Association of salivary flow rate and pH with salivary alkaline phosphatase in smokers and non-smokers with periodontitis
DOI:
https://doi.org/10.53685/jshmdc.v7i1.443Keywords:
Periodontitis; Saliva; Alkaline Phosphatase; Hydrogen-Ion Concentration; Tobacco Smoking; Biomarkers; Case-Control Studies; Pakistan.Abstract
Background: Changes in salivary flow rate, pH, and salivary alkaline phosphatase (S-ALP) may reflect periodontal disease activity in smokers.
Objective: To determine the association of salivary flow rate and salivary pH with salivary alkaline phosphatase in smokers and non-smokers with periodontitis.
Methods: This cross-sectional study was conducted at Azra Naheed Medical & Dental College from February to December 2025. A total of 200 adults (100 smokers with ≥5 pack-years and 100 non-smokers) aged 18-40 years with clinically diagnosed periodontitis were recruited by consecutive sampling. Unstimulated whole saliva was collected by passive drool for 5 minutes. Salivary pH was measured with a calibrated pH meter, and S-ALP was measured by spectrophotometry. Data was analyzed using SPSS version-25.
Results: There was a significant difference in salivary pH (5.64±0.514 vs. 7.02±0.12, p<0.001) and S-ALP (59.67±34.28 vs. 31.73±18.86, p<0.001) between smokers and non-smokers, respectively, while the difference in salivary flow rate was non-significant (Smokers:0.648±0.136 vs. Non-smokers:0.652±0.257 mL/min; p=0.880). There is a negative correlation of salivary flow rate (r=-0.651, p<0.001) and salivary pH (r=-0.450, p<0.001) with S-ALP among smokers; in non-smokers, only salivary flow rate (r=-0.560, p<0.001) showed a negative correlation with S-ALP. Among smokers, salivary pH showed a significant association with elevated S-ALP levels (p-value < 0.001), and among those with acidic salivary pH, 77.4% had elevated S-ALP levels compared with 22.6% with normal levels.
Conclusion: Smokers with periodontitis show significantly lower salivary pH and higher S-ALP than non-smokers. Since salivary pH is associated with elevated S-ALP among smokers, pH can serve as a useful marker for monitoring smoking-related periodontal biochemical changes.
References
Shafique R, Hassan H, Shakoor A, Aziz S, Aslam K, Najfi NZ. Perception and misconceptions of patients about dental scaling treatment: a cross-sectional study. J Oral Health Oral Epidemiol. 2024; 13(3): 122-126.
Bernabe E, Marcenes W, Abdulkader RS, Abreu LG, Afzal S, Alhalaiqa FN, et al. Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2025; 405(10482): 897-910.
Zhang Y, Shen Z, Yang J, Ren J, Zhang C, Tan L, et al. Single-cell spatial atlas of smoking-induced changes in human gingival tissues. Int J Oral Sci. 2025; 17(1): 60-73.
Leite FRM, Nascimento GG, Scheutz F, Lopez R. Effect of smoking on periodontitis: a systematic review and meta-regression. Am J Prev Med. 2018; 54(6): 831-841.
Alwithanani N. Periodontal disease and smoking: systematic review. J Pharm Bioallied Sci. 2023; 15(Suppl-1): S64-71.
Battancs E, Gheorghita D, Nyiraty S, Lengyel C, Eördegh G, Baráth Z, et al. Periodontal disease in diabetes mellitus: a case-control study in smokers and non-smokers. Diabetes Ther. 2020; 11(11): 2715-28.
Boynes SG, Sofiyeva N, Saw T, Nieto V, Palomo L. Assessment of salivary matrix metalloproteinase-8 and activated salivary matrix metalloproteinase-8 in periodontitis patients: a systematic review and meta-analysis. Front Oral Health. 2025; 6: 1444399.
Mohd Hasan NW, Baharin B, Mohd N, Abdul Rahman M, Hassan N. Comparative effects of e-cigarette smoking on periodontal status, salivary pH, and cotinine levels. BMC Oral Health. 2024; 24(1): 861.
Thomas SC, Xu F, Pushalkar S, Lin Z, Thakor N, Vardhan M, et al. Electronic cigarette use promotes a unique periodontal microbiome. MBio. 2022; 13(1) :e00075-22.
Koppolu P, Sirisha S, Mishra A, Deshpande K, Lingam AS, Alotaibi DH, et al. Alkaline phosphatase and acid phosphatase levels in saliva and serum of patients with healthy periodontium, gingivitis, and periodontitis before and after scaling with root planing: a clinico-biochemical study. Saudi J Biol Sci. 2021; 28(1): 380-385.
Rasaei N, Ghadiri A, Peighan M, Rekabi A, Atashkar N. Evaluation of alkaline phosphatase in gingival crevicular fluid and saliva of patients with periodontitis and healthy individuals. J Family Med Prim Care. 2022; 11(11): 6983.
Noh JW, Jang JH, Yoon HS, Kim KB, Heo MH, Jang HE, et al. Evaluation of salivary biomarkers of periodontal disease based on smoking status: a systematic review. Int J Environ Res Public Health. 2022; 19(21): 14619.
Ahmadi-Motamayel F, Falsafi P, Goodarzi MT, Poorolajal J. Comparison of salivary pH, buffering capacity and alkaline phosphatase in smokers and healthy non-smokers: retrospective cohort study. Sultan Qaboos Univ Med J. 2016; 16(3): e317-21.
Buktare K, Parikh S, Shah J. Comparative evaluation of salivary flow rate, pH, and alkaline phosphatase in tobacco users and healthy individuals: a biomarker study. J Int Oral Health. 2024;16(6):479-86.
Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2015;11:45–51.
Navazesh M, Kumar SK. Measuring salivary flow: challenges and opportunities. J Am Dent Assoc. 2008; 139: 35S-40S.
Patel RM, Varma S, Suragimath G, Zope S. Estimation and comparison of salivary calcium, phosphorus and alkaline phosphatase levels in patients with periodontal disease. J Clin Diagn Res. 2016; 10(10): ZC136–ZC139.
Sreeramareddy CT, Acharya K, Ramakrishna Reddy N. Single, dual, and poly use of tobacco products, and associated factors among adults in 18 Global Adult Tobacco Survey countries during 2015–2021. Int J Ment Health Addict. 2025; 23: 4118-33.
Zięba S, Zalewska A, Żukowski P, Maciejczyk M. Can smoking alter salivary homeostasis? A systematic review on the effects of traditional and electronic cigarettes on qualitative and quantitative saliva parameters. Dent Med Probl. 2024; 61(1): 129-44.
Atagün ÖS, Baltacıoğlu E, Alver A, Yücesan FB, Yuva P, Kehribar MA, et al. Effects of smoking on local and systemic oxidative stress markers in individuals with periodontitis. Northwest Med J. 2024;4(4): 195–205.
Alqahtani SM, Gokhale ST, Elagib MFA, Shrivastava D, Nagate RR, Alshmrani BAM, et al. Assessment and correlation of salivary Ca, Mg, and pH in smokers and non-smokers with generalized chronic periodontitis. Medicina (Kaunas). 2023; 59(4): 765.
Wang X, Mi Q, Yang J, Guan Y, Zeng W, Xiang H, et al. Effect of electronic cigarette and tobacco smoking on the human saliva microbial community. Braz J Microbiol. 2022; 53(2): 991-1000.
Shapiro H, Goldenberg K, Ratiner K, Elinav E. Smoking-induced microbial dysbiosis in health and disease. Clin Sci (Lond). 2022; 136(18):1371-87.
Basic A, Dahlén G. Microbial metabolites in the pathogenesis of periodontal diseases: a narrative review. Front Oral Health. 2023;4:1210200.
Sczepanik FSC, Grossi ML, Casati M, Goldberg M, Glogauer M, Fine N, et al. Periodontitis is an inflammatory disease of oxidative stress: we should treat it that way. Periodontol 2000. 2020; 84(1): 45-68.
Nayak DS, Dave A, Manek PV, Jambhekar SV, Shetty RR, Syed NK, et al. Evaluating alkaline phosphatase level and inflammation parameters in smokers with chronic periodontitis. Adv Hum Biol. 2026; 16(1): 161-7.
Silva H. Tobacco use and periodontal disease: the role of microvascular dysfunction. Biology (Basel). 2021; 10(5): 441.
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