Evaluation of the Salivary Level of Cortisol in Patients with Oral Lichen Planus: A Meta-Analysis

Abstract

Background and objective: Cortisol, as the main human glucocorticoid, is considered to be a biological marker of stress and anxiety. Since it is known that oral lichen planus (OLP) can appear and worsen during stressful events, cortisol levels have been previously studied in OLP patients. The present meta-analysis aims to assess the salivary concentration of cortisol in OLP patients compared to healthy controls. Materials and methods: Web of Science, PubMed, Cochrane Library, and Scopus databases were searched up to October 2018. The RevMan 5.3 software was used with the mean difference (MD) and 95% confidence intervals (CIs). The CMA 2.0 Software was used to evaluate the publication bias, sensitivity analysis, and meta-regression as possible sources of heterogeneity. Results: 10 studies were analyzed and a total of 269 OLP patients and 268 controls were included. The pooled MD of the salivary levels of cortisol in OLP patients compared with controls was 4.27 ng/mL (95% CI: 2.33, 6.21; P < 0.0001), thus, the salivary level of cortisol in OLP patients was significantly higher than in controls. In Indian-based population studies, a significant difference in the salivary cortisol levels in OLP patients compared with controls was detected (MD = 5.62 ng/mL; 95% CI: 2.67, 8.56; P = 0.0002). In addition, a significant difference in the salivary cortisol levels in the OLP patients compared with the controls was obtained in studies performed with enzyme-linked immunosorbent assay (ELISA) method (MD = 5.33 ng/mL; 95% CI: 2.72, 7.93; P < 0.0001). Conclusion: We suggest that supportive psychological treatment together with the conventional therapy could increase patients’ capability to prevent stress, anxiety, and depression.

Impact on Quality of Life of Oral Diseases Related to Stress

“…Se ha reportado que el estrés produce un desgaste y desregulación fisiológica debido a que eleva los niveles de cortisol (4). De tal forma que si el paciente presenta repetidos o continuos episodios de estrés se activan continuamente mecanismos compensatorios fisiológicos, lo que podría desencadenar o alterar el curso de enfermedades orales (19), y en consecuencia ocasiona un efecto negativo sobre la salud oral.…”

“…Se define a enfermedades orales asociadas a estrés como aquellas enfermedades de la mucosa oral que se ven agravadas, exacerbadas o desarrolladas por estados emocionales tales como estrés, ansiedad y/o depresión (2,3). Entendiendo por estrés, a un factor psicológico que causa una elevación en los niveles de cortisol, asociado a su vez, con un desbalance de citoquinas las cuales pueden predisponer al desarrollo de enfermedades autoinmunes orales (4). Las características clínicas y sintomáticas de estas enfermedades interfieren con el comer, hablar o con la correcta higiene oral.…”

“…El OHIP-49 evalúa dimensiones que presumiblemente están asociadas a estrés y/o angustia. El estrés, como se mencionó anteriormente predispone al desarrollo de enfermedades autoinmunes orales debido al desbalance de citoquinas asociado a un incremento en los niveles de cortisol (4). Además, se ha sugerido que la respuesta de compensación fisiológica continua al estrés crónico conduce a un desgaste fisiológico denominado carga alostática.…”

Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies

“…Salivary cortisol values have been widely studied in relation to the effects of stress- and anxiety-related psychological factors on immune diseases. Elevated salivary cortisol values have been observed in patients diagnosed with OLP than in those without this disease [ 17 , 18 , 19 ], and it has been suggested that there is a link between high cortisol levels and psychological strains as triggering factors of OLP [ 20 ]. Given reports that stress can be responsible for the recurrence of OLP, cortisol has been proposed as a possible diagnostic marker for this disease [ 21 ].…”

Saliva and Oral Diseases

“…Many authors have suggested salivary cortisol as a biomarker in OLP [65][66][67][68][69][70]. Cortisol is considered a biological marker of stress and anxiety, the variation of which can alter cytokine profiles [71].…”