1
|
Michail A, Almirza M, Alwaely F, Arany S. Anticholinergic burden of medications is associated with dry mouth and reflected in minor labial gland secretion. Arch Oral Biol 2023; 156:105824. [PMID: 37865013 PMCID: PMC10841478 DOI: 10.1016/j.archoralbio.2023.105824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
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.
Collapse
Affiliation(s)
- Abdallah Michail
- General Dentistry, Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, USA
| | - Mohammed Almirza
- General Dentistry, Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, USA
| | - Furqan Alwaely
- General Dentistry, Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, USA; Specialty Care Clinic, Eastman Institute of Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, USA
| | - Szilvia Arany
- Specialty Care Clinic, Eastman Institute of Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, USA.
| |
Collapse
|
2
|
Ramadoss R, Krishnan R, Raman S, Padmanaban R, Anbuelangovan N, Eswaramoorthy R. Salivary stimulatory effect of novel low level transcutaneous electro neurostimulator in geriatric patients with xerostomia. BMC Oral Health 2023; 23:334. [PMID: 37246232 DOI: 10.1186/s12903-023-03049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Xerostomia (dryness of the mouth) is one of the most common long-term consequences of ageing, and it causes a tremendous impact on the function and morphology of the salivary ductal system. As a consequence, it leads to a decrease in the amount of salivary output and also affects the overall quality of life. The purpose of this study was to determine whether electrostimulation using a custom designed transcutaneous electrical nerve stimulation (TENS) device will help to improve the quality of secreted saliva following electrostimulation. METHODS One hundred thirty-five participants underwent the intervention for three months, twice daily (80 Hz). Pre-intervention and post-intervention unstimulated saliva were collected. Parameters such as salivary pH, cortisol level, salivary antioxidants, total protein, the viscosity of saliva, and microbial carriage were analysed. RESULTS Salivary pH, cortisol, microbial cultures, viscosity, and antioxidants showed a significant difference at the end of the 3rd month (p < 0.05). Irrespective of the patient's age, gender, and common underlying systemic illnesses (diabetes and hypertension), a significant change in the quality of the salivary analytes was observed. CONCLUSION The study emphasises the use of a custom designed TENS device in improving the quality of secreted saliva among old patients with oral dryness.
Collapse
Affiliation(s)
- Ramya Ramadoss
- Department of Oral Biology, Saveetha Dental College, Chennai, India.
| | | | - Swarnalakshmi Raman
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Rajashree Padmanaban
- Centre of Advanced Study in Crystallography & Biophysics, University of Madras, Chennai, India
| | | | - Rajalakshmanan Eswaramoorthy
- Department of Biomaterials, Centre of Molecular Medicine and Diagnostics (COMMAND), Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India.
- Department of Applied Chemistry, School of Applied Natural Science, Adama Science and Technology University (ASTU), PO. 1888, Adama, Ethiopia.
| |
Collapse
|
3
|
Agorastos G, van Halsema E, Bast A, Klosse P. On the importance of saliva in mouthfeel sensations. Int J Gastron Food Sci 2023. [DOI: 10.1016/j.ijgfs.2023.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
4
|
Salivary film thickness and MUC5B levels at various intra-oral surfaces. Clin Oral Investig 2023; 27:859-869. [PMID: 35941397 PMCID: PMC9889518 DOI: 10.1007/s00784-022-04626-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In this study, we investigated the salivary film thickness and the MUC5B levels at various intra-oral locations in healthy volunteers, with a focus on the palate. Besides, measurements of the palatal surface area were included to explore the possible relationships between the palatal surface area and the palatal salivary film and MUC5B levels. MATERIALS AND METHODS The salivary film thickness was determined using filter strips, which were pressed to the mucosal surfaces of five different intra-oral locations; conductance was then analysed using a Periotron. After elution of the strips, the MUC5B levels at various intra-oral locations were determined using ELISA. The palatal surface area was measured using an intra-oral scanner. The surface area was subsequently calculated using the software. RESULTS The anterior tongue had the thickest salivary film and also the highest levels of MUC5B, while the anterior palate had the thinnest salivary film and lowest MUC5B levels. There was no association between the palatal surface area and the salivary film thickness of the palate. CONCLUSION The salivary film and MUC5B levels are unequally distributed over the intra-oral regions of the soft tissues. The lack of association between the palatal surface area and the salivary film thickness indicates that a larger surface area is not associated with a relative thinner palatal salivary film. CLINICAL RELEVANCE The results of the current study increase our understanding of saliva distribution in the oral cavity and could be used as reference values for future studies.
Collapse
|
5
|
Advances in the Diagnosis, Monitoring, and Progression of Oral Cancer through Saliva: An Update. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2739869. [DOI: 10.1155/2022/2739869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/27/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
The early detection of cancer, and in particular oral cancer, has been a priority objective of study in recent years. Saliva has been proposed as an easy-to-obtain means of providing the necessary information to diagnose malignant lesions in the oral cavity, since it can be obtained very easily and completely noninvasively. There are a number of molecules, known as biomarkers, which may be involved in the malignant transformation of oral lesions, and which have different natures. The involvement of proteins (“proteomics”), metabolites (“metabolomics”), and even certain genes in the structural changes of altered tissue has been investigated in order to establish validated parameters for the early diagnosis of oral cancer. In addition, the development of new analytical assay methods that can reduce costs and obtain better results in terms of sensitivity and specificity has been a key point in recent research in this field. Even though there are numerous biomarkers with results showing high sensitivity and specificity, there is still a need for more studies, with a larger sample and with analytical methods that can constitute a real advance in time and cost. Although salivary biomarkers are a promising new diagnostic tool for oral cancer, for the moment they do not replace biopsy as the “gold standard”.
Collapse
|
6
|
Assy Z, Jager DHJ, Brand HS, Bikker FJ. Correlations of palatal surface area with anthropometric dimensions of the head and face. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1261-1267. [PMID: 36056237 PMCID: PMC9492607 DOI: 10.1007/s00276-022-03008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
Purpose Saliva distribution over the palatal surface plays an important role in the perception of dry mouth. It is envisaged that non-invasive estimation of the palatal surface area by anthropometric measurements of the head and face can be useful in the assessment of oral dryness. For this purpose, the relationship between the palatal surface area and anthropometric measurements of the head and face was investigated. Methods The palatal surface was measured in 51 healthy volunteers using an intra-oral scanner. The distances between anthropometric landmarks of the head and face were determined using an anatomical sliding caliper. Correlations between the palatal surface area and the anthropometric landmarks were investigated. Results The median palatal surface area for the total study population was found to be 2120.6 mm2. Virtually, all anthropometric measurements showed significant differences between females and males. Various head and face measurements had a significant correlation with the palatal surface area. However, these correlations disappeared when the participants were stratified based on their sex, with the exception of mandibular length and palatal width in females. Conclusion The surface area of the palate correlates with nearly all anthropometric measurements of the head and face included in this study. Yet, the clinical applicability seems limited to females.
Collapse
Affiliation(s)
- Z Assy
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| | - D H J Jager
- Department of Maxillofacial Surgery and Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Institute for Infection and Immunity Amsterdam, Amsterdam, The Netherlands
| | - H S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - F J Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Arany S, Kopycka-Kedzierawski DT, Caprio TV, Watson GE. Anticholinergic medication: Related dry mouth and effects on the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:662-670. [PMID: 34593340 DOI: 10.1016/j.oooo.2021.08.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 01/25/2023]
Abstract
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.
Collapse
Affiliation(s)
- Szilvia Arany
- Specialty Care, Department of General Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, NY, USA.
| | - Dorota T Kopycka-Kedzierawski
- Department of Community Dentistry and Oral Disease Prevention, University of Rochester, Rochester, NY, USA; Center for Oral Biology, University of Rochester, Rochester, NY, USA
| | - Thomas V Caprio
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Gene E Watson
- Center for Oral Biology, University of Rochester, Rochester, NY, USA; Department of Dentistry, University of Rochester, Rochester, NY, USA; Department of Environmental Medicine and Pharmacology and Physiology, University of Rochester, Rochester, NY, USA
| |
Collapse
|
8
|
Assy Z, Bikker FJ, Picauly O, Brand HS. The association between oral dryness and use of dry-mouth interventions in Sjögren's syndrome patients. Clin Oral Investig 2021; 26:1465-1475. [PMID: 34374853 PMCID: PMC8816756 DOI: 10.1007/s00784-021-04120-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/30/2021] [Indexed: 12/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Z Assy
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan, 3004, Amsterdam, 1081 LA, the Netherlands.
| | - F J Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan, 3004, Amsterdam, 1081 LA, the Netherlands
| | - O Picauly
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan, 3004, Amsterdam, 1081 LA, the Netherlands
| | - H S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan, 3004, Amsterdam, 1081 LA, the Netherlands
| |
Collapse
|
9
|
Is a neuropathic mechanism involved in the perception of oral dryness? Arch Oral Biol 2021; 130:105213. [PMID: 34339966 DOI: 10.1016/j.archoralbio.2021.105213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the present study was to review the existing phenomena which could affect subjective oral dryness and to consider the possibility that neural processing is involved in the perception of oral dryness. DESIGN A comprehensive review of scientific literatures relevant to contributing factors of dry mouth symptoms including salivary parameters related with oral dryness and role of neural mechanisms in perception of dry mouth symptoms was conducted. RESULTS Several previous reports suggested the possibility of neural processing mechanisms in perception of oral dryness. The decreased pain threshold in the oral cavity of rats with dry tongue and complaints of subjective oral dryness in patients with burning mouth syndrome, of which lacked an actual decrease in salivary output and mucosal wetness, could support this idea. Sensory changes in the oral mucosa and oral dryness may have a bi-directional influence that patients with oral dryness would be more subject to neuropathic pain in the oral mucosa, and those with neuropathic pain in the oral cavity could have complaints associated with higher levels of dry mouth symptoms. CONCLUSION A bi-directional influence between sensory change in the oral mucosa and subjective oral dryness could be assumed. We suggest the administration of neuropathic pain medications for controlling subjective oral dryness in patients without objective sign of hyposalivation.
Collapse
|
10
|
Vinke J, Oude Elberink M, Stokman MA, Kroese FGM, Nazmi K, Bikker FJ, van der Mei HC, Vissink A, Sharma PK. Lubricating properties of chewing stimulated whole saliva from patients suffering from xerostomia. Clin Oral Investig 2021; 25:4459-4469. [PMID: 33661446 PMCID: PMC8310523 DOI: 10.1007/s00784-020-03758-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study aimed to quantify the lubricating properties of chewing stimulated whole saliva from healthy controls (n = 22), from patients suffering from primary Sjögren's syndrome (n = 37) and from patients undergoing head-and-neck radiotherapy (n = 34). MATERIALS AND METHODS All participants had to complete the Xerostomia Inventory questionnaire to score dry mouth sensation. Lubrication was measured using an ex vivo tongue-enamel friction system in terms of Relief and Relief period. MUC5b and total protein concentrations of the saliva samples were measured by an enzyme-linked immunosorbent assay and a bicinchoninic acid assay, respectively. RESULTS Relief of Sjögren's patients' saliva and post-irradiation patients' saliva was similar compared with healthy controls, but saliva from post-irradiation patients lubricated significantly better than saliva from Sjögren's patients. The Relief period was similar between the three groups. The Relief and Relief period were higher for saliva samples post-irradiation compared to pre-irradiation. MUC5b and total protein concentrations were comparable in all groups. MUC5b and total protein output were significantly lower in patients subjected to radiotherapy compared to saliva from healthy controls and pre-irradiation patients. MUC5b concentrations positively correlated with lubricating properties of post-irradiation patient saliva. CONCLUSIONS The lubricating properties of patient saliva were not any worse than healthy controls. Lower flow rate leads to lower availability of saliva in the oral cavity and decreases the overall output of protein and MUC5b, which might result in an insufficient replenishing of the mucosal salivary film. CLINICAL RELEVANCE An insufficient replenishing might underlie the sensation of a dry mouth and loss of oral function.
Collapse
Affiliation(s)
- Jeroen Vinke
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - Marijn Oude Elberink
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - Monique A Stokman
- Department of Radiation Oncology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Kamran Nazmi
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, Free University and University of Amsterdam, Amsterdam, The Netherlands
| | - Floris J Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, Free University and University of Amsterdam, Amsterdam, The Netherlands
| | - Henny C van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Prashant K Sharma
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands.
| |
Collapse
|
11
|
Norton V, Lignou S, Methven L. Influence of Age and Individual Differences on Mouthfeel Perception of Whey Protein-Fortified Products: A Review. Foods 2021; 10:433. [PMID: 33669435 PMCID: PMC7920461 DOI: 10.3390/foods10020433] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022] Open
Abstract
Protein needs are considered to increase with age, with protein consumption being associated with many positive outcomes. Protein-fortified products are often used to improve nutritional status and prevent age-related muscle mass loss in older adults. Accordingly, older adults are commonly provided with products fortified with whey protein; however, such products can cause mouthdrying, limiting consumption and product enjoyment. Currently, the extent to which age and individual differences (e.g., saliva, oral health, food oral processing) influence the perception of whey protein-derived mouthdrying is relatively unclear. Previous research in this area has mainly focused on investigating mouthdrying, without taking into account individual differences that could influence this perception within the target population. Therefore, the main focus of this review is to provide an overview of the relevant individual differences likely to influence mouthfeel perception (specifically mouthdrying) from whey protein-fortified products, thereby enabling the future design of such products to incorporate better the needs of older adults and improve their nutritional status. This review concludes that age and individual differences are likely to influence mouthdrying sensations from whey protein-fortified products. Future research should focus more on the target population and individual differences to maximise the benefits from whey protein fortification.
Collapse
Affiliation(s)
| | | | - Lisa Methven
- Department of Food and Nutritional Sciences, Harry Nursten Building, University of Reading, Whiteknights, Reading RG6 6DZ, UK; (V.N.); (S.L.)
| |
Collapse
|
12
|
Differences in perceived intra-oral dryness in various dry-mouth patients as determined using the Regional Oral Dryness Inventory. Clin Oral Investig 2021; 25:4031-4043. [PMID: 33496869 PMCID: PMC8137633 DOI: 10.1007/s00784-020-03734-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/04/2020] [Indexed: 01/20/2023]
Abstract
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.
Collapse
|
13
|
Choi JH, Kim MJ, Kho HS. Oral health-related quality of life and associated factors in patients with burning mouth syndrome. J Oral Rehabil 2020; 48:150-159. [PMID: 33031643 DOI: 10.1111/joor.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/19/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to assess oral health-related quality of life (OHRQoL) in patients with burning mouth syndrome (BMS) and to identify clinical factors associated with OHRQoL. METHODS Fifty-seven patients with BMS (56.4 ± 10.7 years) participated in the study. Patients underwent oral examination, laboratory tests, psychological evaluation, measurement of salivary flow rates and evaluation of clinical characteristics using a BMS questionnaire. The OHRQoL of patients was assessed using the Oral Health Impact Profile-14 (OHIP-14). RESULTS The OHIP-14 score for patients with BMS was 38.6 ± 12.8. Patients had higher scores for the psychological discomfort and physical pain dimensions of the OHIP-14. The intensity of taste disturbance or xerostomia symptoms (β = 0.464, P < .001), worry about symptoms (β = 0.307, P = .020), and results of psychological evaluation (β = 0.311, P = .026) were significantly associated with OHIP-14 score. Multiple linear regression showed that the intensity of taste disturbance or xerostomia symptoms was significantly associated with decreased OHRQoL (β = 0.637, P = .026). CONCLUSIONS This study suggests that severity of taste disturbance or xerostomia is an important factor that influences OHRQoL in patients with BMS.
Collapse
Affiliation(s)
- Jee-Hye Choi
- Department of Dental Hygiene, Yonsei University Graduate School, Seoul, Korea
| | - Moon-Jong Kim
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.,Institute on Aging, Seoul National University, Seoul, Korea
| |
Collapse
|
14
|
Norton V, Lignou S, Bull SP, Gosney MA, Methven L. An Investigation of the Influence of Age and Saliva Flow on the Oral Retention of Whey Protein and Its Potential Effect on the Perception and Acceptance of Whey Protein Beverages. Nutrients 2020; 12:E2506. [PMID: 32825104 PMCID: PMC7551043 DOI: 10.3390/nu12092506] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022] Open
Abstract
Protein fortified products are regularly recommended to older adults to improve nutritional status and limit sarcopenia. However protein fortification can elicit negative sensory attributes such as mouthdrying. Sensitivity to mouthdrying can increase with age, yet the influence of saliva flow and mucoadhesion remain uncertain. Here, two studies tested different whey protein beverages (WPB); 22 healthy younger volunteers completed a pilot and 84 healthy volunteers from two age groups (18-30; 65+) completed the main study. In both studies salivary flow rates (mL/min) were measured and saliva samples were collected at time intervals post beverage consumption to measure mucoadhesion to the oral cavity, where protein concentration was analysed by Bradford Assay. Volunteers rated perception and acceptability of WPBs in the main study. WPB consumption resulted in significantly increased protein concentration (p < 0.0001) in saliva samples compared with a control whey permeate beverage. Older adults had significantly lower unstimulated saliva flow (p = 0.003) and significantly increased protein concentration (p = 0.02) in saliva samples, compared with younger adults. Heating of WPB significantly (p < 0.05) increased mouthdrying and thickness perception and reduced sweetness compared with unheated WPB. Mucoadhesion is concluded to be a true phenomenon in WPBs and increases with age.
Collapse
Affiliation(s)
- Victoria Norton
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| | - Stella Lignou
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| | - Stephanie P. Bull
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| | - Margot A. Gosney
- Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK;
| | - Lisa Methven
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| |
Collapse
|
15
|
Berry DN, Simons CT. Assessing regional sensitivity and desensitization to capsaicin among oral cavity mucosae. Chem Senses 2020; 45:bjaa033. [PMID: 32478837 DOI: 10.1093/chemse/bjaa033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Indexed: 02/28/2024] Open
Abstract
This study aimed to determine perceptual response differences and characterize desensitization to capsaicin over time across several oral cavity mucosae- the tongue, cheek, hard palate, and lip. For each region, subjects rated the intensity of capsaicin and a vehicle control over a 10-minute period. Following a rest period, capsaicin was reapplied on each pretreated area and subjects indicated which side felt more irritated then rated each side every 30 seconds, over 3.5 minutes. Results from the initial task indicated significantly greater irritation on the tongue than hard palate, hard palate than cheek and lip, but no significant differences between the cheek and lip. Time to max intensity was delayed on the hard palate compared to the tongue, cheek, and lip. Desensitization, as indicated by a significant proportion of subjects choosing the vehicle-pretreated side over capsaicin-pretreated side as having stronger irritation, was exhibited on the tongue and hard palate, but not the cheek and lip. Given these data, a secondary experiment that utilized a higher capsaicin concentration was conducted on the cheek and lip only. Results showed significantly higher overall irritation on the lip than the cheek. Desensitization was exhibited on both areas, although the extent was greater on the lip. Based on differences in sensitivity and the extent of desensitization among these areas, these results indicate oral cavity mucosae respond to, but are impacted differently by, capsaicin exposure.
Collapse
Affiliation(s)
- Danica N Berry
- Department of Food Science & Technology, The Ohio State University, Columbus, OH
| | - Christopher T Simons
- Department of Food Science & Technology, The Ohio State University, Columbus, OH
| |
Collapse
|
16
|
Assy Z, Jager DHJ, Mashhour E, Bikker FJ, Brand HS. Regional differences in perceived oral dryness as determined with a newly developed questionnaire, the Regional Oral Dryness Inventory. Clin Oral Investig 2020; 24:4051-4060. [PMID: 32382921 PMCID: PMC7544722 DOI: 10.1007/s00784-020-03276-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/04/2020] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Zainab Assy
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| | - D H J Jager
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC, Amsterdam, The Netherlands.,Center for Special Care Dentistry (Stichting Bijzondere Tandheelkunde), Amsterdam, Netherlands
| | - E Mashhour
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - F J Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - H S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Wang G, Zhao B, Kong Y, Ma D, Yang L, Song Y, Wang X. A preliminary study on submariners with xerostomia after a 3-month deployment. Medicine (Baltimore) 2020; 99:e19523. [PMID: 32332601 PMCID: PMC7220551 DOI: 10.1097/md.0000000000019523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To observe the clinical manifestations and salivary secretion of xerostomia patients in submariners who engaged in a three-month deployment. The general conditions and clinical examination of the 136 submariners were evaluated, by which the patients with xerostomia were screened out and their clinical manifestations were recorded. Besides, the flow rate of unstimulated saliva and stimulated saliva was measured and calculated. Subsequently, the related factors of xerostomia were quantitatively classified and statistically analyzed. In all the involved submariners, 42 were diagnosed to have xerostomia by physical examination after they returned from the task, among which 71.4% showed a decrease in unstimulated salivary flow rate and it was significantly correlated with the accompanying symptoms and their general conditions. Therefore, it was concluded that the occurrence of xerostomia could be related to the service life and job responsibilities of the submariners. The main manifestations were the reduction of unstimulated salivary secretion and the accompanying clinical symptoms such as cheilosis and angular cheilitis. Noticeably, the high psychological pressure and harsh living conditions need to be concerned, and further study should place more concentrations on these comprehensive influence factors and preventive actions of xerostomia.
Collapse
Affiliation(s)
- Guowei Wang
- Department of Stomatology, No. 971 Hospital of the PLA Navy
| | - Baodong Zhao
- Department of Oral Implantology, The Stomatological School and The Affiliated Hospital of Qingdao University, Qingdao
| | - Yujia Kong
- Department of Public Health and Management, Weifang Medical University, Weifang, Shandong
| | - DeXun Ma
- Department of Stomatology, No. 971 Hospital of the PLA Navy
| | - Lin Yang
- Department of Stomatology, No. 971 Hospital of the PLA Navy
| | - Yingliang Song
- State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, PR China
| | - Xiaojing Wang
- Department of Oral Implantology, The Stomatological School and The Affiliated Hospital of Qingdao University, Qingdao
| |
Collapse
|
18
|
Saleem M, Yoshinari N, Nakamura S, Sumi Y, Iwai Y, Ozaki Y, Masuda Y, Uchida K, Taguchi A. Improvement of salivary flow and oral wetness by a lip trainer device and sonic toothbrush in older Japanese men and women with dry mouth. J Oral Sci 2019; 61:221-228. [DOI: 10.2334/josnusd.18-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Murtaza Saleem
- Department Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University
| | - Nobuo Yoshinari
- Department Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University
- Department of Operative Dentistry, Endodontology and Periodontology, School of Dentistry, Matsumoto Dental University
| | - Suguru Nakamura
- Department of Operative Dentistry, Endodontology and Periodontology, School of Dentistry, Matsumoto Dental University
| | - Yasunori Sumi
- Department of Center for Development of Advanced Medicine for Dental Diseases, National Center for Geriatrics and Gerontology
| | - Yukiko Iwai
- Department of Operative Dentistry, Endodontology and Periodontology, School of Dentistry, Matsumoto Dental University
| | - Yuki Ozaki
- Department of Operative Dentistry, Endodontology and Periodontology, School of Dentistry, Matsumoto Dental University
| | - Yuji Masuda
- Division of Oral and Maxillofacial Biology, Institute for Oral Science, Matsumoto Dental University
| | - Keiichi Uchida
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University
| | - Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University
| |
Collapse
|
19
|
Xu F, Laguna L, Sarkar A. Aging-related changes in quantity and quality of saliva: Where do we stand in our understanding? J Texture Stud 2018; 50:27-35. [PMID: 30091142 DOI: 10.1111/jtxs.12356] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
Abstract
Saliva is crucial to oral processing of food and consequently is also related to the sensory and textural experience. It is often assumed that the secretion and properties of saliva change with age, which can result in dry mouth conditions, taste aberrations. Such changes may result in reduced nutrient intake and malnutrition besides adversely affecting the quality of life. Based on some recent research findings, this article reviews our current understandings on age-dependent changes on quantity (bulk salivary flow rate) as well as quality of saliva (e.g., composition, viscosity, lubrication) in healthy elderly individuals. The review begins with a short introduction to histological changes of salivary glands upon aging. This is followed by covering different aspects of salivary changes with key articles highlighting decreased flow rate, increased ionic concentration, decreased calcium and mucin content in saliva of elderly subjects consequently affecting the oral coating and flavor perception. We also highlight issues in data associated with respect to variance in saliva collection protocols as well as factors influencing such results other than age, such as health conditions and polypharmacy. Clear gaps in literature have been highlighted with respect to lack of quantitative data in viscoelasticity, rheology, and lubrication properties of saliva in healthy elderly population and the potential impact of changes in these material properties on sensory and textural perception of food and consequently food intake. Such insights will not only have clinical implications for maintaining optimal oral health in elderly population but also serve to optimize food for elderly population. PRACTICAL APPLICATIONS: The population has undergone a fundamental change in its age structure globally, with a rapid increase in elderly population. Innovation of tailored foods is still in its early stage to satisfy the needs of growing aging population. One of the biggest challenges in such food product development is lack of adequate understanding and characterization of endogenous factors, that is, age-related changes in saliva, which may influence oral processing of food and subsequently nutrient intake. Aging affects the salivary glands and alters quantity (flow rate) and quality (e.g., ion and protein composition, rheology, tribology) of saliva. Thus, older adults may suffer from dry mouth, taste aberration, and poor oral hygiene, greatly affecting their quality of life. This review provides insights into how age versus other health conditions influence salivary properties. Understanding of age-dependent changes in salivary rheology and tribology will be of paramount importance to optimize food for elderly population.
Collapse
Affiliation(s)
- Feng Xu
- Food Colloids and Processing Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Laura Laguna
- Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Valencia, Spain
| | - Anwesha Sarkar
- Food Colloids and Processing Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
20
|
Liu H, Prot VE, Skallerud BH. 3D patient-specific numerical modeling of the soft palate considering adhesion from the tongue. J Biomech 2018; 77:107-114. [PMID: 29960734 DOI: 10.1016/j.jbiomech.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 12/29/2022]
Abstract
Collapse of the soft palate in the upper airway contributes to obstructive sleeping apnea (OSA). In this study, we investigate the influence of the adhesion from the tongue on the soft palate global response. This is achieved using a cohesive zone finite element approach. A traction-separation law is determined to describe the adhesion effect from the surface tension of the lining liquid between the soft palate and the tongue. According to pull-off experimental tests of human lining liquid from the oral surface of the soft palate, the corresponding cohesive properties, including the critical normal traction stress and the failure separation displacement, are obtained. The 3D patient-specific soft palate geometry is accounted for, based on one specific patient's computed tomography (CT) images. The calculation results show that influence of the adhesion from the tongue surface on the global response of the soft palate depends on the length ratio between the cohesive length and the soft palate length. When the length of the cohesive zone is smaller than half of the soft palate length, the adhesion's influence is negligible. When the adhesion length is larger than 70 percent of soft palate length, the adhesion force contributes to preventing the soft palate from collapsing towards to the pharynx wall, i.e. the closing pressure is more negative than in the no adhesion case. These results may provide useful information to the clinical treatment of OSA patients.
Collapse
Affiliation(s)
- Hongliang Liu
- Biomechanics Division, Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), NO-7491 Trondheim, Norway
| | - Victorien Emile Prot
- Biomechanics Division, Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), NO-7491 Trondheim, Norway
| | - Bjørn Helge Skallerud
- Biomechanics Division, Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), NO-7491 Trondheim, Norway.
| |
Collapse
|
21
|
Kim MJ, Kim J, Kho HS. Comparison between burning mouth syndrome patients with and without psychological problems. Int J Oral Maxillofac Surg 2018; 47:879-887. [DOI: 10.1016/j.ijom.2018.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/12/2017] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
|
22
|
Affiliation(s)
- Richard Gawel
- Australian Wine Research Institute, Paratoo Road, Urrbrae, Australia
| | - Paul A. Smith
- Australian Wine Research Institute, Paratoo Road, Urrbrae, Australia
| | - Sara Cicerale
- Deakin University Faculty of Health, School of Exercise and Nutrition Sciences, Burwood, Australia
| | - Russell Keast
- Deakin University Faculty of Health, School of Exercise and Nutrition Sciences, Burwood, Australia
| |
Collapse
|
23
|
Chaudhury NMA, Proctor GB, Karlsson NG, Carpenter GH, Flowers SA. Reduced Mucin-7 (Muc7) Sialylation and Altered Saliva Rheology in Sjögren's Syndrome Associated Oral Dryness. Mol Cell Proteomics 2015; 15:1048-59. [PMID: 26631508 DOI: 10.1074/mcp.m115.052993] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 12/20/2022] Open
Abstract
Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration and hypofunction of salivary and lacrimal glands. This loss of salivary function leads to oral dryness, impaired swallowing and speech, and increased infection and is associated with other autoimmune diseases and an increased risk of certain cancers. Despite the implications of this prevalent disease, diagnosis currently takes years, partly due to the diversity in patient presentation. Saliva is a complicated biological fluid with major constituents, including heavily glycosylated mucins MUC5B and MUC7, important for its viscoelastic and hydrating and lubricating properties. This study investigated Sjögren's patient's perception of dryness (bother index questionnaires) along with the rheological, protein composition, and glycan analysis of whole mouth saliva and the saliva on the mucosal surface (residual mucosal saliva) to understand the properties that most affect patient wellbeing. Sjögren's patients exhibited a statistically significant reduction in residual mucosal saliva, salivary flow rate, and extensional rheology, spinnbarkeit (stringiness). Although the concentration of mucins MUC5B and MUC7 were similar between patients and controls, a comparison of protein Western blotting and glycan staining identified a reduction in mucin glycosylation in Sjögren's, particularly on MUC7. LC-MS/MS analysis of O-glycans released from MUC7 by β-elimination revealed that although patients had an increase in core 1 sulfation, the even larger reduction in sialylation resulted in a global decline of charged glycans. This was primarily due to the loss of the extended core 2 disialylated structure, with and without fucosylation. A decrease in the extended, fucosylated core 2 disialylated structure on MUC7, residual mucosal wetness, and whole mouth saliva flow rate appeared to have a negative and cumulative effect on the perception of oral dryness. The observed changes in MUC7 glycosylation could be a potential diagnostic tool for saliva quality and taken into consideration for future therapies for this multifactorial syndrome.
Collapse
Affiliation(s)
- Nayab M A Chaudhury
- From the ‡Salivary Unit, Mucosal and Salivary Biology, Dental Institute, King's College London, Guy's Hospital, Floor 17, Tower Wing, London SE1 9RT, UK
| | - Gordon B Proctor
- From the ‡Salivary Unit, Mucosal and Salivary Biology, Dental Institute, King's College London, Guy's Hospital, Floor 17, Tower Wing, London SE1 9RT, UK
| | - Niclas G Karlsson
- §Department of Medical Biochemistry, Institute of Biomedicine, University of Gothenburg, Medicinaregatan 9A, 405 30, Gothenburg, Sweden
| | - Guy H Carpenter
- From the ‡Salivary Unit, Mucosal and Salivary Biology, Dental Institute, King's College London, Guy's Hospital, Floor 17, Tower Wing, London SE1 9RT, UK
| | - Sarah A Flowers
- §Department of Medical Biochemistry, Institute of Biomedicine, University of Gothenburg, Medicinaregatan 9A, 405 30, Gothenburg, Sweden
| |
Collapse
|
24
|
Karched M, Bhardwaj RG, Inbamani A, Asikainen S. Quantitation of biofilm and planktonic life forms of coexisting periodontal species. Anaerobe 2015; 35:13-20. [PMID: 25926392 DOI: 10.1016/j.anaerobe.2015.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/21/2015] [Accepted: 04/24/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Complexity of oral polymicrobial communities has prompted a need for developing in vitro models to study behavior of coexisting bacteria. Little knowledge is available of in vitro co-growth of several periodontitis-associated species without early colonizers of dental plaque. THE AIM was to determine temporal changes in the quantities of six periodontal species in an in vitro biofilm model in comparison with parallel planktonic cultures. MATERIAL AND METHODS Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Parvimonas micra, Campylobacter rectus and Fusobacterium nucleatum were anaerobically grown as multispecies and monospecies biofilms and parallel planktonic cultures using cell culture plates and microfuge tubes, respectively. After incubating 2, 4, 6, 8 days, biofilms and planktonic cultures were harvested, DNA extracted and the target species quantified using qPCR with species-specific 16S rDNA primers. Biofilm growth as monocultures was visualized at day 2 and 8 with confocal microscopy and crystal violet staining. RESULTS The six species were found throughout the test period in all culture conditions, except that P. gingivalis and F. nucleatum were not detected in multispecies planktonic cultures at day 8. In multispecies biofilm, P. gingivalis qPCR counts (cells/ml) increased (P<0.05) from day 2-8 and were then higher (P<0.05) than those of A. actinomycetemcomitans and C. rectus, whereas in monospecies biofilm, P. gingivalis counts were lower (P<0.05) than those of the other species, except A. actinomycetemcomitans. When multi- and monospecies biofilm cultures were compared, P. gingivalis counts were higher (P<0.05) but those of the other species, except P. intermedia, lower (P<0.05) in multispecies biofilm. Comparison between planktonic and biofilm cultures showed that A. actinomycetemcomitans, P. micra and C. rectus had higher (P<0.05) counts in planktonic cultures no matter whether grown in mono- or multispecies environment. CONCLUSIONS Six periodontal species were able to form multispecies biofilm up to 8 days in vitro without pioneer plaque bacteria. P. gingivalis seemed to prefer multispecies biofilm environment whereas P. micra and A. actinomycetemcomitans planktonic culture.
Collapse
Affiliation(s)
- Maribasappa Karched
- Oral Microbiology, General Facility Laboratory, Faculty of Dentistry, Kuwait University, Kuwait
| | - Radhika G Bhardwaj
- Oral Microbiology, General Facility Laboratory, Faculty of Dentistry, Kuwait University, Kuwait
| | - Anandavalli Inbamani
- Oral Microbiology, General Facility Laboratory, Faculty of Dentistry, Kuwait University, Kuwait
| | - Sirkka Asikainen
- Oral Microbiology, General Facility Laboratory, Faculty of Dentistry, Kuwait University, Kuwait.
| |
Collapse
|
25
|
Kim Y, Kim HI, Kho HS. Characteristics of men and premenopausal women with burning mouth symptoms: a case-control study. Headache 2014; 54:888-98. [PMID: 24628375 DOI: 10.1111/head.12338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify possible clinical differences between male, premenopausal, and postmenopausal female patients with burning mouth symptoms. BACKGROUND Burning mouth symptoms are known to occur predominantly in postmenopausal women. In some rare cases, however, such symptoms may also appear in men and younger premenopausal women. There is no information on the characteristics of male and premenopausal female patients with burning mouth symptoms. METHODS A total of 22 male patients (no age limit) and 19 relatively younger premenopausal female patients (age: ≤45 years) with a burning sensation in the mouth without any visible signs of oral mucosal diseases were included in the experimental groups. Sixty burning mouth patients (postmenopausal females, age: ≥50 years) without oral mucosal diseases were included as a typical older postmenopausal group for comparison. All individuals in the 3 groups were subjected to clinical evaluations including an interview, a comprehensive questionnaire, a simplified psychological evaluation (Symptom Checklist-90-Revision [SCL-90-R]), blood tests, and a measurement of salivary flow rate. RESULTS The male group reported taste problems less commonly (40.9%, P = .009) and less severely (median visual analog scale [VAS] = 0.00, P = .004) than the postmenopausal group (73.3%, median VAS = 4.50). The younger premenopausal group complained of paresthesia more commonly (68.4%, P = .006) and more severely (median VAS = 0.50, P = .007) than the postmenopausal group (30.0%, median VAS = 0.00). The male group (81.8%) reported discomfort of the tongue less commonly than the postmenopausal group (100.0%, P = .004). The percentage of patients with a symptom triad of oral mucosal pain, dysguesia, and xerostomia was significantly higher in the premenopausal (73.7%, P = .005) and postmenopausal (60.0%, P = .012) groups than the male group (27.3%). The flow rate of unstimulated whole saliva was significantly higher in the premenopausal group (0.27 ± 0.18 mL/min) than the postmenopausal group (0.17 ± 0.16 mL/min, P = .006). None of the 9 symptom dimensions of the SCL-90-R were significantly different among the 3 groups. The percentage of patients with abnormal blood tests and taking medications due to comorbid diseases was the lowest in the premenopausal group. CONCLUSIONS Male and premenopausal female patients with burning mouth symptoms showed different characteristics compared with typical postmenopausal female patients.
Collapse
Affiliation(s)
- Yongdae Kim
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | | | | |
Collapse
|
26
|
Sialometry of upper labial minor glands: a clinical approach by the use of weighing method Schirmer's test strips paper. ScientificWorldJournal 2014; 2014:268634. [PMID: 24737963 PMCID: PMC3967662 DOI: 10.1155/2014/268634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/01/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives. To establish referential values ranges of hyposalivation and normosalivation for the salivary flow rate (SFR) of upper labial (LS) and palatal (PS) mucosa using Schirmer's test strips paper and as a second goal to determine the values ranges of the SFR of palatal (PS) and upper labial (LS) mucosa in subjects with and without xerostomia. Methods. A cross-sectional study was conducted among subjects distributed in three groups according to their unstimulated and stimulated whole saliva. Results. 144 subjects were enrolled in groups as follows: severe hyposalivation (n = 24), mild hyposalivation (n = 78), and normosalivation (n = 42). The mean and the 95% confidence interval for the LS flow rate (μL/cm2/min) were 3.2 (2.46 to 3.94), 5.86 (4.96 to 6.75), and 9.08 (7.63 to 10.53) (P < 0.001) for each group, respectively. The PS results were 1.01 (0.68 to 1.34), 1.72 (1.31 to 2.13), and 2.44 (1.66 to 3.22) (P = 0.014). Xerostomia complainers presented lower rates of LS (5.17 (4.06 to 6.23)) than non-complainers (7.33 (6.4 to 8.27)) (P = 0.003). Conclusions. The test was reliable to provide referential values ranges for LS flow rate measurement and was shown to be valid to distinguish normosalivation from severe and mild hyposalivation and also to predict xerostomia.
Collapse
|
27
|
Kim JH, Ahn HJ, Choi JH, Jung DW, Kwon JS. Effect of 0.1% pilocarpine mouthwash on xerostomia: double-blind, randomised controlled trial. J Oral Rehabil 2013; 41:226-35. [PMID: 24527846 DOI: 10.1111/joor.12127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate the effect of 0.1% pilocarpine mouthwash in xerostomic patients. Sixty volunteers were randomly allocated to two groups. The experimental group used 0.1% pilocarpine solution, and the control group used 0.9% saline. The short- and long-term effects of pilocarpine were investigated by measuring the severity of oral dryness, minor salivary flow rates and unstimulated whole salivary flow rate at predetermined times. The severity of oral dryness was decreased in both groups at 0, 30 and 60 min after mouthwashing, with no significant difference between the groups. Buccal and labial secretions were increased in both groups, but only the experimental group exhibited increased palatal secretion. Labial and palatal secretions, but not buccal secretion, differed between the groups. The unstimulated whole salivary flow rate was increased in the experimental group and differed from that in the control group. After 4 weeks, the severity of oral dryness was decreased in both groups and did not differ between them. The oral dryness at night or on awakening significantly decreased in both groups, with no significant difference between them, but the oral dryness at other times of the day and the difficulty in swallowing foods were not significantly changed in both groups. Minor salivary and unstimulated whole salivary flow rates did not increase in both groups. Until 1 h after mouthwashing, 0.1% pilocarpine mouthwash increased minor salivary and unstimulated whole salivary secretions, but was not superior compared with 0.9% saline at relieving subjective oral dryness.
Collapse
Affiliation(s)
- J H Kim
- Department of Orofacial Pain & Oral Medicine, Yonsei Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | | | | | | | | |
Collapse
|
28
|
Kho HS, Chang JY, Kim YY, Kim Y. MUC1 and toll-like receptor-2 expression in burning mouth syndrome and oral lichen planus. Arch Oral Biol 2013; 58:837-42. [DOI: 10.1016/j.archoralbio.2013.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/29/2012] [Accepted: 01/15/2013] [Indexed: 12/16/2022]
|
29
|
Randall K, Stevens J, Yepes JF, Randall ME, Kudrimoti M, Feddock J, Xi J, Kryscio RJ, Miller CS. Analysis of factors influencing the development of xerostomia during intensity-modulated radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:772-9. [PMID: 23523462 DOI: 10.1016/j.oooo.2013.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/28/2012] [Accepted: 01/04/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Factors influencing xerostomia during intensity-modulated radiation therapy (IMRT) were assessed. METHODS A 6-week study of 32 head and neck cancer (HNC) patients was performed. Subjects completed the Xerostomia Inventory (XI) and provided stimulated saliva (SS) at baseline, week 2 and at end of IMRT. Influence of SS flow rate (SSFR), calcium and mucin 5b (MUC5b) concentrations and radiation dose on xerostomia was determined. RESULTS HNC subjects experienced mean SSFR decline of 36% by visit 2 (N = 27; P = .012) and 57% by visit 3 (N = 20; P = .0004). Concentrations of calcium and MUC5b increased, but not significantly during IMRT (P > .05). Xerostomia correlated most with decreasing salivary flow rate as determined by Spearman correlations (P < .04) and linear mixed models (P < .0001). CONCLUSIONS Although IMRT is sparing to the parotid glands, it has an early effect on SSFR and the constituents in saliva in a manner that is associated with the perception of xerostomia.
Collapse
Affiliation(s)
- Ken Randall
- Department of Oral Health Practice, Division of Oral Medicine, Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kho HS, Park MS, Chang JY, Kim YY. Yam tuber mucilage as a candidate substance for saliva substitute:in vitrostudy of its viscosity and influences on lysozyme and peroxidase activities. Gerodontology 2012; 31:34-41. [DOI: 10.1111/ger.12000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis; School of Dentistry and Dental Research Institute; Seoul National University; Seoul Korea
| | - Moon-Soo Park
- Department of Oral Medicine and Diagnosis; College of Dentistry; Kangnung-Wonju National University; Kangnung Korea
| | - Ji-Youn Chang
- Department of Oral Medicine and Oral Diagnosis; School of Dentistry and Dental Research Institute; Seoul National University; Seoul Korea
| | - Yoon-Young Kim
- Department of Oral Medicine and Oral Diagnosis; School of Dentistry and Dental Research Institute; Seoul National University; Seoul Korea
| |
Collapse
|
31
|
A systematic review of methods to diagnose oral dryness and salivary gland function. BMC Oral Health 2012; 12:29. [PMID: 22870895 PMCID: PMC3573918 DOI: 10.1186/1472-6831-12-29] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 07/16/2012] [Indexed: 01/01/2023] Open
Abstract
Background The most advocated clinical method for diagnosing salivary dysfunction is to quantitate unstimulated and stimulated whole saliva (sialometry). Since there is an expected and wide variation in salivary flow rates among individuals, the assessment of dysfunction can be difficult. The aim of this systematic review is to evaluate the quality of the evidence for the efficacy of diagnostic methods used to identify oral dryness. Methods A literature search, with specific indexing terms and a hand search, was conducted for publications that described a method to diagnose oral dryness. The electronic databases of PubMed, Cochrane Library, and Web of Science were used as data sources. Four reviewers selected publications on the basis of predetermined inclusion and exclusion criteria. Data were extracted from the selected publications using a protocol. Original studies were interpreted with the aid of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Results The database searches resulted in 224 titles and abstracts. Of these abstracts, 80 publications were judged to meet the inclusion criteria and read in full. A total of 18 original studies were judged relevant and interpreted for this review. In all studies, the results of the test method were compared to those of a reference method. Based on the interpretation (with the aid of the QUADAS tool) it can be reported that the patient selection criteria were not clearly described and the test or reference methods were not described in sufficient detail for it to be reproduced. None of the included studies reported information on uninterpretable/intermediate results nor data on observer or instrument variation. Seven of the studies presented their results as a percentage of correct diagnoses. Conclusions The evidence for the efficacy of clinical methods to assess oral dryness is sparse and it can be stated that improved standards for the reporting of diagnostic accuracy are needed in order to assure the methodological quality of studies. There is need for effective diagnostic criteria and functional tests in order to detect those individuals with oral dryness who may require oral treatment, such as alleviation of discomfort and/or prevention of diseases.
Collapse
|
32
|
Comparative analysis of gingival wetness at natural teeth and dental implant sites. IMPLANT DENT 2011; 21:57-61. [PMID: 22207055 DOI: 10.1097/id.0b013e31823fca8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND "Gingival Wetness (GW)," which is the thickness of residual saliva on gingiva, functions as a moisture retainer and a protective barrier for microbial colonization. Whether dental implant (DI) treatment affects GW scores and whether gingival inflammation has the capacity to alter GW remains unknown. Thus, this study was designed to evaluate the potential impact of DI treatment on GW. METHODS A total of 118 DIs and natural teeth (NT) sites were comparatively analyzed. Clinical periodontal and periimplant status were determined. Sites were classified into 2 subgroups based on the clinical inflammatory status as inflamed or noninflamed. GW was measured by standardized paper strips and quantified by micromoisture meter. RESULTS Gingival index, clinical attachment loss, plaque index, and gingival bleeding time index scores were generally lower at DI sites. Significant differences were seen in clinical attachment loss, plaque index, and gingival bleeding time index in inflamed sites, presenting higher scores for NT. Comparable values were observed for DI and NT regarding GW for all sites. No differences were noticed in GW scores between the noninflamed NT and DI sites and also wheninflamed sites were concerned. CONCLUSIONS DI treatment does not seem to result in any apparent reduction in GW. Thus, it can be speculated that similar protective processes may occur at dental implant and NT sites. Furthermore, GW does not seem to depend on the local inflammatory status of the soft tissues.
Collapse
|
33
|
Chang WI, Chang JY, Kim YY, Lee G, Kho HS. MUC1 expression in the oral mucosal epithelial cells of the elderly. Arch Oral Biol 2011; 56:885-90. [PMID: 21382610 DOI: 10.1016/j.archoralbio.2011.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 12/30/2010] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE MUC1 is primarily involved in the protection of epithelial surfaces. Decreases in oral mucosal defence can be a predisposing factor for the development of oral mucosal diseases in the elderly. The aim of this study was to compare MUC1 expression level in oral mucosal epithelial cells of the elderly with that of young adults. DESIGN Thirty elderly (mean age, 71.1±4.6 years) and thirty young (mean age, 26.4±2.4 years) adults (15 men and 15 women in each group) were included. Oral examination, including tooth, periodontal, and oral mucosal status, was performed and whole saliva samples were collected along with flow rate measurements. Precipitates of stimulated whole saliva were used for the evaluation of MUC1 expression using real-time PCR. Clarified supernatants were used for the measurement of pro-inflammatory cytokines, IL-1β, IL-6, and TNF-α. RESULTS There was a significant decrease in the amounts of MUC1 transcripts in elderly subjects compared with those of young subjects, a result seen in both men (0.589-fold) and women (0.547-fold). The MUC1 expression level was not correlated with salivary cytokine level but did show a significant positive correlation with the level of periodontal inflammation (r(s)=0.505, P<0.01) in the elderly group. CONCLUSIONS Oral mucosal defence provided by MUC1 was decreased in the elderly; this decrease may play a role in the development of oral mucosal diseases in the aged population.
Collapse
Affiliation(s)
- Woon-Ic Chang
- Dept. of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Yunkeun-Dong 28, Chongro-Ku, Seoul 110-749, Republic of Korea
| | | | | | | | | |
Collapse
|
34
|
Osailan S, Pramanik R, Shirodaria S, Challacombe SJ, Proctor GB. Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis 2010; 17:109-14. [PMID: 21029258 DOI: 10.1111/j.1601-0825.2010.01715.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Mucosal wetness (MW) reflects the layer of residual saliva that covers the oral mucosal surfaces. OBJECTIVES The aim of this study was to determine MW at different oral mucosa sites and to investigate the relationship between MW, unstimulated whole salivary flow rates (UWS) and Clinical Oral Dryness Score (CODS). METHOD A total of 100 dry mouth patients and 50 healthy subjects participated in the study. MW was sampled with filter paper strips at four sites inside the mouth; anterior hard palate (AHP), buccal mucosa (BUC), anterior tongue (AT), lower lip (LL) and measured with a micro-moisture meter. Reproducibility was assessed by repeated sampling and diurnal variation was examined. RESULTS Mucosal wetness in healthy subjects differed according to site and means±SD were; AHP (11± 11.7μm), BUC (32±14.8μm), AT (65±17.2μm), and LL (25 ±13.5μm). Dry mouth patients with reduced UWS showed increased CODS. MW at all four sites was significantly reduced (P<0.05) in dry mouth patients compared with the healthy subjects. Reproducibility of MW measurement using the intra-class correlation coefficient showed agreement at different visits within subject. MW of the AT showed a positive correlation with UWS (P<0.05). CONCLUSION Mucosal wetness is a reliable measure of oral dryness and had a positive correlation with UWS.
Collapse
Affiliation(s)
- S Osailan
- King's College London Dental Institute, London, UK.
| | | | | | | | | |
Collapse
|
35
|
Abstract
In this article, the literature on minor salivary gland secretion rates, composition, and function is reviewed. Measurements of the minor salivary gland secretion rates and composition are complicated, and the secretions display large biological variability. Despite this, some characteristics of these secretions have been found repeatedly in independent investigations. Minor gland saliva varies between different oral sites. Buccal saliva flow is higher than labial saliva flow, which in turn is usually higher than the palatal gland secretion rate. It is generally agreed that minor gland saliva is important for the whole saliva composition, and especially for the secretory immunoglobulin A and mucins. The secretion from these glands seems also important for subjective feelings of dry mouth and general wellbeing. Further research is essential for understanding the role of these secretions for oral, as well as for general, health.
Collapse
Affiliation(s)
- Lars Eliasson
- Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | | |
Collapse
|
36
|
The effects of parafunctional habit control and topical lubricant on discomforts associated with burning mouth syndrome (BMS). Arch Gerontol Geriatr 2010; 51:95-9. [DOI: 10.1016/j.archger.2009.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 08/22/2009] [Accepted: 08/26/2009] [Indexed: 11/22/2022]
|
37
|
Pramanik R, Osailan SM, Challacombe SJ, Urquhart D, Proctor GB. Protein and mucin retention on oral mucosal surfaces in dry mouth patients. Eur J Oral Sci 2010; 118:245-53. [DOI: 10.1111/j.1600-0722.2010.00728.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2010; 37:185-93. [PMID: 20191515 DOI: 10.1111/j.1365-2842.2009.02037.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The role of serum uric acid as an independent risk factor for cardiovascular disease remains unclear, although hyperuricemia is associated with cardiovascular disease such as coronary heart disease (CHD), stroke, and hypertension. METHODS A systematic review and meta-analysis using a random-effects model was conducted to determine the risk of CHD associated with hyperuricemia in adults. Studies of hyperuricemia and CHD were identified by searching major electronic databases using the medical subject headings and keywords without language restriction (through February 2009). Only prospective cohort studies were included if they had data on CHD incidences or mortalities related to serum uric acid levels in adults. RESULTS Twenty-six eligible studies of 402,997 adults were identified. Hyperuricemia was associated with an increased risk of CHD incidence (unadjusted risk ratio [RR] 1.34, 95% confidence interval [95% CI] 1.19-1.49) and mortality (unadjusted RR 1.46, 95% CI 1.20-1.73). When adjusted for potential confounding, the pooled RR was 1.09 (95% CI 1.03-1.16) for CHD incidence and 1.16 (95% CI 1.01-1.30) for CHD mortality. For each increase of 1 mg/dl in uric acid level, the pooled multivariate RR for CHD mortality was 1.12 (95% CI 1.05-1.19). Subgroup analyses showed no significant association between hyperuricemia and CHD incidence/mortality in men, but an increased risk for CHD mortality in women (RR 1.67, 95% CI 1.30-2.04). CONCLUSION Hyperuricemia may marginally increase the risk of CHD events, independently of traditional CHD risk factors. A more pronounced increased risk for CHD mortality in women should be investigated in future research.
Collapse
Affiliation(s)
- Seo Young Kim
- Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Eliasson L, Birkhed D, Carlén A. Feeling of dry mouth in relation to whole and minor gland saliva secretion rate. Arch Oral Biol 2009; 54:263-7. [PMID: 18922513 DOI: 10.1016/j.archoralbio.2008.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 06/24/2008] [Accepted: 09/07/2008] [Indexed: 10/21/2022]
|
40
|
Abstract
BACKGROUND Xerostomia is the feeling of dryness in the mouth, usually owing to hypofunctioning of the salivary glands. Causes of xerostomia include medications, the effects of radiation therapy on the salivary glands during the treatment of head and neck cancer or thyroid cancer, and autoimmune diseases such as Sjögren's syndrome. The primary treatment to reduce xerostomia is oral pilocarpine. OBJECTIVE This review discusses the randomized trials available on the efficacy and tolerability of oral pilocarpine for the treatment of xerostomia. METHODS The randomized trials of pilocarpine for xerostomia available in the medical literature are reviewed. RESULTS/CONCLUSION Pilocarpine has some efficacy in the treatment of xerostomia from radiation therapy, graft-versus-host disease and Sjögren's syndrome. It has limited activity for the prevention of xerostomia during radiation therapy. It may have increased efficacy in combination with newer forms of radiation therapy.
Collapse
Affiliation(s)
- Lawrence Berk
- Moffitt Cancer Center at Tampa General Hospital, Moffitt Cancer Center, Radiation Oncology, 2 Columbia Dr, Tampa, FL 33606, USA.
| |
Collapse
|
41
|
Association of passive smoking with caries and related salivary biomarkers in young children. Arch Oral Biol 2008; 53:969-74. [PMID: 18672230 DOI: 10.1016/j.archoralbio.2008.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 04/29/2008] [Accepted: 05/06/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the association between passive smoking, as determined by salivary cotinine level, and caries, salivary pH, buffering capacity, flow rate and microbiological counts in young children. DESIGN Ninety passive smokers (PS) with a mean age of 5.02 years and 90 healthy age-matched controls were included in this study. Family income, smoking habits of household members, parental education levels, child's tooth-brushing habit and child's daily dietary sugar exposure were recorded by questionnaire. Three categories were formed with respect to the number of cigarettes smoked. A dmft score was calculated according to the criteria recommended by the World Health Organization. The children were also investigated for stimulated salivary cotinine level, pH, flow rate, buffering capacity and salivary Streptococcus mutans and lactobacilli colonisation. RESULTS There were no significant differences in tooth-brushing habit, sugar exposure, family income and parental education levels between the two groups (P>0.05). The mean cotinine level of the PS subjects was 1.58+/-4.3ng/ml. The dmft scores, and salivary S. mutans and lactobacilli colonisation in PS children were significantly higher than in the control subjects (P<0.05). Statistically significant decreases in salivary pH, flow rate and buffering capacity were found in the PS subjects (P<0.05). CONCLUSION PS children are at increased risk of caries compared with control subjects.
Collapse
|
42
|
Oh JK, Lee JY, Park HK, Kho HS. alpha-Galactosidase activity in human saliva. Arch Oral Biol 2008; 53:842-8. [PMID: 18436191 DOI: 10.1016/j.archoralbio.2008.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/12/2008] [Accepted: 03/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether alpha-galactosidase activity is present in whole and glandular saliva and whether alpha-galactosidase activity depends on blood type and secretor status. DESIGN For the first experiments, 30 healthy participants (15 men, 15 women; mean age, 24.2+/-1.5 years) who were 10 A, 10 B, and 10 O blood type subjects were included. alpha-Galactosidase activity in unstimulated whole saliva (UWS) was assayed by using 4-methylumbelliferyl-alpha-d-galactopyranoside as a substrate. Total protein concentration was determined by bicinchoninic acid assay. The secretor status of the blood group antigens was determined by immunoblotting. alpha-Galactosidase activity in UWS according to gender, blood type, secretor status, sample clarification, and buffer was investigated. Daily variations of alpha-galactosidase activity and alpha-galactosidase isozyme activity were also investigated. For the second experiments, 10 healthy blood type B participants (5 men, 5 women; mean age, 27.0+/-2.7 years) were enrolled. alpha-Galactosidase activity in whole and glandular saliva was investigated. RESULTS alpha-Galactosidase activity was detected in UWS and was mainly isozyme A activity. There was no difference in alpha-galactosidase activity according to gender, blood type, and secretor status. alpha-Galactosidase activity in UWS was higher in unclarified samples than in clarified ones and showed wide daily variations. alpha-Galactosidase activity in whole saliva was significantly higher than that in glandular saliva. CONCLUSIONS alpha-Galactosidase activity which is mainly isozyme A activity was detected in human whole and glandular saliva. alpha-Galactosidase activity in UWS did not differ according to blood type and secretor status.
Collapse
Affiliation(s)
- Jeong-Kyu Oh
- Department of Oral Medicine & Oral Diagnosis, School of Dentistry & Dental Research Institute, Seoul National University, Yunkeun-Dong 28, Seoul 110-749, Republic of Korea
| | | | | | | |
Collapse
|
43
|
Lee JY, Chung JW, Kim YK, Chung SC, Kho HS. Comparison of the composition of oral mucosal residual saliva with whole saliva. Oral Dis 2008; 13:550-4. [PMID: 17944671 DOI: 10.1111/j.1601-0825.2006.01332.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Compared with whole saliva, residual saliva comprising the oral mucosal film shows a high protein concentration. The purpose of this study was to compare the composition of residual saliva with unstimulated and stimulated whole saliva in normosalivators. MATERIALS AND METHODS The composition of oral mucosal residual saliva in 30 healthy individuals was investigated and compared with that of whole saliva. The concentrations of total protein, secretory immunoglobin A (sIgA), lactoferrin, total carbohydrate, and sialic acid were examined. The activities of peroxidase, lysozyme and alpha-amylase were determined. RESULTS Residual saliva had higher levels of total protein and carbohydrate than whole saliva, with a higher carbohydrate to protein ratio in the residual saliva suggesting that salivary glycoproteins are concentrated on the oral mucosal surface. sIgA, lactoferrin and sialic acid were present as highly concentrated forms in residual saliva. The enzymatic activity of peroxidase in residual saliva was higher than that of whole saliva. CONCLUSIONS These concentrated carbohydrate and antimicrobials on the oral mucosal surface work for mucosal defence and could be used for targeting sites for the delivery of therapeutic agents.
Collapse
Affiliation(s)
- J-Y Lee
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | | | | | | | | |
Collapse
|
44
|
Suh KI, Lee JY, Chung JW, Kim YK, Kho HS. Relationship between salivary flow rate and clinical symptoms and behaviours in patients with dry mouth. J Oral Rehabil 2007; 34:739-44. [PMID: 17824886 DOI: 10.1111/j.1365-2842.2006.01712.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to investigate the relationship between whole salivary flow rate and dry mouth-related subjective symptoms and behaviours in patients with dry mouth. Seventy-eight patients (13 men and 65 women, 58.2 +/- 13.5 years) with dry mouth were asked a standardized series of questions concerning dry mouth-related symptoms and behaviours. Whole salivary flow rates were measured under unstimulated and stimulated conditions. The effect of oral dryness on daily life was significantly associated with the flow rate of stimulated whole saliva (r(s) = -0.30, P < 0.01) and frequency of oral dryness (r(s) = 0.46, P < 0.01). Dry mouth-related symptoms and behaviours were significantly associated with the whole salivary flow rate and the correlation was more remarkable with respect to stimulated whole saliva. The most common dry mouth-associated complaint was sensation of burning mouth. The effect of oral dryness on daily life was significantly affected by the presence of taste disturbances. Collectively, dry mouth-related symptoms and behaviours were significantly associated with whole salivary flow rate. Moreover, the severity of dry mouth-related symptoms was more closely correlated with the flow rate of stimulated saliva, compared with the unstimulated flow rate.
Collapse
Affiliation(s)
- K-I Suh
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | | | | | | | | |
Collapse
|
45
|
Hershkovich O, Shafat I, Nagler RM. Age-related changes in salivary antioxidant profile: possible implications for oral cancer. J Gerontol A Biol Sci Med Sci 2007; 62:361-6. [PMID: 17452728 DOI: 10.1093/gerona/62.4.361] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Oral cancer's much higher prevalence among older people may be due to an age-related reduction in protective salivary antioxidant mechanisms and/or an age-related increase in the magnitude of oral carcinogen attack, such as reactive oxygen species (ROS) and reactive nitrogen species (RNS), causing DNA aberrations. This study found a significantly reduced total value of salivary antioxidant capacity in elderly persons (as measured by overall antioxidant capacity [ImAnOx] assay), (46% of healthy individuals, p =.004), increased oxidative stress (86% increase in carbonyl concentrations--indicators of enhanced ROS attack, p =.001), and increased salivary concentrations and total values of RNS (7-fold and 3-fold higher respectively, p =.001), all contributing to increased DNA oxidation of oral epithelial cells. Salivary oxidative stress-related changes in the intimately related saliva and oral epithelium compounded with higher viscosity of saliva may explain the higher prevalence of oral cancer in the elderly population. Administration of local therapeutic agents (i.e., antioxidants) to the oral cavity should be considered.
Collapse
Affiliation(s)
- Oded Hershkovich
- Oral Biochemistry Laboratory, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | |
Collapse
|
46
|
Sopapornamorn P, Ueno M, Shinada K, Yanagishita M, Kawaguchi Y. Relationship between total salivary protein content and volatile sulfur compounds levels in malodor patients. ACTA ACUST UNITED AC 2007; 103:655-60. [PMID: 17150382 DOI: 10.1016/j.tripleo.2006.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 08/17/2006] [Accepted: 08/28/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship between total salivary protein and VSC levels. STUDY DESIGN A patient group comprised 67 patients from the Fresh Breath Clinic of the Dental Hospital, Tokyo Medical and Dental University, with 18 healthy subjects as a control group. Gas chromatography was used to measure concentrations of VSCs in mouth air. After collecting resting saliva, flow rate, pH, and the amount of total protein in saliva were measured. Salivary protein patterns were analyzed by polyacrylamide gel electrophoresis (PAGE). RESULTS In the patient group, the amounts of total salivary protein were significantly correlated with CH3SH levels measured by GC, CH3SH/H2S ratio, and organoleptic score. In addition, a significant correlation between flow rate of salivary protein and CH3SH/H2S ratio and the higher levels of salivary proteins from PAGE analyses were found. CONCLUSIONS Total salivary protein was considered to be involved in the formation of oral malodor as one of the nutrient sources. The total salivary protein could be changed both quantitatively and qualitatively in subjects with malodor.
Collapse
Affiliation(s)
- Praweena Sopapornamorn
- Department of Oral Health Promotion, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
| | | | | | | | | |
Collapse
|
47
|
Márton K, Boros I, Varga G, Zelles T, Fejérdy P, Zeher M, Nagy G. Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren's syndrome. Oral Dis 2006; 12:480-6. [PMID: 16910919 DOI: 10.1111/j.1601-0825.2005.01224.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the oral properties of Sjögren's syndrome (SS), including the determination of palatal saliva (PS) flow rate. SUBJECTS AND METHODS Forty-nine SS patients and 43 healthy controls participated. Subjective symptoms were recorded and clinical assessments of the oral mucosal, dental and periodontal status were made. Unstimulated whole saliva (WS) and PS flow rates, the number of decayed, missing and filled teeth (DMF-T number), the gingival bleeding index (GBI) and the periodontal probing depth (PPD) were determined. RESULTS Despite the decrease in the flow rate of WS in SS patients, PS was not different from those of the controls (1.57 +/- 1.02 and 1.35 +/- 2.5 microl cm(-2) min(-1), respectively). GBI (20.0% vs. 10.5%, respectively), DMF-T (27.1 +/- 6.12 vs. 23.0 +/- 6.99, respectively) and PPD (2.28 +/- 1.09 mm vs. 1.82 +/- 0.73 mm, respectively) were higher in SS compared with the controls (P < 0.05). DMF-T and PPD showed a positive correlation with anti-SSA and/or anti-SSB antibody positivity in the serum (P < 0.05). CONCLUSIONS Data of the present study suggest that the subjective feeling of xerostomia in SS patients is the result of a decrease in the volume of the whole saliva, and not of the viscous PS. Correlation of DMF-T and PPD with autoantibody positivity reveals that the oral health status of SS patients may be associated with the general autoimmune process.
Collapse
Affiliation(s)
- K Márton
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary.
| | | | | | | | | | | | | |
Collapse
|
48
|
Nagler RM, Hershkovich O. Age-related changes in unstimulated salivary function and composition and its relations to medications and oral sensorial complaints. Aging Clin Exp Res 2005; 17:358-66. [PMID: 16392409 DOI: 10.1007/bf03324623] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS The purpose of the current study was to examine the salivary flow rate and composition in relation to drug consumption and idiopathic oral sensorial complaints (OSC). OSC cover xerostomia, disturbed sense of taste, or burning mouth sensitivity with no established classical etiology (e.g., Sjogren's syndrome, or a response to radiotherapy). METHODS A thorough sialometrical and sialochemical analysis was performed for all subjects who were healthy non-hospitalized individuals ranging in age from 18-89 years. Saliva samples were all collected in unstimulated conditions. RESULTS The three most significant observations were: a) Elderly people have significantly reduced and altered salivary secretion. Whereas specific concentrations increased, the total values of most salivary components were found to be decreased in the elderly. b) Fifty percent of the elderly make OSC. c) OSC were made mainly by elderly individuals who use drugs. CONCLUSIONS Reduction in salivary function and altered composition are age-related. However, when drugs are not involved, a compensatory capacity which avoids OSC apparently exists. In contrast, the effect of drugs on OSC is extensive. The finding that the total amount of salivary components and not only salivary flow rates are reduced in the elderly is of great clinical importance, since such a reduction is expected to be reflected in compromising various salivary functions.
Collapse
Affiliation(s)
- Rafael M Nagler
- Department of Oral & Maxillofacial Surgery, Oral Biochemistry Laboratory and Salivary Clinic, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | |
Collapse
|
49
|
Nagler RM, Hershkovich O. Relationships between age, drugs, oral sensorial complaints and salivary profile. Arch Oral Biol 2005; 50:7-16. [PMID: 15598412 DOI: 10.1016/j.archoralbio.2004.07.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2004] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the relationships between oral sensorial complaints (OSCs) and salivary flow rate, composition and drug consumption of subjects aged 18-90 years. The results were correlated with both drug consumption and OSCs. Only individuals who were free of conditions that are already known to cause OSCs were included in the study. The three most significant observations were as follows: (1) elderly people have significantly reduced and altered salivary secretion compared with younger people. While specific concentrations increased, the total values of most salivary components decreased in the elderly; (2) 50% of the elderly population have OSCs regarding taste, burning mouth syndrome or xerostomia; and (3) OSCs were more prevalent in elderly people who use drugs than in those who do not. In conclusion, a reduction in salivary function and altered composition are age related. A compensatory capacity that prevents OSCs appears to exist in elderly patients who do not use drugs, but drugs were found to have an extensive effect on OSCs. The finding that the total amounts of salivary components and not only the salivary flow rate were reduced in elderly people is of great clinical relevance, since such a reduction is expected to be reflected in compromising various salivary functions.
Collapse
Affiliation(s)
- Rafael M Nagler
- Department of Oral and Maxillofacial Surgery, Oral Biochemistry Laboratory and Salivary Clinic, Rambam Medical Centre and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | |
Collapse
|
50
|
Eliasson L, Almståhl A, Lingström P, Wikström M, Carlén A. Minor gland saliva flow rate and proteins in subjects with hyposalivation due to Sjögren's syndrome and radiation therapy. Arch Oral Biol 2005; 50:293-9. [PMID: 15740707 DOI: 10.1016/j.archoralbio.2004.08.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2004] [Indexed: 10/26/2022]
Abstract
In this study, the secretion rate and IgA, albumin and lactoferrin concentrations in minor labial and buccal gland saliva were investigated in individuals with hyposalivation due to primary Sjogren's syndrome (pSS; 10 subjects) or head and neck radiation therapy (RT; 10 subjects) and in their matched controls. Whole saliva was similarly examined. The minor gland saliva flow was measured using the Periotron method. IgA, albumin and lactoferrin concentrations were analysed by ELISA techniques. A general finding was that the flow rate and protein concentrations were lower in labial than in buccal gland saliva. In both hyposalivation groups, the labial minor gland saliva secretion rate was lowered compared to their respective controls. The buccal gland saliva flow rate was significantly reduced in the RT group only. IgA and albumin concentrations were not different from the controls in the labial secretions. The concentration of lactoferrin was increased in the RT group. In buccal saliva, the concentrations of all proteins examined but pSS IgA, were increased compared to the controls. Reduced flow rate and increased protein concentrations were seen for whole saliva where the lactoferrin concentration was higher in RT than in pSS subjects. Thus, our findings suggested that minor gland saliva flow rate and protein concentrations are affected in RT and pSS subjects and to highest extent in the former.
Collapse
Affiliation(s)
- L Eliasson
- Department of Cariology, Faculty of Odontology, The Sahlgrenska Academy at Göteborg University, P.O. Box 450, SE-40530 Göteborg, Sweden.
| | | | | | | | | |
Collapse
|