Electrolytes in stimulated whole saliva in individuals with hyposalivation of different origins

doi:10.1016/S0003-9969(02)00200-5

Archives of Oral Biology

Volume 48, Issue 5, May 2003, Pages 337-344

https://doi.org/10.1016/S0003-9969(02)00200-5 Get rights and content

Abstract

There are reasons to believe that changes in the secretion rate of saliva as well as changes in its protein and electrolyte composition promote the growth of micro-organisms associated with oral disorders. Knowledge of the electrolytes in the saliva of those with hyposalivation might therefore be of value in designing oral health-promoting measures. In this study, electrolytes in stimulated whole saliva were analysed in individuals with hyposalivation due to radiation therapy in the head and neck region (RT group), primary Sjögren’s syndrome (pSS group), neuroleptic treatment (Neuro group), and to medication or of unknown origin (Unknown group). The bicarbonate concentration was significantly lower in all four hyposalivation groups compared with controls. The bicarbonate concentration, which in normal conditions is positively correlated with the salivary secretion rate, was lower in the Neuro group than in the RT and Sjögren’s groups despite a stimulated secretion rate about twice as high. Furthermore, the Neuro group had the highest phosphate concentration. The RT and Sjögren’s groups tended to have increased sodium concentrations. For potassium and calcium, the RT group had significantly higher concentrations than the other hyposalivation groups and the controls. The substantial increase in calcium and decrease in bicarbonate suggest that the function of the parotid glands is more affected than that of the other salivary glands. The results also indicate a contribution of plasma to the electrolyte concentrations determined in whole saliva in the RT and Sjögren’s groups. In conclusion, in individuals with hyposalivation the concentrations of electrolytes in stimulated whole saliva seem to be more related to the reason for the hyposalivation than to the salivary secretion rate.

Introduction

Saliva consists of 99% water and 1% organic and inorganic components. The main inorganic components are sodium, potassium, chloride, calcium, phosphate and bicarbonate, all contributing to the ionic strength of saliva. Access to calcium and phosphate is of importance for the remineralisation of the tooth surfaces after acid challenge. Bicarbonate, phosphate and the organic components contribute to the buffer capacity of the saliva. Bicarbonate is the principal buffer at pH 7 down to pH 5,¹ while the organic components perform this role from pH 5 down to pH 4. The phosphates contribute to the buffer capacity at a low salivary flow rate.¹ A pH around neutral is optimal for the growth of micro-organisms associated with oral health.2., 3. A pH below neutral promotes the growth of cariogenic micro-organisms and other acid-tolerant species associated with mucosal infections, while a pH above neutral favours micro-organisms associated with periodontitis.2., 3.

In individuals with a normal salivary secretion rate, the concentrations of sodium, calcium and bicarbonate are positively correlated with the stimulated secretion rate.⁴ The potassium concentration is independent of flow rate and the phosphate concentration decreases slightly when the flow rate increases.⁵

In those with hyposalivation due to primary Sjögren’s syndrome and those treated with radiation therapy in the head and neck region, in spite of a reduction in salivary secretion rate, the sodium and chloride concentrations in stimulated whole saliva are higher than in individuals with normal salivary secretion6., 7., 8. However, for potassium and calcium, the concentrations were found to be increased in stimulated whole saliva in primary Sjögren’s syndrome,7., 8. while in radiation-induced hyposalivation, the potassium concentration was comparable with pre-irradiation levels and the calcium concentration was lower.⁶ Furthermore, in our previous study,⁹ the buffer capacity was lower in individuals on neuroleptic treatment than in those with radiation-induced hyposalivation or primary Sjögren’s syndrome, despite a higher stimulated secretion rate. So there are reasons to believe that the concentrations of inorganic components in saliva not only vary according to the saliva secretion rate but also according to the reason for the hyposalivation.

Our aim now was to assay bicarbonate, sodium, potassium, calcium and phosphate in stimulated whole saliva from individuals with hyposalivation of different origins, due to radiation therapy, primary Sjögren’s syndrome, neuroleptic treatment, medication or of unknown origin.

Section snippets

Material and methods

The study was approved by the ethics committee at Göteborg University. To be included, the participants had to be between 45 and 65 years of age and dentate with ≥16 natural teeth and no removable prosthetic constructions or implants. After obtaining informed consent, the participants comprised nine individuals who had completed radiation therapy in the head and neck region 1–2 years earlier, 10 with primary Sjögren’s syndrome diagnosed according to the Copenhagen criteria¹⁰ 7±5 years

Results

The age and sex distributions, clinical measures, salivary secretion rates, pH and buffer capacities in the groups are presented in Table 1. The neuroleptic group had the highest number of sites with bleeding on probing, about 80% of the total number of sites. The radiotherapy and Sjögren’s syndrome groups had both the lowest unstimulated and the lowest stimulated secretion rates. In the neuroleptic group, the unstimulated secretion rate was slightly higher than in the control group, while the

Discussion

The most common disorders in the mouth, caries, periodontitis, gingivitis and mucosal infection, are associated with an increase in specific micro-organisms. There is reason to believe that changes in the secretion rate of saliva, as well as changes in its protein and electrolyte composition, promote the growth of micro-organisms associated with these disorders.2., 3., 15., 16., 17. A knowledge of the electrolytes in the saliva of individuals with hyposalivation of different origins might

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Electrolytes in stimulated whole saliva in individuals with hyposalivation of different origins

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Arch. Oral Biol.

Arch. Oral Biol.

Oral Oncol. Eur. J. Cancer

Effects of carbohydrate pulses and pH on population shifts within oral microbial communities in vitro

J. Dent. Res.

Analysis of pH-driven disruption of oral microbial communities in vitro

Caries Res.

Mono- and divalent electrolyte patterns, pCO2 and pH in relation to flow rate in normal human parotid saliva

Europ. J. Clin. Invest.

Radiation-induced xerostomia in cancer patients. Effect on salivary and serum electrolytes

Cancer

Analysis of the concentration and output of whole salivary constituents in patients with Sjögren’s syndrome

Eur. J. Oral Sci.

Primary Sjögren’s syndrome (pSS): subjective symptoms and salivary findings

J. Oral Pathol.

Oral microflora at hyposalivation of different origins

Oral. Microbiol. Immunol.

The Copenhagen criteria for Sjögren’s syndrome

Scand. J. Rheumatol.

Clinical investigations of the salivary buffering action

Acta Odontol. Scand.

Mono- and divalent electrolyte patterns, pCO₂ and pH in relation to flow rate in normal human parotid saliva