PURPOSE To evaluate the clinical utility of a salivary alpha-amylase (sAA) biosensor for assessing oral surgery-related stress responses and the differential effect of the personality trait of pain catastrophizing. PATIENTS AND METHODS We conducted a prospective, cohort study of 76 healthy subjects who underwent elective removal of their third molars. Along with subjects’ self-reports of anxiety and pain, biosensor-facilitated measurements of sAA levels were obtained at multiple time points during the preoperative consult, surgery, and post-surgical follow-up visits. Additionally, subjects completed the Pain Catastrophizing Scale at baseline. Mixed-effect regression models examined change in sAA and self-report ratings within and across visits, and the contribution of pain catastrophizing. RESULTS sAA levels were lower during surgery and post-surgical follow-up compared to the consult visit (p < .01). sAA decreased during the surgery visit (p < .05), and did not change during the consult or follow-up visits. Individuals who reported greater helplessness responses to pain manifested higher sAA levels during the surgery visit (p < .05). Self-reported anxiety ratings were highest during the surgery visit, and pain ratings were highest during the follow-up visit. CONCLUSION sAA did not show predicted elevations during the surgery visit compared to the consult and post-surgical follow-up visits, or increases during the surgery visit. However, individuals who reported responding to pain with helplessness had larger sAA levels in anticipation of surgery, providing proof of concept for the value of point-of-care assessments of surgery-induced stresses and the differential effect of personality traits.

Our study indicates that the analytical performance of the sAA biosensor is influenced significantly by the saliva sampling method. In contrast to the relatively imprecise direct mouth measurements, biosensor sAA levels established indirectly from passive drool saliva samples provide more accurate estimation of sAA levels, even after intermediary processing steps (e.g., freezing, thawing, centrifugation).

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