Salivary dysfunction caused by medication usage

Evaluation of salivary nitric oxide levels and anxiety in multiple sclerosis patients, with and without Xerostomia: correlation with clinical variables

BACKGROUND

Xerostomia is a prevalent but often overlooked condition in multiple sclerosis (MS) patients, significantly impacting their quality of life and oral health. This cross-sectional observational study investigates the role of nitric oxide (NO) in the pathophysiology of multiple sclerosis (MS) and explores its association with xerostomia in MS patients. The primary objective was to compare salivary NO concentrations and stress levels between MS patients with and without xerostomia.

METHODS

MS patients diagnosed by neurologists and MRI were categorized into two groups: those with xerostomia and those without. Unstimulated whole saliva samples were collected using the spitting method, and salivary NO levels were quantified using an enzyme-linked immunosorbent assay (ELISA) kit based on the Griess reaction. Stress levels were assessed using the Beck Anxiety Inventory (BAI) questionnaire. The presence of xerostomia was evaluated through the Xerostomia Inventory (XI) and clinical examinations.

RESULTS

Salivary NO levels were significantly higher in MS patients without xerostomia (227.47 ng/mL) compared to those with xerostomia (102.37 ng/mL, p < 0.001). Stress levels were also notably higher in MS patients with xerostomia (17.23) versus those without (11.77, p = 0.03). A moderate negative correlation was observed between salivary NO levels and xerostomia (r = 0.44, p < 0.001), indicating that lower NO levels were associated with a higher likelihood of xerostomia. The correlation between stress levels and xerostomia was weaker but still significant (r = 0.28, p = 0.03). Multivariate binary logistic regression analysis identified salivary NO, stress levels, and age as significant predictors of xerostomia in MS patients. The logistic regression model achieved an 80% accuracy in predicting xerostomia based on salivary NO levels and stress.

CONCLUSION

This study highlights a significant negative correlation between salivary NO levels and xerostomia, suggesting that decreased salivary NO concentrations are associated with an increased risk of xerostomia in MS patients. Additionally, stress levels were positively correlated with xerostomia, indicating a potential link between higher stress and the likelihood of xerostomia in MS patients.

Systemic risk factors contributing to sialolithiasis: a big-data retrospective analysis

AIMS

To investigate systemic risk factors contributing to the formation of sialolithiasis.

METHODS

A retrospective big-data cohort study was conducted using data from Clalit HMO in Israel. Sialolithiasis patients were identified based on ICD-10 codes and matched with controls. Univariate and multivariable logistic regression analyses were performed to assess the relationship between systemic conditions and sialolithiasis. P-value < 0.05 was considered significant.

RESULTS

5100 sialolithiasis cases were collected. The statistical analysis revealed that hypertension (OR = 1.14, 1.08-1.24, p < 0.001), dyslipidemia (OR = 1.33, 1.27-1.41, p < 0.001), nephrolithiasis (OR = 1.55, 1.42-1.63, p < 0.001) and cholelithiasis (OR = 1.22, 1.16-1.27, p < 0.001) were significantly correlated with sialolithiasis.

CONCLUSIONS

Systemic diseases, particularly dyslipidemia, play a role in the development of sialolithiasis. Further research is needed to explore the underlying mechanisms linking these conditions and to develop targeted strategies for the prevention of sialolithiasis.

CLINICAL RELEVANCE

This study highlights the potential interplay between systemic conditions and sialolithiasis. Recognizing these associations can inform clinical practice in understanding the pathogenesis of the disease, risk assessment, early diagnosis, and preventive measures.

Management of Dry Mouth

Background: Dry mouth, or xerostomia, is a common complaint among older people. Dry mouth can result in a variety of dental complications, oral discomfort, difficulty swallowing and eating, and decreased taste sensation, all of which can adversely affect quality of life. Objective: To provide an overview of the definition, diagnosis, causes, potential complications, and treatment strategies for dry mouth. Data Sources: PubMed, Proquest, Cochrane Library, drug prescribing information, drug information databases, and manufacturers' websites were used. Search terms were "xerostomia," "dry mouth," "hyposalivation," "causes," "treatment," and "pharmacology." The resources identified included clinical practice guidelines, review articles, and original research articles. Data Synthesis: The literature described the causes and treatment strategies for managing xerostomia, including concerns for older adults, and pharmacists' involvement for providing care. Discussion: The most common cause of dry mouth in the general population and in older adults is medication use. Individual medications may cause dry mouth, primarily through anticholinergic side effects. Polypharmacy is also a cause. Other causes are dehydration, alcohol and caffeine intake, and systemic diseases such as Sjögren's disease. If not addressed, individuals experiencing chronic dry mouth are at increased risk for various oral conditions such as dental caries, periodontal disease, and infections. Interventions such as good oral hygiene methods, using saliva substitutes containing xylitol and prescription cholinergic agonists, if appropriate, can reduce symptoms and complications. Conclusion: Pharmacists can play an important role in managing dry mouth by conducting medication reviews, providing patient education for oral health practices, and recommending treatment strategies.

Characteristics of Oral Adverse Effects following COVID-19 Vaccination and Similarities with Oral Symptoms in COVID-19 Patients: Taste and Saliva Secretory Disorders

Although coronavirus disease 2019 (COVID-19) vaccines exhibit diverse side effects, taste and saliva secretory disorders have remained poorly understood despite their negative impact on the overall quality of life. The present study aimed to characterize oral adverse effects following COVID-19 vaccination and assess their similarities with oral symptoms in COVID-19 patients. A literature search was conducted in databases, including PubMed, LitCovid, and Google Scholar, to retrieve relevant studies. The narrative review indicated that a certain number of vaccinated people develop ageusia, dysgeusia, hypogeusia, xerostomia, and dry mouth, while they are rare compared with COVID-19 oral symptoms. The prevalence of oral adverse effects varies by country/region and such geographical differences may be related to the type of vaccine used. Similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 vaccination adversely affects taste perception and salivary secretion in females and older subjects more frequently than in males and younger subjects. Their impairments mostly appear within 3 days of vaccination, and bitter taste is specifically impaired in some cases. Considering that oral adverse effects following COVID-19 vaccination share some characteristics with oral symptoms in COVID-19 patients, it is speculated that the spike protein derived from COVID-19 vaccination and SARS-CoV-2 infection may be pathophysiologically responsible for taste and saliva secretory disorders. This is because such spike protein has the potential to interact with ACE2 expressed on the relevant cells, produce proinflammatory cytokines, and form antiphospholipid antibodies. Our results do not deny the advantages of COVID-19 vaccination, but attention should be paid to post-vaccination oral effects in addition to COVID-19 oral symptoms. Although coronavirus disease 2019 (COVID-19) vaccines exhibit diverse side effects, taste and saliva secretory disorders have remained poorly understood despite their negative impact on the overall quality of life. The present study aimed to characterize oral adverse effects following COVID-19 vaccination and assess their similarities with oral symptoms in COVID-19 patients. A literature search was conducted in databases, including PubMed, LitCovid, and Google Scholar, to retrieve relevant studies. The narrative review indicated that a certain number of vaccinated people develop ageusia, dysgeusia, hypogeusia, xerostomia, and dry mouth, while they are rare compared with COVID-19 oral symptoms. The prevalence of oral adverse effects varies by country/region and such geographical differences may be related to the type of vaccine used. Similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 vaccination adversely affects taste perception and salivary secretion in females and older subjects more frequently than in males and younger subjects. Their impairments mostly appear within 3 days of vaccination, and bitter taste is specifically impaired in some cases. Considering that oral adverse effects following COVID-19 vaccination share some characteristics with oral symptoms in COVID-19 patients, it is speculated that the spike protein derived from COVID-19 vaccination and SARS-CoV-2 infection may be pathophysiologically responsible for taste and saliva secretory disorders. This is because such spike protein has the potential to interact with ACE2 expressed on the relevant cells, produce proinflammatory cytokines, and form antiphospholipid antibodies. Our results do not deny the advantages of COVID-19 vaccination, but attention should be paid to post-vaccination oral effects in addition to COVID-19 oral symptoms.

A morphological post mortem profile in minor salivary glands changes in females

Women experience several systemic changes over all stages of life, many due to hormonal fluctuations. The sensation of dry mouth is the most common oral clinical symptom in women from climacteric period onwards, suggesting that sex hormones are important in maintaining salivary glands and oral homeostasis. Although the oral cavity is not conventional considered a target tissue for oestrogen, the extent to which salivary glands morphology and function are impacted by ageing and hormonal variations remain unknown. Due to the clinical demand for understanding oral changes related to the ageing process, this study aimed to portray the glandular morphological aspects in female during the different stages of life. To achieve this, 85 post-mortem specimens of labial minor salivary glands were obtained from females; they were distributed into three groups: group I (reproductive phase: up to 44 years, n = 18); group II (climateric phase: 45-55 years, n = 21) and group III (post-menopausal phase: over 56 years, n = 46). The most significant changes observed included degenerative parenchymal aspects including the replacement of parenchymal structures by fibrous tissue, inflammatory infiltrate as well as vascular and endothelial changes. Ageing was associated with acinar serous metaplasia (p = 0.011), acinar fibrosis (p = 0.042) and ductal ectasia (p = 0.003). The process of acinar atrophy was observed in all groups, with an increase in severity in group III. These degenerative aspects appear to be age-dependent.

Cancer treatment-related xerostomia: basics, therapeutics, and future perspectives

Xerostomia, generally addressed as dry mouth, poses significant challenges to patients' quality of life, particularly in the context of cancer treatment. Although various medications and interventions, including salivary substitutes and stimulants, muscarinic agonists, antineoplastic detoxifying agents, anti-inflammatory agents, superoxide dismutase mimetics, mesenchymal stem cells, submandibular gland transfer, intensity-modulated radiation therapy, dose fractionation, transcutaneous electrical nerve stimulation, hyperbaric oxygen therapy, photobiomodulation, acupuncture, and nutritional interventions, have been proposed for this condition, no approved or definite treatments are currently available. Moreover, the evidence supporting the efficacy of proposed interventions remains limited and subject to controversy in terms of safety, efficacy, and optimal protocol. This review provides a comprehensive insight into cancer treatment-related xerostomia, underlying its pathophysiology, etiology, clinical manifestation, and therapeutic options, providing a clinical guide for clinicians to adopt a patient-tailored approach to cancer treatment-related xerostomia and offering vision on current ongoing and future studies in the field.

Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM)

OBJECTIVE

The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions.

METHOD

One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM.

RESULTS

The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10.

CONCLUSION

Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.

Current developments and opportunities of pluripotent stem cells-based therapies for salivary gland hypofunction

Salivary gland hypofunction (SGH) caused by systemic disease, drugs, aging, and radiotherapy for head and neck cancer can cause dry mouth, which increases the risk of disorders such as periodontitis, taste disorders, pain and burning sensations in the mouth, dental caries, and dramatically reduces the quality of life of patients. To date, the treatment of SGH is still aimed at relieving patients' clinical symptoms and improving their quality of life, and is not able to repair and regenerate the damaged salivary glands. Pluripotent stem cells (PSCs), including embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and extended pluripotent stem cells (EPSCs), are an emerging source of cellular therapies that are capable of unlimited proliferation and differentiation into cells of all three germ layers. In recent years, the immunomodulatory and tissue regenerative effects of PSCs, their derived cells, and paracrine products of these cells have received increasing attention and have demonstrated promising therapeutic effects in some preclinical studies targeting SGH. This review outlined the etiologies and available treatments for SGH. The existing efficacy and potential role of PSCs, their derived cells and paracrine products of these cells for SGH are summarized, with a focus on PSC-derived salivary gland stem/progenitor cells (SGS/PCs) and PSC-derived mesenchymal stem cells (MSCs). In this Review, we provide a conceptual outline of our current understanding of PSCs-based therapy and its importance in SGH treatment, which may inform and serve the design of future studies.

Shirazi F. Saliva Lipids May Determine Alprazolam Toxicity: An FTIR Study

Background

Alprazolam, a commonly prescribed benzodiazepine, poses risks of toxicity and severe withdrawal symptoms. There is an urgent need for a rapid and sensitive diagnostic method for detecting alprazolam poisoning.

Objectives

This study aimed to detect alprazolam poisoning through Fourier-transform infrared (FTIR) analysis of saliva, addressing the need for a quick, cost-effective, and sensitive diagnostic method for poison control and differential diagnosis.

Methods

Saliva samples were collected from 45 individuals with benzodiazepine toxicity, therapeutic consumption, and normal health status, as well as from a control group. The samples were analyzed using FTIR spectroscopy. The resulting spectra were processed with OriginPro software, and statistical analyses were performed using receiver operating characteristic (ROC) and analysis of variance (ANOVA).

Results

The average age of the studied population was approximately 45 years, with women being the most affected by poisoning. Fourier-transform infrared analysis revealed significant differences in the structure of lipids between poisoned individuals, therapeutic receivers, and healthy individuals (P < 0.0001).

Conclusions

Fourier-transform infrared analysis of saliva is a fast and accurate method for diagnosing alprazolam poisoning within minutes, enabling prompt and appropriate treatment during critical life-threatening situations. This non-invasive technique has the potential to guide treatment staff toward effective treatment options.

Hyposalivation but not Sjögren's syndrome associated with microbial dysbiosis in women

Background

Saliva modulates the environment of the oral biofilm through pH buffer, microbial attachment to host surfaces, and nutritional source. The ecology of stress occurs when a physical factor adversely impacts an ecosystem or its biotic components. Therefore, reduced salivary flow can affect oral-host balance. The leading causes of hyposalivation include disease-associated Sjögren's syndrome (SS) and menopausal women as aging-associated. However, little is known about the oral microbiome integrated with sex hormones in hyposalivation. This study aimed to characterize the hyposalivation microbiome caused by aging or disease affecting the salivary glands in women.

Methods

We included 50 women older than 40 years of age in any menopausal phase. We collected stimulated saliva from 25 women diagnosed with SS (SS) and 25 without SS (non-SS). The bacterial profile of the patients was obtained by 16S rRNA sequencing. Bioinformatics analysis used machine learning to analyze the cohort's signs, symptoms, and bacterial profile. Salivary estradiol as a sex hormone variation level was determined.

Results

We obtained that 79% of the SS group, and 52% of the non-SS group had hyposalivation. We found a negatively correlated Prevotella-age and Rothia-estradiol in the SS group. Highlight, we found that the cause of the hyposalivation in the study did not explain differences in microbial diversity comparing non-SS and SS groups. Therefore, microbial communities found in hyposalivation but not related to systemic conditions suggest that changes in the oral environment might underpin host-microbial balance.

Conclusion

The salivary microbiome was similar in women with and without SS. However, hyposalivation showed two distinctive clusters associated with the bacterial population profiles. Our study suggests that local ecological disturbances could drive the change in the microbiome.

Risk factors and interventions for developing recurrent pneumonia in older adults

Background

Pneumonia is common among older adults and often recurrent. Several studies have been conducted on the risk factors for pneumonia; however, little is known about the risk factors for recurrent pneumonia. This study aimed to identify the risk factors for developing recurrent pneumonia among older adults and to investigate methods of prevention.

Methods

We analysed the data of 256 patients aged 75 years or older who were admitted for pneumonia between June 2014 and May 2017. Moreover, we reviewed the medical records for the subsequent 3 years and defined the readmission caused by pneumonia as recurrent pneumonia. Risk factors for recurrent pneumonia were analysed using multivariable logistic regression analysis. Differences in the recurrence rate based on the types and use of hypnotics were also evaluated.

Results

Of the 256 patients, 90 (35.2%) experienced recurrent pneumonia. A low body mass index (OR: 0.91; 95% CI: 0.83‒0.99), history of pneumonia (OR: 2.71; 95% CI: 1.23‒6.13), lung disease as a comorbidity (OR: 4.73; 95% CI: 2.13‒11.60), taking hypnotics (OR: 2.16; 95% CI: 1.18‒4.01) and taking histamine-1 receptor antagonist (H1RA) (OR: 2.38; 95% CI: 1.07‒5.39) were risk factors. Patients taking benzodiazepine as hypnotics were more likely to experience recurrent pneumonia than patients not taking hypnotics (OR: 2.29; 95% CI: 1.25-4.18).

Conclusion

We identified several risk factors for recurrent pneumonia. Among them, restricting the use of H1RA and hypnotics, in particular benzodiazepines, may be useful in preventing the recurrence of pneumonia in adults aged 75 years or older.

Characteristics of medication-induced xerostomia and effect of treatment

OBJECTIVE

Side-effects of medications cause xerostomia. There have been cases where a medication has been discontinued owing to its severe side-effects. Therefore, the xerostomia must be treated to ensure that the primary disease is managed effectively. This study analyzed the actual status of patients with medication-induced xerostomia and investigates factors associated with its improvement.

METHODS

This study assessed 490 patients diagnosed with medication-induced xerostomia who had an unstimulated salivary flow of ≤0.1 mL/min and received treatment for xerostomia at a xerostomia clinic. Patient age, sex, medical history, medications used, disease duration of xerostomia, and psychological disorders were recorded. The anticholinergic burden was assessed using the Anticholinergic Cognitive Burden scale. The unstimulated salivary flow was measured by the spitting method. According to their symptoms and diagnoses, the patients were introduced to oral lubricants, instructed on how to perform massage, and prescribed Japanese herbal medicines, and sialogogues. Factors associated with the subjective improvement of xerostomia and objective changes in the salivary flow rate were recorded at six months.

RESULTS

Xerostomia improved in 338 patients (75.3%). The improvement rate was significantly lower in patients with psychiatric disorders (63.6%) (P = 0.009). The improvement rate decreased as more anticholinergics were used (P = 0.018). However, xerostomia improved in approximately 60% of patients receiving three or more anticholinergics. The unstimulated salivary flow increased significantly more in patients who reported an improvement of xerostomia (0.033±0.053 mL/min) than in those who reported no improvement (0.013±0.02 mL/min) (P = 0.025).

CONCLUSION

Xerostomia treatment improved oral dryness in 75.3% of patients receiving xerogenic medications in this study. If xerostomia due to side-effects of medications can be improved by treatment, it will greatly contribute to the quality of life of patients with xerogenic medications and may reduce the number of patients who discontinue medications.

Sublingual Gland Observed on Salivary Gland Scan

ABSTRACT

The major salivary glands, namely, the parotid, submandibular, and sublingual glands, are important in maintaining oral cavity health. A salivary gland scan is used to evaluate the uptake and excretory function of the salivary glands. By intravenously injecting 99m TcO 4- , which is distributed like chloride ions in the body, the glands become visible on the salivary gland scan. The parotid and submandibular glands are typically appreciated on the salivary gland scan, but the sublingual gland is not. We present a rare image of a prominent sublingual gland on a salivary gland scan.

Continuously Quantifying Oral Chemicals Based on Flexible Hybrid Electronics for Clinical Diagnosis and Pathogenetic Study

Simultaneous monitoring of diverse salivary parameters can reveal underlying mechanisms of intraoral biological processes and offer profound insights into the evolution of oral diseases. However, conventional analytical devices with bulky volumes, rigid formats, and discrete sensing mechanisms deviate from the requirements of continuous biophysiological quantification, resulting in huge difficulty in precise clinical diagnosis and pathogenetic study. Here, we present a flexible hybrid electronic system integrated with functional nanomaterials to continuously sense Ca2+, pH, and temperature for wireless real-time oral health monitoring. The miniaturized system with an island-bridge structure that is designed specifically to fit the teeth is only 0.4 g in weight and 31.5×8.5×1.35 mm3 in dimension, allowing effective integration with customized dental braces and comfort attachment on teeth. Characterization results indicate high sensitivities of 30.3 and 60.6 mV/decade for Ca2+ and pH with low potential drifts. The system has been applied in clinical studies to conduct Ca2+ and pH mappings on carious teeth, biophysiological monitoring for up to 12 h, and outcome evaluation of dental restoration, providing quantitative data to assist in the diagnosis and understanding of oral diseases. Notably, caries risk assessment of 10 human subjects using the flexible system validates the important role of saliva buffering capacity in caries pathogenesis. The proposed flexible system may offer an open platform to carry diverse components to support both clinical diagnosis and treatment as well as fundamental research for oral diseases and induced systemic diseases.

Chronic Cannabis Intoxication and Propofol-Induced Salivation: Causes and Considerations

Legalization/decriminalization of cannabis will increase the numbers of patients who have had recent exposure to recreational or medical cannabis. Currently, little has been reported about potential interactions between cannabis use and Propofol anesthesia e.g., for oropharyngeal procedures. We describe three cases of ‘cannabis-induced hypersalivation after propofol’ (CHAP) and present our institutions’ experience with this unique pharmacological combination. Increased hypersalivation may complicate procedures and represent a procedural risk of suffocation. We evaluate possible pharmacological interactions that might underlie this phenomenon and consider management options going forward.

Lactoferrin in cerebrospinal fluid and saliva is not a diagnostic biomarker for Alzheimer's disease in a mixed memory clinic population

BACKGROUND

The pathological changes in Alzheimer's Disease (AD) and other neurodegenerative disorders begin decades prior to their clinical expression. However, the clinical diagnosis of neurodegenerative dementias is not straightforward. Lactoferrin is an iron-binding, antimicrobial glycoprotein with a plethora of functions, including acting as an important immune modulator and by having a bacteriocidic effect. Two previous studies indicated that salivary lactoferrin could differentiate between neurodegenerative dementias.

METHODS

A total of 222 cerebrospinal fluid (CSF) and saliva samples from a consecutive, mixed memory clinic population were analysed for lactoferrin. In addition, the association between lactoferrin in CSF and saliva and the concentration of tau, phosphorylated tau (p-tau) and amyloid 1-42 (Aβ₄₂) in CSF were addressed.

FINDINGS

CSF lactoferrin was assessed for the first time in a cohort of patients with neurodegenerative dementias. No significant differences were found in the levels of CSF or saliva lactoferrin between the diagnostic groups. In addition, no significant relationships were found between lactoferrin levels and tau, p-tau and Aβ₄₂, respectively.

INTERPRETATION

Neither CSF nor saliva lactoferrin could differentiate between neurodegenerative dementias in this study.