Prevalence of Sjögren's syndrome in patients with dry mouth in the region of Central Hungary

OBJECTIVE

One-third of the Hungarian population suffers from xerostomia. Since there is no evidence of the actual prevalence of Sjögren's syndrome (SS) in Hungary, this study aimed to evaluate the same.

MATERIALS AND METHODS

Data were collected from the Faculty of Dentistry, Semmelweis University from 2008 to 2015. A diagnosis of SS was established based on the American College of Rheumatology and European League Against Rheumatism criteria.

RESULTS

Of the 1076 patients examined with sicca symptoms, 188 patients had confirmed SS. Primary SS (pSS) was diagnosed in 135 patients and secondary SS (sSS) was confirmed in 53 patients. According to the available statistical records of the public health service of Hungary, there were an average of 16 (0.0014%, 5-26) newly diagnosed SS cases in the entire population and 141 SS patient-practitioner consultations (49-232) per 100,000 inhabitants in the country over the past 10 years (based on the past 10 years: 2011-2020).

CONCLUSION

Results revealed that approximately 1/5th-1/6th of patients with sicca symptoms have SS, among whom 72% and 285 have pSS and sSS, respectively. Global Hungarian records simultaneously revealed that the number of both new diagnoses and doctor-SS patient encounters has significantly decreased (by 50%) yearly over the last decade.

Association between Sjögren's Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review

In recent decades, researchers have investigated the bidirectional links between periodontal disease and systemic diseases, and the results have allowed the development of the concept of periodontal medicine. This concept incorporates and analyzes the mutually influential interactions that can occur between periodontitis and systemic diseases such as diabetes mellitus or cardiovascular diseases. Sjögren's syndrome (SS) is a chronic autoimmune disorder that targets the exocrine glands of the body, such as the lacrimal and salivary glands. The amount of saliva produced may gradually decrease with the progression of the disease, which can have an impact on the structures within the oral cavity. Although the reduction in saliva flow produces negative effects in the oral cavity, a direct association between Sjögren's syndrome and periodontal disease has not yet been demonstrated. Available studies on this topic have not identified significant differences in the periodontal status of patients with Sjögren's syndrome and control groups at the clinical and bacteriological levels. On the other hand, other studies on this topic consider that patients with periodontitis have a higher risk of developing Sjögren's syndrome than the general population. Therefore, the results remain inconclusive, highlighting the need for further complementary studies.

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia

OBJECTIVE

The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth.

STUDY DESIGN

A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized.

RESULTS

From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains.

CONCLUSION

There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.

Patient satisfaction and impact of salivary flow rate on effectiveness of xerostomia products

OBJECTIVES

To determine the types of products used to treat dry mouth and their perceived effectiveness, the relationship between salivary function and xerostomia symptoms, and whether salivary function predicts response to management strategies.

STUDY DESIGN

Cross-sectional study of 87 patients with dry mouth and documented unstimulated whole salivary (UWS) and stimulated whole salivary (SWS) flow rates. Participants completed a questionnaire assessing dry mouth complaints and symptoms and effectiveness of specific dry mouth products.

RESULTS

Mean (SD) age was 61.7 (12.9) years including 78 (90%) females. 47 (54%) participants had Sjögren's disease. Oral dryness symptoms (0-10 scale) rated highest with a mean (SD) of 7.2 (2.17); other symptoms scored from 3.4 to 5.1. Lower levels of UWS and SWS were associated with worse dry mouth and difficulty speaking, while lower levels of SWS flow alone were associated with greater difficulty swallowing and a decline in taste. More than half of the participants (55%, n = 48) reported using ≥4 dry mouth products. Participants with normal SWS flow had significantly better responses to lozenges and prescription products.

CONCLUSIONS

Patients with dry mouth and normal stimulated flow rates (i.e., residual salivary capacity) respond better to stimulatory products (parasympathomimetic and lozenges). Salivary flow rate assessments may help with recommendations of dry mouth products.

Influence of Age and Individual Differences on Mouthfeel Perception of Whey Protein-Fortified Products: A Review

Protein needs are considered to increase with age, with protein consumption being associated with many positive outcomes. Protein-fortified products are often used to improve nutritional status and prevent age-related muscle mass loss in older adults. Accordingly, older adults are commonly provided with products fortified with whey protein; however, such products can cause mouthdrying, limiting consumption and product enjoyment. Currently, the extent to which age and individual differences (e.g., saliva, oral health, food oral processing) influence the perception of whey protein-derived mouthdrying is relatively unclear. Previous research in this area has mainly focused on investigating mouthdrying, without taking into account individual differences that could influence this perception within the target population. Therefore, the main focus of this review is to provide an overview of the relevant individual differences likely to influence mouthfeel perception (specifically mouthdrying) from whey protein-fortified products, thereby enabling the future design of such products to incorporate better the needs of older adults and improve their nutritional status. This review concludes that age and individual differences are likely to influence mouthdrying sensations from whey protein-fortified products. Future research should focus more on the target population and individual differences to maximise the benefits from whey protein fortification.

Quantifying Live Microbial Load in Human Saliva Samples over Time Reveals Stable Composition and Dynamic Load

Evaluating microbial community composition through next-generation sequencing has become increasingly accessible. However, metagenomic sequencing data sets provide researchers with only a snapshot of a dynamic ecosystem and do not provide information about the total microbial number, or load, of a sample. Additionally, DNA can be detected long after a microorganism is dead, making it unsafe to assume that all microbial sequences detected in a community came from living organisms. By combining relic DNA removal by propidium monoazide (PMA) with microbial quantification with flow cytometry, we present a novel workflow to quantify live microbial load in parallel with metagenomic sequencing. We applied this method to unstimulated saliva samples, which can easily be collected longitudinally and standardized by passive collection time. We found that the number of live microorganisms detected in saliva was inversely correlated with salivary flow rate and fluctuated by an order of magnitude throughout the day in healthy individuals. In an acute perturbation experiment, alcohol-free mouthwash resulted in a massive decrease in live bacteria, which would have been missed if we did not consider dead cell signal. While removing relic DNA from saliva samples did not greatly impact the microbial composition, it did increase our resolution among samples collected over time. These results provide novel insight into the dynamic nature of host-associated microbiomes and underline the importance of applying scale-invariant tools in the analysis of next-generation sequencing data sets.

IMPORTANCE Human microbiomes are dynamic ecosystems often composed of hundreds of unique microbial taxa. To detect fluctuations over time in the human oral microbiome, we developed a novel workflow to quantify live microbial cells with flow cytometry in parallel with next-generation sequencing, and applied this method to over 150 unstimulated, timed saliva samples. Microbial load was inversely correlated with salivary flow rate and fluctuated by an order of magnitude within a single participant throughout the day. Removing relic DNA improved our ability to distinguish samples over time and revealed that the percentage of sequenced bacteria in a given saliva sample that are alive can range from nearly 0% up to 100% throughout a typical day. These findings highlight the dynamic ecosystem of the human oral microbiome and the benefit of removing relic DNA signals in longitudinal microbiome study designs.

Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis

Background

Effective and selective oral rinses are required in the daily medical and dental practice. Currently mouthwashes used have substantial side effects.

Objectives

Our aim was to evaluate the efficacy of chlorine dioxide-containing mouthwashes in comparison with other previously established mouth rinses in healthy adults using oral hygiene indices.

Methods

This work was registered in PROSPERO (CRD42018099059) and carried out using multiple databases and reported according to the PRISMA statement. The search terms used were “chlorine dioxide” AND “oral”, and only randomised controlled trials (RCTs) were included. The primary outcome was the alteration of the plaque index (PI), while the secondary outcomes were the gingival index (GI) and bacterial counts. For the risk of bias assessment, the Cochrane Risk of Bias Tool was used. Statistical analysis for data heterogeneity was performed by Q-value and I²-tests.

Results

364 articles were found in the databases. After the selection process, only five RCTs were eligible for meta-analysis. Data heterogeneity was low. There were no statistical differences in effectiveness between chlorine dioxide and other effective mouth rinses in PI (0.720±0.119 vs 0.745±0.131; 95%; confidence intervals (CIs): 0.487-0.952 vs 0.489-1.001, respectively) and GI (0.712±0.130 vs 0.745±0.131; 95% CIs: 0.457–0.967 vs 0.489–1.001, respectively) and also in bacterial counts.

Conclusion

Chlorine dioxide reduces both plaque and gingival indices and bacterial counts in the oral cavity similar to other routinely used oral rinses, however, the evidence supporting this outcome is very limited. Therefore, further large scale RCTs are needed to decrease the risk of bias.

Anticholinergic burden, oral hygiene practices, and oral hygiene status-cross-sectional findings from the Northern Finland Birth Cohort 1966

Objectives

To study the association between anticholinergic burden and oral hygiene practices and oral hygiene status among 46-year-old people.

Materials and methods

The study included 1945 participants from the Northern Finland Birth Cohort 1966 (NFBC1966), who had a complete dental status. The participants underwent clinical medical and dental examinations, and their medication data were gathered by combining self-reported drug use with information from the National Prescription Register. Anticholinergic burden was measured using nine previously published anticholinergic scales. Oral hygiene practices were assessed with toothbrushing frequency and oral hygiene status with the presence of visible dental plaque. Poisson regression with robust variance estimation and negative binomial regression models were used to estimate relative risks (RR).

Results

Thirty percent of the participants reported brushing their teeth twice a day and about 25% of their teeth had dental plaque on them. Fifteen percent of the participants used at least one anticholinergic drug or had an anticholinergic burden according to the nine anticholinergic scales. After adjustments for confounding factors, the RRs of anticholinergic burden varied between 0.95 and 1.11 for toothbrushing frequency. Anticholinergic burden (according to Anticholinergic Activity Scale, Anticholinergic Cognitive Burden, Chew’s scale) was associated statistically significantly with the number of teeth with dental plaque. For the three scales, RRs varied from 1.24 to 1.50.

Conclusions

Anticholinergic burden associated with poor oral hygiene.

Clinical relevance

The findings stress the importance of providing oral hygiene instructions and prophylactic measures to patients taking anticholinergic drugs.

Electronic supplementary material

The online version of this article (10.1007/s00784-020-03485-0) contains supplementary material, which is available to authorized users.

Defense Mechanisms Against Acid Exposure by Dental Enamel Formation, Saliva and Pancreatic Juice Production

The pancreas, the salivary glands and the dental enamel producing ameloblasts have marked developmental, structural and functional similarities. One of the most striking similarities is their bicarbonate-rich secretory product, serving acid neutralization. An important difference between them is that while pancreatic juice and saliva are delivered into a lumen where they can be collected and analyzed, ameloblasts produce locally precipitating hydroxyapatite which cannot be easily studied. Interestingly, the ion and protein secretion by the pancreas, the salivary glands, and maturation ameloblasts are all two-step processes, of course with significant differences too. As they all have to defend against acid exposure by producing extremely large quantities of bicarbonate, the failure of this function leads to deteriorating consequences. The aim of the present review is to describe and characterize the defense mechanisms of the pancreas, the salivary glands and enamel-producing ameloblasts against acid exposure and to compare their functional capabilities to do this by producing bicarbonate.

Relationship of MR imaging of submandibular glands to hyposalivation in Sjögren's syndrome

OBJECTIVE

We analysed the correlation between magnetic resonance images of the parotid and submandibular glands and the salivary flow rate in patients with Sjögren's syndrome.

METHODS

We retrospectively reviewed magnetic resonance images (heterogeneous signal-intensity distribution and gland volume on T1- and fat-suppressed T2-weighted images, and multiple high-signal-intensity spots on magnetic resonance sialograms in the parotid and submandibular glands) obtained from 66 patients who were diagnosed with Sjögren's syndrome. We evaluated the relationship between these imaging features and their salivary flow rates in stimulated and unstimulated conditions.

RESULTS

We found that as the disease progressed, both the heterogeneous signal-intensity distribution and the volumes of the parotid and the submandibular glands were significantly related to the stimulated and the unstimulated salivary flow rate. These imaging features were more highly correlated in assessments of the submandibular gland than in those of the parotid gland for both stimulated and unstimulated salivary flow rates.

CONCLUSIONS

Magnetic resonance image features of heterogeneity and smaller volume in the submandibular gland are reliable for predicting hyposalivation related to the progression of Sjögren's syndrome.

Assessing the association between unstimulated whole salivary flow rate (UWSFR) and oral health status among healthy adult subjects: A cross-sectional study

BACKGROUND

This study aimed to test the association between the unstimulated whole salivary flow rate (UWSFR) and the oral health status represented by dental and gingival status among healthy adult subjects.

MATERIAL AND METHODS

This work was a cross-sectional study of patients attending the undergraduate dental clinics at AlFarabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. The study population consisted of 502 systemically healthy adults aged 18-35 years. UWSFR was collected for all study participants and expressed as ml/min. Oral health status was estimated using the Community Periodontal Index (CPI) and the Oral Hygiene Index-Simplified (OHI-S). The number of decayed teeth and the number of available teeth were also calculated to evaluate dental status.

RESULTS

The mean UWSFR was 0.42 (±0.3) ml/min, and the male participants significantly had more UWSFR than the females. UWSFR was significantly affected by CPI, OHI-S, body mass index (BMI) and gender as indicated in the univariate analysis. However, multiple regression analysis revealed that only gender was a significant predictor of UWSFR. The male subjects were shown to have a higher average of 0.133 ml/min than the females.

CONCLUSIONS

High BMI scores, moderate-to-severe gingivitis and low level of oral hygiene increased UWSFR. However, further longitudinal studies are recommended to test the role of salivary cytokine levels to validate the exact association between the UWSFR and the oral health status.

Stimulated salivary flow rate and oral health status

This study examined the relationship between stimulated salivary flow rate and oral health status in an adult population. Multinomial multivariate logistic regression analysis was used to examine the associations of salivary flow rate with dental caries status and periodontal status at the individual level among 2,110 Japanese adults with ≥10 teeth. Then, a spline model was used to examine the nonlinear relationship between salivary flow rate and teeth with dental caries or periodontal disease in multilevel analysis. Odds ratios were calculated for a 1.0-mL/min reduction in salivary flow rate at a point. After adjusting for confounding variables, participants with a flow rate ≤3.5 mL/min had significantly higher odds ratios for high caries status, and participants with a flow rate ≤1.4 mL/min had a higher odds ratio for broad periodontal disease, than did those with a flow rate >3.5 mL/min. In spline models, the odds ratio for teeth with dental caries or periodontal disease increased with reduced saliva secretion. The present findings suggest that decreased saliva secretion affects both dental caries and general periodontal health status.

Early and late oral features of chronic graft-versus-host disease

Background

Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites.

Objective

The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation.

Methods

This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year).

Results

Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation.

Conclusion

Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation.

© 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.

Sodium gradient, xerostomia, thirst and inter-dialytic excessive weight gain: a possible relationship with hyposalivation in patients on maintenance hemodialysis

Purpose

The aim of the study was to assess whether hyposalivation is linked with increased thirst sensation and weight gain in hemodialysis (HD) patients and whether there is any connection between hyposalivation and sodium balance.

Methods

One hundred and eleven participants (64 males and 47 females) receiving maintenance hemodialysis, mean age 59.1 ± 13.6 years old, were involved in the study. All participants completed a survey evaluating thirst intensity (DTI) and xerostomia inventory (XI). In addition, pre-dialysis sodium concentration and inter-dialytic weight gain (IWG) were assessed. The division into no-hyposalivation and hyposalivation groups was based on an unstimulated whole saliva (UWS) flow rate.

Results

Hyposalivation, UWS below 0.1 mL/min, was reported in 28.8 % of HD patients. In these participants, IWG was higher than in patients with UWS > 0.1 mL/min (3.65 ± 1.78 vs 3.0 ± 1.4; p = 0.042), as well as the pre-dialysis sodium gradient (3.22 ± 2.1 vs 1.6 ± 2.8; p = 0.031). The mean XI and DTI scores did not differ between study groups. In the hyposalivation group, pre-dialysis sodium serum gradient negatively correlated with saliva outflow (ρ = −0.61, p = 0.019) and positively with IWG (ρ = 0.49, p = 0.022). IWG correlated with XI (ρ = 0.622, p = 0.016) in hyposalivation group and with DTI in no-hyposalivation group (ρ = 0.386, p = 0.033).

Conclusions

Hyposalivation significantly correlates with IWG; however, its influence on thirst and self-reported mouth dryness seems to be weaker than expected. Additionally, hyposalivation was found to be associated with an elevated pre-dialysis sodium gradient.

Urban legends series: Sjögren's syndrome

Sjögren's syndrome (SjS) is one of the most common autoimmune rheumatic diseases, clinically characterized by xerostomia and keratoconjunctivitis sicca. We investigated the following controversial topics: (i) Do we have reliable ways of assessing saliva production? (ii) How important are the quantity and quality of saliva? (iii) Are only anti-SSA/Ro and anti-SSB/La relevant for the diagnosis of SjS? (iv) Are the American-European Consensus criteria (AECC) the best way to diagnose SjS? Results from literature searches suggested the following: (i) Despite the fact that numerous tests are available to assess salivation rates, direct comparisons among them are scarce with little evidence to suggest one best test. (ii) Recent developments highlight the importance of investigating the composition of saliva. However, more research is needed to standardize the methods of analysis and collection and refine the quality of the accumulating data. (iii) In addition to anti-Ro/La autoantibodies, anti α-fodrin IgA and anti-MR3 autoantibodies seem to be promising diagnostic markers of SjS, but more studies are warranted to test their sensitivity and specificity. (iv) AECC are classification, not diagnostic criteria. Moreover, recent innovations have not been incorporated into these criteria. Consequently, treatment directed to patients diagnosed using the AECC might exclude a significant proportion of patients with SjS.

Diagnostic performance of labial minor salivary gland flow measurement for assessment of xerostomia

OBJECTIVE

Minor salivary gland flow rate (MF) has been proposed as a key feature of xerostomia (subjective feeling of dry mouth). To assess its diagnostic performance, MF was compared in xerostomia and control subjects.

DESIGN

Sixty-six subjects with xerostomia and 30 controls were enrolled. MF was measured in the lower labial mucosa using the iodine-starch filter paper method. Stimulated whole salivary flow rates were also measured using the gum test (stimulated-WF).

RESULTS

Both labial-MF and stimulated-WF were significantly lower in xerostomia subjects than in controls. There was a positive correlation between labial-MF and stimulated-WF in control but not xerostomia subjects. In xerostomia subjects compared to controls, there was a significantly larger reduction in labial-MF than in stimulated-WF. Xerostomia was most accurately diagnosed using a labial-MF cutoff value of 0.25 μL/cm(2)/min. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy at this cutoff value were 1.00, 0.87, 0.93, 1.00, and 0.96, respectively. Compared to respective values of 0.64, 1.00, 1.00, 0.56, and 0.75 for stimulated-WF at the traditional cutoff of 1.0 mL/min, these data indicate the higher sensitivity, negative predictive value, and diagnostic accuracy of labial-MF.

CONCLUSIONS

Xerostomia was more strongly related to reduction of labial-MF than to that of stimulated-WF. Xerostomia was most likely triggered at a labial-MF cut-off value of 0.25 μL/cm(2)/min based on results from the iodine-starch method.

Periodontitis in non-smoking type 1 diabetic adults: a cross-sectional study

AIM

To compare levels of periodontitis in non-smoking type 1 diabetic patients and controls.

MATERIAL AND METHODS

Type 1 diabetic patients, aged 20-55 years, were recruited from outpatient clinics at five hospitals in Glasgow, UK. Control subjects were recruited from physiotherapy clinics, using the buddy system and through an advertisement in a free newspaper. The primary outcome was severe periodontitis defined by clinical attachment level ≥6 mm on ≥1 tooth.

RESULTS

There were 34 well controlled patients (HbA1c ≤ 7.5%), 169 poorly controlled patients and 112 non-diabetic subjects. Prevalence of severe periodontitis was higher in all type 1 diabetic patients [24.1% (95% CI: 18.4-30.6%)] and poorly controlled patients [27.2% (20.7-34.6%)] than in controls [20.5% (13.5-29.2%)]. The fully adjusted odds ratios (ORs) in never smokers comparing the whole diabetic group, and the poorly controlled group, with the control group were 1.35 [0.66-2.8] (p = 0.41) and 1.58 [0.75-3.33] (p = 0.23), respectively. Mean clinical attachment level was higher in all type 1 diabetic and poorly controlled patients than in controls (both p < 0.001).

CONCLUSIONS

These results indicate worse periodontal health in type 1 diabetic patients than in control subjects.

TRIAL REGISTRATION

This study was registered with the UKCRN, ID: 9314 and Scottish Diabetes Research Network registration number: 128.

Oral complaints and stimulated salivary flow rate in 1188 adults

BACKGROUND

Recently, oral sensory complaints (OSC) were proposed as a disease entity to represent idiopathic sensory disturbances of dry mouth, burning mouth, and taste disturbance, even though neither the status of OSC in the general population nor its underlying mechanism has yet been elucidated. Moreover, these three OSC-related complaints have not been assessed in combination by means of a visual analog scale (VAS) in a large-scale, community-dwelling population of a broad age range.

METHODS

In a 1188-member community-dwelling adult population, comprised of 373 males and 815 females, aged 20-90 years, the three OSC-related complaints and stimulated salivary flow rate (SSFR) were assessed by means of a VAS and modified Saxon test, respectively. Association of each complaint with age, gender, SSFR, and other complaints was analyzed.

RESULTS

Increases in both prevalence and intensity of subjective dry mouth and burning mouth were associated closely with decreasing SSFR. Even for taste disturbance, which may be affected less significantly by salivation status than the other two complaints, a significant association was suggested between decreasing SSFR and especially severe taste disturbance. However, these oral complaints were found in considerable prevalence even in the individuals with high SSFR. Often overlapping presentation of these complaints and a close association in intensity between the complaints to each other were also found.

CONCLUSIONS

Hyposalivation may be a significant and common etiology for the three oral complaints, although the considerable prevalence of complaints without hyposalivation suggests other etiologies, including those related to the OSC.

The unstimulated salivary flow rate in a jordanian healthy adult population

Background

Early diagnosis of xerostomia is very important for oral health. The purpose of this study was to determine the unstimulated whole salivary flow rates (UWSFR) in a Jordanian Arab population aged 15 years and older. The effect of age, gender, height, weight, body mass index (BMI), smoking, alcohol consumption, and dental conditions, on UWSFR was also investigated.

Methods

The study was conducted on 244 subjects, 110 males and 134 females, with an average age of 33 ± 15.5 years. They were healthy, unmedicated, and with no history of dry mouth. Unstimulated whole saliva was collected during five minutes, and UWSFRs (ml/min) were determined. Data were analyzed by univariate analysis and multivariate regression analysis.

Results

The mean UWSFR was 0.46 ± 0.25 ml/min (range: 0.10-1.6 ml/min). Eighteen patients (7.4%) had UWSFR between < 0.20 ml/min. In univariate analysis, UWSFR was significantly affected by age, BMI, number of missing and restored teeth, and DMFT score. Regression analysis revealed that only age and number of missing teeth were of significance in explaining the variability of the UWSFR.

Conclusions

We established basic standard values of UWSFR to be used in the evaluation of Jordanian patients with complaints of xerostomia and to be compared to data reported in other studies. UWSFR 0.1 ml/min could be considered the cut-off value that distinguishes normal from abnormal salivary function in this healthy unmedicated population.

Keywords

Whole saliva flow rate; Unstimulated; Jordan

Periodontal Disease and Sjögren Syndrome: A Possible Correlation?

Sjögren syndrome (SS) is a chronic autoimmune rheumatic disease characterized by a progressive lymphocytic infiltration of exocrine glands, especially salivary and lachrymal ones, leading to xerostomia, parotid gland enlargement, and xerophthalmia. The aim of this study is to describe the capillaroscopic pattern of the interdental papilla in patients with SS and to evaluate a possible correlation with periodontal disease. Methods: A total of 25 patients affected by SS and 25 healthy controls were examined. The patients with conditions that compromise microcirculation, such as diabetes, hypertension, hyperlipidemia, or some pharmacological treatments, were not included in the study. All the patients were nonsmokers. Periodontal capillaroscopy has been used to investigate the features of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhage, the average caliber of the capillary loops, and the number of visible capillary loops per square millimeter were evaluated for each patient. Results: The results show evident alterations to the capillaries and a typical conformation of the interdental papilla microcirculation in patients with SS; it was possible to observe a reduced caliber of capillaries, as well as a greater number and tortuosity of capillary loops. Conclusion: This study shows that capillary alterations to patients with SS occur in gingival microcirculation.