Comparative assessment of salivary flow rates among reverse smokers and smokers using modified schirmer test: A randomized prospective trial

Background: Saliva, a complex fluid secreted by the salivary glands within the oral cavity, is the first to interact with smoke while smoking. Nicotine in smoke causes structural and functional changes in the saliva, leading to a significant reduction in salivary flow. Aim: The present study was done to compare the salivary flow between reverse smokers, regular smokers, and non-smokers with the help of the Modified Schirmer Test (MST) to assess unstimulated saliva. Materials and Methodology: Ninety subjects were randomly divided into three groups; Group A (30) subjects who had the habit of reverse smoking daily for >6 months, Group B (30) subjects who had the habit of smoking daily for >6 months, and Group C (30) healthy, non-tobacco users. MST was done in the morning hours; they were not asked to eat/drink for 2 h before the procedure. Later, they were asked to raise their tongue, and the rounded end of Schirmer's strip was placed on the floor of the mouth. Wetting of the strip was recorded every 1, 2, and 3-minute intervals. Results: Data was recorded, and statistical analysis was done by the paired t-test. The mean value of salivary flow rate in reverse smokers per 3 minutes (19.73 ± 4.16) was less when compared to conventional smokers (22.53 ± 2.75) and healthy individuals (31.53 ± 2.90), with a significant P value of P < 0.0001. Conclusion: There was a significantly reduced unstimulated salivary flow rate in reverse smokers compared to conventional smokers and healthy individuals.