Evaluation of unstimulated whole saliva flow rate and stimulated parotid flow as confirmatory tests for xerostomia
Unstimulated whole saliva collection (U.W.S.C.) and stimulated parotid flow rate (S.P.F.R.) are routine tests for evaluation of xerostomia. Different groups of investigators, however, use different normal values; some prefer one test (either one) more than the other. This prompted us to evaluate these tests in 81 well documented primary Sjögren's syndrome (prim. SS) patients and 188 age and sex matched normal volunteers. The U.W.S.C. as well as the S.P.F.R. were performed for 5 min. Lemon juice was used for stimulation and the saliva from the parotid gland was collected using modified Carlson-Crittenden cups. Normal individuals produced from between 0.20 and 6.81 ml/5 min (x +/- SD: 2.03 +/- 1.36 ml) of U.W.S. and from between 0.00 and 7.50 ml/5 min (x +/- SD: 1.00 +/- 1.10 ml) of S.P.F. No statistical differences were observed between the two salivary flow rates. Primary Sjögren's syndrome patients produced from 0.04 to 2.00 ml/5 min (x +/- SD: 0.47 +/- 0.50 ml) of U.W.S. and from 0.00 to 2.00 ml/5 min (x +/- SD: 0.37 +/- 0.56 ml) of S.P.F. Using the 95% confidence limit of the flow rates (U.W.S.: 1.25 ml/5 min and S.F.P.: 1.5 ml/5 min) observed in prim. SS patients, it was observed that 57% of the U.W.S. and 78% of the S.P.F values produced from normal individuals fall into that range. Based on these findings we conclude that these two tests are not useful for the evaluation of xerostomia.
Available from: Masafumi Moriyama
- "SWS was determined using the chewing gum test (Fujibayashi et al, 2004) and the Saxon test (Kohler and Winter, 1985). UWS was determined using the spitting method (Skopouli et al, 1989; Vitali et al, 2002). "
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ABSTRACT: Oral Diseases (2012) 18, 667–672
Objective: Heightened interest in oral health has lead to an increase in patients complaining of xerostomia, which is associated with various oral mucosal disorders. In this study, we investigated the relationship between Candida species and oral mucosal disorders in patients with xerostomia.
Subjects and Methods: We evaluated whole salivary flow rate and presence of oral mucosal disorders in 48 patients with xerostomia and 15 healthy controls. The number of Candida species was measured as colony-forming units after propagation on selective medium. Identification of Candida at the species level was carried out by polymerase chain reaction and restriction fragment length polymorphism analysis. We then examined the relationship between Candida species and oral mucosal symptoms.
Results: Compared with controls, patients with xerostomia exhibited significantly decreased whole salivary flow rate, increased rate of oral mucosal symptoms, and higher numbers of Candida. Salivary flow rate negatively correlated with the number Candida. Among patients with oral candidiasis, Candida albicanswas isolated from the tongue mucosa and Candida glabratawas isolated from the angle of the mouth.
Conclusion: These results suggest that particular Candida species are involved in the pathogenesis of oral mucosal disorders in patients with xerostomia.
Oral Diseases 02/2012; 18(7):667-72. DOI:10.1111/j.1601-0825.2012.01923.x · 2.43 Impact Factor
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ABSTRACT: Symptomatology and objective findings of Sjögren's syndrome were evaluated in 38 consecutive patients with primary biliary cirrhosis. Symptoms of Sjögren's syndrome were present in 18 (47.4%) patients, but were severe enough to warrant therapy in only four (10.5%). Nineteen patients consented to evaluation for Sjögren's syndrome, which included Schirmer's I test, measurement of parotid flow rate and serum autoantibodies, labial minor salivary gland biopsy and human leukocyte antigen typing. Histological changes diagnostic of Sjögren's syndrome were present in five patients (26.3%). All five patients had symptoms of Sjögren's syndrome and three had abnormal Schirmer's I tests, but none had corneal ulcerations or decreased parotid flow rates. Results of serological tests and human leukocyte antigen typing were not similar to those described in patients with primary Sjögren's syndrome but were similar to those described in patients with rheumatoid arthritis and Sjögren's syndrome. These findings indicate that Sjögren's syndrome associated with primary biliary cirrhosis is a form of secondary Sjögren's syndrome resembling that associated with rheumatoid arthritis.
Hepatology 05/1990; 11(5):730-4. DOI:10.1002/hep.1840110504 · 11.06 Impact Factor
Available from: bmj.com
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ABSTRACT: The criteria for a clinical diagnosis of Sjögren's syndrome remain controversial and vary widely from study to study. With respect to the oral component it is considered necessary to use some form of objective test, but many of those available are not suitable for use in a busy clinical situation. The purpose of this study was to evaluate a simple method for measuring the whole unstimulated salivary flow. Twenty five patients with Sjögren's syndrome, 69 young control subjects, 20 age matched normal older control subjects and 20 patients with rheumatoid arthritis without Sjögren's syndrome had their salivary flows measured. Whole unstimulated salivary flows in the young control subjects were higher than in all other groups. Patients with primary Sjögren's syndrome had lower flows than either the older controls or the rheumatoid patients. Among the patients with Sjögren's syndrome 52% had a flow of 0.1 ml/min or less compared with only 8% of age matched controls. The positive predictive value of this low flow was 81%. It is concluded that whole unstimulated salivary flows of 0.1 ml/min or less are highly specific for xerostomia. When interpreted in the context of all the clinical findings whole unstimulated salivary flows are useful for diagnosing the oral component of Sjögren's syndrome.
Annals of the Rheumatic Diseases 05/1992; 51(4):499-502. DOI:10.1136/ard.51.4.499 · 10.38 Impact Factor
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