Dental Caries and its Relation to Salivary Calcium and Phosphate Among Soft Drinks Factory Workers

Safa Adnan Al-Tayar^1* and Athraa Mustafa Alwaheb²

^*Correspondence: Safa Adnan Al-Tayar, Ministry of Health and Environment, Iraq, Email:

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Introduction

Soft drinks have inveterate sugars and acids that include both cariogenic and acidogenic possibility. Numerous studies manifested a direct relation between tooth decay and the consuming of soft beverages [1,2].

Soft drinks were proposed as giving rise to injury to the dental tissues for two purposes. Primarily, depressed PH and high titratable acidity of some beverages may cause erosion of tooth surface. Secondly, sugar contents in beverages were metabolized by microorganisms in the plaque to produce acids that causing demineralization and resulting of dental caries [3].

Dental caries is one of the oral health troubles, which bring about the dental hard tissue damage by action of both bacteria and fermentable carbohydrates [4]. Tooth decay is a multifactorial microbial disorder that is caused by the effect of acidogenic bacteria, fermentable carbohydrates and different host factors involve saliva [5].

Dental caries is a general health issues worldwide, about 60–90% of babies and around 100% of adults have tooth decay [6]. Soft beverages may consist of many various kinds of acid that causing depresses in salivary PH. They may ingrain and derived from the inherent ingredients that utilized in manufacture. These acids involve phosphoric and citric acids found in cola-type beverages and another acid that supply taste and carbonic acid under pressure in sparkling beverages. Lastly, preservatives, like insertion of vitamin C (ascorbic acid), as well as participate to acidity of soft bevareges [7].

Subjects and Methods

An ethical approval was received from Research Ethics Committee of College of Dentistry, University of Baghdad, Iraq. The subjects of current study were (80) soft drink factory workers aged (27-40) years old classified into five groups according to frequency of soft drinks consumption into: several times daily, once daily, several times weekly, once weekly and several times monthly (WHO 2013).

Clinical examination was performed under natural light Teeth were dried using cotton wools. Oral examination and DMF index were conducted according to WHO 2013 basic survey method. Collection of unstimulated saliva was done between 10-12 a.m., at least two hours after worker's breakfast time. The workers asked to incline forward and spit saliva that produced in 5 minutes into a graduated test tube, through a glass funnel.

The salivary samples were centrifuged at 5000 r.p.m for 30 minutes; the clear supernatant was separated by micropipette and it was divided into 3 portions in test tubes, stored at -20ºC in a deep freeze till the time of analysis.

Salivary PH was measured directly by digital PHmeter. Then flow rate was estimated as ml/ min. Calcium in saliva was measured by CPC (O-Cresol Phtalein Complexne) procedure. Calcium OCPC procedure (AGAPPPE Kit) is based on the reaction of calcium ions (Ca++) and O-cresolphthalein complex in an alkaline solution to make a bright violet colored complex, that appears maximum absorbance at 57 8nm. 8-hydroxy quinoloine prevents Mg ++ interference upto 4 mmol/L. Salivary phosphorus was measured by AGAPPE Kit. Determination of inorganic phosphorous according to the following reaction:

Ammonium molybdate + Sulfuric acide Phosphorous Phosphomolybdic complex.

Data description, analysis and presentation were carried out by use Statistical Package for social Science (SPSS version 21); mean and standard deviation (SD) for quantitative variables while frequency and percentage for qualitative ones. One Way Analysis of Variance (ANOVA): use to detect the differences between K independent means of the quantitative variable with Dunnett’s T3 (unequal variance and equal sample size, Tukey honestly significant difference (HSD) (equal variance and equal sample size. Levene test: test variance of the data for independent groups about homogeneity or heterogeneity of variance. Pearson correlation: Test the correlation between quantitative variables either strong >0.5 or weak <0.5 and either negative or positive. Level of significance as: Not significant P>0.05, Significant P<0.05, highly significant P<0.01. Intra and intercalibration had been conducted with well-trained dentist to ensure the consistency of diagnostic criteria followed.

Results

Results concerning caries experience are displayed in Table 1 in which there was highly significant in "DMFS" and "DMFT" and the difference times of soft beverages consuming.

Table 1: Caries experience (means ± SD) and different frequencies of soft drinks consumption.

Results concerning flow rate and PH are displayed in Table 2 in which there was highly significant p<0.0. Highest mean of salivary flow rate for workers that drink the soft drinks once weekly, followed by those several times monthly drinking, the lowest was found in those once daily. Highest mean of salivary PH in those once weekly followed by several times weekly and the lowest was found in those several times daily.

Table 2: Salivary flow rate and PH (means ± SD) and different times of soft beverages intake.

Table 3 illustrate the correlation between dental caries and flow rat and PH by different frequencies of soft beverage intake, in which there was indirect relation between flow rate and PH and both "DMFS" and DMFT".

Table 3: Correlation between dental caries and flow rate and PH with differences times of soft drinks consuming.

Results concerning calcium and phosphorous are displayed in Table 4 in which there was marginal significant at p<0.05 in salivary calcium. Highest mean for workers that drink the soft drinks once weekly was (7.925), followed by those several times daily drinking(7.538) followed by those several times weekly (6.950), followed by several times monthly (6.713) and the lowest mean for once daily (6.550). The total of calcium was (7.135). There was highly significant p<0.01in salivary phosphorous. Highest mean for workers that drink the soft drinks several times weekly was (6.925), followed by those once weekly drinking(6.763) followed by those several times monthly (6.300), followed by once daily (6.038) and the lowest mean for several times daily (6.012). The total of phosphorous was (6.408).

Table 4: Salivary calcium and phosphorous (means ± SD) and times of consumption of soft drinks.

Table 5 demonstrates the correlation between caries experience and salivary biochemical analysis (calcium and phosphorous) by times of consumption of soft drinks. There was direct relationship in those highly consumption of soft drinks (several times daily and once daily) between salivary calcium and both "DMFS" and "DMFT", but this relation was not significant, while it was highly significant in those several times monthly. There was indirect relationship in those several times daily and once weekly between salivary phosphorous and both "DMFS" and "DMFT" that was highly significant.

Table 5: Correlation between caries experience and salivary biochemical analysis by different frequencies of soft drinks consumption.

Discussion

The study consists of 80 males who work at least for three years in the Al-Waha Soft Drink Company. The selected workers were nonsmokers, looking healthy and not take any medications in the last two weeks to exclude their effects on the oral health status. All teeth except the third molar were examined.

Data analysis in this study demonstrated that dental caries in permanent dentition (DMF) among the workers with highest mean in those with high consumption of the soft drinks (several times daily and once daily). While the lowest mean of "DMF" in those workers that had low frequency of consuming of soft beverages (once weekly and several times monthly). This finding agrees with other studies who have shown a direct relation between dental caries with frequency of soft drinks intake [1,8-13].

Unstimulated whole saliva was used as this kind of saliva is dominates nearly at every time, it’s important for maintenance of oral health and its act as a mirror that manifesting physiological condition of oral cavity and whole body [14].

Data showed that salivary flow rate and PH among workers was highly significant difference with frequency of soft drinks consuming. The correlation coefficient between salivary flow rate and PH and dental caries was negatively correlated among the workers, this is agree with others that considered the salivary flow rate as an indicator of caries susceptibility15 and agree with others that considered the salivary PH as an indicator of caries susceptibility [15-17].

Finding of this study can be demonstrate by that there was marginal significant in calcium and frequency of soft drinks consuming. The highest mean for workers that drink the soft drinks once weekly was, followed by those several times daily drinking. The correlation between caries experience and salivary biochemical analysis (calcium) by times of drinking was differ with direct relationship. However, this relation was not attaining significant level. These results agreed with [18-21], who found that an increase salivary Ca concentration related with the increase in dental caries severity. The direct correlation of salivary Ca levels with dental caries could be assigned to that the main inorganic constituents of saliva, which are Ca, PO4 and hydrogen ions, together with fluoride, have an essential part relating to the solubility of the minerals of dental tissue. Any decline in the salivary PH, it will be causing under saturation of saliva to hydroxyapatite that result in its dissolution to their ionic constituent to increase the grade of the gradient. For that reason, calcium ions diffused from dental tissues to saliva [22]. However, these findings differ from [23-26], who reported that higher calcium levels in those with caries-free. In meanwhile [27], stated that the mean level of calcium was lower in higher caries when compared to lower caries and it was statistically significant. They explained that high calcium concentration in saliva lead to remineralization of incipient caries lesions that decreases caries experience rate. The saliva becomes a reservoir supersaturated with calcium and phosphate that create an environment that support remineralization over demineralization.

The finding of this study can be explicating by that there was highly significant in phosphorous and frequency of soft drinks consumption. The highest mean for workers that drink the soft drinks several times weekly, followed by those once weekly drinking.

The correlation between caries experience and salivary biochemical analysis (phosphorous) by times of drinking was differ with indirect relationship.

This result may give an indication of the protective role of inorganic phosphate ions against tooth decay. The indirect correlation of salivary inorganic phosphate ions with caries may be due to its cariostatic action through its ability to preserve the saturation of saliva with phosphate ions [28] and give notion about potential impact of inorganic phosphate in remineralization of incipient caries lesion. Inverse relation with DMF associated to its action in buffer and remineralization [29] and phosphate can conflict with adherence of pellicle and bacterial plaque to tooth surfaces.28 This finding is in agreement with the conclusion [21,25,26].

Conclusion

It is present from the result of this study the high frequency of soft drinks consuming connected with increase of the dental caries. The results were appeared significant variations in levels of salivary calcium and phosphorus of the workers. Saliva has been used to found caries risk. Inorganic phosphorus level in the saliva has a negative influence on the caries experience and negative relation with DMF index, so the caries activity was associated with depressed level of salivary inorganic phosphorus.

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