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Malik Z, Wright F. Dental and nursing collaboration in oral healthcare research in palliative care inpatient settings. Int J Palliat Nurs 2023; 29:318-320. [PMID: 37478068 DOI: 10.12968/ijpn.2023.29.7.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Collaboration between palliative care nurses and oral health professionals has been frequently recommended to ensure optimal oral healthcare. However, the importance of this collaboration to the success of evidence-based protocols, involving oral healthcare interventions in the inpatient palliative care setting, is less discussed. Feasibility requires consideration during the planning, intervention and implementation phases of any clinical trial; all of which typically rely on good collaboration with nursing staff. Therefore, it is imperative that nursing staff appreciate the need for oral healthcare at the end of a person's life. Nursing and dental collaboration is critical to the feasibility of running research trials in this group and can help overcome some of the logistical and ethical challenges in this vulnerable population.
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Affiliation(s)
- Zanab Malik
- Specialist Special Needs Dentistry, School of Health Sciences, Faculty of Health and Medicine, Campbelltown Hospital Dental Centre Specialist Clinic, Sydney, Australia
| | - Fac Wright
- Clinical Professor, Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, Australia
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Cleary N, Mulkerrin OM, Davies A. Oral symptom assessment tools in patients with advanced cancer: a scoping review. Support Care Cancer 2022; 30:7481-7490. [PMID: 35657401 PMCID: PMC9385820 DOI: 10.1007/s00520-022-07169-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Oral symptoms are common in patients with advanced cancer. The aim of this scoping review was to identify oral symptom assessment tools that have been specifically utilised in patients with "advanced cancer". METHODS The review was conducted/reported according to international guidelines for undertaking scoping reviews. PubMed, Embase, and CINAHL were searched for articles involving adult patients with advanced cancer, which involved assessment of ≥ 2 oral symptoms, and which involved patients with > 1 type of cancer. RESULTS The review identified four validated symptom assessment scales, including one cancer-specific quality of life scale (EORTC QLQ OH-15), one generic tool for assessing the "social impact" of specific oral problems (OHIP), one cancer-specific generic symptom assessment scale (MSAS), and one cancer-specific oral symptom assessment scale (OSAS). CONCLUSION Symptom assessment tools can facilitate good symptom control in clinical practice, and are an integral component of clinical research. The review identified four validated symptom assessment scales that could be utilised to assess oral symptoms in patients with advanced cancer.
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Affiliation(s)
- Niamh Cleary
- Trinity College Dublin, Dublin, Ireland.
- Our Lady of Lourdes Hospital, Drogheda, Drogheda, Ireland.
- Our Lady's Hospice Dublin, Dublin, Ireland.
| | | | - Andrew Davies
- Trinity College Dublin, Dublin, Ireland
- Our Lady's Hospice Dublin, Dublin, Ireland
- University College Dublin, Dublin, Ireland
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Jones JA, Chavarri-Guerra Y, Corrêa LBC, Dean DR, Epstein JB, Fregnani ER, Lee J, Matsuda Y, Mercadante V, Monsen RE, Rajimakers NJH, Saunders D, Soto-Perez-de-Celis E, Sousa MS, Tonkaboni A, Vissink A, Yeoh KS, Davies AN. MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer. Support Care Cancer 2022; 30:8761-8773. [PMID: 35717462 PMCID: PMC9633484 DOI: 10.1007/s00520-022-07211-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer. METHODS This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and "category of guideline" (i.e., "recommendation", "suggestion" or "no guideline possible"). RESULTS Twelve generic suggestions (level of evidence - 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals. CONCLUSIONS This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management.
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Affiliation(s)
- Jac A. Jones
- grid.416224.70000 0004 0417 0648Royal Surrey County Hospital, Guildford, UK
| | - Yanin Chavarri-Guerra
- grid.416850.e0000 0001 0698 4037Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - David R. Dean
- grid.34477.330000000122986657Department of Oral Medicine, University of Washington/Seattle Cancer Care Alliance, Seattle, USA
| | - Joel B. Epstein
- grid.50956.3f0000 0001 2152 9905City of Hope Comprehensive Cancer Center, Duarte & Cedars Sinai Health System, Los Angeles, USA
| | | | - Jiyeon Lee
- grid.15444.300000 0004 0470 5454College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Yuhei Matsuda
- grid.411621.10000 0000 8661 1590Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | | | - Ragnhild Elisabeth Monsen
- grid.5510.10000 0004 1936 8921Department of Medicine, Lovisenberg Diaconal Hospital & Department for Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Natasja J. H. Rajimakers
- grid.470266.10000 0004 0501 9982Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Deborah Saunders
- grid.436533.40000 0000 8658 0974Department of Dental Oncology, Health Services North, Northern Ontario School of Medicine, Sudbury, Canada
| | - Enrique Soto-Perez-de-Celis
- grid.416850.e0000 0001 0698 4037Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana S. Sousa
- grid.117476.20000 0004 1936 7611IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Arghavan Tonkaboni
- grid.411705.60000 0001 0166 0922Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Arjan Vissink
- grid.4830.f0000 0004 0407 1981Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Keng Soon Yeoh
- Special Needs Dental Unit, South Australia Dental Service, Adelaide, Australia
| | - Andrew N. Davies
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, University College Dublin & Our Lady’s Hospice Dublin, Trinity College Dublin, Dublin, Ireland
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Piaton S, Duconseille A, Roger-Leroi V, Hennequin M. Could the use of saliva substitutes improve food oral processing in individuals with xerostomia? A systematic review. J Texture Stud 2021; 52:278-293. [PMID: 33587294 DOI: 10.1111/jtxs.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/14/2023]
Abstract
Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called "saliva substitutes" or "artificial saliva" can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords "saliva substitutes" and "artificial saliva." An advanced search was applied using the terms "xerostomia" and/or "food oral processing" and/or "eating" and/or "mastication" and/or "chewing" and/or "swallowing." The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies, and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavored. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.
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Affiliation(s)
- Sophie Piaton
- Université Clermont Auvergne, CROC, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | | | - Valérie Roger-Leroi
- Université Clermont Auvergne, CROC, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - Martine Hennequin
- Université Clermont Auvergne, CROC, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
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Monsen RE, Herlofson BB, Gay C, Fjeld KG, Hove LH, Malterud KE, Saghaug E, Slaaen J, Sundal T, Tollisen A, Lerdal A. A mouth rinse based on a tea solution of Salvia officinalis for oral discomfort in palliative cancer care: a randomized controlled trial. Support Care Cancer 2021; 29:4997-5007. [PMID: 33586003 PMCID: PMC8295113 DOI: 10.1007/s00520-021-06021-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few clinical studies evaluate interventions to reduce oral discomfort among patients in palliative care. AIM This study examines the efficacy of a Salvia officinalis (SO) based herbal mouth rinse compared to conventional normal saline (NS) in order to improve oral health. DESIGN A block-randomized controlled trial. Data were collected before and after a 4-day intervention with either SO (n=44) or NS (n=44). Numerical rating scales (NRS, 0-10) and 12 items from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Oral Health 17 (EORTC QLQ-OH17) measured patient-reported oral symptoms. An oral examination was performed before and after the intervention. SETTING/PARTICIPANTS This study included adult patients with late-stage cancer in an inpatient hospice unit. RESULTS Of the 88 patients included (mean age=63.9 years, SD=10.6), 73 (83%) completed the study. At baseline, 78% reported dry mouth on the EORTC QLQ-OH17, and 80% rated dry mouth ≥4 on the NRS. Total oral health scores based on the 12 EORTC QLQ-OH17 items improved similarly in both groups (p<0.001). However, dry mouth ratings on both the EORTC QLQ-OH17 (p=0.036) and NRS (p=0.045) improved more in the SO group than in the NS group. Plaque on the teeth improved in both the SO (p=0.008) and NS (p=0.018) groups, but plaque on the tongue and erythema only improved with NS. CONCLUSIONS This study did not detect an overall significant difference between SO and NS. Both mouth rinses improved oral health parameters, indicating that systematic assessment and oral care may reduce oral discomfort. TRIAL REGISTRATION NCT02067572.
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. .,Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Caryl Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Katrine Gahre Fjeld
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Karl Egil Malterud
- Department of Pharmacy, Section Pharmaceutical Chemistry, University of Oslo, Oslo, Norway
| | | | - Joran Slaaen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tone Sundal
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anita Tollisen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Marimuthu D, Han KM, Mohamad MSF, Azman M. Saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia: a randomized controlled trial. Clin Oral Investig 2020; 25:3105-3115. [PMID: 33175253 PMCID: PMC8060215 DOI: 10.1007/s00784-020-03634-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
Objectives Xerostomia is a prevalent sequelae among nasopharyngeal cancer (NPC) survivors; yet, effective treatment protocols have been elusive. This study was a prospective randomized clinical trial to compare the effects of saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia, between two treatment arms, conducted in a tertiary center. Materials and methods This study measured the effects within 4 weeks in relation to summated xerostomia inventory (SXI) and unstimulated whole saliva (UWS). Patients randomized into the interventional arm were prescribed an immunologically active saliva substitute (IASS), while patients in the control arm were prescribed a non-immunologically active mouthwash as placebo. Results The study population consisted of 94 patients. There was a significant difference in SXI difference (p < 0.0001) and UWS difference (p < 0.0001) between control and interventional arms. No harmful side effects associated with the use of either mouthwash encountered throughout the study duration. Conclusion IASS mouthwash significantly reduces subjective xerostomia scores measured using SXI and improves objective measurement of salivary flow using UWS among nasopharyngeal cancer survivors with xerostomia. Clinical relevance IASS is significantly more effective in improving subjective and objective xerostomia measurements compared to non-immunologically active mouthwash. Additionally, this treatment is very safe, with superior side effect profiles. Trial registration ClinicalTrials.gov Identifier: NCT04491435
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Affiliation(s)
- Dayaabaran Marimuthu
- Department of Otorhinolaryngology and Head and Neck Surgery, Level 9, Clinical Block, UKM Medical Centre, National University of Malaysia Kuala Lumpur Campus, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Kong Min Han
- Department of Otorhinolaryngology and Head and Neck Surgery, Level 9, Clinical Block, UKM Medical Centre, National University of Malaysia Kuala Lumpur Campus, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mohd Shawal Firdaus Mohamad
- Centre of Studies for Oral and Maxillofacial Surgery, Faculty of Dentistry, UiTM Sungai Buloh Campus, Jalan Hospital, 47000, Sugai Buloh, Selangor, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology and Head and Neck Surgery, Level 9, Clinical Block, UKM Medical Centre, National University of Malaysia Kuala Lumpur Campus, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
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Gomez-Rossi J, Hertrampf K, Abraham J, Gaßmann G, Meyer G, Schlattmann P, Göstemeyer G, Schwendicke F. Interventions to improve oral health of older people: A scoping review. J Dent 2020; 101:103451. [PMID: 32810577 DOI: 10.1016/j.jdent.2020.103451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES A range of interventions have been tested to improve oral health of older people. We performed a scoping review to map interventions' aims, outcome measures and findings, and to locate them on different levels of care. DATA We systematically screened for (1) controlled studies on (2) people over 65 years of age, (3) comparing at least two interventions to improve oral health. Interventions were summarized according to their aims and the employed intervention type, mapped on their level of action, and classified as primary/secondary/tertiary prevention. SOURCES Studies retrieved via MEDLINE, EMBASE, CINAHL. STUDY SELECTION Eighty-one studies (published 1997-2019, conducted mainly in high-income countries) were included. Sample sizes varied (n = 24-1987). Follow-up was 0.25-60 months. Most studies (64/81) found a statistically significant benefit of the intervention. A total of 13 different aims were identified, and a range of intervention types employed (e.g. educational interventions, professional oral healthcare, restorative treatment, fluoride application and, generally, dentifrices, mouthwashes, chewing gums/food supplements). Most studies were located on the carer/patient level (56/81 studies) or the system/policy-maker level (44/81). The majority of studies aimed for primary prevention (64/81). CONCLUSIONS Oral health improvement interventions are widely studied. However, study aims, methods and outcome measures are highly heterogeneous, which limits the ability for robust conclusions. Current research focusses on primary prevention on the level of patients/carers or system/policy-maker level. Future studies may want to consider interventions on dentists' level focussing on secondary prevention. These studies should rely on a core set of comprehensive, standardized set of outcome measures. CLINICAL SIGNIFICANCE While specific interventions seem efficacious to improve older people's oral health, the current body of evidence is neither comprehensive (significant gaps exists in relevant levels of the care process) nor comparable enough to draw robust conclusions.
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Vinke J, Kaper HJ, Vissink A, Sharma PK. Dry mouth: saliva substitutes which adsorb and modify existing salivary condition films improve oral lubrication. Clin Oral Investig 2020; 24:4019-4030. [PMID: 32303864 PMCID: PMC7544715 DOI: 10.1007/s00784-020-03272-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/04/2020] [Indexed: 01/13/2023]
Abstract
Objectives The aims of this study are to assess different saliva substitutes for their efficacy to lubricate the oral cavity, and to relate this oral lubrication to the ability of saliva substitutes to adsorb on and change the structure of the existing salivary conditioning film (SCF). Materials and methods Quartz crystal microbalance with dissipation was used to study the capability of saliva substitutes to interact with natural SCF and the ability to change the secondary SCF (S-SCF). A tongue-enamel friction system mimicking xerostomic conditions was used to assess the relief and relief period expected from these substitutes under set circumstances. Results Saliva Orthana spray, Biotène spray and Gum Hydral gel had an immediate effect on a SCF, increasing its structural softness. BioXtra gel, Biotène gel, Gum Hydral gel and Glandosane spray changed the S-SCF by increasing salivary protein adsorption, while others showed no sign of interaction. With respect to relief, only 2 out of the 16 saliva substitutes tested (Saliva Orthana spray and Gum Hydral gel) performed better than water. Overall, relief period correlated positively to structural softness change, whereas a positive correlation was seen between relief and mass adsorption. Conclusions The majority of saliva substitutes did not adsorb on the SCF, thus did not enhance lubrication. Only saliva substitutes containing carrageenan, carboxymethylcellulose, pig gastric mucin, xanthan gum and carbomer performed better in enhancing oral lubrication. Clinical relevance This objective assessment will help clinicians and patients make better choice of saliva substitutes. This study provides a scientific basis for future improvement in saliva substitutes.
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Affiliation(s)
- Jeroen Vinke
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Hans J Kaper
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Prashant K Sharma
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
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Fleming M, Craigs CL, Bennett MI. Palliative care assessment of dry mouth: what matters most to patients with advanced disease? Support Care Cancer 2020; 28:1121-1129. [PMID: 31201546 PMCID: PMC6989644 DOI: 10.1007/s00520-019-04908-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/31/2019] [Indexed: 12/02/2022]
Abstract
PURPOSE Dry mouth is a highly prevalent and significant symptom in patients with advanced progressive diseases. It is a poorly understood area of research, and currently, there is no standardised outcome measure or assessment tool for dry mouth. METHODS To assess responses to self-reported dry mouth questions, the impact of dry mouth, methods used to reduce symptoms and relevance of the questionnaire. A cross-sectional multisite study of 135 patients with advanced progressive disease experiencing dry mouth. Participants were located in the inpatient, day care, outpatient or community setting. RESULTS The majority (84.4%) of patients rated their dry mouth as moderate or severe using the verbal rating scale (VRS). Seventy-five percent (74.7%) had a numeric rating scale (NRS) score of 6 or more for dry mouth severity. Patients reported that dry mouth interfered most with talking and was the most important function to assess (median score 6 out of 10) followed by eating (median 5) and taste (median 5). Taking sips of drink was the most common and most effective self-management strategy. Over half of patients (54.6%) also reported impact on swallow and sleep and associated dryness of lips, throat and nasal passages. CONCLUSIONS This study highlights the severity of dry mouth in advanced disease. Important factors when assessing patients with dry mouth should include the functional impact on day-to-day activities including talking, dysphagia and sleep. Simple considerations for patients include provision of drinks and reviewing medications. This study could be used to develop a standardised assessment tool for dry mouth to use in clinical practice.
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Affiliation(s)
- Michelle Fleming
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Cheryl L Craigs
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
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Gardner A, So P, Carpenter G. Endogenous salivary citrate is associated with enhanced rheological properties following oral capsaicin stimulation. Exp Physiol 2020; 105:96-107. [PMID: 31705555 PMCID: PMC6973168 DOI: 10.1113/ep088166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the central question of this study? What are the relationships between physical properties of saliva, protein composition and metabolite composition? What is the main finding and its importance? Salivary citrate, one of the major endogenous metabolites in saliva, increased upon capsaicin stimulation and was associated with improved physical properties measured by extensional rheology. This suggests salivary gland citrate transporters might be a valuable area of future study. ABSTRACT Saliva displays viscoelastic properties which enable coating, lubrication and protection of the oral mucosa and hard tissues. Individuals lacking saliva or perceiving oral dryness can manage their symptoms using artificial saliva preparations, but these often fail to mimic the sensation and functionality of natural saliva. It is widely acknowledged that mucins (MUC7 and MUC5B) confer saliva's rheological properties, but artificial saliva containing purified mucins is still often an inadequate substitute. This work aimed to explore salivary components that influence salivary extensional rheology to better understand how natural saliva could be replicated. Saliva was stimulated via control and capsaicin solutions in healthy volunteers. Extensional rheology was analysed using a CaBER-1 (capillary breakup) extensional rheometer. Protein composition, including mucins, was measured by gel-electrophoresis band densitometry and metabolites were measured by 1 H nuclear magnetic resonance spectroscopy. Capsaicin stimulation significantly increased capillary breakup time, extensional viscosity and the abundance of most major salivary proteins. Stimulation also increased salivary citrate and choline concentrations. Significant correlations were found between capillary breakup time and amylase (r = 0.67, P < 0.05), statherin (ρ = 0.66, P < 0.05) and citrate (ρ = 0.81, P < 0.01). The relationship between citrate and salivary rheology was subsequently investigated in vitro. These results suggest that citrate and non-mucin proteins are stronger predictors of salivary rheology than the more often studied mucin glycoproteins. Potential mechanisms are discussed and future work in this area could help formulate more effective saliva substitutes, more closely resembling natural saliva.
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Affiliation(s)
- Alexander Gardner
- Salivary Research, Centre for Host‐Microbiome InteractionsFaculty of Dental, Oral & Craniofacial SciencesKing's College LondonLondonUK
- Department of Restorative Dentistry, Dental Hospital and SchoolUniversity of DundeeDundeeUK
| | - Po‐Wah So
- Department of Neuroimaging, Institute of PsychiatryPsychology and Neuroscience, King's College LondonMaurice Wohl Clinical Neuroscience InstituteLondonUK
| | - Guy Carpenter
- Salivary Research, Centre for Host‐Microbiome InteractionsFaculty of Dental, Oral & Craniofacial SciencesKing's College LondonLondonUK
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Affiliation(s)
| | - Peter Strang
- Palliative Research Unit, Linköping University, Vrinnevi Hospital, Norrköping, Sweden
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12
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See L, Mohammadi M, Han PP, Mulligan R, Enciso R. Efficacy of saliva substitutes and stimulants in the treatment of dry mouth. Spec Care Dentist 2019; 39:287-297. [PMID: 30811076 DOI: 10.1111/scd.12370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the efficacy of saliva substitutes and stimulants compared to placebo in improving findings of dry mouth not caused by Sjӧgren's. METHODS AND RESULTS Four databases were searched (PubMed, Web of Science, Cochrane Library, and EMBASE) through March 2018. Only randomized controlled trials (RCT) using placebo interventions with dry mouth patients were included. Outcomes included salivary flow and self-reported patient improvement. The Cochrane Collaboration's tool for assessing risk of bias was used. A total of 348 references were reviewed, resulting in 7 RCTs with 257 dry mouth patients with 5 studies at high risk of bias, 1 unclear and 1 low risk being included. Topical spray of 1% malic acid increased unstimulated (Difference in Means [DM] = 0.096, 95% CI = 0.092-0.100; P < 0.001) and stimulated (DM = 0.203, 95% CI = 0.106-0.300; P < 0.001) salivary flow in 2 studies. Patients using 1% malic acid topical spray were 5.4 times more likely to report improvement compared to placebo (95% CI = 2.634-11.091; P < 0.001) in 2 studies. No significant improvements were found with other products when compared to placebo. CONCLUSION Use of 1% malic acid topical spray seems to improve dry mouth compared to placebo. Quality of the evidence was low due to risk of bias and imprecision.
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Affiliation(s)
- Lydia See
- Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Mehdi Mohammadi
- Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California.,Assistant Professor of Clinical Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Phuu P Han
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Roseann Mulligan
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
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Abstract
Mucins glycoproteins are emerging as a multifunctional building block for biomaterials with diverse applications in chemistry and biomedicine.
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Affiliation(s)
- Georgia Petrou
- School of Engineering Sciences in Chemistry
- Biotechnology and Health
- Department of Chemistry
- Kungliga Tekniska Hogskolan
- Stockholm
| | - Thomas Crouzier
- School of Engineering Sciences in Chemistry
- Biotechnology and Health
- Department of Chemistry
- Kungliga Tekniska Hogskolan
- Stockholm
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Authimoolam SP, Dziubla TD. Biopolymeric Mucin and Synthetic Polymer Analogs: Their Structure, Function and Role in Biomedical Applications. Polymers (Basel) 2016; 8:E71. [PMID: 30979166 DOI: 10.3390/polym8030071] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/17/2022] Open
Abstract
Mucin networks are viscoelastic fibrillar aggregates formed through the complex self-association of biopolymeric glycoprotein chains. The networks form a lubricious, hydrated protective shield along epithelial regions within the human body. The critical role played by mucin networks in impacting the transport properties of biofunctional molecules (e.g., biogenic molecules, probes, nanoparticles), and its effect on bioavailability are well described in the literature. An alternate perspective is provided in this paper, presenting mucin’s complex network structure, and its interdependent functional characteristics in human physiology. We highlight the recent advances that were achieved through the use of mucin in diverse areas of bioengineering applications (e.g., drug delivery, biomedical devices and tissue engineering). Mucin network formation is a highly complex process, driven by wide variety of molecular interactions, and the network possess structural and chemical variations, posing a great challenge to understand mucin’s bulk behavior. Through this review, the prospective potential of polymer based analogs to serve as mucin mimic is suggested. These analog systems, apart from functioning as an artificial model, reducing the current dependency on animal models, can aid in furthering our fundamental understanding of such complex structures.
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Hanning SM, Medlicott NJ. Oil-based compositions as saliva substitutes: A pilot study to investigate in-mouth retention. Int J Pharm 2016; 501:265-70. [DOI: 10.1016/j.ijpharm.2016.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/22/2016] [Accepted: 01/23/2016] [Indexed: 11/24/2022]
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17
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Villa A, Wolff A, Aframian D, Vissink A, Ekström J, Proctor G, McGowan R, Narayana N, Aliko A, Sia YW, Joshi RK, Jensen SB, Kerr AR, Dawes C, Pedersen AML. World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction: prevalence, diagnosis, and treatment. Clin Oral Investig 2015; 19:1563-80. [DOI: 10.1007/s00784-015-1488-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/04/2015] [Indexed: 01/12/2023]
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Salom M, Hachulla E, Bertolus C, Deschaumes C, Simoneau G, Mouly S. Efficacy and safety of a new oral saliva equivalent in the management of xerostomia: a national, multicenter, randomized study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:301-9. [DOI: 10.1016/j.oooo.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/17/2014] [Accepted: 12/03/2014] [Indexed: 12/01/2022]
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Skrinjar I, Vucicevic Boras V, Bakale I, Andabak Rogulj A, Brailo V, Vidovic Juras D, Alajbeg I, Vrdoljak DV. Comparison between three different saliva substitutes in patients with hyposalivation. Clin Oral Investig 2015; 19:753-7. [DOI: 10.1007/s00784-015-1405-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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20
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Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Farré M. Salivary Secretory Disorders, Inducing Drugs, and Clinical Management. Int J Med Sci 2015; 12:811-24. [PMID: 26516310 PMCID: PMC4615242 DOI: 10.7150/ijms.12912] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. AIM To review the salivary secretory disorders, inducing drugs and their clinical management. METHODS In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. RESULTS Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. CONCLUSION At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.
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Affiliation(s)
- Jaume Miranda-Rius
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- 2. Servei d'Odontologia. Hospital Sant Joan de Déu. Universitat de Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Magí Farré
- 3. Clinical Pharmacology Unit. Hospital Universitari Germans Trias i Pujol-IGTP and Hospital del Mar Medical Research Institute (IMIM). Facultat de Medicina. Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
Xerostomia, the subjective complaint of dry mouth, and hyposalivation remain a significant burden for many individuals. Diagnosis of xerostomia and salivary gland hypofunction is dependent upon a careful and detailed history and thorough oral examination. There exist many options for treatment and symptom management: salivary stimulants, topical agents, saliva substitutes, and systemic sialogogues. The aim of this review is to investigate the current state of knowledge on management and treatment of patients affected by xerostomia and/or hyposalivation.
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Affiliation(s)
- Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA ; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Christopher L Connell
- Department of General Dentistry, Boston University Henry M Goldman School of Dental Medicine, Boston, MA, USA
| | - Silvio Abati
- Dental Clinic, Department of Health Sciences, University of Milan, Milano, Italy
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Hanchanale S, Adkinson L, Daniel S, Fleming M, Oxberry SG. Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer 2015; 23:881-8. [DOI: 10.1007/s00520-014-2477-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/06/2014] [Indexed: 12/21/2022]
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Turner L, Mupparapu M, Akintoye SO. Review of the complications associated with treatment of oropharyngeal cancer: a guide for the dental practitioner. Quintessence Int 2014; 44:267-79. [PMID: 23444208 DOI: 10.3290/j.qi.a29050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Oropharyngeal cancer (OPC) is the sixth most common cancer worldwide. Focus on risk factors, improved diagnostic methods and effective management strategies have made it possible to successfully treat OPC. However, the 5-year survival rate has not improved for several years due to multiple treatment complications, tissue morbidity, loss of function, and diminished quality of life. Survivors are faced with complications like oral mucositis, hyposalivation, osteoradionecrosis, tissue fibrosis, morbidity from jaw resection, disfigurement, and loss of function that further diminish quality of life. The aim of this review is to highlight major complications associated with treatment of OPC via a literature search and review of available options for identification and management of these complications. DATA SOURCES Relevant publications on oral complications of OPC therapy were thoroughly reviewed from the literature published between the years 1988 and 2012. We evaluated reported incidence, prevalence, and risk factors for oral complications of chemotherapy and radiotherapy for OPC. The authors conducted an electronic search using English language databases, namely PubMed Plus, Medline (Pre-Medline and Medline), Cochrane Database of Systematic Reviews (evidence-based medicine), Dentistry & Oral Sciences Source, A ccessScience, Embase, Evidence-Based Medicine Reviews Multifile, Google Scholar, ISI Journal Citation Reports, and Ovid Multi-Database. CONCLUSION We identified the most common complications associated with the treatment of oral cancers. Based on the information gathered, there is evidence that survival of OPC extends beyond eradication of the diseased tissue. Understanding the potential treatment complications and utilizing available resources to prevent and minimize them are important. Caring for OPC survivors should be a multidisciplinary team approach involving the dentist, oncologist, internist, and social worker to improve the currently stagnant 5-year survival rate of OPC. More emphasis on improved quality of life after elimination of the cancer will ultimately improve OPC survivorship.
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Hanning SM, Yu T, Jones DS, Andrews GP, Kieser JA, Medlicott NJ. Lecithin-based emulsions for potential use as saliva substitutes in patients with xerostomia – viscoelastic properties. Int J Pharm 2013; 456:560-8. [DOI: 10.1016/j.ijpharm.2013.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/07/2013] [Accepted: 08/10/2013] [Indexed: 11/21/2022]
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Abbasi F, Farhadi S, Esmaili M. Efficacy of Pilocarpine and Bromhexine in Improving Radiotherapy-induced Xerostomia. J Dent Res Dent Clin Dent Prospects 2013; 7:86-90. [PMID: 23875086 PMCID: PMC3713866 DOI: 10.5681/joddd.2013.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/06/2013] [Indexed: 11/17/2022] Open
Abstract
Background and aims. Xerostomia is one of the most common complications of head and neck radiotherapy. The aim of this study was to evaluate and compare the efficacy of pilocarpine and bromhexine in improving radiotherapy-induced xerostomia and its associated symptoms.
Materials and methods. In this single-blind, randomized crossover study, pilocarpine and bromhexine tablets were used by twenty-five patients suffered from xerostomia, with a medical history of head and neck radiotherapy. At step A, the patients were treated with pilocarpine for 2 weeks. In addition, they were asked to take bromhexine for 2 weeks with a one-week washout period. At step B, the inverse process was conducted (first bromhexine, then pilocarpine). Whole resting saliva was collected from patients before and after receiving each medication by precise measurements. Then, efficacy of the two drugs in the treatment of xerostomia and its related oral complications was evaluated using questionnaires by Dichotomous format. The results were statistically analyzed using t-student and Fisher’s exact and chi-squared tests. Statistical significance was set at P<0.05.
Results. The difference between saliva secretion rates before and after medications was not significant for bromhexine users at two steps of the study (P=0.35); however, it was significant for pilocarpine users (P=0.0001). Users of both drugs showed significant differences in improvement of xerostomia, chewing, swallowing, tasting and mouth burning.
Conclusion. Pilocarpine is probably more effective in improving xerostomia and its associated problems compared with bromhexine, although the use of the latter was also shown to ease some of the consequences of radiotherapy in the head and neck region.
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Affiliation(s)
- Farid Abbasi
- Associate Professor, Department of Oral Medicine, Faculty of Dentistry, Shahed University, Tehran, Iran
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Madsen KD, Sander C, Baldursdottir S, Pedersen AML, Jacobsen J. Development of an ex vivo retention model simulating bioadhesion in the oral cavity using human saliva and physiologically relevant irrigation media. Int J Pharm 2013; 448:373-81. [DOI: 10.1016/j.ijpharm.2013.03.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 01/29/2023]
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Van Mechelen W, Aertgeerts B, De Ceulaer K, Thoonsen B, Vermandere M, Warmenhoven F, Van Rijswijk E, De Lepeleire J. Defining the palliative care patient: a systematic review. Palliat Med 2013; 27:197-208. [PMID: 22312010 DOI: 10.1177/0269216311435268] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The lack of a clear definition of the palliative care patient hampers the comparison of results across different studies and impedes implementation of research findings in everyday practice. AIM The aim of this article is to propose minimum characteristics that define a palliative care patient. DESIGN The design involved a systematic review of medical literature searching randomised controlled trials (RCTs) in palliative care for clear descriptions of their palliative care patients. We systematically describe relevant characteristics of the study populations of 60 eligible RCTs. DATA SOURCES The data sources used were MEDLINE, EMBASE, CINAHL, and PSYCHINFO, including all non-cancer RCTs (1 January 1995-4 March 2010) and an equivalent number of the most recent cancer RCTs (1 January 2003-4 March 2010). RESULTS Half of the non-cancer studies were excluded because they did not relate to palliative care. We conclude that published RCTs have no clear definitions of their palliative care patients and illustrate the diversity of this patient, the lack of consensus concerning the attributes of illnesses needing palliation and the ambiguous use of the adjective 'palliative'. CONCLUSIONS We propose elements of the patients' health status (e.g. a progressive, life-threatening disease with no possibility of obtaining remission or stabilisation, or modifying the course of the illness) and the care delivered to them (e.g. a holistic interdisciplinary approach that focuses on supporting the quality of the end of life) to be included in the definition of a palliative care patient. We also suggest considering the patients' readiness to accept palliative care and a vision of palliative care shared by the patient and all caregivers involved as potentially important elements in this definition.
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Abstract
BACKGROUND Xerostomia (the feeling of dry mouth) is a common symptom especially in older adults. Causes of dry mouth include medications, autoimmune disease (Sjögren's Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections. OBJECTIVES To determine which topical treatments for dry mouth are effective in reducing this symptom. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (28 October 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2011), MEDLINE via OVID (1950 to 28 October 2011), EMBASE via OVID (1980 to 28 October 2011), CINAHL via EBSCO (1980 to 28 October 2011), AMED via OVID (1985 to 28 October 2011), CANCERLIT via PubMed (1950 to 28 October 2011). SELECTION CRITERIA We included randomised controlled trials of topical interventions such as lozenges, sprays, mouthrinses, gels, oils, chewing gum or toothpastes for the treatment of dry mouth symptom. We classified interventions into two broad categories, saliva stimulants and saliva substitutes, and these were compared with either placebo or another intervention. We included both parallel group and crossover trials. DATA COLLECTION AND ANALYSIS Two or more review authors independently carried out data extraction and assessed risk of bias. Trial authors were contacted for additional information as required. MAIN RESULTS Thirty-six randomised controlled trials involving 1597 participants met the inclusion criteria. Two trials compared saliva stimulants to placebo, nine trials compared saliva substitutes to placebo, five trials compared saliva stimulants directly with saliva substitutes, 18 trials directly compared two or more saliva substitutes, and two trials directly compared two or more saliva stimulants. Only one trial was at low risk of bias and 17 were at high risk of bias. Due to the range of interventions, comparisons and outcome measures in the trials, meta-analysis was possible for only a few comparisons. Oxygenated glycerol triester (OGT) saliva substitute spray shows evidence of effectiveness compared to an electrolyte spray (standardised mean difference (SMD) 0.77, 95% confidence interval (CI) 0.38 to 1.15) which corresponds to approximately a mean difference of 2 points on a 10-point visual analogue scale (VAS) for mouth dryness. Both integrated mouthcare systems (toothpaste + gel + mouthwash) and oral reservoir devices show promising results but there is insufficient evidence at present to recommend their use. Although chewing gum is associated with increased saliva production in the majority of those with residual capacity, there is no evidence that gum is more or less effective than saliva substitutes. AUTHORS' CONCLUSIONS There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10-point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this. Well designed, adequately powered randomised controlled trials of topical interventions for dry mouth, which are designed and reported according to CONSORT guidelines, are required to provide evidence to guide clinical care. For many people the symptom of dry mouth is a chronic problem and trials should evaluate whether treatments are palatable, effective in reducing xerostomia, as well as the long-term effects of treatments on quality of life of those with chronic dry mouth symptoms.
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Affiliation(s)
- Susan Furness
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Rd, Manchester, UK, M13 9PL
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Affiliation(s)
| | - Sally Hall
- in Palliative Care, Royal Surrey County Hospital, Egerton Road, Guildford, SurreyGU2 7XX, England
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Alt-Epping B, Nejad RK, Jung K, Gross U, Nauck F. Symptoms of the oral cavity and their association with local microbiological and clinical findings--a prospective survey in palliative care. Support Care Cancer 2012; 20:531-7. [PMID: 21336528 DOI: 10.1007/s00520-011-1114-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 02/02/2011] [Indexed: 10/25/2022]
Abstract
PURPOSE Symptoms of the oral cavity clearly encompass more than radiation or chemotherapy-induced mucositis. Still, the burden of oral symptoms in palliative care has hardly been addressed directly, and considerations towards underlying disease processes have often been extrapolated from oncology patients. METHODS We therefore conducted a prospective explorative survey with pilot character on patients on a specialized palliative care unit, describing symptom pattern (self assessment), clinical signs, bacteriological, mycological and virological findings, and correlating features of clinical history. RESULTS Taste disturbances, dry mouth and the presence of Candida were found to be the most prevalent and correlating items. The broad spectrum of further symptoms, signs and findings did not show relevant correlations and did not permit any unilateral causal attributions. CONCLUSIONS Apart from the described focus on Candida colonisation/infections, a symptom-guided polypragmatic approach therefore seems to be justifiable for patients with oral symptoms in palliative care.
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Abstract
Patients who undergo treatment for head and neck cancers often suffer from acute or late reactions to therapy. Severity of these oral complications may be based on the location and extent of tumor, as well as the type and extent of treatment. Some complications are transient, whereas others require a lifetime of management secondary to damage that results in permanent dysfunction. Patients who have a history of head and neck cancers are also at an increased risk for recurrences or second malignancies, and therefore require close follow-up. Dental professionals should provide preventive and supportive care, including education and symptom management, for patients experiencing oral complications related to cancer therapy, and should closely monitor patients' level of distress, ability to cope, and treatment response.
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Affiliation(s)
- Dena J Fischer
- Department of Oral Medicine and Diagnostic Sciences, University of Illinois at Chicago College of Dentistry, 801 South Paulina Street, MC 838, Chicago, IL 60612-7213, USA.
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Mouly SJ, Orler JB, Tillet Y, Coudert AC, Oberli F, Preshaw P, Bergmann JF. Efficacy of a new oral lubricant solution in the management of psychotropic drug-induced xerostomia: a randomized controlled trial. J Clin Psychopharmacol 2007; 27:437-43. [PMID: 17873673 DOI: 10.1097/jcp.0b013e31814db434] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Xerostomia is a subjective sensation of mouth dryness often occurring as an unwanted effect of psychotropic drugs. METHODS The clinical efficacy and acceptability of a new oxygenated glycerol triester (OGT) oral spray (1 or 2 sprays up to 4 times daily) in the treatment of xerostomia was compared with those of a commercially available artificial saliva substitute (ASS [Saliveze]) in a 2-week, open-labeled, randomized, parallel-group study. Clinical assessment of xerostomia included evaluation of mouth dryness by means of a 10-cm-long visual analog scale, objective blinded assessment of the oral tissue condition by a dental hygienist by means of a 4-point ordinal scale, and subjective patient-based assessment of dry mouth symptoms by means of dichotomous responses to a questionnaire. [Day 14 - baseline] patient-based mouth dryness score was the primary end point. RESULTS Seventy-four patients (41 women and 33 men, 44 +/- 15 years) undergoing long-term psychotropic drug treatment were consecutively enrolled. At day 14, OGT resulted in better efficacy than ASS in mouth dryness score (mean difference, 1.2 +/- 0.4; P = 0.006), speech difficulties (mean difference, 1.2 +/- 0.4; P = 0.005), taste (mean difference, 1.1 +/- 0.4; P = 0.02), and overall mouth condition (mean difference, 1.4 +/- 0.9; P = 0.005). Taste of OGT was better than that of ASS (mean difference, 1.4 +/- 0.6; P = 0.04), as was OGT acceptability (mean difference, 1.4 +/- 0.9; P = 0.005). CONCLUSION Oxygenated glycerol triester lubricant oral spray was superior to a commercially available ASS in improving xerostomia and overall condition of the oral tissue.
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Affiliation(s)
- Stéphane J Mouly
- Assistance Publique-Hôpitaux de Paris, Unit of Therapeutic Research, Department of Internal Medicine, Lariboisière Hospital, Paris.
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Shiboski CH, Hodgson TA, Ship JA, Schiødt M. Management of salivary hypofunction during and after radiotherapy. ACTA ACUST UNITED AC 2007; 103 Suppl:S66.e1-19. [PMID: 17379158 DOI: 10.1016/j.tripleo.2006.11.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 11/09/2006] [Indexed: 11/30/2022]
Abstract
Salivary hypofunction, the most common complication of high-dose radiation therapy (RT) to the head and neck, has a significant impact on quality of life, and requires careful planning of long-term dental and oral care. This report documents the results and conclusions of an evidence-based literature review on multidisciplinary team management of salivary hypofunction during and after RT. An update is provided on the pathophysiology of salivary hypofunction during and after RT, and recommendations for clinical management. The paper presents aspects managed by dental professionals (use of cholinergic agonists and other saliva stimulants, prevention of hyposalivation-induced rampant caries, and use of saliva substitutes), as well as the role of the radiation oncologist in minimizing salivary gland damage (parotid-sparing RT; cytoprotectants). This summary includes basic science, translational and clinical research topics with respect to radiation-induced salivary hypofunction, and provides an evidence-based management algorithm.
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Affiliation(s)
- Caroline H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143-0422, USA.
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Mouly S, Salom M, Tillet Y, Coudert AC, Oberli F, Preshaw PM, Desjonquères S, Bergmann JF. Management of Xerostomia in Older Patients. Drugs Aging 2007; 24:957-65. [DOI: 10.2165/00002512-200724110-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Shahdad SA, Taylor C, Barclay SC, Steen IN, Preshaw PM. A double-blind, crossover study of Biotene Oralbalance and BioXtra systems as salivary substitutes in patients with post-radiotherapy xerostomia. Eur J Cancer Care (Engl) 2005; 14:319-26. [PMID: 16098116 DOI: 10.1111/j.1365-2354.2005.00587.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study assessed the efficacy of the Bioxtra (BX) and Biotène Oralbalance (OB) systems in the treatment of post-radiotherapy xerostomia. In a double-blind, crossover study, 20 patients with post-radiotherapy xerostomia were randomly allocated to receive either OB then BX, or vice versa, each product for 2 weeks, with a 1 week wash-out period in between. Subject-based dry mouth scores derived from 100-mm visual analogue scales were recorded at days 0 and 14 of each 2-week period, together with subjective perception of changes in dry mouth symptoms. Both treatments were effective, resulting in reduction of visual analogue scale scores from day 0-14. Between-groups comparisons identified that BX achieved significantly better improvements compared with OB for the perception of dry mouth and improvements in speech and was also rated as more pleasant to use than OB (P < 0.05). In conclusion, both treatments were effective in alleviating the symptoms of post-radiotherapy xerostomia, although BX achieved superiority in some of the outcomes assessed compared with OB.
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Affiliation(s)
- S A Shahdad
- Restorative Dentistry, Newcastle Dental Hospital, Newcastle-upon-Tyne, UK.
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Abstract
Dry mouth (xerostomia) is one of the most common complaints following radiation therapy (RT) for head and neck cancers. Notably, RT causes irreparable damage to salivary glands that increases the risk for severe and long-term oral and pharyngeal disorders. Several strategies in the treatment of head and neck cancers have been developed to prevent RT-induced salivary dysfunction while providing definitive oncologic therapy. These include salivary-sparing RT; cytoprotectants (such as amifostine); combination therapy of high-dose-rate intraoperative RT, external beam RT, plus a cytoprotectant; salivary gland surgical transfer; and gene therapy. Future research that incorporates biologic, pharmacologic, and technologic advancements that optimize therapeutic ratios and minimizes adverse oral sequelae is warranted.
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Affiliation(s)
- Jonathan A Ship
- Department of Oral Medicine and the Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY 10010-4086, USA
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Kelly HM, Deasy PB, Busquet M, Torrance AA. Bioadhesive, rheological, lubricant and other aspects of an oral gel formulation intended for the treatment of xerostomia. Int J Pharm 2004; 278:391-406. [PMID: 15196643 DOI: 10.1016/j.ijpharm.2004.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Revised: 03/09/2004] [Accepted: 03/18/2004] [Indexed: 11/23/2022]
Abstract
Xerostomia is commonly known as 'dry mouth' and is characterised by a reduction or loss in salivary production. A bioadhesive gel for its localised treatment was formulated to help enhance the residence time of the product, based on the polymer Carbopol 974P. The bioadhesion of various formulations was evaluated on different mucosal substrates, as simulations of the oral mucosa of xerostomic patients. Depending on the type of model substrate used, the mechanism of bioadhesion could alter. When the rheology of various formulations was examined, changes in bioadhesion were more easily interpreted, as the presence of other excipients caused an alteration in the rheological profile, with a change from a fully expanded and partially cross-linked system to an entangled system. Improving the lubricity of the product was considered important, with optimum incorporation of vegetable oil causing a desirable lowering of the observed friction of the product. The final complex formulation developed also contained salivary levels of electrolytes to help remineralisation of teeth, fluoride to prevent caries, zinc to enhance taste sensation, triclosan as the main anti-microbial/anti-inflammatory agent and non-cariogenic sweeteners with lemon flavour to increase the palatability of the product while stimulating any residual salivary function.
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Affiliation(s)
- H M Kelly
- School of Pharmacy, Trinity College, University of Dublin, Ireland
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Abstract
Maintaining oral health in the critically ill patient is imperative in reducing the risk of nosocomial infections and improving patient comfort and discharge outcomes. Critically ill patients are at great risk for poor oral health as many are elderly, undernourished, dehydrated, immunosuppressed, have a smoking or alcohol history, are intubated or on high-flow oxygen, and are unable to mechanically remove dental plaque. Many modalities for delivering oral care have been reported in the literature. The use of the toothbrush in the mechanical removal of plaque, even in the intubated patient, has been proven to be superior to the swab. Brushing of the gums in edentulous patients is of benefit. Although electric toothbrushes are preferable, their cost, size and the potential for cross-infection limits their use. Chlorhexidine has long been the gold standard for mouthwashes and provides up to 24 hours of antimicrobial activity; therefore infrequent applications are adequate. Sodium bicarbonate and hydrogen peroxide are of limited use due to lack of convincing evidence regarding their safety and antimicrobial effects in the critically ill population. Saliva stimulants or substitutes including lemon and glycerine are also inappropriate for moistening the oral cavity in the critically ill patient. Regular oral assessment and individualized oral care, along with the use of a standardised protocol for oral care (incorporating proven modalities) is vital for optimal oral care in the critically ill patient.
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Affiliation(s)
- Marianne O'Reilly
- Intensive Care Services, Royal Prince Alfred Hospital, Camperdown, NSW
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Abstract
The results of the present systematic review of randomized controlled trials published in peer-reviewed journals demonstrate the presence of a wide variety of biases and the weakness of the existing literature of xerostomia treatment. The report of statistically significant efficacy on an outcome measure is only meaningful in the setting of a well-controlled, appropriately designed clinical trial. This points to the importance of evaluating the quality of the clinical trial closely when deciding if study results are applicable to a specific patient population. Future studies in the management of xerostomia will require an increased effort on the part of investigators to eliminate easily recognized flaws during the planning stages of a clinical trial. Minimizing bias in clinical studies will allow for easier interpretation and comparisons of different studies. Better clinical trial design is vital to provide maximal confidence in the efficacy of xerostomia interventions.
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Affiliation(s)
- Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Post Office Box 3280, Charlotte, NC 28232, USA.
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Abstract
Xerostomia is often considered to be merely a physical problem. The aim of this study was to explore the global effects of xerostomia, with a specific focus on psychological and social consequences. Semi-structured, tape-recorded interviews were conducted with 16 patients with advanced malignancies and symptomatic xerostomia. A phenomenographic (qualitative) analysis was performed. Four main categories were identified in the study: 1) subjective discomfort, e.g. dryness or burning sensation, 2) loss of function, e.g. articulation or swallowing, (3) increased infection, (oral thrush and ulcerations), 4) psychosocial effects, including shame, increased feelings of being a patient rather than a person and a tendency to avoid social contact, resulting in loneliness. Xerostomia and its associated symptoms have a considerable, negative global impact, resulting in shame, anxiety, disappointments and verbal communication difficulties. There should therefore be more focus on the management of xerostomia, which is often neglected in palliative care.
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Affiliation(s)
- J A Ship
- Department of Oral Medicine and The Bluestone Center for Clinical Research, New York University College of Dentistry, New York 10010-4046, USA.
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Affiliation(s)
- A M Cook
- Velindre NHS Trust and Holme Tower, Marie Curie Centre, Cardiff
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Abstract
Poor oral health is an extremely common problem in patients with advanced cancer and, because of its impact on quality of life, promoting oral care should be regarded as a priority by every hospice and palliative care team. At Accord Hospice, Paisley, UK, a protocol for oral care has been developed which is simple, inexpensive and evidence-based. Evaluation of the protocol has shown that it can lead to significant and consistent improvements in oral health and comfort. A survey of mouth-care practices in other Scottish hospice units reveals that although much agreement exists, certain practices that are unsupported by research evidence are still undertaken.
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Affiliation(s)
- S Milligan
- University of Paisley and Ardgowan Hospice, Greenock, UK
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Abstract
Dry mouth must not be considered a trivial problem in the population, since it constitutes a phenomenon with many aspects relative to oral function as well as quality of life. Up until today, no global consensus has been reached with regard to the terminology of dry mouth, creating a substantial problem for research, education, diagnosis, and therapy. In this report, salivary gland hypofunction has been selected as the overarching term for subjective symptoms and objective signs of dry mouth. Its different aspects--xerostomia, hyposalivation, and altered saliva composition--are reviewed with respect to prevalence, diagnosis, and etiology. It is concluded that these aspects of salivary gland hypofunction are separate entities, which in many respects are interrelated, constituting not merely a dental but also a medical and social concern.
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Affiliation(s)
- T Nederfors
- Oral Health Centre, Central Hospital, Halmstad, Sweden.
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Abstract
This was a prospective, randomized, open, crossover study comparing a mucin-based artificial saliva (Saliva Orthana) with a low-tack, sugar-free chewing gum (Freedent) in the management of xerostomia in patients with advanced cancer. The conclusions of this study were that both Saliva Orthana and Freedent are effective in the management of xerostomia in patients with advanced cancer, that both Saliva Orthana and Freedent cause some side-effects in this group of patients, and that patients with cancer think that chewing gum is an acceptable treatment. Sixty-nine per cent of the patients preferred the chewing gum to the artificial saliva. Furthermore, the chewing gum scored better than the artificial saliva on every measure of efficacy. However, none of these results reached statistical significance.
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Abstract
Oral complications are common among patients with advanced cancer, though relatively little research has been undertaken in this field. This review article discusses the common problem of xerostomia among the terminally ill, together with an overview of oral candidosis, oral viral infections, chemotherapy- and radiotherapy-associated mucositis, and alterations in taste sensation among those with advanced cancer. Suggested management regimes, based on the limited clinical trial data available, are provided where appropriate.
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Affiliation(s)
- M P Sweeney
- University of Glasgow Dental School, Glasgow, Scotland
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OICPC Therapeutic Highlights—. Progress in Palliative Care 2000; 8:276-277. [DOI: 10.1080/09699260.2000.11746884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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