Dental fear and anxiety are frequently identified as major contributing factors to non-compliance, uncooperativeness, and difficulties during dental procedures in pediatric patients. These issues can lead to avoidance of dental treatment, resulting in long-term negative consequences for oral health and overall well-being. The assessment and quantification of psychological functioning (i.e., dental fear, anxiety, and self-perceived stress) has traditionally relied on self-reported questionnaires validated for the pediatric population. While this approach is cost-effective and non-invasive, it relies on subjective self-reported data, oftentimes influenced by parental or guardian interaction, especially in young children. Salivary diagnostics has recently emerged as an objective method for the procurement of biological molecules that serve as biomarkers for a variety of oral and systemic conditions. This literature review aims to comprehensively summarize the available literature on the correlation between psychological and salivary physiological measurements assessing dental fear, dental anxiety, and self-perceived stress in pediatric dental patients, highlighting the advantages and disadvantages of each method of assessment. Four databases (PubMed^®, PsycInfo, Dentistry & Oral Sciences Source, and Web of Science) were searched for published articles, in the English language, assessing the correlation between psychological and physiological distress in children undergoing dental procedures. Studies on pediatric patients reveal positive correlations between salivary cortisol and dental fear, stress, and anxiety, especially in returning patients. Conversely, findings on salivary alpha-amylase and secretory immunoglobulin A were inconsistent, with some studies suggesting correlations with dental fear and prior dental experiences.

Background/Objectives: Dental fear and anxiety are areas of concern in clinical pediatric dentistry, often leading to treatment avoidance and negative oral-health consequences. Cortisol and alpha amylase, measurable in saliva, have been proposed as biomarkers of stress and may provide an objective means of assessing and monitoring distress over time. This study examined measures of psychological and physiological distress in pediatric patients undergoing dental procedures and their correlation. Methods: 7-to-17-year-old new patients scheduled for a dental procedure or orthodontic bonding completed a psychological battery assessing dental fear (using Children’s Fear Survey Schedule—Dental Subscale), stress (Perceived Stress Scale), and dental anxiety (Modified Children Dental Anxiety Scale). Before the dental appointment, we assessed anticipated pain intensity, heart rate (HR), and collected two saliva samples to quantify cortisol and alpha amylase. Correlations between psychological and physiological measures were assessed with Pearson’s correlation and treatment groups were compared with independent t-tests. Results: Out 34 participants (12.8 ± 2.7 y/o, 52.9% females, 73.5% pediatric patients and 26.5% orthodontic patients), 38.2% endorsed moderate anxiety; 85.3% reported moderate to high stress; and 29.6% indicated dental fear. Psychological distress was not influenced by procedure type. Dental fear positively correlated with dental anxiety (p < 0.001) and HR (p < 0.001); dental anxiety positively correlated with anticipated pain (p = 0.010) and HR (p = 0.003); stress positively correlated with HR (p = 0.006). Even if 72.2% of participants had cortisol value outside normal range and those with greater stress exhibited elevated cortisol, cortisol and alpha amylase levels (measured on n = 18) were not correlated with psychological variables. Conclusions: Cortisol and alpha amylase levels were not correlated with psychological measures in a cross-sectional study on pediatric patients undergoing dental procedures.