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Aframian DJ, Bar O, Wilensky A, Nadler C, Almoznino G. Integrated therapy of intraductal irrigations and sialoendoscopies of salivary glands to improve mouth dryness. Oral Dis 2024; 30:1198-1208. [PMID: 36630587 DOI: 10.1111/odi.14501] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/22/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the combination of salivary gland intraductal irrigations (IG) followed by sialoendoscopy irrigations (SI) of the parotid gland on the improvement of salivary gland secretory dysfunction (SGSD). METHODS We retrospectively analyzed the records of SGSD patients who underwent major salivary gland IG followed by SI during 2014-2020. Records included demographics, systemic background, signs, and symptoms. Improvement was assessed by comparing the mean unstimulated and stimulated whole salivary flow rate (UWSF, SWSF) from the baseline point (before IG procedure) to the last point (after SI) using repeated measures. The between-subjects effects of various factors and covariants were analyzed using repeated measures ANCOVA. RESULTS One hundred patients were included with an age range of 15-83 years (mean age of 60.1 ± 13.1 years). Improvement was detected on UWSF measurements (p = 0.031, F = 3.83), but not on SWSF measurements (p = 0.165, F = 1.85). The between-subjects effects on UWSF measurements were statistically significant for sex (p = 0.003, F = 9.526) and salivary gland manipulators use (p < 0.001, F = 15.107) and for the interaction between sex and salivary gland manipulators use (p- = 0.002, F = 9.709). Results of long-term follow-up for 10.87 ± 11.79 months after the SI procedure demonstrated sustained improvement in UWSF measurements (p = 0.011, F = 4.91). CONCLUSIONS The combination of IG followed by SI increases UWSF salivary secretion in SGSD patients for a relatively extended duration.
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Affiliation(s)
- Doron J Aframian
- Sjögren's syndrome Center, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Jerusalem, Israel
| | - Ori Bar
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaf Wilensky
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Periodontology, Hadassah Medical Center, Jerusalem, Israel
| | - Chen Nadler
- Sjögren's syndrome Center, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Jerusalem, Israel
| | - Galit Almoznino
- Sjögren's syndrome Center, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Jerusalem, Israel
- Big Biomedical Data Research Laboratory, Dean's office, Hadassah Medical Center, Jerusalem, Israel
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Ramírez L, Sánchez I, González-Serrano J, Muñoz M, Martínez-Acitores ML, Garrido E, Hernández G, López-Pintor RM. Factors influencing xerostomia and oral health-related quality of life in polymedicated patients. Gerodontology 2023. [PMID: 37944110 DOI: 10.1111/ger.12724] [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] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To evaluate whether the severity of xerostomia in older polymedicated patients impacts oral health-related quality of life (OHRQoL). BACKGROUND Medication-associated xerostomia is common in older people. Xerostomia may impair OHRQoL. MATERIALS AND METHODS This cross-sectional study included older hypertensive patients from two health centres. We assessed the severity of xerostomia and OHRQoL using the Xerostomia Inventory (XI) tool, and the Oral Health Impact Profile-14 (OHIP-14) instrument, respectively. We measured unstimulated (UWS) and stimulated (SWS) salivary flows. Univariate and multiple linear regression analyses evaluated the associations of XI and OHIP-14 and different explanatory variables. RESULTS Of the 218 patients enrolled, 51.8% had xerostomia, and 38.1% and 27.5% suffered from UWS and SWS hyposalivation, respectively. Patients with xerostomia, UWS, and SWS hyposalivation scored significantly higher on the XI. However, only those with xerostomia or UWS hyposalivation had significantly higher OHIP-14 scores. A moderate correlation was observed between XI and OHIP-14 scores. The multiple regression model showed that factors with the greatest impact on XI were the patient's complaint of xerostomia, UWS flow rate, age and sex. However, only the XI score was significantly associated with the OHIP-14 score. CONCLUSION Xerostomia has a negative impact on OHRQoL in older polymedicated patients, but this impact is less than in other types of xerostomia. Longitudinal studies are needed to determine whether changes in the detected explanatory variables influence XI and OHIP scores in these patients.
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Affiliation(s)
- Lucía Ramírez
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Isabel Sánchez
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - José González-Serrano
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Marta Muñoz
- Department of Clinical Dentistry, School of Biomedical Science, European University of Madrid, Madrid, Spain
| | | | | | - Gonzalo Hernández
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Rosa María López-Pintor
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
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Nieri CA, Benaim EH, Zhang YH, Garcia-Godoy F, Herr MJ, Zhang W, Schwartz D, Coca KK, Gleysteen JP, Gillespie MB. Botox for the prevention of radiation-induced Sialadenitis and xerostomia in head and neck cancer patients: A pilot study. Head Neck 2023; 45:2198-2206. [PMID: 37403447 DOI: 10.1002/hed.27449] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND To determine the safety of Botox and its potential effect on alleviating radiation therapy (RT)-induced sialadenitis in head and neck cancer patients. METHODS Twenty patients with stage III/IV head and neck cancer were randomized to receive Botox or saline injections into both submandibular glands (SMG). There were three visits: one before RT (V1); 1 week after RT (V2); and 6 weeks after RT (V3), each of which included saliva collection, a 24-h dietary recall, and a quality-of-life survey. RESULTS No adverse events were observed. While the control group was much older, the Botox group more commonly underwent induction chemotherapy compared with controls. From V1 to V2, salivary flow decreased in both groups, but only in the control group from V1 to V3. CXCL-1 (GRO), a neutrophil chemoattractant, was lower in the Botox group compared with the control group at V3. CONCLUSION Botox can be safely administered to the salivary glands prior to external beam radiation without observed complications or side-effects. After an initial reduction in salivary flow following RT, the Botox group showed lack of further flow reduction compared with controls. The inflammatory marker CXCL 1, which was reduced in the in Botox group at V3, may be a candidate for further studies of radiation-induced sialadenitis.
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Affiliation(s)
- Chad Alexander Nieri
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ezer Haim Benaim
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yanhui H Zhang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- The Forsyth Institute, Cambridge, Massachusetts, USA
- Department of Surgery, Herbert Wertheim, College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael J Herr
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Weiqiang Zhang
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kimberly K Coca
- Department of Otolaryngology, Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - John P Gleysteen
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marion Boyd Gillespie
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Srinivasan M, Kamnoedboon P, Angst L, Müller F. Oral function in completely edentulous patients rehabilitated with implant-supported dental prostheses: A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:196-239. [PMID: 37750517 DOI: 10.1111/clr.14068] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES This review evaluated the effects of rehabilitation with implant-supported prostheses on the oral function of completely edentulous adults. MATERIALS AND METHODS Systematic literature searches were performed to identify records reporting on oral function in completely edentulous adults rehabilitated with implant-supported prostheses. Meta-analyses were performed on various outcomes including bite force, masticatory performance, muscle activity, mandibular movement/chewing pattern, and salivary flow. RESULTS 5507 records were identified. Thirty studies qualified for data extraction and analysis. The kappa (𝛋) for the search and identification strategy ranged between 0.50 and 1.00. Meta-analysis was performed grouping the studies by outcomes and split by time points of 6-12 months, 12-36 months, and >36 months after implant therapy. The meta-analyses revealed a significant improvement in oral function of completely edentulous adults after rehabilitation with implant-supported prostheses at 6-12 months (Z = -4.895, p < .001; 95% CI: -0.703, -0.301; τ2 = .609; Q = 114.953, df = 17, p < .001; I2 = 85.2%), at 12-36 months (Z = -4.886, p < .001; 95% CI: -0.580, -0.248; τ2 = .908; Q = 280.611, df = 35, p < .001; I2 = 87.5%) and at more than 36 months (Z = -9.108, p < .001; 95% CI: -1.472, -0.951; τ2 = .019; Q = 7.918, df = 7, p = .340; I2 = 11.6%). The included studies demonstrated a low to moderate risk of bias. CONCLUSIONS This systematic review concluded that the oral function of completely edentate adults significantly improved with implant-supported/retained prostheses, even when only one jaw received implant therapy. Therefore, implant therapy should be promoted for edentulous adults to alleviate the shortcomings of conventional complete removable dental prostheses.
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Affiliation(s)
- Murali Srinivasan
- Clinic of General-, Special Care, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Porawit Kamnoedboon
- Clinic of General-, Special Care, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Lea Angst
- Clinic of General-, Special Care, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Jeamanukulkit S, Vichayanrat T, Samnieng P. Effects of the salivary gland massage program in older type 2 diabetes patients on the salivary flow rate, xerostomia, swallowing and oral hygiene: A randomized controlled trial. Geriatr Gerontol Int 2023. [PMID: 37337980 DOI: 10.1111/ggi.14629] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/06/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
AIM To evaluate the effect of a salivary gland massage program to improve salivary flow, swallowing, and oral hygiene in older type 2 diabetes patients. METHODS This randomized control trial consisted of 73 older diabetes patients with a low salivary flow; 39 and 34 in intervention and control groups, respectively. The intervention group received a salivary gland massage from a trained dental nurse, whereas the control group received a dental education. The salivary flow rates were collected using spit methods at baseline, 1-month and 3-month follow up. All participants were examined for the objective and subjective symptoms of xerostomia, the Simplified Debris Index and the Repetitive Saliva Swallowing Test. RESULTS After 3 months, the resting (0.32 vs 0.14 mL/min, P < 0.001) and stimulating salivary flow (3.66 vs 2.83 mL/min, P = 0.025) in the intervention group was significantly higher than the control group. The objective symptoms in the intervention group were significantly lower than the control group after 3 months (1.41 vs 2.26, P = 0.001). The participants who were able to swallow least three times in the Repetitive Saliva Swallowing Test in the intervention group increased by 35.89% after 3 months, whereas the control group increased by 8.82%. Oral hygiene was improved in both groups, but the changes in the intervention were significantly greater than in the control group. CONCLUSIONS The 3-month salivary glands massage program increases the salivary flow rate, and affects swallowing, objective dry mouth symptoms and oral hygiene in older patients with type 2 diabetes. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2023; ••: ••-••.
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Affiliation(s)
- Supanee Jeamanukulkit
- Master of Science Program in Geriatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Tippanart Vichayanrat
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Patcharaphol Samnieng
- Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
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Ramírez L, Sánchez I, Muñoz M, Martínez-Acitores ML, Garrido E, Hernández G, López-Pintor RM. Risk factors associated with xerostomia and reduced salivary flow in hypertensive patients. Oral Dis 2023; 29:1299-1311. [PMID: 34839577 DOI: 10.1111/odi.14090] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the risk factors associated with xerostomia and hyposalivation in a group of hypertensive patients. SUBJECTS AND METHODS A cross-sectional study was conducted. Hypertensive patients belonged to two healthcare centers were included. Xerostomia was assessed by asking a question and using the Xerostomia Inventory. Unstimulated salivary flow was collected. Different epidemiological variables were analyzed such as age, sex, habits, diseases, drugs, and blood pressure. RESULTS 221 individuals were included. Xerostomia was reported in 51.13% of patients. Patients with xerostomia suffered more from osteoarthritis and diaphragmatic hernia. These patients took more anticoagulants (acenocoumarol), antiarrhythmics (amiodarone), analgesics (paracetamol) and epilepsy drugs (pregabalin) and less platelet aggregation inhibitors and angiotensin II receptor blockers (losartan). Unstimulated flow was reduced in 37.56% of patients. Patients suffering hyposalivation presented more diseases such as anxiety, infectious or parasitic diseases, hepatitis C, diaphragmatic hernia, and osteoarthritis. These patients took more repaglinide, thiazides, anti-inflammatories, anti-rheumatics, glucosamine, diazepam, and selective beta-2-adrenoreceptor agonists and less combinations of candesartan and diuretics. CONCLUSIONS Xerostomia and hyposalivation are frequent in hypertensive patients. It is advisable to take into consideration the comorbidities and the drugs they receive, since they can increase the risk of these salivary disorders.
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Affiliation(s)
- Lucía Ramírez
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Isabel Sánchez
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Marta Muñoz
- Department of Clinical Dentistry, School of Biomedical Science, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | | | - Gonzalo Hernández
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Rosa María López-Pintor
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
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Czerninski R, Finfter O, Nudelman Z, Tal Y, Kirmayer D, Friedman M. Overnight use of oral appliance with sirolimus sustained-release varnish delivery system: a clinical note and an observational study. Quintessence Int 2023; 54:242-249. [PMID: 36426872 DOI: 10.3290/j.qi.b3604821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Maintaining appropriate salivary levels of an active ingredient is challenging. Intraoral trays can be used to deliver medications for localized treatment. Based on previous successful daytime studies with a slow-release sirolimus varnish, the aim was to optimize intraoral appliances/trays for overnight use to deliver slow-release medications in a manner that maintains therapeutic salivary levels of the active ingredient to treat oral conditions. METHOD AND MATERIALS An acrylic tray appliance containing 0.5 mg of sirolimus in a sustained-release varnish was placed on six anterior teeth for 12 hours, in ten healthy volunteers. Whole unstimulated saliva was collected at 1, 2, 10, and 12 hours after application. Blood was collected at the time of recruitment to confirm eligibility, and 12 hours after device removal to measure sirolimus levels. Drug levels in the blood and saliva were analyzed. Slow- and fast-release formulations, varnish position (buccal, palatal, or lingual), and tray placement (mandibular or maxillary) were qualitatively compared. Participants evaluated the varnish and tray. RESULTS Moderate concentrations of sirolimus were detected in the saliva when the fast-release formulation was used. The highest levels were from the mandibular tray with lingual varnish application. Sialometry of all participants was within normal range, and the highest drug levels were detected when low flow was measured. No traces of the medication were found in the blood. CONCLUSIONS Salivary concentrations of medications applied to an intraoral appliance are affected by the placement in the maxilla or mandible, varnish formulation, location of varnish, and salivation rate. These results may help optimize medication release following application to various oral devices. (Quintessence Int 2023;54:242-249; doi: 10.3290/j.qi.b3604821).
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Mossel E, van Ginkel MS, Haacke EA, Arends S, Liefers SC, Delli K, van Nimwegen JF, Stel AJ, Spijkervet FKL, Vissink A, van der Vegt B, Kroese FGM, Bootsma H. Histopathology, salivary flow and ultrasonography of the parotid gland: three complementary measurements in primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 61:2472-2482. [PMID: 34672336 PMCID: PMC9157128 DOI: 10.1093/rheumatology/keab781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/14/2021] [Revised: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The involvement of salivary glands in primary Sjögren's syndrome (pSS) can be assessed in different ways: histopathology, salivary flow and ultrasonography. To understand the relative value of these different approaches, it is crucial to understand the relationship between them. As we routinely perform these three modalities in the parotid gland for disease evaluation, our aim was to investigate the construct validity between these modalities in one and the same gland. METHODS Consecutive sicca patients underwent a multidisciplinary diagnostic work-up including parotid gland biopsy, collection of parotid gland-specific saliva and parotid gland ultrasonography. Patients who were classified as pSS according to the ACR-EULAR criteria were included. Construct validity was assessed using Spearman's correlation coefficients. RESULTS The 41 included pSS patients completed a full work-up within mean time interval of 2.6 months. Correlations between histopathological features and stimulated parotid salivary flow were fair (ρ=-0.123 for focus score, and ρ=-0.259 for percentage of CD45+ infiltrate). Likewise, poor correlations were observed between stimulated parotid salivary flow and parotid ultrasonography (ρ=-0.196). Moderate to good associations were found between the histopathological items focus score and percentage of CD45+ infiltrate, with parotid ultrasound scores (total ultrasound score: ρ = 0.510 and ρ = 0.560; highest for homogeneity: ρ = 0.574 and ρ = 0.633). CONCLUSION Although pSS associated ultrasonographic findings did correlate with histopathological features, the three modalities that evaluate salivary gland involvement assess different (or at best partly related) constructs. Therefore, histopathology, salivary flow and ultrasonography are complementary measurements and cannot directly replace each other in the work-up of pSS.
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Affiliation(s)
- Esther Mossel
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Martha S van Ginkel
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Erlin A Haacke
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands.,Departments of Pathology and Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Suzanne Arends
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Silvia C Liefers
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Konstantina Delli
- Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Jolien F van Nimwegen
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Alja J Stel
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Fred K L Spijkervet
- Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Arjan Vissink
- Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Departments of Pathology and Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Frans G M Kroese
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Hendrika Bootsma
- Departments of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
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Ciulla MM, Re D, Gilardoni E, D’Amato A, Altomare A, Baron G, Carugo S, Aldini G. PHoral: Effects of carnosine supplementation on quantity/quality of oral salivae in healthy volunteer and in subjects affected by common oral pathologies. Medicine (Baltimore) 2021; 100:e26369. [PMID: 34160409 PMCID: PMC8238340 DOI: 10.1097/md.0000000000026369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diseases of the oral cavity (OC) with an infectious trigger such as caries and periodontal disease are extremely common in the general population and can also have effects at the cardiovascular level. The oral salivary flow, with its buffering capacity, is able to regulate the pH of the OC and, therefore, significantly contribute to the ecological balance of the microenvironment in which the oral microbiome (OM) develops. On the other side, when the quality/quantity of salivary flow is altered it is supposed the disruption of this balance with the potential increase in oral pathogens and triggered diseases. Among the endogenous substances able to exert a significant effect on the salivary flow and its characteristics, carnosine (Car), a dipeptide originally isolated in skeletal muscle, represents, thanks to the known buffering properties, a promising principle. METHODS We aimed this protocol to evaluate the quantitative/qualitative characteristics of the salivary flow in healthy volunteer subjects (n = 20) and in subjects suffering from common OC pathologies (n = 40), before and after 7 days of supplementation with SaliflussTM (Metis Healthcare srl, Milan, Italy), a Class I medical device on the market as 400 mg mucoadhesive oral tablets that has Car as the main ingredient. DISCUSSION Combining the characteristics of saliva with the OM and comparing them with OC pathologies, we expect to clarify their reciprocal relationship and, using quantitative proteomics techniques, to help clarify the mechanism of action of Car.
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Affiliation(s)
- Michele M. Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging
- Department of Clinical Sciences and Community Health
- University of Milan, Milan
| | - Dino Re
- Department of Biomedical, Surgical, and Dental Sciences, Istituto Stomatologico Italiano, Aesthetic Dentistry, School of Dentistry
- University of Milan, Milan
| | - Ettore Gilardoni
- Department of Pharmaceutical Sciences “Pietro Pratesi”
- University of Milan, Milan
| | - Alfonsina D’Amato
- Department of Pharmaceutical Sciences “Pietro Pratesi”
- University of Milan, Milan
| | - Alessandra Altomare
- Department of Pharmaceutical Sciences “Pietro Pratesi”
- University of Milan, Milan
| | - Giovanna Baron
- Department of Pharmaceutical Sciences “Pietro Pratesi”
- University of Milan, Milan
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health
- University of Milan, Milan
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Italy
| | - Giancarlo Aldini
- Department of Pharmaceutical Sciences “Pietro Pratesi”
- University of Milan, Milan
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Morita I, Morioka H, Abe Y, Nomura T, Inagawa Y, Kondo Y, Kameyama C, Kondo K, Kobayashi N. [Relationship between the number of prescribed medications and oral dysfunction in elderly individuals]. Nihon Koshu Eisei Zasshi 2021; 68:167-179. [PMID: 33456016 DOI: 10.11236/jph.20-062] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective Polypharmacy in elderly individuals may cause reduced flow of saliva and xerostomia. A dry mouth can lead to poor oral function; however, there are no reports on the relationship between polypharmacy and subjective or objective oral dysfunction. The purpose of this study was to clarify the relationship between the number of prescribed medications and subjective and objective oral dysfunction.Methods The subjects of this study were 215 community-dwelling, elderly individuals, aged 75 years or older, who visited the dental clinic in the Chubu region for a dental health examination from January to February 2019. A medical interview was conducted to assess three items that were related to subjective oral function and record four measurements related to objective oral function. In addition, information was collected on the diseases being treated and prescribed medications. A subject with a decrease in any of the three subjective oral function categories was considered to have subjective oral dysfunction. Objective oral dysfunction was analyzed with respect to two types of oral dysfunction: a decrease in all four objective oral functions and a decrease in two or more of the four objective oral functions. Logistic regression analysis was performed to examine the relationship between subjective and objective oral dysfunction after adjustment for sex, age group, inveterate disease, and the number of prescribed medications.Results Individuals who had eight or more prescribed medications had lower subjective oral function than those with seven or fewer medications (odds ratio, 95% confidence interval: 2.3, 1.0-5.1; P<0.05). Individuals with eight or more medications had lower scores in all four objective oral functions than those with seven or fewer medications (4.4 : 1.5-12.6, P<0.01). A decrease in two or more of the four objective oral functions was related to 10 or more prescribed medications (4.3 : 1.2-16.2, P<0.05). In addition, taking eight or more prescribed medications was associated with a decrease in either subjective oral function or all four objective oral functions (8.1 : 2.1-30.8, P<0.01). A decrease in either subjective oral function or two or more objective oral functions was related to taking 10 or more prescribed medications (4.9 : 1.6-15.6, P<0.01).Conclusion In conclusion, more than eight prescribed pharmaceutical medications in the elderly is associated with subjective or objective oral dysfunction.
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Affiliation(s)
| | - Hisayoshi Morioka
- Department of Public Health, The University of Tokushima Graduate School, Institute of Health Biosciences
| | | | | | | | | | | | - Kanae Kondo
- Japanese Red Cross Toyota College of Nursing
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Bento RF. Sialendoscopy for Improvement of Salivary Flow in Patients with Sjögren Syndrome - Comparative Analysis of Intraglandular Washing Solutions. Int Arch Otorhinolaryngol 2021; 25:e1-e7. [PMID: 33391395 PMCID: PMC7850891 DOI: 10.1055/s-0040-1716574] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/29/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Among the potential diseases that present altered salivary flow and activity is Sjögren syndrome. Sialendoscopy seems to be an important therapeutic option. Objective To compare the results obtained with sialendoscopy for improving salivary flow measured by scintigraphy in patients with primary Sjögren syndrome to those obtained with other intraglandular washing solutions. Methods Patients from our institution's rheumatology clinic diagnosed with primary Sjögren syndrome underwent parotid scintigraphy prior to the sialendoscopy procedure. During the sialendoscopy procedure, one of the parotid glands was randomized to receive a wash with saline while the other was washed with a corticosteroid solution. After 1 month, a new scintigraphy examination of the parotid glands was performed to observe the salivary flow for comparison. Results A total of 13 female patients with mean age of 53.38 years (range, 27-76 years) were included in this study. After sialendoscopy, 10 patients (76.92%) were observed to have improvement in salivary excretion with radiopharmaceutical during scintigraphy. When analyzing each gland that was treated separately (26 glands), after sialendoscopy, improvement was observed in 18 glands (69.23%), 8 treated with dexamethasone and 10 with saline solution in the wash. There was no improvement in 8 glands (30.77%). Conclusion This study demonstrates that sialendoscopy is as an important tool to improve salivary flow measured by scintigraphy in patients with primary Sjogren syndrome, increasing salivary excretion through dilation and consequent unblocking of the ducts. These data suggest that there is no statistically significant difference between intraductal washing solutions using saline or dexamethasone solution.
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Affiliation(s)
- Ricardo Ferreira Bento
- Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Ferrer MD, López-López A, Nicolescu T, Perez-Vilaplana S, Boix-Amorós A, Dzidic M, Garcia S, Artacho A, Llena C, Mira A. Topic Application of the Probiotic Streptococcus dentisani Improves Clinical and Microbiological Parameters Associated With Oral Health. Front Cell Infect Microbiol 2020; 10:465. [PMID: 32984080 PMCID: PMC7488176 DOI: 10.3389/fcimb.2020.00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 01/04/2023] Open
Abstract
Streptococcus dentisani 7746, isolated from dental plaque of caries-free individuals, has been shown to have several beneficial effects in vitro which could contribute to promote oral health, including an antimicrobial activity against oral pathogens by the production of bacteriocins and a pH buffering capacity through ammonia production. Previous work has shown that S. dentisani was able to colonize the oral cavity for 2–4 weeks after application. The aim of the present work was to evaluate its clinical efficacy by a randomized, double-blind, placebo-controlled parallel group study. Fifty nine volunteers were enrolled in the study and randomly assigned to a treatment or placebo group. The treatment consisted of a bucco-adhesive gel application (2.5 109 cfu/dose) with a dental splint for 5 min every 48 h, for a period of 1 month (i.e., 14 doses). Dental plaque and saliva samples were collected at baseline, 15 and 30 days after first application, and 15 days after the end of treatment. At baseline, there was a significant correlation between S. dentisani levels and frequency of toothbrushing. Salivary flow, a major factor influencing oral health, was significantly higher in the probiotic group at day 15 compared with the placebo (4.4 and 3.4 ml/5 min, respectively). In the probiotic group, there was a decrease in the amount of dental plaque and in gingival inflammation, but no differences were observed in the placebo group. The probiotic group showed a significant increase in the levels of salivary ammonia and calcium. Finally, Illumina sequencing of plaque samples showed a beneficial shift in bacterial composition at day 30 relative to baseline, with a reduction of several cariogenic organisms and the key players in plaque formation, probably as a result of bacteriocins production. Only 58% of the participants in the probiotic group showed increased plaque levels of S. dentisani at day 30 and 71% by day 45, indicating that the benefits of S. dentisani application could be augmented by improving colonization efficiency. In conclusion, the application of S. dentisani 7746 improved several clinical and microbiological parameters associated with oral health, supporting its use as a probiotic to prevent tooth decay.
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Affiliation(s)
- María D Ferrer
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Aranzazu López-López
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Teodora Nicolescu
- Clínica Odontológica, Fundació Lluís Alcanyis, Universitat de València, Valencia, Spain
| | | | - Alba Boix-Amorós
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Majda Dzidic
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Sandra Garcia
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Alejandro Artacho
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Carmen Llena
- Clínica Odontológica, Fundació Lluís Alcanyis, Universitat de València, Valencia, Spain
| | - Alex Mira
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
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Sundaram M, Manikandan S, Satheesh B, Srinivasan D, Jayapal D, Kumar D. Comparative Evaluation of Xerostomia among Diabetic and Nondiabetic Subjects Wearing Complete Denture. J Pharm Bioallied Sci 2020; 12:S419-S422. [PMID: 33149498 PMCID: PMC7595564 DOI: 10.4103/jpbs.jpbs_124_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/07/2020] [Accepted: 04/02/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Diabetes mellitus represents a group of metabolic diseases that are characterised by hyperglycaemia due to a total or relative lack of insulin secretion and insulin resistance or both. Diabetes mellitus patients present with a higher susceptibility to infections due to a deficiency in polymorphonuclear leukocytes, as a result of vascular alterations and neuropathies. An increased risk of infections has been observed in complete denture wearing subjects with xerostomia. The objective of this study was to compare diabetic and non-diabetic subjects wearing complete dentures regarding xerostomia of different age group. Materials and Methods: A cross-sectional study was conducted among 50 subjects, 25 with and 25 without a diagnosis of diabetes, were matched for gender, race, and age. Results: In this study we intended to compare diabetic and non-diabetic subjects wearing complete dentures regarding xerostomia and we found that xerostomia was more associated with diabetic denture wearer group in comparison with the non-diabetic denture wearers with a significant P value of <0.05. Conclusion: These results indicate that xerostomia should be diagnosed and effectively managed before any complete denture therapy is initiated in diabetic denture wearing patients to improve the quality of life.
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Affiliation(s)
- Manikandan Sundaram
- Department of Dental Surgery, Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu, India
| | - Saranya Manikandan
- Department of Oral Pathology, Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India
| | - Balakrishnan Satheesh
- Department of Prosthodontics and Crown and Bridge, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Deenadayalan Srinivasan
- Department of Prosthodontics and Crown and Bridge, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Dinakaran Jayapal
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Dhivya Kumar
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Chennai, Tamil Nadu, India
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Sinjari B, Feragalli B, Cornelli U, Belcaro G, Vitacolonna E, Santilli M, Rexhepi I, D'Addazio G, Zuccari F, Caputi S. Artificial Saliva in Diabetic Xerostomia (ASDIX): Double Blind Trial of Aldiamed ® Versus Placebo. J Clin Med 2020; 9:E2196. [PMID: 32664567 DOI: 10.3390/jcm9072196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/21/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Xerostomia is a symptom frequently present in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In the present trial, the activity of an artificial saliva (aldiamed® spray) in comparison to a placebo spray were used to evaluate the xerostomia and the saliva antioxidant capacity (SAT). Sixty patients of both genders with T1DM or T2DM were randomized into two groups of 30 subjects each. The experiment was a double-blind study approved by the Ethics Committee of the “G. d’Annunzio University” of Chieti and Pescara. Moreover, measurements of the stimulated saliva flow rate and the ultrasonography of the submandibular and parotid glands were performed at both the study time points. The results demonstrated statistically significant differences between the treatments in terms of the xerostomia average score. Specifically, the values were at baseline and after 30 days 2.9 ± 1.31 and 3.0 ± 1.44 and 1.4 ± 1.48 and 2.4 ± 0.99 for aldiamed® spray and the placebo, respectively. Meanwhile, no statistically significant differences were shown between the two groups for the other variables, such as the salivary flow rate, the antioxidant capacity of the saliva, and the ultrasonography of the major salivary glands.
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Bairappan S, Puranik MP, R SK. Impact of asthma and its medication on salivary characteristics and oral health in adolescents: A cross-sectional comparative study. Spec Care Dentist 2020; 40:227-237. [PMID: 32357265 DOI: 10.1111/scd.12462] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess and compare the salivary characteristics and oral health and to evaluate the impact of asthma and its medication on dental caries among adolescents with and without asthma. METHODS A cross-sectional comparative study was conducted among 50 asthmatic and 50 nonasthmatic adolescents aged 12-15 years in Bangalore City. Data were acquired using a structured questionnaire. Salivary samples were collected to determine the flow rate, pH, buffering capacity, and Streptococcus mutans and Lactobacilli counts. Oral health assessment was performed using WHO 2013 proforma. Inferential statistics such as chi-square, student's t-test, spearman's correlation, multinomial logistic. and stepwise linear regression were applied with P < .05 considered as significant. RESULTS Asthmatic participants had significantly higher mean number of teeth with dental caries, gingival bleeding, and dental erosion than nonasthmatics (P < .05). The prevalence of fluorosis, traumatic dental injuries, and oral mucosal lesions in asthmatics were 34.0%, 38.0%, and 28.0%, respectively. Most of the asthmatic participants required preventive or routine (18.0%) and prompt treatment (30.0%). Statistically significant difference was found in the flow rate, pH, buffering capacity, S. mutans and Lactobacilli counts, and Decayed, Missing, Filled Teeth (DMFT) index between asthmatic and nonasthmatic participants. Severity of asthma, medication use, and dental caries experience significantly correlated with low salivary flow rate, pH and buffering capacity, and higher levels of S. mutans and Lactobacilli (P < .001). Asthmatic participants had significantly higher odds of having very low unstimulated salivary flow rate (odds ratio [OR] = 3.2), buffering capacity (OR = 2.94), highly acidic pH (OR = 3.65), high risk of S. mutans (OR = 6.02), and DMFT ≥ 1 (OR = 2.06) than nonasthmatics (P < .05). CONCLUSION Salivary characteristics and oral health were significantly poor in asthmatic adolescents. Asthma and its medications had significant impact on salivary characteristics and dental caries among asthmatic adolescents.
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Affiliation(s)
- Santhiya Bairappan
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bangalore, India
| | - Manjunath P Puranik
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bangalore, India
| | - Sowmya K R
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bangalore, India
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Ramírez Martínez-Acitores L, Hernández Ruiz de Azcárate F, Casañas E, Serrano J, Hernández G, López-Pintor RM. Xerostomia and Aalivary Flow in Patients Taking Antihypertensive Drugs. Int J Environ Res Public Health 2020; 17:E2478. [PMID: 32260482 PMCID: PMC7177425 DOI: 10.3390/ijerph17072478] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 02/05/2023]
Abstract
The aims of this systematic review are (1) to compare the prevalence of xerostomia and hyposalivation between patients taking antihypertensive drugs with a control group (CG), (2) to compare salivary flow rate between patients treated with a CG, and (3) to identify which antihypertensives produce xerostomia. This systematic review was carried out according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. To evaluate methodological quality of the eligible studies Cochrane Collaboration tool for assessing the risk of bias for clinical trials and the modified Newcastle-Ottawa scale case-control studies were used. The databases were searched for studies up to November 19th 2019. The search strategy yielded 6201 results and 13 publications were finally included (five clinical trials and eight case-control studies). The results of the included studies did not provide evidence to state that patients taking antihypertensives suffer more xerostomia or hyposalivation than patients not taking them. With regard to salivary flow, only two clinical studies showed a significant decrease in salivary flow and even one showed a significant increase after treatment. The case-control studies showed great variability in salivary flow, but in this case most studies showed how salivary flow is lower in patients medicated with antihypertensive drugs. The great variability of antihypertensive drugs included, the types of studies and the outcomes collected made it impossible to study which antihypertensive drug produces more salivary alterations. The quality assessment showed how each of the studies was of low methodological quality. Therefore, future studies about this topic are necessary to confirm whether antihypertensive drugs produce salivary alterations.
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Affiliation(s)
| | | | | | | | | | - Rosa María López-Pintor
- Department of Dental Clinical Specialities. ORALMED Research Group. School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; (L.R.M.-A.); (F.H.R.d.A.); (E.C.); (J.S.); (G.H.)
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Xue J, Zhu P, He Y, Li Q, Xu Y. Application of computational fluid dynamics models for the evaluation of salivary flow patterns and related bacterial accumulation around orthodontic brackets. Orthod Craniofac Res 2020; 23:291-299. [PMID: 32011803 DOI: 10.1111/ocr.12369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/16/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 12/28/2022]
Abstract
OBJECTS To simulate and compare salivary flow patterns over a tooth surface bonded with different orthodontic appliances using computational fluid dynamics (CFD) and investigate the impact of bracket design on salivary flow in relation to peri-bracket bacterial accumulation. SETTING AND SAMPLE POPULATION The models were constructed using computed tomography (CT) data of 81 patients scheduled for fixed orthodontic treatment: 27 patients (10 males, 17 females) for the metal Victory MBT™ bracket; 27 patients (seven males, 20 females) for the ceramic Clarity MBT™ bracket; 27 patients (15 males, 12 females) for the Mini Uni-Twin (MUT) bracket. METHODS The salivary flow patterns were simulated by CFD and compared between the groups and the model predictions were validated using a bacteriological experiment. RESULTS The MUT bracket was associated with the greatest number of low salivary velocity areas, as it is designed with a connector between double tie wings and a right contact angle between tooth surface and bracket base. After archwire placement, the centred slot in the bracket and the bilateral sites around the bracket had higher bacterial retention and needed special oral hygiene measures. The obtuse contact angle of the ceramic bracket formed a pocket structure in the tie-wing area, retarding salivary flow and contributing to bacteria retention. CONCLUSION With the evaluation of CFD models, we demonstrate that salivary flow patterns over a tooth surface with a bracket vary with bracket designs and further promote bacterial retention in specific locations, suggesting the need for additional oral hygiene measures for specific bracket types.
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Affiliation(s)
- Jingyi Xue
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhu
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yifan He
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Qianli Li
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yue Xu
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
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Rani A, Panchaksharappa MG, Chandrashekarappa NM, Annigeri RG, Kanjani V. Characterization of saliva in immunocompromised patients and tobacco users: A case-control study. Indian J Dent Res 2019; 30:909-914. [PMID: 31939370 DOI: 10.4103/ijdr.ijdr_642_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess salivary flow rate, salivary pH, and salivary albumin concentration in systemically compromised subjects and tobacco users and its comparison to healthy controls. MATERIALS AND METHODS Sixty patients were selected and then were equally divided into systemically compromised group, tobacco users, and control group with 20 in each group. Saliva flow rate was assessed using modified Schirmer test (MST), salivary pH was estimated by pH meter, and salivary albumin concentration was determined using bromocresol green method. RESULTS The salivary flow rate readings measured by MST were 22.65 ± 2.79, 22.6 ± 3.57, and 33.22 ± 2.30 mm/3min in systemically compromised individuals, tobacco users, and control group, respectively (P < 0.001). The salivary pH was 6.80 ± 0.24, 6.81 ± 0.25, and 7.18 ± 0.17 in systemically compromised subjects, tobacco users, and control group, respectively (P < 0.001). The salivary albumin concentration was 2.49 ± 0.61, 0.73 ± 0.13, and 1.14 ± 0.12 g/dl in systemically compromised subjects, tobacco users, and control group, respectively (P < 0.001). CONCLUSION MST can be routinely used as chair-side investigation to evaluate salivary flow which is objective, inexpensive, easy-to-perform, and patient-friendly. The salivary flow rate, salivary pH, and salivary albumin level in systemically compromised subjects, tobacco users, and normal individuals showed significant differences.
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Affiliation(s)
- Abha Rani
- Department of Oral Medicine and Radiology, College of Dental Sciences, Davangere, Karnataka, India
| | | | | | - Rajeshwari G Annigeri
- Department of Oral Medicine and Radiology, College of Dental Sciences, Davangere, Karnataka, India
| | - Varsha Kanjani
- Department of Oral Medicine and Radiology, College of Dental Sciences, Davangere, Karnataka, India
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Aframian DJ, Baaton S, Mazor S, Nadler C, Keshet N, Haviv Y, Zadik Y, Schwimmer-Noy R, Shay B, Almoznino G. Improvement of dry mouth following intraductal irrigation of salivary glands. Oral Dis 2019; 25:1735-1743. [PMID: 31278807 DOI: 10.1111/odi.13152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/30/2019] [Revised: 06/10/2019] [Accepted: 06/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the effect of major salivary gland intraductal irrigations (IGs) to relieve mouth dryness. METHODS We retrospectively analyzed the records of patients with mouth dryness who underwent major salivary gland IG during 2013-2015. Records included demographics, medical background, dry mouth etiologies and symptomatology, and results of sialometry and sialo-cone-beam computerized tomography. Subjective improvement following the IG procedure (yes/no) and sustained subjective improvement (mouth dryness relief for ≥1 month) were recorded. Objective improvement was assessed by comparing the mean unstimulated (USF) and stimulated (SSF) whole salivary flow (WSF) rate before and after the IG. RESULTS Seventy-four patients were included [mean age: 59.08 ± 12.46 years]. Improvement was detected in the USF (p = .027), but not in the SSF (p = .878). Fifty-five (84.6%) noted subjective improvement, while 10 (15.4%) did not. Subjective improvement was positively associated with the USF following IG (p = .037), with salivary gland swelling episodes (p = .033), and with difficulties in swallowing dry foods (p = .014). Of those with subjective improvement, 45 (81.8%) reported sustained improvement, which was positively associated with lack of a gritty eye sensation (p = .042) and abnormal sialo-CBCT findings (p = .001). CONCLUSIONS Major salivary gland IG is a simple and safe procedure that may relieve dry mouth for a relatively extended duration. Further studies are needed to confirm these preliminary findings and assess their underlying mechanisms.
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Affiliation(s)
- Doron J Aframian
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Sagit Baaton
- Faculty of Dental Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Sigal Mazor
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Chen Nadler
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Naama Keshet
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yaron Haviv
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yehuda Zadik
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Rinat Schwimmer-Noy
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Boaz Shay
- Department of Endodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Galit Almoznino
- Sjogren's Syndrome Center, Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Gueiros LA, France K, Posey R, Mays JW, Carey B, Sollecito TP, Setterfield J, Woo SB, Culton D, Payne AS, Lodi G, Greenberg MS, Rossi SD. World Workshop on Oral Medicine VII: Immunobiologics for salivary gland disease in Sjögren's syndrome: A systematic review. Oral Dis 2019; 25 Suppl 1:102-110. [PMID: 31140693 PMCID: PMC6544171 DOI: 10.1111/odi.13062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review evaluated the efficacy of immunobiologics for the management of oral disease in Sjögren's syndrome (SS). MATERIALS AND METHODS MEDLINE® , Embase, Scopus, and the Cochrane Library were searched for evidence on the use of immunobiologics for management of glandular disease in SS. Primary outcomes were xerostomia and salivary gland dysfunction, assessed via visual analogue scales, disease-specific scales for SS, measurement of salivary flow, ultrasound data, and quality of life measures. RESULTS Seventeen studies (11 randomized controlled trials and 6 observational studies) met inclusion criteria. Rituximab showed efficacy in improving salivary gland function but not xerostomia. Abatacept showed promise in improving both xerostomia and salivary flow. Belimumab exhibited long-term improvement of salivary flow and subjective measures. The novel agent CFZ533 improved both disease activity and patient-reported indexes. CONCLUSIONS There is strong evidence pointing to the efficacy of rituximab in the management of oral disease in SS. Future controlled trials may elucidate the efficacy of belimumab and abatacept. The new drug CFZ533 is a promising alternative for the management of SS and its salivary gland involvement. In considering these agents, the promise of efficacy must be balanced against the harmful effects associated with biologic agents.
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Affiliation(s)
- Luiz Alcino Gueiros
- Oral Medicine Unit. Department of Clinic and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Rachael Posey
- William Rand Kenan, Jr. Library of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Jacqueline W. Mays
- Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Barbara Carey
- Department of Oral Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Thomas P. Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Jane Setterfield
- Department of Oral Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sook Bin Woo
- Department of Oral Medicine, Infection, and Immunity. Harvard School of Dental Medicine, Boston, MA, USA
| | - Donna Culton
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aimee S. Payne
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Giovanni Lodi
- Oral Medicine Unit, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Martin S. Greenberg
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Scott De Rossi
- School of Dentistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chen H, Tanaka S, Arai K, Yoshida S, Kawakami K. Insufficient Sleep and Incidence of Dental Caries in Deciduous Teeth among Children in Japan: A Population-Based Cohort Study. J Pediatr 2018; 198:279-286.e5. [PMID: 29709344 DOI: 10.1016/j.jpeds.2018.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/13/2018] [Accepted: 03/14/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To examine whether late bedtime and short nighttime sleep duration at age 18 months are associated with risk of caries in deciduous teeth. STUDY DESIGN Population-based cohort study using health check-up data of 71 069 children born in Kobe City, Japan, who were free of caries at age 18 months and had information on sleep variables at age 18 months and records of dental examinations at age 3 years. Sleep variables were assessed by standardized parent-reported questionnaires, and the incidence of caries in deciduous teeth was defined as the occurrence of at least 1 decayed, missing, or filled tooth assessed by qualified dentists without radiographs. Logistic regression was used to estimate the effects of late bedtime and short sleep duration on dental caries with adjustment for clinical and lifestyle characteristics. RESULTS Overall, 11 343 (16.0%) cases of caries were observed at age 3 years. aORs for children with late or irregular bedtimes compared with those with bedtimes before 21:00 were 1.26 (95% CI 1.19-1.33), 1.48 (1.38-1.58), 1.74 (1.58-1.92), 1.90 (1.58-2.29), and 1.66 (1.53-1.81) for bedtimes at 21:00, 22:00, 23:00, 0:00, and irregular bedtime, respectively. aORs for children with short or irregular sleep duration compared with those with sleep duration of ≥11 hours were 1.30 (95% CI 1.15-1.47), 1.16 (1.09-1.24), 1.11 (1.05-1.18), and 1.35 (1.25-1.46) for sleep duration of ≤ 8, 9, 10 hours, and irregular sleep duration, respectively. CONCLUSIONS In this exploratory study, late bedtime and short sleep duration were both consistently associated with increased risk of caries in deciduous teeth.
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Affiliation(s)
- Hongyan Chen
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Korenori Arai
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
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22
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Lalla RV, Treister N, Sollecito T, Schmidt B, Patton LL, Mohammadi K, Hodges JS, Brennan MT. Oral complications at 6 months after radiation therapy for head and neck cancer. Oral Dis 2017; 23:1134-1143. [PMID: 28675770 DOI: 10.1111/odi.12710] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/25/2017] [Accepted: 06/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC). METHODS Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6 months from the start of RT. RESULTS Mean stimulated whole salivary flow declined from 1.09 to 0.47 ml/min at 6 months (p < .0001). Mean maximal mouth opening reduced from 45.58 to 42.53 mm at 6 months (p < .0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤ .0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p < .0001). CONCLUSIONS Despite advances in RT techniques, patients with HNC experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.
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Affiliation(s)
- R V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, Farmington, CT, USA
| | - N Treister
- 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
| | - T Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.,Division of Oral Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - B Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA
| | - L L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K Mohammadi
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - M T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
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23
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Memtsa PT, Tolia M, Tzitzikas I, Bizakis J, Pistevou-Gombaki K, Charalambidou M, Iliopoulou C, Kyrgias G. Assessment of xerostomia and its impact on quality of life in head and neck cancer patients undergoing radiation therapy. Mol Clin Oncol 2017; 6:789-793. [PMID: 28529753 DOI: 10.3892/mco.2017.1200] [Citation(s) in RCA: 11] [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: 12/21/2016] [Accepted: 03/01/2017] [Indexed: 11/12/2022] Open
Abstract
Xerostomia in head and neck (H&N) cancer patients significantly affects their quality of life (QoL). The aim of the present study was to investigate the associations among QoL, xerostomia and quantity of saliva in a sample of H&N cancer patients who had received conventional radiotherapy (RT). A total of 60 H&N adult patients were enrolled in this prospective study. The patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30), the Quality of Life Questionnaire Head and Neck Module (QLQ-H&N35) and the Greek version of the XQ questionnaire at 4 timepoints: At the beginning of RT, at the end of RT, 6 months after RT completion and 1 year after RT completion. Patients with distant metastases or serious comorbidities were excluded from the study. Salivary pH, and stimulated and unstimulated salivary flow rate were assessed. All functional scales and symptom scales, apart from cognitive functioning in QLQ-C30 and feeding tube in H&N35 exhibited an abrupt deterioration at timepoint 3 and were then gradually restored over time. The difference was statistically significant (P<0.001). XQ scores at different timepoints exhibited a statistically significant negative correlation with salivary flow rates. Salivary flow rate and XQ scores almost parallelled one another. Flow rates recovered at a mean level of 20% below baseline values at the end of the follow-up period. The subjective symptom of xerostomia parallelled salivary flow and QoL. Despite receiving conventional RT, the participants exhibited a considerable preservation of salivary gland function after 12 months, allowing some optimism regarding the course of xerostomia in selected patients.
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Affiliation(s)
- Pinelopi-Theopisti Memtsa
- Department of Radiation Oncology, AHEPA University Hospital of Thessaloniki, Faculty of Medicine, School of Health Sciences, Aristoteleion University of Thessaloniki, 546 21 Thessaloniki, Greece
| | - Maria Tolia
- Department of Radiation Oncology, University Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Ioannis Tzitzikas
- Department of Radiation Oncology, AHEPA University Hospital of Thessaloniki, Faculty of Medicine, School of Health Sciences, Aristoteleion University of Thessaloniki, 546 21 Thessaloniki, Greece
| | - John Bizakis
- Department of Head and Neck Surgery, University Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Kyriaki Pistevou-Gombaki
- Department of Radiation Oncology, AHEPA University Hospital of Thessaloniki, Faculty of Medicine, School of Health Sciences, Aristoteleion University of Thessaloniki, 546 21 Thessaloniki, Greece
| | - Martha Charalambidou
- Department of Radiation Oncology, Theagenio Cancer Hospital of Thessaloniki, 546 39 Thessaloniki, Greece
| | - Chrysoula Iliopoulou
- Department of Radiation Oncology, Theagenio Cancer Hospital of Thessaloniki, 546 39 Thessaloniki, Greece
| | - George Kyrgias
- Department of Radiation Oncology, University Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
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Alkhateeb AA, Mancl LA, Presland RB, Rothen ML, Chi DL. Unstimulated Saliva-Related Caries Risk Factors in Individuals with Cystic Fibrosis: A Cross-Sectional Analysis of Unstimulated Salivary Flow, pH, and Buffering Capacity. Caries Res 2016; 51:1-6. [PMID: 27846621 PMCID: PMC5337435 DOI: 10.1159/000450658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022] Open
Abstract
Salivary flow rate, pH, and buffering capacity are associated with dental caries, but studies from the cystic fibrosis (CF) literature are inconclusive regarding these salivary factors and caries. The aim of this study was to evaluate these factors and their associations with dental caries in individuals with CF. Unstimulated whole saliva was collected from individuals aged 6-20 years at Seattle Children's Hospital CF Clinic, USA (n = 83). Salivary flow rate was measured in milliliters per minute. Salivary pH was assessed using a laboratory pH meter. Buffering capacity was assessed by titration with HCl. The outcome measure was caries prevalence, defined as the number of decayed, missing, or filled primary and permanent tooth surfaces. Spearman's rank correlation coefficient and the t test were used to test for bivariate associations. Multiple variable linear regression models were used to (1) run confounder-adjusted analyses and (2) assess for potential interactions. There was no significant association between salivary flow rate or buffering capacity and caries prevalence. There was a significant negative association between salivary pH and caries prevalence, but this association was no longer significant after adjusting for age. There was no significant interaction between salivary flow rate and buffering capacity or between antibiotic use and the 3 salivary factors. Our results indicate that unstimulated salivary factors are not associated with dental caries prevalence in individuals with CF. Future studies should investigate other potential saliva-related caries risk factors in individuals with CF such as cariogenic bacteria levels, salivary host defense peptide levels, and medication use.
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Affiliation(s)
- Alaa A. Alkhateeb
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
| | - Lloyd A. Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
| | - Richard B. Presland
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
- University of Washington, School of Medicine, Division of Dermatology, Seattle, Washington 98195, U.S.A
| | - Marilynn L. Rothen
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
| | - Donald L. Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
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Gambino A, Broccoletti R, Cafaro A, Cabras M, Carcieri P, Arduino PG. Impact of a sodium carbonate spray combined with professional oral hygiene procedures in patients with Sjögren's syndrome: an explorative study. Gerodontology 2016; 34:208-214. [PMID: 27813150 DOI: 10.1111/ger.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to make an initial estimation on the effects of a sodium bicarbonate and xylitol spray (Cariex® ), associated with non-surgical periodontal therapy, in participants with primary Sjögren's syndrome. BACKGROUND Sjögren's syndrome (SS) is a multisystem autoimmune disease that predominantly involves salivary and lachrymal glands, with the clinical effect of dry eyes and mouth. MATERIALS AND METHODS A prospective cohort of 22 women and two men has been evaluated. They were randomized into three groups (eight patients each): Group A) those treated once with non-surgical periodontal therapy, education and motivation to oral hygiene, associated with the use of Cariex® ; Group B) treated only with Cariex® ; Group C) treated only with non-surgical periodontal therapy, education and motivation to oral hygiene. Clinical variables described after treatment were unstimulated whole salivary flow, stimulated whole salivary flow, salivary pH, reported pain (using Visual Analogue Scale) and the Periodontal Screening and Recording index. RESULTS Salivary flow rate improved in all groups, but the difference was statistically significant only in those treated with Cariex® , alone or in combination with periodontal therapy. Gingival status improved in participants who underwent periodontal non-surgical therapy while remained unchanged in those only treated with Cariex® . Reported pain decreased in all groups, showing the best result in participants treated with periodontal therapy together with Cariex® . CONCLUSIONS We propose a practical approach for improving gingival conditions and alleviating oral symptoms in patients with SS. Future randomized and controlled trials are however required to confirm these results as well as larger population, and also assessing other parameters due to oral dryness, possible oral infections and more comprehensive periodontal indices.
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Affiliation(s)
- Alessio Gambino
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Roberto Broccoletti
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Adriana Cafaro
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Marco Cabras
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Paola Carcieri
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Paolo G Arduino
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
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Plemons JM, Al-Hashimi I, Marek CL; American Dental Association Council on Scientific Affairs. Managing xerostomia and salivary gland hypofunction: executive summary of a report from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2014; 145:867-73. [PMID: 25082939 DOI: 10.14219/jada.2014.44] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OVERVIEW Xerostomia, also known as "dry mouth," is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue. CONCLUSIONS AND PRACTICE IMPLICATIONS Initial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.
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Zero DT, Brennan MT, Daniels TE, Papas A, Stewart C, Pinto A, Al-Hashimi I, Navazesh M, Rhodus N, Sciubba J, Singh M, Wu AJ, Frantsve-Hawley J, Tracy S, Fox PC, Ford TL, Cohen S, Vivino FB, Hammitt KM. Clinical practice guidelines for oral management of Sjögren disease: Dental caries prevention. J Am Dent Assoc 2016; 147:295-305. [PMID: 26762707 DOI: 10.1016/j.adaj.2015.11.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Salivary dysfunction in Sjögren disease can lead to serious and costly oral health complications. Clinical practice guidelines for caries prevention in Sjögren disease were developed to improve quality and consistency of care. METHODS A national panel of experts devised clinical questions in a Population, Intervention, Comparison, Outcomes format and included use of fluoride, salivary stimulants, antimicrobial agents, and nonfluoride remineralizing agents. The panel conducted a systematic search of the literature according to pre-established parameters. At least 2 members extracted the data, and the panel rated the strength of the recommendations by using a variation of grading of recommendations, assessment, development, and evaluation. After a Delphi consensus panel was conducted, the experts finalized the recommendations, with a minimum of 75% agreement required. RESULTS Final recommendations for patients with Sjögren disease with dry mouth were as follows: topical fluoride should be used in all patients (strong); although no study results link improved salivary flow to caries prevention, the oral health community generally accepts that increasing saliva may contribute to decreased caries incidence, so increasing saliva through gustatory, masticatory, or pharmaceutical stimulation may be considered (weak); chlorhexidine administered as varnish, gel, or rinse may be considered (weak); and nonfluoride remineralizing agents may be considered as an adjunct therapy (moderate). CONCLUSIONS AND PRACTICAL IMPLICATIONS The incidence of caries in patients with Sjögren disease can be reduced with the use of topical fluoride and other preventive strategies.
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Metz MJ, Stapleton BM, Harris BT, Lin WS. A cost-effective treatment for severe generalized erosion and loss of vertical dimension of occlusion: laboratory-fabricated composite resin restorations. Gen Dent 2015; 63:e12-e17. [PMID: 26325651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.
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Møller E, Pedersen SA, Vinicoff PG, Bardow A, Lykkeaa J, Svendsen P, Bakke M. Onabotulinumtoxin A Treatment of Drooling in Children with Cerebral Palsy: A Prospective, Longitudinal Open-Label Study. Toxins (Basel) 2015; 7:2481-93. [PMID: 26134257 PMCID: PMC4516924 DOI: 10.3390/toxins7072481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/23/2015] [Revised: 06/14/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022] Open
Abstract
The aim of this prospective open-label study was to treat disabling drooling in children with cerebral palsy (CP) with onabotulinumtoxin A (A/Ona, Botox®) into submandibular and parotid glands and find the lowest effective dosage and least invasive method. A/Ona was injected in 14 children, Mean age 9 years, SD 3 years, under ultrasonic guidance in six successive Series, with at least six months between injections. Doses and gland involvement increased from Series A to F (units (U) per submandibular/parotid gland: A, 10/0; B, 15/0; C, 20/0; D, 20/20; E, 30/20; and F, 30/30). The effect was assessed 2, 4, 8, 12, and 20 weeks after A/Ona (drooling problems (VAS), impact (0–7), treatment effect (0–5), unstimulated whole saliva (UWS) flow and composition)) and analyzed by two-way ANOVA. The effect was unchanged–moderate in A to moderate–marked in F. Changes in all parameters were significant in E and F, but with swallowing problems ≤5 weeks in 3 of 28 treatments. F had largest VAS and UWS reduction (64% and 49%). We recommend: Start with dose D A/Ona (both submandibular and parotid glands and a total of 80 U) and increase to E and eventually F (total 120 U) without sufficient response.
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Affiliation(s)
- Eigild Møller
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark.
- Department of Neurology, Bispebjerg University Hospital, Copenhagen DK-2400, Denmark.
| | - Søren Anker Pedersen
- Departments of Pediatrics and Radiology, Hvidovre University Hospital, Hvidovre DK-2650, Denmark.
| | - Pablo Gustavo Vinicoff
- Departments of Pediatrics and Radiology, Hvidovre University Hospital, Hvidovre DK-2650, Denmark.
| | - Allan Bardow
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark.
| | - Joan Lykkeaa
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark.
| | - Pia Svendsen
- Gerbrandskolen, Copenhagen Municipal Dental Service, Copenhagen DK-2300, Denmark.
| | - Merete Bakke
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark.
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Konić-Ristić A, Šavikin K, Zdunić G, Besu I, Menković N, Glibetić M, Srdić-Rajić T. Acute effects of black currant consumption on salivary flow rate and secretion rate of salivary immunoglobulin a in healthy smokers. J Med Food 2015; 18:483-8. [PMID: 25734687 DOI: 10.1089/jmf.2013.0149] [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: 11/13/2022] Open
Abstract
The role of saliva in maintaining oral health and homeostasis is based on its physicochemical properties and biological activities of its components, including salivary immunoglobulin A (IgA). Both salivary rates and immunological status of saliva are found to be compromised in smokers. The aim of this study was to investigate the acute time-dependent effect of smoking and black currant consumption on the salivary flow rate (SFR) and salivary IgA secretion rate (sIgA SR) in healthy smokers. SFR, sIgA levels in saliva, and sIgA SRs were determined in healthy smokers (n=8) at eight times of assessment within three consecutive interventions: at the baseline; 5, 30, and 60 min after smoking; 5, 30, and 60 min after black currant consumption (100 g), followed by smoking; and 5 min after black currant consumption. Smoking induced a significant delayed effect on SFR measured 60 min after smoking (P=.03), while black currant consumption preceding smoking prevented that effect. Salivary IgA concentrations and sIgA flow rates were not acutely influenced by smoking. Black currant consumption preceding smoking induced a significant decrease in sIgA concentrations 5 min after the intervention compared with the baseline (P=.046), with a further increasing trend, statistically significant, 60 min after the intervention (P=.025). Although smoking cessation is the most important strategy in the prevention of chronic diseases, the obtained results suggest that the influence of black currant consumption on negative effects of tobacco smoke on salivary flow and immunological status of saliva could partly reduce the smoking-associated risk on oral health.
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Affiliation(s)
- Aleksandra Konić-Ristić
- 1 Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade , Belgrade, Serbia
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Satzl M, Schmierer A, Zeman F, Schmalz G, Loew T. Significant variation in salivation by short-term suggestive intervention: a randomized controlled cross-over clinical study. Head Face Med 2014; 10:49. [PMID: 25428655 PMCID: PMC4289223 DOI: 10.1186/1746-160x-10-49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/23/2014] [Accepted: 11/11/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most dental procedures require a dry working environment. Although many evaporative drying methods are available, an additional reduction of salivary flow would often be helpful. METHODS This prospective randomized cross-over study compares salivary production in 31 volunteers during direct, indirect, and non-suggestive (control group) intervention. Overall, each volunteer underwent four salivation measurements, i.e. two measurements during two different types of hypnotic suggestion (indirect and direct) arranged in random order and two control sections. All four measurements were conducted successively. RESULTS Both suggestive methods significantly reduced salivary production in comparison to the two control sections (direct suggestion Δ = 1.46 grams per 5 min, p < 0.001, indirect suggestion Δ = 0.94 grams per 5 min, p = 0.039). Direct suggestion showed a significantly higher reduction of salivary production than indirect suggestion (Δ = -0.53 grams per 5 min, p = 0.001). CONCLUSIONS Hypnotic suggestion represents a simple and inexpensive method to reduce salivation and could thus create a better working environment for more comfortable dental treatments for both patients and dentists.
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Affiliation(s)
- Maximilian Satzl
- />Department of Psychosomatic Medicine, Department of Operative and Restorative Dentistry, Periodontology, and Pedodontics, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | | | - Florian Zeman
- />Center of Clinical Studies, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Gottfried Schmalz
- />Department of Operative Dentistry and Periodontology, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Thomas Loew
- />Department of Psychosomatic Medicine, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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de Moura-Grec PG, Yamashita JM, Marsicano JA, Ceneviva R, de Souza Leite CV, de Brito GB, Brienze SLA, de Carvalho Sales-Peres SH. Impact of bariatric surgery on oral health conditions: 6-months cohort study. Int Dent J 2014; 64:144-9. [PMID: 24410073 DOI: 10.1111/idj.12090] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 01/06/2023] Open
Abstract
OBJECTIVES We evaluate oral health conditions before and after bariatric surgery. METHODS The sample was composed of 59 patients who had undergone Roux-en-Y gastric bypass (RYGB). Salivary flow, periodontal pocket depth and dental wear were evaluated before and after 6 months of surgery. Body mass index (BMI), C-reactive protein (CRP) and glucose levels were obtained from the patient's medical files. A t-test was used for dependent samples. RESULTS The mean BMI decreased from 49.31 ± 8.76 to 35.52 ± 8.12 kg/m(2) in 6 months after surgery (P < 0.000). Before surgery, 67% of patients had high levels of CRP and 38% higher blood glucose levels and after surgery there were significant reductions in these levels (P < 0.001). Salivary flow ranged from 0.84 to 0.95 ml/min. There was increased prevalence of periodontal pockets (P = 0.022) and mean pocket depth increased to about 0.5 mm (P < 0.001). The percentage of surfaces with dental wear in dentine was significantly higher after bariatric surgery (P = 0.002), while dental wear in enamel decreased (P = 0.019). CONCLUSIONS Bariatric surgery may improve systemic conditions. However, it had a negative impact on oral health conditions because of an increase in periodontal disease and dental wear.
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Abstract
The mouth is a complex natural cavity which constitutes the initial segment of the digestive tract. It is an essential actor of the vital functions as nutrition, language, communication. The whole mouth (teeth, periodontium, mucous membranes, tongue) is constantly hydrated and lubricated by the saliva. At any age, a balance becomes established between the bacterial proliferations, the salivary flow, the adapted tissular answer: it is the oral ecosystem. The regulation of this ecosystem participates in the protection of the oral complex against current inflammatory and infectious pathologies (caries, gingivitis, periodontitis, candidiasis). In elderly, the modification of the salivary flow, the appearance of specific pathologies (root caries, edentulism, periodontitis), the local conditions (removable dentures), the development of general pathologies, the development of general pathologies (diabetes, hypertension, immunosuppression, the insufficient oral care are so many elements which are going to destabilize the oral ecosystem, to favor the formation of the dental plaque and to weaken oral tissues. The preservation of this ecosystem is essential for elderly: it allows to eat in good conditions and so to prevent the risks of undernutrition. The authors describe the oral physiopathology (oral microflora, salivary secretion) and the strategies to be adopted to protect the balance of the oral ecosystem in geriatric population.
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Maekita T, Kato J, Nakatani Y, Enomoto S, Kayama T, Tsuji M, Nakaya T, Muraki Y, Deguchi H, Ueda K, Inoue I, Iguchi M, Tamai H, Ichinose M. Usefulness of a continuous suction mouthpiece during percutaneous endoscopic gastrostomy: a single-center, prospective, randomized study. Dig Endosc 2013; 25:496-501. [PMID: 23368904 DOI: 10.1111/den.12017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/06/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND No mouthpiece has been designed to control salivary flow during endoscopic procedures. A new continuous suction mouthpiece (CSM) was developed, and its usefulness for percutaneous endoscopic gastrostomy (PEG) was evaluated. PATIENTS AND METHODS Seventy-two patients who were scheduled to undergo PEG or the exchange of a gastrostomy button or tube were assigned to one of two groups: the group using the CSM and the group using the conventional mouthpiece. Aspiration pneumonia, procedure duration, extent of salivary flow, frequency of saliva suction, and number of choking episodes during the procedures were evaluated and compared between the two groups. RESULTS The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age, procedure type, duration of procedure,depth of sedation, and indication for the procedure. The grade of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece (P < 0.001). Significantly fewer suctions and choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece (P = 0.013, and P = 0.015, respectively). Aspiration pneumonia and other significant adverse events were not observed in either group. CONCLUSIONS CSM reduced the number of episodes associated with salivary flow in PEG-related procedures. The device is expected to reduce complications such as aspiration not only in PEG but in other upper endoscopic procedures.
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Affiliation(s)
- Takao Maekita
- Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama, Japan.
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Rivera C, Núñez-de-Mendoza C. Exfoliative cytology of oral epithelial cells from patients with type 2 diabetes: cytomorphometric analysis. Int J Clin Exp Med 2013; 6:667-676. [PMID: 24040475 PMCID: PMC3762622] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
This research objective is to identify cytomorphometrical changes using exfoliative cytology (EC) and later Papanicolaou (Pap) staining, for oral epithelial cells of patients with type 2 diabetes (DM2) (n = 30), while being compared to patients without the disease (n = 30). Additionally, we investigated an association between cellular changes and salivary flow levels; relationship that until now has not been reported. Results show that the cell diameter and the nuclear-cytoplasmic ratio was significantly higher compared to those patients without the disease (p ≤ 0.001 Student and Welch test). Decreased salivary flow was significantly associated with increased cell diameter and nuclear-cytoplasmic ratio (p ≤ 0.001 ANOVA with Tukey test). Evidence and clinical observations show that DM2 and decreased salivary flow are related to detectable cytomorphometrical changes in exfoliated cells, which may extend the horizon of this cytological technique.
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Affiliation(s)
- César Rivera
- Unit of Histology and Embryology, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of TalcaTalca, Chile
- Biomedical Sciences Master Program, Oral Pathology mention, University of TalcaTalca, Chile
| | - Camila Núñez-de-Mendoza
- Unit of Histology and Embryology, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of TalcaTalca, Chile
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Sakeenabi B, Hiremath SS. Dental caries experience and salivary Streptococcus mutans, lactobacilli scores, salivary flow rate, and salivary buffering capacity among 6-year-old Indian school children. J Int Soc Prev Community Dent 2011; 1:45-51. [PMID: 24478953 PMCID: PMC3894073 DOI: 10.4103/2231-0762.97697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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] [Indexed: 11/28/2022] Open
Abstract
Context: Dental caries is a disease of multifactorial etiology. A variety of potential predictors have been examined for the association with caries increments in longitudinal and cross-sectional studies. Aims: The aim of this study was to assess the possible relationship among salivary cariogenic microflora, buffer capacity, secretion rate, and caries experience among 6-year-old school-going children in Davangere city, India. Settings and Design: A total of 196 6-year-old school children were selected by a two-stage random sampling method. Materials and Methods: Parents were interrogated regarding sociodemographic details. Clinical examination of children was conducted to assess dental caries experience, and stimulated saliva was collected to assess S. mutans levels, lactobacilli, salivary flow, and buffering capacity of saliva. Statistical Analysis: The difference in proportions was tested using Kruskal–Wallis analysis of variance (ANOVA) followed by the Mann–Whitney U-test for intragroup comparison, and the difference in mean was tested using ANOVA and independent sample t-test as necessary. Caries experience was correlated with salivary factors using Spearman's correlation coefficient. Results: Out of 196 children, 96 were boys and 100 were girls. Overall, 97 (49.49%) children were caries free (dmft, DMFT = 0) and 99 (50.51%) children presented with caries (dmft, DMFT>0). The mean dmft and dmfs score for the overall group was 3.20 and 5.43, respectively. The mean DMFT and DMFS score was 0.23 and 0.25, respectively. A highly significant correlation was seen between mean the caries score and salivary variables. Conclusions: High levels of salivary microbiological counts in correlation with the caries data stress the importance of these factors and urge the necessity of elective preventive programs in this region.
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Affiliation(s)
- B Sakeenabi
- Department of Preventive and Community Dentistry, College of Dental Sciences, Davangere, India
| | - S S Hiremath
- Department of Preventive and Community Dentistry, Government Dental College and Research Institute, Fort, Bangalore, Karnataka, India
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Abstract
BACKGROUND Older adults are susceptible to reduced saliva production related to certain medications, radiation and chronic conditions. Many of these people have many physical and oral health problems and limited access to dental care. The use of effective screening tools for xerostomia and hyposalivation would be helpful in identifying those at risk. The authors conducted a study to investigate the association between three measures of oral dryness: hyposalivation (low unstimulated salivary flow), self-reported xerostomia and clinically assessed dry mouth. METHODS The authors included a convenience sample of 252 nondemented and dentate West Virginia participants 70 years and older who were part of a larger study on oral health and cognition among older adults. Participants completed a self-reported xerostomia index, provided an unstipulated salivary sample and underwent an oral assessment for the study. RESULTS Twenty-eight participants (11.1 percent) had hyposalivation, eight of whom reported having xerostomia (sensitivity=28.6 percent). Of the 43 participants who reported having xerostomia, only eight had hyposalivation (positive predictive value=18.6 percent). Hyposalivation and self-reported xerostomia were not significantly related. Clinically assessed dry mouth correlated modestly, but significantly, with hyposalivation and self-reported xerostomia. CONCLUSIONS Obtaining routine unstimulated salivary flow rates in addition to self-reported information and oral evaluations may increase early detection of oral dryness, which would assist in implementing early interventions to improve patients' quality of life. CLINICAL IMPLICATIONS Visually inspecting oral tissues for dryness and asking a patient if his or her mouth is dry are insufficient measures for clinicians to use to determine if the patient has hyposalivation. The authors recommend that clinicians determine the patient's unstimulated salivary flow rate.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA.
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