Clinical oral dryness score: evaluation of a new screening method for oral dryness

Clinically estimated signs of hyposalivation in older adult residents of long-term care

OBJECTIVE

To assess whether the estimation of clinical signs of hyposalivation is applicable in recognising long-term care facility (LTCF) residents with poor oral health, and which individual characteristics are important in that respect.

BACKGROUND

A common inconvenience among older adults, dry mouth, particularly hyposalivation, can cause many complications, such as greater susceptibility to root caries and oral infections, and it can lead to further deterioration of oral health. However, very little is known about the association of clinically assessed signs of hyposalivation with the oral health status of LTCF residents.

METHODS

The study sample comprised 362 individuals (dentate n = 266, edentate n = 96) aged 65 or older. The examinations included a questionnaire and clinical oral examination. Participants were categorised into three groups based on clinically assessed oral dryness: normal salivation (n = 83, 22.9%), lower salivation (n = 182, 50.3%) and dry mouth (n = 97, 26.8%). The association between signs of dry mouth with aspects to oral health was evaluated and further tested with logistic regression analysis.

RESULTS

The signs of oral dryness were observed among females, those with dementia, and those with longer stays in the current facility. Root caries (odds ratio, OR 1.3) and diagnosis of periodontitis (OR 4.1), together with several individual periodontal parameters, as well as having less than ten occluding pairs of natural teeth (OR 3.5) were associated with dry mouth. Edentate participants showed an increased likelihood of having dry mouth with advancing age, and lesions on the lips were associated with dry mouth with OR 3.0.

CONCLUSION

Clinical estimation of signs of oral dryness can be a useful adjunct in evaluating the oral health status of dentate LTCF residents. Poor oral health was a frequent finding, especially among dentate LTCF residents with signs of dry mouth.

As-Needed Pilocarpine for Radiation-Induced Xerostomia in Head and Neck Cancers

OBJECTIVES

This study aimed to evaluate the efficacy of as-needed pilocarpine for the management of radiation-induced xerostomia. Additionally, the study sought to assess the side effects associated with an as-needed regimen.

METHODS

A randomized, double-blinded, placebo-controlled crossover study was conducted on patients who had undergone radiation therapy for head and neck cancers and developed xerostomia. Participants took pilocarpine or placebo as needed for symptom relief at 2 weeks per treatment, which included a one-week washout period. The primary outcome measure was the severity of dry mouth symptoms, quantified using the Xerostomia Inventory (XI). The primary outcome was the change in the XI score.

RESULTS

Among the 20 participants who completed the crossover study, there was a significant reduction in XI scores during the treatment phase with pilocarpine compared to the scores during the placebo phase. The mean difference in XI scores was -18.05 (95% CI: -17.17, -6.13, p < 0.001), with a-49.77 ± 3.22% change (p < 0.001). Only one participant withdrew due to pilocarpine side effects.

CONCLUSION

As-needed pilocarpine administration is effective in relieving symptoms of radiation-induced xerostomia, with fewer side effects and reduced treatment costs compared to fixed-dose regimens. This study guides the potential shift toward flexible dosing strategies in clinical practice, promoting enhanced patient-centered, tailored care and adherence.

LEVEL OF EVIDENCE

Level 2. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines Laryngoscope, 2024.

Anticholinergic burden of medications is associated with dry mouth and reflected in minor labial gland secretion

OBJECTIVE

Medications with anticholinergic potential inhibit saliva secretion. Polypharmacy potentiates anticholinergic burden, causing dry mouth symptoms and chronic deterioration of oral health. Patients of any age can be affected by anticholinergic medication-triggered hyposalivation (the objective measure of dry mouth); therefore, seeking predictions of hyposalivation to screen dry mouth is needed.

DESIGN

In our prospective, cross-sectional clinical study, 55 middle-aged adult patients participated. We examined whether the anticholinergic burden calculated from anticholinergic medications (anticholinergic drug score; ADS) and blood serum anticholinergic activity (SAA; the gold standard measure of anticholinergic burden) is associated with hyposalivation. As no prior studies measured minor salivary glands regarding the quantifiable anticholinergic burden, we assessed hyposalivation by the minor saliva flow (MSF) and unstimulated whole saliva (UWS) secretion.

RESULTS

Our data showed a negative linear relationship between SAA and UWS (p < 0.05); when SAA increases by one pmol/ml unit, the saliva flow decreases by 0.058 ml/min. MSF showed a linear correlation (p < 0.005) with UWS. In a multivariate logistic regression model (including age, gender, race, smoking status, xerostomia severity, ADS, and BMI), we identified SAA and age as predictors of hyposalivation (p < 0.05).

CONCLUSIONS

We provide evidence for the significant relationship between measurable anticholinergic burden and saliva flow. The correlation between UWS and MSF suggests that both saliva flow rate measurement methods could reflect anticholinergics-induced changes in salivary health.

Long-term swallow outcomes and factors affecting swallowing dysfunction and quality of life among oral cancer patients: a prospective observational study

BACKGROUND

Oral cancer is one of the most common cancers among the Indian population. India bears the most burden of oral cancer globally. Impairment of swallowing function is often seen after treatment for oral cancer. The oral phase of swallowing is disrupted in patients undergoing resection for oral cancer. The primary purpose of this study was to evaluate the long-term swallowing outcomes of oral cancer patients using a patient-reported outcome questionnaire.

METHODOLOGY

All consecutive oral cancer patients in the cT2-T4 category undergoing curative-intent surgery and reconstruction at our institute from March 2020 to March 2022 were included in the study. The Sydney Swallow questionnaire (SSQ) and functional oral intake scale (FOIS) assessed swallowing outcomes six months after definitive treatment. WHO BREF quality-of-life questionnaire was used to assess health-related quality of life.

RESULTS

A total of seventy patients with oral cancer were included. The median age was 49 years. The majority of them were males (90%). Tumors with cT4 constituted 62%; the rest, 48%, were cT2 and cT3 categories. The bulk of them were buccoalveolar tumors (64.3%. Almost two-thirds of the patients received multimodal treatment. Trismus and xerostomia were at 46% and 88%, respectively. The mean SSQ score was 257.4 ± 99.1. Swallowing outcomes are affected by T stage (p = 0.01), extent of resection (p = 0.01), multimodality treatment (p < 0.01), trismus (p = 0.05), and xerostomia (p = 0.01). Almost 69% of them required special food preparation for swallowing (FOIS 4&5). Patients with buccoalveolar disease (p = 0.05) had significantly poor quality of life.

CONCLUSION

An advanced stage with extensive resection and receiving multimodal treatment has adverse swallowing outcomes. Post-treatment trismus and xerostomia also significantly affected swallowing results.

Impact of oral/dental disease burden on postoperative infective complications: a prospective cohort study

OBJECTIVES

This prospective cohort study aimed to assess the association between dental disease burden and postoperative infective complications (POICs) in patients undergoing major surgical procedures under general anaesthesia.

METHODS

Pre-surgical dental assessment was undertaken on patients planned for major surgery. Demographic and surgical variables including putative risk factors for POICs and POIC status were documented. The univariable association between POIC status and each factor was examined. Those variables associated at P value ≤ 0.2 were candidates for inclusion in multiple logistic regression models. Backward stepwise variable selection was used to identify the independent predictors for POIC in the best fitting logistic regression model. The area under the receiver operating curve (AUC) was used to quantify the model's global classification performance.

RESULTS

Among the 285 patients, 49 patients (17.2%) had POICs. The independent predictors for POIC were expected length of hospital stay (4-6 days; odds ratio [OR] = 4.80, 95% confidence internal [CI]: 1.30-17.70, P = 0.018, 7-9 days; OR = 5.42, 95% CI: 1.51-19.41, P = 0.009, ≥ 10 days; OR = 28.80, 95% CI: 4.12-201.18, P < 0.001), four or more decayed teeth (OR = 6.03, 95% CI: 2.28-15.94, P < 0.001) and visible tongue plaque (OR = 3.21, 95% CI: 1.54-6.70, P = 0.002). The AUC was 0.78 (95% CI: 0.71-0.85) indicating good discrimination. A simple screening tool for POIC was developed.

CONCLUSIONS/CLINICAL RELEVANCE

In addition to systemic/surgical factors, this study identified clinically detected decayed teeth and visible tongue plaque as independent predictors for POICs. Preoperative dental assessment/care might be beneficial to assess risk for POICs and improve postoperative outcomes.

Developing diagnostic criteria for tooth wear, a preliminary beta version based on expert opinion, and a narrative literature review

BACKGROUND

Tooth wear is a multifactorial condition, leading to the irreversible loss of dental hard tissues. The availability of an unambiguous, universally applicable assessment protocol remains lacking.

OBJECTIVES

The goal of the authors is to develop a set of diagnostic criteria for the assessment of tooth wear (DC-TW). A two-step approach will be used to achieve this objective: (1) to develop a preliminary beta version of the DC-TW, based on the authors' clinical experience and their shared expertise and supported by a narrative review of the existing literature, and (2) to develop the final DC-TW, with input from a larger group of experts using an international Delphi process. This paper relates to the first step.

METHODS

The authors outlined the components that should be incorporated into the DC-TW. The literature search was performed to investigate if their concept was in line with the available literature. The search was conducted to identify eligible publications from inception to July 11, 2022. Two authors independently screened all publications, and differences in judgements were resolved through a consensus procedure.

RESULTS

The search yielded 5362 publications, resulting in the final inclusion of 383. These publications were divided into four main topics: (1) nomenclature/taxonomies; (2) self-report tools; (3) clinical assessment tools; and (4) clinical decision-making.

CONCLUSIONS

The information from the publications was used and fused with the clinical experience and shared expertise of the authors to contribute to the development of a preliminary beta version of the DC-TW.

Use and efficacy of dry-mouth interventions in Sjögren's disease patients and possible association with perceived oral dryness and patients' discomfort

OBJECTIVES

Sjögren's disease (SjD) patients use various interventions to relief their oral dryness. However, the use and efficacy of these interventions have only partially been evaluated. The present study aims to investigate whether there is an association between the perceived oral dryness and discomfort of SjD patients and their use of specific interventions.

MATERIALS AND METHODS

A cross-sectional study was performed among SjD patients, who completed several questionnaires to assess the severity of their oral dryness and an inventory of dry-mouth interventions. The perceived efficacy of each intervention was reported on a 5-point Likert-scale.

RESULTS

The questionnaires were returned by 92 SjD patients. For relief of oral dryness, they mostly used "eating fruit", "drinking tea", "moistening the lips", "drinking water, and "drinking small volumes" (> 50%). Three interventions had a frequency of use ranging from 2-6 times/day, whereas, "drinking water" and "drinking small volumes" showed higher frequencies (> 14). The highest overall efficacy (≥ 3.5) was reported for "chewing gum" and "using a mouth gel". Furthermore, various dry-mouth interventions showed significant associations with oral dryness scores and/or patients' discomfort. For example, "drinking small volumes" and "using XyliMelts" were associated with the Bother Index score.

CONCLUSION

Great variation was found in the use of dry-mouth interventions by the participants and the severity of the oral dryness and/or patients' discomfort seemed to affect their choice of intervention. Notably, the mostly used interventions did not show the highest reported efficacy.

CLINICAL RELEVANCE

These findings might help SjD patients and clinicians in their choice of effective dry-mouth interventions.

Intraoperative Visualization and Treatment of Salivary Gland Dysfunction in Sjögren's Syndrome Patients Using Contrast-Enhanced Ultrasound Sialendoscopy (CEUSS)

In sialendoscopy, ducts are dilated and the salivary glands are irrigated with saline. Contrast-enhanced ultrasound sialendoscopy (CEUSS), using microbubbles, may facilitate the monitoring of irrigation solution penetration in the ductal system and parenchyma. It is imperative to test CEUSS for its safety and feasibility in Sjögren's syndrome (SS) patients. CEUSS was performed on 10 SS patients. The primary outcomes were safety, determined by the occurrence of (serious) adverse events ((S)AEs), and feasibility. The secondary outcomes were unstimulated and stimulated whole saliva (UWS and SWS) flow rates, xerostomia inventory (XI), clinical oral dryness score, pain, EULAR Sjögren's syndrome patient reported index (ESSPRI), and gland topographical alterations. CEUSS was technically feasible in all patients. Neither SAEs nor systemic reactions related to the procedure were observed. The main AEs were postoperative pain (two patients) and swelling (two patients). Eight weeks after CEUSS, the median UWS and SWS flow had increased significantly from 0.10 to 0.22 mL/min (p = 0.028) and 0.41 to 0.61 mL/min (p = 0.047), respectively. Sixteen weeks after CEUSS, the mean XI was reduced from 45.2 to 34.2 (p = 0.02). We conclude that CEUSS is a safe and feasible treatment for SS patients. It has the potential to increase salivary secretion and reduce xerostomia, but this needs further investigation.

Exploring oral health indicators, oral health-related quality of life and nutritional aspects in 23 medicated patients from a short-term psychiatric ward

Background

Patients suffering from psychiatric disorders face many difficulties due to their condition, medications and lifestyle. Oral health and nutrition may be affected, further complicating their lives. Our aim was to provide in-depth information on oral health and nutritional factors in a small group of patients in short-term psychiatric ward.

Methods

Twenty-three patients (mean age 36, average medications five) were recruited during short-term hospitalization in a psychiatric ward. Inclusion criteria: anxiety, psychosis and/or depression, and use of at least one antidepressant or anxiolytic/antipsychotic drug with xerostomia as a known side effect. Subjective oral dryness was evaluated using the Shortened Xerostomia Inventory (SXI). Oral examination included Clinical Oral Dryness Score (CODS), secretion of unstimulated (UWS) and stimulated whole saliva (SWS), and evaluation of dental, gingival, and periodontal status. Self-reported complaints of oral disorders were recorded. The Oral Health Impact Profile-14 (OHIP-14) was used to explore oral health-related quality of life. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and diet quality was assessed using the Mediterranean diet score (KIDMED).

Results

Compared to healthy controls, the patients had significantly higher SXI scores and CODS, and SWS secretion was lower. Complaints of dysgeusia and halitosis were significantly more frequent among patients. Gingivitis was more common in patients. OHIP-14 scores were much higher in the patients, and they reported significantly poorer oral and general health. Most patients lacked a regular meal pattern. Very low diet quality was observed in five patients, while improvements were needed in twelve. "Dry mouth" and "No appetite, just did not feel like eating" were the most common symptoms preventing patients from eating enough. The PG-SGA-SF symptoms component score showed a strong negative correlation with self-reported oral health, and a strong positive correlation with OHIP-14.

Conclusion

This relatively small group of patients in short-term psychiatric ward had both reduced oral health and poor oral health-related quality of life. Furthermore, their nutritional intake was affected by their oral health problems. Although larger groups need to be studied, these findings indicate that oral health and nutrition should be evaluated and adjusted in these patients to improve their overall care.

Anticholinergic Medication and Caries Status Predict Xerostomia under 65

The use of anticholinergic medications is increasing in younger ages, yet information about xerostomia, the most common anticholinergic side effect, is limited. This case–control retrospective study examines the relationship between anticholinergic medication-induced xerostomia and caries status among adults between 18 and 65 years of age. The study sample comprised 649 cases with xerostomia and 649 age- and gender-matched controls. The anticholinergic burden was estimated using the anticholinergic drug scale (ADS). Caries experience was recorded by calculating the Decayed, Missing, Filled Tooth (DMFT) index. Individuals with xerostomia had a higher mean DMFT index (16.02 ± 9.50), which corresponded with a higher level of anticholinergic exposure from medications (3.26 ± 2.81) compared to their age and gender-matched controls without xerostomia (13.83 + 8.83 and 1.89 ± 2.45, respectively). Logistic regression analysis verified the effects of DMFT, the total number of AC medications, and the ADS burden on xerostomia status. Comparing adults with or without xerostomia revealed statistical differences in several risk factors, such as smoking, diabetes, sleep apnea, and the utilization of anticholinergic medications. A personalized dental care plan should include the evaluation of the anticholinergic burden from medications regardless of the patient’s age to prevent increased caries severity.

Prevalence of frailty and its association with oral hypofunction in older adults: a gender perspective

BACKGROUND

Previous studies have indicated an association between oral hypofunction and frailty in community-dwelling older adults. However, this issue has not been evaluated in institutionalized older patients. We aimed to determine the prevalence of physical frailty in this particularly vulnerable group and evaluate its association with oral hypofunction, analyzing possible differences by gender.

METHODS

This cross-sectional study was conducted in private and public care homes in Guayaquil (Ecuador) from January 2018 until December 2019. Participants were classified as robust, pre-frail, and frail according to the Fried's frailty phenotype. Oral hypofunction was defined as the presence of at least three positive items in the following list: poor oral hygiene, oral dryness, reduced occlusal force, decreased masticatory function, and deterioration of swallowing function. The relationships between frailty and oral hypofunction were analyzed using logistic regression models for the whole sample and stratified by gender. Statistical analyses were performed using STATA 15.0 software (Stata Corp. LP, College Station, TX, USA).

RESULTS

Among the 589 participants analyzed (65% women), the median age was 72 years (interquartile range: 66-82). Pre-frailty and frailty were presented in 66.7% and 28.9% of them respectively. Weakness was the most frequent item (84.6%). There was a significant relationship between frailty and oral hypofunction in women. In the overall sample, the frequency of frailty was 2.06 times higher (95% CI 1.30-3.29) in patients with oral hypofunction, and this association was maintained in women (ORa: 2.18; 95% CI 1.21-3.94). Reduced occlusal force and decreased swallowing function were items significantly associated with the presence of frailty (ORa: 1.95; 95% CI 1.18-3.22 and ORa: 2.11; 95% CI 1.39-3.19, respectively).

CONCLUSION

The prevalence of frailty and pre-frailty was high among institutionalized older people and was associated with the presence of hypofunction, especially in women. Decreased swallowing function was the most strongly item associated with frailty.

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.

Candida species and oral mycobiota of patients clinically diagnosed with oral thrush

Overgrowth of Candida yeasts in the oral cavity may result in the development of oral thrush in immunocompromised individuals. This study analyzed the diversity and richness of the oral mycobiota of patients clinically diagnosed with oral thrush (OT), follow-up of oral thrush patients after antifungal therapy (AT), and healthy controls (HC). Oral rinse and oral swab samples were collected from 38 OT patients, 21 AT patients, and 41 healthy individuals (HC). Pellet from the oral rinse and oral swab were used for the isolation of oral Candida yeasts on Brilliance Candida Agar followed by molecular speciation. ITS1 amplicon sequencing using Illumina MiSeq was performed on DNA extracted from the oral rinse pellet of 16 OT, 7 AT, and 7 HC oral rinse samples. Trimmed sequence data were taxonomically grouped and analyzed using the CLC Microbial Genomics Module workflow. Candida yeasts were isolated at significantly higher rates from oral rinse and swab samples of OT (68.4%, p < 0.001) and AT (61.9%, p = 0.012) patients, as compared to HC (26.8%). Predominance of Candida albicans specifically, was noted in OT (60.5%, p < 0.001) and AT (42.9%, p = 0.006) vs. HC (9.8%), while non-albicans Candida species was dominant in HC. Analysis of oral mycobiota from OT patients showed the presence of 8 phyla, 222 genera, and 309 fungal species. Low alpha diversity (Shannon index, p = 0.006; Chao-1 biased corrected index, p = 0.01), varied beta diversity (Bray-Curtis, p = 0.01986; Jaccard, p = 0.02766; Weighted UniFrac, p = 0.00528), and increased relative abundance of C. albicans (p = 3.18E-02) was significantly associated with the oral mycobiota of OT vs. HC. This study supported that C. albicans is the main etiological agent in oral thrush and highlights the association of fungal biodiversity with the pathophysiology of oral thrush.

Increased Oral Dryness and Negative Oral Health-Related Quality of Life in Older People with Overweight or Obesity

This cross-sectional study was to evaluate the association between the oral health-related quality of life (OHRQoL) of older Thai people with obesity and oral health indicators. General and oral conditions were assessed. Oral dryness was determined using the Xerostomia Inventory-11 (XI-11) and clinical oral dryness score (CODS). OHRQoL was evaluated by the oral health impact profile (OHIP-14). Participants were aged 60-86 years; 73 (59.3%) were overweight or obese, and 50 (40.7%) were normal weight. Older patients with obesity had almost four times the rate of hypertension (OR = 3.59; 95%CI:1.34-9.60; p = 0.002), more missing teeth (p = 0.025), and higher CODS (p = 0.014) than those without obesity. The total XI-11 scores were positively associated with the total CODS, after adjusting for BMI (r = 0.267, p = 0.003). Those with obesity had almost three times the tendency for a negative OHRQoL compared with the non-obese (OR = 2.73; 95%CI:1.12-6.71; p = 0.04). After adjusting for all related factors, the chances of predicting an OHIP-14 score of four based on obesity and total XI-11 score were 4.42 (95%CI:1.57-12.47; p = 0.005) and 1.11 (95%CI:1.02-1.20; p = 0.013), respectively. Obesity had an increasingly undesirable negative impact on the OHRQoL of older Thai people and was influenced by BMI and oral dryness.

Evaluation of Oral Dryness and the Salivary-flow Rate in Patients with Oral Lichen Planus

Background and Objectives:

Oral lichen planus (OLP) is a common T-cell-mediated inflammatory oral mucosal disease. One of the complaints among OLP patients is xerostomia. However, the relationship between oral dryness and a decreased salivary-flow rate in these patients is not yet conclusive. So, we investigated oral dryness and the salivary-flow rate in OLP patients using various measurements.

Material and Methods:

Thirty OLP patients and 30 controls were included. The oral-dryness symptoms were collected using the Xerostomia Inventory (XI) and Bother Index (BI). The salivary-flow rate was measured using a Modified Schirmer Test (MST) and the spitting method. The clinical signs of dry mouth were determined by the clinical oral-dryness score (CODS). The Thongprasom score was used to evaluate the severity of OLP. The data were analyzed using the Mann-Whitney U test and Spearman’s rank correlation coefficient.

Results:

The XI score and BI score in the OLP group were significantly higher than in the control group. However, CODS, MST, the unstimulated salivary-flow rate, and the stimulated salivary-flow rate were not significantly different between the two groups. There was no correlation between oral dryness and the salivary-flow rate in OLP patients. The severity of OLP was also not correlated to oral dryness and the salivary-flow rate.

Conclusion:

OLP patients had more complaints about mouth dryness than the controls. However, the salivary-flow rates between the two groups were not different. Additionally, the severity of OLP was not related to dry mouth or the salivary-flow rate. The possible reasons for oral dryness among people with OLP require further investigation.

A randomized controlled trial to verify the irrigation of salivary glands in relieving xerostomia in patients with Sjögren's syndrome

OBJECTIVE

To verify the effect of triamcinolone acetonide (TA) and major salivary glands saline irrigation on relieving xerostomia in Sjögren's syndrome (SS) patients.

METHODS

The enrolled 49 SS patients were randomly assigned to the control group (no irrigation, n=16), saline group (irrigation with saline, n=17) and TA group (irrigation with TA, n=16). Fourteen cases of each group were treated differently but received the same examinations. The examinations include 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) and EULAR SS Patient Reported Index (ESSPRI) of 1 week before irrigation (T0) and 1 week(T1), 8 weeks (T8), 16 weeks (T16) and 24 weeks (T24) after major salivary irrigation.

RESULTS

Each group had 14 cases with completed follow-ups. Both TA and saline irrigation of major salivary glands resulted in higher SWS and SPF of T8, T16 and than those at T0. ESSPRI (oral dryness domain) of T8, T16 and T24 were significantly lower than that at T0, respectively (P < 0.05). SWS and SPF of T8, T16 and T24 in the saline group were significantly higher than in the control group (P< 0.05). XI and ESSPRI (oral dress domain) of T8, T16 and T24 in the saline group were significantly lower than those in the control group, respectively (P< 0.05). SWS and SPF of T16 and T24 in the TA group were significantly higher than in the control group (P< 0.05). All cases with completed follow-up in TA and saline groups were divided into responders and non-responders. Compared with responders, the UWS, SWS, SPF and CODS of T0 in non-responders were significantly increased (P<0.05). Compared with responders, the XI and ESSPRI of T0 in non-responders were significantly decreased (P<0.05).

CONCLUSION

The irrigation of major salivary glands by TA and saline relieve xerostomia in SS patients. Patients with non-severe xerostomia (responders) have better relief after irrigation than patients with severe xerostomia (non-responders).

CLINICAL TRIAL REGISTRATION

www.chictr.org.cn, identifier (ChiCTR210052314).

The relationship between ocular and oral dryness in a cohort from the 65-year-old population in Norway

In the present study, the relationship between dry eyes and dry mouth was explored in 150 65-year-old subjects randomly selected from the general population in Oslo, Norway. The number of drugs, including xerogenic drugs, and current and previous systemic diseases were recorded. Ocular parameters recorded were the McMonnies Dry Eye Questionnaire, the Ocular Surface Disease Index, the Schirmer I Test, tear film break-up time and ocular surface staining. The oral parameters were xerostomia frequency, Summated Xerostomia Inventory, Clinical Oral Dryness Score, and unstimulated and stimulated whole saliva. The participants with current or previous systemic diseases had significantly more ocular and oral symptoms and significantly more oral clinical findings than the participants without a history of disease. Moreover, correlation and factor analyses demonstrated an association between subjective ocular and oral parameters. A significant correlation between the total number of drugs and the presence of ocular and oral symptoms was also noted. When the participants were categorized based on their ocular symptoms, poorer values were found for the oral parameters among the participants more troubled with dry eyes. The results in the present study call for increased awareness and an interdisciplinary approach in matters related to dry eyes and dry mouth.

Individual Sweet Taste Perception Influences Salivary Characteristics After Orosensory Stimulation With Sucrose and Noncaloric Sweeteners

Emerging evidence points to a major role of salivary flow and viscoelastic properties in taste perception and mouthfeel. It has been proposed that sweet-tasting compounds influence salivary characteristics. However, whether perceived differences in the sensory properties of structurally diverse sweet-tasting compounds contribute to salivary flow and saliva viscoelasticity as part of mouthfeel and overall sweet taste perception remains to be clarified. In this study, we hypothesized that the sensory diversity of sweeteners would differentially change salivary characteristics in response to oral sweet taste stimulation. Therefore, we investigated salivary flow and saliva viscoelasticity from 21 healthy test subjects after orosensory stimulation with sucrose, rebaudioside M (RebM), sucralose, and neohesperidin dihydrochalcone (NHDC) in a crossover design and considered the basal level of selected influencing factors, including the basal oral microbiome. All test compounds enhanced the salivary flow rate by up to 1.51 ± 0.12 g/min for RebM compared to 1.10 ± 0.09 g/min for water within the 1st min after stimulation. The increase in flow rate was moderately correlated with the individually perceived sweet taste (r = 0.3, p < 0.01) but did not differ between the test compounds. The complex viscosity of saliva was not affected by the test compounds, but the analysis of covariance showed that it was associated (p < 0.05) with mucin 5B (Muc5B) concentration. The oral microbiome was of typical composition and diversity but was strongly individual-dependent (permutational analysis of variance (PERMANOVA): R² = 0.76, p < 0.001) and was not associated with changes in salivary characteristics. In conclusion, this study indicates an impact of individual sweet taste impressions on the flow rate without measurable changes in the complex viscosity of saliva, which may contribute to the overall taste perception and mouthfeel of sweet-tasting compounds.

First isolation and identification of Cystobasidium calyptogenae from the oral samples of an elderly patient presenting with angular cheilitis

Background

Angular cheilitis, an infection mainly caused by Candida yeasts, is featured by the appearance of inflammatory lesions at the bilateral corners of the mouth, particularly in patients with poor oral hygiene, ill-fitting dentures and old age. The first isolation of an atypical yeast, Cystobasidium calyptogenae, from oral samples of a patient presenting with angular cheilitis is discussed in this study.

Case presentation

Angular cheilitis was diagnosed in a 60-year-old denture-wearing woman who presented with an irritation fibroma on her right lower buccal sulcus over the premolar region. Primary cultures of her oral swab and oral rinse samples grew a pure culture of an uncommon yeast strain resembling Rhodotorula sp. Sequence analysis of the yeast internal transcribed spacer (ITS) gene region and D1D2 domain showed highest similarity (99.6% and 100%, respectively) to C. calyptogenae CBS 9125 type strain. Following 2 weeks of treatment with miconazole/fusidic acid and mouthwash, the oral lesion showed improvement with less erythema. C. calyptogenae was not isolated from the patient’s oral samples upon repeat sampling.

Conclusion

This is the first report on the isolation of C. calyptogenae from human oral samples. The ability of C. calyptogenae to grow at 37 °C and the fact that it was the only yeast species isolated from the patient’s oral samples suggests its pathogenic potential and possible involvement in angular cheilitis. The ubiquitous nature of the Cystobasidium yeast is believed to increase the likelihood of opportunistic infections among immunocompromised individuals. As Cystobasidium is phenotypically indistinguishable from Rhodotorula, an emerging opportunistic pathogen, surveillance using molecular identification in clinical settings is essential in providing accurate diagnosis and treatment of uncommon yeast infections.

A Stimulator of the Salivary Excretion Based on Physical Vibration of the Parotid Glands

Oral dryness causes significant health problems both functional (difficulty speaking, chewing and swallowing) and structural in teeth (increased number of infections) and oral mucosa. The main objective of this study is to show an alternative treatment to help stimulate the salivary secretion thus improving the quality of life of the patient. In this study, a salivary stimulation equipment using vibrotactile stimuli is shown. The system has been placed bilaterally in the parotid glands and assessed the efficacy of the salivary secretion by sialometry before and after the stimulation. The new proposal is capable of stimulating salivary secretion, in a significative way after 7 minutes of use, at least in the cases analyzed, and fulfills low-cost, easy-to-use, and safe technical restrictions. In this setting, this paper suggests the performance of a deep clinical trial to measure the exact efficacy of the prototype and the times and frequencies needed to state the optimal treatment depending in each case.

An assessment of unstimulated salivary flow rate, IgA and clinical oral dryness among active and passive smokers

OBJECTIVES

The aim of this study was to assess the impact of smoking on the whole salivary flow rate (SFR), IgA levels and clinical oral dryness (COD) among active and passive smokers.

MATERIAL AND METHODS

The participants were categorized as active smokers (N = 54) or passive smokers (N = 163). Saliva was collected in tubes and placed in ice storage at -70°C. Salivary IgA levels were assessed in duplication using the enzyme linked immunosorbent assay (ELISA) method. Following the saliva sample collection, the subjects were assessed for COD using the COD score, SFR and caries. Chi-square test, the t-test and ANOVA were employed to compare the clinical impact of the smoking status associated with specific variables (smoking status, number of cigarettes, active caries, gender, age, COD score, IgA level and SFR). A p-value of <0.05 was considered significant.

RESULTS

Two hundred and seventeen subjects with the mean age of 32.86±6.30 years, with 145 males (66.8%) and 72 females (33.2%), were included in the study. Among the active smokers, 88.8% were males compared to 11.2% females. The active smokers had the mean age of 32.52 years, a COD score of 1.43, an IgA level of 1.39 g/l, and a SFR of 0.37 ml/min. Among the passive smokers, 59.5% were males and 40.5% were females, with the mean age of 32.97 years, a COD score of 0.87 g/l, an IgA level of 1.47, and a SFR of 0.42 ml/min. Active caries showed a positive correlation with the number of cigarettes, with significance in the >35 years age group (p < 0.05).

CONCLUSIONS

The study demonstrated significant differences in SFR, IgA and COD scores among the active and passive smokers. The number of cigarettes had a negative impact on saliva production, IgA levels, the oral health status, and the progression of caries with respect to age and gender. Smoking potentially leads to xerostomia associated with active caries. Int J Occup Med Environ Health. 2022;35(1):39-51.

Effect of hepatitis C antiviral therapy on oral lichen planus and hyposalivation in inmates

Background

Oral lichen planus (OLP) and hyposalivation have been reported as extrahepatic manifestations of hepatitis C virus (HCV) infection. Our study evaluated the effect of direct antiviral agents (DAAs) on OLP and hyposalivation in convicts with chronic hepatitis C, examining patients before, during and after the antiviral treatment period with direct acting antiviral agents (DAAs).

Methods

We screened 198 inmates for the presence of the HCV antibody. Patients found to be positive underwent a quantitative HCV-RNA test and HCV genotype typing, as well as an oral cavity examination using a scoring system for OLP (REU score) and the clinical oral dryness score (CODS). Subsequently, all patients underwent DAA therapy and a systematic physical examination of the oral cavity at 1, 3 and 6 months from the beginning of treatment.

Results

Fifty patients (25.25%) had a positive HCV-RNA test. At baseline, OLP was detected in 4 patients (8%), with a mean REU score of 10.13±4, and different degrees of hyposalivation were seen in 17 patients (34%), with a mean CODS score of 4.71±1.72. Six months after the start of DAA therapy, we observed resolution of OLP in 3 patients (75%) and improvement in the remaining subject with a significantly lower mean REU score (2±4). Hyposalivation disappeared in 5 patients, improved in 10, and remained unchanged in 2 patients with a significantly lower mean CODS score (0.06±0.24).

Conclusion

This study demonstrated the effectiveness of DAAs in the treatment of OLP and hyposalivation.

Oral health-related quality of life in patients with early rheumatoid arthritis is associated with periodontal inflammation and painful temporomandibular disorders: a cross-sectional study

OBJECTIVES

To evaluate oral health-related quality of life (OHRQoL) in early rheumatoid arthritis (ERA) patients and individuals at risk of rheumatoid arthritis (RA) compared to healthy controls, and to explore possible associated factors.

MATERIALS AND METHODS

Fifty ERA patients, 50 at-risk individuals, and 50 age and gender matched healthy controls were recruited. OHRQoL (Oral Health Impact Profile-14 (OHIP-14)); number of decayed, missing, and filled teeth (DMFT); denture use; periodontal inflamed surface area (PISA); xerostomia (xerostomia inventory (XI)); and possible TMD (-pain) diagnoses were recorded. The groups were compared on these variables. Subsequently, backward multiple regression analyses were performed for the ERA and at-risk groups, with OHRQoL as the dependent variable and gender, age, DMFT, denture use, PISA, XI, non-painful TMD, and TMD pain as independent variables.

RESULTS

At-risk individuals had higher XI scores (U = 789.5, z = -3.181, p = 0.001, r = -0.32) and higher prevalence of TMD pain (p = 0.046, OR = 4.57; 95% CI 0.92-22.73) than healthy controls and higher OHIP-14 scores than the ERA group (U = 894.5, z = -2.418, p = 0.016, r = -0.24), while no difference in OHIP-14 was found between the control group and both other groups. For ERA patients, OHRQoL was associated with PISA and TMD pain (R2 = 0.498, p < 0.001). For at-risk individuals, OHRQoL was associated with XI score (R2 = 0.410, p < 0.001).

CONCLUSIONS

Alertness of health professionals to TMD pain and periodontal inflammation in ERA patients and to xerostomia and TMD pain in at-risk individuals is recommended.

CLINICAL RELEVANCE

The results of this study address orofacial aspects that require attention of health professionals in the timeframe around RA onset.

TRIAL REGISTRATION

Dutch National Trial Register (NTR, NTR6362).

Anticholinergic medication and dental caries status in middle-aged xerostomia patients-a retrospective study

Background/purpose

Xerostomia is the most frequent side effect of anticholinergic (AC) medications, which block the cholinergic neurotransmission of saliva secretion. As the most significant increase in AC medications’ usage reported in middle-aged adults, we aimed to explore whether the level of exposure to AC medication show association with the severity of caries status of middle-aged individuals who complained about medication-induced xerostomia.

Materials and methods

Our retrospective study included 414 individuals (between 45 and 64 years) with self-reported xerostomia. We determined caries status by the Decayed, Missing, or Filled Teeth (DMFT) index and quantified the level of AC drug exposure by the AC Drug Scale (ADS), verified through electronic medication records. Statistical analyses were performed using chi-square and ANOVA tests. Covariates were age, gender, smoking, edentulism, comorbidities, polypharmacy, number, and the type of AC medications.

Results

In total, 54% of patients were taking five or more AC drugs. The mean number of anticholinergics was 5.41 (±3.44), most frequently antidepressants and antipsychotics, among all medications 10.63 (±5.79). Higher ADS scores were associated (p = 0.006) with a higher number of missing teeth. Multiple linear regression model showed that the number of AC medications, age, and smoking status are associated with DMFT (mean of 18.7 ± 8.96) scores.

Conclusion

Caries status of middle-aged xerostomia patients was found to be reflective of the level of AC exposure from medications. Our finding emphasizes the importance of assessing AC medication burden in affected dental patients to improve clinical prevention strategies and guide interdisciplinary treatment plans.

Anticholinergic medication: Related dry mouth and effects on the salivary glands

OBJECTIVE

Salivary glands are among the most sensitive target organs of medications with anticholinergic (AC) properties, interrupting the neural stimulation of saliva secretion and reducing saliva flow. Hyposalivation results in dry mouth, leading to dental caries, intraoral infection, orofacial pain, problems with speaking and swallowing, and diminished oral health--related quality of life. Current understanding of the pharmacokinetics of AC medications and their effect on muscarinic receptors in the salivary glands were reviewed to assist clinicians in predicting salivary damage in patients with AC medication-induced dry mouth.

STUDY DESIGN

We summarized the literature related to the mechanisms and properties of AC medications, anticholinergic adverse effects, and their effect on salivary function and management strategies to prevent oral health damage.

RESULTS

Although a large number of studies reported on the frequencies of medication-induced dry mouth, we found very limited data on predicting individual susceptibility to AC medication--caused hyposalivation and no prospective clinical studies addressing this issue.

CONCLUSION

Dry mouth is most frequently caused by medications with AC properties, which interrupt the neural stimulation of saliva secretion. Interdisciplinary care should guide pharmacotherapeutics and dental interventions should aim in preventing AC salivary adverse effects and reducing the oral health burden from AC medication-induced dry mouth.

The association between oral dryness and use of dry-mouth interventions in Sjögren's syndrome patients

Objective

Sjögren’s syndrome patients use different dry-mouth interventions for the relieve of their oral dryness. Recently, it was shown that patients with dry-mouth complaints have regional differences in perceived intra-oral dryness. Therefore, the aim of the present study was to investigate whether the use of dry-mouth interventions is related to the perceived regional oral dryness.

Materials and methods

A cross-sectional study was performed among Sjögren’s patients. Volunteers could anonymously administer various questionnaires, including the Regional Oral Dryness Inventory (RODI), Xerostomia Inventory (XI), Bother Index (BI) and a list of dry-mouth interventions.

Results

Sjögren’s syndrome patients use a wide variety for the relieve of oral dryness. “Drinking water’’ and “moistening the lips’’ were used most frequently. Dry-mouth interventions, “drinking water’’, “rinsing of the mouth”, and “drinking small volumes” had significant associations with the RODI-scores of the posterior palate, and anterior and posterior tongue, respectively. On the other hand, “using mouth gel’’ had a significant association with the RODI-scores of the inside cheeks.

Conclusion

Sjögren’s syndrome patients are more likely to use mouth gels when their inside cheeks were experienced as most dry, while they drank water, rinsed their mouth or drank small volumes if the posterior palate, and anterior and posterior tongue were considered as dry. It can be concluded that intra-oral dryness affects dry-mouth perception and thereby also the use of the various dry-mouth interventions.

Clinical relevance

The therapeutic choice of dry-mouth interventions by Sjögren’s syndrome patients seems to some extent to be related to dryness at specific intra-oral regions.

Sialendoscopy increases saliva secretion and reduces xerostomia up to 60 weeks in Sjögren's syndrome patients: a randomized controlled study

Objective

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-five patients with SS were randomly assigned to a control group (no irrigation, control, n = 15), to irrigation of the major salivary glands with saline (saline, n = 15) or to irrigation with saline followed by corticosteroid application (triamcinolone acetonide in saline, saline/TA, n = 15). Unstimulated whole saliva flow (UWSF), chewing-stimulated whole saliva flow (SWSF), citric acid-stimulated parotid flow, Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) scores were obtained 1 week before (T0), and 1, 8, 16, 24, 36, 48 and 60 weeks after sialendoscopy. Data were analysed using linear mixed models.

Results

Irrespective of the irrigation protocol used, sialendoscopy resulted in an increased salivary flow during follow-up up to 60 weeks. Significant between-group differences in the longitudinal course of outcomes were found for UWSF, SWSF, XI and ESSPRI scores (P = 0.028, P = 0.001, P = 0.03, P = 0.021, respectively). UWSF at 60 weeks was higher compared with T0 in the saline group (median: 0.14 vs median: 0.10, P = 0.02) and in the saline/TA group (median: 0.20, vs 0.13, P = 0.035). In the saline/TA group SWSF at 48 weeks was higher compared with T0 (median: 0.74 vs 0.38, P = 0.004). Increase in unstimulated salivary flow was also reflected in improved CODS, XI and ESSPRI scores compared with baseline.

Conclusion

Irrigation of the major salivary glands in patients with SS increases salivary flow and reduces xerostomia.

Recent Advances in Salivary Scintigraphic Evaluation of Salivary Gland Function

Saliva plays an important role in supporting upper gastrointestinal tract function and oral well-being. Salivary dysfunction mainly manifests with a decrease in salivary flow. Among varieties of quantitative methods, salivary scintigraphy is a relatively noninvasive, well-tolerated, reproducible, and objective approach for functional evaluation of salivary disorders, yet the lack of precise quantitative reference values and no standardized protocol limit its generalized utilization. In this article, we review the scintigraphic performance between the visual analysis and quantitative methods in predicting Sjögren’s syndrome and verify the potential aspects of the application in interpreting different disease entities and phases of functional salivary disorders.

Xerostomia and hyposalivation among a 65-yr-old population living in Oslo, Norway

This study aimed to describe the prevalence and associated factors for xerostomia and hyposalivation in a young‐elderly population. A random sample of 460 65‐yr‐old people living in Oslo, Norway, answered a questionnaire and underwent a clinical examination (237 men and 223 women; response rate 58%). Ten percent of respondents reported xerostomia. The median Summated Xerostomia Index was 6 (interquartile range [IQR]: 5–7) and the median Clinical Oral Dryness Score was 2 (IQR: 1–3). The median unstimulated whole saliva (UWS) secretion rate was 0.34 (IQR: 0.20–0.53) mL min^–1 and the median stimulated whole saliva (SWS) secretion rate was 1.74 (IQR: 1.24–2.38) mL min^–1. In 8% of the study participants the UWS secretion rate was ≤0.1 mL min^–1 and in 4% the SWS secretion rate was ≤0.7 mL min^–1. Three percent of the study participants had both xerostomia and hyposalivation with respect to UWS. Xerostomia was significantly associated with medication use, having rheumatic disease, and having received radiation therapy to the head/neck region. Hyposalivation with respect to UWS and SWS was significantly associated with medication use and type II diabetes. Even though xerostomia and hyposalivation were not prevalent conditions in this population, clinicians should be especially aware of the salivary conditions in patients taking four or more medications, patients diagnosed with type II diabetes, and those who have undergone radiation therapy to the head/neck region.

Differences in perceived intra-oral dryness in various dry-mouth patients as determined using the Regional Oral Dryness Inventory

Objectives

Recently, it was shown that the Regional Oral Dryness Inventory (RODI) could determine differences in dry-mouth perception at different intra-oral locations. The main aim of this study was to determine whether the RODI might help to discriminate between various causes of oral dryness in dry-mouth patients. The second aim was to ascertain whether the RODI could become an additional diagnostic tool in dry-mouth patients.

Materials and methods

Data were collected retrospectively from patients who visited a specialized saliva clinic. Salivary flow rates, Xerostomia Inventory scores, and RODI scores were extracted from the medical records. Patients were stratified into subgroups according to their health status.

Results

Five hundred twenty-eight patients participated in this study (mean age of 59.6 ± 16.0 years; 68.4% female). Specific patient groups differed with regard to the region of the mouth they experienced as the most and least dry. The posterior palate was the area perceived as most dry by controls and Sjögren patients. In patients using limited or multiple medications, it was the anterior tongue. RODI scores also differed significantly among dry-mouth patient groups: whereas controls and patients using limited medication had the lowest RODI scores and experienced less intra-oral dryness, Sjögren patients had the highest RODI scores.

Conclusion

Our use of the RODI questionnaire showed that perceived intra-oral dryness differed between the various dry-mouth patients.

Clinical relevance

The RODI can be a valuable clinical diagnostic tool in dry-mouth diagnostics, in which it can be used to discriminate between the various causes of oral dryness in patients.

Xerostomia and polypharmacy among dependent older New Zealanders: a national survey

BACKGROUND

Medication-induced xerostomia is common in older people. We investigated medication use and xerostomia in dependent older New Zealanders.

METHODS

Medication and xerostomia data analysed from a nationally representative survey of dependent older people. Automatic interaction detection analysis identified medications combinations most strongly associated with xerostomia, and then xerostomia was modelled.

RESULTS

Just over half were taking five to nine different medications; one in five was taking 10+. Xerostomia prevalence (29.4%; 95% confidence interval 26.5, 32.5) was higher among the latter and lowest in psychogeriatric patients. After controlling for age and sex, it was higher among people taking any antidepressant, and higher still with a tricyclic antidepressant and either a steroid or an anticholinergic, or among people taking a bronchodilator without prophylactic aspirin.

CONCLUSIONS

Health practitioners should work together to ensure that those with xerostomia are managed in a timely and appropriate manner. Medication review is an important component of that.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium

BACKGROUND

The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs.

METHODS

Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence.

RESULTS

Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP).

CONCLUSIONS

The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBERS

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

Oral health and salivary function in ulcerative colitis patients

Background

Although ulcerative colitis primarily involves the colon, extra-intestinal manifestations are common and oral and dental complaints are no exception.

Objective

This study aims at evaluating oral and dental health problems and salivary function and composition in ulcerative colitis patients and its correlation with disease activity.

Methods

Xerostomia Inventory score, (unstimulated/stimulated) salivary flow rates, salivary amylase and mucin/ Mucin 5B levels, self-reported oral and dental complaints, the oral health related quality of life, Simple Clinical Colitis Activity Index and inflammatory bowel disease-specific health related quality of life were determined.

Results

The cohort consisted of 51 ulcerative colitis patients. Hyposalivation was experienced by 16% of patients under resting conditions and 24% under chewing-stimulated conditions. Xerostomia was not correlated with salivary flow rates. Disease activity did not influence salivary amylase and Mucin 5B concentrations. The Xerostomia Inventory score was correlated with the Simple Clinical Colitis Activity Index (p = 0.042) and inflammatory bowel disease-specific health related quality of life (p = 0.001). Most reported oral health problems were halitosis (29%) and aphthae (28%). Frequently reported dental problems were cavities (35%) and gum problems (31%). Patients with active disease experienced significantly more oral and dental complaints. The number of oral problems was positively correlated with the Simple Clinical Colitis Activity Index (p = 0.045) and negatively correlated with the inflammatory bowel disease-specific health related quality of life (p = 0.005).

Conclusion

The subjective feeling of a dry mouth (xerostomia) is related to disease activity and disease activity-associated quality of life in ulcerative colitis patients, whereas the objective saliva secretion rate is not. Oral and dental health problems are frequently observed in patients with ulcerative colitis, especially during active disease.

A Tutorial on Saliva's Role in Swallowing With a Focus on Sjögren's Syndrome

Purpose Saliva is integral to swallowing and necessary for oral health. Understanding saliva's origin and properties is important for swallowing assessment and management. Diseases such as Sjögren's syndrome (SS) can affect saliva negatively, often contributing to dysphagia. Our objectives are to (a) highlight saliva's fundamental role in swallowing, (b) provide a bibliometric overview of literature pertaining to SS pathophysiology and effects on saliva, (c) explore implications of salivary changes on swallowing and quality of life in SS and other populations, and (d) provide suggestions for systematic saliva assessment in practice. Method This tutorial reviews saliva production, composition, and involvement in swallowing within health and disease. Using rapid review methodology, we outline the effect of SS on saliva and describe SS etiology, diagnosis, and treatment. We discuss formal saliva assessments and a multidisciplinary approach. Results Saliva plays a vital role in swallowing, particularly lubrication, bolus formation, and oral health. SS affects the salivary glands altering salivary flow rate and composition. We identified 55 studies (N) measuring salivary changes, grouping them according to four strata demarcated by SS classification criteria updates. For some, xerostomia, dysphagia, and reduced life quality result. Formal saliva assessments include the Clinical Oral Dryness Score, Xerostomia Inventory, and Secretion Rating Scale. Multidisciplinary care is optimal for patients with salivary changes. Conclusion Understanding salivary changes in disease may enhance understanding of swallowing and inform dysphagia practice. Expanding swallowing assessments with formal saliva evaluations, and patient perspectives thereof, may aid in developing bespoke treatments, ultimately improving outcomes and quality of life. Supplemental Material https://doi.org/10.23641/asha.12456449.

Regional differences in perceived oral dryness as determined with a newly developed questionnaire, the Regional Oral Dryness Inventory

OBJECTIVES

Several questionnaires, such as the internationally validated and frequently used Xerostomia Inventory (XI), have been developed to quantify the subjective feeling of a dry mouth. These questionnaires quantify the overall perception of dry mouth but lack the possibility to differentiate between various intra-oral regions. In this light, a novel questionnaire, the Regional Oral Dryness Inventory (RODI), which quantifies the severity of dryness at various locations in the mouth, was evaluated.

MATERIALS AND METHODS

A retrospective case report study was designed. Data were collected from patients who visited the saliva clinic for Special Care Dentistry in Amsterdam. Data, including the saliva secretion rates, RODI scores, the Xerostomia Inventory (XI) score, and Clinical Oral Dryness Score (CODS), were extracted from the electronic health record system Oase Dental.

RESULTS

A total of 337 patients participated in this study with an average age of 54 ± 17 years. The majority of the patients were female (68.5%). The perceived dryness as determined by the RODI was the highest for the posterior palate and the lowest for the floor of the mouth. The highest correlations were found between the corresponding regions in the RODI and regionally related individual items of the XI and CODS.

CONCLUSION

There is a significant difference in dry-mouth feeling at different intra-oral locations.

CLINICAL RELEVANCE

Regional evaluation of xerostomia with RODI might improve diagnosis of xerostomia by helping to discriminate between different potential causes of oral dryness in patients and for evaluating the efficacy of mouth-moistening products. RODI is highly accessible and easy to perform in dental practices during routine clinical assessment.

Disease activity and patient reported outcome measures in Sjögren's - what are the best tools to evaluate?

In primary SS (pSS), clinical features in SS can be divided into two facets: the patient perceived manifestations such as dryness, pain and fatigue, and the systemic manifestations. In the past decades, with efforts made by an international collaboration, consensual clinical indexes were developed for assessing both facets: one patient reported outcome, the EULAR SS Patients Reported Index (ESSPRI), and one activity index for systemic manifestations, the EULAR SS Disease Activity Index (ESSDAI). In addition, objective measures were developed to quantify the importance and consequence of ocular and oral dryness, few being specific of pSS. Work is ongoing to develop indexes combining all these approaches. Recent changes in the assessment of pSS patients, and the emergence of new targeted therapies, have put a greater emphasis on the design of clinical trials in pSS, and led for the first time to a positive randomized clinical trial.

Correlation between Xerostomia index, Clinical Oral Dryness Scale, and ESSPRI with different hyposalivation tests

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.

Sialendoscopy enhances salivary gland function in Sjögren's syndrome: a 6-month follow-up, randomised and controlled, single blind study

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.