Research Paper (postgraduate), 2007
Aims: To study the effect of Beta-adrenergic agonist (salbutamol) and Beta adrenergic antagonist (at- enolol) on salivary protein concentration and to study relation between salivary protein concentration and oral health. Materials and Methods: This study was carried out on 45 individuals; 15 individuals of them were apparently healthy with no history of systemic diseases and represent a control group, the second group which comprised 15 subjects were given adrenergic agonist drug (salbutamol) for treat- ment of asthma, and third group (15 individuals) were given adrenegic antagonist drug (atenolol) for treatment of hypertension. subjects were selected from the out patients attending Oral Surgery De- partment, College of Dentistry, University of Mosul. The samples of saliva were collected using spit- ting method and oral hygiene index simplified was recorded for each individual and total protein con- centration of these saliva samples were determined. Its relation to oral health was measured according to simplified oral hygiene index by Greene and Vermillion. Results: The results of this study revealed that in all study groups, significant differences were present for both salivary protein concentration and oral health scores and there is correlation between salivary protein concentration and oral health in pa- tients receiving atenolol. Conclusions: Chronic treatment with adrenergic agonist and antagonist drugs, resulted in changes in salivary protein concentration and those will affect the oral health of patients treated by these drugs.
Key words: Salivary proteins, adrenergic agonist and antagonist, oral health.
Normal salivary gland function, secre- tion and composition have an important role in the protective mechanism of oral cavity. Saliva is essential for maintenance of good oral health (1,2 ).
Quantitative variation in salivary pro- tein concentration will affect oral disease prevalence(3 ). The proteins of saliva in- clude enzymes, immunoglobins (IgA, IgG, IgM), mucous, glycoproteins (mucins), trace of albumin, certain polypeptides and other antibacterial factors of importance in oral health (4 ). Medications like Beta- adrenergic agonist (salbutamol) which is Beta-2 adrenergic long acting agonist used as bronchodilator, and adrenrgic antago- nist (atenolol) which is used for treatment of hypertension (5 ) may influence concen- trations of these proteins (6 ) leading to changes of oral health status among indi- vidual using these drugs.
The aim of this study was to evaluate the salivary protein concentrations in pa- tients receiving salbutamol and atenolol, and to find out their effects on oral health of these patients.
Forty-five individuals have partici- Al-Sandook TA, Al-Mashhadane FAM, Taqa A pated in this study, their age ranged be- tween 30-60 years with mean age of 45 1 year. Fifteen of them were healthy indi- viduals and considered as control group, while the other 15 individuals, asthmatic patients, were treated with salbutamol only with dose ranged 2-4 mg/day (mean 3 1 mg/day). The third group, hypertensive patients, were treated with atenolol only with dose ranged 50-100 mg/day (mean 75 1 mg/day). The duration of treatment for both groups ranged between 2-10 years (mean 6 1 year). All these indi- viduals were selected from out patients clinic at Oral Surgery Department, College of Dentistry, University of Mosul.
Subjects were seated on a straight chair under quite standardized condition (1 ). The samples of stimulated saliva were collected from 45 individuals using spit- ting method, the time of collection was 10 minutes and the collection of saliva was performed at the same time of day (2 hr after having breakfast) to avoid circadian (7,8) of 0 to 3, only mouth mirror and sickle type dental explorer were used for the ex- amination. The criteria for scoring the de- bris and calculus components of the sim- plified oral hygiene index are as follows:
Oral Debris Index (D1-S): 0 = no de- bris or stain present; 1= soft debris cover- ing not more than one third of the surface or the presence of extrinsic stains without other debris, regardless of surface area covered; 2 = soft debris covering more than one third but not more than two third of the exposed tooth surface; 3 = soft de- bris covering more than two thirds of the exposed tooth surface.
Calculus Index (C1-S): 0= no Calcu- lus present; 1= supragingival Calculus not more than one third of the exposed tooth surface; 2= supragingival calculus cover- ing more than one third but not more than two thirds of the exposed tooth surface, or the presence of individual flecks of sub- gingival calculus around the cervical por- tion of the tooth, or both; 3= supragingival calculus covering more than two thirds of variation , each subject was asked to wash his/ her mouth three times with dis- tilled water and to take drops of lemon juice before spitting. Saliva volume was measured (5 ml) and placed in a test tube then closed with a plastic stopper (9 ).
Total proteins for each sample of sa- liva was determined using the Biuret me- thod by a mixing of 0.2 ml of saliva with 2.8 ml of distilled water and then adding 5 ml of Biuret reagent which was prepared by dissolving 9 gm of sodium potassium tarrate in 500 ml of 0.2 N - sodium hy- droxide, adding 3 gm of copper sulphate and dissolved by stirring, then adding 5 gm of potassium iodide and making the volume to be 4 L with 0.2 N-sodium hy- droxide(7 ).
Ultraviolet visible spectrophotometer (CECIL, CEI021, England) at wave length of 540 nm was used to determine the total protein in saliva sample according to me- thod of NAZHAT 2003.
On the other hand, oral hygiene for each individual was evaluated by Simpli- fied Oral Hygiene Index according to Greene and Vermillion (1960), it consists of two components, a Simplified-Debris Index and a Simplified Calculus Index. Each component was assessed on a scale the exposed tooth surface or a continuous heavy band of subgingival calculus around the cervical portion of the tooth, or both.
The simplified oral hygiene index score per person is the total of the debris and calculus scores per person (10 ).
Statistical analysis of the data was car- ried out using ANOVA test (p < 0.05) to examine the differences among the 3 groups, also correlation was used to study the relation salivary protein concentration and oral health scores because salivary protein concentration is a quantitative measure while, oral health score is a qua- litative measure.
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3 Rudney J. Dose variability in salivary protein concentrations influence oral microbial ecology and oral health? Oral Biol Med. 1995; 6(4): 343-367.
4 Hall H. Protective and maintenance function of human saliva. Br J Dent. 1993; 24(11): 813-816.
5 Richard D, Mary J. Beta-adrenergic agonists. In: Lippincott’s Illustrated reviews in pharmacology. 3rd ed. 2006; Pp: 65-81.
6 Johnson D, Cortez J. Chronic treatment with Beta adrenergic agonists and antagonists alter the composition of proteins in rat parotid saliva. J Dent Res. 1988;l67:1103-1108.
7 Nazhat M. Evaluation of physical and chemical properties of saliva, and it’s effect on the retention of Acrylic Resin Denture Base. MSc. Thesis. College of Dentistry. University of Mosul. 2003.
8 Neder fors T, Dahlof C. Effects on salivary flow rate and composition of with drawal of and re-exposure to the Beta- selective antagonist metoprolol in hypertensive patient population. Eur J Oral Sci. 1996; 104(3): 262-268.
9 Elfenbaum K. The role of biochemical study of the saliva in diagnosis diseases. J Am Dent Assoc. 1988; 129(6): 733 - 739.
10 Fermin A, Michael G. Simplified Oral Hyginene Index. In: Clinical periodon- tology. 8th ed. WB Saunders Company. 1996; Pp:67-68.
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