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Khavandgar Z, Warner BM, Baer AN. Evaluation and management of dry mouth and its complications in rheumatology practice. Expert Rev Clin Immunol 2024; 20:1-19. [PMID: 37823475 PMCID: PMC10841379 DOI: 10.1080/1744666x.2023.2268283] [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: 06/02/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The symptom of dry mouth has multiple potential etiologies and can be a diagnostic clue to the presence of common systemic diseases encountered in rheumatology practice. The presence of decreased saliva flow (i.e. salivary hypofunction) defines a subset of dry mouth patients in whom there may be reversible drug effects, an iatrogenic insult such as head and neck irradiation, or a disease that directly involves the salivary glands (e.g. Sjögren's disease). The assessment of salivary hypofunction includes sialometry, salivary gland imaging, salivary gland biopsy, and an assessment for relevant systemic diseases. Optimal management of dry mouth requires accurate definition of its cause, followed by general measures that serve to alleviate its symptoms and prevent its complications. AREAS COVERED Through a literature search on xerostomia and salivary hypofunction, we provide an overview of the causes of dry mouth, highlight the potential impact of salivary hypofunction on oral and systemic health, detail routine evaluation methods and treatment strategies, and emphasize the importance of collaboration with oral health care providers. EXPERT OPINION Our Expert Opinion is provided on unmet needs in the management of dry mouth and relevant research progress in the field.
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Affiliation(s)
- Zohreh Khavandgar
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Blake M. Warner
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Alan N. Baer
- Johns Hopkins University School of Medicine, Baltimore, MD
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Fox RI, Fox CM, Gottenberg JE, Dörner T. Treatment of Sjögren's syndrome: current therapy and future directions. Rheumatology (Oxford) 2021; 60:2066-2074. [PMID: 31034046 DOI: 10.1093/rheumatology/kez142] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/08/2019] [Indexed: 12/12/2022] Open
Abstract
SS is usually described as having severe fatigue, dryness, diffuse pain, glandular swelling, and various extraglandular (systemic) manifestations. Clinical trials have generally failed because the vast majority of enrolled patients had no extraglandular manifestations at the time of enrolment but suffered from fatigue, dryness and pain that did not significantly respond to the study medication. A number of hypotheses on the pathogenesis of pSS have been put forward, including disturbances of innate and adaptive immunity as well as abnormalities of the interface between immune disorders and the neuro-endocrine system related to lacrimal and secretory gland dysfunction. Thus, future therapies must be designed for improvement of the symptoms of dry eyes and dry mouth, extraglandular disease, and fatigue and cognitive deficits. Given the inadequacies and limitations of current treatment options, we suggest that innovative directions involving interactions with neuroscientists and neuropsychiatrists together or combined with new immune targeting may be hold promise for better treating pSS.
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Affiliation(s)
- Robert I Fox
- Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, CA
| | - Carla M Fox
- Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, CA
| | - Jacques Eric Gottenberg
- Strasbourg University Hospital, National Center for Rare Systemic Autoimmune Diseases, Strasbourg, France
| | - Thomas Dörner
- Department of Medicine/Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin & DRFZ Berlin, Berlin, Germany
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Pego-Reigosa JM, Restrepo Vélez J, Baldini C, Rúa-Figueroa Fernández de Larrinoa Í. Comorbidities (excluding lymphoma) in Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:2075-2084. [PMID: 30770715 DOI: 10.1093/rheumatology/key329] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
The information about comorbidities (excluding lymphoma) in primary Sjögren's syndrome (pSS) is relatively scarce. Cardiovascular disease, infections, musculoskeletal conditions or malignancy are likely the most relevant comorbid conditions in pSS. Different infections (particularly oral candidal infections) and fibromyalgia are extremely frequent in the daily clinical practice. On the other hand, the incidence of cardiovascular events and cancer in pSS is low, so information about them comes from large epidemiological studies or meta-analysis. For this reason, preclinical vascular disease is investigated by different techniques, demonstrating the presence of early atherosclerosis in pSS patients. Coronary events could be slightly more frequent in pSS than in the general population. The overall risk of malignancy in pSS patients seems to be slightly increased, likely due to excess occurrence of lymphoma. An association between pSS and thyroid cancer might exist, although it should be confirmed by further investigations.
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Millet N, Solis NV, Swidergall M. Mucosal IgA Prevents Commensal Candida albicans Dysbiosis in the Oral Cavity. Front Immunol 2020; 11:555363. [PMID: 33193324 PMCID: PMC7642201 DOI: 10.3389/fimmu.2020.555363] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
The fungus Candida albicans colonizes the oral mucosal surface of 30–70% of healthy individuals. Due to local or systemic immunosuppression, this commensal fungus is able to proliferate resulting in oral disease, called oropharyngeal candidiasis (OPC). However, in healthy individuals C. albicans causes no harm. Unlike humans mice do not host C. albicans in their mycobiome. Thus, oral fungal challenge generates an acute immune response in a naive host. Therefore, we utilized C. albicans clinical isolates which are able to persist in the oral cavity without causing disease to analyze adaptive responses to oral fungal commensalism. We performed RNA sequencing to determine the transcriptional host response landscape during C. albicans colonization. Pathway analysis revealed an upregulation of adaptive host responses due to C. albicans oral persistence, including the upregulation of the immune network for IgA production. Fungal colonization increased cross-specific IgA levels in the saliva and the tongue, and IgA+ cells migrated to foci of fungal colonization. Binding of IgA prevented fungal epithelial adhesion and invasion resulting in a dampened proinflammatory epithelial response. Besides CD19+ CD138− B cells, plasmablasts, and plasma cells were enriched in the tongue of mice colonized with C. albicans suggesting a potential role of B lymphocytes during oral fungal colonization. B cell deficiency increased the oral fungal load without causing severe OPC. Thus, in the oral cavity B lymphocytes contribute to control commensal C. albicans carriage by secreting IgA at foci of colonization thereby preventing fungal dysbiosis.
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Affiliation(s)
- Nicolas Millet
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, United States.,Institute for Infection and Immunity, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Norma V Solis
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, United States.,Institute for Infection and Immunity, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Marc Swidergall
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, United States.,Institute for Infection and Immunity, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.,David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Rhodus NL, Bloomquist C, Liljemark W, Bereuter J. OralCandida albicansin Patients with Sjögren's Syndrome. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556139907800110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Cynthia Bloomquist
- Departments of Diagnostic-Surgical Sciences, University of Minnesota, Minneapolis, Minnesota
| | - William Liljemark
- Departments of Diagnostic-Surgical Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Janna Bereuter
- Departments of Minnesota Clinical Dental Research Center, Minneapolis, Minnesota
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Price EJ, Baer AN. How to treat Sjögren's syndrome. Rheumatology (Oxford) 2019; 60:2574-2587. [PMID: 30770917 DOI: 10.1093/rheumatology/key363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/03/2018] [Indexed: 01/03/2023] Open
Abstract
SS is a chronic, autoimmune disease of unknown aetiology for which there is no known curative treatment. Although dryness of the eyes and mouth are the classically described features, patients often experience drying of other mucosal surfaces and systemic manifestations, including fatigue and arthralgia. There is an association with other autoimmune diseases, especially thyroid disease, coeliac disease and primary biliary cholangitis. Systemic features may affect up to 70% and include inflammatory arthritis, skin involvement, haematological abnormalities, neuropathies, interstitial lung disease and a 5-10% lifetime risk of B cell lymphoma. Treatment should aim to empower patients to manage their condition; conserve, replace and stimulate secretions; prevent damage; and suppress underlying systemic disease activity.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Alan N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zampeli E, Kalogirou EM, Piperi E, Mavragani CP, Moutsopoulos HM. Tongue Atrophy in Sjögren Syndrome Patients with Mucosa-associated Lymphoid Tissue Lymphoma: Autoimmune Epithelitis beyond the Epithelial Cells of Salivary Glands? J Rheumatol 2018; 45:1565-1571. [DOI: 10.3899/jrheum.180101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/22/2022]
Abstract
Objective.Primary Sjögren syndrome (pSS), an autoimmune epithelitis, bears the risk of evolving to non-Hodgkin lymphoma and most frequently to the mucosa-associated lymphoid tissue (MALT) subtype. Based on the observation that pSS patients with MALT present a more atrophic and more intensely fissured tongue, we aimed to semiquantify severity of tongue atrophy and clinically assess lingual appearance in pSS patients with and without MALT, and investigate whether tongue atrophy and fissured appearance could serve as clinical indicators/signs of MALT.Methods.A blinded complete oral examination was performed in pSS patients with and without MALT. Tongue atrophy was scored using a semiquantified atrophy score. Clinical and laboratory variables were recorded for all patients.Results.After excluding pSS patients with oral candidiasis, iron deficiency, and megaloblastic anemia, 19 pSS patients with salivary MALT were matched 1:3 for age, sex, and disease duration with 57 pSS patients without MALT. The pSS-MALT patients had increased prevalence of salivary gland enlargement, lymphadenopathy, monoclonal gammopathy, rheumatoid factor positivity, higher focus and Tarpley scores in the minor salivary gland biopsy, and hyposalivation, compared to the pSS non-MALT patients. A significantly higher prevalence of tongue atrophy (68% vs 30%, p = 0.006) and fissured tongue (89% vs 33%, p < 0.001) was observed in the former group. Multivariate analysis showed that fissured tongue appearance, hyposalivation, and lymphadenopathy associate independently with salivary MALT in pSS.Conclusion.These results suggest that pSS patients with lymphoid malignancy exhibit a more atrophic and more fissured tongue. This particular clinical tongue appearance can serve as an additional clinical sign for salivary MALT lymphoma in pSS patients.
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Serrano J, Lopez-Pintor RM, Gonzalez-Serrano J, Fernandez-Castro M, Casanas E, Hernandez G. Oral lesions in Sjogren's syndrome: A systematic review. Med Oral Patol Oral Cir Bucal 2018; 23:e391-e400. [PMID: 29924754 PMCID: PMC6051685 DOI: 10.4317/medoral.22286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/18/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sjogren's syndrome (SS) is an autoimmune disease related to two common symptoms: dry mouth and eyes. Although, xerostomia and hyposialia have been frequently reported in these patients, not many studies have evaluated other oral manifestations. The aim of this systematic review was to investigate prevalence rates of oral lesions (OL) in SS patients and to compare it to a control group (CG), when available. MATERIAL AND METHODS An exhaustive search of the published literature of the Pubmed, Scopus, Web of Science and the Cochrane Library databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) for relevant studies that met our eligibility criteria (up to September 1st 2017). RESULTS Seventeen cross-sectional studies and one cohort study were finally included. The results showed that SS patients presented more OL compared to non-SS patients. The most frequent types of OL registered in primary and secondary SS were angular cheilitis, atrophic glossitis, recurrent oral ulcerations and grooves or fissurations of the tongue, also when compared to a CG. CONCLUSIONS OL are common and more frequent in SS patients when compared to a CG. This may be a consequence of low levels of saliva. More studies where these OL and all the possible cofounding factors are taken into account are needed.
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Affiliation(s)
- J Serrano
- Departamento de Especialidades, Clinicas Odontologicas, Facultad de Odontologia, Universidad Complutense de Madrid, Plaza Ramon y Cajal s/n, 28040 Madrid, Spain,
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Medeiros CCG, dos Anjos Borges LG, Cherubini K, Salum FG, Medina da Silva R, de Figueiredo MAZ. Oral yeast colonization in patients with primary and secondary Sjögren's syndrome. Oral Dis 2018; 24:1367-1378. [DOI: 10.1111/odi.12896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Luiz Gustavo dos Anjos Borges
- Geobiology Laboratory; Institute of Petroleum and Natural Resources; Pontifical Catholic University of Rio Grande do Sul (PUCRS); Porto Alegre RS Brazil
| | - Karen Cherubini
- Department of Oral Medicine; Pontifical Catholic University of Rio Grande do Sul (PUCRS); Porto Alegre RS Brazil
| | - Fernanda Gonçalves Salum
- Department of Oral Medicine; Pontifical Catholic University of Rio Grande do Sul (PUCRS); Porto Alegre RS Brazil
| | - Renata Medina da Silva
- Immunology and Microbiology Laboratory; Biosciences School; Pontifical Catholic University of Rio Grande do Sul (PUCRS); Porto Alegre RS Brazil
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Bhaskaran N, Weinberg A, Pandiyan P. Th17 inflammation model of oropharyngeal candidiasis in immunodeficient mice. J Vis Exp 2015:52538. [PMID: 25742163 PMCID: PMC4354660 DOI: 10.3791/52538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Oropharyngeal Candidiasis (OPC) disease is caused not only due to the lack of host immune resistance, but also the absence of appropriate regulation of infection-induced immunopathology. Although Th17 cells are implicated in antifungal defense, their role in immunopathology is unclear. This study presents a method for establishing oral Th17 immunopathology associated with oral candidal infection in immunodeficient mice. The method is based on reconstituting lymphopenic mice with in vitro cultured Th17 cells, followed by oral infection with Candida albicans (C. albicans). Results show that unrestrained Th17 cells result in inflammation and pathology, and is associated with several measurable read-outs including weight loss, pro-inflammatory cytokine production, tongue histopathology and mortality, showing that this model may be valuable in studying OPC immunopathology. Adoptive transfer of regulatory cells (Tregs) controls and reduces the inflammatory response, showing that this model can be used to test new strategies to counteract oral inflammation. This model may also be applicable in studying oral Th17 immunopathology in general in the context of other oral diseases.
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Affiliation(s)
- Natarajan Bhaskaran
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University
| | - Aaron Weinberg
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University
| | - Pushpa Pandiyan
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University;
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Levels of the antimicrobial proteins lactoferrin and chromogranin in the saliva of individuals with oral dryness. J Prosthet Dent 2014; 113:35-8. [PMID: 25300178 DOI: 10.1016/j.prosdent.2013.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/21/2013] [Accepted: 12/05/2013] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Many individuals in an aging society experience oral dryness. Maintaining the flow of saliva and the presence of antimicrobial substances is important to maintain oral health. The inhibition of the secretion of antimicrobial substances could lead to oral dryness. PURPOSE The purpose of this study was to evaluate the antimicrobial substances lactoferrin and chromogranin A in the saliva of elderly individuals with oral dryness. MATERIAL AND METHODS The study included 25 controls and 28 participants with subjective oral dryness. The levels of lactoferrin and chromogranin A were determined in unstimulated whole saliva with an enzyme-linked immunosorbent assay method. The differences in secretion of lactoferrin and chromogranin A between the controls and the participants with oral dryness were analyzed with the Mann-Whitney U test (α=.05). RESULTS The flow rate of lactoferrin and chromogranin A was lower in the group of participants with oral dryness (lactoferrin, 7.43 ±7.08 ng/min; chromogranin A, 0.24 ±0.24 ng/min) than in the control group (lactoferrin, 21.52 ±7.67 ng/min; chromogranin A, 0.97 ±0.69 ng/min) (P<.01). The ratio of both antimicrobial proteins to total protein was also lower in participants with oral dryness than in the controls. CONCLUSIONS The results of this study indicated that the levels of lactoferrin and chromogranin A were lower in those with oral dryness. A reduction in the secretion of these antimicrobial substances may be associated with oral dryness.
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Feng P, Huang L, Wang H. Taste bud homeostasis in health, disease, and aging. Chem Senses 2013; 39:3-16. [PMID: 24287552 DOI: 10.1093/chemse/bjt059] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The mammalian taste bud is an onion-shaped epithelial structure with 50-100 tightly packed cells, including taste receptor cells, supporting cells, and basal cells. Taste receptor cells detect nutrients and toxins in the oral cavity and transmit the sensory information to gustatory nerve endings in the buds. Supporting cells may play a role in the clearance of excess neurotransmitters after their release from taste receptor cells. Basal cells are precursor cells that differentiate into mature taste cells. Similar to other epithelial cells, taste cells turn over continuously, with an average life span of about 8-12 days. To maintain structural homeostasis in taste buds, new cells are generated to replace dying cells. Several recent studies using genetic lineage tracing methods have identified populations of progenitor/stem cells for taste buds, although contributions of these progenitor/stem cell populations to taste bud homeostasis have yet to be fully determined. Some regulatory factors of taste cell differentiation and degeneration have been identified, but our understanding of these aspects of taste bud homoeostasis remains limited. Many patients with various diseases develop taste disorders, including taste loss and taste distortion. Decline in taste function also occurs during aging. Recent studies suggest that disruption or alteration of taste bud homeostasis may contribute to taste dysfunction associated with disease and aging.
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Affiliation(s)
- Pu Feng
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA 19104, USA.
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Keszler A, Adler LI, Gandolfo MS, Masquijo Bisio PA, Smith AC, Vollenweider CF, Heidenreich AM, de Stefano G, Kambo MV, Cox DP, Narbaitz M, Lanfranchi HE. MALT lymphoma in labial salivary gland biopsy from Sjögren syndrome: importance of follow-up in early detection. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e28-33. [PMID: 23157989 PMCID: PMC3593994 DOI: 10.1016/j.oooo.2012.07.481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/27/2012] [Accepted: 07/24/2012] [Indexed: 02/07/2023]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphomas are known to occur in Sjögren syndrome (SS) patients, but reported cases in labial salivary glands (LSG) are rare. We report a case of 60-year-old female patient with SS who developed MALT lymphoma in the labial salivary glands during a 2-year time interval when she was participating in the Sjögren's International Clinical Collaborative Alliance, an ongoing longitudinal multisite observational study funded by the National Institutes of Health of the United States. At follow-up exam, LSG biopsy showed atypical diffuse infiltration by mononuclear cells of variable size and atypical nuclei affecting the whole specimen with destruction of glandular architecture, leading to a diagnosis of B-cell MALT lymphoma. Computerized tomography and bone marrow biopsy failed to show additional evidence of disease. Clinical, serologic, ocular, histologic and immunohistochemical findings are presented. A "watch and wait" policy was adopted with regular examinations.
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Affiliation(s)
- A Keszler
- Department of Oral Pathology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina.
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Vitali C, Palombi G, Cataleta P. Treating Sjögren's Syndrome: Insights for the Clinician. Ther Adv Musculoskelet Dis 2012; 2:155-66. [PMID: 22870445 DOI: 10.1177/1759720x10363246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease that affects the exocrine glands, mainly the salivary and lachrymal glands, with consequent persistent dryness of the mouth and eyes. In addition to the clinical manifestations related to the exocrine gland involvement, a consistent prevalence of patients may present systemic manifestations. Some of these can be ascribed to the periepithelial extension of lymphocytic infiltration whilst others are determined by an immunomediated process affecting small- or medium-size vessels. While the use of tear and saliva substitutes and local or systemic stimulation of residual secretions represent the mainstays of the therapy of sicca component, different immunomodulating or immunosuppressive agents are usually required to treat extraglandular features, similarly to what happens in other connective tissue diseases. In the last few years, the advancement in the understanding the pathogenetic mechanisms of this disorder and the availability of new biologic target therapies seem to offer completely new therapeutic options. The use of B cell depleting or modulating therapies has achieved promising results.
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Affiliation(s)
- Claudio Vitali
- Department of Internal Medicine and Section of Rheumatology, 'Villamarina' Hospital, Piombino, Italy
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Xerostomia and salivary flow in patients with orofacial pain compared with controls. Arch Oral Biol 2011; 56:1142-7. [DOI: 10.1016/j.archoralbio.2011.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 03/28/2011] [Accepted: 04/03/2011] [Indexed: 01/22/2023]
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López-Jornet MP, García-Teresa G, Viñas M, Vinuesa T. Clinical and antimicrobial evaluation of a mouthwash and toothpaste for xerostomia: a randomized, double-blind, crossover study. J Dent 2011; 39:757-63. [PMID: 21864644 DOI: 10.1016/j.jdent.2011.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Specific toothpaste and mouthwash for xerostomia based on triclosan, fluoride, and mineral salts were studied in order to evaluate their efficacy in improving the quality of life as well as their in vitro antimicrobial action. MATERIALS AND METHODS 30 patients with dry mouth and hyposalivation confirmed by sialometry were included in a randomized, double-blind, crossover study, during two weeks for each experimental phase. Dryness and oral comfort, difficulty in speaking, chewing, swallowing and using dental prostheses, as well as taste and sleep disorders were evaluated. Values of minimal biocidal and minimal inhibitory concentrations of both products against microorganisms that often cause oral disorders in these patients were determined and compared. RESULTS The use of the mouthwash and toothpaste studied improved the dry mouth symptoms, whilst no significant differences when compared with the salivary enzyme substitutes were observed. The test products showed, in general, a higher biocidal and inhibitory action than the control products, with particularly noteworthy action against cariogenic bacteria. CONCLUSIONS The use of a toothpaste and mouthwash based on triclosan, fluoride, gingival revitalizers and mineral salts, improves the quality of life of patients suffering xerostomia.
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A Mandibular Implant-Supported Fixed Complete Dental Prosthesis in a Patient With Sjogren Syndrome: Case Report. IMPLANT DENT 2010; 19:178-83. [DOI: 10.1097/id.0b013e3181dbe081] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Daniels TE, Kapila YL. Comments on atrophic lingual papillae and candidiasis in Sjögren syndrome. ACTA ACUST UNITED AC 2009; 109:4; author reply 4. [PMID: 19828340 DOI: 10.1016/j.tripleo.2009.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 11/27/2022]
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Leung KCM, McMillan AS, Cheung BPK, Leung WK. Sjögren's syndrome sufferers have increased oral yeast levels despite regular dental care. Oral Dis 2008; 14:163-73. [PMID: 18302677 DOI: 10.1111/j.1601-0825.2007.01368.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the prevalence and quantity of oral yeasts and their association with oral candidiasis in Sjögren's syndrome (SS) patients receiving regular dental care. MATERIALS AND METHODS Yeasts in oral rinse and full-mouth supra-gingival plaque samples from 25 primary SS, 27 secondary SS and 29 control subjects were selectively cultured. All yeasts except single-species isolates were genotyped using pulsed field gel electrophoresis (PFGE). RESULTS Ten (19%) SS sufferers had symptomless candidiasis. SS subjects had a higher prevalence (73%vs 7%) and quantity of yeasts than controls in both oral rinse and plaque samples (P < 0.05). The prevalence of yeasts in plaque was associated with candidiasis regardless of denture wearing (P < or = 0.04). Candida albicans was the predominant yeast isolated. PFGE showed 20 (66% of total) C. albicans isolate pairs, i.e. C. albicans species isolated from plaque and oral rinse samples of the same individual, were of closely related genetic clonal types (P < 0.01). CONCLUSIONS Despite effective oral hygiene, more SS subjects than controls had detectable levels of oral yeasts and their presence in supra-gingival plaque was associated with candidiasis. Candida albicans colonized supra-gingival biofilm even in well-maintained SS individuals, posing a challenge to the control of oral candidiasis.
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Affiliation(s)
- K C M Leung
- Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Mavragani CP, Moutsopoulos NM, Moutsopoulos HM. The management of Sjögren's syndrome. ACTA ACUST UNITED AC 2006; 2:252-61. [PMID: 16932698 DOI: 10.1038/ncprheum0165] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 12/14/2005] [Indexed: 12/19/2022]
Abstract
Sjögren's syndrome is a chronic autoimmune disorder, characterized by lymphocytic infiltration and malfunction of the exocrine glands, resulting in dry mouth and eyes. The syndrome can present either alone (primary Sjögren's syndrome) or in the context of an underlying connective tissue disease (secondary Sjögren's syndrome). Systemic features, resulting from cutaneous, respiratory, renal, hepatic, neurologic, and vascular involvement, often occur. Two types of primary Sjögren's syndrome are currently recognized: a benign disease that affects quality of life, and a systemic syndrome associated with increased morbidity and mortality owing to a high risk of malignant transformation, and that requires close follow-up. Ocular involvement, manifested as keratoconjunctivitis sicca, is managed with local and systemic stimulators of tear secretion and supportive surgical procedures. Treatment of oral manifestations includes intense oral hygiene, prevention and treatment of oral infections, use of saliva substitutes, and local and systematic stimulation of salivary secretion. Cholinergic agents, such as pilocarpine and cevimeline, are helpful in patients with residual salivary function, and ciclosporin ocular drops seem to be of some benefit. Systemic immunosuppressives are reserved for treatment of severe extraglandular manifestations of Sjögren's syndrome. Anti-B-cell therapy is a new potential therapy for the glandular and extraglandular manifestations, such as glomerulonephritis or vasculitis, in addition to the management of lymphoma associated with Sjögren's syndrome. Induction of oral tolerance and gene-transfer modalities were recently attempted in animal models, with promising results.
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Leung KCM, McMillan AS, Leung WK, Wong MCM, Lau CS, Mok TMY. Oral health condition and saliva flow in southern Chinese with Sjögren’s syndrome. Int Dent J 2004; 54:159-65. [PMID: 15218897 DOI: 10.1111/j.1875-595x.2004.tb00273.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the oral health condition and saliva flow of southern Chinese patients with Sjögren's syndrome (SS). METHOD 51 SS patients (26 primary and 25 secondary cases) and 29 controls took part in this cross-sectional study. Stimulated whole and parotid saliva flow rates, pH, and buffer capacity, and xerostomia, oral mucosal lesions, oral hygiene status, dental and periodontal conditions, prosthetic status were assessed and compared between groups. RESULTS Stimulated whole saliva (SWS) flow was reduced in primary and secondary SS cases (p<0.001), pH and buffer capacity were also reduced in the primary SS group (p<0.05). SS patients had a greater prevalence of xerostomia than controls (p<0.001). Primary SS patients had a higher mean DMFT, more missing teeth, and more prostheses than secondary SS cases and controls (p<0.05). SWS flow correlated negatively with the number of filled teeth in both SS groups (p<0.05) and the number of decayed teeth in the primary SS group (p<0.05). CONCLUSION Despite good oral hygiene and regular dental check-ups, the oral health of southern Chinese with primary SS was significantly compromised compared with secondary SS cases and controls, most probably due to the combined effect of impaired salivary gland function and poorer saliva buffer capacity.
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Affiliation(s)
- Katherine C M Leung
- Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, 34 Hospital Road, Hong Kong SAR, China.
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22
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Nikawa H, Yamashiro H, Makihira S, Nishimura M, Egusa H, Furukawa M, Setijanto D, Hamada T. In vitro cariogenic potential of Candida albicans. Mycoses 2004; 46:471-8. [PMID: 14641620 DOI: 10.1046/j.0933-7407.2003.00888.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The adherence and dissociation of Candida albicans, C. tropicalis, Streptococcus mutans and S. sanguis to six substrates including hydroxylapatite (HAP) which exhibit various hydrophobicity, was examined by the use of a bioluminescent adenosine triphosphate (ATP) assay. Dissolution of HAP by C. albicans or S. mutans was determined spectrophotometrically by the use of o-cresolphthalein complexone. In the adherence of C. tropicalis, S. mutans and S. sanguis, the amount of adherent cells correlated with the hydrophobicity of the substrates. In contrast, the adherence of C. albicans to HAP was extraordinary high, although the adherence of the fungi also correlated with the hydrophobicity of the substrates, except for HAP. The yeasts attached to HAP was effectively removed by high concentration of either phosphate or calcium ions. The amount of calcium-release from HAP caused by C. albicans and S. mutans was 113 microg ml(-1) (final pH = 3.45), and 5.4 microg ml(-1) (final pH 4.81), respectively and the maximum growth of C. albicans and S. mutans was 10(7) cfu ml(-1) and 7.4 x 10(12) cfu ml(-1), respectively. The results, taken together, suggest that C. albicans adhere to HAP specifically through electrostatic interaction, and that, in a much smaller number (1.0/7.4 x 10(5)), C. albicans possesses the ability to dissolve HAP to a greater extent (approximately 20-fold) when compared with S. mutans.
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Affiliation(s)
- H Nikawa
- Department of Prosthetic Dentistry, Hiroshima University Faculty of Dentistry, Hiroshima, Japan.
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23
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Radfar L, Shea Y, Fischer SH, Sankar V, Leakan RA, Baum BJ, Pillemer SR. Fungal load and candidiasis in Sjögren's syndrome. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:283-7. [PMID: 12973284 DOI: 10.1016/s1079-2104(03)00224-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to investigate the prevalence of Candida carriage and the relationships between salivary flow rates and oral Candida load in patients with Sjögren's syndrome (SS). METHODS The oral Candida load of patients with SS was evaluated by culturing oral rinse (swish and spit) samples. Culture, Gram stain, and wet-mount test results were reported. RESULTS One hundred three patients (96 women) met European criteria for SS (91 with primary SS and 12 with secondary SS). The mean age (95% confidence interval) was 55 years (range, 51-57 years). Oral rinse cultures were positive in 77% of subjects. The total stimulated salivary flow rate was inversely correlated with oral Candida load (r = -0.47; P </=.0001). The oral rinse samples yielded gram-positive results in 38% of patients with SS, and the Fungi-Fluor assay (wet mount) results were positive in 49%. CONCLUSIONS The prevalence of Candida carriage varies according to the methods used to determine the presence of the organism and is similar to that reported in the literature. A low stimulated salivary flow rate-not a low unstimulated flow rate-was associated with Candida carriage.
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Affiliation(s)
- Lida Radfar
- State Univeristy of New York, Buffalo, NY 14214, USA
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24
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Navazesh M, Mulligan R, Barrón Y, Redford M, Greenspan D, Alves M, Phelan J. A 4-year longitudinal evaluation of xerostomia and salivary gland hypofunction in the Women's Interagency HIV Study participants. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:693-8. [PMID: 12789150 DOI: 10.1067/moe.2003.230] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our purpose was to conduct a longitudinal investigation of xerostomia and salivary gland hypofunction in a national cohort of HIV-positive and at-risk HIV-negative participants in the Women's Interagency HIV Study. Study design. Data included responses to a dry mouth questionnaire, clinical evaluations of major salivary glands, and unstimulated and chewing-stimulated whole salivary flow rates. Repeated measures regression models were used to determine factors associated with xerostomia and salivary gland hypofunction. RESULTS Significant univariate associations were found between HIV status and reports of "too little saliva" (P <.0001), < or = 0.1 mL/min, unstimulated saliva (P =.01), and lack of saliva upon palpation of parotid (P =.02) and submandibular/sublingual salivary glands (P =.03). Adjusted odds of reports of "too little saliva" were significantly higher for HIV-positive participants (odds ratio [OR] = 2.44; 95% CI, 1.49 - 3.97; P =.0004) than for HIV-negative participants. Among HIV-positive women, adjusted odds of reports of "too little saliva" and of < or = 0.7 mL/min chewing-stimulated saliva were significantly higher for those with CD4 < 200 (OR = 1.58; 95% CI, 1.07-2.34; P =.022; and OR = 1.53; 95% CI, 1.05-2.23; P =.027, respectively) and for those with CD4 200-500 (OR = 1.47; 95%CI, 1.07-2.02; P = 0.016; and OR = 1.37; 95% CI, 1.01-2.31; P =.001, respectively) than for those with CD4 > 500. Also, adjusted odds of < or = 0.1mL/min unstimulated saliva and < or = 0.7 mL/min chewing-stimulated saliva were significantly higher in women on highly active antiretroviral therapy (HAART) (OR = 1.25; 95% CI, 1.05 - 1.50; P =.014) than in women not on HAART (OR = 1.34; 95% CI, 1.01 - 1.79; P =.044). CONCLUSIONS HIV-positive women are at a significantly higher risk for xerostomia and salivary gland hypofunction than HIV-negative women, and low CD4 cell counts and HAART use are significant risk factors for these conditions.
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Affiliation(s)
- Mahvash Navazesh
- University of Southern California, Los Angeles, California 90089-0641, USA.
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25
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Abstract
BACKGROUND Sjögren's syndrome, or SS, is a multisystem inflammatory disorder of the exocrine glands with a wide range of extraglandular involvement. Symptoms of dry eyes and xerostomia, although not invariably present, are characteristic features of SS. An increased risk of oral and dental diseases is a prominent consequence of SS. TYPES OF STUDIES REVIEWED The author reviewed recent medical and dental studies that have advanced our understanding of the causes and treatment of SS. She particularly focused on studies addressing the diagnosis and treatment of the oral component of the disease. RESULTS Sjögren's syndrome is a widely underdiagnosed disease. A delay in the diagnosis of SS may have a significant physical, psychological and economic impact on the affected person. The pathogenesis of SS appears to involve a number of factors: immunological, genetic, hormonal and possibly infectious. Successful management of SS requires a multidisciplinary approach, and the dentist plays an essential role in the diagnosis and treatment of the disease. ORAL IMPLICATIONS: Impairment of salivary function in SS increases the risk of developing oral diseases. Effective management of oral health comprises enhancement of salivary output (cholinergic agonist drugs such as pilocarpine or cevimeline) and prevention and treatment of dental caries, oral candidiasis and allergic mucositis. Finally, periodic evaluation of various clinical and laboratory parameters is needed to monitor disease status.
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Affiliation(s)
- I al-Hashimi
- Salivary Dysfunction Clinic, Baylor College of Dentistry, Department of Periodontology, 3302 Gastom Ave., Dallas, Texas 75246, USA.
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Pedersen AM, Nauntofte B. Primary Sjögren's syndrome: oral aspects on pathogenesis, diagnostic criteria, clinical features and approaches for therapy. Expert Opin Pharmacother 2001; 2:1415-36. [PMID: 11585021 DOI: 10.1517/14656566.2.9.1415] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary Sjögren's syndrome (pSS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine glands and predominantly the salivary and lacrimal glands. The impaired gland function is assumed to be a result of progressive lymphocyte-mediated destruction of the exocrine gland tissue leading to the cardinal manifestations, hyposalivation and keratoconjunctivitis sicca (KCS), as well as devastating symptoms of oral and ocular dryness. Although primarily characterised as an exocrine dysfunction, non-exocrine organs may also be affected. The onset and course of pSS is usually insidious but may develop into a disabling disease, which profoundly affects the patient's general well being and quality of life. Moreover, pSS may even evolve into a lymphoid malignancy. The aetiology of pSS remains unknown but the pathogenesis of exocrine cell damage is apparently multi-factorial, including immunological, genetic, hormonal and viral components. Recent research also includes neurogenic aspects of exocrine gland dysfunction, including the interference of immune mediators with glandular response to neurotransmitters released from nerve fibres. pSS usually affects middle-aged women and the female:male ratio is 9:1. The prevalence varies from 0.29-4.8%, depending on the population sampled and the diagnostic criteria used. At present, there are no specific diagnostic tests for pSS and no universally accepted diagnostic criteria. The current therapy is primarily symptomatic. This review focuses on the current oral clinical, diagnostic, pathogenic and therapeutic aspects of pSS.
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Affiliation(s)
- A M Pedersen
- Department of Oral Physiology, Pathology and Medicine, School of Dentistry, University of Copenhagen, Denmark.
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27
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Christensen LB, Petersen PE, Thorn JJ, Schiødt M. Dental caries and dental health behavior of patients with primary Sjögren syndrome. Acta Odontol Scand 2001; 59:116-20. [PMID: 11501878 DOI: 10.1080/000163501750266684] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This comprehensive study was carried out to describe and analyze the oral health status, perceived oral health problems, patients' costs, and oral health behavior in a group of patients with primary Sjögren syndrome (PSS). In particular, the objective of this report was to assess whether Sjögren syndrome patients had more dental caries experience than a control group. Data were collected by means of interviews and clinical oral examinations. The study comprised 53 patients with PSS and a control group of 53 persons matched by age. Among the younger patients the number of decayed, missing, or filled teeth (DMFT) was 22.3, compared with 18.8 among controls (P< 0.05). In parallel, the DMFT in the old-age PSS patients was 26.2, against a DMFT of 22.1 for controls (P< 0.001). On average, the young patients had seven teeth missing, whereas two missing teeth were found among controls (P < 0.01). PSS patients had more frequent dental visits--every 3-4 months (40%)--than controls (19%). In parallel, 78% of the PSS patients brushed their teeth more than twice daily, compared with 28% of the control group. The PSS patient group reported having had more teeth extracted, more trouble with their teeth during lifetime, and higher expenses for dental treatment than controls. In spite of the more regular oral health care practices than the general population, PSS patients had experienced more dental caries and more radical dental treatment. It is suggested that the National Health Insurance should give emphasis to preventive care to patients with PSS.
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Affiliation(s)
- L B Christensen
- University of Copenhagen, Faculty of Health Sciences, Department for Community Dentistry, Denmark.
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28
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Affiliation(s)
- R Solans
- Servei de Medicina Interna, Hospital General Vall d'Hebron, Barcelona, Spain
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29
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Dawson LJ, Holt DJ, Higham SM, Longman LP, Field EA. A comparison of salivary gland hypofunction in primary and secondary Sjögren's syndrome. Oral Dis 2001. [DOI: 10.1034/j.1601-0825.2001.70106.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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30
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Abstract
Inadequate saliva can have devastating consequences for a patient, including oral discomfort, rampant caries, increased candida infections, and desiccation of restorative and esthetic dental treatment. Diagnosis of the cause of xerostomia is imperative to treating the condition, and multiple causes should be considered. Treatment options for xerostomia consists of treatment for hyposalivation, palliative and preventive care to combat the results of long-term dry mouth. Treatment of xerostomia should be based on the etiologic factors of the disease, with prevention of further oral destruction and comfort being the primary goals of treatment.
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Affiliation(s)
- G Gibson
- Special Care Dental Clinics, VA North Texas Health Care System, Dallas, USA
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31
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Pedersen AM, Reibel J, Nordgarden H, Bergem HO, Jensen JL, Nauntofte B. Primary Sjögren's syndrome: salivary gland function and clinical oral findings. Oral Dis 1999; 5:128-38. [PMID: 10522209 DOI: 10.1111/j.1601-0825.1999.tb00077.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate salivary gland function, saliva composition and oral findings in patients with primary Sjögren's syndrome (pSS) subdivided into patients with and without focus score > or = 1 (FS) and/or antibodies to SSA/SSB (AB) as well as in healthy controls. SUBJECTS AND METHODS Unstimulated (UWS) and chewing stimulated (SWS) whole saliva, and stimulated parotid saliva (SPS) were collected in 16 patients fulfilling the European classification criteria for pSS subdivided into those with FS and/or AB (n = 8) and those without FS and AB (n = 8), and in age-matched (n = 14) and young healthy controls (n = 13). UWS and SWS were analysed for Na+ and K+. SPS was analysed for Na+, K+, statherin, and proline-rich proteins (PRPs). Sicca symptoms, DMFT/DMFS, plaque (PI) and gingival (GI) scores, periodontal pocket depth (PPD), and mucosal status were recorded. RESULTS The young healthy controls had lower UWS as compared to the aged controls (P = 0.03). However, the aged controls had higher DMFT/DMFS (P < 0.001) and PI, GI and PPD (P < 0.01). Patients with FS and/or AB generally had lower saliva secretory rates than patients without FS and/or AB (P = 0.01 for UWS and SPS) and age-matched healthy controls (P = 0.001). There was no significant difference in the content of Na+ and K+, statherin and PRPs between groups. Patients with FS and/or AB had the highest frequency of oral mucosal changes and higher DMFT/DMFS than patients without FS and/or AB and healthy controls (P < 0.01). However, PI, GI, and PPD did not differ significantly. CONCLUSION Patients with FS and/or AB had lower salivary secretory rates, higher DMFT/DMFS, and more oral mucosal changes than patients without FS and/or AB. Additionally, data suggest that salivary gland function in healthy individuals do not decrease with age.
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Affiliation(s)
- A M Pedersen
- Department of Oral Function and Physiology, School of Dentistry, University of Copenhagen, Denmark.
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32
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Abraham CM, al-Hashimi I, Haghighat N. Evaluation of the levels of oral Candida in patients with Sjögren's syndrome. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:65-8. [PMID: 9690247 DOI: 10.1016/s1079-2104(98)90151-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the levels of oral Candida in patients with Sjögren's syndrome METHODS The Candida count and salivary flow rate of patients with Sjögren's syndrome were compared with those of healthy control subjects. Candida cultures were obtained from oral rinses. The numbers of colony-forming units were determined through use of the Spiral System. RESULTS The mean Candida count of patients with Sjögren's syndrome was 1672 +/- 1455 colony-forming units per mL; the count of healthy control subjects was 0.00 colony-forming units per mL. The mean salivary flow rate of patients with Sjögren's syndrome was significantly lower than that of healthy control subjects (0.16 +/- 0.13 mL/min/gland vs 0.55 +/- 0.24 mL/min/gland, respectively; p = 0.0001). However, Spearman rank correlation analyses did not reveal a significant correlation between salivary flow rate and Candida count (in colony-forming units per mL) among patients with Sjögren's syndrome. CONCLUSIONS Alteration in the oral microbial flora in patients with Sjögren's syndrome may be enhanced by the reduction in salivary output.
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Affiliation(s)
- C M Abraham
- Baylor College of Dentistry, Dallas, Tex., USA
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33
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Abstract
Colonization of the oral and pharyngeal regions by Candida spp., particularly C. albicans, is extremely common in humans, particularly in early and late life. A variety of local and systemic conditions predispose the transformation of the benign colonization to a pathological state, which may have severe local or serious systemic consequences. The finding of oropharyngeal candidosis in an older patient, therefore, merits investigation of the likely host factors responsible for the organism adopting its pathogenic behavior. This paper provides non-dental clinicians managing older patients a review of the clinical characteristics, risk factors, diagnosis, and management of oropharyngeal candidosis in older adults.
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Affiliation(s)
- K Shay
- Dental Service, Ann Arbor VA Medical Center, Michigan 48105, USA
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34
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Abstract
Oral candidosis is a diagnosable and treatable mucosal disease that may be complicated by various other local or systemic disease conditions. Dependable diagnosis always should include a combination of clinical signs and symptoms suggestive of candidal disease as well as positive cytologic or direct culture results. The management of candidal infections should be individualized for each patient, with concern for interactions with current medications, immune status, other concurrent mucosal diseases, and exogenous infectious sources. In selecting the appropriate therapeutic agent(s) the clinician should consider patient health factors, location and severity of infection, and the probability of chronicity.
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Affiliation(s)
- P G Fotos
- Department of Oral Pathology, Radiology, and Medicine, University of Iowa College of Dentistry, Iowa City, USA
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35
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Abstract
Although we have had a useful and internationally agreed-upon definition of Sjögren's syndrome (SS) for more than 30 years, we have not yet agreed upon criteria for diagnosing it. Understanding the clinical spectrum of SS and the various tests used to diagnose its components provides a basis for discussing controversies about diagnostic criteria. A review of the clinical features of SS and their diagnostic tests is followed by assessments of seven sets of diagnostic criteria and a proposal for future criteria. The various existing criteria use different combinations of clinical features and tests, which results in populations of different sizes and homogeneities being given the diagnosis of SS. Some criteria propose alternative tests in diagnosing components of SS, while others do not. Internationally accepted diagnostic criteria for SS that are as disease-specific as possible are needed for us to learn the epidemiology, pathogenesis, treatment, and prognosis of this clinically and scientifically important disease.
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Affiliation(s)
- T E Daniels
- Department of Stomatology, School of Dentistry, University of California, San Francisco 94143-0424, USA
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36
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Navazesh M, Wood GJ, Brightman VJ. Relationship between salivary flow rates and Candida albicans counts. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 80:284-8. [PMID: 7489270 DOI: 10.1016/s1079-2104(05)80384-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Seventy-one persons (48 women, 23 men; mean age, 51.76 years) were evaluated for salivary flow rates and Candida albicans counts. Each person was seen on three different occasions. Samples of unstimulated whole, chewing-stimulated whole, acid-stimulated parotid, and candy-stimulated parotid saliva were collected under standardized conditions. An oral rinse was also obtained and evaluated for Candida albicans counts. Unstimulated and chewing-stimulated whole flow rates were negatively and significantly (p < 0.001) related to the Candida counts. Unstimulated whole saliva significantly (p < 0.05) differed in persons with Candida counts of 0 versus <500 versus < or = 500. Chewing-stimulated saliva was significantly (p < 0.05) different in persons with 0 counts compared with those with a > or = 500 count. Differences in stimulated parotid flow rates were not significant among different levels of Candida counts. The results of this study reveal that whole saliva is a better predictor than parotid saliva in identification of persons with high Candida albicans counts.
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Affiliation(s)
- M Navazesh
- Department of Dental Medicine and Public Health, University of Southern California, School of Dentistry, Calif
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37
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Johansson G, Andersson G, Attström R, Glantz PO, Larsson K. The effect of Salinum on the symptoms of dry mouth: a pilot study. Gerodontology 1994; 11:46-9. [PMID: 7713542 DOI: 10.1111/j.1741-2358.1994.tb00102.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of a new saliva substitute, Salinum, was tested in 37 patients with severe symptoms of reduced salivation. The majority of the patients had suffered from hyposalivation and dry mouth for more than 8 years. The saliva substitute consisted of a water soluble extract of linseed. The physical properties of this extract are similar to those of the glycoproteins of the salivary secretions. The patients used the saliva substitute for a seven days period. Prior to the use of the extract the patients reported that the most severe symptoms of decreased salivation were a feeling of dryness in the mouth and burning sensations in the tongue, pharynx and oesophagus, The majority of the patients reported that the use of Salinum reduced the symptoms of hyposalivation. Great variation in effect occurred from patient to patient. Generally the patients with the most severe symptoms experienced the greatest relief of the symptoms when they used Salinum. Although of short duration the results of this pilot study indicate that an extract of linseeds may compensate for some aspects of the consequences of reduced salivation. Further studies are needed to elucidate the feasibility of the extract as saliva replacement.
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Affiliation(s)
- G Johansson
- Department of Periodontology, Centre for Oral Health Sciences, Lund University, Malmö, Sweden
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38
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Abstract
The three most common known causes of salivary gland dysfunction are medication usage, radiation therapy and Sjogren's syndrome. Current therapeutic options to treat salivary dysfunction are limited. Clinical considerations as well as the outlook for individuals experiencing salivary dysfunction are discussed.
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Affiliation(s)
- J C Atkinson
- Patient Care Branch, National Institute of Dental Research, National Institutes of Health
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39
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Ueta E, Osaki T, Yoneda K, Yamamoto T. Prevalence of diabetes mellitus in odontogenic infections and oral candidiasis: an analysis of neutrophil suppression. J Oral Pathol Med 1993; 22:168-74. [PMID: 8391079 DOI: 10.1111/j.1600-0714.1993.tb01051.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The prevalence of diabetes mellitus (DM) in odontogenic infections and oral candidiasis was examined, and influences of DM on the clinical manifestations of the infections and neutrophil functions were investigated. Among 21 severe and 221 mild odontogenic infections, DM was detected in 5 cases in each group. Of 64 cases of symptomatic oral candidiasis, 8 cases were complicated with DM which was detected by blood examination during treatment. During the period of infection, the mean fasting blood sugar level was 16.0 +/- 4.4 and 9.8 +/- 1.2 mmol/l in the DM-complicated odontogenic infections and candidiasis, respectively. All white blood counts, C-reactive protein levels and erythrocyte sedimentation rates were more elevated in DM(+) odontogenic infection cases than in DM(-) ones. In DM(+) candidiasis, hyposalivation (0.79 +/- 0.54 ml/10 min) was observed. The polymorphonuclear leukocytes from diabetic patients, especially those with candidiasis, produced less free oxygen radicals and exhibited reduced phagocytosis and intracellular killing of Candida cells associated with this reduced O2- generation during the infection. These suppressed neutrophil functions increased after treatment but did not reach control levels. These results indicate that DM is a predisposing condition for odontogenic infections and oral candidiasis, that DM-complicated infections become severe because of neutrophil suppression, and that examination of blood sugar level should be essential for patients with oral infections.
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Affiliation(s)
- E Ueta
- Department of Oral Surgery, Kocki Medical School, Kohasu, Japan
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41
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Fotos PG, Vincent SD, Hellstein JW. Oral candidosis. Clinical, historical, and therapeutic features of 100 cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 74:41-9. [PMID: 1508508 DOI: 10.1016/0030-4220(92)90213-a] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.
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Affiliation(s)
- P G Fotos
- Department of Oral Pathology, Radiology, and Medicine, University of Iowa College of Dentistry, Iowa City
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McCarthy GM. Host factors associated with HIV-related oral candidiasis. A review. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 73:181-6. [PMID: 1532236 DOI: 10.1016/0030-4220(92)90192-s] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human immunodeficiency virus (HIV)-related oral candidiasis affects approximately one third of HIV-seropositive patients and more than 90% of patients with AIDS. It is necessary to identify patients who have a greater risk of candidiasis developing, so that interventions can be designed to reduce the frequency. This is particularly important because there is evidence that Candida species are immunosuppressive and therefore candidiasis may adversely affect the prognosis of patients with HIV. Susceptibility to HIV-related oral candidiasis is associated with xerostomia, severity of disease, depression of cell-mediated immunity, and older age (greater than 35 years). The frequency of HIV-related oral candidiasis is notably increased when the CD4 lymphocyte count falls to less than 300 cells/mm3. Xerostomia appears to be a better predictor of HIV-related oral candidiasis than CD4 count and should be prevented (e.g., by avoiding xerogenic drugs) and treated, when necessary, to minimize the risk of oral candidiasis.
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Affiliation(s)
- G M McCarthy
- Division of Oral Biology, Faculty of Dentistry, University of Western Ontario, London, Canada
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McCarthy GM, Mackie ID, Koval J, Sandhu HS, Daley TD. Factors associated with increased frequency of HIV-related oral candidiasis. J Oral Pathol Med 1991; 20:332-6. [PMID: 1680189 DOI: 10.1111/j.1600-0714.1991.tb00940.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
HIV-related oral candidiasis was investigated in 71 HIV-seropositive patients who received interviews, oral examinations and hematologic investigation. Diagnosis of candidiasis was based on clinical signs and examination of PAS-stained smears. The frequency of candidiasis was 24/71 (34%). The clinical presentations were pseudomembranous 8 (11%), erythematous 14 (20%), angular cheilitis 3 (4%). Twenty-six patients (37%) had candidiasis or were receiving antifungal treatment for recurrent pseudomembranous type. Twelve of 13 (92%) patients with AIDS and 14/58 (24%) without AIDS were affected. Bivariate analyses showed significant associations with AIDS, the use of zidovudine, low T4-count, xerostomia; marital status (sometime married), restricted performance status and age of greater than 35 yr. Multivariate logistic regression analysis showed that the presence of xerostomia was an independent and statistically significant predictor of HIV-related oral candidiasis. T4-count and restricted performance status were the second and third most important predictors.
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Affiliation(s)
- G M McCarthy
- Division of Oral Biology, University of Western Ontario, London, Canada
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