Characterization of the differentiated antioxidant profile of human saliva

Saliva is armed with various defense mechanisms, such as the immunological and enzymatic defense systems. In addition, saliva has the ability to protect the mucosa against mechanical insults and to promote its healing via the activity of epidermal growth factor. However, another defense mechanism, the antioxidant system, exists in saliva and seems to be of paramount importance. The most interesting finding of the present study was the demonstration of the existence of much higher concentrations of the various salivary molecular and enzymatic antioxidant parameters in the parotid saliva compared with the submandibular/sublingual saliva. For example, peroxidase, superoxide dismutase, uric acid, and total antioxidant status were higher in resting parotid saliva compared with resting submandibular/sublingual saliva by 2405, 235, 245, and 147%, respectively. Another important finding was the distinction between the salivary antioxidant system and the immunological and enzymatic protective systems, as represented by the salivary concentrations of secretory IgA and lysozyme, respectively. These findings suggest that the profound antioxidant capacity of saliva secreted from parotid glands is related either to the different physiological demands related to eating (parotid predominance), to oral integrity maintenance (submandibular/sublingual predominance), or to the high content of deleterious redox-active transitional metal ions present in parotid saliva. This also may signify that our oral cavity environment is only partially protected against oxidative stress during most of the day and night.

Salivary analysis in oral cancer patients: DNA and protein oxidation, reactive nitrogen species, and antioxidant profile

BACKGROUND

Free radicals such as reactive oxygen species (ROS) and reactive nitrogen species (RNS), which induce oxidative and nitrative stress, are main contributors to oral carcinogenesis. The RNS (nitrosamines: nitrates, NO(3), and nitrites, NO(2)) are also produced by the reaction of ROS and other free radicals with nitric oxide (NO) and are therefore in equilibrium with it.

METHODS

Whole saliva was collected from a group of 25 consenting oral squamous cell carcinoma (OSCC) patients and from a control group of 25 healthy age- and gender-matched individuals. General and specific salivary antioxidant components, salivary nitrosamines, and oxidatively damaged salivary DNA and proteins were measured.

RESULTS

The findings showed that oxidative and nitrative stress altered the salivary composition in OSCC patients. Analyzed salivary RNS were substantially higher (NO, 60%; NO(2), 190%; NO(3), 93%), whereas all salivary antioxidants were substantially reduced. The 8-hydroxy-deoxyguanosine (8-OHdG) marker (a widely used indicator of DNA oxidation) increased by 65% and the salivary carbonylation level was significantly higher.

CONCLUSIONS

The increase in ROS and RNS may have been the event that led to the consumption and reduction of salivary antioxidant systems, thus explaining the oxidative damage to the DNA and proteins, and possibly the promotion of OSCC. The oxidized proteins and DNA found in the saliva of the cancer patients seems to be the first demonstration of a direct link between salivary free radicals, antioxidants, and OSCC. This may be important for better understanding the pathogenesis of the disease and may contribute to its diagnosis and treatment.

Concomitant analysis of salivary tumor markers--a new diagnostic tool for oral cancer

PURPOSE

Oral squamous cell carcinoma (OSCC) is a common human malignancy. Circulatory epithelial tumor markers were previously investigated in the serum of OSCC patients but almost never in their saliva, in spite of the fact that there is a direct contact between the saliva and the oral cancer lesion. The purpose of the current study was to examine tumor markers in the saliva of OSCC patients.

EXPERIMENTAL DESIGN

We measured the concentrations of the six most studied epithelial serum circulatory tumor markers in the saliva of OSCC (tongue) patients.

RESULTS

Significant increases (of 400%) in salivary concentrations of Cyfra 21-1, tissue polypeptide antigen, and CA125 were shown. Salivary concentrations of CA19-9, SCC, and carcinoembryonic antigen were increased without statistical significance. A concurrent analysis of the three significantly increased markers revealed sensitivity, specificity, and negative and positive predictive values of 71%, 75%, 71%, and 75%, respectively.

CONCLUSIONS

The increase reported in salivary tumor markers may be used as a diagnostic tool, especially when a concurrent analysis for significantly increased markers is done. Salivary testing is noninvasive, making it an attractive, effective alternative to serum testing, and the possibility of developing home testing kits would further facilitate it as a diagnostic aid, enabling patients to monitor their own health at home and is important for those who live far from their treatment centers and especially for those at risk of developing OSCC.

Salivary analysis of oral cancer biomarkers

BACKGROUND

Oral cancer is a common and lethal malignancy. Direct contact between saliva and the oral cancer lesion makes measurement of tumour markers in saliva an attractive alternative to serum testing.

METHODS

We tested 19 tongue cancer patients, measuring the levels of 8 salivary markers related to oxidative stress, DNA repair, carcinogenesis, metastasis and cellular proliferation and death.

RESULTS

Five markers increased in cancer patients by 39-246%: carbonyls, lactate dehydrogenase, metalloproteinase-9 (MMP-9), Ki67 and Cyclin D1 (CycD1) (P< or =0.01). Three markers decreased by 16-29%: 8-oxoguanine DNA glycosylase, phosphorylated-Src and mammary serine protease inhibitor (Maspin) (P< or =0.01). Increase in salivary carbonyls was profound (by 246%, P=0.012); alterations in CycD1 (87% increase, P=0.000006) and Maspin (29% decrease, P=0.007) were especially significant. Sensitivity values of these eight analysed markers ranged from 58% to 100%; specificity values ranged from 42% to 100%. Both values were especially high for the CycD1 and Maspin markers, 100% for each value of each marker. These were also high for carbonyls, 90% and 80%, respectively, and for MMP-9, 100% and 79%, respectively.

CONCLUSION

The significance of each salivary alteration is discussed. As all alterations correlated with each other, they may belong to a single carcinogenetic network. Cancer-related changes in salivary tumour markers may be used as a diagnostic tool for diagnosis, prognosis and post-operative monitoring.

Salivary glands and the aging process: mechanistic aspects, health-status and medicinal-efficacy monitoring

Xerostomia is a major complaint of many elderly individuals, and although they seek medical help, it usually provides no adequate relief. This complaint is considered a major clinical problem, since not less than 25% to 50%-60% of the population over the age of 65 complain of xerostomia. By definition, Xerostomia is a subjective feeling and in up to one-third of the cases does not reflect a real reduction in salivary flow rate but rather the subjective feeling of a dry mouth. Moreover, only a minute portion of the patients suffer from xerostomia with a known aetiology such as radiotherapy or Sjögren's syndrome, while in the majority of the cases, the aetiology is assumed to be related to age, disease, various medications and drugs or is simply idiopathic. The current review focuses on age-related histological, sialometrical and sialochemical changes and on the possible mechanisms which underlie these changes. Finally, directions for further exploring the subject are suggested.

Relationships between age, drugs, oral sensorial complaints and salivary profile

The aim of this study was to investigate the relationships between oral sensorial complaints (OSCs) and salivary flow rate, composition and drug consumption of subjects aged 18-90 years. The results were correlated with both drug consumption and OSCs. Only individuals who were free of conditions that are already known to cause OSCs were included in the study. The three most significant observations were as follows: (1) elderly people have significantly reduced and altered salivary secretion compared with younger people. While specific concentrations increased, the total values of most salivary components decreased in the elderly; (2) 50% of the elderly population have OSCs regarding taste, burning mouth syndrome or xerostomia; and (3) OSCs were more prevalent in elderly people who use drugs than in those who do not. In conclusion, a reduction in salivary function and altered composition are age related. A compensatory capacity that prevents OSCs appears to exist in elderly patients who do not use drugs, but drugs were found to have an extensive effect on OSCs. The finding that the total amounts of salivary components and not only the salivary flow rate were reduced in elderly people is of great clinical relevance, since such a reduction is expected to be reflected in compromising various salivary functions.

The enigmatic mechanism of irradiation-induced damage to the major salivary glands

Irradiation is a central treatment modality administered for head and neck malignancies. Its major and most devastating side-effect is an induced damage to the major salivary glands. This article aims at suggesting a comprehensive explanation for the underlying mechanism of this damage, which has been considered as enigmatic throughout the 90 years since it was first described in 1911. The mechanism suggested is based on the considerable literature concerning this enigma in rat salivary glands. According to this proposed mechanism, the irradiation results in a sublethal DNA damage, which manifests and becomes lethal at a delayed phase. Thus, when the acinar progenitor cells are going through a reproductive phase when parenchymal replenishment is required, they die. The injurious agents, which result in this delayed reproductive cell death, appear to be highly redox-active transition metal ions, such as iron and copper. These metal ions, which seem to be associated with secretion granules, are not necessarily contained within the granules as previously suggested, but rather are probably located at sites more proximal to the DNA.

A comprehensive salivary analysis for oral cancer diagnosis

PURPOSE

This study utilized comprehensive salivary analysis to evaluate biochemical and immunological parameters in the saliva of oral squamous cell carcinoma (OSCC) patients.

METHODS

Whole saliva was collected from 25 otherwise healthy OSCC patients and compared to 25 healthy, age- and gender-matched individuals. All OSCC lesions were located at the lateral aspect of the mobile tongue. The salivary parameters analyzed included: sodium (Na), potassium (K), calcium (Ca), inorganic phosphate (P), magnesium (Mg), total protein (TP), albumin (Alb), lactate dehydrogenase (LDH), amylase (Amy), total immunoglobulin G (IgG), secretory immunoglobulin A (Sec. IgA), epidermal growth factor, insulin growth factor I (IGF-I) and metalloproteinases MMP-2 and MMP-9.

RESULTS

In cancer patients, salivary median total protein concentration was significantly higher by 26% (P = 0.01), as were concentrations of Na, Ca, P and Mg by 14% (P = 0.05), 59% (P = 0.05), 39% (P = 0.08) and 28% (P = 0.12), respectively. Amy and K concentrations were lower by 25% (P = 0.12) and 15% (P = 0.03), respectively. Alb was 108% higher (P = 0.0007), as were salivary LDH (88%, P = 0.002) and total IgG (125%, P = 0.01), while Sec. IgA was lower by 45% (P = 0.001). Concentrations of IGF, MMP-2 and MMP-9 were significantly higher by 117% (P = 0.03), 75% (P = 0.0003) and 35% (P = 0.05), respectively.

CONCLUSIONS

Comprehensive salivary analysis revealed an overall altered salivary composition in OSCC, indicating a compromised oral environment in these patients and suggesting salivary analysis as a new diagnostic tool for oral cancer. Local therapeutic agents can be easily applied to the oral mucosa, altering its "bathing medium"-the saliva.

Association between regional idiopathic neuropathy and salivary involvement as the possible mechanism for oral sensory complaints

The idiopathic sensorial disturbances of burning mouth syndrome (BMS), taste disturbances (dysgeusia), and dry mouth (xerostomia) have recently been recognized as one entity and given the generic name of oral sensorial complaints (OSC). However, not all patients with OSC complain of all three disturbances, and the underlying mechanism of OSC has not yet been elucidated. This study sought to determine whether OSC was associated with the alteration of oral sensory perception, salivary profile and/or personality traits. It examined 35 patients with OSC and 19 controls. Sensory perception was assessed by Quantitative Sensory Testing (QST) applied to the tongue, including thresholds for thermal sensations and pain, and the magnitude estimation of tonic suprathreshold heat pain stimuli. The salivary profile included flow rate and compositional analysis. Personality traits were examined by both state and trait anxiety and somatization scoring. Results showed significantly elevated thermal sensory thresholds and decreased pain scores for tonic heat pain. In addition, there was an increased level of somatization in the OSC group as compared to the control group (15.1 +/- 1.5 vs. 6.6 +/- 2.1, respectively; P = .003). Concomitantly, altered salivary composition (elevated Na, K, Cl, Ca, IgA, and amylase concentrations)-but not salivary flow rate reduction-was observed in those patients despite their complaints of oral dryness. All parameters were similar among the patients with OSC regardless of their type of complaint. Linear regression analysis revealed that an elevated warm sensory threshold was associated with higher levels of salivary K and Cl concentrations in the patients with OSC. These findings may be attributed to a regional small fiber idiopathic neuropathy affecting oral sensation and salivary secretion in OSC. Alternatively, a primary idiopathic salivary dysfunction might cause sensory neural dysfunction at the receptor level by changing the oral cavity milieu.

PERSPECTIVE

Based on the salivary, psychophysical, and personality traits analysis currently presented, as well as on the available literature, we hypothesize that a comprehensive mechanism for OSC is based on a regional neuropathy, which is expressed by complaints of BMS, taste disturbances, and/or xerostomia. All are clearly distinguishable from similar conditions with established organic/therapeutic-related etiologies.

Free radicals related effects and antioxidants in saliva and serum of adolescents with Type 1 diabetes mellitus

OBJECTIVE

The purpose of the current study was to analyze both serum and salivary composition and oxidative stress markers in Type 1 diabetes mellitus (DM) patients.

DESIGN

Twenty consenting patients with DM but otherwise healthy patients aged 13-19 years and 12 healthy controls, matching in age and gender (Group 1), participated in the study. The patients were divided according to those who had controlled diabetes mellitus (Group 2) or uncontrolled diabetes mellitus (Group 3). All were analyzed for saliva composition and antioxidants. Saliva was also analyzed for its levels of superoxide dismutase (SOD) and amylase activity, total IgA and total IgG concentrations and potassium, phosphorus, magnesium and calcium electrolyte concentrations.

RESULTS

A significant correlation was found between the severity of the DM/HbA1c values and the increase in both salivary and/or serum antioxidants (peroxidase, SOD and TAS), and the various TCL parameters (H1, H3, pre-incubation and oxygenation-potential).

CONCLUSIONS

The two most important findings of the current study relate to the role of oxidative stress in the pathogenesis of Type 1 diabetes mellitus and to the involvement of salivary glands in the disease. The profound effects of DM on salivary antioxidant parameters may be also of great importance in respect to the diagnosis and evaluation of the disease. The correlation between altered salivary parameters and the severity of the disease may indicate that evaluation of the salivary status of DM patients as part of the assessment of their disease activity and severity is warranted.

Saliva analysis in the clinical setting: revisiting an underused diagnostic tool

BACKGROUND

One purpose of this study was to compare various biochemical and immunological parameters in blood and saliva that are routinely evaluated only in the blood for general medical requirements. Another purpose was to concomitantly compare these and other oral/salivary parameters differentially in whole, parotid, and submandibular and sublingual saliva to examine the source of those parameters and their specific concentrations.

METHODS

Twelve healthy individuals (6 women, 6 men) were examined in the blood-saliva comparison study, and 30 healthy individuals (15 women, 15 men) were studied in the intersalivary comparison study.

RESULTS

On the basis of the results we obtained, we suggest a classification scheme using a whole saliva compositional profile as a diagnostic tool in the evaluation of systemic and/or local pathologies. This system may be used to analyze various components of saliva beyond those analyzed in this study, thereby increasing the clinician's ability to locate and assess specific pathologies. We also suggest that consideration be given to the use of compositional saliva analysis in the diagnosis of general medical conditions in which there is a high correlation between the salivary and blood concentrations of relevant components.

CONCLUSION

We think that saliva analysis is a useful, worthwhile diagnostic tool because saliva collection is noninvasive, easy, and inexpensive and may be performed by the patient with no need for the involvement of medical personnel, if so desired.

Sialochemical and gustatory analysis in patients with oral sensory complaints

Our objective was to perform concomitant taste and salivary analyses in subjects with oral sensory complaints (OSC), including burning mouth syndrome (BMS), idiopathic taste aberrations, and xerostomia without established etiology, to attempt to find a possible explanation for the mechanism underlying those complaints. BMS is a disorder characterized by a painful burning or scalding sensation in clinically normal and healthy oral mucosa. Taste and salivary analyses were performed on 163 subjects with OSC who complained of BMS, taste aberration, or xerostomia, alone or in combination. These subjects were compared with 84 healthy, age- and sex-matched control subjects. The salivary and taste analyses were found to be helpful in distinguishing control subjects from complaining subjects. The most striking result found was the great similarity of both salivary and taste analyses in the BMS, taste aberration, and xerostomia groups, which were significantly different from the results obtained in the control group. An oral neuropathy or neurologic transduction interruption induced by salivary compositional alterations is suggested as the possible etiology for the complaints. This report might add an important objective diagnostic tool to the clinician treating such patients.

PERSPECTIVE

The merit of the current study stems from the fact that it suggests for the first time a salivary-related local neuropathic mechanism for oral sensorial complaints. This may be of paramount importance, both with respect to the biological background of these complaints and to the possible therapeutic modalities that might be offered to suffering patients.

Biochemical analysis of saliva and taste acuity evaluation in patients with burning mouth syndrome, xerostomia and/or gustatory disturbances

OBJECTIVE

In the current study, we performed taste and salivary analysis on patients suffering from burning mouth syndrome and xerostomia or taste disturbances.

STUDY DESIGN

A total of 180 patients who complained of idiopathic burning mouth syndrome (BMS) and taste aberrations and/or xerostomia that may accompany BMS were evaluated. These patients were compared with 90 healthy, age- and sex-matched controls. Salivary flow rate, biochemical and immunological analysis and taste acuity by the forced-choice drop technique were performed for all subjects. These analyses were found to be conclusive in distinguishing controls from patients with complaints.

RESULTS

The great similarity of both salivary and taste analysis in the BMS, taste aberration and xerostomia groups, which were significantly different from the results obtained in the control group, was found to be the most striking result. Higher salivary concentrations in the experimental group were consistent with a lower saliva (water) flow rate.

CONCLUSION

An oral neuropathy and/or neurological transduction interruption induced by salivary compositional alterations is suggested as the possible aetiology for the complaints. This report may add an important objective diagnostic tool to the clinician treating these patients.

Effect of cigarette smoke on salivary proteins and enzyme activities

Exposure of human plasma in vitro to gas-phase cigarette smoke (CS) causes a marked modification of plasma proteins as measured by protein carbonyl assay. Aldehydes present in CS may cause this elevation of protein carbonyls by reacting with sulfhydryl groups of proteins. Saliva is the first body fluid to confront the inhaled CS. Thus, in vitro exposure of saliva to nine "puffs" of CS also showed a distinct increase in protein carbonyls. Ascorbate and desferrioxamine mesylate had little effect on protein carbonyl formation, while GSH and N-acetylcysteine considerably inhibited the accumulation of protein carbonyls due to CS exposure. Following the exposure to CS, the activities of several salivary enzymes-amylase, lactic dehydrogenase (LDH), and acid phosphatase-were found to be significantly reduced (34, 57, and 77%, respectively). However, CS had no effect on the activities of aspartate aminotransferase and alkaline phosphatase. Addition of 1 mM of GSH and N-acetylcysteine considerably protected LDH and amylase activities, suggesting that sulfhydryl groups are affected in LDH and amylase. On the other hand, addition of 1 mM ascorbate caused a further loss of LDH and amylase activities, which could be partially prevented by the addition of desferrioxamine mesylate, implicating metal-catalyzed oxidation processes. Finally, loss of acid phosphatase activity was completely unaffected by any of the above antioxidants. It is concluded that the loss of salivary enzyme activities may be due to various agents in the CS that affect the enzyme activities via different mechanisms.

New insights into salivary lactate dehydrogenase of human subjects

Lactate dehydrogenase (LDH) is a ubiquitous enzyme that plays a significant role in the clinical diagnosis of pathologic processes. The purpose of the current study was to examine LDH activity and isoenzyme profile of whole saliva and to compare it with the LDH activity of salivary glands and plasma before and after exposure to cigarette smoke (CS). The range of LDH activity in whole saliva at rest was 360 to 430 U/L. The mean +/- SEM of LDH activity in parotid and submandibular/sublingual salivary secretions was 41.3 +/- 19.2 U/L and 77.5 +/- 30.4 U/L, respectively, which implied that 75% of the whole-saliva LDH originated from an extra-salivary gland source. The profile of salivary LDH isoenzymes was found to have an entirely different pattern from that found in plasma, similar to that found in oral epithelium, indicating that the major source of salivary LDH is probably the oral epithelium-shedding cells. Therefore, salivary LDH may be evaluated for possible oral mucosal pathologies in a manner similar to that used for evaluating other tissue pathologies--such as those in heart, muscle, or liver--that can be detected in plasma. Exposure of whole saliva to CS in vitro resulted in a 41% reduction in LDH activity. However, CS exposure had no effect on LDH activity in plasma. Whole saliva, in contrast to plasma, contains redox-active metal ions such as iron and copper that may enhance LDH loss of activity. Therefore we conclude that whole saliva in the presence of CS becomes a potent protein-modifying agent that can destroy some of its endogenous components.

Inhibition of oral peroxidase activity by cigarette smoke: in vivo and in vitro studies

Oral peroxidase (OPO), the pivotal enzyme in the salivary antioxidant system, seems to be of paramount importance in the oral defense mechanism, especially against the attack of free radicals related to cigarette smoke (CS) and the evolution of oral cancer. The major inducer of oral cancer is exposure to tobacco, which is responsible for 50-90% of cases worldwide. The purpose of our study was to elucidate the outcome of interaction between CS and OPO in smokers and nonsmokers. After smoking a single cigarette, a sharp drop of OPO activity was observed in both groups: 42.5% in smokers and 58.5% in nonsmokers (p <.05). After 30 min, the level of activity returned to 90-100% of the presmoking level, presumably due to the secretion of new saliva into the oral cavity. The difference between the two groups was also observed after exposure of saliva to one cigarette in smoking flasks (in vitro studies); however, as expected, no recovery of activity was observed in either group. Similarly, the OPO activity loss was accompanied by increased carbonylation of the salivary proteins, an indicator of the oxidative damage to proteins. These results may be of great clinical importance, as heavy smokers smoke 20 cigarettes or more on a daily basis. Accordingly, most of the time the oral epithelium of heavy smokers is essentially unprotected by OPO against the deleterious effects of thiocyanate ions and hydroxyl radicals produced by unremoved hydrogen peroxide in the presence of the salivary redox-active metal ions. This may pave the way for the CS-induced and saliva-mediated initiation and progression of oral cancer.

Serum and salivary oxidative analysis in Complex Regional Pain Syndrome

Although both inflammatory and neural mechanisms have been suggested as potential contributors to Complex Regional Pain Syndrome type I (CRPS-I), the pathogenesis of the syndrome is still unclear. Clinical trials have shown that free radical scavengers can reduce signs and symptoms of CRPS-I, indirectly suggesting that free radicals and increased oxidative stress are involved in the pathogenesis of CRPS-I. This study investigated this premise by determining the levels of antioxidants in the serum and saliva of 31 patients with CRPS-I and in a control group of 21 healthy volunteers. Serum lipid peroxidation products (MDA) and all antioxidative parameters analyzed were significantly elevated in CRPS-I patients: median salivary peroxidase and superoxide dismutase (SOD) activity values, uric acid (UA) concentration and total antioxidant status (TAS) values were higher in CRPS-I patients by 150% (p=0.01), 280% (p=0.04), 60% (p=0.0001), and 200% (p=0.0003), respectively, as compared with controls. Similar although not as extensive pattern of oxidative changes were found in the serum: mean serum UA and MDA concentrations and TAS value in the CRPS-I patients were higher by 16% (p=0.04), 25% (p=0.02), and 22% (p=0.05), respectively, than in the controls. Additionally, median salivary albumin concentration and median salivary LDH activities in the patients were 2.5 times (p=0.001) and 3.1 (p=0.004) times higher than in the controls. The accumulated data show that free radicals are involved in the pathophysiology of CRPS-I, which is reflected both in serum and salivary analyses. These data could be used for both diagnostic and therapeutic purposes in CRPS-I patients.

Cervicofacial actinomycosis: a diagnostic challenge

Actinomycosis was first described as a clinical entity over 100 years ago. However, the fundamental characteristics of this entity have not been fully discussed, and major questions remain unanswered, such as the highly diversified pathogenicity of the phenomenon according to numerous published case reports and clarification of solid diagnostic criteria. Even the frequency of cervicofacial actinomycosis occurrence is unclear; some authors consider it to be rare and others to be common. We present 11 cases examined and treated in our department within the last 14 years along with a review of the literature. Diagnostic problems are emphasized, and a comprehensive overview of the entity is suggested.

Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease: a sialometrical study

Bone marrow transplantation is considered to be the treatment of choice for various hematological and solid malignancies, as well as for bone marrow failure syndromes and some genetic diseases. Unfortunately, a great number of patients who receive allogeneic BMT suffer from graft-versus-host disease (GVHD) following the procedure. Xerostomia is considered to be one of the most annoying complications of chronic GVHD (cGVHD), and the rapidly growing number of BMT patients with prolonged survival renders GVHD-related xerostomia a major clinical problem. As pilocarpine hydrochloride has been shown to relieve xerostomia in other disease categories, we administered pilocarpine hydrochloride 30 mg/day to six cGVHD patients and measured their whole saliva, parotid and submandibular-sublingual flow rates in both resting and stimulated conditions. Mean values of flow rates of whole saliva in resting conditions at 2 weeks, 2 months and 6 months following administration of pilocarpine hydrochloride 30 mg/day were 0.71 +/- 0.12 ml/min, 0.59 +/- 0.07 ml/min and 0.56 +/- 0.11 ml/min, respectively. In stimulated conditions, mean values were 1.7 +/- 0.3 ml/min, 1.0 +/- 0.17 ml/min and 0.94 +/- 0.21 ml/min, respectively. The mean values of whole saliva flow rates under both conditions represented an increase of 224-284% and 134-247%, respectively (P < 0.01). The pattern and magnitude of parotid and submandibular-sublingual flow rate increases following pilocarpine hydrochloride administration were similar. Patients were followed for 6 months and demonstrated increased levels of secretion, with some reduction after the initial peak values. The medication was discontinued at 2 months and reinstated after 2 weeks in three patients. This resulted in rapid flow rate reduction followed by another profound increase. Contrary to the sialometrical analysis, the subjective scoring showed no fluctuations during the study period. We discuss these results in the context of the clinical experience of xerostomic patients in whom even a minute increase in secretion may be significant. Our results demonstrate that objective and subjective relief from xerostomia in cGVHD patients can be achieved with the routine oral administration of pilocarpine hydrochloride.

Age-related changes in unstimulated salivary function and composition and its relations to medications and oral sensorial complaints

BACKGROUND AND AIMS

The purpose of the current study was to examine the salivary flow rate and composition in relation to drug consumption and idiopathic oral sensorial complaints (OSC). OSC cover xerostomia, disturbed sense of taste, or burning mouth sensitivity with no established classical etiology (e.g., Sjogren's syndrome, or a response to radiotherapy).

METHODS

A thorough sialometrical and sialochemical analysis was performed for all subjects who were healthy non-hospitalized individuals ranging in age from 18-89 years. Saliva samples were all collected in unstimulated conditions.

RESULTS

The three most significant observations were: a) Elderly people have significantly reduced and altered salivary secretion. Whereas specific concentrations increased, the total values of most salivary components were found to be decreased in the elderly. b) Fifty percent of the elderly make OSC. c) OSC were made mainly by elderly individuals who use drugs.

CONCLUSIONS

Reduction in salivary function and altered composition are age-related. However, when drugs are not involved, a compensatory capacity which avoids OSC apparently exists. In contrast, the effect of drugs on OSC is extensive. The finding that the total amount of salivary components and not only salivary flow rates are reduced in the elderly is of great clinical importance, since such a reduction is expected to be reflected in compromising various salivary functions.

Age- and flow-dependency of salivary viscoelasticity

Measuring salivary viscoelasticity (by relaxation times) is of paramount importance, since salivary rheology behavior has been associated with the development of oral disease conditions (such as dental caries) in animal and human model studies. In addition, novel and improved methods to evaluate salivary distribution and lubrication are of clinical interest. We used a novel method for measuring the viscoelasticity of saliva secreted from the different glands, at rest or under stimulation and at different ages, all conditions where different viscoelastic properties might be clinically important. Submandibular/sublingual salivary viscoelasticity was significantly higher than that of parotid saliva, especially under stimulation. In addition, an age-related reduction in flow rate (by 62%) was demonstrated, accompanied by an increase in both relaxation time (by 54%) and protein (by 48%). Increased salivary viscoelasticity results in compromised salivary rheology and lubrication properties, which may render the oral cavities of the elderly and other xerostomic persons more vulnerable.