Journal of Indian Society of Pedodontics and Preventive Dentistry | Oct-Dec 2013 | Vol 31| Issue 4 | 221

ABSTRACT
Objective: Objective was to evaluate the relationship
between physio-chemical properties of saliva such
as ow rate, buffering capacity, pH, Streptococcus
mutans in saliva and its relationship with dental
caries. Study design: Eighty children were evaluated
for physio-chemical properties of saliva, out which
40 were caries-active (group 1) and 40 caries-free
(control group). Caries status of each child was
scored by using DMFS and dfs indices to get a
combined DMFS and dfs score. The physio-chemical
properties were evaluated using Saliva Check (GC
Asia Dental Pte Ltd- India) and streptococcus mutans
using Dentocult SM Strip Mutans. Result: Flow
rate, pH, and buffering capacity of saliva in caries-
active children were decreased but not statistically
signicant. The Streptococcus mutant count of saliva
was increased signicantly in caries-active children.
Conclusion: The physio-chemical properties of
saliva like pH, buffering capacity, salivary ow rate,
concentration of various components like proteins,
calcium and antioxidant defense system play a major
role in the development of caries. Hence, more clinical
and laboratory studies are needed to determine the
exact relationship between these physio-chemical
properties of saliva and dental caries.
KEYWORDS: Dental caries, saliva, Streptococcus
mutans
Evaluation of physio-chemical properties of saliva
and comparison of its relation with dental caries
Subha Dogra, Deepak Bhayya, Ruchi Arora, Deepesh Singh, Dashmesh Thakur
1
Department of Pedodontic and Preventive Dentistry, Darshan Dental College and Hospital, Loyara, Udaipur, Rajasthan,
1
Department of Orthodontics, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
Introduction
Oral cavity is a distinctive ecosystem harvesting
different types of hard and soft tissues and harbors
plethora of microorganisms and is specialized to
perform wide variety of functions.
[1]
Among the oral diseases, dental caries is the most
common chronic disease of mankind.
[2]
In simple
term, it can be dened as a microbial disease of
the calcied tissues of the teeth, characterized by
the demineralization of the inorganic portion and
destruction of the organic substance of the tooth.
[3]
Caries affects persons of both sexes in all races, all
socio-economic strata, and every age group. As
children reach school age, they will have an increasing
incidence of carious lesions because of change in
dietary habits, which includes rened carbohydrates
and sweeteners.

It is also profoundly affected by other
factors like oral hygiene and saliva.
[3]
The saliva circulating in the mouth at any given time
is termed as whole saliva and comprises a mixture
of secretions from the major, minor salivary glands
and traces from the gingival crevicular uid. To a
large extent, it promotes oral health, whereas lack
of its secretion contributes to the disease process.
[3,4]

It is a heterogeneous uid comprising of proteins,
glycoproteins, electrolytes, small organic molecules,
and compounds transported from blood.
[5]
Since this
uid constantly bathes the teeth and oral mucosa,
it acts as a cleansing solution, a lubricant, buffer
and ion reservoir of calcium and phosphate, which
is essential for re-mineralization of initial carious
lesions.
Hence, this study was carried out to determine the
physio-chemical properties of saliva and their relation
with dental caries in children.

Address for correspondence:
Dr. Subha Dogra,
Department of Pedodontic and Preventive Dentistry, Darshan
Dental College and Hospital, Loyara, Udaipur, Rajasthan, India.
E-mail: dr.subahdogra@yahoo.com
Original Article
Access this article online
Quick response code
Website:
www.jisppd.com
DOI:
10.4103/0970-4388.121816
PMID:
******
Dogra, et al.: Physio-chemical properties of saliva and its relationship with dental caries
Journal of Indian Society of Pedodontics and Preventive Dentistry | Oct-Dec 2013 | Vol 31| Issue 4 | 222
Aims and objectives of the study
This study was carried out with the following
objectives:
1. To evaluate the relationship between physio-
chemical properties of saliva such as ow rate,
buffering capacity, pH, calcium level in caries-free
and caries-active children.
2. To evaluate the relationship between Streptococcus
mutans in saliva and its relationship with dental
caries.
Materials and Methods
The present study was conducted in the Department
of Pedodontics and Preventive Dentistry, Darshan
Dental College and Hospital in collaboration with
Jyothi Public School, Fatehpura Udaipur (Rajasthan).
Eighty children of age 7 to 14 years were included as
subjects in the study. Prior to the collection of saliva
from the children, an informed consent was obtained
from their respective parents, and detailed case history
was recorded. Eighty children were selected and
divided into two groups of 40 each. Each group having
equal number of caries-active (group 1) and caries-
free (control group) children. Groups were further
subdivided into 20 each based on male and female
category. Caries status of each child was scored by
using DMFS and dfs indices to get a combined DMFS
and dfs score. Children with DMFS = 0 were taken as
caries-free, and children having at least ve decayed
tooth surfaces requiring restoration were taken as
caries-active subjects respectively.
On the day of collection of saliva, participating children
were instructed not to eat or drink anything for at least
one hour before the collection of saliva sample. To
control the circadian variations, samples were collected
between 10 am-11.30 am. Children were asked to rinse
their mouth with water thoroughly 10 minutes before
collection of saliva to avoid the contamination of
food debris. Each sample was estimated for ow rate,
pH, buffering capacity using Saliva Check (GC Asia
Dental Pte Ltd- India) and Streptococcus mutans using
Dentocult SM Strip Mutans.
Results
The results of the study showed, that there was a
statistically signicant difference in the mean DMFS in
caries-active and in caries-free subjects. The mean ow
rate in caries-active subjects was 4.4625 and in caries-
free subjects was 4.7625. The difference was statically
not signicant where P value was 0.074 (P > 0.05).
Mean pH in caries-active subjects were 7.2000 while in
caries-free subjects were 7.2450. The difference was not
statistically signicant where P value was 0.501 (P >
0.05). Mean buffering capacity in caries-active subjects
was 9.5000 while in caries-free subjects was 9.5500. The
difference was not statistically signicant with P value
0.781 (P > .05). The mean total calcium concentration
of saliva in caries-active subjects was 8.0825 while in
caries-free subjects was 8.8375. The difference was
statistically signicant, P value 0.011 (P < .05). The mean
Streptococcus mutans count in caries-active subjects was
2.1500 while in caries-free subjects was 0.5000. The
difference was statistically signicant, P value 0.000 (P
< .05) Table 1.
Discussion
Good oral health is an integral component of good
general health. Although enjoying good oral health
includes more than just having healthy teeth, many
children have inadequate oral and general health
because of active and uncontrolled dental caries.
The etiology and pathogenesis of dental caries is
multifactorial. Hence, this study was done with the
objective to evaluate the role of ow rate, pH, buffering
capacity, calcium level and Streptococcal mutans level of
saliva in dental caries assessment.
Saliva inuences caries attack mainly by its rate of
ow. An important caries-preventive function of saliva
is to dilute bacterial substrate, mainly different sugars
introduced into the human oral cavity in the form of
food or snacks. The dilution and elimination process of
sugar is usually referred to as Salivary Clearance or
oral clearance of sugar.
[6-8]
Normal salivary ow rate (hydration status and
stimulated saliva ow rate) imparts a strong protective
effect against dental caries.
[9]
In our present study,
the salivary ow rate was decreased in caries-active
children compared to caries-free children but was
not statistically signicant (P > 0.05). Similar results
were seen in the studies conducted by Browen et al.
(1978)

and Scully (1986) where they showed that dental
Table 1: Compiled salivary parameters in both
caries active and caries free subjects
N Mean Std.
deviation
Mean
difference
t P
value
DMFS
Active 40 10.4500 3.21814 10.45000 20.537 0.000
Free 40 0.00000 0.00000
Flow Rate
Active 40 4.4625 0.70153 -0.30000 -1.814 0.074
Free 40 4.7625 0.77615
pH
Active 40 7.2000 0.32026 -0.04500 -0.676 0.501
Free 40 7.2450 0.27358
Buffering
Capacity
Active 40 9.5000 0.75107 -0.05000 -0.280 0.781
Free 40 9.5500 0.84580
Streptococcous
Active 40 2.1500 0.69982 1.65000 11.686 0.000
Free 40 0.5000 0.55470
Dogra, et al.: Physio-chemical properties of saliva and its relationship with dental caries
Journal of Indian Society of Pedodontics and Preventive Dentistry | Oct-Dec 2013 | Vol 31| Issue 4 | 223
that the salivary secretion and substance secreted with
saliva inuence to a high degree the strength of an
individual caries attack. The epidemiological surveys
and experimental studies are gradually increasing our
understanding and awareness of the impact of saliva
on oral health.
Conclusion
The following conclusions were drawn from the
present study:
Flow rate, pH, and buffering capacity of saliva
in caries-active children were decreased but not
statistically signicant.
The Streptococcus mutant count of saliva was
increased signicantly in caries-active children.
Dental caries is a complex and dynamic process
where a multitude of factors inuence and initiate the
progression of disease. Most important factors which
inuence the development of dental caries are dietary
habits and saliva. The physio-chemical properties of
saliva like pH, buffering capacity, salivary ow rate,
concentration of various components like proteins,
calcium, and antioxidant defense system play a major
role in the development of caries.
Hence, more clinical and laboratory studies are needed
to determine the exact relationship between these
physio-chemical properties of saliva and dental caries.
References
1. Gandhy M, Damle SG. Relation of salivary inorganic
phosphorus and alkaline phosphatase to the dental caries status
in children. J Indian Soc Pedod Prev Dent 2003;21:135-8.
2. McDonald RE, Avery DR, Stookey GK. Dentistry for the child
and adolescent. 8
th
ed. New Delhi: Elsevier; 2005. p. 203-35.
3. Shafer, Hine, Levy. Shafers Textbook of Oral Pathology. 5
th

ed. Philadelphia: Saunders; 2002. p. 567-658.
4. Lavelle LB. Christopher Applied oral physiology. 2
nd
ed. London,
UK: Butterworths and Co. (Publishers) Ltd.; 1988. p. 128-41.
5. Battino M, Ferreior MS, Gallardo I, Newman HN, Bullon
P. The antioxidant capacity of saliva. J Clin Periodontol
2002;29:189-94.
6. Lundqvist C. Oral sugar clearance; its inuence on dental
caries activity. Odontol Revy Suppl 1952;3:11-116.
7. Lanke LS. Inuences on salivary sugar of certain properties of
food stuffs and individual oral conditions. Acta Odontol Scand
1957;15:154-6.
8. Lagerlof F, Oliveby A, Ekstrand J. Physiological factors
inuencing salivary clearance of sugar and uoride. J Dent
Res 1987;66:430-5.
9. Gopinath VK, Rahim AA. Saliva as a diagnostic tool for
assessment of dental caries. Arch Orofac Sci 2006;1:57-9.
10. Lenander-Lumikari M, Loimaranta V. Saliva and Dental
Caries. Adv Dent Res 2000;14:40-7.
11. Tulunoglu O, Demirtas S, Tulunoglu I. Total antioxidant levels
of saliva in children related to caries, age, and gender. Int J
Paediatr Dent 2006;16:186-91.
caries is probably the most common consequence of
hyposalivation.
[10]
In studies conducted by Papas et al.
(1993) and Spare et al. (1994), they stated that carious
lesions develop rapidly and also on tooth surfaces that
are usually not susceptible to caries due to decreased
salivary ow rate.
[10]
Studies have shown that patient with low or no caries
activity had a resting salivary pH of around 7.0 and
those with extreme caries activity had a resting pH
below critical pH 5.5.
[3]
In the present study, the mean
pH in resting saliva in caries-active subjects was 7.2000,
which was not sufcient to cause the demineralization
of inorganic substance of the tooth. Similar results were
seen in study conducted by Tuhunoglu O.S. (2006),
[11]

which showed no correlation between pH values and
caries activity, age and gender.
Our study was in contrast to the study conducted
by Ericsson (1959),
[12]
which showed that salivary
buffering capacity has a negative relationship with
caries incidence. Another study conducted by Lagerlof
and Oliveby (1994)
[8]
showed that a low ow rate
combined with low or moderate buffer effect clearly
indicates poor salivary resistance against microbial
attack. This can be attributed to the fact that the pH
of the secreted saliva is dependent on the secreted
acids and bases, most notably the bicarbonate ion. In
the present study, the mean Streptococcal mutans count
in caries-active children was increased and showed
statically signicant difference in comparison to caries-
free children (P < 0.05).
In a study conducted by Behiye SB, Sema C, Buket EA,
Fatma A (2004)
[13]
on associations of dental caries with
salivary mutans streptococci/lactobacilli and plaque
ph in 7-9 years old children in rural of diyarbakr-
turkey, they found that increase in the number
of mutans streptocci has indicated the increasing
number of caries lesions. This was in line with the
clear evidence from the studies by Mattos-Graner et
al. (1998),
[14]
in Brazil and by Alaluusua and Renkonen
(1983)
[15]
in Sweden that children with high numbers of
MS develop a signicantly higher caries incidence than
children with low numbers.
A study conducted by Hegde SK et al. (2005)
[16]
showed
that there was a statistically signicant positive
co-relation between the percentage of salivary bacteria
(S Mutans) and dental caries, which was similar to our
study. Another study conducted by Hedge PP et al.
(2005)
[17]
on dental caries experience and salivary level
of Streptococcus mutans and lactobacilli in 13 to 15 years
of children of Belgaum city showed a highly signicant
statistical relation between Streptococcus mutans and
dental caries, which correlated to our study.
No other etiological factor can inuence the outcome
of dental caries, as much as the saliva can do. There
is a general agreement among dental professionals
Dogra, et al.: Physio-chemical properties of saliva and its relationship with dental caries
Journal of Indian Society of Pedodontics and Preventive Dentistry | Oct-Dec 2013 | Vol 31| Issue 4 | 224
12. Ericsson Y. Clinical investigations of the salivary buffering
action. Acta Odontol Scand 1959;17:131-65.
13. Bolgul BS, Celenk S, Ayna BE, Atakul F. Associations
of Dental Caries with Salivary Mutans Streptococci/
Lactobacilli and Plaque pH in 7-9 Years Old Children
in Rural of Diyarbakr-Turkey. Turk Clin J Dent Sci
2004;10:69-73.
14. Mattos-Graner RO, Zelonte F, Line RC, Mayer MP. Association
between caries prevalence and clinical, microbiological and
dietary variables in 1.0 to 2.5 year old Brazilian children.
Caries Res 1998;32:319-23.
15. Alaluusua S, Renkonen OV. Streptococcus mutans
establishment and dental caries experience in children from
2-4 years old. Scand J Dent Res 1983;91:453-7.
16. Hegde SK, Kumar KB, Sudha P, Bhat SS. Estimation of salivary
bacteria capable of inhibiting and stimulating Streptococcus
mutans, and its correlation to dental caries and untreated
carious teeth. J Indian Soc Pedod Prev Dent 2005;23:126-30.
17. Hegde PP, Ashok Kumar BR, Ankola VA. Dental Caries
experience and salivary levels of Streptococcus mutans and
Lactobacilli in 13-15 years old children of Belgaum city,
Karnataka. J Indian Soc Pedod Prev Dent 2005;23:23-6.
How to cite this article: Dogra S, Bhayya D, Arora R, Singh D,
Thakur D. Evaluation of physio-chemical properties of saliva
and comparison of its relation with dental caries. J Indian Soc
Pedod Prev Dent 2013;31:221-4.
Source of Support: Nil, Conflict of Interest: None declared.
Author Help: Online submission of the manuscripts
Articles can be submitted online from http://www.journalonweb.com. For online submission, the articles should be prepared in two files (first
page file and article file). Images should be submitted separately.
1) First Page File:
Prepare the title page, covering letter, acknowledgement etc. using a word processor program. All information related to your identity should
be included here. Use text/rtf/doc/pdf files. Do not zip the files.
2) Article File:
The main text of the article, beginning with the Abstract to References (including tables) should be in this file. Do not include any information
(such as acknowledgement, your names in page headers etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to
1024 kb. Do not incorporate images in the file. If file size is large, graphs can be submitted separately as images, without their being
incorporated in the article file. This will reduce the size of the file.
3) Images:
Submit good quality color images. Each image should be less than 4096 kb (4 MB) in size. The size of the image can be reduced by decreasing
the actual height and width of the images (keep up to about 6 inches and up to about 1800 x 1200 pixels). JPEG is the most suitable file
format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always retain a good
quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised article.
4) Legends:
Legends for the figures/images should be included at the end of the article file.
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.