Dr. Vidya Bhat S et al / AJMSCR Volume 1 Issue 1 May.-June.

2014

Available online at www.ajmscr.org ISSN AF

Research – Article

ASIAN JOURNAL OF MEDICAL SCIENCES AND CLINICAL RESEARCH

ALTERATIONS IN SALIVARY COMPONENTS AFTER DENTURE WEARING

Dr. Vidya Bhat S*1, Dr. Naushad P1, Dr. K. Kamalakanth Shenoy1, Dr. Nivedita L. Rao2
1
Department of Prosthodontics Yenepoya Dental College, Mangalore
2
Department of Biochemistry, Yenepoya Medical College Yenepoya University, Mangalore

Received: 6 Apr. 2014; Revised: 6 May 2014; Accepted: 22 June. 2014; Available online: 5 July 2014

ABSTRACT
OBJECTIVE: To estimate and compare salivary uric acid and pH levels in completely edentulous individuals before and
after wearing complete dentures.
MATERIALS AND METHODS: In the present study salivary uric acid and pH levels were estimated and compared in 30
completely edentulous subjects before and after wearing complete dentures.
OBSERVATIONS AND RESULTS: The mean values for salivary pH and uric acid were found to be significantly
decreased after denture insertion. Decrease in saliva uric acid level after denture wearing indicates decreased oral antioxidant
potential. Decrease in saliva pH denotes increased acidity of saliva.
CONCLUSION: The changes in pH and uric acid levels observed in the present study are not favorable outcomes in
prosthodontic interventions. Adoption of better oral hygiene, denture cleaning practices and adequate intake of antioxidant
Vitamin C may be recommended to these denture wearers to prevent the possible oxidative damage caused by decreased
saliva uric acid.
Keywords: Saliva, uric acid, pH, edentulous subjects, complete denture wearers

INTRODUCTION

Removable complete denture is a widely accepted treatment modality for complete edentulism. Acrylic resins
have been widely used to fabricate dentures due to their desirable characteristics and have replaced all other
previously used materials1,2.

Saliva plays a significant role in maintaining oral health in denture wearers. Antioxidants in saliva represent one
of the defense mechanisms against free radical induced oxidative stress (OS). Uric acid is the major antioxidant
present in saliva with clinical importance in monitoring oral OS3. OS represents the imbalance between the
production of highly reactive molecular species such as reactive oxygen species (ROS) and the antioxidant
defense systems4. Components of saliva which exhibit buffering capacity such as bicarbonate, phosphate and
proteins protect the oral cavity against damage due to changes in pH5, 6.

An understanding of the changes in a patient’s saliva characteristics can give the dentist valuable information
which can influence treatment choices and strategies. But, there are only few reports in literature which have

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examined levels of salivary components before and after prosthodontic intervention. The present study was
undertaken to identify changes in the oral environment in completely edentulous individuals after wearing
complete denture by estimating markers of oxidative stress and buffering capacity in their saliva. The objective
of this study was to estimate and compare salivary uric acid and pH levels in completely edentulous individuals
before and after wearing complete dentures.
MATERIALS AND METHODS
Selection of Subjects
30 completely edentulous subjects attending the Department of Prosthodontics of Yenepoya Dental College and
Hospital, Deralakatte, Mangalore, for complete dentures were selected for the study. Ethical clearance for
conducting the study was obtained from the Institutional Ethics committee. Informed consent was obtained
from all the subjects. The subjects were examined for oral lesions following a complete medical history taking.
Patients with systemic diseases, oral lesions, smoking habits, recent history of infections, inflammatory
conditions, surgical procedures and trauma were excluded from the study.
Saliva sample collection
Saliva samples were collected from subjects immediately before the insertion of dentures. Subjects were
recalled one month after the denture insertion for collecting their second set of saliva samples.
Unstimulated whole saliva was collected by passive drooling at least 2 hours after any food intake. Samples
visibly contaminated with blood were discarded. After rinsing mouth 3-4 times with water, saliva was allowed
to accumulate in the floor of the mouth for approximately 2 minutes and repeatedly expectorated into ice-chilled
polypropylene vials to collect about 2 mL each. The time and date of specimen collection were recorded. The
samples were stored at −20°C to avoid bacterial growth until their analyses.
Saliva pH estimation
The salivary pH was recorded qualitatively by dipping pH strips (Bright B. Rose, Chemocraft) in the whole
saliva aliquots and the colors obtained were matched on the color scale.
Saliva uric acid estimation
Saliva samples were placed on ice immediately after collection. Then they were centrifuged at 3000 rpm for 15
min. and the supernatants were used for uric acid analyses. Analyses were performed using VITROS Uric slides
and VITROS Chemistry Products Calibrator Kit on VITROS Chemistry Systems Automated analyzer.
Analysis of data
Data were statistically analysed by paired t- test using SPSS 13.0 statistical software. p value < 0.05 was
considered to be statistically significant. The effect of age and gender on the change was analysed by Mann-
Whitney test.

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RESULTS
The study included 30 completely edentulous subjects whose characteristics are shown in Table 1.
Table 1: Characteristics of the study group
Std. Distribution
Mean Deviation (Number)
Age (yrs) 53.47 9.30 50 and below (11)
> 50 (19)
Gender Female 10, Male 20

Table 2: Saliva pH values in edentulous individuals before and after wearing complete dentures
HS: Highly significant

95% Confidence
N Std. Change Interval for Mean
Mean Deviation (%) Lower Upper t value p value
Bound Bound
Pre-denture
30 6.70 .23 4.48 6.62 6.79 9.655 p<0.001
insertion
Post-denture
30 6.40 .20 6.33 6.48 HS
insertion

Saliva pH significantly decreased with mean pH 6.40 in edentulous subjects one month after insertion of
complete denture compared to their mean pH value of 6.70 before denture insertion (Table 2, Figure 1).

Figure 1: Saliva pH

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Table 3: Saliva uric acid levels in completely edentulous individuals before and after wearing complete
dentures

95% Confidence
Interval for Mean
Std. Change Lower Upper
N Mean Deviation (%) Bound Bound t value p value
Pre-denture
30 3.10 1.53 16.47 2.53 3.67 3.991 p<0.001
insertion
Post-denture
30 2.59 1.36 2.08 3.09 HS
insertion
HS: Highly significant

Salivary uric acid was found to decrease significantly with mean value 2.59 mg/dL in edentulous subjects one
month after insertion of complete denture compared to the mean value 3.10 mg/dL before denture insertion
(Table 3, Figure 2).

Figure 2: Saliva uric acid

Table 4: Effect of gender on the changes in saliva parameters

Parameter Gender N Mean Std. deviation Change Mann-Whitney p

difference of difference (%) test Z value value

pH Female 10 .230 .116 3.43 1.247 .212

Male 20 .335 .184 5.00 NS
Uric acid Female 10 .140 .738 7.18 1.925 .054
Male 20 .695 .618 18.94 NS
NS: Not significant

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Table 5: Effect of age on the changes in saliva parameters

Parameter Age N Mean Std. deviation Change Mann-Whitney p

in years difference of difference (%) test Z value value

pH 50 and below 10 .23 .11 3.38 1.464 .143

> 50 20 .34 .19 5.11 NS
Uric acid 50 and below 10 .18 .69 7.72 2.100 .036
> 50 20 .70 .65 19.85 Sig
NS: Not significant Sig: Significant

DISCUSSION
The normal range of salivary pH is 5.6 to 7.0 with an average value of 6.7. Saliva buffers maintain the pH and
offer protection in the mouth by preventing colonization of potentially pathogenic microorganisms, by denying
them optimization of environmental conditions. Additionally, saliva buffers neutralize the acids produced by
acidogenic microorganisms and prevent enamel demineralization6.

Provision of acrylic resin dentures is believed to alter the makeup of oral microflora by encouraging the growth
of certain microorganisms with can adhere to and colonize various surfaces of this material. Studies have
reported that samples of saliva from edentulous patients before wearing dentures contained no S. mutans,
however, these started to appear after denture wearing7. Saliva pH has been reported to be associated with
bacterial number and increase in salivary bacteria is believed to reduce pH of saliva in complete denture
wearers8. Wearing of complete dentures for one month is reported to have altered the microbial flora of the oral
cavity with significant increase in the total colony forming units and appearance of Streptococcus mutans (S.
mutans)9. Alteration of microbial flora and appearance of S. mutans after denture wearing has been attributed to
the presence of micro-porosities in the acrylic resin surface to which salivary pellicle is attached, colonization
of the pellicle with microorganisms and denture plaque formation10,11.

A study on the influence of salivary acidity on leachability of denture base acrylic resin revealed that lower pH
increased leachability of methylmethacrylate in artificial saliva and suggested that chemotoxic actions of auto-
polymerized resins are potentially ascribable to methylmethacrylate12.
The decrease in salivary pH observed in the present study could have been caused by increase in oral bacteria.
Decrease in pH in turn, favors microbial growth, alters leachability of denture resins, which can further disturb
the oral environment. This emphasizes the need for adoption of better oral hygiene and denture cleaning
practices to prevent the decrease in salivary pH observed in complete denture wearers of this study.

Very few clinical studies have evaluated the salivary pH changes after the insertion of complete dentures. The
finding of significant decrease in saliva pH obtained in the present study differs from that obtained in a previous

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study which reported significant increase in saliva pH in complete denture wearers 15 days after denture
insertion13. However in the study, electro pH-meter had been employed for pH measurement whereas in the
present study, pH indicator strips were used. The differences in duration of denture wearing that is 15 days
versus 1 month in the present study, could also have contributed to the difference in findings.

Uric acid is the major antioxidant in saliva accounting for more than 85% of total antioxidant capacity of both
unstimulated and stimulated saliva, with clinical importance in monitoring oxidative stress (OS)3,14. The
decrease in saliva uric acid levels in edentulous subjects after complete denture insertion in the present study
illustrates the presence of oral OS. OS has been implicated in the pathology of several oral diseases such as oral
lichen planus and oral cancer15. Decrease in the levels of saliva antioxidants such as uric acid may be considered
an important mechanism by which toxic effects of free radicals can initiate precancerous transformations, oral
diseases and destroy the oral cavity homeostasis16. The antioxidant Vitamin C has been reported to restore or
increase saliva uric acid level17. Therefore adequate intake of Vitamin C may be recommended to these denture
wearers for its protective effect in preventing oxidative damage.

According to the knowledge of the authors, there are no other reports on saliva uric acid levels or total
antioxidant capacity in edentulous subjects or in denture wearers. The findings of this study may therefore be
the first report in these subjects.

Gender did not have significant influence on the observed changes in pH and uric acid levels before and after
wearing complete dentures (Table 4). Saliva uric acid level but not pH, was found to be influenced by age of the
subjects in the present study (Table 5). Uric acid values were higher in older subjects.

The findings on patient saliva characteristics in this study which have not been reported earlier can be further
confirmed by larger studies and longer evaluation periods.

CONCLUSION
Wearing of acrylic complete dentures for one month lead to significant decreases in levels of salivary pH and
the antioxidant uric acid. Decrease in saliva pH which can be caused by increase in bacteria indicates that
adoption of better oral hygiene and denture cleaning practices may be recommended to these complete denture
wearers. Adequate intake of Vitamin C known to increase saliva uric acid levels may prevent oxidative damage
caused by decrease in uric acid.

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