Salivary cortisol as a neuroendocrine stress biomarker for xerostomia in multiple sclerosis patients: a comparative cross-sectional study

Salivary cortisol levels were associated with the presence and severity of xerostomia in MS patients, despite lower self-reported anxiety levels. This lack of association demonstrates that salivary cortisol may reflect physiological stress or neuroendocrine/autonomic dysregulation rather than subjective anxiety alone. While causality cannot be inferred due to the cross-sectional design, these findings support the potential role of salivary cortisol as a biomarker for xerostomia in MS and provide the importance of integrating biological stress markers into oral health assessment in this population.