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Hosseini M, Jensen SS, Gotfredsen K, Hyldahl E, Pedersen AML. Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren's Syndrome: A Five-Year Prospective Clinical Study. Clin Oral Implants Res 2024. [PMID: 39235273 DOI: 10.1111/clr.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/29/2024] [Accepted: 08/14/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren's syndrome. AIM/HYPOTHESIS We hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration. MATERIAL AND METHODS Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020. The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment. RESULTS We included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group. All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026). CONCLUSION Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.
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Affiliation(s)
- Mandana Hosseini
- Research Section for Oral Health, Society and Technology/Oral Rehabilitation, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon Storgård Jensen
- Research Section for Oral Biology and Immunopathology/Oral Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Gotfredsen
- Research Section for Oral Health, Society and Technology/Oral Rehabilitation, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emil Hyldahl
- Research Section for Oral Biology and Immunopathology/Oral Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Marie Lynge Pedersen
- Research Section for Oral Biology and Immunopathology/Oral Pathology and Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Qi W, Tian J, Wang G, Yan Y, Wang T, Wei Y, Wang Z, Zhang G, Zhang Y, Wang J. Advances in cellular and molecular pathways of salivary gland damage in Sjögren's syndrome. Front Immunol 2024; 15:1405126. [PMID: 39050857 PMCID: PMC11266040 DOI: 10.3389/fimmu.2024.1405126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Sjögren's Syndrome (SS) is an autoimmune disorder characterized by dysfunction of exocrine glands. Primarily affected are the salivary glands, which exhibit the most frequent pathological changes. The pathogenesis involves susceptibility genes, non-genetic factors such as infections, immune cells-including T and B cells, macrophage, dendritic cells, and salivary gland epithelial cells. Inflammatory mediators such as autoantibodies, cytokines, and chemokines also play a critical role. Key signaling pathways activated include IFN, TLR, BAFF/BAFF-R, PI3K/Akt/mTOR, among others. Comprehensive understanding of these mechanisms is crucial for developing targeted therapeutic interventions. Thus, this study explores the cellular and molecular mechanisms underlying SS-related salivary gland damage, aiming to propose novel targeted therapeutic approaches.
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Affiliation(s)
- Wenxia Qi
- Gansu University of Traditional Chinese Medicine, College of Integrative Medicine, Lanzhou, China
| | - Jiexiang Tian
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Department of Rheumatology and Orthopedics, Lanzhou, China
| | - Gang Wang
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Department of Rheumatology and Orthopedics, Lanzhou, China
| | - Yanfeng Yan
- Fourth Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Department of Respiratory and Critical Care Medicine, Lanzhou, China
| | - Tao Wang
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Department of Rheumatology and Orthopedics, Lanzhou, China
| | - Yong Wei
- Gansu University of Traditional Chinese Medicine, College of Integrative Medicine, Lanzhou, China
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Department of Rheumatology and Orthopedics, Lanzhou, China
| | - Zhandong Wang
- Gansu University of Traditional Chinese Medicine, College of Integrative Medicine, Lanzhou, China
| | - Guohua Zhang
- Gansu University of Traditional Chinese Medicine, College of Integrative Medicine, Lanzhou, China
| | - Yuanyuan Zhang
- Gansu University of Traditional Chinese Medicine, College of Integrative Medicine, Lanzhou, China
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Department of Rheumatology and Orthopedics, Lanzhou, China
| | - Jia Wang
- Gansu University of Traditional Chinese Medicine, College of Integrative Medicine, Lanzhou, China
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Kudsi M, Nahas LD, Alsawah R, Hamsho A, Omar A. The prevalence of oral mucosal lesions and related factors in systemic lupus erythematosus patients. Arthritis Res Ther 2021; 23:229. [PMID: 34479636 PMCID: PMC8414847 DOI: 10.1186/s13075-021-02614-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory multi systematic disease of unknown aetiology. SLE has a wide range of symptoms. The most common symptoms are joint pain, skin rash and fever. Oral lesions in SLE manifest in a variety of forms, such as oral mucosal ulceration, mouth burns, xerostomia and salivary gland diseases, temporomandibular joint disease, periodontal disease, dysgeusia, white lesions, oedema, bleeding and petechiae. OBJECTIVE This study was conducted to evaluate the prevalence of oral mucosal lesions and their related factors in patients with SLE, giving the lack of comprehensive statistical data in Syria and the differences between reported prevalence. PATIENTS AND METHODS A cross-sectional study was performed in the Al-Mouassat University Hospital in Damascus. Patients were evaluated appropriating observation, clinical examination, completing questionnaires, studying patient's medical records and paraclinical laboratory tests if required. Four types of oral lesions were evaluated: ulcer, erythema, white plaque and spots. The diagnosis of these lesions was made according to observation and clinical examination, and the location of each lesion was also recorded. Data were analysed using SPSS version 16.0. RESULT In this study, 42 (70% %) out of 60 patients (38 women and 4 men) had oral lesions, while 18 (30%) had none. The most common areas for the lesions were the buccal mucosa (26.1%) and the lips (14.2%). Of the 42 patients with oral lesions, 12 (27.6%) showed ulcers. There was a significant relationship between the following factors and oral lesions: oral hygiene status, the duration of the disease involvement, frequency of pregnancies, the amount of daily use of corticosteroids without significant difference between dosage groups, and medications used for SLE treatment other than corticosteroids (p < 0.008) without mentioned names or dosages. Conversely, age, sex, cigarette smoking and medications other than those used for SLE treatment were not significantly related to the presence of oral lesions (p value was greater than 0.05 in all subjects).
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Affiliation(s)
- Mayssoun Kudsi
- Faculty of Medicine, Syrian Private University, Damascus, Syrian Arab Republic
- Rheumatology Department, Damascus University, Damascus, Syrian Arab Republic
| | - Louei Darjazini Nahas
- Faculty of Medicine, Syrian Private University, Damascus, Syrian Arab Republic
- Otorhinolaryngology Department, Syrian Private University, Damascus, Syrian Arab Republic
| | - Rama Alsawah
- Faculty of Medicine, Syrian Private University, Damascus, Syrian Arab Republic
| | - Ahmad Hamsho
- Faculty of Medicine, Syrian Private University, Damascus, Syrian Arab Republic
| | - Abdullah Omar
- Faculty of Medicine, Syrian Private University, Damascus, Syrian Arab Republic
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Lactoferrin and Its Detection Methods: A Review. Nutrients 2021; 13:nu13082492. [PMID: 34444652 PMCID: PMC8398339 DOI: 10.3390/nu13082492] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Lactoferrin (LF) is one of the major functional proteins in maintaining human health due to its antioxidant, antibacterial, antiviral, and anti-inflammatory activities. Abnormal levels of LF in the human body are related to some serious diseases, such as inflammatory bowel disease, Alzheimer’s disease and dry eye disease. Recent studies indicate that LF can be used as a biomarker for diagnosis of these diseases. Many methods have been developed to detect the level of LF. In this review, the biofunctions of LF and its potential to work as a biomarker are introduced. In addition, the current methods of detecting lactoferrin have been presented and discussed. We hope that this review will inspire efforts in the development of new sensing systems for LF detection.
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Flink H, Tegelberg Å, Arnetz JE, Birkhed D. Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults. Acta Odontol Scand 2020; 78:229-235. [PMID: 31729277 DOI: 10.1080/00016357.2019.1690677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.9 ± 6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p < .001). The CA group reported worse oral health (p < .001) and general health (p < .01), more xerostomia (p < .001) and lower salivary flow rate (p < .01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p < .01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.
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Affiliation(s)
- Håkan Flink
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
- Public Dental Clinic Sala, Public Dental Health Västmanland, Sala, Sweden
| | - Åke Tegelberg
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Pedersen A, Sørensen CE, Proctor GB, Carpenter GH. Salivary functions in mastication, taste and textural perception, swallowing and initial digestion. Oral Dis 2018; 24:1399-1416. [PMID: 29645367 DOI: 10.1111/odi.12867] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022]
Abstract
Saliva exerts multiple functions in relation to the initial digestive processes taking place in the upper parts of the gastrointestinal tract. Ingestion of food and beverages, in turn, is a strong stimulus for secretion of saliva with a differential composition depending on the neuronal stimulation pattern. This review paper provides insight into the mechanisms by which saliva acts in relation to taste, mastication, bolus formation, enzymatic digestion and swallowing. Also, the protective functions of saliva including maintenance of dental and mucosal integrity will be discussed as they indirectly influence the digestive process. The final part of this study focuses on the implications of xerostomia and salivary gland dysfunction on gastrointestinal functions.
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Affiliation(s)
- Aml Pedersen
- Section 1, Oral Medicine, Oral Pathology & Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C E Sørensen
- Section of Oral Biochemistry, Cariology & Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G B Proctor
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
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Zhang Y, Lin T, Jiang A, Zhao N, Gong L. Vision-related quality of life and psychological status in Chinese women with Sjogren's syndrome dry eye: a case-control study. BMC WOMENS HEALTH 2016; 16:75. [PMID: 27955668 PMCID: PMC5154065 DOI: 10.1186/s12905-016-0353-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/30/2016] [Indexed: 02/04/2023]
Abstract
Background Sjogren’s syndrome dry eye (SSDE) mainly affects middle-aged women and can negatively affect women’s psychological and social functioning. However, little is known about the correlation between vision-related quality of life (VR-QoL) and psychological status for women with SSDE. We therefore examined VR-QoL and psychological status in two groups of Chinese women: an SSDE group and a non-SSDE group. We also explored the associations between VR-QoL scores, sociodemographic measures, ophthalmologic parameters, and psychological status in women with SSDE. Methods The case-control study recruited 30 female outpatients with SSDE and 30 without SSDE from the Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University. Demographic and ophthalmologic data were collected from all participants. Ophthalmologic examinations included best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS), tear break-up time (TBUT) and Schirmer test. Data collected using the National Eye Institute’s Visual Function Questionnaire (NEI-VFQ) and Ocular Surface Disease Index (OSDI) survey instruments were analyzed to identify potential differences in VR-QoL between the SSDE group and the non-SSDE group. We also used the Zung Self-Rating Anxiety and Self-Rating Depression Scales (SAS and SDS) to determine psychological status in both groups. Results The SSDE group scored significantly lower than the non-SSDE group on the NEI-VFQ subscales of general health, general vision, and long-distance vision activities (all p < 0.05). The SSDE group achieved a significantly higher ocular symptoms score compared with the control group (p = 0.0256). The SAS and SDS scores of the SSDE group were significantly higher than the non-SSDE group (p = 0.0072 and 0.0162, respectively). The prevalence of anxiety and depression in the SSDE group was significantly higher than the non-SSDE group (p = 0.0240 and 0.0200, respectively). Nine of twelve NEI-VFQ subscales were negatively correlated with SAS/SDS scores (all p values were <0.05). The exceptions were social function, color vision and peripheral vision. The composite OSDI score and its three subscale scores for the women in the SSDE group were all positively correlated with overall SAS/SDS scores (all p values were <0.05). Conclusions Both VR-QoL and psychological status were significantly worse in SSDE group than in the non-SSDE group. The VR-QoL of women with SSDE had a negative correlation with their anxiety and depression levels.
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Affiliation(s)
- Yuqiu Zhang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of myopia, Ministry of Health, Shanghai, People's Republic of China
| | - Tong Lin
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of myopia, Ministry of Health, Shanghai, People's Republic of China
| | - Alice Jiang
- School of Medicine & Public Health, University of Wisconsin, Madison, USA
| | - Naiqing Zhao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Lan Gong
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,Key Laboratory of myopia, Ministry of Health, Shanghai, People's Republic of China.
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Soscia DA, Sequeira SJ, Schramm RA, Jayarathanam K, Cantara SI, Larsen M, Castracane J. Salivary gland cell differentiation and organization on micropatterned PLGA nanofiber craters. Biomaterials 2013; 34:6773-84. [PMID: 23777914 PMCID: PMC3755621 DOI: 10.1016/j.biomaterials.2013.05.061] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/24/2013] [Indexed: 12/20/2022]
Abstract
There is a need for an artificial salivary gland as a long-term remedy for patients suffering from salivary hypofunction, a leading cause of chronic xerostomia (dry mouth). Current salivary gland tissue engineering approaches are limited in that they either lack sufficient physical cues and surface area needed to facilitate epithelial cell differentiation, or they fail to provide a mechanism for assembling an interconnected branched network of cells. We have developed highly-ordered arrays of curved hemispherical "craters" in polydimethylsiloxane (PDMS) using wafer-level integrated circuit (IC) fabrication processes, and lined them with electrospun poly-lactic-co-glycolic acid (PLGA) nanofibers, designed to mimic the three-dimensional (3-D) in vivo architecture of the basement membrane surrounding spherical acini of salivary gland epithelial cells. These micropatterned scaffolds provide a method for engineering increased surface area and were additionally investigated for their ability to promote cell polarization. Two immortalized salivary gland cell lines (SIMS, ductal and Par-C10, acinar) were cultured on fibrous crater arrays of various radii and compared with those grown on flat PLGA nanofiber substrates, and in 3-D Matrigel. It was found that by increasing crater curvature, the average height of the cell monolayer of SIMS cells and to a lesser extent, Par-C10 cells, increased to a maximum similar to that seen in cells grown in 3-D Matrigel. Increasing curvature resulted in higher expression levels of tight junction protein occludin in both cell lines, but did not induce a change in expression of adherens junction protein E-cadherin. Additionally, increasing curvature promoted polarity of both cell lines, as a greater apical localization of occludin was seen in cells on substrates of higher curvature. Lastly, substrate curvature increased expression of the water channel protein aquaporin-5 (Aqp-5) in Par-C10 cells, suggesting that curved nanofiber substrates are more suitable for promoting differentiation of salivary gland cells.
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Affiliation(s)
- David A. Soscia
- College of Nanoscale Science and Engineering, University at Albany, State University of New York, 257 Fuller Road, Albany, NY 12203, USA
| | - Sharon J. Sequeira
- Dept. of Biological Sciences, University at Albany, State University of New York, 1400 Washington Avenue, Life Sciences Bldg., Albany, NY 12222, USA
| | - Robert A. Schramm
- College of Nanoscale Science and Engineering, University at Albany, State University of New York, 257 Fuller Road, Albany, NY 12203, USA
| | - Kavitha Jayarathanam
- College of Nanoscale Science and Engineering, University at Albany, State University of New York, 257 Fuller Road, Albany, NY 12203, USA
| | - Shraddha I. Cantara
- Dept. of Biological Sciences, University at Albany, State University of New York, 1400 Washington Avenue, Life Sciences Bldg., Albany, NY 12222, USA
| | - Melinda Larsen
- Dept. of Biological Sciences, University at Albany, State University of New York, 1400 Washington Avenue, Life Sciences Bldg., Albany, NY 12222, USA
| | - James Castracane
- College of Nanoscale Science and Engineering, University at Albany, State University of New York, 257 Fuller Road, Albany, NY 12203, USA
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Jean-Gilles R, Soscia D, Sequeira S, Melfi M, Gadre A, Castracane J, Larsen M. Novel Modeling Approach to Generate a Polymeric Nanofiber Scaffold for Salivary Gland Cells. J Nanotechnol Eng Med 2010; 1:31008. [PMID: 22229076 DOI: 10.1115/1.4001744] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND: Electrospun nanofibers have been utilized in many biomedical applications as biomimetics of extracellular matrix proteins that promote self-organization of cells into 3D tissue constructs. As progress towards an artificial salivary gland tissue construct, we prepared nanofiber scaffolds using PLGA, a biodegradable and biocompatible material. METHOD OF APPROACH: We used electrospinning to prepare nanofiber scaffolds using PLGA with both DMF and HFIP as solvents. Using a design of experiment (DOE) approach, system and process parameters were optimized concurrently and their effects on the diameter of the resulting fibers were computed into a single model. A transfer function was used to reproducibly produce nanofibers of a defined diameter, which was confirmed by SEM. The mouse salivary gland epithelial cell line, SIMS, was seeded on the nanofiber scaffolds, and morphology, cell proliferation, and viability were assayed. RESULTS: Varying two or more parameters simultaneously yielded trends diverging from the linear response predicted by previous studies. Comparison of two solvents revealed that the diameter of PLGA nanofibers generated using HFIP is less sensitive to changes in the system and process parameters than are fibers generated using DMF. Inclusion of NaCl reduced morphological inconsistencies and minimized process variability. The resulting nanofiber scaffolds supported attachment, survival and cell proliferation of a mouse salivary gland epithelial cell line. In comparison with glass and flat PLGA films, the nanofibers promoted self-organization of the salivary gland cells into 3D cell clusters, or aggregates. CONCLUSIONS: These data indicate that nanofiber scaffolds promote salivary gland cell organization, and suggest that a nanofiber scaffold could provide a platform for engineering of an artificial salivary gland tissue construct. This study additionally provides a method for efficient production of nanofiber scaffolds for general application in tissue engineering.
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Flink H, Bergdahl M, Tegelberg Å, Rosenblad A, Lagerlöf F. Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults. Community Dent Oral Epidemiol 2008; 36:523-31. [DOI: 10.1111/j.1600-0528.2008.00432.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mignogna MD, Fedele S, Lo Russo L, Lo Muzio L, Wolff A. Sjögren's syndrome: the diagnostic potential of early oral manifestations preceding hyposalivation/xerostomia. J Oral Pathol Med 2005; 34:1-6. [PMID: 15610399 DOI: 10.1111/j.1600-0714.2004.00264.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainly the salivary and lacrimal glands, leading to progressive reduction in saliva and tear flow. Although the underlying immuno-mediated glandular destruction is thought to develop slowly over several years, a long delay from the start of the symptoms to final diagnosis has been frequently reported. A limited knowledge concerning SS natural history is among the major causes of the actual diagnostic delay. Although very few studies have been focused on the analysis of SS early clinical onset, a series of oral features preceding xerostomia/hyposalivation development in patients eventually diagnosed as having SS have been reported. Sialochemistry alterations, salivary gland swelling, early dental loss and sialorrhea have been observed before the onset of typical signs and symptoms (namely xerostomia and/or hyposalivation), which usually lead to SS clinical presentation and diagnosis. Here we suggest, after evaluating available data, that the traditional 'untouchable' association between SS and xerostomia/hyposalivation might probably be reconsidered, and that astute clinicians should not underestimate the possible presence or development of SS in patients without xerostomia/hyposalivation and presenting these atypical early oral features.
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Affiliation(s)
- M D Mignogna
- Department of Odontostomatological and Maxillofacial Sciences, Section of Oral Medicine, University of Naples Federico II, Naples, Italy.
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Pedersen AML, Bardow A, Nauntofte B. Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjogren's syndrome. BMC Clin Pathol 2005; 5:4. [PMID: 15740617 PMCID: PMC554998 DOI: 10.1186/1472-6890-5-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 03/01/2005] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: the classification criteria for primary Sjogren's syndrome (pSS) include a number of oral components. In this study we evaluated if salivary flow and composition as well as dental caries are oral markers of disease severity in pSS. METHODS: in 20 patients fulfilling the American-European Consensus criteria for pSS and 20 age-matched healthy controls whole and parotid saliva flow rates and composition, measures of oral dryness, scores of decayed, missing and filled tooth surfaces (DMFS), periodontal indices, oral hygiene, and dietary habits were examined. RESULTS: in pSS, salivary flow rates, pH, and buffer capacities were lower, and DMFS, salivary sodium and chloride concentrations higher than in the healthy controls. DMFS also correlated inversely to salivary flow rates and positively to oral dryness. Apart from slightly increased gingival index, and more frequent dental visits in pSS, the periodontal condition, oral hygiene or sugar intake did not differ between these two groups. In pSS, findings were correlated to labial salivary gland focus score (FS) and presence of serum-autoantibodies to SSA/SSB (AB). The patients having both presence of AB and the highest FS (>2) also had the highest salivary sodium and chloride concentrations, the lowest salivary phosphate concentrations, lowest salivary flow rates, and highest DMFS compared to those with normal salivary concentrations of sodium and chloride at a given flow rate. CONCLUSION: the salivary changes observed in some pSS patients reflect impaired ductal salt reabsorption, but unaffected acinar transport mechanisms, despite low salivary secretion. Our results suggest that changes in salivary flow and composition as well as dental caries may serve as potential markers of the extent of autoimmune-mediated salivary gland dysfunction in pSS. The study also indicates that the ductal epithelium is functionally affected in some pSS patients, which calls for future pathophysiological studies on the mechanisms underlying this impaired salt reabsorption.
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Affiliation(s)
- Anne Marie Lynge Pedersen
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, and Copenhagen Gerodontological Research Centre, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, 2200 Copenhagen N, Denmark
| | - Allan Bardow
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, and Copenhagen Gerodontological Research Centre, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, 2200 Copenhagen N, Denmark
| | - Birgitte Nauntofte
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, and Copenhagen Gerodontological Research Centre, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, 2200 Copenhagen N, Denmark
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Flink H, Tegelberg A, Lagerlöf F. Influence of the time of measurement of unstimulated human whole saliva on the diagnosis of hyposalivation. Arch Oral Biol 2004; 50:553-9. [PMID: 15848148 DOI: 10.1016/j.archoralbio.2004.10.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 10/28/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVE An unstimulated whole saliva flow rate (UWSFR) of less than 0.1 mL/min is often related to symptoms of dry mouth. It is also used as a diagnostic criterion for Sjogren's syndrome, and for assessment of hyposalivation as a caries risk factor. The main hypothesis was that the circadian rhythm of salivary flow affects this diagnosis if saliva is collected at different morning time-points. DESIGN UWSFR was tested at 7:30 and 11:30 a.m. in 108 individuals, age 15-46 years (mean 33+/-9). The participants were allocated to one of three groups (very low< or =0. 1/min, low 0.1-0.2 mL/min and normal>0.2 mL/min) based on the UWSFR at 7:30 a.m. Different aspects of the perception of oral dryness were rated using Visual Analog Scales. RESULTS All three groups displayed a statistically significant increase in UWSFR at 11:30 a.m. compared with 7:30 a.m., all of similar magnitude (0.08-0.09 mL/min). In the group with very low UWSFR, 70% at 11:30 a.m. exceeded the 0.1 mL/min limit. There were significant difference in perception of oral dryness between the normal group and both the low and the very low groups. Only the subjects in the groups with a low or very low UWSFR perceived an increase in oral wetness at 11:30 a.m. CONCLUSIONS It was concluded that the time of measurement strongly influences the diagnosis of hyposalivation. To control the influence of variations in the time of saliva collection, we suggest that unstimulated whole saliva tests are performed at a fixed time-point or in a limited time interval early in the morning.
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Affiliation(s)
- H Flink
- Center for Clinical Research, Uppsala University, Central Hospital, SE-721 89 Västerås, Sweden.
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Vitale S, Goodman LA, Reed GF, Smith JA. Comparison of the NEI-VFQ and OSDI questionnaires in patients with Sjögren's syndrome-related dry eye. Health Qual Life Outcomes 2004; 2:44. [PMID: 15341657 PMCID: PMC517949 DOI: 10.1186/1477-7525-2-44] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 09/01/2004] [Indexed: 11/21/2022] Open
Abstract
Background To examine the associations between vision-targeted health-related quality of life (VT-HRQ) and ocular surface parameters in patients with Sjögren's syndrome, a systemic autoimmune disease characterized by dry eye and dry mouth. Methods Forty-two patients fulfilling European / American diagnostic criteria for Sjögren's syndrome underwent Schirmer testing without anesthesia, ocular surface vital dye staining; and measurement of tear film breakup time (TBUT). Subjects were administered the Ocular Surface Disease Index (OSDI) and the 25-item National Eye Institute Vision Functioning Questionnaire (NEI-VFQ). Main outcome measures included ocular surface parameters, OSDI subscales describing ocular discomfort (OSDI-symptoms), vision-related function (OSDI-function), and environmental triggers, and NEI-VFQ subscales. Results Participants (aged 31–81 y; 95% female) all had moderate to severe dry eye. Associations of OSDI subscales with the ocular parameters were modest (Spearman r (ρ) < 0.22) and not statistically significant. Associations of NEI-VFQ subscales with the ocular parameters reached borderline significance for the near vision subscale with TBUT (ρ = 0.32, p = .05) and for the distance vision subscale with van Bijsterveld score (ρ = 0.33, p = .04). The strongest associations of the two questionnaires were for: ocular pain and mental function with OSDI-symptoms (ρ = 0.60 and 0.45, respectively); and general vision, ocular pain, mental function, role function, and driving with OSDI-function (ρ = 0.60, 0.50, 0.61, 0.64, 0.57, and 0.67, respectively). Conclusions Associations between conventional objective measures of dry eye and VT-HRQ were modest. The generic NEI-VFQ was similar to the disease-specific OSDI in its ability to measure the impact of Sjögren's syndrome-related dry eye on VT-HRQ.
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Affiliation(s)
- Susan Vitale
- Division of Epidemiology and Clinical Research, National Eye Institute, Building 31, room 6A52, 31 Center Drive, MSC 2510, Bethesda, Maryland, USA
| | - Linda A Goodman
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - George F Reed
- Division of Epidemiology and Clinical Research, National Eye Institute, Building 31, room 6A52, 31 Center Drive, MSC 2510, Bethesda, Maryland, USA
| | - Janine A Smith
- Division of Epidemiology and Clinical Research, National Eye Institute, Building 31, room 6A52, 31 Center Drive, MSC 2510, Bethesda, Maryland, USA
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis 2002; 8:117-29. [PMID: 12108756 DOI: 10.1034/j.1601-0825.2002.02851.x] [Citation(s) in RCA: 429] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Saliva has multiple essential functions in relation to the digestive process taking place in the upper parts of the gastrointestinal (GI) tract. This paper reviews the role of human saliva and its compositional elements in relation to the GI functions of taste, mastication, bolus formation, enzymatic digestion, and swallowing. The indirect function of saliva in the digestive process that includes maintenance of an intact dentition and mucosa is also reviewed. Finally, pathophysiological considerations of salivary dysfunction in relation to some GI functions are considered.
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Affiliation(s)
- A M Pedersen
- Copenhagen Gerodontological Oral Health Research Centre, Department of Clinical Oral Physiology, Anatomy, Pathology and Medicine, School of Dentistry, Denmark
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