International Journal of Clinical Pediatric Dentistry

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VOLUME 16 , ISSUE 4 ( July-August, 2023 ) > List of Articles


Salivary Total Protein and Alkaline Phosphatase Activity as Biomarkers for Skeletal Maturity and Growth Prediction in Healthy Children: An In Vivo Study

Khyati K Abhangi, Shantanu R Choudhari, Purva B Butala, Swati R Goyal, Tej G Yadav

Keywords : Growth prediction, Middle phalanx of third finger radiographic stages, Pubertal growth spurt, Salivary alkaline phosphatase, Salivary total protein

Citation Information : Abhangi KK, Choudhari SR, Butala PB, Goyal SR, Yadav TG. Salivary Total Protein and Alkaline Phosphatase Activity as Biomarkers for Skeletal Maturity and Growth Prediction in Healthy Children: An In Vivo Study. Int J Clin Pediatr Dent 2023; 16 (4):603-607.

DOI: 10.5005/jp-journals-10005-2629

License: CC BY-NC 4.0

Published Online: 11-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Skeletal maturity assessment involves radiographic analysis and visual inspection of developing bone and their initial appearance or sequential ossification and related changes in size and shape along with the expression of various biomarkers in body fluids. Aim: To investigate the correlation of biomarkers such as salivary alkaline phosphatase (S-ALP) and salivary total protein (STP) with skeletal maturity assessment and growth prediction in growing children. Materials and methods: A total of 8–15-year-old 150 healthy children were divided into five groups depending upon radiographic stage maturity of the middle phalanx of the left hand's third finger according to the Hagg and Taranger method. Radiographs were taken using intraoral periapical (IOPA) radiographic films. Results: Salivary alkaline phosphatase (S-ALP) activity in the MP3 G group was significantly higher than MP3 F group and MP3 I group. Total protein levels in MP3 F were significantly lower than in MP3 G. The mean value of S-ALP (33541.45 IU/L) and that of STP (2.77 mg/mL) was observed to be highest in the MP3 G group (G3) group. Conclusion: Salivary total protein (STP) and S-ALP may be used as an additional diagnostic tool to assess skeletal maturation and optimize growth prediction during myofunctional orthodontic treatment. Clinical significance: Skeletal maturity assessment plays a significant role in orthodontic diagnosis, treatment planning, and stability of orthodontic treatment. Radiographic parameters involve radiographic exposure; hence in this study noninvasive biomarkers such as S-ALP and STP have been evaluated for skeletal maturity assessment and growth prediction.

  1. Davidovitch M, Eleftheriadi I, Kostaki A, et al. The use of Bjork's indications of growth for evaluation of extremes of skeletal morphology. Eur J Orthod 2016;38(6):555–562. DOI: 10.1093/ejo/cjv084
  2. Ghafari JG, Shofer FS, Laster LL, et al. Monitoring growth during orthodontic treatment. Semin Orthod 1995;1(3):165–175. DOI: 10.1016/s1073-8746(95)80020-4
  3. Araujo MTdS, Cury-Saramago AdA, Motta AFJd. Guias clínicos e radiográficos utilizados para a predição do surto de crescimento puberal. Dental Press J Orthod 2011;16(5):98–103. DOI: 10.1590/S2176-94512011000500015
  4. Hägg U, Taranger J. Skeletal stages of the hand and wrist as indicators of the pubertal growth spurt. Acta Odontol Scand 1980;38(3):187–200. DOI: 10.3109/00016358009004719
  5. Gv V, Tripathi T. Non-invasive methods for the assessment of biomarkers and their correlation with radiographic maturity indicators - a scoping review. Prog Orthod 2021;22(1):26. DOI: 10.1186/s40510-021-00372-6
  6. Jürimäe J, Mäestu J, Jürimäe T. Bone turnover markers during pubertal development: relationships with growth factors and adipocytokines. Med Sport Sci 2010;55:114–127. DOI: 10.1159/000321976
  7. Perinetti G, Baccetti T, Contardo L, et al. Gingival crevicular fluid alkaline phosphatase activity as a non-invasive biomarker of skeletal maturation. Orthod Craniofac Res 2011;14(1):44–50. DOI: 10.1111/j.1601-6343.2010.01506.x
  8. Komoda T, Sakagishi Y. The function of carbohydrate moiety and alteration of carbohydrate composition in human alkaline phosphatase isoenzymes. Biochim Biophys Acta 1978;523(2):395–406. DOI: 10.1016/0005-2744(78)90042-6
  9. Narayan VK, Samuel SR. Appropriateness of various behavior rating scales used in pediatric dentistry: a review. J Global Oral Health 2019;2(2):112–117. DOI: 10.25259/JGOH_64_2019
  10. Meghana H, Sri Charan K, Pramod G, et al. Radiographic comparisons between middle phalanx of the third finger and cervical vertebrae maturation for the assessment of skeletal maturity. J Forensic Sci Med 2016;2(3):141–145.
  11. Lasisi TJ, Lawal FB. Preference of saliva over other body fluids as samples for clinical and laboratory investigations among healthcare workers in Ibadan, Nigeria. Pan Afr Med J 2019;34:191. DOI: 10.11604/pamj.2019.34.191.18738
  12. K YP, K MP. Methods of collection of saliva - a review. Int J Oral Health Dent 2017;3(3):149–153.
  13. Dawes C. Circadian rhythms in human salivary flow rate and composition. J Physiol 1972;220(3):529–545. DOI: 10.1113/jphysiol.1972.sp009721
  14. Jazaeri M, Malekzadeh H, Abdolsamadi H, et al. Relationship between salivary alkaline phosphatase enzyme activity and the concentrations of salivary calcium and phosphate ions. Cell J 2015;17(1):159–162. DOI: 10.22074/cellj.2015.523
  15. Emmanuel M, Bokor BR. Tanner Stages. [Updated 2021 Dec 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:
  16. Abdel-Kader HM. The reliability of dental x-ray film in assessment of MP3 stages of the pubertal growth spurt. Am J Orthod Dentofacial Orthop 1998;114(4):427–429. DOI: 10.1016/s0889-5406(98)70188-x
  17. Jasim H, Olausson P, Hedenberg-Magnusson B, et al. The proteomic profile of whole and glandular saliva in healthy pain-free subjects. Sci Rep 2016;6:39073. DOI: 10.1038/srep39073
  18. Malhotra R, Grover V, Kapoor A, et al. Alkaline phosphatase as a periodontal disease marker. Indian J Dent Res 2010;21(4):531–536. DOI: 10.4103/0970-9290.74209
  19. Cabras T, Pisano E, Boi R, et al. Age-dependent modifications of the human salivary secretory protein complex. J Proteome Res 2009;8(8):4126–4134. DOI: 10.1021/pr900212u
  20. Alhazmi N, Trotman CA, Finkelman M, et al. Salivary alkaline phosphatase activity and chronological age as indicators for skeletal maturity. Angle Orthod 2019;89(4):637–642. DOI: 10.2319/030918-197.1
  21. Nagler RM, Hershkovich O. Relationships between age, drugs, oral sensorial complaints and salivary profile. Arch Oral Biol 2005;50(1):7–16. DOI: 10.1016/j.archoralbio.2004.07.012
  22. Deshpande RR, Panvalkar PS, Kulkarni AA, et al. Age-related changes of the human salivary secretory total protein complex and trace elements in children between the age group of 3-16 years. J Biomed Sci and Res 2011;3(1):362–367.
  23. Deshpande R, Vinchurkar S, Deshpande S. Comparative evaluation of salivary total proteins in deciduous and permanent. Int J Sci Res 2015;4(12);528–530.
  24. Vibhakar A P, Patankar SR, Yadav R M, et al. Salivary total protein levels and their correlation to dental caries. Int J Oral Maxillofac Pathol 2013;4(3);13–16.
  25. Kalipatnapu P, Kelly RH, Rao KN, et al. Salivary composition: effects of age and sex. Acta Med Port 1983;4(7-8):327–330.
  26. Saitou M, Gaylord EA, Xu E, et al. Functional specialization of human salivary glands and origins of proteins intrinsic to human saliva. Cell Rep 2020;33(7):108402. DOI: 10.1016/j.celrep.2020.108402
  27. Sivakumar T, Hand AR, Mednieks M. Secretory proteins in the saliva of children. J Oral Sci 2009;51(4):573–580. DOI: 10.2334/josnusd.51.573
  28. Dodds MW, Johnson DA, Mobley CC, et al. Parotid saliva protein profiles in caries-free and caries-active adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83(2);244–251. DOI: 10.1016/s1079-2104(97)90012-3
  29. Tarvade SM, Ramkrishna S, Sarode S. Salivary alkaline phosphatase- a biochemical marker for growth prediction. Int J Basic Appl Med Res 2015;4(3):17–22.
  30. Irham F, Bahirrah S, Nazruddin D. The level of alkaline phosphatase in saliva as biomarker for pubertal growth phase. Proceedings of the IDCSU 2017 2018.
  31. Christenson RH. Biochemical markers of bone metabolism: an overview. Clin Biochem 1997;30(8):573–593. DOI: 10.1016/s0009-9120(97)00113-6
  32. Tobiume H, Kanzaki S, Hida S, et al. Serum bone alkaline phosphatase isoenzyme levels in normal children and children with growth hormone (GH) deficiency: a potential marker for bone formation and response to GH therapy. J Clin Endocrinol Metab 1997;82(7):2056–2061. DOI: 10.1210/jcem.82.7.4081
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