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Increased Plasma Osteocalcin, Oral Disease, and Altered Mandibular Bone Density in Postmenopausal Women. Int J Dent 2019; 2019:3715127. [PMID: 31781221 PMCID: PMC6855022 DOI: 10.1155/2019/3715127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 01/20/2023] Open
Abstract
An association between oral diseases and postmenopausal status has been recognized. However, the relationship between all oral disease, mandibular bone density, health status, and osteocalcin (OCN) bone markers in postmenopausal dental patients has not been reported. This study was therefore to verify the differences in plasma OCN levels, dental, periodontal, and oral mucosal disease, and mandibular bone density alterations from panoramic radiograph and systemic parameters in postmenopausal women, compared to premenopausal women. Oral, radiographic, and blood examination were performed in 92 females. Dental, periodontal, and oral mucosal statuses were recorded. Health profile parameters were collected from medical charts. Plasma OCN was evaluated by enzyme-linked immunosorbent assay. Forty-two (45.7%) participants were postmenopausal with a higher median age (55 (51, 62) years) than the premenopausal group (43 (38, 45) years). Overweight or obesity, hypercholesterolemia, and impaired fasting blood sugar were more prevalent in postmenopause. The average postmenopausal OCN level (425.62 ng/mL) was significantly higher than the premenopausal group (234.77 ng/mL, p < 0.001). The average number of missing teeth, mean attachment loss, alveolar bone loss, periapical lesion count, and clinical oral dryness score were also significantly higher in postmenopause (p=0.008, < 0.001, 0.031, 0.006, and 0.005, respectively). However, mandibular bone density determined by mandibular cortical index was lower in postmenopause (p < 0.001). The panoramic mandibular index, mandibular cortical width, fractal dimension, and other oral mucosal disease did not differ between the groups. Postmenopause was associated with elevated plasma OCN (β = 0.504, p < 0.001) when related covariates were adjusted. Elevated plasma OCN, oral mucosal dryness, high number of periapical radiolucencies and missing teeth, and lower mandibular bone density from panoramic radiograph were prevalent in postmenopausal women. Dentists should suspect an increased risk of low bone mineral density in postmenopausal patients who display these clinical and radiographic findings, and they should be referred for further examination. Plasma OCN may interconnect a relationship between postmenopausal status and the low mandibular bone density.
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Abed H, Reilly D, Burke M, Daly B. Patients with head and neck cancers' oral health knowledge, oral health‐related quality of life, oral health status, and adherence to advice on discharge to primary dental care: A prospective observational study. SPECIAL CARE IN DENTISTRY 2019; 39:593-602. [DOI: 10.1111/scd.12418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/06/2019] [Accepted: 08/23/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Hassan Abed
- Department of Sedation and Special Care DentistryGuys and St Thomas' NHS Foundation Trust London UK
- Department of Basic and Clinical Oral SciencesFaculty of DentistryUmm Al‐Qura University Makkah Saudi Arabia
- Centre for OralClinical and Translational ScienceFaculty of Dentistry, Oral and Craniofacial Sciences, King's College London London UK
| | - Damien Reilly
- Department of Sedation and Special Care DentistryGuys and St Thomas' NHS Foundation Trust London UK
- Department of Special Care DentistrySurrey and Sussex Healthcare NHS Trust Redhill Surrey UK
| | - Mary Burke
- Department of Sedation and Special Care DentistryGuys and St Thomas' NHS Foundation Trust London UK
| | - Blánaid Daly
- School of Dental ScienceTrinity College Dublin and Dublin Dental University HospitalLincoln Place Dublin 2 Ireland
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53
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Cho H, Kumar N. Dental management of a patient with head and neck cancer: a case report. Br Dent J 2019; 227:25-29. [DOI: 10.1038/s41415-019-0464-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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54
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Rusthen S, Kristoffersen AK, Young A, Galtung HK, Petrovski BÉ, Palm Ø, Enersen M, Jensen JL. Dysbiotic salivary microbiota in dry mouth and primary Sjögren's syndrome patients. PLoS One 2019; 14:e0218319. [PMID: 31211815 PMCID: PMC6581286 DOI: 10.1371/journal.pone.0218319] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/31/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives Primary Sjögren’s syndrome (pSS) is an autoimmune disease characterized by reduced lacrimal and salivary secretion. Sicca symptoms together with fatigue and musculoskeletal pain can significantly reduce the patients’ quality of life. Furthermore, low salivary secretion may disrupt the oral microbial homeostasis. The aim of this study was to compare the salivary microbiota from pSS patients with patients with sicca symptoms not fulfilling the classification criteria for pSS (non-SS), and with healthy controls without sicca complaints. Methods Pellets from centrifuged chewing-stimulated whole saliva from pSS patients (n = 15), non-SS sicca patients (n = 15) and healthy controls (n = 15) were prepared. DNA was extracted and analyzed by 16S rRNA gene sequencing. The acquired sequencing data were performed using the human oral microbiome database (HOMD). Results We detected 42, 45, and 34 bacterial genera in saliva samples from pSS patients, non-SS sicca patients, and healthy controls, respectively. The most abundant genera in all samples were Prevotella, Veillonella, Streptococcus, and Haemophilus. At species level Streptococcus intermedius, Prevotella intermedia, Fusobacterium nucleatum subsp. vincentii, Porphyromonas endodontalis, Prevotella nancensis, Tannerella spp., and Treponema spp. were detected in the samples from pSS and non-SS only, while Porphyromonas pasteri was mostly found among the healthy controls. Conclusion Our study indicated dysbiosis in the salivary microbiota from pSS and non-SS patients compared to healthy controls. Additionally, the results showed that the salivary microbiome in the pSS group differed significantly from the non-SS group.
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Affiliation(s)
- S. Rusthen
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - A. K. Kristoffersen
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - A. Young
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - H. K. Galtung
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - B. É. Petrovski
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ø. Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - M. Enersen
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - J. L. Jensen
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
- * E-mail:
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55
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Cheng YM, Lan SH, Hsieh YP, Lan SJ, Hsu SW. Evaluate five different diagnostic tests for dry mouth assessment in geriatric residents in long-term institutions in Taiwan. BMC Oral Health 2019; 19:106. [PMID: 31196048 PMCID: PMC6567641 DOI: 10.1186/s12903-019-0797-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Residents in long-term care (LTC) institutions require care plans to effectively resolve dry mouth. Simple and easily comprehensible dry mouth indices must be developed to assist care professionals in determining dry mouth among residents. Therefore, this study aim of the study was to evaluate five different diagnostic tests for dry mouth assessment. METHODS A total of 568 residents were recruited from several LTC institutions in central Taiwan. The research instruments and tools comprised of the characteristics of the residents, state of oral health care, self-perceived ability to chew food, Taiwanese short-form of the Oral Health Impact Profile (OHIP-7 T), self-perceived levels of dry mouth, oral moisture checking, and a repetitive saliva swallowing test (RSST). The data collected were analyzed through demographic analysis, Correlation coefficient and chi-squared automatic interaction detection. RESULTS Results of the decision tree analysis indicated that RSST results, tooth brushing frequency, and age were the three indices that exerted the greatest influence on oral moisture levels. Specifically, in residents with relatively high RSST results, a daily tooth brushing frequency > 1, and an age < 68 years exhibited more favorable oral moisture levels. The results indicated that residents' self-perceived oral status was not associated with their oral moisture levels. CONCLUSION The three indices can be provided to LTC institutions for on-site assessment of dry mouth among residents to facilitate early detection of those with dry mouth.
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Affiliation(s)
- Yao-Ming Cheng
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan
| | - Shao-Huan Lan
- School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian City, China
| | - Yen-Ping Hsieh
- Department of Long-term Care, National Quemoy University, No. 1 University Rd., Jinning Township, Kinmen County 89250 Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shang-Wei Hsu
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan
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56
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Holliday R, Preshaw PM, Ryan V, Sniehotta FF, McDonald S, Bauld L, McColl E. A feasibility study with embedded pilot randomised controlled trial and process evaluation of electronic cigarettes for smoking cessation in patients with periodontitis. Pilot Feasibility Stud 2019; 5:74. [PMID: 31171977 PMCID: PMC6547559 DOI: 10.1186/s40814-019-0451-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/29/2019] [Indexed: 11/21/2022] Open
Abstract
Background Tobacco smoking is a major risk factor for several oral diseases, including periodontitis, and electronic cigarettes (e-cigarettes) are increasingly being used for smoking cessation. This study aimed to assess the viability of delivering and evaluating an e-cigarette intervention for smoking cessation within the dental setting, prior to a definitive study. Methods A feasibility study, comprising a pilot randomised controlled trial and qualitative process evaluation, was conducted over 22 months in the Newcastle upon Tyne Hospitals NHS Dental Clinical Research Facility, UK. The pilot trial comprised a two-armed, parallel group, individually randomised, controlled trial, with 1:1 allocation. Participant eligibility criteria included being a tobacco smoker, having periodontitis and not currently using an e-cigarette. All participants received standard non-surgical periodontal therapies and brief smoking cessation advice. The intervention group additionally received an e-cigarette starter kit with brief training. Proposed outcomes for a future definitive trial, in terms of smoking behaviour and periodontal/oral health, were collected over 6 months to assess data yield and quality and estimates of parameters. Analyses were descriptive, with 95% confidence intervals presented, where appropriate. Results Eighty participants were successfully recruited from a range of dental settings. Participant retention was 73% (n = 58; 95% CI 62–81%) at 6 months. The e-cigarette intervention was well received, with usage rates of 90% (n = 36; 95% CI 77–96%) at quit date. Twenty percent (n = 8; 95% CI 11–35%) of participants in the control group used an e-cigarette at some point during the study (against advice). The majority of the outcome measures were successfully collected, apart from a weekly smoking questionnaire (only 30% of participants achieved ≥ 80% completion). Reductions in expired air carbon monoxide over 6 months of 6 ppm (95% CI 1–10 ppm) and 12 ppm (95% CI 8–16 ppm) were observed in the control and intervention groups, respectively. Rates of abstinence (carbon monoxide-verified continuous abstinence for 6 months) for the two groups were 5% (n = 2; 95% CI 1–17%; control group) and 15% (n = 6; 95% CI 7–29%; intervention group). Conclusions Data suggest that a definitive trial is feasible and that the intervention may improve smoking quit rates. Insights were gained into how best to conduct the definitive trial and estimates of parameters to inform design were obtained. Trial registration ISRCTN, ISRCTN17731903; registered 19 September 2016 http://www.isrctn.com/ISRCTN17731903. Electronic supplementary material The online version of this article (10.1186/s40814-019-0451-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard Holliday
- 1Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK
| | - Philip M Preshaw
- 1Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK.,2National University Centre for Oral Health, National University of Singapore, Singapore, Singapore
| | - Vicky Ryan
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Falko F Sniehotta
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Suzanne McDonald
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK.,4Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane and Women's Hospital Campus, Herston, Queensland 4029 Australia
| | - Linda Bauld
- 5Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Elaine McColl
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
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Chen X, Aqrawi LA, Utheim TP, Tashbayev B, Utheim ØA, Reppe S, Hove LH, Herlofson BB, Singh PB, Palm Ø, Galtung HK, Jensen JCL. Elevated cytokine levels in tears and saliva of patients with primary Sjögren's syndrome correlate with clinical ocular and oral manifestations. Sci Rep 2019; 9:7319. [PMID: 31086200 PMCID: PMC6513950 DOI: 10.1038/s41598-019-43714-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/16/2019] [Indexed: 12/22/2022] Open
Abstract
Investigating cytokines in tear fluid and saliva may offer valuable information for understanding the pathogenesis of primary Sjögren's syndrome (pSS). Cytokine profiles in both tear fluid and saliva of pSS patients, non-Sjögren's syndrome (non-SS) subjects with sicca symptoms, and healthy controls without sicca complaints were analysed. Furthermore, relationships associating the severity of clinical ocular and oral manifestations with the upregulated cytokines were assessed. In tear fluid, pSS patients showed elevated levels of IL-1ra, IL-2, IL-4, IL-8, IL-12p70, IL-17A, IFN-γ, IP-10, MIP-1b, and Rantes compared to non-SS subjects and healthy controls. The increased cytokine levels (except IP-10) correlated significantly with reduced tear production, less stable tear film, and greater ocular surface damage. In saliva, pSS patients had a higher IP-10 level, which correlated with higher candida score; and an elevated MIP-1a level, which correlated significantly with lower unstimulated and stimulated whole saliva secretion rates. The upregulated cytokines identified in tear fluid and saliva of pSS patients show a clear interplay between innate and adaptive immune responses that may contribute to disease pathogenesis. The increase of IP-10 and MIP in both tears and saliva further emphasises the essential role of macrophages and innate immunity in pSS.
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Affiliation(s)
- Xiangjun Chen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
- The Norwegian Dry Eye Clinic, Oslo, Norway.
| | - Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- The Norwegian Dry Eye Clinic, Oslo, Norway
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Behzod Tashbayev
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
| | | | - Sjur Reppe
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Preet Bano Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Hilde Kanli Galtung
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Fukushima Y, Sano Y, Isozaki Y, Endo M, Tomoda T, Kitamura T, Sato T, Kamijo Y, Haga Y, Yoda T. A pilot clinical evaluation of oral mucosal dryness in dehydrated patients using a moisture-checking device. Clin Exp Dent Res 2019; 5:116-120. [PMID: 31049213 PMCID: PMC6483039 DOI: 10.1002/cre2.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022] Open
Abstract
This study included 30 patients (17 males and 13 females; mean age, 73.7 ± 13.1 years) who were diagnosed with dehydration based on vital signs, skin symptoms, and blood test findings by emergency medicine physicians. First, the attending physician of our department measured oral mucosal dryness. Subsequently, the emergency medicine physician blindly divided the severity of dehydration into three stages according to clinical findings and blood test results. In this study, the oral moisture-checking device (Mucus®; Life Co., Ltd., Saitama, Japan) was used to measure the oral mucosal dryness. We examined the oral moisture level for each dehydration severity level and the correlations of each severity level of dehydration with the measured values. Spearman's correlation coefficient (Medcalc version 11.3 for Windows) was used for statistical analysis. P < 0.05 indicated significant differences. Twenty-six patients were diagnosed with dry mouth, and a moderate negative correlation was found between the severity of dehydration and oral moisture degree (r = -0.686). The correlation coefficient for the relationship between oral moisture degree and severity of dehydration was -0.686, indicating a negative correlation (P < .05). These results suggest that the oral mucosal dryness may be a useful index of dehydration severity.
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Affiliation(s)
- Yosuke Fukushima
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Yoshie Sano
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Yuta Isozaki
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Mao Endo
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Taketo Tomoda
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Tomohisa Kitamura
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Tsuyoshi Sato
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Yoshito Kamijo
- Emergency Medical Center and Poison CenterSaitama Medical University HospitalJapan
| | - Yoshiyuki Haga
- Emergency Medical Center and Poison CenterSaitama Medical University HospitalJapan
| | - Tetsuya Yoda
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
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Hijjaw O, Alawneh M, Ojjoh K, Abuasbeh H, Alkilany A, Qasem N, Al-Essa M, AlRyalat SA. Correlation between Xerostomia index, Clinical Oral Dryness Scale, and ESSPRI with different hyposalivation tests. Open Access Rheumatol 2019; 11:11-18. [PMID: 30655709 PMCID: PMC6324613 DOI: 10.2147/oarrr.s188937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background and objective Xerostomia is a subjective measure of dry mouth, while hyposalivation is an objective measure of reduced saliva flow rate. In this study, we aim to assess the association between commonly used xerostomia scoring systems, with different hyposalivation measures among Sjogren Syndrome (SS) patients. Methods In a cohort of SS patients, we assessed xerostomia using Xerostomia index, clinical oral dryness scale (CODS), and the European League Against Rheumatism SS Patient-Reported Index (ESSPRI), and we assessed hyposalivation using unstimulated whole saliva flow (UWS), stimulated whole saliva flow (SWS), and stimulated parotid flow (SPF). We analyzed the association between xerostomia and hyposalivation using association tests in SPSS. Results We included a total of 49 patients in this study, of which 34 (68%) had primary SS, and 15 (32%) had secondary. CODS was significantly correlated with SWS (P=0.048), with a negative correlation coefficient of 0.216, and with SPF (P=0.009), with a negative correlation coefficient of 0.291. The dryness domain of ESSPRI was significantly correlated with UWS (P=0.031) with a negative correlation coefficient of 0.233. Conclusion CODS is the scoring system with the highest correlation with hyposalivation, particularly SWS and SPF, followed by ESSPRI dry domain, which is correlated with UWS. Xerostomia index is not correlated with hyposalivation.
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Affiliation(s)
- Ola Hijjaw
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mohammad Alawneh
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
| | - Khaled Ojjoh
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
| | - Hazem Abuasbeh
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
| | - Ahmad Alkilany
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
| | - Nabeel Qasem
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mohammad Al-Essa
- Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan
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Baer AN, Walitt B. Update on Sjögren Syndrome and Other Causes of Sicca in Older Adults. Rheum Dis Clin North Am 2018; 44:419-436. [PMID: 30001784 DOI: 10.1016/j.rdc.2018.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dry eye and dry mouth symptoms are each reported by up to 30% of persons more than 65 years of age, particularly in women. Medication side effects are the most common contributing factors. The evaluation of these symptoms requires measures of ocular and oral dryness. Sjögren syndrome is the prototypical disease associated with dryness of the eyes and mouth and predominantly affects women in their perimenopausal and postmenopausal years. In addition to topical treatment of the mucosal dryness, patients with Sjögren syndrome may require treatment with systemic immunomodulatory and immunosuppressive agents to manage a variety of extraglandular manifestations.
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Affiliation(s)
- Alan N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4000, Mason Lord Center Tower, Baltimore, MD 21224, USA; National Institute of Dental and Craniofacial Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Brian Walitt
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
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61
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Jazzar A, Manoharan A, Brown JE, Shirlaw PJ, Carpenter GH, Challacombe SJ, Proctor GB. Predictive value of ultrasound scoring in relation to clinical and histological parameters in xerostomia patients. Oral Dis 2018; 25:150-157. [PMID: 30120806 DOI: 10.1111/odi.12959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Salivary gland dysfunction is one of the main clinical features of Sjögren's syndrome (SS), manifested by xerostomia with subsequent complications and well-established effects on the person's quality of life. OBJECTIVES To determine firstly whether selected tests of salivary gland function and structure, unstimulated whole salivary flow rate (UWSFR), parotid flow rate (PFR), clinical oral dryness score (CODS) and ultrasound score (USS), can discriminate SS from non-SS sicca patients and secondly whether these tests can differentiate between patients in different subgroups of SS. METHOD Unstimulated whole salivary flow rate, PFR, CODS and USS were determined in 244 patients comprised of SS patients (n = 118), SS patients at higher risk of lymphoma (n = 30) or with lymphoma (n = 26), and non-SS sicca disease controls (n = 70). RESULTS All assessments showed a significant difference between the overall SS group and the disease control group, attributed mainly to the lymphoma subgroups of SS (p < 0.0001 for all parameters). There was a significant correlation (Spearman r = 0.7, p value <0.0001) and 87.3% agreement between USS and the histology focus scores of 119 patients. CONCLUSION The results suggest that salivary gland tests including USS can aid in differentiating between SS and non-SS dry mouth, especially the subgroups of SS with lymphoma or at higher risk of developing lymphoma.
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Affiliation(s)
- Ahoud Jazzar
- Mucosal and Salivary Biology Division, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK.,Department of Oral Medicine, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Andiappan Manoharan
- King's College London Dental Institute at Guy's Hospital, King's Health Partners, Biostatistics, London, UK
| | - Jackie E Brown
- Department of Radiology, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Penelope J Shirlaw
- Department of Oral Medicine, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Guy H Carpenter
- Mucosal and Salivary Biology Division, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - Stephen J Challacombe
- Mucosal and Salivary Biology Division, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK.,Department of Oral Medicine, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Gordon B Proctor
- Mucosal and Salivary Biology Division, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
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62
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Jazzar AA, Shirlaw PJ, Carpenter GH, Challacombe SJ, Proctor GB. Salivary S100A8/A9 in Sjögren's syndrome accompanied by lymphoma. J Oral Pathol Med 2018; 47:900-906. [PMID: 29998578 DOI: 10.1111/jop.12763] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sjögren's syndrome (SS) is an autoimmune inflammatory disease that affects the exocrine glands. The absence of early diagnostic markers contributes to delays in its diagnosis. Identification of changes in the protein profile of saliva is considered one of the promising strategies for the discovery of new biomarkers for SS. OBJECTIVE To identify salivary protein biomarkers with potential for use in discriminating between different lymphoma risk subgroups of SS. METHOD Parotid and whole mouth saliva samples were collected from patients with SS, including those in subgroups at higher risk of developing or with confirmed lymphoma, non-SS sicca disease controls and healthy subjects. An initial proteomics analysis by mass spectrometry (LCMSMS) identified S100A8/A9 as a biomarker and was followed by validation with an enzyme-linked immunosorbent assay (ELISA). RESULTS Significant differences were found in levels of S100A8/A9 in parotid saliva but not whole mouth saliva between patients with SS compared with healthy and disease control subjects (P = 0.001 and 0.031, respectively). Subgroups of patients with SS based on lymphoma risk showed significant differences in salivary levels of S100A8/A9. CONCLUSION The results suggest that salivary levels of S100A8/A9 can aid in differentiating between SS, disease control and healthy control subjects, especially the subgroups of SS with lymphoma or at higher risk of lymphoma.
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Affiliation(s)
- Ahoud A Jazzar
- Mucosal and Salivary Biology Division, Dental Institute, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK.,Department of Oral Medicine, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Penelope J Shirlaw
- Mucosal and Salivary Biology Division, Dental Institute, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK.,Department of Oral Medicine, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Guy H Carpenter
- Mucosal and Salivary Biology Division, Dental Institute, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - Stephen J Challacombe
- Mucosal and Salivary Biology Division, Dental Institute, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK.,Department of Oral Medicine, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Gordon B Proctor
- Mucosal and Salivary Biology Division, Dental Institute, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
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Zampeli E, Kalogirou EM, Piperi E, Mavragani CP, Moutsopoulos HM. Tongue Atrophy in Sjögren Syndrome Patients with Mucosa-associated Lymphoid Tissue Lymphoma: Autoimmune Epithelitis beyond the Epithelial Cells of Salivary Glands? J Rheumatol 2018; 45:1565-1571. [DOI: 10.3899/jrheum.180101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/22/2022]
Abstract
Objective.Primary Sjögren syndrome (pSS), an autoimmune epithelitis, bears the risk of evolving to non-Hodgkin lymphoma and most frequently to the mucosa-associated lymphoid tissue (MALT) subtype. Based on the observation that pSS patients with MALT present a more atrophic and more intensely fissured tongue, we aimed to semiquantify severity of tongue atrophy and clinically assess lingual appearance in pSS patients with and without MALT, and investigate whether tongue atrophy and fissured appearance could serve as clinical indicators/signs of MALT.Methods.A blinded complete oral examination was performed in pSS patients with and without MALT. Tongue atrophy was scored using a semiquantified atrophy score. Clinical and laboratory variables were recorded for all patients.Results.After excluding pSS patients with oral candidiasis, iron deficiency, and megaloblastic anemia, 19 pSS patients with salivary MALT were matched 1:3 for age, sex, and disease duration with 57 pSS patients without MALT. The pSS-MALT patients had increased prevalence of salivary gland enlargement, lymphadenopathy, monoclonal gammopathy, rheumatoid factor positivity, higher focus and Tarpley scores in the minor salivary gland biopsy, and hyposalivation, compared to the pSS non-MALT patients. A significantly higher prevalence of tongue atrophy (68% vs 30%, p = 0.006) and fissured tongue (89% vs 33%, p < 0.001) was observed in the former group. Multivariate analysis showed that fissured tongue appearance, hyposalivation, and lymphadenopathy associate independently with salivary MALT in pSS.Conclusion.These results suggest that pSS patients with lymphoid malignancy exhibit a more atrophic and more fissured tongue. This particular clinical tongue appearance can serve as an additional clinical sign for salivary MALT lymphoma in pSS patients.
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Dietary Intake, Body Composition, and Oral Health Parameters among Female Patients with Primary Sjögren's Syndrome. Nutrients 2018; 10:nu10070866. [PMID: 29973575 PMCID: PMC6073564 DOI: 10.3390/nu10070866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023] Open
Abstract
There is limited knowledge about dietary intake and body composition among patients with primary Sjögren’s syndrome. We assessed dietary intakes with 24-h recalls and body composition with anthropometry and bioelectrical impedance in 20 female patients. Various scoring tools were used to assess oral health. The patients had a lower energy percentage (E%) from carbohydrates (p = 0.02) and a higher E% from fat (p = 0.01) compared to a reference group. The lower intake of carbohydrates was due to a lower bread intake (p = 0.04), while the higher intake of fat was due to a higher intake of butter, margarine, and oil (p = 0.01). The patients ate more than twice (p = 0.02) as much fish as the reference group. The compliance to recommended intakes of macro- and micronutrients was good. Forty-percent of the patients were overweight/obese. Increased intake of beverages was observed in patients with severe xerostomia and/or low oral health-related quality of life, whereas reduced fat intake was found in hyposmic patients. In conclusion, the dietary intake among the patients was not much different from the reference group and complied with recommendations. Most oral health parameters were not associated with nutrient intakes. Specific dietary guidelines are probably not needed to ensure adequate nutrition among such patients.
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65
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Jose A, Singh ML, Magnuson B, Farag A, Varghese R, Papas A. A randomized controlled study to evaluate an experimental moisturizing mouthwash formulation in participants experiencing dry mouth symptoms. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:231-239.e5. [PMID: 29941402 DOI: 10.1016/j.oooo.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/24/2018] [Accepted: 05/18/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and tolerability of an experimental moisturizing mouthwash versus water only in participants experiencing dry mouth symptoms, including those with Sjögren syndrome (n = 28). STUDY DESIGN Participants were randomized to the experimental mouthwash group (n = 53) or the water-only group (n = 47). For 8 days, the mouthwash group used 1 to 2 doses/day at home; both groups could sip water, as needed. Supervised treatment occurred on days 1, 3, and 8, and during this treatment, before and after administration, participants completed the Product Performance and Attributes Questionnaire parts 1 through 4. RESULTS Significant between-treatment differences on all Product Performance and Attributes Questionnaire questions were shown at most time points. On day 8, at 120 minutes, there was a significant difference on Product Performance and Attributes Questionnaire 3-Question 1 ("Relieves the discomfort of dry mouth"; the predefined primary efficacy variable) in favor of mouthwash versus water (0.63 [95% confidence interval 0.17-1.10]; P = .0084). Subgroup analysis found a significant difference that favored mouthwash in participants without Sjögren syndrome (0.67 [0.11,1.23]; P = .0203) but not with Sjögren syndrome (0.52 [-0.35,1.38; P = .2272). Eight, non-serious, oral treatment-related adverse events were reported by the mouthwash group. CONCLUSIONS The findings of a subjective questionnaire showed that an experimental moisturizing mouthwash provided greater relief than water only from dry mouth symptoms over 8 days.
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Affiliation(s)
- Anto Jose
- GSK Consumer Healthcare, Weybridge, Surrey, UK.
| | - Mabi L Singh
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Britta Magnuson
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Arwa Farag
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; Department of Oral Diagnostic Sciences, King Abdul Aziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | | | - Athena Papas
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
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66
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Ormond M, McParland H, Donaldson A, Andiappan M, Cook R, Escudier M, Hullah E, Higham J, McMillan R, Taylor J, Shirlaw P, Challacombe S, Setterfield J. An Oral Disease Severity Score validated for use in oral pemphigus vulgaris. Br J Dermatol 2018; 179:872-881. [DOI: 10.1111/bjd.16265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Ormond
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - H. McParland
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - A.N.A. Donaldson
- Biostatistics and Research Methods Centre; Dental Institute; King's College London; London U.K
| | - M. Andiappan
- Biostatistics and Research Methods Centre; Dental Institute; King's College London; London U.K
| | - R.J. Cook
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - M. Escudier
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
- Mucosal and Salivary Biology Division; Dental Institute; King's College London; London U.K
| | - E. Hullah
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - J. Higham
- Birmingham Dental Hospital; Birmingham U.K
| | - R. McMillan
- Eastman Dental Hospital; UCLH/Eastman Dental Institute; University College London; London U.K
| | - J. Taylor
- University Dental Hospital; Manchester U.K
| | - P.J. Shirlaw
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - S.J. Challacombe
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
- Mucosal and Salivary Biology Division; Dental Institute; King's College London; London U.K
| | - J.F. Setterfield
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
- Mucosal and Salivary Biology Division; Dental Institute; King's College London; London U.K
- St John's Institute of Dermatology; Guy's and St Thomas's NHS Foundation Trust; London U.K
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Karagozoglu KH, Vissink A, Forouzanfar T, Brand HS, Maarse F, Jager DHJ. Sialendoscopy enhances salivary gland function in Sjögren's syndrome: a 6-month follow-up, randomised and controlled, single blind study. Ann Rheum Dis 2018; 77:1025-1031. [PMID: 29475854 DOI: 10.1136/annrheumdis-2017-212672] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS). METHODS Forty-nine patients with SS were randomly assigned to a control group (n=15) and two intervention groups: irrigation of the major glands with saline (n=16) or with saline followed by triamcinolone acetonide (TA) in saline (n=18). Unstimulated whole saliva flow (UWS), chewing-stimulated whole saliva flow (SWS), citric acid-stimulated parotid flow (SPF), Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) score and the European League Against Rheumatism (EULAR) SS Patient-Reported Index (ESSPRI) were obtained 1 week (T0) before, and 1 (T1), 8 (T8), 16 (T16) and 24 (T24) weeks after sialendoscopy. RESULTS Median baseline UWS, SWS and SPF scores were 0.14, 0.46 and 0.22 mL/min, respectively. After intervention, significant increases in UWS and SWS were observed in the saline group (at T8 (P=0.013) and T24 (P=0.004)) and the saline/TA group (at T24 (P=0.03) and T=16 (P=0.035)). SPF was increased significantly in the saline/TA group at T24 (P=0.03). XI scores declined after sialendoscopy in both intervention groups. Compared with the control group, CODS, XI and ESSPRI improved in the intervention groups. UWS, SWS and SPF were higher in the intervention groups compared with the control group, but these differences were not significant except for SPF in the saline/TA group at T24 (P=0.005). CONCLUSIONS Irrigation of the major salivary glands in patients with SS enhances salivary flow and reduces xerostomia up to 6 months after sialendoscopy.
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Affiliation(s)
- K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim Forouzanfar
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, Netherlands
| | - Floor Maarse
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Derk Hendrik Jan Jager
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Oral Health Sciences, KU Leuven & University Hospitals Leuven, Leuven, Belgium
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68
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Jager DHJ, Bots CP, Forouzanfar T, Brand HS. Clinical oral dryness score: evaluation of a new screening method for oral dryness. Odontology 2018; 106:439-444. [PMID: 29356914 PMCID: PMC6153998 DOI: 10.1007/s10266-018-0339-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/20/2023]
Abstract
The purpose of this study was to explore the association of the clinical oral dryness score (CODS) with salivary flow rates, xerostomia inventory (XI), and bother index (BI). 147 patients were screened using CODS, which determined 10 features of oral dryness. Each feature contributed 1 point, and the total score varied from 0 to 10. Unstimulated (UWS), chewing-stimulated (CH-SWS) and acid-stimulated (A-SWS) whole salivary flows and the XI and BI were measured. Associations were explored with a bootstrapped Spearman rank correlation test (1000 × bootstrapping). Based on unstimulated salivary flow, 55 patients were classified as hyposalivators, 31 as low salivators, 48 as normosalivators and 13 as high salivators. Median CODS in the hyposalivation group was 5 (IQR 3–6) compared with 3 (IQR 2–5) in the low salivation group, 2 (IQR 1–4) in the normal salivation group and 2 (IQR 1–2.5) in the high salivation group. Significant associations between CODS and the other parameters were only found in the hyposalivation group between CODS and UWS (ρ(53) = − 0.513; p < 0.01), between CODS and CH-SWS (ρ(53) = − 0.453; p < 0.01), between CODS and A-SWS (ρ(53) = − 0.500; p < 0.01), CODS and XI (ρ(53) = 0.343; p < 0.001) and between CODS and BI (ρ(53) = 0.375; p = 0.01). In patients with hyposalivation, CODS is associated with unstimulated and stimulated salivary flow and XI and BI. CODS alone or a combination of CODS with a subjective measure, such as the XI or BI, could be recommended during routine clinical assessment to detect hyposalivation.
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Affiliation(s)
- Derk H Jan Jager
- Department of Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1118, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Oral Health Sciences, KU Leuven & University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
| | - Casper P Bots
- Dutch Institute for Salivary Research, Tuinfluiter 5, 3752 NA, Bunschoten, The Netherlands
| | - Tim Forouzanfar
- Department of Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1118, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1118, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
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69
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Tashbayev B, Rusthen S, Young A, Herlofson BB, Hove LH, Singh PB, Rykke M, Aqrawi LA, Chen X, Utheim ØA, Utheim TP, Palm Ø, Jensen JL. Interdisciplinary, Comprehensive Oral and Ocular Evaluation of Patients with Primary Sjögren's Syndrome. Sci Rep 2017; 7:10761. [PMID: 28883442 PMCID: PMC5589846 DOI: 10.1038/s41598-017-10809-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022] Open
Abstract
A comprehensive evaluation of oral and ocular symptoms and findings in primary Sjögren’s syndrome (pSS) patients may provide valuable information for management. Medical history was obtained from female pSS patients, and sex- and age-matched non-SS patients with sicca symptoms (non-SS sicca controls) as well as healthy subjects without sicca complaints (healthy controls). Oral (Summated Xerostomia Inventory, SXI) and ocular (McMonnies Dry Eye questionnaire, MDEIS, and Ocular Surface Disease Index, OSDI) subjective complaints were recorded. Objective findings including clinical oral dryness scores (CODS), unstimulated and stimulated saliva secretion rates (UWS/SWS), Schirmer I test, tear osmolarity, tear film break-up time (TFBUT), and ocular surface staining (OSS) were determined. The pSS and non-SS sicca controls were extensively troubled by subjective dryness, while the pSS group had higher CODS, significantly lower saliva and tear secretion, shorter TFBUT and higher OSS than both control groups. Furthermore, candida counts were significantly higher in the pSS patients. In the pSS group, subjective oral dryness significantly correlated with ocular dryness (MDEIS: r = 0.5, OSDI: r = 0.413) and SWS was significantly correlated with Schirmer I (r = 0.419). The findings imply that interdisciplinary subjective and objective evaluation of patients with xerostomia and xerophthalmia not only have implications for patient care, but also may guide clinicians in differentiating between pSS and non-SS sicca patients.
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Affiliation(s)
- Behzod Tashbayev
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Shermin Rusthen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Alix Young
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Preet Bano Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Morten Rykke
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lara Adnan Aqrawi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | | | | | - Tor Paaske Utheim
- The Norwegian Dry Eye Clinic, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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70
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Chamani G, Shakibi MR, Zarei MR, Rad M, Pouyafard A, Parhizkar A, Mansoori M. "Assessment of relationship between xerostomia and oral health-related quality of life in patients with rheumatoid arthritis". Oral Dis 2017; 23:1162-1167. [PMID: 28749607 DOI: 10.1111/odi.12721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the relationship between xerostomia and oral health-related quality of life in patients with rheumatoid arthritis. MATERIALS AND METHOD Two hundred patients with rheumatoid arthritis were assessed using Fox and OHIP-14 questionnaires concerning xerostomia and oral health-related quality of life, respectively. The sum of decayed, missing, and filled teeth (DMFT) was determined via an intra-oral examination. In addition, intergroup comparisons were evaluated using t test, chi-square, regression, and Tukey analysis. RESULT Among rheumatoid arthritis patients, 51% had been afflicted with xerostomia. We found a statistically significant relationship between xerostomia and oral health-related quality of life (p-value=.004), as xerostomia cases have significantly worse oral health-related quality of life. Also, there was a statistically significant association between oral health-related quality of life and gender as well as DMFT. CONCLUSION Because there seem to be a high prevalence of xerostomia in patients with rheumatoid arthritis, screening in such population is highly recommended. Therefore, educational programs and/or workshops should be encouraged among healthcare providers to prevent worsening of oral health-related quality of life.
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Affiliation(s)
- G Chamani
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran
| | - M R Shakibi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - M R Zarei
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran
| | - M Rad
- Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Science, Kerman, Iran
| | - A Pouyafard
- Department of Oral Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A Parhizkar
- Department of Dental Materials, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mansoori
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran
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Fukushima Y, Yoda T, Araki R, Sakai T, Toya S, Ito K, Funayama S, Enoki Y, Sato T. Evaluation of oral wetness using an improved moisture-checking device for the diagnosis of dry mouth. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1348-8643(17)30017-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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72
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Thanakun S, Pornprasertsuk-Damrongsri S, Izumi Y. Increased oral inflammation, leukocytes, and leptin, and lower adiponectin in overweight or obesity. Oral Dis 2017; 23:956-965. [DOI: 10.1111/odi.12679] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/19/2017] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Affiliation(s)
- S Thanakun
- Department of Oral Medicine and Periodontology; Faculty of Dentistry; Mahidol University; Bangkok Thailand
| | | | - Y Izumi
- Department of Periodontology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
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73
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Doppalapudi R, Vundavalli S, Rao AK, Vadapalli SB, Rao DC, Thabusum A. Relation between Clinical Oral Dryness Score and Denture Satisfaction among Patients' in a Tertiary Care Centre, India. J Clin Diagn Res 2017; 11:ZC64-ZC67. [PMID: 28658910 PMCID: PMC5483812 DOI: 10.7860/jcdr/2017/25696.9881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Xerostomia is a subjective feeling of dryness commonly seen in elderly populations which impairs the quality of life. Due to loss of lubricating property of saliva the buccal mucosa, tongue and lips tend to stick leading to dry, freckled, ulcerated and sore mucosa which is of major concern to the patient to use complete denture. AIM The aim of the study was to assess the relation between oral dryness score and denture satisfaction among elderly patients. MATERIALS AND METHODS A cross-sectional study was conducted in prosthodontics department of a dental institution. Patients wearing dentures for at least six months were invited to participate in study. Visual Analogue Scale (VAS) with scores ranging from 0-100 was used to assess patient's satisfaction and clinical oral dryness score was assessed using the criteria described by Osailan SM et al., with scores ranging from 0-10. Data was analysed with SPSS software (version-20) and Kendall's tau-b correlation was used to determine the relationship between mean denture satisfactions and mean clinical oral dryness scores. RESULTS A total of 220 participants were included in the study based on inclusion criteria. Mean dryness score of the participants was 1.8±0.6 and mean VAS-score for denture satisfaction was 74.32±21.20 for aesthetics, for chewing ability the mean score was 62.31±19.64 and for phonetics it was 67.82±30.60. Strong negative correlation between VAS-scores and oral dryness scores was observed. CONCLUSION Clinical oral dryness score is one of the important factors which influence denture satisfaction. Dentist should consider in predicting prognosis.
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Affiliation(s)
- Radhika Doppalapudi
- Senior Lecturer, Department of Oral Medicine and Radiology, Lenora Institute of Dental Sciences, Rajanagaram Rajahmundry, Andhra Pradesh, India
| | - Sudhakar Vundavalli
- Lecturer, Department of Preventive Dentistry, College of Dentistry, Al Jouf University, Kingdome of Saudi Arabia
| | - A Kaleswara Rao
- Professor and Head, Department of Prosthodontics, Drs. S and NR Siddhartha Institute of Dental Sciences, Gannavaram, Andhra Pradesh, India
| | - Sriharsha Babu Vadapalli
- Reader, Department of Prosthodontics, Drs. S and NR Siddhartha Institute of Dental Sciences, Gannavaram, Andhra Pradesh, India
| | | | - Ayesha Thabusum
- Senior Lecturer, Department of Oral Medicine and Radiology, Drs. S and NR Siddhartha Institute of Dental Sciences, Gannavaram, Andhra Pradesh, India
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74
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Nam Y, Kim NH, Kho HS. Geriatric oral and maxillofacial dysfunctions in the context of geriatric syndrome. Oral Dis 2017; 24:317-324. [PMID: 28142210 DOI: 10.1111/odi.12647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To propose the application of the concept of geriatric syndrome for common geriatric oral and maxillofacial dysfunctions and to suggest the necessity of developing effective evaluation methods for oral and maxillofacial frailty. DESIGN The concepts of frailty and geriatric syndrome based on multi-morbidity and polypharmacy were applied to five common geriatric oral medicinal dysfunctional problems: salivary gland hypofunction (dry mouth), chronic oral mucosal pain disorders (burning mouth symptoms), taste disorders (taste disturbances), swallowing disorders (dysphagia), and oral and maxillofacial movement disorders (oromandibular dyskinesia and dystonia). RESULTS Each of the dysfunctions is caused by various kinds of diseases and/or conditions and medications, thus the concept of geriatric syndrome could be applied. These dysfunctions, suggested as components of oral and maxillofacial geriatric syndrome, are associated and interacted with each other in a complexity of vicious cycle. The resulting functional impairments caused by this syndrome can cause oral and maxillofacial frailty. CONCLUSIONS Geriatric oral and maxillofacial dysfunctions could be better appreciated in the context of geriatric syndrome. The development of effective methods for evaluating the severity of these dysfunctions and the resulting frailty is essential.
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Affiliation(s)
- Y Nam
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Jongno-gu, Seoul, Korea
| | - N-H Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, Gangwon-do, Korea
| | - H-S Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Jongno-gu, Seoul, Korea.,Institute on Aging, Seoul National University, Gwanak-Gu, Seoul, Korea
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Fostad IG, Eidet JR, Lagali NS, Dartt DA, Ræder S, Messelt EB, Utheim TP. Identification of Objective Morphometric Markers of Xerostomia in the Oral Mucosa Epithelium with In Vivo Confocal Microscopy. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2017; 23:88-96. [PMID: 28162126 DOI: 10.1017/s1431927617000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this work was to determine whether the morphology of the oral mucosa epithelium (OME) of patients with xerostomia differ from patients without xerostomia. In total, 34 patients with dry eye disease (DED) with or without xerostomia were examined at The Norwegian Dry Eye Disease Clinic with in vivo confocal microscopy of the lower lip. In addition, age- and gender-matched healthy controls (HC) were included. DED patients with xerostomia had a higher superficial to deep backscatter ratio compared with DED patients without xerostomia (p=0.002) and HC (p=0.001). Regression analysis demonstrated that this ratio was related to xerostomia independently of gender and age (p<0.001). Sensitivity and specificity of detecting xerostomia were 0.78 and 0.85, respectively, when using a superficial to deep backscatter ratio cut-off value of 0.995 (p=0.004). The mean nucleus to cytosol backscatter ratio in the superficial OME was lower in patients with xerostomia than in those without xerostomia (p=0.034). In vivo confocal microscopy is a potential tool for evaluating the oral cavity and to assess changes in the OME associated with xerostomia, objectively and quantitatively. The cause of the increased backscatter in the superficial OME in xerostomia, however, remains to be elucidated.
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Affiliation(s)
- Ida G Fostad
- 1Department of Oral Biology, Faculty of Dentistry,University of Oslo,Sognsvannsveien 10,PO Box 1052,0316 Oslo,Norway
| | - Jon R Eidet
- 2The Norwegian Dry Eye Clinic,Lille Grensen 7,0159 Oslo,Norway
| | - Neil S Lagali
- 4Department of Clinical and Experimental Medicine,Linköping University,SE-581 83 Linköping,Sweden
| | - Darlene A Dartt
- 5Schepens Eye Research Institute/Massachusetts Eye and Ear,Harvard Medical School,20 Staniford Street,Boston,MA 02114,USA
| | - Sten Ræder
- 2The Norwegian Dry Eye Clinic,Lille Grensen 7,0159 Oslo,Norway
| | - Edvard B Messelt
- 1Department of Oral Biology, Faculty of Dentistry,University of Oslo,Sognsvannsveien 10,PO Box 1052,0316 Oslo,Norway
| | - Tor P Utheim
- 1Department of Oral Biology, Faculty of Dentistry,University of Oslo,Sognsvannsveien 10,PO Box 1052,0316 Oslo,Norway
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76
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Abstract
Dry mouth or xerostomia is the feeling that there is not sufficient saliva in the mouth. If this is present all or most of the time then it can be uncomfortable. It can also sometimes indicate health problems and as a result should be brought to the attention of a health care professional. Xerostomia does not always equate to hyposalivation. There are ways to assess degrees of oral dryness, namely-CODS (clinical oral dryness scoring) which helps to give a numerical value to the oral signs.
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77
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Jager DJ, Karagozoglu KH, Maarse F, Brand HS, Forouzanfar T. Sialendoscopy of Salivary Glands Affected by Sjögren Syndrome: A Randomized Controlled Pilot Study. J Oral Maxillofac Surg 2016; 74:1167-74. [PMID: 26850868 DOI: 10.1016/j.joms.2015.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Derk Jan Jager
- Assistant Professor, Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam; Center for Special Care Dentistry (Stichting Bijzondere Tandheelkunde), Amsterdam, The Netherlands.
| | - K Hakki Karagozoglu
- Maxillofacial Surgeon and PhD Candidate, Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Floor Maarse
- Postgraduate Resident and PhD Candidate, Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk S Brand
- Associate Professor, Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam; Departments of Oral Biochemistry and Medical-Dental Interaction, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Tim Forouzanfar
- Professor and Department Head, Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands
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78
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Chaudhury NMA, Proctor GB, Karlsson NG, Carpenter GH, Flowers SA. Reduced Mucin-7 (Muc7) Sialylation and Altered Saliva Rheology in Sjögren's Syndrome Associated Oral Dryness. Mol Cell Proteomics 2015; 15:1048-59. [PMID: 26631508 DOI: 10.1074/mcp.m115.052993] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 12/20/2022] Open
Abstract
Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration and hypofunction of salivary and lacrimal glands. This loss of salivary function leads to oral dryness, impaired swallowing and speech, and increased infection and is associated with other autoimmune diseases and an increased risk of certain cancers. Despite the implications of this prevalent disease, diagnosis currently takes years, partly due to the diversity in patient presentation. Saliva is a complicated biological fluid with major constituents, including heavily glycosylated mucins MUC5B and MUC7, important for its viscoelastic and hydrating and lubricating properties. This study investigated Sjögren's patient's perception of dryness (bother index questionnaires) along with the rheological, protein composition, and glycan analysis of whole mouth saliva and the saliva on the mucosal surface (residual mucosal saliva) to understand the properties that most affect patient wellbeing. Sjögren's patients exhibited a statistically significant reduction in residual mucosal saliva, salivary flow rate, and extensional rheology, spinnbarkeit (stringiness). Although the concentration of mucins MUC5B and MUC7 were similar between patients and controls, a comparison of protein Western blotting and glycan staining identified a reduction in mucin glycosylation in Sjögren's, particularly on MUC7. LC-MS/MS analysis of O-glycans released from MUC7 by β-elimination revealed that although patients had an increase in core 1 sulfation, the even larger reduction in sialylation resulted in a global decline of charged glycans. This was primarily due to the loss of the extended core 2 disialylated structure, with and without fucosylation. A decrease in the extended, fucosylated core 2 disialylated structure on MUC7, residual mucosal wetness, and whole mouth saliva flow rate appeared to have a negative and cumulative effect on the perception of oral dryness. The observed changes in MUC7 glycosylation could be a potential diagnostic tool for saliva quality and taken into consideration for future therapies for this multifactorial syndrome.
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Affiliation(s)
- Nayab M A Chaudhury
- From the ‡Salivary Unit, Mucosal and Salivary Biology, Dental Institute, King's College London, Guy's Hospital, Floor 17, Tower Wing, London SE1 9RT, UK
| | - Gordon B Proctor
- From the ‡Salivary Unit, Mucosal and Salivary Biology, Dental Institute, King's College London, Guy's Hospital, Floor 17, Tower Wing, London SE1 9RT, UK
| | - Niclas G Karlsson
- §Department of Medical Biochemistry, Institute of Biomedicine, University of Gothenburg, Medicinaregatan 9A, 405 30, Gothenburg, Sweden
| | - Guy H Carpenter
- From the ‡Salivary Unit, Mucosal and Salivary Biology, Dental Institute, King's College London, Guy's Hospital, Floor 17, Tower Wing, London SE1 9RT, UK
| | - Sarah A Flowers
- §Department of Medical Biochemistry, Institute of Biomedicine, University of Gothenburg, Medicinaregatan 9A, 405 30, Gothenburg, Sweden
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79
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Chaudhury N, Shirlaw P, Pramanik R, Carpenter G, Proctor G. Changes in Saliva Rheological Properties and Mucin Glycosylation in Dry Mouth. J Dent Res 2015; 94:1660-7. [DOI: 10.1177/0022034515609070] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Saliva is vital for the maintenance of normal oral physiology and mucosal health. The loss of salivary function can have far-reaching consequences, as observed with dry mouth, which is associated with increased orodental disease, speech impairment, dysphagia, and a significant negative effect on quality of life. The timely diagnosis of oral dryness is vital for the management of orodental disease and any associated often-undiagnosed systemic disease (e.g., Sjögren syndrome). Our aim was to investigate differences in mucin glycoproteins and saliva rheological properties between sufferers and nonsufferers of dry mouth in order to understand the relationship between saliva composition, rheological properties, and dryness perception and provide additional potential diagnostic markers. All patients exhibited objective and subjective oral dryness, irrespective of etiology. Over half of the patients ( n = 20, 58.8%) had a saliva secretion rate above the gland dysfunction cutoff of 0.1 mL/min. Mucin (MUC5B and MUC7) concentrations were generally similar or higher in patients. Despite the abundance of these moisture-retaining proteins, patients exhibited reduced mucosal hydration (wetness) and significantly lower saliva spinnbarkeit (stringiness), suggesting a loss of the lubricating and retention/adhesion properties of saliva, which, at least partially, are associated with mucin glycoproteins. Over 90% of patients with dry mouth (DMPs) consistently had unstimulated whole mouth saliva (UWMS) spinnbarkeit below the proposed normal cutoff (10 mm). Further analysis of mucins revealed the reduced glycosylation of mucins in DMPs compared to healthy controls. Our data indicate that UWMS mucin concentrations are not reduced in dry mouth but that the mucin structure (glycosylation) is altered. UWMS from DMPs had reduced spinnbarkeit, the assessment of which, in conjunction with sialometry, could improve sensitivity for the diagnosis of dry mouth. Additionally, it may be useful to take into consideration the altered mucin glycosylation and saliva rheological properties when designing synthetic or purified mucins for saliva substitutes and dry mouth therapy.
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Affiliation(s)
- N.M.A. Chaudhury
- Mucosal and Salivary Biology Division, Dental Institute, Guy’s Hospital, King’s College London, London, UK
| | - P. Shirlaw
- Department of Oral Medicine, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, UK
| | - R. Pramanik
- Mucosal and Salivary Biology Division, Dental Institute, Guy’s Hospital, King’s College London, London, UK
- Genetic Skin Disease Group, St. John’s Institute of Dermatology, National Institute for Health Research Biomedical Research Centre, Guy’s and St. Thomas’ National Health Service Foundation Trust and King’s College London, London, UK
| | - G.H. Carpenter
- Mucosal and Salivary Biology Division, Dental Institute, Guy’s Hospital, King’s College London, London, UK
| | - G.B. Proctor
- Mucosal and Salivary Biology Division, Dental Institute, Guy’s Hospital, King’s College London, London, UK
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80
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Salivary hypofunction: An update on aetiology, diagnosis and therapeutics. Arch Oral Biol 2015; 60:242-55. [DOI: 10.1016/j.archoralbio.2014.10.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/15/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
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82
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Abstract
Both acute and chronic dehydration can have important implications for human behaviour and health. Young children, non-autonomous individuals and the elderly are at a greater risk of dehydration. Mild hypertonic dehydration could be related to less efficient cognitive and physical performance and has been reported to be associated with frequently occurring pathological conditions, especially nephrolithiasis. The assessment of hydration status in a large sample appears to be of interest for conducting epidemiological and large clinical studies aimed at improving preventive and curative care. Especially in large-population studies, methods that are used have to be accurate, cheap, quick and require no technical expertise. Body weight change is widely used to determine acute hydration changes, but seems to be insufficiently accurate in longitudinal studies. Bioimpedance analysis methods enable the assessment of total body water content, but their use is still under debate. Because plasma osmolality directly reflects intracellular osmolality, it constitutes a good marker to assess acute hydration changes, but not chronic hydration status because it changes constantly. Moreover, venepuncture is considered to be invasive and is not suitable for a large-sample study, especially in children. Urinary markers appear to be good alternatives for assessing hydration status in large populations. Collection of urine samples is non-invasive and cheap. High technical expertise is not required to perform urinary marker measurements and these measurements can be carried out quickly. Thus, methods based on urinary markers are very well suited for field studies. Urine colour is probably the least sensitive marker despite its high specificity. Urine osmolality and especially urine specific gravity could be easily used for determining hydration status in large-sample studies.
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84
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Davies HS, Pudney PDA, Georgiades P, Waigh TA, Hodson NW, Ridley CE, Blanch EW, Thornton DJ. Reorganisation of the salivary mucin network by dietary components: insights from green tea polyphenols. PLoS One 2014; 9:e108372. [PMID: 25264771 PMCID: PMC4180932 DOI: 10.1371/journal.pone.0108372] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/19/2014] [Indexed: 01/20/2023] Open
Abstract
The salivary mucins that include MUC5B (gel-forming) and MUC7 (non-gel-forming) are major contributors to the protective mucus barrier in the oral cavity, and it is possible that dietary components may influence barrier properties. We show how one dietary compound, the green tea polyphenol epigallocatechin gallate (EGCG), can substantially alter the properties of both the polymeric MUC5B network and monomeric MUC7. Using rate-zonal centrifugation, MUC5B in human whole saliva and MUC5B purified from saliva sedimented faster in the presence of EGCG. The faster sedimentation by EGCG was shown to be greater with increasing MUC5B concentration. Particle tracking microrheology was employed to determine the viscosity of purified MUC5B solutions and showed that for MUC5B solutions of 200-1600 µg/mL, EGCG caused a significant increase in mucin viscosity, which was greater at higher MUC5B concentrations. Visualisation of the changes to the MUC5B network by EGCG was performed using atomic force microscopy, which demonstrated increased aggregation of MUC5B in a heterogeneous manner by EGCG. Using trypsin-resistant, high-molecular weight oligosaccharide-rich regions of MUC5B and recombinant N-terminal and C-terminal MUC5B proteins, we showed that EGCG causes aggregation at the protein domains of MUC5B, but not at the oligosaccharide-rich regions of the mucin. We also demonstrated that EGCG caused the majority of MUC7 in human whole saliva to aggregate. Furthermore, purified MUC7 also underwent a large increase in sedimentation rate in the presence of EGCG. In contrast, the green tea polyphenol epicatechin caused no change in the sedimentation rate of either MUC5B or MUC7 in human whole saliva. These findings have demonstrated how the properties of the mucin barrier can be influenced by dietary components. In the case of EGCG, these interactions may alter the function of MUC5B as a lubricant, contributing to the astringency (dry puckering sensation) of green tea.
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Affiliation(s)
- Heather S. Davies
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Institute of Biotechnology, Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom
| | | | - Pantelis Georgiades
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
- Biological Physics, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Thomas A. Waigh
- Biological Physics, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Nigel W. Hodson
- BioAFM Facility Centre for Tissue Injury and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline E. Ridley
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Ewan W. Blanch
- Manchester Institute of Biotechnology, Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom
| | - David J. Thornton
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
- * E-mail:
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85
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Summary of: the assessment of oral dryness by photographic appearance of the tongue. Br Dent J 2014; 217:80-1. [PMID: 25060458 DOI: 10.1038/sj.bdj.2014.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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86
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The assessment of oral dryness by photographic appearance of the tongue. Br Dent J 2014; 217:E3. [DOI: 10.1038/sj.bdj.2014.597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 11/09/2022]
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87
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Tappuni AR, Kovacevic T, Shirlaw PJ, Challacombe SJ. Clinical assessment of disease severity in recurrent aphthous stomatitis. J Oral Pathol Med 2013; 42:635-41. [PMID: 23509958 DOI: 10.1111/jop.12059] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases in many parts of the world. However, there is very limited published clinical evidence for the therapies used in this condition. This could be partly due to the difficulty in evaluating the efficacy of oral ulcer treatment objectively. In this paper, we present a method for assessing and monitoring the severity of oral ulcers before and after treatment. METHODS Six ulcer characteristics, number, size, duration, ulcer-free period, site and pain, were used to generate an ulcer severity score (USS). The scores for 223 RAS patients were determined, and 79 were scored again after 3-month therapy with topical betamethasone. RESULTS The scores for the minor RAS group were between 18 and 43 (mean 29.2 ± 5.3). The mean score in the major ulcers group (range: 28-60, mean 39.9 ± 6.1) was significantly greater than in the minor group (P < 0.001). The herpetiform recurrent ulcers score range was wide (range: 18-57, mean 36.6 ± 8.4). The mean severity score decreased significantly after treatment (P < 0.001). CONCLUSIONS The USS was indicative of the disease activity in recurrent oral ulceration. It helped in assessing the efficacy of therapy, as the change in the numerical score reflected the change in ulcer severity in response to treatment. This tool may well prove to be of value in clinical management, research and in clinical trials.
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Affiliation(s)
- Anwar R Tappuni
- Barts and The London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
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88
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Salivary flow, testosterone, and femur bone mineral density in menopausal women with oral dryness feeling. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:612-6. [PMID: 23433570 DOI: 10.1016/j.oooo.2012.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 11/09/2012] [Accepted: 11/17/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We compared salivary flow, serum and saliva testosterone, and femur bone mineral density (BMD) of menopausal women with or without xerostomia. STUDY DESIGN A case/control study was performed on 60 selected menopausal women with or without xerostomia. BMD and testosterone concentration were measured by a dual-energy x-ray absorptiometry system and enzyme-linked immunosorbent assay method, respectively. RESULTS Multinomial logistic regression demonstrated that low saliva flow rate (odds ratio [OR] = 22.8, 95% confidence interval [CI]: 5.4, 96.8), low femur BMD (OR = 6.0, CI: 1.8, 20.0), high stimulated saliva testosterone (OR = 5.2, CI: 2.0, 18.9), high unstimulated saliva testosterone (OR = 3.8, 95% CI: 1.6, 12.3), and high serum testosterone (OR = 2.7, CI: 1.1, 7.2) were associated with an increased risk of xerostomia in menopausal women. CONCLUSIONS High serum and salivary testosterone and low femur BMD and saliva flow were associated with xerostomia. Of these factors, low salivary flow seems to be the most important element in the perception of dry mouth.
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