Article

Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background and overview: Xerostomia, also known as "dry mouth," is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue. Conclusions and practice implications: Initial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Saliva has decreased production in patients undergoing radiotherapy compared to normal people (Irna & Subita, 2008;Surjadi & Amtha, 2012). Hyposalivation could cause negative effects on the physical aspects of making oral mucositis, pain during eating and talking, papilla loss on chapped tongue and lips (Plemons et al., 2014) as well as psychological effects causing feelings of discomfort, sadness, and, eventually, depression (Traktama & Sufiawati, 2018). ...
... Factors that can affect the achievement of saliva are the patient's hydration status (Samuels, 2017). drugs consumed, sleep, fasting, nutrition and imagining food and psychological factors are sadness and depression (Plemons et al., 2014). ...
... This research was conducted using time series to obtain the most effective time effect. In line with previous opinions (Plemons et al., 2014), measuring saliva periodically is an effective way to monitor changes in the volume and composition of saliva. Chewing or sucking sugar-free gum to stimulate saliva flow is an intervention to minimize dry mouth (Dental & Ada, 2015). ...
Article
Full-text available
especially challenged by using online learning for nursing students. The adaptation of nursing instructors and nursing students take into account significant factors to overcome barriers during the changes. In our point of view, the biggest challenge faced during this faculty crisis is how to adopt a response and manage nursing education based on the standard of nursing education. An online learning program was considered as a first choice to solve the issue during this crisis. Online learning would be appropriate due to flexibility, convenience, interactive learning experiences, and advancement opportunities for nursing education during the Faculty of Nursing closure, including serving the international and national policies that recommend to make a decision on social distancing and personalized protection. Online learning resources were concerned that nursing instructors and students received support about online learning knowledge, e-learning platform, notebook and internet package from the national and university policy. Nursing instructors provided home study exercises and followed up their students such as with feedback on their study exercises and study discussion as an active learner by chat application and/or an e-learning platform at least once a week. During the nursing education, nursing students were evaluated based on desired learning outcomes, such as online examination and study report, including teaching evaluation. However, the online learning program must be evaluated for reviewing outcomes using a SWOT analysis, strengths, weaknesses, opportunities, and threats, that helps to understand the outcomes and improve the quality of nursing education. As the new normal after COVID-19, nursing education should be designed based on international and national policies, standard of nursing education, desired learning outcomes, nursing competency, and nursing educational resources. In addition, blended learning as an integrative online and traditional classroom should be considered based on the quality of nursing education, such as balancing between online and face-to-face learning hours, learning content, and nursing educational resources, including research and innovation experiences. ABSTRACT Introduction: Traditional markets are a financial resource for traders. Fire disasters at the traditional markets will have a bad effect in terms of generating both financial and psychological problems. There is a lack of studies about the psychological problems experienced by traditional market fire victims. The aim of this study is to identify the correlation of psychological capital (hope, self-efficacy, resilience, and optimism) with the anxiety level among the victims of market fire disasters in Central Jakarta.
... Saliva has decreased production in patients undergoing radiotherapy compared to normal people (Irna & Subita, 2008;Surjadi & Amtha, 2012). Hyposalivation could cause negative effects on the physical aspects of making oral mucositis, pain during eating and talking, papilla loss on chapped tongue and lips (Plemons et al., 2014) as well as psychological effects causing feelings of discomfort, sadness, and, eventually, depression (Traktama & Sufiawati, 2018). ...
... Factors that can affect the achievement of saliva are the patient's hydration status (Samuels, 2017). drugs consumed, sleep, fasting, nutrition and imagining food and psychological factors are sadness and depression (Plemons et al., 2014). ...
... This research was conducted using time series to obtain the most effective time effect. In line with previous opinions (Plemons et al., 2014), measuring saliva periodically is an effective way to monitor changes in the volume and composition of saliva. Chewing or sucking sugar-free gum to stimulate saliva flow is an intervention to minimize dry mouth (Dental & Ada, 2015). ...
Article
Full-text available
Introduction: Hyposalivation is a common problem experienced by head and neck (H&N) cancer patients undergoing radiotherapy. Hyposalivation can cause negative effects on the physical aspects of making oral mucositis, pain during eating and talking as well as psychological effects that cause feeling of discomfort sadness and, ultimately, depression. Many nonpharmacological interventions can be done for hyposalivation that occur in patients, among which are chewing gum and cryotherapy because they are easy to do, easy to access, inexpensive and have minimal side effects. However, the effectiveness of these interventions is not yet clear. Hence, this study is aimed to determine the effectiveness of chewing gum versus cryotherapy to increase salivary volume in H&N cancer patients undergoing radiotherapy. Methods: A quasi-experimental time series group design to determine the most effective time to influence the increase in salivary volume. This research was conducted on 36 respondents H&N cancer undergoing radiotherapy with four times measurement are pretest-posttest on the 3rd, 5th, and 7th day of intervention between February and March 2020. Subjects were chosen using consecutive sampling. Chewing gum group will chew gum six (6) pieces/day and cryotherapy group will suck on ice cubes five (5) minutes before and after radiotherapy. The spitting method was used to collect saliva and the data were analyzed using General Linear Model-Repeated Measure (GLMRM). Results: Chewing gum is more effective to increase salivary volume than cryotherapy. The GLMRM within subjects at four (4) times measurement showed a significant difference between chewing gum and cryotherapy group with p value
... [4][5][6][7][8][9][10][11][12] Xerostomia is the most common symptom of salivary gland hypofunction, which reflects an objective, measurable decrease in salivary flow. [13] However, as it is a subjective sensation, it can occur without noticeable saliva decrease and reflective of a saliva quality or perceptual problem. [5,13] Causes of xerostomia in the terminally ill are most commonly related to systemic disease, polypharmacy and medications, such as anticholinergic medications, antihistamines, antihypertensive agents, opioids and psychotropic agents including antidepressants and antipsychotics, which can affect salivary flow rate and composition. ...
... [13] However, as it is a subjective sensation, it can occur without noticeable saliva decrease and reflective of a saliva quality or perceptual problem. [5,13] Causes of xerostomia in the terminally ill are most commonly related to systemic disease, polypharmacy and medications, such as anticholinergic medications, antihistamines, antihypertensive agents, opioids and psychotropic agents including antidepressants and antipsychotics, which can affect salivary flow rate and composition. [5,[13][14][15] Many of these drugs that can result in xerostomia are regularly used by patients in the palliative and supportive care setting. ...
... [5,13] Causes of xerostomia in the terminally ill are most commonly related to systemic disease, polypharmacy and medications, such as anticholinergic medications, antihistamines, antihypertensive agents, opioids and psychotropic agents including antidepressants and antipsychotics, which can affect salivary flow rate and composition. [5,[13][14][15] Many of these drugs that can result in xerostomia are regularly used by patients in the palliative and supportive care setting. [3] Patients in these settings commonly have a history of head and neck radiotherapy and the salivary glands show both early and late radiation damage; quickly resulting in reductions in salivary flow rates with no significant recovery after completion of the radiation treatment schedule. ...
... The causes for decreased production include old age, side effects of many types of medications, chemotherapy and radiation to the head and neck area. Some autoimmune conditions such as Sjogren's syndrome (SS) and IgG4 related disease (IgG4RD) and neurological diseases have also been associated with hyposalivation [1]. ...
... Xerostomia, the subjective feeling of dry mouth, is common with an increasing incidence mainly attributed to increased life expectancy [1]. ...
... SS is a systemic chronic autoimmune disease that causes inflammation and dysfunction of the salivary glands and may lead to severe decrease in the lacrimal and salivary secretions. It may be primary, if it is limited to the execratory glands, or secondary, when accompanied with at least one additional inflammatory condition [1,2]. Diagnosis of SS is based on a combination of objective and subjective signs of which at least four are mandatory for a diagnosis of SS, and two must be objective parameters. ...
Article
Full-text available
Background and Objective: Hyposalivation and xerostomia can result from a variety of conditions. Diagnosis is based on a combination of medical history, clinical and serological parameters, imaging, and minor salivary gland biopsy when indicated. The Objective was to characterize microscopic changes in minor salivary gland biopsies taken in patients with xerostomia. Materials and Methods: 10-year retrospective analysis of minor salivary gland biopsies, 2007–2017. Histomorphometric analysis included gland architecture, fibrosis, fat replacement, inflammation and stains for IgG/IgG4, when relevant. Results: 64 consecutive biopsies, of which 54 had sufficient tissue for diagnosis of Sjogren’s Syndrome (SS) were included (18 males, 46 females, average age 56 (±12.5) years). Only 12 (22.2%) were microscopically consistent with SS, none stained for IgG4. Medical conditions were recorded in 40 (63%), most frequently hypertension and hyperlipidemia (28% each). Medications were used by 45 (70%), of which in 50% more than one. Xerostomia in non-SS cases was supported by abnormal gland morphology, including acinar atrophy, fibrosis and fatty replacement. All morphological abnormalities are correlated with age, while fatty replacement correlated with abnormal lipid metabolism. Multiple medications correlated with microscopic features which did not correspond with SS. Conclusions: SS was confirmed in a minority of cases, while in the majority fatty replacement, fibrosis and multiple medications can explain xerostomia, and are related to aging and medical conditions. Medical history and auxiliary tests could lead to correct diagnosis in non-SS patients, avoiding biopsy. The necessity of a diagnostic biopsy should be given serious consideration only after all other diagnostic modalities have been employed.
... Oral mucosa assessment was based on the WHO Guide [8] and Xerostomia was assessed by American Dental Association criteria [9]. ...
... The age of participants ranged between 18 to 86 years with a mean age of (46.5) years. Xerostomia which was assessed by American Dental Association criteria [9]. was found among 145patients (64.2%) , 78 were males and 67 were females, The association between xerostomia and other manifestations is illustrated in table (2). ...
Preprint
Full-text available
Background: Chronic renal failure is defined as kidney damage, or a reduction in the glomerular filtration rate, for three or more months. Few studies were performed regarding the oral health status of chronic renal failure patients in Sudan. Objective: Study aims to investigate the pattern of orofacial manifestations in patients with chronic renal failure in Sudan and how the disease affecting their oral health. Methods: The present study is a hospital based study conducted at Dr. Salma Center for Treatment of Kidney diseases, University of Khartoum, Sudan and Department of Nephrology at Ahmed Gasim Hospital for Heart Surgery and Kidney Diseases –khartoum Bahri, Sudan, between January to June 2019. Two hundred and twenty six patients participated in the study. The frequency and pattern of orofacial manifestations among those patient in addition to presence of additional systemic diseases ,duration of dialysis and mean levels of urea ,creatinine and hemoglobin were all investigated. Results: Oral lesions were present in 103 out of 226 (45.6%) patients with chronic renal failure .Xerostomia was the most manifestation encountered [145 (64.2%)], followed by orofacial abcess , ulcers and candidiasis . Hypertention was the commonest systemic disease encountered .No significant difference was found regarding the orofacial manifestations with duration of dialysis ,urea ,hemoglobin and creatinine mean levels. Conclusions: Prevalence of orofacial manifestations was significantly high among CRF patients .Xerostomia was the main complaint recognized. The findings of the present study emphasize the importance of dental practitioners in monitoring the oral health of patients with chronic renal faliure, and the need for regular clinical examinations to ensure early diagnosis and management of patients.
... They are oil and sugar-based (PEG-40, castor oil, xylitol, sucralose) and saliva substitutes resemble natural saliva, increasing salivary viscosity; therefore, saliva substitutes provide mucosal lubrification granting oral lubrification and comfort. In addition, given their content of Fluoride, they promote the enamel remineralization 7 . A more effective treatment of xerostomia should pay a particular attention to patient's therapies since dry mouth is a critical problem in elderly people with poly drugs: it is known that this problem can be a side effect of several medications such as neuroleptics, SSRI, FANS, Calcium channel blockers, sulfonylureas, opioids and so on (more than 1800 drugs and 80 classes, according to the literature) 8 . ...
Article
Atrophy or hypofunction of the salivary gland because of aging, radiotherapy or disease causes hyposalivation and impairs the quality of life of patients by compromising mastication, swallowing and speech and by leading to a loss of taste. Moreover, hyposalivation exacerbates dental caries and induces periodontal disease, and oral candidiasis. Currently, no satisfactory therapies have been established to solve salivary hypofunction. Current treatment options for atrophy or hypofunction of the salivary glands in clinical practice are only symptomatic and include saliva substitutes and parasympathetic agonists, such as pilocarpine, to stimulate salivary flow. However, parasympathomimetics have systemic side effects, so different treatment options are necessary, and research has recently focused on this. The main strategies that have been proposed to restore salivary gland atrophy and hypofunction are gene therapy by gene activation/silencing during stem cell differentiation and by the use of viral vectors, such as adenoviruses; cell-based therapy with salivary gland cells, stem cells and non-salivary gland and/ or non-epithelial cells to regenerate damaged salivary gland cells; replacement with tissue bioengineering in which organoids from pluripotent stem cells are used in the development of organ replacement regenerative therapy. Remarkable progression in this research field has been made in the last decade, but a definitive therapy for salivary gland hypofunction has not been developed due to intrinsic challenges that come with each approach. However, with research efforts in the future, a range of precision medicine therapies
... An important factor that contributes to poor hygiene is a disorder of saliva secretion. It is most often a side effect of medications taken or a consequence of therapeutic irradiation [8,9]. The change in dietary habits often observed in old age favors the maintenance of the metabolism of dental plaque [10]. ...
Article
Full-text available
Demographic ageing is a global growing process and the quality of ageing is an important parameter in this process. The aim of the study was to analyse the distribution of remaining dentition in relation to oral hygiene indicators among elderly people remaining in institutional care and those who participated in a 3-month rehabilitation program, aimed at increasing time of independent functioning, in southern Poland. The patients underwent a questionnaire and clinical examination. An analysis of missing teeth was performed, plaque index, and gingival index were measured. Residents of the Municipal Health Centre for Older and Dependent People (n = 50) had a higher incidence of missing teeth in the maxilla (88.4%), mandible (77.6%), as well as in the maxilla and mandible combined (83%) than residents of the Daily Medical Care House (n = 30). The distribution of the remaining teeth, in both groups, corresponds to the outlets of the large salivary glands. The group of 53.8% of patients with dry mouth had PI scored 3. Residents with dry mouth were more likely to have plaque deposits and gingival inflammation. It is necessary to develop and implement an oral care program for patients with reduced saliva secretion, with a particular focus on dependents.
... PSS is commonly associated to hyposalivation (decreased production of salivary flow and the amount of produced saliva is ≤ to 0.1 mL / min) and xerostomia (subjective feeling dry mouth) [17,18]. ...
... Following a patient's periodontal maintenance appointment, the RDH completed the RDH dry mouth observation questionnaire (Plemons et al., 2014) that includes questions about the patient's salivation volume and consistency, observable symptoms dry mouth and use of dry mouth aids -to assess the potential association between a patient's unstimulated salivary flow rate and dry mouth observations made by the RDH. A symptom score was calculated from the list of observable symptoms, with 1 observed symptom equating to 1 point for a possible total of 14 points. ...
Article
Full-text available
Objective Non‐surgical scaling and root planing (SRP), as an initial form of periodontal treatment, followed by ongoing periodontal maintenance appointments is necessary to manage periodontal disease and prevent tooth loss. Saliva also has an essential role in oral health though the relationship between low salivary flow and periodontal outcomes has not been extensively investigated. This study determined if patients with dry mouth have similar clinical outcomes as patients without dry mouth when receiving regular periodontal maintenance after SRP. Materials and methods This is a retrospective study that investigated clinical periodontal outcomes in patients with (n = 34) or without (n = 85) dry mouth who had undergone SRP 1 to 5 years prior and had routine periodontal maintenance. The presence of dry mouth was established based on a patient's unstimulated salivary flow rate. Results Probing depth for both patients with or without dry mouth was similar between groups and maintained 1 to 5 years following initial SRP. Improved probing depth achieved post‐SRP was sustained regardless of dry mouth status. Conclusion Patients with or without dry mouth did not exhibit different probing depths.
... Appropriate patient assessment, including a comprehensive medical-dental history and diagnostic tests, e.g. salivary flow measurement, are essential when diagnosing xerostomia (12). A decrease in the amount of saliva accompanying the dry mouth sensation requires further investigation, as this might suggest a systemic condition affecting the salivary glands (e.g. ...
Article
Full-text available
Background: Xerostomia or dry mouth sensation corresponds to a common clinical problem that can significantly impair the oral health related quality of life (OHRQoL). Currently, there is a large variety of local agents available for the treatment of xerostomia, but there is a lack robust evidence supporting the use of one treatment over another. We aimed to compare the effectiveness of a 1% malic acid salivary stimulant spray with a 1.33% betaine-based saliva substitute mouthwash in the improvement of xerostomia. Material and methods: Fifty-one participants with drug induced or idiopathic xerostomia were randomly allocated into three groups, two intervention and one control group (placebo). OHRQoL and severity of xerostomia were assessed with the OHIP-14sp questionnaire and a visual analogue scale (VAS) respectively. Stimulated and non-stimulated salivary flow rates before and after treatments were also measured. Results: All three groups reported a significantly improvement in the dry mouth sensation and non-stimulated salivary flow rates, but only the malic acid spray and the betaine-based mouthwash significantly improved the OHRQoL. There were no significant differences between both intervention groups. Conclusions: This study provides evidence that both tested agents are comparable in improving the dry mouth sensation and OHRQoL of patients with drug induced and idiopathic xerostomia. Key words:Xerostomia, dry mouth, malic acid, betaine, oral-health related quality of life.
... Xerostomia is a subjective sensation of oral dryness which may or may not be associated with a reduced salivary flow rate. 5 The overall prevalence of xerostomia is estimated to be 23% according to a systematic review and meta-analysis. 6 In a prospective study of adults aged 20e59 years, xerostomia prevalence was 11%. ...
Article
Full-text available
Objective Xerostomia may result in several oral conditions, which ultimately affect oral health-related quality of life (OHRQOL). This study aims to evaluate the relationship of stress, xerostomia, salivary flow rate, and OHRQOL among young adults. Method We invited 72 participants to complete three validated questionnaires including the Perceived Stress Scale-10 (PSS-10), a shortened version of the Xerostomia Inventory (SXI), and the shortened Oral Health Impact Profile (S–OHIP). Unstimulated saliva was collected, and flow rate was determined. Based on the SXI scores and hyposalivation, the participants were categorised into four groups: subjective xerostomia, subjective and objective xerostomia, objective xerostomia, and true non-xerostomia. Based on the median PSS score, participants were categorised into high stress and low stress groups. Data were analysed using the Mann–Whitney U test, Kruskal–Wallis H test, and Spearman's correlation coefficient. A p value of 0.05 was set for all tests. Results A significant difference was observed in the unstimulated salivary flow rate (χ²(3) = 26.677, p < 0.001) and PSS scores (X²(3) = 8.552, p = 0.036) between xerostomia groups, while OHIP scores were not statistically different (X²(3) = 5.488, p = 0.139). A significant correlation was observed between SXI and S–OHIP scores (r = 0.348, p = 0.003) and unstimulated salivary flow rate and PSS (r = −0.259, p = 0.028). Conclusion This study shows that perceived stress can influence salivary flow rate. Among the xerostomia groups, stress scores and salivary flow rates varied significantly. Additionally, subjective xerostomia has an impact on OHRQOL.
... The presence of saliva is vital for maintaining oral health and adequate oral functions. The lack of saliva results in a rapid deterioration in oral health and has a negative impact on a patient's quality of life [55]. ...
Article
Full-text available
Since aging has been associated with increased production of inflammatory biomarkers, the ability to monitor older adults repeatedly is highly desirable, and saliva is an interesting biofluid for the search of biomarkers, as it is easily accessible in a noninvasive manner. However, given the incipient knowledge of salivary biomarkers in aging and its relationship to physical exercise, the present study is aimed at evaluating the protein expression and the levels of inflammatory and NETosis biomarkers in the saliva of practitioners (PE) and nonpractitioners (NPE) of physical exercise older adults. Six (6) practitioner and 4 nonpractitioner older adults were enrolled in this study. Unstimulated whole saliva was collected for analysis of the proteome by label-free mass spectrometry, as well as of the inflammatory status by evaluation of C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and cytokines (TNF-α, interleukin- (IL-) 1β, and IL-8), while NETosis was assessed by myeloperoxidase (MPO) and neutrophil elastase. Regarding oral health, the decayed, missing, and filled teeth (DMF-T) index, bleeding on probing, suppuration, and probing depth measurement (mm) were evaluated. In addition, functional capacity was investigated using the General Physical Fitness Index (GPFI). In relation to the proteome analysis, 93 and 143 proteins were found exclusively in the PE and NPE groups, respectively; 224 proteins were common to both groups. Among these proteins, 10 proteins showed statistical difference (p
... As many as 500 medicationsdboth prescription and those you can buy over the counter (like allergy and cold medicines)dcan be factors. 1 Radiation treatments for head and neck cancer often damage the salivary glands and result in chronic dry mouth. 2 Saliva production also may be affected by diseases. 2 Longterm diseases, such as Sjögren syndrome, diabetes, and rheumatoid arthritis, can be associated with dry mouth. ...
... In another study by Peres et al. (24) undertaken on 27 patients, using chewable maltose tablets resulted in increased compared with baseline measurements. Furthermore, 2 literature reviews carried out by Brosky et al. (25) and by Plemons (26) claim that chewable tablets increase salivary secretion in patients with xerostomia, thus improving their quality of life. The present study also observed that the saliva-buffering capacity increased significantly on the final visit among patients treated with tablets, compared to those who were not treated with them. ...
Article
Background: Besides dental erosion syndrome, other oral syndromes could benefit from the stimulation of salivary secretion, in patients with gastro-oesophageal reflux disease (GORD). Our aims is evaluate the improvement of oral extra-oesophageal manifestations in patients with GORD using xylitol-malic acid tablets to stimulate salivary secretion. Material and methods: The effectiveness of salivary stimulation using xylitol-malic acid tablets (as a supplement to omeprazole 40 mg/day) was assessed in a clinical trial (n = 14) lasting six months with patients with prior positive pH-metry, through GORD extra-oesophageal clinical signs, GerdQ and RDQ questionnaires, odontological variables, basal salivary secretion, stimulated salivary secretion, pH and buffer capacity, mucosal erythema index and dental wear. Statistics: chi-square (Haberman post-hoc), ANOVA, and Mann-Whitney U; variables between visits were evaluated with McNemar's Student's t and Wilcoxon tests; p < 0.05. Results: 100% of patients not taking xylitol-malic acid presented xerostomia, but only 14.3% of patients taking xylitol-malic acid (p < 0.01) did. The mean saliva-buffer capacity at the last visit for patients not taking xylitol-malic acid was 2.14 ± 0.38, versus 2.71 ± 0.49 for patients taking xylitol-malic acid (p < 0.05). Retro-sternal burning (p < 0.05), heartburn (p < 0.05) and regurgitation (p < 0.05) were also reduced. Conclusions: Xylitol-malic acid tablets improve quality of life among patients with GORD, by reducing dry mouth, increasing saliva buffering and reducing heartburn, retro-sternal burning and regurgitation.
... Severity of dry mouth symptoms ranges from mild oral discomfort to significant oral disease that can compromise the patient's health, dietary intake, and QoL (35). The dry mouth mobile application developed in this study is the first of its kind to be pilot tested for ease of use, appeal and instant self-assessment of dry mouth symptoms. ...
Article
Full-text available
Background: Dry mouth, also commonly known as "xerostomia", is a prominent symptom that is often overlooked by dental practitioners and patients. The purpose of this study was to pilot the development of a mobile application for assessing dry mouth symptoms. The application will allow patients to self-assess and enhance knowledge, awareness and communication with dental practitioners in their management of dry mouth. Method: The first phase of the study was to draw on common knowledge and awareness by conducting two focus groups of dental professionals and community members on content, practicality, functionality, design, and effectiveness. The second phase of the study was the development of the dry mouth mobile application followed by the third phase of the study that consisted of face-validity interviews to obtain feedback on the application. Results: Fifty two percent (n=15) of the dental professionals estimated being aware of the prevalence of dry mouth in 40% or more of their patients. Thirty Nine percent of (n=9) community estimated being aware of the prevalence of dry mouth in 40% or more of the community. When asked about their awareness of the etiologies of dry mouth, 100% (n=29) of dental professionals reported that multiple medications and smoking were primary factors whereas the community members indicated that illness and dehydration (87%, n=20) were primary factors in dry mouth. Dental professional's (25% n=7) were very confident in recognizing symptoms and 28% (n=8) were very confident they knew how to manage dry mouth symptoms. Furthermore, 22% (n=5) of the community members were also very confident about recognizing dry mouth symptoms and 13% (n=3) were very confident knowing how managing it. The ToP report generated from the discussions identified "themes" that were utilized in the development of the mobile application. Most individuals who participated in the validity interviews agreed that the dry mouth mobile application was useful, appealing, easy to use and the self-assessment test gave clear and concise information. The application was made available to download from the iTunes Appstore (2019-2020). Conclusion: The dry mouth pilot study indicated that the mobile application was beneficial for self-assessment and easy to use. Development of advanced technology tools such as the dry mouth application can promote communication between patients and their dental practitioners to discuss management options for dry mouth.
... They are oil and sugar-based (PEG-40, castor oil, xylitol, sucralose) and saliva substitutes resemble natural saliva, increasing salivary viscosity; therefore, saliva substitutes provide mucosal lubrification granting oral lubrification and comfort. In addition, given their content of Fluoride, they promote the enamel remineralization 7 . A more effective treatment of xerostomia should pay a particular attention to patient's therapies since dry mouth is a critical problem in elderly people with poly drugs: it is known that this problem can be a side effect of several medications such as neuroleptics, SSRI, FANS, Calcium channel blockers, sulfonylureas, opioids and so on (more than 1800 drugs and 80 classes, according to the literature) 8 . ...
Article
Full-text available
Atrophy or hypofunction of the salivary gland because of aging, radiotherapy or disease causes hyposalivation and impairs the quality of life of patients by compromising mastication, swallowing and speech and by leading to a loss of taste. Moreover, hyposalivation exacerbates dental caries and induces periodontal disease, and oral candidiasis. Currently, no satisfactory therapies have been established to solve salivary hypofunction. Current treatment options for atrophy or hypofunction of the salivary glands in clinical practice are only symptomatic and include saliva substitutes and parasympathetic agonists, such as pilocarpine, to stimulate salivary flow. However, parasympathomimetics have systemic side effects, so different treatment options are necessary, and research has recently focused on this. The main strategies that have been proposed to restore salivary gland atrophy and hypofunction are gene therapy by gene activation/silencing during stem cell differentiation and by the use of viral vectors, such as adenoviruses; cell-based therapy with salivary gland cells, stem cells and non-salivary gland and/ or non-epithelial cells to regenerate damaged salivary gland cells; replacement with tissue bioengineering in which organoids from pluripotent stem cells are used in the development of organ replacement regenerative therapy. Remarkable progression in this research field has been made in the last decade, but a definitive therapy for salivary gland hypofunction has not been developed due to intrinsic challenges that come with each approach. However, with research efforts in the future, a range of precision medicine therapies may become available individualized to each patient.
... contains supplementary material, which is available to authorized users. speculated that drugs could have an impact on oral hygiene through detrimental effects on cognitive or physical functioning [7], or by reducing the rinsing effect of saliva [8]. ...
Article
Full-text available
Objectives To study the association between anticholinergic burden and oral hygiene practices and oral hygiene status among 46-year-old people.Materials and methodsThe study included 1945 participants from the Northern Finland Birth Cohort 1966 (NFBC1966), who had a complete dental status. The participants underwent clinical medical and dental examinations, and their medication data were gathered by combining self-reported drug use with information from the National Prescription Register. Anticholinergic burden was measured using nine previously published anticholinergic scales. Oral hygiene practices were assessed with toothbrushing frequency and oral hygiene status with the presence of visible dental plaque. Poisson regression with robust variance estimation and negative binomial regression models were used to estimate relative risks (RR).ResultsThirty percent of the participants reported brushing their teeth twice a day and about 25% of their teeth had dental plaque on them. Fifteen percent of the participants used at least one anticholinergic drug or had an anticholinergic burden according to the nine anticholinergic scales. After adjustments for confounding factors, the RRs of anticholinergic burden varied between 0.95 and 1.11 for toothbrushing frequency. Anticholinergic burden (according to Anticholinergic Activity Scale, Anticholinergic Cognitive Burden, Chew’s scale) was associated statistically significantly with the number of teeth with dental plaque. For the three scales, RRs varied from 1.24 to 1.50.Conclusions Anticholinergic burden associated with poor oral hygiene.Clinical relevanceThe findings stress the importance of providing oral hygiene instructions and prophylactic measures to patients taking anticholinergic drugs.
... People with decreased salivary flow experience symptoms that may include the burning and itching of the oral mucosa and tongue. They also have trouble chewing, tasting, and swallowing foods and communicating with others [12]. The aetiology of dry mouth is unclear, but hyperglycemia in patients with DM results in polyuria and osmotic diuresis, thus causing dehydration, which is related to a reduced salivary flow. ...
Article
Full-text available
Xerostomia is a symptom frequently present in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In the present trial, the activity of an artificial saliva (aldiamed® spray) in comparison to a placebo spray were used to evaluate the xerostomia and the saliva antioxidant capacity (SAT). Sixty patients of both genders with T1DM or T2DM were randomized into two groups of 30 subjects each. The experiment was a double-blind study approved by the Ethics Committee of the “G. d’Annunzio University” of Chieti and Pescara. Moreover, measurements of the stimulated saliva flow rate and the ultrasonography of the submandibular and parotid glands were performed at both the study time points. The results demonstrated statistically significant differences between the treatments in terms of the xerostomia average score. Specifically, the values were at baseline and after 30 days 2.9 ± 1.31 and 3.0 ± 1.44 and 1.4 ± 1.48 and 2.4 ± 0.99 for aldiamed® spray and the placebo, respectively. Meanwhile, no statistically significant differences were shown between the two groups for the other variables, such as the salivary flow rate, the antioxidant capacity of the saliva, and the ultrasonography of the major salivary glands.
... Although xerostomia is often a manifestation of impaired salivary gland function, it can occur with or without a noticeable decrease in saliva production (hyposalivation) (6). In a population-based sample of aged South Australians, Thomson et al (7) supported the fact that low salivary flow may not be the key factor in the etiology of xerostomia among older people. ...
Article
The purpose of this study was to test the safety and efficacy of AqualiefTM in patients affected by xerostomia. The main ingredients of AqualiefTM are carnosine and dried calyces of Hibiscus sabdariffa L. (karkadè) for their buffering effect at pH 7 as well as for their antioxidant, antimicrobial and lenitive properties. In a Randomized, Placebo-Controlled, Double-Blind Trial, sixty patients with xerostomia (RTOG/EORTC grade 1-2) were randomly assigned to receive either placebo, or AqualiefTM tablets (three times/day after meals) for 6 consecutive days. A questionnaire was used to evaluate dry mouth symptoms before and after 6 days of AqualiefTM or placebo application. Unstimulated and stimulated salivary flow rates and pH were measured before and after application. Treatment with AqualiefTM for 6 days induced a significant increase in saliva pH from 6.2 ± 0.5 to 6.4 ± 0.6 (P < 0.05) while placebo was ineffective (from 6.2 ± 0.5 to 6.3 ± 0.5). AqualiefTM also induced a significant increase in the pH of stimulated saliva from 6.3 ± 0.5 to 6.6 ± 0.5 (P < 0.01). Placebo was ineffective also in this setting (from 6.2 ± 0.5 to 6.3 ± 0.5). Besides an expected normalization of the saliva pH value, AqualiefTM treatment for 6 days greatly increased (56%, P < 0.0001) saliva production. Placebo induced a 19% increase (P < 0.05), which was likely due to mechanical stimulation. AqualiefTM also increased stimulated saliva production (27% increase with respect to day 0, P < 0.05), while placebo was ineffective. AqualiefTM was effective in regulating the saliva pH, in increasing saliva production and improving dry mouth symptoms in xerostomic patients.
... 26 Symptoms of OSCC are mucositis, dry mouth (xerostomia) and dysphagia, which generally appear during and after cancer treatments. 27 The most commonly known symptom in oral cancer patients is xerostomia, in which there is reduction in salivary gland flow resulting in oral fungal infection, swallowing problems, and altered taste. 28 The malignant neoplasm occurs at various sites, the most frequent being the lip, lateral edges of the tongue and floor of the oral cavity. ...
Article
Full-text available
Oral squamous cell carcinoma (OSCC) is one of the most common type of head and neck squamous cell carcinoma and one of the multifactorial process that consists of most contributing factors such as tobacco smoking, chewing and alcohol consumption that altered the intracellular environment. Recent studies have shown relevance of Toll like receptor (TLR) associated with carcinogenesis. This review aim’s to explore that how TLR associates with progression and suppression of OSCC. This review is a classical review that has confined to articles published in the past 19 years (i.e. 2000-2019) and has summarized the perspective of the authors. 62 articles were reviewed and it was found that progression and suppression of OSCC is associated with different TLRs promoting tumor development and also inhibiting the progression of oral neoplasm. It was found that TLR2, TLR3, TLR4, TLR5, TLR7 and TLR9 are associated with tumor development i.e. in progression of OSCC, where as suppression of OSCC through TLR3 and TLR7. We authors would like to conclude that literature survey has indicated effective TLR’s against OSCC development and can be explored to investigate other TLRs that can be used for therapeutic purposes in near future.
... However, only transient relief and reported adverse e↵ects (of pilocarpine) limit their use [117,118]. Following the concept of integrative medicine, the guideline of using THM compounds as part of the management recommendations for xerostomia patients has been developed [119,120]. One open-label parallel study aiming to determine the e↵ectiveness of a 4-week usage of an herbal compound containing Malva sylvestris and Alcea digitata powder compared to artificial saliva, showed a significant di↵erence between two groups in relieving xerostomia symptoms [121]. ...
Article
Head and neck squamous cell carcinoma (HNSCC) is one of the most prevalent neoplasms worldwide. It is well recognized that environmental challenges such as smoking, viral infection and alcohol consumption are key factors underlying HNSCC pathogenesis. Other than major clinical interventions (e.g., surgical resection, chemical and radiotherapy) that have been routinely practiced over years, adjuvant anticancer agents from Traditional Herbal Medicine (THM) are proposed, either alone or together with conventional therapies, to be experimentally effective for improving treatment efficacy in different cancers including HNSCCs. At a cellular and molecular basis, THM extracts could modulate different malignant indices via distinct signaling pathways and provide better control in HNSCC malignancy and its clinical complications such as radiotherapy-induced xerostomia/oral mucositis. In this article, we aim to systemically review the impacts of THM in regulating HNSCC tumorous identities and its potential perspective for clinical use.
... Once patients develop hyposalivation, stimulatory agents can be used to increase residual salivary function. This provides a wide range of interventions for hypofunction of the salivary gland [13]. For patients who present some degree of residual salivary gland parenchyma, stimulation of salivary gland function may be appropriate [12]. ...
Article
Stimulation of saliva production is an alternative to improve the quality of life of patients treated by radio-therapy. However, there is no information about changes in the salivary proteome of stimulated and unstimu-lated saliva in these patients. Objectives: Thus, we evaluated the difference in the proteomic profile of stimulated and unstimulated saliva in patients with head and neck cancer (HNC) treated by radiotherapy. Methods: Stimulated and unstimulated saliva were collected from 9 patients with HNC before (BRT), during (DRT; 2-5 weeks) and after (ART; 3-4 months) treatment. Healthy patients paired by age and gender also had their saliva collected (C; control group). The stimulated and unstimulated salivary flow were evaluated (p < 0.05). Salivary proteins were extracted and processed for shotgun proteomic analysis. Results: Significant differences were observed between stimulated and unstimulated salivary flows for C and BRT (p greater than 0.001), but not for DRT and ART. Proteins involved with apoptosis, antibacterial and acid-resistance were decreased in stimulated saliva in comparison to unstimulated saliva DRT and ART. Isoforms of keratins were not identified in control and BRT. Conclusion: there is a marked difference in the protein profile of stimulated and unstimulated salivary flows in HNC patients treated by radiotherapy. In addition, saliva stimulation in patients with HNC decreases important proteins involved with dental protection. The unstimulated salivary flow seems to be the best alternative to search for biomarkers. Our results contribute in an unprecedented way to understand the changes in the salivary proteome of different flows in HNC patients undergoing radiotherapy treatment.
... In the precise diagnosis of xerostomia, morphological and functional assessments are also proposed, such as histological examination, computed tomography, magnetic resonance imaging (MRI) and ultrasound. As these methods are technically complex and not part of the reality in the overall clinical scenario, these assessments are mainly based on self-reports from patients, especially considering that xerostomia is a subjective symptom [20]. ...
Article
Full-text available
In the last decades, there has been a substantial increase in the occurrence of cancer. The most commonly used treatment for this disease involves surgery, radiotherapy and chemotherapy. These treatment modalities are associated with different kinds of side effects, acute or late. Xerostomia is one of the main oral complications that affect patients undergoing antineoplastic treatments, mainly head and neck cancer patients. It is characterized by a “dry mouth” sensation resulting from decreased salivary flow. It is persistent and affects the integrity of oral tissues, thereby significantly affecting patients’ quality of life. Many strategies have been applied and others developed to prevent and reduce xerostomia. Accordingly, the objective of this study was to review the literature about current prevention and treatment measures aimed at improving the quality of life of xerostomic patients.
... 79,81 Indirectly, hyposalivation may render the oral mucosa sensitive to repeated friction from normal function. 79,82 Therefore, the xerostomia reported in association with VEGF inhibition may contribute to the mucosal toxicity. In addition, sunitinib was reportedly associated with additional types of oral mucosal changes: cheilitis and lichenoid reaction. ...
Article
Full-text available
Oral mucositis (OM) is a common, highly symptomatic complication of cancer therapy that affects patients' function, quality of life, and ability to tolerate treatment. In certain patients with cancer, OM is associated with increased mortality. Research on the management of OM is ongoing. Oral mucosal toxicities are also reported in targeted and immune checkpoint inhibitor therapies. The objective of this article is to present current knowledge about the epidemiology, pathogenesis, assessment, risk prediction, and current and developing intervention strategies for OM and other ulcerative mucosal toxicities caused by both conventional and evolving forms of cancer therapy.
... Vomiting, diarrhea, fever, difficulty swallowing, and anorexia can lead to dehydration, which can lead to xerostomia. [8] Dehydration, diarrhoea, nausea, swallover trouble, and anorexia can contribute to dehydratation and should be advised to water as much of it as practical for hospitalized patients. Mostly during winter months, a moisturizer can mitigate oral dryness, specifically for mouth breaths. ...
Article
Full-text available
Patients in palliative care require special attention from medical and preventive attention to managing their emotions. The role of the dentist in hospice care is to improve quality of life of the patient. The paper explains some basic problems in palliatives dentistry with terminal cancer and treated properly for adults. Treatment for people with serious illnesses throughout the age range is sufficient and can be offered as a primary care target or in combination with curative treatment. The staffs include an interdisciplinary team of doctors, nurses, occupational therapists and physical therapists, voice pathologists, counsellors, social workers, chaplains and dieticians. A variety of settings, such as clinics, outpatients, professional treatment and home environments, may be protected by palliative care. While palliative care is an essential part of end of life, it is not restricted to people close to life. The overall objective of The standard of living in palliative therapy is to control people with severe illness, any life-threatening disease that either decreases the everyday function or quality of life of an individual or increases the burden of caregiving by managing pain and symptoms, recognizing and addressing caregiver needs and organizing care. Historically, palliative care programs have been designed to support patients with incurable cancer, but the medical intervention concept is now being extended to the symptomatic treatment of disease-wide spectrum conditions such as severe heart failure.
... Saliva performs several functions: protection and lubrication of the oral tissues, initiation of digestion, exertion of antibacterial effects, tissue repair, and buffering [13]. Malfunction of the salivary glands can interfere with oral homeostasis by altering the quality and quantity of saliva, which can cause or aggravate several disorders, such as xerostomia and periodontal disease [14,15]. Studies from our group have already shown that salivary glands are susceptible to injury caused by exposure to metals, such as mercury, lead, and even Al [16][17][18][19][20][21][22]. ...
Article
Full-text available
Aluminum (Al) is one of the most abundant elements on Earth, and its high extraction rate and industrial use make human exposure very common. As Al may be a human toxicant, it is important to investigate the effects of Al exposure, mainly at low doses and for prolonged periods, by simulating human exposure. This work aimed to study the effects of low-dose exposure to chloride aluminum (AlCl3) on the oxidative biochemistry, proteomic profile, and morphology of the major salivary glands. Wistar male rats were exposed to 8.3 mg/kg/day of AlCl3 via intragastric gavage for 60 days. Then, the parotid and submandibular glands were subjected to biochemical assays, proteomic evaluation, and histological analysis. Al caused oxidative imbalance in both salivary glands. Dysregulation of protein expression, mainly of those related to cytoarchitecture, energy metabolism and glandular function, was detected in both salivary glands. Al also promoted histological alterations, such as acinar atrophy and an increase in parenchymal tissue. Prolonged exposure to Al, even at low doses, was able to modulate molecular alterations associated with morphological impairments in the salivary glands of rats. From this perspective, prolonged Al exposure may be a risk to exposed populations and their oral health.
... It contains several enzymes, which start the digestion process, and antibacterial, antifungal, and antiviral agents, which are extremely helpful to prevent oral infections [119]. Older people often present with a reduced salivary flow, with negative consequences for oral health, including dysgeusia, halitosis, burning mouth, oral pain, difficulty in chewing and swallowing, speech impairment, and an increased risk of fungal infections, demineralization/caries, and periodontitis [120][121][122][123][124]. ...
Article
Full-text available
Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.
... The nature of symptoms as well as the chronicity of the disease leads to significant adverse impact on patient's life. Hence, a comprehensive management strategy [8] should be the aim that involves patient education and lifestyle modification (smoking cessation, a good oral hygiene and frequent intake of water) as well as palliative therapies [9] like sugar free gums are giving as a first line. ...
... Previous studies found that institutionalised older people tend to have significantly lower levels of saliva flow, higher levels of oral yeast colonisation, and poorer dental statuses than noninstitutionalised older people (Glažar et al., 2016). Providing sufficient saliva serves several protective functions, like cleansing the oral cavity, facilitating the oral processing and swallowing of food, protecting oral tissues against physical and microbial insults, maintaining a neutral pH, and preventing tooth demineralisation (Plemons et al., 2014). A systematic review examining the adverse effects of auricular therapy concluded that auricular therapy is a relatively safe approach (Tan et al., 2014). ...
Article
Aims: To investigate the efficacy of applying auricular acupuncture (AA) treatment in improving dry mouth in institution-dwelling older adults. Background: Dry mouth (xerostomia) is a common distressing problem in older populations, especially for institution-dwelling older adults that can affect oral health and quality of life. Design: A randomised controlled trial was conducted from December 2020 to March 2021 and performed according to STRICTA guidelines extended from the CONSORT statement. Methods: Older adults aged more than 65 years were randomly allocated to an AA group (n = 37) with an 8-week actual auricular points treatment or a control group (n = 38) receiving sham auricular point acupuncture. Measurements comprised a subjective assessment of the level of dry mouth as assessed by a visual analogue scale in a xerostomia questionnaire, and an objective assessment of the physiological wetness of the lingual mucosa measured with a moisture-checking device. A generalised estimating equation model was used for data analyses. Results: After completing an 8-week AA intervention stimulating the Shenmen, Point Zero and Salivary Gland 2-prime points, the AA group exhibited significantly improved subjective symptoms of dry mouth comprised of difficulty speaking (B = -6.47, p < .001), difficulty swallowing (B = -6.73, p < .001), the amount of oral saliva (B = -5.38, p < .001), a dry throat (B = -7.53, p < .001) and thirst (B = -8.06, p < .001) compared with the control group. Moreover, the AA group had higher objective oral saliva flow than the control group (B = 4.73, p < .001). Conclusion: AA is an effective non-pharmacological method for improving subjective symptoms of dry mouth and objective saliva secretion in older populations living in nursing homes. Relevant to clinical practice: Performing regular AA on the Shenmen, Point Zero and Salivary Gland 2-prime auricular points can be considered an alternative treatment approach to improve dry mouth in institution-dwelling older adults.
... HTLV-1 infection is also associated with inflammatory diseases: Sjogren's syndrome, sicca syndrome, uveitis, conjunctivitis, arthritis, myositis, Hashimoto's thyroiditis, Graves' disease, and polyneuropathies, among others health conditions [1]. Regarding oral symptoms, xerostomia is frequent, with its usual consequences of hyposalivation, dysphagia, dysgeusia, opportunistic infections, caries, and periodontal disease [7][8][9]. Moreover, previous studies have shown it to be one of the most common, and it is often the most common, oral manifestation of HTLV-1 infection [8,10]. ...
Article
Full-text available
Objective To compare the oral health status and oral health-related quality of life (OHRQoL) in symptomatic and asymptomatic patients with human T-cell leukemia virus-1 (HTLV-1).Material and methodsThis cross-sectional study included 204 seropositive patients, classified into two groups, symptomatic and asymptomatic. The first group included patients with neurological symptoms associated with HTLV-1 (n = 69), and the second group, asymptomatic HTLV-1 carriers (n = 135). We evaluated the total unstimulated saliva flow, oral mucosa, the Decayed, Missing, Filled Teeth (DMFT) index, and Periodontal Screening and Recording (PSR). The Oral Health Impact Profile (OHIP14) measured the oral health-related quality of life. General health-related quality of life was measured by the 36-Item Short-Form Health Survey (SF-36). Variables with a value of p < 0.25 in bivariate analysis were selected, together with SF-36 summaries’ scores and total OHIP-14, for composing a logistic regression model that had symptomatology as the dependent variable.ResultsThe OHIP-14 total score was poor in symptomatic and asymptomatic groups, but with no marked difference between them. Symptomatic patients showed significantly lower SF-36 scores (P ≤ 0.05) compared to asymptomatic ones, except for mental component summary (MCS). Family income (1–2.99 minimal wages), reduced salivary flow, flossing, and lower physical component summary (PCS) were associated (P ≤ 0.05) with symptomatology.Conclusions Symptomatic individuals living with HTLV-1 showed lower HRQoL and poorer OHRQoL compared to asymptomatic ones. Family income, flossing, reduced salivary flow, and lower PCS were associated with symptomatic HTLV-1 individuals.Clinical relevanceIn the present study, symptomatic individuals with HTLV-1 showed higher family income, poorer oral health status, lower salivary flow, poorer OHRQoL, and lower HRQoL compared to asymptomatic ones.
... [16] [17][18] [19][20] ...
Article
Full-text available
Xerostomia is defined as the subjective sensation of dry mouth. Because it affects various systemic functions, it becomes relevant to research the therapeutic possibilities so that appropriate treatment can be indicated. Thus, this study aims to discuss the therapeutic possibilities for xerostomia treatment and analyze the most studied in clinical trials conducted worldwide. This descriptive exploratory study was conducted through a data analysis of clinical trials conducted worldwide for the treatment of xerostomia registered in the online platform "clinicaltrials.gov". The research was conducted during May 2019. Initially, 234 studies were identified, of which 97 corresponded to interventional clinical studies that addressed therapies for xerostomia. These surveys were recorded from December 1999 to May 2019. The 97 papers reporting treatments for xerostomia included various therapies such as mechanical and taste stimulants, pharmacological interventions, salivary substitutes, natural products, and alternative treatments. Among the researches analyzed, it was concluded that the most studied therapies for xerostomia worldwide were interventions using chewing gum, pilocarpine, biotene spray, honey mouthwash, conventional acupuncture and salivary gland transfer.
... During the late post-operative period alloHSCT patients often also experience significant long-term persistent saliva deficiency [13]. It is a complication that accompanies cGvHD or can also be a side effect of certain drugs (e.g., antihypertensive agents, opioids, antidepressants, tranquillizers) [41]. Saliva deficiencies may be accompanied by changes in its chemical composition, which negatively affect, for example, the remineralization of dental hard tissue [42]. ...
Article
Full-text available
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is one of the most commonly performed transplantation procedures nowadays. Despite the significant progress made in the treatment, alloHSCT is still associated with numerous complications also affecting the oral cavity. One of them is dentin hypersensitivity (DH)—a sharp, short-term pain that occurs when stimuli act on exposed dentin. Various authors point out that DH may result in a significantly lower quality of life, among other things by impeding the consumption of food as well as causing difficulties in daily oral hygiene. The aim of the study was a preliminary analysis of the incidence rate and severity of DH pain in adult patients during late period after alloHSCT. The impact of chronic graft-versus-host disease (cGvHD) and time after alloHCT were also considered. A total of 80 patients were examined. cGvHD was identified in 52 participants. The incidence rate and severity of DH pain was assessed on the basis of a questionnaire and a clinical examination. DH pain appeared a serious problem in late period after alloHSCT regardless of post-transplant time. DH primarily affected cGvHD patients. The prevention-treatment protocol for DH should be developed for this group.
... Uma ampla gama de terapias foi estudada para o tratamento de xerostomia, como medicamentos estimuladores da saliva (pilocarpina, fisostigmina, interferon ou cevimelina), que são eficazes para reduzir a xerostomia, mas podem ser contraindicados em pacientes com doenças respiratórias crônicas, cardiovasculares, ou doença renal (Plemons, Al-Hashimi & Marek, 2014;Delli, Spijkervet, Kroese, Bootsma & Vissink, 2014;Silvestre, 2004). ...
Article
Full-text available
Introdução: A população idosa sofre com diversas alterações decorrentes da senilidade, dentre elas a xerostomia e a hipossalivação. Objetivo: realizar uma revisão integrativa com o intuito de avaliar as diferentes terapêuticas descritas na literatura relacionadas ao tratamento da xerostomia e hipossalivação em idosos. Metodologia: Como estratégia de busca, foi realizada uma pesquisa bibliográfica do tipo integrativa nas bases de dados eletrônicas: PubMed, Lilacs e Web of Science, sobre o assunto, utilizando as seguintes palavras chaves: “Xerostomia”, “Idosos”, “Tratamento” em associação através do operador booleano AND. Foi selecionado os estudos realizados apenas em humanos entre os anos 2011 a 2021. Resultados: Entre os 94 estudos encontrados, somente 5 artigos, publicados entre os anos de 2011 a 2021, foram utilizados dos resultados. Conclusão: Após a análise dos estudos pode-se confirmar a eficácia de diversas alternativas para o tratamento da xerostomia e sua relevância científica e que a xerostomia por si só não é uma doença, mas o não tratamento traz sérias implicações odontológicas, afetando a saúde bucal e geral do paciente.
... [42][43][44] Moreover, increased medication use leads to a decrease in the quantity and quality of saliva, which causes poor self-cleansing, caries-in particular cervical caries-and an increased risk of periodontal inflammation and Candida infections. 45,46 Taken together, these previous findings may explain the relatively high number of dental visits, which was at least 2 times higher than the national average of 2 dental visits per year, for all age groups. 40,47 However, the age of 75 years could be seen as a turning point. ...
Article
Background Some older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices. Methods In this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age. Results A total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist–patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common. Conclusions Older people who visit community dental practices are still relatively healthy, non-frail, and highly educated. Even in this group, there is a turning point in both general and oral health from the age of 75.
Chapter
The population of the United States is aging. Adults 65 years of age and older (or older adults) represent the most rapidly increasing demographic. The fastest growing is the cohort age 85 and older (Ortman et al, An aging nation: the older population in the United States. United States Census Bureau, Economics and Statistics Administration, US Department of Commerce, Washington, DC, 2014). The prevalence of chronic diseases associated with aging is also increasing, including conditions such as heart disease, hypertension, diabetes, arthritic conditions, and dementia. Aging is also associated with a decline in physiologic functioning of the individual. Dementia is a significant and increasingly common age-related disorder and manifests as a slow, progressive decline in cognitive functions (i.e., intellectual abilities, impairment of memory, abstract thinking, and judgment). The pathophysiology and etiology of dementia can vary, but the most common cause is Alzheimer’s disease (AD) (Birks and Harvey, Cochrane Database Syst Rev (6):CD001190, 2018). This chapter presents a case report and a review of the issues and challenges associated with the management of dental patients with AD. Practicing dentistry is no longer limited to oral cavity as dentists are “oral health physicians” who must be knowledgeable of the condition and manage their patients appropriately.
Article
Stromal cells can direct differentiation of epithelial progenitor cells during organ development. FGF signaling is essential for submandibular salivary gland development. Through stromal fibroblast cells, FGF2 can indirectly regulate proacinar cell differentiation in organoids but the mechanisms are not understood. We performed scRNA-Seq and identified multiple stromal cell subsets, including Pdgfrα+ stromal subsets expressing both Fgf2 and Fgf10. When combined with epithelial progenitor cells in organoids, MACS-sorted PDGFRα+ cells promoted proacinar differentiation similarly to total stroma. Gene expression analysis revealed that FGF2 increases multiple stromal genes, including Bmp2 and Bmp7. Both BMP2 and BMP7 synergized with FGF2 stimulating proacinar differentiation, but not branching. However, stromal cells grown without FGF2 did not support proacinar organoid differentiation and instead differentiated into myofibroblasts. In organoids, TGFβ1 treatment stimulate myofibroblast differentiation and inhibited the epithelial progenitor cell's proacinar differentiation. Conversely, FGF2 reversed the TGFβ1's effects. We also demonstrated that adult salivary stromal cells were FGF2 responsive and could promote proacinar differentiation. These FGF2 signaling pathways may have applications in future regenerative therapies.
Article
Full-text available
Background: Head and neck cancer (HNC) patients experience distressing symptoms that can significantly impact their health-related quality of life (HRQoL). We analyzed the implementation of a nurse-led consultation (NLC) and explored potential associations with symptom burden in HNC patients. Methods: We retrospectively analyzed routinely collected data to describe the implementation of the nurse-led interventions and the evolution of the M.D. Anderson Symptom Inventory scores as patient-reported outcome measures (PROMs). Patients who received routine care (n = 72) were compared with patients in the NLC group (n = 62) at a radiation oncology unit between 2017 and 2019. PROMs were measured at T0 (between simulation and the first week of radiotherapy), T1 (week 3-4), and T2 (week 5-6). Results: Screening for nutrition, smoking, oral cavity status, and capacity for swallowing/chewing, but not for pain, was applied in >80% of patients in the NLC group from T0 to T1. Education (16%) and care coordination (7%) were implemented to a lesser extent. Symptom burden increased over time with no significant differences between groups. Conclusions: The nurse-led consultation was not associated with symptom burden over time. A larger implementation study including a detailed process evaluation, larger sample size, and a focus on long-term effects is needed.
Chapter
The traditional view of kidney function is limited and focuses on its regulation of excretory, endocrine, acid–base, and electrolytes domains. This chapter provides a comprehensive and evidencebased overview of the renal structure, function, and diagnostic tools for impaired renal function, and oral symptoms and signs observed in patients with chronic kidney disease prior to and during in‐center hemodialysis, patients undergoing peritoneal dialysis, and those received a kidney transplant. Acute kidney injury (AKI) is not a single disease, but rather a loose collection of diverse syndromes such as sepsis, cardiorenal syndrome, and urinary tract obstruction. AKI are often divided into three diagnostic categories: prerenal failure, postrenal failure, and acute intrinsic renal failure. Studies have started to examine the role of recreational drug use in chronic kidney injury progression. Patients with renal disease present with various oral manifestations and pathologic lesions of soft and hard tissues and teeth.
Article
Few treatment options exist for patients experiencing xerostomia due to hyposalivation that occurs as a result of disease or injury to the gland. An opportunity for a permanent solution lies in the field of salivary gland replacement through tissue engineering. Recent success emboldens in the vision of producing a tissue engineered salivary gland composed of differentiated salivary epithelial cells able to differentiate to form functional units that produce and deliver saliva to the oral cavity. This vision is augmented by advances in understanding cellular mechanisms that guide branching morphogenesis and salivary epithelial cell polarization in both acinar and ductal structures. Growth factors and other guidance cues introduced into engineered constructs help to develop a more complex glandular structure that seeks to mimic native salivary gland tissue. This review describes the separate epithelial phenotypes that make up the gland, and describes their relationship with the other cell types such as nerve and vasculature that surround them. The review is organized around the links between the native components that form and contribute to various aspects of salivary gland development, structure and function and how this information can drive design of functional tissue engineered constructs. Additionally, we discuss the attributes of various biomaterials commonly used to drive function and form in engineered constructs. The review also contains a current description of the state-of-the-art of the field, including successes and challenges in creating materials for preclinical testing in animal models. The ability to integrate biomolecular cues in combination with a range of materials opens the door to the design of increasingly complex salivary gland structures, that, once accomplished can lead to breakthroughs in other fields of tissue engineering of epithelial-based exocrine glands or oral tissues.
Article
Background: Incidence of anxiety and pain in patients undergoing hysterectomy is significant and primarily due to postoperative pain. Most patients usually receive opioids for pain control. Melatonin is a natural hormone produced by the body. Synthetic melatonin is available over the counter for the management of insomnia and jetlag. Clinically, melatonin can also be used to reduce pain and analgesic requirement in patients undergoing surgery. The analgesic benefit of melatonin as primary or adjuvant agents has been reported in various studies. Objective: We aimed to study whether melatonin could improve pain and other postoperative conditions after hysterectomy. Methods: A randomized, double-blinded, placebo-controlled trial study was carried out on 54 women undergoing hysterectomy, with or without oophorectomy under spinal anesthesia. Patients were allocated randomly to receive either 4 mg prolonged-release melatonin at night and in the morning before surgery or 2 doses of placebo. Morphine consumption within 24 hours, visual analog scale (VAS) pain score, quality of sleep, anxiety level score, fatigue, general well-being and satisfaction score were measured. Results: Morphine consumption in melatonin group was significantly low compared to placebo (33.04 ± 10.42 and 42.63 ± 8.21 mg, (p < 0.001). Also, postoperative VAS pain scale was lower in the melatonin group at recovery room arrival (23.41 vs 8.07, p = 0.01). Postoperative fatigue, general well-being and satisfaction scores in the melatonin group were better than the placebo group. Conclusion: Prolonged-release formulation of melatonin decreased pain intensity in post anesthetic care room and reduced morphine consumption within 24 hours after surgery. Melatonin may be an additional choice of multimodal analgesia for hysterectomy.
Article
Full-text available
Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.
Article
Aim : analysis of medical and social characteristics and assessment of the dental status of geriatric patients with cognitive impairment. Materials and methods . The study was carried out at the Department of Therapeutic Dentistry. We analyzed the responses and laboratory results of 43 patients aged 60–92 years. The main methods used in the study were: questioning (Fox test), sialometry, saliva pH determination, microbiological analysis (of the upper respiratory tract) for fungal microflora. Results obtained showed that an objective study of the secretory function of the salivary glands according to the method of M.M. Pozharitskaya found that the average rate was 0.2 ± 0.004 ml/min, and the average saliva pH was 5.7 ± 0.04. The medical and social portrait of a geriatric patient indicates that mainly patients with impaired cognitive functions seeking dental treatment and prophylaxis were women, whose average age was 76.03 ± 2.8 years, as a rule, they were representatives of the humanitarian and natural-scientific professions, 75% are married. According to the results of the Fox test, it was found that 60% of patients complained of dry mouth of a different nature. The perception of dry mouth was statistically significantly dependent on gender (P = 0.025) and the presence of chronic diseases (P = 0.004). Women (OR = 1.17, P = 0.026) with chronic diseases (OR = 2.97, P = 0.002) were more likely to suffer from dry mouth.
Article
This article aims to describe common complicating factors that impact on the success of complete denture treatment and present an overview of the challenges these pose in practice. The authors present a range of medical, oral and social factors to consider when providing treatment to edentulous patients, allowing the practitioner to identify cases which may require referral. The information is applicable to all dental practitioners, and is a useful aid to highlight complicating factors in individual patients and to make well-informed clinical decisions. Dental practitioners must be able to assess complexity in complete dentures and plan care for individual patients.Medical, oral and social factors all contribute to case complexity in complete dentures.Knowledge of these factors, combined with the ability to identify these through patient assessment, may aid practitioners in making well-informed clinical decisions to support edentulous patients. Dental practitioners must be able to assess complexity in complete dentures and plan care for individual patients. Medical, oral and social factors all contribute to case complexity in complete dentures. Knowledge of these factors, combined with the ability to identify these through patient assessment, may aid practitioners in making well-informed clinical decisions to support edentulous patients.
Article
Full-text available
A common question in organ regeneration is the extent to which regeneration recapitulates embryonic development. To investigate this concept, we compared the expression of two highly interlinked and essential genes for salivary gland development, Sox9 and Fgf10, during submandibular gland development, homeostasis and regeneration. Salivary gland duct ligation/deligation model was used as a regenerative model. Fgf10 and Sox9 expression changed during regeneration compared to homeostasis, suggesting that these key developmental genes play important roles during regeneration, however, significantly both displayed different patterns of expression in the regenerating gland compared to the developing gland. Regenerating glands, which during homeostasis had very few weakly expressing Sox9‐positive cells in the striated/granular ducts, displayed elevated expression of Sox9 within these ducts. This pattern is in contrast to embryonic development, where Sox9 expression was absent in the proximally developing ducts. However, similar to the elevated expression at the distal tip of the epithelium in developing salivary glands, regenerating glands displayed elevated expression in a subpopulation of acinar cells, which during homeostasis expressed Sox9 at lower levels. A shift in expression of Fgf10 was observed from a widespread mesenchymal pattern during organogenesis to a more limited and predominantly epithelial pattern during homeostasis in the adult. This restricted expression in epithelial cells was maintained during regeneration, with no clear upregulation in the surrounding mesenchyme, as might be expected if regeneration recapitulated development. As both Fgf10 and Sox9 were upregulated in proximal ducts during regeneration, this suggests that the positive regulation of Sox9 by Fgf10, essential during development, is partially reawakened during regeneration using this model. Together these data suggest that developmentally important genes play a key role in salivary gland regeneration but do not precisely mimic the roles observed during development. A common question in organ regeneration is the extent to which regeneration recapitulates embryonic development. To investigate this concept, we compared the expression of two highly interlinked and essential genes for salivary gland development, Sox9 and Fgf10, during submandibular gland development, homeostasis and regeneration. Our data suggest that developmentally important genes play a key role in salivary gland regeneration but do not precisely mimic the roles observed during development.
Article
Full-text available
This study evaluated the antimicrobial (anti-biofilm) and anti-caries (enamel demineralization prevention) effects of a new cystatin derived from sugarcane (CaneCPI-5). Microcosm biofilm was produced on bovine enamel specimens (4 x 4 mm; n=48) from a mixture of human saliva and McBain saliva at the first 8 h. From this moment until the end of the experiment, the enamel specimens were exposed to lsaMcBain saliva containing 0.2% sucrose and, once a day, they were treated with the test solutions for 1 min. This treatment was performed for 5 days. The solutions evaluated were: PBS (negative control), 0.12% chlorhexidine (positive control), 0.1 mg/ml CaneCPI-5 and 1.0 mg/ml CaneCPI-5. The biofilm viability was determined by fluorescence using confocal microscopy and the enamel demineralization was quantified using transverse microradiography (TMR). The data were analyzed by ANOVA/Tukey or Kruskal-Wallis/Dunn tests for biofilm and enamel, respectively (p<0.05). With respect to the antimicrobial effect, all treatment solutions significantly reduced the biofilm viability compared with PBS. The best antimicrobial effect was found for 1.0 mg/ml CaneCPI-5 (82.37±10.01% dead bacteria) that significantly differed from 0.12% chlorhexidine (73.13±15.07% dead bacteria). For the anti-caries effect, only 0.12% chlorhexidine (ΔZ: 2610, 1683-4343) performed significantly better than PBS (ΔZ: 8030, 7213-9115), but 0.12% chlorhexidine did not significantly differ from 0.1 mg/ml Cane-CPI-5. Under this experimental model, CaneCPI-5 significantly reduced the biofilm viability, but this effect was not reflected on its anti-caries potential.
Article
Full-text available
The intact function of the salivary glands is of utmost importance for oral health. During radiotherapy in patients with head and neck tumors, the salivary glands can be damaged, causing the composition of saliva to change. This leads to xerostomia, which is a primary contributor to oral mucositis. Medications used for protective or palliative treatment often show poor efficacy as radiation-induced changes in the physico-chemical properties of saliva are not well understood. To improve treatment options, this study aimed to carefully examine unstimulated whole saliva of patients receiving radiation therapy and compare it with healthy unstimulated whole saliva. To this end, the pH, osmolality, electrical conductivity, buffer capacity, the whole protein and mucin concentrations, and the viscoelastic and adhesive properties were investigated. Moreover, hyaluronic acid was examined as a potential candidate for a saliva replacement fluid. The results showed that the pH of radiation-induced saliva shifted from neutral to acidic, the osmolality increased and the viscoelastic properties changed due to a disruption of the mucin network and a change in water secretion from the salivary glands. By adopting an aqueous 0.25% hyaluronic acid formulation regarding the lost properties, similar adhesion characteristics as in healthy, unstimulated saliva could be achieved.
Article
The chorda tympani nerve provides parasympathetic innervation to the submandibular gland and is pivotal in basal salivary production.¹ Adequate salivation is critical to oral health, and gland hypofunction may lead to xerostomia, increasing the risk of dental disease.² In cochlear implant (CI) surgery, the chorda tympani nerve is at risk when opening the facial recess and may intentionally or unintentionally be sacrificed. Although dysgeusia is discussed,³ to our knowledge, there is a lack of literature regarding the association of middle ear surgery with salivation. Furthermore, the effect of either injury or sacrifice of the chorda tympani in the CI population is not well characterized. The purpose of this study was to calculate the prevalence of xerostomia among a population of adult CI recipients.
Article
Full-text available
Adolescent smoking continues to rise in the United States. Individuals from economically-disadvantaged households appear at high risk for smoking. This study focused on a sample of economically-disadvantaged adolescents attending New York City schools (N = 1875). Longitudinal predictors of smoking from four domains (socio-demographic background information, social influences to smoke, social and personal competence, and individual differences) were tested. Social influences to smoke, from mothers and friends, both predicted smoking one year later. Poor decision-making skills, and low psychological well-being also predicted subsequent smoking. Conclusion: These findings support social learning theory (Bandura, 1977) and problem behavior theory (Jessor, 1991). Furthermore, the results suggest that training adolescents to resist social influences to smoke, to problem solve and make sound decisions, and how to cope with psychological distress are among the key components for effective smoking prevention approaches.
Data
Full-text available
In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation
Article
Full-text available
Background: The most advocated clinical method for diagnosing salivary dysfunction is to quantitate unstimulated and stimulated whole saliva (sialometry). Since there is an expected and wide variation in salivary flow rates among individuals, the assessment of dysfunction can be difficult. The aim of this systematic review is to evaluate the quality of the evidence for the efficacy of diagnostic methods used to identify oral dryness. Methods: A literature search, with specific indexing terms and a hand search, was conducted for publications that described a method to diagnose oral dryness. The electronic databases of PubMed, Cochrane Library, and Web of Science were used as data sources. Four reviewers selected publications on the basis of predetermined inclusion and exclusion criteria. Data were extracted from the selected publications using a protocol. Original studies were interpreted with the aid of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Results: The database searches resulted in 224 titles and abstracts. Of these abstracts, 80 publications were judged to meet the inclusion criteria and read in full. A total of 18 original studies were judged relevant and interpreted for this review. In all studies, the results of the test method were compared to those of a reference method.Based on the interpretation (with the aid of the QUADAS tool) it can be reported that the patient selection criteria were not clearly described and the test or reference methods were not described in sufficient detail for it to be reproduced. None of the included studies reported information on uninterpretable/intermediate results nor data on observer or instrument variation. Seven of the studies presented their results as a percentage of correct diagnoses. Conclusions: The evidence for the efficacy of clinical methods to assess oral dryness is sparse and it can be stated that improved standards for the reporting of diagnostic accuracy are needed in order to assure the methodological quality of studies. There is need for effective diagnostic criteria and functional tests in order to detect those individuals with oral dryness who may require oral treatment, such as alleviation of discomfort and/or prevention of diseases.
Article
Full-text available
Aim of this review is to summarize the studies carried out, with particular interest in those who dealt with otilonium bromide in treatment of IBS. Irritable bowel syndrome (IBS). IBS is a frequent gastrointestinal disease, characterized by a combination of several symptoms including abdominal pain or discomfort, flatulence and problems related to bowel habits (constipation and/or diarrhea). It affects about 15% of the western population, with a negative impact on the quality of life and also on health care costs. Face to such important complexity and negative impact, therapeutic options are still very limited and most of the pharmacological compounds mostly validated for short term use, are only partially controlling symptoms. Among those, anti-spasmodics are commonly used in clinical settings. Despite a discrete literature in support of these drugs, systematic collections of clinical evidence to support the use of anti-spasmodics and in particular the use of otilonium bromide in course of IBS are scarce. Otilonium bromide is a systemically poorly absorbed antispasmodic, which has shown clear efficacy compared to placebo, in controlling symptoms related to IBS. Otilonium bromide was effective also in comparison to other drugs, such as pinaverium bromide and mebeverine, with a favorable tolerability profile. Further studies are necessary to better define duration of treatment and maximum therapeutic dose.
Article
Full-text available
Hyposalivation is a long-term effect in patients receiving head and neck radiation. Radiotherapy can predispose oral colonization by Candida species of the mucosa. This study aims to evaluate the correlation between hyposalivation, measured by unstimulated saliva flow rates (SFR) and fungal colonization of the oral cavity, and also the resistance of isolated Candida strains to antimicrobial therapy. Fifty-three consecutive patients with radiotherapy were examined for late radiation damage on dental hard tissue and the salivary glands (SFR over a period of 5 min). The SFR were divided into three different values of hyposalivation: grade I (SFR 0.1-0.25 ml/min), grade II (SFR ≤0.1 ml/min), and grade III (SFR = 0.0 ml/min). Candidal colonization was defined using Sabouraud agar and identified using API 20C AUX (biomerieux) in the patients' rinsing water. Susceptibility was tested with Etest (amphotericin B, ketoconacole, voriconacole, and fluconacole). Hyposalivation grade I was detected in 23% (9.1 × 10(1) colony forming units (cfu); range, 200-5,900 cfu), hyposalivation grade II in 26% (4.3 × 10(1) cfu; range, 110-3,300 cfu), and hyposalivation grade III in 51% (2.0 × 10(3) cfu; range, 300-19,475 cfu) of patients. A significant correlation between the SFR and candidal colonization and clinical presentation (European Organization for Research and Treatment of Cancer (EORTC) score) was detected (Mann-Whitney test, p = 0.031). Twenty Candida albicans and 27 non-albicans species were identified. The resistance of C. albicans was higher than that of non-albicans strains against antimicrobial agents. By comparison, amphotericin B showed the greatest and fluconazole the least effect. A higher value of hyposalivation correlates with a higher risk of candidal colonization in patients who have received radiotherapy and also with a higher EORTC score. The spectrum of Candida is wide and susceptibility against antifungal therapy differs. In long-term examinations of patients with xerostomia after radiotherapy, the EORTC score can be used to measure hyposalivation. Reduced susceptibility of C. albicans might introduce complications to therapy. Findings of more non-albicans strains show a change in colonization which should be examined in further studies.
Article
Full-text available
Psychiatric patients have increased comorbid physical illness. There is less information concerning dental disease in this population in spite of risk factors including diet and psychotropic side-effects (such as xerostomia). Aims To compare the oral health of people with severe mental illness with that of the general population. A systematic search for studies from the past 20 years was conducted using Medline, PsycINFO, Embase and article bibliographies. Papers were independently assessed. The primary outcome was total tooth loss (edentulousness), the end-stage of both untreated caries and periodontal disease. We also assessed dental decay through standardised measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS). For studies lacking a control group we used controls of similar ages from a community survey within 10 years of the study. We identified 21 papers of which 14 had sufficient data (n = 2784 psychiatric patients) and suitable controls (n = 31 084) for a random effects meta-analysis. People with severe mental illness had 3.4 times the odds of having lost all their teeth than the general community (95% CI 1.6-7.2). They also had significantly higher scores for DMFT (mean difference 6.2, 95% CI 0.6-11.8) and DMFS (mean difference 14.6, 95% CI 4.1-25.1). Fluoridated water reduced the gap in oral health between psychiatric patients and the general population. Psychiatric patients have not shared in the improving oral health of the general population. Management should include oral health assessment using standard checklists that can be completed by non-dental personnel. Interventions include oral hygiene and management of xerostomia.
Article
Full-text available
A variety of topical and systemic drugs are available to treat primary Sjögren syndrome, although no evidence-based therapeutic guidelines are currently available. To summarize evidence on primary Sjögren syndrome drug therapy from randomized controlled trials. We searched MEDLINE and EMBASE for articles on drug therapy for primary Sjögren syndrome published between January 1, 1986, and April 30, 2010. Controlled trials of topical and systemic drugs including adult patients with primary Sjögren syndrome were selected as the primary information source. The search strategy yielded 37 trials. A placebo-controlled trial found significant improvement in the Schirmer and corneal staining scores, blurred vision, and artificial tear use in patients treated with topical ocular 0.05% cyclosporine. Three placebo-controlled trials found that pilocarpine was associated with improvements in dry mouth (61%-70% vs 24%-31% in the placebo group) and dry eye (42%-53% vs 26%). Two placebo-controlled trials found that cevimeline was associated with improvement in dry mouth (66%-76% vs 35%-37% in the placebo group) and dry eye (39%-72% vs 24%-30%). Small trials (<20 patients) found no significant improvement in sicca outcomes for oral prednisone or hydroxychloroquine and limited benefits for immunosuppressive agents (azathioprine and cyclosporine). A large trial found limited benefits for oral interferon alfa-2a. Two placebo-controlled trials of infliximab and etanercept did not achieve the primary outcome (a composite visual analog scale measuring joint pain, fatigue, and dryness); neither did 2 small trials (<30 patients) testing rituximab, although significant results were observed in some secondary outcomes and improvement compared with baseline. In primary Sjögren syndrome, evidence from controlled trials suggests benefits for pilocarpine and cevimeline for sicca features and topical cyclosporine for moderate or severe dry eye. Anti-tumor necrosis factor agents have not shown clinical efficacy, and larger controlled trials are needed to establish the efficacy of rituximab.
Article
Full-text available
This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions. Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.
Article
Full-text available
This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.
Article
Full-text available
Xerostomia (dry mouth) is a common complaint with widespread implications such as impaired quality of life, oral pain, and numerous oral complications. There are a variety of salivary and nonsalivary causes of xerostomia, the most frequent being medication side effects and systemic disorders. A systematic approach should be employed to determine the etiology of this condition, with distinctions made between patients with subjective complaints of xerostomia alone and those with measurable salivary gland dysfunction. Management is multidisciplinary and multimodal. This review summarizes the current literature on the etiology, diagnosis, and complications of xerostomia, and on the management of patients with xerostomia.
Article
Full-text available
Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.
Article
Full-text available
There is considerable difficulty in the making of initial clinical decisions as to whether a given patient has salivary gland hypofunction, and hence requires additional salivary gland evaluation. This study identified a set of four clinical measures that, together, successfully predicted the presence or absence of salivary gland hypofunction. The four measures were: dryness of lips, dryness of buccal mucosa, absence of saliva produced by gland palpation, and total DMFT; they were derived from discriminant analysis of data collected from 71 individuals with normal and low salivary flow rates. These measures are proposed as criteria for clinical decision-making, as well as for classification of patients in studies of salivary gland dysfunction syndromes. This study also identified unstimulated whole salivary flow rates of 0.12-0.16 mL/min as the critical range separating individuals with salivary gland hypofunction from those with normal gland function.
Article
Full-text available
Oral mucosal colonization and infection with Candida are common in patients receiving radiation therapy for head and neck cancer. Infection is marked by oral pain and/or burning and can lead to significant patient morbidity. The purpose of this study was to identify Candida strain diversity in this population by using a chromogenic medium, subculturing, molecular typing, and antifungal susceptibility testing of clinical isolates. These results were then correlated with clinical outcome in patients treated with fluconazole for infection. Specimens from 30 patients receiving radiation therapy for head and neck cancer were cultured weekly for Candida. Patients exhibiting clinical infection were treated with oral fluconazole. All isolates were plated on CHROMagar Candida and RPMI medium, subcultured, and submitted for antifungal susceptibility testing and molecular typing. Infections occurred in 27% of the patients and were predominantly due to Candida albicans (78%). Candida carriage occurred in 73% of patients and at 51% of patient visits. Yeasts other than C. albicans predominated in carriage, as they were isolated from 59% of patients and at 52% of patient visits. All infections responded clinically, and all isolates were susceptible to fluconazole. Molecular typing showed that most patients had similar strains throughout their radiation treatment. One patient, however, did show the acquisition of a new strain. With this high rate of infection (27%), prophylaxis to prevent infection should be evaluated for these patients.
Article
Full-text available
Medication and psychological processes may affect salivary flow and cause subjective oral dryness. The importance of these factors is unclear. The aim of this study was to evaluate the association of medication, anxiety, depression, and stress with unstimulated salivary flow and subjective oral dryness. We studied 1,202 individuals divided into three groups, and controls. Intake of medication was evaluated. Anxiety, depression, and stress were assessed. Unstimulated salivary flow < 0.1 mL/min and subjective oral dryness were significantly associated with age, female gender, intake of psychotropics, anti-asthmatics, and diuretics. Unstimulated salivary flow < 0.1 mL/min and no subjective oral dryness were significantly associated with age, intake of antihypertensives, and analgesics. Subjective oral dryness and unstimulated salivary flow > 0.1 mL/min were significantly associated with depression, trait anxiety, perceived stress, state anxiety, female gender, and intake of antihypertensives. Age and medication seemed to play a more important role in individuals with hyposalivation, and female gender and psychological factors in individuals with subjective oral dryness.
Article
Full-text available
Sjögren's syndrome, or SS, is a multisystem inflammatory disorder of the exocrine glands with a wide range of extraglandular involvement. Symptoms of dry eyes and xerostomia, although not invariably present, are characteristic features of SS. An increased risk of oral and dental diseases is a prominent consequence of SS. The author reviewed recent medical and dental studies that have advanced our understanding of the causes and treatment of SS. She particularly focused on studies addressing the diagnosis and treatment of the oral component of the disease. Sjögren's syndrome is a widely underdiagnosed disease. A delay in the diagnosis of SS may have a significant physical, psychological and economic impact on the affected person. The pathogenesis of SS appears to involve a number of factors: immunological, genetic, hormonal and possibly infectious. Successful management of SS requires a multidisciplinary approach, and the dentist plays an essential role in the diagnosis and treatment of the disease. ORAL IMPLICATIONS: Impairment of salivary function in SS increases the risk of developing oral diseases. Effective management of oral health comprises enhancement of salivary output (cholinergic agonist drugs such as pilocarpine or cevimeline) and prevention and treatment of dental caries, oral candidiasis and allergic mucositis. Finally, periodic evaluation of various clinical and laboratory parameters is needed to monitor disease status.
Article
Full-text available
Background: Anticholinergics were the first drugs available for the symptomatic treatment of Parkinson's disease and they are still widely used today, both as monotherapy and as part of combination regimes. They are commonly believed to be associated with a less favourable side effect profile than other antiparkinsonian drugs, in particular with respect to neuropsychiatric and cognitive adverse events. They have been claimed to exert a better effect on tremor than on other parkinsonian features. Objectives: To determine the efficacy and tolerability of anticholinergics in the symptomatic treatment of Parkinson's disease compared to placebo or no treatment. Search strategy: The literature search included electronic searches of the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to 2001), Old Medline (1960-1965), Index Medicus (1927 - 1959), as well as handsearching the neurology literature including the reference lists of identified articles, other reviews and book chapters. Selection criteria: Randomised controlled trials of anticholinergic drugs versus placebo or no treatment in de-novo or advanced Parkinson's disease, either as monotherapy or as an add-on to other antiparkinsonian drugs were included. Trials of anticholinergic drugs that were never in general clinical use were excluded. Data collection and analysis: Data was abstracted independently by two authors. Differences were settled by discussion among all authors. Data collected included patient characteristics, disease duration and severity, concomitant medication, interventions including duration and dose of anticholinergic treatment, outcome measures, rates of and reasons for withdrawals, and neuropsychiatric and cognitive adverse events. Main results: The initial search yielded 14 potentially eligible studies, five of which were subsequently excluded. In three cases this was because they dealt with substances that had never been marketed or had not been licensed for as far as could be traced back. One trial had been published twice in different languages. One study was excluded based on the assessment of its methodological quality. The remaining nine studies were all of double-blind cross-over design and included 221 patients. Trial duration was between five and 20 weeks and drugs investigated were benzhexol (mean doses: 8 to 20 mg/d), orphenadrine (mean dose not reported), benztropine (mean dose not reported), bornaprine (8 to 8.25 mg/d), benapryzine (200 mg/d), and methixine (45 mg/d). Only one study involved two anticholinergic drugs. Outcome measures varied widely across studies and in many cases, the scales applied were the authors' own and were not defined in detail. Incomplete reporting of methodology and results was frequent. The heterogeneous study designs as well as incomplete reporting precluded combined statistical analysis. Five studies used both tremor and other parkinsonian features as outcome measures. Outcome measures in these five studies were too different for a combined analysis and results varied widely, from a significant improvement in tremor only to significant improvement in other features but not in tremor. All studies except one (dealing with methixine) found a significant improvement from baseline on the anticholinergic drug in at least one outcome measure. The difference between placebo and active drug was reported in four studies and was found to be significant in all cases. No study failed to show superiority of the anticholinergic over placebo. The occurrence of neuropsychiatric and cognitive adverse events was reported in all but three studies (in 35 patients on active drug versus 13 on placebo). The most frequently reported reason for drop-outs from studies was in patients on placebo due to withdrawal from pre-trial anticholinergic treatment. Reviewer's conclusions: As monotherapy or as an adjunct to other antiparkinsonian drugs, anticholinergics are more effective than placebo in improving motor function in Parkinson's disease. Neuropsychiatric and cognitive adverse events occur more frequently on anticholinergics than on placebo and are a more common reason for withdrawal than lack of efficacy. Results regarding a potentially better effect of the anticholinergic drug on tremor than on other outcome measures are conflicting and data do not strongly support a differential clinical effect on individual parkinsonian features. Data is insufficient to allow comparisons in efficacy or tolerability between individual anticholinergic drugs.
Article
Background: Topically-applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over three decades. This review updates the first Cochrane review of fluoride varnishes for preventing dental caries in children and adolescents, which was first published in 2002. Objectives: To determine the effectiveness and safety of fluoride varnishes in preventing dental caries in children and adolescents, and to examine factors potentially modifying their effect. Search methods: We searched the Cochrane Oral Health Group's Trials Register (to 13 May 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4), MEDLINE via OVID (1946 to 13 May 2013), EMBASE via OVID (1980 to 13 May 2013), CINAHL via EBSCO (1980 to 13 May 2013), LILACS and BBO via the BIREME Virtual Health Library (1980 to 13 May 2013), ProQuest Dissertations and Theses (1861 to 13 May 2013), and Web of Science Conference Proceedings (1945 to 13 May 2013). A search for ongoing trials was undertaken on ClinicalTrials.gov on 13 May 2013. There were no restrictions on language or date of publication in the search of the electronic databases. Selection criteria: Randomised or quasi-randomised controlled trials with blind outcome assessment used or indicated, comparing topically-applied fluoride varnish with placebo or no treatment in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent (D(M)FS) and primary (d(e/m)fs) teeth. Data collection and analysis: At least two review authors assessed all search results, extracted data and undertook risk of bias independently. Study authors were contacted for additional information. The primary measure of effect was the prevented fraction, that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. The caries increments nearest to three years were used from each included study. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects meta-regression analyses. Adverse effects information was collected from the included trials. Main results: Twenty-two trials with 12,455 participants randomised (9595 used in analyses) were included. For the 13 that contributed data for the permanent tooth surfaces meta-analysis, the pooled D(M)FS prevented fraction estimate comparing fluoride varnish with placebo or no treatment was 43% (95% confidence interval (CI) 30% to 57%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001; I(2) = 75%), however this body of evidence was assessed as of moderate quality. The pooled d(e/m)fs prevented fraction estimate was 37% (95% CI 24% to 51%; P < 0.0001) for the 10 trials that contributed data for the primary tooth surfaces meta-analysis, also with some heterogeneity (P = 0.009; I(2) = 59%). Once again this body of evidence was assessed as of moderate quality. No significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the pre-specified factors of baseline caries severity, background exposure to fluorides, application features such as prior prophylaxis, concentration of fluoride, frequency of application were found. There was also no significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the post hoc factors: whether a placebo or no treatment control was used, length of follow-up, or whether individual or cluster randomisation was used, in the meta-regression models. A funnel plot of the trials in the main meta-analyses indicated no clear relationship between prevented fraction and study precision. In both methods, power is limited when few trials are included. There was little information concerning possible adverse effects or acceptability of treatment. Authors' conclusions: The conclusions of this updated review remain the same as those when it was first published. The review suggests a substantial caries-inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate, as it included mainly high risk of bias studies, with considerable heterogeneity.
Article
Background Patients with Sjögren syndrome (SS) experience slowly progressive infiltration of lacrimal and salivary glands by mononuclear cells. This leads to diminished secretions, with resultant symptoms of xerostomia and xerophthalmia. Although pilocarpine hydrochloride tablets are currently indicated for the treatment of radiation-induced xerostomia, their effects on dry mouth or dry eyes in patients with SS are unclear.Objective To assess the safety and efficacy of pilocarpine (Salagen) tablets as symptomatic treatment for dry mouth and dry eyes caused by SS in a multicenter, double-blind, placebo-controlled trial.Methods After providing written informed consent, 373 patients with primary or secondary SS and clinically significant dry mouth and dry eyes were randomized to receive 2.5-mg pilocarpine, 5-mg pilocarpine, or placebo tablets 4 times daily for 12 weeks. Symptoms were assessed by questionnaires with visual analog scales or categorical checkboxes. Whole-mouth salivary flow rates were measured.Results A significantly greater proportion of patients in the 5-mg pilocarpine group showed improvement compared with the placebo group (P≤.01) in global assessments of dry mouth, dry eyes, and other symptoms of dryness (P≤.05). Salivary flow was significantly increased 2- to 3-fold (P<.001) after administration of the first dose and was maintained throughout the 12-week study. The most common adverse effect was sweating, and no serious drug-related adverse experiences were reported.Conclusion Administration of 5-mg pilocarpine tablets 4 times daily (20 mg/d) was well tolerated and produced significant improvement in symptoms of dry mouth and dry eyes and other xeroses in patients with SS.
Article
Sarcoidosis and Sjögren's syndrome are two different diseases; however, when affecting the salivary glands, both diseases exhibit similar clinical signs and symptoms, which often complicates the diagnosis. The purpose of this study was to investigate the possibility of using salivary electrophoresis to differentiate between the two diseases. Saliva was collected from patients with sarcoidosis and patients with Sjögren's syndrome. Salivary flow rate, total protein, and electrophoretic profiles were examined. Mean salivary flow rate was 0.41 ± 0.07 ml/min/gland vs. 0.43 ± 0.07 ml/min/gland; total salivary protein was 130.0 ± 29.2 mg% vs. 104.0 ± 8.8 mg% for sarcoidosis vs. Sjögren's syndrome, respectively. No differences were observed in salivary flow rate, total salivary protein, or electrophoretic profile between patients with sarcoidosis and patients with Sjögren's syndrome (P = 0.768, 0.718, and 1.000, respectively). Salivary protein electrophoresis does not appear to be useful to differentiate between sarcoidosis and Sjögren's syndrome.
Article
Overactive bladder syndrome is defined as urgency with or without urgency incontinence, usually with frequency and nocturia. Pharmacotherapy with anticholinergic drugs is often the first line medical therapy, either alone or as an adjunct to various non-pharmacological therapies after conservative options such as reducing intake of caffeine drinks have been tried. Non-pharmacologic therapies consist of bladder training, pelvic floor muscle training with or without biofeedback, behavioural modification, electrical stimulation and surgical interventions. To compare the effects of anticholinergic drugs with various non-pharmacologic therapies for non-neurogenic overactive bladder syndrome in adults. We searched the Cochrane Incontinence Group Specialised Register (searched 4 September 2012), which includes searches of the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE, and the reference lists of relevant articles. All randomised or quasi-randomised, controlled trials of treatment with anticholinergic drugs for overactive bladder syndrome or urgency urinary incontinence in adults in which at least one management arm involved a non-drug therapy. Trials amongst patients with neurogenic bladder dysfunction were excluded. Two authors evaluated the trials for appropriateness for inclusion and risk of bias. Two authors were involved in the data extraction. Data extraction was based on predetermined criteria. Data analysis was based on standard statistical approaches used in Cochrane reviews. Twenty three trials were included with a total of 3685 participants, one was a cross-over trial and the other 22 were parallel group trials. The duration of follow up varied from two to 52 weeks. The trials were generally small and of poor methodological quality. During treatment, symptomatic improvement was more common amongst those participants on anticholinergic drugs compared with bladder training in seven small trials (73/174, 42% versus 98/172, 57% not improved: risk ratio 0.74, 95% confidence interval 0.61 to 0.91). Augmentation of bladder training with anticholinergics was also associated with more improvements than bladder training alone in three small trials (23/85, 27% versus 37/79, 47% not improved: risk ratio 0.57, 95% confidence interval 0.38 to 0.88). However, it was less clear whether an anticholinergic combined with bladder training was better than the anticholinergic alone, in three trials (for example 74/296, 25% versus 95/306, 31% not improved: risk ratio 0.80, 95% confidence interval 0.62 to 1.04). The other information on whether combining behavioural modification strategies with an anticholinergic was better than the anticholinergic alone was scanty and inconclusive. Similarly, it was unclear whether these complex strategies alone were better than anticholinergics alone.In this review, seven small trials comparing an anticholinergic to various types of electrical stimulation modalities such as Intravaginal Electrical Stimulation (IES), transcutaneous electrical nerve stimulation (TENS), the Stoller Afferent Nerve Stimulation System (SANS) neuromodulation and percutaneous posterior tibial nerve stimulation (PTNS) were identified. Subjective improvement rates tended to favour the electrical stimulation group in three small trials (54% not improved with the anticholinergic versus 28/86, 33% with electrical stimulation: risk ratio 0.64, 95% confidence interval 1.15 to 2.34). However, this was statistically significant only for one type of stimulation, percutaneous posterior tibial nerve stimulation (risk ratio 2.21, 95% confidence interval 1.13 to 4.33), and was not supported by significant differences in improvement, urinary frequency, urgency, nocturia, incontinence episodes or quality of life.The most commonly reported adverse effect among anticholinergics was dry mouth, although this did not necessarily result in withdrawal from treatment. For all comparisons there were too few data to compare symptoms or side effects after treatment had ended. However, it is unlikely that the effects of anticholinergics persist after stopping treatment. The use of anticholinergic drugs in the management of overactive bladder syndrome is well established when compared to placebo treatment. During initial treatment of overactive bladder syndrome there was more symptomatic improvement when (a) anticholinergics were compared with bladder training alone, and (b) anticholinergics combined with bladder training were compared with bladder training alone. Limited evidence from small trials might suggest electrical stimulation is a better option in patients who are refractory to anticholinergic therapy, but more evidence comparing individual types of electrostimulation to the most effective types of anticholinergics is required to establish this. These results should be viewed with caution in view of the different classes and varying doses of individual anticholinergics used in this review. Anticholinergics had well recognised side effects, such as dry mouth.
Article
Background Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy.MethodsA general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy.ResultsSixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose.Conclusion Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life. © 1999 John Wiley & Sons, Inc. Head Neck 21: 1–11, 1999.
Article
We propose new classification criteria for Sjögren's syndrome (SS), which are needed considering the emergence of biologic agents as potential treatments and their associated comorbidity. These criteria target individuals with signs/symptoms suggestive of SS. Criteria are based on expert opinion elicited using the nominal group technique and analyses of data from the Sjögren's International Collaborative Clinical Alliance. Preliminary criteria validation included comparisons with classifications based on the American–European Consensus Group (AECG) criteria, a model-based “gold standard”obtained from latent class analysis (LCA) of data from a range of diagnostic tests, and a comparison with cases and controls collected from sources external to the population used for criteria development. Validation results indicate high levels of sensitivity and specificity for the criteria. Case definition requires at least 2 of the following 3: 1) positive serum anti-SSA and/or anti-SSB or (positive rheumatoid factor and antinuclear antibody titer >1:320), 2) ocular staining score >3, or 3) presence of focal lymphocytic sialadenitis with a focus score >1 focus/4 mm2 in labial salivary gland biopsy samples. Observed agreement with the AECG criteria is high when these are applied using all objective tests. However, AECG classification based on allowable substitutions of symptoms for objective tests results in poor agreement with the proposed and LCA-derived classifications. These classification criteria developed from registry data collected using standardized measures are based on objective tests. Validation indicates improved classification performance relative to existing alternatives, making them more suitable for application in situations where misclassification may present health risks.
Article
This study was to analyze the association of hyposalivation with oral function, nutritional status and oral health in community-dwelling elderly Thai. The subjects were 612 elderly people (mean age = 68.8, SD 5.9 years). Oral function (tasting, speaking, swallowing and chewing) and Mini Nutritional Assessment (MNA) were evaluated. Oral examination investigated teeth and periodontal status. Both unstimulated and stimulated whole saliva were collected for 5 minutes. Among all subjects, 14.4 % were classified within the hyposalivation. Hyposalivation was associated with gender, systemic disease, medication, and smoking. Subjects within the hyposalivation group had a higher number of decayed teeth and a higher prevalence of periodontitis than the normal salivation group (p < 0.05). The hyposalivation group also had a lower number of teeth present and a lower mean MNA score than the normal salivation group (p < 0.05). Logistic regression analysis showed that hyposalivation in both dentate and edentulous subjects was significantly associated with tasting, speaking, swallowing and chewing. This study suggested that hyposalivation is a risk factor not only for dental caries and periodontal disease but also for taste disturbances, speaking problems, swallowing problems, poor chewing ability and malnutrition. Monitoring salivary flow is an important measure in the care of older people.
Article
Xerostomia (the feeling of dry mouth) is a common symptom especially in older adults. Causes of dry mouth include medications, autoimmune disease (Sjögren's Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections. To determine which topical treatments for dry mouth are effective in reducing this symptom. We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (28 October 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2011), MEDLINE via OVID (1950 to 28 October 2011), EMBASE via OVID (1980 to 28 October 2011), CINAHL via EBSCO (1980 to 28 October 2011), AMED via OVID (1985 to 28 October 2011), CANCERLIT via PubMed (1950 to 28 October 2011). We included randomised controlled trials of topical interventions such as lozenges, sprays, mouthrinses, gels, oils, chewing gum or toothpastes for the treatment of dry mouth symptom. We classified interventions into two broad categories, saliva stimulants and saliva substitutes, and these were compared with either placebo or another intervention. We included both parallel group and crossover trials. Two or more review authors independently carried out data extraction and assessed risk of bias. Trial authors were contacted for additional information as required. Thirty-six randomised controlled trials involving 1597 participants met the inclusion criteria. Two trials compared saliva stimulants to placebo, nine trials compared saliva substitutes to placebo, five trials compared saliva stimulants directly with saliva substitutes, 18 trials directly compared two or more saliva substitutes, and two trials directly compared two or more saliva stimulants. Only one trial was at low risk of bias and 17 were at high risk of bias. Due to the range of interventions, comparisons and outcome measures in the trials, meta-analysis was possible for only a few comparisons. Oxygenated glycerol triester (OGT) saliva substitute spray shows evidence of effectiveness compared to an electrolyte spray (standardised mean difference (SMD) 0.77, 95% confidence interval (CI) 0.38 to 1.15) which corresponds to approximately a mean difference of 2 points on a 10-point visual analogue scale (VAS) for mouth dryness. Both integrated mouthcare systems (toothpaste + gel + mouthwash) and oral reservoir devices show promising results but there is insufficient evidence at present to recommend their use. Although chewing gum is associated with increased saliva production in the majority of those with residual capacity, there is no evidence that gum is more or less effective than saliva substitutes. There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10-point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this. Well designed, adequately powered randomised controlled trials of topical interventions for dry mouth, which are designed and reported according to CONSORT guidelines, are required to provide evidence to guide clinical care. For many people the symptom of dry mouth is a chronic problem and trials should evaluate whether treatments are palatable, effective in reducing xerostomia, as well as the long-term effects of treatments on quality of life of those with chronic dry mouth symptoms.
Article
The aim of this study was to examine the symptoms and risk factors associated with self-reported xerostomia. Data were collected from 601 self-administered questionnaires among dental clinic attendees. Logistic regression models to estimate odds ratios and 95% confidence intervals were used to investigate the association for exposures of interest, such as socio-demographic characteristics, self-reported symptoms, oral hygiene habits and xerostomia. Participants reported having dry mouth in 19.6% of cases. Xerostomia was associated with a significant increase in the odds of having dry lips, throat, eye, skin and nose. Patients with self-reported xerostomia were three times more likely to drink water to swallow food than were patients without xerstomia. Older individuals were significantly more likely to report dry mouth, and the prevalence of xerostomia increased with advancing age. The prevalence of xerostomia in patients taking one or more drugs was significantly higher compared to medication-free patients, and increased with increasing numbers of medications used. Finally, individuals with a nervous or mental disorder, or who wore removable dentures were five times more likely to develop xerostomia than patients without disorder or dentures. Dentists should be familiar with the symptoms of xerostomia and be prepared to take an active role in the diagnosis, management and treatment of the oral complications.