Dental care professionals' awareness of oral dryness and its clinical management: a questionnaire-based study

BACKGROUND

Despite the high prevalence of oral dryness and awareness of its complications, there is limited research on the clinical management of patients with oral dryness in general dental care.

PURPOSE

To (1) describe and compare awareness among dental care professionals regarding saliva functions, potential causes and complications of oral dryness, and patient management (2) Investigate if the length of professional experience influences these aspects.

METHODS

A digital self-administrated survey was sent to 2668 dental care professionals working in the general dental care, Public Dental Service, in Sweden. Twelve dental care professionals reviewed the questionnaire prior to its distribution. The questionnaire comprised 32 questions about patient management, awareness of saliva functions, causes and complications of oral dryness, and self-assessment queries.

RESULTS

The response rate was 18.6% (241 dentists and 257 dental hygienists). Older adults (65+) were asked more often about dry mouth (93.0%) compared to those aged 18-23 years (50.0%) and those under 18 years (24.9%). Dental hygienists encountered individuals with oral dryness more frequently (61.1%) than dentists (48.5%) (p < 0.01), and more often asked individuals in the age groups 18-23 years (p = 0.003), 24-40 years (p = 0.045), and 41-65 years (p = 0.031) about dry mouth. A higher proportion of dental hygienists (88.3%) than dentists (51.0%) had measured salivary secretion rate, (p < 0.001) and more often suggested preventive dental care 3-4 times a year, (42.5% vs. 30.5%) (p < 0.007). Dentists had a higher awareness of saliva functions, while dental hygienists had a higher awareness about causes and complications of oral dryness. Higher proportions of dentists and dental hygienists with over 10 years of professional experience had measured salivary secretion rate (69.1% vs. 95.7%) compared to their counterparts with less than 10 years of professional experience (35.9% vs. 79.5%) (p < 0.001 for both).

CONCLUSION

Compared to dentists, dental hygienists were more attentive to patients with oral dryness as they encountered these individuals more often, asked more age-groups, suggested frequent preventive measures, and had higher awareness of the causes and complications of oral dryness. Length of professional experience could improve both the management of patients with oral dryness and awareness of its causes, particularly for dental hygienists.

Salivary Electrostimulation in the Treatment of Radiation Therapy-Induced Xerostomia (LEONIDAS-2): A Multicenter, Randomized, Double-Masked, Sham-Controlled, Phase 3 Trial

PURPOSE

Radiation therapy-induced xerostomia significantly affects quality of life in head and neck cancer survivors. Neuro-electrostimulation of the salivary glands may safely increase natural salivation and reduce dry mouth symptoms.

METHODS AND MATERIALS

This multicenter, double-masked, randomized, sham-controlled clinical trial assessed the long-term effects of a commercially available intraoral neuro-electrostimulating device in lessening xerostomia symptoms, increasing salivary flow, and improving quality of life in individuals with radiation therapy-induced xerostomia. Using a computer-generated randomization list, participants were assigned (1:1) to an active intraoral custom-made removable electrostimulating device or a sham device to be used for 12 months. The primary outcome was the proportion of patients reporting a 30% improvement on the xerostomia visual analog scale at 12 months. A number of secondary and exploratory outcomes were also assessed through validated measurements (sialometry and visual analog scale) and quality-of-life questionnaires (EORTC QLQ-H&N35, OH-QoL16, and SF-36).

RESULTS

As per protocol, 86 participants were recruited. Intention-to-treat analyses showed no statistical evidence of a difference between the study groups with respect to the primary outcome or for any of the secondary clinical or quality-of-life outcomes. Exploratory analyses showed a statistically significant difference in the changes over time of the dry mouth subscale score of the EORTC QLQ-H&N35 in favor of the active intervention.

CONCLUSIONS

LEONIDAS-2 did not meet the primary and secondary outcomes.

Probing behavior of the leafhopper analyzed through DC electropenetrography and microscopy

Yamatotettix flavovittatus Matsumara is a new leafhopper species vector of sugarcane white leaf (SCWL) phytoplasma that causes sugarcane chlorosis symptoms. The effects of probing behavior of Y. flavovittatus on sugarcane and its implication for SCWL phytoplasma transmission are yet to be studied. In this research, we used DC electropenetrography (EPG) to define waveforms produced by adult and fifth-instar nymphal Y. flavovittatus on sugarcane and correlated them with salivary sheath termini (likely stylet tip locations) via light and scanning electron microscopy. The following six waveforms and associated activities are described: (NP) non-probing, (Yf1) stylet probing into epidermal cells, (Yf2) stylet probing through mesophyll/parenchyma, (Yf3) stylet contact with phloem and likely watery salivation, (Yf4) active ingestion of sap from phloem, probably sieve elements, and (Yf5) unknown stylet activity in multiple cell types. Study findings reveal that the Y. flavovittatus vector ingests sieve tube element more frequently and for longer durations than any other cell type, supporting that Y. flavovittatus is primarily a phloem feeder. Adult Y. flavovittatus show a longer total probing duration and produces a high density of puncture holes on sugarcane leaves. Moreover, probing behaviors revealed that adults typically ingest phloem sap more frequently and for longer durations than fifth-instar nymphs, enhancing sap ingestion. Furthermore, we propose that adults are more likely to acquire (during Yf4) and inoculate (during Yf3) higher amounts of phytoplasma than fifth-instar nymphs. This information on the penetration behavior of leafhopper Y. flavovittatus serves as a basis for advanced studies on the transmission mechanism of SCWL phytoplasma.

The Mechanism of Core Chinese Medicine Combination in Treating Salivation

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy

OBJECTIVE

To observe the clinical effect of botulinum toxin type A (BTA) injection into the salivary glands of the severe neurological patients with tracheotomy METHODS: Seven patients with severe neurological disorders after tracheotomy and obvious drooling symptoms were enrolled. BTA was injected into bilateral parotid glands and submandibular glands under the guidance of ultrasound. Unstimulated salivary flow rate (uSFR) and Drooling Severity and Frequency Scale (DSFS) were used to evaluate drooling before injection, 1 week, and 4 weeks after injection. We compared the extubation time, time of changing from balloon cannula to metal cannula, hospitalization time and incidence of recurrent pulmonary infection between these patients and other patients accepted conventional curation.

RESULTS

(1) The drooling severity scale (DSFS-S), the drooling frequency scale (DSFS-F), the drooling frequency and severity scale total score (DSFS-T) were significantly lower at 4 weeks after BTA injection compared to prior-treatment (p < .001). (2) uSFR of 1 week and 4 weeks were both statistically decreased than the untreated condition (p < .001). (3) Compared with the conventional group, the time of changing from balloon cannula to metal cannula was shortened obviously (p < .05) and incidence of recurrent pulmonary infection was clearly decreased (p < .05) after BTA treatment CONCLUSION: Ultrasound-guided BTA injection into salivary glands can effectively reduce saliva secretion. We also found that the time of changing cannula was shortened obviously and the incidence of recurrent pneumonia infection was reduced. BTA injection of salivary glands to cure drooling could advance to the clinical therapy in severe neurological patients after tracheotomy.

Ganoderma lucidum polysaccharides ameliorates D-galactose-induced aging salivary secretion disorders by upregulating the rhythm and aquaporins

Longer-term deterioration in saliva secretion has been observed to occur in response to aging. The functional deterioration of the salivary gland damages swallowing and chewing abilities and consequently reduces life quality of the elderly. There are, however, only a few proven effective treatments for aging salivary secretion disorders. Ganoderma lucidum polysaccharide (GLP) has been applied to treat various diseases because of its safety, efficacy, and low cost. We investigated the protective effect of GLP on the submandibular gland (SMG) during aging. D-galactose (D-gal) was used to treat the aging mice, and the body weight, water consumption, saliva secretion, and flow rate were measured after 6 weeks of modeling. Micromorphological changes of the SMG were assessed by hematoxylin-eosin staining and transmission electron microscopy. RT-qPCR and Western blot were used to detect the expression of apoptotic proteins and inflammatory cytokines. Aquaporins (AQPs) and rhythmic protein expression were analyzed by immunohistochemistry and immunofluorescence. The results showed that GLP effectively promoted the expression of AQP5, AQP4, and AQP1, inhibited the release of TNF-α, IL-6, and Bax, and reduced inflammation and apoptosis. Further experiments showed that GLP promoted the up-regulation of core clock genes and proteins and restored the co-localized expression of CLOCK and AQP5 that were weakened during aging, helping to attenuate aging-induced weight loss, decreased salivation, and structural and functional damage. The findings of this work contribute to understanding the nature of age-related modifications in SMG by identifying changes in AQP5 expression and regulatory mechanisms linked to SMG dysfunction during aging. GLP is a potential drug for maintaining healthy salivary gland (SG) status and preventing SG deficiency in the elderly.

Effect of continuous sweet gustatory stimulation on salivary flow rate over time

OBJECTIVE

This study aimed to determine changes in saliva secretion and subjective taste intensity during a sustained period with continuous gustatory stimulation.

DESIGN

Twenty-two healthy adults participated in this study. The selected taste solutions were aspartame, sucralose, and acesulfame potassium, which are nonnutritive sweeteners. The concentrations of sucralose1 and acesulfame potassium were set to show the same sweetness intensity as aspartame. Sucralose2 was twice the concentration of sucralose1. The solution was continuously fed into the oral cavity at a flow rate of 0.04 mL / min through a neck-worn precise infusion system. The salivary flow rate (g/min) after 10 min of intraoral water supply from the device was used as the baseline. Salivary flow rate, subjective taste intensity evaluated by the visual analog scale (VAS), and salivary flow rate relative to the baseline were recorded at 10, 30, 60, and 120 min after the start of the test.

RESULTS

In the aspartame, sucralose1, and sucralose2 groups, the salivary flow rate increased significantly from 10 min to 120 min after the start of the test when compared to the rate at baseline (p < 0.05). The relative salivary flow rate increased and the VAS value decreased significantly over time and were affected by the time factor (p < 0.001, p = 0.013, respectively) but not by the sweetener-group factor and the interaction effects.

CONCLUSIONS

Continuous gustatory stimulation may maintain increased salivary production for a sustained period.

Impairment of salivary function in juvenile idiopathic oligoarticular arthritis is a sign of early onset disease

AIM

Recent evidences of the presence of reduced stimulated salivary flow rate and altered saliva composition in oligoarticular juvenile idiopathic arthritis (o-JIA) suggest a specific damage to the salivary glands. The aim of this cross-sectional study was to investigate whether reduced salivary flow rate could be related to age and gender at disease onset in o-JIA.

METHODS

A total of 57 Caucasian patients (41 females and 16 males) aged 5 to 16 years affected by o-JIA were consecutively enrolled in the study. Information on medication intake, dietary and oral hygiene habits were gathered through a standardised questionnaire. All patients underwent oral and sialometry examination.

CONCLUSION

Early onset disease would seem to be associated with salivary glands impairment. Regular dental and salivary gland function assessments may be highly recommended in o-JIA patients considering that saliva collection is a non-invasive and inexpensive procedure.

[Effect of intradermal needling combined with oral motor therapy for salivation in children with cerebral palsy: a randomized controlled trial]

OBJECTIVE

To compare the effect of combination of intradermal needling with oral motor therapy and simple oral motor therapy on salivation in children with cerebral palsy.

METHODS

A total of 60 children with salivation in cerebral palsy were randomized into an observation group and a control group, 30 cases in each group. The observation group was treated with intradermal needling (kept for 24 hours each time at Jiache [ST 6], Dicang [ST 4], tongue three needles, etc. ) and oral motor therapy, while the control group was only given oral motor therapy. The intradermal needling was performed 3 times a week, and oral motor therapy was performed 5 times a week, 4 weeks as a course, totally 3 courses of treatment were required. The classification of teacher drooling scale (TDS), drooling severity and Kubota water swallow test, dysphagia disorders survey (DDS) score were compared before treatment and after 4, 8 and 12 weeks of treatment in both groups, and the clinical efficacy was evaluated.

RESULTS

After 8 weeks of treatment in the observation group and after 12 weeks of treatment in the two groups, the classification of TDS and drooling severity were improved (P<0.05), and the observation group was better than the control group after 12 weeks of treatment (P<0.05). After 8 and 12 weeks of treatment, the DDS scores of oral period in the observation group were lower than those before treatment (P<0.05). The total effective rate in the observation group was 83.3% (25/30), which was higher than 53.3% (16/30) in the control group (P<0.05).

CONCLUSION

The combination of intradermal needling with oral motor therapy can improve salivation symptoms and swallowing function in children with cerebral palsy, the effect is better than oral motor therapy alone, and the effect is earlier.

Prevalence of Sialorrhea Among Amyotrophic Lateral Sclerosis Patients: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease (MND), and sialorrhea is a known symptom in patients with ALS, which may cause a social embarrassment and discomfort. However, people do not pay attention to sialorrhea up to now. This study is aimed at conducting a systematic review and meta-analysis of the pooled prevalence of sialorrhea in ALS patients all around the world and raising awareness of salivation.

METHODS

We searched PubMed and EMBASE databases to obtain the comprehensive literatures which reported the prevalence of sialorrhea. We used AHRQ and NOS to evaluate the literature quality. Subgroup analyses were performed based on screening instruments and severity of sialorrhea. At the meantime, sensitivity analyses was also conducted to identify the source of heterogeneity.

RESULTS

A total of 17 eligible studies which included 21 groups of data reported prevalence of sialorrhea. The pooled prevalence of sialorrhea among ALS patients was 30.8% (95% CI: 20.0%-44.2%). For studies using ALSFRS-R, direct questioning, postal survey, and ALSSoL average and ALSFRS-R, the pooled prevalence of sialorrhea was 22.7%, 25.8%, 29.8% and 52.0% respectively. According to the severity of sialorrhea, the prevalence of mild, moderate, and severe sialorrhea were 25.1%, 11.2%, and 10.5%, respectively. And none of the studies alone had a significant effect on the overall prevalence of sialorrhea after we eliminated each study separately in sensitivity analyses.

CONCLUSIONS

Sialorrhea is a relatively common symptom in ALS patients with a comparatively high prevalence. In our study, we found that the prevalence of sialorrhea in ALS patients is relatively higher than the results based on direct questioning or postal survey. Therefore, we deduced that sialorrhea should be evaluated by more complex professional assessment scales to improve the quality of life and improve early prognosis of disease.

Advanced Glycation End Products Increase Salivary Gland Hypofunction in d-Galactose-Induced Aging Rats and Its Prevention by Physical Exercise

A declined salivary gland function is commonly observed in elderly people. Advanced glycation end products (AGEs) are believed to contribute to the pathogenesis of aging. Although physical exercise is shown to increase various organ functions in human and experimental models, it is not known whether it has a similar effect in the salivary glands. In the present study, we evaluated the AGEs burden in the salivary gland in the aging process and the protective effect of physical exercise on age-related salivary hypofunction. To accelerate the aging process, rats were peritoneally injected with D-galactose for 6 weeks. Young control rats and d-galactose-induced aging rats in the old group were not exercised. The rats in the physical exercise group ran on a treadmill (12 m/min, 60 min/day, 3 days/week for 6 weeks). The results showed that the salivary flow rate and total protein levels in the saliva of the d-galactose-induced aging rats were reduced compared to those of the young control rats. Circulating AGEs in serum and secreted AGEs in saliva increased with d-galactose-induced aging. AGEs also accumulated in the salivary glands of these aging rats. The salivary gland of aging rats showed increased reactive oxygen species (ROS) generation, loss of acinar cells, and apoptosis compared to young control mice. However, physical exercise suppressed all of these age-related salivary changes. Overall, physical exercise could provide a beneficial option for age-related salivary hypofunction.

Real-time monitoring of biomechanical activity in aphids by laser speckle contrast imaging

Studying in vivo feeding and other behaviors of small insects, such as aphids, is important for understanding their lifecycle and interaction with the environment. In this regard, the EPG (electrical penetration graph) technique is widely used to study the feeding activity in aphids. However, it is restricted to recording feeding of single insects and requires wiring insects to an electrode, impeding free movement. Hence, easy and straightforward collective observations, e.g. of groups of aphids on a plant, or probing other aphid activities in various body parts, is not possible. To circumvent these drawbacks, we developed a method based on an optical technique called laser speckle contrast imaging (LSCI). It has the potential for direct, non-invasive and contactless monitoring of a broad range of internal and external activities such as feeding, hemolymph cycling and muscle contractions in aphids or other insects. The method uses a camera and coherent light illumination of the sample. The camera records the laser speckle dynamics due to the scattering and interference of light caused by moving scatters in a probed region of the insect. Analyzing the speckle contrast allowed us to monitor and extract the activity information during aphid feeding on leaves or on artificial medium containing tracer particles. We present evidence that the observed speckle dynamics might be caused by muscle contractions, movement of hemocytes in the circulatory system or food flows in the stylets. This is the first time such a remote sensing method has been applied for optical mapping of the biomechanical activities in aphids.

Salivary cortisol in healthy dogs: a randomized cross-over study to evaluate different saliva stimulation methods and their effects on saliva volume and cortisol concentration

BACKGROUND

Salivary cortisol collected at home is a useful test to diagnose and monitor Cushing's syndrome in humans. The main problem in dogs is to retrieve a sufficient amount of saliva. The aim of this study was to evaluate different salivary collection methods and compare their effects on volume, pH and cortisol concentration of saliva. Sixteen healthy Beagles were used in a 4 × 4 randomized crossover study with a washout period of 1 week between each of the following collection methods: 1. Salimetrics® cotton swab dipped in ginger powder (ginger group); 2. beef-flavored Salimetrics® (bouillon group); 3. Salivette® cotton swab with an enclosed treat (treat group); 4. plain Salimetrics® (control group). First, baseline saliva (plain cotton swab, S0) and, 2 min later, experimental saliva (according to group allocation above, SExp) were collected. Saliva was gathered by holding the swabs in the animal's mouth for 2 min. After the cross-over study, another saliva sample was collected from all dogs by the ginger method, using a 30 s sampling time (30s-ginger method). Cortisol concentrations were measured by liquid chromatography tandem mass spectrometry.

RESULTS

All three stimulation methods increased saliva production significantly (S0 compared to SExp: ginger p = 0.0005; bouillon p = 0.009; treat p = 0.007). Only ginger stimulation, however, generated a significantly higher amount of saliva (SExp) compared to the control group (p = 0.00001; median (range) amount of saliva for SExp: ginger 1200 ul (600-1700), bouillon 650 ul (200-1900), treat 700 ul (300-1000), control 400 ul (0-1100)). The amount of saliva retrieved by the 30s-ginger method was still higher than that from the control group (p = 0.0004). Bouillon and treat stimulation led to decreased pH values (bouillon, p = 0.0028; treat, 0.0018). Excitement was higher in the ginger group (p = 0.01). Chewing was intensified in the ginger and treat group (ginger, p = 0.003; treat, 0.0009). The cortisol concentration SExp was higher compared to that of S0 in the ginger and treat group (p = 0.02, 0.003). The experimental cortisol concentrations (SExp) were not different between groups.

CONCLUSIONS

The 30s-ginger method could prove useful in evaluating or monitoring dogs with Cushing's syndrome, as sampling at home for 30 s by the owner seems feasible.

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

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

How Different Snacks Produce a Distinct Effect in Salivary Protein Composition

Saliva secretion changes in response to different stimulation. Studies performed in animals and humans suggest that dietary constituents may influence saliva composition, although the dynamics of these changes, and how they are specific for each type of food, are little known. The objective of the present study was to access the short-term effects of different foods in salivation and salivary protein composition. Twelve participants were tested for four snacks (yoghurt, bread, apple and walnuts). Non-stimulated saliva was collected before and at 0′, 5′ and 30′ after each snack intake. Flow rate, total protein, alpha-amylase enzymatic activity and salivary protein profile were analyzed. Yoghurt and apple were the snacks resulting in higher salivary changes, with higher increases in flow rate and alpha-amylase activity immediately after intake. The expression levels of immunoglobulin chains decreased after the intake of all snacks, whereas cystatins and one pink band (proline-rich proteins—PRPs) increased only after yoghurt intake. Walnut’s snack was the one resulting in lower changes, probably due to lower amounts eaten. Even so, it resulted in the increase in one PRPs band. In conclusion, changes in saliva composition varies with foods, with variable changes in proteins related to oral food processing and perception.

Cross-Modal Effect of Presenting Food Images on Taste Appetite

We researched a method to objectively evaluate the presence of food images, for the purpose of applying it to digital signage. In this paper, we defined the presence of food images as a sensation that makes us recognize that food is there, and investigated the relationship between that recognition and the salivary secretion reaction. If saliva secretion can be detected by a non-invasive method, it may be possible to objectively estimate the presence of the viewer from the outside. Two kinds of experiments were conducted. STUDY 1 included presentations of popular cooking images, which portrayed a sense of deliciousness, and evaluated changes in the volume of saliva secretions and cerebral blood flow near the temples. STUDY 2 included comparisons of changes between presenting images only and images with corresponded smells. The images included scenes that introduced foods (i.e., almond pudding cake/bergamot orange) that were relatively simple, so that they did not induce the subjects themselves. As a result, we clarified the cross-modal effects that were closely related to sense of presence and salivation. Moreover, we clarified presentation of images with smells to improve one's sense of presence, even though the images were relatively simple.

Agonists of Orally Expressed TRP Channels Stimulate Salivary Secretion and Modify the Salivary Proteome

Natural compounds that can stimulate salivary secretion are of interest in developing treatments for xerostomia, the perception of a dry mouth, that affects between 10 and 30% of the adult and elderly population. Chemesthetic transient receptor potential (TRP) channels are expressed in the surface of the oral mucosa. The TRPV1 agonists capsaicin and piperine have been shown to increase salivary flow when introduced into the oral cavity but the sialogogic properties of other TRP channel agonists have not been investigated. In this study we have determined the influence of different TRP channel agonists on the flow and protein composition of saliva. Mouth rinsing with the TRPV1 agonist nonivamide or menthol, a TRPM8 agonist, increased whole mouth saliva (WMS) flow and total protein secretion compared with unstimulated saliva, the vehicle control mouth rinse or cinnamaldehyde, a TRPA1 agonist. Nonivamide also increased the flow of labial minor gland saliva but parotid saliva flow rate was not increased. The influence of TRP channel agonists on the composition and function of the salivary proteome was investigated using a multi-batch quantitative MS method novel to salivary proteomics. Inter-personal and inter-mouth rinse variation was observed in the secreted proteomes and, using a novel bioinformatics method, inter-day variation was identified with some of the mouth rinses. Significant changes in specific salivary proteins were identified after all mouth rinses. In the case of nonivamide, these changes were attributed to functional shifts in the WMS secreted, primarily the over representation of salivary and nonsalivary cystatins which was confirmed by immunoassay. This study provides new evidence of the impact of TRP channel agonists on the salivary proteome and the stimulation of salivary secretion by a TRPM8 channel agonist, which suggests that TRP channel agonists are potential candidates for developing treatments for sufferers of xerostomia.

Intraoperative visualisation and treatment of salivary glands in Sjögren's syndrome by contrast-enhanced ultrasound sialendoscopy (CEUSS): protocol for a phase I single-centre, single-arm, exploratory study

INTRODUCTION

We established a promising sialendoscopic treatment for in vivo enhancement of salivation in salivary glands affected by Sjögren's syndrome (SS). In this technique, the ducts of the salivary glands are irrigated with saline and steroids. This allows for dilatation of ductal strictures and removal of debris. Unfortunately, it is not possible to assess the delivery and penetration of saline or medications in the ductal system and parenchyma. To address this problem, we will conduct contrast-enhanced ultrasound sialendoscopy (CEUSS) using sulphur hexafluoride microbubbles. To the best of our knowledge, microbubbles have never been used for the treatment of salivary glands in SS. It is, therefore, imperative to test this application for its safety and feasibility.

METHODS AND ANALYSIS

A single-arm phase I study will be performed in 10 SS patients. Under local anaesthesia, ultrasound (US) guided infusion of the parotid and submandibular glands with microbubbles will be performed. Continuous US imaging will be used to visualise the glands, including the location of strictures and occlusions. Main outcomes will be the evaluation of safety and technical feasibility of the experimental treatment. Secondary outcomes will consist of determinations of unstimulated whole mouth saliva flow, stimulated whole mouth saliva flow, stimulated parotid saliva flow, clinical oral dryness, reported pain, xerostomia, disease activity, salivary cytokine profiles and clinical SS symptoms. Finally, salivary gland topographical alterations will be evaluated by US.

ETHICS AND DISSEMINATION

Ethical approval for this study was obtained from the Medical Ethics Committee of the Amsterdam University Medical Centre, Amsterdam, The Netherlands (NL68283.029.19). data will be presented at national and international conferences and published in a peer-reviewed journal. The study will be implemented and reported in line with the Standard Protocol Items: Recommendations for Interventional Trials' statement.

TRIAL REGISTRATION NUMBERS

The Netherlands Trial Register: NL7731, MREC Trial Register: NL68283.029.19; Pre-results.

Simultaneously Transplanted Pancreas Improves Salivation and Reduces Oral Fungal Infections Incidence in Type 1 Diabetic Renal Transplant Recipients

BACKGROUND

Long-lasting diabetes mellitus may lead to numerous pathologies in the oral cavity. The aim of the study was to assess the condition of the oral cavity, caries intensity, salivary parameters, and incidence of oral fungal infections in patients with type 1 diabetes (T1D) and end-stage renal disease (ESRD) after kidney transplantation (KTx) or simultaneous kidney and pancreas transplantation (SPK).

METHODS

Twenty-one patients after SPK, 18 T1D patients after KTx, and 14 kidney recipients without diabetes (control group) were included in the study. Donor sources complied with Helsinki Congress and the Declaration of Istanbul.

RESULTS

Approximal plague index in SPK (80% [68%-90%]) was comparable to KTx (80% [37.5%-92.5%]) but higher than in control group (46% [35%-50%]). All 3 groups did not differ in terms of decayed-missing-filled tooth index: 22.3 ± 4.8 vs 22.5 ± 4.5 vs 19.1 ± 4.9, respectively. Normal saliva resting secretion and consistency were more common in SPK (71.4% and 52%, respectively) than in KTx (27.8% and 50.0%, respectively). Stimulated saliva volume in the SPK, KTx and controls, pH value, and buffering capacity were comparable. In KTx higher incidence of Candida albicans infection (55.6%) compared with SPK (23.8%) and controls (no infection) was observed.

CONCLUSIONS

Simultaneously transplanted pancreas improves salivation and reduces the incidence of oral fungal infections in T1D kidney recipients. The severity of caries is higher and oral hygiene is worse in T1D kidney recipients compared with patients after KTx without diabetes.

Oral disorders in children with Prader-Willi syndrome: a case control study

INTRODUCTION

Prader-Willi Syndrome (PWS) is a genetic disorder caused by the lack of expression of certain paternal genes located on chromosome 15q11-q13. This anomaly causes cognitive, neurological and endocrine abnormalities, among which one of the most important is hyperphagia. The aim of this study was to assess the oral health of children with PWA and to establish preventive criteria.

RESULTS

Thirty patients with PWS (mean age 10.2 years) and 30 age- and gender-matched controls were included in the study. Twenty-six patients with PWS(86.6%) followed dietary treatment prescribed by their endocrinologist. Individuals with PWS had a mean caries index of 53.3% and Decayed Missing Filled teeth (DMFT) index 2.5, and 53.3% had gingivitis, in the control group the respective figures were 43.3%, 0.93, and 60%. Only the DMFT index (p 0.017) presented significant differences. Regarding stimulated salivary secretion, patients with PWS presented a mean of 0.475 ml/min with a pH of 6.15, while controls presented a mean of 0.848 ml/min with a pH of 7.53; the differences between the groups were statistically significant in both cases (p 0.032 and p 0.0001 respectively). The population with PWS presented a higher plaque index (> 2) than their healthy peers, but the differences were not significant.

CONCLUSION

Pediatric patients with Prader-Willi syndrome have an increased risk of caries and gingivitis. The children with this syndrome have a decreased salivary flow and a more acidic salivary pH. In these patients, dental care is an essential part of their multidisciplinary medical treatment.

Methods of salivation reduction assessment at a dental appointment

OBJECTIVE

The aim: To develop and study the methods of assessing the decrease in salivation during a dental appointment.

PATIENTS AND METHODS

Materials and methods: We formed an observation group of 185 people (61 men and 124 women), which complained of dry mouth.

RESULTS

Results: According to the results of the survey, we found that 10.3% (19 patients) had moderate xerostomia and 89.7% (166 patients) had pronounced xerostomia. In 179 patients (96.8%) with complaints of dry mouth and with a subjective assessment as pronounced xerostomia, salivation rate was, on average, 0.08 ± 0.01 ml/min. That was reliably objectified by laboratory indicator of hyposalivation - less than 0.1 ml/min.

CONCLUSION

Conclusions: In our studies, we proved a direct relationship between patient complaints of dry mouth and laboratory-confirmed data. This makes it possible for a stomatologistto quickly identify this pathology, analyze it and choose the right treatment tactic during clinical appointment.

Salivary gland metabolism in an animal model of chronic kidney disease

OBJECTIVE

The aim of this study was to determine the effects of experimental CKD into the metabolism of parotid and submandibular glands of rats. CKD was induced by 5/6 nephrectomy.

DESIGN

Serum analyses of BUN (Blood Urea Nitrogen) and creatinine concentrations were performed. Major salivary glands metabolism was investigated in vivo, both at rest and during salivary stimulation conditions by NMR isotopomer analysis, using [U-¹³C]glucose as metabolic tracer.

RESULTS

CKD increases BUN and serum creatinine concentrations (p < 0.001). Multiple metabolic alterations were detected in the parotid glands of this animal model, including decreased concentrations of alanine (p < 0.05) and creatine (p < 0.05) and increased lactate/alanine ratios (p < 0.05). The salivary stimulus fostered accumulations of acetate at both analyzed glands of the CKD model (p < 0.05), indicative of disruption of the oxidative metabolic process.

CONCLUSIONS

Experimental CKD induced by 5/6 nephrectomy altered the parotid salivary gland function, since glucose metabolism is clearly affected after stimulation for salivation in this gland.

Root canal treatment in elderly patients: A review and clinical considerations

Life expectancy has increased as a result of advancements in health care services; thus, maintaining healthy dentition is an important factor in overall health. Furthermore, the growing desire of elderly patients to maintain their teeth has led to an increased need for the performance of complex dental treatment in elderly patients. Root canal therapy is an essential phase of such treatments. Elderly patients may exhibit one or more systemic conditions that require special care, in addition to other changes that occur within the dentition and oral mucosa as a result of aging. These make root canal treatment in elderly patients a great challenge. The aim of this review was to characterize pathologic and physiologic changes in elderly patients that can interfere with root canal treatment procedures, as well as attitudes of elderly patients toward such treatment, guidelines and clinical considerations for management of root canal treatment in elderly patients.

Measurement of unstimulated salivary flow rate in healthy children aged 6 to 15 years

The aim of the present study was to measure unstimulated saliva flow rate (uSFR), pH value and buffer capacity in healthy children aged 6 to 15 years to serve as reference values for subsequent investigations, in particular to define threshold values for abnormality. Our basic data will power the limited amount of currently available data on salivary flow rate in healthy children. The uSFR was evaluated for correlations with pH value and buffer capacity. The unstimulated saliva of 274 children aged 6 to 15 years was collected (n: 154) by the spitting method within three minutes. The samples were examined immediately after saliva collection in terms of uSFR, pH value and buffer capacity. From the 274 participating children 18 were excluded due to the intake of medication. The medians (IQR) of uSFR of the tested children were 0.87 (0.54, 1.11) ml/min for boys, 0.65 (0.37, 0.98) ml/min for girls and 0.76 (0.49, 1.05) ml/min in total. The uSFR correlated with the pH value and the buffer capacity (p < 0.001). For different genders there was a statistically significant difference regarding uSFR (p = 0.008) and pH value (p = 0.016). Based on the available data, the pH value and the buffer capacity were closely related to the uSFR. Boys seemed to have a higher uSFR than girls.

Synergistic effects of ischemic preconditioning and immediate post-conditioning in the protection against ischemia/reperfusion injury in rabbit submandibular glands

Submandibular gland autotransplantation is an effective approach for treating severe keratoconjunctivitis sicca. However, ischemia/reperfusion (I/R) injury, which inevitably occurs during transplantation, is involved in the hypofunction and structural damage that occur early after transplantation. Therefore, it is critical to identify effective strategies to ameliorate I/R injury in submandibular glands. In this study, we investigated the ability of immediate post-conditioning combined with ischemic preconditioning to attenuate I/R injury. We observed that after I/R injury, the level of reactive oxygen species was increased, inflammatory response was strengthened, and severe apoptosis had occurred. In addition, the salivary flow rate was greatly decreased. However, the pathogenesis of I/R injury was significantly ameliorated by ischemia post-conditioning or ischemia preconditioning treatments. In addition, the combination of ischemia preconditioning and post-conditioning achieved synergistic protective effects against I/R injury compared with ischemia preconditioning or ischemia post-conditioning alone. The secretion function was restored in the combination group. Furthermore, the combination treatment involved the same mechanisms of ischemia preconditioning or ischemia post-conditioning, including suppression of the inflammatory reaction and neutrophil accumulation, attenuation of oxidation stress, and inhibition of apoptosis. In conclusion, the combination of ischemia preconditioning and ischemia post-conditioning treatment is a simple and effective approach for treating I/R injury in submandibular glands.

Can different stages of leprosy treatment influence the profile of oral health? Oral status in leprosy

BACKGROUND

The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects.

MATERIAL AND METHODS

A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA).

RESULTS

The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment).

CONCLUSIONS

It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals.

Assessing the association between unstimulated whole salivary flow rate (UWSFR) and oral health status among healthy adult subjects: A cross-sectional study

BACKGROUND

This study aimed to test the association between the unstimulated whole salivary flow rate (UWSFR) and the oral health status represented by dental and gingival status among healthy adult subjects.

MATERIAL AND METHODS

This work was a cross-sectional study of patients attending the undergraduate dental clinics at AlFarabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. The study population consisted of 502 systemically healthy adults aged 18-35 years. UWSFR was collected for all study participants and expressed as ml/min. Oral health status was estimated using the Community Periodontal Index (CPI) and the Oral Hygiene Index-Simplified (OHI-S). The number of decayed teeth and the number of available teeth were also calculated to evaluate dental status.

RESULTS

The mean UWSFR was 0.42 (±0.3) ml/min, and the male participants significantly had more UWSFR than the females. UWSFR was significantly affected by CPI, OHI-S, body mass index (BMI) and gender as indicated in the univariate analysis. However, multiple regression analysis revealed that only gender was a significant predictor of UWSFR. The male subjects were shown to have a higher average of 0.133 ml/min than the females.

CONCLUSIONS

High BMI scores, moderate-to-severe gingivitis and low level of oral hygiene increased UWSFR. However, further longitudinal studies are recommended to test the role of salivary cytokine levels to validate the exact association between the UWSFR and the oral health status.

Do I sound dry? Comparative voice analysis of primary Sjögren's syndrome

OBJECTIVES

Desiccation of the vocal tract can cause many voice problems. Therefore, we aimed to investigate whether patients with primary Sjögren's syndrome (pSS) with dry mouth have more voice-related problems than controls without the disease and to determine the factors affecting voice in pSS patients.

METHODS

Patients with pSS and controls complaining of voice-related symptoms underwent acoustic analysis, aerodynamic study and stroboscopic analysis. They also completed the voice handicap index (VHI) questionnaire and perceptual voice analysis (GRBAS). Various disease-related parameters were obtained from pSS registry data.

RESULTS

Fifty-five pSS patients and 52 controls were analysed. The subjects were all female, and mean age was 53.9 years. VHI score was significantly higher in the pSS patient group (median [interquartile range], 11 [3-30] vs. 5.5 [0- 15.75], p=0.014). However, the results of acoustic analysis aerodynamic study and stroboscopic findings were not different between the two groups. Disease-related parameters were available in 47 pSS patients. Correlation analysis revealed that jitter value positively correlated with ESSDAI (spearman's rho = 0.29, p=0.048) and patient global assessment (rho=0.3, p= 0.04). High VHI score was associated with low quality of life measured by EQ5D (rho=-0.493, p=0.0001). Of note, patients with longer disease duration (≥ 40 months) showed higher noise-to-harmonics ratio (NHR).

CONCLUSIONS

Patients with pSS had higher VHI score, which was associated with low quality of life and longer disease duration was associated with increased noise in pSS patients. The likelihood of voice problems should be addressed with pSS patients, and vocal hygiene education will be important in those patients.

Immune response against the coiled coil domain of Sjögren's syndrome associated autoantigen Ro52 induces salivary gland dysfunction

OBJECTIVES

The structural domains of Ro52, termed the RING, B-box, coiled coil (CC) and B30.2/SPRY are targets of anti-Ro52 in multiple autoimmune disorders. In Sjögren's syndrome patients, the presence of anti-Ro52 is associated with higher disease severity, and in mice, they induce salivary gland hypofunction. This study was undertaken to investigate whether immune responses against different domains of Ro52, influences salivary gland disease in mice.

METHODS

Female NZM2758 mice were immunised with Ro52 domains expressed as recombinant fusion proteins with maltose binding protein (MBP) [MBP-RING-B-box, MBP-CC, MBP-CC(ΔC19), MBP-B30.2/SPRY]. Sera from immunised mice were studied for IgG antibodies to Ro52 by immunoprecipitation, and to salivary gland cells by immunofluorescence. Pilocarpine-induced saliva production was measured to evaluate salivary gland function. Submandibular glands were investigated by histopathology for inflammation and by immune-histochemistry for IgG deposition.

RESULTS

Mice immunised with different Ro52-domains had comparable reactivity to Ro52 and to salivary gland cells. However, only mice immunised with the CC domain and its C-terminal truncated version CC(ΔC19) showed a significant drop in saliva production. None of the mice developed severe salivary gland inflammation. The salivary gland hypofunction significantly correlated with increased intra-lobar IgG deposits in the submandibular salivary glands.

CONCLUSIONS

Our data demonstrate that epitope specificity of anti-Ro52 antibodies plays a critical role in the induction of glandular dysfunction. Clearly, screening Sjögren's syndrome patients for relative levels of Ro52 domain specific antibodies will be more informative for associating anti-Ro52 with clinical measures of the disorder.

Diagnostic and predictive evaluation using salivary gland ultrasonography in primary Sjögren's syndrome

OBJECTIVES

We aimed to assess the diagnostic accuracy of salivary gland ultrasonography (SGUS) as a single test for the detection of primary Sjögren's syndrome (pSS) and examine the prognostic factors for severe structural damage of the salivary glands based on SGUS score.

METHODS

Patients with pSS (n=94) and idiopathic sicca syndrome (n=44) were evaluated using the SGUS 0-48 scoring system, which comprises five parameters: parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechogenic reflections, and clearness of posterior borders. The salivary gland volume and intraglandular power Doppler signal (PDS) were also assessed. A multivariate linear regression analysis was performed to determine the factors associated with SGUS score.

RESULTS

Patients with pSS showed a significantly higher SGUS score than controls [median (IQR): 24.5 (13.0) vs 6 (3.75), p<0.001]. An SGUS cut-off of ≥14 had a sensitivity of 80.9% and a specificity of 95.5% for the diagnosis of pSS. There were no significant differences in the measured volumes and PDS between pSS patients and controls. The SGUS score correlated with unstimulated salivary flow rate (USFR), serum rheumatoid factor and IgG. Double seropositivity with anti-Ro/SS-A and anti-La/SS-B (β=6.060, p=0.001) and USFR (β=-1.913, p<0.001) were independently associated with the SGUS score.

CONCLUSIONS

The SGUS scoring system is a valuable diagnostic method for pSS. Double seropositivity of anti-Ro/SS-A and La/SS-B along with USFR were independent predictive factors for structural damage of the salivary glands.

Discrepancy between subjective symptoms, objective measures and disease activity indexes: the lesson of primary Sjögren's syndrome

Mucosal dryness is a key clinical feature in primary Sjögren's syndrome (pSS) and its assessment relies on both objective measurement of residual secretion and subjective symptoms reported by patients. However, while the objective assessment and grading of glandular dysfunction can be easily performed, the spectrum of clinical symptoms encompassed by the terms 'dry eye' and 'dry mouth' is wide and heterogeneous. Therefore, patient reported outcomes (PROs) for dryness in pSS poorly correlate with the amount of glandular secretion. In addition, subjective dryness is not correlated with the severity of systemic disease and severely affects the patient quality of life even in presence of active extraglandular manifestations. The purpose of this review article is to provide an overview of glandular dysfunction in pSS as well as the impact of discrepancy between objective assessment, subjective symptom and extraglandular disease activity on disease management.

Imaging in primary Sjögren's syndrome: the 'obsolete and the new'

Primary Sjögren's syndrome (pSS) is a complex systemic autoimmune disease primarily characterised by a focal chronic inflammation of glandular parenchyma, with chronic and persistent involvement of major salivary gland remaining a key element of the disease. Indeed, classification criteria proposed for pSS have always included items for histological and/or imaging salivary gland assessment. Over time, the approach to the definition of glandular involvement in pSS is constantly evolving. In this review we will therefore illustrate the state of the art of imaging techniques in pSS, focusing on conventional and novel modalities and discussing their advantages, drawbacks and possible future developments.

[Application of oral Foams Splat Oral Care Foam 2 in 1 in patients with false xerostomia]

The purpose of our study was to identify false xerostomies in students of different nationalities studying at the Faculty of Dentistry of the Sechenov University and to assess the effectiveness of Splat Oral Care Foam 2 in 1 against xerostomia stress-induced. Based on the results of Fox test 40 people were selected who used Splat Oral Care Foam 2 in 1 for three weeks. The participants were divided in 4 groups of 10 depending on the nationality. Oral hygiene was assessed by OHI-S and Silness-Loe indices and saliva was collected by the method of M.M. Pozharitskaya to determine salivation rate. It was found that the use of Splat Oral Care Foam 2 in 1 significantly improves the level of oral hygiene and positively affects the rate of salivation, thereby improving the quality of life.

Salivary lipids: A review

Saliva is produced by both large and small salivary glands and may be considered one of the most important factors influencing the behavior of oral cavity homeostasis. Secretion of saliva plays an important role in numerous significant biological processes. Saliva facilitates chewing and bolus formation as well as performs protective functions and determines the buffering and antibacterial prosperities of the oral environment. Salivary lipids appear to be a very important component of saliva, as their qualitative and quantitative composition can be changed in various pathological states and human diseases. It has been shown that disturbances in salivary lipid homeostasis are involved in periodontal diseases as well as various systemic disorders (e.g. cystic fibrosis, diabetes and Sjögren's syndrome). However, little is known about the role and composition of salivary lipids and their interaction with other important ingredients of human saliva, including proteins, glycoproteins and salivary mucins. The purpose of this review paper is to present the latest knowledge on salivary lipids in healthy conditions and in oral and systemic diseases.

Metabolic remodeling triggered by salivation and diabetes in major salivary glands

The metabolic profile of major salivary glands was evaluated by ¹³ C nuclear magnetic resonance isotopomer analysis (¹³ C NMR-IA) following the infusion of [U-¹³ C]glucose in order to define the true metabolic character of submandibular (SM) and parotid (PA) glands at rest and during salivary stimulation, and to determine the metabolic remodeling driven by diabetes. In healthy conditions, the SM gland is characterized at rest by a glycolytic metabolic profile and extensive pyruvate cycling. On the contrary, the PA gland, although also dominated by glycolysis, also possesses significant Krebs' cycle activity and does not sustain extensive pyruvate cycling. Under stimulation, both glands increase their glycolytic and Krebs' cycle fluxes, but the metabolic coupling between the two pathways is further compromised to account for the much increased biosynthetic anaplerotic fluxes. In diabetes, the responsiveness of the PA gland to a salivary stimulus is seriously hindered, mostly as a result of the incapacity to burst glycolytic activity and also an inability to improve the Krebs' cycle flux to compensate. The Krebs' cycle activity in the SM gland is also consistently compromised, but the glycolytic flux in this gland is more resilient. This diabetes-induced metabolic remodeling in SM and PA salivary glands illustrates the metabolic need to sustain adequate saliva production, and identifies glycolytic and oxidative pathways as key players in the metabolic dynamism of salivary glands.

A retrospective survey of the causes of bracket- and tube-bonding failures

OBJECTIVE

To investigate the causes of bonding failures of orthodontic brackets and tubes and the effect of premedicating for saliva reduction.

MATERIALS AND METHODS

Premedication with atropine sulfate was administered randomly. Failure rate of brackets and tubes placed in a group of 158 consecutive patients was evaluated after a mean period of 67 weeks after bonding.

RESULTS

The failure rate in the group without atropine sulfate premedication was 2.4%. In the group with premedication, the failure rate was 2.7%. The Cox regression analysis of these groups showed that atropine application did not lead to a reduction in bond failures. Statistically significant differences in the hazard ratio were found for the bracket regions and for the dental assistants who prepared for the bonding procedure.

CONCLUSIONS

Premedication did not lead to fewer bracket failures. The roles of the dental assistant and patient in preventing failures was relevant. A significantly higher failure rate for orthodontic appliances was found in the posterior regions.

Ganglioradiculitis (Sensory Neuronopathy) in a Dog: Clinical, Morphologic, and Immunohistochemical Findings

A 9-year-old Labrador Retriever was diagnosed with ganglioradiculitis (sensory neuronopathy). This idiopathic disease of mature dogs is characterized by a profound loss of sensory nerve function due to mononuclear inflammatory infiltration of peripheral ganglia and spinal nerve roots, with destruction of sensory neurons. Immunohistochemistry demonstrates that the infiltrating cells are primarily T lymphocytes and that immunoglobulins are not present on the cell membranes of affected neurons. The pathogenesis of ganglioradiculitis remains unclear, but the evidence points to a cell-mediated immune mechanism.

A preliminary study of the oral microbiota in Chinese patients with Sjögren's syndrome

OBJECTIVE

To investigate the oral microbiota in Sjögren's syndrome (SS) as opposed to that of healthy subjects.

STUDY DESIGN

Ten patients with primary SS, [6 patients daily taking stable dosage of hydroxychloroquine (HC) and 4 patients taking hydroxychloroquine combined with Prednisone acetas (HC+PA)], along with 10 age-matched healthy controls were examined in regard of number of teeth, stimulated/unstimulated saliva secretion rate. Microflora on bilateral buccal mucosa was analyzed by high throughput sequencing. Statistical analyses were performed using the chi-square test, t test and Mann-Whitney U test. The Venn diagrams and Redundancy Analysis (RDA) were also used to evaluate effects of the disease and treatment on the bacterial community composition.

RESULTS

The relative abundance of Proteobacteria in SS group was lower compared to controls (P=0.002). The total richness of genera for all groups was 339. The numbers of genera in SS group and in control group were 248 and 270, respectively. Some taxa with different prevalence and/or relative abundance were found between two groups.

CONCLUSIONS

SS affects the oral microbiota and SS patients carry a different and less diverse microorganism community compared with healthy subjects. Prednisone acetas is an influence on the oral microbiome. This study provides a basic data on the oral flora in SS patients.

Role of the Accessory Parotid Gland in the Etiology of Parotitis: Statistical Analysis of Sialographic Features

This retrospective study aimed to identify if the existence of the accessory parotid gland correlated with the etiology of parotitis. This may aid the development of better treatment strategies in the future. Sialographic features of cases with parotitis and healthy subjects were reviewed. The chi-square test was used to compare the incidence of accessory parotid gland between the groups. The Student's t test was used to compare the length of Stensen's duct, the length from the orifice to the confluence of the accessory duct, and the angle between the accessory duct and Stensen's duct between the groups. The incidence of accessory parotid gland in patients with parotitis was 71.8% (28/39), which was significantly higher than that in healthy subjects (P = 0.005). Patients with parotitis had a longer Stensen's duct than healthy subjects (P = 0.003). There was no significant difference in the length from the orifice to the confluence of the accessory duct or the angle between the accessory duct and Stensen's duct (P = 0.136 and 0.511, respectively) between the groups. The accessory parotid gland might play a role in the pathogenesis of parotitis. The existence of an accessory parotid gland is likely to interfere with salivary flow. Computational fluid dynamics analysis of salivary flow in the ductal system would be useful in future etiologic studies on parotitis.

Sialendoscopy of Salivary Glands Affected by Sjögren Syndrome: A Randomized Controlled Pilot Study

PURPOSE

Sialendoscopy of the major salivary glands could alleviate the oral symptoms of Sjögren syndrome (SS) and restore salivary function. The aim of this pilot study was to evaluate the effect of sialendoscopy of the major salivary glands on salivary flow, saliva composition, and mouthfeel in patients with SS and to collect data for sample size analysis for a larger clinical trial.

MATERIALS AND METHODS

Twenty patients diagnosed with SS were randomly assigned to a nonintervention control group or a sialendoscopy group. Unstimulated whole saliva flow, stimulated whole saliva flow, Clinical Oral Dryness Score, Xerostomia Inventory score, and EULAR Sjögren's Syndrome Patient Reported Index score were obtained 1 week before (T0), 1 week after (T2), and 8 weeks after (T3) sialendoscopy. Unstimulated whole saliva was analyzed for amylase concentration, activity, and mucin 5B concentration. Amylase and mucin 5B output were calculated.

RESULTS

In the sialendoscopy group, unstimulated and stimulated whole saliva flows were numerically higher at T2 and T3 compared with T0. Xerostomia Inventory score was significantly lower in the sialendoscopy group at T2 compared with T0 (P = .03). Unstimulated and stimulated whole saliva flows were higher in the sialendoscopy group compared with the control group at T2 and T3 (not meaningful). Significant differences were found between groups for the EULAR Sjögren's Syndrome Patient Reported Index score at T2 (P = .03) and T3 (P = .001). Xerostomia Inventory score and Clinical Oral Dryness Score in the sialendoscopy group were lower compared with the control group at T2 (P = .02) and at T3 (P = .04), indicating less oral dryness.

CONCLUSION

This pilot study indicates a positive effect of sialendoscopy on some parameters, but it cannot yet be concluded that it has a positive effect on salivary flow in patients with SS. These preliminary results need to be verified in a randomized controlled trial with a larger sample and longer follow-up period.

[Intervention of Yangfei Ziyin Decoction on Sjogren's Syndrome Model Mice]

OBJECTIVE

To observe the effect of Yangfei Ziyin Decoction (YZD) on symptoms, serum levels of TNF-alpha, IL-6, and aquaporin-5 (AQP-5), and pathology of Sj6gren's syndrome (SS) model mice.

METHODS

Totally 60 mice were divided into 6 groups according to random digit table, i.e., the model group, the normal control group, the high, medium, low dose YZD groups (administered with YZD at 36.7, 18.4, 9.2 g/kg, 0.2 mL/10 g), the Chinese patent medicine group [CPM, administered with total glucosides of paeony at 0.6 g/kg], 10 mice in each group. All intervention was performed for six successive days in a week, with an interval of one day, a total of 50 days. Body weight, salivary secretion, food and water intake were measured at day10, 20, 30, 40, and 50, respectively. At day 50 blood was collected. Submandibular gland, thymus, and spleen were weighed. Serum levels of TNF-alpha, IL-6, and AQP-5 were detected by ELISA. Pathological changes of submandibular gland were observed. Results Compared with the normal control group, there was no change in water intake of mice in the model group, but with reduced salivary secretion (P < 0.01, P < 0.05). Thymus/spleen/submandibular gland weight and index increased in the model group (P < 0.01, P < 0.05). Compared with the model group at the same time point, salivary secretion increased in the CPM group and 3 YZD groups (P < 0.01 , P < 0.05). Compared with the model group, thymus/spleen/submandibular gland weight and index decreased in the CPM group (P < 0.01, P < 0.05). Thymus/submandibular gland weight and index decreased in the low dose YZD group (P < 0.01, P < 0.05). Thymus/submandibular gland weight and index, and spleen index decreased in high and medium dose YZD groups (P < 0.01 , P < 0.05). Levels of TNF-alpha and IL-6 decreased, but AQP-5 level increased in the CPM group (P < 0.05). AQP-5 level increased in high and medium dose YZD groups (P < 0.01 , P < 0.05). In the model group alveoli and duct of salivary gland were destroyed, alveoli and duct were irregular, epithelial cells were degenerated, necrotic, and desquamated. Mild-to-moderate lymphocytic infiltration occurred around submandibular gland. Pathological changes were alleviated in the CPM group and 3 YZD groups.

CONCLUSION

YZD could improve clinical symptoms, serum levels of TNF-alpha, IL-6, AQP-5, and pathological changes of SS model mice.

Xerostomia of Various Etiologies: A Review of the Literature

This paper presents the etiopathogenesis, symptomatology, evaluation and treatment of mouth dryness. Xerostomia affects 1-29% of the population, mostly women. It is observed in geriatric patients and in individuals using certain medications, those subjected to radiotherapy of the head and neck region or affected with autoimmune conditions. The main signs of xerostomia include the impression of a dry mouth, problems with food ingestion and dryness of the oral mucosa and skin. Evaluation is based on structured interviews (the Fox test) and determinations of unstimulated and stimulated salivary volume. The signs of xerostomia can be attenuated with saliva substitutes, cevimeline or malic acid. Only palliative treatment of this condition is available at present. Untreated xerostomia significantly impairs the quality of life, which can potentially lead to depression.

Dental Devices; Reclassification of Electrical Salivary Stimulator System. Final order

The Food and Drug Administration (FDA) is issuing a final order to reclassify the salivary stimulator system, a postamendments Class III device, into class II (special controls) and to rename the device the "electrical salivary stimulator system." The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Acoustic Radiation Force Impulse quantitative elastography: a new noninvasive technique for the evaluation of parotid glands. A preliminary study in controls and in patients with irradiated nasopharyngeal carcinoma

AIM

We aim to define the values of the shear wave velocity (SWV) in the normal parotid glands (PG) and to identify the modifications of tissue stiffness in patients with irradiated nasopharyngeal carcinoma.

MATERIAL AND METHODS

Sixty normal parotid glands pertaining to 30 healthy volunteers and 40 pathological parotid glands pertaining to 20 patients who had had underwent radiation therapy for nasopharyngeal carcinoma were included in this study. The patients underwent a B mode ultrasonography examination and the volume of the parotid gland was determined. A subsequent Acoustic Radiation Forde Impulse Imaging (ARFI) examination was performed and the SWV were determined for the central and the periphery of the glandular parenchyma.

RESULTS

The mean volume of the gland in the volunteers' group (12.02+/-0.6 ml) was significantly higher than in the group of patients who underwent radiation therapy (10.3+/-0.74 ml) (p<0.0001). The SWV values in the normal group were lower compared to the patients group (1.54+/-0.6 m/s vs. 1.76+/-0.73 m/s, p<0.0001).

CONCLUSION

Elastography using the ARFI technique constitutes an objective method used for the evaluation of glandular stiffness in both normal and post radiotherapy glands. The SWV values determined in patients who underwent head and neck radiotherapy are increased, indicating a greater tissue stiffness thereby implying a structural transformation of the glandular parenchyma.