## 4 Discussion
In this regard, the enrolled population represented a naive population and included those who reported both urban and rural domicile reporting oral hygiene with toothpaste and a toothbrush. They demonstrated a limited understanding of dental hygiene but were receptive to learning. Biochemical tests for SA described in this investigation were conducted with small volumes of saliva, a sample that can be collected easily in remote settings. Additionally, the biochemical tests for SA identified in the literature are rapid and facilitate the inclusion of multiple replicates to improve accuracy. Long-term storage of collected saliva samplesoffers other flexibility factors in the analysis of SA and can facilitate longitudinal analyses monitoring patient health over time. Furthermore, the analytical features described in this investigation allow procedural adaptations for screening larger populations. Total sialic acid (SA) is a marker of the acute-phase response and is a predictor of several systemic disorders that include cardiovascular events, rheumatoid arthritis and diabetes [28,29]. Studies have demonstrated increased SA in the serum of head & neck cancer patients [30]. In our present study, we estimated salivary SA. The mean salivary SA level of the periodontal group was significantly higher than gingivitis and normal group. Even though SA levels were detected in the saliva of healthy controls these levels were significantly lower than those in the gingivitis and periodontitis groups, indicating that salivary SA could be a potential marker to categorize patients into gingivitis and periodontitis groups. Results from this investigation align with prior research reported from different populations. Subjects with periodontitis consistently registered the highest levels of SA as reported by [PERSON] et al., 2014 [20] and [PERSON] et al., 2019 [15]. In all these studies, the least amount of SA was noted amongst healthy subjects with gingivitis subjects reporting SA levels between these two groups. Correspondingly, in a study with a larger number of subjects, [PERSON] et al. (2021) reported the lowest levels of SA amongst healthy subjects with no significant effects of age or gender on these outcomes [14]. Other reports indicate the lack of an association between salivary SA among other groups of subjects evaluated after swimming representing physical exertion [21] or children with Down's syndrome [22]. The levels of sialic acid in healthy individuals were compared to those individuals suffering from periodontal health disease in a study reported by [PERSON] et al., 2019 [16]. Results from that investigation described increased SA in periodontal disease in comparison to those who were clinically healthy. However, only a marginal difference between early and moderate periodontitis was reported. In the present investigation, our observations corroborate these results and demonstrate an increase in SA concentration from health to disease groups with the highest level observed in periodontitis. These observations were maintained over the entire study period representing stability in oral SA as a viable assessment of health status and were related to the clinical indices of oral health. [PERSON] et al., 2020 [19] evaluated SA levels at different stages of periodontal disease and showed elevated SA in periodontal disease is due to enhanced cleavage of SA molecules from the cell membranes of oral tissues by invading periodontal pathogens. Similarly, [PERSON] et al. [20] also showed elevated total sialic acid [TSA] in periodontal disease and mentioned that high TSA is because of elevated sialidase activity and inflammatory responses in individuals suffering from periodontitis. Many recent studies have also reported increased sialic acid in chronic periodontitis in subjects who had high oxidative stress due to smoking. An increase in the mean concentration of SA might be also due to a rapid synthesis of sialoproteins [31,32,33]. Elevated levels of TSA in saliva may play other roles in oral disease [33].