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Song W, Liu H, Su Y, Zhao Q, Wang X, Cheng P, Wang H. Current developments and opportunities of pluripotent stem cells-based therapies for salivary gland hypofunction. Front Cell Dev Biol 2024; 12:1346996. [PMID: 38313227 PMCID: PMC10834761 DOI: 10.3389/fcell.2024.1346996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Salivary gland hypofunction (SGH) caused by systemic disease, drugs, aging, and radiotherapy for head and neck cancer can cause dry mouth, which increases the risk of disorders such as periodontitis, taste disorders, pain and burning sensations in the mouth, dental caries, and dramatically reduces the quality of life of patients. To date, the treatment of SGH is still aimed at relieving patients' clinical symptoms and improving their quality of life, and is not able to repair and regenerate the damaged salivary glands. Pluripotent stem cells (PSCs), including embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and extended pluripotent stem cells (EPSCs), are an emerging source of cellular therapies that are capable of unlimited proliferation and differentiation into cells of all three germ layers. In recent years, the immunomodulatory and tissue regenerative effects of PSCs, their derived cells, and paracrine products of these cells have received increasing attention and have demonstrated promising therapeutic effects in some preclinical studies targeting SGH. This review outlined the etiologies and available treatments for SGH. The existing efficacy and potential role of PSCs, their derived cells and paracrine products of these cells for SGH are summarized, with a focus on PSC-derived salivary gland stem/progenitor cells (SGS/PCs) and PSC-derived mesenchymal stem cells (MSCs). In this Review, we provide a conceptual outline of our current understanding of PSCs-based therapy and its importance in SGH treatment, which may inform and serve the design of future studies.
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Affiliation(s)
- Wenpeng Song
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huan Liu
- Beijing Laboratory of Oral Health, School of Basic Medicine, School of Stomatology, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qian Zhao
- Research and Development Department, Allife Medicine Inc., Beijing, China
| | - Xiaoyan Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Oral Health, School of Basic Medicine, School of Stomatology, Capital Medical University, Beijing, China
- Biochemistry and Molecular Biology, School of Basic Medical Sciences, Beijing, China
| | - Pengfei Cheng
- Department of Stomatology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Richer LP, Tan Q, Butler MG, Avedzi HM, DeLorey DS, Peng Y, Tun HM, Sharma AM, Ainsley S, Orsso CE, Triador L, Freemark M, Haqq AM. Evaluation of Autonomic Nervous System Dysfunction in Childhood Obesity and Prader-Willi Syndrome. Int J Mol Sci 2023; 24:ijms24098013. [PMID: 37175718 PMCID: PMC10179129 DOI: 10.3390/ijms24098013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The autonomic nervous system (ANS) may play a role in the distribution of body fat and the development of obesity and its complications. Features of individuals with Prader-Willi syndrome (PWS) impacted by PWS molecular genetic classes suggest alterations in ANS function; however, these have been rarely studied and presented with conflicting results. The aim of this study was to investigate if the ANS function is altered in PWS. In this case-control study, we assessed ANS function in 20 subjects with PWS (6 males/14 females; median age 10.5 years) and 27 body mass index (BMI) z-score-matched controls (19 males/8 females; median age 12.8 years). Standardized non-invasive measures of cardiac baroreflex function, heart rate, blood pressure, heart rate variability, quantitative sudomotor axon reflex tests, and a symptom questionnaire were completed. The increase in heart rate in response to head-up tilt testing was blunted (p < 0.01) in PWS compared to controls. Besides a lower heart rate ratio with Valsalva in PWS (p < 0.01), no significant differences were observed in other measures of cardiac function or sweat production. Findings suggest possible altered sympathetic function in PWS.
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Affiliation(s)
- Lawrence P Richer
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Qiming Tan
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Merlin G Butler
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, KS 66160, USA
| | - Hayford M Avedzi
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Darren S DeLorey
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ye Peng
- JC School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Hein M Tun
- JC School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Steven Ainsley
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Camila E Orsso
- Department of Agricultural Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Lucila Triador
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Michael Freemark
- Division of Pediatric Endocrinology, Duke University Medical Center, Durham, NC 27705, USA
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Division of Pediatric Endocrinology, Duke University Medical Center, Durham, NC 27705, USA
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Mackert J, Mears B, Pannu DJ, Ghaly M, Londono J, El-Awady AR, Peacock ME. Prader-Willi syndrome: Periodontal-prosthodontic rehabilitation in an adult patient. SPECIAL CARE IN DENTISTRY 2022. [PMID: 36074071 DOI: 10.1111/scd.12779] [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: 06/14/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prader-Willi syndrome (PWS) is a rare genetic multisystemic disease that is the most common inherited cause of severe childhood obesity. PWS patients are prone to significant oral and systemic health issues that detrimentally affect quality of life and decrease longevity. This report documents full-mouth pre-prosthetic surgical and restorative care in an adult PWS patient. CASE REPORT The patient, a 29-year-old male, presented to the clinic accompanied by his guardians (parents) with the chief complaint that "My Teeth are breaking down and I would like to get them fixed". Periodontal and prosthetic comprehensive clinical and radiographic exams revealed a severely worn dentition, deep anterior overbite, altered passive eruption with generalized biofilm-induced gingivitis, and altered occlusal vertical dimension. Full mouth crown lengthening surgery combined with full mouth prosthodontic reconstruction was performed under parenteral sedation and local anesthesia. Completion of treatment was successful, and the patient was placed on a 3-month periodontal maintenance interval. DISCUSSION Full mouth periodontal surgical and prosthodontic reconstruction on a PWS patient has not previously been reported in the literature. This case underscores the potential need for complex dental care in patients with this syndrome.
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Affiliation(s)
- Justin Mackert
- Department of Prosthodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Brian Mears
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
| | - D J Pannu
- Department of Prosthodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Mira Ghaly
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jimmy Londono
- Department of Prosthodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Ahmed R El-Awady
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Mark E Peacock
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
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Vasconcelos G, Stenehjem JS, Axelsson S, Saeves R. Craniofacial and dentoalveolar morphology in individuals with Prader-Willi syndrome: a case-control study. Orphanet J Rare Dis 2022; 17:77. [PMID: 35193626 PMCID: PMC8864885 DOI: 10.1186/s13023-022-02222-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder with distinct genetic and clinical features. Among other clinical symptoms, PWS is characterized by severe infantile hypotonia with feeding problems, childhood onset hyperphagia, obesity, scoliosis, short stature combined with growth hormone deficiency and developmental delay. PWS is associated with facial dysmorphology, orofacial dysfunction, oral abnormalities, low salivary flow and subsequent severe tooth wear. Little is known about the craniofacial growth direction or dental and skeletal relationships in individuals with PWS in different ages. The purpose of this study was to assess the craniofacial and dentoalveolar characteristics and to investigate the craniofacial growth direction separately in children, young adults and adults with PWS, using a cephalometric analysis of lateral cephalograms. RESULTS Lateral cephalograms of 42 individuals with a confirmed genetic diagnosis of PWS were analysed and divided into three groups according to their age: Children (< 12 years), young adults (12-20 years) and adults (> 20 years). Cephalometric variables were compared between PWS patients and controls by age and sex. Significant deviations and distinct craniofacial patterns were found in children, young adults and adults with PWS compared with the control group. Children showed retrognatic mandible with a skeletal class II relationship, posterior growth direction and longer anterior face height. The young adults had smaller cranial base angle, a skeletal class II pattern and a higher anterior lower face than the control group. Adults with PWS had a prognathic mandible, skeletal class III relationship with anterior growth direction, more retroclined lower incisors and proclined upper incisors than the controls. Similar results were found when comparing the three groups with PWS; the adults had a prognathic mandible, skeletal class III pattern and anterior growth direction. Children had a retropositioned mandibula, skeletal class II relationship and posterior growth direction. CONCLUSION This study may contribute to a better understanding of the craniofacial growth pattern in children, young adults and adults with PWS and may have a clinical importance when planning dental treatment, such as prosthodontics and/or orthodontics.
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Affiliation(s)
- Gisela Vasconcelos
- TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.
| | - Jo S Stenehjem
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Stefan Axelsson
- TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway
| | - Ronnaug Saeves
- TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway
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Zorlu S, Aren G, Balci Ekmekci O. Ghrelin hormone might have a potential role in amelogenesis. Int J Clin Pract 2021; 75:e14223. [PMID: 33871148 DOI: 10.1111/ijcp.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS Amelogenesis imperfecta and generalised enamel hypoplasia are developmental dental anomalies that affect dental enamel. While amelogenesis imperfecta results from various gene mutations, the exact underlying mechanisms of the etiopathogenesis of both remain unclear. This study aims to evaluate Ghrelin hormone levels in children with generalised enamel hypoplasia to establish whether Ghrelin might have a potential role in enamel hypoplasia's etiology. The second purpose is to determine the correlations among the blood levels of Ghrelin, growth hormone (GH), insulin-like growth factor-1 (IGF-1), bone alkaline phosphatase (BALP) and osteocalcin (OC) that are vital in dental development. MATERIAL AND METHODS Study was designed with two study groups, AI (hypoplastic amelogenesis imperfecta) (n = 15; mean-age 10.36 ± 1.90) and GEH (idiopathic generalised enamel hypoplasia) (n = 15; mean-age 10.42 ± 1.84), and a healthy control (n = 15; mean-age 10.39 ± 1.91) group. After fasting for 10-12 hours, simultaneous blood samples were collected; then, after centrifugation, serum and plasma were stored at -80°C until the day of analysis. Total Ghrelin levels of plasma and serum levels of GH, IGF-1, BALP and OC were measured using commercial ELISA kits. RESULTS Ghrelin levels of AI and GEH groups were significantly lower (P < .01) than the control group. CONCLUSION This is the first study to reveal the decreased levels of Ghrelin in plasma of children with generalised enamel hypoplasia, suggesting a potential role for Ghrelin in amelogenesis. In order to determine its function in enamel formation, further studies should be carried out. The result of the present study suggests that paediatricians refer children with abnormal Ghrelin levels to a paediatric dentist to contribute to appropriate prophylactic and therapeutic interventions. Generalised enamel hypoplasia may also indicate possible abnormalities in Ghrelin levels for paediatricians. Therefore, paediatricians' knowledge about the clinical appearance of generalised enamel hypoplasia should be increased.
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Affiliation(s)
- Sevgi Zorlu
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
| | - Gamze Aren
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Kent University, Istanbul, Turkey
| | - Ozlem Balci Ekmekci
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ritwik P, Vu J. Bridging Oral and Systemic Health in Children with Prader-Willi Syndrome: Case Reports and Dental Treatment Recommendations. Curr Pediatr Rev 2021; 17:336-344. [PMID: 34517804 DOI: 10.2174/1573396317666210913101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prader-Willi Syndrome (PWS) is a complex neurodevelopmental disorder caused by gene alterations on chromosome 15q11-q13, resulting in hyperphagia and neuroendocrine deficits. A comprehensive guide for dental treatment for PWS is lacking despite numerous case reports. The objective of this report was to develop a problem-focused list of the interrelationship between oral and systemic parameters of PWS and enable dentists in anticipating the unique treatment needs of children and individuals with PWS. METHODS Four pediatric patients with PWS presenting to an academic dental clinic were evaluated. A literature review spanning the last twenty years was performed to identify the pathophysiological impact of systemic problems on dental health and treatment. RESULTS The four cases along with cases from the literature were used to enumerate salient oro-dental and systemic features influencing treatment decisions in dentistry. They formed the basis for collective recommendations and precautions for rendering dental treatment in patients with PWS. CONCLUSION Sedation for dental treatment is contraindicated due to obesity (BMI over 95th percentile), hypotonia, obstructive sleep apnea (OSA), and respiratory limitations (restricted ventilation due to weight on thoracic cage). Prolonged recovery from general anesthesia, OSA, and temperature dysregulation necessitate extended monitoring after dental rehabilitation under general anesthesia. Orthopedic problems and respiratory limitations exclude protective stabilization. Xerostomia and acidic saliva necessitate recommendations for oral rehydrating products. Periodontal assessment is necessary due to poor oral hygiene and diabetes mellitus. Early establishment of a dental home and risk-based frequency of dental care should address caries prevention and restorative needs.
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Affiliation(s)
- Priyanshi Ritwik
- Department of Pediatric Dentistry, The University of Texas Health Science Center at Houston, School of Dentistry, 7500 Cambridge Street, Ste 5301,Canada
| | - Jaclyn Vu
- Department of Pediatric, School of Dentistry, Dentistry, UT Health Science University, TX,United States
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Uemura Y, Oka A, Kurosaka H, Yamashiro T. Comprehensive Orthodontic Treatment of a Patient With Prader-Willi Syndrome. Cleft Palate Craniofac J 2020; 58:1459-1467. [PMID: 33272028 DOI: 10.1177/1055665620977375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder caused by a defect in paternally expressed genes in the 15q11-q13 region. Prader-Willi syndrome affects many parts of the body and involves craniofacial and dentofacial abnormalities. We herein report the successful 2-stage orthodontic treatment of an 8-year-old girl with PWS caused by paternal 15q11-q13 deletion. She presented with a skeletal class II relationship with mandibular deviation, a deep overbite, and severe crowding of the lower dental arch. Functional appliance therapy was utilized to improve her skeletal discrepancy. The second phase of orthodontic treatment using fixed appliances was started at 14.5 years old, which improved her remained crowding and large overbite. As a result, her facial appearance and occlusion were improved without any discernible relapse after 2 years of retention. We describe the outcomes of orthodontic treatment for a patient with PWS and discuss the specific attention during orthodontic treatment.
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Affiliation(s)
- Yume Uemura
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Ayaka Oka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Hiroshi Kurosaka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Takashi Yamashiro
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
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Munné-Miralvés C, Brunet-Llobet L, Cahuana-Cárdenas A, Torné-Durán S, Miranda-Rius J, Rivera-Baró A. Oral disorders in children with Prader-Willi syndrome: a case control study. Orphanet J Rare Dis 2020; 15:43. [PMID: 32041633 PMCID: PMC7011482 DOI: 10.1186/s13023-020-1326-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Prader-Willi Syndrome (PWS) is a genetic disorder caused by the lack of expression of certain paternal genes located on chromosome 15q11-q13. This anomaly causes cognitive, neurological and endocrine abnormalities, among which one of the most important is hyperphagia. The aim of this study was to assess the oral health of children with PWA and to establish preventive criteria. RESULTS Thirty patients with PWS (mean age 10.2 years) and 30 age- and gender-matched controls were included in the study. Twenty-six patients with PWS(86.6%) followed dietary treatment prescribed by their endocrinologist. Individuals with PWS had a mean caries index of 53.3% and Decayed Missing Filled teeth (DMFT) index 2.5, and 53.3% had gingivitis, in the control group the respective figures were 43.3%, 0.93, and 60%. Only the DMFT index (p 0.017) presented significant differences. Regarding stimulated salivary secretion, patients with PWS presented a mean of 0.475 ml/min with a pH of 6.15, while controls presented a mean of 0.848 ml/min with a pH of 7.53; the differences between the groups were statistically significant in both cases (p 0.032 and p 0.0001 respectively). The population with PWS presented a higher plaque index (> 2) than their healthy peers, but the differences were not significant. CONCLUSION Pediatric patients with Prader-Willi syndrome have an increased risk of caries and gingivitis. The children with this syndrome have a decreased salivary flow and a more acidic salivary pH. In these patients, dental care is an essential part of their multidisciplinary medical treatment.
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Affiliation(s)
- Carla Munné-Miralvés
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg), Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
| | - Abel Cahuana-Cárdenas
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Sergi Torné-Durán
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jaume Miranda-Rius
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg), Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Alejandro Rivera-Baró
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg), Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
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Łysik D, Niemirowicz-Laskowska K, Bucki R, Tokajuk G, Mystkowska J. Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia. Int J Mol Sci 2019; 20:E3199. [PMID: 31261876 PMCID: PMC6651665 DOI: 10.3390/ijms20133199] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022] Open
Abstract
The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers.
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Affiliation(s)
- Dawid Łysik
- Department of Materials Engineering and Production, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland
| | | | - Robert Bucki
- Department of Microbiological and Nanobiomedical Engineering, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland
| | - Grażyna Tokajuk
- Department of Integrated Dentistry, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Joanna Mystkowska
- Department of Materials Engineering and Production, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland.
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Olczak-Kowalczyk D, Korporowicz E, Gozdowski D, Lecka-Ambroziak A, Szalecki M. Oral findings in children and adolescents with Prader-Willi syndrome. Clin Oral Investig 2018; 23:1331-1339. [PMID: 30006686 DOI: 10.1007/s00784-018-2559-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the significance of changes in the saliva in the etiology of gingivitis and tooth wear in children and adolescents with Prader-Willi syndrome (PWS). MATERIALS AND METHODS The study included 80 (2.8-18 years old; 39 girls and 41 boys): 40 in PWS group (mean age 8.0 ± 4.24 years) and 40 in control group (mean age 7.9 ± 4.12 years). General condition, oral para-functional habits, tooth wear (modified TWI), oral hygiene and gingival status (Plaque Index (PLI) and Gingival Index (GI)), localization of gingivitis, and salivary characteristics were assessed. The chi-square test, the Mann-Whitney U test, Spearman's rank correlation, and odds ratio based on logistic regression in a statistical analysis were applied. RESULTS Chances of gingivitis were increased by low PLI (odds ratio (OR) = 32.53), low resting salivary flow (OR = 3.96), increased viscosity of saliva (OR = 3.54), and mouth breathing (OR = 8.17). For gingivitis in anterior regions, low PLI (OR = 107.67), low resting (OR = 5.73) and stimulated (OR = 1.86) salivary flow, increased viscosity of saliva (OR = 5.87), mouth breathing (OR = 10.00), and low stimulated salivary flow (OR = 3.18) were observed. Tooth wear rates were increased by teeth grinding (OR = 16.20), mouth breathing (OR = 4.33), increased viscosity of saliva (OR = 11.67) and low resting (OR = 6.07), and stimulated (OR = 4.22) salivary flow. CONCLUSIONS In PWS, reduced salivary secretion, increased viscosity, of saliva and mouth breathing increase the risk of plaque-induced gingivitis and tooth wear. CLINICAL RELEVANCE The prevention and treatment of tooth wear and gingivitis in PWS patients is necessary not only to treat bruxism and mouth breathing but also to limit the influence of negative changes of saliva.
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Affiliation(s)
- Dorota Olczak-Kowalczyk
- Department of Pediatric Dentistry, Medical University of Warsaw, Miodowa 18, Warsaw, Poland.
| | - Emil Korporowicz
- Department of Pediatric Dentistry, Medical University of Warsaw, Miodowa 18, Warsaw, Poland
| | - Dariusz Gozdowski
- Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Sciences, Nowoursynowska 159, Warsaw, Poland
| | - Agnieszka Lecka-Ambroziak
- Clinic of Endocrinology and Diabetology, Children's Memorial Health Institute, Dzieci Polskich 20, Warsaw, Poland
| | - Mieczysław Szalecki
- Clinic of Endocrinology and Diabetology, Children's Memorial Health Institute, Dzieci Polskich 20, Warsaw, Poland.,Faculty of Medicine and Health Sciences, UJK, Kielce, Poland
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Saeves R, Strøm F, Sandvik L, Nordgarden H. Gastro-oesophageal reflux - an important causative factor of severe tooth wear in Prader-Willi syndrome? Orphanet J Rare Dis 2018; 13:64. [PMID: 29685165 PMCID: PMC5913865 DOI: 10.1186/s13023-018-0809-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/16/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is the most common genetic human obesity syndrome and is characterized by hypotonia, endocrine disturbances, hyperphagia, obesity and mild mental retardation. Oral abnormalities, such as decreased salivary flow rates and extreme tooth wear, have also been described. Studies have shown a significant increase in reflux symptoms in individuals with obstuctive sleep apnoea syndrome and increased BMI, both of which are typical findings in PWS. Gastro-oesophageal reflux disease (GORD) has been identified in some individuals with PWS and is a significant intrinsic factor in dental tooth wear. The aim of this study was therefore to estimate the prevalence of GORD in adults and children and to evaluate a possible correlation between GORD and tooth wear in adults with PWS. They were all registered at the TAKO-centre. RESULTS Twenty-nine individuals, 17 adults with a mean age of 32.6 years (range 18-48) and 12 children with a mean age of 8.8 years (range 3-17), agreed to undergo 24-hour oesophageal pH monitoring, and 90% of those enrolled managed to complete the examination. Four children and eleven adults were diagnosed with pathological gastro-oesophageal reflux, which is defined as acid exposure (pH less than 4) more than 3.6 or 4.3 percent of the time, respectively. Manometry performed in the adult group showed a pathologically high lower oesophageal sphincter pressure in four of the five individuals who had normal oesophageal pH values (pH under 4 less than 4.3% of the time). The two groups (reflux and non-reflux) were well balanced according to BMI, genotype, tooth grinding and hyposalivation. However, twice as many individuals in the reflux group as in the non-reflux group reported high consumption of acidic foods and drinks. Increased tooth wear was significantly correlated with GORD in the two groups (reflux n=6 and non-reflux n=6). CONCLUSIONS The prevalence of gastro-oesophageal reflux is high in individuals with PWS. Tooth wear was strongly associated with GORD and acidic drinks, and both may be important aetiological factors underlying the extreme tooth wear in this group. Our data suggest a need for routine screening for GORD and dental wear in young individuals with Prader-Willi syndrome.
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Affiliation(s)
- Ronnaug Saeves
- TAKO-centre, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440 Oslo, Norway
| | - Finn Strøm
- Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Leiv Sandvik
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Hilde Nordgarden
- TAKO-centre, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440 Oslo, Norway
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Giuca MR, Inglese R, Caruso S, Gatto R, Marzo G, Pasini M. Craniofacial morphology in pediatric patients with Prader-Willi syndrome: a retrospective study. Orthod Craniofac Res 2016; 19:216-221. [PMID: 27717123 DOI: 10.1111/ocr.12131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate craniofacial characteristics in pediatric patients with Prader-Willi syndrome (PWS). SETTING AND SAMPLE POPULATION A retrospective sample of 20 consecutive patients with PWS who had lateral and antero-posterior (AP) cephalograms (14 males and six females; average age 10.2 ± 3 years) was compared to 20 controls matched for age and sex (14 males and six females; average age 10.5 ± 3.7 years). MATERIALS AND METHODS Cephalometric skeletal measurements were performed twice at a 1-week interval by one calibrated operator, and random error was calculated using Dahlberg's formula. Mean values and standard deviations were computed for all variables. Student's t-test for independent samples was used to determine significant differences between PWS and controls. The level of significance was set at p < 0.05. RESULTS Cephalometric values for the length of the maxilla (p < 0.01), mandibular length (p < 0.05) at both the ramus (p < 0.05) and the mandibular body (p < 0.01), and posterior and anterior facial height (p < 0.01) were significantly lower in patients with PWS compared to controls. The AP cephalometric analysis revealed a significant reduction (p < 0.01) in maxillary skeletal width, mandibular skeletal width, and interzygomatic distance. CONCLUSIONS Pediatric patients with PWS seem to have a general reduction in certain craniofacial skeletal parameters (i.e., maxillary and mandibular length) compared to controls, but this study did not assess the overall craniofacial characteristics.
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Affiliation(s)
- M R Giuca
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - R Inglese
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - S Caruso
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, L'Aquila, Italy
| | - R Gatto
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, L'Aquila, Italy
| | - G Marzo
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, L'Aquila, Italy
| | - M Pasini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
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Microscopic structure of dental hard tissues in primary and permanent teeth from individuals with Prader-Willi syndrome. Arch Oral Biol 2016; 66:55-60. [PMID: 26913968 DOI: 10.1016/j.archoralbio.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE severe tooth wear, in terms of both erosive wear and attrition, is a significant problem in individuals with Prader-Willi syndrome (PWS). The purpose of the present study was to describe the structure of enamel and dentine in primary and permanent teeth from individuals with PWS. DESIGN thirty-two primary and 10 permanent teeth representing 16 individuals with PWS were investigated in the study. The enamel surface was studied using scanning electron microscopy (SEM). The microscopic structure of enamel and dentine was studied using SEM, microradiography and light microscopy. RESULTS the microscopic structure of enamel and dentine was found to be normal with the exception of a slight increase of interglobular dentine (IGD). Severe erosive defects were observed in primary teeth and also in permanent teeth with long exposure to the oral environment. CONCLUSION the erosive enamel defects in individuals with PWS seem more related to the factors in the oral environment than to enamel structure which appeared normal. The occurrence of IGD indicate deficient mineralization but is probably of minor clinical significance. Gastro-oesophageal reflux is worthy of further investigation in individuals with Prader-Willi syndrome.
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Armstrong S, Lazorick S, Hampl S, Skelton JA, Wood C, Collier D, Perrin EM. Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review. Pediatrics 2016; 137:e20151766. [PMID: 26817935 DOI: 10.1542/peds.2015-1766] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. The recommendations presented represent a comprehensive review of current evidence as well as expert opinion. The goal of this review is to highlight the importance of conducting a targeted physical examination during pediatric weight management visits.
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Affiliation(s)
| | | | - Sarah Hampl
- Children's Mercy Hospital and Center for Children's Healthy Lifestyles and Nutrition, Kansas City, Missouri
| | - Joseph A Skelton
- Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Charles Wood
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - David Collier
- East Carolina University, Greenville, North Carolina
| | - Eliana M Perrin
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Song KU, Nam OH, Kim MS, Choi SC, Lee HS. An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia. J Dent Anesth Pain Med 2015; 15:251-255. [PMID: 28879288 PMCID: PMC5564163 DOI: 10.17245/jdapm.2015.15.4.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.
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Affiliation(s)
- Ki Un Song
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Mi Sun Kim
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sung Chul Choi
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyo-Seol Lee
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
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Khalaf K, Miskelly J, Voge E, Macfarlane TV. Prevalence of hypodontia and associated factors: a systematic review and meta-analysis. J Orthod 2015; 41:299-316. [PMID: 25404667 DOI: 10.1179/1465313314y.0000000116] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the prevalence and factors associated with hypotonia. DESIGN Systematic review and meta-analysis. DATA SOURCE A search strategy was developed along with inclusion criteria and run in MEDLINE and EMBASE (published from 2002 to August 2012) databases to reveal all studies on the prevalence of hypodontia or associated factors. A hand search of reference lists and a Google search aimed to improve the sensitivity of the literature search. SELECTION CRITERIA All studies on the prevalence of hypodontia or associated factors published from 2002 onwards were included. Abstracts of non-English papers were also analyzed. DATA SELECTION AND EXTRACTION All potential articles were checked against the inclusion criteria independently, and in duplicate by two investigators. A checklist was used to assess the quality of selected studies. MAIN OUTCOME Prevalence of hypodontia, excluding third molars. RESULTS The overall prevalence of hypodontia was found to be 6.4% (95% CI: 5.7, 7.2). There was a statistically significant difference in the prevalence of hypodontia by continent (Q = 34.18, P<0.001). Prevalence of hypodontia was the highest in Africa: 13.4% (95% CI: 9.7, 18.0), followed by Europe (7% CI: 6.0-8.0%), Asia (6.3% CI: 4.4, 9.1) and Australia (6.3% CI: 5.3, 7.4) with a lower prevalence in North America (5.0% CI: 4.1-5.9) and Latin America and Caribbean (4.4% CI: 3.2-6.1). Females were found to have a higher prevalence than males (combined OR 1.22; 95% CI: 1.14, 1.30). The most commonly affected teeth were mandibular second premolars followed by maxillary lateral incisors and maxillary second premolars. The prevalence of mild, moderate and severe hypodontia was found to be 81.6, 14.3 and 3.1% respectively. CONCLUSIONS There was a high variation in the prevalence of hypodontia between the studies. African populations were found to have a higher risk for tooth agenesis and there was an increased risk for females to have hypodontia than males.
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Affiliation(s)
- Khaled Khalaf
- University of Aberdeen Dental School and Hospital, Aberdeen, Aberdeenshire, UK
| | - John Miskelly
- University of Aberdeen Dental School and Hospital, Aberdeen, Aberdeenshire, UK
| | - Elena Voge
- University of Aberdeen Dental School and Hospital, Aberdeen, Aberdeenshire, UK
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Salivary hypofunction: An update on aetiology, diagnosis and therapeutics. Arch Oral Biol 2015; 60:242-55. [DOI: 10.1016/j.archoralbio.2014.10.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/15/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
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Saliva in Prader–Willi syndrome: Quantitative and qualitative characteristics. Arch Oral Biol 2012; 57:1335-41. [DOI: 10.1016/j.archoralbio.2012.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/09/2012] [Accepted: 05/13/2012] [Indexed: 11/18/2022]
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Saeves R, Espelid I, Storhaug K, Sandvik L, Nordgarden H. Severe tooth wear in Prader-Willi syndrome. A case-control study. BMC Oral Health 2012; 12:12. [PMID: 22639910 PMCID: PMC3437195 DOI: 10.1186/1472-6831-12-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 04/18/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare complex multsystemic genetic disorder characterized by severe neonatal hypotonia, endocrine disturbances, hyperphagia and obesity, mild mental retardation, learning disabilities, facial dysmorphology and oral abnormalities. The purpose of the present study was to explore the prevalence of tooth wear and possible risk factors in individuals with Prader-Willi syndrome. METHODS Forty-nine individuals (6-40 years) with PWS and an age- and sex-matched control group were included. Tooth wear was evaluated from dental casts and intraoral photographs and rated by four examiners using the Visual Erosion Dental Examination (VEDE) scoring system and the individual tooth wear index IA. In accordance with the VEDE scoring system, tooth wear was also evaluated clinically. Whole saliva was collected. RESULTS Mean VEDE score was 1.70 ± 1.44 in the PWS group and 0.46 ± 0.36 in the control group (p < 0.001). Median IA was 7.50 (2.60-30.70) in the PWS group and 2.60 (0.90-4.70) among controls (p < 0.001). In the PWS group tooth wear correlated significantly with age (VEDE; r = 0.79, p < 0.001, IA; r = 0.82, p < 0.001) and saliva secretion (VEDE; r = 0.46, p = 0.001, IA; r = 0.43, p = 0.002). Tooth grinding was also associated with tooth wear in the PWS group, as indicated by the mean VEDE 2.67 ± 1.62 in grinders and 1.14 ± 0.97 in non-grinders (p = 0.001) and median IA values 25.70 (5.48-68.55) in grinders and 5.70 (1.60-9.10) in non-grinders (p = 0.003). Multivariate linear regression analysis was performed with tooth wear as the dependent variable and PWS (yes/no), age, tooth grinding and saliva secretion as independent variables. PWS (yes/no), age and tooth grinding retained a significant association with tooth wear, VEDE (p < 0.001) and log IA (p < 0.001). The only factor significantly associated with tooth wear in the control group was age. CONCLUSIONS Our study provides evidence that tooth wear, in terms of both erosion and attrition, is a severe problem in Prader-Willi syndrome. There is therefore considerable need for prosthodontic rehabilitation in young adults with PWS.
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Affiliation(s)
- Ronnaug Saeves
- TAKO-centre, Lovisenberg Diakonale Hospital, Lovisenberggt 17, 0440 Oslo, Norway
| | - Ivar Espelid
- Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Kari Storhaug
- TAKO-centre, Lovisenberg Diakonale Hospital, Lovisenberggt 17, 0440 Oslo, Norway
| | - Leiv Sandvik
- Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Hilde Nordgarden
- TAKO-centre, Lovisenberg Diakonale Hospital, Lovisenberggt 17, 0440 Oslo, Norway
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