Minor salivary gland secretion rates and immunoglobulin A in adults and the elderly

Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update

Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.

Self-perceived Mate Value is Predicted by Biological and self-reported Indices of Health in Young Adults

Immunocompetence can influence an organism's reproductive fitness, and thus presumably their desirability as a mate (i.e., mate value). In humans, the link between immunocompetence and mate value has found circumstantial support by way of both expressed mate preferences for healthy partners, and via preferences for attractive phenotypes that are ostensibly linked to immune functioning. We examined whether a biological marker of immunocompetence, salivary immunoglobulin A (sIgA), along with self-reported frequency and severity of symptoms of poor health predicted individuals' reported mate value and mating behavior in a sample of 691 young adults. Our measures of immunocompetence (sIgA and symptoms of poor health) correlated significantly with one another, suggesting sIgA is a viable marker of general immune function in young adults. We then examined the independent contributions of these variables to mate value, controlling for age, sex, and body mass index (BMI). Results showed that sIgA (positively) and poor health (negatively) predicted mate value, but not lifetime number of sex partners or current romantic relationship status. These findings suggest that those with better health and immune function report being more desirable as mating partners but support past research showing null links to reported mating behavior. Together, these findings suggest that more comprehensive work on links between immunocompetence and mating is required.

Correlation Depending on Age Between Saliva and Plasma Parameters

Introduction. Because of the increasing interest in the study of saliva, many methods have become available that can allow us to perform multiple and rapid analyzes of the composition of salivary secretion using advanced techniques of nanotechnology and fluid micro- engineering. The objectives of our study were to identify immunoglobulin levels variations with age.

Materials and methods. We conducted an analysis to check the correlation between saliva and plasma parameters on 24 patients. The study population was divided into 2 groups based on age, with a cut-off at 35 years. The differences on the variables between two groups were evaluated by TTEST and CORREL.

Results. Total plasma calcium, as well as ionic calcium have increased values in group 2, the increase being statistically significant (p =0.04) only for ionic calcium. Significant correlation of plasma and salivary values in the case of IgA / IgG ratio, and also a significant correlation of salivary and plasma concentrations for IgG were identified in our study.

Conclusions. The correlation between plasma and salivary parameters is closely related to age and these can be used as markers for diagnosis and evaluation of various pathologies. Also, regarding women, salivary calcium and phosphate concentrations increase with age showing peak values around menopause.

Comparative Analysis of Fasting Blood Glucose and Salivary Electrolytes Concentrations among Individuals with Type II Diabetes: A Randomized Controlled Hospital Based Study

Salivary gland dysfunction is common in people with diabetes. This study aimed to compare the measurements of salivary electrolytes (SE); Na+, K+, Cl- and HCO3 - between diabetes and an age matched control group, and assess the relationship between fasting blood glucose (FBG) and salivary electrolytes, and salivary glucose (SG). Eighty-five human participants [diabetes group, n = 45 (23 males and 22 females) and control group, n = 40 (20 males and 20 females)] aged between 25 and 65years were tested. Saliva samples were taken between 7.00 am and 8.00 am after an overnight fast and SG and SE concentrations were analysed. Diabetes mellitus was defined using FBG ≥ 126 mg/dl. SG and SE concentrations were analysed using t-test and Pearson Correlation Coefficient tested the relationship between FBG and Salivary electrolytes and glucose. The participants were matched in their baseline demographic characteristics with a mean age of 49 years (standard deviation SD, 11 years), body mass index (25.7 kg/m2 (SD, 3.6). Half of them were males (50.6 %) and predominantly traders (30.6 %). However, the mean values for the salivary sodium, potassium, chloride and bicarbonate electrolytes were significantly higher in the diabetes group compared with the control group (P < 0.05). Of the salivary electrolytes, only the bicarbonate was significantly correlated with FBG (r = -0.594, p = 0.004) in female participants. This study found that people with diabetes have elevated salivary electrolytes which were not dependent on their age and gender. Although this study suggests some potential for saliva as an alternative in monitoring of diabetes mellitus, extensive research is required before we can reach any firm conclusion.

Salivary Biomarkers (Opiorphin, Cortisol, Amylase, and IgA) Related to Age, Sex, and Stress Perception in a Prospective Cohort of Healthy Schoolchildren

Background

The use of easily accessible biomarkers for assessing young patients' health is weighty. This cohort study is aimed at measuring stress/immune biomarkers in the saliva of healthy school-age children and comparing subgroups according to age, sex, and stress perception. Material and Methods. 503 children under 12 years old (8.7 ± 1.3) were included with anthropometric evaluation (height, waist, hip circumference, body weight, and body mass index (BMI)). Levels of opiorphin (OPI), free cortisol, alpha-amylase (sAA), and secreted immunoglobulin (sIgA) were determined by quantitative assays (ELISA) in unstimulated saliva. Unpaired t-test, Welch test, and Mann-Whitney U test were applied for appropriate group comparisons, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05.

Results

sIgA and sAA exhibited significant differences depending on age and sex: IgA (ng/mL): 86 ± 68.6 vs. 104.9 ± 72.1 for (6-7 y.o.) and (8-11 y.o.), respectively, and 108.1 ± 80.1 vs. 94.6 ± 62.2 for male and females, respectively; sAA (U/mL): 78.9 ± 54.4 vs. 100.5 ± 81.2 for (6-7 y.o.) and (8-11 y.o.). No difference related to age or sex between groups was observed for cortisol and OPI. However, OPI levels were higher and correlated to prior stress exposure in children (0.31 ± 0.4 vs. 0.26 ± 0.5 ng/mL, p = 0.031). sAA was negatively correlated to low mood self-declaration in children in the last two weeks (r = -0.10, p = 0.045).

Conclusions

sIgA and sAA can be used as sex- and age-related biomarkers in children 6-12 y.o., which is not the case for free cortisol and opiorphin. However, OPI reflected previous exposure to stress, suggesting its use for evaluating stress-related changes in children.

Food for the elderly based on sensory perception: A review

Background

The impairments of physiological functions caused by aging are common problems in the elderly, especially the impairments of sensory perception. Besides, close relationship between food sensory perception and nutritional status also suggests the importance of dietary management for the elderly population. The foods taking sensory perception into account are urgently needed by the elderly.

Scope and approach

This review analyzed sensory perception changes and their effects on food behaviors and nutritional status. Besides, sensory properties essential for aged-foods and acquisition methods, as well as current status of such foods were summarized.

Key findings and conclusions

Soft, smooth and moisty foods were more suitable for the elderly with chewing and swallowing dysfunction, which can be prepared by gelation, enzyme treatment, blade tenderization and other non-thermal technologies. Flavor enhancement/enrichment, irritant addition and packet sauces were recommended to compensate the impairment of chemical sensory. Molds, piping bag and 3D printing were suggested for refining appearance of pureed foods, and improving appetite of the elderly.

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Sensory perception changes of the elderly affect food behaviors and health.

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Soft, smooth, and moisty foods are more suitable for the elderly.

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Gelation and enzyme treatment are applied to modify the texture of aged food.

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Packet sauces may meet the heterogenetic flavor requirements of the elderly.

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Visually attractive food made by 3D printing can increase the appetite of elderly.

Stimulated saliva composition in patients with cancer of the head and neck region

BACKGROUND

To analyse over time changes in stimulated whole saliva regarding total protein, Immunoglobulin A (IgA), and mucin type O-glycans (mostly MUC5B and MUC7) in head and neck cancer patients.

METHODS

29 dentate patients (20 men and 9 women, 59 ± 8 years) treated with curative radiation therapy and chemotherapy for cancer of the head and neck region were included. The stimulated whole salivary secretion rate was determined and saliva collected at four time-points: at pretreatment, and at 6 months, 1 and 2 years post treatment. The total protein concentration was determined spectrophotometrically by using Bicinchoninic Acid assay and Immunoglobulin A (IgA) by using ELISA technique. Glycosylation pattern of salivary mucins was determined in samples collected pre- and post treatment by using LC/MS electrospray and mucin content quantified using SDS-AgPAGE gels and PAS staining.

RESULTS

Compared with pretreatment, the total protein concentration was increased already at 6 months post treatment (p < 0.01), and continued to increase up to 2 years post treatment (p < 0.001). During that period no significant changes in IgA concentration was detected. At pretreatment, the output/min of both total protein and IgA was significantly higher than at all time-points post treatment. Saliva from the cancer patients showed a low abundance/no detectable MUC7, while the MUC5B level remained, compared to saliva from a healthy control. The glycomic analysis showed that the percentage of core 2 O-glycans was increased as core 1, 3 and 4 O-glycans were decreased. The level of sialylation was higher at 6 months post treatment, while sulfation was lower.

CONCLUSION

A decreased output per minute of proteins at decreased salivary secretion rate, as well as reduced sulfation of MUC5B at 6 months post treatment tended to correlate with the patients' experience of sticky saliva and oral dryness. At 2 years post treatment, the decreased amount of IgA combined with a lowered salivary secretion rate indicate a reduced oral defense with increased risk of oral infections.

Assessment of Age-Related Changes of Salivary Immunoglobulin A Levels among Healthy Individuals

Background:

Secretory immunoglobulin A (IgA) is the first line of defense against pathogens that invade mucosal surfaces. It has been reported that the immune system exhibits profound age-related changes. The aim of this study was to investigate the age-dependent changes of salivary IgA among healthy individuals.

Materials and Methods:

Saliva samples were collected from 120 healthy individuals (aged 11–70 years). The salivary IgA concentrations were measured by the use of a single radial immunodiffusion technique and analyzed using the Mann–Whitney U, Kruskal–Wallis, and Chi-square tests.

Results:

The mean salivary IgA levels were 81.11 ± 4.50 mg/dl at age 11–20 years, 92.71 ± 13.76 mg/dl at age 21–30 years, 96.50 ± 4.04 mg/dl at age 31–40 years, 104.96 ± 10.15 mg/dl at age 41–50 years, 113.22 ± 7.85 mg/dl at age 51–60 years, and 91.38 ± 4.77 mg/dl at age 61–70 years. There was a significant difference among the mean salivary IgA levels of different age groups (P < 0.001).

Conclusion:

These results showed that the salivary IgA levels exhibit age-related changes. Oral immunization may be considered to improve oral immunity when the salivary concentrations of IgA begin to decrease during lifetime.

Clinical anatomy of the inferior labial gland: a narrative review

Objective

In this article we review the literature on the inferior labial gland from a clinical and anatomical perspective.

Background

Regardless of its importance in clinical practice, there are no medical literature that comprehensively reviewed the inferior labial gland.

Methods

A database search using PubMed and Google Scholar was conducted. The following keywords were used in the search: "lower labial salivary gland", "lower labial gland", "inferior labial salivary gland", AND "inferior labial gland".

Conclusions

The human labial glands are types of minor salivary gland that continuously secrete small amounts of mucous and serous substances to maintain oral health. The inferior labial glands are innervated by the inferior labial branch of the mental nerve, and the inferior labial branch of the facial artery is the main arterial supply to the lower lip. Although they only have an auxiliary role in saliva production compared to the major salivary glands, minor salivary glands provide a certain amount of lubrication in the oral cavity by the continuous outflow of saliva. The inferior labial gland not only promotes moisturization in the oral cavity but also secretes substances with antibacterial effects, which is important for the function of the oral cavity. A recent study showed that the rate of salivary secretion from the inferior labial glands does not change with age, and in some cases the inferior labial glands are used for diagnosing intractable diseases such as Sjogren's syndrome and cystic fibrosis. In addition, since the inferior labial glands themselves can be the site of cyst and/or neoplasia development, we should be careful to distinguish them from other diseases. Elucidation of the anatomy, physiology, and pathology of the inferior labial glands, is important for understanding human health and diseases.

Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update

Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.

General Health, Systemic Diseases and Oral Status in Adult Patients with Coeliac Disease

The prevalence of coeliac disease in the general population is 0.5–1%; however, most patients remain undiagnosed until adult age. In some cases, the onset is represented by sub-clinical signs, some of which can be found in the mouth. The aim of this research was to identify any associations between the clinical characteristics of coeliac disease and oral manifestations. A structured questionnaire was administered to a group of 237 individuals with coeliac disease. 100% of the subjects fully completed the questionnaire. Among them, 182 (76.7%) were female, 64 patients (27%) were aged 15 to 24 years, 159 (67%) were aged 25 to 55 and 14 (6%) were aged 56 and over. Significant associations were observed in caries prevalence and dentin sensitivity; in addition, an inappropriate diet was related to oral manifestations; following a gluten-free diet could be important to control the gingival bleeding levels and to manage oral symptoms associated to coeliac disease. In general, the presence of inflammatory symptoms in the mouth seems to be associated with general symptoms of inflammation related to coeliac disease.

Testosterone, cortisol, and secretory immunoglobulin-A within a single day and across two sequential days among trans- and cis-gender men

BACKGROUND

Previous research on the association between testosterone (T) and immunity has produced conflicting results.

OBJECTIVES

We address two potential reasons for these empirical inconsistencies in the present research. First, the association between T and immunity may depend on which branch of the immune system is considered. Here, we examine secretory IgA (sIgA), a measure of mucosal immunity functionally related to respiratory infection risk. Second, the association between T and immunity may depend on a third regulatory variable. Therefore, we examine the interaction between T and cortisol (CORT) as well as their independent and combined effects on mucosal immunity. To do this, we explore intra-individual associations between sIgA, CORT, and T within a single day (i.e., morning vs. evening) and across 2 sequential mornings. We target two samples of men: (1) cisgender (i.e., born and identifying as men), and (2) transgender (i.e., born female but identifying as men) undergoing T therapy for gender realignment.

MATERIALS AND METHODS

One hundred and forty-eight adult men (transgender n = 29) provided saliva samples at three time points: (1) upon waking, (2) before sleep on the same day, and (3) upon waking the following day. Samples were assayed in duplicate for sIgA, T and CORT.

RESULTS

For cisgender men, sIgA, T, and CORT exhibited clear circadian rhythms and were significantly related within and between samples. For transgender men, evidence for circadian change was found for sIgA and CORT, but not T. Further, sIgA was associated with CORT, but not T.

DISCUSSION AND CONCLUSIONS

This study provides the first evidence that salivary T and sIgA concentrations are associated within a single day and across sequential days for cisgender men. Differences between cis- and transgender men suggest that this may only be true for T levels driven by endogenous production; however, future studies should employ a larger sample size.

Salivary sIgA and PRAP-1 Protein in Relation to Dental Caries: A Comparative Study

Aim:

Certain individuals are more prone to dental caries than others are. Caries risk may be related in the secretion of certain defensive salivary proteins including secretory IgA (sIgA) and proline-rich acidic protein (PRAP-1). In this study, we investigated the relationship between PRAP-1 and sIgA leading to the susceptibility of development of dental caries in adults and explored the differences in the levels of sIgA and PRAP-1 between men and women.

Materials and Methods:

Unstimulated saliva samples were collected from 28 patients with high caries risk and 32 control subjects with low caries risk according to caries management by risk assessment guidelines. sIgA and PRAP-1 levels in clarified saliva samples were measured using the enzyme-linked immunosorbent assay.

Results:

According to our results, sIgA and PRAP-1 levels did not demonstrate statistically significant differences as a function of caries risk or gender, even when potential confounding variables such as age and numbers of teeth were taken into consideration. Estimates of effect size, however, revealed small- to medium-sized effects and suggest that significant results may have been found if larger sample sizes were used.

Conclusion:

The results of this study indicate that caries risk and salivary levels of sIgA and PRAP-1 do not appear to be significantly associated. Statistically significant findings could emerge if the sample size was larger.

Comparative evaluation of salivary immunoglobulin a levels between pedodontic subjects

Background and Aims:

Host immune response is altered by a series of physiologic and pathologic factors like age, gender, inflammation, surgery, medication etc., The present study was conducted to evaluate differences in salivary IgA (S-IgA) levels among pedodontic subjects undergoing active orthodontic treatment with fixed and removable appliance. The levels of S- IgA were determined before 3 months and 6 months post active orthodontic treatment.

Methods:

A total of 40 healthy pedodontic subjects (aged 8-15 years) were recruited in the present study. They were equally divided into Group A (fixed orthodontic group) and Group B (removable orthodontic group) with 20 subjects each. 1.5 mL of saliva per subject was obtained before 3 and 6 months after treatment. Enzyme Linked Immunosorbent Assay (ELISA) technique was used for measurement of Salivary IgA levels.

Results:

Group A and B both showed significant rise in S-IgA levels 3 months and 6 months post active orthodontic treatment. Mean value of S-IgA 3 months post treatment in the saliva of children in group B and group A were (144.27 ± 5.32) and (164.0 ± 3.23) μg/ml respectively. While mean value of S-IgA after 6 months of treatment in group B and group A were (149.8 ± 6.02) and (166.4 ± 3.65) μg/ml respectively.

Conclusion:

Salivary Immunoglobulin A level values were significantly higher statistically in both group A and group B post active orthodontic treatment than before. The results however, showed that Group A (fixed orthodontic group) showed statistically significant higher levels of S-IgA than Group B (removable orthodontic group). Active orthodontic treatment triggered a stronger stimulus for oral secretory immunity, hence the increase in levels were detected. There is a significant positive correlation between S-IgA and active fixed as well as removable orthodontic treatment. Orthodontic treatment is hence a local immunogenic factor.

Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique

Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 μg/mL (inter-quartile range (IQR): 34, 85 μg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections -0.04 log μg/mL (95% confidence interval (CI): -0.08 to -0.005 log μg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages.

Sex-specific differences in the salivary microbiome of caries-active children

Background and Objectives: Dental caries is a chronic disease affecting young children and has multi-factorial risk factors. The purpose of this work was to identify sex-specific differences in the salivary microbiota within caries-active children. Design: Saliva specimens were collected from 85 children (boys: 41; girls: 44) between the ages of 2-12 years. Salivary microbial DNA was subjected to PCR amplification using V3-V4 16S rDNA-specific primers and next-generation sequencing. Results: Significant sex differences in salivary microbiota were found between caries-active boys versus caries-active girls. Neisseria flavescens, Rothia aeria, and Haemophilus pittmaniae were found at significantly higher levels in caries-active boys. In contrast, Lactococcus lactis, Selenomonas species HOT 126, Actinobaculum species HOT 183, Veillonella parvula, and Alloprevotella species HOT 473 were found at significantly higher levels in caries-active girls. Conclusion: We have found the acid-generating, cariogenic Lactococcus lactis to be much more abundant in caries-active girls than caries-active boys, indicating that this microorganism may play a more significant role in shaping the cariogenic microbiome in girls. In addition, in caries-active girls, Alloprevotella species HOT 473 was the only species that exhibited both significant sex differences (4.4-fold difference; p=0.0003) as well as high abundance in numbers (1.85% of the total microbial population).

Testosterone is positively and estradiol negatively associated with mucosal immunity in Amazonian adolescents

OBJECTIVES

A core assumption of life history theory and the immunocompetence handicap hypothesis (ICHH) is that testosterone (T) upregulates energetic investment in mating effort at the expense of immunity. This tenet, along with observed positive relationships between estrogens and immunity, may contribute to the higher observed morbidity and mortality of males. In the present study, we examine the association between sex steroid hormones and mucosal immunity as well as sex differences in immunity in a rural Amazonian population of immune-challenged Bolivian adolescents.

METHODS

Salivary steroid hormones (T [males only] and estradiol [E₂ , females only]), Tsimane-specific age-standardized BMI z-scores, and salivary mucosal immunity (sIgA, secretory IgA) were measured in 89 adolescent males and females.

RESULTS

Males had significantly higher sIgA levels than females, which may be due to the observed immune-endocrine associations found in the present study. Controlling for age and phenotypic condition, higher T significantly predicted higher sIgA; whereas higher E₂ was associated with lower sIgA in females.

CONCLUSIONS

Results stood in contrast to common interpretations of the ICHH, that is, that T should be inversely associated with immunity. Findings from the present study support the notion that the endocrine system likely affects immunity in a regulatory fashion, upregulating certain aspects of immunity while downregulating others. An important remaining question is the adaptive reason(s) for sex differences in endocrine-mediated immuno-redistribution.

Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia

Background. Unstimulated salivary flow rate can be influenced by different factors. This study was undertaken to evaluate the effect of stress, anxiety and depression on unstimulated salivary flow rate in adults.

Methods. A total of 247 adult subjects, randomly selected from patients referring to Zanjan Dental School, were included in this investigation. The study procedures consisted of collecting salivary samples (in 5 minutes), completing a form for feeling of xerostomia and completing Depression Anxiety Stress Scale (DASS) Questionnaire to assess the severity of stress, anxiety and depression. Based on the results, the patients were categorized in four groups: Low salivary flow rate plus xerostomia (group 1, n=60), normal salivary flow rate plus xerostomia (group 2, n=59), low salivary flow rate without xerostomia (group 3, n=60) and normal salivary flow rate without xerostomia (control group, n=68).

Results. The frequencies of subjects with severe and major depression in groups 1, 2 and 3 were 31.4%, 11.7% and 8.5%, respectively, with 4.4% in the control group. The frequencies of subjects with severe stress in groups 1, 2 and 3 were 21.7%, 3.3% and 11.9%, respectively, with 1.5% in the control group. The frequencies of patients with severe anxiety in groups 1, 2 and 3 were 50%, 30% and 61.1%, respectively, with 4.4% in the control group. Stress, anxiety and depression exhibited a statistically significant relationship with unstimulated salivary flow rate and xerostomia (P<0.05).

Conclusion. Stress, anxiety and depression can influence unstimulated salivary flow rate and lead to xerostomia.

A randomized, double-blind, placebo-controlled trial of a traditional herbal formula, Yukmijihwang-tang in elderly subjects with xerostomia

ETHNOPHARMACOLOGICAL RELEVANCE

Yukmijihwang-tang (YMJ) is a typical herbal formula to treat Yin-deficiency (YD) syndrome by enriching the fluid-humor of the body. YMJ has been used to treat dry mouth symptoms for hundreds of years in traditional East Asian medicine. Xerostomia, a subjective oral dryness, is common in the elderly and results in impaired quality of life. Many conventional treatments for xerostomia provide only temporary symptom relief, and have side effects. The aim of this study is to investigate the efficacy and safety of YMJ for the treatment of xerostomia in the elderly.

METHODS

This study was designed as a randomized, placebo-controlled, double-blinded, two center trial. Ninety-six subjects aged 60-80 years who had experienced xerostomia for at least 3 months and presented with score>40 on the visual analog scale (VAS) for subjective oral dryness were recruited and randomly allocated to YMJ and placebo groups. YMJ or placebo was administered to each group for 8 weeks (3g of YMJ or placebo, three times per day). The primary outcome was change of VAS for xerostomia from 0 to 8 weeks.

RESULTS

VAS for xerostomia was decreased by 22.04±22.76 in the YMJ group and 23.58±23.04 in the placebo group. YMJ had no effect on xerostomia. However, participants with BMIs lower than 29.37kg/m(2) showed improvement of xerostomia after 8 weeks of treatment with YMJ compared to placebo. In addition, YMJ improved oral moisture, which is associated with subjective oral dryness in the YMJ group, and the relationship between VAS for xerostomia and YD was significant.

CONCLUSION

A trend was observed in which YMJ improved oral moisture status and subjective oral dryness in elderly subjects with lower BMI and greater tendency toward YD.

Salivary Immunoglobulin A Secretion Rate Is Negatively Associated with Cancer Mortality: The West of Scotland Twenty-07 Study

Immunoglobulins are essential for combating infectious disease although very high levels can indicate underlying pathology. The present study examined associations between secretory immunoglobulin A (sIgA) in saliva and mortality rates in the general population. Participants were 639 adults from the eldest cohort of the West of Scotland Twenty-07 Study aged 63 years at the time of saliva sampling in 1995. From unstimulated 2-minute saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. Mortality data were tracked for 19 years. Cox proportional hazard models were applied to compute hazard ratios (HR) for all-cause mortality from sIgA secretion rate. Associations were adjusted for gender, assay batch, household occupational group, smoking, medication usage, and self-reported health. There was a negative association between log sIgA secretion rate and all-cause mortality, HR = 0.81, 95%CI = 0.73–0.91, p < .001. Further analysis of specific causes of mortality revealed that the all-cause association was due to an underlying association with cancer mortality and in particular with cancers other than lung cancer. The HR for non-lung cancer was 0.68 (95%CI = 0.54 to 0.85) implying a 32% reduction in mortality risk per standard deviation rise in log sIgA secretion rate. Effects were stronger for men than women. For deaths from respiratory diseases, sIgA secretion had a non-linear relationship with mortality risk whereby only the very lowest levels of secretion were associated with elevated risk. SIgA concentration revealed a similar but weaker pattern of association. In the present study, higher secretion rates of sIgA were associated with a decreased risk of death from cancer, specifically non-lung cancer, as well as from respiratory disease. Thus, it appears that sIgA plays a protective role among older adults, and could serve as a marker of mortality risk, specifically cancer mortality.

Optical Coherence Tomography of the Labial Salivary Glands Reveals Age-Related Differences in Women

The labial minor salivary glands (LSGs) play a role in medical research and practice due to their superficial location and involvement in both systemic and localized diseases. Swept-source optical coherence tomography (OCT) is a noninvasive modality that enables in vivo, micrometer resolution, wide-field three-dimensional imaging in seconds. A purpose-built swept-source OCT instrument was employed to acquire three-dimensional datasets covering the area of 2.43 cm(2) of the mucosa of the lower lip to the depth of 3.4 mm in young (n = 14; mean age ± SD: 27 ± 3 years; body mass index [BMI] 20.4 ± 2.3 kg/m(2) ) and middle-aged women (n = 11; 54 ± 6 years; 25.5 ± 3.2 kg/m(2) ). Glandular tissue reflectivity mode (range 0-255; 86 ± 17 vs. 68 ± 12, p = 0.005), average single LSG area in tissue sample (5.26 ± 2.62 mm(2) vs. 2.87 ± 1.26 mm(2) , p = 0.011), and LSG surface filling factor (0.23 ± 0.13 vs. 0.11 ± 0.10, p = 0.027) had higher values in younger than in middle-aged women. A correlation between BMI and glandular tissue reflectivity mode (Spearman's ρ = -0.60) was found (p = 0.002). The results highlight the potential value of LSGs' OCT morphometry in research regarding ageing.

Diabetes Mellitus is Associated With Low Secretion Rates of Immunoglobulin A in Saliva

BACKGROUND

The association between diabetes mellitus (DM) and low secretory immunoglobulin A (s-IgA) secretion rates is one mechanism suspected of influencing susceptibility to infections among DM patients. However, several studies have shown contradictory results. We examined these two factors to seek evidence of an association among older people.

METHODS

We analyzed a prospective cohort of 2306 subjects (1209 men and 1097 women) around 64 years old from the New Integrated Suburban Seniority Investigation (NISSIN) Project in Nisshin, Japan. DM statuses were ascertained from levels of fasting plasma glucose and HbA1c, and s-IgA secretion rates were obtained from 5-min saliva samples. We used an analysis of covariance adjusted for possible confounders to compare s-IgA secretion rates according to DM status.

RESULTS

s-IgA secretion rates in DM participants were lower than in those classified as normal (18.6 µg/min vs 15.0 µg/min, P = 0.03), even after elimination of the effects of possible confounders.

CONCLUSIONS

DM was associated with lower s-IgA secretion rates. This suggests that lower s-IgA levels may be a mechanism of susceptibility to infection in individuals with DM.

Sialometry: aspects of clinical interest

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogren's syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.

Acute effects of black currant consumption on salivary flow rate and secretion rate of salivary immunoglobulin a in healthy smokers

The role of saliva in maintaining oral health and homeostasis is based on its physicochemical properties and biological activities of its components, including salivary immunoglobulin A (IgA). Both salivary rates and immunological status of saliva are found to be compromised in smokers. The aim of this study was to investigate the acute time-dependent effect of smoking and black currant consumption on the salivary flow rate (SFR) and salivary IgA secretion rate (sIgA SR) in healthy smokers. SFR, sIgA levels in saliva, and sIgA SRs were determined in healthy smokers (n=8) at eight times of assessment within three consecutive interventions: at the baseline; 5, 30, and 60 min after smoking; 5, 30, and 60 min after black currant consumption (100 g), followed by smoking; and 5 min after black currant consumption. Smoking induced a significant delayed effect on SFR measured 60 min after smoking (P=.03), while black currant consumption preceding smoking prevented that effect. Salivary IgA concentrations and sIgA flow rates were not acutely influenced by smoking. Black currant consumption preceding smoking induced a significant decrease in sIgA concentrations 5 min after the intervention compared with the baseline (P=.046), with a further increasing trend, statistically significant, 60 min after the intervention (P=.025). Although smoking cessation is the most important strategy in the prevention of chronic diseases, the obtained results suggest that the influence of black currant consumption on negative effects of tobacco smoke on salivary flow and immunological status of saliva could partly reduce the smoking-associated risk on oral health.

Comparison of immunological and microbiological characteristics in children and the elderly with or without dental caries

The purpose of this study was to determine the relationships among early childhood caries (ECC), root caries (RC), the quantity of Streptococcus mutans in saliva, and the concentrations of total and specific secretory IgA (sIgA). Saliva samples were collected from 70 children, 3-4 yr of age, with and without ECC, and from 43 adults, ≥60 yr of age, with and without RC. The decayed, missing, and filled teeth (dmft) and decayed, missing, and filled surfaces (dmfs) scores of each child, and the root decayed and filled teeth (RDFT) and root decayed and filled surfaces (RDFS) scores of each elderly subject, were determined. The S. mutans levels, total sIgA, and specific sIgA against two virulence antigens of S. mutans in saliva were analysed using quantitative real-time PCR (qPCR) and ELISAs. The quantity of S. mutans was significantly higher in caries-positive subjects within the two populations than in the caries-free subjects; and a positive correlation was found between the quantity of S. mutans and the dmft, dmfs, RDFT, and RDFS scores. In addition, the salivary total sIgA was significantly higher in children with severe early childhood caries (SECC) and in the elderly subjects with RC. Moreover, although the S. mutans level was significantly higher, the concentrations of specific sIgA against S. mutans antigens were significantly lower in samples from elderly subjects than in samples from children. These results support the concept that S. mutans is positively associated with ECC and RC. Furthermore, the levels of S. mutans-specific antibodies in saliva are too low to prevent infection with cariogenic bacteria and to inhibit development of ECC and RC.

Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage

BACKGROUND

The irradiation of head and neck cancer (HNC) often causes damage to the salivary glands. The resulting salivary gland hypofunction and xerostomia seriously reduce the patient's quality of life.

PURPOSE

To analyze the literature of actual management strategies for radiation-induced hypofunction and xerostomia in HNC patients.

METHODS

MEDLINE/PubMed and the Cochrane Library databases were electronically evaluated for articles published from January 1, 1970, to June 30, 2013. Two reviewers independently screened and included papers according to the predefined selection criteria.

RESULTS

Sixty-one articles met the inclusion criteria. The systematic review of the literature suggests that the most suitable methods for managing the clinical and pathophysiological consequences of HNC radiotherapy might be the pharmacological approach, for example, through the use of cholinergic agonists when residual secretory capacity is still present, and the use of salivary substitutes. In addition, a modified diet and the patient's motivation to enhance oral hygiene can lead to a significant improvement.

CONCLUSION

Radiation-induced xerostomia could be considered a multifactorial disease. It could depend on the type of cancer treatment and the cumulative radiation dose to the gland tissue. A preventive approach and the correct treatment of the particular radiotherapeutic patient can help to improve the condition of xerostomia.

Characteristics of the saliva flow rates of minor salivary glands in healthy people

OBJECTIVES

To investigate the normal range and characteristics of saliva secretion in the minor salivary glands (MSGs).

DESIGN

The flow rates of MSGs were measured in 4 anatomical locations of oral mucosa, and the relationship between MSG flow rates and whole saliva flow rates were assessed in 300 healthy subjects stratified by age and sex. An additional 30 young females were further evaluated for flow symmetry, effects of stimulation, circadian effects in MSGs, and the relationship with the flow rates of major salivary glands.

RESULTS

(1) The mean saliva flow rates were 2.10 ± 0.66 (lower labial glands), 2.14 ± 0.62 (upper labial glands), 2.88 ± 0.72 (buccal glands) and 2.15 ± 0.51 (palatal glands) μl/min/cm(2), respectively. The flow rate of buccal glands was significantly higher than the rates of SMGs in other locations (P < 0.01). (2) 5-year-old children had the lowest MSG flow rates (P < 0.0001) while the 10-14-year-old group had the highest (P < 0.001). (3) MSG flow rates were independent of sex (P > 0.05), right vs. left (P > 0.05), and citric acid (2.5%) stimulation (P > 0.05). (4) Only labial MSG displayed a significant secretory circadian rhythm with the highest rate in the evening (P < 0.05). (5) A weak correlation was found between the flow rate of palatal glands and that of unstimulated whole saliva (r = 0.195, P = 0.007).

CONCLUSIONS

Our findings provide a reference for functional evaluation of MSGs and for donor site selection of MSG transplantation for treatment of severe dry eye syndrome.

Minor salivary glands and dental caries: Approach towards a new horizon

Introduction:

Reduction of functioning minor salivary glands may contribute to emergence of mucosal infections, mucosal ulceration, and possibly dental caries. A study was, therefore, designed to understand the exact role of minor salivary gland secretions over dental caries.

Methodology:

We studied the average labial distribution of functional minor salivary glands using various pre-defined locations, counted the minor salivary gland secretion imprints, and correlated the decayed missing filledlevels in subjects. The functional level and amount of secretion of minor salivary gland were evaluated. The radial immunodiffusion was performed by Diffu-Plate kit and the dimensions of the ring were correlated with the amount of immunoglobulin A in saliva.

Results:

The mean number of functional labial minor salivary glands, amount of secretion, level of glycoprotein secretion, and immunoglobulin A secretion levels could very well dictate the functional status and role of minor salivary glands over caries assessment.

Conclusion:

The above-mentioned tests could be of major significance in routine diagnosis of the most common oral disease, i.e., dental caries.

Yukmijihwang-tang for the treatment of xerostomia in the elderly: study protocol for a randomized, double-blind, placebo-controlled, two-center trial

BACKGROUND

Xerostomia, a subjective sense of dry mouth, is not generally regarded a disease despite its high prevalence among the elderly, and therefore continues to impair affected patients' quality of life. In traditional Korean medicine, 'Yin-Deficiency' has been implicated in the pathogenesis of xerostomia among the elderly. Yukmijihwang-tang is a famous herbal prescription used to relieve 'Yin-Deficiency', and reportedly has antioxidant effects; therefore, it is postulated that Yukmijihwang-tang can be used to treat xerostomia in the elderly. However, to our knowledge, no clinical trial has been conducted on the effects of Yukmijihwang-tang on xerostomia. Thus, we designed a randomized clinical trial to investigate the effects and safety of Yukmijihwang-tang on xerostomia in the elderly. In addition, we will clarify the aforementioned assumption that 'Yin-Deficiency' is the major cause of xerostomia in the elderly by identifying a correlation between xerostomia and 'Yin-Deficiency'.

METHODS/DESIGN

This randomized, double-blind, placebo-controlled trial will be carried out at two centers: Kyung Hee University Korean Medicine Hospital and Kyung Hee University Hospital at Gangdong. We will recruit 96 subjects aged 60-80 years who have experienced xerostomia for 3 months prior to participation. Subjects who present with score >40 on the visual analogue scale for xerostomia and unstimulated salivary flow rate under 0.3mL/min will be included and the randomization will be carried out by an independent statistician by using a random number creation program. The subjects and all researchers except the statistician will be blinded to the group assignment. Yukmijihwang-tang or placebo will be administered to each group for 8 weeks. The primary outcome is change in the scores for the visual analogue scale for xerostomia and the dry mouth symptom questionnaire from 0 to 8 weeks.

DISCUSSION

It will be assessed whether Yukmijihwang-tang can be used as a new herbal treatment for xerostomia in the elderly by demonstrating its therapeutic effects in a well-designed clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01579877.

Nicotine dependence and biochemical exposure measures in the second trimester of pregnancy

Introduction:

The Heaviness of Smoking Index (HSI) is validated to measure nicotine dependence in nonpregnant smokers, and in these smokers, mean salivary and serum cotinine levels are related by a ratio of 1.25. However, as nicotine metabolism increases during gestation, these findings may differ in pregnancy. We investigated the validity of HSI in pregnancy by comparing this with 3 biochemical measures; in a search for a less-invasive cotinine measure in pregnancy, we also explored the relationship between mean blood and salivary cotinine levels.

Methods:

Cross-sectional analyses using baseline data from the Smoking, Nicotine, and Pregnancy Trial. Participants were 16–46 years old, 12–24 weeks gestation, smoked more than 5 cigarettes per day, and had exhaled carbon monoxide (CO) readings of at least 8 ppm. Linear regression was used to examine correlations between HSI and blood cotinine and salivary cotinine and exhaled CO. Correlation between blood and salivary cotinine was investigated using linear regression through the origin.

Results:

HSI scores were associated with blood cotinine (R² = 0.20, n = 662, p < .001), salivary cotinine (R² = 0.11, n = 967, p < .001), and exhaled CO (R² = 0.13, n = 1,050, p < .001). Salivary and blood cotinine levels, taken simultaneously, were highly correlated (R² = 0.91, n = 628, p < .001) and the saliva:blood level ratio was 1.01 (95% CI 0.99–1.04).

Conclusions:

Correlations between HSI and biochemical measures in pregnancy were comparable with those obtained outside pregnancy, suggesting that HSI has similar validity in pregnant smokers. Salivary and blood cotinine levels are roughly equivalent in pregnant smokers.

Sex/Gender differences in tooth loss and edentulism: historical perspectives, biological factors, and sociologic reasons

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

Interactions of sexual activity, gender, and depression with immunity

INTRODUCTION

Depression can suppress immune function, leading to lower resistance against infection and longer healing times in depressed individuals. Sexuality may also influence immune function, with evidence that sexual activity is associated with lowered immune function in women and mixed results in men. Immune mediators like immunoglobulin A (IgA) are immediately relevant to sexual health, since they are the first line of defense against pathogens at mucous membranes like the vagina.

AIM

This study aims to determine if and how depression, sexual activity, and their interaction impact salivary IgA (SIgA) in men and women.

METHODS

In Study 1, a community-based sample of 84 women and 88 men provided saliva samples and completed questionnaires on their demographic background, level of depression, and frequency of partnered and solitary sexual activity. Study 2, conducted separately in an undergraduate student sample of 54 women and 52 men, had similar methods.

MAIN OUTCOME MEASURES

The main outcome measures were scores on the General Well-Being Schedule depression subscale, reported frequency of sexual activity, and SIgA levels as measured by enzyme immunoassay.

RESULTS

Across studies, higher levels of partnered sexual activity were associated with lower SIgA for women with high depression scores, but not for women with low depression scores. In contrast, higher levels of partnered sexual activity were associated with higher SIgA for men with high depression scores, but not for men with low depression scores.

CONCLUSION

Our results show that partnered sexual activity is a risk factor for lowered immunity in women with depressive symptoms but a possible resilience factor for men with depressive symptoms. This suggests a role for sexual activity in determining the impact of depression on physical health parameters.

Elucidating role of salivary proteins in denture stomatitis using a proteomic approach

Denture stomatitis (DS) is the most common oral pathology among denture wearers, affecting over one-third of this group. DS is usually associated with C. albicans. However, unlike other oral candidiasis, most DS patients have intact host immunity. The presence of a denture alone is usually sufficient for DS. Saliva and its protein contents can theoretically predispose some denture wearers to DS and others resistant toward DS. Here we proposed for the first time to define salivary proteomic profiles of denture wearers with and without DS. SELDI-TOF/MS analysis suggests that there is a proteomic differentiation among control, localized and generalized DS. Based on initial SELDI-TOF/MS profiling, we further used reversed phase liquid chromatography, MALDI-TOF/MS, and LC-MS/MS to characterize the salivary proteins associated with DS. Nineteen proteins based on SELDI-TOF/MS profiling were found including cystatin-SN, statherin, kininogen-1, desmocollin-2, carbonic anhydrase-6, peptidyl-prolyl cis-trans isomerase A like peptides, cystatin C, and several immunoglobulin fragments. The proteomic content gives evidence of the interaction between host tissue, saliva, and candida. Further examination in larger populations of these proteins may help to gain a better understanding of DS pathological processes and improve DS treatments.

Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people

OBJECTIVE

To investigate the associations between age, gender, systemic diseases, medications and labial and whole salivary flow rates in older people.

METHODS

Unstimulated labial (LS) and unstimulated (UWS) and chewing-stimulated (SWS) whole salivary flow rates were measured in 389 randomly selected community-dwelling Danish women and 279 men aged 65-97 years. Systemic diseases, medications (coded according to the Anatomical Therapeutic Chemical (ATC) Classification System), tobacco and alcohol consumption were registered.

RESULTS

The number of diseases and medications was higher and UWS lower in the older age groups. On average, women were slightly older, had more diseases, higher medication intake and lower UWS, SWS and LS than men. High number of diseases and medications was associated with low UWS, SWS and LS. In the healthy (14%) and nonmedicated (19%) participants, flow rates were not associated with age and gender, apart from SWS being lower in nonmedicated women. Low UWS were associated with psychiatric and respiratory disorders, type 2 diabetes and intake of psycholeptics, psychoanaleptics (especially SRRIs), respiratory agents, oral antidiabetics (particularly sulfonylureas), magnesium-hydroxide, cardiac agents, quinine, thiazides, calcium channel blockers, statins, urinary antispasmodics, glucosamine, NSAIDs, opioids and ophthalmologicals. SWS were lower in participants with ophthalmological disorders using ophthalmologicals (especially antiglaucoma agents and miotics), but also in those taking antidepressants, cardiac agents (mostly digitalis glycosides) and calcium channel blockers. Cardiovascular diseases and intake of anti-thrombotics (mainly low dose aspirins), calcium channel blockers and oral antidiabetics were associated with low LS.

CONCLUSIONS

In older people, low salivary flow rates are associated with specific and high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. Low UWS are associated with more diseases and medications than SWS and LS, which were primarily associated with cardiovascular diseases and medications including preventive agents such as low-dose aspirins and statins. New insights into medications and their association with salivary gland function were achieved using the ATC classification system.

Salivary IgA and IgE levels in healthy subjects: relation to age and gender

It has been reported that the immune system undergoes age and gender changes. The aim of this study was to investigate the age- and gender-dependent changes of salivary IgA and IgE levels among healthy subjects. A total of 203 healthy individuals (aged 1-70 years) were enrolled in the study. Two milliliters of saliva were collected from all participants, and salivary IgA and IgE levels were measured by the ELISA technique. Mean salivary IgA levels were significantly higher in subjects aged 11-20 years as compared to subjects aged 1-10 years (P < 0.01). Mean salivary IgA levels increased with age up to the age of 60 years, and then slightly decreased in subjects aged 61-70 years. The frequency of subjects with detectable levels of salivary IgE and mean salivary IgE levels gradually increased with age, with maximum levels being observed in the 31-40 years age group and not changing significantly thereafter. The mean levels of salivary IgA and IgE in adults were significantly higher than those observed in children (P < 0.00001 and P < 0.05, respectively). No significant differences were observed between men and women regarding both salivary immunoglobulins. These results showed age-dependent changes of the salivary IgA and IgE levels. Gender had no effect on the salivary levels of IgA and IgE.

An update on minor salivary gland secretions

In this article, the literature on minor salivary gland secretion rates, composition, and function is reviewed. Measurements of the minor salivary gland secretion rates and composition are complicated, and the secretions display large biological variability. Despite this, some characteristics of these secretions have been found repeatedly in independent investigations. Minor gland saliva varies between different oral sites. Buccal saliva flow is higher than labial saliva flow, which in turn is usually higher than the palatal gland secretion rate. It is generally agreed that minor gland saliva is important for the whole saliva composition, and especially for the secretory immunoglobulin A and mucins. The secretion from these glands seems also important for subjective feelings of dry mouth and general wellbeing. Further research is essential for understanding the role of these secretions for oral, as well as for general, health.

Explaining gender differences in caries: a multifactorial approach to a multifactorial disease

Many studies have demonstrated that caries rates are higher in women than in men. This review attempts to provide an explanation for this trend by examining each factor which contributes to caries and how the factor differs in men and women. Evidence has been provided to demonstrate that caries risk factors for women include a different salivary composition and flow rate, hormonal fluctuations, dietary habits, genetic variations, and particular social roles among their family. Systemic diseases that have been found to be associated with caries have also been found to have an association with the female gender. An extended exposure to the oral cavity or a more cariogenic oral microflora has not been proven to contribute to higher caries in women. Further research in these areas could be done in the future to explain their contribution, or lack thereof, to a higher caries rate in women.

The diagnostic suitability of a xerostomia questionnaire and the association between xerostomia, hyposalivation and medication use in a group of nursing home residents

The study objective was to explore the diagnostic suitability of the Xerostomia Inventory and the association between xerostomia, hyposalivation and medication use in a group of nursing home residents. A cross-sectional study was carried out in 50 physically impaired nursing home residents (20 men) with a mean age of 78.1 years (range, 53–98) in The Netherlands. The Xerostomia Inventory-Dutch version was completed for all residents and the data were subjected to exploratory factor analysis to determine the diagnostic suitability. Residents’ data on xerostomia, whole saliva secretion rates and hyposalivation-related medications used were collected and statistically analyzed. The diagnostic suitability of the Xerostomia Inventory-Dutch version appeared restricted. The prevalence of xerostomia was 52%, without gender and age difference. The prevalence of hyposalivation was 24% for resting, 60% for chewing-stimulated and 18% for acid-stimulated whole saliva. All whole saliva secretion rates were significantly lower in women than in men and in older than in younger residents. Forty-four percent of all medications used were hyposalivation-related and women used significantly more medications than men. Xerostomia was significantly negatively correlated with the resting whole saliva secretion rate. The number of hyposalivation-related medications used was not significantly correlated with the various whole saliva secretion rates. In nursing home residents, xerostomia, hyposalivation and using hyposalivation-related medications seem common and partially associated features.

Imunoglobulina A salivar (IgA-s) e exercício: relevância do controle em atletas e implicações metodológicas

O objetivo do presente estudo é realizar uma análise e discussão dos principais achados envolvendo o comportamento da imunoglobulina A salivar (IgA-s) em relação ao estímulo do exercício e evidenciar a importância de seu controle em atletas. O exercício físico é um importante modulador das características do sistema imune, sobretudo do comportamento da IgA-s, componente fundamental na proteção de infecções do trato respiratório superior (ITRS). No entanto, a relação direta entre baixas concentrações de IgA-s e ITRS precisa de mais evidências para ser confirmada. As concentrações de IgA-s durante e logo após um exercício intenso diminuem, deixando o indivíduo mais suscetível à infecção, porém, atletas envolvidos em atividades extenuantes não são clinicamente imunodeficientes, comparados com indivíduos sedentários. Essas modificações são transitórias, com retorno aos valores normais após aproximadamente 48 horas de repouso. A razão dessas alterações não é clara, mas se apresenta multifatorial: elevação de hormônios estressores; fatores nutricionais; ação de espécies reativas de oxigênio; e estresse psicológico. Apesar do efeito transitório das alterações provocadas nos elementos do sistema imune frente ao exercício, observa-se diferença na variabilidade da IgA-s em populações com diferentes níveis de condicionamento. Diferenças metodológicas - como o protocolo de exercício, o método de coleta, armazenamento e manipulação da saliva, a forma de expressão da IgA-s, o nível de hidratação, o controle da dieta, a sazonalidade do período de competição, a aclimatação entre outros fatores - devem ser levadas em consideração para comparação entre os estudos. Além disso, ajudam a explicar, em parte, os resultados adversos envolvendo exercício moderado e os intermitentes, em que se encontram aumento, redução e até ausência de alteração nos níveis de IgA-s. Investigações de elementos inovadores, como os toll-like receptors, e o avanço tecnológico podem colaborar para aumentar as evidências sobre o tema.

The role of salivary factors in persistent oral carriage of Candida in humans

BACKGROUND

Candida albicans is a commensal oral yeast in approximately one-third to one-half of the healthy population. To date, there are no studies investigating the multiple anti-candidal salivary constituents of healthy individuals with either nil or, consistent oral yeast carriage.

OBJECTIVE

To compare the composition and anti-candidal activity in stimulated whole saliva of healthy 'consistent' oral Candida carriers with Candida-free individuals.

METHODS

A sub-sample of 22 consistent, Candida-free individuals and 10 consistent Candida carriers were recruited from a 12 months screening study investigating oral Candida carriage in 97 healthy patients treated by fixed orthodontic appliances. Unstimulated and stimulated saliva samples were collected. The following salivary attributes were measured using standard methodology: the flow rate, pH, lysozyme, lactoferrin and IgA concentration and, the degree of inhibition of blastoconidial growth and blastospore germination.

RESULTS

Saliva from the Candida-free individuals showed 20.2% higher inhibition of blastoconidial growth (p < 0.05) of a reference strain of Candida albicans. No significant differences between the other salivary attributes of the two groups were found.

CONCLUSION

The fact that saliva of Candida-free individuals significantly inhibited the blastoconidial growth more than Candida-carriers (p < 0.05) suggests that saliva may play a role in modulating oral candidal populations in health. Further studies, with a larger cohort are needed to confirm these findings and determine the factors that confer enhanced salivary anti-candidal activity.