A method for measuring the flow of saliva from the minor salivary glands

A novel diagnostic technique of measuring labial minor salivary gland secretions using sodium fluorescein dye: Implications for patients with dry eyes

Purpose: To evaluate the lower labial minor salivary glands (MSGs) flow rate using fluorescein dye in healthy individuals and patients with Sjögren's syndrome (SS) and Stevens-Johnson syndrome (SJS).Methods: Thirty consecutive patients with SS (N = 15; mean age 35.7 years) and SJS (N = 15; 57.7 years), and their age- and sex-matched healthy controls (N = 40; mean ocular surface disease index (OSDI) = 6.1) had ocular examination and whole lower labial mucosa evaluation after ophthalmic fluorescein strip application under cobalt blue light. Analyzed parameters include average labial distribution of functional MSGs, their secretory flow rate, and comparison between healthy and diseased groups.Results: The mean salivary flow rate from the lower labial MSGs of normal individuals showed decade-wise decline (2.7 ± 0.29 μl/min, 2.6 ± 0.39 μl/min, 2.3 ± 0.6 μl/min, 1.9 ± 0.95 μl/min) with similar trend for the number of secreting MSG openings (38.7, 37.2, 30, 22). The mean OSDI score was 45.3 in SJS and 28.2 in SS group. Thirty eyes in each SS and SJS group had mean Schirmer I value of 1.5 ± 2.2 mm and 5.1 ± 4.4 mm. The mean lower labial salivary flow rate in SS group was 0.5 ± 0.28 μl/min, and 2.0 ± 0.95 μl/min in SJS group. When compared to normal, SS patients had a significant reduction in the flow rate (p < .00001); however, it was not significant for the SJS group (p = .28). The mean number of secreting MSG openings was reduced in both the groups compared to normal (SJS, 20.5; p = .01 and SS, 12; p < .0001). There was a significant difference between SS and SJS groups in terms of flow rate (p < .00001) and number of MSG openings (p = .001). The MSG flow rate and Schirmer values did not show any correlation in SS or SJS patients.Conclusion: The fluorescein-assisted evaluation of the lower lip can be used as a quantitative method for measuring the labial salivary flow rate in SS and SJS patients.

Candida Infection Associated with Salivary Gland-A Narrative Review

Candida species are common global opportunistic pathogens that could repeatedly and chronically cause oral mucosa infection and create an inflammatory environment, leading to organ dysfunction. Oral Candida infections may cause temporary or permanent damage to salivary glands, resulting in the destruction of acinar cells and the formation of scar tissue. Restricted function of the salivary glands leads to discomfort and diseases of the oral mucosa, such as dry mouth and associated infection. This narrative review attempts to summarize the anatomy and function of salivary glands, the associations between Candida and saliva, the effects of Candida infection on salivary glands, and the treatment strategies. Overall, clinicians should proactively manage Candida infections by educating patients on oral hygiene management for vulnerable populations, conducting frequent checks for a timely diagnosis, and providing an effective treatment plan.

Expression of aquaporin 5 during murine palatine glands development: a light and electron microscopic immunocytochemical study

Although aquaporin 5 (AQP5) seems to play a role in cytodifferentiation and cell proliferation during the development of salivary glands, its distribution during minor salivary glands development has been scarcely reported. This study examined the temporal-spatial distribution of AQP5 in the developing rat palatine glands using light and electron microscopy. At embryonic (E) age E18, AQP5 labeling was observed on the cell membranes of some terminal bulb cells. After lumenization at E20, AQP5 labeled the apical membrane in acini where a lumen existed, in addition to displaying positive diffuse cytoplasmic and cell membrane staining. At the electron microscopic level, AQP5 labeled the supranuclear cytoplasm and the luminal microvilli along the apical membrane. At birth, AQP5 was also localized to the lateral membranes associated ultrastructurally with the microvilli of intercellular canaliculi. After postnatal (PN) day PN7, mucous acini and serous demilunes showed reactivity. AQP5 reached peak reactivity around PN13 with a similar staining pattern in all acini, but had reduced dramatically by PN21. Thereafter, AQP5 reactivity was mainly associated with serous cells in adults. In conclusion, the transitory expression of AQP5 during palatine glands development may reflect changing physiological functions of the secretory cells and/or AQP5 throughout the maturation of the glands.

Potentiometric Solid-Contact Ion-Selective Electrode for Determination of Thiocyanate in Human Saliva

A new solid-contact potentiometric ion-selective electrode for the determination of SCN- (SCN-ISE) has been described. Synthesized phosphonium derivative of calix[4]arene was used as a charged ionophore. The research included selection of the ion-selective membrane composition, determination of the ISEs metrological parameters and SCN-ISE application for thiocyanate determination in human saliva. Preparation of the ISEs included selection of a plasticizer for the ion-selective membrane composition and type of the electrode material. The study was carried out using ISE with liquid internal electrolyte (LE-ISE) and solid-contact electrodes made of glassy carbon (GC-ISE) and gold rods (Au-ISE). The best parameters were found for GC sensors for which the ion-selective membrane contained chloroparaffin as a plasticizer (S = 59.9 mV/dec, LOD = 1.6 ´ 10-6 M). The study of potentiometric selectivity coefficients has shown that the thiocyanate-selective sensor could be applied in biomedical research for determination of SCN- concentration in human saliva. The accuracy of the SCN- determination was verified by testing 59 samples of volunteers' saliva by potentiometric sensors and UV-Vis spectrophotometry as a reference technique. Moreover, SCN- concentrations in the smokers' and non-smokers' saliva were compared. In order to investigate the influence of various factors (sex, health status, taken medications) on the thiocyanate level in the saliva, more extensive studies on a group of 100 volunteers were carried out. Additionally, for a group of 18 volunteers, individual profiles of SCN- concentration in saliva measured on a daily basis for over a month were collected.

A clinical study to compare between resting and stimulated whole salivary flow rate and pH before and after complete denture placement in different age groups

PURPOSE

This study compared the flow rate and pH of resting (unstimulated) and stimulated whole saliva before and after complete denture placement in different age groups.

MATERIALS AND METHODS

Fifty healthy, non-medicated edentulous individuals of different age groups requiring complete denture prostheses were selected from the outpatient department. The resting (unstimulated) and stimulated whole saliva and pH were measured at three stages i.e., i)Before complete denture placement;ii)Immediately after complete denture placement; andiii)After 2 to 3 months of complete denture placement. Saliva production was stimulated by chewing paraffin wax. pH was determined by using a digital pH meter.

RESULTS

Statistically significant differences were seen in resting(unstimulated) and stimulated whole salivary flow rate and pH obtained before, immediately after, and after 2 to 3 months of complete denture placement. No statistically significant differences were found between the different age groups in resting (unstimulated) as well as stimulated whole salivary flow rate and pH.

CONCLUSION

Stimulated whole salivary flow rates and pH were significantly higher than resting (unstimulated) whole salivary flow rates and pH obtained before, immediately after, and after 2 to 3 months of complete denture placement. No age related variations in whole salivary flow rate and pH were observed in healthy, non-medicated individuals.

CLINICAL IMPLICATIONS

The assessment of salivary flow rate, pH in different age groups is of prognostic value, which is an important aspect to be considered in the practice of removable prosthodontics.

Sialometry of upper labial minor glands: a clinical approach by the use of weighing method Schirmer's test strips paper

Objectives. To establish referential values ranges of hyposalivation and normosalivation for the salivary flow rate (SFR) of upper labial (LS) and palatal (PS) mucosa using Schirmer's test strips paper and as a second goal to determine the values ranges of the SFR of palatal (PS) and upper labial (LS) mucosa in subjects with and without xerostomia. Methods. A cross-sectional study was conducted among subjects distributed in three groups according to their unstimulated and stimulated whole saliva. Results. 144 subjects were enrolled in groups as follows: severe hyposalivation (n = 24), mild hyposalivation (n = 78), and normosalivation (n = 42). The mean and the 95% confidence interval for the LS flow rate (μL/cm²/min) were 3.2 (2.46 to 3.94), 5.86 (4.96 to 6.75), and 9.08 (7.63 to 10.53) (P < 0.001) for each group, respectively. The PS results were 1.01 (0.68 to 1.34), 1.72 (1.31 to 2.13), and 2.44 (1.66 to 3.22) (P = 0.014). Xerostomia complainers presented lower rates of LS (5.17 (4.06 to 6.23)) than non-complainers (7.33 (6.4 to 8.27)) (P = 0.003). Conclusions. The test was reliable to provide referential values ranges for LS flow rate measurement and was shown to be valid to distinguish normosalivation from severe and mild hyposalivation and also to predict xerostomia.

Minor salivary glands and dental caries: Approach towards a new horizon

Introduction:

Reduction of functioning minor salivary glands may contribute to emergence of mucosal infections, mucosal ulceration, and possibly dental caries. A study was, therefore, designed to understand the exact role of minor salivary gland secretions over dental caries.

Methodology:

We studied the average labial distribution of functional minor salivary glands using various pre-defined locations, counted the minor salivary gland secretion imprints, and correlated the decayed missing filledlevels in subjects. The functional level and amount of secretion of minor salivary gland were evaluated. The radial immunodiffusion was performed by Diffu-Plate kit and the dimensions of the ring were correlated with the amount of immunoglobulin A in saliva.

Results:

The mean number of functional labial minor salivary glands, amount of secretion, level of glycoprotein secretion, and immunoglobulin A secretion levels could very well dictate the functional status and role of minor salivary glands over caries assessment.

Conclusion:

The above-mentioned tests could be of major significance in routine diagnosis of the most common oral disease, i.e., dental caries.

Investigating the relationship between hyposalivation and mucosal wetness

BACKGROUND

Mucosal wetness (MW) reflects the layer of residual saliva that covers the oral mucosal surfaces.

OBJECTIVES

The aim of this study was to determine MW at different oral mucosa sites and to investigate the relationship between MW, unstimulated whole salivary flow rates (UWS) and Clinical Oral Dryness Score (CODS).

METHOD

A total of 100 dry mouth patients and 50 healthy subjects participated in the study. MW was sampled with filter paper strips at four sites inside the mouth; anterior hard palate (AHP), buccal mucosa (BUC), anterior tongue (AT), lower lip (LL) and measured with a micro-moisture meter. Reproducibility was assessed by repeated sampling and diurnal variation was examined.

RESULTS

Mucosal wetness in healthy subjects differed according to site and means±SD were; AHP (11± 11.7μm), BUC (32±14.8μm), AT (65±17.2μm), and LL (25 ±13.5μm). Dry mouth patients with reduced UWS showed increased CODS. MW at all four sites was significantly reduced (P<0.05) in dry mouth patients compared with the healthy subjects. Reproducibility of MW measurement using the intra-class correlation coefficient showed agreement at different visits within subject. MW of the AT showed a positive correlation with UWS (P<0.05).

CONCLUSION

Mucosal wetness is a reliable measure of oral dryness and had a positive correlation with UWS.

An update on minor salivary gland secretions

In this article, the literature on minor salivary gland secretion rates, composition, and function is reviewed. Measurements of the minor salivary gland secretion rates and composition are complicated, and the secretions display large biological variability. Despite this, some characteristics of these secretions have been found repeatedly in independent investigations. Minor gland saliva varies between different oral sites. Buccal saliva flow is higher than labial saliva flow, which in turn is usually higher than the palatal gland secretion rate. It is generally agreed that minor gland saliva is important for the whole saliva composition, and especially for the secretory immunoglobulin A and mucins. The secretion from these glands seems also important for subjective feelings of dry mouth and general wellbeing. Further research is essential for understanding the role of these secretions for oral, as well as for general, health.

Upper airway surface tension but not upper airway collapsibility is elevated in primary Sjögren's syndrome

STUDY OBJECTIVES

Primary Sjögren's syndrome is an autoimmune disease typified by xerostomia (dry mouth) that, in turn, could lead to increased saliva surface tension (gamma) and increased upper airway collapsibility. Fatigue, of unknown etiology, is also frequently reported by patients with primary Sjögren's syndrome. Recent preliminary data indicate a high prevalence of obstructive sleep apnea in healthy-weight women with primary Sjögren's syndrome. Concurrent research highlights a significant role of gamma in the maintenance of upper airway patency. The aim of this study was to compare oral mucosal wetness, saliva gamma, and upper airway collapsibility during wake and sleep between women with primary Sjögren's syndrome and matched control subjects.

SETTING

Participants slept in a sound-insulated room with physiologic measurements controlled from an adjacent room.

PARTICIPANTS

Eleven women with primary Sjögren's syndrome and 8 age- and body mass index-matched control women.

INTERVENTIONS

Upper airway collapsibility index (minimum choanal-epiglottic pressure expressed as a percentage of delivered choanal pressure) was determined from brief negative-pressure pulses delivered to the upper airway during early inspiration in wakefulness and sleep.

MEASUREMENTS AND RESULTS

Patients with primary Sjögren's syndrome had significantly higher saliva gamma ("pull-off" force method) compared with control subjects (67.2 +/- 1.1 mN/m versus 63.2 +/- 1.7 mN/m, P < 0.05). Upper airway collapsibility index significantly increased from wake to sleep (Stage 2 and slow wave sleep) but was not different between groups during wake (primary Sjögren's syndrome versus controls; 36.3% +/- 8.0% vs 46.0 +/- 13.8%), stage 2 sleep (53.1% +/- 11.9% vs 63.4% +/- 7.2%), or slow-wave sleep (60.8% +/- 12.2% vs 60.5% +/- 9.3%).

CONCLUSIONS

Despite having a significantly "stickier" upper airway, patients with primary Sjögren's syndrome do not appear to have abnormal upper airway collapsibility, at least as determined from upper airway collapsibility index.

Oral manifestations of Sjögren's syndrome

Sjögren's syndrome is a common autoimmune rheumatic disease. The most common symptoms of Sjögren's syndrome are extreme tiredness, along with dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Saliva plays an essential role in numerous functions of the mouth. Xerostomia can be caused by medications, chronic diseases like Sjögren's syndrome, and medical treatments, such as radiation therapy and bone marrow transplant. Xerostomia can eventually lead to difficulty in swallowing, severe and progressive tooth decay, or oral infections. Despite having excellent oral hygiene, individuals with Sjögren's syndrome have elevated levels of dental caries, along with the loss of many teeth, early in the disease. Sjögren's syndrome alters the protein profile and brings about a change in the composition of saliva. There is an increase in the levels of lactoferrin, beta(2)-microglobulin, sodium, lysozyme C, and cystatin C, and a decrease in salivary amylase and carbonic anhydrase. Up to 90% of individuals with Sjögren's syndrome have antibodies targeting the Ro 60 and La autoantigens. Natural aging, regardless of Sjögren's syndrome, is also another factor that brings about a significant change in the composition of saliva. The most prevailing cause of xerostomia in elderly persons is the use of anticholinergic medications. Currently, there is no cure for Sjögren's syndrome, and treatment is mainly palliative.

Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren's syndrome

OBJECTIVE

The purpose of this study was to describe the oral properties of Sjögren's syndrome (SS), including the determination of palatal saliva (PS) flow rate.

SUBJECTS AND METHODS

Forty-nine SS patients and 43 healthy controls participated. Subjective symptoms were recorded and clinical assessments of the oral mucosal, dental and periodontal status were made. Unstimulated whole saliva (WS) and PS flow rates, the number of decayed, missing and filled teeth (DMF-T number), the gingival bleeding index (GBI) and the periodontal probing depth (PPD) were determined.

RESULTS

Despite the decrease in the flow rate of WS in SS patients, PS was not different from those of the controls (1.57 +/- 1.02 and 1.35 +/- 2.5 microl cm(-2) min(-1), respectively). GBI (20.0% vs. 10.5%, respectively), DMF-T (27.1 +/- 6.12 vs. 23.0 +/- 6.99, respectively) and PPD (2.28 +/- 1.09 mm vs. 1.82 +/- 0.73 mm, respectively) were higher in SS compared with the controls (P < 0.05). DMF-T and PPD showed a positive correlation with anti-SSA and/or anti-SSB antibody positivity in the serum (P < 0.05).

CONCLUSIONS

Data of the present study suggest that the subjective feeling of xerostomia in SS patients is the result of a decrease in the volume of the whole saliva, and not of the viscous PS. Correlation of DMF-T and PPD with autoantibody positivity reveals that the oral health status of SS patients may be associated with the general autoimmune process.

A simple test for salivary gland hypofunction using Oral Schirmer's test

OBJECTIVE

The objective of this study was to develop a test for detecting salivary gland hypofunction.

STUDY DESIGN

Oral Schirmer's test was performed by placing a strip of filter paper on the floor of the mouth and measuring the wetted length after 5 min. The control group consisted of 70 healthy patients, while another group consisted of 61 patients with Sjögren's Syndrome (SS) and a third group of 31 patients who suffered from xerostomia caused by other pathologies.

RESULTS

The mean saliva flow was 40.92 +/- 22.28 mm/5 min in the control group, 27.25 +/- 24.11 mm/5 min in patients with SS and 36.847 +/- 23.4 mm/5 min in the third group. The differences between the control group and the other two groups were statistically different (P > 0.001).

CONCLUSIONS

The whole saliva test was used to distinguish between healthy adults and subjects with hyposalivation.

Issues in the epidemiological investigation of dry mouth

Despite decades of research, much remains unanswered about the epidemiology of dry mouth. This review aims to provide an overview of the condition's epidemiology and the issues to consider when planning an epidemiological study of dry mouth. The latter can be broadly grouped into: study design; sampling and statistical power considerations; the measurement of dry mouth; and the selection, nature and measurement of relevant exposure measures, including medications and potential confounding variables. Each of these is discussed, in order to provide guidance for prospective researchers based on experience with past research. Finally, an agenda for further epidemiological research into dry mouth is proposed.

Using the modified Schirmer test to measure mouth dryness: a preliminary study

BACKGROUND

Current methods of measuring saliva volume often are difficult to perform in a general dental or medical office setting. This study seeks to determine whether the Schirmer test for measuring eye dryness can be modified to measure mouth dryness.

METHODS

The authors performed a modified Schirmer test (MST) on a control group composed of 41 healthy adult volunteers and a study group composed of 10 patients who had received head and neck radiation and 10 patients who had oral chronic graft-versus-host disease (CGVHD). The authors placed the strip on the floor of each subject's mouth and took readings at one minute, two minutes and three minutes. Fourteen control subjects also spat into a container over a five-minute interval, and the authors weighed the collected saliva.

RESULTS

The mean reading for the control subjects at three minutes was 29.5 millimeters, while the mean reading for the test subjects was 6.9 mm (P < .00005).

CONCLUSIONS

The results of the MST were able to distinguish between healthy adult volunteers and subjects who experienced profound xerostomia and hyposalivation.

CLINICAL IMPLICATIONS

The MST as used in this preliminary study is an objective, inexpensive, easy-to-perform and well-tolerated test for measuring mouth dryness. It readily distinguishes between patients who are healthy and asymptomatic and those who experienced profound xerostomia and hyposalivation.

Minor gland saliva flow rate and proteins in subjects with hyposalivation due to Sjögren's syndrome and radiation therapy

In this study, the secretion rate and IgA, albumin and lactoferrin concentrations in minor labial and buccal gland saliva were investigated in individuals with hyposalivation due to primary Sjogren's syndrome (pSS; 10 subjects) or head and neck radiation therapy (RT; 10 subjects) and in their matched controls. Whole saliva was similarly examined. The minor gland saliva flow was measured using the Periotron method. IgA, albumin and lactoferrin concentrations were analysed by ELISA techniques. A general finding was that the flow rate and protein concentrations were lower in labial than in buccal gland saliva. In both hyposalivation groups, the labial minor gland saliva secretion rate was lowered compared to their respective controls. The buccal gland saliva flow rate was significantly reduced in the RT group only. IgA and albumin concentrations were not different from the controls in the labial secretions. The concentration of lactoferrin was increased in the RT group. In buccal saliva, the concentrations of all proteins examined but pSS IgA, were increased compared to the controls. Reduced flow rate and increased protein concentrations were seen for whole saliva where the lactoferrin concentration was higher in RT than in pSS subjects. Thus, our findings suggested that minor gland saliva flow rate and protein concentrations are affected in RT and pSS subjects and to highest extent in the former.

A simple, yet accurate method for detecting and quantifying secretions from human minor salivary glands using the iodine-starch reaction

The lack of published information about the minor salivary glands is due in part to the difficulties experienced in collecting and quantifying their secretions. In fact, no method exists for measuring their secretions that is both simple and accurate. This investigation examined the accuracy of our newly developed method (which simply employs the iodine-starch reaction) in 10 healthy non-medicated adults. A strip painted with a solution of iodine in absolute alcohol then with a fine starch powder mixed with castor oil was placed at a designated location on the lower-lip mucosa for 2 min to collect saliva. Black-stained spots of various sizes corresponding to the individual glands could be accurately visualized. After removal of the strip, the total stained area (mm2) was calculated by digitizing the spot areas using a computer system. The correlation coefficient (r) between known volumes of saliva and stain size was 0.995, indicating a close correlation. The correlation coefficient (r) between area values obtained in the first trial in each subject (Y) and the second (X; 10 min later) was 0.963, and the simple regression equation was close to Y=X, indicating good reproducibility. The mean flow rate microl/cm2 per min) obtained by converting mean total area to volume and thence to flow rate was 0.49+/-0.26, in good agreement with published values obtained by others. These results suggest that our newly developed method allows both the distribution and secretion rate of the minor salivary glands to be observed, and that it should be of practical value due to its simplicity, accuracy, and reproducibility.

Minor gland and whole saliva in postmenopausal women using a low potency oestrogen (oestriol)

Many women undergo hormone replacement therapy in order to relieve menopausal and postmenopausal symptoms. Oral discomfort is common among these symptoms and studies have shown that the stimulated whole saliva flow rate is increased after combined oestradiol and progesterone replacement therapy. There is, however, no data regarding the effect of other oestrogens or of oestrogen alone on whole and minor gland saliva. In the present study, the flow rate from minor salivary glands (buccal, labial and palatal) and the secretion rate and buffer capacity of whole saliva was examined in 18 postmenopausal women (61-76 years) prior to, and during 1 year of a low potency oestrogen (oestriol) use. The ability of whole saliva to aggregate and mediate bacterial adherence as well as subjective feelings of dry mouth was also examined. For comparison, the same variables were examined in nine peri- and postmenopausal, non-medicated women (reference group, 53-61 years). During hormone treatment, the labial saliva flow was significantly increased and the complaints of dry mouth reduced. Increased stimulated whole saliva flow was seen in both the hormone and reference groups. This was also true for the stimulated whole saliva buffer capacity, which was increased parallel to the flow rate. The secretion rates were generally lower in the hormone group compared to the reference group throughout the study period. Except for stimulated whole saliva, statistical analysis at baseline revealed no age-related reduction of the saliva flow rates. The ability of whole saliva to mediate aggregation of Actinomyces naeslundii was significantly decreased after hormone treatment. Thus, the present findings indicate that a low dose oestrogen (oestriol) may affect the flow rate of labial salivary glands and the bacterial aggregation activity of whole saliva.

Minor salivary gland secretion in children and adults

The minor salivary glands are of great importance in the physiology and pathology of the oral cavity. So far, studies of the minor glands have concentrated on adults. In the present study, minor salivary gland secretion was studied in the buccal and labial mucosa of 3-year-old children, adolescents and young adults. In addition, the number of glands per surface area was assessed in the labial mucosa. A total of 90 individuals were included, 30 in each age-group. Saliva was collected on filter paper discs and the salivary secretion rate was measured using a Periotron 8000. The number of secreting labial glands was assessed on PAS-stained filter paper discs under a microscope. Salivary secretion in the buccal mucosa was found to be age-related, with a statistically significant lower rate of secretion (P=0.003) in the 3-year-olds (mean 7.7 microl x cm(-2) x min(-1)) compared with the young adults (11.9 microl x cm(-2) x min(-1)). No significant differences between the sexes were noted. For the labial glands, no age- or sex-related differences were found. In all age-groups, salivary secretion was significantly higher in the buccal than in the labial mucosal area. A statistically significant difference in number of secreting glands was found between all age-groups, with a decreasing number of glands per surface unit with age. The number of glands was significantly lower in males compared with females in the group of adults. The lower rate of buccal salivary secretion in the young children may imply that the oral mucosa is more vulnerable to external injury and that caries protection on the buccal molar surfaces is lower. Previous studies indicate that adults with a reduced rate of minor salivary gland secretion are more susceptible to caries.

Fine structure of the 7 postnatal days Calomys callosus palatine salivary glands

The aim of this study has been to determine the ultrastructural characteristics of the minor palatine salivary glands on the seventh day of development and to demonstrate wether their secretion is mucous, serous or seromucous by light, transmission and scanning electron microscopy. This study has shown that the palatine gland acinar cells are predominantly mucous with some serous units. These cells contain electron dense (serous) and low electron dense (mucous) granules in the apical portions. The cytoplasmatic organelles like mitochondria, Golgi apparatus and rough endoplasmic reticulum are localized in a supranuclear portion. We could also observe the flattened myoepithelial cells surrounding the basal part of the acini with myofilaments, Golgi apparatus and mitochondria. Desmosomal junctions and membrane interdigitations are present between the acinar and the myoepithelial cells. A basal lamina, divided in two layers, an electron dense and an electron lucent is present between the glandular stroma which is composed of dense connective tissue and the endpieces.

Nizatidine and cisapride enhance salivary secretion in humans

BACKGROUND

Salivation plays an important role in the defence of the oesophageal mucosa against gastric acidic reflux and can be evoked by cholinergic stimulation. Both nizatidine and cisapride have been reported to increase acetylcholine concentrations in the cholinergic system.

AIM

To investigate the effect of nizatidine and cisapride on salivary secretion, salivary epidermal growth factor and bicarbonate output.

METHODS

The salivary volume and concentration of salivary epidermal growth factor and bicarbonate were measured after the administration of nizatidine (150 mg), famotidine (20 mg) and cisapride (5 mg) in 30 male healthy volunteers.

RESULTS

Basal and stimulated salivary secretions were found to be increased after the administration of nizatidine and cisapride. In contrast, salivary secretion was not increased by famotidine. Although epidermal growth factor content was not augmented, nizatidine and cisapride administration also increased the bicarbonate output in mastication-stimulated saliva.

CONCLUSIONS

Increased salivary secretion and bicarbonate output induced by nizatidine may be useful for the treatment of patients with gastro-oesophageal reflux disease.

Analysis of residual saliva and minor salivary gland secretions

Residual saliva and minor salivary gland secretions are important for the maintenance of oral mucosal wetness. Salivary proteins and glycoproteins are the major components of the oral mucosal film, which functions as a moisture retainer and a protective barrier. Here, the correlations between the amounts of residual saliva and minor salivary gland secretions and their protein concentrations were investigated in 30 normal healthy individuals. The thickness of the mucosal film was measured at six mucosal surfaces and minor salivary gland secretion rate was measured at two mucosal surfaces. The thickness of residual saliva was determined by placing filter-paper strips against the mucosa at each site for 5 s and then measuring the volume electronically with a Periotron 8000 micro-moisture meter. The unstimulated rate of minor salivary gland secretion was measured for 30 s by the same method. Unstimulated whole salivary flow rate was measured with the spitting method. The total protein concentration of all salivary samples was measured by bicinchoninic acid assay. Before the experiment, the intra-/inter-examiner reliability of the method using the Periotron and the filter-paper strips was investigated. With a range of 0.4256-0.8846, the intraclass correlation coefficient, measured within and between examiners, was indicative of good reliability. The oral mucosal site with the thinnest coat of residual saliva was the anterior hard palate. Mucosal wetness on the hard palate and buccal mucosa showed significant positive correlations with the unstimulated whole salivary flow rate and significant negative correlations with the total protein concentration of residual saliva. Mucosal wetness on the upper and lower labial mucosa also showed significant negative correlations with the total protein concentration of residual saliva. Mucosal wetness on the soft palate was correlated with the minor salivary gland secretion rate (r=0.477, P<0.01). Among the minor salivary glands, the secretion rate of soft palate glands in females showed a significant correlation with the unstimulated whole salivary flow rate (r=0.563, P<0.05) and a significant negative correlation with its total protein concentration (r=-0.525, P<0.05). These data suggested that oral mucosal wetness and minor salivary gland secretions could be influenced by various factors differently according to mucosal sites.

A simple method to estimate the secretion of saliva from minor salivary glands using iodine-starch reaction

OBJECTIVE/HYPOTHESIS

This study was undertaken to detect the faculty of secretion of saliva from minor salivary glands by analyzing a color reaction on a test tape containing iodine and starch that was applied on the lower lip.

STUDY DESIGN

A study involving 63 patients with oral dryness, 7 patients with Sjogren syndrome, and 70 healthy individuals was performed.

METHODS

A test tape (1 x 1 cm) containing iodine and starch was set on the mucosal area anterior to the labia frenulum for 30 seconds. Because the number of blue spots was considered to correspond to the number of ostia of the salivary gland on the lower lip that was examined, the number of blue spots occurring as a reaction of iodine and starch on the test tape was counted and was compared among three groups. In addition, the relationship between the histopathological findings and the number of spots was analyzed.

RESULTS

The average number of spots in the patients with oral dryness (4.52+/-3.18 [mean +/- SD]) was lower than that in healthy individuals (9.49+/-2.52, P <.01), and that in the patients with Sjögren syndrome (2.14+/-1.35) was the lowest among all groups in the study. Moreover, this reduction in the number of spots in those patients was accompanied by histopathological changes of the minor salivary glands.

CONCLUSION

These findings suggest that this simple, noninvasive method can be successfully used for the estimation of the faculty of secretion of saliva from the minor salivary glands.

Significance of saliva for the denture-wearing population

This paper summarises a series of studies already published in German and presents new data related to the aetiology of the 'dry mouth' and its associated problems.

AIMS

To study factors affecting mucous and serous salivary gland secretion, the aetiology of the 'dry mouth' and its associated problems, causative factors for hyposalivation and it's treatment.

SETTING

Two university dental hospitals.

SUBJECTS

587 denture wearers and 521 control subjects, and autopsy material.

INTERVENTIONS

Exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion therapy, biopsy of the minor glands.

MAIN OUTCOME MEASURES

Palatal secretion (PAL, microL/cm2/min) and parotid salivary flow (PAR), subjective complaints and clinical findings.

RESULTS

Resting flow rates for PAL between 0 and 65 microliters/cm2/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL < or = 6.0 microliters/cm2 suffer from a 'dry mouth' and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, radiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion.

CONCLUSIONS

Variation in palatal salivary secretion occurs and is clinically important.

Minor salivary gland secretion in the elderly

OBJECTIVE

Very little information exists on minor salivary gland output (MSGO) in health and disease. We investigated the minor salivary gland output of elderly subjects with different medical backgrounds and the relationship of that output with life practices, demographic variables, complaints of dry mouth, medication usage, functional status, medical treatments, and dental and medical variables.

STUDY DESIGN

MSGO was measured with a special moisture-detecting paper on the lip, cheek, and palate, which comprised the total MSGO. A parsimonious linear regression model was developed to determine which of the many measured variables influenced the MSGO.

RESULTS

There were significant differences in MSGO between the recruitment sites, with the non-Veteran Affairs (VA) Independent Living participants having significantly lower MSGO than the VA groups. A secretion rate for MSGO based on median values from all subjects of <4.6 microL/min was categorized as being low, whereas a secretion rate for MSGO >/=4.6 microL/min was categorized as high. A regression model was used to examine variables that could be associated with MSGO variability. The results show that being older, a woman, a current smoker, and having a complaint of dry mouth were associated with lower MSGO rates.

CONCLUSIONS

An association between subjective complaints of dry mouth and a decrease in MSGO measured objectively was demonstrated in this elderly population. Furthermore, age and sex effects on MSGO were also demonstrated.

A preliminary study of CA15-3, c-erbB-2, epidermal growth factor receptor, cathepsin-D, and p53 in saliva among women with breast carcinoma

A panel of markers used to aid in the diagnosis and treatment of breast cancer was examined in the saliva of a cohort of healthy women, women with benign lesions of the breast, and women with diagnosed breast cancer. We found recognized tumor markers c-erbB-2 (erb), cancer antigen 15-3 (CA15-3), and tumor suppressor oncogene protein 53 (p53) in the saliva of all three groups of women. The levels of erb and CA15-3 in the cancer patients evaluated, however, were significantly higher than the salivary levels of healthy control subjects and benign tumor patients. Conversely, pantropic p53 levels were higher in control subjects compared with those women with breast cancer and those with benign tumors. Although cathepsin-D and epidermal growth factor receptor were detected, they did not demonstrate any clear correlation with disease status. The results of the pilot suggest that these markers have potential use in initial detection and/or follow-up screening for the detection of breast cancer in women.

Study of saliva secretion and the salivary fluoride concentration of the human minor labial glands by a new method

Unstimulated and stimulated flow rate from minor lower labial glands and the fluoride concentration of resting whole and labial saliva were measured over 15 min using a novel method avoiding eversion of the lips. Resting salivary flow rate was measured as 1.09+/-0.44 microl/min/cm2 and stimulated flow rate as 3.13+/-1.05 microl/min/cm2. Secretion rates were significantly (p<0.001) increased during periods of continuous speaking. The increase in secretion elicited by labial movements and speaking may result from mechanical stimulation and/or activity of myoepithelial cells. Fluoride concentrations in resting whole saliva and in unstimulated minor labial gland saliva were 0.066+/-0.048 and 0.181+/-0.073 parts/10(6), respectively. The secretory capacity of the minor labial glands and the high F concentration in their secretions suggests a significant contribution to the F content of whole saliva. Our non-invasive method permits collection from the minor labial glands of a volume large enough for chemical analysis. It should prove useful for studying the effects of different secretory stimuli.

The flow rate and composition of human labial gland saliva

Since the flow rate of saliva from human labial salivary glands has usually been measured as the secretion from an area of labial mucosa as 0.05-4.8 microl/cm2/min. The only data for single glands gives a comparable figure of 0.1 microl/min/gland. There is no consensus on the effects of gustatory stimulation, gender or ageing, although most reports suggest that flow rate is not related to gender and ageing up to age 60. The main differences in composition between labial gland saliva and that from the major glands are the higher and variable sodium concentration, the very low phosphate and hydrogen carbonate concentrations, and the higher protein concentration despite low concentrations of amylase. The concentrations of IgA and blood group substances are notably higher in labial gland saliva. In Sjogren's syndrome and cystic fibrosis flow rates are decreased. Low rates of flow have been associated with a higher incidence of dental caries.

The relationship between dental disease and cerebral vascular accident in elderly United States veterans

We report here information obtained from a cross-sectional study of 401 veterans, who were at least 60 years of age, which showed that several dental/oral conditions can be significantly associated with the diagnosis of a cerebral vascular accident (CVA), when included in a multivariate logistic regression model with and without many of the known risk factors for a CVA. The dental findings relative to the prevalence of dental caries and periodontal disease were not distinctly different between the subjects with and without a CVA in the bivariate analysis. A higher stimulated salivary flow was negatively associated with a CVA in the multivariate models. The plaque index and oral hygiene habits relating to brushing, flossing, and frequency of having teeth cleaned by a dentist/hygienist were significantly associated with a CVA in the bivariate analysis. Among these oral hygiene parameters, *needing help in brushing one's teeth" and the reported annual visit to the dentist/hygienist for teeth cleaning remained significant in the multivariate models involving the dependent-living subjects. The need for help in brushing one's teeth could reflect the fact that many subjects had reduced manual dexterity as a result of the CVA and required this extra care. However, the finding that those dependent-living individuals who reported that they did not have their teeth cleaned at least once a year were 4.76 times more likely to have had a CVA, suggests that a pattern of oral neglect might be associated with developing a CVA. The implications of this in terms of an intervention strategy for CVA warrants further consideration. However, caution is recommended because the data were obtained from a convenience sampling of older veterans and may not be generalizable to other populations.

Oral pilocarpine HCl stimulates labial (minor) salivary gland flow in patients with Sjögren's syndrome

Pilocarpine HCl has been shown to stimulate parotid and submandibular gland salivary flow. The purpose of this study was to determine whether this cholinergic-muscarinic drug also stimulates labial (minor) salivary gland (LSG) flow and to relate that with whole unstimulated salivary (WUS) flow rates. Subjects diagnosed with primary Sjögren's syndrome (SS-1; n = 9) or secondary Sjögren's syndrome (SS-2; n = 9) were enrolled in this study after meeting stringent enrollment criteria. An age-gender matched control group was also enrolled. The labial saliva was collected in a standardized manner on Periopaper for 5 min and the volume was analysed by the Periotron. Whole unstimulated salivary samples were collected for 5 min by the method of Mandel and Wotman (1976). Each subject was dosed with pilocarpine HCl (5 mg; tablets; p.o.). After 60 min the LSG flow as well as the WUS flow was determined again as previously. The results indicated a significant (> 180%) increase in both labial salivary gland flow as well as whole salivary flow in the SS-1 and SS-2 subjects (mean +/- s.e.m.): [SS-1: WUS = 0.1080 +/- 0.03 vs 0.2242 +/- 0.03 ml per 5 min; LSG = 93.1 +/- 22.2 vs 167.8 +/- 15.9 microliters/5 min; P < 0.001; SS-2: WUS = 0.1384 +/- 0.02 vs 0.2775 +/- 0.09 ml per 5 min; LSG = 97.7 +/- 20.2 vs 182.8 +/- 17.9 microliters per 5 min; P < 0.001]. These results indicate a significant increase in labial salivary gland flow as well as whole salivary flow as stimulated by pilocarpine HCl in Sjögren's syndrome patients.

Studies on human minor salivary gland secretions using the Periotron method

Secretions from minor salivary glands were estimated in 127 individuals by the Periotron method of measuring fluid output from different mucosal sites, and outputs were related to different variables. Large intra- and interindividual variations in secretions (expressed as microliter/cm2 per min) were observed, with means of 0.9 for the palatal, 4.8 for the labial and 16.0 for the buccal mucosal sites. Age had no influence on the secretion rate, but women had 10-20% lower values from all three sites than men (p < 0.05). Individuals wearing upper dentures or using tobacco had 300 and 27% increased palatal secretion rates, respectively (p < 0.001, p < 0.05). In addition, those being treated with diuretics had 15% lower rates of secretion from buccal mucosal glands (p < 0.05), and those complaining of oral dryness had 21% lower fluid output from the labial mucosa (p < 0.05). These results support the use of minor salivary glands in combination with the Periotron method to study mucosal secretions and functions.

The flow rate of unstimulated human labial gland saliva

Although the minor salivary glands contribute an important fraction of the resting flow of saliva, which may be particularly relevant in xerostomia, there is currently no precise method of measuring the flow from individual glands or recording the number of active glands in a given area. These experiments were devised to test a photographic method of assaying labial gland saliva and to see whether subjects of different ages had differing flow rates and/or numbers of glands. Unstimulated saliva secretion from labial salivary glands was measured in healthy non-medicated subjects aged 20 to 55 years by a photographic method. The number of glands in a unit area, the individual gland flow rates, and the flow rates per unit area were assessed. There was a high correlation between flow rate per unit area as measured by this method and measurements from weighing filter paper before and after absorption of the saliva droplets when the latter method could be used. The mean flow rate for 22 subjects was 2.35 +/- 1.65 microL/min over the whole area photographed. Subjects with higher flow rates had both more active glands and a higher rate of secretion from individual glands. There was no correlation between either number of active glands in a unit area or of flow rate and age in the age range represented by these subjects.

Factors which influence levels of selected organisms in saliva of older individuals

The most commonly measured bacterial parameters in saliva are the levels of the mutans group streptococci and lactobacilli, which have diagnostic implications for the incidence of dental decay. Diagnostic guidelines which are applicable to children and young adults in whom most, if not all, teeth are present and in whom the rate of stimulated saliva is almost always greater than 0.5 ml/min have been developed. Dental decay is a potential health problem of considerable magnitude among elderly individuals. In elderly individuals, missing teeth, the presence of dentures, and a reduced salivary flow could confound the interpretation of salivary levels of cariogenic bacteria. In the present study, in which saliva was collected from more than 560 elderly individuals (average age, 70 +/- 8 years), there was a significant positive relationship between the salivary levels of Streptococcus mutans and increased numbers of teeth. There was a positive association between the salivary levels of S. mutans and decay when the data were stratified for the presence of a complaint of xerostomia and the presence of dentures. However, a similar analysis indicated that lactobacilli and yeasts were more likely to be associated with decay. The various variables which could influence the bacterial counts per milliliter of saliva, e.g., independent or dependent living status, complaint of xerostomia, stimulated salivary flow, salivary pH, the presence of dentures, number of teeth, and decay, were analyzed simultaneously by using a multivariable linear model. In that analysis the number of decayed teeth was significantly associated with the presence of lactobacilli (P = 0.0001) and yeasts (P = 0.025) but not with the presence of S. mutans. Our findings indicate that salivary levels of lactobacilli and yeasts, as well as the salivary levels of S. mutans, should be monitored when seeking microbial indicators that might predict the incidence of caries in elderly individuals.

Measurements of human minor salivary gland secretions from different oral sites

Unstimulated secretions from labial (upper and lower), buccal, lingual and palatal minor glands were measured with a Periotron 6000 model 2 (Proflow) in 99 non-medicated, healthy individuals aged from 17 to 81 yr (49 males and 50 females). The palatal minor glands had the lowest flow rates, buccal and anterior lingual glands the highest, and labial glands (upper and lower) intermediate secretory rates. Lower labial glands (p < 0.01) in both sexes and upper labial glands in females (p < 0.05) demonstrated a significant decrease in unstimulated output with age, while buccal glands in both sexes (p < 0.05) showed a significant decrease in flow rates only after the age of 50 yr. Thus minor glands show regional variation in their secretory rates and labial and buccal glands appear to show a decreased unstimulated flow in older individuals.

Dental findings in geriatric populations with diverse medical backgrounds

OBJECTIVE

To determine whether there is a difference in the oral/dental health in older persons with different life styles and medical status.

STUDY DESIGN

Survey (cross-sectional study) included four groups: (1) subjects (n = 123) living in a residential retirement home or community dwelling; (2) subjects (n = 218) seeking dental treatment at a Veterans Affairs Dental Outpatient Clinic; (3) subjects (n = 132) resident in a VA long-term care facility; and (4) subjects (n = 81) recently admitted to a VA acute care ward with a diagnosis of cerebral vascular accident or other neurologic problem. Each subject answered questions on medical and dental health and dietary preferences in a comprehensive interview. They were given a comprehensive dental examination that included measurements of stimulated salivary flow and minor salivary gland output.

RESULTS

The data from groups 2 and 3 confirmed previous reports that independent living subjects have better oral/dental health than dependent living subjects. The data from groups 1 and 4, obtained from geriatric populations on the opposite ends of the medical health/disease continuum provide new information that suggests that good medical health and good oral/dental health are linked. The subjects in group 1 were very healthy as judged by their longevity; 54% were > or = 80 years and they had low reported prevalence of medical disease. Only 6% were edentulous and the dentate persons were missing 4.5 teeth. In contrast, over 50% of the patients in group 4 were < 70 years; they had an edentulous rate of 49% and among the dentate persons had an average 12 missing and 5 decayed teeth.

CONCLUSIONS

The medically healthy persons had excellent dental health whereas the sickest persons were either edentulous or had many missing teeth.

Xerostomia, xerogenic medications and food avoidances in selected geriatric groups

OBJECTIVE

To study the relationship between complaints of xerostomia and salivary performance and food avoidances in four geriatric groups chosen to reflect a broad spectrum of individuals along the health-disease continuum. To determine whether xerogenic medications taken by these individuals could be associated with either complaints of xerostomia or with food avoidances.

DESIGN

Cross-sectional survey. Clinical examinations and interview.

SETTING

A VA dental clinic and a retirement home.

PATIENTS AND OTHER PARTICIPANTS

Subjects were 529 individuals older than 56 years of age, living both in institutions and in the community (average age 70 years). Two hundred eight persons were recruited from a VA Dental Clinic, 114 from a residential retirement home, and 132 from a nursing/long-term-care facility; 75 were from an acute care ward and had a diagnosis of a cerebral vascular accident or other neurological condition.

OUTCOME MEASURES

Prevalence of xerostomia, dental morbidity, salivary flow, and food avoidances.

RESULTS

About 72% of the subjects experienced xerostomia sometime during the day. Stimulated salivary flow was found to be significantly lower in individuals who complained of xerostomia than in those who did not. Fifty-five percent of participants reported using one or more xerogenic medications, with an 86% prevalence in the nursing/long-term-care facility. Individuals with xerostomia had difficulty in chewing and in starting a swallow and were significantly more likely to avoid crunchy foods such as vegetables, dry foods such as bread, and sticky foods such as peanut butter in their diets. Specific medications such as the inhalants ipratropium and triamcinolone and the systemic agents oxybutynin and triazolam could be statistically associated with xerostomia and/or low salivary flow, and/or specific food avoidances.

CONCLUSION

Xerostomia apparently affects the ability to chew and start a swallow. This leads to avoidance of certain foods, which raises the possibility that xerostomia could contribute to undernutrition in older persons. The topically applied ipratropium and triamcinolone and the systemic agents amitriptyline, oxybutynin and triazolam could be statistically associated with one or more complaints of xerostomia.

Comparison of the number and type of dental functional units in geriatric populations with diverse medical backgrounds

Elderly subjects (N 430) from four convenience populations that represented different levels of medical health--independent living (Veterans Affairs and non-Veterans Affairs), nursing home, and hospitalized acute care--were given dental examinations. The independent living groups had significantly higher numbers of functional units (opposing natural or prosthetic tooth pairs) and of contiguous functional units compared with the nursing home and hospitalized groups. There was a shift from functional units that consisted of natural teeth to functional units that consisted of prosthetic teeth in the nursing home and hospitalized groups. Numbers of functional units were negatively correlated to plaque index, papillary bleeding scores, and minor salivary gland output. This study suggests a strong relationship between functional integrity of the dentition and general health.

Calibration and reliability of the Periotron 6000 for individual gingival crevicular fluid samples

The Periotron 6000 fluid analyser has become widely used as a diagnostic tool for a variety of oral diseases and recent work has questioned its reliability. This paper investigates for the first time, the detailed calibration curves of 2 Periotron 6000 machines across a range of 23 different fluid volumes. Within and between machine reliability is analyzed and the shape of the calibration line determined. The measurement errors incurred by using a single fluid sample, as opposed to mean values of triplicate samples are also determined. We conclude that there are 3 sections to the calibration line, 2 linear and a quadrilateral zone, and that 2 separate regression equations should be used; from 0-0.1 microliter and from 0.1-1.0 microliter. Within machine calibration errors were only 3.2 +/- 7.5%, but values for volumes below 0.2 microliter were as high as 18.7%. Using a single fluid sample rather than mean values of multiple samples, incurred a further 4 +/- 4% error, which was as high as 7% for volumes lower than 0.12 microliter. Whilst significant differences in volume reading existed between different machines (p < 0.0004) and between the same volumes of different fluids (p < 0.00001), individual Periotron calibrations were extremely reproducible and reliable. We conclude that the Periotron 6000 is a reliable and convenient instrument for measuring fluid volumes greater than 0.2 microliter. For volumes lower than 0.2 microliter errors in measurement may be too high for some investigations, but this is likely to be due to problems with evaporation and with measurement technique, rather than errors directly due to the Periotron itself. Finally, for optimum accuracy, the digital display should be re-set to zero after each sample is measured.

Influence of age on the secretory rates of the human minor salivary glands and whole saliva

This investigation comprised two studies of healthy, unmedicated individuals. The first measured the effect of collection time on the volume of secretions of the minor salivary glands at four specified areas of the lower lip of 13 individuals before and after a mild gustatory stimulus. The second (n = 51) monitored the influence of age and gender on the secretory rates of unstimulated labial, buccal and palatal salivary glands. Also, unstimulated and stimulated flow rates of whole saliva were monitored to provide a point of reference. Volumes of minor gland secretions were measured with a Periotron unit. Results of the first study indicated a linear increase in volumes with collection time (15, 30, 45 and 60 s). Flow rates were similar among the four labial sites, approx. 1 microliter/cm2/min, and were not influenced by mild citric acid stimulation. Results of the second study indicated that flow rates differed significantly (p = 0.0001) among the anatomical sites, with similar rates on the right- and left-hand sides. Gender exerted no influence on flow from the minor salivary glands. Similarly, age exerted no influence on flow from the buccal or labial glands. However, the secretory rate for the palatal glands decreased significantly with age (r = -0.44; p < 0.005). As for unstimulated whole saliva, secretory rates were not influenced by age nor gender; rates for stimulated whole saliva increased with age (r = 0.31; p < 0.05). No association was detected between the flow rates of the whole saliva and that of the minor salivary glands.

A method for measuring secretions from the palatal minor salivary glands

This study investigated the secretory pattern of unstimulated minor salivary glands in 10 contiguous specified areas of the hard palate in 12 healthy unmedicated adult men and women. Each participant was assessed twice at each of two visits in the same specific palatal areas from the distal portion of the second molar to 30 mm anterior. The 10 areas were isolated, dried, and sampled with a paper strip for 60 seconds. The strips were read with a Periotron device. The rates of flow were significantly influenced by position; higher values were noted posteriorly and medially during testing and retesting at both visits. The rates of flow from the palatal glands were greatest in the area between the maxillary second molars. This method proved to be simple, accurate, and reliable for measuring the secretions of the palatal glands. This method may prove useful for investigating how the relationship between the pattern and the secretory rate of minor salivary glands influences retention of the complete maxillary denture.

Salivary secretion and denture retention

Correlations between the retention of complete dentures and flow rates of the palatal and parotid glands were studied in 86 patients. The determination of secretion rates and forces of the forward leverage leading to a dislocation of the dentures showed a narrow correlation between the secretion of palatal glands and the retention of maxillary dentures. The retention of mandibular complete dentures is adversely influenced by the secretion rate of minor salivary glands. However, there is no correlation between the flow rate of parotid saliva and the retention of either denture. In addition, the medicinal stimulation of salivation showed that an increase of mucus secretion induced an improved retention of maxillary complete dentures.

How much saliva is enough? 'Normal' function defined

Saliva is important for the preservation and maintenance of oral health. It is unclear, however, how much saliva is required to maintain normal oral function. Major salivary gland flow rates, objective measurements of oral health, and subjective complaints of oral problems were assessed in different-aged, healthy persons. Results suggest that the comparison of major salivary gland flow rates of an individual with population standards to identify patients susceptible to the effects of salivary dysfunction is unreliable. Changes in salivary function over time are a more meaningful gauge of the impact of saliva on oral health. The clinician should monitor salivary production to identify patients with declining salivary gland output.

Immunoglobulin isotypes in human minor gland saliva

Lower labial, upper labial, palatine (minor), and parotid (major) gland saliva samples from 18 young adult males were quantitatively assayed for the presence of IgA1, IgA2, IgM, and IgG. The mean (+/- standard deviation) concentrations of IgA (sum of IgA1 + IgA2) were 79 +/- 42 micrograms/mL (parotid), 111 +/- 42 micrograms/mL (lower labial), 69 +/- 72 micrograms/mL (upper labial), and 88 +/- 68 micrograms/mL (palatine). Total IgA concentrations were positively correlated among different minor-gland samples from the same subject, although these correlations did not reach significance. Upper-labial-gland saliva samples contained significantly (at least p less than 0.05) lower concentrations of IgA1 than those found in parotid or lower-labial minor-gland secretions. All three minor-gland sources of saliva contained significantly (p less than 0.002) higher levels of IgG than did parotid saliva. Upper-labial fluids had significantly (p less than 0.02) higher IgG concentrations than lower-labial saliva. IgM could be detected in 89% of parotid saliva samples and 75% of the palatine saliva samples. Palatine IgM concentrations (8.2 +/- 17.8 micrograms/mL) were significantly (p less than 0.05) higher than parotid IgM concentrations (0.6 +/- 0.4 micrograms/mL). IgM was detected much less frequently and at lower concentrations in lower- and upper-labial-gland saliva. These data reveal that minor-gland saliva from different oral sites may contain distinctive immunoglobulin isotype patterns, and expressions of host defense may vary within each micro-environment.