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Díaz-Fabregat B, Ramírez-Carmona W, Cannon ML, Monteiro DR, Pessan JP, Antoniali C. Are salivary NO 2- / NO 2- and NO 3- levels biomarkers for dental caries in children? Systematic review and meta-analysis. Nitric Oxide 2024; 144:11-19. [PMID: 38185241 DOI: 10.1016/j.niox.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
The literature is conflicting regarding salivary nitrite (NO2-)/nitrite and nitrate (NO2- and NO3-) levels in children affected by dental caries. For this reason, a systematic review to provide a consensus on the subject was propose, whose objective is to verify whether these molecules could be used as biomarkers in children with caries. A comprehensive search was performed on online database and eleven articles were included in the meta-analysis. The methodological quality of studies was assessed by Newcastle-Ottawa Scale recommended for case-control studies and by AXIS tool for cross-sectional studies. Grading of Recommendations Assessment, Development and Evaluation was used for the assessment of the certainty of the evidence for each outcome. The results showed lower NO2- levels in the group of children affected by dental caries (SMD = -2.18 [-3.24, -1.13], p < 0.01). Age, saliva collection and methods of evaluation can impact the results. When evaluating the severity of the condition, an important variation was detected in relation to the different evaluation methods NO2-/NO2- and NO3-. In conclusion, based on the evidence presented, the results suggest that NO2- levels in saliva are a possible biomarker of dental caries. Results should be evaluated with caution due to the very low evidence from primary studies. Longitudinal studies are necessary to strengthen this hypothesis.
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Affiliation(s)
- Beatriz Díaz-Fabregat
- São Paulo State University (UNESP), Araçatuba School of Dentistry, Department of Preventive and Restorative Dentistry, Rua José Bonifácio 1193 Araçatuba, SP, Zip code 16015-050, Brazil
| | - Wilmer Ramírez-Carmona
- São Paulo State University (UNESP), Araçatuba School of Dentistry, Department of Preventive and Restorative Dentistry, Rua José Bonifácio 1193 Araçatuba, SP, Zip code 16015-050, Brazil
| | - Mark Lloyd Cannon
- Feinberg School of Medicine, Northwestern University, Ann and Robert Lurie Childrens Hospital, 420 E Superior St, Chicago, IL, 60611, USA
| | - Douglas Roberto Monteiro
- São Paulo State University (UNESP), Araçatuba School of Dentistry, Department of Preventive and Restorative Dentistry, Rua José Bonifácio 1193 Araçatuba, SP, Zip code 16015-050, Brazil; University of Western São Paulo (UNOESTE), Postgraduate Program in Health Sciences, Rua José Bongiovani 700 Presidente Prudente, SP, Zip code 19050-920, Brazil
| | - Juliano Pelim Pessan
- São Paulo State University (UNESP), Araçatuba School of Dentistry, Department of Preventive and Restorative Dentistry, Rua José Bonifácio 1193 Araçatuba, SP, Zip code 16015-050, Brazil
| | - Cristina Antoniali
- São Paulo State University (UNESP), Araçatuba School of Dentistry, Department of Basic Science, Rua José Bonifácio 1193 Araçatuba, SP, Zip code 16015-050, Brazil.
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Zhang H, Qin L. Positive feedback loop between dietary nitrate intake and oral health. Nutr Res 2023; 115:1-12. [PMID: 37207592 DOI: 10.1016/j.nutres.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/12/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023]
Abstract
Nitrate was once thought to be an inert end-product of endothelial-derived nitric oxide (NO) heme oxidation; however, this view has been radically revised over the past few decades. Following the clarification of the nitrate-nitrite-NO pathway, accumulated evidence has shown that nitrate derived from the diet is a supplementary source of endogenous NO generation, playing important roles in a variety of pathological and physiological conditions. However, the beneficial effects of nitrate are closely related with oral health, and oral dysfunction has an adverse effect on nitrate metabolism and further impacts overall systemic health. Moreover, an interesting positive feedback loop has been identified between dietary nitrate intake and oral health. Dietary nitrate's beneficial effect on oral health may further improve its bioavailability and promote overall systemic well-being. This review aims to provide a detailed description of the functions of dietary nitrate, with an emphasis on the key role oral health plays in nitrate bioavailability. This review also provides recommendations for a new paradigm that includes nitrate therapy in the treatment of oral diseases.
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Affiliation(s)
- Haoyang Zhang
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Lizheng Qin
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
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Are Dental Caries Associated with Oxidative Stress in Saliva in Children and Adolescents? A Systematic Review. Metabolites 2022; 12:metabo12090858. [PMID: 36144263 PMCID: PMC9502212 DOI: 10.3390/metabo12090858] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: This systematic review aimed to assess whether dental caries is associated with oxidative salivary stress. Methods: The searches were carried out in electronic databases, including PubMed, Scopus, Web of Science, the Cochrane Library, LILACS, OpenGrey, and Google Scholar, without restrictions on the date of publication and language. The acronym PECO was used, in which the participants (P) were children and adolescents exposed (E) to dental caries compared (C) to those without dental caries, with the outcome (O) of modulation of oxidative biochemical parameters. After the search retrieval, the duplicates were removed, and the articles were evaluated by title and abstract, following the inclusion and exclusion criteria. Then, the papers were read and thoroughly assessed. After selection, the risk of bias assessment and qualitative synthesis were performed using the Newcastle-Ottawa Scale (NOS) for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the level of evidence. Results: A total of 5790 studies were found, and 30 articles were considered eligible and were included for the qualitative synthesis and the level of evidence assessment. The studies showed an imbalance of the antioxidant and pro-oxidant parameters in individuals with dental caries, with primarily increases in both total antioxidant capacity and lipid peroxidation. Most articles showed a low risk of bias, having comparability as the main issue. When exploring through GRADE, a very low level of evidence was found. Conclusions: It was possible to observe an association between oxidative stress and dental caries, showing a disbalance of antioxidants and pro-oxidants, but the evidence level was still very low.
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Wyszyńska M, Nitsze-Wierzba M, Czelakowska A, Kasperski J, Żywiec J, Skucha-Nowak M. An Evidence-Based Review of Application Devices for Nitric Oxide Concentration Determination from Exhaled Air in the Diagnosis of Inflammation and Treatment Monitoring. Molecules 2022; 27:4279. [PMID: 35807523 PMCID: PMC9268246 DOI: 10.3390/molecules27134279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/01/2023] Open
Abstract
The measurement of nitric oxide (NO) in exhaled air is used in diagnostics and monitoring the pathologies not only in the respiratory system but also in the oral cavity. It has shown a huge increase in its level in asthma and diseases of the oral cavity. It seems reasonable to undertake research on the impact of inflammation on the level of NO in exhaled air. The aim of the study is to make an evidence-based review of the application of NO levels in exhaled air in the diagnosis of inflammation and treatment monitoring on the basis of selected measuring devices. METHODS AND RESULTS This paper presents an example of the application of NO measurement in exhaled air in individual human systems. Selected measuring devices, their non-invasiveness, and their advantages are described. DISCUSSION The usefulness of this diagnostic method in pathologies of the oral cavity was noted. CONCLUSIONS Measuring the level of NO in exhaled air seems to be a useful diagnostic method.
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Affiliation(s)
- Magdalena Wyszyńska
- Department of Dental Materials, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland
| | - Monika Nitsze-Wierzba
- Department of Dental Prosthetics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (M.N.-W.); (A.C.); (J.K.)
| | - Aleksandra Czelakowska
- Department of Dental Prosthetics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (M.N.-W.); (A.C.); (J.K.)
| | - Jacek Kasperski
- Department of Dental Prosthetics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (M.N.-W.); (A.C.); (J.K.)
| | - Joanna Żywiec
- Department of Clinical Pharmacology, Diabetology and Nephrology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland;
| | - Małgorzata Skucha-Nowak
- Department of Dental Propedeutics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland;
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Morou-Bermúdez E, Torres-Colón JE, Bermúdez NS, Patel RP, Joshipura KJ. Pathways Linking Oral Bacteria, Nitric Oxide Metabolism, and Health. J Dent Res 2022; 101:623-631. [PMID: 35081826 DOI: 10.1177/00220345211064571] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nitrate-reducing oral bacteria have gained a lot of interest due to their involvement in nitric oxide (NO) synthesis and its important cardiometabolic outcomes. Consortia of nitrate-metabolizing oral bacteria associated with cardiometabolic health and cognitive function have been recently identified. Longitudinal studies and clinical trials have shown that chronic mouthwash use is associated with increased blood pressure and increased risk for prediabetes/diabetes and hypertension. Concurrently, recent studies are beginning to shed some light on the complexity of nitrate reduction pathways of oral bacteria, such as dissimilatory nitrate reduction to ammonium (DNRA), which converts nitrite into ammonium, and denitrification, which converts nitrite to NO, nitrous oxide, and dinitrogen. These pathways can affect the composition and metabolism of the oral microbiome; consequently, salivary nitrate and nitrite metabolism have been proposed as targets for probiotics and oral health. These pathways could also affect systemic NO levels because NO generated through denitrification can be oxidized back to nitrite in the saliva, thus facilitating flux along the NO3--NO2--NO pathway, while DNRA converts nitrite to ammonium, leading to reduced NO. It is, therefore, important to understand which pathway predominates under different oral environmental conditions, since the clinical consequences could be different for oral and systemic health. Recent studies show that oral hygiene measures such as tongue cleaning and dietary nitrate are likely to favor denitrifying bacteria such as Neisseria, which are linked with better cardiometabolic health. A vast body of literature demonstrates that redox potential, carbon-to-nitrate ratio, and nitrate-to-nitrite ratio are key environmental drivers of the competing denitrification and DNRA pathways in various natural and artificial ecosystems. Based on this information, a novel behavioral and microbial model for nitric oxide metabolism and health is proposed, which links lifestyle factors with oral and systemic health through NO metabolism.
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Affiliation(s)
- E Morou-Bermúdez
- University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, Puerto Rico
| | - J E Torres-Colón
- University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, Puerto Rico
| | - N S Bermúdez
- Department of Linguistics, Harvard University, Cambridge, MA, USA
| | - R P Patel
- Department of Pathology, University of Alabama at Birmingham and Center for Free Radical Biology, AL, USA
| | - K J Joshipura
- University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, Puerto Rico.,T. H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
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Burleigh MC, Sculthorpe N, Henriquez FL, Easton C. Nitrate-rich beetroot juice offsets salivary acidity following carbohydrate ingestion before and after endurance exercise in healthy male runners. PLoS One 2020; 15:e0243755. [PMID: 33320868 PMCID: PMC7737958 DOI: 10.1371/journal.pone.0243755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022] Open
Abstract
There have been recent calls for strategies to improve oral health in athletes. High carbohydrate diets, exercise induced dehydration and transient perturbations to immune function combine to increase oral disease risk in this group. We tested whether a single dose of nitrate (NO3-) would offset the reduction in salivary pH following carbohydrate ingestion before and after an exercise bout designed to cause mild dehydration. Eleven trained male runners ( V˙O2max 53 ± 9 ml∙kg-1∙min-1, age 30 ± 7 years) completed a randomised placebo-controlled study comprising four experimental trials. Participants ingested the following fluids one hour before each trial: (a) 140 ml of water (negative-control), (b) 140 ml of water (positive-control), (c) 140 ml of NO3- rich beetroot juice (~12.4 mmol NO3-) (NO3- trial) or (d) 140 ml NO3- depleted beetroot juice (placebo-trial). During the negative-control trial, participants ingested 795 ml of water in three equal aliquots: before, during, and after 90 min of submaximal running. In the other trials they received 795 ml of carbohydrate supplements in the same fashion. Venous blood was collected before and after the exercise bout and saliva was sampled before and repeatedly over the 20 min following carbohydrate or water ingestion. As expected, nitrite (NO2-) and NO3- were higher in plasma and saliva during the NO3- trial than all other trials (all P<0.001). Compared to the negative-control, salivary-pH was significantly reduced following the ingestion of carbohydrate in the positive-control and placebo trials (both P <0.05). Salivary-pH was similar between the negative-control and NO3- trials before and after exercise despite ingestion of carbohydrate in the NO3- trial (both P≥0.221). Ingesting NO3- attenuates the expected reduction in salivary-pH following carbohydrate supplements and exercise-induced dehydration. NO3- should be considered by athletes as a novel nutritional strategy to reduce the risk of developing acidity related oral health conditions.
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Affiliation(s)
- Mia C. Burleigh
- Institute of Clinical Health and Exercise Sciences, University of the West of Scotland, Blantyre, Scotland
| | - Nicholas Sculthorpe
- Institute of Clinical Health and Exercise Sciences, University of the West of Scotland, Blantyre, Scotland
| | - Fiona L. Henriquez
- Institute of Biomedical and Environmental Health Research, University of the West of Scotland, Blantyre, Scotland
| | - Chris Easton
- Institute of Clinical Health and Exercise Sciences, University of the West of Scotland, Blantyre, Scotland
- * E-mail:
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Rosier BT, Buetas E, Moya-Gonzalvez EM, Artacho A, Mira A. Nitrate as a potential prebiotic for the oral microbiome. Sci Rep 2020; 10:12895. [PMID: 32732931 PMCID: PMC7393384 DOI: 10.1038/s41598-020-69931-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
The salivary glands actively concentrate plasma nitrate, leading to high salivary nitrate concentrations (5–8 mM) after a nitrate-rich vegetable meal. Nitrate is an ecological factor that can induce rapid changes in structure and function of polymicrobial communities, but the effects on the oral microbiota have not been clarified. To test this, saliva of 12 healthy donors was collected to grow in vitro biofilms with and without 6.5 mM nitrate. Samples were taken at 5 h (most nitrate reduced) and 9 h (all nitrate reduced) of biofilm formation for ammonium, lactate and pH measurements, as well as 16S rRNA gene Illumina sequencing. Nitrate did not affect biofilm growth significantly, but reduced lactate production, while increasing the observed ammonium production and pH (all p < 0.01). Significantly higher levels of the oral health-associated nitrate-reducing genera Neisseria (3.1 ×) and Rothia (2.9 ×) were detected in the nitrate condition already after 5 h (both p < 0.01), while several caries-associated genera (Streptococcus, Veillonella and Oribacterium) and halitosis- and periodontitis-associated genera (Porphyromonas, Fusobacterium, Leptotrichia, Prevotella, and Alloprevotella) were significantly reduced (p < 0.05 at 5 h and/or 9 h). In conclusion, the addition of nitrate to oral communities led to rapid modulation of microbiome composition and activity that could be beneficial for the host (i.e., increasing eubiosis or decreasing dysbiosis). Nitrate should thus be investigated as a potential prebiotic for oral health.
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Affiliation(s)
- B T Rosier
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Avenida de Catalunya 21, 46020, Valencia, Spain
| | - E Buetas
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Avenida de Catalunya 21, 46020, Valencia, Spain
| | - E M Moya-Gonzalvez
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Avenida de Catalunya 21, 46020, Valencia, Spain
| | - A Artacho
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Avenida de Catalunya 21, 46020, Valencia, Spain
| | - Alex Mira
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Avenida de Catalunya 21, 46020, Valencia, Spain.
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Aksit-Bicak D, Emekli-Alturfan E, Ustundag UV, Akyuz S. Assessment of dental caries and salivary nitric oxide levels in children with dyspepsia. BMC Oral Health 2019; 19:11. [PMID: 30634964 PMCID: PMC6329182 DOI: 10.1186/s12903-018-0707-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/28/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The increase in nitric oxide (NO) levels in the oral cavity and saliva have been associated with various oral diseases; however, the gastro-salivary interaction of NO remains controversial. Thus, the aim of this study was to determine and compare salivary NO levels of dyspeptic and non-dyspeptic healthy children and to conduct an evaluation of its association with dental caries. METHODS Seventy children with dyspepsia (dyspeptic group) and 30 children without any gastrointestinal complaints (control group) were included in the study. Two biopsies from the gastric tissues were collected from dyspeptic children for histopathologic examination. Oral examination involved the assessment of dental caries, gingival index, plaque index, buffering capacity, salivary flow rate and pH. Salivary Streptococcus mutans (S. mutans) and Lactobacilli sp. counts were performed by commercial kits. For the comparison of the normal distribution between dyspeptic and control groups, Student t-test and for the comparison of the non-normal distribution, Kruskal-Wallis and Mann-Whitney-U tests were used. Chi-square test was used for comparison of qualitative data and the Pearson correlation test was used to evaluate the association between certain variables. Significance was assessed at p < 0.05 level. RESULTS Helicobacter pylori (H.pylori) were found in gastric biopsies of 84.2% (59/70) of the dyspeptic children. While the mean salivary NO values did not differ significantly between gastric H.pylori positive, negative and control groups, the salivary NO level of the dyspeptic group (213.7 ± 51.68 μmol/dL) was found to be significantly higher than the control group (185.7 ± 16.66 μmol/dL). No significant relationship was found between the mean salivary NO values, DMFT/dmft numbers and other oral parameters. CONCLUSIONS The association of dental caries and salivary NO levels could not be considered specific in the current study. Although there were no statistically significant differences between salivary NO levels of gastric H.pylori positive, gastric H.pylori negative and control groups, greater salivary NO levels among dyspeptic children compared with the control group demonstrated that the concentration of NO in the saliva could be used as a biological marker in dyspepsia, which could lead to the improvement of more specified, uncomplicated and susceptible methods for analysis.
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Affiliation(s)
- Damla Aksit-Bicak
- Faculty of Dentistry, Department of Pediatric Dentistry, Near East University, Near East Boulevard, ZIP: 99138, Mersin 10, Turkey.
| | - Ebru Emekli-Alturfan
- Faculty of Dentistry, Department of Basic Medical Sciences, Biochemistry, Marmara University, Istanbul, Turkey
| | - Unsal Veli Ustundag
- Faculty of Medicine, Department of Basic Medical Sciences, Biochemistry, Medipol University, Istanbul, Turkey
| | - Serap Akyuz
- Faculty of Dentistry, Department of Pediatric Dentistry, Marmara University, Istanbul, Turkey
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