Salivary Immunological Defence in Children with Rampant Dental Caries: Comparative Assessment of Secretory Immunoglobulin A, Histatin, and Streptococcus mutans in Babylon Governorate, Iraq
Rampant caries; secretory IgA; histatin; Streptococcus mutans; salivary flow rate; children; Iraq
Authorsauthor:AbstractObjective: This study compared salivary secretory immunoglobulin A (sIgA) and histatin concentrations, alongside salivary flow rate, resting pH, buffering capacity, and Streptococcus mutans presence, between children with rampant dental caries and a control group of lower caries burden in AlHilla, Babylon Governorate, Iraq. Material and Methods: A cross-sectional comparative study enrolled 100 children aged 5–12 years: 55 in a control group and 45 with rampant dental caries. Caries experience was recorded using the WHO DMFT/dmft index. Salivary flow rate, resting pH, and buffering capacity were assessed chairside. Salivary s-IgA and histatin were quantified by ELISA, and S. mutans was assessed by salivary culture. Group comparisons used independent t-tests and chi-square tests, with Pearson correlation analysis performed across the full sample. Results: Mean DMFT/dmft was significantly higher in the rampant caries group than in controls (15.60 vs. 5.82; p<0.001). Salivary flow rate differed significantly between groups (p=0.032), with low flow more frequent among rampant caries children. Salivary pH, buffering capacity, s-IgA, histatin, and S. mutans presence did not differ significantly between groups. A significant positive correlation was found between DMFT and buffering capacity (r=0.271; p=0.006), and between histatin and s-IgA (r=0.220; p=0.028). Conclusion: Salivary immune markers did not independently distinguish children with rampant caries from controls, despite a clear and significant clinical separation in caries burden. Salivary flow rate emerged as the most clinically relevant discriminator. These findings support incorporating chairside salivary flow assessment into paediatric caries risk evaluation, and contribute evidence from an Iraqi population that remains underrepresented in the literature.
IntroductionRampant dental caries describes a pattern of aggressive, multi-surface decay that progresses faster than ordinary caries and frequently involves teeth not typically prone to early breakdown. In children, it carries consequences well beyond the mouth itself — pain, infection, disrupted sleep, and interference with normal eating and growth are all common outcomes when the disease is left unaddressed (American Academy of Pediatric Dentistry, 2025; Purohit & Priya, 2022). Iraq carries a heavy burden of childhood caries, yet very little biological data exist describing what actually differs, at a salivary level, between children who develop rampant disease and those who do not. Most of what clinicians rely on locally is extrapolated from studies conducted elsewhere — Europe, East Asia, or wealthier Gulf states — despite meaningful differences in diet, •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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