Low salivary pH reflects high dental anxiety: evidence from a preliminary cross-sectional study

Dental anxiety is a prevalent psychological condition that adversely affects oral health behaviors. Although physiological markers such as salivary cortisol have been explored, the potential role of salivary pH remains under-investigated. This preliminary observational study aimed to examine the association between resting salivary pH and dental anxiety levels in a healthy adult population. Forty adults (28 females, 12 males; aged 18-65 years) participated. Dental anxiety was assessed using the Modified Corah Dental Anxiety Scale (MCDAS). Resting unstimulated saliva samples were collected under standardized conditions, and pH was measured using pH indicator strips. Statistical analyses included Pearson's correlation and ordinal regression to evaluate the association between pH and anxiety scores. The mean salivary pH was 6.19 ± 0.62, while the mean dental anxiety score was 9.18 ± 3.39. A moderate, statistically significant negative correlation was found between salivary pH and dental anxiety (r =  - 0.320, p = 0.022). Ordinal regression analysis indicated a negative, though not statistically significant, predictive effect of pH on anxiety levels (β =  -0.768, p = 0.144). These preliminary findings suggest that salivary pH, as a rapid, simple, and noninvasive parameter, may have adjunctive value in dental anxiety screening protocols. Its incorporation into routine chairside assessments may facilitate the early identification of at-risk patients and enhance individualized care. Further research with larger cohorts is warranted to validate these findings.