Buscar en
Revista Mexicana de Ortodoncia
Toda la web
Inicio Revista Mexicana de Ortodoncia Effect of orthodontic fixed appliances on salivary flow and viscosity
Información de la revista
Vol. 3. Núm. 3.
Páginas e185-e189 (Julio - Septiembre 2015)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Visitas
1257
Vol. 3. Núm. 3.
Páginas e185-e189 (Julio - Septiembre 2015)
ORIGINAL RESEARCH
Open Access
Effect of orthodontic fixed appliances on salivary flow and viscosity
Efecto de la aparatología ortodóntica fija sobre el flujo y viscosidad salival
Visitas
...
Emanuel R Barreto Sánchez1, Marcos J Carruitero Honores2,
Autor para correspondencia
m_carruitero@hotmail.com

Corresponding author.
Contenido relaccionado
Revista Mexicana de Ortodoncia. 2015;3:186-9010.1016/j.rmo.2016.03.049
Emanuel R Barreto Sánchez, Marcos J Carruitero Honores
Información del artículo
Resumen
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Tablas (3)
Table I. Sample distribution by gender and age.
Table II. Salivary flow (mL/min) and viscosity before and after orthodontic fixed appliance placement.
Table III. Salivary flow (mL/min) and viscosity before and after orthodontic fixed appliances placement by gender.
Mostrar másMostrar menos
ABSTRACT
Objective

To determine the effect of orthodontic fixed appliances on salivary flow and viscosity.

Material and methods

Saliva samples from 44 patients between 10-34 years old of both genders were assessed in Trujillo, Peru. Twenty-two of them received orthodontic fixed appliances and the other 22 did not receive then and served as control. Samples for the evaluation of salivary flow and viscosity before and one month after orthodontic fixed appliances placement were obtained. To quantify salivary flow, 5minutes was clocked to obtain saliva in a test tube and then make measurements using a 10mL test tube millimeter. To measure viscosity, 5mL of saliva was collected and calculated by the formula of the relative viscosity (VR = time of 5mL saliva/time to 5mL of water) using a viscometer. For comparison of salivary flow and viscosity before and a month after the Wilcoxon test was used because the data did not exhibit a normal distribution. A significance level of 5% was considered.

Results

Statistically significant differences (p < 0.05) in salivary flow and viscosity were found before orthodontic fixed appliances placement and one month after, showing an increase in salivary flow and a decrease in salivary viscosity.

Conclusion

The use of orthodontic fixed appliances affects salivary flow and viscosity month after placement.

Keywords:
Salivary flow
salivary viscosity
fixed orthodontic appliances
RESUMEN
Objetivo

Determinar el efecto de la aparatología ortodóntica fija sobre el flujo y viscosidad salival.

Material y métodos

Se evaluaron muestras salivales de 44 pacientes de ambos sexos entre 10 a 34 años de edad; de Trujillo, Perú, 22 de ellos recibieron aparatología ortodóntica fija y los otros 22 no la recibieron y sirvieron como control. Se obtuvieron muestras para la evaluación del flujo y viscosidad salival antes y al mes de instalada la aparatología ortodóntica fija. Para cuantificar el flujo salival se cronometraron cinco minutos para obtener saliva en un tubo de ensayo y luego hacer la medición empleando una probeta milimetrada de 10mL. Para medir la viscosidad se recolectaron 5mL de saliva y luego fue calculada mediante la fórmula de la viscosidad relativa (VR = tiempo de 5mL de saliva/tiempo para 5mL de agua) usando un viscosímetro. Para la comparación entre y flujo y viscosidad salival antes y al mes se empleó la prueba de Wilcoxon debido a que los datos no siguieron distribución normal; se consideró un nivel de significancia del 5%.

Resultados

Se encontraron diferencias estadísticamente significativas (p < 0.05) en el flujo y la viscosidad salival entre antes y al mes de instalada la aparatología ortodóntica fija, apreciándose un aumento del flujo salival y una disminución de la viscosidad salival.

Conclusión

El uso de aparatología ortodóntica fija afecta el flujo y viscosidad salival al mes de su instalación.

Palabras clave:
Flujo salival
viscosidad salival
aparatología ortodóntica fija
Texto completo
INTRODUCTION

Patients with orthodontic fixed appliances may be more susceptible to changes in some specific salivary characteristics due to certain conditioning factors.1–3 Saliva is a complex secretion4 that has as its main function the maintenance and protection of the soft and hard tissues of the oral cavity,5,6 where fl ow and viscosity plays a relevant role.3

The quantity of saliva is defined by salivary flow rate, while its quality is defined by its content of salivary protein and its viscosity.3 Salivary flow is calculated by dividing the volume of saliva between time of collection.6 There are 2 types of salivary flow, at rest and stimulated. Salivary flow under normal conditions is 0.25 and 0.40mL/min, while the normal stimulated salivary flow is 2mL/min.7,8 Salivary viscosity is the property of the saliva that opposes its flow when a force is applied. The glycoprotein mucin is responsible for salivary viscosity. It has been suggested that viscosity primarily influences the origin of caries.1,9,10 It plays a very important role in the cleaning of bacterial substrates: if the saliva is highly viscous, then it is less effective in cleaning thus favoring demineralization and caries.11,12

Orthodontic fixed appliances may affect salivary secretion and viscosity due to the fact that there is an increase in bacterial plaque accumulation and a higher level of difficulty for oral hygiene thus leading to changes in saliva characteristics which produce as a consequence enamel demineralization and white lesions.13–15

Koch et al.1 found that one month after orthodontic appliances placement, an increase in salivary flow and a decrease of its viscosity occurred. Li and col15 found an increase in salivary flow rate 1 month after orthodontic appliance placement. Likewise, Lara et al.,14 Romero et al.5 Ulukapi H et al.16 and Peros et al.17 reported that there was an increase in stimulated salivary flow 12 to 18 weeks after treatment with fixed orthodontic appliances. Chang et al18 reported an increase in the rate of stimulated salivary flow at 3 months orthodontic appliances use.

There is no clear relationship between the use of orthodontic appliances and changes in salivary flow and viscosity. At the same time, it is necessary to determine whether the salivary changes are similar or different in different populations after orthodontic appliances placement. Better understanding of these changes could induce the clinician to take preventive measures during the orthodontic treatment.

This research was aimed to determine the effect of orthodontic fixed appliances over salivary flow and viscosity.

MATERIAL Y METHODSStudy sample

This study was conducted with 44 patients, divided into 2 groups of 22 patients each, with an age range between 10 and 34 years (Table I), who attended several dental clinics in the city of Trujillo, Peru seeking orthodontic treatment. The minimum sample size per group was calculated by considering a power test of 80% and a confidence level of 95%. Before considering the patient as suitable for the investigation an interview that served for sample selection phase was conducted. The inclusion criteria were: patients with normal nutritional status, without tooth decay or periodontal disease, without systemic diseases or anomalies, not under any medication, not pregnant and without smoking habits. Saliva samples were collected prior to orthodontic fixed appliance placement and a month after. For the implementation of this project, the authors received approval from the Committee of Research of the School of Dentistry in the Universidad Privada Antenor Orrego with the corresponding resolution from the dean.

Table I.

Sample distribution by gender and age.

Groups  Gender  Mean age  SD  Minimum  Maximum 
Experimental  Female  13  19.23  6.35  10  34 
  Male  14.44  3.57  10  22 
  Total  22  17.27  5.81  10  34 
Control  Female  22.13  4.05  13  27 
  Male  14  17.14  4.50  11  25 
  Total  22  18.95  4.90  11  27 
Determination of salivary flow

The saliva sample collection was carried out between 9 am and 12 pm with the aim of reducing as far as possible the circadian rhythm. The patient was asked not to eat one hour prior to sample collection. At the time of collection, the patients were asked to rinse with water, without moving their heads and not passing saliva for 2minutes. Later, stimulation was induced with orthodontic elastic bands (30seconds). The chronometer was set at 5minutes and stimulated saliva collection was conducted in a straight and relaxed posture. The collected saliva was placed in glass test tubes. To measure salivary flow a 10mL measuring cylinder was used.

Determination of salivary viscosity

In order to measure salivary viscosity, the same procedure for saliva collection to meaure salivary flow was performed. Five milimeters of saliva were collected. For the meaurement of viscosity, an Ostwald Cannon Fesked Mod. 100 viscosimeter was used. To determine the final viscosity, the relative viscosity formula was employed (RV = time for 5mL of saliva/ time for 5mL of water).

Group formation

  • a.

    Experimental group

    It was formed by 22 patients, 10 to 34 years of age (17.27, SD: 5.81) who were programmed for orthodontic fixed appliance placement. The patients selected for this study signed an informed consent form. The collected samples for flow and viscosity were taken prior to appliance placement the same day and a month after.

  • b.

    Control group

    It was formed by 22 patients, 11 to 27 years of age (18.95, SD: 4.90) who did not receive fixed orthodontic appliances until one month after the first saliva sample. The patients selected for this study signed an informed consent form. The collected samples for salivary flow and viscosity were obtained in two moments with a one month waiting time wihout any apppliance placed in the mouth during that period of time.

Statistical analysis

The obtained data was analyzed through the SPSS program, 2.2 version. For the comparison of flow and viscosity before and one month after appliance placement, the Wilcoxon test was used. This nonparametric test was selected beacuse the data obtained from the assessed groups did not follow a normal distribution after the Shapiro-Wilk test was applied. The significance leveal was set at 5%.

RESULTS

Statistically significant differences were found between the flow and viscosity values before and one month after fixed appiances placement in the experiment L group (p < 0.05) but not in the control group. In the experimental group, the initial salivary flow was 1.12mL/min (SD: 0.23) and one month after, it was 1.36mL/min (SD: 0.28); while for viscosity, the initial value was 1.16 (SD: 0.11) and after one month, it was 1.01 (DE: 0.10) (Table II).

Table II.

Salivary flow (mL/min) and viscosity before and after orthodontic fixed appliance placement.

Group  Variables  Period  Mean  SD*  Before-after difference  p** 
Experimental  Flow  Before  22  1.12  0.23  -0.24  0.000 
  Flow  After  22  1.36  0.28     
  Viscosity  Before  22  1.16  0.11  0.15  0.000 
  Viscosity  After  22  1.01  0.10     
Control  Flow  Before  22  1.07  0.21  -0.01  0.762 
  Flow  After  22  1.08  0.14     
  Viscosity  Before  22  1.14  0.15  0.01  0.138 
  Viscosity  After  22  1.13  0.14     
*

Standard deviation;

**

Wilcoxon's test.

In relation to genders, both in the male and female group statistically significant differences were found in the experimental group (p < 0.05) but not in the control group. Values for salivary flow were higer than those for viscosity one month after orthodontic fixed appliances placement (Table III).

Table III.

Salivary flow (mL/min) and viscosity before and after orthodontic fixed appliances placement by gender.

Gender  Group  Variables  Period  Mean  Before and after difference  p* 
Female  Experimental  Flow  Before  13  1.16  -0.22  0.001 
    Flow  After  13  1.38     
    Viscosity  Before  13  1.18  0.14  0.002 
    Viscosity  After  13  1.04     
  Control  Flow  Before  1.00  0.13  0.101 
    Flow  After  0.87     
    Viscosity  Before  1.07  0.01  0.618 
    Viscosity  After  1.06     
Male  Experimental  Flow  Before  1.06  -0.25  0.017 
    Flow  After  1.31     
    Viscosity  Before  1.14  0.17  0.000 
    Viscosity  After  0.97     
  Control  Flow  Before  14  1.16  0.05  0.162 
    Flow  After  14  1.11     
    Viscosity  Before  14  1.17  0.01  0.180 
    Viscosity  After  14  1.16     
*

Wilcoxon test.

DISCUSSION

Orthodontics has become one of the most desirable dental treatments nowadays to enhance the smile; however it is possible that placement of orthodontic appliances may lead to changes in the saliva that may put at risk dental and periodontal health. This study shows e changes that are produced in salivary flow and viscosity after orthodontic fixed appliances placement.

Salivary flow and viscosity were compared before and one month after bracket placement in order to observe the effect it produced. Statistically significant differences were found which coincides with reports from other authors.1,14,15

The increase in salivary flow after fixed orthodontic appliances placement would be considered as a protection factor due to the fact that any foreign body in the oral cavity causes stimulation by increasing salivary flow.2 In consequence, an increase in salivary flow would be favorable for patients because there will be more lubrication and substrate and oral cavity micro-organisms elimination with good oral hygiene.9

The decrease in salivary viscosity is consistent with the results reported by Koch et al.1 Such a decrease is considered a response to an increase in salivary flow.1 When there is an increase in salivary flow a greater amount of water is generated in its biological content which causes a decrease in mucin, the viscous glycoprotein, therefore the relative viscosity also decresaes.9 This interaction is important in the process of caries formation.13

A decrease in salivary flow and an increase in viscosity would be a negative aspect because it has more influence on the formation of dental caries.1–3,12 Another negative aspect is the effect on periodontal disease because if saliva were to be more viscous there would be more risk of periodontal disease which would be totally unfavorable for patients with orthodontic fixed appliances because they experience more difficulty in keeping a good oral hygiene.1,9,12

In the control group not statistically significant differences were found, therefore there is no significant change in flow and viscosity. Such results were due to the absence of a stimulus on the oralcavity.1

The clinical significance of these results lies in the fact that salivary flow and viscosity are elements of great importance in the origin of caries and periodontal disease during orthodontic treatment so it is necessary to understand the changes it causes.

CONCLUSIONS

  • There is an effect of orthodontic fixed appliances on salivary flow and viscosity one month after bracket placement causing an increase in salivary flow and a decrease in the relative viscosity.

  • By gender, the effect of fixed appliances on salivary flow and viscosity was similar for men and women with an increase in salivary flow and a decrease in viscosity.

REFERENCES
[1]
K.E. Koch, C.L. Collantes, M.I. Lewintre, K. Latyn.
Influencia de la aparatología ortodóntica fija en la viscosidad y flujo salival.
Rev Fac Odontol UNNE, 3 (2010), pp. 48-51
[2]
L. Lombardo, Yildiz YÖ, Ö. Gorgun, C. Panza, G. Scuzzo, G. Siciliani.
Changes in the oral environment after placement of lingual and labial orthodontic appliances.
Prog Orthod., 14 (2013), pp. 28
[3]
G. Alesandri, S. Incerti, G. Garulli, M.R. Gatto, L. Checchi.
Effect of fixed orthodontic appliances on salivary properties.
Prog Orthod, 14 (2013), pp. 13
[4]
C. Llena-Puy.
The rôle of saliva in maintaining oral health and as an aid to diagnosis.
Med Oral Patol Oral Cir Bucal, 11 (2006), pp. E449-E455
[5]
H.M. Romero, Y. Hernández.
Modificaciones del Ph y flujo salival con el uso de aparatología funcional tipo Bimler.
Revista Latinoamericana de Ortodoncia y Odontopediatría, (2009), pp. 1-26
[6]
C. Caridad.
El pH, flujo salival y capacidad buffer en relación a la placa dental.
ODOUS Científica, 9 (2008), pp. 25-32
[7]
K. Loyo, R. Balda, O. Gonzales, A.L. Solorzano, M. Gonzales.
Actividad cariogénica y su relación con el flujo salival y la capacidad amortiguadora de la saliva.
Acta Odontol Venez, 37 (1999), pp. 10-17
[8]
J.W. Laurence.
Aspectos clínicos de biología salival para el clínico dental.
J Minin Interv Dent, 1 (2008), pp. 5-22
[9]
B. Ahmed, N. Jafer.
Salivary viscosity in relation to oral health status among a group of 20-22 years old dental students.
Iraqi J Comm Med, 1 (2013), pp. 219-224
[10]
C. Carda, N. Mosquera, L. Salom, M.E. Gomez, A. Peydró.
Structural and functional salivary disorders in type 2 diabetic patients.
Med Oral Patol Oral Cir Bucal., 11 (2006), pp. E309-E314
[11]
M.E. Ortega, M. Calzado, M. Pérez.
Evaluación del flujo y viscosidad salival y su relación con el índice de caries.
Medisan, 2 (1998), pp. 33-39
[12]
Cedillo L, Martinez D, Varela F, Villa T, Zepeda T. La Saliva como método de diagnostico para determinar la incidencia de caries en alumnos de la facultad de estudios superiores Iztacala. Revisado el 15 de abril del 2014. Disponible en: http://odontologia.iztacala.unam.mx/memorias15col/contenido/oral/lasalivacomometode04.htm.
[13]
A.D. Viazis.
Atlas de ortodoncia.
Panamericana, (1995),
[14]
E. Lara, N.M. Montlel, L. Sanchez, J. Alanis.
Effect of Orthodontic treatment on saliva, plaque and the levels of Streptococcus mutans and Lactobacillus.
Med Oral Patol Oral Cir Bucal, 15 (2010), pp. 924-929
[15]
Y. Li, B. Hu, Y. Liu, G. Ding, C. Zhang, S. Wang.
The effects of fixed orthodontic appliances on saliva flow rate and saliva electrolyte concentrations.
Journal of Oral Rehabilitation, 36 (2009), pp. 781-785
[16]
H. Ulukapi, F. Koray, B. Efes.
Monitoring the caries risk of orthodontic patients.
Quintessence Int, 28 (1997), pp. 27-29
[17]
K. Peros, S. Mestrovic, S. Anic, M. Slaj.
Salivary microbial and nonmicrobial parameters in children with fixed orthodontic appliances.
Angle Orthod, 81 (2011), pp. 901-906
[18]
H.S. Chang, L.J. Walsh, T.J. Freer.
The effect of orthodontic treatment on salivary flow, pH, buffer capacity, and levels of mutans streptococci and lactobacilli.
Aust Orthod J., 15 (1999), pp. 229-234

This article can be read in its full version in the following page: http://www.medigraphic.com/ortodoncia

Dental Surgeon, Private Practice, Trujillo, Perú.

Doctor of Stomatology. Professor, Private University Antenor Orrego, Trujillo, Perú.

Copyright © 2015. Universidad Nacional Autónoma de México, Facultad de Odontología
Opciones de artículo
Herramientas