Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Epidemiology wikipedia , lookup
Dental implant wikipedia , lookup
Maternal health wikipedia , lookup
Compartmental models in epidemiology wikipedia , lookup
Dental amalgam controversy wikipedia , lookup
Diseases of poverty wikipedia , lookup
Prenatal testing wikipedia , lookup
Dental avulsion wikipedia , lookup
Focal infection theory wikipedia , lookup
Special needs dentistry wikipedia , lookup
Dental degree wikipedia , lookup
Archives of Orofacial Sciences 2006; 1: 57-59 ORIGINAL ARTICLE Saliva as a Diagnostic Tool for Assessment of Dental Caries V.K. Gopinath*, A.R. Arzreanne School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Malaysia *Corresponding author: [email protected] ABSTRACT The objective of this study was to evaluate the effects of salivary testing in dental caries assessment. The role of saliva flow rate, pH, viscosity and buffering capacity in subjects with high caries (DMFT>5) (group 1) against subjects with low caries (DMFT=0) (control group) were evaluated. 40 subjects between the age of 18 and 40 years old were selected (20 subjects control group and 20 subjects group 1). By using a salivary testing kit (GC Asia Dental Pte Ltd, Japan), each subject underwent test such as hydration status of the oral mucosa, viscosity and pH of resting saliva, stimulated salivary flow rate and buffering capacity of stimulated saliva. The results showed that the flow rate, viscosity, pH and buffering capacity of saliva in subjects of group 1 (DMFT>5) was significantly lower (p<0.01) compared to control group (DMFT=0). Therefore saliva may protect the tooth from demineralizing. Hence we recommended this saliva test to be done in patients with high caries risk. Key words: saliva, dental caries, diagnostic tool _______________________________________________________________________________________________ MATERIALS AND METHODS INTRODUCTION This comparative cross sectional study was conducted in the dental clinic of Hospital Universiti Sains Malaysia (HUSM), Malaysia. The study was conduced in twenty subjects with zero DMFT (control group) and twenty subjects with DMFT more than five (group1). Normal healthy males and females between 18 – 40 years who were not under medications that could affect salivation were selected. Pregnant ladies, smokers or betel leaf chewers were excluded. Informed written consent was obtained from each of the participant and the dental caries was assessed by using DMFT index using WHO criteria 1987 (Oral Health Surveys, 1987). The subjects underwent five tests (hydration status in un-stimulated saliva, salivary viscosity, unstimulated salivary pH, stimulated salivary flow rate, buffering capacity in stimulated saliva) by using a saliva testing kit (GC Asia Dental Pte Ltd, Japan). The above salivary parameters were tested at the same time each day in the test and control subjects. Everting the lower lip and observing the droplets of saliva formation for 1 min assessed hydration status of un-stimulated saliva. However in the case of stimulated saliva the subjects were instructed to chew on the piece of wax (1 g) and expectorate into the spittoon for 5 min. The secretion rate of stimulated saliva is expressed as milliliter per min. Stimulated salivary secretion rate greater than 1 ml / min was considered to be normal. The data was analyzed Dental caries is the most prevalent dental disease affecting human race although the prevalence of dental caries has significantly reduced, it is still a major problem (Beck et al,. 1988). The etiology and pathogenesis of dental caries are known to be multifactorial (Beck et al,. 1988; Reich et al., 1999; Lenander-Lumikari and Loimaranta, 2000; Leone and Oppenheim, 2001; Hicks et al., 2003). The secretion rate and quality of saliva are important not only in caries development but also for remineralization. Saliva is vital to the integrity of the teeth as well as the soft tissues. It is not uncommon to observe patients presenting with loss of tooth structures due to dental caries or dental erosion. The most possible reasons for change in the oral balance that is favoring demineralization may be answered by measuring important salivary parameters. Evaluating the causative factors in saliva of individual’s at risk to dental caries can pay the way to make recommendations that will cater specifically to individual’s needs. Many benefits exist for both patients and dentist by introducing saliva testing as part of practice philosophy. The practice can benefit from enhanced diagnostics, early detection of problems, improved patient communication and motivation and an increased dental awareness for patients. Hence this study was done with the objective to evaluate the role of salivary testing in dental caries assessment. 57 Gopinath and Arzreanne observed in this study that 90 % of subjects in control group had taken less than 30 second to hydrate their mucosa and had a stimulated salivary flow rate greater than 1 ml / min. Significantly lower salivary flow rate in-group 1 may be associated with a number of predisposing factors such as lack of raw material (water), lack of stimulus to the salivary gland or could be a problem with salivary gland itself. The patient with stimulated saliva flow rate less than 1.0 ml / min are considered to be at risk to develop dental caries where as a stimulated salivary flow rate greater than 1.0 ml/min is considered to be normal (Dawes, 1987). In severe cases the unstimulated saliva results will also be low, giving a clear indication of increased levels of dental caries risk. Previous studies have also reported (Holbrook et al., 1993; Vehkalahti et al., 1996) similar findings with regards to salivary flow rate and related it to increased caries risk. In the present study we observed that 70 % of the subjects in-group 1 had frothy and bubbly saliva suggesting increased viscosity when compared to the control group. The reasons for increased viscosity may be due to reduced water content in the saliva. This finding is in correlation with other study (Holbrook et al., 1993). by statistical package (SPSS, Chicago, IL, USA) using Chi-square test. RESULTS The results of the study (Table 1) showed that, 90 % of the subjects in group 1 had taken more than 30 seconds to hydrate the oral mucosa when compared to the control group (p <0.001). Salivary viscosity was significantly higher (p < 0.001) in the group 1 compared with control group. It was observed that 45 % of the subjects from group 1 had a significantly lower unstimulated salivary pH (p<0.001) in the range of 5.2 to 6.2 when compared with the control group. In-group 1, 80 % of the subjects had less than 1 ml of stimulated saliva per min when compared to the control group (p<0.001). 95 % subjects’ in group 1 had a significantly low (p<0.01) salivary buffering capacity when compared to the control group. In this study we observed that 35% of the subjects in-group 1 had all the salivary parameter at a lower level (data not shown). DISCUSSION Normal salivary flow rate (hydration status and stimulated saliva flow rate) imparts a strong protective effect against dental caries. It was Table 1 Salivary parameter in each group Number of subjects (%) DMFT=0 DMFT>5 (Control Group) (Group I) n=20 n=20 Salivary Parameters P value 25.600 0.001 18.027 0.001 2 (10%) 18 (90%) 18 (90%) 2 (10%) 1 (5%) 14 (70%) 19 (95%) 6 (30%) 5.2 to 6.2 > 6.2 0 (0%) 20 (100%) 9 (45%) 11 (55%) 11.613 0.001 Stimulated salivary flow rate ml/min < 1.0 ml/min > 1.0 ml/min 2 (10%) 18 (90%) 14 (70%) 6 (30%) 15.000 0.001 Buffering capacity 0 to 9 10 to 12 4 (20%) 16 (80%) 19 (95%) 1 (5%) 23.018 0.001 Hydration status Salivary viscosity Salivary pH a > 30 seconds < 30 seconds λ2 statistica (df) -Frothy, bubbly, increase viscosity -Watery, clear, normal viscosity Chi-square test 58 Archives of Orofacial Sciences 2006; 1: 57-59 There is a reasonably evidence to state that salivary buffering capacity protects the tooth from dental caries (Leone and Oppenheim, 2001). Salivary buffering capacity prevents reduction in pH by neutralizing acid in oral cavity after sugar intake. In the present study, we observed that 95 % subjects in-group 1 had a lower buffering capacity of saliva. This finding is in correlation with previous results (Johansson et al., 1992; Holbrook et al., 1993). Interestingly we observed that 20 % of the subjects in control group had decreased salivary buffering capacity. The reasons for this may be due to extrinsic factors such as dietary and oral hygiene habit, as well as intrinsic factor such as bicarbonate content. In the present study we observed that 45 % of the subjects in-group 1 had low salivary resting pH level in the range of 5.2 to 6.2. The findings are in correlation with previous research (Pajari, 1988; Holbrook et al., 1993). Interestingly it was observed that 35 % of the subject’s in-group 1 had all the salivary parameter at a lower level indicating the individual risk to develop dental caries (data not shown). Since saliva provides a general protective effect, clinically significant decrease in salivary functions can be considered as an etiologic factor that contributes to the development of dental caries. If only conventional dental treatment is done in these subjects without treating the defect in the salivary parameters, the dentist is sure to see recurrence of dental caries in a relatively short time. diagnosis when treating patient with high dental caries risk. REFERENCES Beck JD, Kohout F and Hunt RJ (1988). Identification of high caries risk adult: attitude, social factors and diseases. Int Dent J, 38: 231-280. Dawes C (1987). Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res, 66: 648-653. Hicks J, Garcia-Godoy F and Flaitz C (2003). Biological factors in dental caries: Role of Saliva and Dental Plaque in the Dynamic Process of Demineralization and Remineralization (part 1). J Clin Pediatr Dent, 28: 47-52. Holbrook WP, de Soet JJ and de Graaff J (1993). Prediction of dental caries in pre-school children. Caries Res, 27:424-430. Johansson I, Saellstrom AK, Rajan BP and Parameswaran A (1992). Salivary flow and dental caries in Indian children suffering from chronic malnutrition. Caries Res, 26: 38-43. Leone CW and Oppenheim FG (2001). Physical and Chemical Aspects of Saliva as Indicators of Risk for Dental Caries in human. J Dent Educ, 65: 1054-1064. Lenander-Lumikari M and Loimaranta V (2000). Saliva and Dental Caries. Adv Dent Res, 14: 4047. Oral health surveys. Basic methods, third edition, WHO (1987). 34 –39. Pajari U (1988). Effect of anti-neoplastic therapy on dental hard tissue and saliva in children and adolescent. A clinical and experimental study. Proc Finn Dent Soc, 84: 1-59. Reich E, Lussi A and Newbrun E (1999). Caries Risk Assessment. Int Dent J, 49: 15-26. Vehkalahti M, Nikula-Sarakorpi E and Paunio I (1996). Evaluation of salivary tests and dental status in the prediction of caries increment in caries susceptible teenagers. Caries Res, 30: 2228 CONCLUSION This study showed that salivary parameters such as salivary flow rate, salivary viscosity, salivary pH and salivary buffering capacity were lower in subjects with high dental caries. Hence, we recommend salivary testing to be a part of routine 59