Parotid hypersalivation after inferior salivatory nucleus glutamate/NMDA receptor excitation in the rat

Although salivation is essential during eating behavior, little is known about the brainstem centers that directly control the salivary glands. With regard to the inferior salivatory nucleus (ISN), the site of origin of the parasympathetic preganglionic cell bodies that innervate the parotid glands, previous anatomical studies have located it within the rostrodorsal medullary reticular formation. However, to date there is no functional data that shows the secretory nature of the somas grouped in this region. To activate only the somas and rule out the activation of the efferent fibers from and the afferent fibers to the ISN, in exp. 1, NMDA neurotoxin was administered to the rostrodorsal medullary region and the secretion of saliva was recorded during the following hour. Results showed an increased secretion of parotid saliva but a total absence of submandibular-sublingual secretion. In exp. 2, results showed that the hypersecretion of parotid saliva after NMDA microinjection was completely blocked by the administration of atropine (a cholinergic blocker) but not after administration of dihydroergotamine plus propranolol (α and β-adrenergic blockers, respectively). These findings suggest that the somata of the rostrodorsal medulla are secretory in nature, controlling parotid secretion via a cholinergic pathway. The data thus functionally supports the idea that these cells constitute the ISN.

Efficacy and influencing factors of cervical perivascular sympathectomy in children with cerebral palsy

BACKGROUND

There is a lack of research to determine the efficacy of cervical perivascular sympathectomy (CPVS) in children with cerebral palsy (CP).

OBJECTIVE

This study aimed to evaluate the efficacy of CPVS in children with CP and analyze the associated influential factors.

METHODS

Using the method of retrospective cohort studies, children who underwent CPVS were included in the CPVS group, whereas those who underwent selective posterior rhizotomy (SPR) were included in the SPR group. The Communication Function Classification System (CFCS) and Teacher Drooling Scale (TDS) were used to evaluate the communication function and salivation in the two groups before and 12 months after surgery and compare the surgical efficiency between the two groups, and the factors affecting the efficacy were screened by binary logistic regression.

RESULTS

The study included 406 patients, 202 in the CPVS group and 204 in the SPR group. No significant differences were observed in the baseline characteristics (p > 0.05). The surgical efficacy of the CPVS group (47.01%) was significantly higher than that in the SPR group (9.81%) (χ2 = 71.08, p < 0.001). Binary logic regression analysis showed that preterm birth and Gross Motor Function Classification System (GMFCS) grade were influencing factors of surgical efficacy. Eighteen patients developed postoperative complications.

CONCLUSION

CPVS is a safe and effective surgery for cerebral palsy. Preterm birth and GMFCS grade are independent factors affecting the efficacy of surgery.

Association between salivary flow and dental caries in institutionalized adolescents: Cross-sectional study

Background

Brazil has a larger number of adolescent offenders, but studies evaluating their oral health are still limited.

Objective

Assess the association between salivary flow and caries experience in youngsters deprived of liberty.

Methodology

Sixty-eight male adolescents in conflict with the law, aged between 15 and 19 years, from a Socio-Educational Assistance Center in Brazil participated in the present study. They answered a structured questionnaire, and oral examination was performed by the Decayed, Missing, and Filled Teeth (DMFT) index. The salivary flow rate was obtained using the mechanically stimulated total saliva method. Adjusted Poisson regression was used for the association with total DMFT and its decayed component, using the salivary flow (continuous fashion) or the hyposalivation (≤1 ml/min) as independent variables.

Results

Participants were divided into two groups, those who did not have any decayed teeth at the moment of the examination (n = 39) and those who had at least one decayed tooth (n = 29). Moreover, two groups were formed based on the DMFT: those who had DMFT = 0 (n = 20) and those who had DMFT≥1 (n = 48). In the multivariate analysis, hyposalivation was associated with DMFT≥1 (p = 0.048), but when the salivary flow was included, no significant association with DMFT index was identified (p = 0.178). Conversely, the presence of at least one decayed tooth was significantly associated with the salivary flow (p = 0.004), but not with hyposalivation (p = 0.091).

Conclusions

Institutionalized adolescents who present hyposalivation or low salivary flow are associated with DMFT≥1 index or presence of at least one decayed tooth, respectively.

The Mechanism of Core Chinese Medicine Combination in Treating Salivation

OBJECTIVE

To analyze the regularity of modern Chinese herbal compound in the treatment of salivation based on data mining technology, and to study the potential mechanism of core Chinese herbal medicine in the treatment of salivation using network pharmacology and molecular docking.

METHODS

CNKI, VIP and Wanfang literature databases were searched.Choose a prescription for salivation.Excel2019 was used to establish a database of formulas for the treatment of salivation.The included TCM compounds were analyzed by frequency statistics and association rules using the ancient and modern medical record cloud platform to obtain the core drug pairs.TCMSP and Uniprot were used to search the components and targets of the core drug pairs, and intersected with the disease targets obtained from Genecards, OMIM, TTD, PharmgKb, and DrugBank platforms.Complex networks were constructed by cytoscape3.9.1; PPI networks were completed by STRING platform; GO and KEEG pathway enrichment analysis was performed by R language; finally molecular docking validation was performed using AutoDockTools software; and the results were visualized by Pymol software.

RESULTS

122 prescriptions were obtained, 194 herbs were used, the total frequency was 1047, and the top ten drugs used were Atractylodes macrocephala Koidz, Poria cocos, Glycyrrhiza uralensis, Yizhiren, Citrus sinensis, Codonopsis pilosula, Yam, Pinellia ternate, Zingiber officinale, and Coptis chinensis.After association rule analysis, the core drug pair Codonopsis pilosula - Atractylodes macrocephala Koidz was obtained.Twenty-seven effective active components of core drug pairs were screened, corresponding to 62 targets for the treatment of salivation, and four core targets were MAPK1, TP53, MAPK14, and ESR1.GO enrichment analysis yielded 1789 biological process entries, 81 cellular component entries and 111 molecular function entries.KEGG enrichment analysis resulted in 157 pathways, and the first 30 were selected for visualization.Molecular docking of luteolin, 7-Methoxy-2-methyl isoflavone, Stigmasterol, 3β-acetoxyatractylone, Frutinone A, 3betaHydroxymethyllenetanshiquinone, glycitein to the core target showed that the key active components had good binding activity to the core target.

CONCLUSION

The key active components of Codonopsis pilosula and Atractylodes macrocephala Koidz in the treatment of salivation act on MAPK1, TP53, MAPK14 and ESR1 through Calcium, PI3K Akt and IL-17 signaling pathways to regulate the physiological processes of nerve, muscle, endocrine and reproductive systems and the physiological functions of nerve cells, providing a theoretical reference for the later study of integrated traditional Chinese and western medicine in the treatment of salivation.

The Role of Uroguanylin in Regulation of Ion Transport in Salivary Glands

Objectives

Guanylin peptides are considered to be the only intrinsic regulators of salivary glands secretion. Therefore, the aim of this study was to determine the effects of systemic uroguanylin (UGN) of the salivary flow and ion composition. Besides, the objective was to investigate whether those effects include activation of guanylate cyclase C (GC-C).

Material and Methods

This study was conducted on 7 months old C57Bl6NCrl (wild type, WT) and GC-C knockout (KO) mice. Salivary flow rate and ion composition were determined after pilocarpine stimulation with UGN (30 µg/animal) or saline i.p. application. The expression of mRNA for AQPs, NHEs, NBCn1, Slc26a3/a6 and CFTR were determined by qPCR in submandibular salivary glands.

Results

When applied i.p., UGN decreased the pilocarpine stimulated saliva flow rate and increased the concentration of Na+, H+ and Cl-. In GC-C KO mice, UGN showed no effect on saliva flow rate, while the concentrations of Na+, H+ and Cl- are the same in GC-C KO littermates when compared to WT mice. UGN increased expression of Slc26a6 while in GC-C KO mice Slc26a6 had a higher expression when compared to WT mice, suggesting involvement of GC-C independent signalling pathway for UGN. The difference in Slc26a6 in GC-C KO mice is not unique for salivary glands because it was also found in duodenum and kidney cortex.

Conclusions

The effects of UGN via basolateral membrane of salivary glands cells have not been considered up to date. In our study, UGN, when applied i.p., decreased salivary flow rate, pH, and changed the composition of other ions. Therefore, plasma UGN, an hour after a meal, could have physiological and pathological importance (development of cavities, inflammations or demineralizations), and the inhibition of systemic UGN effects could be considered a new approach in treatment of those conditions.

Microinjection of NMDA-neurotoxin into the superior salivatory nucleus of the rat: Short-term secretory and long-term drinking behavior effects

The anatomical location of the superior salivatory nucleus (SSN), the site of origin of the parasympathetic preganglionic cell bodies that innervate the submandibular-sublingual salivary glands, is well established in rats. However, as of yet there is no functional data that convincingly shows the secretory nature of this region. Previous studies have not been able to differentiate between interventions on efferent or afferent fibers connected to the SSN versus interventions on the salivatory nucleus itself. Taking advantage of the fact that salivatory neurons express NMDA-receptors on their somas, in the present study SSN cell bodies were activated and lesioned sequentially by means of intracerebral application of NMDA-neurotoxin. In exp. 1 two effects, a short- and a long-term effect, were observed following NMDA administration. The first effect was high submandibular-sublingual saliva secretion during the hour following administration of the neurotoxin and the second was a profound change in drinking behavior once the animals recovered from the lesion. Thus, on post-surgery days 16, 17 and 18, the rats exhibited hyperdipsia in the presence of dry food but not in the presence of wet food. In expt. 2 results showed that saliva hypersecretion observed after NMDA-microinjection was completely blocked by the administration of atropine (a cholinergic blocker) but not after the administration of dihydroergotamine plus propranolol (α and β-adrenergic blockers, respectively). From a functional perspective, these data suggest that the somata of the parvocellular reticular formation control the secretory activity of the submandibular-sublingual salivary glands and thus constitute the SSN.

Recovery of gland function after endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton's duct

The aim of this study was to evaluate the gland function of patients following endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton's duct. The study cohort comprised 115 patients who had undergone successful endoscopy-assisted lithotomy for hilo-parenchymal stones (mean diameter 7.7 mm). Gland function was evaluated at a mean 12 months after surgery using ultrasonography, sialography, and/or sialometry. Postoperative ultrasonography of 51 affected glands revealed a regular gland size in 58.8%, normal parenchyma density in 51.0%, and ductal ectasia in 80.4%. Postoperative sialograms of 109 affected glands were scored as type I (approximately normal) in 13 cases, type II (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and no contrast retention) in 64, type III (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and mild contrast retention) in 23, and type IV (poor shape of the main duct with evident contrast retention) in nine cases. The existence of ductal ectasia corresponded well to larger stone cases (P = 0.002). In the postoperative sialometry of 35 patients with unilateral stones, differences between the two sides were insignificant (P > 0.05). For patients with hilo-parenchymal submandibular gland stones, endoscopy-assisted surgery and extended postoperative follow-up help preserve the gland with good function.

Reactivity to food cues in spicy food cravers: Physiological and behavioral responses

In China, the rate of spicy food consumption is rising, and chili pepper is among the most popular spicy foods consumed nationwide. According to the 'cued overeating' model, visual and olfactory cues of food can lead to changes in physiological responses and increase the likelihood and amount of food intake. However, no studies have explored the role of spicy food cues in cue reactivity among spicy food cravers. The exploratory study aimed to investigate cue-induced physiological responses, subjective cravings, eating behaviors and their associations in spicy food cravers. A group of spicy cravers (n = 59) and a group of age- and sex-matched non-cravers (n = 60) were exposed to food cues that contained or did not contain chili, during which physiological responses and food consumption were measured. The results revealed that spicy food cravers showed increased salivation and heart rate in response to food cues that contained chili compared to cues without chili and consumed significantly more chili oil after chili exposure. For cravers, heart rate during chili exposure was positively correlated with changes in subjective spicy food craving, and increases in subjective spicy food craving during chili exposure positively predicted subsequent chili oil consumption. The current exploratory study confirms the 'cued overeating' model and extends previous findings on food cravings, showing that even though chili peppers can elicit aversive oral burns and pain, they share the same physiological mechanism underlying cue reactivity as other kinds of cravings.

The effect of botulinum neurotoxin A on soft-tissue complications in intraoral reconstructions

BACKGROUND

Intraoral reconstruction has become more common in recent years. Patients may suffer from complications because of hypersalivation. This issue can be overcome with an aid aimed at reducing saliva production. In this study, patients who underwent flap reconstruction were examined. The aim was to compare the complication rates between those who were administered with botulinum neurotoxin type A (BTXA) to the salivary glands before the reconstruction and those who were not.

METHODS

Patients who underwent flap reconstruction between January 2015 and January 2021 were included in the study. The patients were divided into 2 groups. BTXA was applied to the parotid and submandibular glands in the 1st group at least 8 days before the operation to reduce the salivary secretion. BTXA application was not applied to the patients in the 2nd group before the operation.

RESULTS

A total of 35 patients were included in the study. There were 19 patients in group 1 and 16 patients in group 2. The tumor type in both groups was squamous cell carcinoma. For patients in the 1st group, salivary secretion decreased in an average of 3.84 days. In the statistical analysis, no significant difference was found between the groups in terms of age, comorbidity, smoking-complication development, and comorbidity-complication development. When infection was excluded, there was a significant difference in the development of complications between the groups.

CONCLUSIONS

BTXA application before the operation is beneficial to minimize complications in patients who plan to undergo elective intraoral reconstruction.

Proton Pump Inhibitor Treatment Has Little Effects on Secretion of Saliva in Patients with Proton Pump Inhibitor-Responsive Mild Reflux Esophagitis and Non-Erosive Reflux Disease

INTRODUCTION

The secretion of saliva, which is triggered by acid reflux into the esophagus via the esophagosalivary reflex, plays a crucial role in the defensive mechanisms of the esophagus. The volume of saliva secreted in patients with gastroesophageal reflux disease (GERD) is reduced. However, the effects of proton pump inhibitors (PPI) on the secretion of saliva have rarely been reported. Therefore, the present study investigated changes in the volume and pH of saliva after the cessation of PPI.

MATERIALS AND METHODS

We retrospectively reviewed the records of consecutive patients previously diagnosed with mild reflux esophagitis (RE) or non-erosive reflux disease (NERD) controlled with PPI (including vonoprazan) who performed the salivary secretion test before and after a 2-week cessation of PPI. The volume, pH, and pH after acid loading (buffering capacity) of saliva were compared before and after the cessation of PPI.

RESULTS

Thirty-two patients (25 NERD, 7 mild RE) were included. The second saliva test was performed a median interval of 14 months [12.0-15.3] after the first test. No significant differences were observed in the volume of saliva secreted before and after the cessation of PPI (before 4.0 mL [2.7-6.0] vs. after 4.0 mL [2.3-5.9], p = 0.894). No significant differences were noted in pH or changes in pH after acid loading before and after the cessation of PPI (pH: before 7.1 ± 0.24 vs. after 7.0 ± 0.24, p = 0.1. Delta pH after acid loading: before 1.0 [0.8-1.2] vs. after 1.0 [0.8-1.2], p = 0.844).

CONCLUSION

The cessation of PPI did not appear to affect the volume, pH, or buffering capacity of saliva in patients with PPI-responsive mild RE and NERD.

Functional gland-preserving surgery for submandibular gland pleomorphic adenoma

PURPOSE

Conventional surgery for submandibular gland tumour is total excision of the gland affected by the tumour. Gland-preserving surgery is commonly used for benign tumours arising in the parotid gland but not in the submandibular gland. This study evaluated long-term oncological and functional outcomes after gland-preserving surgery in patients with pleomorphic adenoma of the submandibular gland via the submental approach.

METHODS

This longitudinal study included 105 consecutive patients with submandibular gland pleomorphic adenoma who underwent the gland-preserving surgery combined with the en-bloc resection of tumours via the submental approach. Salivary scintigraphy was performed 6 months after surgery, and ultrasonography was regularly followed. Intraoperative findings, postoperative complications, cosmetic and salivary functions, and tumour recurrence were assessed in these patients.

RESULTS

Median tumour size and submental incision length were 2.0 and 3.3 cm, respectively. Median operation time and amount of blood loss were 25 min and 18.5 mL, respectively. None had marginal or lingual nerve paralysis and most patients were satisfied with incision scar and facial contour. The salivary function of the affected gland was equal to that of the unaffected gland. One patient (0.9%) had single nodular recurrence 54 months after surgery and others had no recurrence for follow-up of median 96 months.

CONCLUSIONS

Pleomorphic adenoma of the submandibular gland can be safely removed by the gland-preserving surgery via the submental approach which has operation time, cosmetic and functional benefits with compromising oncological outcomes.

Situating desire: Situational cues affect desire for food through eating simulations

How do situations influence food desire? Although eating typically occurs in rich background situations, research on food desire often focuses on the properties of foods and consumers, rather than on the situations in which eating takes place. Here, we take a grounded cognition perspective and suggest that a situation that is congruent with consuming a food increases simulations of eating it, which, in turn, affect desire, and the expected and actual liking of the food. We tested this idea in four pre-registered experiments (N = 524). Participants processed an image of a food presented in a congruent situation, an incongruent situation, or no background situation. Compared to the incongruent situation, the congruent situation increased expected liking of the food and desire, and this was partially or fully mediated by eating simulations. The congruent situation also increased salivation, a physiological indicator of preparing to eat. However, there was only weak and indirect evidence for congruence effects on actual liking of the food when tasted. These findings show that situational cues can affect desire for food through eating simulations. Thus, background situations play an important but understudied role in human food desires. We address implications for research using food images, and for applications to promote healthy and sustainable eating behaviour.

Effects of low-level light therapy on xerostomia related to hyposalivation: a systematic review and meta-analysis of clinical trials

Hyposalivation is a condition represented by a reduced salivary flow and may include symptoms such as mouth dryness (xerostomia), loss of taste, pain, dysphagia, and dysphonia, all of which greatly affect an individual's quality of life.The aim of the present study was to systematically review the effects of low-level light therapy irradiation (photobiomodulation) on salivary gland function in patients with hyposalivation.The main question of the systematic review was: "Does low-level light irradiation therapy of the salivary glands affect salivary flow rate or indicators of salivary function (ion and protein concentrations) in patients with xerostomia or hyposalivation?" The question was based on the PICO (participant, intervention, control, outcome) principle and followed the PRISMA guidelines. Databases were explored and papers published between the years 1997 and 2020 were reviewed for the following Mesh-term keywords and their corresponding entry terms in different combinations: "Low-level light therapy," "Xerostomia," "Saliva," "Salivary glands," "Salivation."The initial sample consisted of 220 articles. Of those, 47 articles were used for full-text analysis and 18 were used for a systematic review, 14 were used in meta-analysis. According to their individual quality, most articles were classified as high quality of evidence according to the GRADE score. Meta-analysis of the evidence observed increase of unstimulated salivary flow 0.51 SMD compared to placebo (95% CI: 0.16-0.86), I² = 50%, p = 0.005.The findings of our review revealed evidence of a beneficial effect of photobiomodulation therapy on salivary gland function. The therapy alleviates xerostomia and hyposalivation. However, these effects are reported short term only and did not induce lasting effects of photobiomodulation therapy on patients' quality of life.

Bedbug salivation patterns during hematophagy in the skin of a mammalian host

Cimex lectularius (Hemiptera:Cimicidae) infestations have increased over the past decades in several parts of the world, constituting a major urban pest with no reversion signs. The impact on human health caused by these insects, commonly known as bedbugs, is associated with their obligatory hematophagous habit. Allergies induced by hematophagous arthropod bites are related to the deposition of salivary molecules in the host tissues. Many reports of humans developing severe allergic reactions due to bedbug bites have been recorded, however, there is limited information on the salivation of bedbugs on the host, which was the objective of this study. C. lectularius females were fed on blood containing acridine orange fluorochrome, which labeled the principal salivary glands content. The salivation pattern of bedbugs was investigated using intravital microscopy during its blood meal on the ear skin of hairless mice. Saliva deposition occurred during all insect blood-feeding phases, beginning as soon as the mouthpart touched the host skin. During the probing phase, saliva was deposited in large quantities in the host dermis. In contrast, during the engorgement phase (which represents the largest blood meal of the insects), saliva was released at a much slower rate. The apparent release of saliva into the cannulated vessel and/or adjacent tissue occurs only sporadically during insect blood ingestion. However, a small area (spot) of fluorescence was detected around the proboscis tip during this feeding phase. An interesting feature of bedbugs is that they release saliva inside and outside the vessels without removing their mouthparts from the vessel lumen. This is an effective feeding strategy because it does not interrupt blood ingestion and decreases the mouthparts movements on the host's skin, minimizing the damage to tissues and contact time with the host (feeding time).

Subthreshold chemesthetic stimulation can enhance flavor lastingness of a soft chewable candy

In addition to taste and aroma components of a flavor, FEMA GRAS approved chemesthetic flavor ingredients deliver a trigeminal experience or chemesthetic effect and provide a third dimension to overall flavor experience. In this study, we explored the impact of chemesthetic stimulation on dynamic flavor perception, acceptability and salivation, with two base flavors (mint, watermelon), using a soft chewable candy as a model food. Each base flavor was augmented with three increasing levels of a mixture of chemesthetic flavor ingredients, which provided a cooling sensation; subthreshold, detection threshold, and supra-threshold levels. Thirty-six panelists were asked to rate the perceived flavor intensity of each sample during eating and after swallowing using time intensity analysis. Lastingness after swallowing was measured as the time for the flavor intensity to drop below 25% of the maximum intensity perceived during chewing. Compared with the control, the addition of chemesthetic flavor ingredients increased the perceived flavor intensity during chewing and the flavor lastingness after swallowing for both mint and watermelon flavor. These effects started from the addition of subthreshold concentration of chemesthetic flavor ingredients and further increased with increasing the concentration of chemesthetic flavor ingredients added. By adding the subthreshold concentration of chemesthetic flavor ingredients, the flavor lastingness was increased by 32% for mint flavor and 22% for watermelon flavor. The acceptability of these weak-flavored soft chewable candy test samples was significantly increased towards 'just right' with increasing concentrations of chemesthetic flavor ingredients, even at subthreshold level. However, chew time and saliva flow rate were not affected by the addition of chemesthetic flavor ingredients. The increased flavor lastingness by the addition of chemesthetic flavor ingredients could therefore be explained by perceptual interaction between chemesthesis and flavor perception.

Neurochemical regulation of Aedes aegypti salivary gland function

The salivary gland of hematophagous arthropods is critical for blood meal acquisition, blood vessel localization, and secretion of digestive enzymes. Thus, there is significant interest in the regulation of salivary gland function and mechanisms driving the secretion of saliva and digestive proteins. We aimed to gain a broader understanding of the regulatory role of aminergic, cholinergic, and octopaminergic neuromodulators to saliva and protein secretion from the female A. aegypti salivary gland. Quantification of saliva after injection with neuromodulators showed that dopamine, serotonin, and pilocarpine increased the secretory activity of the salivary gland with potency rankings dopamine = serotonin > pilocarpine. No change in saliva secretion was observed with octopamine or ergonovine, which indicates the A. aegypti salivary gland may be regulated by dopaminergic, serotonergic, and cholinergic systems, but are not likely regulated by octopaminergic or tryptaminergic systems. Next, we studied the regulatory control of dopamine-mediated salivation. Data indicate extracellular calcium flux, but not neural function, is critical for dopamine-mediated salivation, which suggests epithelial transport of ions and not neuronal control is responsible for dopamine-mediated salivation. For regulation of protein secretion, data indicate dopamine or serotonin exposure facilitates amylase secretion, whereas serotonin but not dopamine exposure increased apyrase concentrations in the secreted saliva. General immunoreactivity to anti-rat D1-dopamine receptor antibody was observed, yet immunoreactivity to the anti-rat D2-receptor antibody was identified in the proximal regions of the lateral lobes and slight immunoreactivity in the distal portion of the lateral lobe, with no expression in the medial lobe.

Association between anorexia and hyposalivation in community-dwelling older adults in Japan: a 6-year longitudinal study

BACKGROUND

Hyposalivation is associated with the nutritional status. Anorexia of ageing, defined as an age-related decrease in appetite and food intake, presents even in healthy adults and is considered an independent predictor of malnutrition, frailty, and mortality. However, the relationship between anorexia and hyposalivation of ageing is unclear. Thus, the present longitudinal study aimed to investigate the incidence of hyposalivation and its relationship with anorexia in community-dwelling older people in Japan.

METHODS

The study population comprised 220 individuals (80 men and 140 women) aged 65-86 years at baseline. The participants underwent comprehensive health check-ups, including dental examinations and anthropometry, and face-to-face interviews in 2013 and 2019. Hyposalivation was determined on the basis of the unstimulated salivary flow rate measured using the modified cotton roll method. Anorexia was defined as a score of ≤29 in the Japanese version of the Council on Nutrition Appetite Questionnaire. Logistic regression analyses were used to test whether the presence of anorexia at baseline was an independent predictor of hyposalivation.

RESULTS

Hyposalivation developed at a rate of 19.5% during the 6-year observation period. Anorexia was observed in 95 (43.2%) participants at baseline. After adjusting for potential confounding factors, anorexia (adjusted odds ratio [AOR], 2.65; 95% confidence interval [CI], 1.26-5.57) and polypharmacy (AOR, 3.29; CI, 1.06-10.19) were significant predictors of hyposalivation.

CONCLUSION

Loss of appetite is independently correlated with and a risk factor for hyposalivation in older adults. Anorexia of ageing may have negative effects on the salivary flow rate in such settings. Salivation should be a standard feature in clinical assessments of the older adults.

Salivary flow, amylase, and total protein in hospitalized patients with HIV infection / AIDS complications

BACKGROUND

Saliva is a complex secretion produced daily by the salivary glands. Saliva consists mainly of water, enzymes, ions and amino acids and performs several important functions in oral health.

OBJECTIVE

The aim of this study was to investigate the flow rate and concentrations of amylase and total proteins in the saliva of hospitalized patients due to AIDS complications.

METHODS

Ninety-three men and women (20-64 years of age) were divided into two groups (46 HIV-infected patients and 47 controls) and had salivary flow rate and levels of amylase enzyme and total proteins evaluated.

RESULT

The mean salivary flow rate was lower in individuals with HIV when compared to controls (P < 0.05). No significant difference between amylase enzyme levels and total proteins were observed in the saliva of patients with HIV infection when compared to controls.

CONCLUSION

Individuals with HIV / AIDS infection (in hospital treatment) suffer no interference in levels of amylase and total salivary proteins, but they have significantly reduced salivary flow.

Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study

Background

For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and post-intervention study with historical controls tested the effects of a swallowing and oral care (SOC) intervention on patients’ time to resume oral intake and salivary flow following endotracheal extubation.

Methods

The sample comprised intensive care unit patients (≥ 50 years) successfully extubated after ≥ 48 h endotracheal intubation. Participants who received usual care (controls, n = 117) were recruited before 2015, and those who received usual care plus the intervention (n = 54) were enrolled after 2015. After extubation, all participants were assessed by a blinded nurse for daily intake status (21 days) and whole-mouth unstimulated salivary flow (2, 7, 14 days). The intervention group received the nurse-administered SOC intervention, comprising toothbrushing/salivary gland massage, oral motor exercise, and safe-swallowing education daily for 14 days or until hospital discharge.

Results

The intervention group received 8.3 ± 4.2 days of SOC intervention, taking 15.4 min daily with no reported adverse event (coughing, wet voice, or decreased oxygen saturation) during and immediately after intervention. Participants who received the intervention were significantly more likely than controls to resume total oral intake after extubation (aHR 1.77, 95% CI 1.08–2.91). Stratified by age group, older participants (≥ 65 years) in the SOC group were 2.47-fold more likely than their younger counterparts to resume total oral intake (aHR 2.47, 95% CI 1.31–4.67). The SOC group also had significantly higher salivary flows 14 days following extubation (β = 0.67, 95% CI 0.29–1.06).

Conclusions

The nurse-administered SOC is safe and effective, with greater odds of patients’ resuming total oral intake and increased salivary flows 14 days following endotracheal extubation. Age matters with SOC; it more effectively helped participants ≥ 65 years old resume total oral intake postextubation.

Trial registration

NCT02334774, registered on January 08, 2015

Quantitative Analysis of Parotid Gland Secretion Function in Sjögren's Syndrome Patients with Dynamic Magnetic Resonance Sialography

Objective

To evaluate the secretory function of parotid glands by dynamic magnetic resonance (MR) sialography and determine the clinical performance of this technique in diagnosing and evaluating Sjögren's syndrome (SS) patients.

Materials and Methods

This study enrolled 29 healthy volunteers (25 women and 4 men; mean age, 34.8 ± 6.3 years; age range, 26–47 years) and 25 primary SS (pSS) patients (23 women and 2 men; mean age, 37.7 ± 7.9 years; age range, 25–50 years) with decreased secretory function. The volume of the parotid gland ducts was precisely measured for both groups at single pre- and 6 post-gustatory-stimulated phases. Time-dependent volume change ratio curves were generated, four parameters were derived from the curves: the slope of the increase in the first post-stimulation phase (slope_1st), the peak value, the time-to-peak, the total saliva secretion post-stimulation. All values were used to quantitatively evaluate the secretory function of the parotid gland. The repeated measurement analysis, Mann-Whitney U test and receiver operating characteristic curve were applied.

Results

Time-dependent volume change ratio curves demonstrated that there is a statistically significant difference between the two groups (F = 8.750; p = 0.005). A quickly increasing curve was shown in the volunteer group, whereas a slowly increasing curve was shown in the pSS patient group. The slope_1st, peak value and total saliva secretion post-stimulation of the patient group were significantly lower than those of the volunteer group (p = 0.005, p = 0.003, and p = 0.002, respectively). The time-to-peak between the two groups was not significantly different (p = 0.383). The slope_1st can be used as a discriminator to diagnose SS patients (p = 0.015; odds ratio = 4.234; area under the curve = 0.726).

Conclusion

Dynamic MR sialography is proven to be an effective method in evaluating salivary gland function and has a great potential in diagnosing and evaluating pSS patients.

Repetitive Saliva Swallowing Test: Norms, Clinical Relevance and the Impact of Saliva Secretion

Screening tests can be performed to identify stroke patients who require further assessment of swallowing function. The Repetitive Saliva Swallowing Test (RSST) is a screening test during which the patient is asked to swallow saliva as many times as possible for 30 s, while deglutition is counted through palpation of the larynx. This study aimed to establish normative values for three age groups of non-patients (total N = 120) on RSST. One patient group (N = 40) was also recruited from a geriatric stroke unit to assess whether RSST scores predicted outcomes on the Standardised Swallowing Assessment—Svenska (SSA-S), a clinical screening tool here used as a reference test. Since the RSST involves the swallowing of saliva, this study also measured the participants’ saliva secretion in order to examine its effect on RSST performance. This study showed that RSST results vary with age (lower among older) and gender (higher for men than women), while the number of doctor-prescribed medications, objective saliva secretion and self-assessed dryness of mouth did not affect the performance significantly. In comparison to a more extensive clinical screening procedure (SSA-S), the RSST correctly predicted 93% of negative cases and 69% of positive cases. This suggests that patients who show signs of aspiration according to SSA-S have a lower probability of detection with RSST.

Evaluation of laser therapy and alpha-lipoic acid for the treatment of burning mouth syndrome: a randomized clinical trial

The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) and alpha-lipoic acid (ALA) in the treatment of burning mouth syndrome (BMS) and secondary oral burning (SOB) by unstimulated sialometry, symptom assessment, and measurement of salivary TNF-α levels. Forty-four patients were randomized into four treatment groups: BMS/laser (n = 10), BMS/ALA (n = 5), SOB/laser (n = 15), and SOB/ALA (n = 14). The control group consisted of eight healthy female subjects. Unstimulated salivary flow was measured before and after treatment, and the collected saliva was stored at - 20 °C for the analysis of TNF-α. Symptoms were evaluated before and after treatment using a pain visual analog scale. Most patients were women (81.8%) during menopause (72.2%). LLLT and ALA were efficient in increasing salivary flow only in BMS but provided symptom relief in both conditions. TNF-α levels did not differ between patients with BMS and SOB or between those patients and the control group. No differences were observed in posttreatment TNF-α levels in either condition. The results of this study suggest that LLLT and ALA are efficient therapies in reducing burning mouth symptoms, with LLLT being more efficient than ALA.

Buccal drug delivery technologies for patient-centred treatment of radiation-induced xerostomia (dry mouth)

Radiotherapy is a life-saving treatment for head and neck cancers, but almost 100% of patients develop dry mouth (xerostomia) because of radiation-induced damage to their salivary glands. Patients with xerostomia suffer symptoms that severely affect their health as well as physical, social and emotional aspects of their life. The current management of xerostomia is the application of saliva substitutes or systemic delivery of saliva-stimulating cholinergic agents, including pilocarpine, cevimeline or bethanechol tablets. It is almost impossible for substitutes to replicate all the functional and sensory facets of natural saliva. Salivary stimulants are a better treatment option than saliva substitutes as the former induce the secretion of natural saliva from undamaged glands; typically, these are the minor salivary glands. However, patients taking cholinergic agents systemically experience pharmacology-related side effects including sweating, excessive lacrimation and gastrointestinal tract distresses. Local delivery direct to the buccal mucosa has the potential to provide rapid onset of drug action, i.e. activation of minor salivary glands within the buccal mucosa, while sparing systemic drug exposure and off-target effects. This critical review of the technologies for the local delivery of saliva-stimulating agents includes oral disintegrating tablets (ODTs), oral disintegrating films, medicated chewing gums and implantable drug delivery devices. Our analysis makes a strong case for the development of ODTs for the buccal delivery of cholinergic agents: these must be patient-friendly delivery platforms with variable loading capacities that release the drug rapidly in fluid volumes typical of residual saliva in xerostomia (0.05-0.1 mL).

Ketamine-xylazine anaesthesia and orofacial administration of substance P: A lethal combination in rats

BACKGROUND AND AIMS

Ketamine+xylazine mixture is a widely used anaesthetic in animal experiments. In rats anaesthetized with this mixture, we have shown that injection of carrageenan, a standard proinflammatory stimulus, into the cheek (intra-oral injection) induced oedema. A likely mediator of this oedema is substance P (SP), a major transmitter of sensory nerves in orofacial tissue. We have assessed the effects of intra-oral injection of SP in rats.

EXPERIMENTAL APPROACH

SP (50-1μg per rat) was injected intra-orally in male adult Holtzman or Wistar rats, anaesthetized with ketamine+xylazine. For comparison, histamine (50μg) and 5-HT (5μg) were similarly injected. Antagonists of SP (SR140333, 2mg/kg), of histamine (pyrilamine, 2mg/kg) or of 5-HT (pizotifen, 2mg/kg) were subcutaneously (s.c.) injected, 30min before the corresponding agonist. Oedema in the cheek was assessed by measuring tissue thickness with calipers.

RESULTS

Intra-oral injection of SP (1-50μg per rat) in Holtzman or Wistar rats anaesthetized with ketamine+xylazine induced, dose-dependently, death within 15min, accompanied by signs of excessive salivation. Rats pretreated with SR140333 were protected against SP-induced lethality and the excessive salivation. However, intra-oral injection of either histamine or 5-HT did not induce death, only a characteristic cheek oedema. These doses of SP injected into the hindpaws of conscious Holtzman and Wistar rats only induced oedema with no deaths. In rats anaesthetized with inhaled isoflurane, intra-oral SP (50μg) induced only cheek oedema, with no deaths or excessive salivation. This oedema was prevented by pre-treating rats with SR140333, pyrilamine and pizotifen.

CONCLUSION

It is likely that the deaths were due to excessive salivation induced by the particular combination of ketamine and SP. Our results are presented as a warning to other experimenters who might use these two otherwise non-toxic conditions and the consequent unexpected and needless loss of experimental animals.

Drug Induced Sialorrhea and Microfluidic-Chip-Electrophoretic Analysis of Engorged Adult Female Tick Saliva of Haemaphysalis longicornis (Acari: Ixodidae)

BACKGROUND

The aim of the present study was to induce salivation in Haemaphysalis longicornis to increase saliva production and to characterize the collection of proteins present in the collected saliva using on-chip-electrophoresis.

METHODS

Saliva of adult female engorged H. longicornis was collected by treatment with 0.2% dopamine hydrochloride. All protein samples were characterized by SDS-PAGE electrophoresis using a microfluidic High Sensitivity Protein Assay 250 kit by 2100 Bioanalyzer (Agilent Technologies, USA) under non-reducing conditions.

RESULTS

The average salivary protein concentration was 0.169 μg/μl/tick and saliva secretion decreased with increased time of tick detachment from the host. Saliva secretion volume increased to 3.56 μl in the group of ticks with a body weight between 301-350 mg as compared to higher and lower body weight groups. On-chip-electrophoresis results show 13 distinct bands ranging from 9.9 to 294 kDa.

CONCLUSION

Based on molecular weight, the putative salivary proteins are comprised of proline-rich proteins, triabin, apyrase members of the 12-kDa protein family, platelet inhibitors and anti-inflammatory proteins as tick saliva contains anti-inflammatory components.

Integrating genomic data from high-throughput studies with computational modeling reveals differences in the molecular basis of hyposalivation between type 1 and type 2 diabetes

OBJECTIVES

Both type 1 and type 2 diabetes are accompanied by a high prevalence of hyposalivation (decreased salivary secretion), resulting in oral tissue damage. However, the molecular basis for the hyposalivation is yet unknown. Identifying genes and proteins that account for diabetes-related hyposalivation will help understanding the basis for this condition and identifying disease biomarkers in saliva.

MATERIALS AND METHODS

We integrated genomic data from 110 high-throughput studies with computational modeling, to explore the relationship between diabetes and salivary glands on a genomic scale.

RESULTS

A significant overlap exists between genes that are altered in both types of diabetes and genes that are expressed in salivary glands; 87 type 1 diabetes and 34 type 2 diabetes associated genes are also common to salivary glands. However, the overlap between these genes is not significant.

CONCLUSIONS

Type 1 and type 2 diabetes associated genes are involved in the salivary secretion process, but mostly at different parts of it. This suggests that type 1 and type 2 diabetes impair salivary secretion by affecting different processes in the salivary tissue.

CLINICAL RELEVANCE

The genomic characteristics of Type 1 and type 2 diabetes may explain differences in salivary gland tissues morphology and saliva composition in people with diabetes, and suggest candidate proteins for diabetes salivary biomarkers.

The Effect of Tobacco Smoking on Salivation

AIM

The purpose of this study was to examine the detrimental effect of smoking on the function of the salivary glands.

MATERIAL AND METHODS

The study was conducted on 60 patients who were divided into two groups: a test group which included smokers and control group represented by non-smokers. Each group included 30 patients. General information was collected from all the respondents via a questionnaire as well as the data on the duration of smoking and number of cigarettes smoked per day. Saliva was collected by spitting method in a graduated tube and the amount of unstimulated and stimulated saliva was measured and recorded in ml per minute. Stimulated saliva was collected immediately after rinsing the mouth with a 2% aqueous solution of citric acid which is carried salivary stimulation. The presence of pigmentation on the teeth and coated tongue were recorded during clinical examination. The degree of oral hygiene was determined by plaque index. All the obtained data were statistically analyzed with significance level p <0.05.

RESULTS

The results showed no significant differences in the amount of saliva between smokers and non-smokers, however, the amount of saliva decreases significantly with the duration of smoking and increasing age of smokers. Also proven was the difference in the quality of saliva: smokers have thick saliva and nonsmokers predominantly serous. In addition, smokers have poorer oral hygiene status than non-smokers, and demonstrated a positive correlation between the level of oral hygiene and length of smoking tobacco.

CONCLUSION

This study has proven that smoking adversely affects salivation: long-term smoking reduces the secretion of saliva and changes its quality.

Ptyalism in pregnancy - a review of epidemiology and practices

Ptyalism gravidarum is an oral pathological condition specific to gravidity. We present a review of the literature regarding epidemiology internationally, and then highlight therapies reported by patients and caregivers. This often distressing repeated filling of the mouth with watery saliva in a pregnant patient was previously exclusively associated with hyperemesis gravidarum, and the consequent maternal-fetal risk. Our dissertation includes reference to a rare case of isolated sialorrhoea of pregnancy, without nausea or emesis. Both pharmacological and homoeopathic therapies are discussed, and inherent risks to mother and infant are highlighted. It is strongly recommended that this condition be given attention in antenatal care settings, to optimize short, middle and long term pregnancy outcomes.

Juicy lemons for measuring basic empathic resonance

Watch or even think of someone biting into a juicy lemon and your saliva will flow. This is a phenomenon of resonance, best described by the Perception-Action Model, where a physiological state in a person is activated through observation of this state in another. Within a broad framework of empathy, including manifold abilities depending on the Perception-Action link, resonance has been proposed as one physiological substrate for empathy. Using 49 healthy subjects, we developed a standardized salivation paradigm to assess empathic resonance at the autonomic level. Our results showed that this physiological resonance correlated positively with self-reported empathic concern. The salivation test, delivered an objective and continuous measure, was simple to implement in terms of setup and instruction, and could not easily be unintentionally biased or intentionally manipulated by participants. Therefore, these advantages make such a test a useful tool for assessing empathy-related abilities in psychiatric populations.

Increasing food intake in nursing home residents: efficacy of the Sorbet Increases Salivation intervention

The purpose of this study was to test the effect of the Sorbet Increases Salivation (SIS) intervention on resident food intake and body weight. Using a pre- post design, thirty-nine nursing home residents received 2 ounces of lemon-lime sorbet prior to lunch and dinner meals for 6 weeks. As a comparison and prior to the intervention, participants were offered 2 ounces of a non-citrus drink for 6 weeks prior to the lunch and dinner meals. Twenty-two residents completed both the comparison and intervention periods. Of those, 8 gained weight, 10 maintained and 4 lost weight. The amounts of food ingested during dinner increased significantly (p=0.001) from the comparison period to the intervention period (208-253 g). For liquids, the amounts ingested during dinner decreased significantly (p=0.002) from the comparison period to the intervention period (from 356 ml to 310 ml). Further study is needed to test the efficacy of the intervention with a larger sample of residents from multiple nursing homes.

Onabotulinum toxin A for the treatment of sialorrhea in familial dysautonomia

Familial dysautonomia is a rare disease affecting the nervous system. Symptoms include speech and movement problems, anterior sialorrhea (drooling) due to hypersalivation as a consequence of poor oropharyngeal coordination; dysphagia and aspiration pneumonia secondary to recurrent posterior sialorrhea. The treatment for sialorrhea in this population is very challenging. Traditional drugs carry a number of side-effects that are difficult to control in this disease. We report the first documented case series of 3 patients with this condition that successfully responded to Onabotulinum toxin A injection into their salivary glands. This is an innovative, safe method for drooling control in this population.

Occurrence of habituation during repeated food exposure via the olfactory and gustatory systems

BACKGROUND

Greater exposure to an orosensory cue could increase habituation rate. This investigation examined salivary habituation during 10 lemon juice trials providing exposure via olfactory, gustatory, and combined systems.

METHODS

Healthy, normal-weight, unrestrained females (age = 20.7 ± 2.7 year, body mass index [BMI] = 22.2 ± 1.5 kg/m(2), 70.0% white) were randomly assigned to 1 of 3 conditions: olfactory (SMELL: n = 8), gustatory (TASTE: n = 10), or olfactory+gustatory (SMELL+TASTE: n = 9). All conditions completed 12, 2-minute, trials (trials 1-2: water [baseline]; trials 3-12: lemon juice), in which salivation was measured. In conditions with taste exposure, 0.05 ml of the stimulus was placed on the tongue. In conditions with smell exposure, 4.0 g of the stimulus was held 0.5 in from the nose. Salivation was measured using dental rolls and mean salivation of every two trials was the dependent variable.

RESULTS

A mixed-factor ANCOVA, controlling for baseline differences between the conditions in lemon juice hedonics, found a significant (p < 0.05) interaction of condition x trial. SMELL+TASTE significantly (p < 0.05) increased salivation from baseline to lemon juice exposure, and decreased salivation by the last two mean trials. TASTE had a significant (p < 0.05) increase in salivation from baseline to lemon juice, with no decrease.

CONCLUSION

Repeated exposure to an orosensory cue by combined olfactory and gustatory systems produced a faster habituation rate than exposure by the gustatory system alone. Thus, food cues that combine exposure to the olfactory and gustatory systems may enhance satiation.

Characteristics of saliva secreted by patients with TCM-Piyinxu

AIM: To investigate various characteristics of saliva secreted by patients with TCM-Piyinxu (Spleen-yin deficiency).

METHODS: Twenty-five individuals with Piyinxu (15 males and 10 females; age range 26-70 years, mean age = 45 years) diagnosed based on criteria used in traditional Chinese medicine, were compared with 20 individuals with Shenyinxu (Kidney-yin deficiency) (11 males, 9 females; age range 35-75 years, mean age = 50) and 30 normal individuals (17 males, 13 females; age range 35-65 years, mean age = 49 years). After acid stimulation, the saliva flow in each group was measured, and the levels of amylase and protein in saliva were determined using an automatic biochemical analyzer. The resultant data were analyzed using the Kruskal-Wallis test and one-way factorial ANOVA test.

RESULTS: The flow rates of saliva and amylase in Piyinxu patients (0.27 ± 0.016 mL/min and 2134.13 ± 343.51 IU/min, respectively) were lower than those in normal subjects (0.46 ± 0.027 mL/min and 3501.63 ± 1099.63 IU/min, respectively, P < 0.01), but higher than those in the Shenyinxu group (0.13 ± 0.051 mL/min and 951.62 ± 383.17 IU/min, respectively, P < 0.01). The three groups showed no significant difference in their level of total salivary protein (Piyinxu group, 3.07 ± 0.60 g/L; Shenyinxu group, 3.01 ± 0.90 g/L, and control group, 2.94 ± 1.13 g/L, P = 0.869), amount of amylase per saliva volume, or their ratio of amylase to protein in secreted saliva (P = 0.173 and P = 0.436, respectively).

CONCLUSION: Piyinxu patients showed altered rates of saliva and amylase secretion when compared with those parameters in patients with Shenyinxu and normal subjects.