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Hosseini M, Jensen SS, Gotfredsen K, Hyldahl E, Pedersen AML. Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren's Syndrome: A Five-Year Prospective Clinical Study. Clin Oral Implants Res 2024. [PMID: 39235273 DOI: 10.1111/clr.14356] [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: 04/11/2024] [Revised: 07/29/2024] [Accepted: 08/14/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren's syndrome. AIM/HYPOTHESIS We hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration. MATERIAL AND METHODS Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020. The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment. RESULTS We included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group. All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026). CONCLUSION Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.
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Affiliation(s)
- Mandana Hosseini
- Research Section for Oral Health, Society and Technology/Oral Rehabilitation, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon Storgård Jensen
- Research Section for Oral Biology and Immunopathology/Oral Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Gotfredsen
- Research Section for Oral Health, Society and Technology/Oral Rehabilitation, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emil Hyldahl
- Research Section for Oral Biology and Immunopathology/Oral Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Marie Lynge Pedersen
- Research Section for Oral Biology and Immunopathology/Oral Pathology and Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Baram S, Thomsen CE, Øzhayat EB, Karlsborg M, Bakke M. Orofacial function and temporomandibular disorders in Parkinson's Disease: a case-controlled study. BMC Oral Health 2023; 23:381. [PMID: 37308874 DOI: 10.1186/s12903-023-03051-6] [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: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The difficulties and challenges faced by people with Parkinson's disease (PD) in performing daily orofacial function are not systematically investigated. In this study, specific orofacial non-motor and motor symptoms and functions were systematically examined in PD patients in comparison to a matched control group. METHODS The clinical case-controlled study was conducted from May 2021 to October 2022 and included persons with PD and age- and gender-matched persons without PD. The participants with PD were outpatients diagnosed with PD at the Department of Neurology at Bispebjerg University Hospital in Copenhagen, Denmark. The participants underwent a systematic clinical and relevant self-assessment of the orofacial function and temporomandibular disorders (TMD). The primary outcomes were objective and subjective assessments of the general orofacial function, mastication, swallowing, xerostomia and drooling. The secondary outcomes were the prevalence of TMD and orofacial pain. The difference in outcome measures between the two groups was analysed using chi-square and Mann-Whitney U test. RESULTS The study included 20 persons with PD and 20 age- and gender-matched persons without PD. Both objectively and subjectively, persons with PD had poorer orofacial function than the control group. Persons with PD had also a significantly more severe limitation of jaw mobility and jaw function. The objective masticatory function was also significantly reduced for persons with PD compared to the control group, and 60% of persons with PD found it difficult to eat foods with certain consistencies while 0% of the control group reported that problem. Persons with PD could swallow less water per second and the average swallowing event was significantly longer for PD persons. Even though PD persons reported more xerostomia (58% for persons with PD and 20% for control persons), they also reported significantly more drooling than the control group. Additionally, orofacial pain was more prevalent in PD persons. CONCLUSIONS Persons with PD have a compromised orofacial function. Furthermore, the study indicates a link between PD and orofacial pain. In order to screen and treat persons with PD accordingly, healthcare professionals should be aware of and address these limitations and symptoms. TRIAL REGISTRATION The trial was approved by the Regional Committee on Research Health Ethics of the Capital Region (H-20,047,464), the Danish Data Protection Agency (514 - 0510/20-3000), and registered at ClinicalTrials.gov (NCT05356845).
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Affiliation(s)
- Sara Baram
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark.
| | - Carsten Eckhart Thomsen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark
| | - Esben Boeskov Øzhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark
| | - Merete Karlsborg
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Merete Bakke
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark
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Liu J, Lundemann AKJ, Reibel J, Pedersen AML. Salivary gland involvement and oral health in patients with coeliac disease. Eur J Oral Sci 2022; 130:e12861. [PMID: 35247226 PMCID: PMC9314853 DOI: 10.1111/eos.12861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
Coeliac disease (CD) is a chronic immune‐mediated enteropathy triggered by ingestion of gluten. The aim of this study was to investigate if the salivary glands as a component of the mucosal immune system are involved in CD, leading to sialadenitis and salivary gland dysfunction and associated oral manifestations. Twenty patients with CD aged 49.2 (SD 15.5 years) and 20 age‐ and gender‐matched healthy controls underwent an interview regarding general and oral health, serological analysis, a clinical oral examination including bitewing radiographs, Candida smear, assessment of salivary mutans streptococci and lactobacilli levels, unstimulated and chewing‐stimulated whole and parotid saliva flow rates, analysis of secretory IgA, and a labial salivary gland biopsy. Xerostomia, mucosal lesions, dry/cracked lips and focal lymphocytic sialadenitis were more prevalent and extensive in patients with CD than in healthy controls. Moreover, the patients had less gingival inflammation and higher whole saliva flow rates than the healthy controls, but did not differ regarding dental health and levels of cariogenic bacteria and Candida. The major salivary gland function appears unaffected, contributing to maintenance of a balanced microbiota and oral health in CD patients. Xerostomia and labial dryness may be related to minor salivary gland inflammation and subsequent impaired mucosal lubrication.
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Affiliation(s)
- Jason Liu
- Section for Oral Medicine/Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Kristine Juncker Lundemann
- Section for Oral Medicine/Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Reibel
- Section for Oral Medicine/Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Marie Lynge Pedersen
- Section for Oral Medicine/Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Neutrophils, eosinophils, and intraepithelial lymphocytes in the squamous esophagus in subjects with and without gastroesophageal reflux symptoms. Hum Pathol 2021; 115:112-122. [PMID: 34181982 DOI: 10.1016/j.humpath.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 02/07/2023]
Abstract
Whilst intraepithelial lymphocytes (IELs) are considered normal within the distal esophageal mucosa, they have an increasingly recognised role in the pathogenesis of reflux esophagitis, and IEL quantification establishes the diagnosis of lymphocytic esophagitis. Knowledge regarding the upper limit of a normal IEL count in health is lacking. We studied 117 non-healthcare seeking adult volunteers from a random community sample (the Kalixanda study) with esophageal biopsies 2 cm above the gastroesophageal junction. Subjects were divided into four groups based on the presence or absence of gastro-esophageal reflux symptoms and/or esophagitis on endoscopy. Asymptomatic subjects with no endoscopic esophagitis were selected as controls, and the cell counts in this group were used to define the upper limit of normal of IELs, eosinophils and neutrophils. The entire sample was used to identify independent predictors of increased cellular counts by logistic regression analysis. None of the healthy controls had an IEL count of more than three per five high power fields (HPF), and therefore this was considered as the upper limit of normal; no controls had eosinophils or neutrophils in esophageal biopsies. Independent predictors of an elevated IEL count were spongiosis on histology (OR 11.17, 95% CI 3.32-37.58, P < 0.01) and current smoking (OR 4.84, 95% CI 1.13-2.71, P = 0.03). A receiver operating characteristics analysis concluded that a threshold of 3 IELs/5HPFs performs best in predicting reflux symptoms when a normal esophageal mucosa is visualized on endoscopy (sensitivity = 100.0%, specificity = 35.2%). The healthy esophageal mucosa does not contain more than three IELs per five HPF in the distal esophagus.
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Viegas-Costa LC, Friesen R, Flores-Mir C, McGaw T. Diagnostic performance of serology against histologic assessment to diagnose Sjogren's syndrome: a systematic review. Clin Rheumatol 2021; 40:4817-4828. [PMID: 34142295 DOI: 10.1007/s10067-021-05813-5] [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: 02/18/2021] [Revised: 05/20/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
The objective of this review was to assess and evaluate whether the published diagnostic accuracy studies provide evidence to sustain the current diagnostic guidelines put forth by ACR/EULAR used for patients with suspected Sjögren's syndrome (SS). Literature databases, including Medline, Embase, and EBM Reviews, were searched for relevant studies on the correlation between ACR/EULAR criteria, particularly those with a direct comparison between their accuracy in diagnosing Sjögren's syndrome. We followed Cochrane, QUADAS-2, and STARD guidelines and the four-phase flow diagram by the PRISMA Statement. Reports in several languages, but only human studies were considered. Three studies assessed the accuracy of the current diagnostic tests, and these did not present adequate designs that would allow a well-supported conclusion with a high level of certainty. Due to significant clinical and methodological heterogeneity, a meta-analysis was not performed. A qualitative review of the papers was undertaken. Neither the comparative nor the non-comparative study designs permit conclusive recommendations regarding an alternative diagnostic pathway for SS. Well-designed studies of the diagnostic accuracy of SS tests are needed to validate current guidelines or to suggest changes to the current guidelines.
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Affiliation(s)
- Luiz Claudio Viegas-Costa
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Reid Friesen
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Carlos Flores-Mir
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy McGaw
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Edmonton Clinic Health Academy, Room 5-357, 11405 87 Avenue NW, Edmonton, AB, Canada.
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Andrés-Jensen L, Skipper MT, Mielke Christensen K, Hedegaard Johnsen P, Aagaard Myhr K, Kaj Fridh M, Grell K, Pedersen AML, Leisgaard Mørck Rubak S, Ballegaard M, Hørlyck A, Beck Jensen R, Lambine TL, Gjerum Nielsen K, Tuckuviene R, Skov Wehner P, Klug Albertsen B, Schmiegelow K, Frandsen TL. National, clinical cohort study of late effects among survivors of acute lymphoblastic leukaemia: the ALL-STAR study protocol. BMJ Open 2021; 11:e045543. [PMID: 33563628 PMCID: PMC7875271 DOI: 10.1136/bmjopen-2020-045543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION More than 90% of patients diagnosed with childhood acute lymphoblastic leukaemia (ALL) today will survive. However, half of the survivors are expected to experience therapy-related chronic or late occurring adverse effects, reducing quality of life. Insight into underlying risk trajectories is warranted. The aim of this study is to establish a Nordic, national childhood ALL survivor cohort, to be investigated for the total somatic and psychosocial treatment-related burden as well as associated risk factors, allowing subsequent linkage to nation-wide public health registers. METHODS AND ANALYSIS This population-based observational cohort study includes clinical follow-up of a retrospective childhood ALL survivor cohort (n=475), treated according to a common Nordic ALL protocol during 2008-2018 in Denmark. The study includes matched controls. Primary endpoints are the cumulative incidence and cumulative burden of 197 health conditions, assessed through self-report and proxy-report questionnaires, medical chart validation, and clinical examinations. Secondary endpoints include organ-specific outcome, including cardiovascular and pulmonary function, physical performance, neuropathy, metabolic disturbances, hepatic and pancreatic function, bone health, oral and dental health, kidney function, puberty and fertility, fatigue, and psychosocial outcome. Therapy exposure, acute toxicities, and host genome variants are explored as risk factors. ETHICS AND DISSEMINATION The study is approved by the Regional Ethics Committee for the Capital Region in Denmark (H-18035090/H-20006359) and by the Danish Data Protection Agency (VD-2018-519). Results will be published in peer-reviewed journals and are expected to guide interventions that will ameliorate the burden of therapy without compromising the chance of cure.
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Affiliation(s)
- Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Tiedemann Skipper
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Martin Kaj Fridh
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathrine Grell
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - A M L Pedersen
- Section of Oral Medicine/Oral Biology and Immunopathology, Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | | | - Martin Ballegaard
- Department of Neurology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine-Lise Lambine
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Ruta Tuckuviene
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, Odense University Hospital, Odense, Denmark
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thomas Leth Frandsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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Treldal C, Petersen J, Mogensen S, Therkildsen C, Jacobsen J, Andersen O, Pedersen AML. Characterization of burning mouth syndrome profiles based on response to a local anaesthetic lozenge. Oral Dis 2020; 26:656-669. [PMID: 31880064 DOI: 10.1111/odi.13267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Burning mouth syndrome (BMS) is a chronic oral pain condition with unknown aetiology but assumed to involve peripheral/central neuropathological and immune-mediated inflammatory factors. We aimed at characterizing inflammatory and neurogenic profiles and oral symptomatology of patients with BMS based on response to a local anaesthetic lozenge. METHODS Patients with BMS were divided into an Effect (n = 13), No effect (n = 8) or Unspecified (n = 2) group according to their response to a local anaesthetic lozenge on oral pain. Inflammation was assessed in blood plasma and saliva by analyses of IL-6, IL-8, IL-17A, IL-23 and TNF-α levels. The degree of inflammation and distribution of oestrogen receptor, NGF, NGF-receptor, TRPV-1 and IL-17F in buccal mucosal tissue were investigated by immunohistochemistry. RESULTS Immunoreactivity to the oestrogen receptor was most intense in the Effect group, whereas the No effect group tended to have higher plasma levels of the pro-inflammatory cytokines. CONCLUSIONS Our findings indicate that the response to treatment with local anaesthesia enables subgrouping of patients with BMS according to the potential pathogenic mechanisms. Effect of local anaesthesia indicates a peripheral neuropathology involving lack of oestrogen and upregulation of oestrogen receptors, and no effect indicates a systemic inflammation-induced mechanism leading to increased levels of plasma cytokines.
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Affiliation(s)
- Charlotte Treldal
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stine Mogensen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Jette Jacobsen
- Physiological Pharmaceutics, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne Marie Lynge Pedersen
- Section for Oral Pathology and Oral Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kvalheim SF, Marthinussen MC, Haugen DF, Berg E, Strand GV, Lie S. Randomized controlled trial of the effectiveness of three different oral moisturizers in palliative care patients. Eur J Oral Sci 2019; 127:523-530. [DOI: 10.1111/eos.12655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Siri F. Kvalheim
- Department of Clinical Dentistry Faculty of Medicine University of Bergen BergenNorway
| | - Mihaela C. Marthinussen
- Department of Clinical Dentistry Faculty of Medicine University of Bergen BergenNorway
- Oral Health Centre of Expertise in Western Norway BergenNorway
| | - Dagny F. Haugen
- Department of Clinical Medicine K1 Faculty of Medicine University of Bergen BergenNorway
- Regional Centre of Excellence for Palliative Care, Western Norway Haukeland University Hospital Bergen Norway
| | - Einar Berg
- Department of Clinical Dentistry Faculty of Medicine University of Bergen BergenNorway
| | - Gunhild V. Strand
- Department of Clinical Dentistry Faculty of Medicine University of Bergen BergenNorway
| | - Stein‐Atle Lie
- Department of Clinical Dentistry Faculty of Medicine University of Bergen BergenNorway
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Pedersen AML, Sørensen CE, Proctor GB, Carpenter GH, Ekström J. Salivary secretion in health and disease. J Oral Rehabil 2018; 45:730-746. [PMID: 29878444 DOI: 10.1111/joor.12664] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 12/16/2022]
Abstract
Saliva is a complex fluid produced by 3 pairs of major salivary glands and by hundreds of minor salivary glands. It comprises a large variety of constituents and physicochemical properties, which are important for the maintenance of oral health. Saliva not only protects the teeth and the oropharyngeal mucosa, it also facilitates articulation of speech, and is imperative for mastication and swallowing. Furthermore, saliva plays an important role in maintaining a balanced microbiota. Thus, the multiple functions provided by saliva are essential for proper protection and functioning of the body as a whole and for the general health. A large number of diseases and medications can affect salivary secretion through different mechanisms, leading to salivary gland dysfunction and associated oral problems, including xerostomia, dental caries and fungal infections. The first part of this review article provides an updated insight into our understanding of salivary gland structure, the neural regulation of salivary gland secretion, the mechanisms underlying the formation of saliva, the various functions of saliva and factors that influence salivary secretion under normal physiological conditions. The second part focuses on how various diseases and medical treatment including commonly prescribed medications and cancer therapies can affect salivary gland structure and function. We also provide a brief insight into how to diagnose salivary gland dysfunction.
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Affiliation(s)
- A M L Pedersen
- Oral Medicine, Oral Pathology & Clinical Oral Physiology, University of Copenhagen, Copenhagen, Denmark
| | - C E Sørensen
- Oral Biochemistry, Cariology & Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G B Proctor
- Mucosal & Salivary Biology Division, King's College London Dental Institute, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, King's College London Dental Institute, London, UK
| | - J Ekström
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Pedersen A, Sørensen CE, Proctor GB, Carpenter GH. Salivary functions in mastication, taste and textural perception, swallowing and initial digestion. Oral Dis 2018; 24:1399-1416. [PMID: 29645367 DOI: 10.1111/odi.12867] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022]
Abstract
Saliva exerts multiple functions in relation to the initial digestive processes taking place in the upper parts of the gastrointestinal tract. Ingestion of food and beverages, in turn, is a strong stimulus for secretion of saliva with a differential composition depending on the neuronal stimulation pattern. This review paper provides insight into the mechanisms by which saliva acts in relation to taste, mastication, bolus formation, enzymatic digestion and swallowing. Also, the protective functions of saliva including maintenance of dental and mucosal integrity will be discussed as they indirectly influence the digestive process. The final part of this study focuses on the implications of xerostomia and salivary gland dysfunction on gastrointestinal functions.
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Affiliation(s)
- Aml Pedersen
- Section 1, Oral Medicine, Oral Pathology & Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C E Sørensen
- Section of Oral Biochemistry, Cariology & Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G B Proctor
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
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11
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Bezzina OM, Gallagher P, Mitchell S, Bowman SJ, Griffiths B, Hindmarsh V, Hargreaves B, Price EJ, Pease CT, Emery P, Lanyon P, Bombardieri M, Sutcliffe N, Pitzalis C, Hunter J, Gupta M, McLaren J, Cooper AM, Regan M, Giles IP, Isenberg DA, Saravanan V, Coady D, Dasgupta B, McHugh NJ, Young-Min SA, Moots RJ, Gendi N, Akil M, MacKay K, Ng WF, Robinson LJ. Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy. Arthritis Care Res (Hoboken) 2017; 69:1714-1723. [PMID: 27992710 PMCID: PMC5698764 DOI: 10.1002/acr.23165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022]
Abstract
Objective To develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity. Methods Archive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from −5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease‐related factors, and symptoms of pain, fatigue, anxiety, and depression. Results Patients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness −0.42 ± 2.2 and −1.24 ± 1.6 oral dryness). Twenty‐seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self‐reported pain and that of oral dryness sensitivity to be self‐reported fatigue. Conclusion Ocular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögrenʼs syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.
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Affiliation(s)
- Oriana M Bezzina
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sheryl Mitchell
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon J Bowman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bridget Griffiths
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Victoria Hindmarsh
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ben Hargreaves
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elizabeth J Price
- Great Western Hospitals NHS Foundation Trust, Swindon, Wiltshire, UK
| | - Colin T Pease
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michele Bombardieri
- Barts and the London NHS Trust and Barts and the London School of Medicine and Dentistry, London, UK
| | | | - Costantino Pitzalis
- Barts and the London NHS Trust and Barts and the London School of Medicine and Dentistry, London, UK
| | - John Hunter
- Gartnavel General Hospital, Glasgow, Scotland
| | | | | | - Anne M Cooper
- Royal Hampshire County Hospital, Winchester and Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Ian P Giles
- University College London Hospitals NHS Foundation Trust, London, UK
| | - David A Isenberg
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Neil J McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | | | | | | | | | - W Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine & Newcastle NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Newcastle University, and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lucy J Robinson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Reddy BVR, Kuruba KK, Yalamanchili S, Mupparapu M. Granulomatous Diseases Affecting Jaws. Dent Clin North Am 2017; 60:195-234. [PMID: 26614955 DOI: 10.1016/j.cden.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The common aspect of all granulomatous diseases is the typical form of chronic inflammatory response with distinct microscopic granulomas that are formed secondary to either definitive etiologic agents, like bacteria, fungal, or parasitic, or due to an unknown etiologic agent, such as trauma, autoimmune, or even neoplastic process. Although they can be histologically distinct, granulomatous diseases demonstrate a variety of clinical features that may not seem to be inflammatory. Two types of granulomas are typically encountered: foreign body granulomas and immune granulomas. The differences between the two types of granulomas lie in the pathogenesis.
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Affiliation(s)
- Baddam Venkat Ramana Reddy
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Kiran K Kuruba
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Samatha Yalamanchili
- Department of Oral Medicine & Radiology, Sibar Institute of Dental Sciences, Guntur, India
| | - Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, #214, 240 South 40th Street, Suite 214, Philadelphia, PA 19104, USA.
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Larsen KR, Johansen JD, Reibel J, Zachariae C, Rosing K, Pedersen AML. Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis. BMC Oral Health 2017; 17:103. [PMID: 28662707 PMCID: PMC5492674 DOI: 10.1186/s12903-017-0393-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/16/2017] [Indexed: 02/08/2023] Open
Abstract
Background To examine if patients with oral lichen planus, oral lichenoid lesions and generalised stomatitis and concomitant contact allergy have more frequent and severe xerostomia, lower unstimulated and chewing-stimulated saliva and citric-acid-stimulated parotid saliva flow rates, and higher salivary concentration of total protein and sIgA than cases without contact allergy and healthy controls. Methods Forty-nine patients (42 women, aged 61.0 ± 10.3 years) and 29 healthy age- and gender-matched subjects underwent a standardised questionnaire on general and oral health, assessment of xerostomia, clinical examination, sialometry, mucosal biopsy and contact allergy testing. Results Nineteen patients had oral lichen planus, 19 patients had oral lichenoid lesions and 11 patients had generalised stomatitis. 38.8% had contact allergy. Xerostomia was significantly more common and severe in patients (46.9%) than in healthy controls, whereas the saliva flow rates did not differ. The patients had higher sIgA levels in unstimulated and chewing-stimulated saliva than the healthy controls. The total protein concentration in saliva was lower in the unstimulated saliva samples whereas it was higher in the chewing stimulated saliva samples from patients when compared to healthy controls. The differences were not significant and they were irrespective of the presence of contact allergy. Conclusion Xerostomia is prevalent in patients with oral lichen planus, lichenoid lesions and generalised stomatitis, but not associated with salivary gland hypofunction, numbers of systemic diseases or medications, contact allergy, age, or gender. Salivary sIgA levels were higher in patients than in healthy controls, but did not differ between patient groups. The total salivary protein concentration was lower in unstimulated saliva samples and higher in chewing-stimulated saliva samples in patients than in healthy controls, but did not differ between patient groups. Our findings do not aid in the discrimination between OLP and OLL and these conditions with or without contact allergic reactions.
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Affiliation(s)
- Kristine Roen Larsen
- Section for Oral Pathology and Oral Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Noerre Allé, DK-2200, Copenhagen N, Denmark.
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Gentofte University Hospital, 28 Kildegaardsvej, DK-2900, Hellerup, Denmark
| | - Jesper Reibel
- Section for Oral Pathology and Oral Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Noerre Allé, DK-2200, Copenhagen N, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Gentofte University Hospital, 28 Kildegaardsvej, DK-2900, Hellerup, Denmark
| | - Kasper Rosing
- Section for Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Noerre Allé, DK-2200, Copenhagen N, Denmark
| | - Anne Marie Lynge Pedersen
- Section for Oral Pathology and Oral Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Noerre Allé, DK-2200, Copenhagen N, Denmark
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Jørgensen MR, Pedersen AML. Analgesic effect of topical oral capsaicin gel in burning mouth syndrome. Acta Odontol Scand 2017; 75:130-136. [PMID: 28007005 DOI: 10.1080/00016357.2016.1269191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the effectiveness of repeated topical application of oral capsaicin gel in two different concentrations for relief of burning/stinging sensations in patients with burning mouth syndrome (BMS). MATERIAL AND METHODS This randomized double-blind cross-over study included 22 female patients with BMS. The patients were randomized for topical application of either 0.01% or 0.025% oral capsaicin gel on the dorsal part of tongue three times daily for 14 days, followed by 14 days wash-out period, and finally treatment with the other concentration of oral gel three times daily for 14 days. A visual analogue scale (VAS) was used to assess the severity of pain five times during the intervention period. RESULTS 18 patients completed the intervention. Their VAS score at baseline was 5.5 ± 0.6 cm (mean ± SD). Treatment with the two concentrations of capsaicin gels significantly improved the burning/stinging symptoms assessed on VAS compared with baseline (p = 0.002). There was no statistically significant difference between the two concentrations of the gels on relieving symptoms. Four patients dropped out during the intervention period due to gastrointestinal side-effects. CONCLUSIONS Topical capsaicin might be an alternative for the short-term treatment of BMS. However, further studies are needed to investigate especially the gastro-intestinal side-effects which may limit its long-term use.
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Affiliation(s)
- Mette Rose Jørgensen
- Department of Odontology, Section for Oral Medicine, Clinical Oral Physiology, Oral Anatomy and Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Anne Marie Lynge Pedersen
- Department of Odontology, Section for Oral Medicine, Clinical Oral Physiology, Oral Anatomy and Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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Sørensen CE, Tritsaris K, Reibel J, Lauritzen M, Mortensen EL, Osler M, Pedersen AML. Elevated p16ink4a Expression in Human Labial Salivary Glands as a Potential Correlate of Cognitive Aging in Late Midlife. PLoS One 2016; 11:e0152612. [PMID: 27029014 PMCID: PMC4814104 DOI: 10.1371/journal.pone.0152612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/16/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The cell-cycle inhibitor and tumor suppressor cyclin dependent kinase inhibitor, p16ink4a, is one of the two gene products of the ink4a/ARF (cdkn2a) locus on chromosome 9q21. Up-regulation of p16ink4a has been linked to cellular senescence, and findings from studies on different mammalian tissues suggest that p16ink4a may be a biomarker of organismal versus chronological age. OBJECTIVE The aim of this study was to examine the immunolocalization pattern of p16ink4a in human labial salivary gland (LSG) tissue, and to analyze whether its expression level in LSGs is a peripheral correlate of cognitive decline in late midlife. METHODS The present study was a part of a study of causes and predictors of cognitive decline in middle-aged men in a Danish birth cohort. It is based on data from 181 male participants from the Danish Metropolit birth cohort, born in 1953, who were examined for age-associated alterations in cognition, dental health, and morphological and autonomic innervation characteristics of the LSGs. The participants were allocated to two groups based on the relative change in cognitive performance from young adulthood to late midlife. LSG biopsies were analyzed by qRT-PCR for the expression level of p16ink4a. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded sections of LSGs. RESULTS p16ink4a immunoreactivity was observed in LSG ductal, myoepithelial, and stromal cells, but not in acinar cells. The mean relative expression of p16ink4a in LSGs was higher in the group of participants with decline in cognitive performance. A logistic regression analysis revealed that the relative p16 expression was predictive of the participant's group assignment. A negative correlation was found between relative p16ink4a expression and the participant's standardized regression residuals from early adulthood to late midlife cognitive performance scores. CONCLUSIONS p16ink4a expression in human LSGs may constitute a potential peripheral correlate of cognitive decline. Human labial salivary glands seem suitable for studies on organismal as opposed to chronological age.
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Affiliation(s)
- Christiane Elisabeth Sørensen
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katerina Tritsaris
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Reibel
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lauritzen
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Neurophysiology, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Erik Lykke Mortensen
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Aging Research Center, Universities of Aarhus, Southern Denmark and Copenhagen, Odense, Denmark
| | - Merete Osler
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Aging Research Center, Universities of Aarhus, Southern Denmark and Copenhagen, Odense, Denmark
- Research Center for Prevention and Health, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Anne Marie Lynge Pedersen
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sørensen CE, Larsen JO, Reibel J, Lauritzen M, Mortensen EL, Osler M, Pedersen AML. Associations between xerostomia, histopathological alterations, and autonomic innervation of labial salivary glands in men in late midlife. Exp Gerontol 2014; 57:211-7. [DOI: 10.1016/j.exger.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/16/2014] [Accepted: 06/02/2014] [Indexed: 11/25/2022]
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González S, Sung H, Sepúlveda D, González MJ, Molina C. Oral manifestations and their treatment in Sjögren′s syndrome. Oral Dis 2013; 20:153-61. [DOI: 10.1111/odi.12105] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 02/27/2013] [Accepted: 03/07/2013] [Indexed: 11/26/2022]
Affiliation(s)
- S González
- Oral Pathology Department; Faculty of Dentistry; Mayor University; Santiago Chile
| | - H Sung
- Faculty of Medicine; Institute of Biomedical Sciences (ICBM); University of Chile; Santiago Chile
| | - D Sepúlveda
- Faculty of Medicine; Institute of Biomedical Sciences (ICBM); University of Chile; Santiago Chile
| | - MJ González
- Faculty of Medicine; Institute of Biomedical Sciences (ICBM); University of Chile; Santiago Chile
| | - C Molina
- Oral Pathology Department; Faculty of Dentistry; Mayor University; Santiago Chile
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Shimada A, Cairns BE, Vad N, Ulriksen K, Pedersen AML, Svensson P, Baad-Hansen L. Headache and mechanical sensitization of human pericranial muscles after repeated intake of monosodium glutamate (MSG). J Headache Pain 2013; 14:2. [PMID: 23565943 PMCID: PMC3606962 DOI: 10.1186/1129-2377-14-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/19/2012] [Indexed: 11/15/2022] Open
Abstract
Background A single intake of monosodium glutamate (MSG) may cause headache and increased muscle sensitivity. We conducted a double-blinded, placebo-controlled, crossover study to examine the effect of repeated MSG intake on spontaneous pain, mechanical sensitivity of masticatory muscles, side effects, and blood pressure. Methods Fourteen healthy subjects participated in 5 daily sessions for one week of MSG intake (150 mg/kg) or placebo (24 mg/kg NaCl) (randomized, double-blinded). Spontaneous pain, pressure pain thresholds and tolerance levels for the masseter and temporalis muscles, side effects, and blood pressure were evaluated before and 15, 30, and 50 min after MSG intake. Whole saliva samples were taken before and 30 min after MSG intake to assess glutamate concentrations. Results Headache occurred in 8/14 subjects during MSG and 2/14 during placebo (P = 0.041). Salivary glutamate concentrations on Day 5 were elevated significantly (P < 0.05). Pressure pain thresholds in masseter muscle were reduced by MSG on Day 2 and 5 (P < 0.05). Blood pressure was significantly elevated after MSG (P < 0.040). Conclusion In conclusion, MSG induced mechanical sensitization in masseter muscle and adverse effects such as headache and short-lasting blood pressure elevation for which tolerance did not develop over 5 days of MSG intake.
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Affiliation(s)
- Akiko Shimada
- Section of Clinical Oral Physiology, Department of Dentistry, Faculty of Health Sciences, Aarhus University, Vennelyst Boulevard 9, Aarhus C 8000, Denmark.
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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.
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Nandula SR, Dey P, Corbin KL, Nunemaker CS, Bagavant H, Deshmukh US. Salivary gland hypofunction induced by activation of innate immunity is dependent on type I interferon signaling. J Oral Pathol Med 2012; 42:66-72. [PMID: 22672212 DOI: 10.1111/j.1600-0714.2012.01181.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Activation of innate immunity through polyinosinic:polycytidylic acid [poly(I:C)] causes acute salivary gland hypofunction. As a major consequence of poly(I:C) treatment is type I interferon (IFN) production, this study was undertaken to investigate their role in salivary gland dysfunction. METHODS Different strains of mice deficient in either interferon alpha receptor (IFNAR1(-/-)) or IL-6(-/-), or IL-10(-/-), or EBI3(-/-) were treated with poly(I:C). Salivary gland function was determined by measuring pilocarpine-induced saliva volume. Gene expression levels were measured by real-time PCR. Ca(2+) mobilization studies were performed using ex-vivo acinar cells. RESULTS A single injection of poly(I:C) rapidly induced salivary gland hypofunction in wild-type B6 mice (41% drop in saliva volumes compared to PBS-treated mice). In contrast, the loss of function in poly(I:C)-treated IFNAR(-/-) mice was only 9.6%. Gene expression analysis showed reduced levels of Il-6, Il-10, and Il-27 in submandibular glands of poly(I:C)-treated IFNAR(-/-) mice. While salivary gland dysfunction in poly(I:C)-treated IL-10(-/-) and EBI3(-/-) mice was comparable to wild-type mice, the IL-6(-/-) mice were more resistant, with only a 21% drop in function. Pilocarpine-induced Ca(2+) flux was significantly suppressed in acinar cells obtained from poly(I:C)-treated wild-type mice. CONCLUSIONS Our data demonstrate that a combined action of type I IFNs and IL-6 contributes toward salivary gland hypofunction. This happens through interference with Ca(2+) mobilization within acinar cells. Thus, in acute viral infections and diseases like Sjögren's syndrome, elevated levels of type I IFNs and IL-6 can directly affect glandular function.
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Affiliation(s)
- Seshagiri-Rao Nandula
- Division of Nephrology, Center for Immunity Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, VA 22908, USA
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Clinical significance and diagnostic usefulness of anti-centromere antibody in Sjögren’s syndrome. Clin Rheumatol 2011; 31:105-12. [DOI: 10.1007/s10067-011-1789-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/19/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
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Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2011; 38:422-35. [PMID: 20545715 DOI: 10.1111/j.1600-0528.2010.00554.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the associations between age, gender, systemic diseases, medications and labial and whole salivary flow rates in older people. METHODS Unstimulated labial (LS) and unstimulated (UWS) and chewing-stimulated (SWS) whole salivary flow rates were measured in 389 randomly selected community-dwelling Danish women and 279 men aged 65-97 years. Systemic diseases, medications (coded according to the Anatomical Therapeutic Chemical (ATC) Classification System), tobacco and alcohol consumption were registered. RESULTS The number of diseases and medications was higher and UWS lower in the older age groups. On average, women were slightly older, had more diseases, higher medication intake and lower UWS, SWS and LS than men. High number of diseases and medications was associated with low UWS, SWS and LS. In the healthy (14%) and nonmedicated (19%) participants, flow rates were not associated with age and gender, apart from SWS being lower in nonmedicated women. Low UWS were associated with psychiatric and respiratory disorders, type 2 diabetes and intake of psycholeptics, psychoanaleptics (especially SRRIs), respiratory agents, oral antidiabetics (particularly sulfonylureas), magnesium-hydroxide, cardiac agents, quinine, thiazides, calcium channel blockers, statins, urinary antispasmodics, glucosamine, NSAIDs, opioids and ophthalmologicals. SWS were lower in participants with ophthalmological disorders using ophthalmologicals (especially antiglaucoma agents and miotics), but also in those taking antidepressants, cardiac agents (mostly digitalis glycosides) and calcium channel blockers. Cardiovascular diseases and intake of anti-thrombotics (mainly low dose aspirins), calcium channel blockers and oral antidiabetics were associated with low LS. CONCLUSIONS In older people, low salivary flow rates are associated with specific and high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. Low UWS are associated with more diseases and medications than SWS and LS, which were primarily associated with cardiovascular diseases and medications including preventive agents such as low-dose aspirins and statins. New insights into medications and their association with salivary gland function were achieved using the ATC classification system.
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Affiliation(s)
- Dorte Smidt
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2010; 39:276-88. [PMID: 21070322 DOI: 10.1111/j.1600-0528.2010.00588.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the associations between age, gender, systemic diseases, medications, labial and whole salivary flow rates and oral and ocular dryness in older people. METHODS Symptoms of oral and ocular dryness, systemic diseases, medications (coded according to the Anatomical therapeutic chemical (ATC) classification system), tobacco and alcohol consumption were registered, and unstimulated labial (LS) and unstimulated (UWS) and chewing-stimulated (SWS) whole salivary flow rates were measured in 668 randomly selected community-dwelling elderly aged 65-95. RESULTS Presence of oral (12%) and ocular (11%) dryness was positively correlated. Oral dryness was associated with low UWS, SWS and LS, and ocular dryness with low UWS and SWS. Oral and ocular dryness was related to female gender, but not to age. Only four persons in the healthy and nonmedicated subgroups reported oral and ocular dryness. The numbers of diseases and medications were higher in the older age groups and associated with oral and ocular dryness, low UWS, SWS and LS. On average, women were slightly older, reported more oral and ocular dryness and had lower UWS, SWS, LS and higher numbers of diseases and medications. High prevalence and odds ratios for oral dryness were associated with metabolic, respiratory and neurological diseases and intake of thyroid hormones, respiratory agents (primarily glucocorticoids), psycholeptics and/or psychoanaleptics, antineoplastics, proton pump inhibitors, antidiabetics, loop diuretics, antispasmodics, quinine and bisphosphonates. Ocular dryness was especially associated with neurological diseases and intake of psycholeptics and/or psychoanaleptics. Intake of magnesium hydroxide, antithrombotics, cardiac agents, thiazides, beta-blockers, calcium channel blockers, ACE inhibitors/angiotensin II antagonists, statins, glucosamine, paracetamol/opioids, ophthalmologicals and certain combination therapies was related to oral and ocular dryness. CONCLUSIONS In older people, oral and ocular dryness are associated with low salivary flow rates, specific as well as high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. New detailed information concerning associations between medications and oral and ocular dryness has been obtained using the ATC classification system.
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Affiliation(s)
- D Smidt
- Department of Odontology, Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Faculty of Health Sciences, University of Copenhagen, Denmark
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Kragelund C, Hansen C, Torpet LA, Nauntofte B, Brøsen K, Pedersen AML, Buchwald C, Therkildsen MH, Reibel J. Expression of two drug-metabolizing cytochrome P450-enzymes in human salivary glands. Oral Dis 2008; 14:533-40. [DOI: 10.1111/j.1601-0825.2007.01415.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Takahashi F, Takahashi M, Toya S, Morita O. Study on the Relationship between Subjective Oral Dryness and Stimulated Saliva or Oral Mucosal Moisture. ACTA ACUST UNITED AC 2008. [DOI: 10.2186/prp.7.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Devauchelle-Pensec V, Pennec Y, Morvan J, Pers JO, Daridon C, Jousse-Joulin S, Roudaut A, Jamin C, Renaudineau Y, Roué IQ, Cochener B, Youinou P, Saraux A. Improvement of Sjögren's syndrome after two infusions of rituximab (anti-CD20). ACTA ACUST UNITED AC 2007; 57:310-7. [PMID: 17330280 DOI: 10.1002/art.22536] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is evidence to support a dominant role for B cells in the pathophysiology of primary Sjögren's syndrome (SS). Therefore, we evaluated the safety and efficacy of anti-CD20 monoclonal antibody. METHODS Sixteen patients who met the new American-European Consensus Group criteria for primary SS and scored >50 on at least 2 of 4 visual analog scales (VAS; 100 mm) evaluating global disease, pain, fatigue, and global dryness received infusions of low-dose rituximab (375 mg/m(2)) at weeks 0 and 1 without steroid premedication. RESULTS Slow rituximab infusions (100 mg/hour) were well tolerated, with only 1 patient experiencing serum sickness-like disease. There was a dramatic reduction in B cells of the blood and salivary gland (SG). At week 12, VAS scores with respect to fatigue and dryness (P < 0.05), tender point count (P < 0.035), and quality of life as evaluated by the Short Form 36 questionnaire (SF-36; P < 0.001) were significantly improved. At week 36, significant improvements were noted in the 4 VAS scores (P < 0.05), tender joint count (P = 0.017), tender point count (P = 0.027), and SF-36 (P < 0.03). Pulmonary manifestations were ameliorated in 1 patient. Patients with improvements on at least 3 of the 4 VAS scores at any visit (n = 11) had a shorter disease duration than the other patients (n = 5; mean +/- SD duration 3.8 +/- 5.4 versus 30.1 +/- 29.5 years; P = 0.02). CONCLUSION Low-dose rituximab infusions were well tolerated without the benefit of steroids. Infusions induced a rapid depletion of B cells in the blood and SG and could improve primary SS. Controlled studies are needed.
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Saad WA, . LIG, . RCV, . AHF, . LADA, . GG. Effect of Pilocarpine and Angiotensin II on Salivary Flow, Total Protein and Electrolyte Concentrations of Saliva. INT J PHARMACOL 2005. [DOI: 10.3923/ijp.2005.190.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pedersen AML, Bardow A, Nauntofte B. Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjogren's syndrome. BMC Clin Pathol 2005; 5:4. [PMID: 15740617 PMCID: PMC554998 DOI: 10.1186/1472-6890-5-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 03/01/2005] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: the classification criteria for primary Sjogren's syndrome (pSS) include a number of oral components. In this study we evaluated if salivary flow and composition as well as dental caries are oral markers of disease severity in pSS. METHODS: in 20 patients fulfilling the American-European Consensus criteria for pSS and 20 age-matched healthy controls whole and parotid saliva flow rates and composition, measures of oral dryness, scores of decayed, missing and filled tooth surfaces (DMFS), periodontal indices, oral hygiene, and dietary habits were examined. RESULTS: in pSS, salivary flow rates, pH, and buffer capacities were lower, and DMFS, salivary sodium and chloride concentrations higher than in the healthy controls. DMFS also correlated inversely to salivary flow rates and positively to oral dryness. Apart from slightly increased gingival index, and more frequent dental visits in pSS, the periodontal condition, oral hygiene or sugar intake did not differ between these two groups. In pSS, findings were correlated to labial salivary gland focus score (FS) and presence of serum-autoantibodies to SSA/SSB (AB). The patients having both presence of AB and the highest FS (>2) also had the highest salivary sodium and chloride concentrations, the lowest salivary phosphate concentrations, lowest salivary flow rates, and highest DMFS compared to those with normal salivary concentrations of sodium and chloride at a given flow rate. CONCLUSION: the salivary changes observed in some pSS patients reflect impaired ductal salt reabsorption, but unaffected acinar transport mechanisms, despite low salivary secretion. Our results suggest that changes in salivary flow and composition as well as dental caries may serve as potential markers of the extent of autoimmune-mediated salivary gland dysfunction in pSS. The study also indicates that the ductal epithelium is functionally affected in some pSS patients, which calls for future pathophysiological studies on the mechanisms underlying this impaired salt reabsorption.
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Affiliation(s)
- Anne Marie Lynge Pedersen
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, and Copenhagen Gerodontological Research Centre, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, 2200 Copenhagen N, Denmark
| | - Allan Bardow
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, and Copenhagen Gerodontological Research Centre, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, 2200 Copenhagen N, Denmark
| | - Birgitte Nauntofte
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, and Copenhagen Gerodontological Research Centre, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, 2200 Copenhagen N, Denmark
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Bots CP, Brand HS, Veerman ECI, van Amerongen BM, Nieuw Amerongen AV. Preferences and saliva stimulation of eight different chewing gums. Int Dent J 2004; 54:143-8. [PMID: 15218894 DOI: 10.1111/j.1875-595x.2004.tb00270.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Chewing gums have been studied for clinical use to stimulate the salivary flow rate in healthy and diseased individuals. However, differences in preferences of chewing gums may influence patient compliance during long-term use. Therefore, we compared the effect of several chewing gums on the flow rate of whole saliva and pH, and investigated the preferences of these gums. METHODS 83 healthy subjects participated in the first part of the study. Both parafilm-stimulated and chewing gum-stimulated whole saliva from 8 different chewing gums was collected and salivary flow rate and pH were determined. In another group of 112 healthy subjects, we investigated the preferences for the chewing gums with a 10-item questionnaire. RESULTS All gums had comparable effects on salivary flow rate and pH. The average increase in flow rate was 187% during the first minute of chewing compared with parafilm stimulation. After 10 minutes of gum chewing, the amount of saliva was equal to parafilm stimulation. The questionnaire showed differences in preferences for the chewing gums, which were related to taste and gum shape. Gender interactions were observed for sparkling taste (p = 0.019), total judgement (p = 0.047) and the willingness to use the gum for several weeks (p = 0.037). CONCLUSIONS Although all chewing gums stimulated the salivary flow rate equally, the observed differences in preferences may influence long-term compliance. Therefore, we recommend that chewing gums are tested before the start of clinical studies, to identify the most accepted chewing gum for specific groups of patients.
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Affiliation(s)
- C P Bots
- Department of Basic Dental Sciences, Section of Oral Biochemistry, room A-220, Academic Center for Dentistry Amsterdam (ACTA), van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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31
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Tensing EK, Nordström DC, Solovieva S, Schauman KO, Sippo-Tujunen I, Helve T, Natah S, Ma J, Li TF, Konttinen YT. Salivary gland scintigraphy in Sjögren's syndrome and patients with sicca symptoms but without Sjögren's syndrome: the psychological profiles and predictors for salivary gland dysfunction. Ann Rheum Dis 2003; 62:964-8. [PMID: 12972475 PMCID: PMC1754342 DOI: 10.1136/ard.62.10.964] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterise the psychological profiles of Sjögren's syndrome (SS) and patients with sicca symptoms but without SS; to find predictors for salivary gland function; to evaluate salivary scintigraphy as a method to differentiate between SS and patients with sicca symptoms but without SS. PATIENTS AND METHODS Psychological tests (Medical Outcomes Study Short Form General Health Survey (SF-36), Jenkins Activity Survey, Toronto Alexithymia Scale, and Maastricht Questionnaire for vital exhaustion) were performed and assessment of the function of the salivary glands made in 26 patients with primary SS, 8 with secondary SS, and 9 with sicca symptoms but without SS. Data were analysed with BMDP new system version 1.0 statistical program. RESULTS Psychological profiles were similar in all groups. Hb, RF, ANA, and SSA differentiated between the groups. Results of salivary scintigraphy were predicted to 51% by ANA, SSA, SSB, IgG, IgA, diagnosis, vitality, and role limitations due to emotional problems. No predictors were found for the resting salivary flow. Salivary scintigraphy was pathological in 21/26 (81%) and in 8/8 (100%) patients with secondary SS, but only in 2/9 (22%) patients with sicca symptoms without SS (p=0.002) (sensitivity 85.3%, specificity 77.8%). CONCLUSIONS Patients with sicca symptoms but without SS have sickness behaviour similar to that of patients with SS. The results of salivary scintigraphy can be predicted by diagnosis and autoimmune findings; psychological characteristics added 20% to this predictive value. Distinction between SS and patients with sicca symptoms but without SS is difficult, but in addition to autoantibodies, salivary scintigraphy can be used for this purpose.
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Affiliation(s)
- E-K Tensing
- Institute of Biomedicine/Anatomy, Biomedicum Helsinki, University of Helsinki, Finland
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Almståhl A, Wikström M. Electrolytes in stimulated whole saliva in individuals with hyposalivation of different origins. Arch Oral Biol 2003; 48:337-44. [PMID: 12711377 DOI: 10.1016/s0003-9969(02)00200-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are reasons to believe that changes in the secretion rate of saliva as well as changes in its protein and electrolyte composition promote the growth of micro-organisms associated with oral disorders. Knowledge of the electrolytes in the saliva of those with hyposalivation might therefore be of value in designing oral health-promoting measures. In this study, electrolytes in stimulated whole saliva were analysed in individuals with hyposalivation due to radiation therapy in the head and neck region (RT group), primary Sjögren's syndrome (pSS group), neuroleptic treatment (Neuro group), and to medication or of unknown origin (Unknown group). The bicarbonate concentration was significantly lower in all four hyposalivation groups compared with controls. The bicarbonate concentration, which in normal conditions is positively correlated with the salivary secretion rate, was lower in the Neuro group than in the RT and Sjögren's groups despite a stimulated secretion rate about twice as high. Furthermore, the Neuro group had the highest phosphate concentration. The RT and Sjögren's groups tended to have increased sodium concentrations. For potassium and calcium, the RT group had significantly higher concentrations than the other hyposalivation groups and the controls. The substantial increase in calcium and decrease in bicarbonate suggest that the function of the parotid glands is more affected than that of the other salivary glands. The results also indicate a contribution of plasma to the electrolyte concentrations determined in whole saliva in the RT and Sjögren's groups. In conclusion, in individuals with hyposalivation the concentrations of electrolytes in stimulated whole saliva seem to be more related to the reason for the hyposalivation than to the salivary secretion rate.
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Affiliation(s)
- Annica Almståhl
- Department of Oral Microbiology, Institute of Odontology, Göteborg University, P.O. Box 450, 405 30 Göteborg, Sweden
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Cermak JM, Papas AS, Sullivan RM, Dana MR, Sullivan DA. Nutrient intake in women with primary and secondary Sjögren's syndrome. Eur J Clin Nutr 2003; 57:328-34. [PMID: 12571668 DOI: 10.1038/sj.ejcn.1601543] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2001] [Revised: 05/27/2002] [Accepted: 05/28/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recently, it has been proposed that dietary factors may contribute to the etiology and progression of Sjögren's syndrome, and that nutritional intervention may modify the severity of pathological abnormalities. The objective of this study was to determine whether the nutrient intake of women with primary (1 degrees SS) or secondary (2 degrees SS; ie with systemic lupus erythematosus (2 degrees SS/SLE) or rheumatoid arthritis (2 degrees SS/RA) Sjögren's syndrome is significantly different than that of age- and gender-matched controls. DESIGN Women with Sjögren's syndrome were asked to complete the 97 General Purpose Semi-Quantitative Food Frequency Questionnaire, which consists of a list of 147 separate food items that represent the major sources of multiple nutrients. Nutritional data were evaluated in terms of absolute and energy-adjusted nutrient amounts and analyzed by ANOVA. RESULTS Our results showed: (a) greater intake of energy, glutamate, carbohydrates, lactose, phosphorus, caffeine and unsupplemental thiamin and riboflavin in 1 degrees SS, as well as supplemental calcium in 2 degrees SS/SLE, compared with controls; (b) greater nutrient intake of energy, protein, glutamate, methionine, tryptophan, carbohydrates, lactose, supplemental calcium and phosphorus, sodium, caffeine and unsupplemental calcium, riboflavin and thiamin in 2 degrees SS/RA, relative to 1 degrees SS and/or 2 degrees SS/SLE; (c) higher energy-adjusted values for supplemental calcium in 2 degrees SS/SLE, and for vitamin A and supplemental iron and zinc in 2 degrees SS/RA, compared with other groups; and (d) higher energy-adjusted intake of supplemental calcium, and a lower energy-adjusted intake of unsupplemental vitamin C, polyunsaturated fat, linoleic acid, omega-3 fatty acid, and specific other unsaturated fatty acids, in the Sjögren's syndrome group as a whole, relative to controls. CONCLUSIONS Our findings demonstrate that nutrient intake is altered in Sjögren's syndrome.
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Affiliation(s)
- J M Cermak
- Schepens Eye Research Institute, Boston, Massachusetts 02114, USA
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Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis 2002; 8:117-29. [PMID: 12108756 DOI: 10.1034/j.1601-0825.2002.02851.x] [Citation(s) in RCA: 424] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Saliva has multiple essential functions in relation to the digestive process taking place in the upper parts of the gastrointestinal (GI) tract. This paper reviews the role of human saliva and its compositional elements in relation to the GI functions of taste, mastication, bolus formation, enzymatic digestion, and swallowing. The indirect function of saliva in the digestive process that includes maintenance of an intact dentition and mucosa is also reviewed. Finally, pathophysiological considerations of salivary dysfunction in relation to some GI functions are considered.
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Affiliation(s)
- A M Pedersen
- Copenhagen Gerodontological Oral Health Research Centre, Department of Clinical Oral Physiology, Anatomy, Pathology and Medicine, School of Dentistry, Denmark
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35
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Pedersen AM, Nauntofte B. Primary Sjögren's syndrome: oral aspects on pathogenesis, diagnostic criteria, clinical features and approaches for therapy. Expert Opin Pharmacother 2001; 2:1415-36. [PMID: 11585021 DOI: 10.1517/14656566.2.9.1415] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary Sjögren's syndrome (pSS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine glands and predominantly the salivary and lacrimal glands. The impaired gland function is assumed to be a result of progressive lymphocyte-mediated destruction of the exocrine gland tissue leading to the cardinal manifestations, hyposalivation and keratoconjunctivitis sicca (KCS), as well as devastating symptoms of oral and ocular dryness. Although primarily characterised as an exocrine dysfunction, non-exocrine organs may also be affected. The onset and course of pSS is usually insidious but may develop into a disabling disease, which profoundly affects the patient's general well being and quality of life. Moreover, pSS may even evolve into a lymphoid malignancy. The aetiology of pSS remains unknown but the pathogenesis of exocrine cell damage is apparently multi-factorial, including immunological, genetic, hormonal and viral components. Recent research also includes neurogenic aspects of exocrine gland dysfunction, including the interference of immune mediators with glandular response to neurotransmitters released from nerve fibres. pSS usually affects middle-aged women and the female:male ratio is 9:1. The prevalence varies from 0.29-4.8%, depending on the population sampled and the diagnostic criteria used. At present, there are no specific diagnostic tests for pSS and no universally accepted diagnostic criteria. The current therapy is primarily symptomatic. This review focuses on the current oral clinical, diagnostic, pathogenic and therapeutic aspects of pSS.
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Affiliation(s)
- A M Pedersen
- Department of Oral Physiology, Pathology and Medicine, School of Dentistry, University of Copenhagen, Denmark.
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Brayer JB, Cha S, Nagashima H, Yasunari U, Lindberg A, Diggs S, Martinez J, Goa J, Humphreys-Beher MG, Peck AB. IL-4-dependent effector phase in autoimmune exocrinopathy as defined by the NOD.IL-4-gene knockout mouse model of Sjögren's syndrome. Scand J Immunol 2001; 54:133-40. [PMID: 11439159 DOI: 10.1046/j.1365-3083.2001.00958.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
NOD mice manifest many features of autoimmune exocrinopathy (Sjögren's syndrome), a disease generally characterized by a chronic, progressive immunological attack against the exocrine tissues of the salivary and lacrimal glands. Previous studies using the NOD congenic partner strain, NOD.Igmu(null), defined an important role for B lymphocytes in the development of xerostomia, implicating autoantibodies reactive with the acetylcholine muscarinic receptor (M3R) as the possible effector mechanism. In the present study, we have examined the impact of the cytokine, interleukin (IL)-4, on autoimmune exocrinopathy by using the IL-4 gene knockout (KO) NOD mouse strain, NOD.IL-4-/-. Despite manifesting the physiological aberrations and marked leukocytic infiltration of the salivary glands characteristic of autoimmune xerostomia in NOD mice, the NOD.IL-4-/- mice do not develop xerostomia. However, NOD.IL-4-/- mice that received adoptively transferred T lymphocytes derived from NOD.Igmu-/- mice progress to xerostomia, thereby reversing the defect. While progression or lack of progression to xerostomia correlated with the ability of the NOD.IL-4-/- mice to express detectable anti-M3R autoantibodies, the precise mechanism of how IL-4 influences the development of autoimmune xerostomia remains speculative.
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Affiliation(s)
- J B Brayer
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA
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Looms DK, Dissing S, Tritsaris K, Pedersen AM, Nauntofte B. Adrenoceptor-activated nitric oxide synthesis in salivary acinar cells. Adv Dent Res 2000; 14:62-8. [PMID: 11842926 DOI: 10.1177/08959374000140011001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the cellular regulation of nitric oxide synthase (NOS) activity in isolated acinar cells from rat parotid and human labial salivary glands, using the newly developed fluorescent nitric oxide (NO) indicator, DAF-2. We found that sympathetic stimulation with norepinephrine (NE) caused a strong increase in NO synthesis that was not seen after parasympathetic stimulation with acetylcholine. In rat parotid acinar cells, we furthermore investigated to which extent the NOS activity was dependent on the intracellular free Ca2+ concentration ([Ca2+]i) by simultaneously measuring NO synthesis and [Ca2+]i. It was found that a simple correlation between the rise in [Ca2+]i and the rate of NO production following NE stimulation does not exist, and studies in which [Ca2+]i was elevated by means of the Ca2+ ionophore, ionomycin, further established that even a very large rise in [Ca2+]i did not cause significant NO synthesis. We furthermore found that activating adrenoceptors with NE causes synthesis of cGMP by activating a guanylyl cyclase, and that an enhanced [cGMP] evoked by use of caged cGMP causes Ca2+ release from internal stores. Thus, upon sympathetic stimulation, salivary gland acini synthesize NO that, in addition to playing a role in controlling intracellular [Ca2+]i, also might play a role in retrograde signaling processes to the surrounding tissue.
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Affiliation(s)
- D K Looms
- The Panum Institute, Faculty of Health Sciences, University of Copenhagen, Denmark
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