Association of salivary dynamics, psychological stress, and behavioral factors with tooth wear severity: a...

While the etiology of tooth wear is known to be multifactorial, data regarding the interaction between psychological profile, salivary dynamics, and clinical wear severity remain insufficiently elucidated. This study aimed to analyze the effects of psychological profile and salivary parameters-alongside demographic data, medical history, oral hygiene habits, and dietary patterns-on the severity of clinical tooth wear in a multivariable framework.

Following institutional ethical approval and informed consent, this cross-sectional study included 101 volunteers (90% power), categorized by stress severity (DASS-21: normal, mild, moderate, severe, extremely severe), age groups (18-30, 31-40, 41-50, 51-60, 61-65 years) and salivary pH/buffering capacity levels (low, intermediate, high) for intergroup comparisons. Clinical wear severity was assessed using the Smith and Knight Tooth Wear Index (TWI); psychometric profiles were evaluated via the Depression Anxiety Stress Scale-21 (DASS-21). Salivary analyses (unstimulated pH and stimulated buffering capacity) utilized the GC Saliva-Check Buffer kit. Data were analyzed using independent t-tests, one-way ANOVA, and six-block hierarchical multiple linear regression (p < 0.05).

The mean age was 46.7 years; significant differences in TWI scores existed among five age groups (18-30, 31-40, 41-50, 51-60, and 61-65 years; p < 0.05), with the highest wear severity observed in the 61-65 age group (Mean: 2.63). Severe stress (p = 0.008), low salivary pH and insufficient buffering capacity (p = 0.001), and acidic beverage consumption without a straw (p = 0.001) were significantly associated with higher TWI scores. In hierarchical regression, salivary buffering capacity (β = -0.289), straw use (β = -0.248), and salivary pH (β = -0.228) emerged as independent predictors of wear severity (R² = 0.519), whereas psychological variables did not contribute independently.

These observational findings suggest that tooth wear severity is associated with the cumulative interplay of biological, behavioral, and psychological factors. Impaired salivary dynamics and specific behavioral patterns were the strongest independent correlates of wear severity; the role of psychological stress appears to operate indirectly, warranting further longitudinal investigation.

These findings underline the potential value of considering salivary parameters and consumption-related behaviours when evaluating tooth wear risk in adults, while further longitudinal evidence is required before firm clinical recommendations can be made.