Oxidative Stress Levels and the Oral Health Status of Children with Down Syndrome at The Helena Health Center in Erbil City, Kurdistan Region, Iraq
DOI:
https://doi.org/10.56056/Keywords:
Down syndrome, Nitric oxide, Oral health status, Sialic acid, Total antioxidant capacityAbstract
Background and objectives: Down syndrome is the most frequently occurring hereditary reason for cognitive disability, arising from the duplication of either the whole or a section of chromosome 21. The study’s goal was to evaluate the association between salivary oxidative stress indicators, including total antioxidant capacity, nitric oxide, and salic acid, and oral health parameters such as dental caries and periodontal disease in individuals with Down syndrome.
Method: This case-control study conducted at Helena Center, in Erbil City, Kurdistan Region, Iraq between June 1st 2023 and June 1st, 2024.The study included 37 persons with Down syndrome and 37 healthy-matched control volunteers aged 7 to 12 years. The study compared Oral health status (DMFT, Plague Index, and Gingival Index) among individuals with Down syndrome and healthy volunteers aged 7-12 years, using Plaque Index and Gingival Index. The unstimulated salivary samples were used for oxidative stress assessment.
Results: In children with Down syndrome, the value for (Decayed, Missing, Filled Teeth) for permanent teeth (0.75), for (Decayed, Filled Teeth) for deciduous teeth (0.94), plaque index (0.68), gingival index (0.88), Total antioxidant capacity (4.17), Nitric oxide (98.8), Sialic acid (1). whereas the values in the control group were DMFT (1.07), dft (1.27), plaque index (0.69), gingival index (0.56), Total antioxidant capacity (6.37), Nitric oxide (75.8), Sialic acid (0.72). No significant differences were seen in the two groups' regarding (Decayed, Missing, Filled Teeth) for permanent teeth, (Decayed, Filled Teeth) for deciduous teeth, plaque index and Nitric oxide. Down syndrome had significantly higher gingival index, while Total antioxidant capacity was significantly low and Sialic acid was significantly higher.
Conclusions: this study highlights differences in salivary biomarkers in children with Down syndrome, including lower total antioxidative capacity and higher sialic acid levels, which may impact oxidative stress and plaque formation.
Downloads
References
1. O’ Nuallain S, Flanagan O, Raffat I, Avalos G, Dineen B. The prevalence of Down syndrome in County Galway. Ir Med. 2009; 100:329–31.
2. Oredugba FA. Oral health condition and treatment needs of a group of Nigerian individuals with Down syndrome. Downs Syndr Res Pract. 2007; 12(1): 72-6. doi: 10.3104/reports.2022. PMID: 17692192.
3. Wilkins EM. The patient with mental retardation. In: Clinical practices of the dental hygienist, 8th ed. USA: Lippincott Williams & Wilkins; 1999:814-5.
4. Omitola OG, Arigbede AO. Prevalence of dental caries among adult patients attending a tertiary dental institution in south-south region of Nigeria. Port Harcourt Med J. 2012; 6:52–8.
5. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al.Oral diseases: a global public health challenge. Lancet. 2019: 20;394(10194):249-260. doi: 10.1016/S0140-6736(19)31146-8/
6. Hong Y, Boiti A, Vallone D, Foulkes NS. Reactive Oxygen Species Signaling and Oxidative Stress: Transcriptional Regulation and Evolution. Antioxidants (Basel). 2024; 13(3): 312. doi: 10.3390/antiox13030312/
7. Kirstila V, Hakkinen P, Jentsch H, Vilja P, Tenovuo J. Longitudinal analysis of the association of human salivary antimicrobial agents with caries increment and cariogenic microorganisms: a two-year cohort study. J Dent Res 1998;77(1):73-80.
8. Carratelli M, Porcaro L, Ruscica M, De Simone E, Bertelli AA, Corsi MM. Reactive oxygen metabolites and prooxidant status in children with Down’s syndrome. Int J Clin Pharmacol Res 2001;21(2):79-84.
9. Areias C, Sampaio-Maia B, Pereira Mde L, Azevedo A, Melo P, Andrade C, et al. Reduced salivary flow and colonization by mutans streptococci in children with Down syndrome. Clinics (Sao Paulo). 2012; 67(9):1007-11. doi: 10.6061/clinics/2012(09)04/
10. Ahmadi-Motamayel F, Goodarzi MT, Mahdavinezhad A, Jamshidi Z, Darvishi M. Salivary and Serum Antioxidant and Oxidative Stress Markers in Dental Caries. Caries Res. 2018; 52(6):565-569.
11. Hamonari NH. Al-dabbagh AS, Mahmood MA. Oxidative stress in dental caries and periodontal disease among secondary school students in Duhok, Kurdistan region, Iraq. DMK. 2021; 15(1), 69-80.
12. Krawczyk D, Błaszczak J, Borowicz J, Mielnik-Błaszczak M. Life style and risk of development of dental caries in a population of adolescents. Ann Agric Environ Med. 2014; 21(3):576- 80.
13. Rahmani M, Ghorchi V, Rezaei F, Vaisi-Raygani A. Evaluation of Total Antioxidant Capacity of Saliva in High School Students. Glob J Health Sci. 2015; 8(4): 89-94.
14. Banda NR, Singh G, Markam V. Evaluation of total antioxidant level of saliva in modulation of caries occurrence and progression in children. J Indian Soc Pedod Prev Dent. 2016; 34(3): 227-32. doi: 10.4103/0970-4388.186747. PMID: 27461805.
15. Jurczak A, Kościelniak D, Skalniak A, Papież M, Vyhouskaya P, Krzyściak W. The role of the saliva antioxidant barrier to reactive oxygen species with regard to caries development. Redox Rep. 2017; 22(6): 524-33.
16. Kelsey JL, Whittemore AS, Evans AS, Thompson WD. Methods in observational epidemiology (2nd Edition). New York: Oxford university press; 1996.
17. Subramaniam P, Babu KL, Rodriguez A. Relation of salivary risk factors in dental caries in children with cerebral palsy. J Clin Pediatr Dent. 2010; 34(4): 355-60.
18. Oral health surveys: basic methods - 5th edition. Who.int. World Health Organization; 2013. Available from: https://www.who.int/publications/i/item/978924154864/
19. Silness J, Löe H. Periodontal Disease in Pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964; 22(1): 121-35.
20. Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963; 21: 533-51.
21. Subramaniam P, Girish Babu K, Mohan Das L. Assessment of salivary total antioxidant levels and oral health status in children with Down syndrome. Spec Care Dentist. 2014; 34(4): 193-200. doi: 10.1111/scd.12054. Epub 2013 Nov 4. PMID: 24188359.
22. Senthil Eagappan AR, Rao VA, Sujatha S, Senthil D, Sathiyajeeva J, Rajaraman G. Evaluation of salivary nitric oxide level in children with early childhood caries. Dent Res J. 2016; 13: 338-41.
23. Siqueira WL, Nicolau J. Stimulated whole saliva components in children with Down syndrome. Spec Care Dentist. 2002; 22(6): 226-30. doi: 10.1111/j.1754-4505. 2002.tb00276. x/
24. Ulseth JO, Hestnes A, Stovner LJ, Storhaug K. Dental caries and periodontitis in persons with Down syndrome. Spec Care Dentist. 1991; 11(2): 71-3. doi: 10.1111/j.1754-4505. 1991.tb00819. x/
25. Yarat A, Akyüz S, Koç L, Erdem H, Emekli N. Salivary sialic acid, protein, salivary flow rate, pH, buffering capacity and caries indices in subjects with Down's syndrome. J Dent. 1999; 27(2): 115-8. doi: 10.1016/s0300-5712(98)00030-x/
26. Al Habashneh R, Al-Jundi S, Khader Y, Nofel N. Oral health status and reasons for not attending dental care among 12- to 16-year-old children with Down syndrome in special needs centres in Jordan. Int J Dent Hyg. 2012; 10(4): 259-64. doi: 10.1111/j.1601-5037.2012. 00545.x/
27. AlSarheed M. A comparative study of oral health amongst trisomy 21 children living in Riyadh, Saudi Arabia: Part 1 carries, malocclusion, trauma. Saudi Dent J. 2015; 27(4): 220-3. doi: 10.1016/j.sdentj.2015.03.003/
28. Anandan S, Lakshminarayan N, Nagappa KG. Comparison of dental caries experience and salivary parameters among children with Down syndrome and healthy controls in Chennai, Tamil Nadu. J Indian Soc Pedod Prev Dent. 2022; 40(3): 274-280. doi: 10.4103/jisppd.jisppd_296_21/
29. Nilchian F, Mosayebi N, Tarrahi MJ, Pasyar H. Comparison of oral indices in patients with Down syndrome and healthy individuals: A meta-analysis study. Dent Res J (Isfahan). 2023; 20:104.
30. Costacurta M, Epis M, Docimo R. Evaluation of DMFT in pediatric patients with social vulnerability conditions. Eur J Paediatr Dent. 2020; 21:70–3.
31. Kamalabadi YM, Sedigh SS, Abbaslou M. The relationship between DMFT index and cognitive impairment: A descriptive cross-sectional study. J Family Med Prim Care. 2020; 9:4317–22.
32. Pontigo-Loyola AP, Márquez-Corona ML, Minaya-Sánchez M, Lucas-Rincón SE, Casanova-Rosado JF, Robles-Minaya JL, et al. Correlation between the caries status of the first permanent molars and the overall DMFT index: A cross-sectional study. Medicine (Baltimore) 2020;99 (5): e19061. doi: 10.1097/MD.0000000000019061/
33. Davidovich E, Aframian DJ, Shapira J, Peretz B. A comparison of the sialochemistry, oral pH, and oral health status of Down syndrome children to healthy children. Int J Paediatr Dent. 2010; 20:235–41.
34. Sakellari D, Arapostathis KN, Konstantinidis A. Periodontal conditions and subgingival microflora in Down syndrome patients. A case-control study. J Clin Periodontal. 2005; 32: 684–90.
35. Morgan J. Why is periodontal disease more prevalent and more severe in people with Down syndrome Spec Care Dentist. 2007; 27:196–201.
36. Al-Sufiyani GA, Al-Maweri SA, Al- Ghashm AA, Al-Soneidar WA. Oral hygiene and gingival health status of children with Down syndrome in Yemen: A cross-sectional study. J Int Soc Prev Comm Dent. 2014; 4: 82–6.
37. Tsilingaridis G, Yucel-Lindberg, T, Quezada, HC, Modéer, T. The relationship between matrix metalloproteinase (MMP-3, −8, −9) in serum and peripheral lymphocytes (CD8 +, CD56 +) in Down syndrome children with gingivitis. J Periodontal Res. 2014; 49(6):143–48.
38. Tulunoglu O, Demirtas S, Tulunoglu I. Total antioxidant levels of saliva in children related to caries, age, and gender. Int J Paediatr Dent. 2006; 16(3): 186-91.
39. Uberos J, Alarcón JA, Peñalver MA, Molina-Carballo A, Ruiz M, González E, et al. Influence of the antioxidant content of saliva on dental caries in an at-risk community. Br Dent J. 2008; 205(2): E5. doi: 10.1038/sj.bdj.2008.520/
40. Tranquilli AL, Bezzeccheri V, Scagnoli C, Mazzanti L, Garzetti GG. Amniotic levels of vascular endothelial growth factor and nitric oxide at the second trimester in Down’s syndromes. J Mater Fetal Neonatal Med. 2003; 13(1): 28-31.
41. Dykhuizen RS, Frazer R, Duncan C, Smith CC, Golden M, Benjamin N, Leifert C. Antimicrobial effect of acidified nitrite on gut pathogens: the importance of dietary nitrate in host defense. Antimicrob Agents Chemother. 1996; 40(6): 1422-5. doi: 10.1128/AAC.40.6.142240/
42. deSoet JJ, Nyvad B, Killian M. Strain- related acid production by oral streptococci. Caries Res 2000; 34(6): 486-90.
43. Bayindir YZ, Polat MF, Seven N. Nitric oxide concentrations in saliva and dental plaque in relation to caries experience and oral hygiene. Caries Res. 2005; 39(2): 130-3.
44. Rai B. Total salivary glutathione levels: periodontitis in smokers and non-smokers. Adv in Med Dent Sci. 2008; 2(2): 47-9.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Abdulkareem Ali, Ali Fakhree Alzubaidee, Nasreen Hamarash Hamonari
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in AMJ (The Scientific Journal of Kurdistan Higher Council of Medical Specialties )is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0)
