Hyposalivation in autoimmune diseases

Association of Sleep Quality and General, Mental, and Oral Health with Lifestyle Traits (Dietary Intake, Smoking Status) in Arthritis: A Cross-Sectional Study from the Canadian Community Health Survey (CCHS)

Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.

Salivary Alterations in Autoimmune Thyroid Diseases: A Systematic Review

Autoimmune thyroid disease (AITD) is a dysregulation of the immune system that causes an attack on the thyroid gland. Two major clinical manifestations are Hashimoto's thyroiditis and Graves' disease. Saliva performs many functions and, importantly, has the potential for easy, non-invasive diagnostics of several systemic disorders. This systematic review was designed to answer the question whether salivary alterations are reliable for the diagnosis of autoimmune thyroid diseases. Following the inclusion and exclusion criteria, fifteen studies were included. Due to their heterogeneity, saliva analysis was divided into two subgroups: quantitative assessment analysing salivation and qualitative assessment concerning potential salivary biomarkers for AITD. In addition to detecting altered levels of thyroid hormones and antibodies, salivary changes were also observed in the concentrations of total protein, cytokines and chemokines, as well as markers of oxidative status. According to the saliva flow rate values, significantly reduced saliva secretion was observed in patients with HT. In conclusion, it is not possible to unequivocally state if salivary biomarkers can potentially be used in autoimmune thyroid disease diagnosis. Therefore, further investigations, including salivation disorders, are necessary to validate these findings.

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia

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.

Association between Diet and Xerostomia: Is Xerostomia a Barrier to a Healthy Eating Pattern?

Objective. Xerostomia is a subjective feeling of dry mouth and is commonly observed in patients with autoimmune diseases. Our study examines the association between xerostomia and diet. Materials and Methods. The cross-sectional study includes 1405 adults from 15 Lithuanian geographical areas (52% response rate). A self-reported questionnaire inquired about xerostomia, sex, age, education, residence, and consumption of selected 23 diet items. For the multivariable analysis, 23 diet items were categorized into eight major diet groups. The data were analyzed by bivariate and multivariable analyses. Results. When comparing participants with and without xerostomia, there were significant differences in consumption frequencies concerning cold-pressed oil (p = 0.013), bread (p = 0.029), processed meat products (p = 0.016), fat and lean fish (p = 0.009), and probiotic supplements (p = 0.002). In the multivariable binary logistic regression model, when controlled for other determinants, the higher consumption of carbohydrates (OR 0.39, 95% CI 0.23–0.65), proteins (OR 0.56, 95% CI 0.32–0.99), and oils (OR 0.58, 95% CI 0.34–1.00) was associated with a lower likelihood of xerostomia. Conclusions. The association between xerostomia and the consumption of the six diet items—cold-pressed oils, lean and fat fish, bread, processed meat, and probiotic supplements— and the three major diet groups—carbohydrates, proteins, and oils—was observed. Longitudinal studies are needed to validate the observed associations.

Immunosuppressed Miniswine as a Model for Testing Cell Therapy Success: Experience With Implants of Human Salivary Stem/Progenitor Cell Constructs

An urgent need exists to develop large animal models for preclinical testing of new cell therapies designed to replace lost or damaged tissues. Patients receiving irradiation for treatment of head and neck cancers frequently develop xerostomia/dry mouth, a condition that could one day be treated by cell therapy to repopulate functional saliva-producing cells. Using immunosuppression protocols developed for patients receiving whole face transplants, we successfully used immunosuppressed miniswine as a suitable host animal to evaluate the long-term stability, biocompatibility, and fate of matrix-modified hyaluronate (HA) hydrogel/bioscaffold materials containing encapsulated salivary human stem/progenitor cells (hS/PCs). An initial biocompatibility test was conducted in parotids of untreated miniswine. Subsequent experiments using hS/PC-laden hydrogels were performed in animals, beginning an immunosuppression regimen on the day of surgery. Implant sites included the kidney capsule for viability testing and the parotid gland for biointegration time periods up to eight weeks. No transplant rejection was seen in any animal assessed by analysis of the tissues near the site of the implants. First-generation implants containing only cells in hydrogel proved difficult to handle in the surgical suite and were modified to adhere to a porcine small intestinal submucosa (SIS) membrane for improved handling and could be delivered through the da Vinci surgical system. Several different surgical techniques were assessed using the second-generation 3D-salivary tissue (3D-ST) for ease and stability both on the kidney capsule and in the capsule-less parotid gland. For the kidney, sliding the implant under the capsule membrane and quick stitching proved superior to other methods. For the parotid gland, creation of a tissue “pocket” for placement and immediate multilayer tissue closure were well tolerated with minimal tissue damage. Surgical clips were placed as fiduciary markers for tissue harvest. Some implant experiments were conducted with miniswine 90 days post-irradiation when salivation decreased significantly. Sufficient parotid tissue remained to allow implant placement, and animals tolerated immunosuppression. In all experiments, viability of implanted hS/PCs was high with clear signs of both vascular and nervous system integration in the parotid implants. We thus conclude that the immunosuppressed miniswine is a high-value emerging model for testing human implants prior to first-in-human trials.

A case-control study of oral diseases and quality of life in individuals with rheumatoid arthritis and systemic lupus erythematosus

OBJECTIVE

To evaluate the impact of oral alterations on the quality of life (QoL) of individuals with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

METHODS

A case-control study in 32 individuals with RA, 28 with SLE, and 29 in the control group (CG). The questionnaire SF-36 (Medical Outcomes Study Short-Form 36) was used to evaluate the health-related quality of life (HRQoL), and OHIP-14 (Oral Health Impact Profile-14) was used to evaluate the oral health-related quality of life (OHRQoL). The severity of xerostomia was evaluated by the Xerostomia Inventory (XI). In the clinical examination, decayed (D-T), missing(M-T), and filled teeth (F-T) (DMF-T), periodontal status, plaque index (PI), gingival index (GI), unstimulated whole salivary flow rate (UWSFR), and stimulated whole salivary flow rate (SWSFR) were also assessed. Data were analyzed by Student's t tests, chi-square test, Kruskal-Wallis test, ANOVA, Pearson's correlation, and Spearman's correlation.

RESULTS

Individuals with RA had a higher caries index (D-T/p = 0.004) and more frequent periodontal disease (PI/p = 0.017). In the SLE group, there was a significant lower salivary flow (SFR/p = 0.016, SFMS/p = 0.004) and severe xerostomia (p = 0.002). The impact of ORHQoL in individuals with RA occurred due to oral candidiasis, halitosis, and xerostomia, compromising the HRQoL. Overall, OHRQoL and HRQoL were more compromised in individuals with SLE, with xerostomia being the main oral problem.

CONCLUSION

Individuals with RA and SLE present oral diseases with negative impact on their QoL.

CLINICAL RELEVANCE

This study shows the main oral manifestations in rheumatic autoimmune diseases, with mainly xerostomia compromising the quality of life.

Histopathological and biochemical alterations of the parotid gland induced by experimental hypothyroidism in adult male rats and the possible therapeutic effect of Nigella sativa oil

Thyroid hormones are essential for metabolic rate regulation and play a role on the integrity of the salivary glands. Nigella sativa is a widely used plant in medicine. This study aimed to evaluate the effect of Nigella sativa oil (NSO) on the hypothyroidism-induced parotid gland pathological alterations. Rats were divided into four groups: control group, hypothyroid group: received daily oral carbimazole for 3 weeks, hypothyroid-NSO group: NSO was orally given for 4 weeks after hypothyroidism induction and NSO group: administrated NSO only for 4 weeks. After 7 weeks, all rats were sacrificed, serum thyroid hormones were estimated, and parotid glands were assessed by histopathological, immunohistochemical, ultrastructural and morphometric analyses. Hypothyroid group showed a significant decrease in thyroid hormones with increase in thyroid-stimulating hormone (TSH) levels and decrease in body and parotid weights compared to the control rats that were improved with NSO treatment. Sections of the hypothyroid group showed fibrosis, acinar cytoplasmic vacuolations, vascular congestion, ductal dilatation, wide intercellular canaliculi, nuclear pyknosis and decreased number of secretory granules. Also, there were decreased B-cell lymphoma 2 (Bcl-2) and increased p53, Bcl-2 Associated X (Bax) and alpha-smooth muscle actin (α-SMA) immune-expressions; with decreased Bax/ Bcl-2 ratio that all were attenuated by NSO. NSO ameliorates hypothyroidism-induced parotid changes by altering p53, Bax and Bcl-2 pathway.

Salivary gland performance in autoimmune diseases: review and meta-analysis

Objectives: Autoimmune diseases include a spectrum of disorders in which immune response to the autoantigens leads to tissue damage or dysfunction. Xerostomia, salivary gland dysfunction and lack of saliva are some common symptoms associated with many autoimmune diseases.Methods: In this review study, the meta-analysis technique is used to objectively review the relationship between autoimmune diseases and salivary gland dysfunction. We have searched Medline and Embase and Google Scholar. By Revman 5.3, meta-analysis was performed to investigate the salivary flow rate in both stimulatory and non-stimulatory saliva. The sample size obtained from these studies was 130 people with autoimmune diseases and 100 healthy individuals.Results: The results showed a significant decrease in the level of non-stimulatory saliva in people with autoimmune diseases.Conclusions: A complete and comprehensive understanding of the clinical manifestation of systemic diseases is crucial in early diagnosis of diseases and identifying the mechanisms that develop the disease. Other than xerostomia, there is a significant reduction in salivary flow rate in patients with autoimmune diseases. As saliva plays a very important role in oral health and has significant functions, more attention is needed for monitoring and managing of hyposalivation in autoimmune patients.

Mucin 5B in saliva and serum of patients with oral lichen planus

Oral lichen planus (OLP) is among the most common oral diseases. Its etiopathogenesis has yet to be clearly identified. OLP patients complain of mouth dryness. This study aimed to assess the level of Mucin 5B in OLP patients with xerostomia. This study was conducted on 30 OLP patients and 30 healthy individuals. In addition to patient complaint of mouth dryness, xerostomia was assessed by tongue blade and lipstick tests. Stimulated and unstimulated saliva were collected in plastic vials by spitting method. Level of Mucin 5B was measured by ELISA. Unstimulated saliva flow was significantly lower in OLP patients (P = 0.0001). Stimulated saliva flow was not significantly different between the two groups (P > 0.05). Level of Mucin 5B in unstimulated saliva was significantly lower in OLP group (P = 0.0001) while it was not significantly different in stimulated saliva of the two groups (P > 0.05). Level of Mucin 5B was significantly higher in serum of OLP patients (P = 0.016). Both saliva flow and level of Mucin 5B decrease in OLP patients. Since Mucin 5B is effective for wetting and lubrication of the oral cavity, this result can suggest a possible reason for mouth dryness in OLP patients.

Evaluation of Xerostomia and salivary flow rate in Hashimoto's Thyroiditis

BACKGROUND

One of the most common causes of hypothyroidism is Hashimoto's Thyroiditis (HT). Early detection of dry mouth is critical in preserving and promoting systemic and oral health. In this study we have assessed, for the first time, salivary function and xerostomia in HT patients who have not been involved with Sjögren's syndrome.

MATERIAL AND METHODS

HT was diagnosed in 40 patients based on clinical findings and positive anti-thyroid peroxidase antibodies (anti-TPO). Controls, matched by sex, age and body mass index (BMI), and with no history of thyroid disease, were selected. A questionnaire was used for diagnosis of xerostomia. Saliva samples were taken between 8 a.m. and 9 a.m., and at least 2 hours after the last intake of food or drink. The flow rate was calculated in milliliters per minute.

RESULTS

Xerostomia was significantly higher in patients with HT. Unstimulated salivary flow rate was significantly lower in the HT group. Stimulated salivary flow rate was lower in HT group, but the difference was not significant.

CONCLUSIONS

The patients with HT experienced xerostomia, and their salivary flow rate was diminished. Spitting the saliva then assessing salivary flow rate based on milliliter per minute is non-invasive, fast, and simple for chair-side diagnosis of dry mouth. Autoimmune diseases can be accompanied by salivary gland dysfunction. This may be due to the effect of cytokines in the autoimmune process or because of thyroid hormone dysfunctions.

Prevalence of hyposalivation in patients with systemic lupus erythematosus in a brazilian subpopulation

Background. Systemic lupus erythematosus (SLE) is a chronic inflammatory, multisystem, and autoimmune disease. Objective. The aim of this study was to describe the prevalence of hyposalivation in SLE patients and evaluate factors associated. Methods. This is a cross-sectional study developed at the Cuiaba University General Hospital (UNIC-HGU), Mato Grosso, Brazil. The study population consisted of female SLE patients treated at this hospital from 06/2010 to 12/2012. Unstimulated salivary flow rates (SFRs) were measured. Descriptive and inferential analyses were performed in all cases using a significance level P < 0.05. Results. The results showed that 79% of patients with systemic lupus erythematosus suffered from hyposalivation and that the disease activity and age in years were the factors that resulted in statistically significant differences. Conclusion. The activity of the disease, age >27 years, and the drugs used were factors associated with hyposalivation, resulting in a statistically significant decrease in saliva production.

Residual Salivary Secretion Ability May Be a Useful Marker for Differential Diagnosis in Autoimmune Diseases

Background. We have elucidated decreased resting salivary flow in approximately 60% of patients with autoimmune diseases not complicated by Sjögren syndrome (SjS). In this study, salivary stimulation tests using capsaicin were performed to examine residual salivary secretion ability in patients with autoimmune diseases. Materials and Methods. Fifty-eight patients were divided into three groups: patients with primary or secondary SjS (SjS group), patients with systemic sclerosis not complicated by SjS (SSc group), and patients with other autoimmune diseases (non-SjS/non-SSc group). Simple filter paper and filter paper containing capsaicin were used to evaluate salivary flow rates. Results. Resting salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group but did not differ significantly between the SjS and SSc groups. Capsaicin-stimulated salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group, but not significantly different between the SjS and SSc groups. In the non-SjS/non-SSc group, salivary flow rates increased after capsaicin stimulation to the threshold level for determination of salivary gland dysfunction, whereas no improvement was observed in the SjS and SSc groups. Conclusion. Residual salivary secretion ability may be a useful marker for differential diagnosis in autoimmune diseases.