Aging-related changes in quantity and quality of saliva: Where do we stand in our understanding?

Astringency sensitivity to tannic acid: Effect of ageing and salivary proline-rich protein levels

The link between salivary composition and sensitivity to astringency as a function of age has still not been established. In this work, we propose the hypothesis that ageing leads to changes in the concentration of salivary proline-rich proteins (PRPs), which alters the astringency perception threshold with age. To test this hypothesis, astringency sensitivity to tannic acid and saliva was assessed in 30 elderly people and 24 young people. Basic PRPs (bPRPs) and glycosylated PRPs (gPRPs) were quantified immunochemically via western blot analysis. The results showed that the amounts of bPRPs and gPRPs were similar between the young and elderly groups. However, a positive correlation between the gPRP amount and astringency threshold was observed only in the young group, while a negative correlation between the bPRP amount and astringency threshold was observed only in the elderly group. This finding suggests differences in the contribution of PRP type to astringency perception as a function of age.

Pathways in formulating foods for the elderly

The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.

Analysis of the association between salivary proteins and oral mucositis in patients with head and neck cancer undergoing IMRT: a longitudinal study

INTRODUCTION

This longitudinal study assessed the association between salivary protein composition and the clinical onset/severity of oral mucositis (OM) in patients with head and neck tumours treated with intensity-modulated-radiotherapy (IMRT).

METHODS

Saliva samples/clinical data were obtained from 40 head and neck cancer patients treated at Guy's Hospital before -IMRT(T0) and after-IMRT (T1 = 6 m, T2 = 12 m) (ethics approval/consent). Salivary flow rate, total protein concentration, and secretion rate were determined from saliva samples and compared with pre-treatment values. OM was assessed, total/specific salivary proteins, including mucin 5B and 7, IgA, cystatin-S, albumin, and α-amylase, were quantified.

RESULTS

95% patients experienced OM during IMRT, with 33 subjects reaching grade 2&3. At T1, there was a significant reduction in salivary flow rate, total protein secretion rate, α-amylase and cystatin-S compared to baseline. Remarkably IMRT did not significantly alter mucin 5B and 7, or the IgA secretion rate at any time point. At T1, all the analyzed proteins were associated with the OM outcomes. In addition, there was a significant inverse correlation between IgA concentration at T0 and the severity of OM during IMRT.

CONCLUSION

This study revealed significant associations between several salivary proteins and OM in patients with head and neck cancer undergoing IMRT. Further longitudinal studies are needed to confirm these results.

CLINICAL SIGNIFICANCE

The study contributes to the understanding of certain salivary proteins association with OM. This could be the first step towards identifying potential salivary markers that could offer perspectives for personalized medicine approaches to improve their quality of life (QoL).

RESEARCH QUESTION

What is the association between salivary proteins and the occurrence and severity of OM in head and neck cancer patients?

AIM

To assess the association between salivary protein composition with the clinical onset/severity of oral mucositis (OM) in head and neck cancer patients treated with intensity modulated radiotherapy.

NULL HYPOTHESIS

There is no association between salivary proteins and onset/severity of OM in HNC patients.

Nanoplastic Size and Surface Chemistry Dictate Decoration by Human Saliva Proteins

Environmental pollution with plastic polymers has become a global problem, leaving no continent and habitat unaffected. Plastic waste is broken down into smaller parts by environmental factors, which generate micro- and nanoplastic particles (MNPPs), ultimately ending up in the human food chain. Before entering the human body, MNPPs make their first contact with saliva in the human mouth. However, it is unknown what proteins attach to plastic particles and whether such protein corona formation is affected by the particle's biophysical properties. To this end, we employed polystyrene MNPPs of two different sizes and three different charges and incubated them individually with saliva donated by healthy human volunteers. Particle zeta potential and size analyses were performed using dynamic light scattering complemented by nanoliquid chromatography high-resolution mass spectrometry (nLC/HRMS) to qualitatively and quantitatively reveal the protein soft and hard corona for each particle type. Notably, protein profiles and relative quantities were dictated by plastic particle size and charge, which in turn affected their hydrodynamic size, polydispersity, and zeta potential. Strikingly, we provide evidence of the latter to be dynamic processes depending on exposure times. Smaller particles seemed to be more reactive with the surrounding proteins, and cultures of the particles with five different cell lines (HeLa, HEK293, A549, HepG2, and HaCaT) indicated protein corona effects on cellular metabolic activity and genotoxicity. In summary, our data suggest nanoplastic size and surface chemistry dictate the decoration by human saliva proteins, with important implications for MNPP uptake in humans.

Age related impairments in ingestion from a large population based-sample

OBJECTIVES

Epidemiological data regarding the evolution of problems related to mastication and swallowing with age are lacking. This study aims to (i) describe changes in oral function with age, using data from a large French population, (ii) validate online, self-report uses of an ICF questionnaire in older persons, and (iii) assess whether impairment is related to avoidance of certain foods, xerostomia, body mass index (BMI) and oral health related quality of life (OHRQoL).

METHODS

Volunteers aged ≥18 years with internet access completed a series of questionnaires on sociodemographic, anthropometric and oral health characteristics (oral function, Xerostomia Index (XI), OHRQoL, reasons for avoidance of certain food). Oral function was assessed using items derived from the International Classification of Functioning (ICF). Five ICF items related to ingestion function and six items related to activities and participation were used. A validation study was undertaken to identify those with poor chewing ability and low salivary flow amongst older participants reporting impairment.

FINDINGS

39 597 individuals were included. The prevalence of individuals with impairment for ICF items related to ingestion function and oral activity (eating, drinking and speaking), and the percentage of participants with poor OHRQoL increased significantly with age (p < 0.001). Each ICF item was significantly associated with OHRQoL (p < 0.001), XI (p < 0.001), BMI (p < 0.001) and avoidance of certain food due to chewing or swallowing difficulties.

CONCLUSION

Overall, 21.5% and 13.5% of the study population had chewing and/or biting impairments respectively, which might affect food selection and consumption. These findings raise individual and population-based issues. Further studies are needed to assess whether impairment in oral function might increase frailty in older individuals, and also to compare data with those from other countries.

Senescence and fibrosis in salivary gland aging and disease

Salivary gland hypofunction is highly prevalent in aged and diseased individuals leading to significant discomfort and morbidity. One factor that contributes to salivary gland hypofunction is cellular aging, or senescence. Senescent cells can impair gland function by secreting paracrine-acting growth factors and cytokines, known as senescence-associated secretory phenotype (SASP) factors. These SASP factors stimulate inflammation, propagate the senescent phenotype through the bystander effect, and stimulate fibrosis. As senotherapeutics that target senescent cells have shown effectiveness in limiting disease manifestations in other conditions, there is interest in the use of these drugs to treat salivary gland hypofunction. In this review, we highlight the contribution of senescence and fibrosis to salivary gland pathologies. We also discuss therapeutic approaches to eliminate or modulate the senescent SASP phenotype for treating age-related salivary gland diseases and extending health span.

Curcumin effects on age-related changes in oral immunity: an in vivo study

The current study aimed to investigate the effects of ageing on oral immunity using β-defensin (DEFB) 1/2 as a marker and evaluate the effects of curcumin (CUR) on these processes. The study sample included thirty male C57BL/6J mice divided into three groups based on the treatment method used. The young control (YC) and old control (OC) groups received 0·5 % methylcellulose-400 (CUR vehicle) orally for 5 days, whereas the CUR group of older mice received a CUR solution suspended in 0·5 % methylcellulose-400 (dose: 3·0 mg/kg body). DEFB1/2 and immune indicator levels were measured in the saliva and salivary glands post-treatment. The saliva volume and protein content were significantly reduced in the OC group compared with the YC group. CUR administration restored these parameters, decreased DEFB1 expression in the salivary gland and increased DEFB1/2 secretion and DEFB2 expression. These findings were supported by epigenetic gene regulation and partial cytokine activation from changes in WD40 repeat protein 5, TNF alpha and IL-1beta. CUR can partially restore age-related changes in oral immune responses and promote oral health, thereby preventing frailty in the older population through a nutritional therapeutic pathway.

Exploration of reference genes for the development of a diagnostic kit on vascular aging in human saliva

Identifying reliable biomarkers in saliva can be a promising approach to developing a rapid diagnostic kit for detecting vascular aging. This study investigated the most suitable reference gene for polymerase chain reaction (PCR) in saliva that is not affected by vascular aging variables. Whole saliva samples were collected to assess the expression of reference genes: actin beta (ACTB), 18S ribosomal RNA (18S rRNA), beta-2-microglobulin, and glyceraldehyde-3-phosphate dehydrogenase (GAPDH). The most abundantly expressed gene was 18S rRNA, and the least expressed gene was GAPDH. Four genes were ranked according to their relative stability, as determined by mathematical algorithms, indicating that ACTB and 18S rRNA were stably expressed as reference genes. 18S rRNA was identified as the most promising reference gene for detecting systemic diseases using saliva from patients with vascular aging in these limited experimental conditions.

Food Desert Residence Is Not Associated With Dietary Adherence or Complication Rates in Patients With Isolated Mandibular Fractures

BACKGROUND

Mandible fracture management requires postoperative dietary modifications to promote healing. Over 20 million Americans live in food deserts, low-income neighborhoods over one mile from a grocery store. The relationship between food desert residence (FDR) and adherence to postoperative dietary instructions remains unexplored.

PURPOSE

This study's purpose is to evaluate the relationships between FDR, known risk factors, dietary adherence, and complications among patients with isolated mandible fractures.

STUDY DESIGN, SETTING, SAMPLE

This retrospective cohort study was conducted at a level 1 trauma center and analyzed patients with mandible fractures between January 2015 and December 2020. Inclusion criteria included operative treatment of adult patients for mandible fractures; pregnant, incarcerated, and patients with incomplete data were excluded.

PREDICTOR VARIABLE

FDR was the predictor variable of interest. FDR (coded yes or no) was generated by converting patient addresses to census tract GeoIDs and comparing them to the US Department of Agriculture Food Access Research Atlas.

MAIN OUTCOME VARIABLES

The study examined two outcome variables: dietary adherence and postoperative complications. Dietary adherence was coded as adherent or nonadherent, indicating documented compliance with postoperative dietary modifications. Postoperative complications were coded as present or absent, reflecting infection, hardware failure, and mandible malunion or nonunion.

COVARIATES

The covariates analyzed included age, sex, ethnicity, mechanism of injury, medical and psychiatric comorbidities (including diagnoses such as diabetes, hypertension, and schizophrenia), and tobacco use.

ANALYSES

Relative risks (RRs) and multivariate logistic regression models were generated for both outcome variables. Two-tailed P values < 0.05 were considered statistically significant.

RESULTS

During the study period, 143 patients had complete data allowing for FDR and dietary adherence determination, 124 of whom (86.7%) had complication data recorded. Of the cohort, 51/143 (35.7%) resided within a food desert, 30/143 (21.0%) exhibited dietary nonadherence, and 46/124 (37.1%) experienced complications. FDR was not associated with increased risk of dietary nonadherence (RR 0.92, 95% confidence interval [CI] 0.52 to 1.61, P = .76) or complications (RR 1.19, 95% CI 0.75 to 1.89; P = .46). On multivariate regression, dietary nonadherence was associated with increased complications (odds ratio 2.85, 95% CI 1.01 to 8.09, P = .049).

CONCLUSION AND RELEVANCE

There was no association between FDR and dietary nonadherence or complications in mandible fracture patients. However, dietary nonadherence was associated with complications, highlighting the need for further research and intervention.

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly.

Effect of salivary fluid characteristics on the physical features of in vitro bread bolus: From the absence of saliva to artificially simulated hypersalivation

Saliva facilitates food oral processing, bolus formation, swallowing, and sensory perception, in addition to contributing to oral health and phonation. Ageing, health affections, and polymedication are among many causes altering salivary production, modifying the mastication process, the food impregnation ratio, and in turn altering the characteristics of the bolus, swallowing, and digestion. In this in vitro work, using the AM2 masticator apparatus, which replicates the mechanical actions taking place while chewing solid foods and produces realistic food bolus in various oral conditions, we investigated the effect of salivary fluid characteristics, i.e., composition, quantity (from absence to hypersalivation), temperature, and enzymatic action, on the physical characteristics (i.e., particle size distribution (PSD), bolus mass, salivary fluid content) of in vitro boluses of Traditional French baguette. A ready-to-swallow bolus of baguette displayed on average a d50 value (median particle size by mass) of 4.1 ± 0.4 mm, with saliva fluid constituting ∼ 35 % of the final bolus mass. The absence of saliva in mouth led to a deficient oral processing, forming bread boluses constituted by extremely big particles (ca. 80 % of particles had a size > 7.1 mm) that likely cannot be swallowed safely. On the contrary, an excess of saliva favoured an excessive breaking down of bread, leading to bread boluses constituted by smaller particles than those formed under healthy salivary conditions (d50 decreased from 4.1 mm to 3.1 mm), having a higher salivary fluid content (+10 %). On the other hand, the salivary fluid temperature did not affect PSD, d50, bolus mass, or salivary fluid content of in vitro bread boluses, however, the addition of human salivary α-amylase did, favouring particle size reduction (d50 decreased to 2.6 mm). Therefore, beyond the correlation between bolus hydration by saliva and food properties such as hardness and moisture content, our findings indicate that the quantity of salivary fluid present in the oral cavity and the enzymatic activity of salivary α-amylase during bread mastication significantly influence both the particle size distribution and the fluid content of bread boluses, ultimately determining the physical properties of the bolus and, therefore, potentially impacting the subsequent swallowing process.

The minimally important difference for the Xerostomia Inventory among Sjögren's disease patients

OBJECTIVE

Until now, the clinically relevant improvement for the Xerostomia Inventory (XI) has not been defined. Therefore, our aim was to determine the Minimally Important Difference (MID) of the XI for improvement in dry-mouth symptoms in SjD patients.

METHOD

The study recruited 34 SjD patients who underwent sialendoscopy of major salivary glands and 15 SjD patients in a nonintervention control group. XI scores were assessed at several time points. The MID was determined from the mean difference in XI scores between the groups with and without improvement.

RESULTS

In the control group, no significant XI score changes were seen. In the sialendoscopy group, a clinically relevant XI score change of four scale points was identified after 1 week. For a prolonged duration (≥16 weeks), a minimum reduction of seven scale points in the XI score was required to indicate clinically relevant improvement.

CONCLUSION

In SjD patients, a minimum change of four points in the XI score indicates a clinically relevant improvement for evaluating short-term effects. For prolonged effects, a clinically relevant improvement requires a MID of seven points. The determination of the MID in XI could assist in future studies that evaluate changes in xerostomia.

Machine learning and topological data analysis identify unique features of human papillae in 3D scans

The tongue surface houses a range of papillae that are integral to the mechanics and chemistry of taste and textural sensation. Although gustatory function of papillae is well investigated, the uniqueness of papillae within and across individuals remains elusive. Here, we present the first machine learning framework on 3D microscopic scans of human papillae ([Formula: see text]), uncovering the uniqueness of geometric and topological features of papillae. The finer differences in shapes of papillae are investigated computationally based on a number of features derived from discrete differential geometry and computational topology. Interpretable machine learning techniques show that persistent homology features of the papillae shape are the most effective in predicting the biological variables. Models trained on these features with small volumes of data samples predict the type of papillae with an accuracy of 85%. The papillae type classification models can map the spatial arrangement of filiform and fungiform papillae on a surface. Remarkably, the papillae are found to be distinctive across individuals and an individual can be identified with an accuracy of 48% among the 15 participants from a single papillae. Collectively, this is the first evidence demonstrating that tongue papillae can serve as a unique identifier, and inspires a new research direction for food preferences and oral diagnostics.

Proof of concept design for a toothbrush with on-board vacuum to reduce oral aspirates

BACKGROUND

Over the course of brushing, aerosolised particles develop in the mouth. In individuals who do not have the ability to expel these oral aspirates, they can be inhaled and cause aspiration pneumonia. This article showcases a novel vacuum toothbrush, termed "ToothVac," and provides findings from its first human trial.

METHODS

The ToothVac device suctions saliva and aspirates during brushing, storing them in a removable reservoir at the bottom of the brush, to minimise the risk of inhalation and subsequent infection. Further descriptions of the various components of the ToothVac are included. This trial involved 18 participants who brushed using the ToothVac with the vacuum suction turned on and then off.

RESULTS

The volume of saliva produced was measured and compared. The ToothVac significantly reduced the amount of saliva that was produced by these participants when brushing.

CONCLUSION

The device has potential clinical potential in that it may reduce the risk of aspiration pneumonia and related lung infections. Potential future research may include clinical trials for specific indications or marketing for oral aspirate removal, as well as optimisation of brush design using injection moulding for scalable manufacturing.

Gender differences in oral health among prisoners: a cross-sectional study from Taiwan

BACKGROUND

The prevalence of oral diseases among Taiwanese prisoners has rarely been investigated. This study aimed to estimate the gender-specific prevalence of oral disease in a sample of Taiwanese prisoners.

METHODS

We included 83,048 participants from the National Health Insurance (NHI) Program. Outcomes were measured using the clinical version of the International Classification of Diseases, Ninth Revision (ICD-9-CM). For prevalence, we provide absolute values and percentages. We also performed a χ2 test to assess sex and age group differences in the percentage of disease in the oral cavity, salivary glands, and jaw.

RESULTS

The prevalence rate of oral diseases was 25.90%, which was higher than that of the general population. The prevalence of oral diseases in female prisoners was higher than that in male prisoners (p < 0.001), and the prevalence of oral diseases in prisoners aged ≤ 40 was higher than that of prisoners aged > 40. Among all cases of diagnosed oral diseases, the top three diseases were dental hard tissue diseases (13.28%), other cellulitis and abscesses (9.79%), and pruritus and related conditions (2.88%), respectively. The prevalence of various oral diseases in female prisoners was significantly higher than that in male prisoners.

CONCLUSION

Oral disease is common among Taiwanese prisoners. Female prisoners had a higher prevalence of oral, salivary gland, and jaw diseases than male prisoners. Therefore, early prevention and appropriate treatment are required and also a need for gender-specific oral disease products given the differences in the prevalence of oral disease among male and female prisoners.

Benchmarking of a microgel-reinforced hydrogel-based aqueous lubricant against commercial saliva substitutes

Xerostomia, the subjective sensation of 'dry mouth' affecting at least 1 in 10 adults, predominantly elders, increases life-threatening infections, adversely impacting nutritional status and quality of life. A patented, microgel-reinforced hydrogel-based aqueous lubricant, prepared using either dairy or plant-based proteins, has been demonstrated to offer substantially enhanced lubricity comparable to real human saliva in in vitro experiments. Herein, we present the benchmarking of in vitro lubrication performance of this aqueous lubricant, both in its dairy and vegan formulation against a range of widely available and employed commercial saliva substitutes, latter classified based on their shear rheology into "liquids", "viscous liquids" and "gels", and also had varying extensional properties. Strikingly, the fabricated dairy-based aqueous lubricant offers up to 41-99% more effective boundary lubrication against liquids and viscous liquids, irrespective of topography of the tested dry mouth-mimicking tribological surfaces. Such high lubricity of the fabricated lubricants might be attributed to their limited real-time desorption (7%) from a dry-mouth mimicking hydrophobic surface unlike the tested commercial products including gels (23-58% desorption). This comprehensive benchmarking study therefore paves the way for employing these microgel-based aqueous lubricant formulations as a novel topical platform for dry mouth therapy.

Understanding the health benefits and technological properties of β-glucan for the development of easy-to-swallow gels to guarantee food security among seniors

The world's population is growing rapidly and the number of elderly people with undernutrition and malnutrition is increasing. Common health problems among seniors are cardiovascular, inflammatory, gastrointestinal, and cognitive disorders, cancer, diabetes, psychological and dental problems. The food industry is trying to meet the demands of an aging society, but these efforts are not sufficient. New strategies are needed, and they demand foods development with modified textures that are easy to swallow, such as gels suitable for seniors. Depending on the specific needs of the elderly, bioactive compounds with health benefits should be included in food systems. Novel foods may play an important role in the prevention, maintenance, and treatment of age-related diseases. One of the most studied bioactive compound is β-glucan, a polysaccharide with approved health claims confirmed by clinical trials, such as "β-glucan contributes to the maintenance of normal blood cholesterol levels" and "the consumption of β-glucan from oats or barley contributes to the reduction of postprandial glucose spikes." In this review, the health benefits, and technological properties of β-glucan for the development of senior-friendly ready-to-swallow gels were described. In addition, some patents and studies conducted in connection with the development of the gel systems were collected.

Salivary lactate dehydrogenase and salivary total protein as potential biomarkers for screening periodontal disease

Background

Timely diagnosis of periodontal disease is crucial for restoring healthy periodontal tissue and improving patients' prognosis. There is a growing interest in using salivary biomarkers as a noninvasive screening tool for periodontal disease. This study aimed to investigate the diagnostic efficacy of two salivary biomarkers, lactate dehydrogenase (LDH) and total protein, for periodontal disease by assessing their sensitivity in relation to clinical periodontal parameters. Furthermore, the study aimed to explore the impact of systemic disease, age, and sex on the accuracy of these biomarkers in the diagnosis of periodontal health.

Materials and methods

A total of 145 participants were categorized into three groups based on their basic periodontal examination index, with 20 in the periodontally healthy group, 50 in the gingivitis group, and 75 in the periodontitis group. Salivary LDH was measured using the rate of nicotinamide adenine dinucleotide (NADH) oxidation, to measure the kinetics of LDH activity, while total protein was measured using the Lowry method. Descriptive and analytical statistical analyses were performed to examine the associations between the variables and biomarkers.

Results

The results of the study demonstrated that salivary LDH was 72% sensitive, while salivary total protein was 78% sensitive in correlation to clinical periodontal parameters. The accuracy of the test was not influenced by sex, but age had a significant effect on both biomarkers, particularly LDH. Systemic disease was another factor that significantly affected the accuracy of the test.

Conclusions

Although salivary LDH and total protein show promise as biomarkers for screening periodontal disease, their interpretation may be impacted by age and systemic disease. To enhance the accuracy of periodontal disease detection, the study suggests combining these biomarkers with more specific indicators and diagnostic tools.

The experience of eating for older nursing home residents with dysphagia: A qualitative descriptive study

BACKGROUND

Understanding the experience of eating for nursing home residents with dysphagia is essential for developing effective and holistic compensatory intervention programmes for older adults with dysphagia. However, there is a lack of studies on the experience of eating for older adults with dysphagia, especially for individuals in Asian cultures.

OBJECTIVES

This study aimed to understand the experience of eating for older nursing home residents who have difficulty swallowing (dysphagia), which is often a problem for this population.

METHODS

This qualitative descriptive study recruited older nursing home residents with dysphagia from facilities in central Taiwan. Residents were recruited by purposive sampling. Data were collected through individual in-depth semistructured face-to-face interviews. Interviews were audio-recorded and transcribed interview data were analysed with content analysis.

RESULTS

A total of 20 residents participated in the study; the mean age was 78.7 years (standard deviation = 8.54 years); male and female residents were equally represented. The main core theme describing the experience of eating for nursing home residents with dysphagia was irregular coughing, which often occurred spontaneously. Three subthemes described how residents responded: making adjustments to eating and swallowing, receiving assistance from NH staff and fear of eating.

CONCLUSIONS

Our findings can serve as an evidence-based reference for clinical care aimed at nursing home residents with dysphagia. Support programmes that provide safe swallowing skills and emotional support for managing dysphagia are recommended.

IMPLICATIONS FOR PRACTICE

Nursing home residents with dysphagia should receive interventions focussed on self-supporting care, training in swallowing skills and emotional support.

Differential levels of anti-Mycobacterium tuberculosis-specific IgAs in saliva of household contacts with latent tuberculosis infection

Introduction

Mucosal immunity is strongly elicited in early stages of many respiratory and enteric infections; however, its role in tuberculosis pathogenesis has been scarcely explored. We aimed to investigate Mycobacterium tuberculosis (Mtb) specific IgA levels in saliva in different stages of latent Tuberculosis Infection (TBI).

Methodology

A multiplex bead-based Luminex immunoassay was developed to detect specific IgA against 12 highly immunogenic Mtb antigens. A prospective cohort of household contacts (>14 years) of pulmonary TB cases was established in Santiago, Chile. Contacts were classified as Mtb-infected or not depending on serial interferon-γ release assay results. Saliva samples were collected and tested at baseline and at a 12-week follow-up.

Results

Mtb-specific IgA was detectable at all visits in all participants (n = 168), including the "non-Mtb infected" (n = 64). Significantly higher median levels of IgA were found in the "Mtb infected" compared to the uninfected for anti-lipoarabinomannan (LAM) (110 vs. 84.8 arbitrary units (AU), p < 0.001), anti-PstS1 (117 vs. 83 AU, p < 0.001), anti-Cell Membrane Fraction (CMF) (140 vs. 103 AU, p < 0.001) and anti-Culture Filtrate Proteins (CFP) (median 125 vs. 96 AU, p < 0.001), respectively. Nonetheless, the discriminatory performance of these specific mucosal IgA for TBI diagnosis was low.

Conclusion

Saliva holds Mtb-specific IgA against several antigens with increased levels for anti-LAM, anti-PstS1, anti-CMF and anti-CFP found in household contacts with an established TBI. The role of these mucosal antibodies in TB pathogenesis, and their kinetics in different stages of Mtb infection merits further exploring.

Allergen Stability in Food Allergy: A Clinician's Perspective

PURPOSE OF REVIEW

The globally rising food allergy prevalence is associated with the urgent need for new disease prevention methods, efficient treatment, and reliable risk assessment methods for characterization of food allergens. Due to inter-individual variations in the digestive system, food allergens are degraded to a different extent in each person. Food processing also influences allergen digestion.

RECENT FINDINGS

In this review, we provide an overview of the digestive system with focus on relevance for food allergy. Main food proteins causing allergic reactions are evaluated, and the combined role of food processing and digestion for allergen stability is highlighted. Finally, clinical implications of this knowledge are discussed. Recent literature shows that allergen digestibility is dependent on food processing, digestive conditions, and food matrix. Digestion affects proteins allergenicity. It is currently not possible to predict the immunogenicity of allergens solely based on protein stability.

Salivary trefoil factor family peptide 3 (TFF3) and flow rate in persons with and without obstructive sleep apnea: A preliminary study

OBJECTIVES

Obstructive sleep apnea (OSA) is one of the most common chronic diseases. Trefoil factor family 3 (TFF3) peptides are secreted by major and minor salivary glands and may be involved in the pathogenesis of OSA. This study aimed to evaluate salivary TFF3 and flow rate between those with and without OSA.

MATERIAL AND METHODS

This was a prospective experimental study that enrolled patients with OSA and non-OSA. Total unstimulated saliva was collected, the salivary flow rate was measured, and the TFF3 level was analyzed by using a modified sandwich enzyme-linked immunosorbent assay. Baseline characteristics, TFF3 level, and salivary flow rate were compared between both groups. Factors associated with the TFF3 level and flow rate were computed by using multivariate linear regression analysis.

RESULTS

Twenty-eight participants were recruited in the study: 20 patients with OSA (71.42%) and 8 non-OSA as control. The TFF3 and salivary flow rates between both groups of non-OSA versus OSA were comparable (TFF3 non-OSA 61.06 vs. OSA 96.00 ng/mg; p = .276 and flow rate non-OSA 0.40 vs. OSA 0.35 mL/min; p = .320). Factors associated with the TFF3 level were neck circumference with a negative coefficient of -16.419 (p =  .042). For the salivary flow rate, only age was a significant factor with the coefficient of -0.013 (p = .044).

CONCLUSIONS

TFF3 and salivary flow rate were comparable between patients with OSA and non-OSA. The factor associated with TFF3 level was neck circumference, while age was negatively associated with the salivary flow rate in patients with OSA.

Saliva sampling strategies affecting the salivary glucose measurement

Characterized by sustained elevated blood glucose levels, diabetes mellitus has become one of the largest global public health concerns by imposing a heavy global burden on socio-economic development. To date, regular blood glucose level check by performing a finger-prick test has been a routine strategy to monitor diabetes. However, the intrusive nature of finger blood prick tests makes it challenging for individuals to maintain consistent testing routines. Recently, salivary glucose measurement (SGM) has increasingly become a non-invasive alternative to traditional blood glucose testing for diabetes. Despite that, further research is needed to standardize the collection methods and address the issues of variability to ensure accurate and reliable SGM. To resolve possible remaining issues in SGM, we here thoroughly explored saliva sampling strategies that could impact the measurement results. Additionally, the effects of supplements taken, mouth washing, gum chewing, and smoking were collectively analyzed, followed by a continuous SGM over a long period, forming the stepping stone for the practical transitional development of SGM in non-invasive diabetes monitoring.

Paper-based colorimetric sensors for point-of-care testing

By eliminating the need for sample transportation and centralized laboratory analysis, point-of-care testing (POCT) enables on-the-spot testing, with results available within minutes, leading to improved patient management and overall healthcare efficiency. Motivated by the rapid development of POCT, paper-based colorimetric sensing, a powerful analytical technique that exploits the changes in color or absorbance of a chemical species to detect and quantify analytes of interest, has garnered increasing attention. In this review, we strive to provide a bird's eye view of the development landscape of paper-based colorimetric sensors that harness the unique properties of paper to create low-cost, easy-to-use, and disposable analytical devices, thematically covering both fundamental aspects and categorized applications. In the end, we authors summarized the review with the remaining challenges and emerging opportunities. Hopefully, this review will ignite new research endeavors in the realm of paper-based colorimetric sensors.

Histamine deficiency inhibits lymphocyte infiltration in the submandibular gland of aged mice via increased anti-aging factor Klotho

OBJECTIVES

Histidine decarboxylase (HDC), a histamine synthase, is expressed in various tissues and is induced by proinflammatory cytokines such as TNFα. As they age, C57BL/6 mice show auto-antibody deposition and lymphocyte infiltration into various tissues, including salivary glands. However, the mechanism underlying cell infiltration and the change in HDC expression in salivary glands with aging remain unclear. Thus, we aimed to elucidate the relationship between histamine and inflammaging.

METHODS

We investigated the change in histology and HDC expression in the major salivary glands (parotid, submandibular, and sublingual) of 6-week- and 9-month-old wild-type mice. We also determined the histological changes, cytokine expression, and anti-aging factor Klotho in the salivary glands of 9-month-old wild-type and HDC-deficient (HDC-KO) mice.

RESULTS

Cell infiltration was observed in the submandibular gland of 9-month-old wild-type mice. Although most cells infiltrating the submandibular glands were CD3-positive and B220-positive lymphocytes, CD11c-positive and F4/80-positive monocyte lineages were also detected. HDC, TNFα, and IL-1β mRNA expression increased in the submandibular gland of 9-month-old wild-type mice. The expression of PPARγ, an anti-inflammatory protein, declined in 9-month-old wild-type mice, and Klotho expression increased in 9-month-old HDC-KO mice. Immunohistochemistry showed that Klotho-positive cells disappeared in the submandibular gland of 9-month-old wild-type mice, while Klotho was detected in all salivary glands in HDC-KO mice of the same age.

CONCLUSION

Our findings demonstrate the multifunctionality of histamine and can aid in the development of novel therapeutic methods for inflammatory diseases such as Sjogren's syndrome and age-related dysfunctions.

TGF-β1 Triggers Salivary Hypofunction via Attenuating Protein Secretion and AQP5 Expression in Human Submandibular Gland Cells

Aging-related salivary gland degeneration usually causes poor oral health. Periductal fibrosis frequently occurs in the submandibular gland of the elderly. Transforming growth factor β1 (TGF-β1) is the primary driving factor for fibrosis, which exhibits an increase in the fibrotic submandibular gland tissue. This study aimed to investigate the effects of TGF-β1 on the human submandibular gland (HSG) cell secretory function and its influences on aquaporin 5 (AQP5) expressions and distribution. We found that TGF-β1 reduces the protein secretion amount of HSG and leads to the abundance alteration of 151 secretory proteins. Data are available via ProteomeXchange with the identifier PXD043185. The majority of HSG secretory proteins (84.11%) could be matched to the human saliva proteome. Meanwhile, TGF-β1 enhances the expression of COL4A2, COL5A1, COL7A1, COL1A1, COL2A1, and α-SMA, hinting that TGF-β1 possesses the potential to drive HSG fibrosis-related events. Besides, TGF-β1 also attenuates the AQP5 expression and its membrane distribution in HSGs. The percentage for TGF-β1-induced AQP5 reduction (52.28%) is much greater than that of the TGF-β1-induced secretory protein concentration reduction (16.53%). Taken together, we concluded that TGF-β1 triggers salivary hypofunction via attenuating protein secretion and AQP5 expression in HSGs, which may be associated with TGF-β1-driven fibrosis events in HSGs.

The Potential Role of Salivary NT-proBNP in Heart Failure

BACKGROUND

Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little.

METHODS

Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised NPs served as controls, thirteen chronic HF (CHF) patients and fifty patients with acute decompensated HF (ADHF) requiring hospital admission. Electrocardiogram, echocardiogram, 6 min walking distance (6MWD), blood and saliva samples, were acquired in all participants.

RESULTS

Serum NT-proBNP ranged from 60-9000 pg/mL and saliva NT-proBNP from 0.64-93.32 pg/mL. Serum NT-proBNP was significantly higher in ADHF compared to CHF (p = 0.007) and in CHF compared to controls (p < 0.05). There was no significant difference in saliva values between ADHF and CHF, or between CHF and controls. Saliva and serum levels were positively associated only in ADHF patients (R = 0.352, p = 0.012). Serum NT-proBNP was positively associated with NYHA class (R = 0.506, p < 0.001) and inversely with 6MWD (R = -0.401, p = 0.004) in ADHF. Saliva NT-proBNP only correlated with age in ADHF patients.

CONCLUSIONS

In the current study, saliva NT-proBNP correlated with serum values in ADHF patients, but could not discriminate between HF and other causes of dyspnoea. Further research is needed to explore the value of saliva NT-proBNP.

Evaluating the influence of static management on individuals' oral health

PURPOSE

This study aimed to evaluate the effect of static management on individuals' oral health-related quality of life (OHRQoL) according to the dynamic zero-COVID policy in China.

METHODS

The digital questionnaire conducted with three sub-questionnaires was sent to 700 patients who accepted treatment at the Department of Stomatology, 363 Hospital. Data on demographic characteristics, the Oral Health Impact Profile-14 and willingness to invest in oral health were collected from the 658 completed questionnaires. According to the state of individuals' lives, participants were divided into two groups: a static management group (Group 1) and a nonstatic management group (Group 2). The scores of the Oral Health Impact Profile-14 and willingness to invest in oral health were compared between these two groups using IBM SPSS Statistics.

RESULTS

The results showed that individuals undergoing static management reported better OHRQoL. Meanwhile, they also presented lower willingness to invest money and dental visits in oral health. Furthermore, according to the results of the logistic regression analysis, aging acts as a negative correlation factor for the OHRQoL of people undergoing static management, while the willingness to invest money and dental visits in oral health is defined as a positive predictor for OHRQoL.

CONCLUSION

Static management effects the OHRQoL of individuals. Aging and WTIOH in money and dental visits are related the individuals' OHRQoL during static management.

The Impact of Xerostomia on Food Choices-A Review with Clinical Recommendations

Xerostomia and hyposalivation are highly prevalent conditions in old age, particularly among multimorbid elders, and are often attributed to the use of multiple medications. These conditions negatively affect oral functions, such as chewing, swallowing, speech, and taste. Additionally, the lack of lubrication of the oral mucosa frequently leads to super-infections with candida. Denture retention and comfort may also be compromised. The risk of dental caries and erosion of natural teeth increases since saliva, which is essential for repairing initial lesions in tooth structures, is insufficient. The dry sensation in the mouth also impacts the emotional and social well-being of elderly individuals. Patients experiencing xerostomia often avoid certain foods that are uncomfortable or difficult to consume. However, some foods may alleviate the symptoms or even stimulate salivation. This review discusses the limited available evidence on nutritional advice for patients with xerostomia and aims to provide insight into the patient's perspective while offering clinical recommendations. Future studies should focus on investigating the nutritional intake of individuals suffering from xerostomia or hyposalivation in order to ensure oral health comfort, prevent malnutrition, and minimize the impact on their quality of life.

A Novel Salivary Sensor with Integrated Au Electrodes and Conductivity Meters for Screening of Diabetes

The rise in diabetes cases is a growing concern due to the aging of populations. This not only places a strain on healthcare systems but also creates serious public health problems. Traditional blood tests are currently used to check blood sugar levels, but they are invasive and can discourage patients from regularly monitoring their levels. We recently developed nano-sensing probes that integrate Au microelectrodes and conductivity meters, requiring only 50 μL of saliva for measurement. The usage of the co-planar design of coating-free Au electrodes makes the measurement more stable, precise, and easier. This study found a positive correlation between the participant's fasting blood sugar levels and salivary conductivity. We observed a diabetes prevalence of 11.6% among 395 adults under 65 years in this study, using the glycated hemoglobin > 6.5% definition. This study found significantly higher salivary conductivity in the diabetes group, and also a clear trend of increasing diabetes as conductivity levels rose. The prediction model, using salivary conductivity, age, and body mass index, performed well in diagnosing diabetes, with a ROC curve area of 0.75. The study participants were further divided into low and high groups based on salivary conductivity using the Youden index with a cutoff value of 5.987 ms/cm. Individuals with higher salivary conductivity had a 3.82 times greater risk of diabetes than those with lower levels, as determined by the odds ratio calculation. In conclusion, this portable sensing device for salivary conductivity has the potential to be a screening tool for detecting diabetes.

The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a systematic review and meta-analysis

BACKGROUND

Xerostomia negatively affects quality of life. Symptoms include oral dryness; thirst; difficulty speaking, chewing, and swallowing food; oral discomfort; mouth soft tissue soreness and infections; and rampant tooth decay. The objective of this systematic review and meta-analysis was to investigate if gum chewing is an intervention that results in objective improvements in salivary flow rates and subjective relief from xerostomia.

METHOD

We searched electronic databases including Medline, Scopus, Web of Science, Embase, Cochrane Library (CDSR and Central), Google Scholar and the citations of review papers (last searched 31/03/23). The study populations included: 1) elderly people with xerostomia (> 60 years old, any gender, and severity of xerostomia), and 2) medically compromised people with xerostomia. The intervention of interest was gum chewing. Comparisons included gum chewing vs. no gum chewing. The outcomes included salivary flow rate, self-reported xerostomia, and thirst. All settings and study designs were included. We conducted a meta-analysis on studies where measurements of unstimulated whole salivary flow rate for both a gum chewing, and no gum chewing intervention (daily chewing of gum for two weeks or longer) were reported. We assessed risk of bias using Cochrane's RoB 2 and ROBINS-I tools.

RESULTS

Nine thousand six hundred and two studies were screened and 0.26% (n = 25) met the inclusion criteria for the systematic review. Two of the 25 papers had a high overall risk of bias. Of the 25 papers selected for the systematic review, six met the criteria to be included in the meta-analysis which confirmed a significant overall effect of gum on saliva flow outcomes compared to control (SMD = 0.44, 95% CI: 0.22-0.66; p = 0.00008; I² = 46.53%).

CONCLUSIONS

Chewing gum can increase unstimulated salivary flow rate in elderly and medically compromised people with xerostomia. Increasing the number of days over which gum is chewed increases the improvement in the rate of salivation. Gum chewing is linked with improvements in self-reported levels of xerostomia (although it is noted that no significant effects were detected in five of the studies reviewed). Future studies should eliminate sources of bias, standardise methods to measure salivary flow rate, and use a common instrument to measure subjective relief from xerostomia.

STUDY REGISTRATION

PROSPERO CRD42021254485.

The role of microbiome-host interactions in the development of Alzheimer´s disease

Alzheimer`s disease (AD) is the most prevalent cause of dementia. It is often assumed that AD is caused by an aggregation of extracellular beta-amyloid and intracellular tau-protein, supported by a recent study showing reduced brain amyloid levels and reduced cognitive decline under treatment with a beta-amyloid-binding antibody. Confirmation of the importance of amyloid as a therapeutic target notwithstanding, the underlying causes of beta-amyloid aggregation in the human brain, however, remain to be elucidated. Multiple lines of evidence point towards an important role of infectious agents and/or inflammatory conditions in the etiology of AD. Various microorganisms have been detected in the cerebrospinal fluid and brains of AD-patients and have thus been hypothesized to be linked to the development of AD, including Porphyromonas gingivalis (PG) and Spirochaetes. Intriguingly, these microorganisms are also found in the oral cavity under normal physiological conditions, which is often affected by multiple pathologies like caries or tooth loss in AD patients. Oral cavity pathologies are mostly accompanied by a compositional shift in the community of oral microbiota, mainly affecting commensal microorganisms and referred to as 'dysbiosis'. Oral dysbiosis seems to be at least partly mediated by key pathogens such as PG, and it is associated with a pro-inflammatory state that promotes the destruction of connective tissue in the mouth, possibly enabling the translocation of pathogenic microbiota from the oral cavity to the nervous system. It has therefore been hypothesized that dysbiosis of the oral microbiome may contribute to the development of AD. In this review, we discuss the infectious hypothesis of AD in the light of the oral microbiome and microbiome-host interactions, which may contribute to or even cause the development of AD. We discuss technical challenges relating to the detection of microorganisms in relevant body fluids and approaches for avoiding false-positives, and introduce the antibacterial protein lactoferrin as a potential link between the dysbiotic microbiome and the host inflammatory reaction.

Salivary stimulatory effect of novel low level transcutaneous electro neurostimulator in geriatric patients with xerostomia

BACKGROUND

Xerostomia (dryness of the mouth) is one of the most common long-term consequences of ageing, and it causes a tremendous impact on the function and morphology of the salivary ductal system. As a consequence, it leads to a decrease in the amount of salivary output and also affects the overall quality of life. The purpose of this study was to determine whether electrostimulation using a custom designed transcutaneous electrical nerve stimulation (TENS) device will help to improve the quality of secreted saliva following electrostimulation.

METHODS

One hundred thirty-five participants underwent the intervention for three months, twice daily (80 Hz). Pre-intervention and post-intervention unstimulated saliva were collected. Parameters such as salivary pH, cortisol level, salivary antioxidants, total protein, the viscosity of saliva, and microbial carriage were analysed.

RESULTS

Salivary pH, cortisol, microbial cultures, viscosity, and antioxidants showed a significant difference at the end of the 3rd month (p < 0.05). Irrespective of the patient's age, gender, and common underlying systemic illnesses (diabetes and hypertension), a significant change in the quality of the salivary analytes was observed.

CONCLUSION

The study emphasises the use of a custom designed TENS device in improving the quality of secreted saliva among old patients with oral dryness.

In vitro digestion models for the design of safe and nutritious foods

Responsible development of future foods requires in depth understanding of food digestion in the human body based on robust research models, ranging from in vitro models to randomized controlled human trials. This chapter overviews fundamental aspects of food digestion, namely bioaccessibility and bioavailability, and models mirroring gastric, intestinal, and colonic conditions. Second, the chapter demonstrates the potential of in vitro digestion models to help screen adverse effects of food additives, such as Titanium dioxide or carrageenan, or underpin the determinants of macro- and micronutrient digestion in different strata of the population, for example digestion of emulsions. Such efforts support rationalized design of functional foods, such as infant formulae, cheese, cereals and biscuits which are validated in vivo or in randomized controlled trials.

Parameters to Consider for Successful Medication Use in Older Adults - an AGePOP Review

Older adults are the main users of medicine and due to their multimorbidity are often faced/confronted with a complex medication management. This review article provides a brief overview on aspects of medication management such as maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging as well as preparation prior to use. The main focus however is on the drug intake itself and provides an overview about the current understanding of real life dosing conditions of older adults and geriatric patients. Furthermore, it elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by these patient populations. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms and the circumstances under which they manage their medications, will make the design of more patient-centric drug products possible.

Presbyphagia: Dysphagia in the elderly

Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.

Impact of Tablet Size and Shape on the Swallowability in Older Adults

Older adults represent the major target population for oral medications, due to the high prevalence of multimorbidity. To allow for successful pharmacological treatments, patients need to adhere to their medication and, thus, patient-centric drug products with a high level of acceptability by the end users are needed. However, knowledge on the appropriate size and shape of solid oral dosage forms, as the most commonly used dosage forms in older adults, is still scarce. A randomized intervention study was performed including 52 older adults (65 to 94 years) and 52 young adults (19 to 36 years). Each participant swallowed four coated placebo tablets differing in weight (250 to 1000 mg) and shape (oval, round, oblong) in a blinded manner on three study days. The choice of tablet dimensions allowed for a systematic comparison between different tablet sizes of the same shape, as well as between different tablet shapes. Swallowability was assessed using a questionnaire-based method. All tested tablets were swallowed by ≥80% of adults, independent of age. However, only the 250 mg oval tablet was classified as well swallowable by ≥80% of old participants. The same was true for young participants; however, they also considered the 250 mg round and the 500 mg oval tablet as well swallowable. Furthermore, swallowability was seen to influence the willingness to take a tablet on a daily basis, especially for an intake over longer time periods.

Xerogenic medications may contribute to decreased unstimulated salivary flow in patients with oral burning and/or gastro-esophageal reflux disease

Background

Patients who complain of mucosal burning sensations (i.e., glossodynia and gastro-esophageal reflux disease, GERD) often take multiple medications. However, the relationship between xerogenic medication intake and salivary flow in these patients has not been thoroughly examined.

Methods

A retrospective study of 192 consecutive patients diagnosed with glossodynia (ICD-10-CM) at a regional center over a six-year period was performed. Data from electronic health records were extracted and relationships between medication intake, unstimulated whole salivary flow rate (UWSFR), xerostomia and GERD were determined by chi-square, t-test, and correlation analysis.

Results

Of 134 records that met inclusion criteria, 87.1% of patients reported daily intake of one or more xerogenic medications. Two or more xerogenic medications were taken significantly more often by patients with glossodynia reporting GERD than those with glossodynia without GERD (p = .02). UWSFR was negatively correlated with number of medications [r(103) = −.277, p = .005] and xerogenic medications [r(103) = −.195, p = .049]. The lowest UWSFR was observed with use of trazodone and cyclobenzaprine.

Conclusions

Daily xerogenic medication intake, hyposalivation, and xerostomia were commonly present and potentially interrelated in patients who suffer from glossodynia and/or GERD.

Practical implications

Clinicians should be aware of the consequences of prescribing multiple and certain xerogenic medications in reducing UWSFR, especially in patients physiologically at risk of hyposalivation such as those suffering from GERD and/or glossodynia.

Saliva - a new opportunity for fluid biopsy

Saliva is a complex biological fluid with a variety of biomolecules, such as DNA, RNA, proteins, metabolites and microbiota, which can be used for the screening and diagnosis of many diseases. In addition, saliva has the characteristics of simple collection, non-invasive and convenient storage, which gives it the potential to replace blood as a new main body of fluid biopsy, and it is an excellent biological diagnostic fluid. This review integrates recent studies and summarizes the research contents of salivaomics and the research progress of saliva in early diagnosis of oral and systemic diseases. This review aims to explore the value and prospect of saliva diagnosis in clinical application.

The Test of Mastication and Swallowing Solids and the Timed Water Swallow Test: Reliability, associations, age and gender effects, and normative data

BACKGROUND

Quantitative measures can increase precision in describing swallowing function, improve interrater and test-retest reliability, and advance clinical decision-making. The Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST) are functional tests for swallowing that provide quantitative results.

AIMS

To explore the relationship between TOMASS and TWST; evaluate test-retest and interrater reliability; explore age and gender effects; and gather normative data.

METHODS & PROCEDURES

Healthy community dwelling participants (n = 298, ≥ 20 years old) were recruited. Of those, 126 were included in the reliability study. Participants completed the TWST and TOMASS.

OUTCOMES & RESULTS

Associations between TWST and TOMASS measures were found using Pearson's correlation coefficient. Age was positively associated with an increase in the number of bites (n = 292, r = 0.15, p = 0.009), masticatory cycles (n = 291, r = 0.33, p < 0.0001) and duration (n = 292, r = 0.32, p < 0.0001) for the TOMASS. For the TWST, age was positively associated with an increase in duration (n = 296, r = 0.23, p < 0.0001), and negatively associated with volume (n = 296, r = -0.205, p < 0.0001), and swallowing capacity (n = 296, r = -0.24, p < 0.0001). Females required more bites, masticatory cycles, swallows and longer time than males in TOMASS. In TWST, females required more swallows, longer time, and had lower volume per swallow and reduced swallowing capacity than males. Intraclass correlation coefficient (ICC) revealed good test-retest reliability and moderate to excellent interrater reliability.

CONCLUSIONS & IMPLICATIONS

This study provides support for the validity of the TOMASS and TWST. Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Extended chewing time and increased number of masticatory cycles might be compensatory behaviours for reduced oral processing abilities that are motor, sensory and/or mechanical.

WHAT THIS PAPER ADDS

The TOMASS and TWST are functional tests of swallowing that provide quantitative results. They are easy to incorporate as part of the clinical evaluation of swallowing due to low cost and quick administration. Age and gender effects were found for the TWST and TOMASS, but they were only tested on relative measures rather than absolute measures. Different types of crackers used for TOMASS led to differences in performance and in normative values. What is already known on the subject Associations between performance during TWST and TOMASS were found: time, number of swallows and time per swallow were correlated, meaning that need for more time and more swallows is reflected in both drinking and chewing. The study provides further support for age and gender effects in TWST and TOMASS, on both relative and also on absolute measures, which were not investigated previously. Longer durations in TOMASS and TWST with an increase in age, are likely to be the result of compensatory behaviours to allow safe swallowing. Normative data for a country-specific cracker are presented (Israel). What are the potential or actual clinical implications of this work? Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Establishing country specific norms for commonly available crackers is necessary, since crackers size and ingredients, such as fat content and moisture, influence chewing and swallowing. There is a balancing act between safety and efficiency in older adults' swallowing behaviour. Reducing pace in eating and drinking probably supports safer swallowing.

Lubrication behavior of ex-vivo salivary pellicle influenced by tannins, gallic acid and mannoproteins

The objective of this study was to investigate the influence of tannins and gallic acid on the salivary lubrication behavior. Furthermore, the effects of pH and mannoproteins in combination with gallic acid on the lubrication of saliva were studied. The addition of gallic acid and tannins were found to increase friction caused by the removal of the saliva film. Tannins resulted in higher friction compared to gallic acid. Lowering pH increased friction of gallic acid mixtures with saliva, due to stronger interactions between gallic acid and saliva. The increased friction caused by gallic acid was inhibited by the addition of mannoproteins due to the hydrogen bond interactions between gallic acid and mannoproteins, thereby decreasing the complex formation between gallic acid and salivary proteins. A correlation of 0.96 was found between the hydrodynamic diameter of the aggregate and the delta friction suggesting that the formation of aggregates determined the lubrication behavior.

Buccal films: A review of therapeutic opportunities, formulations & relevant evaluation approaches

The potential of the mucoadhesive film technology is hard to ignore, owing to perceived superior patient acceptability versus buccal tablets, and significant therapeutic opportunities compared to conventional oral drug delivery systems, especially for those who suffer from dysphagia. In spite of this, current translation from published literature into the commercial marketplace is virtually non-existent, with no authorised mucoadhesive buccal films available in the UK and very few available in the USA. This review seeks to provide an overview of the mucoadhesive buccal film technology and identify key areas upon which to focus scientific efforts to facilitate the wider adoption of this patient-centric dosage form. Several indications and opportunities for development were identified, while discussing the patient-related factors influencing the use of these dosage forms. In addition, an overview of the technologies behind the manufacturing of these films was provided, highlighting manufacturing methods like solvent casting, hot melt extrusion, inkjet printing and three-dimensional printing. Over thirty mucoadhesive polymers were identified as being used in film formulations, with details surrounding their mucoadhesive capabilities as well as their inclusion alongside other key formulation constituents provided. Lastly, the importance of physiologically relevant in vitro evaluation methodologies was emphasised, which seek to improve in vivo correlations, potentially leading to better translation of mucoadhesive buccal films from the literature into the commercial marketplace.

Changes in oral function, swallowing function, and quality of life in patients with head and neck cancer: a prospective cohort study

Background

Head and neck cancer (HNC) treatment can cause oral morbidities, such as oral dryness and dysphagia, affecting the patient’s quality of life (QOL). The relationship between oral functions and QOL in patients with early-stage HNC remains poorly studied. This study aimed to evaluate changes in the QOL of patients with early-stage HNC and identify factors that affect the QOL of these patients.

Methods

In this prospective cohort study, 37 patients who underwent early-stage (Stage I/Stage II) HNC treatment were evaluated for their oral function, swallowing function, and the QOL score at baseline (BL) and 12 months after surgical treatment (12 M). The participants were divided into two groups: patients who returned to the BL QOL score at 12 M (RE; n = 26) and those who did not (NR; n = 11).

Results

In total, 29.7% (11/37) patients with early-stage HNC did not return to the BL QOL score at 12 M. There was no significant difference between the RE and NR groups regarding the oral and swallowing function. Moreover, oral and swallowing function of all patients returned to the BL at 12 M. The NR group showed lower QOL scores than the RE group in the global health status, and “sticky saliva” parameters in the questionnaires.

Conclusion

Restoration of the oral function is insufficient to improve the QOL of patients with early-stage HNC. The treatment of these patients should instead consider several factors that affect their QOL.

Minimization of Adverse Effects Associated with Dental Alloys

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Untargeted Metabolomic Approach to Study the Impact of Aging on Salivary Metabolome in Women

Despite the growing interest in salivary metabolomics, few studies have investigated the impact of aging on the salivary metabolome. The alterations in metabolic pathways that occur with aging are likely to be observed in pathologies affecting older people and may interfere with the search for salivary biomarkers. It is therefore important to investigate the age-related changes occurring in the salivary metabolome. Using reversed phase liquid chromatography and hydrophilic interaction chromatography coupled to mass spectrometry used in positive and negative ionization modes, the salivary metabolic profiles of young (22 to 45 years old) and older people (55 to 92 years old) were obtained. Those profiles were compared with the use of XCMS online to highlight the under or overexpression of some metabolites with aging. A total of 60 metabolites showed differential expression with age. The identification of 26 of them was proposed by the METLIN database and, among them, 17 were validated by standard injections. Aging seemed to affect most of the main metabolic pathways (amino acid metabolism, Krebs cycle, fatty acid synthesis, and nucleic acid synthesis). Moreover, most of the metabolites that were over- or under-expressed with age in this study have already been identified as being potential biomarkers of diseases affecting older people, such as in Alzheimer's disease. Special attention should be paid in the search for biomarkers of pathologies affecting the elderly to differentiate age-related changes from disease-related changes.

SARS-CoV-2 indoor environment contamination with epidemiological and experimental investigations

SARS-CoV-2 has been detected both in air and on surfaces, but questions remain about the patient-specific and environmental factors affecting virus transmission. Additionally, more detailed information on viral sampling of the air is needed. This prospective cohort study (N = 56) presents results from 258 air and 252 surface samples from the surroundings of 23 hospitalized and eight home-treated COVID-19 index patients between July 2020 and March 2021 and compares the results between the measured environments and patient factors. Additionally, epidemiological and experimental investigations were performed. The proportions of qRT-PCR-positive air (10.7% hospital/17.6% homes) and surface samples (8.8%/12.9%) showed statistical similarity in hospital and homes. Significant SARS-CoV-2 air contamination was observed in a large (655.25 m³ ) mechanically ventilated (1.67 air changes per hour, 32.4-421 L/s/patient) patient hall even with only two patients present. All positive air samples were obtained in the absence of aerosol-generating procedures. In four cases, positive environmental samples were detected after the patients had developed a neutralizing IgG response. SARS-CoV-2 RNA was detected in the following particle sizes: 0.65-4.7 μm, 7.0-12.0 μm, >10 μm, and <100 μm. Appropriate infection control against airborne and surface transmission routes is needed in both environments, even after antibody production has begun.

Functional Evaluation of Major Salivary Glands Using Viscosity PLUS and 2D Shear-Wave PLUS Elastography Techniques in Healthy Subjects-A Pilot Study

Biological soft tissues are characterized by viscoelastic properties. The propagation of shear waves within tissues is influenced by both elasticity, which is linked to the shear wave speed, and viscosity, which is linked to the shear wave dispersion. This study aimed to functionally assess the parotid glands (PG) and submandibular glands (SMG) in a group of 40 healthy subjects using the novel Viscosity PLUS (Vi.PLUS) and 2D Shear-Wave Elastography PLUS (2D-SWE.PLUS) techniques. The viscosity and stiffness of PG and SMG were measured before and after gustatory stimulation with a sialagogue agent (commercially available lemon juice) using the new SuperSonic MACH 30 ultrasound system equipped with a curvilinear C6-1X transducer. PG presented a mean basal viscosity and elasticity of 2.10 ± 0.19 Pa.s and 11.32 ± 1.91 kPa, respectively, which significantly increased poststimulation to 2.39 ± 0.17 Pa.s (p < 0.001) and 12.58 ± 1.92 kPa (p < 0.001), respectively. SMG did not present statistically increased values of viscosity and elasticity following stimulation (2.31 ± 015 Pa.s vs. 2.37 ± 0.18 Pa.s, p = 0.086, and 10.40 ± 1.64 kPa vs. 10.90 ± 1.98 kPa, p = 0.074, respectively). Vi.PLUS measurements presented a good positive correlation with 2D-SWE.PLUS values for PG and SMG, before and after stimulation. Gender and BMI were not confounding factors for these two parameters. Vi.PLUS represents an innovative non-invasive imaging technique that, together with 2D-SWE.PLUS proves to be useful in functionally assessing the major salivary glands in healthy subjects.

Ascorbic acid induces salivary gland function through TET2/acetylcholine receptor signaling in aging SAMP1/Klotho (-/-) mice

Aging affects salivary gland function and alters saliva production and excretion. This study aimed to investigate whether ascorbic acid can be used to treat salivary gland dysfunction in an extensive aging mouse model of SAMP1/Klotho-/- mice. In our previous study, we found that ascorbic acid biosynthesis was disrupted in the salivary glands of SAMP1/Klotho (-/-) mice subjected to metabolomic profiling analysis. In SAMP1/Klotho -/- mice, daily supplementation with ascorbic acid (100 mg/kg for 18 days) significantly increased saliva secretion compared with the control. The expression of salivary gland functional markers (α-amylase, ZO-1, and Aqua5) is upregulated. Additionally, acetylcholine and/or beta-adrenergic receptors (M1AchR, M3AchR, and Adrb1) were increased by ascorbic acid in the salivary glands of aging mice, and treatment with ascorbic acid upregulated the expression of acetylcholine receptors through the DNA demethylation protein TET2. These results suggest that ascorbic acid could overcome the lack caused by dysfunction of ascorbic acid biosynthesis and induce the recovery of salivary gland function.