Correlation of cheek biting with stress and salivary cortisol in final-year dentistry students: a cross-sectional study

Diana Gita Mentari; Indah Puti Rahmayani Sabirin; Rheni Safira; Sutrania Dewi Sulaksana

doi:10.24198/pjd.vol36no3.58218

Correlation of cheek biting with stress and salivary cortisol in final-year dentistry students: a cross-sectional study

Diana Gita Mentari, Indah Puti Rahmayani Sabirin, Rheni Safira, Sutrania Dewi Sulaksana

Abstract

Introduction: Stress is a situation that can feel self-threatening, arising from stressors that exceed the body's ability to cope. Final-year students are particularly vulnerable to stress as they face the pressure of completing their theses. Cheek biting is recognized as a coping mechanism for psychological stress, which is why it is often associated with stress. The purpose of this study is to analyze the correlation between stress levels and the occurrence of cheek biting in final-year students. Methods: This research was an observational study with a cross-sectional approach. The research subjects were final-year students who were completing their theses. The sample size was determined using the correlation sample size formula and employed total sampling, including 40 respondents based on the inclusion criteria. A perceived stress score (PSS-10) questionnaire, salivary cortisol examination, and cheek biting assessment were conducted for all respondents. Results: PSS-10 examination results revealed that five students had a low stress level, 29 students had a moderate stress level, and six students had high levels of psychological stress. The Spearman correlation coefficient between stress perception and cheek biting incidents was 0.638, which indicated a strong relationship and was statistically significant (p-value=0.001). However, salivary cortisol examination of ten respondents with cheek biting showed only slightly higher levels than the control group, and the Mann-Whitney test showed no significant differences. Conclusion: There was a moderate correlation between perceived stress levels and the occurrence of cheek biting in the final-year dentistry students in the Faculty of Dentistry, Jendral Ahmad Yani University, Indonesia. However, there was no difference in salivary cortisol level when compared to students without cheek biting.

Keywords

cheek biting, PSS-10, salivary cortisol, stress

Full Text:

PDF

References

Valencia-Florez KB, Sánchez-Castillo H, Vázquez P, Zarate P, Paz DB. Stress, a brief update. Int J Psychol Res (Medellin). 2023 Oct 10;16(2):105-121. https://doi.org/10.21500/20112084.5815

Kaur M, Sehgal R. Stress levels amongst first year and final year female college students. International Journal of Indian Psychology. 2023; 11(2): 1207-1212. https://doi.org/10.25215/1102.129.

Mussi FC, Pires CGS, Carneiro LS, Costa ALS, Ribeiro FMSS, Santos AF. Comparison of stress in first- and fourth-year student nursing students. Rev Esc Enferm USP. 2019; 53: http://dx.doi.org/10.1590/S1980-220X2017023503431

Kumar B, Shah MAA, Kumari R, Kumar A, Kumar J, Tahir A. Depression, anxiety, and stress among final-year medical students. Cureus. 2019 Mar 16;11(3).https://doi.org/10.7759/cureus.4257

Schönfeld P, Brailovskaia J, Bieda A, Zhang XC, Margraf J. The effects of daily stress on positive and negative mental health: mediation through self-efficacy. Int J Clin Health Psychol. 2016;16(1):1-10.https://doi.org/10.1016/j.ijchp.2015.08.005

Okoh M, Okoh DS. Orofacial manifestations of stress, anxiety, and depression Nig J Dent Sci. 2022; 5(1&2):11-17.

Rana A, Gulati R, Wadhwa V. Stress among students: An emerging issue. Integrated J of Social Sciences. 2019 Jul 3;6(2):44-8.

Owczarek JE, Lion KM, Radwan-Oczko M. Manifestation of stress and anxiety in the stomatognathic system of undergraduate dentistry students. J of Int Med Research. 2020 Feb; 48(2).https://doi.org/10.1177/0300060519889487

Pumklin J, Taechasubamorn P, Luehong A, Pramot S, Panyasoet C, Sowithayasakul T. Relationship between temporomandibular disorder and risk factors in health science students: A cross-sectional study. Dent. 2020;11(6):494-500.https://doi.org/10.5005/jp-journals-10015-1786

Kubo KY, Iinuma M, Chen H. Mastication as a Stress-Coping Behavior. Biomed Res Int. 2015;2015:876409. Epub 2015 May 18. https://doi.org/10.1155/2015/876409

Jansakova K, Kyselicova K, Celusakova H, Repiska G, Ostatnikova D. The effect of saliva stimulation on the secretion of cortisol during stress and physiological conditions. Bratisl Med J. 2020;121(6):428-30.https://doi.org/10.4149/BLL_2020_069

Glick M, Greenberg MS, Lockhart PB, Challacombe SJ. Burket’s oral medicine. Thirteenth edition. USA: Wiley Blackwell; 2021.p. 131–3.https://doi.org/10.1002/9781119597797

Artika IZ, Nur’aeny N, Zakiawati D. Morsicatio buccarum dan labiorum kronis terkait kondisi depresi, kecemasan, dan stres. J Ked Gi. 2023; 35(1):92-99.https://doi.org/10.24198/jkg.v35i1.41858

Fatima R, Abid K, Zulfikar S, Bhutto A. Association of cheek-biting and depression. Jour Pak Med Assoc. 2019; 69(1).

Chojnowska S, Ptaszyńska-Sarosiek I, Kępka A, Knaś M, Waszkiewicz N. Salivary biomarkers of stress, anxiety and depression. Journal of clinical medicine. 2021 Feb 1;10(3):517.https://doi.org/10.3390/jcm10030517

Immanuel AS, Marheni A, Indrawati KR, Swandi NLID, Bajirani MPD. Kajian Stres pada Mahasiswa: Sumber Stress dan Kontribusi Strategi Koping. J Ilm Perilaku. 2021;5(2):138-158.https://doi.org/10.25077/jip.5.2.138-158.2021

Maroufizadeh S, Foroudifard F, Navid B, Ezabadi Z, Sobati B, Omani-Samani R. The Perceived Stress Scale (PSS-10) in women experiencing infertility: A reliability and validity study. Middle East Fertility Society J. 2018 Dec 1;23(4):456-9. https://doi.org/10.1016/j.mefs.2018.02.003

Prasetya AB, Purnama DS, Prasetyo FW. Validity and reliability of the Perceived Stress Scale with Rasch model. Psikopedagogia. 2019;8(2):48-51.https://doi.org/10.12928/psikopedagogia.v8i2.17903

Hakim AR, Mora L, Leometa CH, Dimala CP. Psychometric properties of the Perceived Stress Scale (PSS-10) in Indonesian version. JP3I. 2024;13(2):1-13. https://doi.org/10.15408/jp3i.v13i2.35482.

Goto T, Kishimoto T, Iwawaki Y, Fujimoto K, Ishida Y, Watanabe M, et al. Reliability of screening methods to diagnose oral dryness and evaluate saliva secretion. Dent J. 2020;8(3):102. https://doi.org/10.3390/dj8030102.

Hantsoo L, Jagodnik KM, Novick AM, Baweja R, di Scalea TL, Ozerdem A, et al. The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions. Front Endocrinol (Lausanne). 2023 Dec 12; (14). https://doi.org/10.3389/fendo.2023.1295261.

Karaca Z, Grossman A, Kelestimur F. Investigation of the hypothalamo-pituitary-adrenal (HPA) axis: a contemporary synthesis. Rev Endocr Metab Disord 2021;22: 179–204. https://doi.org/10.1007/s11154-020-09611-3.

Owczarek JE, Lion KM, Radwan-Oczko M. The impact of stress, anxiety and depression on stomatognathic system of physiotherapy and dentistry first-year students. Brain Behav. 2020 Oct;10(10):. https://doi.org/10.1002/brb3.1797.

Ossa YF, Fatah MRM. Anxiety induce morsicatio oris in young patients: a case report and review. J com Dent & Dental Res.2023 Jun; 1(1):5-8

Slimmen S, Timmermans O, Mikolajczak-Degrauwe, Oeneme A. How stress-related factors affect mental wellbeing of university students A cross-sectional study to explore the associations between stressors, perceived stress,and mental wellbeing. Plos One. 2022 Nov; 17(11):1-16.https://doi.org/10.1371/journal.pone.0275925

James KA, Stromin JI, Steenkamp N, Combrinck MI. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Front Endocrinol (Lausanne). 2023 Mar 6;14. https://doi.org/ 10.3389/fendo.2023.1085950.

Pascoe MC, Hetrick SE, Parker AG. The impact of stress on students in secondary school and higher education’, In J of Adolescence and Youth, 2019;25(1):104–112. https://doi.org/10.1080/02673843.2019.1596823.

Kadhim DK, Al-Juboori JNA. Evaluation of salivary cortisol and IgA levels in stress related oro- facial conditions. J Res Med Dent Sci. 2021;9(7):101-106.

Chang M, Kim J, Park YJ, Kwon J, Kim S, Choi J, et al. Treatment of morsicatio buccarum by oral appliance: case report. J Oral Med Pain 2021;46(3):84-87. https://doi.org/10.14476/jomp.2021.46.3.84.

Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021 Aug 12;16(8):e0255634. https://doi.org/10.1371/journal.pone.0255634.

Gao W, Ping S, Liu X. Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China. JAD. Volume 263, 15 February 2020, p 292-300. https://doi.org/10.1016/j.jad.2019.11.121

Klusmann H, Schulze L, Engel S, Bücklein E, Daehn D, Lozza-Fiacco S, et al. HPA axis activity across the menstrual cycle-a systematic review and meta-analysis of longitudinal studies. Frontiers in Neuroendocrinology. 2022 Jul 1;(66).https://doi.org/10.1016/j.yfrne.2022.100998

Aulia S, Panjaitan RU. Kesejahteraan psikologis dan tingkat stres pada mahasiswa tingkat akhir. Jur Keperawatan Jiwa. 2019;7(2):127–34.

Ribeiro IJS, Pereira R, Freire IV, de Oliveira BG, Casotti C, Boery EN. Stress and quality of life among University Students: A Systematic Literature Review. Health Profession Education. 2018 Jun; 4(2): 70-77.https://doi.org/10.1016/j.hpe.2017.03.002

Alzahem AM. Cheek bite keratosis among temporomandibular disorder patients. Journal of Interdisciplinary Dentistry. 2017 Sep 1;7(3):87-90.https://doi.org/10.4103/jid.jid_33_17

Mortazavi H, Safi Y, Baharvand M, Jafari S, Anbari F, Rahmani S. Oral white lesions: an updated clinical diagnostic decision tree. Dent J. 2019;7(1):15. https://doi.org/10.3390/dj7010015

Ngoc VTN, Hang LM, Bach HV, Chu DT. On-site treatment of oral ulcers caused by cheek biting: A minimally invasive treatment approach in a pediatric patient. Clin Case Rep. 2019 Jan 24;7(3):426-430.https://doi.org/10.1002/ccr3.1978.

Dioz PD, Scully C, de Almeida OP, Bargan JV, Taylor AM. Oral medicine and pathology at a glance. 2nd ed. 2016; UK: Wiley-Blackwell. p.68-69.

Balters S, Geeseman JW, Tveten AK, Hildre HP, Ju W, Steinert M. Mayday, mayday, mayday: Using salivary cortisol to detect distress (and eustress!) in critical incident training. Int J Ind Ergon. 2020 Jul;7 8:2–16.https://doi.org/10.1016/j.ergon.2020.102975

Aravena PC, Almonacid C, Mancilla MI. Effect of music at 432 Hz and 440 Hz on dental anxiety and salivary cortisol levels in patients undergoing tooth extraction: a randomized clinical trial. J Appl Oral Sci. 2020; (28). https://doi.org/ 10.1590/1678-7757-2019-0601.

Şeker A, Çelik M, Kanat A. Stress related oral habits: two case reports. Jour Med Case Rep Rev. 2020; 3(04).

DOI: https://doi.org/10.24198/pjd.vol36no3.58218