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Magnesium Research 2013; 26 (3): 120-4
ORIGINAL ARTICLE
Salivary mineral composition in
patients with oral cancer
Copyright © 2017 John Libbey Eurotext. Téléchargé par un robot venant de 88.99.165.207 le 12/08/2017.
Anna Dziewulska1 , Joanna Janiszewska-Olszowska1 , Teresa Bachanek2 ,
Katarzyna Grocholewicz1
1 Chair and Department of General Dentistry Pomeranian Medical University of Szczecin,
Al. Powstancow Wlkp. 72, 70-111 Szczecin; 2 Department of Conservative Dentistry with
Endodontics Medical University in Lublin, 7 Karmelicka Street, 20-081 Lublin
Correspondence: Joanna Janiszewska-Olszowska. Chair and Department of General Dentistry Pomeranian
Medical University of Szczecin. Al. Powstancow Wlkp. 72, 70-111 Szczecin
<[email protected]>
Abstract. Aim. To analyse the mineral content of saliva in patients with oral
cancer in order to identify possible markers that might aid the diagnosis of oral
cancer. Subjects and methods.The study group consisted of 34 patients, aged
35-72 years with a diagnosis of oral cancer, including seven women and 27 men,
before the start of treatment. Samples of unstimulated saliva were collected in
plastic containers. The concentrations of sodium and potassium were assessed
using ion selective electrodes, and the concentrations of calcium, magnesium,
iron and phosphorus were assessed using colorimetric methods. Results. Statistically significant differences between the study and control groups were found
only for the concentration of sodium – higher concentrations were found in the
study group. When comparing different cancer localisations, the highest levels
of salivary sodium were found in cases of cancer of the floor of the oral cavity,
and the lowest levels in tongue or parotid gland cancer. The highest calcium
levels were found in cancer of the floor of the oral cavity, and the lowest levels
in tongue cancer. The highest levels of magnesium were found in cancer of the
floor of the oral cavity, and the lowest in tongue cancer. As regards the different
histological types, higher sodium and calcium levels were found in squamous
cell carcinomas than in other types. Conclusion. Salivary mineral content in
patients with oral squamous cell carcinoma is indicative of oral dehydration;
however, we found no evidence of any salivary mineral markers that would be
useful for the diagnosis of oral cancer.
Key words: oral cancer, squamous cell carcinoma, salivary minerals, sodium, calcium, magnesium
as well as local factors (periodontal and dental status) [2, 3]. Sodium, potassium and calcium are the
major cations in unstimulated, whole saliva [4].
The calcium phosphate found dissolved in
saliva, influences the process of demineralisation
and remineralisation of the enamel [4], as well
as the formation of dental calculus [5, 6]. Other
inorganic components of dental calculus include
magnesium and sodium [6].
There is no evidence that the level of magnesium in saliva reflects the general status, neither
is it increased after supplementation [8]; however,
120
To cite this article: Dziewulska A, Janiszewska-Olszowska J, Bachanek T, Grocholewicz K. Salivary mineral composition in
patients with oral cancer. Magnes Res 2013; 26(3): 120-4 doi:10.1684/mrh.2013.0346
doi:10.1684/mrh.2013.0346
Saliva is part of the natural environment of
the oral cavity. It has a fundamental role in the
integrity of mineralised dental tissues, as well
as of the soft tissues of the oral mucosa. The
inorganic components of dental calculus are predominantly calcium and phosphorus [1]. Apart
from calcium, the role of salivary minerals has not
been described in detail.– In fact, little evidence
exists concerning the association between salivary
electrolytes and oral health. The levels of salivary
minerals are a consequence of the general health
status (including age, smoking and alcohol use),
Salivary mineral composition in oral cancer
Table 1. Distribution of the study group according to cancer localisation and smoking status in
the study and control groups.
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Localisation
Tongue
Oral cavity floor
Tonsil
Parotid gland
Other localisation*
Total
Smoking status
Present smokers
Past smokers
Non-smokers
Total
Females
n
%
1
14.29
1
14.29
2
28.57
1
14.29
2
28.57
7
100
Study group
n
%
13
38.24
13
38.24
8
23.52
34
100
Males
n
%
10
37.04
7
25.93
4
14.81
3
11.11
3
11.11
27
100
Control group
n
%
5
16.67
12
40
13
43.33
30
100
* Mandibular alveolus, maxillary alveolus, velum and
uvula, cheek, throat
lower salivary magnesium concentrations have
been demonstrated in migraine patients as compared to young, healthy individuals [9].
The iron content is a consequence of desquamation of the epithelial cells as well as possible
gingival bleeding [10, 11]. The pathological cell
proliferation seen in oral cancer is associated with
tissue destruction, and loss of cell electrolytes and
macromolecules. Inflammation and bleeding may
also be present.
The aim of the study was to analyse the mineral
content of saliva in patients with oral cancer, in
order to search for markers that might help in the
diagnosis of oral cancer.
Subjects and methods
The study group consisted of 34 patients with
oral cancer, aged 35-72 years, including seven
women and 27 men, before treatment initiation.
All patients were examined shortly after the diagnosis of cancer, and had no detectable metastases.
The control group consisted of generally healthy
dental patients, aged 37-70 years, including five
women and 25 men. The distribution of the study
group according to cancer localisation is presented
in table 1. The most frequently diagnosed oral cancer in women was tonsil cancer, whereas in men,
tongue cancer was the most common. The smoking
status in the study and control groups is presented
in table 1. After ethical approval (Ref No. KE0254/121/2006), informed consent was obtained
from every participant. A detailed questionnaire
concerning oral hygiene, habits, history and family interview was completed in addition to the
examination. Unstimulated saliva was collected
in plastic containers in a separate room, in a comfortable sitting position.
The concentrations of sodium and potassium
were assessed using ion selective electrodes by
Konelab (Thermo Electron Corporation, Vantaa,
Finland). The concentrations of calcium, magnesium, iron and phosphorus were assessed
using colorimetric methods in a Konelab analyser
(Thermo Electron Corporation). The concentration of calcium was assessed using the Calcium
test by Konelab, with Arsenazo III (SigmaAldrich, St.Louis, USA) at a wavelength of
600 nm. Magnesium content was analysed using
an Mg-Kit (bioMerieux, Craponne, France), with
Camalgite (Sigma-Aldrich) at 520 nm, iron, using
the Ferentest with Feren S (bioMerieux) at
593 nm, and phosphorus with phosphore UV with
ammonium molybdate at 340 nm.
Data normality was assessed using the ShapiroWilk test. Variance homogeneity was assessed
using the Fischer F-test. Comparisons were made
between the study and control groups, as well
as within the study group between subgroups of
different cancer localisation or histological type.
The Mann-Whitney test was used for comparisons between the groups and subgroups. The
Spearman rank coefficient was used to assess correlations between parametric variables. For the
latter, cross-tabulation and ␹2 homogeneity or the
independence test with Yates’s correction were
used for subgroups of less than five subjects. The
level of significance p<0.05 was used as a reference. All the tests were performed using statistical
package Statistica 8.0 (StatSoft, Poland).
Results
No statistically significant differences concerning
age and sex, smoking status or alcohol use were
found between the study and control groups. The
general diseases diagnosed were hypertension (14
patients in the study group and 15 in the control
group), and hyperthyroidism (two patients in the
study and two in the control groups). Apart from
121
A. DZIEWULSKA, ET AL.
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mild gingival inflammation in both the study and
control groups, no other concomitant pathology
that might have had a known or probable effect
on salivary mineral composition was seen in any
of the patients examined.
The mineral composition of saliva in the study
and control groups is presented in table 2. Statistically significant differences between the study
and control groups were found only regarding the
concentration of sodium – higher concentrations
were found in the study group (p = 0.01).
There were no statistically significant differences in salivary mineral composition as a
function of age, although the level of phosphorus
was higher in men than in women (p = 0.03). The
mineral salivary composition was not significantly
different in tobacco smokers or alcohol abusers.
When comparing the different localisations,
statistically significant differences were found
involving the concentrations of sodium, calcium
and magnesium. The highest levels of salivary
sodium were found in patients with cancer of the
floor of the oral cavity, and the lowest levels in
tongue and parotid gland cancer (p = 0.001). The
highest calcium levels were found in those with
cancer of the floor of the oral cavity, and the lowest levels in patients with tongue cancer (p = 0.05).
The highest levels of magnesium were found in
patients with cancer of the floor of the oral cavity, and the lowest levels in tongue cancer patients
(p = 0.04).
As regards the histological types of oral cancer, statistically significant differences were found
in sodium and calcium levels. Higher sodium
(p = 0.01) and calcium (p = 0.01) levels were found
in squamous cell carcinomas than in other histological types.
Discussion
Salivary mineral composition in smokers and
non-smokers has seldom been studied and conflicting results have been obtained. Kolte et al.
[7], have concluded that smoking influences the
mineral content of saliva, with higher levels of
salivary magnesium, but lower levels of calcium
and phosphorus having been found in healthy
smokers than in non-smokers. Different results
were reported by Grocholewicz [12] as well as by
Sewon et al. [13], who analysed salivary calcium
levels in 603 female patients aged 50-62 years,
122
including 90 smokers, and found that smokers had
lower bone density and higher salivary calcium
than non-smokers. Contrary to these findings, in
the present study, no significant differences were
found between smokers and non-smokers. This
fact may be due to the high frequency of smoking in present study. Similar results have been
obtained by Erdemir et al. [1] in a study of 12
smokers and 12 non-smokers with chronic periodontitis.
Higher concentration of sodium in the study
group supports an earlier study by Fuchs et al.
[14]. It might be supposed that an elevated sodium
level could reflect dehydration due to the oral
carcinoma itself, as well as smoking and alcohol
consumption. However, the salivary rate was not
analysed in the present study.
Salivary mineral composition in patients with
oral cancer has rarely been studied. The results
from the few studies found are summarised in
table 2. The concentration of potassium in the
present investigation is similar to that reported
by Shpitzer et al. [15] as well as by Błoniarz et
al. [16]. The lack of statistically significant differences between patients with oral cancer and
the control group also supports earlier findings.
The results involving magnesium concentration in
saliva contrast with those found in the study by
Grandinaru et al. [17] who found higher salivary
magnesium levels in patients with parotid gland
tumors. No statistically significant difference in
calcium levels were found which contrasts with
the study by Grandinaru et al.[17] who found significantly lower salivary calcium concentrations
in patients with malignant parotid tumours. This
might have been due to tumour localisation where
there was higher variability than in the present
study.
Shpitzer et al. [15] found a lower mean salivary
concentration of potassium and higher concentrations of sodium, calcium, phosphorus and
magnesium in patients with oral squamous cell
cancer of the lateral aspect of the mobile tongue,
compared to a control group of healthy individuals,
which is generally in agreement with the present
study.
The presence of iron ions in saliva results from
epithelial desquamation and gingival bleeding.
The fact that no differences were seen between
the study and control groups may reflect a similar prevalence of gingivitis and associated gingival
bleeding in both groups. Extremely high iron
concentrations have been reported by Błoniarz
Salivary mineral composition in oral cancer
Table 2. Mineral composition of saliva in the study and control groups in the present study and in the
literature.
Mineral
Sodium [mmol/L]
Potassium [mmol/L]
Calcium [mmol/L]
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Magnesium [mmol/L]
Iron [mmol/L]
Phosphorus [mmol/L]
Sodium [mmol/L]
Potassium [mmol/L]
Calcium [mmol/L]
Magnesium [mmol/L]
Iron [mmol/L]
Phosphorus [mmol/L]
Group
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Study
Control
Present study
SD
Median
13.61
20.5
8.09
18
8.14
25
9.27
25.63
0.66
0.77
0.55
0.75
0.26
0.38
0.39
0.36
1.26
0.36
0.92
0.36
11.2
4.97
9.31
6.61
Data from literature
Błoniarz et al., 2003
47.55
8.35
23.42
18.51
2.96
1.03
0.79
0.21
22.9
4.47
no data
no data
Mean
27.29
20
26.96
25.93
0.99
0.82
0.44
0.42
0.74
0.57
10.3
9.7
Q3
17
15
22.7
21.56
0.46
0.35
0.22
0.2
0.18
0.18
3.46
4.77
Q1
35
21
34.04
31.13
1.55
1.04
0.66
0.5
0.72
0.36
8.53
8.13
Range (min.-max.)
13.00-61.00
12.00-49.00
6.23-44.52
5.37-44.95
0.02-2.72
0.18-2.43
0.08-0.96
0.08-2.20
0,00-7.2
0.00-4.14
1.90-35.22
0.77-34.93
Sphitzer et al., 2007
22.5
19.8
20.7
24.3
1.47
0.92
0.37
0.29
no data
no data
7.52
5.43
et al. [16], both in the study and control groups,
which is difficult to explain.
It can be concluded that the comparison of salivary mineral content in patients with oral cancer
and a control group provided no evidence of any
putative salivary mineral markers that could constitute a diagnostic tool.
2. Bales CW, Freeland-Graves JH, Askey S, Behmardi
F, Pobocik RS, Fickel JJ, Greenlee P. Zinc, magnesium, copper and protein concentrations in human
saliva: age- and sex-related differences. Am J Clin
Nutr 1990; 51: 462-9.
Disclosure
4. Rehak NN, Cecco SA, Csako G. Biochemical
Composition and Electrolyte Balance of “Unstimulated whole Human Saliva. Clin Chem Lab Med
2000; 38: 335-43.
Financial support: none. Conflict of interest: none.
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