Correlation between flacc pain score and salivary alpha-amylase level (a review on children with down syndrome)

Faraghea Yumasdhika, Margaretha Suharsini, Ike Siti Indiarti, Hastin Dian Anggraeni

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Face, leg, activity, cry, and consolability (FLACC) pain scores are commonly used to assess pain intensity in children with developmental disorders. Salivary alpha-amylase (SAA) is an enzyme found in saliva that is used as a reliable biomarker for anxiety because it increases sympatho adrenal medullary (SAM) system activity. The aim of this study was to analyze the correlation between FLACC pain scores and SAA levels, during dental treatment, in children with Down syndrome. Purposive sampling was used to select the population for this study. Pain was assessed during the children's treatments to obtain FLACC pain scores. Salivary alpha-amylase levels were measured with a nipro cocoro meter shortly after local anesthetic injection. A significant correlation was found between FLACC pain scores and SAA levels. Since SAM system activity and the hypothalamic-pituitary-adrenal axis increased with painful stimuli, SAA levels may reflect pain related stress and may be used as non-invasive pain biomarkers. Further studies are required to confirm whether SAA levels can be used as pain biomarkers for other types of special needs children.

Original languageEnglish
Pages (from-to)529-532
Number of pages4
JournalJournal of International Dental and Medical Research
Issue numberSpecialissue
Publication statusPublished - 2017


  • Down syndrome
  • FLACC pain score
  • Salivary Alpha-Amylase level (SAA)


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