Editorial

Modification of salivary pH in patients with orthodontic brackets

0000-0003-1885-0938Yadira Yanes Ruiz^{1  *}  , 0000-0002-8101-9234Orlando Martín Cárdenas¹ 

¹Clínica Estomatológica Provincial, Sancti Spíritus, Cuba.

The formation of white lesions or demineralization of tooth enamel around fixed orthodontic brackets is a common complication during orthodontic treatment and is usually associated with the accumulation of dental plaque or food debris on part of the bracket or on the bonding materials. Saliva plays an important role in the interface of the dynamism of mineral loss and deposition on the enamel-plaque surface; therefore, the role of maintaining an optimal salivary pH for the prevention of oral disease is highlighted, especially in patients with fixed orthodontic brackets. ¹

The term pH is used to define a solution hydrogen ion concentration. High concentrations of hydrogen ions correspond to low pH and low concentrations to high pH. The pH is measured in potentiometric units on a scale ranging from 0 to 14. There are systems capable of controlling pH changes, these are called buffer systems. A buffer system is a solution containing 2 or more chemical compounds capable of preventing significant changes in the concentration of hydrogen ions when an acid or base is added to the solution. ²

Saliva has a buffer mechanism that attempts to maintain the pH between 6.5 and 7.5 throughout the day; this fluid composed of complex molecules must maintain neutral pH by its various mechanisms to regulate the plaque pH, a very significant function for the prevention of caries and periodontopathies. ¹

Saliva is a hypotonic, watery fluid secreted by both major and minor salivary glands that maintains the homeostasis of the oral cavity. Among the functions of saliva are to protect oral tissues from the environment, modulate demineralization-remineralization processes, lubricate occlusal surfaces, and maintain ecological balance. Monzón J et al ² agree in pointing out that as the salivary flow increases, the pH changes, becoming less acidic, so saliva would then play a primordial role in the maintenance of the normal conditions of the oral tissues.

Acids produced by bacterial plaque below the local pH of 6.5 lead to the dissolution of hydroxyapatite and the formation of white spot lesions usually around orthodontic brackets and poorly adapted bands, ³ and if this reduction in pH is maintained over time, it leads to diseases such as dental caries. ⁴

On the other hand, a key link in the irritant chain of periodontal tissue such as dental calculus has as a prerequisite for its formation that the plaque has a more alkaline pH even than the saliva itself or the surrounding crevicular fluid, which depends on high proteolytic activity.

The progression and extension of periodontal disease is associated to a higher alkalinity scale of salivary pH, which is directly related to periodontal tissue alterations. ²

The placement of orthodontic brackets in the oral cavity produces changes in salivary flow and viscosity ⁵, as well as an inevitable ecological modification, with changes in clinical parameters also in the synthesis of supra and subgingival plaque towards more pathogenic populations. This favors the development of specific dental biofilms in patients with orthodontic brackets compared to those without any. ^6,7

The modification of the saliva pH caused by these factors, together with poor oral hygiene and the use of brackets can lead to the appearance of undesirable diseases that interfere with orthodontic treatment and even its definitive interruption.

REFERENCIAS BIBLIOGRÁFICAS

1.  Zárate Daza AN, Leyva Huerta ER, Franco Martínez F. Determinación de pH y proteínas totales en saliva en pacientes con y sin aparatología ortodóncica fija (estudio piloto). Rev Odont Mex [Internet]. 2004 [citado 03 Jun 2019];8(3):59-63. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/odon/uo-2004/uo043b.pdf 1.

2.  Monzón J, Acuña M, Cuzziol F. El Ph salival como indicador de alteraciones en los tejidos periodontales. Revista de la Facultad de Odontología. [Internet]. 2015 [citado 03 Jun 2019];8(1):8-20. Disponible en: Disponible en: https://www.readcube.com/articles/10.30972/rfo.811625 2.

3.  Quintero AM, García C. Control de la higiene oral en los pacientes con ortodoncia. Rev Nac Odontol [Internet]. 2013 [citado 03 Jun 2019];9(ed. Especial):37-45. Disponible en: Disponible en: https://revistas.ucc.edu.co/index.php/od/article/view/430/431 3.

4.  Bretas IP, Rocha ME, Vieira MS, Rodrigues ACP. Fluxo salivar e capacidade tamponante da saliva como indicadores de susceptibilidade à doença cárie. Pesq Bras Odontoped Clin Integr, João Pessoa [Internet]. 2008 [citado 2019 Mayo 16];8(3):289293. Available from: Available from: http://revista.uepb.edu.br/index.php/pboci/article/viewFile/442/252 4.

5.  Barreto Sánchez ER, Carruitero Honores MJ. Efecto de la aparatología ortodóntica fija sobre el flujo y la viscosidad salival. Rev Mex Ortodon [Internet]. 2015 [citado 2019 Jun 03];3(3):186-90. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/ortodoncia/mo-2015/mo153g.pdf 5.

6.  Gésime Oviedo JM, Merino Lavado RL, Briceño Caveda EN. Influencia del PH en las relaciones microbianas de la cavidad bucal. Revisión bibliográfica. Acta Odontológica Venezolana [Internet]. 2014 [citado 09 Jun 2019];52(2). Disponible en: Disponible en: https://www.actaodontologica.com/ediciones/2014/2/art-21/ 6.

7.  Premchind TK, Agarwal A, Kumar RR. Role of Biofilm and its Effects in Orthodontic Treatment. J Orofac Health Sc [Internet]. 2019 [citado 2020 Jan 15];10(1):13-21. Disponible en: Disponible en: http://www.indianjournals.com/ijor.aspx?target=ijor:johs&volume=10&issue=1&article=003 7.  DOI: 10.5958/2229-3264.2019.00003.0

Received: April 01, 2021; Accepted: May 28, 2021

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran no tener conflicto de interés en esta investigación.