Optimizing Pediatric Patient Comfort: A Study of Moisture Isolation Techniques During Dental Treatments

Background: Effective dental isolation is crucial for successful restorative procedures in pediatric patients; however, its potential impact on patient stress remains underexplored. This investigation comprised two independent pilot sub-studies evaluating salivary cortisol responses to dental isolation techniques: one comparing cotton roll isolation (CRI) and the Isolite system (IS), and a second comparing cotton roll isolation (CRI) and the DryShield isolation system (DSI). The sub-studies were reported together due to a shared clinical context and outcome measure. Methods: Pediatric patients underwent sealant placement using CRI, IS, or DSI, depending on sub-study assignment. Salivary cortisol samples were collected for each procedure. In the CRI-IS sub-study, pulse rate was recorded at three time points, and participants completed subjective preference surveys. Cortisol analyses were conducted separately within each sub-study, with pulse rate and preference outcomes evaluated only for the CRI-IS cohort. Results: DSI produced a significant increase in salivary cortisol from pre- to post-procedure compared with CRI (p = 0.0001), indicating a higher acute stress response. In contrast, CRI and IS did not differ significantly in cortisol levels, but heart rate did significantly increase from pre- to post-procedure when CRI was used (p = 0.035). Of the 15 participants in the CRI-IS comparison, 9 provided subjective feedback, with most preferring the IS. Gender was not associated with differences in stress markers in either sub-study. Conclusions: These findings suggest that while CRI and IS produce comparable physiological stress responses, DSI may be associated with heightened cortisol reactivity. Although IS was subjectively preferred, biological stress measures showed no definitive difference from CRI. Clinicians may therefore select CRI or IS based on clinical judgment and patient comfort, while considering the potential for increased stress when using DSI in pediatric populations.