|Year : 2015 | Volume
| Issue : 2 | Page : 122-125
A study to correlate dental caries experience with total antioxidant levels of saliva among adolescents in Mangalore
S Vijay Kumar1, R Hemanth Kumar2, Nagaratna Bagewadi3, Nitin Anand Krishnan4
1 Department of Public Health Dentistry, Amrita School of Dentistry, AIMS Ponekkara, Cochin, Kerala, India
2 Department of Pedodontics and Preventive Dentistry, AME's Dental College and Hospital, Raichur, Karnataka, India
3 Public Health Dentistry, AME's Dental College and Hospital, Raichur, Karnataka, India
4 Department of Oral Medicine and Radiology, Amrita School of Dentistry, AIMS Ponekkara, Cochin, Kerala, India
|Date of Web Publication||18-Jun-2015|
S Vijay Kumar
Department of Public Health Dentistry, Amrita School of Dentistry, AIMS Ponekkara P.O, Cochin-682 041, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: The changes in salivary composition could have some role in controlling and/or maintaining oxidative damage in the oral cavity. Many adolescents and children have inadequate oral and general health because of active and uncontrolled dental caries. Materials and Methods: Oral examination to assess the dental caries experience was carried out using decayed, missing and filled teeth (DMFT) index. The salivary total antioxidant capacity (TAC) was measured by using "ammonium molybdate method." Data were analyzed using Pearsons correlation and one-way ANOVA with Bonferroni multiple comparison test. A P value of 0.05 was taken as the level of significance. Results: With increasing DMFT scores, TAC of saliva also increased correspondingly. When the TAC of saliva was correlated against DMFT scores, there was a correlation of 0.981 (P < 0.0005). Conclusion: With increasing dental caries experience, the TAC of saliva was found to increase. TAC of saliva could be a marker for dental caries activity among children.
Keywords: Antioxidants, dental caries, saliva
|How to cite this article:|
Kumar S V, Kumar R H, Bagewadi N, Krishnan NA. A study to correlate dental caries experience with total antioxidant levels of saliva among adolescents in Mangalore. J Indian Assoc Public Health Dent 2015;13:122-5
|How to cite this URL:|
Kumar S V, Kumar R H, Bagewadi N, Krishnan NA. A study to correlate dental caries experience with total antioxidant levels of saliva among adolescents in Mangalore. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Dec 15];13:122-5. Available from: http://www.jiaphd.org/text.asp?2015/13/2/122/159045
| Introduction|| |
Saliva, secreted by three pair of major salivary glands is a complex, dynamic, and important body fluid. Saliva plays a protective role in oral cavity against various agents such as microorganisms, toxins, and various oxidants. 
Antioxidants are found in all biological species and in all body fluids including saliva. It constitutes the first line of defense against oxidative stress and has a protective effect against microorganism's toxins and oxidants. ,, Biological antioxidants form an important part of our diet and may prevent various pathological diseases.  The changes in salivary composition could have some role in controlling and/or maintaining oxidative damage in the oral cavity. This is the reason why the antioxidant capacity of saliva has been of increasing interest for the oral health professionals.
Many children have inadequate oral and general health because of active and uncontrolled dental caries, and dental caries is the single most common chronic childhood disease.  Untreated oral diseases in children frequently lead to serious general health problems and loss of school time. By 15 years of age, all the permanent teeth except third molar would have erupted and the teeth would have been exposed to the oral environment for at least 2-3 years.
To correlate dental caries experience with total antioxidant levels of saliva among 15-year-old - adolescents.
| Materials and methods|| |
A cross-sectional institution based study was conducted for a period of 2 months from June 2010 to July 2010 among 108 15-year-old - adolescents of two urban schools in Mangalore.
- Adolescents who have completed 15 years of age and are below 16 years of age.
Ethical clearance was obtained from the Ethical Clearance Committee of the institution. Consent from the authorities of schools were also obtained before the start of the study. A pilot study was conducted to assess the feasibility of the study.
- Adolescents with systemic diseases like upper respiratory tract infections, diabetes mellitus, etc
- Adolescents taking antihistamines, antiepileptic drugs or any other drugs influencing salivary constituents 1-day prior to the day of examination.
The study instrument consisted of a proforma with three parts. The first part consisted of personal information of the subject such as class of studying and sex. The second part was to record the clinical data. The third part was to record the total antioxidant levels of saliva.
Oral examination to assess the dental caries experience was carried out using DMFT Index following WHO criteria.  The recorder stood close to the examiner and recorded the scores. The instruments were sterilized using an autoclave, and were carried to the school in adequate numbers. Five to six subjects were examined per day. Five of the subjects were re-examined on a subsequent day to estimate the diagnostic variability. Kappa statistics was found to be 0.90, reflecting a high degree of agreement in the observations.
Subjects were instructed not to eat, drink, perform any oral hygiene practices or put anything into their mouth at least 2 h before the collection time. The salivary samples were collected at daytime at school between 11.30 a.m. to 12 noon and stored in an ice box with the temperature maintained at −4°C. Sterile centrifuge tubes and glass funnel were used for every subject. The saliva samples were analyzed for their salivary total antioxidant capacity (TAC) at a research laboratory. The salivary TAC was measured by using "ammonium molybdate method." 
Data were analyzed using Pearson's correlation and one-way ANOVA with Bonferroni multiple comparison test using Statistical Package for Social Studies (SPSS) version 17 (IBM) and Microsoft Excel. A P < 0.05 was considered to be statistical significance.
| Results|| |
Dental caries experience
The decayed, missing and filled teeth (DMFT) scores of the study population ranged from 0 to 10. The mean DMFT of the study population was 2.85 ± 2.5. The mean DMFT of males was 2.71 ± 2.49 and among the females it was 3.10 ± 2.55. Among the study population, 26 subjects (24.07%) were found to be caries-free, 48 subjects (41.66%) had DMFT ranging from 1 to 3; 28 subjects (25.92%) had DMFT ranging from 4 to 6, and 9 children (0.08%) had DMFT ≥ 7 respectively.
Assessment of salivary total antioxidant capacity
The overall mean TAC was found to be 94.15 ± 60.72 μg/dL. The mean TAC of subjects with DMFT 0, 1-3, 4-7 ≥ 7 were 22.44 ± 8.97, 78.93 ± 25.67, 148.28 ± 21.15, and 209.00 ± 28.70 μg/dL respectively. The mean TAC among males and females were 91.12 ± 61.34 and 99.52 ± 60.02 μg/dL, respectively. The overall TAC values ranged from 4.32-264.42 μg/dL.
Correlation between decayed, missing and filled teeth and total antioxidant capacity
The study subjects were graded according to their DMFT scores as DMFT = 0, DMFT 1-3, DMFT 4-6, and DMFT ≥ 7. The salivary TAC was compared against these DMFT gradings. It was found that with increasing DMFT scores, TAC of saliva also increases correspondingly. When the TAC of saliva was correlated against DMFT scores, there was found to be a correlation of 0.981 (P < 0.0005) [Figure 1] and [Table 1].
|Figure 1: Correlation between decayed, missing and filled teeth scores, and salivary total antioxidant capacity values|
Click here to view
| Discussion|| |
The mean DMFT of the study subjects was 2.85 ± 2.5. In the present study, the salivary TAC demonstrated a positive correlation with dental caries of the study subjects which was statistically significant.
In most of the studies, individual antioxidant components in saliva were correlated with dental caries experience, and no statistically significant results were reported. Perhaps TAC of the salivary sample of an individual is of more relevance in relation to dental caries than any of the single constituent that is a part of salivary TAC as suggested by these studies. 
The TAC levels of saliva in the present study ranged from 4.32 μg/dL to 264.4 μg/dL. Free radical/reactive oxygen species are often essential for biological processes, and that tissue damage can easily take place when antioxidant systems do not efficiently counteract their action. In this sense, the mouth is a critical site because there is evidence that something of this nature may occur in inflammatory diseases like chronic inflammatory periodontal diseases. 
The TAC of study subjects showed a positive correlation (r = 0.981) with their DMFT scores. This finding in similar to that of findings observed by Tulunoglu  and Hegde.  The presence of pathogenic organisms, which cause caries could be one of the factors for the comparatively increased levels of TAC of saliva in those subjects with caries. 
The antioxidant capacity of saliva could be a major factor in determining the disease outcome in the oral cavity. The various pathological changes inside the oral cavity can be traced to reduced oxidant capacity of the saliva. ,,, The correlation of TAC with dental caries as observed in the present study were similar to that of observations made by Kumar et al. 
The physio-chemical properties of saliva like pH, buffering capacity, salivary flow rate, concentration of various components like proteins, calcium, and antioxidant defense system play a major role in the development of caries as observed by Dogra et al.  In a study conducted by Hegde,  TAC has been found to be positively correlated with the incidence of early childhood caries and rampant caries. It was also observed in the same study that TAC of saliva increases with age.  Similar results were observed in among caries free and caries active adults, where TAC of both saliva and serum were compared with four different categories of adults. 
Diet also contributes to the total TAC of saliva. The endogenous antioxidants along with food-derived antioxidants represent the total antioxidant activity of the system. Uric acid has been considered as the major antioxidant present in human saliva. It accounts for more than approximately 85% of the TAC of both unstimulated and stimulated saliva, and is mainly derived from the diet. 
The dental caries pathogens can metabolize various forms of sugars especially fructose, producing uric acid as one of the end products.  This could contribute to rise in serum uric acid levels, which in turn can increase the salivary uric acid levels, thereby giving rise to an increase in TAC.  In accordance with caries formation, the chemical composition of the saliva can vary, and they may be used for recognizing the risk in patients and to maintain prevention. 
| Conclusion|| |
Subjects with higher DMFT scores were found to have increased TAC compared with subjects with lower DMFT scores. With increasing dental caries experience, the TAC of saliva was found to increase. TAC of saliva could be a marker for dental caries activity among adolescents.
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