Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age
Background: Electrolytes, proteins, and other salivary molecules play an important role in tooth integrity and can serve as biomarkers associated with caries. Objective: To determine the concentration of potential biomarkers in children without caries (CF) and children with caries (CA). Methods: Uns...
- Autores:
-
Universidad Cooperativa de Colombia
Angarita-Díaz, María del Pilar
Simon-Soro, Aurea
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana
Forero, Diana
Balcázar, Felipe
Sarmiento, Luisa
Romero, Erika
Mira, Alex
- Tipo de recurso:
- Article of investigation
- Fecha de publicación:
- 2021
- Institución:
- Universidad Cooperativa de Colombia
- Repositorio:
- Repositorio UCC
- Idioma:
- OAI Identifier:
- oai:repository.ucc.edu.co:20.500.12494/45852
- Acceso en línea:
- https://hdl.handle.net/20.500.12494/45852
- Palabra clave:
- Biomarkers
child
dental caries
saliva
- Rights
- openAccess
- License
- Atribución – No comercial – Sin Derivar
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dc.title.spa.fl_str_mv |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
title |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
spellingShingle |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age Biomarkers child dental caries saliva |
title_short |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
title_full |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
title_fullStr |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
title_full_unstemmed |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
title_sort |
Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age |
dc.creator.fl_str_mv |
Universidad Cooperativa de Colombia Angarita-Díaz, María del Pilar Simon-Soro, Aurea Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana Forero, Diana Balcázar, Felipe Sarmiento, Luisa Romero, Erika Mira, Alex |
dc.contributor.author.none.fl_str_mv |
Universidad Cooperativa de Colombia Angarita-Díaz, María del Pilar Simon-Soro, Aurea Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana Forero, Diana Balcázar, Felipe Sarmiento, Luisa Romero, Erika Mira, Alex |
dc.subject.spa.fl_str_mv |
Biomarkers child dental caries saliva |
topic |
Biomarkers child dental caries saliva |
description |
Background: Electrolytes, proteins, and other salivary molecules play an important role in tooth integrity and can serve as biomarkers associated with caries. Objective: To determine the concentration of potential biomarkers in children without caries (CF) and children with caries (CA). Methods: Unstimulated saliva was collected, and the biomarkers quantified in duplicate, using commercial Enzyme Linked Immunosorbent Assay (ELISA) kits to determine IgA, fibronectin, cathelicidin LL-37, and statherin levels, as well as colorimetric tests to detect formate and phosphate. Results: Significantly higher concentrations of statherin was detected in the CF group (Median: 94,734.6; IQR: 92,934.6–95,113.7) compared to the CA2 group (90,875.0; IQR: 83,580.2–94,633.4) (p = 0.03). Slightly higher median IgA (48,250.0; IQR: 31,461.9–67,418.8) and LL-37 levels (56.1; IQR 43.6–116.2) and a lower concentration of formate were detected in the CF group (0.02; IQR 0.0034–0.15) compared to the group with caries (IgA: 37,776.42; IQR: 33,383.9–44,128.5; LL-37: 46.3; IQR: 40.1011–67.7; formate: 0.10; IQR: 0.01–0.18), but these differences were not statistically significant. Conclusion: The fact that these compounds have been identified as good markers for caries among European adults highlights the difficulty of identifying universal biomarkers that are applicable to all ages or to different populations. |
publishDate |
2021 |
dc.date.issued.none.fl_str_mv |
2021-08-17 |
dc.date.accessioned.none.fl_str_mv |
2022-07-22T21:09:11Z |
dc.date.available.none.fl_str_mv |
2022-07-22T21:09:11Z |
dc.type.none.fl_str_mv |
Artículos Científicos |
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http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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info:eu-repo/semantics/article |
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publishedVersion |
dc.identifier.uri.spa.fl_str_mv |
10.1080/20002297.2021.1956219 |
dc.identifier.uri.none.fl_str_mv |
https://hdl.handle.net/20.500.12494/45852 |
dc.identifier.bibliographicCitation.spa.fl_str_mv |
María P Angarita-Díaz, Aurea Simon-Soro, Diana Forero, Felipe Balcázar, Luisa Sarmiento, Erika Romero & Alex Mira (2021) Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age, Journal of Oral Microbiology, 13:1, 1956219, DOI: 10.1080/20002297.2021.1956219 |
identifier_str_mv |
10.1080/20002297.2021.1956219 María P Angarita-Díaz, Aurea Simon-Soro, Diana Forero, Felipe Balcázar, Luisa Sarmiento, Erika Romero & Alex Mira (2021) Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age, Journal of Oral Microbiology, 13:1, 1956219, DOI: 10.1080/20002297.2021.1956219 |
url |
https://hdl.handle.net/20.500.12494/45852 |
dc.relation.ispartofjournal.spa.fl_str_mv |
Journal of Oral Microbiology |
dc.relation.references.spa.fl_str_mv |
[1] Biomarkers Definitions Working Group. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001;69 (3): 89–95. [2] Aronson JK, Ferner RE.. Biomarkers-A General Review. Curr Protoc Pharmacol. 2017;17(76):9.23.1–9.23.17. [3] Califf RM. Biomarker definitions and their applications. Exp Biol Med. 2018;243(3):213–221. [4] Kianoush N, Adler CJ, Nguyen KA, et al. Bacterial profile of dentine caries and the impact of pH on bacterial population diversity. PLoS One. 2014;9(3):e92940. [5] Twetman S. Prevention of dental caries as a non-communicable disease. Eur J Oral Sci. 2018;126(1):19–25. [6] Di Pierro F, Zanvit A, Nobili P, et al. Cariogram outcome after 90 days of oral treatment with Streptococcus salivarius M18 in children at high risk fordental caries: results of a randomized, controlled study. Clin Cosmet Investig Dent. 2015;2015(7):107–113. [7] Mira A, Artacho A, Camelo-Castillo A, et al. Salivary Immune and Metabolic Marker Analysis (SIMMA): a Diagnostic Test to Predict Caries Risk. Diagnostics (Basel). 2017;7(3):38. [8] Hemadi AS, Huang R, Zhou Y, et al. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment. Int J Oral Sci. 2017;9(11):e1. [9] Paqué PN, Herz C, Wiedemeier DB, et al. Salivary Biomarkers for Dental Caries Detection and Personalized Monitoring. J Pers Med. 2021;11(3):235. [10] Divaris K. Predicting Dental Caries Outcomes in Children: a “Risky” Concept. J Dent Res. 2016;95(3):248–254. [11] Piekoszewska-Ziętek P, Turska-Szybka A, Olczak-Kowalczyk D. Salivary proteins and peptides in the aetiology of caries in children: systematic literature review. Oral Dis. 2019;25(4):1048–1056. [12] Tao R, Jurevic RJ, Coulton KK, et al. Salivary antimicrobial peptide expression and dental caries experience in children. Antimicrob Agents Chemother. 2005;49(9):3883–3888. [13] Khurshid Z, Naseem M, Yahya I, et al. Significance and Diagnostic Role of Antimicrobial Cathelicidins (LL-37) Peptides in Oral Health. Biomolecules 2017;7(4):80. [14] Soesilawati P, Notopuro H, Yuliati Y, et al. The role of salivary sIgA as protection for dental caries activity in Indonesian children. Clinical Cosmet and Investigational Dentistry. 2019;11:291–295. 15] Speziale P, Arciola CR, Pietrocola G. Fibronectin and its role in human infective diseases. Cells. 2019;8(12):1516. [16] Llena-Puy MC, Montañana-Llorens C, Forner-Navarro L. Fibronectin levels in stimulated whole-saliva and their relationship with cariogenic oral bacteria. Int Dent J. 2000;50(1):57–59. [17] Park Y-D, Jang J-H, Oh Y-J, et al. Analyses of organic acids and inorganic anions and their relationship in human saliva before and after glucose intake. Arch Oral Biol. 2014;59(1):1–11. [18] Poureslami R, Re S, Poureslami. Concentration of Calcium, Phosphate and Fluoride Ions in Microbial Plaque and Saliva after Using CPP-ACP Paste in 6-9 year-old Children. J Dent Biomater. 2016;3(2):214–219. [19] Margolis HC, Moreno EC. Composition and cariogenic potential of dental plaque fluid. Crit Rev Oral Biol Med. 1994;5(1):1–25. [20] Chawda JG, Chaduvula N, Patel HR, et al. Salivary SIgA and dental caries activity. Indian Pediatr. 2011;48(9):719–721. [21] Omar OM, Khattab NM, Rashed LA. Glucosyltransferase B, immunoglobulin A, and caries experience among a group of Egyptian preschool children. J. Pediatr. Dent. 2012;79(2):63–68. [22] Colombo NH, Ribas LF, Pereira JA, et al. Antimicrobial peptides in saliva of children with severe early childhood caries. Arch Oral Biol. 2016;69:40–46. [23] Lo Giudice G, Nicita F, Militi A, et al. Correlation of s-IgA and IL-6 Salivary with Caries Disease and Oral Hygiene Parameters in Children. Dent J. 2020;8(1):3. [24] Lo Giudice G, Militi A, Nicita F, et al. Correlation between Oral Hygiene and IL-6 in Children. Dent J. 2020,8(3):91. [25] Vitorino R, Lobo MJ, Duarte JR, et al. The role of salivary peptides in dental caries. Biomed Chromatogr. 2005;19(3):214–222. [26] Carpenter G, Cotroneo E, Moazzez R, et al. Composition of enamel pellicle from dental erosion patients. Caries Res. 2014;48(5):361–367. [27] Mutahar M, O’Toole S, Carpenter G, et al. Reduced statherin in acquired enamel pellicle on eroded teeth compared to healthy teeth in the same subjects: an in-vivo study. PLoS One. 2017;12(8):e0183660. [28] Yin A, Margolis HC, Yao Y, et al. Multi-component adsorption model for pellicle formation: the influence of salivary proteins and non-salivary phospho proteins on the binding of histatin 5 onto hydroxyapatite. Arch Oral Biol. 2006;51(2):102–110. [29] Rudney JD, Staikov RK, Johnson JD. Potential biomarkers of human salivary function: a modified proteomic approach. Archives of Oral Biolology. 2009;54(1):91–100. [30] Shimotoyodome A, Kobayashi H, Tokimitsu I, et al. Statherin and histatin 1 reduce parotid saliva-promoted Streptococcus mutans strain MT8148 adhesion to hydroxyapatite surfaces. Caries Res. 2006;40(5):403–411. [31] Razi MA, Qamar S, Singhal A, et al. Role of natural salivary defenses in the maintenance of healthy oral microbiota in children and adolescents. J Family Med Prim Care. 2020;9(3):1603–1607. [32] Simón-Soro Á S-S, D’Auria G, Collado MC, et al. Revealing microbial recognition by specific antibodies. BMC Microbiol. 2015;15(1):132. [33] Davidopoulou S, Diza E, Menexes G, et al. Salivary concentration of the antimicrobial peptide LL-37 in children. Arch Oral Biol. 2012;57(7):865–869. [34] Ribeiro TR, Dria KJ, de Carvalho CB, et al. Salivary peptide profile and its association with early childhood caries. Int J Paediatr Dent. 2013;23(3):225–234. [35] Hasty DL, Simpson WA. Effects of fibronectin and other salivary macromolecules on the adherence of Escherichia coli to buccal epithelial cells. Infect Immun. 1987;55(9):2103–2109. [36] Bagherian A, Asadikaram G. Comparison of some salivary characteristics between children with and without early childhood caries. Indian J Dent Res. 2012;23(5):628–632. [37] Animireddy D, Reddy Bekkem VT, Vallala P, et al. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: an in vivo study. Contemp Clin Dent. 2014;5(3):324–328. [38] Kuribayashi M, Kitasako Y, Matin K, et al. Intraoral pH measurement of carious lesions with qPCR of cariogenic bacteria to differentiate caries activity. J Dent. 2012;40(3):222–228. [39] Featherstone JD, Rodgers BE. Effect of acetic, lactic and other organic acids on the formation of artificial carious lesions. Caries Res. 1981;15(5):377–385. [40] Shahrabi MA, Nikfarjam JA, Alikhani AA, et al. A comparison of salivary calcium, phosphate, and alkaline phosphatase in children with severe, moderate caries, and caries free in Tehran’s kindergartens. J Indian Soc Pedod Prev Dent. 2008;26(2):74–77. [41] Aruna S, Meenakshi B, Rama KV, et al. Salivary levels of calcium and phosphorus in children with and without early childhood caries: a pilot study. SRM J Res Dent Sci. 2020;11:72–75. [42] Young DA, Featherstone JD. Caries management by risk assessment. Community Dent Oral Epidemiol. 2013;41(1):e53–63. |
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Universidad Cooperativa de Colombia Andrej M. Kielbassa |
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Universidad Cooperativa de ColombiaAngarita-Díaz, María del PilarSimon-Soro, AureaFundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat ValencianaForero, DianaBalcázar, FelipeSarmiento, LuisaRomero, ErikaMira, Alex132022-07-22T21:09:11Z2022-07-22T21:09:11Z2021-08-1710.1080/20002297.2021.1956219https://hdl.handle.net/20.500.12494/45852María P Angarita-Díaz, Aurea Simon-Soro, Diana Forero, Felipe Balcázar, Luisa Sarmiento, Erika Romero & Alex Mira (2021) Evaluation of possible biomarkers for caries risk in children 6 to 12 years of age, Journal of Oral Microbiology, 13:1, 1956219, DOI: 10.1080/20002297.2021.1956219Background: Electrolytes, proteins, and other salivary molecules play an important role in tooth integrity and can serve as biomarkers associated with caries. Objective: To determine the concentration of potential biomarkers in children without caries (CF) and children with caries (CA). Methods: Unstimulated saliva was collected, and the biomarkers quantified in duplicate, using commercial Enzyme Linked Immunosorbent Assay (ELISA) kits to determine IgA, fibronectin, cathelicidin LL-37, and statherin levels, as well as colorimetric tests to detect formate and phosphate. Results: Significantly higher concentrations of statherin was detected in the CF group (Median: 94,734.6; IQR: 92,934.6–95,113.7) compared to the CA2 group (90,875.0; IQR: 83,580.2–94,633.4) (p = 0.03). Slightly higher median IgA (48,250.0; IQR: 31,461.9–67,418.8) and LL-37 levels (56.1; IQR 43.6–116.2) and a lower concentration of formate were detected in the CF group (0.02; IQR 0.0034–0.15) compared to the group with caries (IgA: 37,776.42; IQR: 33,383.9–44,128.5; LL-37: 46.3; IQR: 40.1011–67.7; formate: 0.10; IQR: 0.01–0.18), but these differences were not statistically significant. Conclusion: The fact that these compounds have been identified as good markers for caries among European adults highlights the difficulty of identifying universal biomarkers that are applicable to all ages or to different populations.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=00015613820000-0002-5435-3456GIOMETmaria.angaritad@campusucc.edu.co9Universidad Cooperativa de ColombiaAndrej M. KielbassaOdontologíaVillavicencioBiomarkerschilddental cariessalivaEvaluation of possible biomarkers for caries risk in children 6 to 12 years of ageArtículos Científicoshttp://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAtribución – No comercial – Sin Derivarinfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Journal of Oral Microbiology[1] Biomarkers Definitions Working Group. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001;69 (3): 89–95.[2] Aronson JK, Ferner RE.. Biomarkers-A General Review. Curr Protoc Pharmacol. 2017;17(76):9.23.1–9.23.17.[3] Califf RM. Biomarker definitions and their applications. Exp Biol Med. 2018;243(3):213–221.[4] Kianoush N, Adler CJ, Nguyen KA, et al. Bacterial profile of dentine caries and the impact of pH on bacterial population diversity. PLoS One. 2014;9(3):e92940.[5] Twetman S. Prevention of dental caries as a non-communicable disease. Eur J Oral Sci. 2018;126(1):19–25.[6] Di Pierro F, Zanvit A, Nobili P, et al. Cariogram outcome after 90 days of oral treatment with Streptococcus salivarius M18 in children at high risk fordental caries: results of a randomized, controlled study. Clin Cosmet Investig Dent. 2015;2015(7):107–113.[7] Mira A, Artacho A, Camelo-Castillo A, et al. Salivary Immune and Metabolic Marker Analysis (SIMMA): a Diagnostic Test to Predict Caries Risk. Diagnostics (Basel). 2017;7(3):38.[8] Hemadi AS, Huang R, Zhou Y, et al. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment. Int J Oral Sci. 2017;9(11):e1.[9] Paqué PN, Herz C, Wiedemeier DB, et al. Salivary Biomarkers for Dental Caries Detection and Personalized Monitoring. J Pers Med. 2021;11(3):235.[10] Divaris K. Predicting Dental Caries Outcomes in Children: a “Risky” Concept. J Dent Res. 2016;95(3):248–254.[11] Piekoszewska-Ziętek P, Turska-Szybka A, Olczak-Kowalczyk D. Salivary proteins and peptides in the aetiology of caries in children: systematic literature review. Oral Dis. 2019;25(4):1048–1056.[12] Tao R, Jurevic RJ, Coulton KK, et al. Salivary antimicrobial peptide expression and dental caries experience in children. Antimicrob Agents Chemother. 2005;49(9):3883–3888.[13] Khurshid Z, Naseem M, Yahya I, et al. Significance and Diagnostic Role of Antimicrobial Cathelicidins (LL-37) Peptides in Oral Health. Biomolecules 2017;7(4):80.[14] Soesilawati P, Notopuro H, Yuliati Y, et al. The role of salivary sIgA as protection for dental caries activity in Indonesian children. Clinical Cosmet and Investigational Dentistry. 2019;11:291–295.15] Speziale P, Arciola CR, Pietrocola G. Fibronectin and its role in human infective diseases. Cells. 2019;8(12):1516.[16] Llena-Puy MC, Montañana-Llorens C, Forner-Navarro L. Fibronectin levels in stimulated whole-saliva and their relationship with cariogenic oral bacteria. Int Dent J. 2000;50(1):57–59.[17] Park Y-D, Jang J-H, Oh Y-J, et al. Analyses of organic acids and inorganic anions and their relationship in human saliva before and after glucose intake. Arch Oral Biol. 2014;59(1):1–11.[18] Poureslami R, Re S, Poureslami. Concentration of Calcium, Phosphate and Fluoride Ions in Microbial Plaque and Saliva after Using CPP-ACP Paste in 6-9 year-old Children. J Dent Biomater. 2016;3(2):214–219.[19] Margolis HC, Moreno EC. Composition and cariogenic potential of dental plaque fluid. Crit Rev Oral Biol Med. 1994;5(1):1–25.[20] Chawda JG, Chaduvula N, Patel HR, et al. Salivary SIgA and dental caries activity. Indian Pediatr. 2011;48(9):719–721.[21] Omar OM, Khattab NM, Rashed LA. Glucosyltransferase B, immunoglobulin A, and caries experience among a group of Egyptian preschool children. J. Pediatr. Dent. 2012;79(2):63–68.[22] Colombo NH, Ribas LF, Pereira JA, et al. Antimicrobial peptides in saliva of children with severe early childhood caries. Arch Oral Biol. 2016;69:40–46.[23] Lo Giudice G, Nicita F, Militi A, et al. Correlation of s-IgA and IL-6 Salivary with Caries Disease and Oral Hygiene Parameters in Children. Dent J. 2020;8(1):3.[24] Lo Giudice G, Militi A, Nicita F, et al. Correlation between Oral Hygiene and IL-6 in Children. Dent J. 2020,8(3):91.[25] Vitorino R, Lobo MJ, Duarte JR, et al. The role of salivary peptides in dental caries. Biomed Chromatogr. 2005;19(3):214–222.[26] Carpenter G, Cotroneo E, Moazzez R, et al. Composition of enamel pellicle from dental erosion patients. Caries Res. 2014;48(5):361–367.[27] Mutahar M, O’Toole S, Carpenter G, et al. Reduced statherin in acquired enamel pellicle on eroded teeth compared to healthy teeth in the same subjects: an in-vivo study. PLoS One. 2017;12(8):e0183660.[28] Yin A, Margolis HC, Yao Y, et al. Multi-component adsorption model for pellicle formation: the influence of salivary proteins and non-salivary phospho proteins on the binding of histatin 5 onto hydroxyapatite. Arch Oral Biol. 2006;51(2):102–110.[29] Rudney JD, Staikov RK, Johnson JD. Potential biomarkers of human salivary function: a modified proteomic approach. Archives of Oral Biolology. 2009;54(1):91–100.[30] Shimotoyodome A, Kobayashi H, Tokimitsu I, et al. Statherin and histatin 1 reduce parotid saliva-promoted Streptococcus mutans strain MT8148 adhesion to hydroxyapatite surfaces. Caries Res. 2006;40(5):403–411.[31] Razi MA, Qamar S, Singhal A, et al. Role of natural salivary defenses in the maintenance of healthy oral microbiota in children and adolescents. J Family Med Prim Care. 2020;9(3):1603–1607.[32] Simón-Soro Á S-S, D’Auria G, Collado MC, et al. Revealing microbial recognition by specific antibodies. BMC Microbiol. 2015;15(1):132.[33] Davidopoulou S, Diza E, Menexes G, et al. Salivary concentration of the antimicrobial peptide LL-37 in children. Arch Oral Biol. 2012;57(7):865–869.[34] Ribeiro TR, Dria KJ, de Carvalho CB, et al. Salivary peptide profile and its association with early childhood caries. Int J Paediatr Dent. 2013;23(3):225–234.[35] Hasty DL, Simpson WA. Effects of fibronectin and other salivary macromolecules on the adherence of Escherichia coli to buccal epithelial cells. Infect Immun. 1987;55(9):2103–2109.[36] Bagherian A, Asadikaram G. Comparison of some salivary characteristics between children with and without early childhood caries. Indian J Dent Res. 2012;23(5):628–632.[37] Animireddy D, Reddy Bekkem VT, Vallala P, et al. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: an in vivo study. Contemp Clin Dent. 2014;5(3):324–328.[38] Kuribayashi M, Kitasako Y, Matin K, et al. Intraoral pH measurement of carious lesions with qPCR of cariogenic bacteria to differentiate caries activity. J Dent. 2012;40(3):222–228.[39] Featherstone JD, Rodgers BE. Effect of acetic, lactic and other organic acids on the formation of artificial carious lesions. Caries Res. 1981;15(5):377–385.[40] Shahrabi MA, Nikfarjam JA, Alikhani AA, et al. A comparison of salivary calcium, phosphate, and alkaline phosphatase in children with severe, moderate caries, and caries free in Tehran’s kindergartens. J Indian Soc Pedod Prev Dent. 2008;26(2):74–77.[41] Aruna S, Meenakshi B, Rama KV, et al. Salivary levels of calcium and phosphorus in children with and without early childhood caries: a pilot study. SRM J Res Dent Sci. 2020;11:72–75.[42] Young DA, Featherstone JD. Caries management by risk assessment. 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