How can oral health care providers determine if patients have dry mouth?

Dry Mouth Dilemma: A Comprehensive Review of Xerostomia in Complete Denture Wearers

Xerostomia, commonly known as dry mouth, presents a significant challenge for individuals wearing complete dentures, affecting their oral health and quality of life. This review explores the relationship between saliva and complete dentures, highlighting the varied management strategies for xerostomia. Saliva plays a critical role in denture retention, lubrication, and oral environment buffering. Complete denture wearers often experience reduced salivary flow, aggravating symptoms of xerostomia. Various management approaches are discussed, including general measures such as hydration and salivary stimulation techniques which aim to boost saliva production naturally. The use of salivary substitutes provides artificial lubrication and moisture to alleviate dry mouth discomfort. Oral lubricating devices, such as sprays, gels, and lozenges, offer relief by mimicking saliva's lubricating properties, thereby improving denture stability and comfort. This review addresses the etiology of xerostomia in complete denture wearers and explores preventive measures to reduce its impact. A comprehensive approach has been discussed for the management of xerostomia which will help to improve the oral health and well-being of complete denture wearers experiencing dry mouth.

Oral Health and Older Adults: A Narrative Review

Oral health's association with general health, morbidity, and mortality in older adults highlights its importance for healthy aging. Poor oral health is not an inevitable consequence of aging, and a proactive, multidisciplinary approach to early recognition and treatment of common pathologies increases the likelihood of maintaining good oral health. Some individuals may not have regular access to a dentist, and opportunities to improve oral health may be lost if health professionals fail to appreciate the importance of oral health on overall well-being and quality of life. The authors of this narrative review examined government websites, the American Dental Association Aging and Dental Health website, and the Healthy People 2030 oral objectives and identified xerostomia, edentulism, caries, periodontitis, and oral cancer as five key topics for the non-dental provider. These conditions are associated with nutritional deficiencies, poorer quality of life, increased risk of disease development and poorer outcomes for cardiovascular disease, diabetes, and other systemic conditions prevalent among older adults. It is important to note that there is a bi-directional dimension to oral health and chronic diseases, underscoring the value of a multidisciplinary approach to maintaining oral health in older adults.

A Survey of Dental Caries Segmentation and Detection Techniques

Dental caries detection, in the past, has been a challenging task given the amount of information got from various radiographic images. Several methods have been introduced to improve the quality of images for faster caries detection. Deep learning has become the methodology of choice when it comes to analysis of medical images. This survey gives an in-depth look into the use of deep learning for object detection, segmentation, and classification. It further looks into literature on segmentation and detection methods of dental images through deep learning. From the literature studied, we found out that methods were grouped according to the type of dental caries (proximal, enamel), type of X-ray images used (extraoral, intraoral), and segmentation method (threshold-based, cluster-based, boundary-based, and region-based). From the works reviewed, the main focus has been found to be on threshold-based segmentation methods. Most of the reviewed papers have preferred the use of intraoral X-ray images over extraoral X-ray images to perform segmentation on dental images of already isolated parts of the teeth. This paper presents an in-depth analysis of recent research in deep learning for dental caries segmentation and detection. It involves discussing the methods and algorithms used in segmenting and detecting dental caries. It also discusses various existing models used and how they compare with each other in terms of system performance and evaluation. We also discuss the limitations of these methods, as well as future perspectives on how to improve their performance.

Erosive assessment of dry mouth lozenges and tablets on enamel and dentin

OBJECTIVES

To assess the erosive potential of dry mouth lozenges and tablets on enamel and dentin.

MATERIALS AND METHODS

The following lozenges and tablets were tested: Salese, Oracoat Xylimelts, Cotton Mouth, TheraBreath, DenTek OraMoist, SmartMouth, ACT, CVS Health, Rite Aid, Med Active, and Hager Pharma. pH Analysis: Each lozenge or tablet was crushed with a pestle and mortar and 5 g of the resultant powder was dissolved in 10 ml of distilled water (pH 7.02) The pH of each lozenge solution was assessed by using a calibrated pH meter. Titratable Acidity (TA) was determined by adding 0.1 M of NaOH to each homogenous tablet solution until the pH reached 7.0. Gravimetric Analysis was measured with freshly extracted molars crown/roots were sectioned at the CEJ and enamel and dentin specimens were fabricated. The specimens were then submerged in 5 ml of solution containing 2.5 gm of crushed tablets for 24 h, 48 h, 96 h and 14 days with measurements performed at each interval after drying. The solutions were renewed at each interval.

RESULTS

Significant correlation between pH and TA was observed for lozenges and tablets evaluated (p < 0.0001). Both variables were strongly correlated with enamel and dentin loss (p < 0.0001). For enamel, DenTek resulted in significantly more substance loss (p < 0.05) than with the other tested products, while Xylimelts presented the lowest percentage of substance loss. For dentin, Cotton Mouth resulted in the highest substance loss, and Xylimelts presented the lowest percentage of substance loss.

CONCLUSIONS

There is a strong correlation between the pH, tritatable aciditiy, and erosive potential of these products. DenTek and Cotton Mouth reported erosive effect to the enamel and dentin, respectively. Xylimelts performed better than the rest of the products in relationship to enamel and dentin.

Muscarinic cholinergic receptors in minor salivary gland tissues of patients with oral lichen planus: A case-control study

BACKGROUND

Oral lichen planus (OLP) is a common, chronic immunological and inflammatory condition. Many of the OLP patients complain of xerostomia. The M3 muscarinic cholinergic receptors (MR3) are the main receptors in the salivary glands responsible for water secretion into the saliva. This study aimed to assess the level of M3 muscarinic cholinergic receptors in minor salivary glands of OLP patients.

METHODS

This case-control cross-sectional study evaluated 40 OLP patients and 22 controls. All participants completed two questionnaires (xerostomia and xerostomia inventory). Stimulated and unstimulated saliva samples were collected. The saliva flow rate was calculated by dividing the saliva volume (in milliliters) by time (in minutes). Six minor salivary glands were also surgically removed from the lower lip of patients and controls, and weighed using a digital scale with 10^-4  g accuracy. They were then frozen at -80°C, and the level of M3 receptors of the glands was determined using the ELISA kit.

RESULTS

The unstimulated and stimulated saliva flow rate was significantly lower in OLP patients. The xerostomia inventory score was significantly higher in the OLP group. The level of M3 muscarinic receptors in minor salivary glands of OLP patients was significantly higher than that in controls.

CONCLUSIONS

It may be concluded that the reduction in saliva flow significantly increases the number of M3 receptors in an attempt to compensate for this shortage and prevent xerostomia (compensatory upregulation).

Secretor Status of ABO Antigens in Saliva of a Defined Group of Iranian Patients with Pemphigus Vulgaris: A Case-Control Study

INTRODUCTION

Pemphigus is a chronic inflammatory and autoimmune disease which can cause blisters and mucocutaneous erosions. ABO secretor refers to those who secrete ABO blood group antigens based on their blood type in body fluids such as saliva, sweat, tears, semen, and serum. Previous studies showed that nonsecretor people are more prone to certain autoimmune diseases.

AIM

The aim of this study was to determine the ABO secretor status in the saliva of patients with pemphigus vulgaris.

MATERIALS AND METHODS

This case-control study was conducted on 35 patients with pemphigus vulgaris and 35 healthy controls. The two groups were matched for age and gender. Pemphigus vulgaris diagnosis was confirmed by histopathology and direct immunofluorescence microscopy. ABO blood grouping was done, and 5 ml of unstimulated saliva was collected to determine secretor status. Secretors were recognized from nonsecretors by the Wiener agglutination inhibition test. Results were extracted by using statistical chi-square and Fisher's exact tests.

RESULTS

16 male and 19 female patients aged 49.43 ± .12.37 years were compared with 16 male and 19 female controls aged 46.43 ± 11.88 years. The most frequent blood group among case and control groups was O (54.3% and 60%, respectively). There was no significant difference in blood groups (P=0.73). 90% of the samples were ABO secretors. The patient group included 31 (88.6%) and the control group included 32 (91.4%) ABO secretors; there was no significant difference between the two groups (P=1.000).

CONCLUSION

In this study, we observed that the people with nonsecretor status in comparison with the people with secretor status are not more susceptible to develop pemphigus vulgaris.

Aquaporin3 (AQP3) expression in oral epithelium in oral lichen planus

Lichen Planus is an autoimmune disease of skin and mucous membranes, including oral mucosa and genital organs, with the potential to undergo a malignant transformation. Xerostomia and the salivary gland hypofunction are common manifestations and complications in oral lichen planus (OLP), whose exact cause has not been well defined yet. Aquaporins (AQP) are a family of membrane channel cell proteins which play an important role in the intercellular water permeability. This study for the first time compares the expression of the aquaporin-3 (AQP3) gene in oral tissues of a group of OLP patients and a control group. In this study, 30 OLP patients and 30 healthy individuals were selected. The expression of AQP3 gene was measured using Real-Time PCR method. The expression of the gene in the OLP patients was more than the control group. It could be argued that decreased salivation increases the level of expression of the AQP3 gene in an effort to compensate for this deficiency and prevent the onset of xerostomia (compensatory up-regulation).

Relationship between dental plaque formation and salivary cortisol level in pregnant women

Purpose:

Understanding how increased level of salivary cortisol contributes to the development of dental biofilm during pregnancy can help inthe prevention of dental caries and periodontal diseases. This study aims to evaluate the relationship between salivary cortisol level and dental biofilm formation in pregnant women.

Patients and methods:

This descriptive-analytic study was conducted in Hamadan, Iran in 2011. Forty consecutive pregnant women with no history of abortion, stillbirth, or any known physical or psychological disorders at weeks 25 and 33 of gestation were included. Salivary samples were collected for measurement of cortisol levels by Enzyme Linked Immunoabsorbent Assay (ELISA) method. The amount and extension of dental biofilms were determined by using a disclosing agent. Data were analyzed using descriptive and analytical statistics in SPSS version 16.

Results:

The mean levels of salivary cortisol at weeks 25 and 33 of gestation were respectively, 2.45 ± 1.56 μg/dl and 5.24 ± 4.07 μg/dl which demonstrates a significant difference (P<0.001). Evaluation of dental biofilm at two time intervals revealed a significant increase in amount of dental biofilm at week 33 of gestational period (34.65 ± 10.9% vs. 42.45 ± 12.35%, P<0.001). Elevated levels of dental biofilm were significantly correlated with salivary cortisol levels at week 33 (r=0.494, P=0.001),however, it was not significant at week 25 of gestation (r=0.148, P=0.361).

Conclusion:

The findings suggested that increased levels of salivary cortisol can predict dental biofilm formation and accumulation in pregnant women in the last weeks of gestation.

Assessment of Uric Acid Level in the Saliva of Patients with Oral Lichen Planus

OBJECTIVE

The aim of this study was to evaluate the level of uric acid (UA) in saliva, which is considered to be an antioxidant defense biomarker against oxidative stress in patients with oral lichen planus (OLP).

SUBJECTS AND METHODS

In this case-control study, 25 OLP patients were included. The reticular form of OLP was verified by a clinical examination with Wickham striae, and other types (erosive, atrophic, ulcerative) were confirmed by histopathological assessment. Thirty healthy individuals matched for age and gender were selected as the control group. In both groups, the Navazesh technique was used to collect the unstimulated saliva. Then, the amount of UA was measured using a Cobas Mira autoanalyzer with a wavelength of 546 nm. The Student t test was used to analyze the data assuming a significance level at <0.05.

RESULTS

Of the 25 patients, the most common type of OLP was erosive (n = 11, 44%), and the most common site of OLP was seen as bilateral in the buccal mucosa (n = 12, 48%). The mean level of salivary UA was significantly lower in the patients with OLP (2.10 ± 0.19 mg/dL) in comparison with the control group (4.80 ± 0.29 mg/dL; p < 0.001).

CONCLUSION

In this study, OLP was associated with a decrease in UA levels in the saliva. Salivary UA as a biomarker could be used for monitoring and treating OLP.

Can Salivary Acetylcholinesterase be a Diagnostic Biomarker for Alzheimer?

INTRODUCTION

The loss of brain cholinergic activity is a key phenomenon in the biochemistry of Alzheimer's Disease (AD). Due to the specific biosynthesis of Acetylcholinesterase (AChE) of cholinergic neurons, the enzyme has been proposed as a potential biochemical marker of cholinergic activity. AChE is expressed not only in the Central Nervous System (CNS), Peripheral Nervous System (PNS) and muscles, but also on the surface of blood cells and saliva.

AIM

This study aimed to measure salivary AChE activity in AD and to determine the feasibility of creating a simple laboratory test for diagnosing such patients.

MATERIALS AND METHODS

In this cross-sectional study, the recorded data were obtained from 15 Alzheimer's patients on memantine therapy and 15 healthy subjects. Unstimulated whole saliva samples were collected from the participants and salivary levels of AChE activity were determined by using the Ellman colorimetric method. The Mann Whitney U test was used to compare the average (median) of AChE activity between AD and controls. In order to adjust for possible confounding factors, partial correlation coefficient and multivariate linear regressions were used.

RESULTS

Although the average of AChE activity in the saliva of people with AD was lower compared to the control group, we found no statistically significant differences using Mann Whitney U test (138 in control group vs. 175 in Alzheimer's patients, p value=0.25). Additionally, no significant differences were observed in the activity of this enzyme in both sexes or with increased age or duration of the disease. After adjusting for age and gender, there was no association between AChE activity and AD (regression coefficient β=0.08; p value= 0.67).

CONCLUSION

Saliva AChE activity was not significantly associated with AD. This study might help in introduce a new diagnostic aid for AD or monitor patients with AD.

Carbonic Anhydrase VI Gene Polymorphism rs2274327 Relationship Between Salivary Parameters and Dental-Oral Health Status in Children

The aim of this study was to research carbonic anhydrase (CA) VI one single-nucleotide polymorphism (SNP) and its potential association with dental-oral health status (dental caries, Plaque Index (PI) and Gingival Index (GI)) and salivary parameters (salivary buffering capacity, salivary flow rate (SFR)) in children. A total of 178 children were divided into two groups: non-carious (n = 70, 34 boys and 36 girls) and carious (n = 108, 47 boys and 61 girls). The clinical evaluations were performed according to the decayed, missing, and filled teeth (dmft/DMFT) index by a specialist. Clinical parameters including PI, GI, and simplified oral hygiene index (OHI-S) were recorded. Salivary pH (SpH) was measured using pH paper. Blood samples and unstimulated whole saliva were collected, and SFR was calculated. The CA VI rs2274327 polymorphism was determined by a LightSNiP assay on the realtime PCR system. The frequencies of rs2274327 were not significant between groups (p > 0.05). There was a positive correlation between OHI-S and SpH in the carious and non-carious groups (p < 0.05). There was no correlation among the SNPs' frequencies and OHI-S, PI, GI, SFR, and SpH (p > 0.05). CA VI SNP (rs2274327) had no statistically significant association with OHI-S, PI, GI, SFR, and SpH in the children.

Evaluation of Salivary Secretor Status of Blood Group Antigens in Patients with Oral Lichen Planus

OBJECTIVE

To investigate the relationship between secretion or nonsecretion of blood group antigens into the saliva and oral lichen planus (OLP).

SUBJECTS AND METHODS

In this study, 30 patients (women: 22, men: 8) with OLP were examined as the case group and 30 subjects without OLP matched for age and gender as the control group. Diagnosis of OLP was confirmed by clinical and histopathological examinations according to WHO criteria. The control group was randomly selected from healthy individuals without pathological oral changes seeking dental treatment. In both groups, blood group type was determined by hemagglutination, and unstimulated saliva was collected using the Navazesh technique. Establishment of salivary secretor status was carried out using the Wiener agglutination test. The data were analyzed using a Χ2 test, Fisher's exact test, and logistic regression.

RESULTS

The patients with OLP (cases), including 22 (36.7%) women and 8 (13.3%) men with a mean age of 51 ± 14.16 years, were compared with healthy subjects (controls), comprised of 25 (41.7%) women and 5 (8.3%) men with a mean age of 50.7 ± 13.56 years. A large majority of the people examined in both groups were secretors of blood group A. On the other hand, most OLP patients were blood group B. In the case group, 25 subjects (84.4%) were secretors and 5 (16.6%) were nonsecretors. In the control group, 24 subjects (80.0%) were secretors and 6 (20.0%) were nonsecretors. There was no significant difference between the case and control groups for secretor status (p = 0.73).

CONCLUSION

The present study did not indicate a significant difference in salivary secretor status between OLP patients compared to controls.

pH and Erosive Potential of Commonly Used Oral Moisturizers

PURPOSE

To measure the pH values of commonly used oral moisturizers and to evaluate their erosive potential using a gravimetric analysis.

MATERIALS AND METHODS

A pH analysis was performed for seven commercially available oral moisturizers using a calibrated pH meter. The pH recording was repeated three times, from three different bottles each of the same product. The gravimetric analysis was performed by submerging human dentin blocks in 5 ml of each of the moisturizers for a total of 2 weeks, with gravimetric measurements made at baseline, 24 hours, 48 hours, 96 hours, 1 week, and 15 days. Tap water was used as positive control and citric acid as the negative control. The erosive potential was descriptively analyzed, and a Spearman correlation coefficient was used to assess the relationship between the erosive potential and the pH values.

RESULTS

The average pH values are as follows: Oasis, 6.3, Bioténe Moisturizing Mouth Spray, 6.1, CTx2 Spray, 9.1, Mouth Kote, 3.0, Thayer's, 6.3, Bioténe Oral Balance, 6.6, Rain, 7.1, tap water 6.99, and citric acid 1.33. The results (% of tooth structure lost) of the gravimetric analysis were as follows: Mouth Kote, 9.6%, Bioténe Moisturizing Mouth Spray, 4.6%, Oasis, 3.2%, Thayer's, 2.0%, Bioténe Oral Balance, 0.0%, Rain, 0.0%, CTx2 Spray, 0.0%, tap water 0.0%, and citric acid 18.8%. There was a significant negative correlation between the pH values and the erosive potential (r(s) = -0.73; P ≤ 0.0001).

CONCLUSIONS

There is large variation in the composition and pH values of commonly used oral moisturizers, and there is a strong correlation between pH values and erosive potential of commonly used oral moisturizers.

CLINICAL SIGNIFICANCE

Patients with dry mouth are at increased risk for erosion and root caries. Oral moisturizing agents are often prescribed for patients with hyposalivation to be used as needed for symptomatic relief. This study shows that there is large variation in the pH values and erosive potential of commonly used oral moisturizing agents.

Metagenomic investigation of microbes and viruses in patients with jaw osteonecrosis associated with bisphosphonate therapy

OBJECTIVE

The goal of this preliminary study was to use metagenomic approaches to investigate the taxonomic diversity of microorganisms in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ).

STUDY DESIGN

Samples of saliva for planktonic microbial analysis and biofilm cultivation were collected from 10 patients (5 with BRONJ and 5 non-BRONJ control subjects) who met all ascertainment criteria. Prophage induction experiments-16S rRNA polymerase chain reaction and 454 pyrosequencing-and epifluorescent microscopy were performed for characterization and enumeration of microbes and viruses.

RESULTS

Three phyla of microbes-Proteobacteria (70%), Firmicutes (26.9%), and Actinobacteria (1.95%)-dominated all BRONJ samples and accounted for almost 99% of the total data. Viral abundance was ∼1 order of magnitude greater than microbial cell abundance and comprised mainly phage viruses.

CONCLUSIONS

Individuals with jaw osteonecrosis harbored different microbial assemblages than nonaffected patients, and in general viral abundance and prophage induction increased with biofilm formation, suggesting that biofilm formation encouraged lysogenic interactions between viruses and microbial hosts and may contribute to pathogenicity.

Effect of aging on stimulated salivary flow in adults

The literature on the effect of age on saliva production, which has implications for health, quality of life, differential diagnosis, and case management, remains inconclusive. Physiological changes, motor and sensory, are frequently reported with increasing age. It was hypothesized that there would be a change in saliva production with older age. Whole stimulated saliva was collected by asking participants to chew gauze for 1 minute and then comparing the weight of saliva produced according to age and sex. Data were collected in activity centers for older adults, workplaces, universities, and participants' homes. Five hundred forty healthy individuals (aged 20-97) in three age groups (young = 20-30; middle-aged = 40-50; older ≥ 70) participated (90 men and 90 women in each group). A decrement in saliva production was identified for age in that the young and older participants and the middle-aged and older participants differed significantly from each other, but no difference was found between the young and middle-aged participants. The main effect of sex was not significant, nor was the interaction of age and sex. The results have implications for research and clinical work, including the differential diagnosis and subsequent management of salivary flow impairment due to age or underlying medical diagnosis or treatment. The assessment tool is easily administered and inexpensive and lends itself to use in many different clinical and research settings by different professionals.

Plasma-enhanced antibody immobilization for the development of a capillary-based carcinoembryonic antigen immunosensor using laser-induced fluorescence spectroscopy

In this study, antibody immobilization using a microwave-induced H2O/Ar plasma pretreatment was achieved for the first time. Plasma was used to activate the surface of a capillary-based immunosensor by increasing the density of silicon hydroxyls and dangling bonds to ensure better silanization. The capture antibodies were covalently immobilized after the silanized surface reacted with glutaraldehyde and antibodies. A Cy3-labeled detection antibody was used in combination with the antigen captured by the immunosensor to complete the sandwich-type immunoassay, and the signals were measured using a laser-induced fluorescence system. Microwave-induced H2O/Ar plasma pretreatment of the carcinoembryonic antigen (CEA) immunosensor improved the antibody immobilization, and there was an obvious improvement in the linear detection range, i.e., 1 order of magnitude compared with a commercial enzyme-linked immunosorbent assay (ELISA). This novel immobilization method dramatically improved the detection limit (0.5 pmol/L CEA) and sensitivity. Assay validation studies indicated that the correlation coefficient reached 0.9978, and the relative standard deviations were <7% for all samples, with recoveries of 99.7-107.1%. Furthermore, the immunosensor was applied successfully to CEA determination in actual saliva specimens with high sensitivity, acceptable precision, and reasonable accuracy. This enhanced CEA immunosensor based on microwave-induced H2O/Ar plasma was demonstrated to be a sensitive tool for CEA diagnostics.

The caries environment: saliva, pellicle, diet, and hard tissue ultrastructure

The pathogenicity of the dental biofilm is modified by salivary and dietary factors, as well as by the characteristics of the tooth structure. The composition of the acquired pellicle can modify the mineral homeostasis of the tooth surfaces and the attachment of bacteria for the development of the biofilm. The substitution of sucrose from the diet by other less cariogenic sugars and/or sugar substitutes can contribute to reducing the pathogenicity of the biofilm. Saliva clears, dilutes, neutralizes, and buffers acids produced by the biofilm. In addition, saliva provides the biofilm/tooth structure with Ca(2+) PO(4)(3-) and F(-) ions, which can positively affect the equilibrium between demineralization-remineralization toward the remineralization and modify the susceptibility of the tooth structure to caries progression.

Defining dental caries for 2010 and beyond

This introductory article provides an overview of the caries disease process that will help guide readers into the world of evidence-based caries management in the beginning of the twenty-first century and help them understand the ongoing need to update in this field. This issue of Dental Clinics of North America provides clinically relevant reviews, full of chair-side recommendations based on best available evidence, on epidemiology, nomenclature, disease process, and management. A glossary of common terms in cariology is included.

Salivary biosensors for screening trauma-related psychopathology

After facial trauma, a distinct subset of patients goes on to develop mental health problems including recalcitrant psychopathology. Early identification of maladaptive stress reactions provides opportunities for initiating preemptive mental health interventions and hinges on the surgeon's ability to differentiate between transient distress and precursors of recalcitrant psychiatric sequelae. The comprehensive care of injured patients will benefit greatly from objective adjuncts and decision-making tools to complement the clinical evaluation. This article addresses meeting the need for practical, standardized, and reliable screening strategies through promising developments in the use of stress response biomarkers and biosensing technology. The systematic interrogation of differentially expressed stress response biomarkers in saliva now permits rapid assessment of the psychopathogical response to the stressor. Quantitative, point-of-use measurements of the traumatic stress response will greatly improve the nosology of posttraumatic stress disorders and help advance the screening, diagnosis, treatment, and prevention of mental health consequences of violence and trauma.

Critical appraisal: Protocol for the prevention and management of root caries

This critical appraisal deviates from our standard format to address a timely topic of particular interest to clinicians.

Age-dependent deficiency in saliva and salivary antibodies secretion in Down's syndrome

OBJECTIVE

Down's syndrome (DS) individuals suffer from an increased susceptibility to infections. Here, we assessed age-related changes in the salivary-specific humoral immunity of DS subjects.

DESIGN

Parotid and whole saliva were collected from a young group of DS (YDS, n=30, 23.3+/-4 years), an older group of DS individuals (ODS, n=10, 51.9+/-8 years) and compared to two age-matched groups of healthy volunteers--a young group (YC, n=29, 22.8+/-5 years) and an older group (OC, n=10, 48.4+/-9 years). The levels of total IgA, and specific antibodies to three common oral pathogens (Porphyromonas gingivalis, Actinobacillus (Aggregatibacter) actinomycetemcomitans and Streptococcus mutans) were analysed.

RESULTS

The limited increases in IgA concentrations could not compensate the dramatic reduction in the salivary flow rate observed in DS individuals. Therefore, the median secretion rates of the specific antibodies in whole and parotid saliva were 70-77% and 34-60% (respectively) lower in YDS individuals as compared to YC and farther 77-100% and 75-88% (respectively) lower in ODS compared to YDS. In contrast, the antibody secretion rates were similar for parotid saliva, or even increased for whole saliva of OC, compared with YC. Consequently, a dramatic cumulative extreme reduction (>92%) in the bacterial specific salivary antibodies differentiated the adult DS individuals from to their age-matched controls.

CONCLUSIONS

Our results indicate a severe immunodeficiency in the secretion rate of the specific salivary IgA response of in DS individuals which intensifies with age.

Prevalence of xerostomia in population-based samples: a systematic review

The consequences of xerostomia on oral health have been studied for decades; however, the actual prevalence of this disorder on the general population remains controversial. The purpose of this systematic review was to determine the prevalence of xerostomia in population-based samples. Electronic databases were screened for relevant articles and reference lists of pertinent articles were also hand-searched. Thirteen articles meeting the final inclusion criteria were identified. Based on the definition of xerostomia used in this review, only publications including a subjective diagnosis of the disorder were included. All of the self-reported diagnoses were achieved through a questionnaire either by mail, telephone, interview or self-administered by the patient. There was a variation across papers regarding number and content of the questions as well as guidelines for the diagnosis of xerostomia (i.e. answer yes to one or more than one question). The prevalence of xerostomia in the selected articles ranged from 0.9% to 64.8%. The majority of these studies were performed in Scandinavia. In 9 of the articles, the studied samples were 50 years and older. None of the studies evaluated the prevalence xerostomia among individuals younger than 18 years. Based on these observations, it can be concluded that there is a need for population-based studies on prevalence of xerostomia in regions other than Scandinavia. A standardized protocol to diagnose xerostomia needs to be developed. Patient-perceived treatment needs and impact on quality of life should be included to have a complete picture of public health implications of the disease.