Trace elements in saliva and dental caries in young adults

Salivary elemental signature of dental caries: a systematic review and meta-analysis of ionomics studies

Trace- and macro-chemical elements are crucial for cellular physiological functioning, and their alterations in biological fluids might be associated with an underlying pathological state. Hence, this study aimed to examine and summarize the published literature concerning the application of salivary ionomics for caries diagnosis. An extensive search of studies was conducted using PubMed, EMBASE, Web of Science, and Scopus, without any language and year restriction for answering the following PECO question: "In subjects (i.e., children, adolescents, or adults) with good systematic health, are there any variations in the salivary concentrations of trace- or macro-elements between caries-free (CF) individuals and caries-active (CA) subjects?" A modified version of the QUADOMICS tool was used to assess the quality of the included studies. The Review Manager Version 5.4.1. was used for data analyses. The analysis of salivary chemical elements that significantly differed between CF and CA subjects was also performed. Thirty-four studies were included, involving 2299 CA and 1669 CF subjects, having an age range from 3 to 64 years in over 16 countries. The meta-analysis revealed a statistically significant difference (p < 0.05) in the salivary levels of calcium, phosphorus, chloride, magnesium, potassium, sodium, and zinc between CA and CF subjects, suggesting higher levels of calcium, phosphorus, potassium, and sodium in CF subjects while higher levels of chloride, magnesium, and zinc in CA patients. Half of the included studies (17/34) were considered high quality, while the remaining half were considered medium quality. Only zinc and chloride ions were found to be higher significantly and consistent in CF and CA subjects, respectively. Conflicting outcomes were observed for all other salivary chemical elements including aluminum, bromine, calcium, copper, fluoride, iron, potassium, magnesium, manganese, sodium, ammonia, nitrite, nitrate, phosphorus, lead, selenium, and sulfate ions.

Environmental tobacco smoke exposure is associated with increased levels of metals in children's saliva

BACKGROUND

Exposure to environmental tobacco smoke (ETS) has been associated with detectable levels of cotinine (a nicotine metabolite) in children's saliva. However, tobacco smoke also contains toxic and essential trace metals, including chromium (Cr), copper (Cu), lead (Pb), manganese (Mn), nickel (Ni) and zinc (Zn).

OBJECTIVE

The current study examines whether there is a relationship between ETS exposure, as gauged by salivary cotinine, and salivary levels of these metals in a subset (n = 238) of children from the Family Life Project.

METHODS

Using inductively-coupled-plasma optical emission spectrophotometry, we measured levels of metals in saliva from children at ~90 months of age. Salivary cotinine was measured using a commercial immunoassay.

RESULTS

We found that Cr, Cu, Mn, and Zn were detected in most samples (85-99%) with lower levels of detection for Pb and Ni (9.3% and 13.9% respectively). There were no significant differences in any of the metal concentrations between males and females, nor were levels associated with body mass index, although significant differences in salivary Cr and Mn by race, state and income-to-needs ratio were observed. Children with cotinine levels >1 ng/ml had higher levels of Zn (b = 0.401, 95% CI: 0.183 to 0.619; p = 0.0003) and Cu (b = 0.655, 95% CI: 0.206 to 1.104; p = 0.004) compared to children with levels <1 ng/ml, after controlling for multiple confounders, including sex, race, BMI and income-to-needs ratio. Further, we show that children whose cotinine levels were >1 μg/L were more likely to have detectable levels of Pb in their saliva (b = 1.40, 95% CI: 0.424 to 2.459; p = 0.006) compared to children with cotinine levels <1 ng/ml, also considering confounders.

IMPACT STATEMENT

This is the first study to demonstrate significant associations between salivary cotinine and salivary levels of Cu, Zn and Pb, suggesting that environmental tobacco smoke exposure my be one source of increased children's exposure to heavy metals. This study also demonstrates that saliva samples can be used to measure heavy metal exposure, and thus serve as a non-invasive tool for assessing a broader range of risk indicators.

Relationship of levels of trace elements in saliva and dental caries in preschool children using total reflection X-ray fluorescence technique (TXRF)⋆

BACKGROUND

Considering that studies on the relationship between dental caries and trace elements present contradictory and inconclusive results, the purpose of this study was to determine the levels of salivary trace elements in saliva samples of preschool children and investigate their relationship with dental caries.

METHODS

In total, 120 samples of unstimulated saliva were collected from children aged 36-72 months, of both sexes, who participate in the preventative educational program in oral health at the State University of Londrina, Brazil. The children were divided into two groups, caries (n = 60) and non-caries (n = 60). Levels of Al, Cu, Fe, Mn, and Zn were analyzed by total reflection X-ray fluorescence (TXRF). Descriptive statistics, the Student's t-test, Mann-Whitney U test, and Pearson's Chi-squared test were performed (P < 0.05).

RESULTS

The concentrations of Mn and Fe were significantly higher in the caries group (Mn =0.015 mg/L [0.007-0.020]; Fe =0.080 mg/L [0.031-0.239] than the non-caries group (Mn =0.010 mg/L [0.001 - 0.017]; Fe =0.044 mg/L [0.023 - 0.107]).

CONCLUSION

The results suggest a relationship between trace elements and dental caries, indicating possible involvement of these elements in the metabolism of microorganisms involved in the carious process. In addition, the use of TXRF presented satisfactory results, with a simple and fast methodology for the detection of the studied elements.

Mapping the Inorganic and Proteomic Differences among Different Types of Human Teeth: A Preliminary Compositional Insight

In recent years, studies on mineralized tissues are becoming increasingly popular not only due to the diverse mechanophysical properties of such materials but also because of the growing need to understand the intricate mechanism involved in their assembly and formation. The biochemical mechanism that results in the formation of such hierarchical structures through a well-coordinated accumulation of inorganic and organic components is termed biomineralization. Some prime examples of such tissues in the human body are teeth and bones. Our current study is an attempt to dissect the compositional details of the inorganic and organic components in four major types of human teeth using mass spectrometry-based approaches. We quantified inorganic materials using inductively coupled plasma resonance mass spectrometry (ICP-MS). Differential level of ten different elements, Iron (Fe), Cadmium (Cd), Potassium (K), Sulphur (S), Cobalt (Co), Magnesium (Mg), Manganese (Mn), Zinc (Zn), Aluminum (Al), and Copper (Cu) were quantified across different teeth types. The qualitative and quantitative details of their respective proteomic milieu revealed compositional differences. We found 152 proteins in total tooth protein extract. Differential abundance of proteins in different teeth types were also noted. Further, we were able to find out some significant protein-protein interaction (PPI) backbone through the STRING database. Since this is the first study analyzing the differential details of inorganic and organic counterparts within teeth, this report will pave new directions to the compositional understanding and development of novel in-vitro repair strategies for such biological materials.

Salivary metals, age, and gender correlate with cultivable oral Candida carriage levels

Background: Little is known about the normal range of metal levels in unstimulated saliva, nor whether these might impact Candida carriage in healthy individuals. Both are important in determining which populations are at risk for candidiasis, as the availability of metal ions can influence the growth and pathogenesis of Candida albicans.

Objective: We quantified salivary metals of healthy individuals to determine the correlation with C. albicans oral colonization.

Design: Unstimulated whole saliva was collected from healthy adults and plated to determine fungal carriage, and metal content was measured using ICP-mass spectrometry (ICP-MS).

Results: Zinc was most abundant, followed by iron, copper, manganese, and nickel. Cultivable oral Candida carriage was found in 48% of people. Total protein levels did not differ in salivas from donors with or without carriage. However, innate fungicidal activity was increased in donors with carriage; correlations between levels of several metals were stronger in salivas with fungal carriage, indicating a shift in the oral environment. Concentrations of copper and manganese, as well as age and gender, were significantly predictive of carriage levels in a multiple regression model.

Conclusions: Salivary copper and manganese content along with age and gender could be used as a predictive metric for individuals that are more susceptible to Candida overgrowth.

Heavy metals in human teeth dentine: A bio-indicator of metals exposure and environmental pollution

With rapid urbanization and large-scale industrial activities, modern human populations are being increasingly subjected to chronic environmental heavy metal exposures. Elemental uptake in tooth dentine is a bioindicator, the uptake occurring during the formation and mineralization processes, stored to large extent over periods of many years. The uptake includes essential elements, most typically geogenic dietary sources, as well as non-essential elements arising through environmental insults. In this study, with the help of the Dental Faculty of the University of Malaya, a total of 50 separate human teeth were collected from dental patients of various ethnicity, age, gender, occupation, dietary habit, residency, etc. Analysis was conducted using inductively coupled plasma-mass spectrometry (ICP-MS), most samples indicating the presence of the following trace elements, placed in order of concentration, from least to greatest: As, Mn, Ba, Cu, Cr, Pb, Zn, Hg, Sb, Al, Sr, Sn. The concentrations have been observed to increase with age. Among the ethnic groups, the teeth of ethnic Chinese showed marginally greater metal concentrations than those of the Indians and Malays, the teeth dentine of females generally showing greater concentrations than that of males. Greater concentrations of Hg, Cu and Sn were found in molars while Pb, Sr, Sb and Zn were present in greater concentrations in incisors. With the elevated concentration levels of heavy metals in tooth dentine reflecting pollution from industrial emissions and urbanization, it is evident that human tooth dentine can provide chronological information on exposure, representing a reliable bio-indicator of environmental pollution.

The effect of social stress on salivary trace elements

Social stress can alter the saliva in favor of metabolism of trace elements. This study aimed to assess the effect of social stress on salivary copper (Cu), zinc (Zn), manganese (Mn), and iron (Fe) contents in dental students before and after a comprehensive English test. Twelve students with an average age of 27 years were selected from three dental schools. The students were carries-free, and salivary samples were collected 1 week before the test day and right before the comprehensive English test. Unstimulated saliva was collected from the participants. The pH of the saliva samples was measured using a portable pH meter, and the salivary trace element contents were determined using an atomic absorption spectrophotometer. After checking data to be normally distributed, Student's paired t test was used for statistical analysis. Salivary pH significantly increased right before the English test. Salivary Cu concentration decreased in students after the test (P > 0.05). The level of Zn, Mn, and Fe increased, while only Mn change was statistically significant (P < 0.001). Under the limitations of this study, induction of social stress led to a significant increase in Mn concentration in the saliva. The salivary Cu, Zn, and Fe contents, however, did not exhibit significant changes. Changes in salivary inorganic trace element content, as a result of physiological stress, might influence health of teeth, enamel, and oral mucosal tissues.

Trace elements can influence the physical properties of tooth enamel

In previous studies, we showed that the size of apatite nanocrystals in tooth enamel can influence its physical properties. This important discovery raised a new question; which factors are regulating the size of these nanocrystals? Trace elements can affect crystallographic properties of synthetic apatite, therefore this study was designed to investigate how trace elements influence enamel's crystallographic properties and ultimately its physical properties. The concentration of trace elements in tooth enamel was determined for 38 extracted human teeth using inductively coupled plasma-optical emission spectroscopy (ICP-OES). The following trace elements were detected: Al, K, Mg, S, Na, Zn, Si, B, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sb, Se and Ti. Simple and stepwise multiple regression was used to identify the correlations between trace elements concentration in enamel and its crystallographic structure, hardness, resistance to crack propagation, shade lightness and carbonate content. The presence of some trace elements in enamel was correlated with the size (Pb, Ti, Mn) and lattice parameters (Se, Cr, Ni) of apatite nanocrystals. Some trace elements such as Ti was significantly correlated with tooth crystallographic structure and consequently with hardness and shade lightness. We conclude that the presence of trace elements in enamel could influence its physical properties.

Salivary copper and zinc levels in oral pre-malignant and malignant lesions

Recent technological advances have made saliva as a tool for diagnosis of many things; among them are hormone imbalances, liver function, immunodeficiency and even cancer.

Mn and Cu concentrations in mixed saliva of elementary school children in relation to sex, age, and dental caries

To examine the standard Mn and Cu concentrations in mixed saliva from children and the relationship between these levels and dental caries, resting mixed saliva samples obtained from 527 children of an elementary school in Kitakyushu City were collected at 10:00-11:30 a.m. during December 2004. The Mn and Cu concentrations were determined using simultaneous multi-element atomic absorption spectrometry. The standard Mn and Cu levels were 22.0+/-15.2 and 3.8+/-4.1ng/mL, respectively, in the sound teeth group. Mn levels were significantly higher in boys (25.4+/-17.4ng/mL) than girls (19.1+/-12.3ng/mL) and also higher in upper (25.5+/-16.4ng/mL) than lower (19.0+/-13.5ng/mL) grades. The Cu level was unaffected by sex and age in the sound teeth group. The Cu level in children with caries experience (5.7+/-5.3ng/mL) was significantly higher than that of the sound teeth group. Moreover, the Cu levels in children with untreated caries were significantly higher than that of the sound teeth group, and increased with the number of untreated teeth. No significant difference was found in the Cu concentrations between the group in which all decayed teeth were treated and the sound teeth group. The Mn levels were similar with or without caries and treatment. These findings indicate that the Mn level in mixed saliva depended on sex and age, and suggest the possibility of Cu dissolving into mixed saliva by demineralization due to dental caries.

Study of salivary strontium and silver concentrations in primary school children related to dental caries

To investigate the relationship between the salivary Sr and Ag concentrations and tooth conditions, saliva was collected from 521 primary school children in Kitakyushu. The salivary Sr and Ag levels were determined using an atomic absorption spectrophotometry. The salivary Sr and Ag levels were 7.73 +/- 3.62 and 0.03 +/- 0.15 ng/ml, respectively, in the sound teeth group. No sex differences were noted in either element level, nor were there differences between the lower and upper grade groups. In the caries teeth group, the Sr and Ag levels were significantly higher than those in the sound teeth group. The Sr level was significantly increased by caries experience regardless caries being treated or untreated. In second to third grade children, in whom the fluoride experience rate was high, the Sr level tended to be lower than that in the other grades. The salivary Ag level increased as the number of teeth treated with silver alloy rose. These findings suggested that the salivary Sr level increases because of caries susceptibility, and F inhibits Sr dissolution from the teeth. The salivary Ag level varied depending on the type of dental filling and was dependent on the amount of silver alloy in children treated with low-fusing silver alloy.

Trace elements and electrolytes in human resting mixed saliva after exercise

OBJECTIVES

Exercise is known to cause changes in the concentration of salivary components such as amylase, Na, and Cl. The aim of this investigation was to evaluate the effect of physical exercise on the levels of trace elements and electrolytes in whole (mixed) saliva.

METHODS

Forty subjects performed a maximal exercise test on a cycle ergometer. Samples of saliva were obtained before and immediately after the exercise test. Sample concentrations of Fe, Mg, Sc, Cr, Mn, Co, Cu, Zn, Se, Sr, Ag, Sb, Cs, and Hg were determined by inductively coupled plasma mass spectrometry and concentrations of Ca and Na by atomic absorption spectrometry.

RESULTS

After exercise, Mg and Na levels showed a significant increase (p < 0.05) while Mn levels fell (p < 0.05). Zn/Cu molar ratios were unaffected by exercise.

CONCLUSIONS

Intense physical exercise induced changes in the concentrations of only three (Na, Mg, and Mn) of the 16 elements analysed in the saliva samples. Further research is needed to assess the clinical implications of these findings.