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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 72-75

Saliva properties and dental caries prevalence in the South Karnataka population


1 Department of Conservative Dentistry and Endodontics, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India
2 Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
3 Department of Conservative Dentistry and Endodontics, AME's Dental College and Hospital, Raichur, Karnataka, India
4 Department of Orthodontics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India
5 Department of Conservative Dentistry and Endodontics, S.V.S. Institute of Dental Sciences, Mahbubnagar, Telangana, India

Date of Submission02-Mar-2020
Date of Decision27-Nov-2020
Date of Acceptance20-Dec-2020
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Vyapaka Pallavi
Department of Conservative Dentistry and Endodontics, Vinayaka Mission's Sankarachariyar Dental College, Salem - 636 308, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_43_20

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  Abstract 


Context: The biochemical and physicochemical properties of saliva have multifunctional roles in maintaining oral and general health. This article emphasizes the influence of salivary properties on caries process and caries susceptibility. Aims: The aim of the study was to investigate associations between prevalence and activity of intraoral carious lesions and salivary properties tested using the saliva check kit (GC Corp) in adult South Karnataka population. Subjects and Methods: With ethical approval, 100 healthy adult patients coming to the Outpatient Department of Conservative Dentistry and Endodontics who have decayed, missing, and filled teeth (DMFT) index ≥5 have been selected for the study. Saliva properties tested included hydration, viscosity, resting pH, and for quantity and buffering capacity of stimulated saliva. Statistical Analysis Used: Data obtained were analyzed with Spearman's rank correlation. Results: The resting saliva pH and the buffering capacity of the stimulated saliva were shown to be statistically significant (P < 0.05), whereas resting saliva hydration and stimulated saliva viscosity were not significant. The quantity of the stimulated saliva showed no correlation with DMFT. Conclusions: There appeared to be a correlation between the resting pH of saliva, saliva buffering capacity, and the potential lesion activity of dental caries.

Keywords: Buffering capacity, caries detection, caries prevalence, decayed, missing, and filled teeth, resting pH, saliva properties


How to cite this article:
Pallavi V, Hegde MN, Kamakshi G, Indra S, Sainath D. Saliva properties and dental caries prevalence in the South Karnataka population. J Datta Meghe Inst Med Sci Univ 2021;16:72-5

How to cite this URL:
Pallavi V, Hegde MN, Kamakshi G, Indra S, Sainath D. Saliva properties and dental caries prevalence in the South Karnataka population. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 23];16:72-5. Available from: http://www.journaldmims.com/text.asp?2021/16/1/72/322638




  Introduction Top


Saliva has an old history of study, but its physiological importance has only been recognized recently. In the past 50 years, the pace of salivary research has accelerated with the advent of new techniques that illuminated the biochemical and physicochemical properties of saliva comprising the multifunctional roles that saliva has in speech, lubrication, digestion of food, and maintaining oral and general health. Interest in saliva even more increased with the finding that saliva was filled with hundreds of components that may serve to detect systemic disease or evidence of exposure to various harmful substances, as well as provide biomarkers of health and disease status.[1]

The influence of saliva on the caries process is fundamental; in some way, saliva affects all three of the components of Keyes' classic Venn diagram of caries etiology (that is, tooth, plaque, and substrate). Flow rates and clearance, pH and buffer capacity, calcium phosphate homeostasis and effects on bacterial metabolism, adsorption to oral tissues and elimination from the oral cavity are all obvious manifestations of the saliva/caries interaction. Many studies have attempted to relate certain aspects of salivary output and composition to caries susceptibility.[2],[3],[4]

The most common method of recording caries for epidemiological studies is the decayed, missing, and filled teeth (DMFT) index and decayed, missing, and filled surfaces.[3],[4],[5]

Investigations of salivary properties (including flow rate and buffering) and their association with caries prevalence in adult populations have been documented in the past with conflicting results.[5],[6],[7],[8] The advent of a simple chairside saliva check kit (GC Saliva check, GC Corp., Belgium) analyzing levels of labial hydration of unstimulated saliva, the resting pH, volume of stimulated saliva, and its buffering capacity together with the development of the new visual indices creates the potential for using these markers to predict lesion activity.[3],[5]

Thus, the objectives of this study were as follows:

  • To analyze labial hydration of unstimulated saliva and dental caries
  • To analyze resting pH and dental caries
  • To analyze the volume of stimulated saliva and dental caries
  • To evaluate buffering capacity and dental caries.



  Subjects and Methods Top


The source of data was 100 patients visiting the Outpatient Department of Conservative Dentistry and Endodontics, Mangalore, who have a DMFT index of >5 and have been selected for the study, after getting the approval from the institutional Ethics Committee. Patients under the age group of 25–50 years were included in the study. Twenty-five healthy adults without caries in the same age group were taken as the control group. Patients with periodontal disease, hypertension, diabetes, radiotherapy, chemotherapy, systemic diseases of the vital organs, and history of long-term medications were excluded from the study.

A detailed case history of the patient was taken. A case history format was filled with informed consent which is duly signed by each patient.

The smooth and occlusal surfaces of teeth were cleaned with a soft bristle brush, dried, and examined. DMFT score was calculated.

Saliva analysis was done using the GC Saliva-check Kit (GC Corp., Belgium); the unstimulated flow rate was measured visually, noting the time taken for a salivary droplet to form on the lower lip. The lower lip was averted, and the labial mucosa was gently blotted with a small piece of gauze and observed under a good light. Droplets of saliva were formed at the orifices of the minor glands. If time taken for this to occur was >60 s, the resting flow was considered as low. If time taken was between 30 and 60 s, the resting flow rate was considered normal. If time taken was <30 s, the resting flow rate was considered as high (according to the manufacturer's instructions) [Table 1].
Table 1: Grading and scoring for the unstimulated salivary flow

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The resting saliva consistency was visually assessed in the oral cavity [Table 2].
Table 2: Grading and scoring for salivary consistency

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Patients were then asked to pool their saliva on the floor of the mouth and then expectorate into the collection cup over 30 s. A pH strip was dipped into the sample of saliva for 10 s. Color was used to estimate the pH and checked with the testing chart given by the manufacturer. Highly acidic resting saliva was in red section, pH was considered 5.0–5.8; moderately acidic resting saliva was in yellow section, pH was considered as 6.0–6.6; and healthy saliva was in green section, pH was considered 6.8–7.8 (as per the manufacturer's instructions) [Table 3].
Table 3: pH reading and scoring for expectorated saliva

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The patient was given paraffin wax to chew to stimulate salivary flow. After 30 s, the patient was asked to expectorate in a spittoon. The patient was asked to continue chewing for 5 min and saliva was collected in a graduated collection cup at regular intervals. If the quantity of saliva at 5 min was <3.5 ml, it was considered as very low. If the quantity of saliva was in between 5.0 and 3.5 ml, it was considered as low. If the quantity of saliva at 5 min is >5.0 ml, it was considered normal. Normal stimulated saliva varies between 1 ml/min and 1.6 ml/min (as per the manufacturer's instructions) [Table 4].
Table 4: Grading and scoring of stimulated saliva

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Sufficient saliva was taken from the collection cup using a pipette and dispensed one drop on to each of the buffer test strip. Immediately, the strip was turned to 90° to soak up excess saliva on the absorbent tissue. The test pad begins to change color immediately, and after 2 min, the final result was obtained. The results at 2 min were scored according to [Table 5].
Table 5: Scoring of changes in test pad color

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If a color combination provides an unclear result, intermediate scores were used as indicated.

The results of the buffering ability of saliva were interpreted as:

If a combined total is 0–5, the buffering ability of saliva was considered low. If a combined total is 6–9, buffering ability was considered low. If a combined total was 10–12, buffering ability was considered normal or high (as per the manufacturer's instructions) [Table 6].
Table 6: Scoring of buffering capacity of saliva

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The result obtained from an individual patient was scored and combined results of all patients were statistically analyzed using Spearman's rank correlations.

Ethical clearance

Ethical for this study had been approved by Ethical committee. Since no subjects were harmed during this process, all the participants approval was taken, and only salivary samples were collected for this study.


  Results Top


Correlations between salivary properties and caries prevalence and activity were analyzed with Spearman's rank correlations. Statistical significance was set at P < 0.05; the values were calculated to show positive or negative correlations.

Reproducibility was determined using the kappa statistic [Table 7].
Table 7: Prevalence of dental caries and saliva properties

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P < 0.05 was considered statistically significant. The correlations between DMFT and saliva properties of the study group were evaluated using Spearman's ratio. The resting saliva pH and the buffering capacity of the stimulated saliva were shown to be statistically significant (P < 0.05), whereas resting saliva hydration and stimulated saliva viscosity were not statistically significant. The quantity of the stimulated saliva showed no correlation with DMFT.


  Discussion Top


Evaluating the saliva is an integral part of caries risk assessment. Measuring the important salivary parameters offers the answer to why the saliva is not protecting the teeth. When a patient arrives with new oral health problems, the saliva is tested to help to determine the reason why the oral balance is now favoring demineralization.

Testing the resting pH of unstimulated saliva indicates the environment of the mouth. Precavitated lesions are in a constant state of dissolution and repair depending on a critical pH and pH fluctuations can cause a loss of mineral from the tooth when the pH drops and a gain in mineral when the pH rises.

Previous methods to measure unstimulated saliva were described by Navazesh and Christensen,[9] but they did not include using the lower labile minor salivary gland hydration time. The estimation of buffering capacity has been investigated using similar methods using the Dentobuff (Orion Diagnostics, Helsinki).[10] Widodo et al. reported the results of a study on a group of patients with dental erosion using the GC Saliva-check Kit (GC Corp., Belgium).[11] Although the methods used to record the saliva properties are unique to this product, the data recorded in this study appear to correlate with the previously published literature.[11],[12]

The results from this study showed no correlations with hydration, stimulated volume, and stimulated buffering with the caries scores using the modified visual indices and support the findings from studies.[13],[14],[15]

[TAG:2]Conclusion [/TAG:2]

The following conclusions from this study were deduced:

  1. Salivary parameters (hydration, stimulated flow, and viscosity) as tested by the Saliva-check Kit (GC Corp.) showed no correlations with caries prevalence scored using DMFT
  2. There was a negative correlation with resting pH and salivary buffering with the caries activity.


The clinical implications of the findings of this study indicate that the resting saliva pH may be a predictor in patients developing carious lesions. The buffering capacity might help to predict the potential activity of lesions present, but further experimentation and validation is required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Schipper GR, Silletti E, Vingerhoeds HM. Saliva as research material: Biochemical, physiochemical and practical aspects. Arch Oral Biol 2007;52:1114-35.  Back to cited text no. 1
    
2.
Varma S, Banerjee A, Baetlett D. An in vivo investigation of association between saliva properties, caries prevalence and potential lesion activity in an adult UK population. J Dentistry 2008;36:294-9.  Back to cited text no. 2
    
3.
Animireddy D, Reddy Bekkem VT, Vallala P, Kotha SB, Ankireddy S, Mohammad N. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: An in vivo study. Contemp Clin Dent 2014;5:324-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Preethi BP, Reshma D, Anand P. Evaluation of flow rate, pH, buffering capacity, calcium, total protein and total antioxidant capacity levels of saliva in caries free and caries active children: An in vivo study. Indian J Clin Biochem 2010; 25:425-8.  Back to cited text no. 4
    
5.
Dodds MW, Johnson DA, Yeh CK. Health benefits of saliva: A review. J Dent 2005;33:223-33.  Back to cited text no. 5
    
6.
Rask PI, Emilson CG, Krasse B, Sundberg H. Dental caries and salivary and microbial conditions in 50-60-year-old persons. Community Dent Oral Epidemiol 1991;19:93-7.  Back to cited text no. 6
    
7.
Wiktorsson AM, Martinsson T, Zimmerman M. Salivary levels of lactobacilli, buffer capacity and salivary flow rate related to caries activity among adults in communities with optimal and low water fluoride concentrations. Swed Dent J 1992;16:231-7.  Back to cited text no. 7
    
8.
Mazengo MC, Söderling E, Alakuijala P, Tiekso J, Tenovuo J, Simell O, et al. Flow rate and composition of whole saliva in rural and urban Tanzania with special reference to diet, age, and gender. Caries Res 1994;28:468-76.  Back to cited text no. 8
    
9.
Navazesh M, Christensen CM. A comparison of whole mouth resting and stimulated salivary measurement procedures. J Dent Res 1982;61:1158-62.  Back to cited text no. 9
    
10.
Ericson D, Bratthall D. Simplified method to estimate salivary buffer capacity. Scand J Dent Res 1989;97:405-7.  Back to cited text no. 10
    
11.
Widodo G, Wilson R, Bartlett D. Oral clearance of an acidic drink in patients with erosive tooth wear compared with that in control subjects. Int J Prosthodont 2005;18:323-7.  Back to cited text no. 11
    
12.
Ekstrand KR, Ricketts DN, Longbottom C, Pitts NB. Visual and tactile assessment of arrested initial enamel carious lesions: An in vivo pilot study. Caries Res 2005;39:173-7.  Back to cited text no. 12
    
13.
Mazengo MC, Tenovuo J, Hausen H. Dental caries in relation to diet, saliva and cariogenic microorganisms in Tanzanians of selected age groups. Community Dent Oral Epidemiol 1996;24:169-74.  Back to cited text no. 13
    
14.
Lundgren M, Emilson CG, Osterberg T. Root caries and some related factors in 88-year-old carriers and non-carriers of Streptococcus sobrinus in saliva. Caries Res 1998;32:93-9.  Back to cited text no. 14
    
15.
Gábris K, Nagy G, Madléna M, Dénes Z, Márton S, Keszthelyi G, et al. Associations between microbiological and salivary caries activity tests and caries experience in Hungarian adolescents. Caries Res 1999;33:191-5.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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Abstract
Introduction
Subjects and Methods
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