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Indian Pediatr 2011;48: 719-721 |
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Salivary SIgA and Dental Caries Activity
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Jyoti G Chawda, Nandini Chaduvula, Hemali R Patel, Shikha S Jain
and Arti K Lala
From the Department of Oral Pathology, Government Dental
College and Hospital, Ahmedabad, India.
Correspondence to: Dr Nandini Chaduvula, Room number 12,
Dental PG Hostel,
Civil hospital campus, Asarwa, Ahmedabad, India.
Email: [email protected]
Received: September 5, 2010;
Initial review: October 07, 2010;
Accepted: December 14, 2010.
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Abstract
This case-control study was conducted to determine
the protective role of salivary secretory immunoglobulin A (SIgA)
levels in the unstimulated whole saliva of dental caries active (Group
I and II) and caries free children (Group III). Thirty children aged
4-8 years were selected. Their DMFT (Decayed Missing Filled teeth for
permanent teeth) and/or df-t (decayed, filled teeth for deciduous
teeth) scores were determined and the salivary SIgA levels were
measured using Immunoturbidometry. SIgA levels of all three groups
were in the the normal range of 4-30 mg/dL. The SIgA levels for both
Group I and II were less than that in Group III (P=0.018 and
P=0.0013, respectively).
Key words: Child, Dental caries, Immunoglobulin A, India.
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Dental caries is a multifactorial disease and one of the major
contributing factors is saliva [1]. Secretory immunoglobulin A (SIgA) is
the prominent immunoglobulin in whole saliva and is considered to be the
main specific defense mechanism in the oral cavity. SIgA helps in
prevention of dental caries by inhibition of bacterial adherence,
reduction of hydrophobicity, agglutination of bacteria and inactivation of
bacterial enzymes and toxins [2-4]. Several studies on the role of SIgA in
prevention of dental caries showed contradictory results [5-7]. We
compared the SIgA levels in the unstimulated whole saliva of caries free
and caries active children to determine the role of SIgA in protection
from dental caries.
Methods
Thirty children of both sexes, aged 4-8 years were
selected randomly, from those who were enrolled. Their DMFT (decayed
missing filled teeth for permanent teeth) and/or df-t (decayed, filled
teeth for deciduous teeth) scores were determined and were then divided
into three groups. Group I: 10 children with DMFT and/or df-t=1-5 (Low
caries activity), Group II: 10 children with DMFT and/or df-t=6-10 (high
caries activity), and Group III: 10 caries free children. For the children
with mixed dentition, the sum total of DMFT and df-t was considered [8].
The inclusion criteria for subject recruitment were: co-operative
behavior, normal growth and development, and good oral hygiene. The
exclusion criteria were: congenital or systemic disease, protein energy
malnutrition, obesity, dental abscesses, use of antibiotics in the past 7
days, and oral exposure to food in past two hours of sample collection.
After obtaining an informed consent from the parents or
guardians, unstimulated whole salivary samples were collected in sterile
vials. All the salivary samples were collected between 10-12 AM in order
to prevent any differences in the concentration of the saliva due to the
circadian rhythm. Children were asked to pool the saliva in the floor of
mouth and spit the collected saliva at an interval of 5 minutes. After
collection of 0.5mL of salivary sample, it was transported immediately to
the laboratory at a temperature of –70 ºC.
The estimation of SIgA concentration was done using
immunoturbidometry (SpinReact, SA, Gerona, Spain). The principle of the
procedure is that, SIgA antibodies when mixed with salivary samples, it
forms insoluble complexes which cause a change in the optical density, and
is recorded on a semi automatic analyzer (based on the principle of
spectrophotometer). Statistical analysis was performed by using ANOVA
test where P-values less than 0.05 were considered as statistically
significant.
Results
Mean values, standard deviations and range and
statistical significance of the salivary SIgA concentrations for the
studied groups are shown in Table 1. The total salivary
concentration of SIgA was statistically significantly higher in the Group
III than that of both the Group I and II.
TABLE I Salvary Secretory Immunoglobulin A (SIgA) Levels in Caries Active and Caries Free Children (n=30)
Group |
Number |
Mean SIgA (SD) |
Range SIgA |
P value |
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of children |
(mg/dL) |
(mg/dL) |
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I (df-t+-DMFT=1-5) |
10 |
18.66 (4.84) |
11.00-25.06 |
0.55 (Group I and II) |
II (df-t+DMFT=6-10) |
10 |
16.63 (3.04) |
11.30-21.00 |
0.001 (Group II and III) |
III (DMFT=0) |
10 |
24.36 (4.87) |
16.80-32.00 |
0.018 (Group I and III) |
Discussion
The infectious nature of dental caries assumes the
hypothesis that some form of host immunity can regulate caries activity.
If immunity can regulate caries activity then SIgA might give a clear
correlation [2]. It has been suggested that salivary SIgA antibodies
generated by the mucosal immune system play an important role in the
immune response against dental caries [6]. Bagherian, et al. [9]
found higher levels of SIgA in the saliva of children who were colonized
for less than 6 months with S. mutans (cariogenic organisms), and
had a low DMFT score than those who had harbored S. mutans for a
longer period of time (24 months) and had a high DMFT score. Hence the
participants in our study were categorized into two groups based on the
DMFT and/or df-t score. The levels of SIgA in subjects without any
systemic or immunological disease ranges from 4-30 mg/dL [4]. Systemic
conditions like protein energy malnutrition, obesity, infections,
psychological stress, cigarette smoking affect SIgA levels [10]. As the
children in our study group were free of such conditions, levels of SIgA
detected in our study were 11-32 mg/dL which lies within this range. But,
when a comparison was made for the salivary SIgA levels between all the
three groups, the results obtained were on the relatively low end of the
normal range of SIgA for caries active (Group I and II) subjects while
they were at the relatively high end of the normal range for caries free
(Group III) subjects, and the difference of SIgA levels of Group I and II
with Group III were statistically significant. In the present study, a
significant inverse correlation was found between SIgA and the caries
activity, which is in agreement with previous reports [5,6]. Thus, it can
be suggested that the secretory immune system provides local immune
protection against cariogenic organisms in the oral environment and
ultimately prevents dental caries.
In contrast to our study, Thaweboon, et al. [2]
and deFarias, et al. [7] found that the presence of
dental caries was associated with an increase of total salivary SIgA.
However, Shifa, et al. [3] and Koga, et al. [11] found no
correlation between dental caries and SIgA levels. The contradictory
results seen in the literature may be due to different sampling methods,
different criteria for patient selection, and different laboratory tests
used between the studies [8]. Moreover, the concentration of salivary
immunoglobulin may change depending upon the salivary flow rate, hormonal
factors, emotional states, and physical activity [12].
The obtained results of this study show that the SIgA
levels of the whole unstimulated saliva has some role in protection
against dental caries, but regarding the severity of the disease, it does
not show any significant results.
Acknowledgments: Dr Jigar Suthar (MD Path) and Mr
Pinkesh Shah (Laboratory technician) for providing necessary support
regarding laboratory procedures.
Contributors: JGC conceived and designed the study
and revised the manuscript for important intellectual content. NC, HP, SJ,
and AKL collected data and drafted the paper. NC conducted the laboratory
tests, interpreted and analyzed them. The final manuscript was approved by
all authors.
Funding: None.
Competing interests: None stated.
What This Study Adds?
• Salivary SIgA levels may have a role in protection against
dental caries, but do not have a role regarding the severity of the
disease. |
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