Salivary Albumin and Alkaline Phosphatase in Infants: Exploring the Link Between Early Dental Development and Biomarkers

Abstract

Objectives

This study aims to investigate the relationship between dental age and the levels of albumin and alkaline phosphatase (ALP) in saliva among children aged 6 to 24 months. This study evaluates their potential as noninvasive biomarkers for monitoring dental development. Specifically, it sought to determine whether these salivary proteins increase proportionally with dental age, providing an objective method to assess tooth eruption patterns in early childhood.

Materials and Methods

Ethical approval was granted by the Airlangga University Hospital ethics committee to conduct this cross-sectional study in 33 children aged 6 to 24 months to collect data on dental age, albumin, and ALP levels in saliva. Saliva was taken using an absorbent paper and tested by enzyme-linked immunosorbent assay.

Statistical Analysis

The data obtained were then analyzed by statistical tests using SPSS. Correlation test was analyzed using the Pearson's correlation test. A significance level of p < 0.05 was used to determine statistical significance.

Results

The correlation test showed a significant relationship between dental age, albumin, and ALP levels in saliva (p < 0.05), albumin and ALP levels in saliva increase along the children's dental age.

Conclusion

This significant relationship suggests albumin and ALP in saliva as potential biomarkers in detecting dental age and tooth eruption in children.

Keywords

tooth eruption - dental age - albumin - alkaline phosphatase - saliva - good health and well-being

• References

• 1 Marwah N. Textbook of Pediatric Dentistry. 4th ed.. New Delhi: Jaypee Brothers Medical Publisher; 2019: 141
• 2 Dodo M, Ota C, Ishikawa M. et al. Timing of primary tooth eruption in infants observed by their parents. Children (Basel) 2023; 10 (11) 1730
• 3 Verma N, Bansal A, Tyagi P, Jain A, Tiwari U, Gupta R. Eruption chronology in children: a cross-sectional study. Int J Clin Pediatr Dent 2017; 10 (03) 278-282
• 4 Muthu MS, Vandana S, Akila G, Anusha M, Kandaswamy D, Aswath Narayanan MB. Global variations in eruption chronology of primary teeth: a systematic review and meta-analysis. Arch Oral Biol 2024; 158: 105857
• 5 Schüler IM, Hennig CL, Buschek R. et al. Radiation exposure and frequency of dental, bitewing and occlusal radiographs in children and adolescents. J Pers Med 2023; 13 (04) 692
• 6 Julu Y, Nagarathna C. Biomonitoring of genotoxic effect in children exposed to dental radiographs during pulpectomy procedure-BMCyt assay. Int J Clin Pediatr Dent 2022; 15 (Suppl. 01) S63-S70
• 7 American Academy of Pediatric Dentistry. Prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. In: The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2023: 308-311
• 8 Morzel M, Palicki O, Chabanet C. et al. Saliva electrophoretic protein profiles in infants: changes with age and impact of teeth eruption and diet transition. Arch Oral Biol 2011; 56 (07) 634-642
• 9 Ahmadian M, Maleki Kambakhsh S, Einollahi N. et al. Salivary protein and electrolyte profiles during primary teeth eruption: a cross-sectional study. Diagnostics (Basel) 2023; 13 (07) 1335
• 10 Alhazmi N, Trotman CA, Finkelman M, Hawley D, Zoukhri D, Papathanasiou E. Salivary alkaline phosphatase activity and chronological age as indicators for skeletal maturity. Angle Orthod 2019; 89 (04) 637-642
• 11 Manjunatha BS, Soni NK. Estimation of age from development and eruption of teeth. J Forensic Dent Sci 2014; 6 (02) 73-76
• 12 Willmann C, Fernandez De Grado G, Kolb C. et al. Accuracy of age estimation using three dental age estimation methods in a young, large, and multiethnic patient sample. Dent J 2023; 11 (12) 288
• 13 Singh GB, Singh A, Soni A, Barapatre C, Kundu S, Hazra R. Correlation of dental age, skeletal age, and chronological age among children aged 9–14 years: a retrospective study. Int J Health Sci 2022; 6 (S4): 6951-6956
• 14 Cummaudo M, De Angelis D, Magli F, Minà G, Merelli V, Cattaneo C. Age estimation in the living: a scoping review of population data for skeletal and dental methods. Forensic Sci Int 2021; 320: 110689
• 15 Hägg U, Taranger J. Dental development, dental age and tooth counts. Angle Orthod 1985; 55 (02) 93-107
• 16 Bioassay Technology Laboratory. ELISA Protocol Guide. 2021. Accessed September 19, 2025 at: https://www.bt-laboratory.com/index.php/Shop/Index/protocols.html
• 17 Jairam LS, Konde S, Raj NS, Kumar NC. Vitamin D deficiency as an etiological factor in delayed eruption of primary teeth: a cross-sectional study. J Indian Soc Pedod Prev Dent 2020; 38 (03) 211-215
• 18 Cenzato N, Di Iasio G, Menozzi G, Gangi S, Agostoni C, Maspero C. Dental diseases in premature infants: a pilot study on delayed tooth eruption during the first 12 months of life. Eur J Paediatr Dent 2025; 26 (02) 159-164
• 19 Ruhl S, Rayment SA, Schmalz G, Hiller KA, Troxler RF. Proteins in whole saliva during the first year of infancy. J Dent Res 2005; 84 (01) 29-34
• 20 Tabbara N. Identification of the Salivary Proteome in Children Throughout the Identification of the Salivary Proteome in Children Throughout the Course of Dental Eruption Course of Dental Eruption. 2013. Accessed September 19, 2025 at: https://ir.lib.uwo.ca/etd/1429/
• 21 Albat SY, Akyüz S, Yarat A, Şahin F, Çimen H. Proteomic analysis of gingival crevicular fluid during tooth eruption. Clinical and Experimental Health Sciences 2023; 13 (04) 863-870
• 22 Nibali L. Development of the gingival sulcus at the time of tooth eruption and the influence of genetic factors. Periodontol 2000 2018; 76 (01) 35-42
• 23 Nelwan SC, Wahluyo S, Khairani FC. et al. The relationship between chronological age, dental age, and salivary alkaline phosphatase in Indonesian children aged 8–14 years: a cross-sectional study. Pediatr Dent J 2021; 31 (02) 159-167
• 24 Vimalraj S. Alkaline phosphatase: structure, expression and its function in bone mineralization. Gene 2020; 754: 144855
• 25 Nakai Y, Praneetpong N, Ono W, Ono N. Mechanisms of osteoclastogenesis in orthodontic tooth movement and orthodontically induced tooth root resorption. J Bone Metab 2023; 30 (04) 297-310
• 26 Boehm T, Risse M, Schubert R. et al. Salivary proteins in healthy infants and children: developmental aspects and gender differences. Clin Oral Investig 2019; 23 (07) 2889-2898
• 27 Uher I, Streblová E, Himmlová L. Biological variation of selected salivary enzymes with age and sex. Arch Oral Biol 2020; 115: 104730
• 28 de Souza LBR, de Almeida TF, Bezerra Silva PC. et al. Salivary enzymes and proteins in children and adolescents: Influence of age and sex. Arch Oral Biol 2019; 108: 104532