Comparative Evaluation of Salivary Flow Rate, pH, and Alkaline Phosphatase in Tobacco Users and Healthy Individuals: A Biomarker Study

Abstract Aims: Saliva plays a vital role in maintaining oral health, and its composition can be significantly altered by tobacco use. The repeated exposure of saliva to tobacco has been associated with structural and functional changes in its parameters. This study aimed to evaluate salivary flow rate (SFR), salivary pH, and salivary alkaline phosphatase (S-ALP) levels in individuals using different forms of tobacco, including smokeless tobacco, smoking tobacco, combined tobacco use, and healthy controls. Materials and Methods: A total of 160 participants were randomly assigned to four groups: Group I (n = 40), smokeless tobacco users; Group II ( n = 40), smoking tobacco users; Group III ( n = 40), users of both smokeless and smoking tobacco; and Group IV ( n = 40), healthy controls. Resting salivary flow was measured using Schirmer’s strip at 1, 2, and 3 minutes, and salivary pH was assessed using pH strips. A 3 mL sample of unstimulated saliva was collected, centrifuged, and analyzed for S-ALP levels using a biochemical analyzer. Statistical analyses were performed using the Kruskal–Wallis test for multiple group comparisons and the Mann–Whitney U test for pairwise comparisons, with a significance level set at P < 0.001. Results: A statistically significant reduction in mean SFR was observed in all tobacco-using groups compared to the control group ( P < 0.001). Similarly, a significant decrease in salivary pH was noted in tobacco users compared to healthy controls ( P < 0.001). The S-ALP levels were reduced in both smokeless and smoking tobacco users, while the combined tobacco group showed an increase in S-ALP levels compared to the healthy control group. Conclusion: Long-term tobacco use, whether smokeless, smoking, or a combination of both, can lead to significant changes in salivary parameters, including reduced salivary flow, altered pH, and fluctuations in S-ALP levels. These changes can contribute to adverse effects on oral mucosa and dental structures. Clinicians should consider tobacco use as a key factor when assessing oral health, as tobacco-related changes in salivary composition could increase the risk of oral diseases. Further research is needed to explore the underlying mechanisms by which tobacco affects salivary composition and to assess the potential for using these biomarkers in early detection of tobacco-related oral health issues.