Correlation of salivary characteristics with high risk of dental caries; A clinical investigation

Dental caries is one of the most prevalent and alarming oral health problems encountered in people regardless of age. It is a chronic, multifactorial disease resulting in the destruction of tooth structure and may lead to tooth loss if not treated promptly. Furthermore, it has a significant impact on individuals and on the community as a whole [1] (in the form of discomfort, pain, functional impairment, aesthetic concerns and financial burden for treatment [2]). This makes it a prime public health concern that should be addressed immediately. Patients considered to have a high risk of dental caries exhibit active carious lesions that have cavitated smooth surfaces of two or more teeth at one time. Also at a high risk are thosewho show signs of recurrent caries or have a history of smooth surface caries in the past. Several external and internal host factors contribute to the development and progression of dental caries. The development of carious lesions in teeth is highly dependent upon lifestyle and diet [3]. It is a complex process in which bacterial metabolism produces acid by fermentation of carbohydrates [4]. Demineralization of hard tissue occurs as a result of this pronounced acid attack. Amongst the external host factors, dietary sugars play an imperative role. Sugars provide a substrate for bacteria to ferment and Streptococcus Mutans is majorly involved [5]. The amount, frequency, concentration, and form of sugars are strongly related to the prevalence of dental caries [6]. In addition, dietary routine of low fiber, sugared/carbonated beverages and refined food can result in reduced clearance and an overall acidic environment. Other factors include inadequate oral hygiene [7] and irregular dental recall. Poor oral hygiene leads to increased plaque accumulation on the surfaces of teeth. This leads to increased bacterial load, lower pH of the mouth and eventually demineralization [8]. Internal host factors contributing to dental caries are tooth surface and saliva. The surfaces not accessible to cleaning aids are more prone to bacterial attack and thus, caries. Saliva plays a fundamental role in the maintenance of oral homeostasis [9]. Saliva has been used as a diagnostic tool for more than two thousand years, utilized as a marker of health or disease states [10]. Various functions of saliva include buffering, lubrication, antibacterial properties, antiviral action, and digestion. Being a complex aggregate of proteins, enzymes, regulating hormones, essential vitamins, immunoglobulins, a reservoir of electrolytes and metabolites makes saliva an important defense mechanism of the body [11]. This natural defense mechanism counteracts the acidic effect of bacteria by washing away debris, neutralizing pH and establishing equilibrium in the remineralization and demineralization cycle. Remineralization of hard tissue relies on saliva being a reservoir of calcium, phosphate and fluoride ions [4]. Therefore, saliva plays an extremely vital role in safeguarding and maintaining the integrity of oral soft and hard tissues in the mouth. Salivary characteristics such as pH, flow rate, consistency and buffering capacity have been associated with dental caries. The flow rate is the quantitative measure of salivary secretion in milliliters per minute. A greater flow rate leads to increase in clearance of debris and bacteria. Xerostomia caused by decreased salivary production or secretion results in increased caries incidence, compromised periodontal health and functional impairment. * Corresponding author. Department of Restorative Dentistry/ Endodontics, Islamic International Dental College and Hospital, Islamabad, Pakistan. E-mail addresses: anumk@outlook.com (A. Khan), badaraq@gmail.com (B. Qureshi), dr.amir28792@gmail.com (A. Qureshi), yaqootimtiaz@hotmail.com (Y. Imtiaz), sidraqadeer07@gmail.com (S. Qadeer). Peer review under responsibility of Faculty of Oral & Dental Medicine, Future University.