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ORIGINAL ARTICLE
Year : 2010  |  Volume : 28  |  Issue : 3  |  Page : 156-161
 

Relation of salivary calcium, phosphorus and alkaline phosphatase with the incidence of dental caries in children


1 Professor, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India
2 Professor and HOD, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India
3 Sr. Lecturer, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India

Date of Web Publication11-Dec-2010

Correspondence Address:
K E Vijayaprasad
Professor, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru - 534 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.73789

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   Abstract 

Aim: The purpose of this study was to assess possible relationship of Calcium, Phosphorus and Alkaline-phophatase levels in saliva with incidence of caries in child patients. Settings and Design: Children (n=75) attending Department of Pedodontics, St. Joseph Dental college, Eluru, with and without caries were categorized in to Group I: Consisting of 25 children with non-rampant caries, Group II: Consisting of 25 children with rampant caries, Group III: Consisting of 25 children without caries. (Control group). Materials and Methods: The samples of saliva were collected one week after oral prophylaxis. Unstimulated directly expectorated whole saliva samples were collected in clean, dry, sterilized glass bottles and fitted with proper rubber stoppers immediately. The samples were subjected to biochemical assay for estimation of calcium, phosphorus and alkaline phosphatase levels. Statistical analysis used: ANOVA. Results: The alkaline Phosphatase activity for rampant caries group was 18.66 K.A, and control group was 4.68 K.A. The values of alkaline phosphatase activity for minimal caries group was 6.16 KA. Conclusion: Saliva could reflect a caries risk situation was supported by the fact that alkaline phosphatase activity was very much significantly higher in caries prone groups.


Keywords: Alkaline phosphatase, rampant caries, salivary calcium and phosphorus


How to cite this article:
Vijayaprasad K E, Ravichandra K S, Vasa A, Suzan S. Relation of salivary calcium, phosphorus and alkaline phosphatase with the incidence of dental caries in children. J Indian Soc Pedod Prev Dent 2010;28:156-61

How to cite this URL:
Vijayaprasad K E, Ravichandra K S, Vasa A, Suzan S. Relation of salivary calcium, phosphorus and alkaline phosphatase with the incidence of dental caries in children. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2019 Nov 21];28:156-61. Available from: http://www.jisppd.com/text.asp?2010/28/3/156/73789



   Introduction Top


Despite hundreds of research investigations for more than a century, dental caries still remains the most common disease of modern civilization. Many aspects of dental caries are still obscure and efforts at prevention have only partially been successful.

The fact that there is remarkable variation in the caries incidence between different individuals of the same age, sex, race and geographic area subsisting on similar diets under the same living conditions underscores the complexity of caries problem.

The mere presence of microorganisms and a suitable substrate at a given point on a tooth surface is apparently insufficient to establish a carious lesion in all cases. It can be stated that variation in caries incidence exists because of a number of possible "indirect or contributing" factors.

The fact that the teeth are in constant contact with and bathed by the saliva suggests that this "environmental" agent would profoundly influence the dental caries process. The complex nature of saliva and the great variations in its composition are premonitory of the difficulties involved in establishing the causative factors, which may directly influence the dental caries process. Composition of saliva varies between individuals and exhibits no apparent constant relation to the composition of blood.

The concentration of inorganic calcium and phosphorus in saliva shows considerable variation depending on a number of factors. Previous studies, such as the one reported by Karshan, stated that the calcium and phosphorus content of saliva is low in caries-active persons. But, most investigators have been unable to confirm this finding. The levels and state of calcium and phosphate in saliva may be related to the susceptibility to dental caries.

Saliva is also rich in enzymes. Some of these enzymes, such as alkaline phosphatase, may play an important part in the dental caries process. The role of alkaline phosphatase in the mineralization process has been established unequivocally.

Hence, the present study was envisaged to study the possible relationship of salivary calcium, phosphorous and alkaline phosphatase activity with the incidence of dental cariotypes in child patients.


   Aims and Objectives Top


  1. To estimate the levels of calcium, phosphorus and alkaline phosphatase in the salivary samples of children with minimal caries, rampant caries and no caries, in the age group of 5-13 years.
  2. To compare and evaluate correlation in salivary levels of calcium, phosphorus and alkaline phosphatase in the rampant caries group with the control group.



   Materials and Methods Top


The present study was conducted in the Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College and Hospital, Eluru. The study comprised of 75 children, divided into the following groups:

Group I: consisting of 25 children with nonrampant caries (minimal caries group)

Group II: consisting of 25 children with rampant caries

Group III: consisting of 25 children without caries (control group)

Selection of individuals

All the subjects ranged between five and thirteen years of age. Both sexes were considered, precaution was taken to exclude cases having acute oral afflictions, acute systemic infections, chronic debilitating diseases and metabolic bone disorders (e.g., Osteitis deformans) to avoid interference in salivary calcium, phosphorus and alkaline phosphatase activity estimation.

Collection of salivary samples

The samples of saliva were collected one week after oral prophylaxis. Unstimulated, directly expectorated, whole saliva samples were collected in clean, dry, sterilized glass bottles and fitted with proper rubber stoppers immediately [Figure 1]. The samples were subjected to a biochemical assay for estimation of calcium, phosphorus and alkaline phosphatase levels [Figure 2],[Figure 3],[Figure 4]. Phosphorus and alkaline phosphatase levels are estimated by the "colorimetric method" whereas calcium levels are estimated by the "Trituration method" [Figure 5],[Figure 6].
Figure 1 :Method of salivary sample collection

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Figure 2 :Armamentarium for phosphorus estimation

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Figure 3 :Armamentarium for calcium estimation

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Figure 4 :Armamentarium for alkaline phosphatase estimation

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Figure 5 :Colorimeter

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Figure 6 :Water bath

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Examination of child patients

All the children were examined adequately. A mouth-mirror with good reflecting surface and a stainless steel explorer were used to examine the patients [Figure 7]. The DMFS/defs index was calculated for each patient as per the recommendations of the oral health survey, basic methods, W.H.O.
Figure 7 :Armamentarium for clinical examination

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   Results Top


The present study comprised of 75 children divided into three groups of 25 each.

Salivary calcium

The mean salivary calcium content in the control group (4.29 mg%) is found to be slightly higher when compared to the minimal caries group (3.95 mg%) as well as the rampant caries group (3.94 mg%), which are statistically not significant (P > 0.05) [Table 1] and [Table 3].
Table 1 :Mean values


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Salivary phosphorus

The mean phosphorus content in the control group (17.04 mg%) is found to be only slightly higher as compared with the minimal caries group (15.76 mg%) as well as the rampant caries group (15.87 mg%), which are statistically not significant (P > 0.05) [Table 1] and [Table 3].

It is very interesting that there exists literally no difference in the salivary calcium and phosphorus values among the three groups [Figure 8].
Figure 8 :Mean values of three groups

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Salivary alkaline phosphatase

This enzyme activity for the rampant caries group is much higher (18.66 K.A.) than that for the control group (4.68 K.A), which is statistically highly significant (P < 0.001).

The value of enzyme activity for the minimal caries group (6.16 K.A.) stands in between that of the rampant caries group and the control group [Table 1] and [Table 3].

DMFS/defs

The average score for groups I and II were 3.96 and 13.24, respectively, as compared with the control groups.

The children of the rampant caries group showed the highest DMFS/defs index of 13.24, with highest salivary alkaline phosphatase activity of 18.66 K.A. [Table 1].

A negative or indirect correlationship exists between salivary calcium and phosphorus concentrations and caries [Table 2].

A direct positive and highly significant correlationship exists between alkaline phosphatase concentration and caries [Table 2], [Table 3] and [Table 4].
Table 2 :Correlation of dmfs vs other parameters


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Table 3 :Comparison between groups


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Table 4 :Analysis of variance (ANOVA)


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The mean calcium values and the mean phosphorus values of the three groups does not differ significantly.

The mean values of alkaline phosphatase for the three groups differ significantly [Figure 8].


   Discussion Top


In its essence, caries process requires diffusion of solubilizing ions into and of solubilized products out of the lesion. [1] The dissolution of hard tissues of tooth in the state of calcium and phosphorus occurs in the oral cavity in the presence of saliva. The ionic concentration of calcium and phosphate in saliva helps maintain an equilibrium between dissolution and remineralization of enamel. Even when highly simplified, the formation of carious lesion is a relatively complex physicochemical process. Several mathematical models have been proposed to describe the diffusion process during lesion progression. [2],[3] Clearly, the rate of formation of the lesion is strongly dependent on diffusion, but the relative importance of the various phenomena governing diffusion rates is not fully understood.

Caries process is controlled by:

  1. The rate of diffusion of ions
  2. The composition of the solution
  3. The membrane potential/permselectivity of the tooth surface


The tooth surface may be an important factor controlling the relative rates of ion diffusion.

If we assume that the period of acid production in plaque is relatively short compared with the time required for diffusion of ions out of the lesion, it is sufficiently long so that the pH within the lesion approaches the equilibrium value for whatever is required by the plaque acidity. For each cycle of acid production, the amount of mineral that dissolves will be proportional to:

  1. The calcium and phosphate concentrations within the lesion, as determined by pH
  2. Volume of the lesion


Thus, the rate of caries formation accelerates as the volume of the caries lesion grows. [4]

The initial stages of caries lesion formation are frequently marked by subsurface demineralization with a relatively intact surface layer, [5],[6] Also, it has long been known that the lesions can be remineralized in vivo. [7],[8]

The dissolution of calcium and phosphate and, hence, diffusion of these ions into and out of the lesion is influenced by alkaline phosphatase, which leads to the initiation and progression of caries.

Therefore, the present study was undertaken to study the possible relationship between salivary calcium and phosphorus concentrations and alkaline phosphotase activity with DMFS/defs index in nonrampant caries as compared with the control group. The present study showed a close relationship between salivary alkaline phosphatase activity and caries. A direct and highly significant positive correlationship exists between salivary alkaline phosphatase and caries.


   Conclusion Top


Attention of research works revealed an important factor that influences the development of dental caries, i.e. SALIVA, which is often regarded as "blood stream of tooth." Saliva also contains several enzymes that may influence dental caries. In order to evaluate the risk of development of dental caries, several salivary parameters have often been used, but not with particular success.

In the present study, an attempt had been made to relate calcium, phosphorus and alkaline phosphatase activity in saliva for the prediction of caries activity. The results suggest that in the complexity of the caries development, caries-free and caries-susceptible individuals can possess similar salivary properties. For example, there was almost no difference in the levels of calcium and phosphorus in the saliva of caries-free and rampant caries groups. The many overlapping individual values completely negate the possibility of using calcium and phosphorus levels in the diagnosis of caries susceptibility.

However, the situation that saliva could reflect the caries risk situation was supported by the fact that alkaline phosphatase activity was significantly higher in caries-prone groups.

Clearly, additional studies are needed to understand the role of alkaline phosphatase and other salivary factors that may influence dental health.

 
   References Top

1.Chow LC, Brown WE. A physico chemical benchscale caries model. J Dent Res 1984;63:868-73.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Holly FJ, Gray JA. Mechanism for incipient caries lesion growth utilising a physical model based on diffusion concepts. Arch Oral Biol 1968;13:319-34.  Back to cited text no. 2
[PUBMED]    
3.Fetherston JD, Duncan JF, Cutress TW. A mechanism for dental cariesbased on chemical processes and diffusion phenomena during invitro caries simulation on human tooth enamel. Arch Oral Biol 1979;24:101-12.  Back to cited text no. 3
    
4.Brown WE. Physicochemical mechanisms of dental caries. J Dent Res 1974;53:204-16.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Darling AI. Studies on the early lesion of enamel caries. Br Dent J 1956;101:289-97/329-41.  Back to cited text no. 5
    
6.Silverston LM. Structure of carious enamel, including the early lesion. Oral Sci Rev 1973;3:100-60.  Back to cited text no. 6
    
7.Arends J, Tencate JM. Tooth enamel remineralisation. J Cryst Growth 1981;53:135-47.  Back to cited text no. 7
    
8.Backer Dirks O. Post eruptive changes in dental enamel. J Dent Res 1966;45:503-11.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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    Abstract
    Introduction
    Aims and Objectives
    Materials and Me...
    Results
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    Conclusion
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