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Chemical salivary composition and its relationship with periodontal disease and dental calculus

Abstract

Aim:

To determine the relationship between the chemical composition of saliva, periodontal disease and dental calculus.

Methods:

An observational analytical cross-sectional study was conducted with patients over 55 years of age. Ethical principles of autonomy and risk protection were applied according to the international standards. Sociodemographic and diagnosis variables (presence of dental calculus and periodontal status) were considered to measure salivary concentrations of glucose (by the glucose oxidase/peroxidase method, amylase (by the colorimetric test), urea (by the amount of indophenol), total protein (by the Bradford method) and albumin (by the nephelometric method). Patients chewed a sterile rubber band and 3 mL of stimulated saliva were collected. The samples were stored at -5 °C, centrifuged at 2,800 rpm for 10 min, and the supernatant was removed and stored at -20 °C. Data were presented as frequencies and proportions for qualitative variables and measures of central tendency and dispersion for quantitative variables. Data were analyzed by either analysis of variance or Kruskal Wallis test . A p value <0.05 was considered statistically significant.

Results:

Significant relationships were observed between the concentration of salivary urea and periodontal status (p = 0.03) and the presence of dental calculus and urea (p = 0.04) was demonstrated.

Conclusions:

A relationship between the salivary urea concentration and the presence of periodontal disease and dental calculus is suggested.

dental calculus; urea; periodontal diseases; saliva


Introduction

Saliva is an important biological fluid in oral physiology1Llena-Puy C. The role of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Patol Oral Cir Bucal. 2006; 11: e449-55.. The reduction of salivary secretion or changes in the properties of the saliva are responsible for a lot of dental and oral problems, such as cavities or periodontal disease, as they remain major diseases, with a direct impact on the quality of life of patients affected by them2 - 4Bretas I, Rocha M, Vieira M, Rodríguez A. Flow Rate and Buffering Capacity of the Saliva as Indicators of the Susceptibility to Caries Disease. Pesq Bras Odontoped Clin Integr. 2008; 8: 289-93 [portuguese] .. Among the important components of saliva, there are several enzymes released by stromal, epithelial cells and by bacteria. Salivary amylase involved in digestion of starches also acts as a buffer to protect oral pharyngeal and esophageal mucosae from ingested acids. Saliva protects the teeth against acid by its bicarbonate as buffer and urea5Dawes C, Pedersen AM, Villa A, Ekström J, Proctor GB, Vissink A, et al. The functions of human saliva: A review sponsored by the World Workshop on Oral Medicine VI. Arch Oral Biol. 2015; 60: 863-74.. Moreover, drugs like cyclic antidepressants and others could affect the levels of salivary amylase, total proteins and urea6Milton BA, Bhambal A, Nair P. Sialochemical analysis: Windfall to the oral physician (A hospital-based clinical cross-sectional study in depressive disorders). J Int Oral Health. 2014; 6: 82-9. - 7Milton BA, Bhambal A. Sialochemical analysis: a portal for the oral diagnostician. J Clin Diagn Res. 2014; 8: ZC43-8..

Analysis of the enzymes in salivary secretion and in the crevicular fluid may help to clarify the pathogenesis and improve the early diagnosis and prognosis of periodontal disease8Cosío Arévalo DJ, Ortega Cambrains A, Vaillard Jiménez E. Determination salivary pH before, during and after consumption of sweets in children aged 3, 4 and 5 years old. Oral. 2010; 11: 642-5 [spanish] .

Qian X, Dong H, Hu X, Tian H, Guo L, Shen Q, et al. Analysis of the interferences in quantitation of a site-specifically PEGylated exendin-4 analog by the Bradford method. Anal Biochem. 2014; 465: 50-2.
- 1010 Hegde MN, Malhotra A, Hegde ND. Salivary pH and buffering capacity in early and late human immunodeficiency virus infection. Dent Res J (Isfahan). 2013; 10: 772-6.. Among salivary composition studies are those concerning lactoferrin, urea, glucose, total proteins, which provide advantages such as elasticity, moisture, buffering effect and repair, thus promoting oral health1111 Martins C, Buczynski AK, Maia LC, Siqueira WL, Castro GF. Salivary Proteins as a Biomarker for Dental Caries-A Systematic Review. J Dent. 2013; 41: 2-8.

12 Al Kawas S, Rahim ZH, Ferguson DB. Potential uses of human salivary protein and peptide analysis in the diagnosis of disease. Arch Oral Biol. 2012; 57: 1-9

13 Acevedo AM, Laguna F. Salivary Mucins and their implications for the rheology of human saliva and saliva substitutes. Acta Odontol Venez. 2009; 47. [spanish]. [cited 2014 Apr 10] Available from: http://www.scielo.org.ve/pdf/aov/v47n2/art24.pdf.
http://www.scielo.org.ve/pdf/aov/v47n2/a...

14 Felizardo KR, Gonçalves RB, Schwarcz WD, Poli-Frederico RC, Maciel SM, Andrade FBD. An evaluation of the expression profiles of salivary proteins lactoferrin and lysozyme and their association with caries experience and activity. Rev Odonto Cienc. 2010; 25: 344-9.
- 1515 Sajewicz E. Effect of saliva viscosity on tribological behavior of tooth enamel. Tribology International. 2009; 42: 327-32..

With respect to periodontal disease, investigations evaluate the salivary chemical compounds, which contribute in the destruction and/or protection of the periodontal tissues. Concentration of some salivary compounds increases or decreases in patients with periodontal disease because it contains enzymes from periodontal damaged cells, which can be identified in saliva and gingival crevicular fluid1616 Wolf DL, Lamster IB. Contemporary concepts in the diagnosis of periodontal disease. Dent Clin N Am. 2011; 55: 47-61. - 1717 Castrillón RLE, Ramos AP, Cabrera SM. Innovative study on lactoferrin in periodontal disease. Rev Odont Mex. 2011; 15: 231-8.. Thus, these biomarkers could be used routinely in clinical practice to assess disease progression. The aim of this study was to determine the chemical components in saliva and their relationship with periodontal status and dental calculus in the elderly.

Material and methods

Population and sample

An observational analytical cross-sectional study was conducted. The sample consisted of senior patients of the School of Dentistry at Universidad Santo Tomás - Colombia. The sample size was calculated based on a population of 120 individuals, treated at the elderly clinic of Universidad Santo Tomás, between January and December 2013 with 95% confidence level, 5% margin of error and a 30% rate of affected patients. The sample size established for obtaining significant differences was 88 individuals, with an approximate loss of 10%, for a total sample of 98 subjects. People under 55 years old and those who did not wish to participate in the study were not included. In addition, privacy and autonomy was respected, by signing the informed consent and ethical support of the Universidad Santo Tomás, according to national and international standards of human research, # protocol 18/04072013.

Evaluated variables

Sociodemographic and socioeconomic data such as age, gender (male and female), origin (rural and urban) and educational level (illiterate, elementary, high school, post-secondary) were collected and the medical condition was registered in a clinical record form. After standardization, clinical assessment was performed to evaluate the periodontal status with a WHO probe according to the criteria established by Bassani et al. (2006)1818 Bassani DG, da Silva CM, Oppermann RV. Validity of the Community Periodontal Index of Treatment Needs´(CPITN) for Population Periodontitis Screening. Cad Saude Publica. 2006; 22: 277-83. and Tan (2003)1919 Tan B. Basic periodontal examination a simple screening tool in general practice. Singapore Dent J. 2003; 25: 55-7.. For the measurement of dental calculus, the Greene and Vermillion modified method was used, according to criteria established by Aguilar Agulló et al. (2003)2020 Aguilar Agulló MJ, Cañamas Sanchis MV, Ibáñez Cabanelli P, Gil Loscos F. Importance of the use of index in the periodontal practice by dental hygienist. Periodoncia (Barc.) 2003; 13: 233-44. [spanish] .. The concentration of amylase, glucose, urea, total proteins and albumin in saliva was evaluated.

Procedures

Saliva collection:

The patients were instructed not to drink or eat 120 min before saliva sample collection and then asked to chew a previously sterilized rubber band. Samples of 3 mL of saliva were collected, stored in 6 mL sterile Falcon tubes and kept refrigerated at 5 ºC for 1 h2121 Vuletic L, Peros K, Spalj S, Rogic D, Alajbeg L. Time-related Changes in pH, Buffering Capacity and Phosphate and Urea Concentration of stimulated saliva. Oral Health Prev Dent. 2014; 12: 45-53.. The samples were centrifuged at 2,800 rpm for 10 min and the supernatant was separated from the substrate and frozen at -20 ºC. Next, the sample was defrosted at room temperature, in groups of twenty samples, and centrifuged at 3,000 rpm. The supernatant was separated again and processed to determine the concentrations of glucose, amylase activity, urea, total protein and albumin.

Chemical analysis

Glucose:

The concentration of glucose was determined by the glucose oxidase / peroxidase2222 Abikshyeet P, Ramesh V, Oza N. Glucose estimation in the salivary secretion of diabetes mellitus patients. Diabetes Metab Syndr Obes. 2012; 5: 149-54. method. The technique is based on the following reaction:

Glucose+H2O+O2 → gluconic acid+H2O2

H2O2+4 aminophenazone-fenol → Quinonaimine+H2O

Considering the following detection limits:

Detection limit: 0.23 mg/dL=0.0126 mM/L

Linearity limit: 500 mg/dL=27.5 mM/L measured by spectrophotometer at 505 nm.

Total Proteins:

The concentration of proteins was determined following the Bradford method (Qian et al., 20149Qian X, Dong H, Hu X, Tian H, Guo L, Shen Q, et al. Analysis of the interferences in quantitation of a site-specifically PEGylated exendin-4 analog by the Bradford method. Anal Biochem. 2014; 465: 50-2.) based on the binding of a dye, Coomassie Blue G-250 to proteins and considering the following detection limits:

Detection Limit: 250 μg/mL

Linearity limit: 5 mg/mL

Albumin

It was determined by the nephelometry method2323 Florvall G, Basu S, Helmersson J, Larsson A. Microalbuminuria measured by three different methods, blood pressure and cardiovascular risk factors in elderly Swedish males. Anal Chem Insights. 2008; 3: 69-74.. Using spheres that increase the sensitivity, loaded with antibodies against albumin, it was quantified by colorimetry2424 Chen WW, Guo YM, Zheng WS, Xianyu YL, Wnag Z, Jiang XY. Recent progress of colorimetric assays based on gold nanoparticles for biomolecules. Chin J Anal Chem. 2014; 42: 307-14. in an acid medium with bromocresol green, using a spectrophotometer at 600 nm.

The following detection limits were considered:

Detection limit: 25/μg/mL

Linearity limit: 2.5 mg/mL

Urea

The urea was quantified by determining the amount of green colored indophenol2525 Shirzaiy M, Heidari F, Dalirsani Z, Dehghan J. Estimation of salivary sodium, potassium, calcium, phosphorus and urea in type II diabetic patients. Diabetes Metab Syndr. 2013 Mar 14. doi: 10.1016/j.dsx.2013.02.025. [cited 2014 Apr 10]. Available from: http://dx.doi.org/10.1016/j.dsx.2013.02.025.
http://dx.doi.org/10.1016/j.dsx.2013.02....
. It was quantified by spectrophotometer at 600 nm. The technique is based on the following reaction:

Urease

Urea+H2O → NH4+CO2

Nitroprusside

NH4 salicylate+NaClO → Indophenol

Considering the following detection limits:

Detection limit: 1.3 mg/dL

Linearity limit: 300 mg/dL

Amylase

The amylase was quantified by the colorimetric test using a 2- chloro - 4 nitrophenil - malatotriosido (CNPG3) substrate. By longline action of amylase the CNPG3 degrades releasing 2 -chlor- 4 nitrophenol by increasing the absorbance measured on a spectrophotometer at 405 nm2626 Rohleder N, Nater UM. Determinants of salivary á-amilase in humans and methodological considerations. Psychoneuroendocrinology. 2009; 34: 469-85.. The technique is based on the following reaction:

α amylase

5CNPG3 → 3CNP+2CNPG2+3G3+2G

All the techniques were verified for accuracy and precision processing a sample of known concentration 10 times for each one, always following the same protocol. With these results, standard deviation, mean, coefficient of variation, absolute error and relative error were calculated.

Normal values of chemicals in saliva:

As normal parameters, the following control values reported by Carda et al. (2006)2727 Carda C, Mosquera-Lloreda N, Salom L, Gomez de Ferraris ME, Peydro A. Structural and functional salivary disorders in type 2 diabetic patients. Med Oral Patol Oral Cir Bucal. 2006; 11: E309-14. were considered:

glucose: <2 mg/dL; amylase: 11.9-304.7 U/mL; urea: 17-41 mg/dL; albumin: 246-344mg/L; total protein: 1.1-1.8 g/L.

Parameters were considered high when they were above the reference value and low when they were not equal to or lower than reference values.

Processing and analysis of data

The results of the quantification of quality controls as well as their calculations were entered into Excel and the information was processed in SPSS 21.

Description of the data, frequencies and proportions were calculated for qualitative variables and measures of central tendency and dispersion for quantitative variables. Either an analysis of variance (ANOVA) or a Kruskal Wallis test was conducted, according to the nature and distribution of the variables. A p<0.05 was considered statistically significant.

Results

The sample included 98 subjects, 55.1% (n=54) of them were women. The mean age of the subjects was 66.92 years with a standard deviation (SD) of 9.23. The mean age of periodontal status in advanced periodontitis was 70.8±14.4 years (Figure 1.A) and according to their procedence; urban individuals had a higher participation with 60% in gingivitis and 40% of incipient periodontitis (Figure 1.B). The registered medical condition showed that 4 (4.1%) of the patients had acute kidney disorders and chronic kidney conditions were not present.

Fig. 1
Sociodemographyc and periodontal status. ¨ Chemical salivary composition and their relationship with periodontal disease and dental calculus¨ Part A: periodontal status and age; part B: periodontal status and procedence, part C: periodontal status and educational level, part D: periodontal status and Sex. - SpC=Supragingival calculus/ SbC= Subgingival calculus/PD=Probing depth.

Regarding the association between educational level and periodontal status, showed participation of elementary educational level with similar distribution in all cases (Figure 1.C).

Regarding the association between sex and periodontal status, 30 females had periodontal disease, 21 (48.8%) of them presented gingivitis; while 39 males had periodontal disease, 20 (48.8%) of them with incipient periodontitis. There was statistically significant (p=0.017) between sex and periodontal status (Figure 1.D).

Regarding dental calculus, the age had similar distribution (Figure 2.A). According to the precedence, the rural group patients without dental calculus had a higher distribution of cases (n=32; 43.2%) (Figure 2.B).

Fig. 2
Sociodemographyc and presence of calculus.¨Salivary Chemical Characteristics and Its Relationship with Periodontal Disease & Dental Calculus¨ Part A: presence of calculus and age; part B: presence of calculus and procedence, part C: presence of calculus and educational level, part D: presence of calculus and Sex.

Regarding the educational level, elementary education had the highest participation and 15 (19.2%) patients had no dental calculus (Figure 2.C). In the analyses of dental calculus versus sex, higher percentages of dental calculus were found in males (Figure 2.D).

The salivary components were evaluated for total proteins, glucose, albumin, urea and amylase, which were measured quantitatively (by mean and standard deviation) and qualitatively (high, low and normal concentration of chemicals). The average values found globally and according to reference data are shown in Table 1.

Table 1
Concentration of chemicals in saliva.

Regarding to confidence intervals, glucose and total protein were found in high concentrations in nearly all patients, except for a subject with an average glucose of 2.0 mg/dL. Low albumin concentrations were found in a large part of the population and the patients presented normal concentrations of urea and amylase (Table 1).

Regarding periodontal status and its relationship with the chemical concentrations of the various salivary components, increased amylase and albumin concentrations was observed in patients with advanced periodontitis, but with no statistically significant differences. On the other hand, a significant association (p = 0.03) was found for urea concentration and periodontal disease (Table 2), especially in patients with high concentrations of urea and diagnosed with advanced periodontitis.

Table 2
Periodontal status and salivary composition.

Regarding the presence of dental calculus, a higher concentration of amylase was observed in the presence of calculus in more than 2/3 of the tooth surface with no significant difference. Regarding urea, as well as periodontal disease, a statistically significant difference (p=0.04) was observed when relating urea and the presence of dental calculus (Table 3), especially when it is observed in more than 2/3 of the tooth structure.

Table 3 :
Dental calculus and salivary composition

Generally, it could be established that the higher the concentration of urea, the greater the presence of calculus and the severity of periodontal disease.

In order to assess the concentration of salivary urea and kidney disease, the urea average was 28.8 mg/dL in patients with acute kidney conditions. Compared with patients without it, in whom the urea mean was 37.6 mg/dL there was no statistically significant difference (p=0.46).

Discussion

Protein concentration is considered a biomarker for periodontal disease, since plasma protein leakage occurs as a result of the inflammatory process, which raises the concentration of total proteins in saliva. In this study, higher concentrations of total proteins in the whole population were observed. Shaila et al. (2013)2828 Shaila M, Pai P, Shetty P. Salivary protein concentration, flow rate, buffer capacity and pH estimation: a comparative study among Young and elderly subjects, both normal and with gingivitis and periodontitis. J Indian Soc Periodont. 2013; 17: 42-6. also found an increase in the concentration of proteins in the presence of gingivitis and periodontitis; however, no differences were found in the group of edentulous patients.

It is known that salivary protein content averages 3,000 mg/L. Due to these proportions, salivary proteins are involved in numerous biological processes, including cellular support, tissue strain and flexibility, immune response and participation in enzymatic reactions. The functions of these proteins vary according to the type of molecule, so there are some that regulate the maintenance of dental and mucosal integrity, soft tissue repair, regulators of pH and antimicrobial activity. The salivary concentration of this component may be influenced by factors such as the circadian rhythm, the presence of hormones, psychological disorders, tooth brushing and/or exercise2929 Gutiérrez Nova P, Olivares Navarrete R, Leyva Huerta ER. Epidermal growth factor and total protein in saliva of smokers and non smokers. Av Odontoestomatol. 2008; 24: 377-83 [spanish] . - 3030 Zárate Daza AN, Leyva Huerta ER, Franco Martínez F. Determination of pH and total proteins in saliva in patients with and without fixed orthodontic appliances (pilot study). Rev Odontol Mex. 2004; 8: 59-63 [spanish] ..

With respect to albumin, which is considered a marker of disease, as it originates at a sulcus level. Shaila et al. (2013)2828 Shaila M, Pai P, Shetty P. Salivary protein concentration, flow rate, buffer capacity and pH estimation: a comparative study among Young and elderly subjects, both normal and with gingivitis and periodontitis. J Indian Soc Periodont. 2013; 17: 42-6. and Cheaib and Lussi (2013)31 31 Cheaib Z, Lussi A. Role of amilase, mucin, IgA and albumin on salivary protein buffering capacity: A pilot study. J Biosci. 2013; 38: 259-65.have suggested that the albumin present in saliva is a consequence of contamination by traces of blood or gingival fluid, considering albumin as an infiltration of serum into the mouth. Its presence has also been reported in patients with periodontitis3232 Terrapon B, Mojon PH, Mensi N, Cimasoni G. Salivary albumin of edentulous patients. Arch Oral Biol.1996; 41: 1183-5..

Terrapon et al. (1996)3232 Terrapon B, Mojon PH, Mensi N, Cimasoni G. Salivary albumin of edentulous patients. Arch Oral Biol.1996; 41: 1183-5. in their study, observed an average of over 218.5 mg/L of albumin. These values are close to the average of albumin in our study, with 206.23 mg/L. The same authors found a positive correlation between albumin concentration and the severity of periodontitis, increasing the concentration of salivary albumin. However, those authors did not find a significant relationship between pocket depth and the concentration of albumin. In this study, no significant differences in the concentration increase of albumin were observed in the presence of periodontal disease. Nevertheless, an increment in the concentration of albumin was observed as the severity of the disease increased, possibly due to the release of gingival exudate, which increases with the presence of this pathology.

Shaila et al. (2013)2828 Shaila M, Pai P, Shetty P. Salivary protein concentration, flow rate, buffer capacity and pH estimation: a comparative study among Young and elderly subjects, both normal and with gingivitis and periodontitis. J Indian Soc Periodont. 2013; 17: 42-6. found a significant difference in the concentration increase of albumin and periodontal destruction, concurring with Terrapon et al. (1996)3232 Terrapon B, Mojon PH, Mensi N, Cimasoni G. Salivary albumin of edentulous patients. Arch Oral Biol.1996; 41: 1183-5., who mentioned that the saliva in edentulous patients contained five times less albumin than that of dentate patients. They suggested the gingival sulcus as origin of the albumin. Likewise, this study found lower concentrations of albumin in edentulous patients with no statistically significant differences, confirming the data reported by other authors.

Meurman et al. (2002)33 33 Meurman J, Rantonen P, Pajukoski H, Sulkava R. Salivary albumin and other constituents and their relation to oral and general health in the elderly. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94: 432-8.evaluated the salivary albumin, observing higher concentrations of albumin in systemically compromised or weak older adults; what the authors suggest can be used as a reference for comprehensive care of the elderly.

Regarding the presence of dental calculus, Banderas-Tarabay et al. (1997)34 34 Banderas-Tarabay JA, González-Begné M, Sánchez-Garduño M, Millán-Cortéz E, López-Rodriguez A, Vilchis-Velázquez A. Flow and protein concentration in human whole saliva. Salud Publica Mex. 1997:9433-43 [spanish] .found that the protein concentration decreases in the presence of dental calculus, contrary to this study, which generally found no protein concentration decrease in the presence of calculus. However, a lower total protein concentration in those with more calculus than others or more than 2/3 of the dental surface without statistically significant differences was observed specifically. This may occur due to the presence of subgingival calculus, preventing the release of plasma proteins as a result of the inflammatory process, decreasing the concentration of total proteins.

Leite et al. (2014)35 35 Leite MF, Lima HM, Vang SJS, Santos MT, Ohon R. Effect of astaxanthin and fish oil on enzymatic antioxidant. System and a-amylase activity of salivary glands from rats. Braz J Oral Sci. 2014; 13: 58-63.suggested that there are reduced risks of inflammatory disease in patients who have a polyunsaturated fatty acid (PUFAs) rich diet. PUFAs could be related with an increment of salivary amylase. On the other hand, in this study amylase concentration showed no differences between groups of periodontal disease.

It is important to mention urea as a salivary component since it plays a primary role in the formation of dental calculus. This is why significant values were observed in this study with the presence of dental calculus and urea concentration, possibly due to the alkalization of saliva as a result of high concentrations of urea.

In this regard, Tomás et al. (2008)36 36 Tomás I, Marinho JS, Limeres J, Santos MJ, Araújo L, Diz P. Changes in salivary composition in patients with renal failure. Arch Oral Biol. 2008; 53: 528-32.found alkaline saliva and high urea concentration, which shows a relationship with the presence of dental calculus. Indirect evidence showed that the metabolism of urea might enhance caries resistance which was seen in patients with chronic renal failure. They are able to produce 10 to 50-fold greater salivary urea levels. Patients with low levels of urease have low capacity to neutralize glucolite acidification even though high levels of urea are available. This urease could come from bacteria and be a potential caries control strategy3737 Reyes E, Martin J, Moncada G, Neira M, Palma P, Gordan W, et al. caries-free subjects have high levels of urease and arginine deiminase activity. J Appl Oral Sci. 2014; 22: 235-40..

Other studies have shown the relationship between dental calculus, phosphate and urea concentration in renal patients3838 Martins C, Siqueria WL, Oliveira E, Nicolau J, Primo LG. Dental calculus formation in children and adolescents undergoing hemodialysis. Pediatr Nephrol. 2012; 27: 1961-6. - 3939 Andrade MR, Salazar SL, de Sá LF, Portela M, Ferreira-Pereira A, Soares RM, et al. Role of saliva in the caries experience and calculus formation of Young patients undergoing hemodialysis. Clin Oral Investig. 2015 Mar 20 ]In press]. doi: 10.1007/s00784-015-1441-4.
https://doi.org/10.1007/s00784-015-1441-...
. In this study, the salivary urea concentration was not related to a renal condition because only 4 (4.1%) patients had acute kidney conditions, without significant relationship.

Queiroz et al. (2013)4040 Queiroz SM, Amorim AG, Andrade ALD, Gordón-Núñez MA, Freitas RA, Galvao HC. Influence of dialysis duration and parathyroid Hormone on the clinical and radiographic oral conditions pre-transplant patients with chronic kidney disease. Braz J Oral Sci. 2013; 12: 125-31. found urea reduction ratio of <65%, in patients with higher frequencies of calculus in pre-transplant patients with chronic kidney disease.

Based on the results, the information regarding salivary composition and its relationship with the different oral alterations has increased, as demonstrated by periodontal disease and the presence of dental calculus. These findings suggest a relationship between dental calculus and variation in the concentration of salivary urea, which makes the study of saliva meaningful as diagnostic and prognostic aids for clinical assessment in dental practice.

Acknowledgements

The research project had financial support from the Departamento Administrativo de Ciencia, Tecnología e Innovación COLCIENCIAS (Colombia) and the Dentistry School of Universidad Santo Tomás - Colombia.

References

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    Llena-Puy C. The role of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Patol Oral Cir Bucal. 2006; 11: e449-55.
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    Bretas I, Rocha M, Vieira M, Rodríguez A. Flow Rate and Buffering Capacity of the Saliva as Indicators of the Susceptibility to Caries Disease. Pesq Bras Odontoped Clin Integr. 2008; 8: 289-93 [portuguese] .
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    Dawes C, Pedersen AM, Villa A, Ekström J, Proctor GB, Vissink A, et al. The functions of human saliva: A review sponsored by the World Workshop on Oral Medicine VI. Arch Oral Biol. 2015; 60: 863-74.
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    Milton BA, Bhambal A, Nair P. Sialochemical analysis: Windfall to the oral physician (A hospital-based clinical cross-sectional study in depressive disorders). J Int Oral Health. 2014; 6: 82-9.
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    Milton BA, Bhambal A. Sialochemical analysis: a portal for the oral diagnostician. J Clin Diagn Res. 2014; 8: ZC43-8.
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  • 9
    Qian X, Dong H, Hu X, Tian H, Guo L, Shen Q, et al. Analysis of the interferences in quantitation of a site-specifically PEGylated exendin-4 analog by the Bradford method. Anal Biochem. 2014; 465: 50-2.
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    Hegde MN, Malhotra A, Hegde ND. Salivary pH and buffering capacity in early and late human immunodeficiency virus infection. Dent Res J (Isfahan). 2013; 10: 772-6.
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    Martins C, Buczynski AK, Maia LC, Siqueira WL, Castro GF. Salivary Proteins as a Biomarker for Dental Caries-A Systematic Review. J Dent. 2013; 41: 2-8.
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    Al Kawas S, Rahim ZH, Ferguson DB. Potential uses of human salivary protein and peptide analysis in the diagnosis of disease. Arch Oral Biol. 2012; 57: 1-9
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    Acevedo AM, Laguna F. Salivary Mucins and their implications for the rheology of human saliva and saliva substitutes. Acta Odontol Venez. 2009; 47. [spanish]. [cited 2014 Apr 10] Available from: http://www.scielo.org.ve/pdf/aov/v47n2/art24.pdf.
    » http://www.scielo.org.ve/pdf/aov/v47n2/art24.pdf
  • 14
    Felizardo KR, Gonçalves RB, Schwarcz WD, Poli-Frederico RC, Maciel SM, Andrade FBD. An evaluation of the expression profiles of salivary proteins lactoferrin and lysozyme and their association with caries experience and activity. Rev Odonto Cienc. 2010; 25: 344-9.
  • 15
    Sajewicz E. Effect of saliva viscosity on tribological behavior of tooth enamel. Tribology International. 2009; 42: 327-32.
  • 16
    Wolf DL, Lamster IB. Contemporary concepts in the diagnosis of periodontal disease. Dent Clin N Am. 2011; 55: 47-61.
  • 17
    Castrillón RLE, Ramos AP, Cabrera SM. Innovative study on lactoferrin in periodontal disease. Rev Odont Mex. 2011; 15: 231-8.
  • 18
    Bassani DG, da Silva CM, Oppermann RV. Validity of the Community Periodontal Index of Treatment Needs´(CPITN) for Population Periodontitis Screening. Cad Saude Publica. 2006; 22: 277-83.
  • 19
    Tan B. Basic periodontal examination a simple screening tool in general practice. Singapore Dent J. 2003; 25: 55-7.
  • 20
    Aguilar Agulló MJ, Cañamas Sanchis MV, Ibáñez Cabanelli P, Gil Loscos F. Importance of the use of index in the periodontal practice by dental hygienist. Periodoncia (Barc.) 2003; 13: 233-44. [spanish] .
  • 21
    Vuletic L, Peros K, Spalj S, Rogic D, Alajbeg L. Time-related Changes in pH, Buffering Capacity and Phosphate and Urea Concentration of stimulated saliva. Oral Health Prev Dent. 2014; 12: 45-53.
  • 22
    Abikshyeet P, Ramesh V, Oza N. Glucose estimation in the salivary secretion of diabetes mellitus patients. Diabetes Metab Syndr Obes. 2012; 5: 149-54.
  • 23
    Florvall G, Basu S, Helmersson J, Larsson A. Microalbuminuria measured by three different methods, blood pressure and cardiovascular risk factors in elderly Swedish males. Anal Chem Insights. 2008; 3: 69-74.
  • 24
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Publication Dates

  • Publication in this collection
    Apr-Jun 2015

History

  • Received
    07 Apr 2015
  • Accepted
    17 June 2015
Faculdade de Odontologia de Piracicaba - UNICAMP Avenida Limeira, 901, cep: 13414-903, Piracicaba - São Paulo / Brasil, Tel: +55 (19) 2106-5200 - Piracicaba - SP - Brazil
E-mail: brjorals@unicamp.br