A Meta-Analytical Correlation Between Salivary pH, Buffer Capacity, and Microbiome Composition in Caries-Free and Caries-Active Individuals
DOI:
https://doi.org/10.36283/ziun-pjmd15-1/029Keywords:
Saliva, Streptococcus mutans, Dental Caries, Dental Caries Susceptibility, Oral Microbiome, Biomarkers, Preventive DentistryAbstract
Background: Salivary composition, including pH, buffer capacity, and microbial profile, which are important in oral health and susceptibility to caries. This systematic review and meta-analysis aimed to provide an aggregate of available information on salivary pH, buffer capacity, and levels of S. mutans in caries-active and caries-free individuals.
Methods: PubMed, Scopus, Web of Science, and Google Scholar (2010-2025) were searched according to PRISMA 2020. Studies included examined salivary pH, buffer capacity, and the level of Streptococcus mutans of human populations in correlation with dental caries. RoB 2 and NOS determined the risk of bias, and quality of evidence was assessed using the GRADE. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated by a random-effects meta-analysis based on the inverse-variance technique. Subgroup and sensitivity analyses were also conducted.
Results: A total of 12 studies were incorporated, of which 09 studies were used for meta-analysis. There was no statistically significant difference in salivary pH in cohorts of experiments and controls (SMD = 1.68; I2 = 94%). Experimental cohorts had much better scores in salivary buffer capacity (SMD = 0.55; I2 = 82%). There were no significant changes in Streptococcus mutans (SMD = 1.79; I2 = 97%). Risk of bias was low to moderate, and the quality of the evidence was moderate, as per GRADE.
Conclusion: Salivary buffer capacity seems to be a major protective variable related to caries in dentistry, whereas salivary pH and S. mutans alone do not seem to be reliable predictors of caries.
References
1. Ribeiro AA, Paster BJ. Dental caries and their microbiomes in children: what do we do now? J Oral Microbiol 2023 Apr 10;15:2198433. doi:10.1080/20002297.2023.2198433.
2. Lemos JA, Palmer SR, Zeng L, Wen ZT, Kajfasz JK, Freires IA, et al. The biology of Streptococcus mutans. Microbiol Spectr 2019 Jan;7:10.1128/microbiolspec.gpp3-0051-2018. doi:10.1128/microbiolspec.gpp3-0051-2018.
3. Motsay M, Saputo S. Acid adaptation alters Streptococcus mutans drug susceptibility profile. Microbe 2024 Mar;2:100028. doi:10.1016/j.microb.2023.100028.
4. Krzyściak W, Jurczak A, Kościelniak D, Bystrowska B, Skalniak A. The virulence of Streptococcus mutans and the ability to form biofilms. Eur J Clin Microbiol Infect Dis 2014 Apr;33:499–515. doi:10.1007/s10096-013-1993-7.
5. Farooq I, Bugshan A. The role of salivary contents and modern technologies in the remineralization of dental enamel: a narrative review. F1000 Res 2021 Mar 9;9:171. doi:10.12688/f1000research.22499.3.
6. Shah T, Dutta K, Saha S, Nair MR. Evaluation of salivary parameters and remineralizing effects of yogurt in counteracting the cariogenic impact of candy consumption: an in vivo study. J Oral Biol Craniofac Res 2025 Mar-Apr;15:390–4. doi:10.1016/j.jobcr.2025.02.007.
7. Ahmad L, Aljoujou AA, Nadra R, Mashlah AM, Al Beesh FA, Alyafi A, et al. The association between dental caries and salivary buffering capacity in Syrian patients diagnosed with sickle cell disease. Cureus 2024 July;16:e64887. doi:10.7759/cureus.64887.
8. Javed K, Nasir MZ, Jalees M, Manzoor MA. Role of diet and dietary habits in causing dental caries among adults reporting to a tertiary care hospital in Pakistan: a case-control study. Heliyon 2023 Nov;9:e23117. doi:10.1016/j.heliyon.2023.e23117.
9. da Silveira EG, Prato LS, Pilati SFM, Arthur RA. Comparison of oral cavity protein abundance among caries-free and caries-affected individuals: a systematic review and meta-analysis. Front Oral Health 2023 Sep;4:1265817. doi:10.3389/froh.2023.1265817.
10. Spatafora G, Li Y, He X, Cowan A, Tanner ACR. The evolving microbiome of dental caries. Microorganisms 2024 Jan 7;12:121. doi:10.3390/microorganisms12010121.
11. Hemadi AS, Huang R, Zhou Y, Zou J. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment. Int J Oral Sci 2017 Nov 10;9:e1. doi:10.1038/ijos.2017.35.
12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021 Mar 29;372:n71. doi:10.1136/bmj.n71.
13. Fekete JT, Gyorffy B. MetaAnalysisOnline.com: an online tool for the rapid meta-analysis of clinical and epidemiological studies. J Med Internet Res. 2025 Mar 6;27:e64016. doi: 10.2196/64016.
14. Kodaman Dokumacıgil N, Sezer B, Oktay Ş, Alpay H, Kargül B. Dental caries, oral hygiene and salivary characteristics in children with chronic kidney disease: a case-control study. Pediatr Nephrol 2025 Aug;40:2627–37. doi:10.1007/s00467-025-06730-4.
15. Jain S, Mathur S. Estimating the effectiveness of lollipops containing xylitol and erythritol on salivary pH in 3-6 years olds: a randomized controlled trial. J Indian Soc Pedod Prev Dent 2022 Jan-Mar;40. doi:10.4103/jisppd.jisppd_54_21.
16. Ribelles Llop M, Guinot Jimeno F, Mayné Acién R, Bellet Dalmau LJ. Effects of xylitol chewing gum on salivary flow rate, pH, buffering capacity and presence of Streptococcus mutans in saliva. Eur J Paediatr Dent 2010 Mar;11:9–14.
17. Padminee K, Poorni S, Diana D, Duraivel D, Srinivasan MR. Effectiveness of casein phosphopeptide-amorphous calcium phosphate and xylitol chewing gums on salivary pH, buffer capacity and Streptococcus mutans levels: an interventional study. Indian J Dent Res 2018 Sep-Oct;29:616. doi:10.4103/ijdr.IJDR_166_17.
18. Aminabadi NA, Najafpour E, Razavi Rohani Z, Sighari Deljavan A, Ghojazadeh M, Jamali Z. Linear reciprocal interaction between dental caries and salivary characteristics. J Oral Sci 2013 Dec 18;55:337–42. doi:10.2334/josnusd.55.337.
19. Cardoso AA, Lopes LM, Rodrigues LP, Teixeira JJ, Steiner-Oliveira C, Nobre-dos-Santos M. Influence of salivary parameters in the caries development in orthodontic patients: an observational clinical study. Int J Paediatr Dent 2017 Nov;27:540–50. doi:10.1111/ipd.12295.
20. Feres de Melo AR, Ferreira de Souza A, de Oliveira Perestrelo B, Leite MF. Clinical oral and salivary parameters of children with juvenile idiopathic arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol 2014 Jan;117:75–80. doi:10.1016/j.oooo.2013.08.024.
21. Vieira KA, Rosa-Júnior LS, Souza MAV, Santos NB, Florêncio TMMT, Bussadori SK. Chronic malnutrition and oral health status in children aged 1–5 years: an observational study. Medicine (Baltimore) 2020 May;99:e19595. doi:10.1097/MD.0000000000019595.
22. Nanda J, Sachdev V, Sandhu M, Deep-Singh-Nanda K. Correlation between dental caries experience and mutans streptococci counts using saliva and plaque as microbial risk indicators in 3–8 year-old children: a cross-sectional study. J Clin Exp Dent 2015 Feb 1;7:e114–8. doi:10.4317/jced.51814.
23. Shafaie E, Badri Z, Salehiniya H, Abbaszadeh H. Comparison of salivary Streptococcus mutans levels between caries-active and caries-free children from Birjand, Iran: a case-control study. Heliyon 2024 Feb 6;10:e25663. doi:10.1016/j.heliyon.2024.e25663.
24. Sounah SA, Madfa AA. Correlation between dental caries experience and the level of Streptococcus mutans and Lactobacilli in saliva and carious teeth in a Yemeni adult population. BMC Res Notes 2020 Feb 27;13:112. doi:10.1186/s13104-020-04960-3.
25. ElSalhy M, Honkala S, Söderling E, Varghese A, Honkala E. Relationship between daily habits, Streptococcus mutans, and caries among schoolboys. J Dent 2013 Nov;41:1000–6. doi:10.1016/j.jdent.2013.08.005.
26. Okuyama K, Yanamoto S. Saliva in balancing oral and systemic health, oral cancer, and beyond: a narrative review. Cancers (Basel) 2024 Dec 23;16:4276. doi:10.3390/cancers16244276.
27. Koopaie M, Shahri FK, Montazeri R, Kolahdooz S, Shahri MM, Moshkbouy E. Comparison of salivary statherin and β-defensin-2 levels, oral health behaviours and demographic factors in children with and without early childhood caries. BMC Oral Health 2025 May 31;25:868. doi:10.1186/s12903-025-06252-3.
28. Sedghi L, DiMassa V, Harrington A, Lynch SV, Kapila YL. The oral microbiome: role of key organisms and complex networks in oral health and disease. Periodontol 2000 2021 Oct;87:107–31. doi:10.1111/prd.12393.
29. Grohe B, Mittler S. Advanced non-fluoride approaches to dental enamel remineralization: the next level in enamel repair management. Biomater Biosyst 2021 Oct 29;4:100029. doi:10.1016/j.bbiosy.2021.100029.
30. Enax J, Fandrich P, Schulze zur Wiesche E, Epple M. The remineralization of enamel from saliva: a chemical perspective. Dent J (Basel) 2024 Oct 23;12:339. doi:10.3390/dj12110339.
31. Madariaga VI, Pereira-Cenci T, van Gennip LLA, van Leeuwen SJM, Walboomers XF, Loomans BAC. Exploring the relationship of salivary pH and flow rate with tooth wear severity: a cross-sectional study. J Dent 2025 Jan;152:105499. doi:10.1016/j.jdent.2024.105499.
32. Polyakova M, Egiazaryan A, Doroshina V, Zaytsev A, Malashin A, Babina K, et al. The effect of oral care foams and a spray on salivary pH changes after exposure to acidic beverages in young adults. Dent J (Basel) 2024 Apr 3;12:93. doi:10.3390/dj12040093.
33. Zhang JS, Chu CH, Yu OY. Oral microbiome and dental caries development. Dent J (Basel) 2022 Sep 30;10:184. doi:10.3390/dj10100184.
34. Gao Z, Chen X, Wang C, Song J, Xu J, Liu X, et al. New strategies and mechanisms for targeting Streptococcus mutans biofilm formation to prevent dental caries: a review. Microbiol Res 2023 Oct 14;278:127526. doi:10.1016/j.micres.2023.127526.
35. Chen W, Jiang Q, Yan G, Yang D. The oral microbiome and salivary proteins influence caries in children aged 6–8 years. BMC Oral Health 2020 Oct 28;20:295. doi:10.1186/s12903-020-01262-9.
36. Tamayo-Estebaranz N, Muñoz-González C, Gil-Valcárcel AM, Calvo López-Dávalos P, Martín-Vacas A, Paz-Cortés MM, et al. Salivary microbiota profile in adult and children population according to active dentin caries: a metagenomic preliminary analysis. Front Oral Health 2025 Jul 28;6:1599925. doi:10.3389/froh.2025.1599925.
37. Kurtzman GM, Horowitz RA, Johnson R, Prestiano RA, Klein BI. The systemic oral health connection: biofilms. Medicine (Baltimore) 2022 Nov;101:e30517. doi:10.1097/MD.0000000000030517.
38. Nath S, Zilm P, Jamieson L, Santiago PHR, Ketagoda DHK, Weyrich L. The influence of diet, saliva, and dental history on the oral microbiome in healthy, caries-free Australian adults. Sci Rep 2025 May 28;15:18755. doi:10.1038/s41598-025-03455-0.
39. Alghamdi M, Ingle NA, Baseer MA. Assessment of salivary pH, buffer capacity and flow in COVID-19-infected and vaccinated dental patients. Cureus 2023 May 28;15:e39591. doi:10.7759/cureus.39591.
40. Surdu A, Foia LG, Luchian I, Trifan D, Tatarciuc MS, Scutariu MM, et al. Saliva as a diagnostic tool for systemic diseases: a narrative review. Medicina (Kaunas) 2025 Jan 23;61:243. doi:10.3390/medicina61020243
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