Salivary parameters and periodontal inflammation in obstructive sleep apnoea patients

Abstract

The aim of this cross-sectional study was to objectively assess the salivary flow rate and composition and periodontal inflammation in obstructive sleep apnoea (OSA) patients. The subjects, who underwent whole-night polysomnography or polygraphy, were referred for saliva sampling and periodontal examination. According to the severity of OSA based on the Apnoea Hypopnea Index (AHI) value, the subjects were classified into groups: no OSA (AHI < 5; N = 17), mild to moderate OSA (AHI 5–29.9; N = 109), and severe OSA (AHI > 30; N = 79). Salivary flow rate, pH, salivary electrolytes, and cortisol were measured from collected saliva samples. Periodontal examination included assessment of the number of teeth, dental plaque, bleeding on probing and periodontal measurements: gingival recession, probing pocket depth, clinical attachment level (CAL) and periodontal inflamed surface area (PISA) score. There were no significant differences in salivary flow rate, salivary pH, salivary electrolyte concentrations or electrolyte ratios among the groups classified according to the severity of OSA. However, subjects without OSA had higher salivary cortisol concentrations than OSA groups (p < 0.001). Increased plaque scores were associated with a higher AHI (r = 0.26; p = 0.003). According to the salivary flow rate, subjects with hyposalivation and reduced salivation had higher concentrations of salivary electrolytes and lower salivary pH than subjects with normal salivation. Subjects with hyposalivation had an increased Mg/PO4 ratio (p < 0.001) and a reduced Ca/Mg ratio (p < 0.001). Furthermore, subjects with severe OSA tended to have higher CALs and plaque volumes. In conclusion, under pathological conditions, such as OSA, multiple interactions might impact salivary flow and electrolyte composition. Complex interrelationships might affect the integrity of oral health, especially considering OSA severity, inflammation, concomitant diseases and medications.

Salivary E‐cadherin as a biomarker for diagnosis and predicting grade of periodontitis

“…Report from a previous study indicated that SFR in patients with periodontitis significantly decreased, almost twofold, as compared to healthy controls 44 . Additionally, significantly higher concentration of electrolytes and decreased pH were observed in periodontitis patients with hyposalivation and reduced salivation as compared to subjects with normal salivation 45 . Similarly, patients with stage IV periodontitis exhibited acidic pH and significantly reduced SFR 46 .…”

“…44 Additionally, significantly higher concentration of electrolytes and decreased pH were observed in periodontitis patients with hyposalivation and reduced salivation as compared to subjects with normal salivation. 45 Similarly, patients with stage IV periodontitis exhibited acidic pH and significantly reduced SFR. 46 Although passive drooling technique is widely used for collecting salivary samples, further standardization is advised.…”

Salivary trefoil factor family peptide 3 (TFF3) and flow rate in persons with and without obstructive sleep apnea: A preliminary study

“…These findings may indicate that TFF3 is upregulated in the inflammatory mucous epithelium of the gastrointestinal tract and oral mucosa. A previous study found that patients with mild to moderate OSA and severe OSA had significantly higher proportions of plaques versus the control group (59% and 73% vs. 38%; p = .001) (Tranfić Duplančić et al, 2022). Dental plaques, containing over 700 bacteria, lead to local inflammation resulting in higher TFF3 levels in patients with OSA (Gao et al, 2018;Murakami et al, 2018;Paul et al, 2021).…”

Perspective chapter: Role of the Oral Healthcare Team in the Management of Obstructive Sleep Apnea

“…Xerostomia is often associated with mouth breathers and can predispose to caries and periodontal disease through complete or partial reduction of protective salivary flow to portions of the dentition during sleep or during the day. OSA and periodontal disease share some of the same risk factors and it is not uncommon to see a greater periodontal disease prevalence in patients with OSA [40]. Common risk factors may include obesity, gender, male more than female, age, smoking and mouth breathing resulting in xerostomia, and alcoholism.…”

“…Duplancic and colleagues, evaluating salivary parameters and periodontal inflammation in OSA patients, showed that patients with hyposalivation and reduced salivation had higher concentrations of salivary electrolytes and lower salivary pH than subjects with normal salivation and that patients with severe OSA tended to have a higher clinical attachment levels and plaque volume. The authors noted that multiple interactions might impact salivary flow and electrolyte composition and that complex interrelationships might affect the integrity of oral health, especially considering OSA severity, inflammation, concomitant diseases and medication [40].…”