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The influence of hormone replacement therapy on the salivary flow of post-menopausal women
Gynecological Endocrinology
Abstract
The aim of this study is to investigate the influence of hormone therapy on salivary flow in menopausal women. It is a case–control study involving 86 post-menopausal women. The case group consisted of 47 women undergoing estroprogestative or estrogen hormone replacement therapy (HRT), and the control group consisted of 39 women who did not receive any HRT. All patients were submitted to a standard questionnaire, followed by total stimulated sialometry and determination of body mass index (BMI). The salivary flow was classified as follows: normal (1.0–3.0 mL/min), low (0.7–1.0 mL/min), and hyposalivation (<0.7 mL/min). The results were analyzed statistically by the chi-square test, logistic regression model, and linear regression (p < 0.05). The HRT group presented an association of protection, even after adjusting the analysis, for low salivary flow (Adjusted OR = 0.22; 95% CI = 0.05–0.88; p = 0.034), and hyposalivation (Adjusted OR = 0.30; 95% CI = 0.10–0.92; p = 0.036). The results suggest that estroprogestative therapy (β = + 0.53; p = 0.022) has greater influence on the increase of salivary flow than estrogen therapy (β = +0.35; p = 0.137). The study concludes stating salivary flow was influenced by HRT on the post-menopausal women studied.
... Similarly, ovariectimized rodents and menopausal women also shown salivary gland degeneration and dysfunction, characterized by a reduction in the quantity of salivary acini and ducts [5][6][7]. It is clear that dysfunction of salivary glands secondary to deficiency of sex steroids, like menopause in women usually causes a significant decrease in salivary flow, resulting in hypo-salivation and xerostomia [8]. However, the mechanisms by which deficiency of sex steroids cause degeneration and dysfunction of salivary glands still remain largely unknown. ...
... The percentage of both SMG acini and ducts in ORC was markedly lower than in IM, indicating a more severe degeneration of SMG in ORC than in IM. Dysfunction of salivary glands commonly induces hypo-salivation and causes poor oral health and dry mouth symptoms [7,8]. In this regard, immunocastration appears to be more superior and suitable than surgical castration to be applied as a castration approach in animal husbandry and companion animal species, or as a treatment for sex hormone-dependent diseases in men. ...
Background
Salivary gland (SMG) degeneration and dysfunction are common symptoms that occur after sex hormone deprivation, but the underlying mechanisms remain largely unknown. Additionally, immunocastration, which causes drop of sex hormones, has been developed as an alternative to surgical castration, however whether it exerts similar effects as surgical castration on the salivary glands is unknown. Through histological and RNA-seq analysis, we assessed changes in morphology and transcriptome of SMG in response to immunocastration (IM) versus surgical castration (bilateral orchiectomy, ORC).
Results
Compared to entire males (EM), ORC caused severe degeneration of SMG in rats, as evidenced by both decreased ( P < 0.01) SMG weight and organ index, and by decreased ( P < 0.01) quantity of SMG acini and ducts. IM had minimal effects ( P > 0.05) on SMG weight and organ index, but it still caused degeneration ( P < 0.05) of the acini and ducts. Even though, the quantity of both SMG acini and ducts was much higher ( P < 0.001) in IM than in ORC. Functional enrichment analysis of the common regulated genes by ORC/IM revealed disrupted epithelial cell development, angiogenesis, anatomical structure morphogenesis and enhanced cell death are associated with SMG degeneration in deprivation of androgens. Integrated data analysis shown that there existed a selective hyperfunction of SMG ribosome and mitochondrion in ORC but not in IM, which might be associated with more severe degeneration of SMG in ORC than in IM.
Conclusions
Our findings suggested that both surgical castration and immunocastration caused SMG degeneration by disrupting epithelial cell development, angiogenesis, anatomical structure morphogenesis and enhancing cell death. But, surgical castration selectively induced hyperfunction of SMG ribosome and mitochondrion, thus causing more severe degeneration of SMG than immunocastration.
... Reports from the literature suggest that xerostomia affects mostly menopausal women and individuals older than 65 years (Minicucci et al., 2013;D R et al., 2014). Clinical studies have demonstrated that estrogen therapy could effectively alleviate oral dryness by augmenting salivary secretion in menopausal women (Eliasson et al., 2003;Lago et al., 2015). However, long-term estrogen therapy possesses a risk for endometrial and breast cancer (Liang and Shang, 2013;Marjoribanks et al., 2017). ...
... Postmenopausal estrogen deficiency is linked to various diseases, including xerostomia, osteoporosis, diabetes, and other inflammatory diseases (Caputo and Costa, 2014;Baer and Walitt, 2018). Hormone replacement therapy (HRT) had been reported to increase salivary secretion in postmenopausal women (Yalçin et al., 2005;Lago et al., 2015). However, HRT possesses a risk of adverse side effects, including the development of endometrial and breast cancer (Pietrzak et al., 2015). ...
Xerostomia is a common symptom in menopausal women, suggesting the role of sex steroids in disease development. Shreds of literature had reported the potential use of herbal extracts to relieve xerostomia. However, a cocktail of multiple components in herbal extract makes it difficult to understand the exact mechanism of action. Aquaporin5 (AQP5), the specific aquaporin expressed in salivary glands, plays an important role in salivary secretion as a downstream of estrogen signaling. In this study, we aimed to unravel a single active herbal component as a therapeutic for xerostomia and investigate its mechanism of action. The effects of apigenin (flavonoid), dauricine (alkaloids), protopine (alkaloids), and lentinan (polysaccharides) on AQP5 transcription were screened in vitro. Only apigenin robustly induced AQP5 transcription and expression, and this effect was even robust compared to the effect of estradiol (E2, a positive control). Overexpression of estrogen receptor α (ERα) in the human salivary gland cell line (HSG) upregulated the AQP5 transcription and expression and the knockdown ERα reversed this effect, suggesting the role of ERα signaling on AQP5 activation in HSG cells. Docking results showed apigenin-specific binding sites in ERα. We further analyzed the therapeutic effect of apigenin on ovariectomized mice as a xerostomia model. The saliva secretion in the xerostomia group was reduced to one-third of the sham group, whereas the apigenin or E2 treatment for 12 weeks reversed this effect. Meanwhile, the water consumption in the xerostomia group was augmented obviously compared to the sham group, whereas the water consumption in the apigenin and E2 group was declined to the level of the sham group. Immunohistochemistry of submandibular glands revealed the downregulation of AQP5 expression in xerostomia mice compared to control. Apigenin, or E2 treatment, upregulated AQP5 expression in xerostomia mice. In conclusion, apigenin, a single active component of herbal extract, upregulated AQP5 expression in HSG cells via activation of ERα signaling and restored saliva flow rates in OVX mice. These results revealed apigenin as a single active component of herbal extract with the potential to treat xerostomia.
... The main peri-and postmenopausal symptoms include xerostomia (subjective oral dryness) and/or hyposalivation (Mahesh et al., 2014), which may increase the occurrence of mucosal and dental diseases, such as candidiasis. Few studies have investigated the effects of hormone replacement therapy in such patients (Mahesh et al., 2014;Lago et al., 2015), although the existing results show an improvement in symptoms following such treatment (Mahesh et al., 2014;Lago et al., 2015). ...
... The main peri-and postmenopausal symptoms include xerostomia (subjective oral dryness) and/or hyposalivation (Mahesh et al., 2014), which may increase the occurrence of mucosal and dental diseases, such as candidiasis. Few studies have investigated the effects of hormone replacement therapy in such patients (Mahesh et al., 2014;Lago et al., 2015), although the existing results show an improvement in symptoms following such treatment (Mahesh et al., 2014;Lago et al., 2015). ...
Sex differences in gut microbiota are acknowledged, and evidence suggests that gut microbiota may have a role in higher incidence and/or severity of autoimmune diseases in females. Additionally, it has been suggested that oral, vaginal, and gut microbiota composition can be regulated by estrogen levels. The association of vaginal microbiota with vulvovaginal atrophy at menopause is well described in the literature. However, the relevance of oral and gut microbiota modulation in the immune system during estrogen deficiency and its effect on inflammatory diseases is not well explored. Estrogen deficiency is a condition that occurs in menopausal women, and it can last approximately 30 years of a woman’s life. The purpose of this mini- review is to highlight the importance of alterations in the oral and gut microbiota during estrogen deficiency and their effect on oral and inflammatory diseases that are associated with menopause. Considering that hormone replacement therapy is not always recommended or sufficient to prevent or treat menopause-related disease, we will also discuss the use of probiotics and prebiotics as an option for the prevention or treatment of these diseases.
... In addition, the MMP-9 enzyme is a degradation protein whose increase can be caused periodontal damage. Thus, the decreasing pH in the oral ambient for a long time in hypertension patients results in aggregation of bacteria colonization and influences oral health [27]. Therefore, several previous studies considered inflammatory mediators a key indicator for cardiovascular and hypertension diseases. ...
... The means of stimulated salivary f low volume are similar to the values obtained by Rahnama et al. [15] (0.812 ± 0.095 ml/min). Lago et al. [10] observed that hormone therapy increases salivary f low in 0.52 ml/min, showing an inf luence of hormone therapy drugs used by postmenopausal women, especially the ones under estroprogestative therapy. This study did not aim to assess whether women were pre-or postmenopausal, but it allows inferring that these drugs work on the salivary glands and affect salivary flow. ...
The appearance of new drugs for cancer treatment has increased patient survival but it has also brought adverse effects, such as the sensation of dry mouth and hyposalivation Objective: To assess the relationship of using hormone therapy in breast and prostate cancer patients and the occurrence of xerostomia and hyposalivation. Material and methods: Cross-sectional study with 114 patients diagnosed with cancer and treated with hormone therapy. The researcher collected resting and stimulated salivary flows in the morning. The descriptive statistic analysis, chi-square test (p<0.005), and t-test (><0.005), and t-test (<0.005) were performed using the Statistical Package for Social Science™ (SSPS), version 21, for different variables of hyposalivation and hormone therapy. Results: The results showed that 67 (55.8%) patients using hormone therapy drugs presented hyposalivation and 73 (64%) patients presented xerostomia. a. Conclusion: According to the results of this study, there is a positive association between stimulated hyposalivation and the use of hormone therapy drugs (p = 0.015). There was also a positive association between hyposalivation and xerostomia and the use of hormone therapy drugs (p = 0.049 and p = 0.001).
... A clinical study demonstrated that therapy with estrogen hormone increased saliva production (16). Also, ovariectomized rats treated with estradiol returned the levels of muscarinic receptors to normal, indicating a protective role played by estrogen in saliva formation (17). ...
Homeostasis between salivary calcium and phosphorus is important for maintaining oral health. The aim of this study was to evaluate if polymorphisms in ESR1 (Estrogen Receptor Alpha), ESR2 (Estrogen Receptor Beta) and miRNA17 (microRNA17) are associated with calcium and phosphorus levels in saliva. Saliva from 276 12-year-old children were collected by masticatory stimulation and calcium and phosphorus levels were determined by Mass Spectrometry. Genomic DNA was extracted from remaining saliva and genetic polymorphisms in ESR1 (rs12154178, rs1884051, rs9340799 and rs2234693), in ESR2 (rs4986938 and rs1256049) and in miRNA17 (rs4284505) were genotyped using TaqMan chemistry and a real-time PCR equipment. Statistical differences in genotype and allele distributions between ‘low’ and ‘high’ calcium and phosphorus levels were determined using chi-square or Fisher´s exact tests. The analysis was also adjusted by sex (alpha of 5%). ESR1 rs9340799 had the less common genotype associated with higher calcium levels (p=0.03). The less common allele of ESR1 rs1884051 was associated with lower phosphorus levels (p=0.005) and there was an excess of heterozygotes for miRNA17 rs4284505 among individuals with lower calcium levels (p=0.002), both adjusted by sex. This study provides evidence that genetic polymorphisms in ESR1 and miRNA17 are involved in determining salivary calcium and phosphorus levels.
... The means of stimulated salivary ow volume are similar to the values obtained by Rahnama et al. [17] (0.812 ± 0.095 mL/min). Lago et al. [18] observed that hormone therapy increases salivary ow in 0.52 mL/min, showing an in uence of hormone therapy drugs used by postmenopausal women, especially the ones under estroprogestative therapy. This study did not aim to assess whether women were pre-or postmenopausal, but it allows inferring that these drugs work on the salivary glands and affect salivary ow. ...
Background: The appearance of new drugs for cancer treatment has increased patient survival but it has also brought adverse effects, such as the sensation of dry mouth and hyposalivation.
Objective: To assess the relationship of using hormone therapy in breast and prostate cancer patients and the occurrence of xerostomia and hyposalivation.
Method: Cross-sectional study with 114 patients diagnosed with cancer and treated with hormone therapy (anastrozole or bicalutamide). Age, type of neoplasia, sex, presence of xerostomia (yes or no), and type of medication were obtained with a questionnaire. The researcher collected resting and stimulated salivary flows in the morning. The descriptive statistic analysis, chi-square test (p<0.005), and t-test (<0.005) were performed using the Statistical Package for Social Science™ (SSPS), version 21, for different variables of hyposalivation and hormone therapy. Results: The results showed that 67 (55.8%) patients using hormone therapy drugs presented hyposalivation and 73 (64%) patients presented xerostomia.
Conclusion: According to the results of this study, there is a positive association between stimulated hyposalivation and the use of hormone therapy drugs (p = 0.015). There was also a positive association between hyposalivation and xerostomia and the use of hormone therapy drugs (p = 0.049 and p = 0.001).
... The average of rest salivary flow found in this study was higher than the value found by Niklander [17] and Villa [20], what makes evident there is no functional changes on salivary glandules. When the average of stimulated salivary flow was observed, the results are according to those obtained by Falcão [21] and Lago [22]. This situation allows us to infer that drugs used on hormone therapy act on salivary glandules, decreasing their production when they suffer stimulation. ...
Background: the emergence of new drugs for cancer treatment has reflected on increasing patient survival. However, these drugs bring side effects, such as dry mouth sensation and hyposalivation. This study aimed to evaluating the relationship between patients with cancer and xerostomia and hyposalivation. Method : cross-sectional study with 114 patients diagnosed with cancer treated with anastrozole and / or bicalutamide. Age, type of neoplasia, gender, xerostomia, and type of medicine were obtained through questionnaire. Resting and stimulated salivary flow were collected by the researcher. After collection, using a 10 mL disposable syringe, salivary flow was quantified in millimeters and divided into 6 (collection period). A Descriptive statistical analysis, Chi-square test and T-test were carried out through Statistical Package for Social Science® (SSPS) version 21, considering p<0.05. Results : results showed that 67 (55.8%) patients who use hormone therapy presented hyposalivation and 73 (64. 0%) patients presented xerostomia. Conclusion : According to the results from this study, there is statistically significant association between stimulated hyposalivation and hormone therapy usage (p = 0.015). Statistically significant association was also observed among hyposalivation and xerostomia and hormone therapy usage (p=0.049 and p = 0.001).
... If decreased pH in oral environment lasts for too long, it can cause colonization of cariogenic bacteria instead of useful ones and this leads to more caries and jeopardizes individuals oral health which can lead to compromised oral health in patients with chronic hypertension [19]. ...
Statement of the Problem: Systemic conditions can affect the salivary glands and oral health. Hypertension induces xerostomia. Because the function of saliva is related to its quality and quantity, therefore, any changes in saliva can lead to diminished quality of patient’s life.
Purpose: The aim of this study was to determine the relationship between pH and viscosity of cumulative unstimulated saliva and hypertension in adults with sustained hypertension.
Materials and Method: This cross sectional study took place on patients referred to oral medicine faculty of Shahid Sadoughi University of Medical Science. The patients’ blood pressure was measured and the 135 patients fitting the inclusion criteria participated in the study. Their unstimulated cumulative saliva was collected by spitting method and pH of the samples was measured by digital pH-meter set. The viscosity of the samples was measured by comparing the amount of saliva displacement in the thistle tube with control fluids at mm/10 seconds. The data was analyzed by SPSS version 20 software and ANOVA tests and Tukey multiple comparison and their nonparametric equivalent (p≤ 0.005).
Results: The results of this study showed that there was a significant relationship between pH and viscosity of unstimulated saliva of normotensive and borderline hypertensive patients (p
... erefore, it is important to normalize salivary flow to prevent oral disorders and maintain oral health by eliminating possible causes for the reduction of salivary flow rates, advising patients for frequent water sipping and/or artificial saliva use. e administration of hormone replacement therapy (HRT) to postmenopausal women was reported to be useful for preventing osteoporosis and indirectly increasing the salivary flow rate [28]. However, data on the effect of menopause on saliva are based on small patient numbers, and there are no randomized controlled trials on the effect of HRT on salivary secretion and composition. ...
An association between oral diseases and postmenopausal status has been recognized. However, the relationship between all oral disease, mandibular bone density, health status, and osteocalcin (OCN) bone markers in postmenopausal dental patients has not been reported. This study was therefore to verify the differences in plasma OCN levels, dental, periodontal, and oral mucosal disease, and mandibular bone density alterations from panoramic radiograph and systemic parameters in postmenopausal women, compared to premenopausal women. Oral, radiographic, and blood examination were performed in 92 females. Dental, periodontal, and oral mucosal statuses were recorded. Health profile parameters were collected from medical charts. Plasma OCN was evaluated by enzyme-linked immunosorbent assay. Forty-two (45.7%) participants were postmenopausal with a higher median age (55 (51, 62) years) than the premenopausal group (43 (38, 45) years). Overweight or obesity, hypercholesterolemia, and impaired fasting blood sugar were more prevalent in postmenopause. The average postmenopausal OCN level (425.62 ng/mL) was significantly higher than the premenopausal group (234.77 ng/mL, p
... In our study UWS/FR values of menopausal patients (0.29 ± 0.17 mL/min) was lower than those of fertile patients (0.48 ± 0.19 mL/min). Such difference (0.19 mL/min) was statistically significant (p<0.0001) and in line with most of the studies showing a similar decrease in FR that used SWS samples 8,13,15,16,[19][20][21] . Interestingly, the study lead by Minicucci et al 14 used UWS samples and found similar FR values for the two samples. ...
Objective:
This study aims at determining pH and Flow Rate (FR) of Unstimulated Whole Saliva (UWS) in a sample of 120 ♀ (60 menopausal women and 60 healthy fertile women with similar mean age); detecting the DMFT index (Decayed, Missing, Filled Teeth index) and evaluating any correlations between pH, FR, age and DMFT.
Patients and methods:
Concerning the day before sample collection, patients were advised to keep a relaxed attitude and not to practice sports. They were also told to not eat or drink during the hour preceding sampling procedures. Saliva was collected via "spitting" method. Each sampling session started at 11:00 a.m., lasted for 5 minutes and used a pre-weighed, dry, deionized and sterile test tube. The procedure took place under controlled environmental temperature and humidity conditions (means 23.27°C; 60.08%). FR was evaluated via weighing technique and pH was measured with a portable pH-meter.
Results:
There was a minimal but significant pH difference (0.11; p<0.05) between menopausal women (6.75 ± 0.34) and fertile women (6.86 ± 0.24); and a FR difference (0.19; p<0.0001) between menopausal women (0.29 ± 0.17 mL/min) and fertile women (0.48 ± 0.19 mL/min). Correlation (R2) between pH and age was 0.0135 for fertile women and 0.0055 for menopausal women; while the correlation between FR and age was 0.0673 for fertile women and 0.139 for menopausal women. Mean DMFT was 11.93 ± 7.14 in menopausal women and 12.23 ± 6.37 in fertile women.
Conclusions:
We observed a minimal decrease in pH and a decrease in FR in menopausal women. Further studies will be needed to investigate the possible role of other environmental and individual variables in the determination of such values.
Objective:
To identify all outcome measures used to assess salivary gland hypofunction (i.e., objective measures used to determine actual changes in saliva quantity or to assess response to treatment of salivary gland hypofunction) and to group these into domains.
Study design:
A systematic review including clinical trials and prospective or retrospective observational studies involving human participants with dry mouth, with any type of intervention where the objective assessment of salivary gland hypofunction was described.
Results:
Five hundred fifty-three studies involving 31,507 participants were identified. Most assessed salivary gland hypofunction and xerostomia (68.7%), whereas 31.3% assessed salivary gland hypofunction alone. Most studies investigated the "amount of saliva," and the highest number of outcome measures were within the domain of "clinical/objective signs of salivary gland hypofunction."
Conclusions:
Seven domains encompassing 30 outcome measures were identified, confirming the diversity in outcomes and outcome measures used in research regarding salivary gland hypofunction. Identified items will be used in conjunction with those identified regarding xerostomia to create a core outcome set for dry mouth quantification for use in future clinical trials, with the overall goal of improving the standardization of reporting, leading to the establishment of more robust evidence for the management of dry mouth and improving patient care.
Backgroud: Salivary gland degeneration and dysfunction are common symptoms that occur after sex hormone deprivation, but the underlying mechanisms remain largely unknown. Additionally, immunocastration, which causes drop of sex hormones, has been developed as an alternative to surgical castration, however whether it exerts similar effects as surgical castration on the salivary glands is unknown. Through histological and RNA-seq analysis, we assessed changes in morphology and transcriptome of submaxillary gland (SMG) in response to immunocastration (IM) versus surgical castration (bilateral orchiectomy, ORC).
Results: Compared to intact males (EM), ORC caused a dramatical degeneration of SMG in rats, as evidenced by both decreased (P < 0.01) SMG weight and organ index, and by decreased (P < 0.01) quantity of SMG acini and ducts. IM had minimal effects (P > 0.05) on SMG weight and organ index, but it still caused degeneration (P < 0.05) of the acini and ducts. Even though, the quantity of both SMG acini and ducts was much higher (P < 0.001) in IM than in ORC. Functional enrichment analysis of the common regulated genes by ORC/IM revealed disrupted epithelial cell development, angiogenesis, anatomical structure morphogenesis and enhanced cell death are associated with SMG degeneration in deprivation of androgens. Integrated data analysis shown that there existed a selective hyperfunction of SMG ribosome and mitochondrion in ORC but not in IM, which might be associated with more severe degeneration of SMG in ORC than in IM.
Conclusions: Our findings suggested that both surgical castration and immunocastration caused SMG degeneration by disrupting epithelial cell development, angiogenesis, anatomical structure morphogenesis and enhancing cell death. But, surgical castration selectively induced hyperfunction of SMG ribosome and mitochondrion, thus causing more severe degeneration of SMG than immunocastration.
In this study, we amplified aquaporin 1(AQP1) promoter sequence with polymerase chain reaction(PCR), then AQP1 promoter fragment and pGL2 basic vector were linked to create an artificial pGL2/AQP1 promoter re-porter system. A certain concentration of 17β-estradiol(E2) activated pGL2/AQP1p, which demonstrated the pGL2/AQP1p transcriptional system effective. The pGL2/AQP1 promoter reporter system was applied to evaluate the activate effect on AQP1 of different kinds of phytoestrogens. Dual luciferase reporter gene activity assay showed that a certain concentration phytoestrogens including daidzein and genistein can increase AQP1 promoter transcription activity. In addition, E2, daidzein and genistein can make AQP1 protein endoge- nous expression level increase and promote the function of water scretion. The result can guide the clinical application to treat the Sjogren’s syndrome and provide a necessary molecular tool for the subsequent drug screening.
Oral dryness is a common feature in menopausal women. Estrogen therapy can relieve this symptom; however, the underlying mechanism was not clear. Standardized isopropanolic black cohosh (Actaea racemosa; Remifemin) can also relieve menopausal symptoms, such as hot flashes and sweating. Our previous study showed that standardized isopropanolic black cohosh could protect the submandibular gland structure. To investigate the effects and possible mechanisms of action of estrogen and standardized isopropanolic black cohosh on submandibular gland function in ovariectomized (OVX) rats, we measured body weight, daily water consumption, and blood flow in the submandibular glands. Immunohistochemistry and western blotting were used to detect the expression of muscarinic acetylcholine receptors 1 (M1) and 3 (M3), and aquaporin 5 (AQP5) in the submandibular gland. OVX increased daily water consumption and reduced vasodilation in the submandibular gland. It suggested that ovariectomy could damage the salviary function. Moreover, the expression of M1 and M3 receptors decreased, whereas that of AQP5 increased. These changes may explain the dysfunction of saliva secretion in menopause. Estrogen and standardized isopropanolic black cohosh treatment had the same effect on daily water consumption and vasodilation in the submandibular gland. It indicated that estrogen and standardized isopropanolic black cohosh could relieve oral dryness in menopause. However, the mechanism of the two treatments may differ because standardized isopropanolic black cohosh only protected against changes in M1 expression, whereas estrogen protected against variations in M1, M3, and AQP5 expression.
Embora a reposição estrogênica esteja disponível há mais de 6 décadas, as mulheres e mesmo os profissionais da saúde estão confusos pelas opiniões divergentes em relação aos riscos e benefícios da terapia hormonal na menopausa (THM), estrogênica (TE) ou estro-progestagênica (TEP). A principal indicação para terapêutica hormonal na menopausa é o alívio dos sintomas menopausais, tais como sintomas vasomotores, alterações gênito-urinárias e a prevenção de osteoporose nas pacientes de risco. Em outras áreas de pesquisa, principalmente ao que se refere aos efeitos nos sistemas cardiovasculares e nervoso central, os resultados atuais na literatura são conflitivos. O tratamento por mais de 5 anos não adiciona risco significativo para câncer de mama, mas diminui significativamente o risco de fratura osteoporótica. Algumas mulheres podem ser susceptíveis a risco tromboembólico precoce, mas quando a TH for adequada após avaliação individualizada, os benefícios superam os riscos e o tratamento deve ser recomendado. Estudos futuros são necessários para identificar novas indicações para TH e diminuir ou abolir seus riscos. A pesquisa clínica continua na identificação de fatores genéticos que possam influenciar a resposta individual à TH, diferentes formulações estrogênicas, diferentes vias de administração e liberação, além das opções de dose. Nas mulheres que apresentam os sintomas da síndrome climatérica de forma severa durante a peri e pós-menopausa já existem evidências conclusivas oriundas de vários estudos randomizados controlados de que a TH é a única terapia com resultados satisfatórios. Os médicos devem sempre fazer suas decisões terapêuticas com base nos riscos e benefícios individuais de cada paciente, tendo a responsabilidade e o dever de promover as condições para a mulher atravessar a transição menopáusica com qualidade de vida.
Menopause may be associated with some adverse changes, such as oral dryness (OD) feeling. The exact mechanisms that mediate sensation of OD in menopausal women have not been firmly established. The purpose of this study was to assess the relationship of unstimulated whole saliva cortisol level with severity of OD feeling in menopausal women.
A case control study was carried out on 70 selected menopausal women with/without OD feeling, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences, Iran. The xerostomia inventory (XI) score was used as an index of OD feeling severity. Unstimulated whole saliva cortisol concentration was measured by ELISA. Statistical analysis of student's t-test and Spearman correlation was used.
The mean cortisol concentration of saliva was significantly higher in women with OD feeling than the control. There was significant positive correlation between the XI score and the concentration of unstimulated whole saliva cortisol (r = 0.559, p = 0.025).
Unstimulated whole saliva cortisol is higher in menopausal women with OD feeling than in controls and this correlates with the severity of OD.
Objetivo: Avaliar quantitativamente o fluxo salivar e a ocorrência de xerostomia em mulheres na pós-menopausa, conforme a enfermidade sistêmica relatada pelas pacientes. Métodos: A amostra foi composta por 20 mulheres na pós-menopausa, que foram submetidas à anamnese e à sialometria total estimulada. Resultados: Os resultados revelaram que 50% das mulheres examinadas relataram presença de xerostomia; a hipossalivação foi mais prevalente que o fluxo salivar normal e o baixo fluxo salivar; dentre as pacientes que relataram possuir enfermidades sistêmicas, as doenças cardiovasculares foram as mais freqüentes, seguida por depressão e nervosismo. Conclusão: Concluiu-se que a xerostomia e a alteração quantitativa no fluxo salivar são comuns em mulheres na pós-menopausa e que as enfermidades de ordem psicológica demonstraram estar relacionadas com a manifestação de xerostomia.
A comparison of salivary flow rates was made between three groups of female individuals according to their menopausal status. The three groups consisted of healthy, dentate, nonmedicated women (with the exception of the use of estrogen) from the Baltimore Longitudinal Study of Aging. One group consisted of premenopausal women (n = 51), their mean age was 39 years. Another group (n = 26) was perimenopausal with a mean age of 48 years. A third group (n = 76) was postmenopausal with a mean age of 69 years. The groups were evaluated for unstimulated (UPAR) and stimulated parotid gland flow rates (SPAR), unstimulated (USUB) and stimulated submandibular/sublingual gland flow rates (SSUB), and stimulated whole-saliva flow rates (SWHOLE). The parotid flow rates were determined using a Carlson-Crittenden cup, while the submandibular/sublingual flow rates were determined using the National Institute of Dental Research collector. A 2% citrate solution was used for stimulation in glandular collections. Chewing a 1-cm3 cube of paraffin was used to stimulate whole saliva. The results showed no significant differences in UPAR, SPAR, and SWHOLE between the three groups. However, the premenopausal women had higher USUB than the postmenopausal group. The premenopausal women also had higher SSUB than perimenopausal and postmenopausal groups. There were no differences in salivary flow rates between those taking estrogen and those that were not medicated.
This review presents data from the literature on oral adverse reactions from the perspectives of subjective feelings of dry mouth (xerostomia) and objective measures of salivary gland hypofunction during and after cancer therapy. Special emphasis is paid to the mechanisms behind xerostomia, impaired saliva secretion and changes in the composition of saliva and to how these relate to radiation therapy involving the salivary glands and to systemic chemotherapy. The oral complications that relate to such iatrogenic changes in salivary gland function are also discussed.
This study investigated weight changes of seven different light-cured composite restorative materials, one polyacid glass ionomer compomer, and one light-cured glass-ionomer cement following short-term and long-term storage in water. Two packable composites, three universal (hybrid) composites, one microglass composite, one polyacid glass ionomer resin composite (compomer), one microhybrid low-viscosity (flowable) composite, and one light cured glass ionomer composite cement were evaluated in this study. The weight changes of these specimens were measured daily (short-term storage), and they were measured after six weeks (long-term storage) using an electronic analytical balance. A significant difference was found in Ionoliner, Dyract AP, Opticor flow, Charisma, and Solitare 2, but no significant difference was found in the others (Filtek Z 250, Filtek P60, TPH Spectrum, and Valux Plus). Weight change showed a tendency to increase with the time of water storage. The greatest weight change occurred in light-cured glass ionomer composite cement (Ionoliner), which is followed in order by the weight changes in Dyract AP, Opticor Flow, Charisma, Solitare 2, Filtek Z250, Filtek P60, TPH Spectrum; Valux Plus had the least amount of change.
Citation
Keyf F, Yalcin F. The Weight Change of Various Light-Cured Restorative Materials Stored in Water. J Contemp Dent Pract 2005 May;(6)2:072-079.
In menopausal women many physiological changes take place, most of which are due to decreased estrogen production. It is known estrogen influences oral health in a number of ways and saliva undergoes variations depending upon the levels of this hormone.
The study was designed to evaluate the relationship of menopause, hormone replacement therapy (HRT), alendronate (ALN), and calcium supplements on salivary flow rate, saliva pH, and electrolytes. A group of a group of 14 osteoporotic women in menopause with an age average of 50.7 and 14 non-menopausal women with an age average of 42.4 and were selected as subjects. The oral status of the subjects was determined using the Community Periodontal Index of Treatment Needs (CPITN), the Decayed, Missing and Filled Teeth (DMFT) and the Decayed, Missing and Filled Surfaces (DMFS) indices. The non-stimulated whole saliva samples were subsequently collected from the women in both the control and experimental groups and then analyzed biochemically. The women comprising the experimental group received HRT supplemented with ALN and calcium; saliva collecting and analyzing procedures were repeated at the third and sixth months of the treatment.
The most significant oral discomfort in women in the menopausal period was oral dryness, and this symptom was relieved after HRT with ALN and calcium supplements. The oral status of the non-menopausal women was better than the women in menopause. The salivary flow rate was decreased in the menopausal period and increased after HRT, ALN, and calcium supplementation. The saliva pH values were not affected by menopause and HRT with ALN and calcium supplementation. The level of Na+ was increased with menopause and did not change with HRT supplemented with ALN and calcium, whereas the K+ level decreased in the menopausal period and remained constant after HRT with ALN and calcium. The Cl- level was not affected by menopause and the HRT supplemented with ALN and calcium. The Ca++ level was not different in the two groups of women and did not change after HRT supplemented with ALN and calcium.
HRT with ALN and calcium supplementation affected some factors in saliva positively.
Xerostomia is the subjective feeling of mouth dryness, caused or not by function lowering of salivary glands, with decrease of saliva quality or quantity. It's a frequent symptom in palliative care patients and its prevalence is referred to be 60% to 88% in advanced and progressive oncological disease patients. Xerostomia has physical, social and psychological consequences. Saliva plays an important role in maintaining the best physiological conditions of mouth. Besides humidifying the oral cavity tissues, its lubricating properties help swallowing, talking and prevents other damages caused by mechanical and noxious microbiological agents. Xerostomia is caused by three basic mechanisms: factors that compromise the salivary centre, factors related to the autonomic stimulation or factors related to salivary glands themselves. The diagnosis is mainly clinical. Mouth condition must be thoroughly evaluated. If justified, a quantitative evaluation of saliva secretion, in rest and under stimulation, might be done. The treatment must be oriented by aetiology and directed towards the disease effects in patient comfort and quality of life. During treatment, the use of xerogenic drugs should be controlled, hydration should be promoted and other symptom control measures improved. The symptomatic treatment has three pathways: the increasing of saliva production by mechanical, gustatory or pharmacological stimulation; the using of saliva substitutes and the improving of active mouth care. Mechanical stimulation is obtained by chewing gum and gustatory stimulation may be reached by sucking Vitamin C tablets. Pilocarpine is the available drug to improve salivation. A soft diet must be advised, hard and dry food, tobacco and alcoholic beverages should be avoided. It's important that health workers teach patients with xerostomia the best way to get relief and the measures to prevent its complications that could, even more, compromise their quality of life.
Saliva is a complex secretion. 93% by volume is secreted by the major salivary glands and the remaining 7% by the minor glands. 99% of saliva is water and the other 1% is composed of organic and inorganic molecules. While the quantity of saliva is important, so is its quality. The components of saliva, its functions in maintaining oral health and the main factors that cause alterations in salivary secretion will be reviewed, the importance of saliva in caries development and bacterial plaque formation will be discussed and its role as an aid to diagnosing certain pathologies will be examined. Variations in salivary flow can be affected, reversibly or irreversibly, by numerous physiological and pathological factors. Saliva plays an essential role in maintaining the integrity of the oral structures, in personal relationships, in the digestion and in controlling oral infection. The part that saliva plays in protecting teeth from caries can be summarised under four aspects: diluting and eliminating sugars and other substances, buffer capacity, balancing demineralisation/remineralisation and antimicrobial action. Saliva is a promising option for diagnosing certain disorders and monitoring the evolution of certain pathologies or the dosage of medicines or drugs. Its advantages as a diagnostic tool include its being easy to obtain and the positive correlation between many parameters in serum and saliva.
The climacteric is the transition period of the life of the woman marked by menopause and characterized by symptoms that often affect the welfare of women that feel. It is more attention to the woman in fertile age and it is necessary that the nurse prepares himself to woman attention in the climacteric period. The study aimed to evaluate the adequacy of the nursing guidelines on the exercise, nutrition and physical activity. Study of the type with descriptive qualitative approach used forms that were applied after meetings with 36 women, aged between 45 and 55 years, divided into three groups. From discussions and guidelines made by the nurse in meetings with each group, it was observed that there is a promotion of health when the majority of women managed to change their habits, confirming the theory of Roy to express yourself and your paper (Roy) and adaptation to the climacteric.
The aim of this study was to evaluate the symptoms of dry mouth and salivary flow in menarche and menopausal women.
Objective and subjective assessment of salivary function were analysed by Xerostomia Inventory and Visual Analogue Scale questionnaire in menopausal and menarche women (control group). Salivary flow was evaluated by a chemical absorption stimulation test. Each subject provided three saliva samples: S1, non-stimulated saliva; S2, saliva initially stimulated with two drops of citric acid 2.5%; and S3, saliva super-stimulated with two drops of citric acid 2.5% every 30 seconds for two minutes.
No intergroup association was observed between Xerostomia Inventory and Visual Analogue Scale questionnaire. In both groups, the salivary flow was greatest at S3, followed by S2 and finally S1. Salivary flow was lower in the menopausal group compared to the control group only in S2 and S3.
In the menopausal group, the salivary flow showed reduction but without clinical symptoms of dry mouth. It is important to normalize salivary flow to prevent oral abnormalities and maintain oral health.
Objectives:
We compared salivary flow, serum and saliva testosterone, and femur bone mineral density (BMD) of menopausal women with or without xerostomia.
Study design:
A case/control study was performed on 60 selected menopausal women with or without xerostomia. BMD and testosterone concentration were measured by a dual-energy x-ray absorptiometry system and enzyme-linked immunosorbent assay method, respectively.
Results:
Multinomial logistic regression demonstrated that low saliva flow rate (odds ratio [OR] = 22.8, 95% confidence interval [CI]: 5.4, 96.8), low femur BMD (OR = 6.0, CI: 1.8, 20.0), high stimulated saliva testosterone (OR = 5.2, CI: 2.0, 18.9), high unstimulated saliva testosterone (OR = 3.8, 95% CI: 1.6, 12.3), and high serum testosterone (OR = 2.7, CI: 1.1, 7.2) were associated with an increased risk of xerostomia in menopausal women.
Conclusions:
High serum and salivary testosterone and low femur BMD and saliva flow were associated with xerostomia. Of these factors, low salivary flow seems to be the most important element in the perception of dry mouth.
The goal of this article is to review existing research on the prevalence and etiology of dry mouth in the vulnerable elders and identify knowledge gaps.
Vulnerable elders (VE) are persons aged >65 years who have any or all of the following: limited mobility, limited resources, or complex health status. A systematic search was conducted of PubMed sources from 1989 to May 2010. Evidence was evaluated on the prevalence and etiology of xerostomia and salivary gland hypofunction (SGH) in VE.
The search identified 1,422 publications. The inclusion/exclusion criteria yielded 348 articles, 80 of which are cited herein.
Research has showed a high prevalence of xerostomia and SGH in VE. Common etiologies include medications, poor general health, female gender, and age. Gaps still exist in the evaluation of dry mouth in VE. Nonetheless, oral dryness will remain an important health issue as life expectancy increases.
The aim of this study was to compare serum and saliva calcium, phosphorus and alkaline phosphatase of menopausal women with/without dry mouth (DM) feeling.
The composition of saliva in menopause women with/without DM feeling is different. Some of these differences are in hormones that are related to bone turnover.
A case-control study was carried out on 60 selected menopausal women aged 45-79 years with or without DM feeling (30 as case, 30 as control), conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. The phosphorus concentration was measured by photometrical measurement of the blue colour formed after the addition of ammonium molybdate and stannous chloride; calcium was measured by Arsenazo reaction; and alkaline phosphatase by the pNPP-AMP method. Statistical analysis of Student's t-test was used.
The mean serum phosphorus and alkaline phosphatase, stimulated and unstimulated saliva calcium and alkaline phosphatase levels were significantly higher in the menopausal women suffering from DM. There were no significant differences between groups regarding saliva phosphorus and serum calcium concentration.
Calcium, phosphorus and alkaline phosphatase appear associated with DM feeling in menopause.
This study aims to investigate salivary flow and biochemical constituents of menopausal-age women with the hypothesis that women using hormone therapy (HT) might present better saliva values than non-users. Two hundred HT users and 200 non-users were selected at random from a cohort study of 3,173 peri- and postmenopausal women and invited to a 2-year clinical follow-up study. Clinical examination with saliva sampling was made at baseline and 2 years later. Salivary total protein, albumin, and immunoglobulin (Ig) concentrations were analyzed. Final material included 106 consistent HT users and 55 non-users. Backward logistic regression analysis was made to determine the risk factors for higher or lower than medium salivary protein values. No difference was seen in salivary flow rate, total protein, and IgA values between baseline and follow-up measurements or between the groups. Albumin, IgG, and IgM concentrations were significantly lower in the 2-year samples of the HT group when compared with baseline. IgA and IgM values were higher in the non-HT 2-year samples when compared with the corresponding HT samples. The only significant explanatory factor for higher than median salivary albumin concentration was the number of teeth both at baseline and 2 years later. HT possibly improved epithelial integrity since the concentrations of serum components albumin, IgG, and IgM decreased during the follow-up. HT as such does not seem to affect saliva, although it may modify it. The clinical relevance of these results needs to be assessed in future studies.
The aim of this study was to investigate the stimulated and unstimulated salivary progesterone in menopausal women with oral dryness (OD) feeling. A case-control study was carried out on 70 selected menopausal women aged 42-78 years with or without OD feeling (35 as cases with xerostomia and 35 as control without xerostomia), conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences (TUMS). Unstimulated and paraffin-stimulated saliva samples were obtained by expectoration. The salivary concentration of progesterone was determined with an enzyme immunoassay kit. Statistical analysis of the Student's t test was used. The mean stimulated and unstimulated whole saliva progesterone concentrations and unstimulated saliva flow, but not stimulated saliva flow rate, was significantly lower in the case than in the control. The results showed that subjects with dry mouth had decreased unstimulated saliva flow and salivary progesterone compared with those without dry mouth. Thus, salivary progesterone level appears associated with OD feeling in menopause.
To evaluate the relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth (DM) in menopausal women.
A feel of DM is a major complaint for many elderly individuals and strongly associated with the menopause. The exact mechanisms that mediate sensation of DM in menopausal women have not been firmly established.
A case-control study was carried out on 104 selected menopausal women with/without a feeling of DM, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. Xerostomia Inventory (XI) score was used as an index of DM severity. Stimulated whole saliva cortisol concentration (stimulated by chewing standard-sized paraffin for 60 s) was measured by ELISA. Statistical analysis by Student's t-test and Spearman correlation was used.
The mean cortisol concentration of saliva, but not saliva cortisol output, was significantly higher in the cases than in the controls. There was significant positive correlation between XI score and concentration (r = 0.357, p = 0.000) or output (r = 0.223, p = 0.017) of stimulated whole saliva cortisol.
It appears that stimulated whole saliva cortisol is high in menopausal women with a feeling of DM.
Xerostomia is a subjective sensation of oral dryness. It is caused by many factors, among them, hypo/hyper salivation. This article covers the etiology, local and systemic factors related to dryness of the mouth, its diagnosis, and clinical and at-home management of the syndrome. It also reviews the role of dental hygiene intervention to improve and promote the patient's quality of life. It is hoped this review will help dental health care providers better respond to patients afflicted with xerostomia.
To review the literature about oral symptoms and signs at the menopause with an emphasis on hormone replacement therapy (HRT). To give practical guidelines for women and their physicians in menopause-related oral health problems.
The PubMed and Cochrane databases was searched until mid January 2009 with key words such as "menopause", "menopausal complaints", "postmenopausal complaints" and "oral diseases", "oral discomfort", "dental health", "dental diseases", "saliva", "burning mouth syndrome", "dry mouth", "xerostomia". Because of a scarcity of controlled studies no systematic review could be conducted.
Oral discomfort is found in many menopausal women in addition to more general climacteric complaints. The principal peri- and postmenopausal symptoms are dry mouth and burning mouth (glossodynia) which, in turn, may increase the occurrence of oral mucosal and dental diseases, such as candidiasis. The mechanisms of hormone-related oral symptoms and signs are not known although oestrogen receptors, for example, have been detected in the oral mucosa and salivary glands. In principle, the histology of oral and vaginal mucosa is very similar and thus their symptoms might share a common cause. Yet, hormone replacement therapy use does not necessarily prevent or help women with oral symptoms.
Properly controlled long-term randomized studies are needed to assess the effect of HRT on oral discomfort. Future gene profiling could identify women who may or may not benefit from HRT with regard to oral symptoms.
Five hundred twenty-nine adult outpatients were studied to determine the relationship of xerostomia to other oral symptoms and salivary flow (reported in part I) and to nonoral symptoms, drugs, and select diseases (reported here in Part II). It was observed that dry throat, blurred vision, dry eyes, dry skin, and vaginal itching and fungal infections are prominently associated with oral dryness. These nonoral symptoms were positively correlated with the oral symptoms cited in part I of this study and were inversely related to the flow of resting, but not stimulated, whole saliva. Several classes of drugs were associated with dry mouth. In addition, diabetes mellitus and hypertension were significantly associated with it. Approximately half of the diabetic and hypertensive patients complained of dry mouth. Although a majority of them were taking medications, the association between xerostomia and these diseases cannot be completely attributed to drugs, since many of these patients did not take any xerogenic medicaments. The data show that xerostomia and several other oral symptoms are valid indicators of salivary gland hypofunction. They suggest, moreover, that select nonoral symptoms are an indicator of generalized xerosis.
The effects of hormone replacement therapy (HRT) on salivary gland functions were examined in a longitudinal study. The flow rate, buffer effect and pH of paraffin-stimulated whole saliva were analysed in 8 perimenopausal and 19 postmenopausal women. The saliva samples were collected 1-2 days before as well as 3 and 5 months after the start of HRT. Salivary flow rates were higher (p <0.033) in the perimenopausal than in the postmenopausal group. The flow rates increased significantly (p <0.001) during HRT in both groups. Similarly, buffer effect and pH showed significant (p = 0.004 and p = 0.009, respectively) time-related changes without any differences between the groups. It appears that HRT improves both the quantity and the quality of salivary gland function in peri- and postmenopausal women.
This review considers the changes in salivary glands associated with ageing and concludes that there is no evidence to show
that xerostomia is likely to result from the ageing process alone. The four main factors causing xerostomia are presented
and it can be seen that the condition is a side-effect of diseases and the drugs used to treat these diseases. As xerostomia
has a significant effect on a person's quality of life, a multifaceted approach to treating xerostomia is presented. All health
care workers should be sensitive to those complaining of dry mouth and help them to seek care.
Saliva is essential for the preservation of oral-pharyngeal health, and disorders of salivary physiology are associated with numerous oral and pharyngeal problems, particularly in older people. Although salivary function is remarkably intact in healthy aging, medical problems, medications, and head and neck radiotherapy can cause salivary dysfunction and complaints of xerostomia among older people. Sjögren's syndrome, an autoimmune exocrinopathy, is the most common medical disease associated with salivary dysfunction. Medications with anticholinergic side effects will impair salivary output, and head and neck radiotherapy for cancer will cause permanent destruction of salivary glands. Treatments for salivary problems are based upon establishing a diagnosis, protecting oral and pharyngeal health, stimulating remaining glands, and replacing lost salivary fluids.
To evaluate salivary flow rate and buffering capacity using a quantitative pH measurement among three broad age groups.
The population consisting of 117 patients was classified into three age groups: young, middle-aged, and elderly group. The volume of stimulated saliva after chewing gum was measured. Saliva samples were titrated with 0.1N HCl to evaluate the buffering capacity. Saliva pH change was measured directly using a hand-held pH meter. At the point of 50 microL of titrated HCl, individual salivary buffering capacities were ranked into one of the following three categories; high buffering capacity (above pH 5.5), medium buffering capacity (from pH 5.5 to 4.5), and low buffering capacity (below pH 4.5).
Chi(2)-test showed that the proportional distribution of individuals in the three buffering capacity groups was not statistically different among the age groups (p>0.05). One-way ANOVA and Tukey's HSD test showed the flow rate of stimulated whole saliva in the young group was significantly greater than that of the middle-aged and elderly groups (p<0.05). Two-way ANOVA showed there was no significant interaction between the independent variables buffering capacity and age group (F=0.419, p=0.7950). One-way ANOVA and Tukey's HSD test indicated the flow rate showed significant differences among the three age and buffering capacity groups.
Although a limited number of subjects were investigated in this study, the quantitative saliva assessment is useful as a screening method for different ages to identify patients with a low saliva flow rate and/or buffering capacity.
Although estrogen has been clinically available for more than 6 decades, women have been confused by different opinions regarding the risks and benefits of menopausal hormone therapy (HT), estrogen therapy (ET), and estrogen-progestin therapy (EPT). The main indication for HT use in postmenopausal women remains the relief of vasomotor symptoms and vulvovaginal atrophy, and is effective in the prevention of osteoporosis. In other areas of research, notably in cardiovascular and central nervous system effects, the recent literature has produced conflicting results. Treatment for up to 5 years does not add significantly to lifetime risk of breast cancer, but significantly decreases bone loss and risk of osteoporotic fractures. Some women may be susceptible to early thrombotic risk, but when appropriate HT is given after individual clinical evaluation, the benefits will far outweigh any potential risks and the treatment should be recommended. Clinical research continues into genetic factors influencing the response to ET/HT, different estrogen formulations, different modes of delivery and lower-dose options. Patients and clinicians should make treatment decisions on the basis of an individuals needs and risks, and should enhance a woman's ability to undergo the menopausal transition with minimal disruption to her quality of life. In women experiencing distressing climacteric symptoms during the peri and postmenopause there is conclusive evidence from abundant randomized controlled trials that systemic hormone therapy (HT) of any type affords symptom relief, with no alternative treatment producing similar effect. Future research is needed to identify new indications for HRT and to diminish or abolish its potential risks.
To determine the treatment effects of hyposalivation on denture retention, the authors conducted a systematic review of the literature.
The authors reviewed clinical investigations that assessed the treatment effects of hyposalivation on denture retention. They searched six electronic databases for works from 1950 to the second week of September 2007 by using the key words "denture," "hyposalivation," "xerostomia," "dry mouth," "elderly" and "aged." They limited the citation search to articles written in English and describing studies that involved human subjects.
The authors identified 11 articles in the search; none was a report of a randomized controlled clinical trial.
The few clinical research studies published on the topic of hyposalivation and denture retention represent a low level of evidence for establishing clinical practice guidelines. The authors found that they could make no conclusions regarding the treatment effects of hyposalivation on denture retention. The article provides a literature review regarding the etiologies and clinical presentation of salivary disorders and xerostomia in elderly people, the role of saliva in denture retention, the effect of dry mouth on denture use and the treatment of dry mouth problems in denture wearers. Prospective clinical trials are needed to establish a framework for evidence-based treatment of denture-wearing patients experiencing dry mouth.
Estudo sobre o fluxo salivar e xerostomia em mulheres na pré e pós-menopausa
- Lfg Silva
- F F Lopes
- Aef Oliveira
Silva LFG, Lopes FF, Oliveira AEF. Estudo sobre o fluxo salivar e
xerostomia em mulheres na pré e pós-menopausa. Pesq Bras
Odontoped Clin Integr 2007;7:125-9.
Avaliação da influência da terapia hormonal na saúde oral de mulheres na menopausa
- Pcgf Ferraz
- M S Trindade
- Lgo Brito
Ferraz PCGF, Trindade MS, Brito LGO, et al. Avaliação da
influência da terapia hormonal na saúde oral de mulheres na
menopausa. Reprod Clim 2009;24:107-12.
Estudo sobre xerostomia, fluxo salivar e enfermidades sistêmicas em mulheres na pós-menopausa
- F F Lopes
- Lfge Silva
- F L Carvalho
- Aef Oliveira
Xerostomia: a symptom which acts like a disease
- R L Ettinger