Volume 7, Issue 2 (3-2022)                   J Res Dent Maxillofac Sci 2022, 7(2): 77-85 | Back to browse issues page

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Rabiei M, Tayefeh Davalloo R, Shenavar masooleh I, Samimi M, Samami M. Salivary Calcium Level in Patients with Sjogren's Syndrome. J Res Dent Maxillofac Sci 2022; 7 (2) :77-85
URL: http://jrdms.dentaliau.ac.ir/article-1-355-en.html
Salivary Calcium Level in Patients with Sjogren's Syndrome
M Rabiei1 , R Tayefeh Davalloo2 , I Shenavar masooleh3 , M Samimi4 , M Samami * 5
1- Department of Oral and Maxillofacial Medicine, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
2- Department of Operative Dentistry, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
3- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
4- Department of Orthodontics, School of Dentistry, Tehran university of Medical Sciences, Tehran, Iran
5- Dental Sciences Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran , m_samami@alumnus.tums.ac.ir
Abstract:   (1872 Views)

Background and Aim: This study assessed the salivary calcium level, salivary flow rate, and dental problems of patients with Sjogren’s syndrome.
Materials and Methods: This case-control study was conducted on 30 patients with Sjogren’s syndrome and 30 healthy controls. The salivary flow rate, salivary calcium level, and the decayed, missing, and filled surfaces (DMFS) index were recorded. The total salivary concentration of calcium was assessed by atomic absorption spectrometry using Arsenazo III calcium-sensitive dye. The Kolmogorov-Smirnov test, the parametric independent t-test, and the Mann Whitney U test were used to compare the variables between the two groups. The Pearson’s and the Spearman’s correlation coefficients were used to analyze the relationship between quantitative variables.
Results: The salivary calcium level was insignificantly higher in the case group (4.44±0.78 mg/dL versus 4.22±0.51 mg/dL, P=0.189, independent t-test). The salivary flow rate in patients with Sjogren’s syndrome was significantly lower than that in controls (0.12±0.07 mL/minute versus 0.4±0.14 mL/minute, P<0.0001, Mann Whitney U test). The cut-off point for discrimination of patients with Sjogren’s syndrome was 0.165 mL/minute with 96% sensitivity and 90% specificity. The DMFS score was higher in the case group (78.08 versus 38.35, P<0.0001 based on independent t-test). The salivary flow rate was responsible for 34% of the changes in DMFS score while the calcium level was responsible for 0.2% of the changes.  
Conclusion: The salivary calcium level cannot serve as an indicator for the Sjogren’s syndrome while 0.165 mL/min salivary flow rate is the cutoff point for accurate case detection.
Keywords: Sjogren’s syndrome, Dental Caries, Calcium, Saliva
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Type of Study: Original article | Subject: Oral medicine
References
1. Bowman SJ. Primary Sjögren's syndrome. Lupus. 2018 Oct;27(1_suppl):32-5. [DOI:10.1177/0961203318801673] [PMID]
2. Mariette X, Criswell LA. Primary Sjögren's Syndrome. N Engl J Med. 2018 Mar 8;378(10):931-9. [DOI:10.1056/NEJMcp1702514] [PMID]
3. Mavragani CP, Moutsopoulos HM. Sjögren's syndrome. Annu Rev Pathol. 2014;9:273-85. [DOI:10.1146/annurev-pathol-012513-104728] [PMID]
4. Christodoulou MI, Kapsogeorgou EK, Moutsopoulos HM. Characteristics of the minor salivary gland infiltrates in Sjögren's syndrome. J Autoimmun. 2010 Jun;34(4):400-7. [DOI:10.1016/j.jaut.2009.10.004] [PMID]
5. Rischmueller M, Tieu J, Lester S. Primary Sjögren's syndrome. Best Pract Res Clin Rheumatol. 2016 Feb;30(1):189-220. [DOI:10.1016/j.berh.2016.04.003] [PMID]
6. Thorne I, Sutcliffe N. Sjögren's syndrome. Br J Hosp Med (Lond). 2017 Aug 2;78(8):438-42. [DOI:10.12968/hmed.2017.78.8.438] [PMID]
7. Fernandez Castro M, Sánchez-Piedra C, Andreu JL, Martínez Taboada V, Olivé A, Rosas J, et al. Factors associated with severe dry eye in primary Sjögren's syndrome diagnosed patients. Rheumatol Int. 2018 Jun;38(6):1075-82. [DOI:10.1007/s00296-018-4013-5] [PMID] [PMCID]
8. Berman N, Vivino F, Baker J, Dunham J, Pinto A. Risk factors for caries development in primary Sjogren syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Aug;128(2):117-22. [DOI:10.1016/j.oooo.2019.04.011] [PMID]
9. Both T, Dalm VA, van Hagen PM, van Daele PL. Reviewing primary Sjögren's syndrome: beyond the dryness - From pathophysiology to diagnosis and treatment. Int J Med Sci. 2017 Feb 23;14(3):191-200. [DOI:10.7150/ijms.17718] [PMID] [PMCID]
10. Hernández-Molina G, Avila-Casado C, Nuñez-Alvarez C, Cárdenas-Velázquez F, Hernández-Hernández C, Luisa Calderillo M, et al. Utility of the American-European Consensus Group and American College of Rheumatology Classification Criteria for Sjögren's syndrome in patients with systemic autoimmune diseases in the clinical setting. Rheumatology (Oxford). 2015 Mar;54(3):441-8. [DOI:10.1093/rheumatology/keu352] [PMID]
11. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H, et al. American College of Rheumatology classification criteria for Sjögren's syndrome: a data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken). 2012 Apr;64(4):475-87. [DOI:10.1002/acr.21591] [PMID]
12. Miller BE, Deutsch O, Redlich M, Konttinen YT, Benoliel R, Zaks B, et al. Sialochemistry and cortisol levels in patients with Sjogren's syndrome. Oral Dis. 2012 Apr;18(3):255-9. [DOI:10.1111/j.1601-0825.2011.01866.x] [PMID]
13. Cecchettini A, Finamore F, Puxeddu I, Ferro F, Baldini C. Salivary extracellular vesicles versus whole saliva: new perspectives for the identification of proteomic biomarkers in Sjögren's syndrome. Clin Exp Rheumatol. 2019 May-Jun;37 Suppl 118(3):240-8.
14. Leehan KM, Pezant NP, Rasmussen A, Grundahl K, Moore JS, Radfar L, Lewis DM, et al. Fatty infiltration of the minor salivary glands is a selective feature of aging but not Sjögren's syndrome. Autoimmunity. 2017 Dec;50(8):451-7. [DOI:10.1080/08916934.2017.1385776] [PMID] [PMCID]
15. Pedersen AM, Bardow A, Nauntofte B. Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjogren's syndrome. BMC Clin Pathol. 2005 Mar 1;5(1):4. [DOI:10.1186/1472-6890-5-4] [PMID] [PMCID]
16. Jensen SB, Vissink A. Salivary gland dysfunction and xerostomia in Sjögren's syndrome. Oral Maxillofac Surg Clin North Am. 2014 Feb;26(1):35-53. [DOI:10.1016/j.coms.2013.09.003] [PMID]
17. Fiyaz M, Ramesh A, Ramalingam K, Thomas B, Shetty S, Prakash P. Association of salivary calcium, phosphate, pH and flow rate on oral health: A study on 90 subjects. J Indian Soc Periodontol. 2013 Jul;17(4):454-60. [DOI:10.4103/0972-124X.118316] [PMID] [PMCID]
18. Jazaeri M, Malekzadeh H, Abdolsamadi H, Rezaei-Soufi L, Samami M. Relationship between Salivary Alkaline Phosphatase Enzyme Activity and The Concentrations of Salivary Calcium and Phosphate Ions. Cell J. 2015 Spring;17(1):159-62.
19. Fabritius-Vilpoux K, Enax J, Herbig M, Raabe D, Fabritius HO. Quantitative affinity parameters of synthetic hydroxyapatite and enamel surfaces in vitro. Bioinspired, Biomimetic and Nanobiomaterials. 2019 Feb 1;8(2):141-53. [DOI:10.1680/jbibn.18.00035]
20. Ambudkar I. Calcium signaling defects underlying salivary gland dysfunction. Biochim Biophys Acta Mol Cell Res. 2018 Nov;1865(11 Pt B):1771-7. [DOI:10.1016/j.bbamcr.2018.07.002] [PMID]
21. Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2014 Dec 22;11:45-51. [DOI:10.2147/TCRM.S76282] [PMID] [PMCID]
22. Nederfors T. Xerostomia and hyposalivation. Adv Dent Res. 2000 Dec;14:48-56. [DOI:10.1177/08959374000140010701] [PMID]
23. Yalçin F, Gurgan S, Gurgan T. The effect of menopause, hormone replacement therapy (HRT), alendronate (ALN), and calcium supplements on saliva. J Contemp Dent Pract. 2005 May 15;6(2):10-7. [DOI:10.5005/jcdp-6-2-10] [PMID]
24. Subashri A, Sowmya K, Dhanraj G. Comparison Of Dental Caries Experience Among 35-40 Year Old Population Using Dmft And Dmfs Index - An Institution Based Cross Sectional Study. Journal of Contemporary Issues in Business and Government. 2021; 27(2): 3251- 60. [DOI:10.47750/cibg.2021.27.02.331]
25. Bellagambi FG, Lomonaco T, Salvo P, Vivaldi F, Hangouët M, Ghimenti S, et al. Saliva sampling: Methods and devices. An overview. TrAC Trends in Analytical Chemistry. 2020 Mar 1;124:115781. [DOI:10.1016/j.trac.2019.115781]
26. Wasti A, Wasti J, Singh R. Estimation of salivary calcium level as a screening tool for the osteoporosis in the post-menopausal women: A prospective study. Indian J Dent Res. 2020 Mar-Apr;31(2):252-6. [DOI:10.4103/ijdr.IJDR_879_19] [PMID]
27. Bautista-Vargas M, Vivas AJ, Tobón GJ. Minor salivary gland biopsy: Its role in the classification and prognosis of Sjögren's syndrome. Autoimmun Rev. 2020 Dec;19(12):102690. [DOI:10.1016/j.autrev.2020.102690] [PMID]
28. Wicheta S, Van der Groen T, Faquin WC, August M. Minor Salivary Gland Biopsy-An Important Contributor to the Diagnosis of Sjögren Syndrome. J Oral Maxillofac Surg. 2017 Dec;75(12):2573-8. [DOI:10.1016/j.joms.2017.05.021] [PMID]
29. Wicheta S, Van der Groen T, Faquin WC, August M. Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren Syndrome. J Oral Maxillofac Surg. 2019 Aug;77(8):1628-35. [DOI:10.1016/j.joms.2019.01.052] [PMID]
30. Guellec D, Cornec D, Jousse-Joulin S, Marhadour T, Marcorelles P, Pers JO, et al. Diagnostic value of labial minor salivary gland biopsy for Sjögren's syndrome: a systematic review. Autoimmun Rev. 2013 Jan;12(3):416-20. [DOI:10.1016/j.autrev.2012.08.001] [PMID]
31. Giovelli RA, Santos MC, Serrano ÉV, Valim V. Clinical characteristics and biopsy accuracy in suspected cases of Sjögren's syndrome referred to labial salivary gland biopsy. BMC Musculoskelet Disord. 2015 Feb 15;16:30. [DOI:10.1186/s12891-015-0482-9] [PMID] [PMCID]
32. Serin G, Karabulut G, Kabasakal Y, Kandiloğlu G, Akalin T. The Importance of Minor Salivary Gland Biopsy in Sjögren Syndrome Diagnosis and the Clinicopathological Correlation. Turk Patoloji Derg. 2016;32(2):65-9. [DOI:10.5146/tjpath.2015.01346] [PMID]
33. Vitali CB, Del Papa N. Classification criteria for Sjögren's syndrome. Sjögren's Syndrome. 2016 Jan 1:47-60. [DOI:10.1016/B978-0-12-803604-4.00004-6] [PMID]
34. Baldini C, Talarico R, Tzioufas AG, Bombardieri S. Classification criteria for Sjogren's syndrome: a critical review. J Autoimmun. 2012 Aug;39(1-2):9-14. [DOI:10.1016/j.jaut.2011.12.006] [PMID]
35. Stefanski AL, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T. The Diagnosis and Treatment of Sjögren's Syndrome. Dtsch Arztebl Int. 2017 May 26;114(20):354-61. [DOI:10.3238/arztebl.2017.0354]
36. Lesan S, Hajifattahi F, Rahbar M, Mohammadi S. The effect of probiotic yoghurt on the frequency of salivary candida. Journal of Research in Dental and Maxillofacial Sciences. 2017 Jul 10;2(2):1-7. [DOI:10.29252/jrdms.2.2.1]
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