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E
xaminations are the bane of students. How- Previous studies have utilized oral presenta-
ever, they have an important role in evaluat- tions as acute stress situations to study the stress para-
ing students’ learning outcomes and their digm.3,5,7 The intensity and nature of the stress en-
mastery of a subject. Passing or failing usually has countered in an oral presentation might be different
strong consequences for one’s career development, from the stress in a written examination. This study
so examinations cause psychological stress for most of dental undergraduate students investigated the use
students.1Academic examinations have been consid- of salivary cortisol, IgA, and CgA to assess stress
ered as one of the most acute stresses experienced before and after a written term test. Other objectives
by students.2-7 of the study were to assess if there was a difference
Acute stress has been reported to increase the in self-perceived stress before and after a test and to
activity of the hypothalamus-pituitary adrenal (HPA) study the association of self-perceived stress with
axis with subsequent rise in cortisol level.8 Mucosal performance on the test.
immunity, as reflected by salivary immunoglobulin
A (IgA) levels,9 is also influenced by psychological
stress. With chronic stress, the production of immu-
noglobulin is suppressed, whereas acute psychologi-
Materials and Methods
cal challenge increases IgA levels. 10 Recently, This cross-sectional study was conducted at the
Nakane et al.11 and Kanon et al.12 demonstrated that Faculty of Dentistry, National University of
salivary chromogranin A (CgA) can be a quantita- Singapore during a written term test in pediatric den-
tive index for monitoring the activity of the sympa- tistry. This test is part of the continuous assessment
thetic nervous system. This constitutes the initial process that constitutes a small proportion of the stu-
alarm reaction phase in stress response. dents’ final examination marks. Students were re-
Table 1. Mean values of salivary cortisol, Immunoglobulin A (IgA), and Chromogranin A (CgA) before and after a
written examination among thirty-one dental undergraduates
Salivary Biomarkers Before After Before-After 95% CI* P value
*Before-After 95% CI refers to the 95% Confidence Interval of difference between before and after test readings.