Comparative Analysis of Salivary Electrolyte Concentrations and Flow Rate in Chronic Smokers versus Non-Smokers: Salivary Changes in Chronic Smokers

Maham Maooz  Ansari; Maryam Asim  Khan; Hamna  Khanani; Ayesha Yaqoob  Kahout

Authors

Maham Maooz Ansari Ziauddin University, Karachi, Pakistan https://orcid.org/0009-0003-1175-967X
Maryam Asim Khan Ziauddin University, Karachi, Pakistan
Hamna Khanani Ziauddin University, Karachi, Pakistan
Ayesha Yaqoob Kahout Bolan Medical College, Quetta, Pakistan

Keywords:

Biomarkers, Electrolytes, Oral Health, Saliva, Smoking, Tobacco

Abstract

Background: Tobacco smoking has well-documented adverse effects on oral health, yet the specific mechanisms by which smoking alters salivary electrolyte composition remain incompletely understood. Given saliva's critical role in maintaining oral homeostasis, investigating smoking-induced changes in salivary electrolytes may provide insights into disease susceptibility patterns observed in smoking populations. This study aimed to quantify and compare salivary electrolyte concentrations and flow rates between chronic smokers and non-smokers, while examining relationships between smoking duration and observed salivary changes.

Methods: We conducted a cross-sectional analysis involving 200 participants (100 smokers, 100 non-smokers) between ages 25-55 years. Both stimulated and unstimulated saliva samples underwent electrolyte analysis using ion-selective electrodes and spectrophotometric methods. Statistical evaluation employed independent t-tests, correlation analysis, and multiple regression modeling.

Results: Smokers demonstrated significantly elevated sodium (p<0.001), chloride (p<0.001), and calcium concentrations (p<0.05) relative to non-smokers. Conversely, potassium and phosphate concentrations were significantly decreased in the smoking group (p<0.01). Both stimulated and unstimulated salivary flow rates showed marked reductions in smokers (p<0.001). Strong positive correlations emerged between smoking duration and sodium/chloride concentrations.

Conclusion: Chronic tobacco use produces substantial alterations in salivary electrolyte composition and secretion rates, which may contribute to the heightened oral disease susceptibility observed in smoking populations. These findings suggest potential utility of salivary electrolyte profiles as biomarkers for smoking-related oral health risk assessment.

DOI: https://doi.org/10.59564/amrj/03.04/012

Author Biographies

Maham Maooz Ansari, Ziauddin University, Karachi, Pakistan

Ziauddin Medical College

Maryam Asim Khan, Ziauddin University, Karachi, Pakistan

Ziauddin Medical College

Hamna Khanani, Ziauddin University, Karachi, Pakistan

Ziauddin Medical College

Ayesha Yaqoob Kahout, Bolan Medical College, Quetta, Pakistan

House Officer

References

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. Dental and Medical Problems. 2024;61(1):129-44.

DOI: https://doi.org/10.17219/dmp/172084

Kurniawan AV, Amtha R, Gunardi I, Heriandi A, Sari EF. The Impact of Electronic and Conventional Cigarette Use towards Saliva Profile and Oral Microbiota in Adolescents. Asian Pacific Journal of Cancer Prevention. 2025 Jan 1;26(1):309-18.

DOI: https://doi.org/10.31557/APJCP.2025.26.1.309

Hasan NW, Baharin B, Mohd N, Rahman MA, Hassan N. Comparative effects of e-cigarette smoking on periodontal status, salivary pH, and cotinine levels. BMC Oral Health. 2024 Jul 29;24(1):861.

DOI: https://doi.org/10.1186/s12903-024-04650-7

Erdemir EO, Erdemir A. The detection of salivary minerals in smokers and non‐smokers with chronic periodontitis by the inductively coupled plasma‐atomic emission spectrophotometry technique. Journal of periodontology. 2006 Jun;77(6):990-5. DOI: https://doi.org/10.1902/jop.2006.050202

Tjahajawati S, Rafisa A, Lestari EA. The effect of smoking on salivary calcium levels, calcium intake, and bleeding on probing in female. International journal of dentistry. 2021;2021(1):2221112.

DOI: https://doi.org/10.1155/2021/2221112

Alqahtani SM, Gokhale ST, Elagib MF, Shrivastava D, Nagate RR, Alshmrani BA, Alburade AM, Alqahtani FM, Nagarajappa AK, Natoli V, Srivastava KC. Assessment and correlation of salivary Ca, Mg, and pH in smokers and non-smokers with generalized chronic periodontitis. Medicina. 2023 Apr 14;59(4):765.

DOI: https://doi.org/10.3390/medicina59040765

Rad M, Kakoie S, Brojeni FN, Pourdamghan N. Effect of long-term smoking on whole-mouth salivary flow rate and oral health. Journal of dental research, dental clinics, dental prospects. 2010 Dec 21;4(4):110.

DOI: https://doi.org/10.5681/joddd.2010.028

Yiu AJ, Kalejaiye A, Amdur RL, Hesham HT, Bandyopadhyay BC. Association of serum electrolytes and smoking with salivary gland stone formation. International journal of oral and maxillofacial surgery. 2016 Jun 1;45(6):764-8.

DOI: https://doi.org/10.1016/j.ijom.2016.02.007

Singh M, Ingle NA, Kaur N, Yadav P, Ingle E. Effect of long-term smoking on salivary flow rate and salivary pH. Journal of Indian Association of Public Health Dentistry. 2015 Jan 1;13(1):11-3.

Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent. 2001;85(2):162-169.

DOI: https://doi.org/10.1067/mpr.2001.113778

Nigar S, Hassan S, Maqsood A, Ahmed N, Al-Askar M, Mokeem SA, Alqutub MN, Aldahian N, AlSagob EI, AlMubarak AA, Vohra F. An assessment of unstimulated salivary flow rate, IgA and clinical oral dryness among active and passive smokers. International journal of occupational medicine and environmental health. 2022 Jan 1;35(1):39.

DOI: https://doi.org/10.13075/ijomeh.1896.01829

Dawes C, Pedersen AM, Villa A, et al. The functions of human saliva: a review sponsored by the World Workshop on Oral Medicine VI. Arch Oral Biol. 2015;60(6):863-874.

DOI: https://doi.org/10.1016/j.archoralbio.2015.03.004

Jessie K, Pang WW, Haji Z, Rahim A, Hashim OH. Proteomic analysis of whole human saliva detects enhanced expression of interleukin-1 receptor antagonist, thioredoxin and lipocalin-1 in cigarette smokers compared to non-smokers. International journal of molecular sciences. 2010 Nov 9;11(11):4488-505.

DOI: https://doi.org/10.3390/ijms11114488

Dolatabadi A, Noori F, Raee A. Effect of conventional cigarettes and e-cigarettes on salivary biomarkers: A systematic review. Journal of Advanced Periodontology & Implant Dentistry. 2024 Apr 22;16(1):44.

DOI: https://doi.org/10.34172/japid.2024.006

Tomar SL, Asma S. Smoking‐attributable periodontitis in the United States: findings from NHANES III. Journal of periodontology. 2000 May;71(5):743-51.

DOI: https://doi.org/10.1902/jop.2000.71.5.743

Nagler R, Lischinsky S, Diamond E, Drigues N, Klein I, Reznick AZ. Effect of cigarette smoke on salivary proteins and enzyme activities. Archives of Biochemistry and Biophysics. 2000 Jul 15;379(2):229-36.

DOI: https://doi.org/10.1006/abbi.2000.1877

Kamal NM, Shams NS. The impact of tobacco smoking and electronic cigarette vaping on salivary biomarkers. A comparative study. The Saudi Dental Journal. 2022 Jul 1;34(5):404-9.

DOI: https://doi.org/10.1016/j.sdentj.2022.05.003

Larsen MJ. Enamel/saliva-inorganic chemical reactions. Textbook of cariology. 1986.

Fiyaz M, Ramesh A, Ramalingam K, Thomas B, Shetty S, Prakash P. Association of salivary calcium, phosphate, pH and flow rate on oral health: A study on 90 subjects. Journal of Indian Society of Periodontology. 2013 Jul 1;17(4):454-60.

DOI: https://doi.org/10.4103/0972-124X.118316

Bergström J, Eliasson S, Dock J. A 10‐year prospective study of tobacco smoking and periodontal health. Journal of periodontology. 2000 Aug;71(8):1338-47.

DOI: https://doi.org/10.1902/jop.2000.71.8.1338

Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annual review of pharmacology and toxicology. 2009 Feb 10;49(1):57-71.

DOI: https://doi.org/10.1146/annurev.pharmtox.48.113006.094742

Saputri D, Nasution AI, Surbakti MR, Gani BA. The correlation between pH and flow rate of salivary smokers related to nicotine levels labelled on cigarettes. Dental Journal. 2017 Jun;50(2):61-5.

DOI: https://doi.org/10.20473/j.djmkg.v50.i2.p61-65

Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol. 2004;75(2):196-209.

DOI: https://doi.org/10.1902/jop.2004.75.2.196

Krüger K, Dischereit G, Seimetz M, et al. Time course of cigarette smoke-induced changes of systemic inflammation and muscle structure. Am J Physiol Lung Cell Mol Physiol. 2015;309(2):L119-L128.

DOI: https://doi.org/10.1152/ajplung.00074.2015

Kambalyal P, Kambalyal P, Hungund S. Comparison of salivary calcium level in smokers and non-smokers with chronic periodontitis, aggressive periodontitis, and healthy controls. Journal of International Society of Preventive and Community Dentistry. 2015 Dec 1;5(Suppl 2):S68-73.

DOI: https://doi.org/10.4103/2231-0762.171595