Normal and frictional interactions of purified human statherin adsorbed on molecularly-smooth solid substrata

Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta-analysis of randomised controlled trials

AIMS AND OBJECTIVES

This meta-analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery.

BACKGROUND

Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial.

DESIGN

A meta-analysis of randomised controlled trials was performed.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a meta-analysis involving no people or animals.

METHODS

The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement.

TRIAL REGISTRATION

PROSPERO CRD42022330223.

RESULTS

Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta-analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p = .13) and gastric fluid volume (p = .25) compared with non-gum-chewing group. In comparison with the non-gum-chewing group, the gum-chewing group was associated with shorter preoperative thirst score (p = .02), lower incidence of postoperative nausea (p = .0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p < .00001), shorter first postoperative defecation time (p < .00001) and shorter hospital days (p = .02).

CONCLUSIONS

Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults.

RELEVANCE TO CLINICAL PRACTICE

This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery.

Caries Management-The Role of Surface Interactions in De- and Remineralization-Processes

BACKGROUND

Bioadhesion and surface interactions on enamel are of essential relevance for initiation, progression and prevention of caries and erosions. Salivary proteins on and within initial carious and erosive lesions can facilitate or aggravate de- and remineralization. This applies for the pellicle layer, the subsurface pellicle and for proteins within initial carious lesions. Little is known about these proteinaceous structures related to initial caries and erosion. Accordingly, there is a considerable demand for an understanding of the underlying processes occurring at the interface between the tooth surface and the oral cavity in order to develop novel agents that limit and modulate caries and erosion. Objectives and findings: The present paper depicts the current knowledge of the processes occurring at the interface of the tooth surface and the oral fluids. Proteinaceous layers on dental hard tissues can prevent or aggravate demineralization processes, whereas proteins within initial erosive or carious lesions might hinder remineralization considerably and restrict the entry of ions into lesions.

CONCLUSIONS

Despite the fact that organic-inorganic surface interactions are of essential relevance for de- and remineralization processes at the tooth surface, there is limited knowledge on these clinically relevant phenomena. Accordingly, intensive research is necessary to develop new approaches in preventive dentistry.

Saliva: An all-rounder of our body

Saliva is a multifaceted bodily fluid that is often taken for granted but is indispensable for oral health and overall well-being in humans. Although mainly comprised of water (99.5%), proteins, ions and enzymes turn saliva into a viscoelastic solution that performs a variety of vital tasks. This review article gives a brief overview of the salivary gland system, as well as the composition, output and functions of saliva. It also addresses the current applications of saliva for diagnostic purposes, the clinical relevance of saliva in oral diseases as well as current treatment options.

Reduced statherin in acquired enamel pellicle on eroded teeth compared to healthy teeth in the same subjects: An in-vivo study

The aim of this in-vivo study was to compare total protein and four key salivary proteins present in the acquired enamel pellicle (AEP) on eroded and non-eroded surfaces in participants with erosive tooth wear. Participants with erosive tooth wear of dietary non-intrinsic origin, present on the occlusal surfaces of the lower first molars and an unaffected posterior occlusal surface in the same quadrant were recruited from restorative dental clinics at King's College London Dental Institute (n = 29, REC ref 14/EM/1171). Following removal of the salivary film, AEP samples were collected from the eroded occlusal surfaces (EP, n = 29) and the non-eroded occlusal surfaces (NP, n = 29) using 0.5% sodium dodecyl sulfate (SDS) soaked filter papers. Total protein concentration was analysed using bicinchoninic acid assay (BCA). Protein fractions were separated using SDS-PAGE and immunoblotted against: mucin5b, albumin, carbonic anhydrase VI (CA VI) and statherin antibodies. Amounts were quantified using ImageLab software against purified protein standards of known concentration. ANOVA followed by paired t-test and Wilcoxon's matched-pair signed-rank test were used to test statistical significance. The difference was considered to be significant at a P value < 0.05. The total protein on eroded surfaces was significantly lower compared to the total protein on non-eroded surfaces [0.41mg/mL (0.04) and 0.61 mg/mL (0.11)] respectively (p< 0.05). The median (min, max) amount of statherin was also significantly lower on eroded occlusal surfaces [84.1 (20.0, 221.8) ng] compared to AEP from non-eroded teeth in the same subjects [97.1(30.0, 755.6) ng] (p = 0.002). No statistical differences were observed for mucin 5b, albumin or CA VI. The total protein and statherin in the in-vivo AEP were different between eroded and non-eroded tooth surfaces of the same patient.

Structural modifications of the salivary conditioning film upon exposure to sodium bicarbonate: implications for oral lubrication and mouthfeel

The salivary conditioning film (SCF) that forms on all surfaces in the mouth plays a key role in lubricating the oral cavity. As this film acts as an interface between tongue, enamel and oral mucosa, it is likely that any perturbations to its structure could potentially lead to a change in mouthfeel perception. This is often experienced after exposure to oral hygiene products. For example, consumers that use dentifrice that contain a high concentration of sodium bicarbonate (SB) often report a clean mouth feel after use; an attribute that is clearly desirable for oral hygiene products. However, the mechanisms by which SB interacts with the SCF to alter lubrication in the mouth is unknown. Therefore, saliva and the SCF was exposed to high ionic strength and alkaline solutions to elucidate whether the interactions observed were a direct result of SB, its high alkalinity or its ionic strength. Characteristics including bulk viscosity of saliva and the viscoelasticity of the interfacial salivary films that form at both the air/saliva and hydroxyapatite/saliva interfaces were tested. It was hypothesised that SB interacts with the SCF in two ways. Firstly, the ionic strength of SB shields electrostatic charges of salivary proteins, thus preventing protein crosslinking within the film and secondly; the alkaline pH (≈8.3) of SB reduces the gel-like structure of mucins present in the pellicle by disrupting disulphide bridging of the mucins via the ionization of their cysteine's thiol group, which has an isoelectric point of ≈8.3.

Influence of substratum hydrophobicity on salivary pellicles: organization or composition?

Different physico-chemical properties (eg adsorption kinetics, thickness, viscoelasticity, and mechanical stability) of adsorbed salivary pellicles depend on different factors, including the properties (eg charge, roughness, wettability, and surface chemistry) of the substratum. Whether these differences in the physico-chemical properties are a result of differences in the composition or in the organization of the pellicles is not known. In this work, the influence of substratum wettability on the composition of the pellicle was studied. For this purpose, pellicles eluted from substrata of different but well-characterized wettabilities were examined by means of sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). The results showed that substratum hydrophobicity did not have a major impact on pellicle composition. In all substrata, the major pellicle components were found to be cystatins, amylases and large glycoproteins, presumably mucins. In turn, interpretation of previously reported data based on the present results suggests that variations in substratum wettability mostly affect the organization of the pellicle components.

Lubrication and load-bearing properties of human salivary pellicles adsorbed ex vivo on molecularly smooth substrata

In a series of Surface Force Balance experiments, material from human whole saliva was adsorbed to molecularly smooth mica substrata (to form an 'adsorbed salivary film'). Measurements were taken of normal (load bearing, F (n)) and shear (frictional, F (s)*) forces between two interacting surfaces. One investigation involved a salivary film formed by overnight adsorption from undiluted, centrifuged saliva, with the adsorbed film rinsed with pure water before measurement. Measurements were taken under pure water and 70 mM NaNO(3). In a second investigation, a film was formed from and measured under a solution of 7% filtered saliva in 10 mM NaNO(3). F (n) results for both systems showed purely repulsive layers, with an uncompressed thickness of 35-70 nm for the diluted saliva investigation and, prior to the application of shear, 11 nm for the rinsed system. F (s)* was essentially proportional to F (n) for all systems and independent of shear speed (in the range 100-2000 nm s(-1)), with coefficients of friction μ ≈ 0.24 and μ ≈ 0.46 for the unrinsed and rinsed systems, respectively. All properties of the rinsed system remained similar when the pure water measurement environment was changed to 70 mM NaNO(3). For all systems studied, shear gave rise to an approximately threefold increase in the range of normal forces, attributed to the ploughing up of adsorbed material during shear to form debris that stood proud of the adsorbed layer. The results provide a microscopic demonstration of the wear process for a salivary film under shear and may be of particular interest for understanding the implications for in vivo oral lubrication under conditions such as rinsing of the mouth cavity. The work is interpreted in light of earlier studies that showed a structural collapse and increase in friction for an adsorbed salivary film in an environment of low ionic strength.