EFFECT OF SCREEN TIME ON ORAL HEALTH STATUS IN CHILDREN-AN EXPERIMENTAL STUDY WITH SALIVARY ANALYSIS

Background: The prospect of side effects associated with the electromagnetic waves emitted by the mobile phones is a questioned issue. The current study was designed to assess the impact of mobile phone use on salivary concentrations of amylase in children. Methods: The children were divided into dominant and non-dominant groups based on the questionnaire. For each subject, saliva samples from the dominant and non-dominant mobile phone users were collected. Salivary flow rate and salivary concentrations of proteinamylase were measured. Data were analysed using one-way analyses of variance and t-tests conducted with the statistical software version 18 (SPSS; Chicago, Illinois, USA). Results: Salivary flow rate and salivary concentrations of protein amylase were significantly higher in the non- dominant group than the dominant group. Conclusion: The dominant mobile phone use was associated with differences in salivary flow rate and salivary concentrations of amylase. Significant changes in salivary amylase and salivary flow rate suggest the adverse effects of the high use of cell phones on cell health in children.


ISSN: 2320-5407
Int. J. Adv. Res. 10(02), 1304-1313 1305 traces of albumin, some polypeptides and oligopeptides of importance to oral health. 4,5 A healthy person's mean daily saliva production ranges from 1 to 1.5L. The functions of saliva are lubrication, buffering action, cleansing, mucosal integrity and many more. 6 Amylase, one among the constituents of saliva, plays a vital role as it begins the chemical digestion process. The enzyme breakdowns the food so that it can easily be digested and releases all the nutrients from the food, which are absorbed into the body. 7 In the past, extensive studies have been done on the effect of mobile phone usage in direct proportionality to the time of its usage. Clinical symptoms such as burning sensation, tingling of the skin on the head and extremities, fatigue, sleeping disorders, vertigo, mental distraction, increased reaction time, diminished memory, headaches, weakness, palpations, and digestive system dsturbances were reported 8. Although a cause-effect relationship has not been established conclusively; there is a possibility that carcinoma incidence and other genetic conditions may be associated with such exposure. 9 Due to this pandemic, the usage of virtual reality has increased drastically, increasing screen time, especially in children in the form of classes held in a web-supported format. When relating these two, the global trend and oral cavity, there has beena tremendous increase in the usage of mobile phones over the last two decades.
The present study evaluates the quantity of unstimulated saliva produced depending on the amount of time spent on the mobile. In addition, to assessthe salivary concentration of amylase and compare the concentrations between dominant and non-dominant mobile phone users.

Materials and Methods:-
This study was carried out in the outpatient Department of Paediatric and Preventive Dentistry, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam. Inclusion criteria 1) Children aged between 4-14 years are included. 2) Children with no systemic disorders. 3) Children not under any medication.Exclusion criteria 1) Children with systemic diseases. 2) Children who are on long-term medication. Implication: To evaluate the effect of screen time on oral health and what necessary precautions can be taken to decrease the impact on the oral health status. Equitable gender distribution was ensured. After explaining the study's aim and completing the demographic data sheet, informed consent was taken from each participant. All subjects were assured that the data they provided would be confidential and would only be used for statistical analysis. For each subject, saliva samples from the dominant and non-dominant mobile phone users were collected and compared. 1306

Measurements:-
After completing the questionnaire on mobile phone usage, Unstimulated salivary samples were collected from children in the dental chair in a relaxed atmosphere under proper lighting conditions. (FigII) Unstimulated salivary sample collections were done in a measured beaker for 2 minutes and kept on ice during and after sample collection. The samples were then transferred to the pathobiology laboratory and kept in a frozen state at -18C until all subjects were collected. To determine the activity of salivary amylase, the frozen samples were placed at an ambient temperature for 30 minutes before being centrifuged at 3500 revolutions per minute for 20 minutes.

FigII:-a collection of salivary samples from children in a measured test tube.
Using appropriate samplers, the supernatant clear fluid was then transferred into an Eppendorf microtube Sigma-Aldrich, St. Louis, Missouri, USA) using suitable samplers. The particulars of each sample were inscribed on each microtube. 10

Procedure:-
Principles of the Procedure: The Slide is a multi-layered, analytical element coated polyester support. A drop of the patient's saliva sample is deposited on the vitros amyl slide and is distributed evenly by the spreading layer to the underlying layers. The spreading layer comprises the dyed starch substrate (dye covalently linked to amylopectin) for the reaction. The amylase in the sample catalyses the hydrolysis of this dyed starch into smaller dyed saccharides. The dyed saccharides formed diffuse into the underlying reagent layer. Then the reflection density of these dyed saccharides in the reagent layer is measured by reflectance spectrophotometry at 2.3 for 5 minutes ( fig  III). The difference in the slide's reflection density between the two readings is proportional to sample amylase activity. 11 The handling of the reagent is given in fig IV.

Analysis:
Data was analysed using one-way analyses of variance and t-tests conducted with the statistical software version 18 (SPSS;Chicago,Illinois,USA). Statistical significance was well-defined as p <0.05.

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Results:-   The results in both tables III and IV depictedan increase in salivary amylase concentration in the dominant group and decreased salivary flow rate in the dominant group with increased time duration of mobile phone usage, which is vice-versa for the non-dominant group, i.e., decreased salivary amylase concentration and increased salivary flow with decreased time duration of mobile phone usage.

Discussion:-
The use of digital technology has raised rapidly during the last two decades. Mobile phones emit radiofrequency (RF) radiation during use. the scientific evidence on theevaluation of brain tumor risk was made by the International Agency for Research on Cancer in May 2011 concluded that radiofrequency radiation emitted from devices in the frequency range 30 kHz-300 GHz is a Group 2B, a "possible" human carcinogen. 12 Potential health effects of cell phone use have not been adequately examined in children. As children are using cell phones at earlier ages, research among this group has been identified as the highest priority by both national and international organizations. Exposure to cell phone prenatally and a lesser degree postnatally was associated with more behavioral difficulties. 13 Early disease detection is vital to reduce disease severity and prevent complications and critical to increase the success rate of any therapy. Saliva has been studied widely as a potential diagnostic tool due to its ease and noninvasive accessibility, along with its abundance of biomarkers, and proteins 14 . The use of saliva to identify individuals with the disease and to follow the affected individual's progress has attracted the attention of numerous investigators. Its non-invasive method of collection, simplicity, and cost-effectiveness make it a valuable tool to the 1311 general practitioner and the paediatric dentist1 3 saliva as a diagnostic fluid offers distinctive advantages over serum because it can be collected non-invasively by individuals with modest training. Furthermore, saliva may provide a cost-effective approach for screening large populations. The whole saliva may be used to diagnose systemic diseases because it contains serum constituents1 4 . The concentration of saliva's substances varies according to the responses to physiological processes in the human body. Genetic constituents such as DNA and RNA also highlight saliva as a potential diagnostic tool 17 . A saliva is a vital tool containing biomarkers used in the diagnosis and treatment of many oral and systemic diseases. 18 Saliva analysis has advantages such as being non-invasive, cheaper than blood tests, good patient cooperation, and low technical sensitivity. It is also promising for its ease of collecting and storing samples 17 . Alpha-amylase is the primary form of amylase found in humans, most prominently in pancreatic juice and saliva. The salivary amylase is an amylolytic enzyme that acts on cooked or boiled starch and converts it into maltose. It has become interesting to study the behavior of salivary amylase when it is secreted as a result of different stimuli. 18 Salivary amylase is a glucose-polymer cleavage enzyme synthesized by the salivary glands. It contains a small portion of the total amylase excreted, made mainly by the pancreas. Amylases digest starch into smaller molecules, ultimately yielding maltose, which in turn is cleaved into two glucose molecules by maltase. 19 Internationally, there has been aincrease in the number of people using hand-held mobile phones over the past two decades 20,21 . Human beings are exposed to radiofrequency radiation emitted by the mobile phone device (which operates as a receiver and a transmitter),which has created a need to investigate possible ill effects of mobile phone use on individuals'health of individuals 22,23 . Cell phones have been considered modern man's nemesis. Reports indicate a wide range of adverse effects of long-term usage of cell phones on the reproductive system, nervous system, cornea, gastrointestinal system, and kidneys 24,25,26 . The negative effects of electromagnetic radiations have been proposed to be mediated by various mechanisms like increasing the generation of free radicals 27 , alterations in gene expression 28 , damage to DNA, loss of DNA integrity 29 , and chromosomal instability 30 . Studies have reported increased lipid peroxidation and decreased levels of antioxidants in the blood of regular cell phone users 31,32 , and in the blood and tissues of experimental animals exposed to electromagnetic radiations for prolonged periods 33,34 . Due to the present pandemic situation, as usage of mobile phones isin high demand, the current study was commenced to evaluate the effect of screen time on children's oral health. Saliva is an underused diagnostic tool, gaining a lot of attention in the last three decades due to the non-invasiveness of its collection, non-necessity of skilled persons, and special equipment for its collection 35 . Researchers worldwide have attempted to evaluate the practicality of salivary constituents as biomarkers of systemic diseases, malignancy, infectious diseases, drug toxicity, and hormonal imbalances 35 . Due to its non-invasiveness, saliva was selected for the present study for evaluation. Salivary amylase activity was significantly higher in high mobile users, indicating the adverse effect of mobile phone use on cell health. Previous studies have reported increased salivary amylase in oral cancer 36. Thus, the evaluation of the amylase was taken into consideration.
A previous study has reported increased salivary cortisol and amylase levels on exposure to electromagnetic radiations from the Global System for Mobile Communication (GSM) mobile base station 37 . Recently, a study has observed decreased salivary flow, total protein, albumin, and amylase activity in mobile phone users 38 . This supports the present study where there is a rise in the salivary amylase concentration and decreased salivary flow rate in the dominant group. Comparing the salivary flow rate in children of the dominant group is less than the nondominant group, which is contradicting to the various studies 39,40,41 Limitations: However, this was a preliminary project and had the limits of a small sample size and only assessing saliva. We also could not ascertain the wave strength of the mobiles used, different companies of smartphones used, and the effect of only hand-held mobile phone use was considered.

Conclusion:-
The findings of this study suggest an adverse effect of mobile phone usage on oral health as indicated by increased salivary amylase and decreased salivary flow rate in children, wherein salivary biochemical parameters have served as sensitive indicators of oral health in mobile users. The age group of the children might be the reason for the decrease in salivary flow rate in the dominant group, which was vice-versa for the adult group.

Extension of the study:
As an extension of the present research on the same children, a comparison of the effect of the screen time on the oral health status of the children between dominant and non-dominant categories at the cellular level, the buccal