Exploratory Analysis of Systemic Illness and Associated Medication on Salivary Flow Rate, pH and Clinical Oral Dryness: A Cross-sectional Study

Subject Areas : Journal of Chemical Health Risks

Namrata Prakash ¹ , Junaid Ahmed ^{2 *} , Nanditha Sujir ³ , Nandita Shenoy ⁴ , Archana Muralidharan ⁵ , Srikant Natarajan ⁶

1 - Department of Oral Medicine and Radiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
2 - Department of Oral Medicine and Radiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
3 - Department of Oral Medicine and Radiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
4 - Department of Oral Medicine and Radiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
5 - Department of Oral Medicine and Radiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
6 - Department of Oral pathology & Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India

Received: 2025-03-21 Accepted : 2025-11-25 Published : 2025-09-28

Keywords: Chronic Diseases, Diabetes Mellitus, Drug Side Effects, Hypertension, Saliva, Psychiatric Diseases, Xerostomia,

Abstract :

The aim of the study was to analyse the effects of systemic illnesses, and medications on the salivary flow, salivary pH, and clinical oral dryness score. A cross-sectional comparative study was done on 51 patients. Consecutive patients visiting the outpatient department fulfilling the inclusion criteria were included in the study after obtaining informed consent. Current illnesses, its duration and type of medications taken for the same were duly recorded.  The salivary flow rate was assessed by Schirmer tear strips, pH by pH strips, and xerostomia by Clinical oral dryness score. Descriptive statistics, independent t test, one-way ANOVA and Posthoc Tukey test was utilized for statistical analysis. p value <0.5 was considered significant. 51 patients of which 28 were males and 23 were females were broadly divided into 3 groups namely the Systemic illness group (Group 1), the Psychiatric illness group (Group 2) and a healthy control group (Group 3). After a detailed assessment of the salivary flow rate, salivary pH, and clinical oral dryness score across the three groups, we found a significant difference in the salivary flow rate in comparison to control group. A thorough assessment of salivary flow, salivary pH, and other measurable parameters among the vulnerable groups like those with systemic disorders or with a positive history of psychiatric illness is needed at regular intervals for improving an individuals’ general health and well-being and ensure a better quality of life.

References:

1. Bergdahl M., Bergdahl J., 2000. Low unstimulated salivary flow and subjective oral dryness: Association with medication, anxiety, depression, and stress. Journal of Dental Research. 79(9), 1652–1658.
2. Łysik D., Niemirowicz-Laskowska K., Bucki R., Tokajuk, G., Mystkowska, J., 2019. Artificial saliva: Challenges and future perspectives for the treatment of xerostomia. International Journal of Molecular Sciences. 20(13), 3199.
3. Scarabelot V.L., Munerato M.C., Medeiros L.F., Oliveira M.G.D., Chaves A.C.M., Souza A.D., Torres I.L.D.S., 2014. Factors associated to salivary flow alterations in dry mouth female patients. Revista Dor. 15(3), 186-190.
4. Glick M., 2015. Burket’s Oral Medicine. 12th ed. USA: People’s Medical Publishing House.104–108.
5. Ongole R., Praveen B.N., 2021. Textbook of Oral Medicine, Oral Diagnosis and Oral Radiology. Elsevier Health Sciences.274-279
6. Wolff A., Joshi R.K., Ekström J., Aframian D., Pedersen A.M.L., Proctor G., Narayana N., Villa A., Sia Y.W., Aliko A., McGowan R., 2017. A guide to medications inducing salivary gland dysfunction, xerostomia, and subjective sialorrhea: a systematic review sponsored by the world workshop on oral medicine VI. Drugs in R&d.17(1), 1-28.
7. Gholami N., Sabzvari B.H., Razzaghi A., Salah S., 2017. Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia. Journal of Dental Research, Dental Clinics, Dental Prospects. 11(4), 247–252.
8. Shubha G., Fasalkar S.S., Praveen B.N., Patrick S., Shubhasini A.R., Keerthi G., 2018. Assessment of salivary flow rate and salivary pH in subjects with smoking and smokeless form of tobacco habits. Journal of Medical Radiology, Pathology & Surgery. 5(5), 11–15.
9. Das P., Challacombe S.J., 2016. Dry mouth and clinical oral dryness scoring systems. Primary Dental Journal. 5(1), 77–79.
10. Morales-de la Luz R., Aldape-Barrios B., 2013. Flujo salival y prevalencia de xerostomía en pacientes geriátricos. Revista de la Asociación Dental Mexicana. 70(1), 25–29.
11. Kumar P., Mastan K.M., Chowdhary R., Shanmugam K., 2012. Oral manifestations in hypertensive patients: A clinical study. Journal of Oral and Maxillofacial Pathology. 16(2), 215–218.
12. Mohiti A., Eslami F., 2020. Does hypertension affect saliva properties? Journal of Dentistry. 21(3), 190–195.
13. Carramolino-Cuéllar E., Lauritano D., Silvestre F.J., Carinci F., Lucchese A., Silvestre-Rangil J., 2018. Salivary flow and xerostomia in patients with type 2 diabetes. Journal of Oral Pathology & Medicine. 47(5), 526–530.
14. Lima D.L., Carneiro S.D., Barbosa F.T., Saintrain M.V., Moizan J.A. & Doucet J., 2017. Salivary flow and xerostomia in older patients with type 2 diabetes mellitus. PLoS One. 12(8), e0180891.
15. Borahan M.O., Pekiner F.N., Atalay T., 2012. Evaluation of effects of the psychological factors on saliva. Journal of Marmara University Institute of Health Sciences. 2(S1), S8–S14.
16. Cohen M., Khalaila R., 2014. Saliva pH as a biomarker of exam stress and a predictor of exam performance. Journal of Psychosomatic Research. 77(5), 420–425.
17. Veerabhadrappa S.K., Chandrappa P.R., Patil S., Roodmal S.Y., Kumarswamy A., Chappi, M.K., 2016. Evaluation of xerostomia in different psychological disorders: An observational study. Journal of Clinical and Diagnostic Research. 10(9), ZC24–ZC27.
18. Nimma V., Talla H., Poosa M., Gopaladas M., Meesala D., Jayanth L., 2016. Influence of hypertension on pH of saliva and flow rate in elder adults correlating with oral health status. Journal of Clinical and Diagnostic Research. 10(11), ZC34–ZC37.
19. Diep M.T., Jensen J.L., Skudutyte Rysstad R., Young A., Sødal A.T.T., Petrovski B.É., Hove L.H., 2021. Xerostomia and hyposalivation among a 65‐yr‐old population living in Oslo, Norway. European Journal of Oral Sciences. 129(1), p.e12757.
20. Kagawa R., Ikebe K., Enoki K., Murai S., Okada T., Matsuda K., Maeda,Y., 2013. Influence of hypertension on pH of saliva in older adults. Oral diseases. 19(5), 525-529.
21. Khalaila R., Cohen M., Zidan J., 2014. Is salivary pH a marker of depression among older spousal caregivers for cancer patients? Behavioural Medicine. 40(5), 71–80.
22. Osailan S.M., Pramanik R., Shirlaw P., Proctor G.B., Challacombe S.J., 2012. Clinical assessment of oral dryness: Development of a scoring system related to salivary flow and mucosal wetness. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 114(5), 597–603.
23. Jager D.H., Bots C.P., Forouzanfar T., Brand H.S., 2018. Clinical oral dryness score: Evaluation of a new screening method for oral dryness. Odontology. 106(4), 439–444.
24. Wu A.J., Ship J.A., 1993. A characterization of major salivary gland flow rates in the presence of medications and systemic diseases. Oral Surgery, Oral Medicine, Oral Pathology. 76(3), 301–306.
25. Ivanovski K., Pesevska S., Ristoska S., Dirjanska K., Mindova S., Pandilova M., 2015. The impact of antihypertensive medications on quantitative and qualitative characteristics of saliva. Research Journal of Pharmacy, Biology and Chemical Sciences. 6(5), 1356–1364.