|Year : 2021 | Volume
| Issue : 1 | Page : 72-75
Saliva properties and dental caries prevalence in the South Karnataka population
Vyapaka Pallavi1, Mithra N Hegde2, G Kamakshi3, Shanthiprasad Indra4, Dinapadu Sainath5
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 Submission||02-Mar-2020|
|Date of Decision||27-Nov-2020|
|Date of Acceptance||20-Dec-2020|
|Date of Web Publication||29-Jul-2021|
Dr. Vyapaka Pallavi
Department of Conservative Dentistry and Endodontics, Vinayaka Mission's Sankarachariyar Dental College, Salem - 636 308, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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|| |
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.
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.,,
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.,,
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.,,, 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.,
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|| |
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].
The resting saliva consistency was visually assessed in the oral cavity [Table 2].
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].
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].
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].
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].
The result obtained from an individual patient was scored and combined results of all patients were statistically analyzed using Spearman's rank correlations.
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|| |
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].
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|| |
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, 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). 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). 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.,
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.,,
The following conclusions from this study were deduced:
- 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
- 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
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]