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Original Article
ABSTRACT
Introduction: Saliva is an important diagnostic biofluid and the salivary composition is affected by various systemic
conditions including pregnancy. Aims: The study was conducted to evaluate the salivary flow rate and pH in pregnant
and non-pregnant Indian women and, consequently, to compare and correlate the salivary flow rate, pH, and prevalence
of dental caries in both groups. Settings and Design: A cross-sectional study was conducted in our institute on a sample
of 30 pregnant and 30 non-pregnant women. Materials and Methods: The clinical findings for Decayed-Missing-Filled
Teeth (DMFT) index were recorded. Unstimulated whole saliva was collected to determine the salivary flow rate and pH.
Statistical Analysis Used: Data were statistically analyzed using Students t-test. Results: Salivary flow rate was lower in
pregnant women (0.63 ml/min) as compared to that in non-pregnant women (0.81 ml/min) (P < 0.05) and the pH was also
lesser in pregnant women (6.56) than in non-pregnant women (6.86) (P < 0.05). DMFT index showed a strong negative
correlation with pH in pregnant women and non-pregnant women (P < 0.05). Conclusion: A difference was observed
between the salivary parameters of pregnant and non-pregnant women in this sample. However, all the values were within
the normal range. A significant inverse relation was found between salivary pH and dental caries for both the groups.
Key words: DMFT index, pH of saliva, pregnancy, salivary flow rate, unstimulated whole saliva
S
and oral biology.[5]
aliva is essential for the maintenance of oral health
and it is an important diagnostic biofluid.[1] It Oral health is affected by many systemic conditions. It
plays a pivotal role in protection and lubrication
is influenced by female steroid sex hormones through
of oral mucosal tissues, remineralization of teeth, and
alimentation.[2,3] The salivary composition gives it many different mechanisms. The composition of human
important physical and biochemical properties.[4] It is saliva is altered during pregnancy, menstruation, and
useful for diagnosis, prognosis, and management of menopause due to changes in steroid hormone levels.
patients with oral and systemic diseases.[1] There is
increasing inclination toward using saliva samples for This is an open access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
the diagnosis of oral and systemic diseases.[1] Salivary
License, which allows others to remix, tweak, and build upon the
Access this article online work non-commercially, as long as the author is credited and the
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Website: For reprints contact: reprints@medknow.com
www.jiaomr.in
Address for correspondence: Dr. Amruta A. Karnik, 302/C, Rajendra Vihar, Evershine Nagar, Malad - (West),
Mumbai-400064, Maharashtra, India. E-mail: karnik_amruta@yahoo.in
Received: 10-03-2015 Accepted: 05-11-2015 Published: 25-11-2015
372 2015 Journal of Indian Academy of Oral Medicine and Radiology | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.jiaomr.in on Monday, September 11, 2017, IP: 112.215.45.20]
Many human studies indicate that during ovulation collection. The subjects were advised to rinse their
time, hormonal change influences the composition of mouth several times with deionized (distilled) water and
human saliva.[6] During pregnancy, there are profound then relax for 5 min before the procedure. The subjects
physiologic changes due to complex hormonal were asked to sit comfortably with head tilted slightly
interactions.[7] Pregnancy brings changes in the salivary forward and expectorate the saliva accumulated in the
flow rate, pH of saliva, and biochemical composition.[8] floor of the mouth into disposable plastic containers for
Salivary composition is of great importance for preventing duration of 5 min. Each saliva sample was collected on
caries incidence.[9] The present study aims to evaluate the ice. The salivary samples were quantified volumetrically
effect of pregnancy on salivary flow rate and pH of saliva using graduated measuring cylinder. The salivary flow
and to compare and correlate the salivary flow rate, pH rate was expressed as ml/min. The saliva samples were
of saliva, and prevalence of dental caries in pregnant and centrifuged (centrifugal force: 1000 rpm) for the removal
non-pregnant Indian women. The a priori hypothesis of bacteria and extraneous material. The resulting
was there are differences in the salivary flow rate and pH supernatant fluid was used to measure salivary pH using
of saliva between pregnant and non-pregnant women. a bench type pH meter.
Materials and Methods Statistical analysis was done using SPSS software
version 15.0 using Students t-test. All the dependent
A cross-sectional study was conducted in the Department variables in the study were measured using ratio-scale
of Oral Medicine and Radiology of Dr. DY Patil Dental parametric statistical tests and were appropriate for
College and Hospital, Navi Mumbai, Maharashtra, comparison with respect to the independent variable, i.e.
India. A total convenience sample of 60 women aged the pregnant and non-pregnant groups. Comparison of
between 18 and 37 years was selected. Subjects willing to all the variables between the pregnant and non-pregnant
participate and aged 18 years and above were included in groups was performed using Students t-test for
the study. Subjects with any systemic diseases, complaint independent samples. The correlations between DMFT
of xerostomia, and smoking habit were excluded from index and saliva parameters were measured using
the study. Thirty consecutive healthy pregnant women Pearsons correlation coefficients. P value <0.05 was
between the third and the ninth months of gestation considered statistically significant.
comprised the pregnant group and 30 non-pregnant
women consecutively sampled in the same department Results
composed the comparison group. None of the healthy,
non-pregnant women were taking oral contraceptive Data of all 60 subjects were available and statistically
pills. analyzed. The mean age of women belonging to
the pregnant group was 24.57 years and that of the
The study protocol was in compliance with the Helsinki non-pregnant group was 22.27 years. In the pregnant
Declaration and an approval was obtained from the group, 11 (36.6%) subjects belonged to the age group
institutions ethical committee. A written informed of 18-22 years, 12 (40%) subjects to 23-27 years, 6 (20%)
consent was obtained from all participants prior to subjects to 28-32 years, and 1 (3.33%) to 33-37 years. In
the study procedure. A questionnaire was structured the non-pregnant group, 20 (66.67%) belonged to the
to acquire data on oral hygiene habits (tooth brushing age group of 18-22 years followed by 6 (20%) subjects
frequency and method, use of interproximal brushes, to 23-27 years, 4 (13.33%) subjects to 28-32 years, and no
dental floss, tongue cleaning habit). Information subject belonged to the age range of 33-37 years. Among
regarding pregnancy trimester and use of medication the pregnant women, 1 (4%) was in the first trimester,
was procured from the subjects medical charts. The 7 (23%) were in the second trimester, and 22 (73%) were
intraoral examination was conducted by a single in the third trimester [Graph 1].
examiner under favorable lighting conditions using a
sterile mouth mirror, diagnostic probe, and explorer. The The pregnant women had lower salivary flow rate
clinical findings were recorded in the study proforma. (0.63 0.24 ml/min) as compared to the non-pregnant
The Decayed-Missing-Filled Teeth (DMFT) index, women (0.81 0.15 ml/min) (P = 0.001). On comparison,
an irreversible index, was obtained to determine the the pH of saliva was also lesser in pregnant women
prevalence of dental caries. (6.56 0.35) than in non-pregnant women (6.86 0.42)
(P=0.004). There was a statistically significant difference
The saliva sample collection procedure was standardized in the salivary flow rate and pH between pregnant
prior to the study. The collection of unstimulated whole and non-pregnant women [Tables 1 and 2]. The DMFT
saliva was performed under resting conditions between index was higher in non-pregnant group (8.23) than in
9.00 am and 11.00 am. The participants refrained from the pregnant group (7.97) [Table 1]. However, this was
eating and drinking for a minimum of 1 h prior to saliva statistically insignificant (P > 0.05) [Table 2].
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gradually to a great extent due to placental production of carbohydrates, which leads to increased production of
these hormones. Levels of human chorionic gonadotropin organic acids that decrease the pH of saliva and plaque
(HCG), cortisol, and beta-endorphin also increase in resulting in caries. Thus, maintenance of oral hygiene is
pregnancy and to a greater extent in the third trimester essential for prevention of caries.[25] In this study, patients
of pregnancy. Estradiol and estriol (biologically active in the pregnant group had better oral hygiene maintenance
forms of estrogen) increase by 100-fold and 1000-fold, than the patients belonging to the non-pregnant group.
respectively, during pregnancy. As a result, physiological The values of salivary variables reported in this study
changes occur in women that lead to adaptive changes at group of pregnant and non-pregnant Indian women
both systemic and oral levels.[19] In the second trimester, are similar to the values reported for other populations
there is increased HCG causing decrease in the salivary and are within international references of normality.
flow rate. During pregnancy, the levels of human The differences detected in the saliva of pregnant and
chorionic somatomammotropin (HCS) and progesterone non-pregnant women in our study and those reported
increase markedly, which leads to reduction in the in previous studies are small in absolute values and they
salivary flow rate.[7,20,21] Also, the increased progesterone do not seem to affect the oral health and prevalence of
decreases the plasma bicarbonate level resulting in a dental caries in these individuals.
decrease in the pH of saliva.[22]
Conclusion
During the third trimester of pregnancy, salivary pH
and buffering capacity reach their lowest levels, which In conclusion, the salivary flow rate and pH of saliva were
increases the risk of caries incidence with higher levels lower in pregnant women than in non-pregnant women.
of Streptococcus mutans.[6,17] Maternal saliva is the main DMFT index showed a strong negative correlation with
vehicle for bacterial transfer to the children.[23-25] Hence, pH in pregnant women and non-pregnant women; hence,
it is essential to evaluate the prevalence of caries in a significant inverse relationship was found between
pregnant women. We chose to use DMFT index to pH and caries prevalence. However, further studies are
evaluate the caries prevalence. We found that the essential evaluating salivary parameters in medically
DMFT index was higher in non-pregnant women than compromised women with high-risk pregnancy.
in pregnant women. However, these values were not
statistically significant [Tables 1 and 2]. It has been Financial support and sponsorship
established that the flow rate and pH of saliva are Nil.
significant in the development of caries.[5,26] Hence, we
considered evaluating the correlation between salivary Conflicts of interest
pH and flow rate with DMFT index in Indian pregnant There are no conflicts of interest.
women.
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