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Blitzer GC, Paz C, Glassey A, Ganz OR, Giri J, Pennati A, Meyers RO, Bates AM, Nickel KP, Weiss M, Morris ZS, Mattison RJ, McDowell KA, Croxford E, Chappell RJ, Glazer TA, Rogus-Pulia NM, Galipeau J, Kimple RJ. Functionality of bone marrow mesenchymal stromal cells derived from head and neck cancer patients - A FDA-IND enabling study regarding MSC-based treatments for radiation-induced xerostomia. Radiother Oncol 2024; 192:110093. [PMID: 38224919 PMCID: PMC10922976 DOI: 10.1016/j.radonc.2024.110093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Salivary dysfunction is a significant side effect of radiation therapy for head and neck cancer (HNC). Preliminary data suggests that mesenchymal stromal cells (MSCs) can improve salivary function. Whether MSCs from HNC patients who have completed chemoradiation are functionally similar to those from healthy patients is unknown. We performed a pilot clinical study to determine whether bone marrow-derived MSCs [MSC(M)] from HNC patients could be used for the treatment of RT-induced salivary dysfunction. METHODS An IRB-approved pilot clinical study was undertaken on HNC patients with xerostomia who had completed treatment two or more years prior. Patients underwent iliac crest bone marrow aspirate and MSC(M) were isolated and cultured. Culture-expanded MSC(M) were stimulated with IFNγ and cryopreserved prior to reanimation and profiling for functional markers by flow cytometry and ELISA. MSC(M) were additionally injected into mice with radiation-induced xerostomia and the changes in salivary gland histology and salivary production were examined. RESULTS A total of six subjects were enrolled. MSC(M) from all subjects were culture expanded to > 20 million cells in a median of 15.5 days (range 8-20 days). Flow cytometry confirmed that cultured cells from HNC patients were MSC(M). Functional flow cytometry demonstrated that these IFNγ-stimulated MSC(M) acquired an immunosuppressive phenotype. IFNγ-stimulated MSC(M) from HNC patients were found to express GDNF, WNT1, and R-spondin 1 as well as pro-angiogenesis and immunomodulatory cytokines. In mice, IFNγ-stimulated MSC(M) injection after radiation decreased the loss of acinar cells, decreased the formation of fibrosis, and increased salivary production. CONCLUSIONS MSC (M) from previously treated HNC patients can be expanded for auto-transplantation and are functionally active. Furthermore IFNγ-stimulated MSC(M) express proteins implicated in salivary gland regeneration. This study provides preliminary data supporting the feasibility of using autologous MSC(M) from HNC patients to treat RT-induced salivary dysfunction.
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Affiliation(s)
- Grace C Blitzer
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Cristina Paz
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Annemarie Glassey
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Olga R Ganz
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Jayeeta Giri
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Andrea Pennati
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ross O Meyers
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Amber M Bates
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kwangok P Nickel
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Marissa Weiss
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Zachary S Morris
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ryan J Mattison
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kimberly A McDowell
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Emma Croxford
- Department of Biostatistics and Medical Informatics, 610 Walnut Street, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53726 USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, 610 Walnut Street, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53726 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Tiffany A Glazer
- Department of Surgery, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Nicole M Rogus-Pulia
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; Geriatric Research Education and Clinical Center, 2500 Overlook Terrace, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
| | - Jacques Galipeau
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Randall J Kimple
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA.
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Blitzer GC, Glazer T, Burr A, Gustafson S, Ganz O, Meyers R, McDowell KA, Nickel KP, Mattison RJ, Weiss M, Chappell R, Rogus-Pulia NM, Galipeau J, Kimple RJ. Marrow-Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction (MARSH): A pilot, first-in-human study of interferon gamma-stimulated marrow mesenchymal stromal cells for treatment of radiation-induced xerostomia. Cytotherapy 2023; 25:1139-1144. [PMID: 37589639 PMCID: PMC10615723 DOI: 10.1016/j.jcyt.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AIMS Xerostomia, or the feeling of dry mouth, is a significant side effect of radiation therapy for patients with head and neck cancer (HNC). Preliminary data suggest that mesenchymal stromal/stem cells (MSCs) can improve salivary function. We performed a first-in-human pilot study of interferon gamma (IFNγ)-stimulated autologous bone marrow-derived MSCs, or MSC(M), for the treatment of radiation-induced xerostomia (RIX). Here we present the primary safety and secondary efficacy endpoints. METHODS A single-center pilot clinical trial was conducted investigating the safety and tolerability of autologous IFNγ-stimulated MSC(M). The study was conducted under an approved Food and Drug Administration Investigational New Drug application using an institutional review board-approved protocol (NCT04489732). Patients underwent iliac crest bone marrow aspirate and MSC(M) were isolated, cultured, stimulated with IFNγ and cryopreserved for later use. Banked cells were thawed and allowed to recover in culture before patients received a single injection of 10 × 106 MSC(M) into the right submandibular gland under ultrasound guidance. The primary objective was determination of safety and tolerability by evaluating dose-limiting toxicity (DLT). A DLT was defined as submandibular pain >5 on a standard 10-point pain scale or any serious adverse event (SAE) within 1 month after injection. Secondary objectives included analysis of efficacy as measured by salivary quantification and using three validated quality of life instruments. Quantitative results are reported as mean and standard deviation. RESULTS Six patients with radiation-induced xerostomia who had completed radiation at least 2 years previously (average 7.8 years previously) were enrolled in the pilot study. The median age was 71 (61-74) years. Five (83%) patients were male. Five patients (83%) were treated with chemoradiation and one patient (17%) with radiation alone. Grade 1 pain was seen in 50% of patients after submandibular gland injection; all pain resolved within 4 days. No patients reported pain 1 month after injection, with no SAE or other DLTs reported 1 month after injection. The analysis of secondary endpoints demonstrated a trend of increased salivary production. Three patients (50%) had an increase in unstimulated saliva at 1 and 3 months after MSC(M) injection. Quality of life surveys also showed a trend toward improvement. CONCLUSIONS Injection of autologous IFNγ-stimulated MSC(M) into a singular submandibular gland of patients with RIX is safe and well tolerated in this pilot study. A trend toward an improvement in secondary endpoints of salivary quantity and quality of life was observed. This first-in-human study provides support for further investigation into IFNγ-stimulated MSC(M) injected in both submandibular glands as an innovative approach to treat RIX and improve quality of life for patients with HNC.
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Affiliation(s)
- Grace C Blitzer
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Tiffany Glazer
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adam Burr
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sara Gustafson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Olga Ganz
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ross Meyers
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kimberly A McDowell
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kwangok P Nickel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ryan J Mattison
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marissa Weiss
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Richard Chappell
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nicole M Rogus-Pulia
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Jacques Galipeau
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Blitzer GC, Rogus‐Pulia NM, Paz C, Nickel KP, Cannaday VL, Kelm‐Nelson CA, Sudakaran S, Chappell RJ, Glazer T, Kimple RJ. Quantification of very late xerostomia in head and neck cancer patients after irradiation. Laryngoscope Investig Otolaryngol 2022; 7:1018-1024. [PMID: 36000048 PMCID: PMC9392383 DOI: 10.1002/lio2.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Radiation therapy (RT) for head and neck cancer (HNC) can result in severe xerostomia, or the subjective feeling of dry mouth. Characterizing xerostomia is critical to designing future clinical trials investigating how to improve HNC patients' quality of life (QoL). Few studies have investigated the very late (>5 years post-RT) effects of RT for HNC. We undertook preliminary studies quantifying very late xerostomia. Methods Six adults who underwent RT for HNC at least 5 years prior and reported xerostomia were enrolled. Five healthy adults without a self-reported history of HNC or xerostomia were enrolled as controls. All participants completed three validated surveys to measure xerostomia-related QoL. Salivary production rates were measured and compositional analysis of the saliva and oral microbiome was completed. Results The QoL survey scores for the HNC participants were significantly worse as compared to the control participants. The HNC participants produced less unstimulated saliva (p = .02) but not less stimulated saliva. The median salivary mucin significantly higher in HNC participants than in control participants (p = .02). There was no significant difference between the pH, amylase, or total protein. Microbiome analysis revealed alpha diversity to be significantly lower in the HNC participants. Conclusion In the survivors of HNC who suffer from late toxicities, multiple means of measuring toxicity may be useful. We found that in patients with radiation-induced xerostomia over 5 years after therapy, not only were the QoL surveys significantly worse, as expected, but other measurements such as mucin and oral microbiome diversity were also significantly different. Level of evidence 3.
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Affiliation(s)
- Grace C. Blitzer
- Department of Human OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Nicole M. Rogus‐Pulia
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Cristina Paz
- Department of Human OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kwangok P. Nickel
- Department of Human OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Vanessa L. Cannaday
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Cynthia A. Kelm‐Nelson
- Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | | | - Richard J. Chappell
- Department of Biostatistics & Medical InformaticsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of StatisticsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Tiffany Glazer
- Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Randall J. Kimple
- Department of Human OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Blitzer GC, Rogus-Pulia NM, Mattison RJ, Varghese T, Ganz O, Chappell R, Galipeau J, McDowell KA, Meyers RO, Glazer TA, Kimple RJ. Marrow-Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction (MARSH): Study protocol for a phase 1 dose-escalation trial of patients with xerostomia after radiation therapy for head and neck cancer. Cytotherapy 2022; 24:534-543. [PMID: 35183442 PMCID: PMC9038658 DOI: 10.1016/j.jcyt.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/11/2021] [Accepted: 11/03/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Xerostomia, or dry mouth, is a common side effect of head and neck radiation. Current treatment options for radiation-induced xerostomia are generally supportive in nature. Adult stem cells are the ultimate source for replenishment of salivary gland tissue. Bone marrow-derived mesenchymal stromal cells (BM-MSCs) are a viable cell-based therapy for xerostomia. We have undertaken studies enabling U.S. Food and Drug Administration Investigational New Drug status, demonstrating the normal phenotype, intact functionality, and pro-growth secretome of interferon-γ (IFNγ)-stimulated BM-MSCs taken from patients with head and neck cancer who have undergone radiation ± chemotherapy. Here we present the protocol of MARSH, a first-in-human clinical trial of bone marrow-derived, IFNγ-activated BM-MSCs for the treatment of radiation-induced xerostomia. METHODS This single-center phase 1 dose-escalation with expansion cohort, non-placebo-controlled study will assess the safety and tolerability of BM-MSCs for the treatment of radiation-induced xerostomia in patients who had head and neck cancer. The phase 1 dose-escalation study will be a 3 + 3 design with staggered enrollment. A total of 21 to 30 subjects (9 to 18 in phase 1 study, 12 in expansion cohort) will be enrolled. The primary endpoint is determining the recommended phase 2 dose (RP2D) of IFNγ-stimulated BM-MSCs to enable further studies on the efficacy of BM-MSCs. Patients' bone marrow will be aspirated, and BM-MSCs will be expanded, stimulated with IFNγ, and injected into the submandibular gland. The RP2D will be determined by dose-limiting toxicities occurring within 1 month of BM-MSC injection. Secondary outcomes of saliva amounts and composition, ultrasound of salivary glands, and quality of life surveys will be taken at 3-, 6-, 12-, and 24-month visits. DISCUSSION Autotransplantation of IFNγ-stimulated BM-MSCs in salivary glands after radiation therapy or chemoradiation therapy may provide an innovative remedy to treat xerostomia and restore quality of life. This is the first therapy for radiation-induced xerostomia that may be curative. TRIAL REGISTRATION World Health Organization International Clinical Trials Registry Platform: NCT04489732.
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Piaton S, Duconseille A, Roger-Leroi V, Hennequin M. Could the use of saliva substitutes improve food oral processing in individuals with xerostomia? A systematic review. J Texture Stud 2021; 52:278-293. [PMID: 33587294 DOI: 10.1111/jtxs.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/14/2023]
Abstract
Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called "saliva substitutes" or "artificial saliva" can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords "saliva substitutes" and "artificial saliva." An advanced search was applied using the terms "xerostomia" and/or "food oral processing" and/or "eating" and/or "mastication" and/or "chewing" and/or "swallowing." The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies, and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavored. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.
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Affiliation(s)
- Sophie Piaton
- Université Clermont Auvergne, CROC, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | | | - Valérie Roger-Leroi
- Université Clermont Auvergne, CROC, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - Martine Hennequin
- Université Clermont Auvergne, CROC, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
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Mungia R, Mendoza M, de la Rosa E, Nguyen T, Reyes SC, Schramm D, Taverna M. Development of a Mobile Application to Enhance Knowledge, Awareness and Communication of Dry Mouth Amongst Dental Practitioners and Patients: A South Texas Oral Health Network Study. TEXAS DENTAL JOURNAL 2021; 138:172-185. [PMID: 34108744 PMCID: PMC8186466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dry mouth, also commonly known as "xerostomia", is a prominent symptom that is often overlooked by dental practitioners and patients. The purpose of this study was to pilot the development of a mobile application for assessing dry mouth symptoms. The application will allow patients to self-assess and enhance knowledge, awareness and communication with dental practitioners in their management of dry mouth. METHOD The first phase of the study was to draw on common knowledge and awareness by conducting two focus groups of dental professionals and community members on content, practicality, functionality, design, and effectiveness. The second phase of the study was the development of the dry mouth mobile application followed by the third phase of the study that consisted of face-validity interviews to obtain feedback on the application. RESULTS Fifty two percent (n=15) of the dental professionals estimated being aware of the prevalence of dry mouth in 40% or more of their patients. Thirty Nine percent of (n=9) community estimated being aware of the prevalence of dry mouth in 40% or more of the community. When asked about their awareness of the etiologies of dry mouth, 100% (n=29) of dental professionals reported that multiple medications and smoking were primary factors whereas the community members indicated that illness and dehydration (87%, n=20) were primary factors in dry mouth. Dental professional's (25% n=7) were very confident in recognizing symptoms and 28% (n=8) were very confident they knew how to manage dry mouth symptoms. Furthermore, 22% (n=5) of the community members were also very confident about recognizing dry mouth symptoms and 13% (n=3) were very confident knowing how managing it. The ToP report generated from the discussions identified "themes" that were utilized in the development of the mobile application. Most individuals who participated in the validity interviews agreed that the dry mouth mobile application was useful, appealing, easy to use and the self-assessment test gave clear and concise information. The application was made available to download from the iTunes Appstore (2019-2020). CONCLUSION The dry mouth pilot study indicated that the mobile application was beneficial for self-assessment and easy to use. Development of advanced technology tools such as the dry mouth application can promote communication between patients and their dental practitioners to discuss management options for dry mouth.
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Affiliation(s)
- Rahma Mungia
- Department of Periodontics, University of Texas Health Science Center at San Antonio
| | - Marissa Mendoza
- South Texas Oral Health Network, Clinical Translational Science Award and Institute for Integration of Medicine & Science, University of Texas Health Science Center at San Antonio
| | - Elisabeth de la Rosa
- Institute for Integration of Medicine & Science, University of Texas Health Science Center at San Antonio
| | - Thi Nguyen
- University of Texas San Antonio Student Intern at the South Texas Oral Health Network, University of Texas Health Science Center at San Antonio
| | - Stephanie C Reyes
- Research Department, University of Texas Health Science Center at San Antonio
| | - Danielle Schramm
- University of Texas San Antonio student intern at the South Texas Oral Health Network, University of Texas Health Science Center at San Antonio
| | - Melanie Taverna
- Department of Periodontics, University of Texas Health Science Center at San Antonio
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Woon C. Improving oral care for hospitalised patients: choosing appropriate products. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:520-525. [PMID: 32407235 DOI: 10.12968/bjon.2020.29.9.520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Oral care is a fundamental part of nursing but it is often performed as a routine task, often based on historic practice, and lacks an evidence base. A variety of oral care products are used in practice. AIM To discover evidence of effective oral care products for use in hospitalised patients. DESIGN A systematic literature review was undertaken. METHODS A review of articles was conducted using CINAHL, PubMed, the Cochrane Database and Google Scholar between 2007 and 2019. All articles were compared and contrasted and some excluded due to the quality of the evidence. DISCUSSION The literature review identified a number of oral care problems and investigated a range of products. RESULTS The main finding was that there is a need for a definitive, evidence-based oral care guideline on the products suitable for different oral care conditions, including dysphagia, xerostomia, mucositis, and for patients wearing dentures.
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Affiliation(s)
- Caroline Woon
- Nurse Educator, Neurosciences, Wellington Hospital, New Zealand
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Coelho AS, Laranjo M, Gonçalves AC, Paula A, Paulo S, Abrantes AM, Caramelo F, Ferreira MM, Silva MJ, Carrilho E, Botelho MF. Cytotoxic effects of a chlorhexidine mouthwash and of an enzymatic mouthwash on human gingival fibroblasts. Odontology 2019; 108:260-270. [PMID: 31624978 DOI: 10.1007/s10266-019-00465-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 09/26/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the cytotoxic effects of an enzymatic mouthwash and of a chlorhexidine mouthwash on human gingival fibroblasts. The metabolic activity of the fibroblasts exposed to each mouthwash was assessed by the MTT assay and the protein content was assessed by the SRB assay. The flow cytometry was used to evaluate the cell cycle and the types of cell death. The oxidative status was evaluated through the DCF and the DHE probes and the intracellular GSH concentration and the mitochondrial membrane potential through JC-1. The cytotoxicity of both mouthwashes was found to be dependent on the exposure time and on the concentration. However, the cytotoxicity of the enzymatic mouthwash was found to be lower than that of the chlorhexidine mouthwash. A trend towards increased oxidative stress was observed for both mouthwashes. After exposing the fibroblasts to the mouthwashes, a G2/M phase block was observed and cell death occurred predominantly by necrosis. The effects of chlorhexidine on fibroblasts were identified at lower concentrations than those used in clinical practice. Therefore, the use of chlorhexidine as an antiseptic in surgical and postoperative situations should be limited. In order to clarify the clinical significance of the enzymatic mouthwash cytotoxicity new clinical studies will be necessary.
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Affiliation(s)
- Ana Sofia Coelho
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal. .,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal. .,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal. .,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal. .,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.
| | - Mafalda Laranjo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Ana Cristina Gonçalves
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Anabela Paula
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Siri Paulo
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Endodontics Institute, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Ana Margarida Abrantes
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Francisco Caramelo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Manuel Marques Ferreira
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Endodontics Institute, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | | | - Eunice Carrilho
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
| | - Maria Filomena Botelho
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CIMAGO - Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Área de Medicina Dentária, Av. Bissaya Barreto, Bloco de Celas, 3000-075, Coimbra, Portugal
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10
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Garrido-Cardenas JA, Mesa-Valle C, Manzano-Agugliaro F. Trends in plant research using molecular markers. PLANTA 2018; 247:543-557. [PMID: 29243155 DOI: 10.1007/s00425-017-2829-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/08/2017] [Indexed: 05/21/2023]
Abstract
A deep bibliometric analysis has been carried out, obtaining valuable parameters that facilitate the understanding around the research in plant using molecular markers. The evolution of the improvement in the field of agronomy is fundamental for its adaptation to the new exigencies that the current world context raises. In addition, within these improvements, this article focuses on those related to the biotechnology sector. More specifically, the use of DNA markers that allow the researcher to know the set of genes associated with a particular quantitative trait or QTL. The use of molecular markers is widely extended, including: restriction fragment length polymorphism, random-amplified polymorphic DNA, amplified fragment length polymorphism, microsatellites, and single-nucleotide polymorphisms. In addition to classical methodology, new approaches based on the next generation sequencing are proving to be fundamental. In this article, a historical review of the molecular markers traditionally used in plants, since its birth and how the new molecular tools facilitate the work of plant breeders is carried out. The evolution of the most studied cultures from the point of view of molecular markers is also reviewed and other parameters whose prior knowledge can facilitate the approach of researchers to this field of research are analyzed. The bibliometric analysis of molecular markers in plants shows that top five countries in this research are: US, China, India, France, and Germany, and from 2013, this research is led by China. On the other hand, the basic research using Arabidopsis is deeper in France and Germany, while other countries focused its efforts in their main crops as the US for wheat or maize, while China and India for wheat and rice.
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11
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Hammitt KM, Naegeli AN, van den Broek RWM, Birt JA. Patient burden of Sjögren's: a comprehensive literature review revealing the range and heterogeneity of measures used in assessments of severity. RMD Open 2017; 3:e000443. [PMID: 28955493 PMCID: PMC5604724 DOI: 10.1136/rmdopen-2017-000443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/20/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022] Open
Abstract
CONTEXT The severity of Sjögren's syndrome has been evaluated using a wide variety of clinical measures and patient-reported outcomes (PROs). This may contribute to the lack of clarity concerning the burden of Sjögren's from the patient perspective. OBJECTIVE To perform a comprehensive peer-reviewed literature analysis of the patient aspects of Sjögren's, focusing on PROs, to investigate the complexity underlying the evaluation of the syndrome and to elucidate the discordance between the different measures. METHODS We searched Embase for articles published between January 2005 and September 2015. Research articles, clinical and diagnostic reviews, and validation studies with a focus on patient aspects of Sjögren's were selected as the primary information source. RESULTS 157 articles met the eligibility criteria. A wide variety of assessment measures used to evaluate glandular, extraglandular and functional domains were observed. Many different, non-validated Visual Analogue Scales, with a wide range of anchor words, were used in the quantification of Sjögren's disease burden, impeding comparisons between studies. Relatively few clinical trials of drug therapies used validated scales: European League Against Rheumatism Sjögren's Syndrome Patient Reported Index was used most often for symptom assessment and 36 Item Short Form Survey for quality of life (QoL). CONCLUSION A wide range and diversity of measures are used to evaluate the patient burden of Sjögren's; most are not validated for use in this disease. PRO endpoints, validated specifically in Sjögren's, that demonstrate improvement are needed. These measures should focus on QoL aspects important to patients and will most likely involve gauging change in function rather than patient-reported symptoms.
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Affiliation(s)
| | - April N Naegeli
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | - Julie A Birt
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
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12
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Rogus-Pulia NM, Gangnon R, Kind A, Connor NP, Asthana S. A Pilot Study of Perceived Mouth Dryness, Perceived Swallowing Effort, and Saliva Substitute Effects in Healthy Adults Across the Age Range. Dysphagia 2017; 33:200-205. [PMID: 28879557 DOI: 10.1007/s00455-017-9846-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/22/2017] [Indexed: 11/29/2022]
Abstract
Xerostomia, or perceived mouth dryness, increases with advancing age, but its influence on swallowing effort is unknown. This study: (1) quantified relationships among age, perceived sense of swallowing effort, and ratings of perceived mouth dryness, and (2) examined changes in swallowing effort following application of a gel-based saliva substitute in healthy participants. This was a cross-sectional observational study and data were collected from attendees of a community healthy aging fair. Forty-two healthy participants (mean age = 65 years; 20 female) were enrolled. Each participant rated perceived effort with swallowing and perceived mouth dryness on a 10-cm horizontal, undifferentiated line. After participants applied a gel-based saliva substitute (Biotene® Oral Balance) to their tongue and oral mucosa, they rated perceived effort with swallowing again. Age was associated with greater perceived mouth dryness (r = 0.37, p < 0.03) but not with perceived swallowing effort (r = 0.16, p = 0.32). Perceived mouth dryness was associated with greater perceived swallowing effort (r = 0.62, p < 0.001). Perceived swallowing effort declined following application of the salivary substitute (mean difference = 9.39 mm, p < 0.002). Age was found to be a significant predictor of perceived mouth dryness (p < .02); and perceived mouth dryness was found to significantly predict perceived swallow effort (p < .001). Perceived mouth dryness increased with advancing age, but perceived swallowing effort did not. Regardless of age, participants with higher levels of perceived mouth dryness also reported more perceived effort with swallowing suggesting a role for adequate oral lubrication in this perception. Even in healthy participants, use of a gel-based saliva substitute lowered perceived swallowing effort.
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Affiliation(s)
- Nicole M Rogus-Pulia
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA. .,Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA. .,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Ronald Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy Kind
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Nadine P Connor
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Sanjay Asthana
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,NIA/NIH Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
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13
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Gambino A, Broccoletti R, Cafaro A, Cabras M, Carcieri P, Arduino PG. Impact of a sodium carbonate spray combined with professional oral hygiene procedures in patients with Sjögren's syndrome: an explorative study. Gerodontology 2016; 34:208-214. [PMID: 27813150 DOI: 10.1111/ger.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to make an initial estimation on the effects of a sodium bicarbonate and xylitol spray (Cariex® ), associated with non-surgical periodontal therapy, in participants with primary Sjögren's syndrome. BACKGROUND Sjögren's syndrome (SS) is a multisystem autoimmune disease that predominantly involves salivary and lachrymal glands, with the clinical effect of dry eyes and mouth. MATERIALS AND METHODS A prospective cohort of 22 women and two men has been evaluated. They were randomized into three groups (eight patients each): Group A) those treated once with non-surgical periodontal therapy, education and motivation to oral hygiene, associated with the use of Cariex® ; Group B) treated only with Cariex® ; Group C) treated only with non-surgical periodontal therapy, education and motivation to oral hygiene. Clinical variables described after treatment were unstimulated whole salivary flow, stimulated whole salivary flow, salivary pH, reported pain (using Visual Analogue Scale) and the Periodontal Screening and Recording index. RESULTS Salivary flow rate improved in all groups, but the difference was statistically significant only in those treated with Cariex® , alone or in combination with periodontal therapy. Gingival status improved in participants who underwent periodontal non-surgical therapy while remained unchanged in those only treated with Cariex® . Reported pain decreased in all groups, showing the best result in participants treated with periodontal therapy together with Cariex® . CONCLUSIONS We propose a practical approach for improving gingival conditions and alleviating oral symptoms in patients with SS. Future randomized and controlled trials are however required to confirm these results as well as larger population, and also assessing other parameters due to oral dryness, possible oral infections and more comprehensive periodontal indices.
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Affiliation(s)
- Alessio Gambino
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Roberto Broccoletti
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Adriana Cafaro
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Marco Cabras
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Paola Carcieri
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
| | - Paolo G Arduino
- Department of Surgical Sciences, CIR - Dental School, University of Turin, Turin, Italy
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14
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Murakami M, Nishi Y, Fujishima K, Nishio M, Minemoto Y, Kanie T, Nishimura M. Impact of Types of Moisturizer and Humidity on the Residual Weight and Viscosity of Liquid and Gel Oral Moisturizers. J Prosthodont 2016; 25:570-575. [PMID: 26376003 DOI: 10.1111/jopr.12341] [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] [Accepted: 03/15/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Oral moisturizers need to be selected based on their material properties. The purpose of this study was to investigate the effects of moisturizer type and humidity on the residual weight and viscosity of oral moisturizers. MATERIALS AND METHODS The weight and viscosity of 17 oral moisturizers (7 liquid and 10 gel) at baseline and after 8 hours were measured using an incubator maintained at 37°C at either 85% or 40% relative humidity (RH). The rate of change in weight (RCW) and the rate of change in viscosity (RCV) were calculated. Data were analyzed with two-way analysis of variance (ANOVA) and Scheffe's test to evaluate the effect of the type of moisturizer (liquid or gel) and humidity (85% or 40% RH) on RCW and RCV. Pearson's correlation coefficient was used to evaluate the relationship between RCW and RCV. RESULTS Two-way ANOVA results indicated that the type of moisturizer and RH had a significant effect on RCW and RCV (p < 0.05); however, the interaction between them was not significant. The results of multiple comparisons showed that gel moisturizers had a significantly lower RCW and higher RCV than liquid moisturizers (p < 0.05). The RCW and RCV at 40% RH were significantly higher than those at 85% RH (p < 0.05). There was no correlation between RCW and RCV in the liquid moisturizer group, but a significant negative correlation was found in the gel moisturizer group (pp = 0.01). CONCLUSION Because viscosity of gel moisturizers increases as weight decreases, selecting gel moisturizers with a minimal change in weight and viscosity would be preferable in the case of a long-time application and severe dry mouth.
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Affiliation(s)
- Mamoru Murakami
- Denture Prosthodontics Restoration, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan.
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kei Fujishima
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Misaki Nishio
- Denture Prosthodontics Restoration, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
| | - Yoko Minemoto
- Denture Prosthodontics Restoration, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
| | - Takahito Kanie
- Department of Biomaterials Science, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masahiro Nishimura
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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15
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16
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Recommendations for the treatment of Sjögren's syndrome. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:446-57. [PMID: 26360421 DOI: 10.1016/j.rbr.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 12/15/2022] Open
Abstract
The recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 items classified according to Oxford & Grade were included. These recommendations were developed in order to guide the appropriate management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.
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17
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Epstein JB, Villines DC, Sroussi HY. Patient reported outcomes of the clinical use of a proprietary topical dry mouth product. SPECIAL CARE IN DENTISTRY 2015; 35:197-204. [DOI: 10.1111/scd.12112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joel B. Epstein
- Diplomate, American Academy of Oral Medicine Collaborative Member, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles; Consultant, Division of Otolaryngology Head and Neck Surgery, City of Hope National Medical Center; CA
| | | | - Herve Y. Sroussi
- Diplomate, American Academy of Oral Medicine; Associate Professor and Chief of Oral Medicine, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry University of Illinois at Chicago; Chicago IL
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18
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Abstract
This article provides an overview of the published literature in English in the past 63 years involving the management of xerostomia and other oral complications of Sjögren's syndrome. The evidence supporting studied interventions was evaluated using published criteria.
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19
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Swick A, Kimple RJ. Wetting the whistle: neurotropic factor improves salivary function. J Clin Invest 2014; 124:3282-4. [PMID: 25036702 DOI: 10.1172/jci77194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Xerostomia, or dry mouth, is a common side effect of head and neck radiotherapy, Sjögren syndrome, diabetes, old age, and numerous medications. In this issue of the JCI, Xiao and colleagues identified glial cell line-derived neurotrophic factor (GDNF) as a potential stimulus for salivary stem cell growth. Due to its ability to promote neuronal growth, differentiation, and survival, GDNF is currently being used in clinical trials as a treatment for Parkinson disease; therefore, the findings of Xiao and colleagues may initiate a potential treatment for the millions of patients who suffer from xerostomia each year.
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20
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A phase II clinical trial of a natural formulation containing tea catechins for xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:447-454.e3. [PMID: 25240992 DOI: 10.1016/j.oooo.2014.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous animal studies indicated catechins from the tea plant (Camellia sinensis) may modulate salivary function and possess a therapeutic effect for xerostomia. The objective of this study was to evaluate a natural formulation containing tea catechins in 60 patients with xerostomia, including patients with Sjögren syndrome. STUDY DESIGN This study used a double-blind, placebo-controlled, randomized design. The functional placebo contained all natural formulation ingredients and 500 mg xylitol, but without the key plant extracts. RESULTS After 8 weeks of therapy, the xylitol-containing placebo failed to modulate saliva output. In comparison, the catechin-containing natural formulation resulted in a statistically significant increase in unstimulated (3.8-fold) and stimulated (2.1-fold) saliva output vs baseline. The quality of life score showed a significant improvement in both groups but no significant difference between groups. CONCLUSIONS The catechin-containing natural formula partially restored salivary function in patients with xerostomia and provided an objective improvement in saliva output, which warrants large-scale clinical trials.
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21
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Dost F, Farah CS. Stimulating the discussion on saliva substitutes: a clinical perspective. Aust Dent J 2013; 58:11-7. [DOI: 10.1111/adj.12023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2012] [Indexed: 11/29/2022]
Affiliation(s)
- F Dost
- School of Dentistry; The University of Queensland; Brisbane and The University of Queensland Centre for Clinical Research; Herston
| | - CS Farah
- School of Dentistry; The University of Queensland; Brisbane and The University of Queensland Centre for Clinical Research; Herston
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