Aleksandrov MT^1* and Bashtovoy AA²

¹Central State Medical Academy, Moscow, Russia
²Moscow Regional Research Clinical Institute Named After M.F. Vladimirsky, Moscow, Russia

*Corresponding Author: Aleksandrov MT, Central State Medical Academy, Moscow, Russia.

Received: June 11, 2026; Published: July 14, 2026

The purpose of the study is to conduct a systematic analysis of modern data on the principle of additivity of errors in a comprehensive assessment of dental status, taking into account the influence of stress factors and general adaptation syndrome on diagnostic accuracy.

Methodology: An analysis of 53 scientific sources (1960-2025) was carried out, including:

1. Methodological articles;
2. Consensus reports;
3. Systematic reviews;
4. Clinical guidelines;
5. Monographs;

Results: In the course of the study, it was found that the total error of the comprehensive assessment of dental status demonstrates a high correlation with the sum of errors of individual components [29,39,46], which indicates the cumulative nature of diagnostic errors.

The mean deviation is (95% confidence interval:). The structure of the contribution of various sources of error to the total error is as follows: subjective methods — 45-60%; instrumental methods — 20-30%; methodological errors are 15-25%.

In addition, it was revealed that stress factors introduce an additional error in the range of 20-50% and more, which is currently practically not taken into account in existing diagnostic models (methods).

Thus, the principle of additivity of errors requires that the influence of stress factors be taken into account in a comprehensive assessment of dental status. To minimize diagnostic errors, it is necessary to implement the following measures:

1. Optimize the set of valuation methods used;
2. Standardize diagnostic protocols;
3. Calibrate researchers;
4. To introduce control systems that ensure the objectification of taking into account the influence of stress factors and general adaptation syndrome in a comprehensive assessment of dental status.

Keywords: Dental Status; Stress; Comprehensive Assessment; Additivity of Errors; Diagnostic Accuracy; General Adaptation Syndrome; Methodology

References

1. Александров МТ. “Lasernaya klinicheskaya biofotometry (teoriya, eksperiment, praktika) [Laser clinical biophotometry (theory, experiment, practice)]”. Moscow: Technosphere, (2008): 584.
2. Aleksandrov MT., et al. “Raman-fluorescent characteristics of various anatomical and topographic zones of teeth of various functional groups”. 23.5-6 (2019): 45-52.
3. Aleksandrov MT., et al. “Laser Raman-Fluorescence Medical Technologies in Dentistry — From Experiment to Clinic”. Moscow, (2020): 348.
4. Aleksandrov MT., et al. “Possibilities and prospects for the use of raman-fluorescent diagnostics in dentistry”. 1 (2018): 12-17.
5. Method for assessing the adaptability and quality of dental treatment, patent RU23702210C1.
6. GOST R 8.009-84. State System for Ensuring the Unity of Measurements. Normalized Metrological Characteristics of Measuring Instruments.
7. , Fedorenko PO. “Stress correction in patients during outpatient dental appointments”. Klinicheskaya i meditsinskaya psikhologiya: issledovaniya, obuchenie, praktika 2 (2015).
8. Kryukova TL., et al. “Adaptation of S. Cohen's Perceived Stress Scale in the Russian Language Sample”. 41.3 (2020): 89-101.
9. mil.ru +1
10. Richter AA., et al. “Diagnostic efficiency of modern digital methods for identifying carious lesions of the chewing group of teeth”. 3.100 (2023): 63-65.
11. Sel'e G. “Ocherki ob adaptatsionnom sindrome [Essays on adaptation syndrome]”. Moscow, (1960).
12. Selye G. “Stress without distress”. (1979).
13. Bashtovoy AA and Mamedova LA. “Features of the initial forms of caries in adult patients. Literature review”. Stomatology 20 (2023): 78-82.
14. Gorizontov PD. “Stress”. Homeostasis (1981): 570.
15. Bilinsky II., et al. “Change of biochemical properties of saliva and their impact on the dental status of students under stress”. Naukovi Pratsi VNTU 1 (2017): 1-6.
16. Bichun AB., et al. “Correction of patients' stress at an outpatient dental appointment”. Clinical and Medical Psychology: Research, Training, Practice 2 (2015).
17. Boyko VV., et al. “Risk factors affecting the deterioration of physiological indicators in patients at a dental appointment”. Institute of Dentistry 1 (2009): 15-20.
18. Altynova EE., et al. “Using the method of raman-fluorescence diagnostics for the study of mineralization of hard tissues of the tooth in non-carious lesions and after the removal of braces”. 1 (2025): 70-76.
19. Aleksandrov MT., et al. “Method and Device for Raman Fluorescence Diagnostics of the State of Human Tissues in Health and Pathology”. Acta Scientific Microbiology4 (2025): 49-58.
20. Aleksandrov MT., et al. “Development of a Method of Volumetric Activated Photodynamic Therapy Based on the Use of Raman Fluorescence Technology”. Acta Scientific Microbiology4 (2025): 32-40.
21. ru +2
22. Aleksandrov MT., et al. “Conceptual Justification of the use of Raman-Fluorescent Medical Technologies for A Comprehensive Assessment of the Hygienic Condition of the Oral Cavity”. Acta Scientific Dental Sciences4 (2025): 40-49.
23. Alexandrov MT., et al. “Features of mineralization of hard tissues of the tooth in carious and non-carious lesions”. Journal of Dental Health Oral Research1 (2025): 1-9.
24. Aleksandrov MT., et al. “Range of clinical application of raman-fluorescence diagnostics in the assessment of the state of human tissues in the norm and in pathology”. Stomatology2 (2025): 99-108.
25. Gerashchenko SM and Demidov AV. “Sovremennye metody otsenki sostoyaniya mucous cavity orta i periodonta [Modern methods of assessing the state of the mucous cavity of the mouth and periodontium]”. 2 (2023): 154-171.
26. Aleksandrov MT., et al. “Clinical significance of indication of mouth microorganisms based on raman-fluorescence diagnostics”. 2.107 (2025): 105-107.
27. Korolkova KV., et al. “Study of the psycho-emotional status of pilots and flight attendants of civil aviation to assess the relationship with their dental status”. Scientific and Practical Journal Institute of Dentistry103 (2024): 20-21.
28. Landis JR and Koch GG. “The measurement of observer agreement for categorical data”. Biometrics1 (1977): 159-174.
29. Aleksandrov MT., et al. “Conceptual substantiation of the use of raman-fluorescence medical technologies for comprehensive assessment of dental status”. Scientific and Practical Journal Institute of Dentistry107 (2025): 88-93.
30. Fletcher RKh., et al. “Clinical epidemiology: fundamentals”. 5^th - Philadelphia: Lippincott, Williams and Wilkins, (2012): 274.
31. García M., et al. “Review of hygiene impact studies”. Journal of Clinical Periodontology5 (2022): 456-468.
32. NS Kuznetsova., et al. “Analysis of the features of dental status in young people in a state of psycho-emotional stress”. Scientific and Methodological Electronic Journal "Concept" (2017).
33. Kaitlyn Reynolds., et al. “Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta analyses”. BMC Oral Health 23 (2023): 769.
34. Kim S., et al. “Review of quality indicators in dental care”. International Journal for Quality in Health Care8 (2018): 612-620.
35. Huling LB., et al. “Study Summary. The effects of stress on general and oral health are increasingly recognized”. Oral Pathology Medicine 41 (2012): 149-152.
36. , et al. BMC Oral Health 23 (2023): 769.
37. International Caries Detection and Assessment System. “ICDAS consensus”. Caries Research4 (2023): 289-298.
38. Singh A., et al. “Economic evaluation of diagnostic methods in dentistry”. Value in Health6 (2021): 834-842.
39. Prikule DV., et al. “Indicators of dental status as a reference test-system of general adaptation syndrome (stress)”. Russian Dental Journal5 (2018): 237-241.
40. Chen X., et al. “Digital technologies in dental diagnosis”. Advances in Dental Research1 (2021): 15-22.
41. European Dental Research Network. “Comparative effectiveness of diagnostic approaches”. European Journal of Oral Sciences4 (2022): 234-243.
42. European Association of Dental Public Health. “Consensus on diagnostic protocols”. European Journal of Dental Public Health 12.2 (2021): 78-85.
43. Patient Experience Research Group. “Qualitative study of diagnostic experiences”. Qualitative Health Research 33.5 (2023): 456-467. Tsarinskiy M. M., Tsarinskaya N. M. Diagnostika prestressov'ih sostoyaniya v stomatolii [Diagnostics of prestress-bearing conditions in dentistry]. 3 (2012).
44. International Consortium for Dental Metrology. “Variability in dental measurements”. Journal of Dental Metrology 3 (2020): 112-120.
45. Richter AA., et al. “Effektivnost' primeneniya sovremennykh tsifrovykh metodov diagnostiki pri vyyavlenii karioznoy pathologii laterovoy gruppy zubov [Effectiveness of the use of modern digital methods of diagnostics in the identification of carious pathology of the lateral group of teeth]. 18.2 (2025): 11-16.
46. Aleksandrov MT., et al. “Substantiation of the application of digital methods for the assessment of dentistry Oral Status in Normal and Pathological Conditions”. Russian Dental Journal4 (2023): 301-310.
47. rTsarinsky MM and Tsarinskaya NM. “Diagnostics of pre-stress conditions in dentistry”. Kuban Scientific Medical Bulletin132 (2012): 181-185.
48. MT GUNKO., et al. medi.ru. Instrumental diagnostics of the emotional state of patients”. Endodontics Today (2012): 3-9.
49. dr-martin.ru
50. Aleksandrov MT., et al. “Laser Raman-Fluorescent Medical Technologies in Dentistry - From Experiment to Clinic”. Moscow: KnizhIzdat; (2020): 160.
51. Bashtovoy AA. “The influence of general adaptation syndrome (stress as an indicator of the psycho-emotional state of a person) on the indicators of dental status”. Problems of Dentistry4 (2026).
52. ru +2
53. ru +2
54. ru›info/12076/catad_tema Oral Diseases - Articles. “Instrumental diagnostics of the emotional state of patients at a dental appointment”.

Citation

Citation: Aleksandrov MT and Bashtovoy AA. “Additive Effect of Stress Factors on Dental Status: A Comprehensive Analysis of Relationships (Literature Review)". Acta Scientific Dental Sciences 10.8 (2026): 03-12.

Copyright

Copyright: © 2026 Aleksandrov MT and Bashtovoy AA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.