Saliva PH – Measure, Monitor and Educate – Now it is EASY!
Tony S. Hashemian, D.D.S.
Saliva plays an important role in maintaining good oral health. Ongoing studies indicate that saliva may be useful for detecting various cancers, heart disease, diabetes, periodontal diseases, GERD, and other conditions. Technologies that will enable saliva to be used as a window into the body are being explored for their utility for detecting disease and monitoring health. NIH supports research for such technologies that use saliva to look for indicators of health conditions or diseases.
PH2OH is a new tool that helps to educate patients and to increase awareness about oral pH. Most people understand the concept of acidic substances like citrus fruits, soda and sports drinks. The concept of acids and bases are commonly introduced in middle and high school education as early as 8th grade. This prior exposure to the topic will facilitate communication and understanding of acidic saliva. The increase of intraoral acidity usually results in dental disease, especially caries and erosion.
Currently saliva-testing examination tools are used by the dental team to educate patients, assist in preventive treatment planning and properly select dental materials to initiate changes in the patient’s oral health and hygiene. Dental professionals can measure salivary pH with a pH level test strip or litmus paper. Placed in a saliva sample, the paper turns a different color depending upon the pH of the saliva. This color changes from a range of red (indicating a strong acidic state (pH < 3) to dark blue or purple (indicating a strong alkaline state (pH >11 ). Salivary pH testing can play a significant role in helping to improve oral health by assessing pH as a risk factor for dental caries and dental erosion. It can also be used as an educational tool to engage patients in monitoring and maintaining their self-care.
Salivary pH testing can be introduced to patients during a dental visit:
• As a follow up to discussions about oral hygiene and preventive recommendations • As a tool to help remind them and motivate them about maintaining their oral care at home • As a tool to help increase the dental IQ of the patient
The Arizona School of Dentistry & Oral Health (ASDOH) at A.T. Still University has been collaborating with GC America to develop an easy simple way to measure, monitor and educate patients about oral pH through enhancing technologies that improve overall health and wellness. PH2OH is an example of this type of technology.
In addition to GC America, ASDOH has also collaborated with Henry Schein to make a cost effective pH paper kit available to dental offices to use with their patients. Dental professionals can now order PH2OH - pH paper kits which include 15 pH strips inside of an informational trifold kit at a cost of $3.60 ($0.25 per pH strip) through the Henry Schein catalog. These affordable kits allow dental professionals to test patients’ salivary pH at chairside and send them home with the test strips for home testing.
Patients can now use their smartphone or tablet with the free PH2OH app for iPhone or Android to record their pH values (Figure 1). Patients capture a picture of the litmus paper test strip after testing their pH, and auto or manually calculate the pH using color-coding analysis. They can save the data and track their pH readings on their smartphone to share with their dental and health professionals.
Which patients should we recommend saliva testing for and when? • New patients—record a baseline and monitor • Perio patients—those with unexplained caries or newly diagnosed with periodontal disease • Current patients—prior to orthodontics, implant, or restorative treatments • High-risk patients—prior to other medical treatments
Figure 1: PH2OH app
Instructions for your patients on how to use the PH2OH app: 1. Download the PH2OH app, free from the iOS App/Google Play store. 2. Spit into a medicine cup; place one end of litmus paper in the cup to draw the saliva onto the paper. Remove and lay on paper towel for 30 seconds. 3. Using the PH2OH app, check your litmus paper results with the pH wheel; save the read; and record on the history graph. It will list the time and date of your pH reading. 4. Show the results to your hygienist, dentist, or doctor to assist in a better diagnosis and for good home-care tips for your oral health. Instructions for dental professionals on how to read your patient’s saliva pH from the PH2OH app: • 6 or below = acidic • 7 = neutral • 8 or above = alkaline = healthy patient Dental professionals can take this information and recommend good home-care routines to promote oral health.
Many prescribed and over-the-counter medications have been recognized as a primary cause of chronic dry mouth. PH2OH can be used to teach patients with dry mouth about their risk for dental disease. Chronic dry mouth is particularly common among individuals taking multiple drugs, including antihistamines, decongestants, pain relievers, medications for high blood pressure, antidepressants and many others.
The combination of an inexpensive test strip kit and the mobile app to monitor, track and report the results can be a powerful new tool for oral health professionals as they continue to find new ways to educate and motivate patients toward better oral health.
ADDITIONAL READING
http://jackdillenberg.com/wp-content/uploads/2015/03/CR1504Editorial.pdf
http://www.dentistryiq.com/articles/2016/06/saliva-technology-and-all-that-jazz.html
http://www.dentalproductsreport.com/hygiene/article/hey-dental-hygienists-its-time-stop- blaming-victim
REFERENCES
1.Danielsen RD. It's All About the Spit! Clinician Reviews. April, 2015
2. Wingrove SS, Saliva, technology, and all that jazz! Dentistry. IQ May 31,2016
3. DiGangi P, Hey dental hygienists, it's time to stop blaming the victim Modern Hygienist, August 2015
4. Tilenius S. Will an app a day keep the doctor away? The coming health revolution. Forbes website. forbes.com/sites/ciocentral/2013/09/08/will-an-app-a-day-keep-the-doctor-away-the- coming-health-revolution. Published September 8, 2013.
5. Lawrence HP. Salivary markers of systemic disease: noninvasive diagnosis of disease and monitoring of general health. J Can Dent Assoc. 2002;68(3):170–174. 6. Devi TJ. Saliva: a potential diagnostic tool. J Dental Med Sci. 2014:13(2):52–57. 7. Gopinath VK, Arzreanne AR. Saliva as a diagnostic tool for assessment of dental caries. Arch Orofacial Sci. 2006;1:57–59. 8. Streckfus CF, Bigler LR. Salivary glands and saliva; saliva as a diagnostic fluid. Oral Dis. 202;8:69–76. 9. Lee JM, Garon E, Wong DR. Salivary diagnostics. Orthod Cranioffac Res. 2009;12:206–211.