Objectives: The objective of this study is to determine the changes in salivary cortisol levels during the dental treatment of child patients by slow-speed round bur, hand excavation and chemomechanical caries removal system (Carisolv) and to evaluate the stress produced by these methods.

Methods: Patients between 4-6 years of age selected for the research. 30 children (15 male, 15 female) who never visited a dentist before, participated in the present study. The participant children were classified with Frankl behavior scale and three groups of 10 patients were formed for three methods. Saliva samples were collected via cotton rolls placed to the floor of the mouth at three stages; prior to treatment, during cavitation and the restoration. Totally 90 samples were collected and the cortisol levels were measured. Salivary cortisol levels were determined by ELISA using a commercially available kit. Statistical comprasion of the results were done by LSD multiple comparisons test.

Results: The mean cortisol values (ng/ml) at prior to treatment, during cavitation, and stage of restoration were 15.7, 14.95, and 14.95 for slow-speed round bur, 17.0, 15.15, and 17.15 for hand excavation, and 13.8, 16.4, and 14.4 for Carisolv, respectively. At prior to treatment and restoration stages there found to be no statistically significant difference between cortisol levels in all methods (P>0.05), whereas a significant difference between slow-speed round bur-Carisolv and hand excavation-Carisolv methods in terms of cortisol level during cavitation stage was observed (P<0.05).

Conclusion: The results of this study suggest that at dental treatment, mostly it is the cavitation step that creates stress and anxiety in children. Also, this study has shown that chemomechanical caries removal is well-suited for the dental treatment of anxious peadiatric patients. Knowledge of the most stressful condition may be helpful for the dentist to prepare the child to treatment steps.

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