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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 96-100

An attempt to correlate biochemical parameters in saliva with dental carries in children of two different age groups: A comparative study


1 Department of Biochemistry, Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana, Punjab, India
2 Department of Pedodontics, Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana, Punjab, India
3 Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana, Punjab, India

Date of Web Publication8-Jan-2018

Correspondence Address:
Dr. Santosh Mahajan
Department of Biochemistry, Baba Jaswant Singh Dental College Hospital and Research Institute, Sector 40, Chandigarh Road, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_48_17

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  Abstract 


Aim: Dental caries is one of the most common chronic dental diseases of childhood. Saliva by virtue of its chemical composition provides the main host defence in the oral cavity and plays an essential role in maintaining the integrity of oral structure. The present study was an attempt to correlate the changes in biochemical parameters with dental caries in the saliva samples of children of two different age groups.
Materials and Methods: The level of calcium, phosphorous, α-amylase, and pH was measured in the saliva of caries-free (control group with decayed, missing, and filled teeth [DMFT] = 0) and caries-affected (test group with DMFT ≥5) children of 3–8 years and 9–14 years of age.
Results: Statistical analysis of the data thus obtained revealed no significant difference in the mean values of calcium, phosphorus, α-amylase, and pH in caries-affected children when compared to their age-matched control group except phosphorous which increased significantly in caries-affected children of 3–8 years of age. There was also a significant correlation between calcium and phosphorous levels (r = 0.192*, P = 0.04) irrespective of age group.
Conclusions: This study indicated a direct relationship between phosphorous level and dental caries in children of younger age group (3–8 years of age) and was attributed to their greater susceptibility to dental caries leading to their more DMFT status than children of 9–14 years of age. Greater susceptibility of primary enamel to demineralization is well documented in the literature, and it is because of its less mineralized, significantly softer and less elastic nature and higher organic content that dissolves faster in the acidic environment than the permanent enamel. Increased phosphorus in the saliva sample of caries-affected children might be due to the hydrolysis of organic phosphates of their enamel. Significant correlation between calcium and phosphorous supports the involvement of these two minerals in the formation of hydroxyapatite of tooth.

Keywords: Calcium, caries, children, decayed, missing and filled teeth, pH, phosphorous, saliva, α-amylase


How to cite this article:
Mahajan S, Suneja B, Kaur P. An attempt to correlate biochemical parameters in saliva with dental carries in children of two different age groups: A comparative study. Int J Oral Health Sci 2017;7:96-100

How to cite this URL:
Mahajan S, Suneja B, Kaur P. An attempt to correlate biochemical parameters in saliva with dental carries in children of two different age groups: A comparative study. Int J Oral Health Sci [serial online] 2017 [cited 2019 Oct 21];7:96-100. Available from: http://www.ijohsjournal.org/text.asp?2017/7/2/96/222403




  Introduction Top


Dental caries (a multifactorial disease of the calcified tissues), though prevalent in both the sexes of every age group and all socioeconomic strata, is one of the most common dental disease of childhood.[1] Despite the general decrease in dental caries in the past decade childhood caries remains a major problem in developing countries and in a few industrialized nations.[2],[3] As the children reach school age, they have an increasing incidence of carious lesions due to the change in dietary habits, in addition to oral hygiene, tooth structure, and composition of saliva, etc.[4] The balance between protective and pathological factors determines the progression or reversal of dental caries. The disease starts with the fermentation of carbohydrates producing organic acids that decrease the pH of the oral cavity resulting in demineralization [5] and creating an environment favorable for the growth of Streptococcus mutans.[6] Saliva provides the main host defence against these cariogenic challenges. By virtue of its chemical composition, it is capable of rehardening the buffer softened enamel surface, resulting in remineralization but at a slower rate than demineralization.[7] Since the reparative capacity of saliva is related to its mineral constituents bathing the teeth, a considerable research attention has been directed to evaluate salivary calcium and phosphorous level in relation to dental caries. However, no conclusive evidence has been presented to support that the concentration of either is of any importance in caries prevention.[8] Amylase, besides its function in digestion, is of considerable significance in dental health because of its intraoral action.[9],[10] However, its overall effect on caries is still questionable.[9] In view of this, the present study was an attempt to estimate the level of calcium, phosphorous, α-amylase, and pH in the saliva samples of caries-free and caries-affected children of two different age groups and elucidate if any correlation exists between these parameters and dental caries.


  Materials and Methods Top


The study sample was comprised of a total of 120 children from 3 to 8 years and 9–14 years of age attending the Pedodontics Outpatient Department in Baba Jaswant Singh Dental College and Research Institute, Ludhiana. This study was approved by the ethical committee of institute. Informed consent was obtained from the parents of children included in this study after explaining them the study protocol.

Screening of the children for their decayed, missing, and filled status of both primary and permanent teeth (decayed, missing, and filled teeth [DMFT]) was done using dental mirror and explorer following Cappeli and Mobley.[11] Children were divided into four groups of 30 children in each group. Group I and group III comprised caries-free children with DMFT score 0 (control group) of 3–8 and 9–14 years of age, whereas group II and IV comprised children having DMFT score ≥5 (test group) from the respective age group.

To control the circadian rhythm, the saliva samples of the children were collected between 10:00 am and 11:30 am.[12] The children were asked not to eat or drink 1 h before the collection of the sample. Stimulated saliva samples were collected in sterilized vials by churning 10 ml distilled water in the mouth for 2–3 min and were analyzed biochemically.

Each sample was analyzed for calcium by titrimetric method of Clark and Collip.[13] Level of phosphorous and α-amylase was measured following the colorimetric methods of Kuttner and Lichenstein,[14] and Bansal et al.,[15] respectively. The pH of all the samples was noted by pH meter. The data obtained were analyzed statistically.

Mean ± Standard deviation (SD) value for different parameters in the two age groups and the comparison of their levels in control with the test was done using Student's t-test. The correlations between different parameters were analyzed following nonparametric Spearman's correlation. The level of significance was established at P < 0.05.


  Results Top


A total of 120 children (71 boys and 49 girls) were included in this study. Range and mean ± SD values of age, DMFT, calcium, phosphorous, α-amylase, and pH in different study groups have been shown in [Table 1]. Comparison of the mean values of Calcium, phosphorous, α-amylase, and pH of control group with age-matched test group is given in [Table 2]. Difference in the mean ± values of calcium, phosphorous, amylase, and pH between caries-affected children was not significant statistically when compared to their age-matched control group except phosphorous which increased significantly (P = 0.010) in caries-affected children of 3–8 years of age [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Spearman's correlation revealed no significant correlation between different parameter studied except between calcium and phosphorous levels (r = 0.192, P = 0.04) [Table 3].
Table 1: Range and mean±S.D values of age, decayed, missing, and filled teeth, calcium, phosphorous, α-amylase, and pH in different study groups (n=30 in each age group)

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Table 2: Comparison of mean±standard error values of calcium, phosphorous, amylase, and pH between control and respective test group

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Figure 1: Intergroup comparison of mean values of calcium, phosphorous, amylase, and pH between control and respective test group

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Figure 2: Intergroup comparison of salivary phosphorous levels

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Figure 3: Intergroup comparison of salivary pH

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Figure 4: Intergroup comparison of salivary amylase

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Table 3: Correlations among decayed, missing, and filled teeth, salivary calcium, phosphorous, amylase, and pH irrespective of age group

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  Discussion Top


The composition of saliva in relation to dental caries has been studied extensively showing positive, negative, or no correlation.[16],[17],[18],[19],[20] Protective role of saliva against dental caries is a complex phenomenon involving its composition, tooth structure, hormonal status, external factors such as microbial flora oral hygiene.[21] In the present study, no significant difference is found in the level of calcium, phosphorous, amylase, and pH between caries-free and caries-affected children except phosphorous which increased significantly in caries affected children of 3–8 years when its level was compared with their age-matched control group. The results are “partially” in accordance with Shahrabi et al.[22] who could not establish any relationship between dental caries and the level of calcium, phosphorous, and alkaline phosphatase in children of 3–5 years age group. The results are also in line with Hubbel and Bunting [23] who did not find any difference in the concentration of calcium and phosphorous in caries-free and caries-affected children of 7–16 years. Bagherian and Asadikaram [20] did not find statistically significant difference in the level of calcium and phosphorus in children with and without early childhood caries. The results of the present study are suggestive of the fact that demineralization and remineralization might be taking place simultaneously, thereby maintaining the level of these minerals same in control and test group. However, as demineralization occurs at faster rate than remineralization, it leads to the formation of a cavity.[7] It is further hypothesized that as saliva is a blood filtrate,[10] unaltered calcium level in caries affected children might be due to the regulatory role of parathyroid hormone (PTH) maintaining its level in the caries-affected children to the level as found in caries-free children. Role of PTH in regulating serum calcium level is well documented.[24] Significant increase in phosphorous levels in caries-affected children of 3-8 years indicated a direct relationship between phosphorus and dental caries in this age group and that might be because of their more susceptibility to dental caries than children of 9–14 years of age. It has been documented in the literature that the primary enamel is significantly softer and elastic,[25] exhibit more diffusion coefficient [26] and showed a significantly greater susceptibility to demineralization in the acidic medium due to more organic content that dissolves faster than the permanent enamel.[27] Increased phosphorus in the caries affected children of 3–8 years might have been derived from the hydrolysis of phosphoprotein and/or phospholipids (the organic content) of their enamel leading to their more DMFT status than 9–14-year-old children [Table 1] and [Figure 5]. Direct relationship between alkaline phosphatase, phosphorus, and dental caries has been established in children of 4–6-year-old by Gandhy and Damle.[28] On the other hand, Watanbe et al.[29] indicated that calcium concentration of resting saliva has no relationship with the DMFT status of children. Mean ± SD values of amylase in caries affected children was less as compared to their age-matched control groups. However, the decrease was not significant statistically. It is proposed that as amylase is purely of salivary origin,[30] decrease in mean values of amylase in caries-affected children might be because of decrease in salivary flow rate hence caries development.[31],[32] Further, calcium acts as cofactor for α-amylase and the activity of α-amylase is strongly linked with the level of calcium.[33] No significant decrease in the level of amylase in caries affected children is attributable to their unaltered calcium level. The present study revealed no significant difference in salivary pH in caries-free and caries-affected children. These findings find support from Mukherjee [34] who did not find any change in pH and phosphorus level in caries susceptible and calculus susceptible subjects aged 6–50 years. Strong correlation was noted between calcium and phosphorous with correlation coefficient of 0.192 and P = 0.040 irrespective of age group reflects that these two minerals are the integral constituents of tooth structure.
Figure 5: Decayed, missing, and filled teeth status

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  Conclusions Top


Significantly increased phosphorus in caries-affected children of 3–8 years might have been derived from the hydrolysis of more organic content in their enamel that dissolves faster leading to more DMFT status than the children of 9–14 years of age group.

Pitfalls and future recommendations

Saliva samples were taken only once. The future studies with multiples of saliva samples are needed to confirm the present results. The studies involving the organic composition of the primary and the permanent, and the role of PTH on salivary calcium should be undertaken to support the present study.

Acknowledgment

We are highly indebted to the children who participated willingly in the present study. We are also thankful to the technical staff of the Department of Pedodontics and the Department of Biochemistry for the successful completion of the study. Special thank goes to Master Raunak Mahajan (Son of Dr. Santosh Mahajan and a 7th standard student) for helping in the typing the manuscript.

Financial support and sponsorship

The work would not have been completed without the financial support by the institute.

Conflicts of interest

There are no conflflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

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