Characterization of GH pulsatility in male Shiba goats: effects of postpubertal castration and KP102

The present study was conducted in order to characterize the secretory pattern of GH in the Shiba goat, a native Japanese miniature goat, and to examine the effects of castration and KP102, a GH secretagogue, on this pattern. Blood samples were taken from an indwelling jugular catheter every 15 min for 24 h, and plasma GH was measured by radioimmunoassay. In intact males, GH was secreted in a pulsatile manner with very regular 5-h periodicity, which consisted of a distinctive GH pulse and a trough of virtually no GH secretion. Postpubertal castration increased the height and decreased the width of GH pulses, though it did not affect the interpulse interval and area under the curve. Modification of the shape of each GH pulse by testicular androgen might play a role in the expression of GH action in the male. KP102 (10 microg/kg, i.v.) immediately induced a robust GH pulse, which was followed by a spontaneous GH pulse of normal characteristics at regular intervals, suggesting that the clock generating GH pulses was reset by KP102. From these observations, we concluded that the Shiba goat is a very suitable experimental model for elucidating the mechanisms underlying GH pulse generation, and in particular, the involvement of androgen and GH secretagogues.

FSH secretion patterns during pregnant and nonpregnant luteal periods and 24 h secretion patterns in male and female dogs

The aim of this study was to investigate the secretion patterns of FSH: (i) during the canine oestrous cycle with particular attention to the luteal period; and (ii) during 24 h in male and female dogs. Plasma FSH concentrations were measured by a highly specific homologous canine immunoradiometrical (IRMA) assay using monoclonal antibodies specific for canine FSH. In the first study, FSH concentrations were measured daily from +/- 15 days before until 150 days after the LH surge in groups of pregnant (n = 5) and nonpregnant (n = 5) Beagle bitches. Day 0 of the cycle was the day of the preovulatory LH peak as measured by LH radioimmunoassay. In the second study, FSH concentrations were measured at 1 h intervals for 24 h in five bitches at day 120 after the LH surge and in five males. From day 35 to day 40 after the LH peak, FSH concentrations were higher in pregnant than in nonpregnant luteal phases. A significant and abrupt decrease in FSH concentrations was observed at about the time of parturition (day 65) and was followed by lower FSH concentrations during lactation compared with nonpregnant bitches. FSH concentrations in nonpregnant animals were fairly constant from the end of oestrus to mid-anoestrus. In both post-lactation and anoestrous bitches, plasma concentrations of FSH increased consistently as anoestrus progressed. No significant differences in the mean hour-to-hour patterns of FSH secretion were observed over 24 h and no differences were detected between male and female dogs. However, a clear pulsatile pattern of secretion was observed in all individuals, both males and females, with an apparent 4.8 h interval between peaks. The results of this study demonstrate major differences in FSH secretion between pregnant and nonpregnant bitches. This finding indicates that there are differences in the regulation of the hypothalamo-pituitary-ovarian axis during pregnancy, possibly related to changes in activity of the corpus luteum. The results of this study also demonstrate a pulsatile pattern of FSH secretion in both male and female bitches, with a 4.8 h interval between peaks, and confirms the progressive increase in plasma FSH concentrations observed during anoestrus.

Role of changes in the pulsatile secretion pattern of FSH in initiation of ovarian folliculogenesis in bitches

The results of two studies in which the pulsatile secretion patterns of LH and FSH were investigated in six Beagle bitches during early, mid- and late anoestrus and in six anoestrous Beagle bitches treated with bromocriptine are summarized to improve our knowledge of the endocrine changes that lead to a new follicular phase in bitches. Blood samples for the determination of secretory profiles were obtained via jugular venepuncture at 10 min intervals for 6 h. In untreated bitches, blood samples were collected during early, mid- and late anoestrus. In bromocriptine-treated bitches (20 micrograms kg-1 twice each day, starting 100 days after ovulation until the start of the next oestrous cycle), blood samples were collected before treatment and at 2 week intervals after the start of bromocriptine treatment until the next ovulation. In all bitches, FSH and LH were secreted in a pulsatile manner and FSH pulses coincided with LH pulses. Progression from early to late anoestrus was associated with an increase in FSH secretion without a concomitant increase in LH secretion. The bromocriptine-induced shortening of the interoestrous interval was also associated with an increase in FSH secretion without a concomitant increase in LH secretion. These results indicate that in bitches an increase in circulating FSH should be considered to be a critical event required for the initiation of ovarian folliculogenesis and consequently the termination of anoestrus.

[Hormone profile in the aging man]

During male ageing serum levels of testosterone, free testosterone, DHEA, growth hormone and maltonin decrease in contrary to the increase of FSH, LH, SHBG. Estradiol, Prolaktin and dihydrotestosterone show no significant changes. The terminus "andropause" is not correct, because there is no sudden decrease in sexual hormones, which is seen in the female (menopause). We should characterize the hormonE changes as "partial endocrine variations of the ageing male" or "partial androgen deficiency of the ageing male". Wether hormone replacement therapy leads to delay of ageing or increase of well being in ageing males can only be demonstrated in long term studies over ten years. Otherwise an evidence is required to demonstrate that long time hormone replacement therapy will not lead to tumour induction or increase of tumour growing.

Salivary Streptococcus mutans and Lactobacillus sp levels in cardiac children

This study assesses salivary conditions of 20 children with cardiac disease comparing with a control group of 15 healthy children. The results showed that there was no difference between the groups on salivary flow, buffer capacity and the level of Streptococcus mutans (Sm). The test group i.e., children with cardiac disease, showed a lower level of Lactobacillus sp. The association between the usage of antibiotics and the risk of developing caries, measuring the level of Streptococcus mutans and Lactobacillus sp., showed that children taking antibiotics frequently had a significant lower level of Lactobacillus sp (p<0.05) than healthy children. This association was not found on relation to the levels of Streptococcus mutans.

Stimulated parotid salivary flow rate in patients with Down syndrome

Saliva is essential for oral defense against infections. Decreased salivary secretion may result in increased dental caries, oral mucosal changes, an altered sense of taste, difficulty in swallowing, and oral pain. A review of the literature reveals sporadic and contradictory reports on the use of sialometry and sialochemistry to explain the role of saliva in the oral health and well-being of subjects with Down syndrome. The present study documents parotid gland saliva secretion at different ages in a group of subjects with Down syndrome. Saliva was collected from 39 patients 11 to 62 years old, by means of a parotid salivary gland cup and under standardized conditions of stimulated secretion. The rate of salivary secretion in the entire group of patients with Down syndrome was lower than that of healthy controls and lower in the older study group compared with the younger group. Institutionalized subjects or those living in hostel-like apartments had a lower secretion rate than those living at home. No difference in salivary flow was found between those patients with Down syndrome with normal thyroid output and those with hypothyroidism who were receiving replacement therapy. In a four-way ANOVA with flow as the dependent variable and Down syndrome, hypothyroidism, institutionalization, and age as factors, Down syndrome was found to be the only variable significantly related to flow (p = 0.017). Our findings indicate that stimulated parotid salivary hypofunction in Down syndrome subjects is mainly related to their genetic disorder.

Vascular endothelial growth factor in minor salivary glands: effect of ageing

Morphological and physiological age changes are described in human salivary glands. Vascular endothelial growth factor (VEGF) is neoangiogenic growth factor found in normal salivary glands. Considering the neoangiogenic properties of VEGF and its important function in inflammation, repair and, probably, in oral mucosa homeostasis, the purpose of the present study was to evaluate the effect of ageing on the immunolocalization of VEGF in minor salivary glands. Paraffin-embedded tissue blocks containing normal labial salivary glands were retrieved and classified according to the patients' age in two groups (< 20 and > 40-year-old). The biotin-streptavidin-peroxidase system was used to detect the VEGF antigen. The results demonstrated that the mean level of VEGF immunoreaction in the young group was not statistically different from the old group when compared by the Mann-Whitney U-test (P = 0.54). This may indicate that although salivary flow reduction may develop in old patients, some properties of the salivary glands may not be affected.

Lactoferrin, amylase and mucin MUC5B and their relation to the oral microflora in hyposalivation of different origins

There are several reasons for hyposalivation, each affecting the salivary composition in different ways. The aim of this study was to analyze and compare lactoferrin, amylase and mucin MUC5B in stimulated whole saliva collected from subjects with hyposalivation of different origins and to relate the results to the presence of some microbial species associated with oral disorders. Albumin was determined as a marker of serum leakage. The characteristic feature for subjects with radiation-induced hyposalivation was a large increase in lactoferrin, probably due to leakage through inflamed mucosal tissues, while it was a high albumin content for the group with primary Sjögren's syndrome, probably due to disruption of the fragile mucosa. The saliva composition in subjects with hyposalivation of unknown origin or due to medicines was close to that in the healthy controls. All three hyposalivation groups tended to display a decrease in the concentrations of MUC5B and amylase. None of the microbial species analyzed (streptococci, mutans streptococci, Lactobacillus spp., Fusobacterium nucleatum, Prevotella intermedia/Prevotella nigrescens, Candida albicans, Staphylococcus aureus and enterics) correlated with concentration of MUC5B in saliva. The RT group, having the highest concentration of lactoferrin, had the lowest median number of F. nucleatum and was the only group in which median number of P. intermedia/P. nigrescens was zero.

A study of some parameters in stimulated saliva from adolescents with dental fluorosis

In this study, parameters such as the flow rate, buffer capacity, sialic acid, protein and electrolyte concentrations, and amylase and peroxidase activities were analyzed in stimulated whole saliva from adolescents with dental fluorosis. From 135 adolescents (13 and 14 years-old) attending a primary and secondary school in the coastal city of Vitoria-Brazil, 72 were selected to participate in this study. The degree of fluorosis was graded using the TSIF, and was carried out by a calibrated and trained dentist. No variation in the flow rate, pH and buffer capacity, protein concentration or amylase activity was observed between the groups with dental fluorosis and the control group (fluorosis score 0). The peroxidase activity and sialic acid concentration showed some differences compared to the control. Sialic acid concentrations were reduced in the groups with dental fluorosis scores above 2. The concentration of Na was lower in adolescents with dental fluorosis, while Mg concentrations were higher in two fluorosis groups, Ca concentration was reduced in two groups with fluorosis. We conclude, that 13 and 14 year-old adolescents attending a school in the coastal city of Vitoria-Brazil showed no variations relative to some parameters and some variations in relation to others of the salivary parameters studied.

The cerebrospinal fluid production rate is reduced in dementia of the Alzheimer's type

OBJECTIVE

To evaluate the production rate of CSF in patients with differing disease states.

METHODS

The authors measured the production rate of CSF in three groups of patients: five patients with PD below age 60 (aged 51 +/- 4 years, mean +/- SD), nine with PD over age 60 (aged 69 +/- 6 years, mean +/- SD), and seven with dementia of the Alzheimer's type (AD) (aged 72 +/- 9 years, mean +/- SD). This method, based on the Masserman technique, employs ventricular rather than a lumbar access to the CSF space. Furthermore, the volume of CSF removed during the procedure is only 3 mL rather than 10 mL.

RESULTS

These measurements indicate that the mean rate of CSF production in patients with PD under age 60 was 0.47 +/- 0.13 mL/minute, in patients with PD aged 60 or older the mean rate was 0.40 +/- 0.12 mL/minute, and in patients with AD the mean rate was 0.20 +/- 0.06 mL/minute.

CONCLUSION

These results indicate that the rate of CSF production in patients with PD is normal, and that the rate of CSF production in patients with AD is markedly reduced.

Circadian secretion of cortisol in bipolar disorder

OBJECTIVE

To compare the 24-h cortisol secretion profiles of normal control subjects and patients with bipolar disorder who were in the depressive, manic and euthymic phases of the disorder.

PARTICIPANTS

Eighteen patients, 25-62 years of age, in depressed (n = 5), manic (n = 5) or euthymic (n = 8) phase of bipolar disorder recruited through a psychiatric outpatient clinic, and 5 control subjects, 24-41 years of age, recruited through advertisement or word of mouth.

OUTCOME MEASURES

Subjects were interviewed and symptom ratings were obtained using the Hamilton Depression Rating Scale, Beck Depression Inventory and Young Mania Scale. Blood collection began at 0800 and continued at hourly intervals for 24 h. Serum cortisol levels were assayed using a validated commercial radioimmunoassay kit.

RESULTS

An analysis of variance of the area under the cortisol 24-h time-concentration curve (AUC) revealed a significant difference between the control group and patient groups (F = 3.69, p = 0.03). the mean AUCs of the patients in the depressed (263.4 micrograms/dL) and hypomanic (262.2 micrograms/dL) phases were beyond the 95% confidence interval for the controls (120.9-253.3 micrograms/dL). There were no significant group differences in cosinor acrophase and no significant effects of sex, education, age of illness onset, duration of illness or duration of mood state at time of testing on the cortisol measures. Pearson correlations between symptom rating scores and cortisol secretion variables were not significant.

CONCLUSION

The increases in cortisol secretion in patients in both the depressed and manic phases of bipolar disorder suggest that cortisol level is probably not a state marker in bipolar disorder.

Levels of pre-kallikrein in resting and stimulated human parotid and submandibular saliva

Salivary tissue kallikrein is stored in an active form in human salivary glands. Pre-kallikrein has been demonstrated in mixed saliva, but it is not clear if the various salivary glands contribute equally. This study set out to determine if pre-kallikrein is present in human parotid and submandibular salivas at rest, whether levels change during stimulation, and to compare the pattern of pre-kallikrein and kallikrein secretion with that of total protein. Resting and citric acid-stimulated parotid and submandibular, and gum-stimulated parotid saliva samples were collected from 6 healthy subjects. Salivary flows were determined gravimetrically. Total protein concentration and kallikrein enzymic activity were assayed using standard techniques. Pre-kallikrein was assayed following trypsinisation of duplicate samples. Pre-kallikrein was present in parotid and submandibular ductal saliva. Proportions of pre-kallikrein and active kallikrein were similar in salivas secreted at rest and during stimulation, and both outputs mirrored protein output in both major glands. Gum-stimulated parotid saliva showed lower activity than resting, and no differences were seen between resting and stimulated submandibular samples.

Saliva flow rate, amylase activity, and protein and electrolyte concentrations in saliva after acute alcohol consumption

OBJECTIVE

The aim of our study was to evaluate the effects of acute alcohol consumption on saliva secretion rate and selected salivary parameters in healthy nonalcoholic volunteers.

STUDY DESIGN

Twenty-four volunteers (37.7 +/- 9.6 years, mean +/- SD) consumed 0.6 g or 0.7 g alcohol/kg of body weight (for women and men, respectively) in a soft drink. Saliva samples were collected, first (S0) before any alcohol was consumed, 45 minutes after consumption (S1) and, finally, 60 minutes after S1 (S2). Flow rates of both resting whole saliva and paraffin-stimulated (SWS) whole saliva were assessed. SWS was assessed for amylase, total protein, inorganic phosphate (PO4(3-)), sodium (Na+), potassium (K+), and calcium (Ca2+) content.

RESULTS

SWS, but not resting whole saliva (in milliliters/minute), decreased significantly after consumption of alcohol. Amylase activity (P =.010) and the concentrations of Na+ (P =.000) and Ca2+ (P =.002) decreased significantly between S0 and S1. When SWS was analyzed for output, the total protein concentration (S0 to S1, P =.000; S0 to S2, P =.033) and amylase activity (S0 to S1, P =.000) decreased significantly. Further, the output of all the studied electrolytes decreased significantly as blood alcohol concentration increased.

CONCLUSIONS

We conclude that acute alcohol consumption causes a decrease in SWS flow rate. The decrease in flow rate also results in impaired output of total protein and amylase, as well as in a decrease in the output of electrolytes.

Type 1 diabetes mellitus, xerostomia, and salivary flow rates

OBJECTIVE

The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications.

STUDY DESIGN

The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates.

RESULTS

Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow.

CONCLUSIONS

Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.

Caries prediction factors in children with primary dentition

Previous studies have indicated an association between the dmft and the lactobacilli counts in small children. This study evaluated and compared a number of salivary factors that could have an effect on caries progression in two groups of children with primary dentition (group 1 = 3-6 years; group II = 9 years). The average dmft score was higher for group II. The dmft score of group I consisted mainly of a large dt component, while in group II a large ft component was found. Lactobacilli were present in 44.83% of group I and in 77.27% of group II. Significant positive correlations were found for group I between the dt component of the dmft and lactobacilli count (P < 0.05, r = 0.48) as well as the total dmft and lactobacilli count (P < 0.05, r = 0.45). Significant positive correlations were found for group II between the dmft and lactobacilli count (P < 0.05, r = 0.39) and the plaque index and lactobacilli count (P < 0.05, r = 0.31). Significant correlations between the dmft and the prevalence of lactobacilli in the oral cavity were also indicated (group I: P < 0.05, r = 0.45; group II: P < 0.05, r = 0.36). Significant correlations confirmed the association of lactobacilli with the caries process and indicated the reliability of lactobacilli counts to determine caries activity. Correlations between the dmft and the prevalence of lactobacilli in the oral cavity indicated the possibility of an excellent but simple test for the prediction of caries susceptibility in children.

Oligodontia is associated with extra-oral ectodermal symptoms and low whole salivary flow rates

INTRODUCTION

Ectodermal dysplasias (EDs) involve abnormal development of hair, teeth, nails, and sweat glands.

OBJECTIVES

(1) To investigate the frequency of extraoral ectodermal symptoms in persons with oligodontia (>6 congenitally missing teeth). (2) To examine whole salivary flow rates in oligodontia patients, with special emphasis on persons with EDs. SURVEY GROUP AND METHODS: Sixty-eight persons with oligodontia and 39 healthy control persons were included. All participants underwent an interview, general and oral examinations, and whole salivary secretory tests.

RESULTS

Thirty-nine (57%) of the oligodontia patients had disturbances in either hair, nails and/or sweat production in addition to teeth and were classified as the ED group. The remaining 29 oligodontia patients had no obvious signs of EDs (non-ED group). The prevalences of dry skin, asthma and eczema were higher, and whole salivary secretory rates lower, in the ED group as compared to the control group. Intermediate values were observed in the non-ED group. Incisors, canines and molars were more frequently missing in the ED group than in the non-ED group, whereas no differences were observed in the frequency of missing premolars. Negative correlations between the number of missing teeth and unstimulated and chewing stimulated whole salivary secretory rates were found.

Syndromes with salivary dysfunction predispose to tooth wear: Case reports of congenital dysfunction of major salivary glands, Prader-Willi, congenital rubella, and Sjögren's syndromes

Four cases-of congenital dysfunction of the major salivary glands as well as of Prader-Willi, congenital rubella, and Sjögren's syndromes-were identified in a series of 500 patients referred for excessive tooth wear. Although there was evidence of consumption of highly acidic drinks, some occlusal parafunction, and unacceptable toothbrushing habits, salivary dysfunction was the salient factor predisposing a patient to tooth wear in these syndromal cases. The 500 subjects have been characterized either as having medical conditions and medications that predispose them to xerostomia or lifestyles in which workplace- and sports-related dehydration lead to reduced salivary flow. Normal salivation, by buffering capacity, clearance by swallowing, pellicle formation, and capacity for remineralization of demineralized enamel, protects the teeth from extrinsic and intrinsic acids that initiate dental erosion. Thus, the syndromes, unrelated in many respects, underline the importance of normal salivation in the protection of teeth against tooth wear by erosion, attrition, and abrasion.

Influence of aging on candidal growth and adhesion regulatory agents in saliva

Although oral candidiasis is frequently seen in the elderly, the factors determining candidal growth have insufficiently been explored. Hence, we examined the influence of aging on candidal adhesion and growth-inhibitory agents in saliva in 45 healthy volunteers and 60 patients with oral candidiasis. Both non-stimulated and stimulated salivary flow rates (SFRs) in the healthy controls decreased with aging. A gradual decrease of SFRs with aging was also observed in the patients, and the SFR levels were markedly lower than those in the controls. Although the salivary glucose levels were almost constant in all age groups, secretory immunoglobulin A and lactoferrin levels in saliva were significantly decreased statistically with age, and a marginal age-associated decrease in transferrin levels was also observed. In addition, the generation of superoxide from neutrophils in saliva and their Candida killing activity decreased with age, and these phenomena were more apparent in the patients. Furthermore, a larger number of Candida adhered to oral keratinocytes obtained from the elderly healthy controls than to those obtained from young controls. Correspondingly, keratinocytes from the aged controls showed more concanavalin-A binding sites than those from the young controls. However, oral Candida did not increase with increasing age in the controls, although an age-associated increase of oral Candida was observed in the patients. Taken together, these results indicate that the decreases of SFRs and salivary anti-candidal factors, suppression of salivary neutrophil function and the increase of candidal adhesion sites on keratinocytes predispose elderly individuals to oral candidiasis.

[Relationship between the symptom of xerostomia and non-stimulated salivary flow rates in patients with burning mouth syndrome]

OBJECTIVE

Many patients with burning mouth syndrome (BMS) complain of xerostomia, but the consistent relationship between the symptom of xerostomia and non-stimulated salivary flow rates remains unclear. This study tried to investigate the variety of non-stimulated salivary flow rates in patients with BMS.

METHODS

The non-stimulated salivary flow rates of 52 BMS patients and 37 healthy controls were recorded.

RESULTS

The non-stimulated salivary flow rates were low in the group of BMS patients, but there is no statistical difference when compared with that of the normal individuals. There was also no significant difference in non-stimulated salivary flow rates among theses three subtypes of BMS patients. Further, no significant difference of non-stimulated salivary flow rates was observed in patients with and without xerostomia.

CONCLUSION

The non-stimulated salivary flow rate may be not associated with the symptom of xerostomia in patients with BMS.

Sialogogic activity in the rat of peptides analogous to [Tyr8]-substance P in which substitutions have been made in the N-terminal amino acids

In order to elucidate the regulatory roles for salivation of amino acids in positions 1-4 of the N-terminal region of [Tyr8]-substance P (SP), the structure-sialogogic activity correlations of various synthetic octa- to undecapeptides replaced in positions 1-4 of [Tyr8]-SP with each of 19 common amino acids, one by one, and with the same sequence of the C-terminal hepatapeptide as that of [Tyr8]-SP, were studied in the submandibular glands of rats after intraperitoneal injection. Each of 19 octa-, nona-, deca- and undecapeptides with replaced amino acids and a penta- to decapeptide with the progressive elimination of the N-terminal portion were newly synthesized by the multipin peptide method. All octa- to undecapeptides replaced with each of 19 common amino acids in positions 1-4 had sialogogic activities. In 19 octa- and decapeptides in which P4 and P2 had been replaced, four and three replacements, respectively, had significantly increased secretory activities. In contrast, in 19 nonapeptides in which K3 had been replaced, none had significantly increased secretory activities. Furthermore, in 19 undecapeptides in which R1 had been replaced, most replacements had significantly increased or equipotent activities for fluid secretion. It is concluded that amino acids in the N-terminal region of various tachykinins may not need to be strictly conserved and that amino acid residues in the N-terminal portion, R1 in particular and P2, may strongly inhibit secretory activity.

A review of saliva: normal composition, flow, and function

An adequate supply of saliva is critical to the preservation and maintenance of oral tissue. Clinicians often do not value the many benefits of saliva until quantities are decreased. Much is written on the subject of salivary hypofunction, but little attention is paid to normal salivary flow and function. This article is a brief, up-to-date overview of the literature on the basics of normal salivary composition, flow, and function. A review of the literature was conducted using MEDLINE and Healthstar (1944 through 1999); articles were selected for inclusion on the basis of relevance and significance to the clinician.

A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes

OBJECTIVE

Many diabetics complain of xerostomia, a condition that can affect oral health, nutritional status, and diet selection. This study's purposes were (1) to investigate the effect on salivary flow of type 2 diabetes and change in glycemic control in a group of older adults over time and (2) to compare flow rates with subjective complaints of xerostomia.

STUDY DESIGN

A total of 39 older adults, 24 with type 2 diabetes and 15 who were nondiabetic (controls), aged 54-90 years, participated in a 1-year follow-up study. Diabetic status was determined by means of glycosylated hemoglobin (HbA1c) levels and 2-hour glucose tolerance tests. Poor glycemic control was defined as HbA1c > 9%. Unstimulated whole, unstimulated parotid, and stimulated parotid saliva flow rates were measured for all subjects by a single examiner at baseline and 1 year later. Each subject completed a standardized xerostomia questionnaire at every visit.

RESULTS

Age, sex, and duration of diabetes did not adversely affect salivary flow rates. Subjects with poorly controlled diabetes had significantly lower stimulated parotid saliva flow rates at both visits. There were no significant changes in flow rates over time on the basis of diabetic status or glycemic control. Subjects with diabetes reported significantly more complaints of thirst but not of xerostomia at 1 year.

CONCLUSIONS

These results suggest that older adults with poorly controlled diabetes may have impaired salivary flow in comparison with subjects with better controlled diabetes and nondiabetic subjects, yet they may not have concomitant xerostomic complaints. There were no significant changes in salivary flow rates or glycemic control over the 1-year period.

Fluid dynamics of gingival tissues in transition from physiological condition to inflammation

BACKGROUND

An increase in gingival sulcular fluid filtration is a common clinical sign of early gingivitis. The aim of this study was to describe the fluid dynamics of the gingival interstitial tissues at the level of the sulcus in the transition towards inflammation.

METHODS

In 13 anesthetized rabbits, a silk ligature was placed around incisors close to the gingival margin, in order to prevent mechanical cleaning of plaque deposition. After 2 to 7 days, animals were anesthetized and interstitial fluid pressure measured using glass micropipettes connected to a servonull pressure system at the level of the free and attached gingiva.

RESULTS

Interstitial pressure was 3.8 +/- 2.9 cmH2O, significantly higher than the normal physiological value (about -1 cmH2O). Colloid osmotic pressure of interstitial fluid samples collected using the wick technique was measured using an osmometer whose membrane had a molecular cut-off of 30 kD and averaged 12.8 +/- 2.8 cmH2O (unchanged relative to control). Mean gingival sulcular fluid flow, measured by placing a PE tube (0.5 mm OD, 0.28 mm ID) in the sulcus, was 0.16 +/- 0.12 microl/h; the mean colloid osmotic pressure was 13.6 +/- 6.6 cmH2O, corresponding to a protein concentration of approximately 2.8 g/dl. Proteins of gingival fluid may leak from inflamed gingival interstitium or derive from bacteria of dental plaque. Histological analysis of gingival biopsies showed neutrophilic polymorphonuclear leukocyte infiltrates in both the dermis and epidermis layer.

CONCLUSIONS

Based on hydraulic and colloid osmotic data, the Starling pressure gradient favored filtration from gingival interstitium to the sulcular space, a condition opposite to that observed in healthy gingiva where fluid filtration is absent.

Xerostomia and hyposalivation

Dry mouth must not be considered a trivial problem in the population, since it constitutes a phenomenon with many aspects relative to oral function as well as quality of life. Up until today, no global consensus has been reached with regard to the terminology of dry mouth, creating a substantial problem for research, education, diagnosis, and therapy. In this report, salivary gland hypofunction has been selected as the overarching term for subjective symptoms and objective signs of dry mouth. Its different aspects--xerostomia, hyposalivation, and altered saliva composition--are reviewed with respect to prevalence, diagnosis, and etiology. It is concluded that these aspects of salivary gland hypofunction are separate entities, which in many respects are interrelated, constituting not merely a dental but also a medical and social concern.

The effect on human salivary flow rate of the temperature of a gustatory stimulus

In the first study, whole saliva was collected from ten adults during stimulation with sour, carbonated, sweet and water stimuli in the form of 5-ml of ice at about -10 degrees C or of liquids at 0, 8, 20 or 37 degrees C. Parotid saliva was also collected in response to ice or infusion into the mouth of the liquids at different temperatures. Another group of ten adults also collected whole saliva in response to water at 20 degrees C, with or without the presence in the mouth of an acrylic cube of dimensions similar to those of the ice. In a second study, 20 adults collected whole saliva in response to stimulation with 5 ml of water and of an astringent stimulus at 0, 8, 37 and 70 degrees C. In the first study, flow rates fell in the order sour, carbonated, sweet and water and flow rates in response to stimuli in the form of ice were very significantly higher than in response to the corresponding liquids at the four different temperatures. With the sour stimulus, liquids at 0 and 8 degrees C elicited higher flow rates than liquids at 20 or 37 degrees C. Although the presence in the mouth of the acrylic block increased the flow rate of whole saliva, the increase was only about 30% of that achieved with ice. In the second study, the astringent stimulus was a more effective salivary stimulus than water; flow rates were significantly higher in response to liquids at 0 and 8 degrees C than at the higher temperatures and flow rates in response to liquids at 37 degrees C were significantly lower than with the other temperatures. In summary, stimuli in the form of ice were the most effective and liquids at 37 degrees C were least effective in stimulating salivary flow.

The foam production system of the male Japanese quail: characterization of structure and function

The research described here characterizes a unique neuromuscular system involved in reproductive behavior--the foam production system of the male Japanese quail (Coturnix japonica). Male quail produce a large amount of foam that is transferred to the female during copulation, enhancing male fertilization success. The source is the foam gland complex, a large sexually dimorphic, androgen sensitive, external protuberance of the dorsal cloaca, consisting of glandular units interdigitated with striated muscle fibers of the sphincter cloacae muscle (mSC). Electromyographic (EMG) analysis of mSC activity in freely moving males interacting with females revealed different characteristics of the EMG signal during copulation, voiding of excreta, and other mSC movement. The amount of mSC activity and also the amount of foam produced were greatly increased by the presence of a female behind a screen. Denervation of mSC eliminated normal mSC movement and also abolished foam production, confirming that mSC activity is the mechanism for foam production. The spinal cord locations of the motoneurons innervating the major cloacal muscles, including mSC, were determined by injecting cholera-toxin conjugated horseradish peroxidase into each muscle. Labelled somata with multiple primary dendrites were located in Area IX of the lateral motor column of synsacral segments 7, 8, or 9 or 8, 9, and 10. The motoneurons serving mSC were intermingled with those projecting to the other cloacal muscles, but there were differences in the rostralcaudal placement of these neural populations. Thus mSC activity is an integral part of the male's reproductive behavior, mSC activity can be socially stimulated, and mSC activity occurring in anticipation of copulation is likely to be functionally significant. Continued investigation of this highly accessible system has the potential to shed light on the mechanisms by which complex motor acts are produced and hormonally regulated.

Tongue piercing and associated oral and dental complications

The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.

Effect of donor age on the concentrations of histatins in human parotid and submandibular/sublingual saliva

Histatins are small proteins of human glandular saliva that have antifungal properties. Recent studies show that oral candidal infections increase with age, suggesting an age-associated compromise in oral host defence. Here, the effect of age and of physiological gland stimulation on the concentration and secretion of salivary histatins was investigated. Parotid and submandibular/sublingual salivas were collected from six young adults under unstimulated, mechanical (chewing) and gustatory (0.025 M and 0.1 M citric acid) stimulation, and the concentration and secretion of histatins was measured by cationic polyacrylamide gel electrophoresis with subsequent densitometric scanning of the stained gels. With gland stimulation, parotid saliva showed no significant increase in histatin concentration (microg/ml); however, histatin secretion (microg/min) increased up to 26-fold (p<0.005; ANOVA). Stimulation of submandibular/sublingual saliva resulted in significant increases in both histatin concentration (p<0.005) and secretion (p<0.0005). Ageing effects on salivary histatins were determined in citric acid (0.1 M)-stimulated parotid and submandibular/sublingual saliva samples collected from 80 individuals (divided into four age groups having approximately equal numbers of males and females: 35-44 years; 45-54 years; 55-64 years and 65-76 years). None of the patients was taking medications or wore dentures. ANOVA showed no sex differences in histatins. Regression analysis showed significant age-associated decreases for parotid saliva histatin concentration (p<0.002) and secretion (p<0. 002) as well as for submandibular/sublingual saliva histatin concentration (p<0.0001) and secretion (p<0.0001). Both saliva types showed significant (p<0.0001) decreases in the histatin concentration per mg of total protein, suggesting a preferential decrease in salivary histatins compared to total salivary protein. These results suggest that the salivary histatin component of the oral host defence system is compromised with increasing age.

Correlation between quantitative salivary gland scintigraphy and salivary secretion rates in children and young adults treated for hematological, malignant and metabolic diseases

OBJECTIVES

To study the correlation between whole salivary secretion rates and different variables from the radionuclide time-activity curve and to determine a reliable region for background correction in salivary gland scintigraphy.

METHODS

Salivary gland scintigraphy (SGS) was performed before bone marrow transplantation or more than 4 years later in 23 patients aged 13.5 (s.d. 4.9) years. Unstimulated and stimulated whole salivary secretion rates were measured before SGS. Six different methods for background correction were evaluated.

RESULTS

The unstimulated secretion rate was significantly correlated (P < 0.05) with the percentage stimulated secretion (S) and reaccumulation-slope (RS) after stimulation. The stimulated secretion rate was significantly correlated with RS, S and down-slope (DS). The temporal region above the parotid glands and the area above the thyroid gland was used for subtraction of background radiation for the parotid and submandibular glands respectively showed a strong correlation between repeated measurements of the variables analysed. The mean maximum uptake was 0.73-1.34% of total dose injected.

CONCLUSIONS

The salivary scintigraphic variables which correlated more strongly with salivary secretion rates were RS, S and DS. The temporal region above the parotid gland and the area above the thyroid gland can be used reliably for correction background radiation in the analysis of the time-activity curve in SGS of the parotid and submandibular glands respectively.

Gonadotrophin secretion in prepubertal bull calves born in spring and autumn

The reproductive development of bull calves born in spring and autumn was compared. Mean serum LH concentrations in calves born in spring increased from week 4 to week 18 after birth and decreased by week 24. In bull calves born in autumn, mean LH concentrations increased from week 4 to week 8 after birth and remained steady until week 44. LH pulse amplitude was lower in bull calves born in autumn than in calves born in spring until week 24 of age (P < 0.05). There was a negative correlation between LH pulse frequency at week 12 after birth and age at puberty in bull calves, irrespective of season of birth, and LH pulse frequency at week 18 also tended to correlate negatively with age at puberty. Mean serum FSH concentrations, age at puberty, bodyweight, scrotal circumference, testes, prostate and vesicular gland dimensions, and ultrasonographic grey scale (pixel units) were not significantly different between bull calves born in autumn and spring. However, age and body-weight at puberty were more variable for bull calves born in autumn (P < 0.05). In a second study, bull calves born in spring received either a melatonin or sham implant immediately after birth and at weeks 6 and 11 after birth. Implants were removed at week 20. Mean LH concentrations, LH pulse frequency and amplitude, mean FSH concentrations and age at puberty did not differ between the two groups. No significant differences between groups in the growth and pixel units of the reproductive tract were observed by ultrasonography. In conclusion, although there were differences in the pattern of LH secretion in the prepubertal period between bull calves born in autumn and spring, the postnatal changes in gonadotrophin secretion were not disrupted by melatonin treatment in bull calves born in spring. Reproductive tract development did not differ between calves born in spring and autumn but age at puberty was more variable in bull calves born in autumn. LH pulse frequency during the early prepubertal period may be a vital factor in determining the age of bull calves at puberty.

Oral pH and drinking habit during ingestion of a carbonated drink in a group of adolescents with dental erosion

OBJECTIVES

To investigate the relationship between dental erosion, oral pH and drinking habit in a group of adolescents.

METHODS

Oral pH was measured simultaneously at the surface of four teeth in 11 patients, aged 10-16 years, with erosion and in 10 controls subjects without erosion using antimony electrodes. Measurements were made before, during and after drinking 330 ml of a carbonated drink. The method and timing of drinking the beverage, reported dietary intake of acidic foods and flow rate and buffering capacity of saliva were recorded.

RESULTS

The erosion patients reported drinking more carbonated drinks (p<0.01) and drinking directly from a can more frequently than the controls (p<0.05). They also drank twice as quickly (p<0.05). The pH at the buccal surface of a molar remained lower for longer in the erosion patients than in the patients without erosion (p<0.01), whilst the labial surface of the upper central incisor had a longer exposure to low pH in the controls subjects (p<0.05).

CONCLUSION

The pattern of oral pH differed between subjects with and without erosion after drinking an acidic beverage. This may be related to observed differences in drinking habit, which could have influenced the pattern of erosion in these subjects.

Association of salivary flow rates with maximal bite force

Mean salivary secretion and bite force decrease with advancing age. Previous studies have shown that salivary flow rates are influenced by mastication. In the present study, we examined the relationship between salivary flow rates and maximal bite force in a community-based sample of men and women 35 years of age or older. Salivary flow rates for unstimulated whole and unstimulated submandibular/sublingual (SMSL) saliva as well as citrate-stimulated parotid and SMSL saliva were measured in 399 subjects. Bite force was assessed with a bilateral force transducer. Pearson correlation analysis yielded significant positive correlations between bite force and flow rates for unstimulated whole saliva (r = 0.24, p < 0.0001), stimulated parotid saliva (r = 0.13, p < 0.03), unstimulated SMSL (r = 0.14, p < 0.0001), and stimulated SMSL (r = 0.16, p < 0.003). When adjusted for age and gender, the partial correlations between bite force and salivary flow rates remained significant for unstimulated whole saliva (r = 0.10, p < 0.05), stimulated parotid saliva (r = 0.13, p < 0.02), and stimulated SMSL saliva (r = 0.14, p < 0.006). Subjects were divided into four groups based on their maximal bite force score (low, medium low, medium high, and high). For each saliva type, the flow rate of the high-bite-force group was significantly greater than that of the low-bite-force group as well as that of the medium-high-bite-force group. These results confirm an age-related decrease in bite force and salivary flow rates and show that, regardless of age or gender, bite force is correlated with salivary flow.

Pulsatile secretion pattern of growth hormone during the luteal phase and mid-anoestrus in beagle bitches

The pulsatile secretion pattern of growth hormone was investigated during four stages of the luteal phase and during mid-anoestrus in six cyclic beagle bitches. Plasma samples were obtained via jugular venepuncture at 10 min intervals for 12 h at 19 +/- 2 (mean +/- SEM; luteal phase 1), 38 +/- 2 (luteal phase 2), 57 +/- 2 (luteal phase 3), 78 +/- 2 (luteal phase 4) and 142 +/- 4 days (mid-anoestrus) after ovulation. During all stages, growth hormone was secreted in a pulsatile fashion. The mean basal plasma growth hormone concentration during luteal phase 1 (2.2 +/- 0.3 microgram l(-1)) was significantly higher than that during luteal phase 4 (1.5 +/- 0.1 microgram l(-1)) and mid-anoestrus (1.4 +/- 0.2 microgram l(-1)). The mean area under the curve (AUC) above zero during luteal phase 1 (27.3 +/- 2.7 microgram l(-1) in 12 h) tended to be higher than that during luteal phase 4 (20.8 +/- 1.8 microgram l(-1) in 12 h) and mid-anoestrus (19.2 +/- 2.5 microgram l(-1) in 12 h). In contrast, the mean AUCs above the baseline during luteal phase 1 (1.1 +/- 0.5 microgram l(-1) in 12 h) and luteal phase 2 (1.2 +/- 0.5 microgram l(-1) in 12 h) were significantly lower than that during luteal phase 4 (2.8 +/- 0.5 microgram l(-1) in 12 h). In conclusion, the pulsatile secretion pattern of growth hormone changes during the luteal phase in healthy cyclic bitches: basal growth hormone secretion is higher and less growth hormone is secreted in pulses during stages in which the plasma progesterone concentration is high. It is hypothesized that this change is caused by a partial suppression of pituitary growth hormone release by progesterone-induced growth hormone production in the mammary gland. The progesterone-induced production of growth hormone in the mammary gland may promote the physiological proliferation and differentiation of mammary gland tissue during the luteal phase of the bitch by local autocrine-paracrine effects. In addition, progesterone-induced mammary growth hormone production may exert endocrine effects, such as hyperplastic changes in the uterine epithelium and insulin resistance.

Hepatitis C infection and associated oral health problems

Hepatitis C infection is widespread throughout the community. This study aimed to assess the status of oral health of persons infected with hepatitis C. DMFT and CPITN indices were recorded at a clinic providing priority dental care for people with hepatitis C infection. The data were compared with information from an existing survey of general dental patients. Social impact was assessed using a modified Oral Health Impact Profile questionnaire. The DMFT index differed significantly between hepatitis C and general patients. The number of decayed and missing teeth was greater in those infected with hepatitis C for all patients aged between 25 and 50 years. Although there was no significant difference in CPITN categories for subjects evaluated, a marked trend for poor periodontal health was noted for those individuals with hepatitis C. Salivary flow was reduced in 50 per cent of hepatitis C infected subjects. Social impact was significantly affected with 71 per cent of hepatitis C subjects reporting painful aching in the mouth and 56 per cent having difficulty in relaxing. In conclusion, the results from the project strongly indicate an urgent need for priority delivery of dental care for people with hepatitis C infection.

Chloride channels and salivary gland function

Fluid and electrolyte transport is driven by transepithelial Cl- movement. The opening of Cl- channels in the apical membrane of salivary gland acinar cells initiates the fluid secretion process, whereas the activation of Cl- channels in both the apical and the basolateral membranes of ductal cells is thought to be necessary for NaCl re-absorption. Saliva formation can be evoked by sympathetic and parasympathetic stimulation. The composition and flow rate vary greatly, depending on the type of stimulation. As many as five classes of Cl- channels with distinct gating mechanisms have been identified in salivary cells. One of these Cl- channels is activated by intracellular Ca2+, while another is gated by cAMP. An increase in the intracellular free Ca2+ concentration is the dominant mechanism triggering fluid secretion from acinar cells, while cAMP may be required for efficient NaCl re-absorption in many ductal cells. In addition to cAMP- and Ca(2+)-gated Cl- channels, agonist-induced changes in membrane potential and cell volume activate different Cl- channels that likely play a role in modulating fluid and electrolyte movement. In this review, the properties of the different types of Cl- currents expressed in salivary gland cells are described, and functions are proposed based on the unique properties of these channels.

Dental and periodontal status of Sjögren's syndrome

BACKGROUND

Sjögren's syndrome (SS) is one of the most common systemic autoimmune diseases in middle-aged women. The present study had the aim to examine the dental and periodontal condition in patients with SS in comparison with disease controls and to evaluate the influence of reduced salivary flow in the periodontal tissues.

METHOD

We examined 24 patients with primary or secondary SS in comparison with 27 patients who had another autoimmune disease but no signs or symptoms of SS, as well as with 29 subjects who had a subjective feeling of xerostomia or xerophthalmia without exhibiting an underlying disease. The clinical evaluation included examination of the oral mucosa, determination of missing, decayed and filled teeth, fixed or removable prosthetic appliances, plaque index, gingival index, probing pocket depth, probing attachment level, oral hygiene habits and frequency of dental visits. Statistical analysis was performed using the 2-tailed Fisher exact and Kruskal-Wallis tests.

RESULTS

No significant difference was found in the dental or periodontal condition of the 3 groups. The number of teeth, feelings and distal or mesial decay lesions correlated negatively with age, while the number of fixed prosthetic appliances correlated positively. The salivary flow was statistically lower in patients with SS and exhibited a negative correlation with the number of cervical decay lesions. It was also found that SS patients had better oral hygiene habits than subjects of the control groups.

CONCLUSIONS

No significant,difference could be detected concerning the dental and periodontal status of SS patients, compared with that of patients with other immune diseases as well as with that of controls who had subjective xerostomia.

Salivary function and glycemic control in older persons with diabetes

OBJECTIVE

There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population.

STUDY DESIGN

Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated (age range, 54-90 years). Diabetic status was determined by a glycosylated hemoglobin (HbA(1c)) test and a 2-hour glucose tolerance test. Poor glycemic control was defined as HbA(1c) >9%. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire.

RESULTS

Persons with poorly controlled diabetes had lower (P =.01) stimulated parotid flow rates than persons with well-controlled diabetes and nondiabetic control subjects. There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates.

CONCLUSIONS

These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.

Secretory immunoglobulin A and cardiovascular activity during mental arithmetic: effects of task difficulty and task order

Secretory immunoglobulin A (sIgA) in saliva and cardiovascular activity were measured at rest and during mental arithmetic. Task difficulty was manipulated by presenting easy, hard, and impossible versions of the mental arithmetic task in counterbalanced order, while task novelty was operationalised as order of presentation (i.e. first, second, third). Mental arithmetic elicited significant increases in sIgA concentration and sIgA secretion rate, as well as significant cardiovascular effects. Performance decreased and rated difficulty increased with increasing task difficulty. However, sIgA and cardiovascular activity, with the exception of diastolic blood pressure, were insensitive to variations in task difficulty. In contrast, sIgA concentration and a broad range of cardiovascular variables were influenced by task novelty, with more pronounced activity characterising the task version presented first, irrespective of its level of difficulty. Task novelty would seem to be a more important determinant of sIgA and cardiovascular activity than task difficulty.

Secretory cell differentiation and mucus secretion in cultures of human nasal epithelial cells: use of a monoclonal antibody to study human nasal mucin

We have developed an air-liquid interface culture system for human nasal epithelial cells that differentiate into mucociliary phenotypes in a defined serum-free medium. Dissociated cells obtained from nasal polyps were cultured on a collagen gel substrate. At confluence, the cells lost characteristics of differentiated cells, and secretory cell and ciliated cell differentiation appeared after 7 days in an air-liquid interface. After 21 days, about half of the epithelial cells were stained with Alcian blue-periodic acid-Schiff stain or monoclonal antibody HCS18, which was directed against human nasal mucin specific for epithelial secretory (goblet) cells. The quantitative examination using the antibody HCS18 revealed that the antibody-reactive nasal mucin was secreted only on the apical side of the cultures, and interleukin-1beta and tumor necrosis factor alpha stimulated these mucus secretions. The culture system with an antimucin monoclonal antibody developed in this study should be useful for studying polarized mucus secretion from human nasal epithelial cells.

Cardiovascular and secretory immunoglobulin A reactions to humorous, exciting, and didactic film presentations

Secretory immunoglobulin A (sIgA) in saliva and cardiovascular activity were measured at rest and in response to three film extracts varying in affective content. Subjective ratings of film impact confirmed a priori assumptions; the humorous film was rated as funnier than the other two films, the didactic film as more boring than the other two films, and the exciting film as more exciting and more stressful than the other two films. The films elicited distinct patterns of cardiovascular autonomic activity. The exciting film provoked changes characteristic of beta-adrenergic activation: increased systolic blood pressure (SBP); heart rate (HR); cardiac output (CO); and shortened pre-ejection period (PEP). The didactic film had little impact on cardiovascular activity. While an increase in total peripheral resistance (TPR) occurred, the humorous film was largely notable for a reduction in beta-adrenergic drive, as evidenced by reduced CO and a lengthening of PEP. In contrast to previous research reporting a rise in sIgA particular to humorous exposures, the sIgA secretion rate, although enhanced by exposure to the films, did not vary with film content.

Neurological damage and duodenopancreatic reflux in the pathogenesis of alcoholic pancreatitis

OBJECTIVE

To present a new theory on the pathogenesis of acute alcoholic pancreatitis based on experimental data, the significance of which has not been recognized, and on evidence from the current literature.

HYPOTHESIS

That chronic alcoholism damages muscarinic receptors in the pancreas, duodenum, and Oddi sphincter, producing heightened sensitivity to acetylcholine, stimulation of protein-rich pancreatic juice, hypertonicity of the duodenum and esophagus, relaxation of the Oddi sphincter, and intraduodenal pressures exceeding those shown to cause duodenopancreatic reflux and acute pancreatitis in humans and experimental animals.

OUTCOME

The duodenopancreatic reflux mechanism can explain all of the clinical features of acute alcohol pancreatitis, including the intraductal site and rapid activation of zymogens by enterokinase, the recurrent episodes of pancreatitis, the precipitation of protein plugs by partial proteolytic hydrolysis, the severe vascular changes, the relation to infection by the most direct route, and the progression to chronic pancreatitis via the necrosis-fibrosis sequence.

CONCLUSIONS

Damage to the nervous system, with a time lag of 5 to 15 years between the onset of heavy drinking and the development of neurological disorders (peripheral neuropathy and cerebellar degeneration), is a characteristic complication of chronic alcoholism. The similarity to events in alcoholic pancreatitis is striking.

Salivary buffer effect in relation to late pregnancy and postpartum

We studied the salivary pH, buffer effect (BE), and flow rates of unstimulated and paraffin-stimulated saliva of 8 women in their late pregnancy and postpartum. Salivary samples were collected about 1 month prior to and about 2 months after delivery. In non-pregnant control women, two paraffin-stimulated salivary samples were collected 1 month apart. The salivary BE increased significantly from late pregnancy to postpartum without exception. The increase was 2.04 +/- 1.17 pH units (P < 0.001) on average. The BE increased from 4.79 +/- 1.64 (final pH) to 6.82 +/- 1.01 (final pH). This change was not due to variation in salivary flow rates, since both unstimulated and paraffin-stimulated flow rates remained unchanged. In control women the difference between the 2 BE measurements was only 0.13 +/- 0.47 pH units on average. We concluded that women with high postpartum BE values may have moderate or even low BE values in late pregnancy. In control women, individual variation was found to be low in all variables studied.

Clinical evaluation of a commercially available oral moisturizer in relieving signs and symptoms of xerostomia in postirradiation head and neck cancer patients and patients with Sjögren's syndrome

A major complication of irradiation therapy for head and neck cancer is salivary gland dysfunction and xerostomia. The purpose of this clinical investigation was to evaluate the effects of a commercially available oral moisturizer (Optimoist) on salivary flow rate, symptoms of xerostomia, oral pH, oral microflora, and swallowing in postirradiation head and neck cancer patients (XRT) and patients with Sjögren's syndrome (SS). Subjects who were post-XRT and subjects with SS (n = 24; mean age = 54.1) discontinued their use of any salivary substitute or moisturizer for 2 weeks prior to entering the study. Baseline whole unstimulated saliva was collected for 5 minutes using a standard sialometric technique. Candida albicans and Lactobacillus cultures were performed using kits from Orion Diagnostica, Inc., and a pH analysis was performed on the salivary sample using a Markson (model 00663) pH meter. Swallowing was assessed by clinical measures by videofluoroscopic techniques. Several subjective assessments were performed to evaluate symptoms of xerostomia. Subjects were instructed in the use of a daily diary and to use only the provided article ad libitum for a period of 2 weeks. After the 2-week period, the results indicated significant subjective and objective improvements in signs and symptoms of xerostomia. Whole unstimulated salivary flow rate improved from (mean +/- SEM) 0.1150 +/- 0.02 to 0.2373 +/- 0.09 mL/min. Salivary pH did not change. Global subjective improvement in xerostomia improved in 58% of the subjects. Candida colonization decreased in 43% of the subjects. There was no change in Lactobacilli colonization. Swallowing objectively improved in 75% of subjects. These results indicate significant improvement in both signs of hyposalivation and symptoms of xerostomia with the use of Optimoist in postirradiation head and neck cancer patients and patients with SS.

Longitudinal influence of age, menopause, hormone replacement therapy, and other medications on parotid flow rates in healthy women

BACKGROUND

Recent investigations have demonstrated that parotid salivary dysfunction is not a normal process of aging, but may be the consequence of systemic conditions and their treatment, including medications and menopause. The purpose of this study was to assess longitudinally the influence of age, menopausal status, hormone replacement therapy, and other medications on stimulated parotid flow rates (SPFRs) in healthy women.

METHODS

Medical diagnoses, menopausal status, medication utilization, and 2% citric acid stimulated parotid salivas were collected from 396 women, aged 21 to 96 years, from the Baltimore Longitudinal Study of Aging (National Institute on Aging, National Institutes of Health) over a 17-year span by three investigators.

RESULTS

There was no overall longitudinal effect of time on SPFR. Age at first visit was a significant predictor of a decrease in SPFR when adjusted for time and xerostomic medications. However, the deleterious effect of taking one xerostomic medication was equivalent to approximately 14 years of aging. Menopausal status and hormone replacement therapy were not consistently associated with diminished SPFR.

CONCLUSIONS

These results suggest that menopause and hormone replacement therapy are not associated with parotid salivary dysfunction. Aging may have a statistically significant yet small deleterious influence on SPFR; however, the adverse influence of xerostomic medications is much larger.

[Whole saliva flowmetry. Evaluation of 3 measurement technics]

Several methods traditionally have been used to collect and measure whole mouth saliva. The purpose of the study was to determine resting and stimulated whole saliva secretion rates and to evidence decreased saliva production (xerostomia) in outpatients' clinic. In this prospective study, saliva production was quantified by swab weighing, suction method (before and after chewing) and by oral sugar clearance. The 3 methods were carried out in 30 healthy subjects (16 females and 14 males) and 7 subjects with dry mouth (2 females and 5 males). Our results indicate that whole saliva formation can be reliably quantitated by standardized procedures of weighing sterile sponge and suction methods on healthy subjects. But the suction technique was found to be inferior in the group with xerostomia (impossibility of quantitative measurement in 5 patients out of 7). The 3 methods did significantly differ when mean flow rates in the group with xerostomia and in the healthy group were compared (p < 0.01). To conclude, in a physician's office, direct weighing of the swabs can be done easily and more reliable when using a balance that is accurate to 0.1 gm. Oral sugar clearance can be used to screen for xerostomia.

The contribution of mechanoreceptive neurones in the gingival tissues to the masticatory-parotid salivary reflex in man

The masticatory-parotid salivary reflex has been studied in fully dentate subjects. Salivary flow was recorded by siting a modified Lashley cup over the orifice of the parotid duct on one side of the mouth. Subjects chewed on small pieces of silicone rubber for 1-min periods which resulted in a reflex secretion of parotid saliva. The secretion was greatest when the subject chewed on the same side of the mouth (ipsilateral) as the salivary flow was recorded. Less salivary flow resulted when the subjects chewed on the opposite side of the mouth (contralateral). Selected areas of the buccal or lingual gingival tissues were then anaesthetized on the side ipsilateral to the Lashley cup. Anaesthesia of the lingual and buccal gingival tissues together resulted in a reduction of salivary flow in response to similar chewing cycles. Anaesthesia of the lingual gingival tissues alone also resulted in a reduction of salivary flow, but anaesthesia of the buccal gingival tissues alone did not. During mastication it is likely that mechanoreceptors in the gingival tissues will be stimulated which may result in salivary flow. This requires further study as other mechanoreceptive neurones are also known to be involved in the masticatory-parotid salivary reflex.

Effect of age on variability of parotid salivary gland flow rates over time

BACKGROUND

although several reports indicate that qualitative and quantitative assessments of parotid salivary function are age-stable in healthy adults, there have been no studies of the influence of age on the variability of repeated parotid flow rates.

OBJECTIVE

to examine the influence of age on the variability of repeated parotid flow rates in unmedicated, healthy adults.

MATERIALS AND METHODS

we assessed unilateral unstimulated and 2% citrate-stimulated parotid flow rates and collected responses to a five-item subjective xerostomia questionnaire in 14 subjects aged 20-40 years and 14 subjects aged 60-80 years. All subjects were healthy and unmedicated. We collected saliva and asked subjects to complete the questionnaire at baseline, 1 h and 2 h.

RESULTS

unstimulated and stimulated parotid flow rates were similar at each time point in young and older subjects, and remained stable over the collection period. There were no differences in the standard deviations of the three collections of unstimulated and stimulated flow rates between young and older subjects. There were no differences between questionnaire responses between the two groups, and no change in response over time.

CONCLUSIONS

there is no increased age-related variability in parotid salivary flow rates over repeated measures. Stimulated parotid flow rates are stable over 2 h in healthy people, and are similar in young and older individuals. These results suggest that parotid glands have a large secretory reserve.

Oral microflora in subjects with reduced salivary secretion

It is generally assumed that a decreased salivary secretion rate will promote plaque accumulation and increase the risk for caries, gingival inflammation, and mucosal infections. In this study, the effect of hyposalivation on the oral microflora was examined. The following micro-organisms were analyzed in rinsing samples from 14 subjects with hyposalivation: the total number of anaerobically growing micro-organisms, alpha-hemolytic streptococci, mutans streptococci, lactobacilli, Fusobacterium nucleatum, Prevotella intermedia/Prevotella nigrescens, Staphylococcus aureus, Candida albicans, and enterics. The study group, age 53 +/- 7 years, had no history of radiation therapy and showed no signs of inflammation in their salivary glands on biopsy. All were dentate with a mean of 24 +/- 3 teeth. Their salivary secretion rates were 0.03 +/- 0.02 mL/min (unstimulated) and 0.84 +/- 0.65 mL/min (stimulated). The control group was matched to the hyposalivation group according to age, sex, and number of teeth. There was a significantly increased number of lactobacilli, and a tendency, not statistically significant and with large variations within the groups, toward a higher proportion of mutans streptococci and a lower proportion of alpha-hemolytic streptococci in the hyposalivation group. The presence of micro-organisms associated with gingival inflammation and mucosal infections was comparable with that in the healthy controls. The results indicated that a low salivary secretion rate mainly promotes a flora associated with the development of caries.

Metabolic indicators of hydration status in the prediction of parotid salivary-gland function

Salivary glands require body fluids for normal function. It has been suggested that decreased levels of hydration (dehydration) may cause diminished salivary output, but it is not known whether salivary flow rates are related to biological measures of hydration status. The purpose of this study was to determine whether reduced parotid salivary flow rates, as a result of dehydration, can be assessed through physiological markers of hydration status. Twenty-four healthy and unmedicated adults abstained from eating and drinking for 24 h and then underwent intravenous rehydration to replace all lost weight. Unstimulated (UPFR) and 2% citric acid-stimulated (SPFR) parotid flow rates, body weight, and markers of hydration status (haematocrit, haemoglobin, serum sodium, plasma protein, creatinine, serum and urine osmolality) were assessed at baseline, at the completion of the 24-h dehydration period, and 1 h after rehydration had been completed. Correlation coefficients (r) and coefficients of determination (r2) were obtained between: (a) UPFR and each metabolic variable at each time point, (b) the change in UPFR and the corresponding change in each metabolic variable due to dehydration and rehydration, and (c) the percentage change in UPFR and the corresponding percentage change of each metabolic variable due to dehydration and rehydration. These tests were then repeated for SPFR. There were several isolated significant correlations but no consistent trends between salivary flow rates and metabolic markers of hydration status. These findings suggest that metabolic indicators of hydration status are not accurate predictors of parotid salivary flow rates.