J Bagh College Dentistry Vol. 29(2), June 2017 Dental caries severity Pedodontics, Orthodontics and Preventive Dentistry 115 Dental caries severity in relation to selected salivary variables among a group of pregnant women in Baghdad city/Iraq. Nadia Qasim Mutlak, B.D.S. (1) Baydaa Ahmed Yas, B.D.S., M.Sc., Ph.D. (2) ABSTRACT Background: During pregnancy many physiological, anatomical and biochemical changes take place that affect almost all body systems. In the oral pregnant women have serious changes such as more sever dental caries. This study was conducted to measure dental caries severity and selected salivary variables (salivary flow rate, PH and viscosity)and to find the relation of dental caries with these salivary variables. Subjects, materials and methods: The study group consisted of 60 pregnant women that were divided into three equal groups according to trimester (20 pregnant women in each trimester).They were selected randomly from the Maternal and Child Health Care Centers in Baghdad city, the age range was 20-25 years. In addition to 20 unmarried women as a control group and matched with age. Stimulated salivary samples were collected .Then salivary flow rate, pH and viscosity were measured. Dental caries severity was recorded by using Decay, Missing and Filled index (D1-4MFS) using the criteria described by Manjie et al, (1989). Plaque index system by Silness and Löe, (1964) was used for measuring dental plaque thickness. For measuring dental calculus the calculus index component of the periodontal diseases index (PDI) by Ramfjord (1959) was used. Results: Results of the current study revealed that dental caries parameter represented by (DMFT ,DMFS,DS and MS) were higher among pregnant than non –pregnant women with significant differences (p<0.05) for DMFT,DMFS and DS also all grades of lesion severity(D1-4)were higher among pregnant than non –pregnant women with nonsignificant differences(p>0.05).Almost all dental caries parameter were higher in the 2nd trimesters with highly significant difference (p<0.01) for D1,DS ,DMFS and DMFT among four groups . Concerning oral cleanliness both plaque and calculus indices recorded higher values among pregnant than non- pregnant with highly significant difference for both (p<0.01). Values were higher during 2nd trimester with high significant and non-significant differences among four groups .Regarding the relations of dental caries with oral cleanliness ,it was found that all dental caries parameters recorded positive correlations with both plaque and calculus indices with significant and highly significant relations Regarding salivary variables ,results revealed that salivary flow rate was higher among pregnant (especially in the 2nd trimester)than non-pregnant women but with non-significant difference (p>0.05).On the other hand salivary PH value was lower among pregnant than non- pregnant women with highly significant difference (p<0.01)among them. Salivary PH was lowest in the 2nd trimester with highly significant difference (p<0.01) among four groups .Also Salivary viscosity was higher among pregnant than non-pregnant women with highly significant difference (p<0.01) and it recorded higher mean value in the 3rd trimester with highly significant difference among four groups (p<0.01). Salivary PH recorded inverse relation with almost all dental caries parameters with significant relations with D4, MS and highly significant relations with DS,DMFS and DMFT ,while salivary flow rate and salivary viscosity revealed non-significant relations with dental caries parameters (p>0.05). Conclusion: Dental caries severity was higher among pregnant women probably due to the effect of pregnancy itself on oral hygiene (higher plaque and calculus indices) and salivary variables (increased salivary acidity and viscosity).Therefore, intensive education and preventive programs should be directed for pregnant women. Key words: dental caries, pregnancy, salivary viscosity. (J Bagh Coll Dentistry 2017; 29(2):115-121) INTRODUCTION Pregnancy is a physiological process that affects even healthy women and involves many physiological, biochemical and anatomical changes (1, 2). In addition to noticeable oral changes among them is an increase in dental caries severity (3-5). Dental caries is an infectious transmissible bacterial diseases caused by acid from bacterial metabolism diffusing into enamel and dentine and dissolving the mineral (6). Several studies recorded an increase in dental caries severity among pregnant women (7-9). (1) Master Student, Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad. (Ministry of Health) (2) Assistant Professor, Depart ment of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad. In Iraq comparison studies had been carried out and recorded an increase in dental caries among pregnant in comparison to non-pregnant (10-13). A longitudinal study was found that recorded an increase in DMFT and DMFS during pregnancy but a decrease in decay severity DS from initial 2.58 to 1.54 before labor by Papp et al (14). Some pregnant women might experience excessive salivation (i.e. ptyalism) (15, 16) on the other hand xerostomia or hypo-salivation was reported to be a frequent complaint among pregnant women. Al Taie( 17) found the flow rate of resting and stimulated saliva were significantly higher in pregnant than control group. While Suliaman( 10) showed that stimulated salivary flow rate was significantly reduced among pregnant women and Al-Zaidi (12) reported no statistically J Bagh College Dentistry Vol. 29(2), June 2017 Dental caries severity Pedodontics, Orthodontics and Preventive Dentistry 116 significant difference between pregnant and control group also salivary pH is affected during pregnancy. Kivela et al,( 18) reported a decrease in salivary PH during pregnancy followed by rapid and significant increase after delivery .While in Iraq AL-Zaidi (12) found statistically non- significant difference of salivary pH, among pregnancy trimesters as compared to control. Laine and Pienihakkinen, (19) reported a decrease in salivary pH during pregnancy. Regarding salivary viscosity fresh mixed human saliva is viscoelastic fluid with distinct surface activity (20). During pregnancy. However, study in blood viscosity during pregnancy could be fond (21). These changes in salivary flow rate, PH and salivary viscosity during pregnancy might increase dental caries severity among them (10, 22, 24). However limited studies could be found regarding changes in salivary flow rate and PH during pregnancy while no studies could be found that measure salivary viscosity among pregnant women. Therefore it was decided to carry out this study to assess dental caries severity in addition to salivary flow rate, pH and viscosity among pregnant women in comparison to un-married women and to evaluate the relation of salivary flow rate, pH and viscosity with dental caries severity. SUBJECTS, MATERIALS AND METHODS The study group consisted of (60) pregnant women that were divided according to trimester into three equal groups (20 pregnant women in each trimester). The age range was 20-25 years. In addition to 20 un married women as a control group, these women should be matched with age Both pregnant and control women were selected randomly from the Maternal and Child Health Care centers in Baghdad city. Stimulated salivary samples were collected according to Tenovuo and Lagerlof (25) instructions. After saliva collection the PH was measured by using digital PH meter. Salivary volume was measured by using measuring cylinder and the rate of secretion was expressed in milliliter per minute (ml/min).Salivary viscosity was determined by using the Ostwald viscometer (U-type viscometer)(26).Then salivary samples were centrifuged and stored at (-20oC) for subsequent chemical analysis. Plaque index by Silness and Löe, (27) was used for measuring dental plaque thickness. For measuring the amount of dental calculus, calculus index (Cal I) component of the periodontal diseases index (PDI) by Ramfjord, (1959)(28) was used, and all teeth was diagnoses Dental caries experience was recorded by lesion severity according to Decay, Missing and Filled index (D1-4 MFS) Index according to criteria described by Manjie et al., (1989)(29). Statistical analyses were done by using IBM SPSS version 23 computer software (Statistical Package for Social Sciences) in association with Microsoft Excel 2016. RESULTS Table (1) showed that dental caries parameters (DMFS), (DS) were higher among pregnant than non-pregnant women (mean 17± 9.5; mean 9± 5.5) respectively with significant differences (p<0.05) in the 2nd trimester. While missing surfaces (MS) recorded higher mean rank value among pregnant than non-pregnant with significant difference (p<0.05) (MS) was higher in the 1st trimester of pregnancy. Data showed that all grades of caries severity (D1- 4) were higher among pregnant than non-pregnant but with non-significant differences (p>0.05). According to trimester all grades (D1,D2,D4) of severity were higher in the 2nd trimester except for D3 that was higher in the 3rd trimester with highly significant difference among the four groups for D1 only(p<0.01). Statistical difference in MS between pregnant and non-pregnant (U test=414.0, Z value=-2.293, P value =0.022*) Statistical difference in DS between pregnant and non-pregnant (t-test=-2.26, d.f=78, P value =0.027). Statistical difference in DMFS between pregnant and non-pregnant (t test=-2.46, d.f =78, P value=0.016). Table (2) show that Both Pl I and Cal I values were higher in the second trimester with highly significant difference among four groups for plaque (p<0.01) and for calculus index the p-value was close to the confidence limit. Statistical difference in Plaque index between pregnant and non-pregnant (U test=238.5, Z value =-4.017, P value<0.001; Statistical difference in Calculus index between pregnant and non-pregnant (U test=414, Z value =-2.076, P value<0.001) In Table (3) Salivary flow rate was higher in pregnant than non-pregnant in the 2nd trimester but with non-significant difference among four groups (p>0.05). Salivary pH was lower (more acidic) among pregnant than non-pregnant with highly significant difference (p<0.01). Salivary PH was lower in the 2nd trimester with highest significant difference among four groups. Salivary viscosity was higher among pregnant women than non-pregnant with high significant differences (p<0.01). It was higher in the 3rd trimester with highly significant difference among four groups (Statistical difference in PH between pregnant and non-pregnant women (F=5.464, d.f J Bagh College Dentistry Vol. 29(2), June 2017 Dental caries severity Pedodontics, Orthodontics and Preventive Dentistry 117 =1, p<0.01) Statistical difference in Viscosity between pregnant and non-pregnant women (F= 7.687, d.f =1, p=0.006). Table (4) revealed that statistical significance was significant (p<0.05) and highly significant for both plaque and calculus index with (DMFT, DMFS, DS, MS) of dental caries parameters. The relation of dental caries parameters with salivary physico-chemical characteristic are shown in Table (5) It was found that the relation of salivary flow rate with dental caries parameters were weak non- significant correlations (p>0.05).Salivary pH revealed weak inverse relations with dental caries parameters except for (FS) that was weak positive relations statistical significance were significant (p<0.05)for(D4)-and highly significant (p<0.01) for (DS, MS, DMFS, DMFT). Salivary viscosity revealed weak non-significant (p>0.05) correlations with dental caries parameters. The effect of pregnancy on oral variables analyzed by using (ROC test) is shown in Table (6) also adverted in Fig. (1,2). Results showed that the most affected oral variables by pregnancy was salivary (PH) with highly significant difference (p<0.05). Followed by Pl I GI (salivary viscosity). Table 1: Dental caries experience among non- pregnant and pregnant women according to trimester. Statistical differences among four groups (ANOVAs test) Total (Pregnant women) 3rd trimester 2nd trimester 1st trimester Non pregnant women Parameters P -value D .F C hi- square M ean rank M edian N o. M ean rank M edian N O . M ean rank M edian N O . M ean rank M edian N o. M ean rank M edian N 0. 0.001** 3 16.26 40.6 3 60 39.5 3.5 20 55.9 7 20 26.5 1.5 20 40.3 3.5 20 D1 0.42 3 2.79 42.7 3 60 40.4 2 20 45.9 3 20 41.8 3 20 33.9 1.5 20 D2 O.49 3 2.42 42 0 60 43 0 20 42.7 0 20 40.4 0 20 36 0 20 D3 0.51 3 2.32 41.3 0 60 40 0 20 42 0 20 42 0 20 38 0 20 D4 0.05 3 7.74 43.6 4.5 60 37.6 0 20 45.9 5 20 47.3 5 20 31.2 0 20 MS 0.19 3 4.75 39 0.5 60 32.2 0 20 39.4 1 20 45.4 3 20 45 3 20 FS d.f F ± SD Mean N0. ±SD Mean ±SD Mean ±SD Mean ±SD Mean No. <0.001 3 6.9** 5.5 9 60 4.1 9 20 5.9 12 20 4.8 6 20 4.4 6 20 DS 0.007 3 4.3** 9.5 17 60 8.9 14 20 8.2 21 20 10.3 17 20 6.3 12 20 DMFS 0.007 3 4.3** 3.2 9 60 2.8 8 20 2.6 11 20 3.6 9 20 2.8 8 20 DMFT *significant p<0.05; **High .significant p<0.01. Table 2: Oral cleanliness among pregnant and non-pregnant women according to trimesters. Parameters Non-pregnant 1st trimester 2nd trimester 3rd trimester Total pregnant Statistical differences between trimester and non-pregnant No. MedianMean rank No. MedianMean rank No. MedianMean rank No. MedianMean rank No. MedianMean rank Chi- square d.f P value Plaque index 20 0.142 22.4 20 0.321 35.7 20 0.6155 52.7 20 0.589 51.2 60 0.463 46.5 22.6 3 <0.001** Calculus index 20 0.0089 31.2 20 0.01875 37.6 20 0.0285 49.4 20 0.0175 43.9 60 0.o191 43.6 6.92 3 0.07 *significant p<0.05; Highly significant value<0.01 Table 3: Salivary physico chemical characteristic among non- pregnant and pregnant women according to trimesters. Statistic al differences among four groups Total pregnant women 3rd trimester 2nd trimester 1st trimester Non-pregnant women Parameters P -value d.f F ±SD Mean No. ±SD Mean No.±SD Mean No.± SD Mean No. ± SD Mean No. 0.23 3 1.470 0.51 1.21 60 0.42 1.16 20 0.72 1.36 20 0.29 1.11 20 1.21 1.07 20 Salivary flow rate <0.001** 3 17.811 0.4 7.4 60 0.4 7.4 20 0.3 7.1 20 0.4 7.5 20 0.3 7.9 20 Salivary PH <0.001** 3 7.687 0.0038 0.0131 60 0.0038 0.0154 20 0.0043 0.0122 20 0.0018 0.0117 20 0.00330.010420 VISCOSITY *significant p<0.05; Highly significant value<0.01 J Bagh College Dentistry Vol. 29(2), June 2017 Dental caries severity Pedodontics, Orthodontics and Preventive Dentistry 118 Table 4: Relation of dental caries with oral cleanliness for pregnant women. Parameter P LI Cal I r P r P D1 0.062 0.58 0.201 0.07 D2 0.298 0.007 0.195 0.08 D3 0.44 <0.001** 0.164 0.15 D4 0.225 0.045 0.204 0.07 DS 0.432 <0.001** 0.331 0.003** MS 0.373 <0.001** 0.4 <0.001** FS -0.11 0.33 -0.086 0.45 DMFS 0.401 <0.001** 0.363 <0.001** DMFT 0.28 0.012* 0.25 0.025* *significant p<0.05; highly significant value<0.01 Table 5: Relation of dental caries with salivary physicochemical characteristic for pregnant women. DMFT DMFS FS MS DS D4 D3 D2 D1 Parameters P r P r P r P R P r P R P R P R P r 0.91 -0.013 0.35 0.106 0.36 0.103 0.32 0.113 0.64 -0.053 0.78 0.031 0.2 -0.146 0.58 0.064 0.7 -0.044 S.F.R **<0.001-0.364 <0.001**-0.43 0.55 0.067 *0.008 -0.293 <0.001 ** -0.424 0.042 * -0.228 0.08 -0.198 0.12 -0.173 0.09 -0.189 PH 0.23 -0.136 0.64 -0.054 0.08 -0.199 0.55 0.067 0.76 0.053 0.23 0.136 0.85 0.022 0.48 -0.081 0.41 -0.094 VISCOSITY Table 6: Effect of pregnancy on oral variables (ROC test). Variables ROC area P-value Salivary PH 0.907 <0.001** Plaque index 0.801 <0.001** Salivary viscosity 0.757 <0.001** DMFS 0.673 0.021* Ds 0.668 0.025* Calculus index 0.655 0.039* Ms 0.655 0.039* D2 0.610 0.14 DMFT 0.605 0.16 D3 0.576 0.31 Fs 0.575 0.32 D4 0.542 0.58 Salivary flow rate 0.538 0.61 D1 0.504 0.96 *significant p-value<0.05;**Highly .significant p-value<0.01. Figure 1: Roc curves for oral variables. Figure 2: Roc curves for selected oral variables (salivary PH and FS). J Bagh College Dentistry Vol. 29(2), June 2017 Dental caries severity Pedodontics, Orthodontics and Preventive Dentistry 119 DISCUSSION Physiologic changes during pregnancy may result in noticeable changes in the oral cavity these changes may include dental caries, pregnancy gingivitis, periodontitis, and other oral diseases (3-5). The same results found in the current study pregnant women experienced an increase in dental caries severity represented by significant higher (DMFS, DS and MS values) ,all grades of caries lesion severity (D1-4) were higher among pregnant women than non-pregnant but with non-significant differences .This is probably due to increased consumption of carbohydrates, and reduced salivary production and/or increased acidity of saliva, increased acid in the mouth from vomiting. (30-32). In addition the number of certain salivary cariogenic microorganisms as streptococcus mutants and lactobacilli found to be increased (10, 33). The same result was also found by other studies (9-12). While the result reached was in opposite with Papp et al., (14) who found a decrease in decay teeth surfaces during pregnancy. Regarding trimesters, dental caries experience (DMFT, DMFS, and DS) was higher in the second trimester. , as well the grades of caries severity (D1, D2, D4) were this probably due to hormonal changes that reached to peak level in the second trimester (34).That was reported to affect oral health (4)this this finding in accordance with previous Iraqi study by AL-Zaidi, (13) that revealed the mean values of dental caries were higher in pregnant women especially in the first and second trimesters than the control group but the differences were statistically non-significant. Regarding oral cleanliness, results of the current study revealed that both plaque and calculus accumulation were higher among pregnant women than non-pregnant with significant difference for both. This finding may further explain higher caries severity during pregnancy since). Dental plaque is the main etiologic factor for dental caries (35). Also dental calculus act as retentive factor for dental plaque (36). This is further supported by the positive correlations of plaque and calculus indices with dental caries parameters that were significant and highly significant with most of the dental caries parameters for pregnant women. Also by using the ROC test it has been found that plaque index is the second oral variable after salivary PH to be affected or changed during pregnancy with highly significant differences. This is probably because pregnant women might become anxious, restless and exhausted, in addition to nausea and vomiting during pregnancy that made the routine oral hygiene practices more difficult (36). Poor oral hygiene was also reported by. Tilakaratne et al (37). But contraindicated with other study by Yas (2004) (11) who found low values of plaque in pregnant than non-pregnant while calculus index was similar, also results revealed that both plaque and calculus indices were higher in the second trimester with higher significant differences for plaque .That is further explained higher caries severity during the 2nd trimester. This is consistent with previous studies Suliaman (10). While Al-zaidi,(12) revealed higher plaque in the first trimester followed by 3rd trimester. Saliva play an important role in maintaining oral health through its flow rate, buffer capacity and organic and in organic constituent (38, 39). In the current study results revealed that salivary flow rate was higher during pregnancy than non-pregnant women but with non-significant differences. This might be attributed to the sensitivity of the salivary glands by the nausea and vomiting that are usually linked with pregnancy (16-18). The same result was added by Al-Taie (17) but the result was in opposite with Suliaman (10). While Al-zaidi(12) reported no statistically significant difference. Regarding salivary PH in the current study. Salivary PH was lower (more acidic) among pregnant women than non-pregnant with highly significant difference. This may give another explanation for higher caries severity during pregnancy. Since lower salivary PH means more acidic saliva that enhance or exaggerated the demineralization of dental enamel also most of the chemical reactions occurs in the oral cavity affected by hydrogen ion. (40). This is further supported by the inverse correlations of salivary PH with dental caries parameters .By using ROC test results revealed that salivary pH was the first and the mostly affected oral variable during pregnancy with highly significant difference and ROC area that was 0.907. Saliva during pregnancy may become more acidic because serum concentration of estrogens is elevated IgA increases, whereas sialic acid and buffer capacity decreased in saliva (41). Lower salivary PH was also reported by another studies Kivela et al, (18) and Al-Zaidi (12). Results also revealed that salivary PH was lowest in the 2nd trimester with highly significant difference among four groups this give another explanation for higher caries severity during 2nd trimester. Finally, salivary viscosity revealed higher mean value among pregnant than non-pregnant women with high significant difference especially in the 3rd trimester with high significant differences among the four groups this viscosity of saliva depended greatly on the method of stimulation (acid or mechanical)(42), and progesterone hormone will rise especially during the first two months of the J Bagh College Dentistry Vol. 29(2), June 2017 Dental caries severity Pedodontics, Orthodontics and Preventive Dentistry 120 third trimester after that it declined during the last month prior to child birth (43), also by using ROC test, it was found that salivary viscosity was the third oral variable affected by pregnancy with highly significant differences (ROC area= 0.757). 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[IVSL]. المستخلص النساء الفم تجویف في كما. الجسم نظام كل على تقریبا تؤثر التي الحیویة والكیمیائیة التشریحیة الفسیولوجیة، التغیرات من تجري العدید الحمل فترة خالل: خلفیة .األسنان تسوس شدة في زیادة وھناك بینھا، فیما التغییرات من العدید من یعانین الحوامل األسنان تسوس بین العالقة على وللعثور). واللزوجة الحموضة ودرجة اللعاب، تدفق معدل( مختارة اللعابیة والمتغیرات األسنان تسوس شدة لقیاس: الدراسة أھداف .المتغیرات ھذه مع امرأة 20( لالشھرالثالثھ من الحمل وفق متساویة مجموعات ثالث إلى تقسیمھا تم التي حامال امرأة 60نم الدراسة مجموعة تكونت: لطرقوا والمواد المواضیع غیر امرأة 20 إلى باإلضافة سنة) 25- 20(من المحددالعمر كان بغداد، مدینة في الطفل ورعایة األم صحة مراكز من عشوائیا اختیرت و). أشھر ثالثة كل في حامال األسنان تسوس شدة وسجلت. واللزوجة الحموضة درجة ثم. المحفزه اللعاب عینة تدفق معدل قیاس تم وقد. العمر في المطابقھ مع مقارنھ كمجموعة متزوجة البالك مؤشر نظام ,)1989( وآخرون Manjieوصفھا التي المعاییر باستخدامD)MFS) 4-1بحشوات المعالجھ والسطوح والمفقود تسوس، مؤشر باستخدام لمعاییر (PDI) اللثة أمراض مؤشر من والتكامل التفاضل حساب ومؤشر. األسنان على البالك سمك لقیاس ) تستخدم(Silness and Löe1964 اعتمدھا Ramffjord 1959)(. واالسطح المتاكلھ واالسطح المفقوده) والمفقوده والمعالجھ بحشواتاالسنان واالسطح المتاكلھ یمثلھا ( التي األسنان تسوس أن الحالیة الدراسة نتائج كشفت :النتائج (االسنان واالسطح المتاكلھ والمفقوده والمعالجھ بحشوات ل (p <0.05) االحتمالیة القیمة في معنوي اختالف مع الحوامل غیر النساء من الحوامل بین أعلى كانت من الدرجھ االولى اوالنخر التاكل ( من المستویات جمیع وشدة (p = 0.05) االحتمالیة القیمة حد من قریبة كانت كانت كما , واالسطح المتاكلھ واالسطح المفقوده) فتره من الثاني الثلث( في أعلى المفحوصھ األسنان جمیع تسوس وكان . (P> 0.05) ملحوظة غیر اختالفات وجود مع الحوامل غیر من الحوامل بین أعلى )للرابعھ واالسطح المتاكلھ وتنخر االسنان من الدرجھ االولى) (االسنان واالسطح المتاكلھ والمفقوده والمعالجھ بحشواتل (P <0.01) معنویة اختالفات وجود مع) الحمل .مجموعات ربعالأ بین غیر النساء من) الحمل فتره من الثالثةالوسطى األشھر في وخصوصا( الحوامل بین أعلى كان اللعاب تدفق معدل أن النتائج كشفت اللعابیة المتغیراتب یتعلق وفیما وجود مع الحوامل غیر النساء من الحوامل النساء لدى أقل كان اللعابیة الحموضة ودرجة (P> 0.05).قیمة من ملحوظة غیر اختالفات وجود مع ولكن الحوامل بین عالیة معنویة اختالفات وجود مع) الحمل فتره من الوسطى الثالثة األشھر( في األقل اللعابیة الحموضة درجة كانت .(P <0.01) بینھم عالیة معنویة اختالفات قیمھ أعلى وسجلت ،(P <0.01) معنویة اختالفات وجود مع الحوامل غیر النساء من الحوامل بین أعلى كانت اللعابیھ امااللزوجة (P <0.01) ,أالربع المجموعات قیم والقلح البالك مؤشر من كل سجلت الفم نظافة ناحیھ امامن.(P <0.01) مجموعات أالربع بین عالیة معنویة اختالفات وجود مع ) الحمل االخیرمن الثلث( في حموضھ درجھ سجلت قدو مجموعات أالربع بین التوالي على (P> 0.05) معنوي وغیر (p <0.01) معنوي ارتفاع مع الحوامل غیر من الحوامل بین أعلى للتاكل اوالنخرمن الدرجھ الرابعھ واالسطح ل( ) (p<0.05ظوفرق احصائي ملحو عالقات مع المفحوصھ األسنان تسوس مقاییس مع تقریبا عكسیة عالقة اللعاب اللزوجھ ومعدل تدفق اللعاب بینما ) و االسنان واالسطح المتاكلھ والمفقوده والمعالجھ بحشوات (السطوح المتاكلھمعبدالالت احصائیھ عالیھ العالقات و ) المفقوده .)(p>0.05 اظھر عالقات احصائیھ غیر ملحوظھ مع مقاییس التسوس اي اللعابیة والمتغیرات) والقلح للبالك مستوى أعلى( الفم نظافة على نفسھ الحمل تأثیر إلى یرجع ربما الحوامل النساء بین أعلى األسنان تسوس شدة كانت: االستنتاج الحوامل للنساء توجھ أن یجب الوقائیة والبرامج المكثف التعلیم لذلك،). واللزوجة اللعابیة الحموضة زیادة( .بیھاللعا اللزوجة الحمل، األسنان، تسوس: الرئیسیة الكلمات