|Year : 2013 | Volume
| Issue : 1 | Page : 22-25
Correlation between dental caries and salivary immunoglobulin in adult Indian population: An in vivo study
Mithra Hegde, Darshana Devadiga, Chitharanjan Shetty, Aditya Shetty
Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, NITTE University, Mangalore, Karnataka, India
|Date of Web Publication||29-Apr-2013|
Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, NITTE University, Mangalore, Karnataka
Source of Support: Central Research Laboratory A. B. Shetty Memorial Institute Of Dental Sciences, Mangalore India., Conflict of Interest: None
Aim: To evaluate the relationship between dental caries and salivary immunoglobulins (S-Igs) in unstimulated saliva of young adults between the age group of 20 and 30 years from South Canara district, Karnataka with varying caries experience as determined by their Decayed Missing Filled Teeth (DMFT) scores. Materials and Methods: The study was conducted on 80 healthy adult subjects with age group between 20 and 30 years. The healthy subjects without any chronic diseases were selected. The patients were divided into four groups according to DMFT status (WHO, 1997) as G-I, DMFT 0; G-II, DMFT 1-5; G-III, DMFT 6-10; and G-IV, as DMFT above 10. Unstimulated saliva samples were collected from each subjects and checked for S-IgA and IgG. The obtained data was statistically analyzed using one-way ANOVA and Tukey`s Honestly Significant Difference test. Results: Correlation of DMFT with S-IgA showed that as the S-IgA levels decreased in the saliva, there was increase in the DMFT levels. With intergroup comparison of S-IgA, there is no significant difference between group I and group II. There was no significant correlation seen between the S-IgG G levels and dental caries experience. Conclusion: The S-IgA increases with decrease in caries activity and S-IgG does not show any correlation with dental caries.
Keywords: Dental caries, decayed missing filled teeth, saliva, salivary IgA, salivary IgG
|How to cite this article:|
Hegde M, Devadiga D, Shetty C, Shetty A. Correlation between dental caries and salivary immunoglobulin in adult Indian population: An in vivo study. J Res Dent 2013;1:22-5
|How to cite this URL:|
Hegde M, Devadiga D, Shetty C, Shetty A. Correlation between dental caries and salivary immunoglobulin in adult Indian population: An in vivo study. J Res Dent [serial online] 2013 [cited 2021 Jun 16];1:22-5. Available from: http://www.jresdent.org/text.asp?2013/1/1/22/111229
| Introduction|| |
Dental caries is one of the most common microbial infection, but rarely it is a critical disease.  Caries is characterized by a localized, transmissible, microbial infectious process that ends up in the destruction of hard dental tissue.  There are many factors which can cause dental caries; among which, poor dental hygiene and oral care, family history of dental caries, greater concentration of bacteria in oral cavity with acidophilic activity, decreased salivary flow, more cariogenic diet, and reduced level of fluoride in drinking water are the important factors. 
Immunoglobulins (antibodies) are produced by B cells, which are plasma proteins. They are active in the defence against bacterial and viral infections. In the late 19 th century, the action of immunoglobulin was first studied by Von Behring and Kitasato. They found that the serum taken from rabbits immune to tetanus toxin could protect nonimmune rabbits from infection.  An immunoglobulin is typically a Y-shaped structure consisting of four polypeptide chains-two heavy chains and two light chains. An antigen-binding site is present in each arm.
Major secretory immunoglobulin is salivary immunoglobulin A (S-IgA). It is the first line of defence of the host against pathogens which invade mucosal surfaces.  Oral immunity is improved by S-IgA antibodies by preventing microbial adherence, neutralizing enzymes, toxins, and viruses; or by acting in synergy with other factors such as lysozyme and lactoferrin. Systemic conditions like protein energy malnutrition, obesity, infections, psychological stress, and cigarette smoking affect S-IgA levels. Human studies have been contradictory and its role in protection is still not clear. It has been suggested that oral microorganisms may have a selective advantage in colonization, if they were able to inhibit mucosal immunity by proteolytic degradation of IgA. 
Any substance that significantly delays or prevents the oxidation of oxidizable substance is an antioxidant. The salivary antioxidant system includes various molecules and enzymes. The most important are the uric acid molecule and the peroxidase enzyme, both are water-soluble. Uric acid contributes approximately 70% of the total salivary antioxidant capacity.
Free radicals are the molecules or molecular fragments containing one or more unpaired electrons in atomic or molecular orbit.  This unpaired electron usually gives a considerable degree of reactivity to the free radical.
| Materials and Methods|| |
The study was conducted in 80 healthy adult patients coming to the outpatient department of Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka with both caries active and caries free subjects under the age group of 20 to 30 years after the approval of Institutional Ethics Committee. The patients fulfilling the inclusion criteria were free from systemic and local disease which affects salivary secretions, and their caries status was assessed according to WHO criteria.  Patients with periodontal disease, hypertension, diabetes, radiotherapy, chemotherapy, systemic disease of the vital organs and history of long-term medications were excluded from the study. A detailed case history of the subject was taken. A case history format was filled with an informed consent which was duly signed by the subject.
The smooth occlusal surfaces of the teeth were cleaned with soft bristle brush, dried and examined. Decayed Missing Filled Teeth (DMFT) score was calculated. On the basis of the DMFT scores, the study groups were divided as follows: Control group [Group I] consists of 20 healthy subjects who were caries free. The caries active groups contains as follows: Group II consists of 20 adults with DMFT 1-5, Group III consists of 20 subjects of DMFT 6-10, and Group IV with 20 adults of DMFT above 10.
Unstimulated [resting] saliva samples were collected according to Dawes` method. , Subjects were asked to abstain from smoking, brushing of teeth, use of mouth wash, eat or drink for 1 hour prior to the collection of sample. Samples were collected between 10 and 11 a.m. During sample collection, the subject was seated in a normal chair instead of the dental chair to maintain a stress-free environment. The unstimulated saliva was collected by asking the subjects to pool the saliva on the floor of the mouth and then made to expectorate it into a collection cup. Collected saliva was refrigerated at − 10°C till the evaluation of S-IgA and S-IgG done.  The S-IgA and S-IgG are estimated using immunoglobulin estimation kit AGAPPE IgA and IgG kit 11815001, 11816001, Switzerland].
The data collected were statistically analyzed with one-way ANOVA and Tukey's honestly significant difference (HSD) test.
| Results|| |
A steady decrease in the mean values of S-IgA from Group I-IV was seen with Group I showing the highest value of S-IgA 315.51 mg/dL followed by Group II-294.61 mg/dL, Group III-156.27 mg/dL, and Group IV-120.65 mg/dL, respectively [Table 1], [Table 2], and [Graph 1[Additional file 1]].
|Table 1: Comparison of S-IgA and S-IgG levels in caries free and caries active groups.|
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|Table 2: Inter group comparison of S-IgA levels in caries free and caries active groups.|
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Intergroup comparison between the experimental groups using Posthoc analysis by Tukey`s HSD test showed that the decrease in S-IgA levels was not significant (NS) between G I and II (P > 0.05), very highly significant between all other groups (P </=0.001).
A random variation was seen in S-IgG values from Groups I to IV with mean values of 1357.11, 1147.49, 1293.61, and 1326.74 mg/dL, respectively.
The S-IgG levels in control Group (DMFT = 0) showed the highest value of 1357. A total of 11 mg/dL followed by a sudden decrease to 1147.49 mg/dL in Group II (DMFT = 1 -5) and thereafter a gradual increase in Group III (DMFT 6 -10) 1293.61 mg/dL and Group IV (DMFT > 10) 1326.74 mg/Dl, respectively [Table 1] and [Table 3], [Graph 2[Additional file 2]].
|Table 3: Inter group comparison of S-IgG levels in caries free and caries active groups.|
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Intergroup comparison between the experimental groups using Posthoc analysis by Tukey`s HSD test showed that the variation in S-IgG level was NS between all the groups (P > 0.05).
| Discussion|| |
The immunoglobulins S-IgA and S-IgG present in human saliva play a major role in immunity of the oral cavity. Although IgA has been evaluated in several studies in the past in young children, the role of both IgA and IgG on incidence of dental caries in healthy young adults is relatively unknown. ,,, The present study was done for the evaluation of the relationship between dental caries and S-Igs in stimulated saliva of young adults between the age group of 20 to 30 years from South Canara district, Karnataka with varying caries experience as determined by their DMFT scores.
Among the immunoglobulins, S-IgA values showed an inverse relationship to the DMFT values which was statistically significant, while the S-IgG values showed a variable relationship when compared to the DMFT which was not statistically significant. The results of IgA are in agreement to previous studies conducted by Everhart et al.  The resultant variable relationship of S-IgG values and DMFT possibly occurred since the periodontal status of the patients was not taken into consideration.
On intergroup comparison, there was a steady decrease observed in the values from I to IV groups, with slight increase between Groups I and II. [P value is more than 0.005]. The results of the present study are in agreement with results of Everhart et al., and various other studies where higher levels of S-IgA were seen in children with low caries activity. ,,, The above observations are suggestive of the fact that S-IgA serves a protective function in dental caries. The increase in S-IgA in decreased DMFT is an indication of protective mechanism of immunoglobulin against dental caries.
In this study, unlike S-IgA the S-IgG levels showed a random variation in values from Groups I to IV. On intergroup comparison statistically no significant correlation was noticed between the groups. This is in agreement with a study conducted by Dahlén et al. 
The infectious nature of dental caries assumes the hypothesis that some form of host immunity can regulate caries activity. If immunity could regulate the caries activity then S-IgA might give a clear correlation. It has been suggested that S-IgA antibodies generated by the mucosal immune system play an important role in the immune response against dental caries. Bagherian et al. found higher levels of S-IgA in the saliva of children who were having a low score.  In another investigation which utilized children aged three to seven years, high S-IgA levels correlated with low caries activity; however, only total IgA levels were measured. 
Secretory immunoglobulin AS-IgA constitutes the predominant immunoglobulin isotype in secretions, including saliva. Naturally occurring S-IgA antibodies reactive with a variety of indigenous bacteria have been detected in saliva. Contribution of S-IgA and S-IgG for dental caries is obtained by the measurement of salivary antibody level to the antigen obtained from cariogenic microorganisms. 
The S-IgA and S-IgG levels were determined using immunoturbidimetry. The principle of the immunoturbidimetry is that IgA or IgG antibodies when mixed with samples containing IgA or IgG form insoluble complexes. These complexes cause an absorbance change in the spectrophotometer, depending upon the immunoblobulin concentration of the patient sample. The reading in the spectrometer can be noted and compared with a calibrator of known immunoglobulin concentration. The control used in our study was human serum.
In the present study, the values of S-IgG were not statistically significant (P > 0.05), also the S-IgG values were not correlating to DMFT status. On the contrary, the S-IgA increases with decrease in caries activity and S-IgG levels show significant correlation with dental caries.
Further studies are recommended with broader age groups and periodontal condition as consideration.
| Conclusion|| |
The S-IgA increases with decrease in caries activity and has a significant correlation with caries activity. In contrast, S-IgG do not show any correlation with dental caries. This emphasizes the importance of immunoglobulins in controlling the caries activity in the oral environment. This study was conducted in South Canara population, it can be further considered for the study in South India.
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[Table 1], [Table 2], [Table 3]
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