=0.46, P<0.001).
Conclusion: Initial orthodontic bracket bonding was associated with increased anxiety and physiological stress responses. Salivary alpha-amylase may serve as a useful non-invasive biomarker for assessing treatment-related stress in orthodontic patients.