In patients with reduced quantity of saliva the mechanisticand cleaning properties of saliva in the mouth

are impaired.A slow oral sugar clearance rate inevitably increases the riskof caries. Thus, numerous
clinical studies have shown that a reduced ability to produce saliva is associated with an increased caries
experience . Concerning this relation, the unstimulated flow rate has been found to be diagnostically
more important than the stimulated one. Although many clinicians have observed that patients suffering
from chronically impaired saliva secretion are prone to dental decay,no cut off value has been defined
for the increased risk of developing dental caries with regard to unstimulated or stimulated flow rates. It
seems that individuals with subnormal unstimulated saliva flow rates (<0.2 ml/min) as a group have an
elevated demineralization rate and a higher risk of developing caries. Unstimulated saliva flow rates
below this level will also markedly increase the clearance time compared with flow rates above this level
(Dawes,1983). This will prolong periods with low pH values in the plaque. A low saliva flow rate, and
especially a low unstimulated saliva flow rate,also seems to favor an acidic and more cariogenic dental
microflora rich in acidogenic andaciduric bacteria, such as lactobacilli and mutans streptococci.Thus, a
low saliva flow rate not only will pro long clearance time and periods with low plaque pH, but alsomay
change the ecology of the mouth. The long-term effectsof a low saliva flow rate may become much
more complex than the purely mechanistic considerations relating to long clearance times. Patients with
low saliva flow rates generally experience a faster caries lesion progression rate than individuals with
normal saliva flow rates.Where it may take years for caries to progress through the enamel in individuals
with normal saliva flow rates it may take only months in patients with low saliva flow rates.Therefore,
regular dental examinations at short time intervals are important in these patients

The teeth that are most bathed in saliva, the lower canines and lower incisors, are less susceptible to
caries than the teeth in other oral locations. Such intraoral differences in caries susceptibility are in part
due to intraoral differences in clearance, and also to the numerous substances in saliva that protect
against caries. Early studies on caries and saliva composition mainly related the inorganic composition of
saliva to caries. In those times, with high caries incidence and before fluoride dentifrice, relationships
were often obtained between saliva composition and caries. Thus, bycomparing large groups of
individuals with caries to groups without caries it was often shown that high saliva buffer capacity and
high saliva concentrations of calcium and phosphate were caries protective . Therefore,several simple
tests of the saliva buffer capacity have been developed over the years and used as ‘caries tests’. The
usefulness of these tests for predicting caries risk is, however,questionable, because what can be shown
for a group maystill have little predictive value on an individual level. In addition, the introduction of
powerful caries-control measures such as fluoride dentifrice may to some extent have reduced the
importance of weaker biological factors such as saliva buffer capacity and saturation levels with respect
tohydroxyapatite.Apart from determining the inorganic chemistry of the mouth, a steady supply of
saliva will also guarantee a continuous presence of both non-immune and immune proteins in the
mouth . The immunological factors, such as secretory IgA and serum IgG antibodies,are present in saliva
at an early age, but their capacity to inactivate pathogens is highest among adults. Most non
immunoglobulin factors,however, work at almost full capacity during early childhood, thus providing
protection while the humoral immune system is still immature. In relatively infrequent cases of
immunodeficiency, it has been observed that the non-immunoglobulin factors of saliva form a back-up
system, which compensates for the lack of anti bodies. Therefore, for example, IgA-deficient patients or
patients with common variable immuno deficiency do not seem to have an increased risk of dental
caries. Furthermore,there is no evidence, despite extensive study, that seems to be genetically
determined, new aspects of saliva composition for dental caries may arise in the future.
Many of the proteins present in saliva are critical for the protection of oral tissues against fungal
or viral infections. Therefore, salivary protein composition may play an important role in the
etiology of oral disease prevalence and dental caries development. Saliva collection and storage
is easy, non-invasive, relatively inexpensive and is low risk for both the patient and medical
staff. These characteristics of saliva are advantageous when studying caries biomarkers in
infants, children and adults. In recent studies, saliva was used to evaluate the incidence of caries
by examining bacterial abundance, protein identity and concentration, and buffer capacity within
the saliva samples.
The physiological states of the human body can be examined by monitoring changes in the
composition of saliva. The changes in salivary protein composition with aging were significantly
correlated with dental caries prevalence. Saliva secretion and concentration differs depending on
age and gender. The differences in total protein concentration of human whole saliva varies
among different ages groups, as salivary protein concentration increases with increasing age.
Changes in saliva production with aging are correlated with higher caries risk and may be an
index of caries incidence. In a longitudinal study, salivary concentrations of alpha-defensins 1–3,
cathelicidins LL-37, LF, calprotectin and salivary immunoglobulin A (IgA) in 1-year-old
children were measured at baseline. The concentrations of the same salivary components were
measured in the same children at 3 years of age. The results showed increased concentrations of
antimicrobial peptides (AMPs), IgA and Streptococcus mutans over time.

Hemadi, Abdullah; Ruijie,S ; Zhou,Yuan; Zou; Jing. Salivary proteins and microbiota as biomarkers for
early childhood caries risk assessment. Int J Oral Sci. 2017 Nov; 9(11): e1