Salivary Cortisol and Chromogranin A as Biomarkers of Academic Stress in Dental Students

Objective: This study aimed to assess academic stress among second-year dental students by evaluating changes in salivary biomarkers—cortisol, α-amylase, and chromogranin A—before and after examinations.

Methods: A pre–post observational study was conducted involving 40 second-year dental students (aged 20–22) from Al Hadi College of Dentistry. Saliva samples were collected twice from each participant: once a week before the exams (baseline) and again after the exam period. Participants were instructed to rinse their mouths and provide unstimulated saliva samples for 5 minutes. Samples were stored at −18°C and analyzed using an enzyme-linked immunosorbent assay (ELISA) according to the manufacturer's protocols. Paired t-tests were used to compare biomarker levels before and after exams.

Findings: Cortisol levels significantly decreased after exams (26.33 ± 0.56 to 24.31 ± 0.71 µg/L; p = 0.0272), indicating heightened stress during the assessment period. Chromogranin A levels also decreased significantly post-exam (462.62 ± 9.64 to 434.15 ± 7.01 ng/mL; p = 0.0190). However, no significant change was observed in salivary α-amylase (14.24 ± 0.55 to 13.10 ± 0.37 U/L; p = 0.0946). These findings suggest that cortisol and chromogranin A are more reliable biomarkers of academic stress in this context than α-amylase.

Conclusion: Salivary cortisol and chromogranin A are sensitive indicators of academic stress among dental students. Their use in educational and clinical settings may provide non-invasive insight into students' psychological well-being during critical assessment periods.