Salivary Biomarkers Associated with Academic Assessment Stress Among Dental Undergraduates

Abstract

This study aims to assess the difference in self-perceived stress before and after an academic assessment and its association with the marks scored and to study the association of salivary cortisol, Immunoglobulin A (IgA), and chromogranin A (CgA) with stress levels before and after the assessment. Thirty-one third-year dental undergraduates indicated how stressed they felt on a 5-point rating scale just prior to and immediately after a one-hour written test. Five-minute unstimulated whole saliva samples were also collected at those times to measure salivary cortisol, IgA, and CgA. Students rated significantly higher stress scores before (median [inter quartile range]: 3[1]), compared to after the test (2[2]) (p=0.015). Higher cortisol levels (mean: 6.32 nmol/l) were observed before than after the exam (mean: 5.16 nmol/l) (p=0.015). No significant differences were noted between the pre-and post-test saliva samples for salivary IgA and CgA levels. A negative correlation was seen between post-test stress scores and test marks (Spearman's r = -0.325, p=0.07). Dental students perceived a higher level of stress prior to the test, which declined after that. Pre-test stress scores were associated with raised salivary cortisol, but not IgA or CgA. Students who perceived higher levels of stress after the test generally had poorer results.

The influence of academic stress on gingival inflammation

“…In the present study, the students revealed significantly higher levels of cortisol during the exam period compared with after the exams. Increased levels of cortisol in saliva have also been observed in a study of dental students before an exam period compared with afterwards (28). Repeated exposure to stress, such as that in exam periods, may result in the over‐active release of glucocorticoids, including cortisol from the adrenal cortex.…”

“…In the study by Ng et al. (28), the students were asked how stressed they felt on a 5‐point scale prior to and after the exam. The response alternatives to the questions were as follows; not stressed at all (1), a little stressed (2), moderately stressed (3), quite stressed (4) and extremely stressed (5).…”

Equivalence of students' scores on timed and untimed anatomy practical examinations

“…In a traditional curriculum, where anatomy is offered at the beginning of the academic year, heightened emotional and academic stress can be challenging for many students. Previous studies have demonstrated that students possess higher levels of stress before examinations, as monitored by significantly increased levels of salivary cortisol (Ng et al, ; Singh et al, ). A study on stress associated with anatomy practical examinations demonstrated that the concentration of salivary cortisol was at its highest level before the first examination (Lester et al, ).…”

“…We believe that this system provides sufficient time for the prepared student to examine a specimen and answer a relevant question. However, we realize that examinations are inherently stressful for many students (Ng et al, ; Singh et al, ), and that time limitations add additional stress that may undermine student confidence and/or performance. Students frequently complain that they need more time to answer difficult test questions, arguing that the “one size fits all” approach is fatally flawed.…”

Tattooing to “Toughen up”: Tattoo experience and secretory immunoglobulin A

“…Cortisol is released in humans as part of the hypothalamic‐pituitary‐adrenal stress response 30–60 min after stressor onset and functions, in part, to suppress this immune response and restore it to baseline (Sapolsky, ). Studies of SIgA and sCORT responses to stress indicate that they display inverse patterns before and after stress response (Ng et al, ; Watanuki and Kim, ). However, this inverse association is only statistically significant in awakening diurnal levels (Hucklebridge et al, ).…”