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Choi JH, Kim MJ, Kho HS. Oral health-related quality of life and associated factors in patients with xerostomia. Int J Dent Hyg 2021; 19:313-322. [PMID: 34092041 DOI: 10.1111/idh.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to investigate clinical and demographic factors associated with oral health-related quality of life (OHRQoL) in patients with xerostomia. METHODS Forty-one patients (55.2 ± 13.8 years) with xerostomia as a chief complaint participated in the study. Comprehensive information about clinical and demographic characteristics of the patients with xerostomia, xerostomia-related symptoms and behaviours, and xerostomia-associated complaints was investigated using a xerostomia questionnaire. Flow rates of unstimulated and stimulated whole saliva were measured. The Oral Health Impact Profile-14 (OHIP-14) score was used to assess the OHRQoL of patients. The relationships between various factors and the OHIP-14 score were assessed by simple and multiple linear regression analyses. RESULTS The OHIP-14 score of patients with xerostomia was high (44.3 ± 13.2). Characteristics of the patients with xerostomia associated with high OHIP-14 score were the intensity of xerostomia-related symptoms, frequency of xerostomia-related behaviours and the presence of speaking difficulty. Results from multiple linear regressions found that self-reported amount of saliva in usual, everyday life (β = 0.622, p = 0.012) and the presence of a speaking difficulty (β = 0.348, p = 0.014) had significant adversely affected the OHRQoL in patients with xerostomia. CONCLUSIONS Subjective perceptions of the amount of saliva in the mouth and the experience of speaking difficulty affected the OHRQoL in patients with xerostomia.
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Affiliation(s)
- Jee-Hye Choi
- Department of Dental Hygiene, Yonsei University Graduate School, Seoul, Korea
| | - Moon-Jong Kim
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.,Institute on Aging, Seoul National University, Seoul, Korea
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2
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Rodrigues A, Kannappan S, Sadhu B. A primary care approach for oral health promotion among HIV patients: An interventional study. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2021. [DOI: 10.4103/jiaphd.jiaphd_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ryder MI, Shiboski C, Yao TJ, Moscicki AB. Current trends and new developments in HIV research and periodontal diseases. Periodontol 2000 2020; 82:65-77. [PMID: 31850628 DOI: 10.1111/prd.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the advent of combined antiretroviral therapies, the face of HIV infection has changed dramatically from a disease with almost certain mortality from serious comorbidities, to a manageable chronic condition with an extended lifespan. In this paper we present the more recent investigations into the epidemiology, microbiology, and pathogenesis of periodontal diseases in patients with HIV, and the effects of combined antiretroviral therapies on the incidence and progression of these diseases both in adults and perinatally infected children. In addition, comparisons and potential interactions between the HIV-associated microbiome, host responses, and pathogenesis in the oral cavity with the gastrointestinal tract and other areas of the body are presented. Also, the effects of HIV and combined antiretroviral therapies on comorbidities such as hyposalivation, dementia, and osteoporosis on periodontal disease progression are discussed.
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Affiliation(s)
- Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anna-Barbara Moscicki
- Division of Adolescent Medicine, Department of Pediatrics, University of California, Los Angeles, California, USA
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4
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Verma N, Patil R, Khanna V, Singh V, Tripathi A. Evaluation of salivary flow rate and gustatory function in HIV-positive patients with or without highly active antiretroviral therapy. Eur J Dent 2019; 11:226-231. [PMID: 28729798 PMCID: PMC5502570 DOI: 10.4103/ejd.ejd_289_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this study is to evaluate the salivary flow rate and gustatory changes in HIV-positive patients on highly active anti-retroviral therapy (HAART) and without HAART. We also correlated CD4 count and salivary flow rate and gustatory function in both groups. Methods: Sample size for each group was thirty. After obtaining informed consent, we measured salivary flow rate using Schimer's method and gustatory function using four tastants (sweet, sour, bitter, and salty) of different concentrations. The readings were recorded at 0 month, 2nd, 4th, and 6th month interval. The data obtained was statistically analyzed. Results: The mean salivary flow rate was decreased more in Group I as compared to Group II. The mean identification score for sweet, salty, sour, and bitter was significantly higher in Group II than Group I. The mean detection threshold score for sweet, salty, sour and bitter taste was comparatively higher in Group I than Group II. The Pearson's correlation analysis showed inverse relation between age and salivary flow rate in Group II. No significant correlation was observed in CD4 count and salivary flow rate. Conclusion: Along with routine oral health appraisal in seropositive patients, evaluation of salivary flow rate, and taste abnormalities should also be considered an integral part of patient assessment.
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Affiliation(s)
- Neha Verma
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Ranjitkumar Patil
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Vikram Khanna
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Vandana Singh
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Anurag Tripathi
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
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5
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Greenspan D, Gange SJ, Phelan JA, Navazesh M, Alves MEAF, MacPhail LA, Mulligan R, Greenspan JS. Incidence of Oral Lesions in HIV-1-infected Women: Reduction with HAART. J Dent Res 2016; 83:145-50. [PMID: 14742653 DOI: 10.1177/154405910408300212] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Few studies assess the effectiveness of HAART on reducing the incidence and recurrence of oral lesions. We investigated such changes among 503 HIV+ women over six years in the Women’s Interagency HIV Study. The incidence of erythematous candidiasis (EC), pseudomembranous candidiasis (PC), hairy leukoplakia (HL), and warts was computed over follow-up visits after HAART initiation compared with before HAART initiation. Analysis of our data demonstrates a strong decrease in candidiasis after HAART initiation. The incidence of EC fell to 2.99% from 5.48% (RR 0.545); PC fell to 2.85% from 6.70% (RR 0.425); and EC or PC fell to 3.43% from 7.35% (RR 0.466). No changes were seen in HL or warts. Higher HIV-RNA was associated with greater incidence of candidiasis and HL, but not warts. Analysis of these data indicates that recurrence and incidence of candidiasis are reduced by HAART, and that recurrence is reduced independently of CD4 and HIV-RNA.
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Affiliation(s)
- D Greenspan
- Department of Stomatology, University of California San Francisco, San Francisco, CA 94143-0422, USA.
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6
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Abstract
Human Immunodeficiency Virus (HIV) transmission through genital and rectal mucosa has led to intensive study of mucosal immune responses to HIV and to the development of a vaccine administered locally. However, HIV transmission through the oral mucosa is a rare event. The oral mucosa represents a physical barrier and contains immunological elements to prevent the invasion of pathogenic organisms. This particular defense differs between micro-compartments represented by the salivary glands, oral mucosa, and palatine tonsils. Secretory immunity of the salivary glands, unique features of cellular structure in the oral mucosa and palatine tonsils, the high rate of oral blood flow, and innate factors in saliva may all contribute to the resistance to HIV/Simian Immunodeficiency Virus (SIV) oral mucosal infection. In the early stage of HIV infection, humoral and cellular immunity and innate immune functions in oral mucosa are maintained. However, these particular immune responses may all be impaired as a result of chronic HIV infection. A better understanding of oral mucosal immune mechanisms should lead to improved prevention of viral and bacterial infections, particularly in immunocompromised persons with Acquired Immune Deficiency Syndrome (AIDS), and to the development of a novel strategy for a mucosal AIDS vaccine, as well as vaccines to combat other oral diseases, such as dental caries and periodontal diseases.
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Affiliation(s)
- F X Lü
- California National Primate Research Center and Center for Comparative Medicine, University of California Davis, Davis, CA 95616, USA.
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7
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Becker AS, Manoliu A, Wurnig MC, Boss A. Intravoxel incoherent motion imaging measurement of perfusion changes in the parotid gland provoked by gustatory stimulation: A pilot study. J Magn Reson Imaging 2016; 45:570-578. [DOI: 10.1002/jmri.25393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Anton S. Becker
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Andrei Manoliu
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Moritz C. Wurnig
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Andreas Boss
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
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8
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Vernon LT, Jayashantha P, Chidzonga MM, Komesu MC, Nair RG, Johnson NW. Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report. Oral Dis 2016; 22 Suppl 1:135-48. [PMID: 27109282 PMCID: PMC5986297 DOI: 10.1111/odi.12412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.
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Affiliation(s)
- L T Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Plp Jayashantha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia and Dental Hospital, and Sri Lanka Air Force Station Colombo, Sri Lanka, Australia
| | - M M Chidzonga
- College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - M C Komesu
- Department of Morphology, Stomatology Physiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - R G Nair
- Oral Medicine, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia and Cancer Services, Gold Coast University Hospital, Queensland Health, Qld, Autralia, Australia
| | - N W Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
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9
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Kumar JV, Baghirath PV, Naishadham PP, Suneetha S, Suneetha L, Sreedevi P. Relationship of long-term highly active antiretroviral therapy on salivary flow rate and CD4 Count among HIV-infected patients. J Oral Maxillofac Pathol 2015; 19:58-63. [PMID: 26097309 PMCID: PMC4451670 DOI: 10.4103/0973-029x.157203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/25/2015] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine if long-term highly active antiretroviral therapy (HAART) therapy alters salivary flow rate and also to compare its relation of CD4 count with unstimulated and stimulated whole saliva. Materials and Methods: A cross-sectional study was performed on 150 individuals divided into three groups. Group I (50 human immunodeficiency virus (HIV) seropositive patients, but not on HAART therapy), Group II (50 HIV-infected subjects and on HAART for less than 3 years called short-term HAART), Group III (50 HIV-infected subjects and on HAART for more than or equal to 3 years called long-term HAART). Spitting method proposed by Navazesh and Kumar was used for the measurement of unstimulated and stimulated salivary flow rate. Chi-square test and analysis of variance (ANOVA) were used for statistical analysis. Results: The mean CD4 count was 424.78 ± 187.03, 497.82 ± 206.11 and 537.6 ± 264.00 in the respective groups. Majority of the patients in all the groups had a CD4 count between 401 and 600. Both unstimulated and stimulated whole salivary (UWS and SWS) flow rates in Group I was found to be significantly higher than in Group II (P < 0.05). Unstimulated salivary flow rate between Group II and III subjects were also found to be statistically significant (P < 0.05). ANOVA performed between CD4 count and unstimulated and stimulated whole saliva in each group demonstrated a statistically significant relationship in Group II (P < 0.05). There were no significant results found between CD4 count and stimulated whole saliva in each groups. Conclusion: The reduction in CD4 cell counts were significantly associated with salivary flow rates of HIV-infected individuals who are on long-term HAART.
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Affiliation(s)
- J Vijay Kumar
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
| | - P Venkat Baghirath
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
| | - P Parameswar Naishadham
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
| | - Sujai Suneetha
- Research and Training, Nireekshana AIDS care Education and Training (ACET) Hyderabad, Telangana, India
| | - Lavanya Suneetha
- Research and Training, Nireekshana AIDS care Education and Training (ACET) Hyderabad, Telangana, India
| | - P Sreedevi
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
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10
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Pseudomembranous Type of Oral Candidiasis is Associated with Decreased Salivary Flow Rate and Secretory Immunoglobulin A Levels. Mycopathologia 2015; 180:75-80. [PMID: 25682023 DOI: 10.1007/s11046-015-9874-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/10/2015] [Indexed: 12/17/2022]
Abstract
Saliva plays an important role in maintaining microbial homeostasis in the oral cavity, while salivary gland hypofunction predisposes the oral mucosa to pathologic alteration and increases the risk for oral candidiasis. This study sought to determine the salivary flow rate (SFR) and secretory immunoglobulin A (SIgA) levels in HIV-positive and HIV-negative individuals and evaluate their relationship with the determinants of oral candidiasis. Sixty HIV-positive (30 with and 30 without oral candidiasis) and 30 healthy HIV-negative individuals were enrolled. Cotton pellet was weighed pre- and post-saliva collection for the assessment of SFR, while SIgA levels were estimated by commercial ELISA (Diametra, Italy) kit. The mean ± SD, SFR and SIgA levels in HIV-positive individuals with candidiasis, without candidiasis and HIV-negative controls were 0.396 ± 0.290, 0.546 ± 0.355 and 0.534 ± 0.214 ml/min and 115.891 ± 37.621, 136.024 ± 51.075 and 149.418 ± 31.765 µg/ml, respectively. A positive correlation between low CD4 counts (indicator of immunodeficiency) and SIgA was observed in HIV-positive individuals with candidiasis (r = 0.373, p = 0.045). We also report here for the first time the significant decrease in SFR and SIgA levels in individuals presenting with pseudomembranous type of oral candidiasis and Candida albicans infection.
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11
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Nittayananta W, Tao R, Jiang L, Peng Y, Huang Y. Oral innate immunity in HIV infection in HAART era. J Oral Pathol Med 2015; 45:3-8. [PMID: 25639844 DOI: 10.1111/jop.12304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 02/05/2023]
Abstract
Oral innate immunity, an important component in host defense and immune surveillance in the oral cavity, plays a crucial role in the regulation of oral health. As part of the innate immune system, epithelial cells lining oral mucosal surfaces not only provide a physical barrier but also produce different antimicrobial peptides, including human β-defensins (hBDs), secretory leukocyte protease inhibitor (SLPI), and various cytokines. These innate immune mediators help in maintaining oral homeostasis. When they are impaired either by local or systemic causes, various oral infections and malignancies may be developed. Human immunodeficiency virus (HIV) infection and other co-infections appear to have both direct and indirect effects on systemic and local innate immunity leading to the development of oral opportunistic infections and malignancies. Highly active antiretroviral therapy (HAART), the standard treatment of HIV infection, contributed to a global reduction of HIV-associated oral lesions. However, prolonged use of HAART may lead to adverse effects on the oral innate immunity resulting in the relapse of oral lesions. This review article focused on the roles of oral innate immunity in HIV infection in HAART era. The following five key questions were addressed: (i) What are the roles of oral innate immunity in health and disease?, (ii) What are the effects of HIV infection on oral innate immunity?, (iii) What are the roles of oral innate immunity against other co-infections?, (iv) What are the effects of HAART on oral innate immunity?, and (v) Is oral innate immunity enhanced by HAART?
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Affiliation(s)
| | - Renchuan Tao
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Guangxi, China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Guangxi, China
| | - Lanlan Jiang
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Guangxi, China
| | - Yuanyuan Peng
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Guangxi, China
| | - Yuxiao Huang
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Guangxi, China
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12
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Arirachakaran P, Poovorawan Y, Dahlén G. Highly-active antiretroviral therapy and oral opportunistic microorganisms in HIV-positive individuals of Thailand. ACTA ACUST UNITED AC 2014; 7:158-67. [PMID: 25537925 DOI: 10.1111/jicd.12142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/25/2014] [Indexed: 12/01/2022]
Abstract
AIM Oral mucosal lesions and opportunistic microorganisms in HIV-positive Thais treated with highly-active antiretroviral therapy (HAART) for more than 5 years were investigated. METHODS A total of 221 HIV-infected patients, comprising 148 HIV patients undergoing HAART for more than 5 years, 20 non-HAART HIV patients, 53 vertically-transmitted (VT) HAART HIV patients, and 30 HIV-negative controls, were examined for CD4+ counts, viral load, saliva secretion rate, and oral mucosal lesions. Samples from the tongue, gingival crevices, and mucosal lesions when present were cultured for the amounts of Candida, staphylococci, enterococci, and aerobic Gram-negative bacilli. RESULTS HAART (including HIV-VT) maintained oral microbial homeostasis predominated by alpha-hemolytic streptococci similar to the non-HIV controls and with a low prevalence of mucosal lesions. The HAART group had a reduced saliva secretion rate. The frequency and load of opportunistic microorganisms in the HAART group were similar to the non-HAART group, which was significantly higher than the HIV-negative controls. Candida spp. was found significantly more frequently on the tongue in HIV-infected individuals with CD4+ counts <500 cells/mm(3). CONCLUSION Although we did not find lower levels of mucosal lesions among HAART compared to non-HAART individuals, HAART therapy could prolong the time before opportunistic oral pathogens overwhelm the commensal members of oral microbiota.
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Affiliation(s)
- Pratanporn Arirachakaran
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Infectious Diseases Clinic and Dental Hospital, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Gunnar Dahlén
- Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Syebele K, Munzhelele TI. Oral mucocele/ranula: Another human immunodeficiency virus-related salivary gland disease? Laryngoscope 2014; 125:1130-6. [PMID: 25446909 DOI: 10.1002/lary.25058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2014] [Accepted: 11/05/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe clinical characteristics of oral mucoceles/ranulas, with a focus on human immunodeficiency virus (HIV)-related salivary gland diseases. STUDY DESIGN A descriptive and clinical study, with review of patient data. MATERIAL AND METHODS We reviewed 113 referred cases of oral mucocele. The following anatomical sites were identified: lip, tongue, and floor of the mouth (simple ranulas), as well as plunging ranulas. The age and gender data of the patients with oral mucoceles were recorded. The HIV status of the patients and other information were reviewed. RESULTS There were 30 (26.5%) males and 83 (73.5%) females. Most patients were below 30 years of age, with the peak frequency in the first and second decade. Ranula (simple and plunging) represented 84.1% of the mucocele locations. Mucocele on the lips represented 10.6%. Seventy-two (63.7%) patients were HIV positive; and 97.2% of them had ranulas. Thirty-eight (33.6%) patients presented with plunging ranulas; and 92.1% of them were HIV positive, compared with two patients presenting with plunging ranulas in the HIV-negative group. These results strongly suggest that an HIV-positive patient is statistically (P < 0.001) more at risk of presenting with not only a simple, but also a plunging ranula type. CONCLUSION This study presents a different clinical picture of oral mucoceles/ranulas, as observed in HIV-positive patients. Additionally, it suggests a possible clinical link between the two pathologies. The authors strongly support the suggestion that oral mucocele/ranula is an HIV-related salivary gland disease. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Kabunda Syebele
- Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa
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14
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TINÓS AMFG, SALES-PERES SHDC. Xerostomia related to HIV infection /AIDS: a critical review. REVISTA DE ODONTOLOGIA DA UNESP 2014. [DOI: 10.1590/rou.2014.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The presence of oral manifestations in HIV positive individuals is quite common. Xerostomia appears as one of the most frequent problems and may lead to a reduction in the quality of life of this population. Objective: This study was a critical review of the relationship between xerostomia and HIV infection, to attract the attention of dentists on the importance of dental care to these patients. Material and method: We included articles published between 2000 and 2009, indexed in PUBMED database. The descriptors used were "HIV" and "xerostomia", the exclusion criteria adopted were: the absence of these descriptors associated, non-location of the full-text, articles based on case studies or case series and the absence of the abstract in the database. Result: Based on studies in the review, it can be said that the xerostomia is a common manifestation of HIV infection, predisposing the patient to several other oral problems. Among the risk factors for its occurrence it was reported: low counts of CD4+ T cells, high plasma viral load, the use of some medications and antiretroviral therapy. Conclusion: The HIV/AIDS can change the salivary glands, and were considered important risk factors for the occurrence of xerostomia the presence of didanosine and the drug class which corresponds to protease inhibitors in antiretroviral therapy.
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15
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Burnett NP, Dunki-Jacobs EM, Callender GG, Anderson RJ, Scoggins CR, McMasters KM, Martin RCG. Evaluation of alpha-fetoprotein staging system for hepatocellular carcinoma in noncirrhotic patients. Am Surg 2013; 116:e32-6. [PMID: 23816006 DOI: 10.1016/j.oooo.2013.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/06/2013] [Accepted: 02/15/2013] [Indexed: 01/12/2023]
Abstract
The Barcelona Clinic Liver Cancer (BCLC) staging classification is commonly used for staging hepatocellular carcinoma (HCC). This system assumes the coexistence of cirrhosis; however, a significant proportion of patients with HCC present without cirrhosis. Recently, an alternative system was proposed that stratifies patients according to alpha-fetoprotein (AFP) level. The aim of this study was to apply the AFP staging system to noncirrhotic patients with HCC and evaluate its ability to predict overall survival (OS). A prospective hepatopancreatobiliary database was reviewed for all patients with a diagnosis of HCC. Patients were staged based on BCLC classification as well as by AFP stage according to four levels: less than 10 ng/mL, 10 to 150 ng/mL, 150 to 500 ng/mL, and greater than 500 ng/mL. Cirrhotic patients were compared with noncirrhotic patients in terms of patient demographics and HCC stage. Kaplan-Meier (KM) analysis of OS was performed for noncirrhotic patients according to BCLC and AFP staging systems. Cirrhotic and noncirrhotic patients differed significantly in terms of median age at presentation (64 vs 70 years, P < 0.001) and gender (76 vs 65% male, P = 0.006). BCLS staging classification did not distinguish between cirrhotics and noncirrhotics (P = 0.733), whereas AFP staging demonstrated a significant difference between the two groups (P < 0.0001). KM analysis of OS for noncirrhotic patients with HCC was significant for both the BCLC and the AFP staging systems (P = 0.003 vs P < 0.0001, respectively). Patients presenting with HCC in the absence of cirrhosis appear to have different characteristics than patients with cirrhosis. Staging according to AFP level is an appropriate predictor of prognosis in noncirrhotic patients with HCC.
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Affiliation(s)
- Nicolas P Burnett
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky 40206, USA.
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16
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Nittayananta W, Chanowanna N, Pruphetkaew N, Nauntofte B. Relationship between xerostomia and salivary flow rates in HIV-infected individuals. ACTA ACUST UNITED AC 2013; 4:164-71. [DOI: 10.1111/jicd.12052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nilnara Chanowanna
- Dental Division; Songkhla Rajanagarindra Psychiatric Hospital; Songkhla Thailand
| | - Nannapat Pruphetkaew
- Epidemiology Unit; Faculty of Medicine; Prince of Songkla University; Hat Yai Songkhla Thailand
| | - Birgitte Nauntofte
- Department of Oral Function and Physiology; School of Dentistry; University of Copenhagen; Copenhagen Denmark
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López-Verdín S, Andrade-Villanueva J, Zamora-Perez AL, Bologna-Molina R, Cervantes-Cabrera JJ, Molina-Frechero N. Differences in Salivary Flow Level, Xerostomia, and Flavor Alteration in Mexican HIV Patients Who Did or Did Not Receive Antiretroviral Therapy. AIDS Res Treat 2013; 2013:613278. [PMID: 24455222 PMCID: PMC3880737 DOI: 10.1155/2013/613278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 11/17/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction. Objective and subjective alterations related to salivary flow have been reported in patients infected with human immunodeficiency virus (HIV), and these alterations are associated with the introduction of antiretroviral therapy. The aim of the current study was to discern whether these alterations are disease induced or secondary to drug therapy. Objective. The objective was to determine the relationships between low salivary flow, xerostomia, and flavor alterations in HIV patients who did or did not receive antiretroviral therapy. Materials and Methods. In this cross-sectional study, HIV patients were divided into two groups based on whether they had received antiretroviral therapy. Those patients with a previous diagnosis of any salivary gland disease were excluded. A survey was used to assess subjective variables, and colorimetry and salivary flow rates were measured using the Schirmer global test. Results. A total of 293 patients were included. The therapy group showed a significantly lower average salivary flow than did the group without therapy, and we observed that the flow rate tended to decrease after one year of therapy. The results were not conclusive, despite significant differences in xerostomia and flavor alteration between the groups. Conclusion. The study results suggest that antiretroviral therapy can cause cumulative damage that affects the amount of salivary flow.
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Affiliation(s)
- Sandra López-Verdín
- 1Instituto de Investigación en Odontología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico
| | - Jaime Andrade-Villanueva
- 2Unidad de VIH del Hospital Civil de Guadalajara “Fray Antonio Alcalde”, 44340 Guadalajara, JAL, Mexico
| | - Ana Lourdes Zamora-Perez
- 1Instituto de Investigación en Odontología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico
| | - Ronell Bologna-Molina
- 3Departamento de Investigación, Facultad de Odontología, Universidad Juárez del Estado de Durango, 34100 Durango, DGO, Mexico
- 4Facultad de Odontología, Universidad de la República (UDELAR), 11600 Montevideo, MVD, Uruguay
| | - José Justino Cervantes-Cabrera
- 1Instituto de Investigación en Odontología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico
| | - Nelly Molina-Frechero
- 5Departamento de Atención a la Salud, Universidad Autónoma Metropolitana, Xochimilco, Calz del Hueso 1100 Villa Quietud, Coyoacán, 04960 Ciudad de México, DF, Mexico
- *Nelly Molina-Frechero:
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Perera M, Tsang PCS, Samaranayake L, Lee MP, Li P. Prevalence of oral mucosal lesions in adults undergoing highly active antiretroviral therapy in Hong Kong. ACTA ACUST UNITED AC 2012; 3:208-14. [DOI: 10.1111/j.2041-1626.2012.00124.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rezaei-Soufi L, Davoodi P, Jazaeri M, Niknami H. The comparison of root caries experience between HIV-positive patients and HIV-negative individuals in a selected Iranian population. Int J Dent Hyg 2011; 9:261-5. [PMID: 21356026 DOI: 10.1111/j.1601-5037.2010.00491.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) infection is a concerning problem in dentistry and HIV-infected patients may experience root caries due to different risk factors. The aim of this study was to find the prevalence of root caries in a selected Iranian HIV-positive population. METHODS One hundred and seven IV drug users, based on ELISA and Western Blot test, were divided into two groups: group 1: HIV-positive patients and group 2: HIV-negative individuals. According to the T-CD4(+) cell count, subjects in group 1 were placed in two subgroups: Moderate immunodeficiency (200 mm(-3) < T-CD4(+) cells <500 mm(-3)) and Severe immunodeficiency patients (T-CD4(+) cells <200 mm(-3)). Teeth were examined by an examiner under suitable light to detect any changes in colour, texture or contour. The values of DMFT, DMFS, decayed root surfaces and total decayed surfaces were calculated. Data were analysed by independent t-test and chi-squared test. RESULTS The mean DMFT, DMFS and decayed root caries in group 1 and 2 had no significant difference. The mean value of total decayed surfaces of HIV+ patients was significantly higher compared with HIV- individuals (P = 0.03). The comparison of all parameters between two subdivisions of group 1 showed no significant difference. CONCLUSIONS The results indicate that HIV+ patients experienced more dental caries, but not more root caries than healthy ones. Along with decreasing T-CD4(+) cell count, tooth caries' prevalence did not increase. CLINICAL RELEVANCE Based on our findings, root caries prevalence is almost the same in HIV-positive and negative individuals; however, it is necessary to decrease tooth caries by continual monitoring and periodic dental examination.
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Affiliation(s)
- L Rezaei-Soufi
- Department of Operative Dentistry, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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Navazesh M, Mulligan R, Kono N, Kumar SKS, Nowicki M, Alves M, Mack WJ. Oral and systemic health correlates of HIV-1 shedding in saliva. J Dent Res 2010; 89:1074-9. [PMID: 20671205 DOI: 10.1177/0022034510375290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The relationship among oral and systemic health and HIV shedding in saliva is not well-understood. We hypothesized that oral and systemic health are associated with HIV shedding in saliva of HIV-infected women. Saliva from 127 participants enrolled in the Women's Interagency HIV Study (WIHS) was collected at repeated visits over a 5½-year study period (October 1998 through March 2004) and was evaluated for HIV-1 RNA. Demographic, lifestyle, and systemic and oral health characteristics were evaluated as possible correlates of salivary HIV-1 shedding. Multivariate models showed significantly increased risk of HIV-1 shedding in saliva as blood levels of CD4 cell counts decreased (p < 0.0001) and HIV RNA increased (p < 0.0001). Diabetes (p = 0.002) and a high proportion of gingival bleeding sites (p = 0.01) were associated with increased likelihood, while anti-retroviral therapy (p = 0.0003) and higher levels of stimulated saliva flow rates (p = 0.02) were associated with a lower likelihood of HIV-1 RNA shedding in saliva.
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Affiliation(s)
- M Navazesh
- Division of Periodontology, Diagnostic Sciences and Dental Hygiene, 925 West 34th Street, DEN 4320, Herman Ostrow School of Dentistry of USC, University of Southern California, Los Angeles,CA 90089-0641, USA.
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Nittayananta W, Talungchit S, Jaruratanasirikul S, Silpapojakul K, Chayakul P, Nilmanat A, Pruphetkaew N. Effects of long-term use of HAART on oral health status of HIV-infected subjects. J Oral Pathol Med 2010; 39:397-406. [PMID: 20202089 DOI: 10.1111/j.1600-0714.2009.00875.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to determine the effects of long-term use of highly active antiretroviral therapy (HAART) on oral health status of HIV-infected subjects. METHODS Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in HIV-infected subjects with and without HAART, and in non-HIV individuals. The following data were recorded; duration and risk of HIV infection, type and duration of HAART, CD4 cell count, viral load, presence of orofacial pain, oral dryness, oral burning sensation, oral lesions, cervical caries, and periodontal pocket. Multiple logistic regression analysis was performed to determine the effects of long-term use of HAART on oral health status of HIV-infected subjects. RESULTS One hundred and fifty-seven HIV-infected subjects - 99 on HAART (age range 23-57 years, mean 39 years) and 58 not on HAART (age range 20-59 years, mean 34 years) - and 50 non-HIV controls (age range 19-59 years, mean 36 years) were enrolled. The most common HAART regimen was 2 NRTI + 2 NNRTI. HIV-infected subjects without HAART showed greater risks of having orofacial pain, oral dryness, oral lesions, and periodontal pockets than those with short-term HAART (P < 0.01). The subjects with long-term HAART were found to have a greater risk of having oral lesions than those with short-term HAART (P < 0.05). The unstimulated and stimulated salivary flow rates of the subjects with HAART were significantly lower than in those without HAART (P < 0.05). CONCLUSION We conclude that long-term HAART has adverse effects on oral health status of HIV-infected subjects.
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Affiliation(s)
- Wipawee Nittayananta
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
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Jainkittivong A, Lin AL, Johnson DA, Langlais RP, Yeh CK. Salivary secretion, mucin concentrations and candida carriage in HIV-infected patients. Oral Dis 2009; 15:229-34. [DOI: 10.1111/j.1601-0825.2009.01514.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Flink H, Bergdahl M, Tegelberg Å, Rosenblad A, Lagerlöf F. Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults. Community Dent Oral Epidemiol 2008; 36:523-31. [DOI: 10.1111/j.1600-0528.2008.00432.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Navazesh M, Mulligan R, Karim R, Mack WJ, Ram S, Seirawan H, Greenspan J, Greenspan D, Phelan J, Alves M. Effect of HAART on salivary gland function in the Women's Interagency HIV Study (WIHS). Oral Dis 2008; 15:52-60. [PMID: 19017280 DOI: 10.1111/j.1601-0825.2008.01456.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the impact of highly active antiretroviral therapy (HAART) on salivary gland function in human immunodeficiency virus (HIV) positive women from the Women's Interagency HIV Study (WIHS). DESIGN Longitudinal cohort study. SUBJECTS AND METHODS A total of 668 HIV positive women from the WIHS cohort with an initial and at least one follow-up oral sub-study visit contributed 5358 visits. Salivary gland function was assessed based on a dry mouth questionnaire, whole unstimulated and stimulated salivary flow rates, salivary gland enlargement or tenderness and lack of saliva on palpation of the major salivary glands. MAIN OUTCOME MEASURES Changes in unstimulated and stimulated flow rates at any given visit from that of the immediate prior visit (continuous variables). The development of self-reported dry mouth (present/absent), enlargement or tenderness of salivary glands (present/absent), and absence of secretion on palpation of the salivary glands were binary outcomes (yes/no). RESULTS Protease Inhibitor (PI) based HAART was a significant risk factor for developing decreased unstimulated (P = 0.01) and stimulated (P = 0.0004) salivary flow rates as well as salivary gland enlargement (P = 0.006) as compared with non-PI based HAART. CONCLUSIONS PI-based HAART therapy is a significant risk factor for developing reduced salivary flow rates and salivary gland enlargement in HIV positive patients.
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Affiliation(s)
- M Navazesh
- USC School of Dentistry, Los Angeles, CA 90089-0641, USA.
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Mulligan R, Seirawan H, Alves ME, Navazesh M, Phelan JA, Greenspan D, Greenspan JS, Mack WJ. Oral health-related quality of life among HIV-infected and at-risk women. Community Dent Oral Epidemiol 2008; 36:549-57. [PMID: 18782330 DOI: 10.1111/j.1600-0528.2008.00443.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Objective measures of dental diseases reflect only their clinical end-point. There is a need to use multidimensional measures of diseases that consider their psychosocial aspects and functional impact. The aim of this study is to compare the oral health-related quality of life (OHRQOL) between a group of HIV-infected women and a similar group of at-risk HIV-uninfected women, and to investigate the role of potential confounding clinical oral health and behavioral factors. METHODS Our sample included HIV-infected women (87%) and women at risk for HIV infection (13%) followed up for 5.5 years. OHRQOL was measured using the short version of the Oral Health Impact Profile (OHIP-14), which is a validated and reliable instrument. RESULTS HIV-infected women averaged 10% poorer OHRQOL than HIV-uninfected women; this difference was not apparent after adjusting for the number of study visits attended and significant behavioral and clinical oral health factors. The OHRQOL was inversely related to dental and periodontal diseases and to smoking and freebase cocaine use; these relationships were not confounded by HIV status. CONCLUSIONS The study identified specific clinical and behavioral factors where dental professionals can intervene to possibly improve the OHRQOL of HIV-infected or at-risk HIV-uninfected women.
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Affiliation(s)
- R Mulligan
- School of Dentistry, University of Southern California, Los Angeles, CA, USA.
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Patel M, Shackleton JA, Coogan MM, Galpin J. Antifungal effect of mouth rinses on oral Candida counts and salivary flow in treatment-naïve HIV-infected patients. AIDS Patient Care STDS 2008; 22:613-8. [PMID: 18627277 DOI: 10.1089/apc.2007.0160] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Oral candidiasis is a major problem in developing countries where antiretroviral therapy is available to a small percentage of the infected population. HIV patients are prone to xerostomia and predisposed to Candida infection. Preventing oral candidiasis is better than the frequent use of antifungals that may lead to the development of drug resistance. This study investigated the ability of commercial mouth rinses and sodium bicarbonate to reduce salivary Candida and to improve the saliva flow of HIV-positive patients. One hundred fifty HIV patients without oral candidiasis were examined for oral lesions initially and after 2, 4, and 12 weeks. Unstimulated saliva was collected; the volume was measured and cultured for yeasts. Subjects were provided with mouth rinses containing either benzydamine hydrochloride, benzydamine hydrochloride with chlorhexidine gluconate, triclosan with sodium fluoride, 5% sodium bicarbonate, or placebo and asked to rinse twice daily for 12 weeks. The effect of the mouth rinses and placebo on Candida counts and saliva flow was analyzed using analysis of variance (ANOVA). A total of 108 patients completed the trial, 35 missed appointments, 4 died, 2 developed oral candidiasis, and 1 herpetic lesion. Triclosan/fluoride decreased the Candida count more than the placebo (p = 0.005) while chlorhexidine/benzydamine hydrochloride (p = 0.001) and triclosan/fluoride mouthrinses (p = 0.002) increased the salivary flow during the initial 4 weeks. The most effective mouth rinse triclosan/fluoride decreased oral Candida counts and increased saliva flow. Studies are needed to determine the efficacy of these mouth rinses for the long-term prevention of clinical oral candidiasis in adult HIV-positive patients.
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Affiliation(s)
- Mrudula Patel
- Division of Oral Microbiology, Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jo-Anne Shackleton
- Division of Oral Microbiology, Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maeve M. Coogan
- Division of Oral Microbiology, Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacky Galpin
- School of Statistics and Actuarial Science, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
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Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations. ACTA ACUST UNITED AC 2007; 103 Suppl:S57.e1-15. [PMID: 17379156 DOI: 10.1016/j.tripleo.2006.11.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 11/08/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia. STUDY DESIGN Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005. RESULTS Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient. CONCLUSIONS These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.
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Ikebe K, Matsuda KI, Morii K, Wada M, Hazeyama T, Nokubi T, Ettinger RL. Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese. ACTA ACUST UNITED AC 2007; 103:216-22. [PMID: 17234539 DOI: 10.1016/j.tripleo.2005.12.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 11/13/2005] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the association of hyposalivation and the perception of dry mouth with oral health-related quality of life for independently living elderly. STUDY DESIGN The study sample consisted of 287 participants (mean age, 66.1 years) at a Senior Citizen educational system. Stimulated salivary flow rates during chewing were measured. The OHIP-14 to measure the impact of oral conditions on health-related quality of life was used, and summary OHIP-14 scores combining the response codes for the 14 items were analyzed. RESULTS A logistic regression analysis showed that a higher OHIP-14 score indicating a poorer quality of life was related to fewer residual teeth, perception of dry mouth on eating (OR: 4.01, P = .012) and hyposalivation (OR: 2.71, P = .006). CONCLUSION It is suggested that both dry mouth and hyposalivation are important problems influencing the quality of life in independently living, relatively healthy elderly Japanese.
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Affiliation(s)
- Kazunori Ikebe
- Division of Oromaxillofacial Regeneration Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.
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Orellana MF, Lagravère MO, Boychuk DGJ, Major PW, Flores-Mir C. Prevalence of xerostomia in population-based samples: a systematic review. J Public Health Dent 2006; 66:152-8. [PMID: 16711637 DOI: 10.1111/j.1752-7325.2006.tb02572.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The consequences of xerostomia on oral health have been studied for decades; however, the actual prevalence of this disorder on the general population remains controversial. The purpose of this systematic review was to determine the prevalence of xerostomia in population-based samples. Electronic databases were screened for relevant articles and reference lists of pertinent articles were also hand-searched. Thirteen articles meeting the final inclusion criteria were identified. Based on the definition of xerostomia used in this review, only publications including a subjective diagnosis of the disorder were included. All of the self-reported diagnoses were achieved through a questionnaire either by mail, telephone, interview or self-administered by the patient. There was a variation across papers regarding number and content of the questions as well as guidelines for the diagnosis of xerostomia (i.e. answer yes to one or more than one question). The prevalence of xerostomia in the selected articles ranged from 0.9% to 64.8%. The majority of these studies were performed in Scandinavia. In 9 of the articles, the studied samples were 50 years and older. None of the studies evaluated the prevalence xerostomia among individuals younger than 18 years. Based on these observations, it can be concluded that there is a need for population-based studies on prevalence of xerostomia in regions other than Scandinavia. A standardized protocol to diagnose xerostomia needs to be developed. Patient-perceived treatment needs and impact on quality of life should be included to have a complete picture of public health implications of the disease.
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Affiliation(s)
- M F Orellana
- Orthodontic Graduate Program, Department of Dentistry, University of Alberta, Edmonton, Canada
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Navazesh M, Mulligan R, Pogoda J, Greenspan D, Alves M, Phelan J, Greenspan J, Slots J. The effect of HAART on salivary microbiota in the Women's Interagency HIV Study (WIHS). ACTA ACUST UNITED AC 2005; 100:701-8. [PMID: 16301151 DOI: 10.1016/j.tripleo.2004.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 10/04/2004] [Accepted: 10/08/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Study the prevalence of potentially pathogenic microorganisms in saliva of HIV-positive women in the Women's Interagency HIV Study. STUDY DESIGN 157 HIV-positive and 31 HIV-negative women were studied. At baseline and every 6 months over 4 years, information was collected on socioeconomic and educational status, oral and systemic health, including HIV markers and antiretroviral therapy, and frequency of professional oral care utilization. Bacterial and yeast pathogenic isolates from stimulated whole saliva were tentatively identified using standard methodologies. RESULTS The prevalence of microorganisms in stimulated saliva of HIV-positive women was not significantly different from that of HIV-negative women. In HIV-positive women, highly active antiretroviral therapy (HAART) was independently and significantly associated with the presence of a variety of salivary bacterial species. HAART increased the risk for recovering Fusobacterium species (P < .001), enteric gram-negative rods (P < .05), Peptostreptococcus micros (P < .05), Campylobacter species (P < .0001), Eubacterium species (P < .001), and Tannerella forsythia (P < .01). In contrast, HAART led to decreased recovery rate of yeasts (Candida albicans and Candida dubliniensis) (P < .0001). CONCLUSION The present findings suggest that the institution of HAART promotes an increasingly pathogenic salivary microbiota, at least temporarily. Similar findings have been reported for various nonoral microbial ecosystems.
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Affiliation(s)
- Mavash Navazesh
- Division of Diagnostic Sciences, School of Dentistry, University of Southern California, Los Angeles, California 90089-0641, USA.
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Flink H, Tegelberg A, Lagerlöf F. Influence of the time of measurement of unstimulated human whole saliva on the diagnosis of hyposalivation. Arch Oral Biol 2004; 50:553-9. [PMID: 15848148 DOI: 10.1016/j.archoralbio.2004.10.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 10/28/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVE An unstimulated whole saliva flow rate (UWSFR) of less than 0.1 mL/min is often related to symptoms of dry mouth. It is also used as a diagnostic criterion for Sjogren's syndrome, and for assessment of hyposalivation as a caries risk factor. The main hypothesis was that the circadian rhythm of salivary flow affects this diagnosis if saliva is collected at different morning time-points. DESIGN UWSFR was tested at 7:30 and 11:30 a.m. in 108 individuals, age 15-46 years (mean 33+/-9). The participants were allocated to one of three groups (very low< or =0. 1/min, low 0.1-0.2 mL/min and normal>0.2 mL/min) based on the UWSFR at 7:30 a.m. Different aspects of the perception of oral dryness were rated using Visual Analog Scales. RESULTS All three groups displayed a statistically significant increase in UWSFR at 11:30 a.m. compared with 7:30 a.m., all of similar magnitude (0.08-0.09 mL/min). In the group with very low UWSFR, 70% at 11:30 a.m. exceeded the 0.1 mL/min limit. There were significant difference in perception of oral dryness between the normal group and both the low and the very low groups. Only the subjects in the groups with a low or very low UWSFR perceived an increase in oral wetness at 11:30 a.m. CONCLUSIONS It was concluded that the time of measurement strongly influences the diagnosis of hyposalivation. To control the influence of variations in the time of saliva collection, we suggest that unstimulated whole saliva tests are performed at a fixed time-point or in a limited time interval early in the morning.
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Affiliation(s)
- H Flink
- Center for Clinical Research, Uppsala University, Central Hospital, SE-721 89 Västerås, Sweden.
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Phelan JA, Mulligan R, Nelson E, Brunelle J, Alves MEAF, Navazesh M, Greenspan D. Dental caries in HIV-seropositive women. J Dent Res 2004; 83:869-73. [PMID: 15505238 DOI: 10.1177/154405910408301109] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reports that compare dental caries indices in HIV-seropositive (HIV+) subjects with HIV-seronegative (HIV-) subjects are rare. The objective of this study was to determine if there was an association between HIV infection and dental caries among women enrolled in the Women's Interagency HIV Study. Subjects included 538 HIV+ and 141 HIV- women at baseline and 242 HIV+ and 66 HIV- women at year 5. Caries indices included DMFS and DFS (coronal caries) and DFSrc (root caries). Cross-sectional analysis of coronal caries data revealed a 1.2-fold-higher caries prevalence among HIV+ women compared with HIV- women. Longitudinally, DMFS increased with increasing age and lower average stimulated salivary volume. Root caries results were not significant except for an overall increased DFSrc associated with smoking. Anti-retroviral therapy was not identified as a risk factor for dental caries.
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Affiliation(s)
- J A Phelan
- Department of Oral Pathology (Mail Code 9436), New York University, College of Dentistry, 345 East 24th Street, New York, NY 10010, USA.
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Leigh J. Saliva composition and flow rates are impacted by early HIV disease irrespective of xerostomic medications. J Evid Based Dent Pract 2004. [DOI: 10.1016/j.jebdp.2004.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leigh J. HIV infection in women may lead to xerostomia and salivary gland hypofunction. J Evid Based Dent Pract 2004. [DOI: 10.1016/j.jebdp.2004.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mulligan R, Phelan JA, Brunelle J, Redford M, Pogoda JM, Nelson E, Seirawan H, Greenspan JS, Navazesh M, Greenspan D, Alves MEAF. Baseline characteristics of participants in the oral health component of the Women's Interagency HIV Study. Community Dent Oral Epidemiol 2004; 32:86-98. [PMID: 15061857 DOI: 10.1111/j.0301-5661.2004.00128.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study described baseline sociodemographic and oral health characteristics of a subset of HIV sero-positive and sero-negative women who participated in the oral health component of the Women's Interagency HIV Study (WIHS). METHODS In 1995-96, 584 HIV sero-positive and 151 sero-negative women from five WIHS core sites were enrolled in the oral study. Data on oral mucosa, salivary glands, dentition and periodontium, along with demographics, socioeconomics, and behavioral characteristics, were used to characterize this population. RESULTS Mean (SD) age was 37 (8) years for HIV sero-positive and 36 (8) years for sero-negative women; 27% of sero-positive women had CD4 counts < or =200 and 34% had viral loads >50,000 copies/ml. Sero-positive and sero-negative women were similar demographically, as well as on plaque index, gingival bleeding, linear gingival banding, and numbers of DMF teeth and surfaces, but sero-positive women had more abnormal gingival papilla (P = 0.004) and fewer teeth (P = 0.01). Among sero-positive women, those with <200 CD4 counts had more DMF teeth (P = 0.007), and the number of DMF surfaces increased with decreasing CD4 counts (P = 0.04). Sero-positive women who fit the Center for Disease Control (CDC) AIDS criteria were also more likely to have more DMF teeth (P = 0.004), DMF surfaces (P = 0.003), and decayed and/or filled (DF) root surfaces (P = 0.0002) compared to sero-positive women without AIDS. CONCLUSIONS Dental and periodontal variables showed little difference between HIV sero-positive and sero-negative women. Among sero-positive women, there were significant differences in coronal and root caries by AIDS diagnostic criteria, but no periodontal indicators by either AIDS diagnostic criteria or CD4 status, were observed.
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Affiliation(s)
- Roseann Mulligan
- University of Southern California School of Dentistry, Los Angeles, CA 90089-0641, USA.
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Abstract
The etiology of salivary gland hypofunction in HIV(+) patients is unclear. This study was designed to determine the effect of early-stage HIV(+) infection (CD4(+) > 200 cells/ micro L; n = 139) on salivary gland function and the relationship of this dysfunction to the taking of xerostomic medications. Salivary flow rates and the content of electrolytes and antimicrobial proteins in stimulated parotid and submandibular/sublingual saliva were determined. Compared with healthy controls (n = 50), the HIV(+) group showed significant reductions in flow rates of unstimulated whole (35%), stimulated parotid (47%), unstimulated submandibular/sublingual (23%), and stimulated submandibular/sublingual (39%) saliva. The flow rates for the HIV(+) patients taking xerostomic medications did not differ from those of patients who did not. Concentrations of some salivary gland components were altered in the HIV(+) group. Analysis of these data suggests that salivary gland function is adversely affected early in HIV infection and that these changes do not appear to be compounded by the taking of xerostomic medications.
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Affiliation(s)
- A L Lin
- Departments of Dental Diagnostic Science, University of Texas Health Science Center at San Antonio, TX 78229-4404, USA
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Navazesh M, Mulligan R, Barrón Y, Redford M, Greenspan D, Alves M, Phelan J. A 4-year longitudinal evaluation of xerostomia and salivary gland hypofunction in the Women's Interagency HIV Study participants. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:693-8. [PMID: 12789150 DOI: 10.1067/moe.2003.230] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our purpose was to conduct a longitudinal investigation of xerostomia and salivary gland hypofunction in a national cohort of HIV-positive and at-risk HIV-negative participants in the Women's Interagency HIV Study. Study design. Data included responses to a dry mouth questionnaire, clinical evaluations of major salivary glands, and unstimulated and chewing-stimulated whole salivary flow rates. Repeated measures regression models were used to determine factors associated with xerostomia and salivary gland hypofunction. RESULTS Significant univariate associations were found between HIV status and reports of "too little saliva" (P <.0001), < or = 0.1 mL/min, unstimulated saliva (P =.01), and lack of saliva upon palpation of parotid (P =.02) and submandibular/sublingual salivary glands (P =.03). Adjusted odds of reports of "too little saliva" were significantly higher for HIV-positive participants (odds ratio [OR] = 2.44; 95% CI, 1.49 - 3.97; P =.0004) than for HIV-negative participants. Among HIV-positive women, adjusted odds of reports of "too little saliva" and of < or = 0.7 mL/min chewing-stimulated saliva were significantly higher for those with CD4 < 200 (OR = 1.58; 95% CI, 1.07-2.34; P =.022; and OR = 1.53; 95% CI, 1.05-2.23; P =.027, respectively) and for those with CD4 200-500 (OR = 1.47; 95%CI, 1.07-2.02; P = 0.016; and OR = 1.37; 95% CI, 1.01-2.31; P =.001, respectively) than for those with CD4 > 500. Also, adjusted odds of < or = 0.1mL/min unstimulated saliva and < or = 0.7 mL/min chewing-stimulated saliva were significantly higher in women on highly active antiretroviral therapy (HAART) (OR = 1.25; 95% CI, 1.05 - 1.50; P =.014) than in women not on HAART (OR = 1.34; 95% CI, 1.01 - 1.79; P =.044). CONCLUSIONS HIV-positive women are at a significantly higher risk for xerostomia and salivary gland hypofunction than HIV-negative women, and low CD4 cell counts and HAART use are significant risk factors for these conditions.
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Affiliation(s)
- Mahvash Navazesh
- University of Southern California, Los Angeles, California 90089-0641, USA.
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Abstract
BACKGROUND Dentists recognize the importance of saliva in maintaining oral health and often are familiar with the clinical effects an insufficient salivary flow can have on oral tissues. A variety of medical conditions and medications can alter salivary secretion and composition. Typically, diagnosis of hyposalivation is made only after damage has occurred to the oral tissues. OVERVIEW The author describes a series of clinical steps that, if followed properly, may help in the early detection of salivary gland hypofunction and prevention of its severe complications. This four-step approach includes identifying a patient's chief complaint and the symptoms and duration of illness that brought the patient to the dentist, as well as any approaches the patient took to relieve symptoms; obtaining a medical history that includes a review of the body systems; performing a clinical evaluation that notes the patient's overall condition in addition to the health and functioning of the salivary glands and oral soft and hard tissues; and, when needed, conducting further diagnostic evaluations. CONCLUSIONS AND CLINICAL IMPLICATIONS Oral health care providers will continue to face the challenges of treating new and recurrent carious lesions if the profession's approach to salivary hypofunction remains reactive rather than proactive. The recommendations in this article may enhance clinicians' awareness of the objective methods used to identify patients with salivary gland hypofunction or those at risk of developing it. It is hoped that early identification of asymptomatic patients at risk of developing hyposalivation, as well as symptomatic patients will lower the incidence and prevalence of dental caries and fungal infection in this population and ultimately enhance their quality of life.
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Affiliation(s)
- Mahvash Navazesh
- Division of Diagnostic Sciences, University of Southern California, School of Dentistry, Los Angeles 90089-0641, USA.
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Ikebe K, Sajima H, Kobayashi S, Hata K, Morii K, Nokubi T, Ettinger RL. Association of salivary flow rate with oral function in a sample of community-dwelling older adults in Japan. ACTA ACUST UNITED AC 2002. [DOI: 10.1067/moe.2001.124001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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MacPhail LA, Komaroff E, Alves MEAF, Navazesh M, Phelan JA, Redford M. Differences in risk factors among clinical types of oral candidiasis in the Women's Interagency HIV Study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:45-55. [PMID: 11805777 DOI: 10.1067/moe.2002.120050] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the prevalence and concurrence/associations of oral candidiasis types and multiple risk factors in women. STUDY DESIGN A cross-sectional analysis of baseline data for 577 human immunodeficiency virus (HIV)-seropositive and 152 HIV-seronegative women from the Women's Interagency HIV Study was conducted. Pseudomembranous candidiasis (PC) and erythematous (EC) candidiasis, angular cheilitis (AC), and denture stomatitis (DS) were studied, and bivariate and multivariate regression analyses were performed. RESULTS Prevalences were 8% for PC, 7% for EC, 18% for DS, and 3% for AC; all except AC usually occurred alone. HIV seropositivity was associated with PC, EC, and DS, but not AC. Among HIV-seropositive women, low CD4 cell counts were associated with PC, but not with EC or DS. Heroin/methadone use was associated with PC and EC; salivary hypofunction was associated with PC; high viral load was associated with EC, and poor oral hygiene, with EC and DS. CONCLUSIONS Risk factors varied among candidiasis types, suggesting differences in pathogenic mechanisms and usefulness as markers of HIV infection/progression.
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Affiliation(s)
- Laurie A MacPhail
- Department of Oral & Maxillofacial Pathology, Medicine and Surgery, Temple University School of Dentistry, Philadelphia, Pa 19140, USA.
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