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Coggins JM, Saito MH, Cook R, Urata S, Urata M, Harsell NL, Tan WN, Figueira BT, Bradley M, Quadri NZ, Saripada JAI, Reyna RA, Maruyama J, Paessler S, Makishima T. Histopathology of the Tongue in a Hamster Model of COVID-19. RESEARCH SQUARE 2024:rs.3.rs-4590482. [PMID: 39011098 PMCID: PMC11247945 DOI: 10.21203/rs.3.rs-4590482/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Objective With altered sense of taste being a common symptom of coronavirus disease 2019 (COVID-19), our objective was to investigate the presence and distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) within the tongue over the course of infection. Methods Golden Syrian hamsters were inoculated intranasally with SARS-CoV-2 and tongues were collected at 2, 3, 5, 8, 17, 21, 35, and 42 days post-infection (dpi) for analysis. In order to test for gross changes in the tongue, the papillae of the tongue were counted. Paraffin-embedded thin sections of the tongues were labeled for the presence of SARS-CoV-2 antigen. Results There was no difference in fungiform or filiform papillae density throughout the course of infection. SARS-CoV-2 antigen was observed in the circumvallate papillae taste buds (3-35 dpi) and autonomic ganglia (5-35 dpi), as well as in the serous and mucous salivary glands of the posterior tongue (2-42 dpi). Conclusion The presence and distribution of SARS-CoV-2 suggest that the virus could cause taste disturbance by infecting the circumvallate taste buds. This effect could be exacerbated by a diminished secretion of saliva caused by infection of the serous salivary glands and the autonomic ganglia which innervate them.
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Sasso-Cerri E, Martinelli VD, de Oliveira SA, da Silva AAS, de Moraes JCG, Cerri PS. Submandibular Gland Pathogenesis Following SARS-CoV-2 Infection and Implications for Xerostomia. Int J Mol Sci 2024; 25:6820. [PMID: 38999930 PMCID: PMC11241347 DOI: 10.3390/ijms25136820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 07/14/2024] Open
Abstract
Although SARS-CoV-2 induces mucin hypersecretion in the respiratory tract, hyposalivation/xerostomia has been reported by COVID-19 patients. We evaluate the submandibular gland (SMGs) pathogenesis in SARS-CoV-2-infected K18-hACE2 mice, focusing on the impact of infection on the mucin production and structural integrity of acini, ductal system, myoepithelial cells (MECs) and telocytes. The spike protein, the nucleocapsid protein, hACE2, actin, EGF, TNF-α and IL-1β were detected by immunofluorescence, and the Egfr and Muc5b expression was evaluated. In the infected animals, significant acinar hypertrophy was observed in contrast to ductal atrophy. Nucleocapsid proteins and/or viral particles were detected in the SMG cells, mainly in the nuclear membrane-derived vesicles, confirming the nuclear role in the viral formation. The acinar cells showed intense TNF-α and IL-1β immunoexpression, and the EGF-EGFR signaling increased, together with Muc5b upregulation. This finding explains mucin hypersecretion and acinar hypertrophy, which compress the ducts. Dying MECs and actin reduction were also observed, indicating failure of contraction and acinar support, favoring acinar hypertrophy. Viral assembly was found in the dying telocytes, pointing to these intercommunicating cells as viral transmitters in SMGs. Therefore, EGF-EGFR-induced mucin hypersecretion was triggered by SARS-CoV-2 in acinar cells, likely mediated by cytokines. The damage to telocytes and MECs may have favored the acinar hypertrophy, leading to ductal obstruction, explaining xerostomia in COVID-19 patients. Thus, acinar cells, telocytes and MECs may be viral targets, which favor replication and cell-to-cell viral transmission in the SMG, corroborating the high viral load in saliva of infected individuals.
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Affiliation(s)
- Estela Sasso-Cerri
- Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School–São Paulo State University (UNESP), Araraquara 14801-903, Brazil; (V.D.M.); (J.C.G.d.M.)
| | - Vitor Dallacqua Martinelli
- Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School–São Paulo State University (UNESP), Araraquara 14801-903, Brazil; (V.D.M.); (J.C.G.d.M.)
| | - Salmo Azambuja de Oliveira
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo 04023-900, Brazil; (S.A.d.O.); (A.A.S.d.S.)
| | - André Acácio Souza da Silva
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo 04023-900, Brazil; (S.A.d.O.); (A.A.S.d.S.)
| | - Juliana Cerini Grassi de Moraes
- Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School–São Paulo State University (UNESP), Araraquara 14801-903, Brazil; (V.D.M.); (J.C.G.d.M.)
| | - Paulo Sérgio Cerri
- Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School–São Paulo State University (UNESP), Araraquara 14801-903, Brazil; (V.D.M.); (J.C.G.d.M.)
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Sedighi L, Khari S, Hasheminik M, Salimi Akinabadi A, Alipour H, Shafigh E, Shafigh N. The effect of artificial saliva on the control of dry mouth: a semi-experimental study on COVID-19 patients under Non-invasive mechanical ventilation. BMC Oral Health 2024; 24:643. [PMID: 38822326 PMCID: PMC11140887 DOI: 10.1186/s12903-024-04386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/20/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES Since maintaining oral hygiene is essential in nursing care, the present study was conducted to determine the effect of oral care using Mucosamin artificial saliva spray to control dry mouth in ICU patients with COVID-19. MATERIALS AND METHODS The current semi-experimental research was conducted on eighty patients with COVID-19 selected using the available sampling method. The study tool was a Beck oral assessment scale (BOAS). The case and control groups were selected from two hospitals with relatively similar conditions and treatment procedures. For patients in the intervention group, mucosamin artificial saliva spray was used in addition to the common care, while control group patients received only common care. RESULTS Eighty patients were randomly assigned to two groups named control and intervention (40 patients in each group). The intervention was very effective in reducing the BOAS score after four days in comparison with the control group (9.23 vs. 12.05, respectively; p-value < 0.001). Based on the adjusted model, the application of artificial saliva reduced the BOAS score, indicating improvement in mouth dryness. While the BOAS score was increased in the control group, it had a declining trend in the intervention one. CONCLUSION The study's results showed that using artificial saliva spray could effectively reduce the symptoms of dry mouth in patients with COVID-19 treated with non-invasive mechanical ventilation. CLINICAL RELEVANCE The present study introduced an applicable solution (artificial saliva) to treat mouth dryness in ICU patients under mechanical ventilation.
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Affiliation(s)
- Ladan Sedighi
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Clinical Research Development Center, Shahid Modarres Educational hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sorour Khari
- Master of Critical Care Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Hasheminik
- Department of Nursing, Sabzevar Branch, Islamic Azad University, Sabzevar, Iran
| | - Atefe Salimi Akinabadi
- Master of Medical Surgical Nursing, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Haleh Alipour
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Shafigh
- Operative Dentistry Department, Faculty of Dentistry, AJA University of Medical Sciences, Tehran, Iran
| | - Navid Shafigh
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Novianti Y, Hidayat W, Rosa DE. Severe Xerostomia Induced by Multiple Systemic Diseases in a Patient with Psoriasis Vulgaris: A Case Report and Literature Review. Int Med Case Rep J 2024; 17:77-88. [PMID: 38314323 PMCID: PMC10838493 DOI: 10.2147/imcrj.s453097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/26/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Psoriasis is a complex autoimmune disease associated with chronic systemic keratinization and inflammation, which can affect the skin, joints, and oral cavity. Xerostomia is a subjective feeling of oral dryness that impairs patient comfort and lowers the quality of life. The aim of this case report is to describe the clinical mechanism of xerostomia in a psoriasis patient with multiple systemic diseases. Case Report A 51-year-old inpatient man with psoriasis vulgaris was referred to the Oral Medicine Department with complaints of difficulty swallowing due to a sore throat and dry tongue since last week. The patient had psoriasis vulgaris 15 years ago, chronic adrenal insufficiency, psoriatic arthritis, acute circulatory collapse, anemia of inflammation, acute kidney injury, dehydration, gastritis, urinary tract infections, and malnutrition. A complete anamnesis and oral examination were done. The patient was diagnosed with severe xerostomia, a fissured tongue, exfoliative cheilitis, angular cheilitis, and gingivitis by the Oral Medicine Department. Case Management The patient was treated with petroleum jelly, chlorine dioxide mouthwash, miconazole cream, and benzydamine HCl lozenges. Conclusion Based on case reports and reviews, multiple systemic diseases may not only increase the risk of xerostomia but also aggravate its severity.
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Affiliation(s)
- Yessy Novianti
- Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Wahyu Hidayat
- Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Desi Elvhira Rosa
- Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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Jain A, Lamperti M, Lobo FA. Renin-Angiotensin-Aldosterone System Imbalance and Altered Aquaporin Activity: A New Perspective for COVID-19-Associated Xerostomia. EAR, NOSE & THROAT JOURNAL 2023; 102:NP574-NP575. [PMID: 34233506 DOI: 10.1177/01455613211030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Amit Jain
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Francisco A Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Guauque-Olarte S, Cifuentes-C L, Fong C. Oral manifestations in patients with coronavirus disease 2019 (COVID-19) identified using text mining: an observational study. Sci Rep 2023; 13:17770. [PMID: 37853031 PMCID: PMC10584950 DOI: 10.1038/s41598-023-44784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
Text mining enables search, extraction, categorisation and information visualisation. This study aimed to identify oral manifestations in patients with COVID-19 using text mining to facilitate extracting relevant clinical information from a large set of publications. A list of publications from the open-access COVID-19 Open Research Dataset was downloaded using keywords related to oral health and dentistry. A total of 694,366 documents were retrieved. Filtering the articles using text mining yielded 1,554 oral health/dentistry papers. The list of articles was classified into five topics after applying a Latent Dirichlet Allocation (LDA) model. This classification was compared to the author's classification which yielded 17 categories. After a full-text review of articles in the category "Oral manifestations in patients with COVID-19", eight papers were selected to extract data. The most frequent oral manifestations were xerostomia (n = 405, 17.8%) and mouth pain or swelling (n = 289, 12.7%). These oral manifestations in patients with COVID-19 must be considered with other symptoms to diminish the risk of dentist-patient infection.
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Affiliation(s)
| | - Laura Cifuentes-C
- Faculty of Dentistry, Universidad Cooperativa de Colombia, Pasto, Colombia
| | - Cristian Fong
- Faculty of Medicine, Universidad Cooperativa de Colombia, Santa Marta, Colombia
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Tsuchiya H. Treatments of COVID-19-Associated Taste and Saliva Secretory Disorders. Dent J (Basel) 2023; 11:140. [PMID: 37366663 DOI: 10.3390/dj11060140] [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: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Since the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, treating taste and saliva secretory disorders associated with coronavirus disease 2019 (COVID-19) has become a critical issue. The aim of the present study was to update information on treatments applicable to such oral symptoms and discuss their pathogenic mechanisms. The literature search indicated that different treatments using tetracycline, corticosteroids, zinc, stellate ganglion block, phytochemical curcumin, traditional herbal medicine, nutraceutical vitamin D, photobiomodulation, antiviral drugs, malic acid sialagogue, chewing gum, acupuncture, and/or moxibustion have potential effects on COVID-19-associated ageusia/dysgeusia/hypogeusia and xerostomia/dry mouth/hyposalivation. These treatments have multiple modes of action on viral cellular entry and replication, cell proliferation and differentiation, immunity, and/or SARS-CoV-2 infection-induced pathological conditions such as inflammation, cytokine storm, pyroptosis, neuropathy, zinc dyshomeostasis, and dysautonomia. An understanding of currently available treatment options is required for dental professionals because they may treat patients who were infected with SARS-CoV-2 or who recovered from COVID-19, and become aware of their abnormal taste and salivary secretion. By doing so, dentists and dental hygienists could play a crucial role in managing COVID-19 oral symptoms and contribute to improving the oral health-related quality of life of the relevant patients.
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Affiliation(s)
- Hironori Tsuchiya
- Department of Dental Basic Education, Asahi University School of Dentistry, Mizuho, Gifu 501-0296, Japan
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MOHAMMED FARAZ, FAIROZEKHAN ARISHIYATHAPASUM, MOHAMED SHAMAZ, ALMOUMEN SAUDABDULLAH, BUGSHAN AMRS, ALMOMEN ZAINABI, ALMOMEN AMINAHMOHAMMAD, M SHASHIKIRAN, ALMULHIM KHALIDS. Oral manifestations associated with Novel Coronavirus Disease - 2019 (COVID-19): A questionnaire based hypothetical study. F1000Res 2023; 11:1443. [PMID: 37360936 PMCID: PMC10285348 DOI: 10.12688/f1000research.128125.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Since the Coronavirus disease 2019 (COVID-19) outbreak in 2019, the virus has evolved drastically, presenting with sets of mutations that influence its properties, including transmissibility and antigenicity. The oral mucosa is postulated as probable portal entry and several oral manifestations have been identified, which places dental professionals in a position to recognize probable COVID-19 patients depending on oral signs and symptoms in the initial phases of the disease itself. As co-existing with COVID-19 seems to be a new reality, greater understanding is required regarding early oral signs and symptoms which can be predictors for timely intervention and prevention of complications in COVID-19 patients. The objective of the study is to identify the distinguishing oral signs and symptoms among COVID-19 patients and to establish possible correlation between severity of COVID-19 infection and oral symptoms. Methods: This study recruited 179 ambulatory, non-hospitalized COVID-19 patients from the Kingdom of Saudi Arabia's Eastern Province's designated hotels for COVID-19 and home isolated patients from the same region using a convenience sample method. Data was collected by qualified and experienced investigators, including two physicians and three dentists, using a validated comprehensive questionnaire through telephonic interviews with the participants. The X 2 was used to assess the categorical variables, and odd's ratio was calculated to determine the strength of the association between general symptoms and oral manifestations. Results: Oral and nasopharyngeal lesions or conditions like loss of smell and taste, xerostomia, sore throat, and burning sensation were predictors of COVID-19-related systemic symptoms such as cough, fatigue, fever, and nasal congestion were identified to be statistically significant (p<0.05). Conclusions: The study reveals the occurrence of olfactory or taste dysfunction, dry mouth, sore throat, and burning sensation along with COVID-19 generic symptoms, should be considered as suggestive yet not conclusive indicators of COVID-19.
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Affiliation(s)
- FARAZ MOHAMMED
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, P.O. Box 1982, Saudi Arabia
| | - ARISHIYA THAPASUM FAIROZEKHAN
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, P.O. Box 1982, Saudi Arabia
| | - SHAMAZ MOHAMED
- Senior Manager, BioQuest Solutions Pvt Ltd, Bangalore, Karnataka, India
| | - SAUD ABDULLAH ALMOUMEN
- Oral & Maxillofacial Surgery - Dental Division, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
- Postgraduate Scholar, Oral & Maxillofacial Surgery, Riyadh Elm University, Riyadh, Saudi Arabia
| | - AMR S. BUGSHAN
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, P.O. Box 1982, Saudi Arabia
| | - ZAINAB I. ALMOMEN
- Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, P.O. Box 1982, Saudi Arabia
| | | | - SHASHI KIRAN M
- Manager, BioQuest Solutions Pvt Ltd, Bangalore, Karnataka, India
| | - KHALID S. ALMULHIM
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
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Hamed SA. Post-COVID-19 persistent olfactory, gustatory, and trigeminal chemosensory disorders: Definitions, mechanisms, and potential treatments. World J Otorhinolaryngol 2023; 10:4-22. [DOI: 10.5319/wjo.v10.i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023] Open
Abstract
The nose and the oral cavities are the main sites for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry into the body. Smell and taste deficits are the most common acute viral manifestations. Persistent smell disorders are the most common and bothersome complications after SARS-CoV-2 infection, lasting for months to years. The mechanisms and treatment of persistent post-coronavirus disease 2019 (COVID-19) smell and taste disorders are still challenges. Information sources for the review are PubMed, Centers for Disease Control and Prevention, Ovid Medline, Embase, Scopus, Web of Science, International Prospective Register of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Elton Bryson Stephens Company, Cochrane Effective Practice and Organization of Care, Cooperation in Science and Technology, International Clinical Trials Registry Platform, World Health Organization, Randomized Controlled Trial Number Registry, and MediFind. This review summarizes the up-to-date information about the prevalence, patterns at onset, and prognoses of post-COVID-19 smell and taste disorders, evidence for the neurotropism of SARS-CoV-2 and the overlap between SARS-CoV-1, Middle East respiratory syndrome coronavirus, and SARS-CoV-2 in structure, molecular biology, mode of replication, and host pathogenicity, the suggested cellular and molecular mechanisms for these post-COVID19 chemosensory disorders, and the applied pharmacotherapies and interventions as trials to treat these disorders, and the recommendations for future research to improve understanding of predictors and mechanisms of these disorders. These are crucial for hopeful proper treatment strategies.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
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Saleem MK, Lal A, Ahmed N, Abbasi MS, Vohra F, Abduljabbar T. Oral health related quality of life and the prevalence of ageusia and xerostomia in active and recovered COVID-19 Patients. PeerJ 2023; 11:e14860. [PMID: 36908817 PMCID: PMC9997189 DOI: 10.7717/peerj.14860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 01/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background Salivary disturbance is associated with patients who either have an active coronavirus disease 2019 (COVID-19) or have recovered from coronavirus infection along with loss of taste sensation. In addition, COVID-19 infection can drastically compromise quality of life of individuals. Objective This study aimed to analyze xerostomia, ageusia and the oral health impact in coronavirus disease-19 patients utilizing the Xerostomia Inventory scale-(XI) and the Oral Health Impact Profile-14. Methods In this cross-sectional survey-based study, data was collected from 301 patients who suffered and recovered from COVID-19. Using Google Forms, a questionnaire was developed and circulated amongst those who were infected and recovered from coronavirus infection. The Xerostomia Inventory (XI) and Oral Health Impact Profile-14 were used to assess the degree and quality of life. A paired T-test and Chi-square test were used to analyze the effect on xerostomia inventory scale-(XI) and OHIP-14 scale scores. A p-value of 0.05 was considered as statistically significant. Results Among 301 participants, 54.8% were females. The prevalence of xerostomia in participants with active COVID-19 disease was 39.53% and after recovery 34.88%. The total OHIP-14 scores for patients in the active phase of infection was 12.09, while 12.68 in recovered patients. A significant difference was found between the mean scores of the xerostomia inventory scale-11 and OHIP-14 in active and recovered COVID patients. Conclusion A higher prevalence of xerostomia was found in COVID-19 infected patients (39.53%) compared to recovered patients (34.88%). In addition, more than 70% reported aguesia. COVID-19 had a significantly higher compromising impact on oral function of active infected patients compared to recovered patients.
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Affiliation(s)
- Mahnoor K.M. Saleem
- Prosthodontics Department, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Abhishek Lal
- Prosthodontics Department, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Naseer Ahmed
- Prosthodontics Department, Altamash Institute of Dental Medicine, Karachi, Pakistan
- Prosthodontics Department, University Sains Malaysia, Kelantan, Malaysia
| | - Maria S. Abbasi
- Prosthodontics Department, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Fahim Vohra
- Prosthetic Dental Sceinces, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Abduljabbar
- Prosthetic Dental Sceinces, King Saud University, Riyadh, Saudi Arabia
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Wadhwa S, Yoon A, Kister K, Bolin I, Chintalapudi N, Besmer A, Cantos A, Shah J, Gaitonde S, Granger S, Bryce C, Fischer R, Eisig S, Yin M. Detection of SARS-CoV-2 IgG antibodies and inflammatory cytokines in saliva-a pilot study. J Oral Biol Craniofac Res 2023; 13:267-271. [PMID: 36846089 PMCID: PMC9937664 DOI: 10.1016/j.jobcr.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Objective The pandemic caused by SARS-CoV-2 virus continues to have a profound effect worldwide. However, COVID-19 induced oral facial manifestations have not been fully described. We conducted a prospective study to demonstrate feasibility of anti-SARS-CoV-2 IgG and inflammatory cytokine detection in saliva. Our primary objective was to determine whether COVID-19 PCR positive patients with xerostomia or loss of taste had altered serum or saliva cytokine levels compared to COVID-19 PCR positive patients without those oral symptoms. Our secondary objective was to determine the correlation between serum and saliva COVID-19 antibody levels. Materials and methods For cytokine analysis, saliva and serum were obtained from 17 participants with PCR-confirmed COVID-19 infection at three sequential time points, yielding 48 saliva samples and 19 paired saliva-serum samples from 14 of the 17 patients. For COVID-19 antibody analyses, an additional 27 paired saliva-serum samples from 22 patients were purchased. Results The saliva antibody assay had 88.64% sensitivity [95% Confidence Interval (CI) 75.44%, 96.21%] to detect SARS-CoV-2 IgG antibodies compared to serum antibody. Among the inflammatory cytokines assessed - IL-6, TNF-α, IFN-γ, IL-10, IL-12p70, IL-1β, IL-8, IL-13, IL-2, IL-5, IL-7 and IL-17A, xerostomia correlated with lower levels of saliva IL-2 and TNF-α, and elevated levels of serum IL-12p70 and IL-10 (p < 0.05). Loss of taste was observed in patients with elevated serum IL-8 (p < 0.05). Conclusions Further studies are needed to construct a robust saliva-based COVID-19 assay to assess antibody and inflammatory cytokine response, which has potential utility as a non-invasive monitoring modality during COVID-19 convalescence.
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Affiliation(s)
- S. Wadhwa
- Division of Orthodontics, Columbia University Irving Medical Center, New York, NY, USA
| | - A.J. Yoon
- Division of Oral & Maxillofacial Pathology and Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - K. Kister
- Division of Orthodontics, Columbia University Irving Medical Center, New York, NY, USA
| | - I. Bolin
- Division of Orthodontics, Columbia University Irving Medical Center, New York, NY, USA
| | - N. Chintalapudi
- Division of Orthodontics, Columbia University Irving Medical Center, New York, NY, USA
| | - A. Besmer
- Division of Orthodontics, Columbia University Irving Medical Center, New York, NY, USA
| | - A. Cantos
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
| | - J. Shah
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - C. Bryce
- Salimetrics, LLC, Carlsbad, CA, USA
| | | | - S.B. Eisig
- Division of Oral & Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - M.T. Yin
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
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Tripathi V, Bundel R, Mandal CC. Effect of environmental factors on SARS-CoV-2 infectivity in northern hemisphere countries: a 2-year data analysis. Public Health 2022; 208:105-110. [PMID: 35753085 PMCID: PMC9068792 DOI: 10.1016/j.puhe.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The COVID-19 pandemic that emerged in December 2019 brought human life to a standstill. With over 2-year since the pandemic originated from Wuhan, SARS-CoV-2 has caused more than 6 million deaths worldwide. With the emergence of mutant strains and COVID-19 surge waves, it becomes critically important to conduct epidemiological studies that allow us to understand the role of various environmental factors on SARS-CoV-2 infectivity. Our earlier study reported a strong negative correlation between temperature and COVID-19 incidence. This research is an extension of our previous study with an attempt to understand the global analysis of COVID-19 in northern hemisphere countries. STUDY DESIGN This research aims at achieving a better understanding of the correlation of environmental factors such as temperature, sunlight, and humidity with new cases of COVID-19 in northern hemisphere from March 2020 to February 2022. METHODS To understand the relationship between the different environmental variants and COVID-19, a statistical approach was employed using Pearson, Spearman and Kendall analysis. RESULTS Month-wise univariate analysis indicated a strong negative correlation of temperature and sunlight with SARS-CoV-2 infectivity, whereas inconsistencies were observed in correlation analysis in the case of humidity in winter months. Moreover, a strong negative correlation between average temperature of winter months and COVID-19 cases exists as evidenced by Pearson, Spearman, and Kendall analyses. In addition, correlation pattern between monthly temperature and COVID-19 cases of a country mimics to that of sunlight of a country. CONCLUSION This pilot study proposes that low temperatures and low sunlight might be additional risk factors for SARS-CoV-2 infectivity, mostly in northern hemisphere countries.
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Affiliation(s)
- Vaishnavi Tripathi
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Rashmi Bundel
- Department of Statistics, University of Rajasthan, Jaipur, Rajasthan, India
| | - Chandi C Mandal
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India.
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Alghamdi SA, Mugri MH, Elamin NMH, Kamil MA, Osman H, Eid BG, Shaik RA, Shaker SS, Alrafiah A. A Possible Novel Protective Effect of Piceatannol against Isoproterenol (ISO)-Induced Histopathological, Histochemical, and Immunohistochemical Changes in Male Wistar Rats. Curr Issues Mol Biol 2022; 44:2505-2528. [PMID: 35735612 PMCID: PMC9221942 DOI: 10.3390/cimb44060171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022] Open
Abstract
Dry mouth is characterized by lower saliva production and changes in saliva composition. In patients with some salivary gland function remaining, pharmaceutical treatments are not recommended; therefore, new, more effective methods of promoting saliva production are needed. Hence, this study aimed to provide an overview of the histological changes in the salivary gland in the model of isoproterenol (ISO)-induced degenerative changes in male Wistar rats and to evaluate the protective effect of piceatannol. Thirty-two male Wistar rats were randomly divided into four groups: the control group, the ISO group, and the piceatannol (PIC)-1, and -2 groups. After the third day of the experiment, Iso (0.8 mg/100 g) was injected intraperitoneally (IP) twice daily into the animals. PIC was given IP in different daily doses (20 and 40 mg/kg) for three days before ISO and seven days with ISO injection. The salivary glands were rapidly dissected and processed for histological, histochemical, immunohistochemical (Ki-67), and morphometric analysis. Upon seven days of treatment with ISO, marked hypertrophy was observed, along with an increased number of positive Ki-67 cells. Proliferation was increased in some endothelial cells as well as in ducts themselves. Despite the significant decrease in proliferation activity, the control group did not return to the usual activity level after treatment with low-dose PIC. Treatment with a high dose of PIC reduced proliferative activity to the point where it was substantially identical to the results seen in the control group. An ISO-driven xerostomia model showed a novel protective effect of piceatannol. A new era of regenerative medicine is dawning around PIC’s promising role.
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Affiliation(s)
- Samar A. Alghamdi
- Department of Oral Biology, Faculty of Dentistry, King AbdulAziz University, Jeddah 22254, Saudi Arabia;
| | - Maryam H. Mugri
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (M.H.M.); (N.M.H.E.)
| | - Nahid M. H. Elamin
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (M.H.M.); (N.M.H.E.)
| | - Mona Awad Kamil
- Department of Preventive Dental Science, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (M.A.K.); (H.O.)
| | - Hind Osman
- Department of Preventive Dental Science, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (M.A.K.); (H.O.)
| | - Basma G. Eid
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King AbdulAziz University, Jeddah 22254, Saudi Arabia; (B.G.E.); (R.A.S.)
| | - Rasheed A. Shaik
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King AbdulAziz University, Jeddah 22254, Saudi Arabia; (B.G.E.); (R.A.S.)
| | - Soad S. Shaker
- Department of Histology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Aziza Alrafiah
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King AbdulAziz University, Jeddah 22254, Saudi Arabia
- Correspondence: ; Tel.: +966-0126401000 (ext. 23495); Fax: +966-0126401000 (ext. 21686)
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Luna-Mazzola I. [Oral manifestations of COVID-19 and the role of the ACE2 receptor: what is known so far?]. REVISTA CIENTÍFICA ODONTOLÓGICA 2022; 10:e108. [PMID: 38389661 PMCID: PMC10880690 DOI: 10.21142/2523-2754-1002-2022-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/16/2022] [Indexed: 02/24/2024] Open
Abstract
COVID-19 is a currently pandemic disease that worries professionals in all areas of the Health Sciences. Current literature indicates that certain components of the stomatognathic system (such as lips, oral mucosa, tongue, and tonsils) express ACE2 receptors, responsible for the binding of SARS-CoV-2 to the human cell. This expression has a big impact on organular compromise, turning the oral cavity not only into an important route of viral entry but also into a region with the possibility of various manifestations such as xerostomia, halitosis, chemosensory alteration, opportunistic coinfection, and mucosal lesions. The fact that mouth manifestations are reported in the early stages of this disease suggests a possible predictive nature, which would make them very useful for diagnostic referral. In this sense, it is important that the dental professional knows how to recognize this early presentation symptomatology, being able to presumptively detect patients with COVID-19 in whom a significant systemic commitment has not yet been consolidated. This would allow the referral to medical consultation for definitive diagnostic purposes and, if correct, prevent both transmission and the advancement of the disease in the patient. Based on this important work, this review article synthesizes the scientific evidence published in the last 3 years (2019-2021 period) about the oral manifestations of COVID-19.
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Affiliation(s)
- Ivo Luna-Mazzola
- Sociedad Científica de Estudiantes de Odontología, Universidad Nacional Mayor de San Marcos. Lima, Perú. Universidad Nacional Mayor de San Marcos Sociedad Científica de Estudiantes de Odontología Universidad Nacional Mayor de San Marcos Lima Peru
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15
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Chibly AM, Aure MH, Patel VN, Hoffman MP. Salivary Gland Function, Development and Regeneration. Physiol Rev 2022; 102:1495-1552. [PMID: 35343828 DOI: 10.1152/physrev.00015.2021] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Salivary glands produce and secrete saliva, which is essential for maintaining oral health and overall health. Understanding both the unique structure and physiological function of salivary glands, as well as how they are affected by disease and injury will direct the development of therapy to repair and regenerate them. Significant recent advances, particularly in the OMICS field, increase our understanding of how salivary glands develop at the cellular, molecular and genetic levels; the signaling pathways involved, the dynamics of progenitor cell lineages in development, homeostasis and regeneration and the role of the extracellular matrix microenvironment. These provide a template for cell and gene therapies as well as bioengineering approaches to repair or regenerate salivary function.
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Affiliation(s)
- Alejandro Martinez Chibly
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Marit H Aure
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Vaishali N Patel
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Matthew Philip Hoffman
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
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Utama R, Hapsari R, Puspitasari I, Sari D, Hendrianingtyas M, Nurainy N. Self-collected gargle specimen as a patient-friendly sample collection method for COVID-19 diagnosis in a population context. Sci Rep 2022; 12:3706. [PMID: 35260654 PMCID: PMC8904449 DOI: 10.1038/s41598-022-07690-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/21/2022] [Indexed: 12/23/2022] Open
Abstract
Scaling up SARS-CoV-2 testing and tracing continues to be plagued with the limitation of the sample collection method, which requires trained healthcare workers to perform and causes discomfort to the patients. In response, we assessed the performance and user preference of gargle specimens for qRT-PCR-based detection of SARS-CoV-2 in Indonesia. Inpatients who had recently been diagnosed with COVID-19 and outpatients who were about to perform qRT-PCR testing were asked to provide nasopharyngeal and oropharyngeal (NPOP) swabs and self-collected gargle specimens. We demonstrated that self-collected gargle specimens can be an alternative specimen to detect SARS-CoV-2 and the viral RNA remained stable for 31 days at room temperature storage. The developed method was validated for use on multiple RNA extraction kits and commercially available COVID-19 RT-PCR kits. Our developed method achieved a sensitivity of 91.38% when compared to paired NPOP swab specimens (Ct < 35), with 97.10% of patients preferring the self-collected gargle method.
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Affiliation(s)
- Revata Utama
- Nusantics, PT. Riset Nusantara Genetika, Jakarta, Indonesia
| | - Rebriarina Hapsari
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.,Diponegoro National Hospital, Semarang, Indonesia
| | - Iva Puspitasari
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.,Central General Hospital Dr. Kariadi, Semarang, Indonesia
| | - Desvita Sari
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.,Central General Hospital Dr. Kariadi, Semarang, Indonesia
| | - Meita Hendrianingtyas
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.,Diponegoro National Hospital, Semarang, Indonesia
| | - Neni Nurainy
- PT. Bio Farma, Development of Translational Biopharmaceutical Products Division, Bandung, Indonesia.
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Tsuchiya H. Gustatory and Saliva Secretory Dysfunctions in COVID-19 Patients with Zinc Deficiency. Life (Basel) 2022; 12:life12030353. [PMID: 35330104 PMCID: PMC8950751 DOI: 10.3390/life12030353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/22/2022] Open
Abstract
Given the ever-progressing studies on coronavirus disease 2019 (COVID-19), it is critical to update our knowledge about COVID-19 symptomatology and pathophysiology. In the present narrative review, oral symptoms were overviewed using the latest data and their pathogenesis was hypothetically speculated. PubMed, LitCovid, ProQuest, and Google Scholar were searched for relevant studies from 1 April 2021 with a cutoff date of 31 January 2022. The literature search indicated that gustatory dysfunction and saliva secretory dysfunction are prevalent in COVID-19 patients and both dysfunctions persist after recovery from the disease, suggesting the pathogenic mechanism common to these cooccurring symptoms. COVID-19 patients are characterized by hypozincemia, in which zinc is possibly redistributed from blood to the liver at the expense of zinc in other tissues. If COVID-19 induces intracellular zinc deficiency, the activity of zinc-metalloenzyme carbonic anhydrase localized in taste buds and salivary glands may be influenced to adversely affect gustatory and saliva secretory functions. Zinc-binding metallothioneins and zinc transporters, which cooperatively control cellular zinc homeostasis, are expressed in oral tissues participating in taste and saliva secretion. Their expression dysregulation associated with COVID-19-induced zinc deficiency may have some effect on oral functions. Zinc supplementation is expected to improve oral symptoms in COVID-19 patients.
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COVID-19 Pandemic and Periodontal Practice: The Immunological, Clinical, and Economic Points of View. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3918980. [PMID: 35047633 PMCID: PMC8763038 DOI: 10.1155/2022/3918980] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022]
Abstract
The recent global health problem, COVID-19, has had far-reaching impacts on lifestyles. Although many effective WHO-approved vaccines have been produced that have reduced the spread and severity of the disease, it appears to persist in humans for a long time and possibly forever as everyday it turns out to have new mutations. COVID-19 involves the lungs and other organs primarily through cytokine storms, which have been implicated in many other inflammatory disorders, including periodontal diseases. COVID-19 is in a close association with dental and periodontal practice from two respects: first, repeated mandatory lockdowns have reduced patient referrals to dentists and limited the dental and periodontal procedures to emergency treatments, whereas it is important to recognize the oral manifestations of COVID-19 as well as the influence of oral and periodontal disease on the severity of COVID-19. Second, dentistry is one of the high-risk professions in terms of close contact with unmasked individuals, necessitating redefining the principles of infection control. The pressures of the economic recession on patients as well as dentists add to the difficulty of resuming elective dental services. Therefore, this study is divided into two parts corresponding to what mentioned above: the first part examines the clinical and immunological associations between COVID-19 and periodontal and oral diseases, and the second part delineates the measures needed to control the disease transmission in dental clinics as well as the economic impact of the pandemic era on dental services.
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Henry A. Welcome to the 17th volume of Future Virology. Future Virol 2022. [DOI: 10.2217/fvl-2021-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Atiya Henry
- Future Science Group, Unitec House, 2 Albert Place, Finchley, London,*0 N3 1QB, UK
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20
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Tsuchiya H. Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review. Dent J (Basel) 2021; 9:dj9110130. [PMID: 34821594 PMCID: PMC8625834 DOI: 10.3390/dj9110130] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19) have become known to present with different oral symptoms. However, xerostomia remains poorly recognized compared with taste dysfunction. For better understanding of COVID-19 symptomatology, xerostomia associated withCOVID-19 was characterized and its possible pathogenesis was speculated by a narrative literature review. Scientific articles were retrieved by searching PubMed, LitCovid, ProQuest, Google Scholar, medRxiv and bioRxiv from 1 April 2020 with a cutoff date of 30 September 2021. Results of the literature search indicated that xerostomia is one of prevalent and persistent oral symptoms associated with COVID-19. In contrast to taste dysfunction, the prevalence and persistence of xerostomia do not necessarily depend on ethnicity, age, gender and disease severity of patients. COVID-19 xerostomia is pathogenically related to viral cellular entry-relevant protein expression, renin-angiotensin system disturbance, salivary gland inflammation, zinc deficiency, cranial neuropathy, intercurrent taste dysfunction, comorbidities and medications. Despite a close association with COVID-19, xerostomia, dry mouth and hyposalivation tend to be overlooked unlike ageusia, dysgeusia and hypogeusia. Although mouth dryness per se is not life-threating, it has an impact on the oral health-related quality of life. More attention should be paid to xerostomia in COVID-19 patients and survivors.
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Therapeutic Strategies for Dry Mouth Management with Emphasis on Electrostimulation as a Treatment Option. Int J Dent 2021; 2021:6043488. [PMID: 34691182 PMCID: PMC8536447 DOI: 10.1155/2021/6043488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives Xerostomia is a subjective sensation of dry mouth. It is commonly associated with salivary gland hypofunction. Both changes in the composition of the saliva and a reduction in the quantity secreted may be an objective finding of dry mouth. Although there are no currently available cures for the conditions resulting in dry mouth, there are several treatment options that give hope for patients who suffer from xerostomia. Individuals with some residual salivary gland function, which are contraindicated to pharmacological therapies, would benefit the most from identifying novel, alternative effective methods for stimulating production of saliva. The aim of this study was to give an overview of the latest and most relevant data related to treatment modalities for the management of dry mouth conditions. Data Resources and Study Selection. The present review was prepared by searching the National Library of Medicine database using the relevant medical terms and their combinations. A total of thirty-three studies met the inclusion criteria. Data were extracted by one author and verified by another. Conclusion A number of patients showed positive treatment outcomes, and the adverse effects of both electrical stimulation (ES) and acupuncture have been reported as mild and transient. In patients who have undergone radiotherapy, acupuncture is shown to increase salivation. However, in patients with Sjogren's syndrome, the effects of ES devices seem to be elusive. Moreover, due to the instability of the findings in relation to longevity of clinical effect, patient satisfaction, quality of life, and clinical effectiveness of such treatments, the results remain vague.
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