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Gül D, Atasoy BM, Ercan E, Başkan Z, Bektaş Kayhan K. Does lower dose pilocarpine have a role in radiation-induced xerostomia in the modern radiotherapy era? A single-center experience based on patient-reported outcome measures. Eur Arch Otorhinolaryngol 2024; 281:3727-3733. [PMID: 38573515 PMCID: PMC11211147 DOI: 10.1007/s00405-024-08616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This study aims to investigate the efficacy of lower dose pilocarpine in alleviating late dry mouth symptoms in head and neck cancer patients received radiotherapy. METHODS Eighteen head and neck cancer patients experiencing persistent dry mouth were enrolled in this study. All participants started pilocarpine treatment a median of 6 months post-radiotherapy. Initially, patients received pilocarpine at 5 mg/day, with a gradual increase to the recommended dose of 15 mg/day. A Patient-Reported Outcome Measurement (PROMs) questionnaire assessed symptoms' severity related to hyposalivation. RESULTS All patients reported symptomatic dry mouth above grade 2 before starting the medication. Pilocarpine treatment continued based on patients' self-assessment, with a median duration of 12 months (range, 3-36 months). The median daily maintenance dose was 10 mg (range, 5 to 20 mg). Total PROMs scores significantly decreased following medication, from 13 points (range 7-18 points) to 7 points (range 4-13 points) (p = 0.001). Significant improvements were observed in questions related to dry mouth (p < 0.001), water intake during eating (p = 0.01), carrying water (p = 0.01), taste (p < 0.001), and water intake during speech (p < 0.001). Initial and maintenance doses of pilocarpine were lower, and the duration of pilocarpine usage was shorter in patients treated with intensity-modulated radiation therapy compared to conformal radiotherapy (12 months vs. 25 months, p = 0.04). CONCLUSION Pilocarpine may be considered at doses lower for late-term dry mouth. With modern radiotherapy techniques effectively preserving the parotid gland, short-term use may be recommended in these patients. Future studies may enhance the development of a more robust patient selection criteria model.
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Affiliation(s)
- Dilek Gül
- S.B.-Marmara University Pendik Education and Research Hospital Radiation Oncology Clinic, Istanbul, Turkey
| | - Beste M Atasoy
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey.
- Marmara Üniversitesi Pendik EAH Radyasyon Onkolojisi Kliniği, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 8, 34899, Istanbul, Turkey.
| | - Ece Ercan
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Zilan Başkan
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Kıvanç Bektaş Kayhan
- Department of Oral and Maxillofacial Surgery, İstanbul University Faculty of Dentistry, Istanbul, Turkey
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Kim YJ. Xerostomia: Advances and Challenges in Drug Development. Curr Drug Targets 2024; 25:301-305. [PMID: 38424432 DOI: 10.2174/0113894501293941240228050343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Yoon-Jung Kim
- Department of Physiology and Neuroscience, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Korea
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Chung J, Chen X, Zhang N, Zhou Y. Oral conditions and other symptoms among older persons in long-term care facilities during the end of life. SPECIAL CARE IN DENTISTRY 2023; 43:530-538. [PMID: 36446555 DOI: 10.1111/scd.12805] [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: 07/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022]
Abstract
AIMS The purpose was to examine the association between oral conditions and other symptoms in long-term care facilities during the last days of life. METHODS A retrospective case-control study approach was used in this study, with the Minimum Data Set (MDS, ver. 3.0 2015) that was maintained and administrated by the Centers for Medicare and Medicaid Services (CMS). Residents with oral conditions (n = 4304) were selected with any oral conditions (e.g., ulcers, inflamed/bleeding gums, mouth/facial pain). The control cases (n = 12 912) were selected using propensity analysis. RESULTS Oral conditions had significant impacts on depression, poor appetite, pain, shortness of breath, and constipation. Although no statistically significant differences in trouble sleeping, vomiting, internal bleeding, and dehydration were found between the cases with oral conditions and the control, more residents with oral conditions reported trouble sleeping and dehydration compared to the control. CONCLUSIONS It is important to provide preventive and proactive intervention for oral conditions, not only to minimize the negative effects of oral conditions on other symptoms in long-term care facilities, but also to share philanthropic support with people who might be suffering other symptoms due to oral conditions at the end of life.
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Affiliation(s)
- Joohyun Chung
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Xi Chen
- University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Ning Zhang
- Northeastern University, Boston, Massachusetts, USA
| | - Yanhua Zhou
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Kontogiannopoulos KN, Kapourani A, Gkougkourelas I, Anagnostaki ME, Tsalikis L, Assimopoulou AN, Barmpalexis P. A Review of the Role of Natural Products as Treatment Approaches for Xerostomia. Pharmaceuticals (Basel) 2023; 16:1136. [PMID: 37631049 PMCID: PMC10458472 DOI: 10.3390/ph16081136] [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: 06/16/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Xerostomia, commonly known as dry mouth, is a widespread oral health malfunction characterized by decreased salivary flow. This condition results in discomfort, impaired speech and mastication, dysphagia, heightened susceptibility to oral infections, and ultimately, a diminished oral health-related quality of life. The etiology of xerostomia is multifaceted, with primary causes encompassing the use of xerostomic medications, radiation therapy to the head and neck, and systemic diseases such as Sjögren's syndrome. Consequently, there is a growing interest in devising management strategies to address this oral health issue, which presents significant challenges due to the intricate nature of saliva. Historically, natural products have served medicinal purposes, and in contemporary pharmaceutical research and development, they continue to play a crucial role, including the treatment of xerostomia. In this context, the present review aims to provide an overview of the current state of knowledge regarding natural compounds and extracts for xerostomia treatment, paving the way for developing novel therapeutic strategies for this common oral health issue.
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Affiliation(s)
- Konstantinos N. Kontogiannopoulos
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (I.G.); (M.-E.A.); (P.B.)
| | - Afroditi Kapourani
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (I.G.); (M.-E.A.); (P.B.)
| | - Ioannis Gkougkourelas
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (I.G.); (M.-E.A.); (P.B.)
| | - Maria-Emmanouela Anagnostaki
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (I.G.); (M.-E.A.); (P.B.)
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Andreana N. Assimopoulou
- Laboratory of Organic Chemistry, School of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Natural Products Research Centre of Excellence-AUTH (NatPro-AUTH), Center for Interdisciplinary Research and Innovation (CIRI-AUTH), 57001 Thessaloniki, Greece
| | - Panagiotis Barmpalexis
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (I.G.); (M.-E.A.); (P.B.)
- Natural Products Research Centre of Excellence-AUTH (NatPro-AUTH), Center for Interdisciplinary Research and Innovation (CIRI-AUTH), 57001 Thessaloniki, Greece
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
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.
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Motamed B, Alaee A, Azizi A, Jahandar H, Fard MJK, Jafari A. Comparison of the 1 and 2% pilocarpine mouthwash in a xerostomic population: a randomized clinical trial. BMC Oral Health 2022; 22:548. [PMID: 36457091 PMCID: PMC9713117 DOI: 10.1186/s12903-022-02576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS & BACKGROUND Pilocarpine is an accepted treatment for xerostomia, but limited research has been conducted on the oral, topical form. The present study aimed to compare the effects of 1 and 2% pilocarpine mouthwash on xerostomic participants. METHODS In this double-blind clinical trial study, 48 subjects with xerostomia were randomly divided into three groups to measure the effects of 1 and 2% pilocarpine and placebo mouthwashes on saliva levels. The amount of saliva in the 1st and 14th days was measured at 0, 45, 60, and 75 mins, while participants used their mouthwash three times a day for 14 days. On the 1st and 14th days, they filled out the information forms on xerostomia and the medicine's side effects before and after the intervention. RESULTS On the 1st day, the mean salivary flow at 45, 60, and 75 mins in the 2 and 1% pilocarpine mouthwash were significantly higher than in the placebo mouthwash group (p < 0.05). On the 14th day, the mean salivary flow time at 45 mins in the 2% pilocarpine mouthwash group was significantly higher than in the placebo mouthwash group (p = 0.007). Furthermore, the mean salivary flow at 60 and 75 mins in the 2% (p < 0.001) and 1% pilocarpine mouthwash (p = 0.028) was significantly higher than in the placebo group. Moreover, the salivary flow in the 2% pilocarpine mouthwash group was significantly higher than the 1% pilocarpine mouthwash (p < 0.05) during these two times. No side effects were observed in any of the subjects. CONCLUSIONS The study showed that 5 ml of 2 and 1% pilocarpine mouthwash for 2 weeks increased salivary flow in xerostomic participants compared to placebo without any side effects.
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Affiliation(s)
- Babak Motamed
- grid.411463.50000 0001 0706 2472Member of Dental Materials Research Center, School of Dentistry, Islamic Azad University - Tehran Medical Branch, Tehran, Iran
| | - Arezoo Alaee
- grid.411463.50000 0001 0706 2472Department of Oral Medicine, Member of the dental material research center, School of Dentistry, Islamic Azad University - Tehran Medical Branch, No.9, Neyestan 9, Pasdaran St., Tehran, Iran
| | - Arash Azizi
- grid.472338.90000 0004 0494 3030Department of Oral Medicine, School of Dentistry, Islamic Azad University Tehran Medical Branch, Tehran, Iran
| | - Hoda Jahandar
- grid.411463.50000 0001 0706 2472Pharmaceutical Sciences Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammad Javad Kharazi Fard
- grid.411705.60000 0001 0166 0922Epidemiologist, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Jafari
- grid.411463.50000 0001 0706 2472Member of Dental Materials Research Center, School of Dentistry, Islamic Azad University - Tehran Medical Branch, Tehran, Iran
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Margalit DN, Salz T, Venchiarutti R, Milley K, McNamara M, Chima S, Wong J, Druce P, Nekhlyudov L. Interventions for head and neck cancer survivors: Systematic review. Head Neck 2022; 44:2579-2599. [PMID: 35848095 PMCID: PMC9796901 DOI: 10.1002/hed.27142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions for head/neck cancer (HNC) survivors may not address their cancer-related and general health needs. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided this systematic review of studies from 2000 to 2021 of interventions targeting cancer survivors treated with curative-intent, using MEDLINE, Embase, Emcare, and PsycINFO. Interventions were categorized into domains of the Quality of Cancer Survivorship Care Framework to characterize the scope and quality of interventions. RESULTS We identified 28 studies for inclusion: 13 randomized and 15 non-randomized. Most targeted surveillance/management of physical effects (n = 24) including 13 that also targeted psychosocial effects. Four studies addressed prevention/surveillance for recurrence/new cancers, one addressed health promotion/disease prevention, and one addressed chronic medical conditions. Most studies (n = 27) had medium-high risk of bias. CONCLUSIONS There are few high-quality studies addressing HNC survivorship. Future rigorously designed studies should address broader areas of care, including chronic disease management and health promotion/disease prevention.
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Affiliation(s)
- Danielle N. Margalit
- Department of Radiation Oncology, Head and Neck Oncology ProgramDana‐Farber Cancer Institute/Brigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Talya Salz
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,School of Public Health, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Mairead McNamara
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Department of Cancer Imaging, Peter MacCallum Cancer CentreMelbourneVICAustralia
| | - Sophie Chima
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Jamieson Wong
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Larissa Nekhlyudov
- Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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A Review on the Role of Pilocarpine on the Management of Xerostomia and the Importance of the Topical Administration Systems Development. Pharmaceuticals (Basel) 2022; 15:ph15060762. [PMID: 35745681 PMCID: PMC9230966 DOI: 10.3390/ph15060762] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Xerostomia is linked to an increased risk of dental caries, oral fungal infections, and speaking/swallowing difficulties, factors that may significantly degrade patients’ life, socially- or emotionally-wise. Consequently, there is an increasing interest in developing management approaches for confronting this oral condition, at which pilocarpine, a parasympathomimetic agent, plays a vital role. Although the therapeutic effects of orally administrated pilocarpine on the salivary gland flow and the symptoms of xerostomia have been proved by numerous studies, the systemic administration of this drug is affiliated with various adverse effects. Some of the typical adverse effects include sweating, nausea, vomiting, diarrhea, rhinitis, dizziness and increased urinary frequency. In this vein, new strategies to develop novel and effective dosage forms for topical (i.e., in the oral cavity) pilocarpine administration, in order for the salivary flow to be enhanced with minimal systemic manifestations, have emerged. Therefore, the purpose of the current review is to survey the literature concerning the performance of topical pilocarpine delivery systems. According to the findings, the topical delivery of pilocarpine can be regarded as the equivalent to systemic delivery of the drug, efficacy-wise, but with improved patient tolerance and less adverse effects.
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Sarideechaigul W, Priprem A, Limsitthichaikoon S, Phothipakdee P, Chaijit R, Jorns TP, Lungruammit N, Chaiya K. Efficacy and safety of two artificial saliva-based polymers containing 0.1% pilocarpine for treatment of xerostomia: A randomized clinical pilot trial. J Clin Exp Dent 2021; 13:e994-e1000. [PMID: 34667494 PMCID: PMC8501859 DOI: 10.4317/jced.58415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Topical agents are the mainstay in the treatment of xerostomia, a common complaint most frequently associated with salivary dysfunction. This study aimed to compared the efficacy and safety for xerostomia treatment of 2 artificial saliva preparations containing 0.1% pilocarpine, and, either sodium carboxymethylcellulose (SCMC), or, sodium polyacrylate (SPA).
Material and Methods Thirty-one xerostomia patients were randomly allocated into either a SCMC-treated group (15 patients), or, a SPA-treated group (16 patients). The formulations were taken 0.5 ml, 4 times daily for 6 weeks and double-blinded assessed before and after treatments using Xerostomia Inventory (XI) and Clinical Oral Dryness Score (CODs). Unstimulated and stimulated whole salivary flow rates were measured.
Results After treatment, the SCMC-treated group had significantly lower CODs and higher unstimulated and stimulated whole salivary flow rates (p<0.001, p=0.035, and p=0.013, respectively), while the SPA-treated group showed significantly lower CODs only (p=0.004). In contrast, SCMC-treated and SPA-treated groups at the 6th week after treatments showed non-significant differences in all assessments (p>0.05, all). Some adverse events (AEs) were reported, e.g., burning tongue, dizziness and watery eyes, but no severe AEs.
Conclusions This randomized controlled pilot trial demonstrated superior efficacy of SCMC-formula over a SPA-formula after 6 weeks of xerostomia treatment. These formulations with topical pilocarpine proved safe in clinical use with minimal reported AE. Key words:Xerostomia, artificial saliva, sodium carboxymethylcellulose, sodium polyacrylate, pilocarpine.
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Affiliation(s)
- Wilairat Sarideechaigul
- Department of Oral Biomedical Science, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002, Thailand.,Neuroscience Research and Development Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Aroonsri Priprem
- Faculty of Pharmacy, Mahasarakham University, Mahasarakham 44150, Thailand.,Melatonin Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sucharat Limsitthichaikoon
- Department of Pharmaceutical Technology, College of Pharmacy, Rangsit University, Pathum Thani 12000, Thailand
| | - Pensri Phothipakdee
- Department of Oral Biomedical Science, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Rajda Chaijit
- Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Teekayu P Jorns
- Department of Oral Biomedical Science, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002, Thailand.,Neuroscience Research and Development Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | | | - Krittiporn Chaiya
- Dental Student, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002, Thailand
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