Evaluation of Salivary Ph and Vitamin D Status in Areca Nut Induced Oral Submucous Fibrosis

Abstract

Background: Oral Submucous Fibrosis (OSMF) is a progressive, potentially malignant disorder driven by the cytotoxic and fibrogenic effects of areca nut alkaloids. While the pharmacological neuro humoral effects of arecoline are recognized, its interactions with local salivary buffering and systemic pharmacodynamic regulators, such as vitamin D receptor (VDR) signalling, require detailed characterization.

Objective: To evaluate salivary pH alterations and serum 25 hydroxyvitamin D [25(OH)D] status in habitual areca nut chewers with OSMF from a pharmacodynamic perspective, establishing their correlation with clinic anatomical disease severity.

Material and Methods: A prospective observational study was conducted on 120 habitual areca nut chewers categorized across Khanna & Andrade clinical stages (I–IV). Resting salivary pH was measured using a digital pH meter, and serum 25(OH)D levels were quantified using an enzyme linked immunosorbent assay (ELISA). Clinic anatomical severity was quantified via interincisal distance (mm) and cheek flexibility. Pharmacological habit parameters (daily alkaloid exposure duration and dosage) were correlated with biochemical parameters using ANOVA, Tukey's post hoc tests, and Pearson's correlation analysis (p < 0.05).

Results: Mean resting salivary pH demonstrated a significant, step wise shift toward acidity from Stage I (6.92 ± 0.18) to Stage IV (5.64 ± 0.22, p < 0.001). Serum 25(OH)D levels declined concurrently from Stage I (28.4 ± 4.2ng/mL) to Stage IV (11.8 ± 3.1ng/mL, p < 0.001). Strong positive correlations were identified between salivary pH, serum 25(OH)D, and interincisal distance (r = 0.742 and r = 0.698, respectively; p < 0.001). Chronic exposure to areca nut alkaloids was inversely correlated with both salivary pH (r =  0.612) and systemic vitamin D levels (r =  0.584).

Conclusion: Areca nut induced salivary acidification and systemic depletion of anti fibrotic vitamin D signaling closely parallel the clinico anatomical progression of OSMF. Integrating local salivary buffering agents and VDR targeted pharmacotherapy offers a promising strategy for halting submucosal fibrogenesis.

Keywords: Oral Submucous Fibrosis; Arecoline Pharmacodynamics; Salivary pH; Vitamin D Receptor; Interincisal Distance; Fibrogenesis.